Healing and Autonomy

Biomedical Ethics in the Christian Narrative                                                                                   

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. Healing and Autonomy

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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?”

Based on the “Healing and Autonomy” case study, fill out all the relevant boxes below. Provide the information using bullet points or a well-structured paragraph in the box. Gather as much data as possible.

Answer each of the following questions about how the four principles and four boxes approach would be applied:

1. In 200-250 words answer the following: According to the Christian worldview, how would each of the principles be specified and weighted in this case? Explain why. (45 points)

2. In 200-250 words answer the following: According to the Christian worldview, how might a Christian balance each of the four principles in this case? Explain why. (45 points)

Beauchamp, T. L., & Childress, J. F. (2001). Principles of biomedical ethics. Oxford University Press, USA.

Teven, C. M., & Gottlieb, L. J. (2018). The four-quadrant approach to ethical issues in burn care. AMA journal of ethics, 20(6), 595-601.

Journal Entry Essay

Assignment: Journal Entry

Critical reflection of your growth and development during your practicum experience in a clinical setting has the benefit of helping you to identify opportunities for improvement in your clinical skills, while also recognizing your strengths and successes.  Journal Entry Essay

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Use this Journal to reflect on your clinical strengths and opportunities for improvement, the progress you made, and what insights you will carry forward into your next practicum

• Refer to the “Advanced Nursing Practice Competencies and Guidelines” found in the Week 1 Learning Resources, and consider the quality measures or indicators advanced nursing practice nurses must possess in your specialty of interest.
• Refer to your “Clinical Skills Self-Assessment Form” you submitted in Week 1, and consider your strengths and opportunities for improvement.
• Refer to your Patient Log in Meditrek, and consider the patient activities you have experienced in your practicum experience. Reflect on your observations and experiences.

In 450–500 words, address the following:

Learning From Experiences

•  Revisit the goals and objectives from your Practicum Experience Plan. Explain the degree to which you achieved each during the practicum experience.
• Reflect on the three (3) most challenging patients you encountered during the practicum experience. What was most challenging about each?
• What did you learn from this experience?
• What resources did you have available?
• What evidence-based practice did you use for the patients?
• What new skills are you learning?
• What would you do differently?
• How are you managing patient flow and volume?

Communicating and Feedback

• Reflect on how you might improve your skills and knowledge and how to communicate those efforts to your Preceptor.
• Answer the questions: How am I doing? What is missing?
• Reflect on the formal and informal feedback you received from your Preceptor.

Nursing homework help

Training Title 50

Name: Harold Griffin

Gender: male

Age:58 years old

T- 98.8 P- 86 R 18 134/88 Ht 5’11 Wt 180lbs

Background: Has bachelor’s degree in engineering. He is homosexual and dates casually, never married, no children. Has one younger sister. Sleeps 4-6 hours, appetite good. Denied legal issues; MOCA 27/30 difficulty with attention and delayed recall; ASRS-5 20/24; denied hx of drug use; enjoys one scotch drink on the weekends with a cigar. Allergies Morphine; history HTN blood pressure controlled with losartan 100mg daily, angina prescribed ASA 81mg po daily, metoprolol 25mg twice daily. Hypertriglyceridemia prescribed fenofibrate 160mg daily, has BPH prescribed tamsulosin 0.4mg po bedtime. Nursing homework help

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 Symptom Media. (Producer). (2017). Training title 50 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-50

Differential Diagnoses: : Explain relate it the patient

ADHD

Anxiety Disorder

Major depressive disorder:

Assignment: Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders

To Prepare:

• Review this week’s Learning Resources and consider the insights they provide. Consider how neurocognitive impairments may have similar presentations to other psychological disorders.
• Review the Comprehensive Psychiatric Evaluation template, which you will use to complete this Assignment.
• select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.
• Consider what history would be necessary to collect from this patient.
• Consider what interview questions you would need to ask this patient.
• Identify at least three possible differential diagnoses for the patient.

Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate 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 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria 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.
• Reflection notes: What would you do differently with this client if you could conduct the session over? 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.).

APPLIED FINAL PROJECT

In your applied final project for this course, you will analyze a case study, select a diagnosis, create a treatment plan, and support your decisions with evidence from the course readings or outside scholarly resources. APPLIED FINAL PROJECT

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Psychological Case Study

Name:  Ms. Smith                                                                                            Dates of Interview: 03/18/19; 03/25/19

Date of Birth: 03/21/1987                                                                             Age: 32 years

Gender: Female                                                                                               Education: Highschool Graduate

Background information:

Ms. Smith is a 32-year-old biracial, female, who has completed high school and is currently employed as a waitress.  Ms. Smith was taken to the hospital on 3/18/2019 by local police, who found her screaming, pacing, and weeping inconsolably outside of a local apartment building on 5^th Street. Apartment residents called police to the scene, concerned by the disturbance Ms. Smith was creating.

