Development of Primary Health Organizations in New Zealand

Development of Primary Health Organizations in New Zealand Body The delivery of healthcare services to the people in every nation had always been a problem for the government considering there are a lot of factors affecting its delivery. New Zealand is an example of a government which delivers healthcare to its citizens and permanent residents through public subsidies and private insurance. Even with the help of private insurance, there still exist a number of problems faced by the government. These problems revolve in the availability and accessibility of healthcare services. New Zealand has its concerns and these barriers to healthcare can be categorized into four: economic barriers, utilisation and socio-economic status, interplay of material, cultural and geographic factors, and the implications for the wider health system (Barnett R. and Barnett P. 2003). All of these factors have had an implication in the shaping of the national healthcare policy. The social and economic inequality within New Zealand has widen substantially, thus new initiatives have been made to address such problems. The government has learned its lessons from the previous health system and is now undergoing constant changes and improvements. The policy formulated is now more focused on cooperative over competitive models of service provision and giving emphasis on the delivery of primary care as the key in achieving its goal of health for all and as a sign of overall improvement in the health system (Barnett R. and Barnett P. 2003). Ref: Barnett, R., Barnett, P. (April 3, 2003). Primary Health Care in New Zealand: Problems and Policy Approaches. Retrieved from https://www.msd.govt.nz/about-msd-and-our-work/publications-resources/journals-and-magazines/social-policy-journal/spj21/21-primary-health-care-in-new-zealand-pages49-66.html Evidence of New Zealand’s attempts to develop better equitable policies was the implementation of New Zealand Health Strategy and Primary Health Care Strategy (Minister of Health, 2001). The former had anticipated new arrangements and have chosen district health boards (DHBs) to implement these new policies. Within the charter of DHBs is the Primary Health Care Strategy (more recent) that suggests new organisational structures. This newly proposed structure is known as primary health organisations (PHOs), to solve problems relating to accessibility and availability in the provision of healthcare services. Moreover, primary health organisations address the lack of co-ordination between health providers. Although the district health boards (DHBs) are well established and setting up of Primary health organisations is going well, there still lies uncertainty about achieving equity in the provision of health (Barnett R. and Barnett P. 2003). Economic Barriers to Primary Health Care in New Zealand Just like in many other developed countries, the economic restructuring in New Zealand and the abolishment welfare state had led to the increase incidence of poverty (Waldegrave et al. 1995, Jamieson 1998) and socio-economic disparities in health (Ministry of Health, 2000). In the beginning with the legislation of Social Security in 1938, medical services have been provided as free of service to the people through government subsidies. However, it is also true that the subsidies did not cover 100% of the total cost of patient care. At first the effect to the masses was minor during 1970s where there is â€Å"long boom† of prosperity in New Zealand. Then again, in 1980 the utilisation of the GP and other health services from the ethnic groups, including the positive class are diminishing due to the economic restructuring and growing cost of doctor fees (Gribben 1992, Barnett and Kearns 1996). Utilisation and Socio-Economic Status The utilisation of health services according to socio-economic status is mixed in New Zealand. A recent survey from the National Health Survey 1996/97 (Ministry of Health 1999) reports that people with low-income status are more likely to have a higher frequency of visits to General Practitioner than families from a more affluent areas or people with a higher income. However, the results from the survey shows that people living in a less well-off area have a late seeking behaviour and less visits to GPs because of cost. Key results from the survey are as follows: People had continued to express their dissatisfaction towards the cost of GP fees. The percentage of patients who considered the GPs fee expensive as â€Å"too high† or â€Å"far too high† rose from 32.3% to 68.3% from people paying $10 – $14 and $15 $19 and some rose to 90% from people paying $25 or more (Fergusson et al. 1989). Patients with financial difficulties in obtaining health services opt to have a number of strategies, both active and passive, such as; late seeking behaviour of care, delay in obtaining medication and seeking financial help from GPs (Barnett R. and Barnett P. 2003). Patients frequently change their doctors even when they don’t want to. The introduction of Community Service Card (CSC) in 1992 is relatively ineffective in accessing the health provision of care. There is a high level of unmet need among CSC population. The reason for a rising unmet needs among the population group was partly due to low usage by those entitled and the stigma attached to it (Barnett R. and Barnett P. 2003). Interplay of Material, Cultural and Geographic Factors Low utilisation of health services in relation to health needs cannot be attached to cost alone. According to Barnett et al. (2003) it is also because of the interplay of factors; material, cultural and geographic factors. It was proved in a survey that MÄ ori and low-income New Zealanders have a low rate of GP utilisation given that the centres where set up to provide service in a low-income population. The health centres were there to improve access to care to MÄ ori and low-income populace. The cost for the provision of service was reduced as compared to the average cost. It was clear in the survey that financial barrier was not the reason but rather cultural values and expectations as well as the benefits from the services rendered (Barnett R. and Barnett P. 2003). It is also important to consider the geographic factors in understanding the levels of GP utilisation. There is a strong relationship between distance and patterns of use in both hospital and GP services; it is also not surprising that there is a sub pattern to it. People with poorer population have a 30% less expenditure or budget