In this paper you will read the scenario and present a position on that issue. Papers shall cite a minimum of three sources. One of the sources must be from the text, one must be an Internet source (with hyperlink) and the third may be from any source (print, personal experience, Internet, learned treatise, journal, etc.). You shall cite each source in APA format.

In this paper you will read the scenario and present a position on that issue. Papers shall cite a minimum of three sources. One of the sources must be from the text, one must be an Internet source (with hyperlink) and the third may be from any source (print, personal experience, Internet, learned treatise, journal, etc.). You shall cite each source in APA format.

In this paper you will read the scenario and present a position on that issue.  Papers shall cite a minimum of three sources. One of the sources must be from the text, one must be an Internet source (with hyperlink) and the third may be from any source (print, personal experience, Internet, learned treatise, journal, etc.). You shall cite each source in APA format.

New medical treatments, by strict definition, are not the “current medical practice.” Should a physician be immune from liability for harm suffered from a patient who is among the first to be treated in a new and innovative manner in which the potential risks have not been discovered? Report on a new and possibly innovative medical treatment (i.e., medication or medical procedure, diagnostic tests, etc.) where there exist uncharted waters about the possible outcome. Review carefully the Perez case and the Hardi case as a starting point.

This week assignment I need a (650-words minimum). In this paper you will read the scenario and present a position on that issue.  Papers shall cite a minimum of three sources. One of the sources must be from the text, one must be an Internet source (with hyperlink) and the third may be from any source (print, personal experience, Internet, learned treatise, journal, etc.). You shall cite each source in APA format.

New medical treatments, by strict definition, are not the “current medical practice.” Should a physician be immune from liability for harm suffered from a patient who is among the first to be treated in a new and innovative manner in which the potential risks have not been discovered? Report on a new and possibly innovative medical treatment (i.e., medication or medical procedure, diagnostic tests, etc.) where there exist uncharted waters about the possible outcome. Review carefully the Perez case and the Hardi case as a starting point.

Remarks from the Prof. (hopeful we can improve this week) still have 3 more short story.
Good paper and commentary. It contained and illustrated several valid points. *Expand your discussion more fully for more points. Your reasoning could be further expanded. Good effort.
Reading ( you would have to goggle the cases)
Perez v. Wyeth Laboratories, Inc., available in Doc Sharing
– Liabilities created by pharmaceutical direct advertising to consumers

•         Hardi v. Mezzanotte, pp. 405-412
– Delayed, uncertain, or shared responsibility of medical error

