Analysis of the Use of Clinical Audits in Healthcare

Analysis of the Use of Clinical Audits in Healthcare Introduction The quality of health care system is important to patients and the Government. High level of quality patient care is the ultimate aim in current health care practices. Service providers wish to deliver quality health care. Patients are the appropriate authority to determine whether the experience of health care is good. Effectiveness of care pertains to treatment and support and helps us to judge whether staffs are, doing the right thing in a right way to achieve best clinical outcomes (Patel, 2010).Audit of services is therefore very important to ensure that the clinical practices are adhered to set professional standards and criteria. On the other hand health services are focusing on new information and knowledge for advanced clinical practice. Research is focused on this area in order to develop new practices and standards in health care system. Researches make changes to health care system by advancement of knowledge and practice. The aim of this paper is to identify the difference between audit and research and analyzing the benefits and limitations of audit. An overview of clinical audit. Audit derived from a Latin word, which means an official inspection of an organizations official accounts, by an independent body (Esposito Canton, 2014). Clinical audit is measuring the quality of patient care provided against a set well defines standards (Yorston Wormald, 2010). It gives staff a systemic way of looking into their practice and making improvements (Bennadi et al, 2014). Pioneer of clinical audit is Florence Nightingale whose work was searching reasons for high mortality in hospitals in 1850s. As per her assessment she reinforced cleanliness resulted in a drastic reduction in mortality rate. (Bennadi et al, 2010). Clinical audit Vs research Clinical audit and clinical research are entirely two different domains (Yorston Wormald, 2010). Clinical audit and research involves some common components. Hence, there is a great deal of controversy (Bennadi et al, 2014) in both terms. Audit compares the current clinical practice against well-defined standard/criteria, while research aims to define the characteristics of good practice on an unknown land (Esposito Canton, 2014). Audit focused on evaluating the existing practice; rather than discovering new information. Research is proven to be a larger scale study that aims at establishing new practices or procedures to carry out a particular task in a different method. The focus of research is further development of existing practice. However, audit is monitoring a task to determine whether a particular task has undertaken as per set standards or criteria. Audits check the quality of the task or procedure (Bennadi et al, 2014). Audit is generally undertaken on a local basis; how ever it is not limited to. (Hughes, 2005). Research aims to obtain new knowledge and to fill in any knowledge gaps. Research focuses on defining questions, making inclusion and exclusion criterias for people or problems to address and any developing clinical interventions or outcomes. Research methods for data collection and analysis that is applied are suitable to the topics for research (Strauss and Sackett, 1998, Hughes, 2005). Audit focuses on evaluating and analyzing the existing ones, not developing new practices (Difference between audit and research, 2014). But, research is aimed at developing new procedures to carry out in a more effective ways of carrying out. The focus on research is invention of new and further development of the old. The aim of an audit is to determine whether the standards and procedures are being followed and whether a task is completed properly. The aim of research is to add onto a body of research and to increase the amount of knowledge and learning available on a specific subject matter (Difference between audit and research, 2014). Also, unlike audits that measure tasks and procedures against a set out standard, research aims to test the hypothesis that is established by the researcher when beginning their experiments (Twycross Shorten 2014). Research considered as a broader field in the field of health. Research requires lot of education and training. Researchers undergo research education and training as a part of their university programme of study to gain the foundation to conduct a research (Hughes, 2005). In contrast, audit emphasized on areas, which needs improvement. Audit can undertake by anyone who is interested in a particular field and few receive education and