in health as compared to the well-off population with 40% over funding as computed by the Health Funding Authority (Malcolm 1998b). It shows that the basing on the budget in each region, the number of GP available is also dependent on the budget, thus with low budget comes less number of available GP and health centres while areas with higher budget comes a larger number of GPs available (Barnett R. and Barnett P. 2003). Implications for the wider health system New Zealand research had been focused on the different patterns in GP and hospitalisation utilisation. However, there is also another reason that can be attributed to the low health status among low-income population in the access of health care services. There is a relationship between patient admission and average length of hospital stay. Reducing the average length of stay contributes in the increased rate of readmissions within the poor (Barnett R. and Barnett P. 2003). One factor that might have an effect in the rate of readmissions among the poor is that the access to primary care is prevented by circumstances such as distance, cost and availability of the service itself. It is said that the importance of primary care is great in reducing or limiting hospitalisation (Barnett R. and Barnett P. 2003). Primary Health Organisation Model To address the problems New Zealand has in the delivery of health care and to provide equity to all, new initiatives were created. The development of primary care organisations (PHOs) created new frameworks for health service delivery and an avenue for change. Not only it involves the general practitioner and the community but it includes a wide variety of health providers to achieve the goal of giving equity in the access of health care provision. PHOs are a broad based organisation comprised of many primary care providers. These providers include midwives, iwi groups, and non-government organisations aside from General Practitioners. The new system is locally based, funds were computed through the affected population and PHOs are given an important role in formulating new public health initiatives. Partnership with MÄ ori and with Pacific communities is expected and where if needed, Ethnic group representation in the governance is allowed (Barnett R. and Barnett P. 2003). Potential Benefits of PHOs Upon the development of Primary Health Organisations, there are three potentials benefits that can be gained. One would be the likelihood of improving the population health is higher as compared to before, the rate of hospital admission will decrease and an empowerment to both the health providers and the consumer. Although after the introduction of capitation, in itself, is not an assurance of an improved population health and access to health. However, there are evidence claiming that a country with strong primary health care and a fewer barriers to healthcare accessibility have a better health outcomes (Barnett R. and Barnett P. 2003). A better primary health care have another advantage of potentially reducing the rate of admissions in hospitals. It is an important factor in determining health outcomes in New Zealand, given the case that it has a high rate of hospital admissions. With higher rate of admissions means higher hospital expenditure for the government. Although, there is no clear relationship between access to primary care and hospital admissions, there exist evidence that shows a reduction in healthcare cost reduces Ambulatory care sensitive (ACS) admissions just like in the United States. Some studies in New Zealand back it up with data showing after the removal of patient charges for consultation; a significant decline in hospitalisation was seen (Barnett R. and Barnett P. 2003). Lastly, with the development of primary health organisations with a greater emphasis in community will have the potential in increasing social empowerment in the poorer and disadvantage populations. This is important because cultural and economic barriers influence health seeking behaviour of an individual. Moreover, with the goal of fostering a broader links between health organisations, the potential of having a more holistic and social model of health is made. It has the possibility of not only improving the access to care but also other social conditions that foster inequalities in health (Barnett R. and Barnett P. 2003). Conclusion The development of the Primary Health Care Strategy and the recent move toward the development of PHOs in New Zealand has the potential to improve equity of access to care, reduce unnecessary hospitalisation and improve overall population health. It represents a fundamental shift in national primary health care policy away from an individual to a population focus (although this has been emerging among primary care organisations for some time), and from fee-for-service to a funding approach stressing capitation with reduced co-payments, with inter-regional distribution of funds based on population need. The potential is for a fairer system of primary health care where services will be more freely available to those in need (Barnett R. and Barnett P. 2003). However, improved equity of access may be difficult to achieve, given the problems and risks in developing PHOs. In New Zealand these include fragmentation of providers, inadequate attention to the regional sensitivity of allocation formulas, concern over the extent to which funding should be based on individuals or areas, and the extent to which full participation of both providers and the public is secured. Given the significant additional investment by the government, PHOs will need to demonstrate not only fairer access to primary care reductions in health inequalities, but also improvements in population health overall (Barnett R. and Barnett P. 2003). . Gribben, B. (1992) Do access factors affect utilisation of general practitioners in South AucklandNew Zealand Medical Journal, 105:453-455. Barnett, J.R. and R.A. Kearns (1996) Shopping around?: Consumerism and the use of private accident and medical clinics in Auckland, New ZealandEnvironment and Planning A,28:1053-1075. Waldegrave, C., R.J. Stephens and P. Frater (1995)Most Recent Findings of the New Zealand Poverty Measurement Project, The Family Centre, Lower Hutt. Minister of Health (2001a)Minimum Requirements for Primary Health Organisations, Minister of Health, Wellington. Minister of Health (2001b)The New Zealand Health Strategy, Minister of Health, Wellington. Jamieson, K. (1998)Poverty and Hardship in Christchurch, Christchurch City Council, Christchurch.