•         Herskovits v. Group Health Cooperative of Puget Sound, pp. 425-435
– The “Loss of Chance” doctrine of damages
PEREZ v. WYETH LABORATORIES, INC.
713 A.2d 520 (1998)
313 N.J. Super. 511
Saray PEREZ, Cheryl Bailey, Kimberly Bartlett, Anna Cesareo and Soraya Arias, Plaintiffs-Appellants,1
v.
WYETH LABORATORIES, INC., a subsidiary of American Home Products Corporation; American Home Products Corporation; Wyeth-Ayerst Laboratories Division of American Home Products Corporation; Wyeth-Ayerst International Inc.; Wyeth-Ayerst Laboratories Company and Dow Corning France, S.A., Defendants-Respondents.
Superior Court of New Jersey, Appellate Division.
Argued May 19, 1998.
Decided June 12, 1998.
Richard Galex for plaintiffs-appellants (Galex, Tortoreti & Tomes, Brunswick, attorneys; Mr. Galex, on the brief).
Anita Hotchkiss, Morristown, for defendants-respondents (Porzio, Bromberg & Newman, attorneys; Ms. Hotchkiss and Linda Pissott Reig, on the brief).
Before Judges DREIER, KEEFE and PAUL G. LEVY.
The opinion of the court was delivered by DREIER, P.J.A.D.
Various plaintiffs, designated as the “bellwether” parties in consolidated product liability actions, have appealed from a summary judgment determining that defendants had no duty to warn these consumers of possible adverse effects attendant upon the insertion, maintenance and removal of defendants’ Norplant contraceptive medication. Judge Corodemus in her comprehensive decision of December 5, 1997, reported at 313 N.J.Super. 646, 713 A.2d 588 (Law Div.1997), traced the history of plaintiffs’ complaints, the State of New Jersey law, out-of-state authority, and how our statutory and common law learned intermediary rules bear upon a prescription drug provider’s duty to warn the consumer of its products. We agree with her analysis and decision to select bellwether plaintiffs, as such practice of using bellwether cases is firmly established in the law. See In re Norplant Contraceptive Products Liability Litigation, 955 F.Supp. 700 (E.D.Tex.1997), in which, incidentally, Chief Judge Schell reached the same substantive result as Judge Corodemus.
While we readily affirm the summary judgment based upon the clear and scholarly opinion of Judge Corodemus, some issues nevertheless need further elaboration.
It has been argued that the Restatement (Third) of Torts: Products Liability (1998) posits an additional basis for liability to be imposed upon a manufacturer of a prescription drug for failure to warn a patient. Section 6 of the new Restatement separates defects in prescription drugs or medical devices from those in other products. Although the rules governing manufacturing defects in prescription drugs or medical devices are the same as those governing other products under § 2(b) of the Restatement, design defects and warning defects receive separate treatment. The warning defect language, contained in § 6(d), reads:
(d) A prescription drug or medical device is not reasonably safe because of inadequate instructions or warnings if reasonable instructions or warnings regarding foreseeable risks of harm are not provided to:
(1) prescribing and other health care providers who are in a position to reduce the risks of harm in accordance with the instructions or warnings; or(2) the patient when the manufacturer knows or has reason to know that health care providers will not be in a position to reduce the risks of harm in accordance with the instructions or warnings.
Subsection (d)(1) mirrors N.J.S.A. 2A:58C-4 which defines an adequate warning as
one that a reasonably prudent person in the same or similar circumstances would have provided with respect to the danger and that communicates adequate information on the dangers and safe use of the product, … in the case of prescription drugs, taking into account the characteristics of, and the ordinary knowledge common to, the prescribing physician.
The Restatement, however, adds subsection (d)(2), positing warnings being given directly to a patient “when the manufacturer knows or has reason to know that health care providers will not be in a position to reduce the risks of harm in accordance with the instructions or warnings.” The Reporters have appended Comment b, suggesting the application of this section to situations where the physician or health care provider has a “diminished role as an evaluator or decision maker.” In such an instance, the manufacturer would have a duty to provide direct warnings to the patient. Exceptions are further explored in Comment e. For example, in mass inoculations where health care providers are unable to supervise the administration of the drug and individually advise patients about the risks attendant upon the drug’s use, the manufacturer may have a duty to provide warnings.
Despite the Reporter’s suggestion of a manufacturer’s duty to warn in mass inoculations, we need not decide the outcome of such a case in New Jersey, even with the more restrictive language of N.J.S.A. 2A:58C-4. By the Legislature’s use of the words “the prescribing physician,” we might assume that it intended this statute to have effect only where there is such a prescribing physician (or other health care professional with the power to prescribe drugs, as is discussed infra). In instances such as mass inoculations where there may be no prescribing physician for the individual patients, some other form of warning might be necessary.
The more salient question in this case is whether the Legislature intended to define an adequate warning in the area of prescription drugs as one given to physicians only. It is true that the New Jersey statute speaks only of a prescribing “physician.” Are we to take this as a word of limitation limited to one licensed to practice medicine or surgery under N.J.S.A. 45:9-6, et seq.? It is clear that drugs may be prescribed by dentists (N.J.S.A. 46:6-19.5b), optometrists (N.J.S.A. 45:12-1), podiatrists (N.J.S.A. 45:5-7), nurse practitioners (N.J.S.A. 45:11-49), home health care service firms (N.J.S.A. 45:11-49.1), physician’s assistants (N.J.S.A. 45:9-27.16), or others similarly permitted to prescribe or administer drugs on a limited basis. It would be difficult to believe that the Legislature intended that warnings be geared only to those licensed to practice medicine and surgery, when the Legislature has authorized other health care professionals to provide a similar service. We thus assume that the Legislature intended to include within the term “physician” other such health care providers in the same manner as is stated in the Restatement.
In fact, in the case before us, plaintiff Perez had the Norplant® inserted by a nurse, Diane Brevet. As noted in the trial judge’s opinion, “Nurse Brevet is certified in women’s health by the National Association of Obstetricians and Gynecologists. She is authorized by law to prescribe and insert Norplant.” It would be incongruous to apply different rules to the physicians and Nurse Brevet.
We specifically agree with Judge Corodemus that the language of N.J.S.A. 2A:58C-4 precludes any general relaxation of the learned intermediary doctrine governing prescription drugs to the point where the warnings would be required to be given directly to patients, either in the general area where drugs have been advertised directly to consumers, or in the specific area of contraceptive products. The American Law Institute in Comment e to the new Restatement left this area of developing law to the progress of individual cases. The Reporters’ notes to Comment e chronicle the state of the law in this area and document the various calls to abandon the learned intermediary rule where manufacturers have marketed drugs directly to the public, but have inadequately warned the consumers. Apart from the mass inoculation situations noted earlier, where the answer might not be clear, it appears that in New Jersey the Legislature has effectively blocked the progress of the law to require such direct notification of consumers. This is consistent with the Legislature’s expressed intent to limit the expansion of product liability law in certain areas. See Roberts v. Rich Foods, Inc., 139 N.J. 365, 374, 654 A.2d 1365 (1995), and the cases there cited.
Lest it be thought that N.J.S.A. 2A:58C-4 could be read to require direct notification of consumers, because the language merely speaks of the adequacy of the warning, not to whom the warning must be given, we look at the Senate Judiciary Committee Statement included with the legislative history of the Products Liability Act. N.J.S.A. 2A:58C-1a provides that such “committee statements that may be adopted or included in the legislative history of this act shall be consulted in the interpretation and construction of this act.” That statement, which has been reproduced following N.J.S.A. 2A:58C-1 states in its relevant portion:
[A] manufacturer or seller is not liable in a warning-defect case if an adequate warning is given when the product has left the control of the manufacturer or seller…. The subsection contains a general definition of an adequate warning and a special definition for warnings that accompany prescription drugs, since, in the case of prescription drugs, the warning is owed to the physician.
We see, therefore, that the warning not only must be that which would be adequate to a prescribing physician, but also “is owed to the physician.” If the warning is legislatively deemed adequate and has been given to the proper party, we cannot find a warning defect under the Products Liability Act.
Even if the New Jersey statute did not provide the limitation that it does, the learned intermediary doctrine is firmly established in New Jersey in the area of prescription drugs. It stands for the proposition that “a pharmaceutical manufacturer generally discharges its duty to warn the ultimate user of prescription drugs by supplying physicians with information about the drug’s dangerous propensities.” Niemiera v. Schneider, 114 N.J. 550, 559, 555 A.2d 1112 (1989). See also Torsiello v. Whitehall Labs., 165 N.J.Super. 311, 323, 398 A.2d 132 (App. Div.), certif. denied, 81 N.J. 50, 404 A.2d 1150 (1979) (noting the wide acceptance of the learned intermediary doctrine in the context of prescription drug cases). Under this doctrine, the pharmaceutical manufacturer is relieved of the duty to warn patients of a drug’s potential adverse side effects if adequate warnings are given to physicians. Spychala v. G.D. Searle & Co., 705 F.Supp. 1024, 1031 (D.N.J.1988); Niemiera, supra, 114 N.J. at 559, 555 A.2d 1112; New Jersey Products Liability & Toxic Torts Law, § 6:3-3 at 68-70 (Gann 1998). Thus, the treating physician, as the learned intermediary, is solely responsible for communicating to the patient the risks involved in taking the drug. 114 N.J. at 559, 555 A.2d 1112. The rationale behind this rule is that because of the complexity of prescription drugs, “the physician is in the best position to take into account the propensities of the drug and the susceptibilities of the patient, and to give a highly individualized warning to the ultimate user based on the physician’s specialized knowledge.” Spychala, supra, 705 F.Supp. at 1031-32.
Finally, a question was raised by plaintiffs at oral argument before us concerning whether the summary judgment entered by Judge Corodemus effectively terminated the litigation involving these plaintiffs as to all claims or merely as to their complaints concerning pain and scarring, or even whether this determination is limited to the individual “bellwether” plaintiffs selected for consideration by the trial judge. We note that in this case there was no claim against the prescribing physicians for failure to warn the particular patients of the dangers covered in the manufacturers’ warnings or otherwise known to the physicians. While there may be portions of other cases for which we have not been provided the full records, it appears that in the claims before us as well as those from which these were selected to be bellwether or test cases, the only claim is against the manufacturers. Furthermore, the claim against the manufacturers has been limited to their failure to warn the patients directly, and has not included any assertion of a design or manufacturing defect in the product or a failure to provide an adequate warning to the prescribing physicians. As this is our understanding, it appears that Judge Corodemus’s resolution of the bellwether cases and this affirmance thereof, effectively disposes of all of the pending claims, and not merely those asserted in the test cases. If in fact, however, there are other claims in the cases not pending before us, we do not, nor could we, adjudicate such claims, nor can we predict the effect of this decision upon them.
In sum, while there may be a sound basis for expansion of liability in this area, the matter is one both for legislative determination and for the Supreme Court’s review of the learned intermediary doctrine as it has applied it in this area of the law.
As noted earlier, we have in this opinion merely supplemented Judge Corodemus’s opinion to answer issues raised at oral argument or in the appellate briefs that may not have been presented to her. We have not done so by way of limitation. With these additions, we affirm the summary judgment, as stated earlier, substantially for the reasons expressed in her opinion of December 5, 1997.
FOOTNOTES