training (Nettleton and Ireland, 2000). As per Hughess review, researchers involved in audit may benefit from approaches and techniques used to implement findings that could potentially serve to fill the research-practice gap. Equally, those involved in audit will benefit from sampling techniques in research that can help to improve generalisability. Some similarities are identified between audit and research despite their differences. Audit and research starts with a question, require data to answer questions, and systematic approach (Twycross Shorten 2014), also both needs an investigator (Abbasi Heath, 2005). Difference between clinical audit and research is showed in the below table, which was adapted from Bennadi et al, 2014 and Twycross Shorten 2014. Clinical audit Research 1 Audit uses comparison of current clinical practice Research uses experimental methods such as randomised control trials. 2 Uses simple descriptive statistics to describe current practice standards. Uses a range of statistics to make inferences. 3 Audit relates to a particular area of attention. Research can be generalized to other populations. 4 Audit measures how well current practices are carried out against clinical policies and procedures. Research provided evidences for clinical policies and procedures. 5 It is practice based. Research is theory based practice. 6 Ongoing process of quality assurance. One- off study. 7 No involvement of placebo treatment. May involve placebo treatment. 8 No changes involved in treatments of patients. Changes in treatment process. 9 Ethical approval is not required. Requires ethical approval. Benefits of clinical audit Audit conducted against set standards (Patel, 2010, Hughes, 2005) in a cyclic (Tsaloglidou, 2009, Hughes, 2005) process to ensure tasks carried out correctly. At the end of audit cycle auditors are able to address the areas of improvement and give feedback to the personnel who are involved in that particular task. Reaudit should carry out after an agreed period of implementing changes (Bennadi et al, 2014). Regular auditing alerts the health care professional the shortfall (Patel, 2010) in health care delivery system. Also helps us to find out whether staffs are practicing as per standards set by the organization to achieve therapeutic (Patel, 2010) patient care, identifies the factors causing failure to make improvements (Yorston Wormald, 2010). Therefore, organization can take actions to improve the area. Every time an audit cycle is completed there should be further improvement in patient care (Yorston and Wormald, 2010). Audit and feedback often used in health care setting to improve health care professional performance. Discrepancies in health care practices against set standards are highlighted in clinical audit that helps to identify the practices needed to improve for quality care (Esposito Canton, 2014). Tsaloglidou explains that the key for quality assurance and consistent delivery of high quality health services is the appropriate organization of the health center environment. The benefits of audit are apparent for health care professionals as it reduces frustration, reduces organizational and clinical error, improves communications between professionals and secures effective medical defense through risk avoidance (Tsaloglidou, 2009). An audit is not only a tool for monitoring change in clinical practice, but also an educational tool (Tsaloglidou, 2009). As the improvement of health care is a cost-effective procedure, audit is revealed to be a very useful tool in management Limitations of clinical audit Educational and training issue has a huge impact on carrying out an effective audit. Audit should not consider as a light work. It does require knowledge, experience and skills to perform effectively because auditing required to choose appropriate question, analytical method and to be undertaken in a sensitive (Hughes, 2010) way. In general, audit tends to be an activity that be undertaken by anyone without proper training and analytical skills with an aim to improve clinical practice. Nevertheless, it is very important for the staff member who will take on to implement the audit cycle to have proper training, supervision and protected time (Mercel et al, 2006). Bowie et al identified that lack of protected time to conduct a clinical audit is a major disadvantage for health care professional. They have to do it within their own allocated clinical time. Therefore, it can potentially affect direct patient care when allocating clinical time for auditing. It is not possible to justify leaving wards understaffed