When to Speak and not to Speak-That is the Question

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Ethics-A trickier subject is difficult to find.  UNFORTUTELY, one reason ethics is so hard is that it is so important. As a leader or someone with authority ethics become even more exponentially critical. Leaders without ethics are how we get cults and genocide in my opinion. (Yes, that is an extreme but I am using it to illustrate a point).

Ethics take thought and practice, like many other things in life.  This is a good avenue for both.  I have chosen to scenarios out of the book Students Helping Students and then will discuss what I hope my response would be, (because practice like this helps you prepare for situations, but you can never really know until you are in them), and what ethical principles it touches on.

1

“you are talking with a student who describes having taken part in an activity that, if caught, would probably be a felony. This person says this rather casually and even asserts rather boldly that nothing of consequence ‘happened’”.

This relates to principle 10 to take responsible action if learning about an illegal behavior. I think I would report it to my supervisor first if it happened on a shift. If not I would talk with a the campus police, but ask that my supervisor support me when I do this. I could also do this though an anonymous tip. However I think that doing it directly or though the supervisor would be more responsible and fair. Especially if it was a felony, which may mean someone got hurt.  This could mean a loss of relationship with the individual, or even retaliatory harassment. And if a case was made out of my statement there would be legalities I would have to do. However I think that the risk should be worth it.

2

“As a discussion leader in a group, you notice a student with whom you have had un unresolved conflict during the past year. You have some strong feelings and reactions to seeing this individual.”

 

This deals with principle 7-continue to deal appropriately when working with someone you have some aversion for. And with Principle 9-managing your emotional response. I am not going to lie. This would be a difficult situation for me. However, what I think I would do is 2 parts. One I might have a conversation with that person just to say that while we have issues, lets do this project professionally and deal with our issues later. Or I might just treat him/her with professional detachment. Not mean or rude, but fair. Just try and act like they are just another person in the group. The fall out could come if the other person does not agree to be professional or if the other person starts something. If a conflict happens, I might have to step down from a leadership role.

Transcatheter Aortic Valve Replacement

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Aortic valve replacement continues to be rejected in patients over 75 years of age and who have severe cases of aortic stenosis. This procedure is considered far too risky, with poor health outcomes (Rozeik et al., 2014). However, technological advancements have made it possible to revolutionize the placement of an aortic valve, which is generally performed under open heart surgery, to a less invasive procedure. The transcatheter aortic valve replacement (TAVR) procedure allows for a valve to be placed percutaneously and makes it possible to avoid open heart surgery altogether (AHA, 2014). Similarly to stent placement, TAVR replaces the old valve through a catheter without having to remove the old one (AHA, 2014). Once the new valve  expands, it pushes the old leaflets out of the way and begins to take over as follows:

Although the procedure is currently only FDA approved to use in high risk patients with severe aortic stenosis, it is incredible to know that there is now a solution for those who were previously denied treatment. Technological advancements continue to revolutionize both the science and art of medicine. Although the procedure is not free of possible complications, it does have a shorter recovery period (3-5 days) as compared to the alternative open heart surgery (AHA, 2014). In one case, a high risk patient with severe aortic stenosis previously turned down by a multitude of surgeons underwent TAVR and immediately saw a transvalvular pressure gradient decrease of 24 mm Hg and a 3% improvement in ejection fraction indicating promising outcomes (Rozeik et al., 2014). Although this procedure continues to be performed in selective facilities, it is promising to know that one of our own local community hospitals, Los Robles Hospital and Medical Center, is currently pioneering it (Los Robles Hospital). I look forward to witnessing and taking part in the revolution of medicine that technology has allowed us to have!

References:
Rozeik, M.M., Wheatly, D.J., Gourlay, T. (2014). The aortic valve: structure, complications and implicationsfor transcatheter aortic valve replacement. Perfusion, 29 (4), 285-300.

American Heart Association. (2014). Retrieved from http://www.heart.org/HEARTORG/Conditions/More/HeartValveProblemsandDisease/What-is-TAVR_UCM_450827_Article.jsp

Los Robles Hospital. Retrieved from http://losrobleshospital.com/service/transcatheter-aortic-valve-replacement-procedure

 

 

 

 

 

How to practice good ethics and strategies as a Peer educator?

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1) Principles that cover situation one is to take responsible action if you learn about illegal behavior. In this principle you want to give the student insight of what potentially could happen, but doing it in a general way.This is very important not to point the finger at the student and judge them, but to appropriately guide them. What I think would be appropriate to say to students is to make sure they stay within the conduct of their school and are representing their university well. And just to be safe.  I think some of the follow-up actions are the student my get offended. Or not want to share with their peer educator again.

2) In the third situation I would use principles showing respect and dignity for the student and consulting supervisor. I think letting the student know  that you may not assist them in their workouts but leave with them a sense of confidence and motivation that they can think back on would be great. Also if unaware of how to tell or approach student in this situation then go to supervisor. I would tell the student to seek out roommates, classmates, and friends to go help keep them motivated. I would stress the fact that they their peers are the best possible people to go to because they are in the same place as you and can relate to your goal. I think some follow-up consequences can be the student no longer being motivated to their goal or feeling unworthy of their peer educator’s presence to help them out.

