Is this an Externality?

For this assignment, please read the attached news story about litigation over odor and other nuisances from hog farms in North Carolina.Then answer the question, do you think that this counts as an externality?An important but often overlooked element of economic policy is the need to discover the givens of our economic models.We can apply the models developed in this class to examine taxing, regulating, or otherwise addressing externalities, once the existence of the externality is established, or stipulated.But before they can be stipulated, society first must consider and determine if there is an externality involved in such a case at all.Once decided, it is easy to recognized the consensus that, say, automobile exhaust is an externality.In contemporary or ongoing cases, there is more disagreement.

Do you agree with the verdicts awarding damages to the neighbors in this case?Do you think the jury awards are justified?Is the court system likely to result in good decisions in such cases?Why or why not?Are there other cases you might be familiar with where you think the court system produced good or poor decisions on whether to proceed.

Please write 2 to 3 pages on this topic.

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Question Description

CASE STUDY

This case study from the peer-identified nurse expert project illustrates Benner’s approach to knowledge development in clinical nursing practice (Brykczynski, 1993–1995, 1998). The project was undertaken to identify and describe expert staff nursing practices. Exemplars were obtained and participant observations conducted to yield narrative text that was interpreted through Benner’s multiphase interpretive phenomenological process (Benner, 1984a, 1994). In the final phase of data analysis, Benner’s (1984a) domains and competencies of nursing practice were an interpretive framework. A critical aspect of using Benner’s practice approach is that domains and competencies form a dynamic evolving interpretive framework, which is used to interpret the narrative and observational data collected. The nurse who described this situation had approximately 8 years of experience in critical care. She shared that her project participation was significant to her practice because it taught her how to integrate care of a family in crisis along with care of a critically ill patient. Thus this was a paradigm case for that nurse, who learned many things from it that affected her future practice.

“Mrs. Walsh, a woman in her 70s, was in critical condition after repeat coronary artery bypass graft (CABG) surgery. Her family lived nearby when Mrs. Walsh had her first CABG surgery. They had moved out of town but returned to our institution, where the first surgery had been performed successfully. Mrs. Walsh remained critically ill and unstable for several weeks before her death. Her family was very anxious because of Mrs. Walsh’s unstable and deteriorating condition, and a family member was always with her 24 hours a day for the first few weeks.

The nurse became involved with this family while Mrs. Walsh was still in surgery, because family members were very anxious that the procedure was taking longer than it had the first time and made repeated calls to the critical care unit to ask about the patient. The nurse met with the family and offered to go into the operating room to talk with the cardiac surgeon to better inform the family of their mother’s status.

One of the helpful things the nurse did to assist this family was to establish a consistent group of nurses to work with Mrs. Walsh, so that family members could establish trust and feel more confident about the care their mother was receiving. This eventually enabled family members to leave the hospital for intervals to get some rest. The nurse related that this was a family whose members were affluent, educated, and well informed, and that they came in prepared with lists of questions. A consistent group of nurses who were familiar with Mrs. Walsh’s particular situation helped both family members and nurses to be more satisfied and less anxious. The family developed a close relationship with the three nurses who consistently cared for Mrs. Walsh and shared with them details about Mrs. Walsh and her life.

The nurse related that there was a tradition in this particular critical care unit not to involve family members in care. She broke that tradition when she responded to the son’s and the daughter’s helpless feelings by teaching them some simple things that they could do for their mother. They learned to give some basic care, such as bathing her. The nurse acknowledged that involving family members in direct patient care with a critically ill patient is complex and requires knowledge and sensitivity. She believes that a developmental process is involved when nurses learn to work with families.

She noted that after a nurse has lots of experience and feels very comfortable with highly technical skills, it becomes okay for family members to be in the room when care is provided. She pointed out that direct observation by anxious family members can be disconcerting to those who are insecure with their skills when family members ask things like, “Why are you doing this? Nurse ‘So and So’ does it differently.” She commented that nurses learn to be flexible and to reset priorities. They should be able to let some things wait that do not need to be done right away to give the family some time with the patient. One of the things that the nurse did to coordinate care was to meet with the family to see what times worked best for them; then she posted family time on the patient’s activity schedule outside her cubicle to communicate the plan to others involved in Mrs. Walsh’s care.