Captain Logan, with Fire and Rescue, arrived second on the scene and treated Ms. Smith for multiple cuts on her arms.  Exhausted by apparent despair, Ms. Smith conveyed she moved to town one month earlier from Memphis, TN, looking for a new start. She met her boyfriend, Frank, six days after starting her new job, and they have gone out six times.  According to Ms. Smith, “Frank is my destiny, he has to love me as much as I love him!”  Officers at the scene learn that Frank, hours earlier, told Ms. Smith he never wanted to see her again and that Ms. Smith has a restraining order against her in San Diego, CA.

Referral Question:

Ms. Smith has been referred to Dr. Liam for psychological evaluation due to immediate concerns for risk of self-harm. 

Current Symptoms:

Currently, Ms. Smith, reports that her head sometimes feels numb and that her thoughts are confused.  She is experiencing incredibly strong feelings of fear, seeing herself as being abandoned and alone in a strange new town. She self identifies as a passionate woman capable of foolish things that she is sometimes sorry for, to include unprotected sex with multiple partners before meeting Frank. 

When interviewed by police the day Ms. Smith was escorted from his apartment complex, Frank reported that Ms. Smith’s behaviors toward him rapidly became impulsive and demanding after their first date.  At first Ms. Smith was charming and thoughtful.  She would surprise him with small, simple gifts (e.g., movie tickets).  She then started to send affectionate text messages every half hour. The nature of the text messages quickly shifted from casual and flirty to strong expressions of passion and love sent every 10 minutes.  When Frank did not respond to these messages, in frequency or kind, Ms. Smith would suddenly ignore him or lash out. 

When asked about this behavior, Ms. Smith reported she regretted her negative actions towards Frank immediately after she did them, experiencing regret or panic after lashing out. Having been in many relationships before, that according to her, ‘did not work out,’ Ms. Smith could not stand the idea of Frank, her perfect love, seeing her as unkind.

Now that Frank has broken up with Ms. Smith, she feels empty, powerless, and worthless.  She attributes this sorrow as the reasons behind her sudden mood swings.  Her thoughts and emotions stray between extreme agitation and a compulsion to act out to apathy and a desire to withdraw.     

Relevant History:

Developmental/Medical/Social:

Ms. Smith’s mother, Helen Taylor, and father, Jake Smith, were both heroin addicts.  Her mother claims she did not use drugs while pregnant with Ms. Smith, attributing the life-style change to having completed rehabilitation two months prior to becoming pregnant.  During the pregnancy, Ms. Taylor did not seek prenatal care due to a fear of doctors and a lack of financial security.  At delivery, Ms. Smith reports she thinks she was a normal, healthy infant. 

Ms. Smith reports that her mother, Ms. Taylor, was not interested in being a mother and abandoned her to the care of Mr. Smith when she was 8-months old, upon his release from jail, following incarceration for stealing a wedding band to wed Ms. Taylor. 

Growing up, Ms. Smith had two older half-brothers, and one younger half-sister.  Her mother had multiple relationships prior to meeting Mr. Smith and is the mother of Ms. Smith’s brothers. Ms. Smith’s half-sister is the child of her father and stepmother.  Ms. Smith lived with her father and stepmother until she was 18 years-of-age.  The years between 2 and 8 she describes as the most influential. She struggled with confusion as to why her mother did not want her and why her stepmother ignored her.  She also suffered malnutrition due to lacking food in the home. 

Between the ages of 7 and 17, Ms. Smith continued to lack food and emotional security. She also withdrew into bouts of self-loathing and wishing for a permanent out for her mental, emotional, and physical suffering.  Her father’s moods were unpredictable, and her stepmother hit her frequently. Ms. Smith reports that no longer what she did (skipped school, brought home straight A’s), her stepmother expressed upset towards her. Owning one pair of jeans, four shirts and one pair of shoes by the time she turned 18, Ms. Smith was sensitive to the judgement of others.  In middle school and high school, she was overly self-focused and overreacted if she sensed a hint of judgement or rejection from others.  This reactance often led to sudden moments of violence (fights, throwing objects, verbal assaults) against those Ms. Smith felt wronged by.  During this period, Ms. Smith also took up the use of alcohol to counter regrets for her negativity towards others, and the wallowing emotional pit of nothingness she sometimes found herself in. 

Ms. Smith did disclose a family history of mental health challenges and anger management issues, though most she attributes to illegal substance use difficulties. Ms. Smith says she has worked with multiple therapists over the years but has not had luck finding one who understands her enough to bring about change.  Reportedly, Ms. Smith was not athletic as a child or teen, but was good at art, music, and writing.  She participated in band until her stepmother made it impossible for her to make it to band practice on time, making her miss the morning school bus. 

Pointed to above, Ms. Smith’s relationships with others have, and continue to be brief, beginning with idealization of a person and then a rapid period of denigration and demands of that person.