1. The caption has been amended to show as plaintiffs the five “bellwether” individuals chosen from five consolidated cases, all against the same defendants. The other plaintiffs are: Camellia Daniels, Debra Little, Dria Moore, Melinda Rojas, Jamella Muhammad, Veda Sellers, Michelle Diaz and Sayed B. Pacha Said.
According to the evidence, appellee was treated by Dr. John O’Connor in 1990 for diverticulitis, an infectious process affecting the colon. In January and February of 1994, she experienced symptoms which she believed to be a recurrence of that illness. After trying without success to reach Dr. O’Connor, she saw Dr. Hardi, a Board-certified gastroenterologist, on February 3, 1994, and informed him of her suspicions and provided him with a copy of an x-ray report that Dr. O’Connor ordered after he treated her for diverticulitis. The doctor took appellee’s history and noted on her chart that Dr. O’Connor had treated her previously with antibiotics for diverticulitis. During his physical examination of appellee, Dr. Hardi felt a mass which he thought to be of gynecological origin. However, he also understood that the mass could be caused by a recurrence of diverticulitis. His medical chart does not show alternate likely causes of appellee’s condition or specify diverticulitis as one such cause. Dr. Hardi did not order a CAT-Scan, a test typically ordered when diverticulitis may be present, or initiate a course of antibiotic therapy. He informed appellee that her problems were gynecological in nature and referred her to Dr. Joel Match, a gynecologist, for a work-up with respect to the mass.
On February 8, 1994, Dr. Match saw appellee. He ordered a CA-125 blood test, which he testified is 80% reliable in predicting the existence of gynecological cancer. The test was negative for the disease. The report from the ultrasound examination, which Dr. Match ordered, revealed that there was a mass in the left lower quadrant of appellee’s abdomen, but it could not be determined whether it was diverticular or gynecological in origin. Therefore, the radiologist recommended a “close clinical and sonographic follow-up.” Notwithstanding the results of the tests, Dr. Match concluded that appellee had ovarian cancer and scheduled a complete hysterectomy (the surgical removal of her uterus, fallopian tubes and ovaries) for March 1994. Dr. Match informed Dr. Hardi of the test results. Although the blood test did not reveal cancer, and the ultrasound exam did not reveal an enlarged uterus, Dr. Hardi “cleared” the performance of gynecological surgery. Dr. Match requested that Dr. Hardi undertake further testing within his specialty in order to rule out the possibility that appellee was suffering from any gastrointestinal diseases.
On February 21, 1994, Dr. Hardi performed a sigmoidoscopy on appellee, which entailed the introduction of an endoscope into her sigmoid colon for purposes of observation. He was unable to complete the procedure after multiple attempts because of an apparent obstruction of the colon caused by the diverticulitis. Appellee’s expert witness, Dr. Robert Shapiro, explained that such an obstruction is a “red flag,” telling the doctor “there is 978*978 something wrong with the bowel.” Dr. Hardi scheduled a more intrusive procedure, a colonoscopy, performed under general anesthesia, for March 2, 1994. He attempted the procedure multiple times, without success, due to the obstruction, and desisted finally because of “fear of perforation.” He ordered Dr. Odenwald, a Sibley Hospital radiologist, to perform a third exploratory procedure, a barium enema of the sigmoid colon, but it could not be completed due to the same obstruction. Dr. Odenwald discussed with Dr. Hardi the possibility that the obstruction resulted from a gastrointestinal disease rather than gynecological cancer.
Immediately following the exploratory procedures on March 2, 1994, appellee’s condition deteriorated markedly. These procedures had exerted pressure on her sigmoid colon and caused the spread of her diverticular infection. Appellee was admitted as an emergency patient to Columbia Hospital for Women on March 7, 1994. By then, her diverticular abscess had ruptured, resulting in peritonitis (i.e., infection of the abdomen). Dr. Match ordered a CAT-Scan on March 7, 1994. However, appellee’s condition precluded the use of contrast media. Dr. Match also ordered an ultrasound that day, which proved to be non-diagnostic. On March 8, 1994, appellee had surgery which involved removal of her noncancerous reproductive organs. During surgery, multiple infectious abscesses and pus were encountered. Dr. Hafner, the general surgeon who performed the operation, removed the infectious matter from the patient’s abdomen, excised the affected portion of her bowel, and performed a colostomy. After surgery, Dr. Hafner informed appellee’s husband that she had diverticulitis, not gynecological cancer. Appellee had a slow recovery due to peritonitis and associated complications, and ultimately, she was required to undergo four additional surgical procedures, involving a “take-down” of her colostomy and the correction of hernias caused by the related weakening of her abdominal wall. These surgical procedures extended into March 1996. Appellee spent a total of eighty-three days as an inpatient at Columbia Hospital for Women and George Washington University Hospital, and a nursing home.

Appellants argue that the trial court awarded costs to appellee which are not recoverable. Specifically, they contend that the costs related to the earlier mistrial are not taxable against them in the second trial. Alternatively, they challenge specific costs, including certain witness fees, deposition transcripts, copying costs, and medical records. Appellee responds that some of appellants’ arguments are moot, as the trial court reduced the amount she requested originally, excluding some of their requested costs. Further, she contends that costs associated with the first trial were awarded properly, as the second trial was based upon the testimony and exhibits from the first.
Pursuant to Super. Ct. Civ. R. 54(d), costs may be awarded to the prevailing party. Harris v. Sears Roebuck & Co., 695 A.2d 108, 109 (D.C.1997) (citing Super. Ct. Civ. R. 54(d)(1)) (other citations omitted). The rule provides that “costs other than attorneys’ fees shall be 986*986 allowed as of course to the prevailing party unless the Court otherwise directs ….” Super. Ct. Civ. R. 54(d)(1). “The authority of a court to assess a particular item as costs is partly a matter of statute (or court rule), and partly a matter of custom, practice, and usage.” Robinson v. Howard Univ., 455 A.2d 1363, 1368-69 (D.C.1983) (citing Newton v. Consolidated Gas Co., 265 U.S. 78, 44 S.Ct. 481, 68 L.Ed. 909 (1924) (annotation and other citation omitted)). Under Super. Ct. Civ. R. 54-I(b), the costs of depositions and transcripts may be taxed as costs, in the trial court’s discretion. Witness fees are recoverable as costs upon compliance with certain technical requirements of Super. Ct. Civ. R. 54-I(a). Whether to award costs is committed to the trial court’s discretion, and, upon review, it is not for the appellate court to substitute its discretion for that of the trial court. Harris, 695 A.2d at 110; Robinson, 455 A.2d at 1369 (citations omitted). With these general principles in mind, we consider the trial court’s order awarding costs and appellants’ challenges to it.
The trial court awarded costs to appellee in the amount of $14,903.92.[6] Appellants contend that there was included improperly in this amount costs incurred in the first jury trial associated with the claim against Dr. Match and the mistrial. They contend that it was error to award these costs because appellee was not the prevailing party on either claim in the first trial. Further, they contend that the only costs necessary for the retrial of appellee’s claims were for trial transcripts, which totaled $1,773.00.
In support of their argument that costs related to the mistrial are not taxable, appellants cite United States v. Deas, 413 F.2d 1371 (5th Cir.1969). Deas concerned whether costs of a mistrial could be taxed under a federal statute, 28 U.S.C.A. § 1918(b), to a criminal defendant convicted in a subsequent trial. Id. at 1372-73. The statute permitted an assessment of costs upon conviction.[7] The court held that where the previous mistrial was “due solely to the jury’s failure to agree upon a verdict,” separate court costs were not encompassed within the provisions of the statute. Id. In reaching this conclusion, the court considered that: (1) levying such costs upon a criminal defendant “is a deprivation of property that may be imposed only in accordance with reasonable and narrowly defined standards;” (2) it would have the effect of penalizing a defendant for the government’s failure of proof in the first case; and (3) it might have a deterrent effect on the right of the accused to plead not guilty and go to trial the second time. Id. at 1372. No similar statute or considerations are present here.
Moreover, in this case, there was no new presentation of the evidence, since the parties agreed to a second trial by the court based on the record of the testimony and evidence adduced at the first trial. Thus, the costs incurred for the first trial essentially were used to produce the evidence used again in the second 987*987 trial. Appellee had not previously recovered the costs of the presentation upon which she later prevailed. Under these circumstances, the trial court could properly exercise its discretion to award these costs, which were necessary for the presentation of appellee’s case.[8] “An appellant contesting an award of costs `bears the burden of convincing this court on appeal that the trial court erred …. [and] the burden is even greater when the standard of review is abuse of discretion. “`Talley v. Varma, 689 A.2d 547, 555 (D.C.1997) (quoting Robinson, supra, 455 A.2d at 1370). Appellants filed in the trial court an opposition in response to appellee’s bill of costs in which it attempted to meet this burden, and appellee filed a reply. With all this information before it, the trial court, with a full knowledge of the issues and arguments, rejected appellants’ argument that the costs it awarded were not necessary to the presentation of appellee’s medical malpractice action. Having reviewed the record related to the costs awarded, we conclude that appellants have failed to demonstrate that the trial court abused its discretion in this regard.