Carrie Chapter Fifteen

Q. What is your address? A. I got a room over the pool hall. That's where I work. I mop the floors, vacuum the tables, work on the machines-pinball machines, you know. Q. Where were you on the night of May twenty-seventh at 10.30 P.M., Mr Quillan? A. Well . . . actually, I was in a detention cell at the police station. I get paid on Thursdays, see. And I always go out and get bombed. I go out to The Cavalier, drink some Schlitz, play a little poker out back. But I get mean when I drink. Feels Eke the Roller Derby's going on in my head. Bummer, hub? Once I conked a guy over the head with a chair and Q. Was it your habit to go to the police station when you felt these fits of temper coming on? A. Yeah. Big Otis, he's a friend of mine. Q. Are you referring to Sheriff Otis Doyle of this county? A. Yeah. He told me to pop in any time I started feeling mean. The night before the prom, a bunch of us guys were in the back room down at The Cavalier playing stud poker and I got to thinking Fast Marcel Dubay was cheating. I would have known better sober – a Frenchman's idea of pullin' a fast one is to look at his own cards – but that got me going. I'd had a couple of beers, you know, so I folded my hand and went on down to the station. Plessy was catching, and he locked me right up in Holding Cell number 1. Plessy's a good boy. I knew his mom, but that was many years ago. Q. Mr Quillan, do you suppose we could discuss the night of the twenty-seventh? 10:30 P.M.? A. Ain't we? Q. I devoutly hope so. Continue. A. Well, Plessy locked me up around quarter to two on Friday morning, and I popped right Off to sleep. Passed out, you might say. Woke up around four o'clock the next afternoon, took three Alka-Seltzers, and went back to sleep. I got a knack, that way. I can sleep until my hangover's all gone. Big Otis says I should find out how I do it and take out a patent. He says I could save the world a lot of pain. Q. I'm sure you could, Mr Quillan. Now when did you wake up again? A. Around ten o'clock on Friday night. I was pretty hungry, so I decided to go get some chow down at the diner. Q. They left you all alone in an open cell? A. Sure. I'm a fantastic guy when I'm sober. In fact, one time Q. Just tell the committee what happened when you left the cell. A. The fire whistle went of, that's what happened. Scared the beJesus out of me. I ain't heard that whistle at night since the Viet Nam war ended. So I ran upstairs and sonofabitch, there's no one in the office. I say to myself, hot damn, Plessy's gonna get it for this. There's always supposed to be somebody catching, in case there's a callin. So I went over to the window and looked out. Q. Could the school be seen from that window? A. Yeah. People were running around and yelling. And that's when I saw Carrie White. Q. Had you ever seen Carrie White before? A. Nope. Q. Then how did you know it was she? A. That's hard to explain. Q. Could you see her clearly? A. She was standing under a street light, by the fire hydrant on the corner of Main and Spring. Q. Did something happen? A. I guess to Christ. The whole top of the hydrant exploded of three different ways. Left, right, and straight up to heaven. Q. What time did this †¦ uh †¦ malfunction occur? A. Around twenty to eleven. Couldn't have been no later. Q. What happened then? A. She started downtown. Mister, she looked awful. She was wearing some kind of party dress, what was left of it, and she was all wet from that hydrant and covered with blood. She looked like she just crawled out of a car accident. But she was grinning. I never saw such a grin. It was like a death's head. And she kept looking at her hands and rubbing them on her dress, trying to get the blood off and thinking she'd never get it off and how she was going to pour blood on the whole town and make them pay. It was awful stuff Q. How would you have any idea what she was thinking? A. I don't know. I can't explain. Q. For the remainder of your testimony, I wish you would stick to what you saw, Mr Quillan. A. Okay. There was a hydrant on the corner of Grass Plaza, and that one went, too. I could see that one better. The big lug nuts on the sides were unscrewing themselves. I saw that happening. It blew, just like the other one. And she was happy. She was saying to herself, that'll give 'em a shower, that'll †¦ whoops, sorry. The fire trucks started to go by then, and I lost track of her. The new pumper pulled up to the school and they started on those hydrants and saw they wasn't going to get no water. Chief Burton was hollering at them, and that's when the school exploded. Je-sus. Q. Did you leave the police station? A. Yeah. I wanted to find Plessy and tell him about that crazy broad and the fire hydrants. I glanced over at Teddy's Amoco, and I seen something that made my blood run cold. All six gas pumps was off their hooks. Teddy Duchamp's been dead since 1968, God love him but his boy locked those pumps up every night just like Teddy himself used to do. Every one of them Yale padlocks was hanging busted by their hasps. The nozzles were laying on the tarmac, and the automatic feeds was set on every one. Gas was pouring out on to the sidewalk and