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Essay Instructions: What explains the directionality of flows in health care? Patients, health workers, managerial practices? What are the five segments of patients who are willing to travel across borders to obtain health care? Are there other patient segments beside these five? Why is there growing rivalry for inbound international patients? Under what conditions should a hospital invest in plant and equipment to attract international patients? What explains the global price differential among hospitals? Why would countries like the U.S. have 10x the charges for procedures like hip replacements?

Essay Instructions: Application: Using an Ethical Decision-Making Model
With practice, incorporating an ethical framework in your decision making will become natural and even instinctive to you. To begin to develop this habit, you will apply a decision-making model to an ethical dilemma from your own practice or to one of these examples:
Case Presentation #1: Jody Smith (Guido, p. 17)
Case Presentation #2: Joan (Burkhardt & Nathaniel, p. 92)
Review the two decision-making models offered in this week?s textbook readings, and decide which one you wish to apply to the dilemma.
In a 3- to 5-page paper provide an account of your application of the decision-making model, addressing the following:
? Briefly describe the ethical dilemma and identify the decision-making model you chose, explaining why you chose it.
? Proceed through the steps of the model, summarizing the choices and conclusions you would make in this case. Be sure to describe the follow-up actions you think would be necessary.
? After completing your summary of the decision-making process, note any ways in which an ethic of care entered into your decision making.
This Application is due at the end of Week 4. Directions for submission can be found in the Week 4 Application.
Your written assignments must follow APA guidelines. Be sure to support your work with specific citations from this week?s Learning Resources and any additional sources. Refer to the Pocket Guide to APA Style to ensure your citations in the text and reference list are correct.
You have completed Week 3. The course now shifts in focus to legal issues. Please proceed to Week 4.


Book
Burkhardt, M. &. (2008). Ethics issues in Contemporary Nursing. Clifton Park: Delmar.
Guido, G. W. (2010). Legal & Ethical Issues in Nursing (5 ed.). Vancouver, Washington: Julie Levin Alexander.
The follow scenario is the ones we can choose from
The first is from Burkhardt
Differences in Personal and Organizational Values
?Joan has been the nurse manager of her unit for the past ten years and is highly regarded by the hospital?s administration. For the past several months, however, she has been feeling more frustrated and less satisfied with her work because of staffing cuts and other institutional decisions related to managed care. Attending to patient needs has always been the most rewarding part of her job. However, recently she feels that she has been forced to overlook these needs and attend more to the need of the organization. She considers leaving, but she has seniority, good benefits, and two children to support. She is also aware that her distress at work is affecting her family, because she carries a lot of the frustration home with her.?
The following is from Ginny Wacker Guido Book

?Jody Smith, a retired nurse with 3 adult children and numerous adult grandchildren, lives alone in a small rural area. Her income is limited. Two months ago, she fell and broke her left hip. After surgery for an artificial hip replacement, she was transferred to a rehabilitation center, where she had a left sided cerebrovascular accident (CVA). She was then readmitted to the acute care facility, where she has received aggressive therapy of the CVA.

Completely paralyzed on her left side, Mrs. Smith has decided that she no longer desires aggressive therapy and frequently asks the staff why she cannot die in peace. ?The rehabilitation is so painful and I?ll never walk again. What?s the use??
Both the doctors and her family are much more optimistic. The orthopedic surgeon is convinced that she will walk again, and the neurologist believes that she will make a full recovery and be able to return home and care for herself. Both doctors have excluded Mrs. Smith from their conversations, assuring her children that she will be ?as good as new? and ignoring her requests to discontinue anticoagulant and rehabilitative therapy.
While not in a life-threatening condition, Mrs. Smith refuses to cooperate with the physical and occupational therapists and to take her medications. She also refuses to perform simple tasks, relying on staff to meet her activities of daily living.
Using the MORAL model, how would you begin to resolve this dilemma? Does the Code of ethics assist in resolving this dilemma: If so which provisions are the most helpful?

We studied Ethical principles and theories in relation to challenges of today?s health care
The impact of legal factors on ethical decision making
Evaluate the ethic of care as an approach to ethical decision making
Apply an ethical decision making process to an ethical dilemma
Also the justice of care

Essay Instructions: Introduction:

Elderly patients have many needs that younger patients do not. Being discharged from the hospital after surgery can present additional issues beyond those associated with physical recovery. In this task, you will assume the role of a case management nurse who is responsible for determining the most appropriate discharge placement for an elderly patient named Mr. Trosack. The patient is to be discharged from the hospital after undergoing total hip replacement surgery.
Review the ?Elder Care Case Study? (attached below) for information on your patient. You will use this information to complete this task.