 

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Select and describe a specific healthcare operating unit. Examples are an emergency department, a surgical service, a specific nursing unit, and a physician’s office practice. Select a type of healthcare service you are familiar with. Locate at least three recent (within the past four years) journal articles from professional and peer-reviewed journals that discuss dashboard, balanced scorecard, or performance measurement. Write a brief review of the articles, giving complete citations.

Performance Measures

Performance Measures

Order Description

Performance Measures

In healthcare, the terms “balanced scorecard” and a “dashboard” are used to describe performance measurement tools that are broad in scope but summarized in a few key

indicators. In this assignment, you will create a specific dashboard for an operating unit of a healthcare organization.

Tasks:

Select and describe a specific healthcare operating unit. Examples are an emergency department, a surgical service, a specific nursing unit, and a physician’s office

practice. Select a type of healthcare service you are familiar with.
Locate at least three recent (within the past four years) journal articles from professional and peer-reviewed journals that discuss dashboard, balanced scorecard, or

performance measurement. Write a brief review of the articles, giving complete citations.
On the basis of the literature review and your knowledge of the unit, create four categories of measurement. They must include both clinical and financial categories.

Describe the categories and write a justification for each.
For each category, create at least three specific performance measures. For each measure, describe how it is calculated and where the data can be found.
Explain how the performance measures may change if the unit of analysis is the organization as a whole and not the specific operating unit.

 

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5. The issues for determination by the Tribunal are: – Did Mrs. Smith receive age pension in excess of her entitlement for the period 15 August 2012 to 1 October 2014? – If so, is the excess payment a debt? – If it is, is the debt recoverable?

SECTION 37 DOCUMENTS (T DOCUMENTS)

AAT No: 2015/0001
Applicant: Betty Smith
Respondent: Secretary of the Department of Community Services

1. Mrs. Smith has been in receipt of age pension since 15 August 2012.

2. On 14 November 2014 a Centrelink officer made a decision to raise and recover a debt of age pension of $21,000.50 in respect of the period
15 August 2012 to 1 October 2014.

3. Mrs. Smith requested a review of this decision. The decision was reviewed and affirmed by an Authorised Review Officer (ARO) on 5 January 2015.
4. On 6 January 2015 Mrs. Smith appealed to the Social Security Appeals Tribunal (“the Tribunal”). Half of the debt had been repaid by the date of the hearing.

ISSUES

5. The issues for determination by the Tribunal are:

– Did Mrs. Smith receive age pension in excess of her entitlement for the period 15 August 2012 to 1 October 2014?
– If so, is the excess payment a debt?

– If it is, is the debt recoverable?

INFORMATION PROVIDED AT THE HEARING

6. Mrs. Smith provided the following information to the Tribunal on the day of the hearing:
– She thought Centrelink would update their information about how much money she had in her bank account automatically.
– When Centrelink asked her to inform them of her financial investments she didn’t include the term deposit because she did not have immediate access to those funds.

She had a cataract operation in October 2012. She wanted her neighbour, Mr. Bye, to help her read the letters but he was on a holiday in the Cotswolds U.K, so she

didn’t read the letters while he was away. After the operation she could read the letters but found that it strained her eyes and made her eyes weepy. She said she

could read properly for about three days after the operation but she didn’t read the letters because she had misplaced her glasses.
– She suffered depression when her pet cockatoo, Bertie, died, her best friend for 30 years. She did not receive medication for this depression, but she withdrew from

socialising and spent more time at home.
– She read the letter of 17 August 2012 but thought it was a mere typographical error and that since she had given the information only a couple of days before she

didn’t need to do it again.
– She did not read the other letters from Centrelink because she thought she was receiving the correct pension rate so didn’t think anything was wrong, she thought her

details were correct.
– Repayment of the debt has caused her stress. She now has less than $1,000 in her everyday bank account, and is finding it difficult to pay bills and the rent.
– Her husband died five years ago, she has been lonely ever since; he used to handle their financial matters.

DOCUMENTS

7. The Tribunal had access to Mrs. Smith’s Centrelink paper and electronic files. The Tribunal had particular regard to the following documents:
– Details of Mrs. Smith’s savings balances during the period under review;
– Mrs. Smith’s Centrelink file including payment summaries, debt calculations, debt recovery actions, contact records, ARO letter and decision; and

– Centrelink letters to Mrs. Smith dated 17 August 2012, 30 October

2012, 30 June 2013, 1 October 2014, and 30 October 2014.

DISCUSSION OF THE EVIDENCE & FINDINGS OF FACT

8. Mrs. Smith applied for age pension on 15 August 2012 in person at her local Centrelink branch.
9. On 17 August 2012 Centrelink sent Mrs. Smith a letter asking her to check her details and financial investments and to inform Centrelink if the information was

incorrect. There is no record of Mrs. Smith contacting Centrelink.
10. On 30 October 2012 Centrelink sent a letter imposing certain obligations on Mrs. Smith to advise of matters which might affect her pension rate. She was asked to

advise Centrelink if her financial investments were over
$1,000. There is no record of Mrs. Smith contacting Centrelink.

11. On 30 June 2013 Centrelink sent another letter, the same as in paragraph

10 above. Mrs. Smith was asked to advise Centrelink if her financial investments were over $1,000. There is no record of Mrs. Smith contacting Centrelink.
12. On 1 October 2014 Centrelink sent another letter asking Mrs. Smith to advise Centrelink if her financial investments were over $1,000. There is no record of

Mrs.Smith contacting Centrelink.
13. On 30 October 2014 Centrelink sent Mrs. Smith a letter stating that she

has been overpaid $21,000.50 in age pension which she owes as a debt to the Commonwealth. Centrelink records show Mrs. Smith called Centrelink on 3 November 2014 to

ask why she owed a debt to the Commonwealth.

APPLICATION OF THE LAW

14. According to the Social Security Act 1991(“the Act”), the amount overpaid is a debt to the Commonwealth.

15. Mrs. Smith has repaid part of the debt in this case and accordingly there are no grounds to write off the debt.

16. Under the Act, there is no reason to waive the right to recover the debt and there are no special circumstances that warrant the waiver of the debt.

Dear Mrs. Smith

Term Deposit Account Number: 342434 2612 0410 3245

Term deposit details –

Amount: $50,000

Period: 3 years

Start Date: 1 December 2011

Date of maturation: 1 December 2014

Interest amount: 3% per annum

Balance as of 15 January 2012: $50,000CR

If you have any queries regarding your term deposit please contact one of our customer services officers on 123 456, our operating hours are Monday to Friday 8.00am to

8.00pm.

Kind Regards,

Clark Kal-El

RichBank branch manager, Smallville

T3

CRN: 0001S
Mrs. Betty Smith
8 Peacock Place
Smallville NSW
2123

17 August 2012

Dear Mrs. Smith,

Thank you for your application for age pension on 15 AUGUST 2012.

You gave Centrelink the following details. Please check that these details are correct. If these details are not correct, please contact Centrelink immediately. It is

important these details are correct as your age pension will be calculated on the information you give us.

Marital status: Widowed
Dependent children: Nil Own home: No Living in an aged care facility: No Bank Accounts: Yes
$1,000 savings account
Government bonds: Nil Loans: Nil Shares or options: Nil Managed investments: Nil Other country pensions: Nil Current employment: None Own any other real estate: No

Life insurance policies: Nil Disabilities: Nil

Based on the above information, your pension rate per fortnight is $695.30.