When Mrs. Walsh died, the son and daughter wanted to participate in preparing her body. This had never been done in this unit, but after checking to see that there was no policy forbidding it, the nurse invited them to participate. They turned down the lights, closed the doors, and put music on; the nurse, the patient’s daughter, and the patient’s son all cried together while they prepared Mrs. Walsh to be taken to the morgue. The nurse took care of all intravenous lines and tubes while the children bathed her. The nurse provided evidence of how finely tuned her skill of involvement was with this family when she explained that she felt uncomfortable at first because she thought that the son and daughter should be sharing this time alone with their mother. Then she realized that they really wanted her to be there with them. This situation taught her that families of critically ill patients need care as well. The nurse explained that this was a paradigm case that motivated her to move into a CNS role, with expansion of her sphere of influence from her patients during her shift to other shifts, other patients and their families, and other disciplines” (Brykczynski, 1998, pp. 351–359).

Domain: The helping role of the nurse

This narrative exemplifies the meaning and intent of several competencies in this domain, in particular creating a climate for healing and providing emotional and informational support to patients’ families (Benner, 1984a). Incorporating the family as participants in the care of a critically ill patient requires a high level of skill that cannot be developed until the nurse feels competent and confident in technical critical care skills. This nurse had many years of experience in this unit, and she felt that providing care for their mother was so important to these children that she broke tradition in her unit and taught them how to do some basic comfort and hygiene measures. The nurse related that the other nurses in this critical care unit held the belief that active family involvement in care was intrusive and totally out of line. A belief such as this is based on concerns for patient safety and efficiency of care, yet it cuts the family off from being fully involved in the caring relationship. This nurse demonstrated moral courage, commitment to care, and advocacy in going against the tradition in her unit of excluding family members from direct care. She had 8 years of experience in this unit, and her peers respected her, so she was able to change practice by starting with this one patient-family situation and involving the other two nurses who were working with them.

Chesla’s (1996) research points to a gap between theory and practice with respect to including families in patient care. Eckle (1996) studied family presence with children in emergency situations and concluded that in times of crisis, the needs of families must be addressed to provide effective and compassionate care. The skilled practice of including the family in care emerged as significantly meaningful in the narrative text from the peer-identified nurse expert study. This was defined as an additional competency in the domain called the helping role of the nurse and was named maximizing the family’s role in care (Brykczynski, 1998). The intent of this competency is to assess each situation as it arises and develops over time, so that family involvement in care can adequately address specific patient-family needs, and so they are not excluded from involvement nor do they have participation thrust upon them.

This narrative illustrates how Benner’s approach is dynamic and specific for each institution. The belief that being attuned to family involvement in care is in part a developmental process is supported by Nuccio and colleagues’ (1996) description of this aspect of care at their institution. They observed that novice nurses begin by recognizing their feelings associated with family-centered care, whereas expert nurses develop creative approaches to include patients and families in care. The intricate process of finely tuning the nurse’s collaboration with families in critical care is delineated further by Levy (2004) in her interpretive phenomenological study that articulates the practices of nurses with critically burned children and their families.

Review:Benner’s Stages by Ashlie Whitt (Links to an external site.)Links to an external site.

QUESTIONS

1. Regarding the various aspects of the case as they unfold over time, consider questions that encourage thinking, increase understanding, and promote dialogue, such as: What are your concerns in this situation? What aspects stand out as salient? What would you say to the family at given points in time? How would you respond to your nursing colleagues who may question your inclusion of the family in care?

2. Using Benner’s approach, describe the five levels of competency and identify the characteristic intentions and meanings inherent at each level of practice.

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Select a family to complete a family health assessment. (The family cannot be your own.)

Before interviewing the family, develop three open-ended, family-focused questions for each of the following health patterns:

1. Values, Health Perception
2. Nutrition
3. Sleep/Rest
4. Elimination
5. Activity/Exercise
6. Cognitive
7. Sensory-Perception
8. Self-Perception
9. Role Relationship
10. Sexuality
11. Coping

NOTE: Your list of questions must be submitted with your assignment as an attachment.