into the street. Holy mother of God, when I seen that, my balls drew right up. Then I saw this gay running along with a lighted cigarette. Q. What did you do? A. Hollered at him. Something like Hey! Watch that cigarette! Hey, don't, that's gas! He never heard me. Fire wrens and the town whistle and cars rip-assing up and down the street, I don't wonder. I saw he was going to pitch it, so I started to duck back inside. Q. What happened next? A. Next? Why, next thing, the Devil came to Chamberlain †¦ When the buckets fell, she was at first only aware of a loud, metallic clang cutting through the music, and then she was deluged in warmth and wetness. She closed her eyes instinctively. There was a grunt from beside her, and in the part of her mind that had come so recently awake, she sensed brief pain. (tommy) The music came to a crashing, discordant halt, a few voices hanging on after it like broken strings, and in the sudden deadness of anticipation, filling the gap between event and realization, like doom, she beard someone say quite clearly: ‘My God, that's blood.' A moment later, as if to ram the truth of it home, to make it utterly and exactly clear, someone screamed. Carrie sat with her eyes closed and felt the black bulge of terror rising in her mind. Momma had been right, after all. They had taken her again gulled her again, made her the butt again. The horror of it should have been monotonous, but it was not; they had gotten her up here, up here in front of the whole school, and had repeated the shower-room scene †¦ only the voice had said (my god that's blood) something too awful to be contemplated. If she opened her eyes and it was true, oh, what then? What then? Someone began to laugh, a solitary, affrightened hyena sound, and she did open her eyes, opened them to see who it was and it was true, the final nightmare, she was red and dripping with it, they had drenched her in the very secretness of blood, in front of all of them and her thought (oh†¦i †¦ COVERED- with it) was coloured a ghastly purple with her revulsion and her shame. She could smell herself and it was the stink of blood. the awful wet, coppery smell. In a flickering kaleidoscope of images she saw the blood running thickly down her naked thighs, hear the constant beating of the shower on the tiles, felt the soft patter of tampons and napkins against her skin as voices exhorted her to plug it UP, tasted the plump, fulsome bitterness of horror. They had finally given her the shower they wanted. A second voice joined the first, and was followed by a third – girl's soprano giggle – a fourth, a fifth, six, a dozen, all of them, all laughing. Vic Mooney was laughing. She could see him. His face was utterly frozen, shocked, but that laughter issued forth just the same. She sat quite still, letting the noise wash over her like surf They were still all beautiful and there was still enchantment and wonder, but she had crossed a line and now the fairy tale was green with corruption and evil. In this one she would bite a poison apple, be attacked by trolls, be eaten by tigers. They were laughing at her again. And suddenly it broke. The horrible realization of how badly she had been cheated came over her, and a horrible, soundless cry (they're LOOKING at me) tried to come out of her. She put her hands over her face to hide it and staggered out of the chair. Her only thought was to run, to get out of the light, to let the darkness have her and hide her. But it was like trying to run through molasses. Her traitor mind had slowed time to a crawl; it was as if God had switched the whole scene from 78 rpm to 33 1/3. Even the laughter seemed to have deepened and slowed to a sinister bass rumble. Her feet tangled in each other, and she almost fell of the edge of the stage. She recovered herself, bent down, and hopped down to the floor. The grinding laughter swelled louder. It was like rocks rubbing together. She wanted not to see, but she did see; the lights were too bright and she could see all their faces. Their mouths, ,their teeth, their eyes. She could see her own gorestreaked hands in front of her face. Miss Desjardin was running toward her, and Miss Desjardin's face was filled with lying compassion. Carrie could we beneath the surface to where the real Miss Geer was giggling and chuckling with rancid old-maid ribaldry. Miss Desjardin's mouth opened and her voice issued forth, horrible and slow and deep: ‘Let me help you, dear. Oh I am so sor-‘ She struck out at her (flex) and Miss Desjardin went flying to rattle off the wall at the side of the stage and fall into a heap. Carrie ran. She ran through the middle of them. Her hands were to her face but she could see through the prison of her fingers, could see them, how they were, beautiful, wrapped in light, swathed in the bright, angelic robes of Acceptance. The shined shoes, the clear faces, the careful beauty-parlour hairdos, the glittery gowns. They stepped back from her as if she was plague, but they kept laughing, then, a foot was stuck slyly out (o yes that comes next o yes) and she fell over on her hands and knew and began to crawl, to crawl along the floor with her blood-clotted hair hanging in her face, crawling