Thank you for your co-operation.
? T4
RichBank Smallville Branch
BSB: 362436
Everyday Account Statement

Mrs. Betty Smith
8 Peacock Place
Smallville NSW
2123

1 September 2012

Dear Mrs. Smith

Everyday Account Number: 362436 8150 2650 3280
For period beginning: 1 May 2012 and ending 31 August 2012. Opening balance: $9,288.05CR
Closing balance: $10,000CR

Transaction details: Balance:

1 June 2012 Deposit of $340.95 $9,629CR
1 July 2012 Deposit of $240 $9,869CR
1 August 2012 Deposit of $131 $10,000CR

No further transaction details for period. End of statement.

If you have any queries regarding your banking please contact one of our customer services officers on 123 456, our operating hours are Monday to Friday 8.00am to

8.00pm.

Kind Regards,

Clark Kal-El

RichBankSmallville

T5

CRN: 0001S

Mrs. Betty Smith
8 Peacock Place
Smallville
2123

30 October 2012

Dear Mrs. Smith,

Your age pension rate per fortnight is $695.30

WHAT YOU MUST TELL US

You must tell us within 14 days (28 days if residing outside Australia) if any of these things happen, or may happen. You can tell us by writing to us, by phoning or

you can come in and talk to us at any of our offices. This is an information notice given under the social security law.

INCOME
– if your combined income changes, not including financial investments;
– if you or your partner start work or recommence work;
– if you or your partner start any form of profession, trade, business or self employment;
– if you or your partner buy or sell any shares or managed investments;
– if you or your partner receive any bonus shares;
– if you or your partner receive a lump sum amount of money or one-off payment from any source;

ASSETS
– if your combined assets other than financial investments are more than $0;
– if you and your partner’s combined financial investments are more than
$1,000;
– if you or your partner start any new accounts;
– if you or your partner gift assets or sell them for less than their value;

OTHER THINGS YOU MUST TELL US
– if you stop living with your partner;
– if you divorce or your partner dies;
– if you or your partner move into a nursing home. Thank you for your co-operation.
? T6
RichBank
Smallville Branch
BSB: 362436
Everyday Account Statement

 

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You will be required to provide a 2500-word written submissions based on a fictional AAT fact scenario. The scenario will include (as much as possible)

Administrative Appeals Tribunal (AAT) Written Submission

Administrative Appeals Tribunal (AAT) Written Submission

Order Description

Administrative Law Assignment
(2500-word Administrative Appeals Tribunal (AAT) Written Submission)

Before getting started, please be noted that ALL of your work has to be based on AUSTRALIAN sources and authorities. If you have not complied with any of my

instructions provided below, I will have to ask you to edit the essay. (For your information, this has happened quite often and I had to ask the writer to edit more

than four times in one instance). Thank you for taking my work and I look forward to your awesome work.

Instructions: You will be required to provide a 2500-word written submissions based on a fictional AAT fact scenario. The scenario will include (as much as possible)

tribunal documents as attachments. A more detailed description along with the assignment and other resources will be attached for your information. The aim of this

assessment is to allow students an opportunity to adopt a problem-solving, process-focused approach along with practising the application of legal knowledge in the

manner required by the legal profession.

You MUST footnote in accordance with the Australian Guide to Legal Citation (3rd edition)
(‘AGLC’). The AGLC is available through the UTS Library in both electronic and hardcopy forms. It is also available here:

http://www.law.unimelb.edu.au/files/dmfile/FinalOnlinePDF-2012Reprint.pdf . Do not use previous editions of the AGLC as they are substantially different.

FACT SCENARIO

Mrs. Betty Smith is now 70 years old. She retired in 2012 at the age of 67. She applied for age pension on 15 August 2012. Mrs. Smith lives around the corner from her

local Centrelink branch and walked into this local branch to fill in the appropriate application form for age pension.

The application form asked her to state her financial assets and financial investments. Mrs. Smith stated that she had $10,000 in financial investments as this was the

amount of money she had in her everyday banking account. She omitted to tell Centrelink she had a $50,000 term deposit which would mature on 1 December 2014. As Mrs.

Smith could not access the money in the term deposit, she did not consider this to be money she needed to tell Centrelink about.

The Centrelink customer services officer (CSO), Wilma, took the application form from Mrs. Smith and input the information into Centrelink’s computer system. However,

Wilma mistakenly input $1,000 instead of $10,000 for Mrs. Smith’s financial investments.

On 17 August 2012, Centrelink sent Mrs. Smith a letter asking her to check her details. The letter requested Mrs. Smith to check that the amounts entered on Centrelink

records were correct. The letter stated that Mrs. Smith had $1,000 in her bank account. Mrs. Smith thought this was a typing error and ignored the notice as she had

filled in the application form only a couple of days earlier with $10,000.

On 30 October 2012, Centrelink sent another letter asking Mrs. Smith whether she had more than $1,000 in financial investments. Mrs. Smith, who was still recovering

from her cataract operation, which she had on 15 October 2012, wanted to get her neighbour, Mr. Bye, to read the letter for her but Mr. Bye was away on holidays in the

U.K. Instead, she turned the Centrelink letter into a liner for the bottom of her birdcage.

On 30 June 2013, Centrelink sent Mrs. Smith a further letter requesting her to update her financial investments if they had changed. Mrs. Smith did not read the letter

and used it again to line her birdcage. During this time she was deeply upset by the death of her pet cockatoo, Bertie, who had been her pet
for 30 years.
On 1 October 2014, Centrelink sent a further letter to Mrs. Smith requesting her to update her financial investments. Mrs. Smith did not read the letter.

On 30 October 2014, Mrs. Smith received a letter from Centrelink stating she had been overpaid $21,000.50 in the age pension between 15 August 2012 and 1 October 2014

which was a debt owed to the Commonwealth.

Centrelink has recovered half the debt in a lump sum and the remainder is being deducted from her age pension payments in instalments.

BRIEF FOR THE APPLICANT

You are the legal representative for Mrs. Betty Smith, the Applicant in this application.

Mrs. Smith has made an application to the Administrative Appeals Tribunal (AAT) seeking a review of the decision of the Social Security Appeals Tribunal (SSAT). The

SSAT has affirmed a decision by a Centrelink Authorised Review Officer (ARO) that Mrs. Smith has been overpaid the age pension and has therefore incurred a debt to the

Commonwealth.

Centrelink is the service provider for the Respondent in this application: the Secretary of the Department of Human Services.

From the information provided, you must prepare and present arguments to the AAT as to why Mrs. Smith does not owe the Commonwealth a debt and an alternative argument

that if she does owe a debt, why the debt should be waived.

Your argument must be in the form of submissions and should cite relevant case law and sections of the relevant Act(s) to support your arguments.

NOTE: The calculation of Mrs. Smith’s debt and overpayment is NOT an issue. Please assume that she qualifies for the age pension; that her rate of pension is correct

on the basis of the information she gave to Centrelink, and the debt amount has been calculated correctly.

BRIEF FOR THE RESPONDENT

You are the legal representative for the Secretary of the Department of Human Services, the Respondent in this application.

Mrs. Betty Smith, the Applicant in this application, has made an application to the Administrative Appeals Tribunal (AAT) seeking a review of the decision of the

Social Security Appeals Tribunal (SSAT). The SSAT has affirmed a decision by a Centrelink Authorised Review Officer (ARO) that Mrs. Smith has been overpaid the age

pension and has therefore incurred a debt to the Commonwealth. Centrelink is the service provider for the Respondent.

From the information provided, you must prepare and present arguments to the AAT as to why Mrs. Smith owes the Commonwealth a debt and why that debt should not be

waived.