and underfunded to undertake audit unless instant results are attained (Esposito Canton, 2014, Ellis et al, 2000, Hughes 2005). Subsequently it causes additional workload on key staff members when undertaking an audit (Collis, 2006, Johnston et al, 2000). Lack of support from management to make audit related improvements and changes with the view of providing quality patient care. Inadequate organizational monitoring of auditing activities and progress is a barrier to make changes in patient care. It can lead to frustration and distress on auditors (Bowie et al, 2012, Hughes, 2005). Indirect situational factors influence the success of auditing such as lack of time and resources, lack of supervision, lack of support from management, conflict within multidisciplinary team, negative attitudes associated with audit process ((Travaglia Debono, 2009, Hughes, 2005). A systematic review of Cochrane study of 140 studies tested the effectiveness of clinical audit outcome against other methods of study such as meetings and distribution of printed materials. Results were variable. Audit outcome ranges from negative outcome to very positive effect. When the audit was effective, results range from small to moderate. Moreover, the study concluded that effectiveness of audit is likely greater, when baseline adherence to recommended practice is low. Therefore, there is no clear scientific evidence to support the real effectiveness of clinical audit (Esposito Canton, 2014, Ivers et al, 2014). Conclusion In general, clinical audit considered as an effective and cost effective method for continuous quality improvement even though there are numerous limitations. Therefore, it is important to pay more attention to clinicians having trouble in auditing and to determine what recommendations are made to make the audit more effective. In order to overcome the difficulties of audit, auditors need to be clear about the areas of clinical practice audited. In addition, it is very important to know the difference between audit and research to avoid inappropriate data collection while conducting an audit. Clearly, audit and research serve two distinctive purposes. References Abbasi, K., Heath, A. (2005). Ethics review of research and audit, BMJ, 330(7489), 431-432. doi: 10.1136/bmj.330.7489.431 Bennadi, D., Konekeri, V., Kshetrimayum, N., Sibyl, S., Reddy, V. (2014). Clinical audit a literature review, Journal of international dental and medical research, 7 (2), 49-55.Retrieved from http://www.ektodermaldisplazi.com/journal.htm. Difference between audit and research (2014), Audit vs research, retrieved from http://www.differencebetween.com/difference-between-audit-and-vs-research/ Esposito, P., Canton, A.D. (2014). Clinical audit, a valuable tool to improve quality of care: General methodology and applications in nephrology, World journal of nephrology, 3(4), 249-255. doi: 10.5527/wjn.v3.i4.249. Hughes, R. (2005). Is audit research? The relationships between clinical audit and social research, International Journal of Health Care Quality Assurance, 18(4), 289-299. doi: 10.1108/09526860510602550. Mercel, S.W., Sevar, K., Sadutshan, T.D. (2006). Using clinical audit to improve the quality of obstetric care at the Tibetan Delek Hospital in North India: a logitudinal study. Quality health care, 3(4), 1-4. doi:: 10.1186/1742-4755-3-4 Nettleton, J. Ireland, A. (2000). Junior doctors views on clinical audit. Has anything changed?, International Journal of Health Care Quality Assurance,13(6), 245-53. Retrieved from careers.bmj.com/careers/advice/Quality improvement. Patel, S. ( 2010).Iidentifying best practice principles of audit in health care, Nursing standard, 24 (32), 40-48. Retrieved from journals.rcni.com/doi/pdfplus/10.7748/ns2011.01.25.19.51.c8271. Travaglia, J., Debono,D. ( 2009) Clinical audit: a comprehensive review of the literature, Centre for Clinical Governance Research, University of New South Wales, Sydney Australia . Retrieved from http://health.gov.ie/wp-content/uploads/2015/01/literature_review_clinical_audit.pdf Tsaloglidou, A. (2009). Does audit improve the quality of care, International journal of caring sciences, 2(2), 65- 72. Retrieved from http://www.internationaljournalofcaringsciences.org Twycross, A., Shorten, A. (2014). Service evaluation, audit and research: what is the difference?, Evid Based Nursing , 17(3), 65-67. doi:10.1136/eb-2014-101871 Yorston, D., Wormald, R. (2010). Clinical auditing to improve patient outcomes, Community eye health journal, 23(74), 48-49. Retrieved from www.cehjournal.org/article/clinical-auditing-to-improve-patient-outcomes.