After interviewing the family, compile the data and analyze the responses. 

In 1,000-1,250 words, summarize the findings for each functional health pattern for the family you have selected.

Identify two or more wellness nursing diagnoses based on your family assessment. Wellness and family nursing diagnoses are different than standard nursing diagnoses.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

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In this week’s discussion question you were asked to consider a potential problem (appropriate to your role option) that you would like to investigate through nursing research. For this assignment you will review current research from South’s Online Library and provide a critical evaluation on that research through an annotated bibliography. An annotated bibliography is a brief summary and analysis of the journal article reviewed. For more information on annotated bibliographies please visit Purdue’s OWL: https://owl.english.purdue.edu/owl/resource/614/01/

A total of four annotated bibliographies are to be submitted (not to exceed one page each). The articles must come from nursing scholarly literature and may not be older than 5 years since publication. Please note that the articles must be research based and reflect a quantitative methodology (review our reading assignments). Web pages, magazines, textbooks, and other books are not acceptable. 

Each annotation must address the following critical elements:

• Explanation of the main purpose and scope of the cited work
• Brief description of the research conducted
• Value and significance of the work (e.g., study’s findings, scope of the research project) as a contribution to the subject under consideration
• Possible shortcomings or bias in the work
• Conclusions or observations reached by the author
• Summary as to why this research lends evidence to support the potential problem identified specific to your role option.

** My submitted discussion and bibliography, choose 4 for the assignment:

Diabetes has achieved epidemic levels in the US, making effective management a high priority in the health care system struggling to simultaneously enhance care and lower cost. Family nurse practitioners (FNPs), which is my nursing specialty, have become much more aware of the significance of this preventable epidemic and have the fundamental knowledge, insight and resources to help diagnosis, treat and manage patients that are at risk of being diagnosed with diabetes or already have it. My reason for researching diabetes is because there still continues to be a major communication gap between patients and FNPs on the overall treatment and management of diabetes and its related medical conditions. The need for FNPs to educate diabetes patient on self-management strategies is imperative. However, it appears that many FNPs educate diabetes patients in one fashion. The problem with this is that each patient has a different cultural background, so FNPs need to tailor diabetes self-management strategies/plans that are going to be effective based on the patients cultural background.

My library research strategy for this project is to examine multiple databases, such as the National Library of Medicine, the National Institutes of Health, and PubMed, Society for Biomedical Diabetes Research, as well as government agencies and professional nursing organizations that have reported the most up-to-date evidence-based practices for diabetes research. In doing so, I must utilize search terms that are relevant to diabetes. Some of these identifiable concept search terms include (but not limited to) blood glucose, diabetes, diabetes mellitus, type-1 and type-2, hemoglobin A1C, hyperglycemia, and insulin; just to name a few.

According the 2014 National Diabetes Statistics Report, there are 29.1 million individuals in the United States that have diabetes, of which 21 million of the total individuals have been diagnosed with diabetes and the remainder, 8.1 million individuals are either underdiagnosed or have not been diagnosed as of yet (CDC, 2014). This statistics are alarming, to say the very least.

Provider-patient self-care communication is fundamental to enhancing patient adherence, yet various boundaries exist that undermine successful healthcare provider-patient self-care communication. From the health care professional point of view, the most regularly referred to barrier to self-care communication is time. Researchers, Bundesmann & Kaplowitz (2011), conducted a study of family medicine practices found that the time physicians went through talking about self-care with their patients shifted from 1 to 17 minutes, proposing that time is a noteworthy obstruction to self-care correspondence. Different obstructions incorporate absence of joint effort and cooperation among healthcare professionals, absence of patients’ access to resources, and lack of psychosocial support for patients with diabetes (Bundesmann & Kaplowitz, 2011). Relatedly, Beverly and associates found that doctors frequently feel deficiently prepared to address diabetes patients’ psychosocial issues and this apparent absence of aptitude may add to doctors feeling overpowered and disappointed inside the provider–patient relationship, which may hinder open self-care correspondence ((Beverly et al., 2011).

