Nicholle Macadangdang HSC 4700 Spring 2016

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Contents Page Section Page

Contents Page.............................................................................................................................. i

Introduction ................................................................................................................................ ii

I - Technical Report

i) Four Case Scenarios .................................................................................................................3

ii) Five Journal Article Summaries ..............................................................................................10

iii) Professional Interview ..........................................................................................................21

iv) Five Scientific Journals from Health Science Courses ............................................................24

v) Three Samples Work from Upper Division Courses ................................................................27

II - Career Search

i) Job Advertisement .................................................................................................................51

ii) Cover Letter ..........................................................................................................................53

iii) Resume ................................................................................................................................55

iv) Personal Essay ......................................................................................................................59

III - Systems Analysis

i) Systems Analysis Chart ...........................................................................................................61

IV - Papers

i) Legacy Role Paper ..................................................................................................................63

ii) Alumni Role Paper .................................................................................................................65

V - Health Philosophy

i) My Philosophy........................................................................................................................69

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Introduction This portfolio showcases what I have learned through obtaining my bachelor’s degree and my ability to find a career in health sciences. In this personal portfolio, there are summaries, journals, and chosen samples of my works. The case scenarios are my problem solving and analyzing skills on certain situations involving healthcare and public health. The articles are demonstrating that I can extract information in order to use the information or share the information based on what I read in the journals. The peer-reviewed articles, are articles that I have read and analyzed through different research papers in courses. The samples of my work involved my best works based on what I learned through my courses.

I also show my ability to find a particular job that describes what I want to do with my degree and my plans in achieving my career in health administration. This portfolio is to present potential employers and health organizations my ability to perform their requirements and duties based on my expertise and knowledge.

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Four Case Scenarios

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Macadangdang, Nicholle - HSC 4700 Spring 2016 Case Scenario #6

Understanding the importance of balanced nutrition for youngsters, describe the strategies you would put forth to encourage parents to feed their children healthy food.

1. Parents should do research: The first thing parents should do is educate themselves on how to eat healthy. Eating healthy should not just be towards children but also the parents themselves. Parents may talk to a nutritionist or even their child’s school to find out more information on children’s nutrition. Another place parents can go to is Choosemyplate government website for information on nutrition.

2. Parents should be in control: In order for parents to feed their children healthy food, they need to make sure they decide what is in the home’s refrigerator and pantries. Children tend to tell their parents what they want to eat and sometimes children may want to eat something less nutritious (i.e. McDonalds chicken nuggets). When parents decide what foods and drinks to have in their household, they take better charge of their children’s diet.

3. Start Small: Children are typically picky eaters and do not like certain tastes or textures of fruits and vegetables. Parents should make an effort of having their child slowly adding vegetables as part of their meals. For example, parents should add carrot sticks to a meal that is simple to eat and pick up. Another example is using blended vegetables and adding it to pasta sauce for children to eat.

4. Be a role model: Young children will tend to follow their parents in some their eating habits. Parents should be aware of what they eat around their children when going out on restaurants. For example, if parents often eat out for burgers and fries with their children, they should be aware of what they order and choose a healthy alternative (i.e. a chicken salad and apples with yogurt dip). Children will want to try out what Mom and Dad eat when the parents choose healthier dishes.

5. Have children help with food preparation: Having children be useful in kitchen, will help them learn about food and encourage healthy eating. Parents can let their child choose a healthy recipe and maybe choose vegetables they like. Children will become more interested in what goes into their meal, gain knowledge from goes into their diet, and know how important it is to eat healthy for their bodies to grow.

6. Mood and Brain development: Children with a diet high in sugar, fats, and carbohydrates may get moody and angry. The mood swings may often be from what the child eats, which then should make the parent think about what the child should be eating. Eating healthy will also improve a child’s brain through being more attentive and not having a delay in brain development.

