JUST NEED A RESPONSE TO THESE DISCUSSION QUESTIONS1) Natasha1. Torrance Memorial HospitalMission: To improve the community health within the scope and expertise of its resources; Offer the most current and effective medical technologies rendered in a compassionate, caring manner; Maintain long-term stability in order to assure its strength and viability for the benefit of the community.Values: The employees, physicians and volunteers of Torrance Memorial Medical Center support our mission through a set of core values. Each and every member of our care team promotes recovery and healing by embracing these values.This was a very weak statement that did not list the set of core values that they spoke of. The company didn’t include a vision statement. What is the hospitals vision for improvement in the community’s health? The mission statement should resonate with both employees and the community. Ethical considerations that were not included was patient safety, error reduction, autonomy, and how to resolve disagreements.2. St. Mary’s HospitalMission: Rooted in the loving ministry of Jesus as healer, we commit ourselves to serving all persons with special attention to those who are poor and vulnerable. Our Catholic health ministry is dedicated to spiritually centered, holistic care which sustains and improves the health of individuals and communities. We are advocates for a compassionate and just society through our actions and our words.Vision: We envision a strong, vibrant, Catholic health ministry in the United States which will lead to the transformation of healthcare. We will ensure service that is committed to health and well-being for our communities and that responds to the needs of individuals throughout the life cycle. We will expand the role of laity, in both leadership and sponsorship, to ensure a Catholic health ministry of the future.Values: We are called to: Service of the Poor, Reverence, Integrity, Wisdom, Creativity, DedicationOverall these are great statements that reflect the company’s goals, professional responsibility and accountability. I don’t think there are any elements that should be excluded. 3. Simi Valley HospitalMission: Is to demonstrate God’s love by providing exceptional service and quality care to meet the physical, mental, and spiritual needs of our community.Values: Compassion, Integrity, Excellence, and RespectVision: To provide high-quality care within the scope of services appropriate to the needs of the people we serve. Ethical considerations that could have been addressed include; Autonomy of choice, confidentiality, avoiding harm, improving access to care and addressing end of life issues. A more detailed vision statement identifying where the company sees itself in the future should have been included.4. Scripps health in San DiegoMission: Scripps strives to provide superior health services in a caring environment and to make a positive, measurable difference in the health of individuals in the communities we serve.Vision: Scripps health will continue to be the leading health care delivery system in the greater San Diego community, as evidenced by the highest clinical quality, patient safety, and patient, physician and employee satisfaction. This will be achieved through unending focus on patient-centered and compassionate care, cost-effective operations, research, advanced technology and innovation.Values: We provide the highest quality of service, we demonstrate complete respect for the rights of every individual, and we care for our patients every day in a responsible and efficient manner.These statements address a variety of ethical concerns and considerations which includes; patient rights, quality of care, employee satisfaction, and building relationships with patients. 5. Riverside Community HospitalMission: Riverside Community Hospital is committed to the care and comfort of our patients and improving the overall health of our community by providing healthcare services within integrity, compassion and excellence.Vision: Riverside Community Hospital will be the employer and provider of choice by offering comprehensive healthcare services whose cornerstones are quality, safety, compassion, and service excellence.Values: Passion for excellence, Integrity, Dignity, Teamwork, Diversity’Patient safety and error reduction raise several ethical concerns. These issues include reducing and preventing risk of harm and promoting patient well-being; truth telling, honesty, and integrity; maintaining patient trust; respecting patient autonomy; and professional responsibility and accountability’ (Erlen, 2007).ReferencesDoran, E., Fleming, J., Jordens, C., Stewart, C.L., Letts, J., & Kerridge, I.H. (2005). Managing ethical issues in patient care and the need for     clinical ethics support. Australian Health Review, 39(1), 44. doi: 10.1071/AH14034Erlen, J. (2007). Patient safety, error reduction, and ethical practice. Orthopaedic Nursing, 26(2), 140-133 4p.————————————————————————————————————————————————2)tammyThe term ‘moral distress’ originated in the nursing literature as a label for situations is which nurses feel compelled, for various reasons, to perform acts that are morally questionable in their eyes. Balancing institutional barriers or duties with individual moral responsibility within intense situations requires serious reflective deliberation. Ranging from clinical case studies and examples to theological and ethical reflections, this group has begun to clarify a working concept and its scope. In this situation you are dealing with two diagnoses/prognoses that are at stake. The underlying chronic diseases of Huntington’s which has no available treatment and a beak long term prognosis.; and you have a drug overdose in which there are effective and available treatments for the acute diagnoses.One has to wonder whether further aggressive medical treatment is advisable. They think it may be futile or even harmful. Should the emphasis in care switch to providing comfort for the remainder of life, rather than continuing  a struggle that cannot be won? It’s one thing to make an argument and another thing to act on it. This case of treatment refusal  potentially life sustaining  treatment when the competency of the patient to decide if questionable. as well as the distinction between the acute and chronic conditions of the patient. The precedent for one of these cases is clear. The acute condition is treatable and the harm of not treating is very great. So when  the patients preferences are unclear treatment can be provided for the life threatening condition allowing the patient to discuss his preference regarding his chronic condition at a later time. If treatment to the acute condition would be considerably less effective,  the decision might have been different regarding the patients beliefs and certain about his competency to decide to refuse. His surrogate (wife) is available and is requesting them to proceed with the gastric emptying. Understanding the difficult that Huntington’s can be on an individual especially seeing his own mom die with this disease, maybe now that his wife knows she can give him all the support he needs to get out of this depression state of mind. The underlying chronic disease of Huntington’s has no available treatment but there are effective treatments available for the acute diagnoses of drug overdose. Even though the patient has a legal right to refuse treatment,  he is in a state of unconsciousness and his wife is requesting treatment. The emergency has to weigh various competing legal and regulatory duties by the duty to respond to per hospital emergencies and disasters of respect for patient autonomy and is expressed in the legal doctrine of informed consent. In following the request of John’s wife, the outlook on life might  be different for John. One cannot assume what one doesn’t know. Maybe this was a wake up call to a second chance to life with a different and supportive balance and maintain a comfortable level of life that remains for John.Resources:  Yale University(Nod). IRB cases Retrieved from http://www.yale.edu/bioethics/research-irbcases.shtm ; Norms of Ethical Healthcare  Administration

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