Newest ATI updates

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Hello. I wanted to update you regarding a few items.

First, the ATI comprehensive Med-Surg test was not on your individual profiles for ATI. I have contacted the ATI representative and gotten that sorted out. I do not want to overload you with test-taking, but I will be assigning the comprehensive Med-Surg practice test A for homework the week after the exam.

Second, the ATI proctored comprehensive med-surg exam has been scheduled April 29 130-3 pm in Ojai 1952 and 1372. This will impact our neurology content a bit that day, but I will keep you updated on any schedule changes as we move forward with content. Happy studying!

 

 

Statement of Ethics

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During this brain storming activity I found the ideas of ethics we discussed were similar to many of the principles we read about in chapter 10. Here is a list of ideas

  1. Integrity(honesty)
  2. Knowing your limits of expertise
  3. Demonstrating leadership being a Role model
  4. Acting appropriately to people you may find attractive
  5. Relate or include yourself as a part of the mentees environment
  6. If you don’t know how to carry out an extreme situation consult with supervisor
  7. Act responsibly when hearing something that may endanger you or others
  8. Respect others privacy such as personal information they may share

Implantable Wireless Device that Measures Pulmonary Artery Pressure in Patients with HF

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Heart Failure is a   common condition  with more than 5 million Americans affected by it. In order to treat heart failure lifestyle modifications and a medication regimen is followed.  Currently St Jude Medical released their new product called the Cardio MEMS HF System. It is the first FDA-approved HF monitoring device that has been proven to reduce hospital admissions and improve quality of life in NYHA class III HF patients who have been hospitalized in the previous 12 months. Wow! But you may ask your self how does this really work? Well a senor is placed in the pulmonary artery, it reads the  pressures, and sends the reading  automatically to your providers desktop where he can view the reading through a secure website. The sensor itself is powered by radio frequency energy and is implanted in the pulmonary artery via a a catheter. The procedure is non-invasive and the sensor lasts for the lifetime of the patient. No battery is required, and the sensor sends out information to an electronic transmitter. In order to initiate readings the patient lies down on a special pillow and the electronic unit guides the patient on how to initiate a reading. Once the reading is complete, which only takes a few minutes, the readings are transmitted wirelessly  to a secure website.  The physician  reviews the readings and makes any necessary adjustments to the patients treatment. Pulmonary artery pressure is reflective of the patients heart condition. The sensor allows daily monitoring at home without the inconvenience of having to visit the doctors office. It is also easy and fast. Most importantly it can prevent future hospitalizations through early detection of changes pulmonary artery pressure.

CardioMEMS™ HF System

Peer Educator Ethics

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  • You are talking with a student who describes having taken part in an activity that, if caught, would probably be a felony. The persons says this rather casually and even asserts rather boldly that nothing of consequence “happened.”

The principles applicable to this situation include principle ten, principle three, and principle one. Principle ten because as a peer educator I need to take responsible action when hearing about illegal behavior, in this situation there is illegal behavior. Principle three because if I am doubting myself on my ability to handle the situation I need to consult with my supervisor immediately in order to properly carry out the situation. Last Principle one because I have to be careful in crossing my limits and training on how to respond to such a situation.

  1. Describe some different ways for dealing with each situation

One different way of dealing with this situation I feel not just confronting the students and laying down the foundation of norms and consequences but, reaching out to the student as a role model. Explain to the student that such activity is not worth jeopardizing the opportunities they have, relate to them with struggles you’ve dealt with similar. Explain that they are “here” for a reason and that is not the direction they need to take for they’ve worked hard to get where they are at. Give the student a change of perception they can feed off of, illuminate a brighter path for them.

2.What are the consequences of possible follow-up actions?

If the student continues such behavior as a peer educator I feel it is my duty to report this activity to the highest level of expertise in order to carry out the right consequences. The student will be reported.

  • You are very attracted to a person you have tutored in the past couple of weeks, you would really like to ask that person out. You are looking for a “go between” friend to check out the situation for a “yes” or “no” interest without having to directly ask the other party.

The principles applicable to this situation include Principle five, Principle eight and Principle nine. Principle five because even thought you were to find someone very attractive it is still your obligation to show respect and dignity to not just the person you find attractive but other individuals around them as well. Principle eight I feel the most important in this situation I also feel it has correlation with principle five. Principle eight elaborates acting appropriately when working with someone you find attractive, this can compromise your job or position as a peer leader. Principle nine because knowing the emotions of the person your attracted to can compromise your well being. She/he may tell you things that you feel deeply and affect your ability to perform.

  1. Describe some different ways for dealing with each situation

I feel the best way to deal with this situation is to put your job or leadership position before your desires or attractions. I feel you can still get to know that person and be friends, you should always show respect for that person and serve as a role model. Plus it would give you time to get to know that person, your first priority is to serve as a peer educator.

2.What are the consequences of possible follow-up actions?

Some consequences of pursuing that person your attracted to may result in release from your leadership position. You may lose your credibility to serve as a peer educator. Also you may end up messing up your relationship with this person.