Public Slave System :: essays papers

Public Slave System In 1999, a young man named Ryan John Sargeant removed himself from the public school system. His letter of intent, filled with harsh, condemnatory rhetoric, decried a school system that uses students as, ? a means to an end, a worthless commodity. Pupils are made nothing but workers by the educational system.? Such words would aptly describe a proposal by the United States government, which calls for three years of mandatory public service following high school before pursuing any higher education. A sweeping educational reform of this type sacrifices the Constitutional, personal, and moral rights of the individual students in favor of the public good, creating a new class of disenfranchised and rebellious youths. A mandatory post-high school public service program violates the Constitution of the United States. In Amendment Thirteen, Section One, the Constitution states that ?Neither slavery, nor involuntary servitude [emphasis added] ? shall exist within the United States A proposal to involuntarily enlist students from the ages of 18-23 in forms of public service (or servitude) blatantly attacks the premise of this basic constitutional right of everyone, including students in the school system. Additionally, the Declaration of Independence, that touchstone of ?unalienable rights,? provides its citizens with ?Life, Liberty, and the pursuit of Happiness.? Through a public works mandate , the government itself would be depriving each student of their ?unalienable right? to have liberty from oppressive mandatory requirements, barring them from pursuing happiness in whatever manner they choose. Furthermore, the Declaration of Independence defines a government as a system ?instituted among me n, deriving their just powers from the consent of the governed.? Again, a mandatory work program for students attacks the fundamental values of a government for the people, by the people, in favor of a government that legislates basic rights to its people. In countries built without such documents of inalienable rights, mandatory work programs are the norm for their students. In the United States, however, these programs violate the rights of each individual as demanded by the law. Mandatory work programs for students also break a fundamental moral code, alluded to by the Constitution, found in many religious and governmental societies around the earth. As the Constitution recognizes, there exists a ?Law of Nature,? and certain entitlements according to that Law. Among these entitlements is the inalienable right that ?

Ethical Decision Making

Ethics-PHI 220 03/16/2012 Ethical Decision Making Paper Case Study: From Santa Clara University There are two types of surrogacy. One type involves a surrogate mother who uses her own egg and carries the baby for someone else. The other type is a â€Å"gestational surrogacy† in which the mother has no genetic tie to the child she carries. In the case presented, a gestational surrogate is used. A woman, after a bout with uterine cancer had a hysterectomy (surgical removal of the uterus). Before, its removal, however, she had several eggs removed for possible fertilization in the future.Now married, the woman wishes to have a child with her husband. Obviously she cannot bear the child herself, so the couple utilizes a company to find a surrogate mother for them. The husband's sperm is used to fertilize one of the wife's eggs, and is implanted in the surrogate mother. The couple pays all of the woman's pregnancy-related expenses and an extra $18,000 as compensation for her surrog acy, and after all expenses are taken into account the couple pays the woman approximately $31,000 and the agency approximately $5,000.Though the surrogate passed stringent mental testing to ensure she was competent to carry another couple's child, after carrying the pregnancy to term, the surrogate says that she has become too attached to â€Å"her† child to give it up to the couple. A legal battle ensues. Step 1: Gather Relevant Information The Surrogate is carrying a baby that has no genetic ties to her. The Surrogate was paid quiet well to do a service and decides not to follow through with the service.The surrogate now decides to keep the baby and the money because she has grown to close to the baby. Step 2: Type of ethical problem According to Markkula center for applied ethics, justice means giving each person what he or she deserves or, in more traditional terms, giving each person his or her due. Justice and fairness are closely related terms that are often today use d interchangeably. There have, however, also been more distinct understandings of the two terms.While justice usually has been used with reference to a standard of rightness, fairness often has been used with regard to an ability to judge without reference to one's feelings or interests; fairness has also been used to refer to the ability to make judgments that are not overly general but that are concrete and specific to a particular case. In any case, a notion of desert is crucial to both justice and fairness. (SCU)The most fundamental principle of justice—one that has been widely accepted since it was first defined by Aristotle more than two thousand years ago—is the principle that â€Å"equals should be treated equally and unequal’s unequally. † In its contemporary form, this principle is sometimes expressed