Your argument must be in the form of submissions and should cite relevant case law and sections of the relevant Act(s) to support your arguments.

NOTE: The calculation of Mrs. Smith’s debt and overpayment is NOT an issue. Please assume that she qualifies for the age pension; that her rate of pension is correct

on the basis of the information she gave to Centrelink, and the debt amount has been calculated correctly.

 

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Students are required to provide discussion and analysis of the relevant nursing care required providing evidence of wide reading.

identify and prioritise the clinical issues identified within the clinical scenario provided.

INSTRUCTION
This assessment is a written discussion to identify and prioritise the clinical issues identified within the clinical scenario provided.
The purpose of this essay is for students to present a comprehensive discussion linking the health issues identified through a client assessment to the impact they have on the client and their level of function in the community setting. It requires the student to prioritise the health issues and to show analysis of the complexity of care provision demonstrating critical reflection on practice.
Students are required to provide discussion and analysis of the relevant nursing care required providing evidence of wide reading.

1.Please follow the instruction, case scenario and marking criteria.
2. Please use journal article AND books to be reference ONLY. APA style.
3. The references must be within 5 years and Australian.
4. This is an essay. So please use essay style.
For example:
Introduction:
One paragraph
Body:
Three paragraph (Not limit)
Conclusion:
One paragraph

 

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For adults on the medical-surgical unit in a hospital, will the use of bed alarms reduce the number of falls per year, compared to usual care, as defined by fall risk protocol by nursing staff?

Bed alarm

Bed alarm

Order Description

For adults on the medical-surgical unit in a hospital, will the use of bed alarms reduce the number of falls per year, compared to usual care, as defined by fall risk

protocol by nursing staff?
P: Falls; Adult patients aged 18 years of age and older; Medical-surgical unit
I: Use of bed alarms
C: Usual care, as defined by fall risk protocol by nursing
O: To reduce the number of falls
CPG: https://www.guideline.gov/content.aspx?id=36906&search=falls+medical+surgical+and+fall+prevention

do a literature review/crituqe on 2 articles. 1/2 page per article is suggested. Please post your 2 articles again this week – it was suggested to avoid any meta

analysis or meta synthesis – look back at the 2 articles previously posted and your article was one of these, please look for another article – hint: this can be the

articles previously critiqued and submitted but must pertain to our project – when you post your 2 articles, please list your reference for your article as it should

be listed on the reference page – In with your literature review/critique you need to make sure you list the following:
Review of evidence for or against our recommended practice i.e. bed alarms or usual care, summative statement on evidence, practice implication from your finding and

recommendations for practice.
Lastly, we all need to do a 1 page part for the paper regarding recommended practice interventions. I reviewed our clinical practice guideline and here are the

assignments I have made for this part:
Ngozi – performing risk assessments to identify risk factors –
– Communicating risk factors i.e. patient education, visual cues
– establish a process for evaluation of the hospitalized patient for risk of falling
– performing environmental risk factor interventions
– falls prevention program for organization
– observation/surveillance – sitters, time rounding
The above information came from the interventions listed under our clinical practice guideline. Click on the link above to open the page and scroll down and you will

see these interventions listed. If you continue looking through the guideline you will see additional information for each intervention
Please write only on ? performing risk assessments to identify risk factors, the one that bears my name.( 1 page)
Literature review/critique on 2 articles ? page per article.

Effectiveness of Intervention Programs In Preventing Falls: A Systematic Review of Recent 10 Years and Meta-Analysis.

 

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Grand theory discussion:  identify and discuss the inter-related concepts from your selected theory.  What aspects of the nursing meta-paradigm are addressed by your grand theory?  Then provide information about how you will view your POI through the lens of the grand theory.  How does the theory guide your assessment of the POI?

Theoretical and Ethical basis of practice paper

Theoretical and Ethical basis of practice paper

For this assignment, you will be further defining your Phenomenon of Interest within a theoretical and ethical framework.

The same Phenomenon of Interest (POI) identified in your first written paper should also be used for this assignment.  You will begin this paper by providing a concise

description of your POI, this information should be a short summary of information your presented in your first paper.

Next, you will  discuss the Fawcett’s Meta-paradigm of Nursing and relate the paradigm directly to your POI. How do the four concepts (PATIENT, ENVIRONMENT, HEALTH,

AND NURSING) within the meta-paradigm relate to your POI? Is one more important? Do all four have the same level of importance?  You should support this section with

peer reviewed references as appropriate.  Specifically identify the components of the meta-paradigm within your discussion. Be sure to reference the meta-paradigm

appropriately.

Then, you will select both a Grand nursing theory as well as a Middle range nursing theory.

Take time to review several examples of each type of theory as the selected theories need to “fit” your POI…and work well together.

Grand theory discussion:  identify and discuss the inter-related concepts from your selected theory.  What aspects of the nursing meta-paradigm are addressed by your

grand theory?  Then provide information about how you will view your POI through the lens of the grand theory.  How does the theory guide your assessment of the POI?

How does the theoretical framework chosen categorize or define your POI? How does the theoretical framework effect your perception of the POI?

Middle range theory discussion: identify and discuss the inter-related concepts within the middle range theory.  What aspectsof the nursing meta-paradigm are addressed

in the mid-range theory? How will this theory guide your assessment/perception of the POI?  How does this mid range theory relate to your grand theory?

Complexity science: how does complexity science relate to your POI?  Depending on the nature of your POI, this conversation may have different foci for different

students.  For example, if your POI is glycemic management of the peri-operative patient, this discussion would center on the complex responses of the human body as a

Complex Adaptive System.  If your POI is focused on a policy change issue, the focus may be on organizational complexities with communication, change, etc.

Ethical framework:  you should discuss your specific POI in the context of ethical principles.  Basic principles include autonomy, justice, beneficence, and non-

maleficence. Is your POI in violation of a core ethical principle?  Is it possible it may be in violation?  What ethical principles do you need to be sure to

safeguard?

Conclusion:  this section should not contain any new information but should only provide a summary of what what discussed in the paper.

 

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Write a paper (1,500-2,000 words) in which you analyze and appraise each of the (15) articles identified , Pay particular attention to evidence that supports the problem, issue, or deficit, and your proposed solution.

“About Catheter-Associated Urinary Tract Infection” (2013). Center for Disease and Control Retrieved from http://www.cdc.gov/hai/pdfs/uti/ca-uti_tagged.pdf

Write a paper (1,500-2,000 words) in which you analyze and appraise each of the (15) articles identified , Pay particular attention to evidence that supports the

problem, issue, or deficit, and your proposed solution.

Hint: The Topic 2 readings provide appraisal questions that will assist you to efficiently and effectively analyze each article.

“About Catheter-Associated Urinary Tract Infection” (2013). Center for Disease and Control
Retrieved from http://www.cdc.gov/hai/pdfs/uti/ca-uti_tagged.pdf
Summary of Article:

The author breaks down aspects of catheter-associated urinary tract infections. The authors specifically examine silver oxide-coated catheters.

Research Elements: Design, Methods, Population, Strengths, Limitations:

The authors provide an evidence-based synopsis of preventative approaches for both urinary and central line-related infections.  The purpose is to contemplate the

evidences supporting particular prophylactic techniques.

Outcome(s): Research Results:

These results reveal that numerous variables affected the occurrence of CAUTI’s and that the silver impregnated catheter seemed to have helped to prevent CAUTI’s

amongst women not getting antibiotics.