like St Paul on the Damascus Road, whose eyes had been blinded by the light. Next someone would kick her ass. But no one did and then she was scrabbling to her feet again. Things began to speed up. She was out through the door, out into the lobby, then flying down the stairs that she and Tommy had swept up so grandly two hours ago. (tommy's dead full price paid full price for bringing a plague into the place of light) She went down them in great, awkward leaps, with the sound of the laughter flapping around her like black birds. Then, darkness. She fled across the school's wide front lawn, losing both of her prom slippers and fleeing barefoot The closely cut school lawn was like velvet, lightly dusted with dewfall, and the laughter was behind her. She began to calm slightly. Then her feet did tangle and she fell at full length out by the flagpole. She lay quiescent, breathing raggedly, her hot face buried in the cool grass. The tears of shame began to flow, as hot and as heavy as that first flow of menstrual blood had been. They had beaten her, bested her, once and for all time. It was over. She would pick herself up very soon now, and sneak home by the back streets, keeping to the shadows in case someone came looking for her, find Momma, admit she had been wrong (! NO !) The steel in her- and there was a great deal of it suddenly rose up and cried the word out strongly. The closet? The endless, wandering prayers? The tracts and the cross and only the mechanical bird in the Black Forest cuckoo clock to mark off the rest of the hours and days and years and decades of her life? Suddenly, as if a videotape machine had been turned on in her mind, she saw Miss Desjardin running toward her, and saw her thrown out of her way like a rag doll as she used her mind on her, without even consciously thinking of it. She rolled over on her back, eyes staring wildly at the stars from her painted face. She was forgetting (! THE POWER !) It was time to teach them a lesson. Time to show them a thing or two. She giggled hysterically. It was one of Momma's pet phrases. (momma coming home putting her purse down eyeglasses flashing well i guess i showed that elt a thing or two at the shop today) There was the sprinkler system. She could turn it on, turn it on easily. She giggled again and got up, began to walk barefoot back toward the lobby doors. Turn on the sprinkler system and close all the doors. Look in and let them see her looking in, watching and laughing while the shower ruined their dresses and their hairdos and took the shine off their shoes. Her only regret was that it couldn't be blood. The lobby was empty. She paused halfway up the stairs and FLEX, the doors all slammed shut under the concentrated force she directed at them the pneumatic door-closers snapping of. She heard some of them scream and it was music, sweet soul music. For a moment nothing changed and then she could feel them pushing against the doors, wanting them to open. The pressure was negligible. They were trapped (trapped) and the word echoed intoxicatingly in her mind. They were under her thumb, in her power. Power! What a word that was! She went the rest of the way up and looked in and George Dawson was smashed up against the glass, struggling, pushing, his face distorted with effort. There were others behind him, and they all looked like fish in an aquarium. She glanced up and yes, there were the sprinkler pipes, with their tiny nozzles like metal daisies. The pipes went through small holes in the green cinderblock wall. There were a great many inside, she remembered. Fire laws, or something. Fire laws. In a flash her mind recalled (black thick cords like snakes) the power cords strung all over the stage. They were out of the audience's sight, hidden by the footlights, but she had had to step carefully over them to get to the throne. Tommy had been holding her arm. (fire and water) She reached up with her mind, felt the pipes, traced them Cold; full of water. She tasted iron in her mouth, cold wet metal, the taste of water drank from the nozzle of a garden hose. Flex For a moment nothing happened. Then they began to back away from the doors, looking around. She walked to the small oblong of glass in the middle door and looked inside. It was raining in the gym. Carrie began to smile. She hadn't gotten all of them, only some. But she found that by looking up at the sprinkler system with her eyes, she could trace its course more easily with her mind. She began to turn on more of the nozzles, and more. Yet it wasn't enough. They weren't crying yet, so it wasn't enough (hurt them then hurt them) There was a boy up on the stage by Tommy, gesturing wildly and shouting something. As she watched, he climbed down and ran toward the rock band's equipment. He caught hold one of the microphone stands and was transfixed. Carrie watched, amazed, as his body went through a nearly motionless dance of electricity. His feet shuffled in the water, his hair stood up in spikes, and his mouth jerked open, like the mouth of a fish. He looked funny. She began to laugh. (by christ then let them all look funny) And in a sudden, blind thrust, she yanked at all the power she could feel.