Task:

Write an essay (suggested length of 4 pages) in which you analyze the case study information to complete the following:

A. Assessment of the Situation (suggested length of 2 pages)
1. Identify at least three healthcare issues that you, as the case manager, must address when working with an interdisciplinary team to determine the most appropriate discharge plan for Mr. Trosack.
a. Explain why these are important issues when planning for management of the elderly discharge patient.
2. Identify three to five members to make up an interdisciplinary team to determine the most appropriate discharge placement for Mr. Trosack.
a. Describe the role expected of each person on the team.
3. Analyze the issues from the safety assessment that could affect the determination of discharge placement.
Note: You may include any other safety issues you think might be a problem if this patient returns home upon discharge.

B. Discharge Plan of Care (suggested length of 2 pages)
1. Explain to the family what care Mr. Trosack needs and how he should be discharged based on the interview data and the safety assessment. Your explanation should include the following:
a. Discuss the ability of the family to adequately care for Mr. Trosack if he is discharged home.
b. Discuss how social isolation affects an older adult?s recovery from surgery or illness.
c. Discuss the ways psychological factors play a role in the recovery process.

2. Recommend a discharge placement for Mr. Trosack with supportive documentation.

C. If you use sources, include all in-text citations and references in APA format.

Note: When using sources to support ideas and elements in a paper or project, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the paper or project.

Note: No more than a combined total of 30% of a submission can be directly quoted or closely paraphrased from sources, even if cited correctly.

724.2.4-01-07 Case Study
You have just accepted the assignment of Mr. Trosack?s case management. As such, you are responsible for determining the most appropriate discharge placement and plan. From the patient?s chart, you are able to ascertain the following information:

PATIENT CHART:
Mr. Henry Trosack is a 72-year-old, second-generation Polish American who, until recently, has been in excellent health for all of his life. He reticently admits that prior to this hospitalization he has not had a physical examination in over 10 years, is taking no prescription medications, and has never had surgery in his life. In passing, he mentions taking some ?vitamins? to ?help his energy? every day, but he is not sure what they are. He wears glasses for reading and has hearing loss at 60% in his left ear.

Mr. Trosack manages a family-owned bakery along with his brother Karl, who is a widower. Mr. Trosack?s wife of 40 years, Helena, died two years ago at the age of 70. Mr. Trosack has lived in a two-bedroom apartment on the second floor in a three-story, post?WWII apartment building in downtown Chicago since he married his wife, Helena.

Mr. Trosack has one married son, Peter, 44, a financial consultant. Peter and his 43-year-old wife, Rita, both work an average of 60 hours a week and are trying to conceive their first child. They live in a condominium in downtown Chicago close to the lake and not far from the bakery. Although both were raised Catholic, neither chooses to practice their religion at this time. This infuriates Henry, but he doesn?t talk about it. Contact between Peter and his father is infrequent.

One month ago while taking out the trash, Mr. Trosack fell down the long flight of steps leading to the ground floor of his apartment building, fracturing his right hip. His brother called 911, and Henry was brought to the hospital where he underwent a right total hip replacement (THR) within 24 hours of admission. After a successful and uneventful surgery, Mr. Trosack has been in in-hospital rehabilitation for the past 2 weeks.

While in the hospital for the THR, it was determined that Mr. Trosack had hypertension. Mr. Trosack was prescribed Lopressor 25 mg bid for an average B/P of 160/100. He was also diagnosed with noninsulin-dependent diabetes for which he was prescribed Glucophage 500 mg twice a day to control his condition. After diabetic teaching in the hospital, he was able to perform his own blood sugar checks and was issued a glucometer for home use. Being overweight at 5?7?and 210 lbs., Mr. Trosack was also given dietary counseling to help him lose weight and to control his blood sugar. He was prescribed Percocet for any residual postoperative pain that might surface.

Upon discharge, Mr. Trosack will use a walker as the only means of assisted mobility. To determine the appropriate plan of care, you meet with the patient and then the family to gain more information. With the patient and family?s permission, you conduct a safety assessment of the patient?s apartment.

PATIENT INTERVIEW RESULTS:
Mr. Trosack is not happy about being what he calls ?disabled? and having to take the ?darn? medications. His apartment is on the second floor, and he is concerned that it will be difficult and painful to climb the stairs. While this frustrates him, he is determined to be able to help in the bakery. However, he admits that he cannot go down to the basement where the supplies are stored. Mr. Trosack insists that he can take care of himself and can take his own medications. He has lived alone for two years since his wife died.

FAMILY INTERVIEW RESULTS:
The family insists that according to earlier family discussions Mr. Trosack was supposed to return home with daily assistance from family members who would take turns running the store while seeing to his needs. When asked, the son and his wife admitted that they work a minimum of sixty-hour weeks and have had little time in the past to visit Mr Trosack. They hope to do better once he is home, but they know that right now there is a lot of pressure from work.

