[SOLVED 2023] For this Focused Note Assignment you will select a
For this Focused Note Assignment you will select a patient with common gynecologic Assignment 2: Episodic Visit: Common Gynecologic Health Conditions Focused Note For this Focused Note Assignment you will select a patient with common gynecologic health conditions from your clinical experience and construct a patient history, assess and diagnose the patient’s health condition(s), and justify the best treatment option(s) for the patient. To prepare: Use the Focused SOAP Note Template found in this week’s Learning Resources to complete this Assignment. Select a patient with common gynecologic health conditions whom you examined during the last three weeks in your practicum experience. With this patient in mind, address the following in your Focused Note Template: Assignment: Subjective: What details did the patient provide regarding her personal and medical history? Objective: What observations did you make during the physical assessment? Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority. What was your primary diagnosis and why? Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan. Reflection notes: What would you do differently in a similar patient evaluation? Episodic/Focused SOAP Note Template Patient Information: Initials, Age, Sex, Race S. CC (chief complaint): This is a brief statement identifying why the patient is here in the patient’s own words, for instance, “headache,” not “bad headache for 3 days.” HPI: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES Mnemonic to complete your HPI. You need to start every HPI with age, race, and gender (e.g., 34-year-old African American male). You must include the seven attributes of each principal symptom in paragraph form, not a list. If the CC was “headache,” the LOCATES for the HPI might look like the following example: Location: head Onset: 3 days ago Character: pounding, pressure around the eyes and temples Associated signs and symptoms: nausea, vomiting, photophobia, phonophobia Timing: after being on the computer all day at work Exacerbating/relieving factors: light bothers eyes, Naproxen makes it tolerable but not completely better Severity: 7/10 pain scale Current Medications: Include dosage, frequency, length of time used, and reason for use. Also include over-the-counter (OTC) or homeopathic products. Allergies: Include medication, food, and environmental allergies separately. Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction versus intolerance. PMHx: Include immunization status (note date of last tetanus for all adults), past major illnesses, and surgeries. Depending on the CC, more info is sometimes needed. Soc & Substance Hx: Include occupation and major hobbies, family status, tobacco and alcohol use (previous and current use), and any other pertinent data. Always add some health promotion questions here, such as whether they use seat belts all the time or whether they have working smoke detectors in the house, the condition of the living environment, text/cell phone use while driving, and support systems available. Fam Hx: Illnesses with possible genetic predisposition, contagious illnesses, or chronic illnesses. The reason for death of any deceased first-degree relatives should be included. Include parents, grandparents, siblings, and children. Include grandchildren if pertinent. Surgical Hx: Prior surgical procedures. Mental Hx: Diagnosis and treatment. Current concerns: (Anxiety and/or depression). History of self-harm practices and/or suicidal or homicidal ideation. Violence Hx: Concern or issues about safety (personal, home, community, sexual—current and historical). Reproductive Hx: Menstrual history (date of last menstrual period [LMP]), pregnant (yes or no), nursing/lactating (yes or no), contraceptive use (method used), types of intercourse (oral, anal, vaginal, other), and any sexual concerns. ROS: This covers all body systems that may help you include or rule out a differential diagnosis. You should list each system as follows: General: Head: EENT: and so forth. You should list these in bullet format and document the systems in order from head to toe. Example of Complete ROS: GENERAL: No weight loss, fever, chills, weakness, or fatigue. HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat. SKIN: No rash or itching. CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema. RESPIRATORY: No shortness of breath, cough, or sputum. GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood. GENITOURINARY: Burning on urination. Pregnancy. LMP: MM/DD/YYYY. NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control. MUSCULOSKELETAL: No muscle pain, back pain, joint pain, or stiffness. HEMATOLOGIC: No anemia, bleeding, or bruising. LYMPHATICS: No enlarged nodes. No history of splenectomy. PSYCHIATRIC: No history of depression or anxiety. ENDOCRINOLOGIC: No reports of sweating or cold or heat intolerance. No polyuria or polydipsia. REPRODUCTIVE: Not pregnant and no recent pregnancy. No reports of vaginal or penile discharge. Not sexually active. ALLERGIES: No history of asthma, hives, eczema, or rhinitis. O. Physical exam: From head to toe, include what you see, hear, and feel when conducting your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and history. Do not use “WNL” or “normal.” You must describe what you see. Always document in head-to-toe format (i.e., General: Head: EENT:). Diagnostic results: Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines). A. Differential Diagnoses (list a minimum of 3 differential diagnoses). Your primary or presumptive diagnosis should be at the top of the list. For each diagnosis, provide supportive documentation with evidence-based guidelines. P Includes documentation of diagnostic studies that will be obtained, referrals to other health care providers, therapeutic interventions, education, disposition of the patient, and any planned follow-up
[ANSWERED] In 200-250 words, respond to the following: Should the physician allow Mike to continue making decisions that seem to him to be irrational and harmful to James, or would that mean a disrespect of a patient’s autonomy?
