N522PE Life-Span Assessments Ethics & Legal Issues Final Project

Discussion 7

Caring for persons across the life span and from very diverse cultural backgrounds can present challenges in nursing practice. As you studied the ethical and legal issues related to advanced physical assessment what insights have you gained to advance your clinical reasoning? Describe knowledge gained or re-affirmed through a de-identified clinical story.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Discussion Participation Guidelines & Grading Criteria.

Sample Approach To Discussion 7

Cultural differences can often be misinterpreted and applied only when caring for individuals with a foreign language and those from various religious backgrounds that appear different from us. I have learned through studying cultural competency in many courses through this program and through conducting an assessment and exam through Shadow health on patients from different backgrounds that it is not enough to be educated about various cultures and beliefs.

The most crucial aspect of gaining cultural competence is recalling one’s own biases and assumptions and being aware of them to identify them as they appear. A practitioner needs to be able to reassess their own sensitivities and what biases they might have to approach patients without any prejudice (Henderson et al., 2018). The only way we can do that is to be exposed to various ethical situations and types of patients to build our own “moral reasoning,” where we need to make tough decisions (Henderson et al., 2018).

For example, during my interview with Ms. Park, an older woman with abdominal pain, I thought nothing of merely asking if she has experienced an increase in gas production and expelling gas. Her answer was very vague at first, and she appeared very modest. I realized that might not be appropriate in Korean culture, or even for an elderly lady who seems very modest. 

I also made assumptions when interviewing Tina initially, as she appeared not to care for her well-being, therefore not checking her glucose levels, not checking her blood pressure, etc. In further assessment, I realized that Tina required my understanding and undivided attention between lack of knowledge and stress related to work and school, so I can understand her needs and plan her care appropriately.

In my clinical experience, I have had multiple encounters with various situations where ethical decisions needed to be made. The lack of cultural sensitivity on the clinical team’s part made the decisions worse for the patient outcome. I feel that elderly patients could be misunderstood and mismanaged because practitioners can sometimes be less culturally sensitive to their needs.

I had patients who would shake their heads in agreement during education on diabetes and insulin injections, as they were hearing impaired and felt embarrassed to keep asking me to repeat myself. Later, when I asked for a return demonstration, they could not do that, so they finally admitted that they could not hear me. That was a bias on my part for assuming and not asking if they are able to understand and hear. It was reported that 50% of older adults have hearing problems (Bickley & Szilagyi., 2017).

I had an elderly patient I was caring for that came in with abdominal pain. She lived by herself and had three children, who all lived far away, so they could not travel quickly to see her when she was admitted to the hospital. Upon admission, I noticed that she was not oriented, which is not her usual state, and did not have a living will with her. I voiced my concern to the clinical team, as her condition was getting worse, and they dismissed my worry and encouragement to call her family to discuss this topic further.

The family did not question it either. I walked in to check on the patient, and she was not breathing and turned a greying color. I called the code, and CPR was started with chest compressions on this frail woman. Every time we compressed the chest she was vomiting stool content that we all had to take a turn every couple of minutes as it was unberable.

After 25 minutes, the patient’s pulse returned. She was intubated and sent to intensive care. She suffered broken ribs, ended up with the aspiration of fecal content in her lungs, and became septic. When her family arrived the next day, they were mortified, as they brought her living will where she clearly stated she was to be DNR and DNI.

They did not think to question the clinical team and assumed that the team already had this information. I felt that my team failed, as they did not question her family and inquire further due to their assumption that she was a full code. The patient was extubated that day and passed away after what I felt was severe trauma at her last moments of life.

  • Bickley, L. S., & Szilagyi, P. G. (2017). Bates guide to physical examination and history taking (12th ed.).
  • Wolters Kluwer Dains, J.E., Baumann, L.C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). Elsevier.
  • Henderson, S., Horne, M., Hills, R., Kendall, E. (2018). Cultural competence in healthcare in the community: A concept analysis. Health Soc Care Community, (26), 590–603. http://dx.doi.org.americansentinel.idm.oclc.org/10.1111/hsc.12556

Final Project

The Final Project (6-8 page paper) synthesizes the previous weeks’ study of advanced physical assessment by conducting a comprehensive assessment in ShadowHealth. The final project synthesis is focused upon designing evidence-based, culturally competent nursing interventions through the development of an individualized health plan. Assessment of competency is based on the Comprehensive Patient Interview, Physical Examination and Individualized Plan of Care incorporating Healthy People 2020 and evidence-based interventions and patient-centered goals.

You will use one comprehensive digital clinical experience health history and physical assessment for this assignment: Comprehensive Assessment. Please submit your summary documentation in MS Word. Use the submission parameters and rubric below to guide you in completion of this written assignment. The use of Headers in your paper is strongly encouraged.

Submission Parameters:

For this written assignment, please use the following guidelines and criteria. Also, please refer to the rubric for point allocation and assignment expectations. The expected length of the paper is approximately 6-8 pages, which does not include the cover page and reference page(s).

  • Introduction (including purpose statement)
  • Subjective Findings Synthesis
  • Objective Findings Synthesis
  • Plan of Care
  • Apply one nursing theory in planning care for this patient
  • Incorporate Healthy People 2020 Objectives into the plan of care prioritized to meet the health needs of the patient
  • Document evidence to support clinical reasoning for selected evidence-based plan of care
  • Plan of care is individualized to findings, life-span stage of development with culturally specific considerations, and patient-centered.
  • Conclusion
  • References (use primary and/or reliable electronic sources)

In regards to APA format, please use the following as a guide:

  • Include a cover page and running head (this is not part of the 6-8 pages limit)
  • Include transitions in your paper (i.e. headings or subheadings)
  • Use in-text references throughout the paper
  • Use double space, 12 point Times New Roman font
  • Apply appropriate spelling, grammar, and organization
  • Include a reference list (this is not part of the 6-8 pages limit)

Attempt to use primary sources only. That said, you may cite reliable electronic sources (i.e. NCSBN, AANP)

The Final Project documentation is due in Week Seven. Please see the Final Project below to help you complete the assignment.