as follows: â€Å"Individuals should be treated the same, unless they differ in ways that are relevant to the situation in which they are involve d. (SCU) By the surrogate keeping this baby, she is going against everything that was in the agreement.This baby has no attachment to the surrogate; it is the egg of the husband and wife who paid her to carry their child. In the United States it is illegal to pay a person for non-replenish able organs. The fear is that money will influence the poor to harm their bodies for the benefit of the rich. Is there a parallel between this case and this law? Can allowing surrogate mothers to be paid for their troubles allow poorer women to be oppressed? On their website, the AMA says â€Å"that surrogacy contracts [when the surrogate uses her own egg], while permissible, should grant the birth other the right to void the contract within a reasonable period of time after the birth of the child. If the contract is voided, custody of the child should be determined according to the child's best interests. † (SCU) However this is not the case with this couple, the couple used their own egg and implanted it into the surrogate so should the same rules apply? Step 3: Apply Ethical Theories and Approaches Ethical theory is divided into two main types or approaches in this case which are virtue and duty ethics.Virtue ethics begins by considering what makes a person (or his/her character or motives) morally good (Aristotle, Hume). Duty Ethics focuses on rules or acts and what makes them right (Mill, Kant, Rawls). (Ethical Theory) According to the both theories the surrogate should hand over the child to the biological parents. This surrogate has no real ties to the child and was paid for a service and is violating a contract by not providing the child she was paid to deliver. Step 4: Exploring Practical AlternativesWith this particular case there are not many alternatives. Option 1- being that the surrogate keeps the child and returns all the money she was paid to do the service and the money put out for her medical bills. The surrogate could also reimburse the couple for t heir time and heart ache. Option 2- The couple and the surrogate could go in front of a judge and have the judge decide what is best for the child and the people involved, and what the outcome shall be. Step 5: Complete the Action This is the most important step in the ethical decision making process.This is where the actions are carried out. After reviewing all the details and options for this case the most ethical thing to be done is for the surrogate mother to give the baby, who has no biological attachments to her back to the biological parents. The surrogate can keep the $18,000 she was paid for compensation for her time and expenses, plus the money put out for all her medical expenses. Works Cited â€Å"Justice and Fairness. † Santa Clara University. Web. 17 Mar. 2012. . â€Å"Ethical Theory. † Web. . Ethical Decision Making Ethical Decision Making End of Life Submitted by: Anthony Mcdew Ethical nursing care Nurses are faced with ethical decision making on a daily basis. This could be both stressful and challenging. The following case study I chose to walk through is: Mr. Clarke is a patient who has advanced AIDS with related pain syndromes and is also actively abusing drugs. The nurse is concerned about his abusing his pain medications and is not sure if she should give them to him as he leaves the hospital. It will be my assumption that this patient is nearing the end of their life. The value, be, do ethical decision-making model will provide the framework I need to assess this case study (Schaffer and Norlander). I also will be using ethical decision making tools to guide my decision making process. What should I value? The first step of the value, be, do ethical decision-making model answers the question what should I value? It is time that I look deep into the meaning of my life in regards to my professional nursing practice. What do I value in life? The meaning of life for me involves personal and professional respect for my patient and his physician in charge of his care. This involves respecting my patient and his situation. Also, trusting the prescribing Physicians education and training is something I value. Along with valuing respect; I value quality end of life care for my patient. Every individual deserves a peaceful death with minimal pain and suffering if possible. To obtain this, I also need to value my relationship with my patient. Developing a trusting relationship is important for him and also me when dealing with uncomfortable conversations that may have to take place. Finally, I think that I value my education and critical thinking skills. These skills are important to value because I will have to make a decision if I think my patient can handle taking his own pain medications on his own. My education and critical thinking skills will guide me to problem resolution that has the best outcome for the patient. Who should I be? Not only is it important to understand what values impact my actions and decisions; it is also important to make sure my actions reflect my values. The values I have make sure that I am an advocate for my patient’s comfort as well as their safety. They also help me be an active and compassionate listener as well as a teacher. If I am a trustworthy person; my patient will hopefully feel comfortable