In 200-250 words, respond to the following: Should the physician allow Mike to continue In addition to the topic study materials, use the chart you completed and questions you answered in the Topic 3 about “Case Study: Healing and Autonomy” as the basis for your responses in this assignment. Answer the following questions about a patient’s spiritual needs in light of the Christian worldview. In 200-250 words, respond to the following: Should the physician allow Mike to continue making decisions that seem to him to be irrational and harmful to James, or would that mean a disrespect of a patient’s autonomy? Explain your rationale. In 400-500 words, respond to the following: How ought the Christian think about sickness and health? How should a Christian think about medical intervention? What should Mike as a Christian do? How should he reason about trusting God and treating James in relation to what is truly honoring the principles of beneficence and nonmaleficence in James’s care? In 200-250 words, respond to the following: How would a spiritual needs assessment help the physician assist Mike determine appropriate interventions for James and for his family or others involved in his care? Remember to support your responses with the topic study materials. While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center. 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. This benchmark assignment assesses the following competencies: BS Nursing (RN to BSN) 5.2: Assess for the spiritual needs and provide appropriate interventions for individuals, families, and groups. Case Study: Healing and Autonomy Mike and Joanne are the parents of James and Samuel, identical twins born 8 years ago. James is currently suffering from acute glomerulonephritis, kidney failure. James was originally brought into the hospital for complications associated with a strep throat infection. The spread of the A streptococcus infection led to the subsequent kidney failure. James’s condition was acute enough to warrant immediate treatment. Usually cases of acute glomerulonephritis caused by strep infection tend to improve on their own or with an antibiotic. However, James also had elevated blood pressure and enough fluid buildup that required temporary dialysis to relieve. The attending physician suggested immediate dialysis. After some time of discussion with Joanne, Mike informs the physician that they are going to forego the dialysis and place their faith in God. Mike and Joanne had been moved by a sermon their pastor had given a week ago, and also had witnessed a close friend regain mobility when she was prayed over at a healing service after a serious stroke. They thought it more prudent to take James immediately to a faith healing service instead of putting James through multiple rounds of dialysis. Yet, Mike and Joanne agreed to return to the hospital after the faith healing services later in the week, and in hopes that James would be healed by then. Two days later the family returned and was forced to place James on dialysis, as his condition had deteriorated. Mike felt perplexed and tormented by his decision to not treat James earlier. Had he not enough faith? Was God punishing him or James? To make matters worse, James’s kidneys had deteriorated such that his dialysis was now not a temporary matter and was in need of a kidney transplant. Crushed and desperate, Mike and Joanne immediately offered to donate one of their own kidneys to James, but they were not compatible donors. Over the next few weeks, amidst daily rounds of dialysis, some of their close friends and church members also offered to donate a kidney to James. However, none of them were tissue matches. James’s nephrologist called to schedule a private appointment with Mike and Joanne. James was stable, given the regular dialysis, but would require a kidney transplant within the year. Given the desperate situation, the nephrologist informed Mike and Joanne of a donor that was an ideal tissue match, but as of yet had not been considered—James’s brother Samuel. Mike vacillates and struggles to decide whether he should have his other son Samuel lose a kidney or perhaps wait for God to do a miracle this time around. Perhaps this is where the real testing of his faith will come in? Mike reasons, “This time around it is a matter of life and death. What could require greater faith than that?” Expert Answer and Explanation Benchmark – Patient’s Spiritual Needs: Case Analysis Recent advances in technology have had significant transformation of the healthcare industry. In one way, however, the service and cure-oriented model has been abandoned by the introduction of various technological practices in spirituality (Mesquita et al., 2017). In the past, healthcare was often linked with spirituality, where healthcare givers served to incorporate the physical, social, spiritual, and emotional being to healthcare. Nurse leaders and nurse educators today are encouraged to actively re-introduce this compassionate consideration of the patients’ spiritual needs (Timmins & Caldeira, 2017). This essay involves the analysis of a case of James, an 8 y.o. pt. whose parents are confused at the level or extent to which they should encourage spirituality in his health. Should the physician allow Mike to continue making decisions that seem to him to be irrational and harmful to James? The physician should not allow further mistakes to happen in the case of James, and should not let Mike, his father to continue making faulty decisions for him. The initial presentation of the case of James to the facility was clear that the only needed intervention after an infection of acute glomerulonephritis was to perform a kidney dialysis and then with the aid of an antibiotic, he would easily recover. However,
[ANSWERED 2023] Explain the linkage between internal environmental analysis and the value adding service delivery
Explain the linkage between internal environmental analysis and the value adding service Assignment: Exercises: Explain the linkage between internal environmental analysis and the value adding service delivery and support strategies. How are the value adding strategies linked with action plans? How does the marketing of a service differ from the marketing of a physical product (good)? Professional Development: Case Study #15: “So, Doctor, can you fix this?” A case involving a medical spa. Perform an internal analysis of the medical spa to determine key challenges faced by the organization. Based on that information, create a “Strategic Thinking Map” for value-adding support strategies (Exhibit 8-9, p. 336). Evaluate the effectiveness of service delivery strategies by answering the questions posed in Exhibit 8-10 (p. 338) The Professional Development assignment should be between 1500 and 2000 words in length and contain at least two scholarly sources, in addition to the textbook and provided material. Please submit your assignment in one APA formatted document. Expert Answer and Explanation Value-Adding Support Strategies Exercise Internal environmental analysis is an important aspect in the development of strategies that lead to organizational growth. When considering internal analysis, attributes that are inherent to the organization that either promote or hinder quality service provision are evaluated. Value addition, on the other hand, is usually controlled by components that are internal to the organization. Therefore, an internal environmental analysis will assist the organization to understand the areas that can be enhanced within the organization, to improve the value of services delivered to clients (Ginter et al., 2013). By developing effective value-adding strategies, one can then evaluate how they ought to improve their services; who those strategies are aimed at; or who needs to act; where resources need to be placed to achieve better service delivery, all of which can then be condensed into implementable action plans. There are several differences between marketing a product and marketing a service. Given that products are tangible, in most cases, they are marketed based on their value, whereby, the customer has to evaluate the value and match it with the price offered for the product to make the purchase. However, for services, marketing is done based on relationships, this includes the interaction between the service delivery personnel and the client (Rather, 2019). While most of the products offered to the market are fixed, the services given to a client may vary from person to person and is therefore important to ensure that the level of quality of service provision is maintained at a constant or better still improved. Therefore, based on these aspects, service marketing can be seen to be more complex as compared to marketing a product That can also explain the difference in marketing mix between products and services with services having more elements attached to the mix (Isa et al., 2020). Professional Development Internal organization analysis is an important step in developing strategic plans that can assist the organization to navigate through the various market challenges and gain a competitive edge. This section of the paper will conduct an internal analysis of a medical spa, and provide value-adding strategies that can assist the organization. Internal Analysis Strengths From the case of Dr. Goyzueta’s spa, various attributes can be observed after conducting an internal analysis. Starting with the strengths of the business, it can be seen that Dr. Goyzueta has been a medical practitioner for a long time and his professional history is one of the aspects that made him more appealing as compared to non-medical spa operators. Like most medical spas run by doctors, the “halo effect” which clients had about a doctor’s reputation, made them even more willing to receive most of their cosmetic services in medical spas as compared to non-medical spas (Young & Chen, 2020). However, his medical background was in a different field and not cosmetics, which was also one of the issues that proved to be a weakness to the reputation of his spa.Another strength was that the spa industry had high reimbursement rates, with most of the clients coming to receive the services having the ability to pay upfront. In most cases, the clients had to pay out of pocket or using credit cards, with very few, if any insurance companies covering for procedures done in the spa. The medical spa industry had relatively cheap malpractice insurance, which also made the cost of operations slightly lower in comparison to other medical practices. Still, on strengths, the market base in the spa business has also been rapidly growing from one million in 1997 to over nine million in 2006 for non-surgical cosmetic procedures. This means that the cosmetic industry was still in its thriving stage and with the promise of better profit margins. The advertising efforts made on products offered in medical spas increased the demand for those services. Another aspect that made Dr. Goyzueta’s spa to have an edge is the fact that he was appealing to the Latino community where he comes from. The fact that he is bilingual also made him appealing to the English-speaking clients too. Weaknesses Some of the weaknesses faced by Dr. Goyzueta’s spa include lack of insurance coverage for most of the services offered in the spa. While most of the clients were able to fork out the incurred expenses out of their pockets, there was still a large chunk of the population who wanted but could not afford the facilities offered by the spa. Therefore, having insurance coverage could potentially open up a wide market that was currently locked out from accessing procedures offered in the medical spa (Sandberg, 2017). Another weakness that was apparent to the spa was its location. The fact that it was affected by flooding makes it to be susceptible to such events in case they happen again in the future and may pose a threat, including damage to property if a solution is not found.Starting a medical spa was also very expensive given the cost of high-end technology required to perform some of the
[ANSWERED 2023] Have you ever been involved in union organizing, collective bargaining, or worked in a union shop?
