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Discussion Question:
Describe two historical events that have influenced the development of ethical codes and regulations for nursing and healthcare research. Explain how each event has impacted ethical codes and regulations.
Your initial posting should be at least 400 words in length and utilize at least one scholarly source other than the textbook. Please reply to at least two classmates. Replies to classmates should be at least 200 words in length.

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Betsy Heasley posted Dec 12, 2019 10:05 AM

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We all no that research ethics govern the standards of conduct for scientific researchers. Our job is to follow and adhere to this conduct for the patients, also when doing the research, we need to maintain safety, moral rights and safety for all who is involved with the research. People who are doing the research and conducting any such research should take all possible steps to limit access to confidential information, minimize risks of disclosure, and (when possible) obtain informed consent for research use of clinical data. The most effective strategy for preventing disclosure of confidential information is to remove all identifying information from medical records data before any research use.
Impact on ethical code and regulations. The historical events that were initiated under the guise of health research gave rise to ethical guidelines for conducting genuine clinical research. One important part is making sure the benefits out way the risk, and that we are doing what’s right for the clinical research. We also need to keep in mind people in the trial have the right to remove them self at any time with no questions asked so we need to keep that in mind and remember to have enough people to cover those numbers if people choose to remove themselves. We also need to remember everyone has the right to treatment as well if it is need we will give that treatment to them no matter what race, sexual gender, religious beliefs they have, we do not discriminate against anyone for any reason and we need to always remember this during any type of trail and research we are conducting. As a result, the researchers took the matters into their own hands where they created awareness on the existence of a problem. They also set the pace for the formulation of the ethical codes and policies that followed (Metcalf, 2014). The event had an impact on contemporary moral codes of conduct by pointing out the pressing concerns in medical research. It also provided suggestions on the most ethical ways to overcome them based on what worked for the researchers and what did not. We need to always just remember we are working withy people who all have rights and we need to never forget that. With all the changes over the many years with healthcare and ethics we need to always do what is best for them no matter wat.

Reference
Metcalf, J. (2014). Ethics codes: History, context, and challenges. Retrieved from https://bdes.datasociety.net/council-output/ethics-codes-history-context-and-challenges/.

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Brenda Fontaine Joseph posted Dec 11, 2019 7:15 AM
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There was a time in modern human history when there were no ethical rules governing research which involved human subjects. In the course of history and various parts of human civilizations, many were subject to atrocious acts in the name of clinical research. This is what the first-century Roman historian Celsius said, "It is not cruel to inflict on a few criminals sufferings which may benefit multitudes of innocent people through all centuries." (Ogundiran, n/d). The two historical events favored for this discussion are the Nuremberg Code and the Tuskegee Syphilis Study.
The Nuremberg Code. On December 9, 1946, a military tribunal set up by the United States convened to conduct criminal proceedings against 23 leading German physicians and political authorities for knowingly participated in war crimes and crimes against humanity. Crimes against humanity include murder, extermination (of the Jewish race), enslavement, and deportation before or during the war – World War II. War crimes included ill-treatment of prisoners of war or on high seas, killing of hostages, and plunder of public or private property. War crimes were committed against both fighting men and civilians.
Tuskegee Syphilis Study. Tuskegee experimentation is one of America's most heinous, so-called research, crimes against humanity. From 1932-1972 the U.S. Public Health Service performed testing on six hundred poor African-American males from Tuskegee, Alabama. Four hundred were infected with syphilis and as monitoring tactics, received free medical examinations for forty years, yet they were denied any form of treatment. Many subjects died of the disease during the experiment, though a cure for syphilis was available in the 1950s. The project was discontinued in 1972 only when it became a public political issue and an embarrassment to the health system.
Impact on ethical code and regulations. The historical events that were initiated under the guise of health research gave rise to ethical guidelines for conducting genuine clinical research. Included in the Nuremberg Code was voluntary or Informed consent of participants must be obtained before participation in trials. A Favorable risk-benefit analysis should be conducted, and the benefits must outweigh the risks. Participants must be told of their right to withdraw, at will, without penalty. The Tuskegee Syphilis Study had a similar impact on ethical codes and regulations as the Nuremberg Code. Additionally, Participants were denied treatment. In today's healthcare system, no healthcare professional can deny a patient any part of the care that will result in quality patient outcomes. Patients should be treated equally irrespectively of race, gender, or social class. Also, alternatives were not discussed with the Tuskegee participants, which inspired the concept of patient preference.

Reference
Ogundiran, T., O. (n/d). Introduction & History of Research Ethics. Retrieved from http://nhrec.net/nhrec/HRE_%20training_slides/Introduction%20and%20History%20of%20Research%20Ethics.pdf

Discussion Question:
Identify potential hazards of hospitalization for all older adult patients (including immobility, delirium, medication side effects, malnutrition, pressure ulcers, procedures, peri- and postoperative periods, and hospital-acquired infections) and identify potential prevention strategies.
Your initial posting should be at least 400 words in length and utilize at least one scholarly source other than the textbook. Please reply to at least two classmates. Replies to classmates should be at least 200 words in length.