Foxman, B. (2002). Epidemiology of Urinary Tract Infections: Incidence, Morbidity, and Economic Costs. The American Journal of Medicine 113(1): 5-13.
Summary of Article:

The author breaks down aspects of CAUTI’s including its prevention, pathogenesis and epidemiology.  This is performed through a qualitative research process by

examining research from previous sources.

Research Elements: Design, Methods, Population, Strengths, Limitations:

Both qualitative and quantitative methods were operated to understand all areas including epidemiology, pathogenesis, and prevention. They wanted to determine that

inability to stratify patients by main risk influences, particularly catheter duration, sex, and antibiotic exposure, makes analysis of several tests incomprehensible.

Outcome(s): Research Results:

Further research of pioneering catheter system design, targeted antimicrobial prophylaxis, and bacterial-host epithelial cell relations, seem like the most probable

methods to managing UTI’s yet to come.

Goetz, A.M., and S. Kedzuf (1999) Feedback to Nursing Staff as an Intervention to ReduceCatheter-associated Urinary Tract Infections American Journal of Infection

Control 27(5): 402-404
Summary of Article:

Researchers Goetz and Kedzuf (1999) decided to try a new form of intervention in order to reduce rates of catheter-causing urinary tract infection.  The authors

provided nurses with detailed feedback about the rates at the hospital to see if it would improve the outcome.

Research Elements: Design, Methods, Population, Strengths, Limitations:

Nursing staff associates were given quarterly reports with CAUTI occurrences shown by graphs on each unit. Within the 18 months following this intervention, the

average UTI frequency diminished to 17.4/1000 catheter-patient-days (95% CI, 14.6-20.6, P = .002)

Outcome(s): Research Results:

The authors concluded that feedback of each unit to each unit of nosocomial CAUTI rates to nursing staff is an extremely beneficial approach of decreasing infection

occurrences and cutting expenses related to nosocomial UTI’s.

Jain, P., J.P. Parada, and A. David (2005) Overuse of the Indwelling Urinary Tract Catheter inHospitalized Medical Patients Arch Med. 155(13): 1425-1429.
Summary of Article:

Researcher Jain examines intervention to reduce catheter-causing infections—specifically the overemployment of indwelling urinary tract catheters of hospital patients.

Research Elements: Design, Methods, Population, Strengths, Limitations:

As stated by the researcher, the method was the following: “This prospective study involved 202 patients admitted to either the medical intensive care unit (n=135) or

the medical floors (n=67) of a tertiary care university hospital who were catheterized during the hospital admission. An independent observer assessed the indication

of initial catheterization by chart review and interview with the patient and the nurse. “

Outcome(s): Research Results:

The IUTCs are considerably over utilized in l patients and vigilant notice to this facet of patient care might decrease catheter-related difficulties through primary

prevention.
Johnson, J.R., Roberts P.L, and R.J. Olsen (2009).Prevention of Catheter-Associated Urinary Tract Infection with a Silver Oxide-Coated Urinary Catheter: Clinical and

Microbiologic Correlates. The Journal of Infectious Diseases 162(5): 1145-1150.
Summary of Article:

Johnson examines a general overview of how to prevent catheter-related bacteria including urinary tract infection. Specific attention was provided for the silver

oxide-coated urinary catheter.

Research Elements: Design, Methods, Population, Strengths, Limitations:

Johnson utilized a study that observed patients from similar demographics. The participants provided their consent to be observed.  The author was able to determine

possible causes as well as implications of the outcomes of patients that were at risk for UTI’s.

Outcome(s): Research Results:

Johnson concluded that additional research of advanced catheter system design is necessary to improve catheter insertion and bacteria resistance.

Karchmer, T.B., and E.T. Giannetta (2000). A Randomized Crossover Study of Silver-Coated Urinary Catheters in Hospitalized Patients Arch Intern Med. 160(21): 3294-

3298.
Summary of Article:

The author’s objective was to measure the efficiency of silver-impregnated urinary catheters for the avoidance of nosocomial CAUTIs.

Research Elements: Design, Methods, Population, Strengths, Limitations:

The Author’s approach was a 12-month randomized crossover trial-compared occurrences of CAUTI’s in patients with silver-impregnated vs. non silver impregnated

catheters. A cost examination was organized.

Outcome(s): Research Results:

The author concluded that the chance of infection deteriorated by 21% amongst random patients, who received silver-impregnated catheters and by 32% amongst patients in

which silver-impregnated catheters were operated on the units.  The utilization of the more costly silver-coated catheters seemed to present expense reserves by

avoiding additional expenditures from CAUTI’s.

Nazarko, L. (2013). Recurrent Urinary Tract Infection in Older Women: an Evidence-Based Approach”. British Journal of Community Nursing. 18(8): 407-412
Summary of Article:

Author L. Nazarko (2013) inspects an evidence-based method in recurring UTI’s amongst older women in her research piece—particularly, why age is such a significant

issue in women with the infection. Aging, according to Nazarko, enlarges the risk of women acquiring the ailment. Additional connected ideas are investigated in her

editorial counting improper use of antibiotics when doctors misdiagnose older women.  “Antibiotic therapy has costs as well as benefits and can lead to changes in gut

and vaginal flora that further predispose women to UTI” (Pg. 407).

Research Elements: Design, Methods, Population, Strengths, Limitations:

The author tackles these stages in an evidence-based way with the use of research.  Her qualitative method permits her to operate current studies done on the matter to

derive terminations about UTIs amongst the elderly.

Outcome(s): Research Results:

Nazarko’s evidence based approach to UTIs among elderly women educates us that evidence based practice is an incredibly valuable function in a nursing setting.  We

should use EBP in every-day actions such as a UTI’s because it has the ability to run into bigger problems.

Nicolle, L.E. (2005). Catheter-Related Urinary Tract Infection Drugs and Aging 22(8): 627-639.
Summary of Article:

Nicolle explores features of CAUTI including epidemiology, acquirement of infection, antimicrobial treatment, diagnosis, prevention and infection, and complications.

Research Elements: Design, Methods, Population, Strengths, Limitations:

Qualitative researched utilized several studies that involved previous hospital records from the last ten years.  Events of catheter-related urinary tract infections

were examined to understand their possible causes and complications.

Outcome(s): Research Results:

The author concluded the following: “Complications of infection may be prevented by giving antibacterials immediately prior to any invasive urological procedure, and

by avoiding catheter blockage, twisting or trauma.”

Richards, M.J., Edwards, J.R., and D.H. Culver. (2009). Nosocomial Infections in Pediatric Intensive Care Units in the United States. Pediatrics. 103(4): 39-52.
Summary of Article:

The authors’ objectives were to define the occurrence of CAUTI’s in pediatric intensive care units (ICUs) in America.

Research Elements: Design, Methods, Population, Strengths, Limitations:

The Methods used in the study were the following: Info was gathered from January 1992 till December 1997 from 61 pediatric ICUs in the USA, by means of the regular

inspection procedures and nosocomial infection site delineations of the National Nosocomial Infections Surveillance System’s ICU surveillance component.

Outcome(s): Research Results:

The authors concluded that blood infections were the greatest widespread nosocomial infection. The spreading of infection sites and bacteria fluctuated with age and

from that registered from adult ICUs.

Saint, S. (2000). Clinical and Economic Consequences of Nosocomial Catheter-Related Bacteria. American Journal of Infection Control. 28(1): 68-75.
Summary of Article:

Saint reviews the clinical and economic consequences of catheter-causing urinary tract infections.  His research is based on qualitative study of various forms of

data.
Research Elements: Design, Methods, Population, Strengths, Limitations:

Utilizing quantitative research, Saint observed patients with indwelling catheters for 2 to 10 days. He then gathered data on those patients to determine who obtained

a urinary tract infection and the possible causes. Specific focus was on the economic impact and consequences of these infections placed on hospitals.