Ethical and Legal Issues

Ethical and Legal Issues in Nursing Over the last several decades, professional nursing has evolved and changed because of the influence of ethical and legal issues. There may be a variety of reasons for the changes. Examples in changes are advances in medical technology, legal changes about abortion and euthanasia, a push toward patient rights and litigation, and ever decreasing resources in which to provide nursing care. With all these influences affecting care, it has become increasingly difficult to have a true understanding of the direction nursing should take when faced with moral, ethical, and legal issues. Examination of personal moral and ethics along with utilization of available resources will no doubt aid nurses in sorting out feelings, strategizing for the patient and families, and providing guidance to give the best care possible. One resource available is the American Nurses Association, they have developed a code of ethics that should act as a guide in directing care and solving the ethical and legal dilemmas that surface. When applying the code of ethics resource; nurses can assist their patients families in making informed decisions as well as understand their own and their colleague’s responsibilities. By examining two case scenarios, the first involving end of life decisions, the second involving nursing conduct, the application of the code of ethics, the legal aspects, and the nurses responsibilities would be better understood. It is prudent to begin by examining the legal responsibilities of the nurse in the work setting. A Registered Nurse carries a legal responsibility in the work setting. A nurse has a commitment to the safety of the patient and must be aware of inappropriate practice. All nurses have ethical duties to the patients they serve. According to the American Nurses Association; a nurse â€Å"promotes, advocates for, and strives to protect the health, safety, and rights of the patient† (ANA, 2001, p. 18). If an action is taken that poses harmful effect on a patient’s health this needs to be immediately reported to a higher authority within the workplace or if necessary to a suitable outside authority. A nurse must be accountable for his or her individual nursing practice. The nurse’s duty is to identify anyone with questionable practice. All workplaces have guidelines set in place for these types of events. A nurse should concern herself about repercussions when reporting unethical practice. A nurse should be familiar and compliant with his or her state’s nurse practice act and his or her workplace policies applicable practice standards of care for each clinical area. In the malpractice exercise the nurse was observed on several occasions violating standards of care. The occurrences were reported immediately through the chain of command which in this case was administration. After anecdotal notes were kept by the nurse, she should prepare written documentation, including the time and location of the incident and names of any witnesses. Time should be taken to think about the incident and write down all important points that come to mind, who and, when, she notified in administration and what was told to them. This way everything would be in order and accessible if you need to recall when answering questions. Be honest and truthful if there is something you cannot remember you, state that you do not recall. There should be no disregard during this process, it is the ethical and legal duty of a nurse, as the patient advocate, to stand up, and protect the patient. Every nurse is equally responsible for his or her own actions. Responsibility also carries over to patients not under her direct care, the obligation for all patients. The incident was reported in the correct manner and she kept personal anecdotal records and upheld her ethical duties. Personal and societal views play a major role in the way a nurse views a current ethical situation. As nurses and as human beings, we each will have our own way of evaluating and assessing different circumstances that we are part of daily. No matter what kind of nursing or nursing experience that you may have, you cannot run from these trying predicaments. â€Å"Our ethical framework assists us when we experience serious ethical dilemmas† (Cameron & Salas, 2010, p. 655). In the case regarding Marianne, there are countless ways in which personal and societal values could have played a part. They could affect how the family would be viewed by society if they did not try everything to save their loved one, or how would it look if they went through with the surgery and it looked as if Marianne was experiencing torture. Ethical dilemmas are never straightforward and never with a right or wrong answer. It is our job as nurses to put aside our feelings and beliefs and to educate the family on all of the potential outcomes that may be expected. We must remember as health care providers, to be non-judgmental. When reviewing the case of Marianne, the significant legal aspect to consider is the lack of a Healthcare Power of Attorney and Living Will. Not possessing Marianne’s documented wishes creates a legal ethical dilemma and creates family conflict. The responsibility of deciding the future of Marianne’s care will fall on the family with guidance from the hospital’s Ethics Committee. The ANA Code of Ethics provides nurses with guidance in legal and ethical responsibilities. The code describes the obligation of treating patients and families with autonomy. Lachman describes the role of autonomy in nursing care: â€Å"patients have a moral and legal right to determine what will be done with their own person; to be given accurate, complete, and understandable information in a manner that facilitates an informed judgment; to be assisted with