3

Kimberly Shoemaker posted Dec 12, 2019 7:00 AM
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Wow, I can not believe this is the next to last Discussion Board for this class. It truly feels like this class has flown by. When older adults are admitted to the hospital, they have more than their current health issue to worry about. Older adult patients typically have multiple co-morbidities that can complicate their admission and the care that they receive. Older adult patients who were previously completely independent could now be completely reliant on the help of home health nurses and family members. Older adult patients are often malnourished in the fact that they are not getting enough protein and calories in their diets’ that can cause delayed wound healing and increased skin breakdown since they are also not as active and mobile while they are admitted to the hospital as they would be at home. Older adult patients are also in a new place once admitted to the hospital and their normal daily routines and sleeping habits may also be disturbed which can cause hospital induced delirium as well. The interruption in routine combined with certain infections like a urinary tract infection and also a possible underlying un-diagnosed problem with dementia could increase the chances for hospital induced delirium. Older adult patients may also have their normal schedule for taking medications interrupted while admitted to an acute care facility, or some medications may be stopped all together due to the medication itself actually causing more harm to the patient. Sometimes when these medications are stopped it can also have an adverse effect to the body as well and compile even more problems on top of the ones the patient is already experiencing. When patients are admitted to the hospital, they are also susceptible to hospital acquired infections such as central line associated blood stream infections and catheter associated urinary tract infections. These are exponentially increased due to potential dehydration, urinary retention and the need for the long term antibiotics. Hospital acquired infections can increase the patient’s length of stay for the admission longer than it would typically be. This is also more expensive for the patient and the hospital in the long run as well. Preventative measures to make sure that these issues do not arise, or are identified early enough to prevent long term detrimental effects. Proper nutrition and medication education would be helpful to make sure the patient is getting all the nutrients needed to maintain healthy skin and bones and a healthy lifestyle as well. Proper education for the patient’s medication is imperative to make sure the patient is compliant with their treatment plan and also to make sure they are not taking too much of a medication that could lead to falls or other health issues. Prevention and education is not just for older adult patients, it is also necessary to make sure that all patients and members of the community maintain healthy lifestyles and decrease potential hospital admissions.

References:
Bickley, L. S., Szilagyi, P. G., & Hoffman, R. M. (2017). Bates guide to physical examination and history taking (12th ed.). Philadelphia, PA: Wolters Kluwer.

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Angela Parker posted Dec 12, 2019 12:08 PM
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The hospitalized elderly patient is faced with many challenges. These include a difference in environment, illness, and being cared for my someone besides family or even loss of self-care if the patient lived alone prior to admission. A combination of these factors may place the patient at risk for falling. According to research, inpatient falls are the most common adverse event within the hospital setting accounting for 70% of hospital accidents (Olveczky, 2009). Research supports that while in the hospital, different hazards that might increase risk for falling include altered mental status, poly pharmacy, commodities, incontinence, and weakness. What can the healthcare team do to help the patient avoid falls? The nursing process begins with an assessment. The elderly patient should have a multifocal assessment that addresses physical and mental deficits (Olveczky, 2009). When completed, the assessment should have specific interventions that address the deficits. When working on a Progressive Care Unit during nursing school, I experienced interventions that included placing fall risk signs outside the door. The patient should have a sign placed that indicates their risk for falling. One star is minimal risk and each additional star indicates an increased risk. Four stars is the highest risk. In addition to the signs, patients should also have a yellow fall band on their wrist, yellow slip resistant socks, and fall risk patients should be identified during shift start huddle. Nurses and patient care technicians should set up a plan for assisting the patient to the restroom. Assistive devices should be in place and the patient should be educated on fall risks, how to call for help when needing the ambulate, and if needed, a bed alarm should also be on. This additional prevention will sound as the patient starts to get out of bed and since all staff members have educated on the patients with high fall risks, will increase the likelihood of a staff member being able to assist patient with their needs. In addition to these interventions, family members should also be educated on risks. This will helpful regarding the importance of calling for help should the patient ask family to help instead of staff members. Currently, I work with post surgical patients and these interventions are in place. I also educate the patient on the side effects of medications and when reassessing pain, I assess if any new signs and symptoms are present from the potential side effects. It is important to allow patients to maintain their sense of independence, however, considering the ramifications of a fall, it is also important to work with the patient on maintaining safety.
References
Olveczky, D. (2009). How do I keep my elderly patients from falling? Retrieved from https://www.the-hospitalist.org/hospitalist/article/123872/how-do-i-keep-my-elderly-patients-falling
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Discussion Question:
Have you ever worked with someone who caused problems with you or others? (Explain how the problem manifested itself and how it was managed).
What are the common signs of bullying in nursing?
What are common stressors in the nursing workplace? What are some strategies to manage personal and professional stress?
Your initial posting should be at least 400 words in length and utilize at least one scholarly source other than the textbook. Please reply to at least two classmates. Replies to classmates should be at least 200 words in length.