7. A healthier child: Children with a healthier diet will become healthier physically. Children who eat healthy will not face dental issues, like cavities due to an excess sugar diet. Children who eat healthy will also not have to face major health problems when they are older like heart disease or diabetes. Children with a healthy diet are also physically fit and grow up well because they are consuming the necessary nutrients for growth.

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Macadangdang, Nicholle - HSC 4700 Spring 2016 Case Scenario #3

You want to ensure that all senior adults at an adult facility you manage remain alert and cognitively functional for a long time. Discuss your approach to achieving this goal.

1. Monitor Patients: Senior adults may not be aware of any changes that may happen to them cognitively. Nurses and Doctors can help with their alertness just by asking their name when they need medication or when they stop by doing patient rounds. When physicians and nurses ask simple questions to the older adults, they should monitor the patient’s reactions and responses.

2. Look for Signs: Family members are usually first to see if there are any changes to their loved ones living in an adult facility. Family members should look for signs of memory loss no matter how small or if it was a matter of forgetfulness. In addition to the doctors and nurses monitoring the patient's cognitive function, family members should also ask questions, such as an important date or a name of their child. They should help the patient keep track and record the times where the patient may not remember something or may see more forgetful than usual.

3. Brochures and Information Booklets: Senior adults admitted to an adult facility should information on mental health provided from their designated doctor and people who will help aide the patient. The family of the older adult should also receive information on alertness and cognitive function to recognize what the signs of memory loss or trouble remembering or understanding might be.

4. Senior Adults and Brain Activities: The program or activities director should make brain training and mental exercising an important part of an older adult’s lifestyle. Activities such as reading, painting, and word and math puzzles. Having older adults engaged with activities that help their brain, will keep their mind stimulated and keep alert.

5. Exercise for Older Adults: Older adults that keep a daily exercise routine does not only help their bodies physically but also mentally. Seniors will keep physically and mentally fit in order to maintain great health. Exercising is known to reduce mental stress. I think exercise is important for older adults to maintain to reduce stress because being placed in an unfamiliar environment and seeing family everyday may be stressful for some seniors and exercising has the ability to engage in physical activity and keep that oxygen into the brain. This activity even applies to older adults undergoing rehab in a facility. For example, swelling in the legs through diabetes is something common for some seniors who have diabetes, they would have to walk around the halls of the facility to reduce swelling, which is also a type of exercise.

6. Communication: Communication for senior adults in the facility is very important for alertness and cognitive function. Seniors should make an effort to create a social network and not be alone. Working in a nursing home and rehabilitation facility, I have seen patients who will not have many family members visit and at times I know that some patients love talking and have someone listen to their stories. I think it is ideal to create an environment for the seniors to talk and make friends which will keep them stimulated and feel good.

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Macadangdang, Nicholle - HSC 4700 Spring 2016 Case Scenario # 7

What do you think are the most important health issues facing developing nations of the world today? These are nations primarily in Central America, Asia, Africa and South America.

1. Water Quality: People in developing nations are in need of a clean water source. In places where the economic environment is poor, people do have a place to get readily accessible clean water. Developing countries would not have enough places to get clean water, that people would have to travel far to obtain clean water. Some people would often use contaminated water to clean themselves or use water that is used by sewers or streams that are contaminated by trash and waste. Without accessible clean water, people in developing countries are more susceptible to diseases. Oftentimes, the source of most diseases in rural and developing areas are from unclean water.

2. Sanitization and Poor Living Conditions: Having experienced travelling in a developing country, in the Philippines, there were instances of awful sanitization and living qualities. The one thing I noticed being in a developing country outside of the major cities, there was poor sanitization. The low-income communities often lived in shanties made out of rubble and trash (broken plastic or metal sheets from old or destroyed buildings. The poor would also live right by major highways with just a small bed mat made out of dry braided grass. Some people lived in cemeteries, like in mausoleums of their ancestors because families could not afford homes. People did not have access to places where they could shower or have clean water. Most people had to travel long distances to get access to basic needs with no money. A lot of the poor would squat in areas that were very dirty just to beg or sell what they are able to sell. I think that most developing nations have this issue for a majority of the poorly dense low-income populations and the unsanitary living conditions.