When questioned, the family did not appear to understand the need for taking medications at regular times. They do not believe that he really has diabetes since he has always been so healthy. They believe a change of diet will probably be all that is needed.

The family states that they do not know how Mr. Trosack obtains his groceries, but they are sure there is a store nearby that will deliver. Mr. Trosack usually eats his meals in the bakery so he does not keep much food in the apartment.

The family also believes that Mr. Trosack will follow directions and remain in the apartment rather than going downstairs to the bakery. The family refuses any outside nursing assistance since they know that Mr. Trosack will not want anyone ?fussing? over him. However, they will try to visit as often as possible.
The family states that Mr. Trosack?s apartment is small and cluttered with WWII memorabilia. They admit that it may be difficult to maneuver the walker around furniture and his ?valuables.? However, they state that, ?Maybe this will finally get him to get rid of all that junk.? The family states that Mr. Trosack is alert and well able to care for himself. He has been living alone without difficulty for two years since his wife died.

SAFETY ASSESSMENT:
??Apartment is small and cluttered with furniture and memorabilia.
??Bathroom is small and does not include any safety features.
??Kitchen is small but clean, and there is room to maneuver with the walker.
??Controls for the stove are in the front making it easy to reach.
??Access to the apartment is by two flights of stairs.
??There is no elevator.
??Trash must be taken down the two flights of stairs to the rear of the building.
??Groceries must be brought up the two flights of stairs.
??Bathroom medicine cabinet is filled with old prescriptions.
??Food in the refrigerator is expired.
??Multiple, small scatter rugs are present throughout the apartment, even on top of other carpets.

Essay Instructions: Scenario: 72 years old male,wife died 2 years ago,second generation Polish American. No prior health problems, no medication,just vitamins for energy,not sure which,using glasses for reading,lost 60% of hearing in the left ear. Managing family bakery with his widowed brother.
Did not have medical examination for ten years.Has son, who is married, both son and wife work 60 hours a week, trying to have a child, contact with son infrequent.

Admitted to the hospital after fell down the long flight of stairs in his apartment building ,taking out trash. Underwent Right hip replacement.

While in the hospital diagnosed with hypertension, prescribed Lopressor 25mg BID, also diagnosed with non-insulin-dependent diabetes prescribed Glucophage 500 mg BID. After diabetic teaching able to check his own blood sugar,issued glucometer for home use. Overweight 5'7 210lb given dietary teaching to help him to loose weight and control blood sugar. Prescribed Percocet for residual pain. Upon discharge will use walker.

Patient interview:Not happy being "disabled" and take "darn" medications. His apartments on the second floor,concerned how he will climb the stairs. While this frustrates him,determine to be able to help in the bakery. Admits he can not go to the basement to get supplies, insist he can take care of himself. he lived alone for two years since his withe died.

Family interview: family insist that according to earlier family discussion patient was supposed to return home with daily assistance from family members who will take turns. When asked son and his wife admitted that they work 60 hours a week and have little time to visit, but hope to do better. when questioned family did not appear to understand the need to take medications at regular times,do not believe patient really has diabetes, think he just need to change diet, because he was so healthy all his life. promise to found store which delivers groceries,patient usually eats in the bakery do not keep much food in the apartment. family believe patient will stay in the apartment and will not go downstairs to the bakery. Family refuse any outside nursing help, stated patient wont like it.


Safety assessment: apartment small and cluttered with furniture and memorabilia. Bathroom small without any safety features.Kitchen small,clean, there is a room to maneuver walker. Controls for the stove on the front and easy to reach. No elevator, apartment on the second floor,two flights of stairs, trash outside in the ground floor. Bathroom medicine cabinet filled with old prescriptions, food in the refrigerator expired. Multiple, small scattered rugs throughout apartment, even on the top of other carpets.

Write an essay (4 pages) to analyze case study information.

I. Assessment of the Situation
a. Identify 3 or 4 healthcare issues, as a case manager, should address when working with interdisciplinary team to determine the most appropriate discharge plan for given patient.
b. explain why these issues important when planning for management of the elderly discharge patient.
c. Identify 5 members to make up interdisciplinary team to determine the most appropriate discharge placement for given patient.
d,Describe the role expected from each identify team member.
II.. Analyze the issues from the safety assessment that could affect determination of discharge placement.
III. Discharge plan
a.Explain to the family what care patient needs and how he should be discharged based on the interview data and safety assessment. explanations should include:
1.discuss the ability of the family to adequately care for the patient if he is discharge home
2.discuss how social isolation affects older adult's recovery from surgery or illness.
3.discuss the ways psychological factors play a role in the recovery process.
IV. Recommend a discharge placement for the given patient with supportive documentation.

Include all in-text sitations and references in APA format.