5

Milan Davis posted Dec 12, 2019 10:10 AM
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Working with different types of people can be a cause for conflict to come about. In my experiences, I have had my fair share of issues with coworkers and I believe it has come about due to jealousy and/or the fact that I was often one of the younger staff members. Unfortunately, I have been so uncomfortable that I have resigned from jobs or requested to be assigned to a different unit or shift. Many times, I have had issues with a coworker who simply has a bad attitude, or poor people skills, and tends to rub many people the wrong way. Luckily, I have not had true issues as a nurse but I have had problems in the past. My very first job, I was 17 years old and worked as a host in a restaurant. I encountered petty interactions and was talked about by my peers because the car I drove (a Benz my dad owned), the fact that the guys liked me, and even more ridiculous things. I ended up isolating myself and made it a point to only speak to others regarding work instead of being as friendly as I was before. Being so young, it did not occur to me to bring my concerns up to my manager which would have been ideal.

In nursing, I have encountered more experienced nurses leave novice nurses to fend for themselves, give them terrible patient assignments, and talk about them to managers or other nurses instead of offering help and providing them with constructive criticism. It is argued that due to their work overload and the double supervision they are subjected to by doctors and chief nurses (Ariza-Montes, Muniz, Montero-Simó, & Araque-Padilla, 2013). Nurses are often stressed for an absurd amount of reasons but still struggle with dealing with supervisors, coworkers, doctors, and more. Common signs of bullying include gossiping, giving the silent treatment, being verbally aggressive, and more. Common stressors in the workplace include short staffing, inappropriate patient assignments, stressful families, improper unit management, etc. Ways to deal with the above mentioned stressors would be to facilitate a unit that allows open communication, practicing good self care to preserve your mental health, and understanding what you can and cannot tolerate at work. Overall, it is important to understand yourself and to exude that presence whenever at work. I have come to find that the way I act is the way people will act around me and will be the determining factor to how any given shift goes.

Ariza-Montes, A., Muniz, N. M., Montero-Simó, M. J., & Araque-Padilla, R. A. (2013). Workplace bullying among healthcare workers. International journal of environmental research and public health, 10(8), 3121–3139. doi:10.3390/ijerph10083121

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Agustin Urra posted Dec 10, 2019 8:34 PM
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Throughout my nursing career I have encounter several coworkers that for one reason or another have represented a challenge to work with. My most recent experience was with a fellow nurse victim of domestic violence, and despite all the support and guidance we offered, including involving the police, she seemed unable to break the abuse cycle. After some time, personal issues started to affect her work. She became distracted, forgetful, and careless, raising concerns about patient safety. She was counselled several times by peers, and management, until she resigned after not showing up for a call.
Bullying is defined as “repeated, offensive, abusive, intimidating, or insulting behaviors; abuse of power; or unfair sanctions that make recipients feel humiliated, vulnerable, or threatened, thus creating stress and undermining their self-confidence.” Depending on the situation, bullying may be termed horizontal hostility, lateral violence, hazing, relational aggression, or workplace incivility. When the bully is on the same authority level as the victim (as when a nurse bullies another nurse or a manager bullies another manager), the behavior may be termed horizontal hostility or lateral violence. Of course, bullying also may take the form of aggressive behavior by superiors toward subordinates.
Common bullying behaviors used by nurses include innuendo, verbal affront, undermining, withholding information, sabotage, infighting, scapegoating, backstabbing, failing to respect privacy, and breaking confidences. Such behaviors as gossiping, exclusion, eye-rolling, silence, and humiliation also may qualify as bullying.
According to the American Holistic Nurses’ Association (2015) , nurses are experiencing workplace stress at higher rates than most other professions. These stressors include physical demands, management issues, lack of resources, and difficulty balancing home and work responsibilities. Day to day nursing is full of potential physical stressors, including frequent lifting and bending, changeable shifts or rosters, noisy work environments, and long hours. Nurses working nightshift may also suffer from disruption to their natural circadian rhythms, which in turn, can predispose them to illness. As well, many nurses face exposure to infection and toxic substances on a regular basis. The sheer anxiety of contracting a disease, especially in the face of rising resistance, can also play on a nurse’s mind. Finally, with the current median age of a nurse being 45, many are simply not as physically resilient as they were in their younger years.
Some of the strategies recommended by the American Psychological Association to manage stress include track your stressors, keeping a journal for some time to identify which situations create the most stress and how you respond to them, learn healthy responses, take time to decompress and recharge, learn how to relax, seek help, and get some support.

Reference
American Holistic Nurses Association (2015). Holistic Stress Management for
Nurses. May 27, 2015. Retrieved from
https://www.ahna.org/Resources/Stress-Management
American Psychological Association (2019) Coping with Stress at Work.
Retrieved from https://www.apa.org/helpcenter/work-stress