Have you ever been involved in union organizing, collective bargaining, or worked Power in Organizations Have you ever been involved in union organizing, collective bargaining, or worked in a union shop? If so, share your experience. If not, locate a scholarly journal article that describes collective bargaining and describe how it works within an organization. Have you ever worked in a healthcare facility that had Magnet accreditation, or had experience with shared governance? If so, share your experience. If not, locate a scholarly journal article that describes shared governance and explain how it could be implemented in your current facility. Expert Answer and Explanation Power in Organizations Over the years, people have been forming organizations to campaign for their employment rights and discuss other social factors. Through the formation of organizations, equality has been achieved in some sectors, such as the treatment of people with different sexual orientations and cultural, ancestral, and racial backgrounds. If people such as Martin Luther King had tried to negotiate for equal treatment individually, probably, he could not be successful. The phenomenon is also experienced in the workplace, where it is easier for workers to negotiate work conditions as a group than as individuals through collective bargaining. In other situations, companies engage in shared governance as it is necessary to create favorable policies for all participants. Through collective bargaining and shared governance, it is possible to understand organizations’ power in advocating for their members at the workplace. Collective Bargaining And How It Works In An Organization Collective bargaining is a process through which working people can negotiate their employment contracts with their employers to understand the terms of employment, job safety, benefits, leave and pay, among others. Over the years, it is through collective bargaining that employees have achieved better status at their workplace and further ensured that their safety is not compromised. According to Cazes et al. (2019), collective bargaining can occur at different levels which include firm level, sectoral level, and national level. The authors also explain multi-level bargaining, which combines firms and higher-level collective bargaining. Cazes et al. (2019 note that coordinated systems such as those that have organized decentralization have higher employment than full decentralization. It is also notable that in areas where there is collective bargaining, there is lower or greater wage dispersion compared to systems that lack collective bargaining and those that set wages independently. This shows that employees can enjoy the same salaries if they are in the same job group through collective bargaining. Cazes et al. (2019) further note that in areas where there are centralized bargaining systems, there is likely to have lower productivity. This shows that a lack of flexibility at the firm level, which mostly represents a centralized bargaining system, can affect the firm’s productivity. On the other hand, when there are decentralized systems, it is clear that there are no adverse effects on productivity. As far as collective bargaining is concerned, Cazes et al. (2019) explain that where coordination works effectively, it is more likely to be supported by employer associations because it moderates wage growth and ensures a high level of mediation. The authors concluded that engaging in collective bargaining greatly contributes to labor market inclusiveness and can create a macroeconomic effect when it covers a large share of workers and companies. The process of collective bargaining has been essential as it can contribute to either the success or failure of the initiative. It is notable that collective bargaining mostly occurs as a better alternative when comparing options such as strikes and quitting (Julius & DiGiovanni, 2019). The first step in collective bargaining is preparing for bargaining, where the teams are involved in identifying areas they want to improve and determining a strategy to help them move forward with the negotiations (National Education Association). The second stage involves conducting the negotiations and the union and management explain the rationale behind their proposals. This stage usually depends on the law provisions concerning the areas being addressed. In the third stage, the contract can be ratified if the parties have reached a tentative contract agreement. However, this is after the union has a meeting with the employees to discuss the offers made by the company, and then they are asked to vote using a secret ballot where the majority of votes determines if the contract will be ratified or rejected. The fourth stage occurs if the parties fail to reach an agreement, and through state law, they can decide on how to resolve the dispute, either using mediation, arbitration, or a strike (National Education Association). The fifth and last stage is changing or clarifying the contracts, where the parties can discuss any section of the ratified contracts and revise it to ensure that issues of mutual concerns are solved as the employees continue their employment contracts. Shared Governance And How It Can Be Implemented In The Facility When focusing on nursing, shared governance is crucial as it promotes nursing empowerment and encourages shared decision-making, ensuring that all professionals are accountable for their actions and contribution to the hospital’s processes. Shared governance is therefore defined as a process through which the board of governance, faculties, and staff participation are coordinated in the work and decision-making process and administrative leadership. The main aim of shared governance is to balance participation and ensure that all members take equal responsibility in their organizational roles. Through shared governance, it is possible to improve patient outcomes as all clinicians are involved in decision-making about the issues that impact them and the hospital’s services. Moreover, shared governance is crucial as it enables a culture that fosters a transparent review of work practices and further supports personal and professional development by involving evidence-based practices. It is, however, important to understand that implementing shared governance is hard and time-consuming, and therefore more organizations are likely to shun the practice. Nonetheless, the outcomes of shared governance usually outweigh the obstacles experienced, and with a good process in place, it is possible to have an effective, shared governance policy. According to Brennan & Wendt (2021), several principles should be ensured when implementing shared governance. They include accountability, innovation, autonomy, team building, leadership, ownership, and practice equity. Combining these models makes it possible to create a shared governance model that ensures quality patient care and promotes continuous quality improvement in the health facility. When forming shared governance, Kiwanuka (2022) explains using Kotter’s
[ANSWERED 2023] How did Greece influence the culture of Rome? What were the similarities and differences? Why did the Romans accept these ideas?