talking to me about his addiction. Finally, to ensure a quality end of life experience for my patient, I will stay educated on medication dosages, side effects, and other treatments for pain. By critically thinking, I should be able to educate my patient and help communicate to the Physician about the patients concerns regarding pain addiction and pain control. What should I do? By understanding what I value and who I am; I now should be able to fulfill my actions. First, I feel that I should take time to analyze the patients past medical history and medications that helped his pain. Second, I will review the pain medications with the Physicians to ensure I have a proper understanding of his or her plan. Then I will review what is needed to provide quality end of life care with good pain control to a dying AIDS patient. After I feel that I have a great understanding of the situation; it is time I listen and talk with my patient. Assure them that I am there as their advocate for safe and complete end of life care. This may require me to act as a counselor or bring in interdisciplinary team members to assist my patient. My number one goal is to provide safe end of life care; but as painless and comfortable as possible. Analyze response to case study It is always challenging to give patients medications knowing that they may become, or have become addicted. In my current practice we see many patients who go to pain clinics and have pain contracts to help with their addiction and pain management. The difference is, my patients are not dying. Thiroux’s universal ethical principles allow nurses to take time and review the ethical situation. In my case study, I personally feel the Mr. Clarke has the right to a peaceful death if possible. The problem is that the medications we are giving him may kill him first. Thiroux’s principles allows for individual freedom and valuing life. My patient should have the freedom he needs to decide if the pain if worse or the addiction. Depending on how long he has to live, the addiction may be the least of his problems. I feel that I need to value his life and quality of life. Also, I need to understand that death most likely is going to happen. (Blackboard). Thiroux’s universal ethical principles allow nurses to assess the client situation; as well as the caring and justice model (blackboard). This model enhances how nurses feel about ethical problems. Mr. Clarke’s situations force me as his primary nurse to understand how to be an advocate for him and his situation. It also reminds me to use my compassion and virtue when caring and talking with him about his pain addiction. Finally, I have learned that solving or being part of an ethical dilemma can be easier on a nurse by incorporating spirituality. I think that by assessing Mr. Clarke’s spirituality; I may be able to help him with his addiction or suffering he is facing. Isaiah 43:4-5 says that â€Å"Since you are precious and honored in my sight, and because I love you, I will give men in exchange for you and people in exchange for your life†. It goes on to say that we should not be afraid because God is with us and will unite us together. This bible verses supports my belief that God is there for us as nurses and that he had a purpose for us. God gave us the power to support all situations. The verses also leads me to believe that the purpose of life is to help others physically, emotionally, or spiritually with whatever gifts you may have. I truly believe that God gave me the guidance I need to make this ethical decision on how to help Mr. Clarke. I believe that with proper education and assessment of his pain protocol; Mr. Clarke deserves to have pain relief. This can be done by having his medications monitored. However, they should not be withheld. God does not want suffering and either do I. Quality guidelines Domains of end of life quality care. The domains of end of life quality care that apply to my case study include: pain and symptom control, achieving a sense of control, and possibly strengthen the relationship with loved ones. It is my goal to provide quality end of life care to Mr. Clarke. This includes symptom and pain management. By allowing him to have a sense of control with his pain medications; he is able to help determine is end of life experience. Finally, by assessing Mr. Clarke’s relationship with his family I will be able to see if they can help him. There help could be support, symptom monitoring, and medication management. They also may be able to help him with alternative measures at times including: guided imagery, music therapy, massage etc. Bill of last rights. Not only is it important to understand the domains of end of life quality care; it is also important to remember the bill of last rights. These rights are consistent reminders of the rights dying patients have or basic human rights. Mr. Clarke has a right to control, to be comfortable, and the right to hear the truth. These rights remind me as his caregiver that he is part of this process as well as his medical care team. Even though I feel we still should prescribe his medications; I also believe that he is entitled to know that he has become addicted and how to work through it. Seven Promises. Another tool to use when assessing Mr. Clarkes case study would be reviewing the Seven Promises. The one promise that stands out the most to me is â€Å"never be overwhelmed