 

Week 4: Cardiovascular

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StJudeMedical_CardioMEMS_monitoring_sensorThe CardioMEMS HF System is a small implantable device for patients with heart failure, hypertension, peripheral neuropathy and other additional cardiovascular disorders that eventually result in heart failure. This device was created with the purpose of better managing heart failure in patients from their homes. The CardioMEMS HF is a sensor/ monitor device that is smaller than a dime and does not require any batteries. The device is placed through the distal pulmonary artery. Once home, the patient’s heart rate and artery pressures will be monitored daily by the CardioMEMS HF; on the other side, at a health facility, a physician or nurse will review the information. If there is an abnormality noted then a change to the patient’s medical therapy will be made. Through the use of CardioMEMS HF, the researchers hope to decrease hospitalizations by not having the patients come in to the hospital until they are experiencing severe symptoms from HF. In other words, the aim is to reduce hospitalizations through early interventions.

In regards to my opinion regarding CardioMEMS HF, I think it’s a great idea in that it could possibly decrease hospitalizations through early intervention; however, I find it a bit difficult on how the healthcare workers are going to get in contact with the patient to change the medical regimen when they identify an abnormality. Furthermore, in the case when the patient does have the CardioMEMS HF is implanted I believe that the patient should use standard self-monitoring in conjunction; this includes: self-monitoring of blood pressures.

Below is the link regarding CardioMEMS HF.

http://www.ucsf.edu/news/2014/10/119411/new-miniature-device-monitors-heart-failure-patients-remotely

Ethics

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I chose the second bullet scenario which has to do with seeing another student in which I have unresolved conflict with.

Principals 5 – Show respect and dignity for other individuals, 6- Understand your own personal bias and avoid imposing this bias on others, and 7- Continue to deal appropriately when working with persons whom you feel some aversion are the most applicable in this situation because no matter what you should always treat other with respect,  whatever is going on between me and another student/student leader is between us and I should not give a bias opinion to another student about the student I am having conflict with, and whether the other person and I do not like it, we have to work together in order to accomplish a common goal/task.

Some different ways in dealing with this situation is to always act appropriate with this other person, or to try and talk to this person about how we can resolve whatever the situation is, because sometimes people just need a good talk to realize that the person they have conflict with is not an enemy and can actually end up having a lot in common and turn out be friends or really great friends.

Some consequences of follow up actions are just not coming up with a resolution and just making things worse than they were before.

The second scenario I chose was if I was attracted to person I have tutored and I asked for a “go between” friend to see if he had interest in me as well.

Principles 8- Act appropriately when working with persons for whom you feel attraction and 9- Knowing and managing my emotional response, while helping another, is crucial to your own well-being and to your ability to help, because sometimes you cannot deny feelings but knowing how manage those emotions is very important.

Some different ways of dealing with this situation is by really thinking through all the different possibilities that can come from either a.) getting together or b.) just maintaining the relationship  we already have.

Some consequences could be getting together, not working out and then ruining the relationship in which we initially had.

Cardiovascular Technology

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After navigating my way through the web I found an interesting website that illustrated some of the most recent technological advances in the medical world. Although this site has multiple devices for all different kinds of medicine, I am going to focus on the new devices I saw that are related to cardiovascular health. The first item are the wellness wristbands that everyone seems to be purchasing to monitor things such as heart rate and the amount of steps taken during the day. However, this new wellness band not only can just monitor heart rate, distance, etc, but it can actually now determine the individual’s body fat percentage and track the amount of fat lost and gained. Even though it sounds like a great product that could be utilized by people to become more heart healthy when trying to exercise and lose weight, I am curious is to how accurate the device is. Some serious clinical trials and studies will have to be completed before I would recommend this device to patients.

The second device is wearable medical sensor. Basically, this sensor allows for continuous monitor of the individuals pulse and oxygen saturation levels. Not only is the new piece of technology far lese bulky than other pulse oximeters, but is flexible (almost like a Band-Aid) therefore allowing it to be utilized wherever, whenever, and for however long. I think this would give the ability for patients with cardiovascular disease to see how activities affect oxygen demand and if they have heart failure how they can monitor for oxygen insufficiency.

The last device I would like to talk about is called “A Cardiologist in Your Pocket.” I thought this was the neatest piece of technology because it allows doctors and patients to have a stethoscope that will record the individual’s heartbeat and pulse. These sounds and pulses will then be transmitted through Bluetooth into the individual’s mobile phone where then the doctor and individual can listen to them and determine if there is a problem or concern. I like this idea because I think this would be a great application for people who may live in rural communities where medical help is not easily accessible. They can also then send PCP vital information that can be tracked not only giving them the ability to catch problems earlier, but also to watch for certain trends such as declining health etc.

In conclusion, all of these products will continue to advance medicine, but the only concern is how accurate are these new forms of technology? Even though the three devices mentioned above would be beneficial for cardiac patients, they first must all be tested and studied to determine if they are accurate and effective. If you would like to learn more about these devices go check out…

 

http://latestmedicaltechnology.net/

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