How did Greece influence the culture of Rome? What were the similarities and differences? Why did the Romans accept these ideas? Expert Answer and Explanation Rome was culturally influenced by their two great neighbors, Romans and Etruscans. Just like the Etruscans, Greeks had a significant influence on the Roman culture. The Greek influenced the Roman through various ways such as through Greek architectural designs, art, and mythology (Marconi, 2015). One of the key similarities between the two cultures was the way they designed their buildings. Greek architecture was among the significant influence of Greek culture on the Romans. The Greek temples, home of their gods, were made using marbles. Temples such as the Parthenon was made up of columns which added to its beauty. The Romans borrowed the Greek designs and started applying them in their public buildings. As time went by, they learnt how to use concrete to come up with larger structures such as the Circus Maximus, famous for horse racing, which could hold up to 200,0000 fans or more. The other similarity which emerged between the two as a result of their interaction was the use of Greek art. By that time, Greek pottery was highly valued throughout Mediterranean world just because of its beauty and usefulness (Marconi, 2015). The Greek potters made large clay pots which were used to store wine, food and water. What amused many were the paintings made on the pots. They depicted great leaders and warriors. The same modeling technique was later adopted by the Roman artists although they had their own designs. Other form of Greek art imitated by the Romans was painting. The third similarity relates to mythology. The Greeks worshipped various gods and goddesses. These governed their daily life. They conducted rituals and sacrifices to acquire the favors from these gods for everything right from curing the sick to celebrating good harvest. The Romans had their gods too. However, the knowledge about the gods shifted the moment they started relating with the Greeks. The gods from the Greek culture which portrayed almost similar features as theirs were automatically blended into their culture. They adopted various gods from the Greek and what they just simply did was changing the names. For instance, Zeus, the greatest Greek god was named as Jupiter. The Greek goddess of love, Aphrodite, was named as Venus. Despite sharing a lot in common as far as the idea of culture is concerned, the two had some differences too. For instance, the Romans were efficient at practical applications whereas their counterparts were good at theoretical pursuits and abstractions. The second difference related to the access of public places by women. Greek women were separated and could not go to public places. On the other hand, their counterparts had rights of movement, rights to own property or even divorce. The reason as to why the Romans accepted these ideas was because their region was situated in the middle of various cities in the Greece (Marconi, 2015). These cities were separated by Peninsula. This increased the chances of contact between the Greeks and the Romans hence leading to significant influence. Discuss the Roman division of social classes. How did Rome attempt to reconcile these differences in law and culture? What problems did these divisions cause? How could Rome have stopped these problems? The ancient Rome was made up two social classes, upper and lower classes. The difference between the two was clear. The first class or division was known as the patricians. The patricians consisted of leading citizens, wealthy landowners, very successful businessmen, and government officials. Patricians occupied the upper class. This group of individuals controlled both administrative and political power and enjoyed wealth (Alfoldy, 2014). They were well represented in Roman assemblies. They dominated for centuries because of their large number in the senate. On the other hand, the Plebians were just ordinary residents, some small businessmen others very prosperous entrepreneurs. The Plebians occupied the lower class of the social structure. Unlike the Patricians, the Plebians did not have administrative or political power. They were only supposed to engage in various activities but not politics (Alfoldy, 2014). Slaves in the ancient Roman social structure didn’t have any legal privileges. They completely depended on their masters. Roman tried to reconcile the differences by dividing the residents into major divisions based on the quantity of property owned. Obviously, the wealthiest individuals (patricians) had bigger chucks of land, and as a result, they occupied the senate. Separation of the people based on the amount of wealth brought a lot of confrontations among the Plebians, slaves, Lords, and Patricians. The groups openly opposed each other and sometimes the confrontations resulted to fights. One of the ways Rome could solve these problems was by allowing senate be occupied by individuals based on their ability to lead and not by the amount of wealth they possess. This means that individuals could come from any social class. This could have helped to bring some sought of inclusivity in the government. The other way could be through encouraging citizens to register. This could have helped to indentify the individuals together with their status. It could also present the simplest way to get public participation or consensus or opinion regarding a particular policy. How did the Hellenists govern the lands that Alexander had conquered? What were the differences and similarities in how each area was governed? How did Hellenic regions cooperate with one another? What were the problems that these areas faced, and how could these problems have been overcome? The reign of Hellenists started after the successful conquest by the Alexander the Great from Macedon to India. This success brought about tremendous changes especially in regard to the spread of the Greek culture in the conquered regions. During the reign of Alexander the Great, all the conquered regions maintained their initial system of governance (Alston, 2014). The only difference was that the regions were working and taking instructions from him. They paid taxes to him
[ANSWERED 2023] Mike and Joanne are the parents of James and Samuel, identical twins born 8 years ago. James is currently suffering from acute glomerulonephritis, kidney failure
Mike and Joanne are the parents of James and Samuel, identical twins born 8 years ago This assignment will incorporate a common practical tool in helping clinicians begin to ethically analyze a case. Organizing the data in this way will help you apply the four principles of principlism. Based on the “Case Study: Healing and Autonomy” and other required topic study materials, you will complete the “Applying the Four Principles: Case Study” document that includes the following: Part 1: Chart This chart will formalize principlism and the four-boxes approach by organizing the data from the case study according to the relevant principles of biomedical ethics: autonomy, beneficence, nonmaleficence, and justice. Part 2: Evaluation This part includes questions, to be answered in a total of 500 words, that describe how principalism would be applied according to the Christian worldview. Remember to support your responses with the topic study materials. APA style is not required, but solid academic writing is expected. You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance. Case Study: Healing and Autonomy Mike and Joanne are the parents of James and Samuel, identical