by symptoms† (blackboard). This includes never having to â€Å"endure overwhelming pain, shortness of breath, or other symptoms (blackboard). This promise reminds me as his care giver that his care team needs to consistently be assessing his pain protocol and symptom management. The other promise that I feel would be beneficial to remember when caring for Mr. Clarke is â€Å"make the best of everyday† (blackboard). This allows the care team to remember that Mr. Clarke is an individual and each day we need to make sure we are helping him. Not only is it important to offer medications for pain management; it is also important to offer alternatives. Each day as his nurse I can document what time of day his pain is worse, what stimulus increases and decreases pain. Every day, I can do my best to help him make the best of his day. Precepts of Palliative care. The last option I have encountered that I can to do assess my patient’s situation is to analyze the organization. By reviewing the Precepts of care, I will be able to make sure the organization is not lacking in any areas that may help Mr. Clarke. This tools will allow us to make sure the organization is respecting the patients decisions, giving comprehensive care, utilize resources of team members, address caregivers concerns, and analyzing the environment (blackboard). This can ensure that not only I am providing good ethical care to my patient, as well as the organization and medical care team. Actions/Response After analyzing and utilizing all of the tools available to me; I have decided that Mr. Clarke deserves to get his pain medication. He is actively dying and has the right to pain and symptom control. It is easier to monitor his addiction then his suffering. The Physician is prescribing only a certain quantity of medications at a time. This can help the care team to monitor his addiction. I believe that the situation would be different if the patient was not dying. I believe that with my strong understanding of my values; I will be able to allow my actions to be appropriate. This will help guide me through â€Å"what should I do†? Ethical decision making is never an easy process. By having the proper tools, it can help medical care team members make a decision. It is my job to educate, counsel, support, and advocate for Mr. Clarke. I would need to be concerned with his medication addiction if he started to overdose. The case study said he is only having trouble with addiction. However, his medication management still needs to be closely monitored for this scenario. Ethical situations can change depending on the situation. I hold strong to by choice that Mr. Clarke needs his pain medications. Reference Bethel College of Nursing Department (n. d. ). Bethel University NURS344 Blackboard Course modules 2010, St. Paul MN. Schaffer, M. , Norlander, L. (2009) Being present A Nurse’s resource for end of life communication. Indianapolis, IN: Sigma Theta Tau International. . Ethical Decision Making Ethics-PHI 220 03/16/2012 Ethical Decision Making Paper Case Study: From Santa Clara University There are two types of surrogacy. One type involves a surrogate mother who uses her own egg and carries the baby for someone else. The other type is a â€Å"gestational surrogacy† in which the mother has no genetic tie to the child she carries. In the case presented, a gestational surrogate is used. A woman, after a bout with uterine cancer had a hysterectomy (surgical removal of the uterus). Before, its removal, however, she had several eggs removed for possible fertilization in the future.Now married, the woman wishes to have a child with her husband. Obviously she cannot bear the child herself, so the couple utilizes a company to find a surrogate mother for them. The husband's sperm is used to fertilize one of the wife's eggs, and is implanted in the surrogate mother. The couple pays all of the woman's pregnancy-related expenses and an extra $18,000 as compensation for her surrog acy, and after all expenses are taken into account the couple pays the woman approximately $31,000 and the agency approximately $5,000.Though the surrogate passed stringent mental testing to ensure she was competent to carry another couple's child, after carrying the pregnancy to term, the surrogate says that she has become too attached to â€Å"her† child to give it up to the couple. A legal battle ensues. Step 1: Gather Relevant Information The Surrogate is carrying a baby that has no genetic ties to her. The Surrogate was paid quiet well to do a service and decides not to follow through with the service.The surrogate now decides to keep the baby and the money because she has grown to close to the baby. Step 2: Type of ethical problem According to Markkula center for applied ethics, justice means giving each person what he or she deserves or, in more traditional terms, giving each person his or her due. Justice and fairness are closely related terms that are often today use d interchangeably. There have, however, also been more distinct understandings of the two terms.While justice usually has been used with reference to a standard of rightness, fairness often has been used with regard to an ability to judge without reference to one's feelings or interests; fairness has also been used to refer to the ability to make judgments that are not overly general but that are concrete and specific to a particular case. In any case, a