weighing the benefits, burdens, and available options in their treatment, including the choice of no treatment; to accept, refuse, or terminate treatment without deceit, undue influence, duress, coercion, or penalty; and to be given necessary support throughout the decision-making and treatment process â€Å"(Lachman, 2009, p. 55). Providing autonomous nursing care to Marianne and her family will ensure all the options are presented. The family members place trust in the nurse to provide good care and be supportive, regardless of the decision they make for Marianne’s future. The trust placed on nurses includes responsibility to the patient and the institution ensuring policies are adhered to thus avoiding the possibilities of negligence. With trust, nurses have an obligation to society. Legally we are â€Å"responsible to preserve integrity and safety, to maintain competence and to continue personal and professional growth† (ANA, 2001, p. 8). No matter the situation of the patient in regard to age, race, religion, economic status, etc. We are to treat each patient and family member with the same amount of respect. Both case studies The Nurse as the Witness and The Six Caps are unique in different ways. Nurses often have the tendency to develop close relationships with patients. Reminders may be ne eded often that the purpose of nursing is not friendship but to alleviate suffering, protect the patient, promote wellness, and to help restore the health. In Marianne’s case the legal responsibility of the nurse is to communicate all possibilities of Marianne’s care. The nurse in this situation has an obligation to provide all the information possible to help the family come to a decision in regard to Marianne’s life. Nurses are to be truthful and never withhold any information. No matter what a family or patient decides, the nurse is to advocate for that decision. Family decisions are not the function of nurse, no matter what the nature. There may be instances when a nurse will be a witness or perhaps a defendant. Medical professionals see many and unique situations some will have to be reported and investigated. Documentation is a huge legal aspect of nursing. It will be always important to document exactly what you do and see. Opinions and assumptions are not good practice for documentation purposes as this would not hold up in court and may sway decisions. The malpractice case regarding the nurse as the witness is a fine example of the need to be proficient in documentation. Months and years later, what is in writing is what will count. As nurses we know, if it was not documented, it did not happen! For this particular case study, the nurse was obligated to report exactly what she wrote about the nurse in question. That nurse has an obligation to report any suspicions of abuse and neglect to administration even repeatedly if necessary. In any situation, the nurse has an obligation to act in the best interest of the patient. It may have consequences but, the overall nurse’s responsibility is to keep the patient safe. Summing up, it is clear that nursing practice can be influenced by personal ethics and morals. The American Nurses Association’s code of ethics provides a guide for practice. When applied to a practical case, such as Marianne and her family, the code of ethics allows the nurse caring for here to remain professional and objective without letting her own feelings influence the family. The nurse has a responsibility to Marianne, her family and the employing institution. Overall, these guidelines extend throughout practice and are set in place to protect society. It becomes a mutual trust and is why nursing is held to such a high standard. References American Nurses Association (ANA). (2001). Code of ethics for nurses with interpretive statements. Washington, DC: ANA. Blais, K. K. , Hayes, J. S. , Kozier, B. , & Erb, G. (2006). Professional nursing practice. Upper Saddle River, New Jersey: Pearson, Prentice Hall. Cameron, B. L. , & Salas, A. S. (2010). Ethical openings in practical home care practice. Nursing Ethics, 17(5), 655-665. Retrieved from http://web. ebscohost. com. ezproxy. apollolibrary. com Practical use of the nursing code of ethics: part I. Medsurg nursing: official journal of the academy of medical-surgical nurses, 18(1), 55-57. Retrieved  from  http://EBSCOhost

The Effects Of Binge Drinking On Teens - 1519 Words

For my research project I decided to look at binge drinking in teens. Binge drinking interested me because so many teenagers drink alcohol when they go out and don’t know what consequences it has on the body. Binge drinking is the consumption of an unreasonable amount of alcohol in a short period of time. I have chosen to research ‘What are the psychological and physiological effects of binge drinking in teens?’. I chose this question because I wanted to inform myself and other teens on the effects of binge drinking. The research methods used throughout my research were internet articles and a survey. After researching ‘what is binge drinking’ I found that it is the consumption of a large amount of alcohol on a single occasion or drinking at a constant rate over a number of days or even weeks. Binge drinking is risky business. The powerful liquid known as alcohol has major effects on a person. Alcohol has the ability to wreck a person’s life and change it permanently. Alcohol impairs judgement making it easy for someone to do or say something that he or she will regret. For a male to binge drink he has to drink 5 or more standard drinks in a 2 hour period. For a female it is only 4 or more standard drinks in a 2 hour period. This could vary of the weight and age of the person. When conducting my survey I asked the participants how many drinks they believe classified as binge drinking. Figure 1 showing