twins born 8 years ago. James is currently suffering from acute glomerulonephritis, kidney failure. James was originally brought into the hospital for complications associated with a strep throat infection. The spread of the A streptococcus infection led to the subsequent kidney failure. James’s condition was acute enough to warrant immediate treatment. Usually cases of acute glomerulonephritis caused by strep infection tend to improve on their own or with an antibiotic. However, James also had elevated blood pressure and enough fluid buildup that required temporary dialysis to relieve. The attending physician suggested immediate dialysis. After some time of discussion with Joanne, Mike informs the physician that they are going to forego the dialysis and place their faith in God. Mike and Joanne had been moved by a sermon their pastor had given a week ago, and also had witnessed a close friend regain mobility when she was prayed over at a healing service after a serious stroke. They thought it more prudent to take James immediately to a faith healing service instead of putting James through multiple rounds of dialysis. Yet, Mike and Joanne agreed to return to the hospital after the faith healing services later in the week, and in hopes that James would be healed by then. Two days later the family returned and was forced to place James on dialysis, as his condition had deteriorated. Mike felt perplexed and tormented by his decision to not treat James earlier. Had he not enough faith? Was God punishing him or James? To make matters worse, James’s kidneys had deteriorated such that his dialysis was now not a temporary matter and was in need of a kidney transplant. Crushed and desperate, Mike and Joanne immediately offered to donate one of their own kidneys to James, but they were not compatible donors. Over the next few weeks, amidst daily rounds of dialysis, some of their close friends and church members also offered to donate a kidney to James. However, none of them were tissue matches. James’s nephrologist called to schedule a private appointment with Mike and Joanne. James was stable, given the regular dialysis, but would require a kidney transplant within the year. Given the desperate situation, the nephrologist informed Mike and Joanne of a donor that was an ideal tissue match, but as of yet had not been considered—James’s brother Samuel. Mike vacillates and struggles to decide whether he should have his other son Samuel lose a kidney or perhaps wait for God to do a miracle this time around. Perhaps this is where the real testing of his faith will come in? Mike reasons, “This time around it is a matter of life and death. Expert Answer and Explanation Applying the Four Principles: Case Study Part 1: Chart (60 points) Based on the “Healing and Autonomy” case study, fill out all the relevant boxes below. Provide the information by means of bullet points or a well-structured paragraph in the box. Gather as much data as possible. Medical Indications Beneficence and Nonmaleficence Patient Preferences Autonomy Beneficence focuses on how the patient can positively benefit by interacting with the medical practitioner. The benefits include treatment, care delivery, and medication prescription to alleviate the pain and other issues affecting the patient. Nonmaleficence on the other hand entails the measures that can be taken by the doctor to prevent harm either by intentional or unintentional. These principles are evident in the case where the doctor informs the parents who have the power of attorney for the child of the best modes of medication to mitigate the severity of the symptoms on the child. The doctor also takes measure to prevent harm by telling the parent that they should consider visiting the facility in the event that their decision to focus on prayer alone does not lead to the outcome they want. The principle of autonomy is controversial as it binds the doctors, despite having professional knowledge, to abide by the needs and requirements set forth by the patients. The doctor has to conform to the needs of the patients and offer medical care that is aligned with how the patient wants. The most important attribute of care is the preference of the patient even when the doctor is against the decision. Autonomy is evident in the care where the parents decide to take the hold for prays as opposed to following the doctor’s advice of offering dialysis treatment. The parents are now faced with the decision on whether to use the twin brother as the donor. Quality of Life Beneficence, Nonmaleficence, Autonomy Contextual Features Justice and Fairness Patient car can have two outcomes depending on the mode of medication, patient decision and availability of resources. In order to ensure the quality if life and the overall sustenance of the patient from harm, there is need for collaboration. The patient is responsible for
[SOLVED 2023] The National Organization of Nurse Practitioner Faculties (NONPF) has determined core competencies that apply to all nurse practitioners, regardless of specialty or patient population focus
The National Organization of Nurse Practitioner Faculties (NONPF) has determined core The National Organization of Nurse Practitioner Faculties (NONPF) has determined core competencies that apply to all nurse practitioners, regardless of specialty or patient population focus. NONPF has represented them within nine broad areas of core competence. NONPF created the first set of Nurse Practitioner Competencies in 1990; the most recent updates were incorporated in 2017. This synthesis course has had the overarching objective of preparing you to be able to synthesize knowledge gained throughout the program and be prepared to apply each of the nine core competencies within your selected areas of practice and your representative communities. The nine broad areas of competency are: Scientific Foundations Leadership Quality Practice Inquiry Technology and Information Literacy Policy Health Delivery System Ethics Independent Practice To Prepare: Review this week’s Learning Resources, focusing on the NONPF Core Competencies Content. The Assignment For each of the nine NONPF competencies, write one paragraph explaining how the program has prepared you to meet it (for a total of at least nine paragraphs). Then, propose and explain how you plan to engage in social change in your community as a nurse practitioner. Be specific and provide examples. Expert Answer and Explanation National Organization of Nurse Practitioner Faculties (NONPF) Competencies The nursing practice is constantly changing to include new modes of practice and a wider scope of practice (Moore, & Hawkins-Walsh, 2020). Nurses make up the vast majority of staff in the healthcare sector and need to demonstrate certain competencies to better impact the positive outcomes in health. This paper analyzes how the program has prepared me to meet the nine NONPF core competencies. NONPF Competencies Scientific Foundations The scientific foundation competency addresses the need for the crucial analysis of data in the improvement of advanced nursing practice and proceeds to integrate the new knowledge into the overall practice of nursing (NONPF, 2020). The components also focus on the translation of research and the development of new practices. The program has been effective in training on best research techniques and how to obtain reliable information from data and derive new knowledge. The process is an important scientific process as it enables the formation of reliable and credible knowledge to be applied in practice. Leadership Competencies