From the patient’s perspective of self-care diabetes communication, boundaries have a tendency to vary from those apparent by healthcare providers. In one subjective review with healthcare providers and patients, both noticed that patients were hesitant to discuss self-care for the fear of being judged or disgraced about food intake and weight (Ritholz, Beverly, Brooks, Abrahamson, & Weinger, 2014). This finding was bolstered in a quantitative follow-up study surveying patient hesitance to talk about self-care. According to the article, 30% of studied patients reported hesitance to examining self-care with their healthcare providers because of a paranoid fear of being judged, not having any desire to frustrate their provider, guilt, and shame (Beverly et al., 2012).

Diabetes self-management is a key element in the overall management of diabetes. Identifying barriers to disease self-management is a critical step in achieving optimal health outcomes. According to Holt and his fellow colleagues, they explained that knowledge of the pathophysiology and pharmacology of diabetes structures the establishment of care. It encourages composing scripts and observing substance changes, however this information alone is not adequate (2013). A fundamental comprehension of the social and psychological parts of diabetes care is likewise required. Care that does include acknowledgment and comprehension of these parts of the disease prompts to dissatisfaction, outrage, frustration, weakness, disruption, and burnout for both the healthcare provider and the patient. This prompts to a feeling of disappointment and the additional barrier of “idleness” (Holt et al., 2013). The healthcare provider, patient, or both feel that there is no hope and pass on that sense through activities, words, and nonverbal conduct. However, in another article from Shrivastava, Shrivastava, & Ramasamy (2013), they determined that socio-demographic and cultural boundaries have been barriers to why diabetes patient lack self-care management strategies. As one can clearly see from the literature above, there are varying barriers that comprise the communications between providers and patients when it comes to diabetes self-care management.

One solution to this problematic issue would be to implement a psychoeducational training program that would educate healthcare providers on being more culturally competent and to teach them various techniques for motivational interviewing of patients with diabetes.

References

Beverly, E. A., Ganda, O. P., Ritholz, M. D., Lee, Y., Brooks, K. M., Lewis-Schroeder, N. F., Weinger, K. (2012). Look Who’s (Not) Talking: Diabetic patients’ willingness to discuss self-care with physicians. Diabetes Care, 35(7), 1466-1472. doi:10.2337/dc11-2422

Beverly, E. A., Hultgren, B. A., Brooks, K. M., Ritholz, M. D., Abrahamson, M. J., & Weinger, K. (2011). Understanding Physicians’ Challenges When Treating Type 2 Diabetic Patients’ Social and Emotional Difficulties: A qualitative study. Diabetes Care, 34(5), 1086-1088. doi:10.2337/dc10-2298

Bundesmann, R., & Kaplowitz, S. A. (2011). Provider communication and patient participation in diabetes self-care. Patient Education and Counseling, 85(2), 143-147. doi:10.1016/j.pec.2010.09.025

CDC. (2015). 2014 Statistics Report | Data & Statistics | Diabetes | CDC. Retrieved from https://www.cdc.gov/diabetes/data/statistics/2014s…

Holt, R. I., Nicolucci, A., Kovacs Burns, K., Escalante, M., Forbes, A., & Hermanns, N. (2013). Diabetes Attitudes, Wishes and Needs second study (DAWN2™): Cross-national comparisons on barriers and resources for optimal care-healthcare professional perspective. Diabetic Medicine, 30(7), 789-798. doi:10.1111/dme.12242

Ritholz, M. D., Beverly, E. A., Brooks, K. M., Abrahamson, M. J., & Weinger, K. (2014). Barriers and facilitators to self-care communication during medical appointments in the United States for adults with type 2 diabetes. Chronic Illness, 10(4), 303-313. doi:10.1177/1742395314525647

Shrivastava, S., Shrivastava, P., & Ramasamy, J. (2013). Role of self-care in management of diabetes mellitus. Journal of Diabetes & Metabolic Disorders, 12(1), 14. doi:10.1186/2251-6581-12-14

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