Educational/Occupational:

Ms. Smith explained that she was an early reader and began to read while attending a Jump Start Program.  Ms. Smith stated that, during the first grade, she “loved” her teacher Mr. V., but he never paid attention to her.  Ms. Smith reported that she performed quite well academically from the second through the fifth grade. This period marks a time before a move across country to a new town.  In sixth grade, Ms. Smith changed schools.  The middle school and high school years marked a period where her teachers knew her homelife was poor and they worked to get her into advanced classes. Currently, Ms. Smith is working as a waitress, but aspires to enter the music industry as a song writer. She has always been talented with the written word, according to her.  This career focus will be her fourth “remaking of herself” in the past 18 months. 

Alcohol Substance Abuse:

Ms. Smith denied use of any illegal drugs or any prescription drugs, but does overindulge in alcohol.

Conduct and Legal:

Reportedly, Ms. Smith has a restraining order against her in the state of California.  The order is to maintain over 100 feet from a past romantic interest.  Ms. Smith acknowledge she was disappointed her affection was perceived as overly demanding and blames the failure of the relationship on the fact the person was married.

Observations:

Ms. Smith is a 32-year-old, biracial female of average height and petite frame. She appeared her stated age, arrived at the evaluation agitated and dressed in clothes that may have been slept in. She was polite and cooperative at one moment and then sarcastic or argumentative the next during the evaluation.  Ms. Smith is left-handed. When challenged she would response with explosive anger, then retrack with an apology and body language that expressed guilt or remorse.  Attention and concentration were slightly impaired.  Ms. Smith’s thought processes were connected, while logic applied to decision making was not always coherent.  Ms. Smith’s eye contact during the evaluation was dependent on her mood. 

Regarding her motor functioning, there are no apparent abnormalities.  No evidence of impaired vision or hearing was present during this evaluation.  Ms. Smith did not demonstrate any difficulties with speech and appeared to demonstrate the ability to both understand and express the English language without notable exceptions. The content of her thought was occasionally tangential, moving off topic to the discussion of Frank, or to make personal inquiries directed at getting to know Dr. Liam. Her preoccupation with being abandoned does not appear to reflect paranoid thinking.  Her affect shifts rapid, contingent on topic of the discussion.  She did not report hallucinations or delusions.  Ms. Smith’s gait and pace reflected shifts in mood throughout the session. She did express suicidal but not homicidal ideation.

Apply cumulative knowledge from this course and others (i.e., abnormal psychology) to diagnosis Ms. Smith, support your diagnosis with evidence from the case and recommend further assessment and treatment options. Your paper should consist of the following sections:

Title Page

Part I: Reason for Referral

1. What was the reason for the referral?
2. What sources of data do you have and need?

Part II: Background Summary

1. Family/Social, (supports) Include ethnic/racial/cultural
2. Medical/ developmental
3. Educational/occupational (hobbies)
4. Behavioral observations

Part III: Assessment Data

1. Assessment:
2. In addition to a good diagnostic interview, what assessment tools would you recommend using to aid in giving an accurate diagnosis and developing a treatment plan?

Part IV: Tentative Diagnosis

1. Select a diagnosis using the DSM-5
   • DSM codes (add resources) http://ezproxy.umgc.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=1610168&site=eds-live&scope=site&ebv=EK&ppid=Page-__-1
2. Defend which diagnosis/diagnoses are possible using specific examples from the case.

Part V: Treatment Recommendations

1. Consider which treatment would be the ethical choice (community, group, referral to a forensic psychologist, psychiatrist, physician or for a neuropsychology evaluation).
2. Provide one or two Evidence Based Treatment recommendation for the diagnosis given.  Be sure to cite the source that helped you to determine the best Evidence Based Treatment for this diagnosis.

Part VI: Considerations

Clearly present your analysis of developmental, sociocultural, and ethical considerations that contribute to the diagnosis and treatment recommendations made.

1. Developmental Considerations
2. Sociocultural Considerations
3. Ethical Considerations

Part VII: Conclusion

1. Conclude with a summary of your findings.

Part VIII: References

Your paper should be 6-8 pages in length.  Use APA style headings and subheadings, double-spacing, an appropriate serif or sans serif font (e.g., Times Roman12-point; Arial 11-point; Calibri 11-point), one-inch margins (left, right, top, and bottom), page numbering, and logical flow from topic to topic.  Write with clarity, paying attention to spelling, grammar, and syntax.

PLEASE NOTE:

While a typical Case Conceptualization would not contain a reference section, we are asking you to include one here to demonstrate good practice in attributing and citing the ideas of others correctly. Please also include in text citations as appropriate.

Consult the UMGC Citing and Writing Guide, for proper form of APA Style in-text citations and references.

Please reference the rubric accompanying this assignment for scoring details.