Outcome(s): Research Results:

The author concluded the following: “Each episode of symptomatic urinary tract infection is expected to cost an additional $676, and catheter-related bacteremia is

likely to cost at least $2836.”

Saint, S., S.H. Savel, and M.A. Matthay. (2002). Enhancing the Safety of Critically Ill Patients by Reducing Urinary and Central Venous Catheter-Related Infections.

American Journal     of Respiratory and Critical Care Medicine. 165(2): 1475-1479.
Summary of Article:

The authors state that augmenting the protection of seriously sick patients necessitates that intensive care experts be cognizant of the developed techniques for

avoiding CAUTI’s and CLAB’s
Research Elements: Design, Methods, Population, Strengths, Limitations:

The authors provide an evidence-based synopsis of preventative approaches for CAUTI’s and CLAB’s..  The object is to contemplate the evidences supporting particular

preventive techniques, and paying more notice to interventions that may be controversial.

Outcome(s): Research Results:

“Infections due to CVCs are common among the critically ill and lead to substantial morbidity and healthcare costs. Several new methods will likely reduce the

incidence of this common patient safety problem, including the use of: (1) maximum sterile barriers during catheter insertion; (2) CVCs coated with an antimicrobial

agent; and (3) CHG at the insertion site.”
Saint, S., and B.A. Lipsky. (1999). Preventing Catheter-Related Bacteriuria. Arch Intern Med.  159(8): 800-808
Summary of Article:

Saint examines a general overview of how to prevent catheter-related bacteria including urinary tract infection. The author utilized a study that observed over 10

hospitals with patients ranging from ages 30-50.

Research Elements: Design, Methods, Population, Strengths, Limitations:

As mentioned above, Saint utilized a study that observed patients from similar demographics. The participants provided their consent to be observed.  The author was

able to determine possible causes as well as implications of the outcomes of patients who were at risk for a urinary tract infection.

Outcome(s): Research Results:

Saint concluded that additional research in the areas of groundbreaking catheter system design is essential to improve catheter insertion and bacteria resistance.

Stamm, W. E. (1991). Catheter-Associated Urinary Tract Infections: Epidemiology, Pathogenesis, and Prevention. The American Journal of Medicine. 91(3): S65-S71.
Summary of Article:

The author breaks down aspects of CAUTI’s including its prevention, epidemiology, and pathogenesis.  This is performed through a qualitative research process by

examining research from previous sources.

Research Elements: Design, Methods, Population, Strengths, Limitations:

Both qualitative and quantitative methods were utilized to understand all areas including epidemiology, pathogenesis, and prevention. They wanted to determine that

failure to stratify patients by major risk factors, particularly catheter duration, sex and antibiotic exposure, and makes perception of numerous tests

incomprehensible.

Outcome(s): Research Results:

Additional research of a new catheter system design, targeted antimicrobial prophylaxis, and bacterial-host epithelial cell interaction, seem the most probable methods

to governing UTI’sc in the future.

Trautner, B.W., and R.O. Darouiche. (2004). Catheter-Associated Infections. Arch Intern Med. 164(8): 842-850.
Summary of Article:

Trautner explores aspects of catheter-related urinary tract infection including epidemiology, acquisition of infection, diagnosis, antimicrobial treatment, prevention

and infection, and complications.

Research Elements: Design, Methods, Population, Strengths, Limitations:

Qualitative researched utilized several studies that involved previous hospital records from the last ten years.  Events of catheter-related urinary tract infections

were examined to understand their possible causes and complications.

Outcome(s): Research Results:

The author decided that further research is necessary to prevent UTIs including possible alternatives to catheters.

Warren, J. W. (2001). Catheter-Associated Urinary Tract Infections. International Journal of Antimicrobial Agents. 17(4): 299-303.
Summary of Article:

Warren examines a specific urinary tract infection known as the nosocomial UTI, which is the most widespread type. The author points out that instance of catheter-

related UTIs have decreased, but more research is needed to improve this.

Research Elements: Design, Methods, Population, Strengths, Limitations:

The author utilized a qualitative research technique. He examined external sources to understand the best procedures for eliminating catheter-induced urinary tract

infection.

Outcome(s): Research Results:

Warren’s conclusions were: “Once a catheter is put in place, the clinician must keep two concepts in mind: keep the catheter system closed in order to postpone the

onset of bacteriuria, and remove the catheter as soon as possible. If the catheter can be removed before bacteriuria develops, postponement becomes prevention.”

Topic 2: Checklist
Review of Literature and Incorporating Theory

Instructions:

This checklist is designed to help students organize the weekly exercises/assignments to be completed as preparation for the final capstone project proposal. This

checklist will also serve as a communication tool between students and faculty. Comments, feedback, and grading for modules 1-4 will be documented using this

checklist.

Topic     Task    Completed    Comments / Feedback    Points
Review of Literature
•    Analyze and appraise each of the 15 articles identified in module 1.  (15 articles).            _____ / 90
•    Analysis organized using the sample provided in “Sample Format for Review of Literature.”
_____ / 10
Total    _____/100

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Next, you will  discuss the Fawcett’s Meta-paradigm of Nursing and relate the paradigm directly to your POI. How do the four concepts (PATIENT, ENVIRONMENT, HEALTH, AND NURSING) within the meta-paradigm relate to your POI?

Theoretical and Ethical basis of practice paper

For this assignment, you will be further defining your Phenomenon of Interest within a theoretical and ethical framework.

The same Phenomenon of Interest (POI) identified in your first written paper should also be used for this assignment.  You will begin this paper by providing a concise description of your POI, this information should be a short summary of information your presented in your first paper.

Next, you will  discuss the Fawcett’s Meta-paradigm of Nursing and relate the paradigm directly to your POI. How do the four concepts (PATIENT, ENVIRONMENT, HEALTH, AND NURSING) within the meta-paradigm relate to your POI? Is one more important? Do all four have the same level of importance?  You should support this section with peer reviewed references as appropriate.  Specifically identify the components of the meta-paradigm within your discussion. Be sure to reference the meta-paradigm appropriately.

Then, you will select both a Grand nursing theory as well as a Middle range nursing theory.

Take time to review several examples of each type of theory as the selected theories need to “fit” your POI…and work well together.

Grand theory discussion:  identify and discuss the inter-related concepts from your selected theory.  What aspects of the nursing meta-paradigm are addressed by your grand theory?  Then provide information about how you will view your POI through the lens of the grand theory.  How does the theory guide your assessment of the POI?  How does the theoretical framework chosen categorize or define your POI? How does the theoretical framework effect your perception of the POI?

Middle range theory discussion: identify and discuss the inter-related concepts within the middle range theory.  What aspectsof the nursing meta-paradigm are addressed in the mid-range theory? How will this theory guide your assessment/perception of the POI?  How does this mid range theory relate to your grand theory?

Complexity science: how does complexity science relate to your POI?  Depending on the nature of your POI, this conversation may have different foci for different students.  For example, if your POI is glycemic management of the peri-operative patient, this discussion would center on the complex responses of the human body as a Complex Adaptive System.  If your POI is focused on a policy change issue, the focus may be on organizational complexities with communication, change, etc.

Ethical framework:  you should discuss your specific POI in the context of ethical principles.  Basic principles include autonomy, justice, beneficence, and non-maleficence. Is your POI in violation of a core ethical principle?  Is it possible it may be in violation?  What ethical principles do you need to be sure to safeguard?

Conclusion:  this section should not contain any new information but should only provide a summary of what what discussed in the paper.

 

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