The competencies focus on the ability of nurses to be able to assume advanced and complex leadership positions (OSU, 2022). In this regard, nurses should be able to lead in a critical and reflective manner, advocate for better access, advance the practice setting and improve collaboration (NONPF, 2020). The program has been useful in creating awareness of the different leadership styles and character traits of an effective leader. During the course, I have been able to learn how to become a reliable and effective leader. The program also provided insights on issues related to teams and teamwork management, crisis management, and stress management within a team and the entire organization. The information is relevant in the development of an effective leader. Quality Competencies The healthcare sector is constantly changing, and with it, the modes ofc are delivery. One of the key components that need to change as well is the quality of care for the patients (NONPF, 2020). The quality competencies focus on how nurses can make use of available evidence to constantly provide better improvements in clinical practice (OSU, 2022). The program provided insights on the culture of safety and the use of different tools such as the Plan-Do-Study-Act, which offer guidelines on better change implementation. Nurses can make use of data from evidence-based practice to the teaching of implementing change to ensure the attainment of quality competencies. Practice Inquiry Competencies While the identification of new knowledge is important, it needs to be translated to meet the needs of the patient or specific practice (NONPF, 2020). The practice inquiry competencies ensure that a nurse in the leadership position has the capacity to translate new knowledge into practice. In this regard, the nurse would then be able to come up with knowledge based on the clinical research to better provide a better-quality model of care (OSU, 2022). However, in order to implement the practice inquiry competencies, a nurse needs to be able to know where the challenge or gap is before creating the desired changes. The program teaches how to identify practice problems and appraisal of evidence to determine the best available mode of intervention. Technology and Information Literacy Competencies The program advocated for nurses to be aware of new technologies, such as the use of nurse informatics to identify patterns and trends from evidence. The technology can be useful in the translation of beneficial information towards the delivery of better care. As a nurse, ensuring that proper strategies are used to integrate technology in healthcare can improve the effectiveness of care (OSU, 2022). Policy Competencies The program is essential in informing about the correlation between internal or external policies with the overall nursing practice. The program advocates for the nurses to understand the relevance of advocacy and be part of the leadership categories responsible for the creation of policies. The intervention is essential in providing better patient care and an effective working environment for the nurses (Kottwitz & Owens, 2021). Health Delivery System Competencies The program provided information on how nurses can apply the knowledge obtained from research and in school into practice. Information such as the organizational structure and decision-making strategies can be used as the basis of health delivery. The competency addresses the need to interpret, use and correlate data within the facility. Ethics Competencies As a nurse, it is important that the decisions made are ethical and lead to the best patient outcomes. The program provides a nurse with different ethical requirements for a nurse and how they can be applied in practice. Can then make use of the information related to ethics and apply the knowledge in determining best patient practice (Chan et al., 2020). Independent Practice Compliances With the increasing nursing roles, nurses need to be
[ANSWERED 2023] A 15-year-old male reports dull pain in both knees. Sometimes one or both knees click
A 15-year-old male reports dull pain in both knees. Sometimes one or both knees click Assessing Musculoskeletal Pain Case 3: Knee Pain A 15-year-old male reports dull pain in both knees. Sometimes one or both knees click, and the patient describes a catching sensation under the patella. In determining the causes of the knee pain, what additional history do you need? What categories can you use to differentiate knee pain? What are your specific differential diagnoses for knee pain? What physical examination will you perform? What anatomic structures are you assessing as part of the physical examination? What special maneuvers will you perform? With regard to the case study you were assigned: · Review this week\\\’s Learning Resources, and consider the insights they provide about the case study. · Consider what history would be necessary to collect from the patient in the case study you were assigned. · Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient\\\’s condition. How would the results be used to make a diagnosis? · Identify at least five possible conditions that may be considered in a differential diagnosis for the patient. Post an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient\\\’s differential diagnosis and justify why you selected each. Expert Answer and Explanation Knee Pain Episodic/Focused SOAP Note Patient Information: JD is a 15-year-old African American Male. S. CC “Dull pain in both knees for four days.” HPI: JD is a 15-year-old African American Male who came to the hospital with complaints of dull pain in his both knees for the three days. He reports that he sometimes feels catching sensation under the patella and both knees often click. The pain started after playing basketball tournament three days ago. He has not applied any medication. The severity of the pain I 8/10. Current Medications: No medications Allergies: No allergies. PMHx: No history of major medical conditions. Pneumonia and influenza vaccines are up to date. Soc Hx: Denies tobacco or alcohol use. He is the only child in a middle-class family. He loves playing basketball. Fam Hx: He is the only child in a family of three. Both parents are alive and healthy. Grandfather died of depression. He committed suicide. Grandmother is alive as has type II diabetes. ROS: GENERAL: No fatigue, weight loss, or fever. HEENT: Eyes: No vision problems. Ears, Nose, Throat: No hearing problem, sneezing, runny nose, congestion, or sore throat. SKIN: No rash or itching. CARDIOVASCULAR: No heart problems. RESPIRATORY: No breathing problems. MUSCULOSKELETAL: Knee pain. HEMATOLOGIC: No anemia or bleeding. O. Physical exam: Constitutional: General Appearance: Healthy adult with moderate distress. A+O+3, mucous membranes moist, flushed, answers questions properly. Vitals: BP 122/90; P 57; R 20; T 36.3; W 58kgs; H 157cm. HEENT: Head: NC/AT. Eyes: Pupils are PERRL, extraocular movements intact; conjunctivae pink. Ears: Hearing intact, normal external appearance. Nose: Appears normal, clear mucus. Mouth: The are in good shape. Throat: No lesions or inflammation of the tonsils. Skin: Normal color for ethnicity, dry, warm, with no rashes or lesions. Cardiovascular: S1, S2 with regular rhythm and rate. No heart sounds. Lungs: Chest walls symmetric. Lungs clear and bilateral. Regular respirations. Knee: MRI shows ACL tear in both knees. Diagnostic results: Diagnosis for knee musculoskeletal can be done using MRI or X-ray (Ball et al., 2019). The authors note that X-ray cannot see the ligaments, and in this case, MRI