some of the results for survey about home many drinks they believedShow MoreRelated18 vs. 21: Drinking Age1389 Words   |  6 Pageswant to change the drinking age from 21 to 18, when there are other activities that have limit of age such as marriage at 18, driving at 16 and 35 to be a president? Alcohol plays a major role in today society, which becomes a controversial issue among teens. Alcohol is a mind-altering chemical that is potentially more dangerous than any other drug and can be very destructive. For past few years, many people are trying to lower the drinking age without knowing the negative effects of alcohol and howRead MoreResearch Paper Drinking Age1565 Words   |  7 PagesThe legal drinking age refers to the youngest age at which a person is legally allowed to buy and consumes alcoholic beverages. The drinking age varies from country to country. Here in the United States the legal drinking age is twenty-one. There has been much debate on wh ether the drinking age in the United States should be lowered from twenty-one to eighteen. People in favor of keeping the drinking age at twenty-one believe that there will be less alcohol related injuries and deaths fromRead MoreTeens and Alcohol Essay1416 Words   |  6 PagesTeens and Alcohol Everyday teenagers are faced with many decisions. One of the most important of these is whether or not to join in with the trend of teenage drinking. The decision teenagers make can be crucial to their future well being and success in life. Teenage drinking has many causes, namely peer pressure, the attitudes of society, parental influence, and addiction. Changes need to be made in each of these areas for teenagers to be protected from alcohol related problems. Peer pressureRead MoreThe Dangers Of Adolescent Binge Drinking1279 Words   |  6 Pages This has been one of the principles calculated in high school binge drinking. There is frequently a necessity to contend with one another. When living in a fraternity or sorority house, on campus, there is consistent partying. In an exertion to contend with the more seasoned person, the youthful youngster needs to substantiate themselves deserving of being with the more seasoned swarm by strategic alcoholism, contending in drinking amusement. Some different variables have been ecological and theRead More Teenage Drinking and Its Effects on the Development of Alcoholism Later1613 Words   |  7 PagesTeenage Drinking and Its Effects on the Development of Alcoholism Later Teenage drinking is something that goes on every day. No matter how many videos you show to kids about drinking they will still drink. Surveys show that the average teen seventeen and up spends $475.00 a year on liquor, mostly beer; thats more than books, soda, coffee, juice and milk combined. Most parents dont know about teenage drinking unless they catch their kids doing it. Parents usually say oh, my my kid would neverRead MoreTo Lower or Not to Lower the Legal Drinking Age to 18, That Is the Question881 Words   |  4 Pagessuggests that binge drinking is on the rise among college students (Eisenberg n.p.). With an increase of alcohol consumption by underage drinkers, it only seems logical to lower the drinking age to prevent binge drinking, however there are far more consequences to be seen. Lowering the drinking age to 18 will not solve the binge drinking problem among college students but will cause more problems. In this paper I will explain the reason why lowering the drin king age will not stop binge drinking and theRead MoreEffects Of Binge Drinking On College Campuses846 Words   |  4 Pagesâ€Å"According to the CDC, about 90% of all teen alcohol consumption occurs in the form of Binge Drinking, which experts say peaks at the age of nineteen.† (qtd by Listfield). Binge Drinking is the consumption of excessive amounts of alcohol in a short period of time. The author, Emily Listfield, defines that the standard alcohol consumption over a two hour period is considered to be four beers for women and five beers for men. This has become a great distraction for college students nationwide and aRead MoreEssay about Unbderage Drinking934 Words   |  4 Pages Is Underage Drinking a Big Issue in the United States? Teenagers rarely think before they do many things. Many times teenagers go to big blowouts or little get together with their friends. Their first thought is not about death, their grades, or alcoholism; their main purpose is to get drunk fast and sober up before going home by their set curfews. Each year most teen deaths have been caused from underage drinking in the United States, which is a big topic that the government is trying to preventRead MoreEssay about Keeping the Drinking Age at 211662 Words   |  7 PagesWhen it comes to the subject of drinking and teenagers, what is the first thing that comes to mind? To me its the legal age limit of when teens should be able to drink. Having it lowered is controversial because according to prior experiences, data shows that younger age drinking is well known for its fatalities. According to Mothers Against Drunk Driving (MADD), on one of the most popular prom nights in 1999, as many as 62 percent of the traffic deaths were alcohol -related (). The most importantRead MoreThe Drinking Age Of The United States Should Be Lowered929 Words   |  4 PagesAn argument that many tend to dispute today, whether the drinking age of the United States should be lowered from 21 to 18. The drinking age for people to drink alcoholic beverages was made into law by the National Minimum Drinking Age Act. This ant enforced all states to raise their legal drinking age to 21. To get this law pass, the congress tried to strongarm the states, if the states did not comply, the government would take away their highway funds. Both arguments for it to be lowered and to