notion of desert is crucial to both justice and fairness. (SCU)The most fundamental principle of justice—one that has been widely accepted since it was first defined by Aristotle more than two thousand years ago—is the principle that â€Å"equals should be treated equally and unequal’s unequally. † In its contemporary form, this principle is sometimes expressed as follows: â€Å"Individuals should be treated the same, unless they differ in ways that are relevant to the situation in which they are involve d. (SCU) By the surrogate keeping this baby, she is going against everything that was in the agreement.This baby has no attachment to the surrogate; it is the egg of the husband and wife who paid her to carry their child. In the United States it is illegal to pay a person for non-replenish able organs. The fear is that money will influence the poor to harm their bodies for the benefit of the rich. Is there a parallel between this case and this law? Can allowing surrogate mothers to be paid for their troubles allow poorer women to be oppressed? On their website, the AMA says â€Å"that surrogacy contracts [when the surrogate uses her own egg], while permissible, should grant the birth other the right to void the contract within a reasonable period of time after the birth of the child. If the contract is voided, custody of the child should be determined according to the child's best interests. † (SCU) However this is not the case with this couple, the couple used their own egg and implanted it into the surrogate so should the same rules apply? Step 3: Apply Ethical Theories and Approaches Ethical theory is divided into two main types or approaches in this case which are virtue and duty ethics.Virtue ethics begins by considering what makes a person (or his/her character or motives) morally good (Aristotle, Hume). Duty Ethics focuses on rules or acts and what makes them right (Mill, Kant, Rawls). (Ethical Theory) According to the both theories the surrogate should hand over the child to the biological parents. This surrogate has no real ties to the child and was paid for a service and is violating a contract by not providing the child she was paid to deliver. Step 4: Exploring Practical AlternativesWith this particular case there are not many alternatives. Option 1- being that the surrogate keeps the child and returns all the money she was paid to do the service and the money put out for her medical bills. The surrogate could also reimburse the couple for t heir time and heart ache. Option 2- The couple and the surrogate could go in front of a judge and have the judge decide what is best for the child and the people involved, and what the outcome shall be. Step 5: Complete the Action This is the most important step in the ethical decision making process.This is where the actions are carried out. After reviewing all the details and options for this case the most ethical thing to be done is for the surrogate mother to give the baby, who has no biological attachments to her back to the biological parents. The surrogate can keep the $18,000 she was paid for compensation for her time and expenses, plus the money put out for all her medical expenses. Works Cited â€Å"Justice and Fairness. † Santa Clara University. Web. 17 Mar. 2012. . â€Å"Ethical Theory. † Web. .

SSD2 Module 1 Notes - 31223 Words

MODULE 01 NOTES SOP- STANDARD OPERING PROCEDURE Determine the SOP purpose and target audience for distribution. Uniforms Your reference will be Local Policy, AR 670-1 Leaves and Passes Your reference will be AR 600-8-10 Motor Stables Your reference will be DA Pam 750-1 Key Control Your reference will be AR 190-51, 190-11, 735-5 References Citations must be accurate and thorough-title, type, number, and date of publication; online links if appropriate; and identifying information for correspondence or meetings. Purpose A brief statement that outlines the purpose of the SOP, describing its function, applicability, and objective. Summary A few sentences summarizing the content. Though placed near the beginning, it should be composed last.†¦show more content†¦You should coordinate a final review of the SOP by another person or persons to correct any grammatical and doctrinal errors prior to obtaining authentication, or the signature of the approving authority. Now your SOP is complete and ready for distribution. Determine your reproduction and distribution requirements in accordance with your local (unit) procedures. Base your reproduction and distribution on a need to know basis and the SOP s security classification. Remember, any copies of the SOP not issued will require you to have a place or area to secure them, so keep reproduction of the SOP to a bare minimum. In this lesson, you learned to write a platoon standard operating procedure (SOP) by: Determining the SOP purpose and target audience for distribution, Determining the SOP content, Determining the SOP coordination approval requirement, Preparing the final SOP. Communicate effectively at the direct leadership level Methods of Human communication: Verbal or oral, nonverbal and written. Verbal/Oral Communication - This type of communication relies on word, visual aids, and nonverbal elements to convey the meaning. Oral communication includes discussion, speeches, presentations, interpersonal communication and many other varieties. In face to face communication, the tone of voice and voice tonality