is recommended. X-ray: Pending MRI: Pending A. Differential Diagnoses Anterior Cruciate Ligament (ACL) Injury. The primary diagnosis for this ACL injury. ACL injury is a sprain or tear ACL, one of the major ligaments in the knee (Korakakis et al., 2019). The injury occurs mostly in sportspersons. The disease causes pain in the knee. It has been included as the primary diagnosis because the patient is a sportsperson and recently got injured during a game. Knee locking: Characteristics of knee locking include catching sensation, swelling of the affected knee, and pain with extension (Lee, Nixion, Chandratreya & Murray, 2017). The disease is not a primary diagnosis because the patient is no swelling in the knee. Osteochondritis Dissecans: OCD is a joint condition that occurs when blood is not enough in the end of the bone. It also causes pain in the knee, and that is why it has been included in the diagnosis. Juvenile idiopathic arthritis: JIA is the swelling of the joints. The disease occurs before a kid reaches 16 years (Ramanan et al., 2017). It causes joint pain, and that is why it has been included in the diagnosis. Repeated kneecap dislocation: Repeated patellar subluxation is the continued instability of the patellar, which causes knee pain. References Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel\’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby. Korakakis, V., Saretsky, M., Whiteley, R., Azzopardi, M. C., Klauznicer, J., Itani, A., … & Malliaropoulos, N. (2019). Translation into modern standard Arabic, cross-cultural adaptation and psychometric properties’ evaluation of the Lower Extremity Functional Scale (LEFS) in Arabic-speaking athletes with Anterior Cruciate Ligament (ACL) injury. PloS one, 14(6), e0217791. https://doi.org/10.1371/journal.pone.0217791 Lee, P. Y. F., Nixion, A., Chandratreya, A., & Murray, J. M. (2017). Synovial plica syndrome of the knee: a commonly overlooked cause of anterior knee pain. The Surgery Journal, 3(1), e9. doi: 10.1055/s-0037-1598047 Ramanan, A. V., Dick, A. D., Jones, A. P., McKay, A., Williamson, P. R., Compeyrot-Lacassagne, S., … & Beresford, M. W. (2017). Adalimumab plus methotrexate for uveitis in juvenile idiopathic arthritis. New England Journal of Medicine, 376(17), 1637-1646. https://www.nejm.org/doi/full/10.1056/NEJMoa1614160 Place your order now for a similar assignment and get fast, cheap and best quality work written by our expert level assignment writers.Use Coupon Code: NEW30 to Get 30% OFF Your First Order FAQs Osgood-schlatter disease Osgood-Schlatter disease
[ANSWERED 2023] Review the video Case Study Dev Cordoba. You will use this case as the basis of this Assignment
Review the video Case Study Dev Cordoba. You will use this case as the basis of this Assignment. In this video Assignment: Focused SOAP Note for Anxiety, PTSD, and OCD In assessing patients with anxiety, obsessive-compulsive, and trauma and stressor-related disorders, you will continue the practice of looking to understand chief symptomology in order to develop a diagnosis. With a differential diagnosis in mind, you can then move to a treatment and follow-up plan that may involve both psychopharmacologic and psychotherapeutic approaches. In this Assignment, you use a case study to develop a focused SOAP note based on evidence-based approaches. To Prepare Review this week’s Learning Resources. Consider the insights they provide about assessing and diagnosing anxiety, obsessive compulsive, and trauma-related disorders. Review the Focused SOAP Note template, which you will use to complete this Assignment. There is also a Focused SOAP Note Exemplar provided as a guide for Assignment expectations. Review the video Case Study Dev Cordoba. You will use this case as the basis of this Assignment. In this video, a Walden faculty member is assessing a mock patient. The patient will be represented onscreen as an avatar. Consider what history would be necessary to collect from this patient. Consider what interview questions you would need to ask this patient. The Assignment Develop a Focused SOAP Note, including your differential diagnosis and critical-thinking process to formulate a primary diagnosis. Incorporate the following into your responses in the template: Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life? Objective: What observations did you make during the psychiatric assessment? Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TRcriteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case. Plan: What is your plan for psychotherapy? What is your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan. Also incorporate one health promotion activity and one patient education strategy. Reflection notes: What would you do differently with this patient if you could conduct the session again? Discuss what your next intervention would be if you could follow up with this patient. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion, and disease prevention, taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.). Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old). Expert Answer and Explanation SOAP Note for Major Depressive Disorder Subjective: CC (chief complaint): “anxious and worried all the time.” HPI: DC is a 7-year-old African American boy who is brought to the school clinic by her mother with a CC of being “anxious and worried all the time.” The patient reports that he is worried all the time about many things, including being left by his family and being lost, and has nightmares about the same. He reports having nightmares almost daily. The patient states that she feels lonely due to his father’s absence and feels his mother is not giving him much attention compared to his brother. Her mother reports a decrease in the patient’s school performance characterized by increased absenteeism and lack of concentration in school. He has issues with wetting the bed even after being given medications to help with the issue. As a result, he finds it difficult to interact with his peers at school since they say he smells bad. DC has also been displaying violence both in school and at home. The patient’s mother reports a sudden loss in appetite, with the patient losing three pounds within the past three days. He has never had any prior visitations to a psychiatric clinic before this and was referred by the child’s pediatrician who states that there is nothing physically wrong with DC. Past Psychiatric History: General Statement: The patient has never had any psychiatric assessment before and was referred back to the school clinic by his pediatrician citing the absence of physiological issues. Caregivers: The patient is under the care of his mother. Hospitalizations: No hospitalization. The patient also denies having any thoughts of hurting himself Medication trials: No indication from the mother of having participated in any medical trials. Psychotherapy or Previous Psychiatric Diagnosis: Denies having a past diagnosis of a psychological health condition. Substance Current Use and History: Denies any history of substance use or secondary exposure to the same. Family Psychiatric/Substance Use History: denies knowing any family member with a psychiatric or substance use history. Psychosocial History: The patient is currently a grade two student but has very few social interactions or friends at school. The patient’s father was killed on a military mission and currently lives with her mother. The patient has a dog called sparky and LEGOs which he likes to play with. Medical History: No history of mental conditions. Current Medications: Previous prescription of desmopressin. Allergies: no allergies reported. Reproductive Hx: N/A. ROS GENERAL: positive for sudden weight loss, occasional loss of concentration. Denies having any fever or fatigue. HEENT: N/A SKIN: N/A CARDIOVASCULAR: No chest discomfort, tightness, or pain RESPIRATORY: No shortness of breath or wheezing sound GASTROINTESTINAL: N/A GENITOURINARY: Denies having UTI. Normal volume and consistency of urination NEUROLOGICAL: No neurological disorders. MUSCULOSKELETAL: No MS disorders noted HEMATOLOGIC: N/A LYMPHATICS: Non-contributory ENDOCRINOLOGIC: No endocrinologic abnormalities were noted Objective: Physical exam: Vital Signs: T 35.2, HR, 70, BP 100/58, Wt. 38, Ht. 4’5, RR 18, HEENT: Non-contributory. Skin: Non-contributory. CV: Regular HR and rhythm. No bruits or murmurs, chest
[2023] Identify an organizational issue that, if addressed, could positively impact organizational effectiveness or outcomes. Your organizational issue should reflect
Identify an organizational issue that, if addressed, could positively impact organizational Identify an organizational issue that, if addressed, could positively impact Instructions Issue: Identify an organizational issue that, if addressed, could positively impact organizational effectiveness or outcomes. Your organizational issue should reflect a performance gap or potential problem of practice that you will describe as your area of interest in the assignment. Identify the organizational issue by completing a description of the issue just as done in the Examples of Gaps section that follows the blank gap analysis worksheet below. Process or Activity Title: Identify each process, factor, or activity associated with the organizational issue or performance gap identified in the issue statement. List those processes or associated activities related to the issue that are not performing as desired or expected. Each process or activity needs to be analyzed to determine its related performance gaps and its impact on the organization. Expected Performance (A): Regarding each process or activity, describe performance expectations based on established goals, performance standards (for example, state testing), or organizational intent/vision. In the Examples of Gaps section below, the expected performance for the discipline tickets report was anticipated to be at a low level because the system was designed for exceptions. The gap analysis revealed other issues and gaps in expected instructor performance. Note: If the expected performance level or number or percent is known, provide it, or if possible, provide a reasonable estimate and label it as an estimate only. Another approach is to qualitatively describe the expected performance. Current Performance (B): Describe the current performance. In the Examples of Gaps section below, a high number of ticket reports were identified as consistently submitted across semesters. Note: provide the most accurate performance indicators possible. In the Examples of Gaps, the exact number such as total number of tickets for the previous term or the average of tickets per week for the past term would have been a more precise measurement. Be as precise as you can in describing the current performance. Performance Gap (A minus B): Describe the difference between expected performance and the current performance: what should be and what is. Note that the comparison between expected performance and the current performance could involve additional gaps. In the Examples of Gaps table, the ticket report analysis showed additional problems. As with describing the expected and current performance use the most precise numbers, data, or language that you can. Effect of Gap on Organization: Describe in detail how each performance gap affects the organization. Describe both known effects and potential effects. Within the Examples of Gaps table for the ticket reports, the obvious overtaxed system was an effect and ethical issues and their implications were identified as potential effects. Carefully think through and identify the effects and potential effects of the gaps on the organization. Gap Analysis Worksheet Using the template below, do your own gap analysis. Complete each cell clearly and completely. Add rows for additional processes and activities that need to be analyzed. Use number/percentage data to support your statements only when the numbers are known. Otherwise, use descriptive words where no actual numbers are available. Gaps are often qualitative. If there are no established numbers (or reasonable estimates) to support a quantification of a gap, explain it in qualitative terms. Use a separate row for each process and activity and include the specific information requested for each column. Cells will expand as needed. Issue: Process or Activity Title Expected Performance (A) Current Performance (B) Performance Gap (A minus B) Effect of Gap on Organization Examples of Gaps Issue: Suspension rates at a high school are at unacceptably high levels. Process or Activity Title Expected Performance (A) Current Performance (B) Performance Gap (A minus B) Effect of Gap on Organization Discipline Ticket Reports The system is in place to accommodate exceptions. Exceptions are expected to be few in number. (Note: If expected number is known, provide it. Or provide a reasonable estimate and label it an estimate only.) A high number of ticket reports are consistently submitted across semesters. (Note: Provide actual data, e.g., number of tickets), if possible.) System that was created to handle exceptions routinely handles too many. (Note: If actual numbers are known for A and B, subtract the difference.) System is taxed. Ticket Distribution Tickets that enter the system are expected to be representative of the overall race and gender ratios at the institution. (Note: Provide actual data current race and gender ratios of student body if possible.) Students of color and males are overrepresented as recipients of behavioral/disciplinary tickets. (Note: Provide actual data about race, ethnicity, and gender if possible.) Ticket distribution ratios in terms of race and gender are not representative of student body demographics. (Note: Describe the difference.) Potential ethical implications; potential unbalanced or biased application of disciplinary regulations. May affect institution’s learning environment and climate. Classroom Management Faculty manage behavior in the classroom and submit tickets as a last resort. Faculty default to sending students out of class. Classroom resolution is not happening. Classroom instruction is missed by students; disruptions lower quality of instruction for all. Classroom Management Faculty manage behavior with cultural sensitivity. Faculty display limited skills in responding to behavioral issues or to facilitate a multicultural classroom effectively. Skills to manage and resolve behavioral problems and desired level of cultural competence are lacking. Ill will and distress for students and faculty; loss of incentive to attend class. Loss of opportunities to learn about others. Classroom Management and Support Faculty can, as an interim option, require students who have behavior issues schedule an appointment with student services counseling support. As a result students receive counseling and return to the classroom able to manage their behavior. Faculty do not exercise their interim option and do not require students who have behavior issues schedule an appointment with student services counseling support. Interim resolution with support is not happening. Classroom instruction is missed by students;