3. Communicable Diseases: A major health issue to developing countries are communicable diseases. Populations in low socioeconomic areas are more at risk of having diseases like malaria, HIV/AID, and tuberculosis, hepatitis B, and dengue, to name several diseases. These diseases are usually from lack of clean water, poor sanitation, and lack of sexual education. People, in developing areas, are more exposed to communicable diseases that they spread rapidly. With high populations that have diseases, the low-income communities have little to no resources to help aid the sick or have access to medication. I think these diseases need to be constantly addressed by developing nations to prevent death. Also, I think that diseases can be at low-risk if the developing nation put the effort in helping the poor communities gain access to better water and sanitation, clinics, and medical aid.

4. Lifestyle and Diet: The developing nations are finding ways to help the population have better nutrition and trying to aim for people to be healthy. Unfortunately, in developing countries there are still people dying from heart diseases, diabetes, or cancer. Most developing countries are trying to be more modern and urbanize, it might be to attract more tourists or improving their nation. Industrializing the developing nations, may lead their people to be less active and more passive and sedentary because everything can be delivered or food can be retrieved through take out than eating in. People may be inactive because recreation areas are being used to build bigger buildings or stores. People who

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live in cities in developing countries do not bother to walk and just use cars as transportation. As for low income populations in urban areas of the developing countries, they do not have access to healthy diets and eat what they can afford and will fill them up fast. They are more exposed to unhealthy fast food joints with what they can afford that is cheap and filling. Low income populations may not be able to farm to grow vegetables and fruit due to a growing industrialized country, they have to resort to what they can afford. Poor populations have no access to nutrition and will often be at a higher risk of scurvy and lack other essential vitamins.

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Macadangdang, Nicholle - HSC 4700 Spring 2016 Case Scenario #2

You manage a facility which deals with expectant and postpartum mothers. You want to ensure that all expectant mothers who come to the facility have access to prenatal care. How will you ensure they have the knowledge, resources, information and access to prenatal care?

1. Information Sessions: Information sessions will help expectant mothers be more aware of the effects of receiving prenatal care. The mothers will think about the next steps to ensure they have a healthy pregnancy and birth. The session will provide them knowledge on how important it is to follow pre-natal care. Postpartum mothers can attend sessions that will help them learn how to take care of their baby and providing materials that the baby will need.

2. Access to Information Online: Sometimes mothers will not have time to attend information sessions. By having the facility post recordings of the lecture, the expectant mothers will be able to learn what they have missed in the session. The facility should also post links to health sheets for pregnant mothers and have an appointment link to have an easily accessible way to make an appointment.

3. Monitoring of Current Resources: The facility has to make sure we have enough resources to provide the expectant mothers their needs. The facility should cater to what the expectant and the postpartum want like more check-ups, visitations with doctors, or more supplies for the mother in postpartum (i.e. diapers or formula). Knowing that the facility has enough resources, those resources will be readily available to the mothers.

4. Plan for Physician Care: When expectant mothers go into a facility, they should not only receive information, but also see a doctor. It is important to have expectant mothers to regularly see their physician as part of prenatal care. The facility should stress about coming into the facility to seek a doctor’s advice and aid for expectant mothers. For example, expectant mothers communicate with their doctor if they have complications during pregnancy or request certain things during/at birth It must be stressed to see a physician to monitor the mother’s pregnancy, plans for birth, and any supplements to take. Expectant mothers also need to get tested and monitored to ensure a healthy pregnancy. If mothers cannot see a doctor physically, then the possibility of having an online appointment through webcam may suffice.

5. Keeping Track of Appointments: Scheduling appointments to expectant mothers is important part of their prenatal care. The mothers need to have a relationship with their doctors to make sure the mother communicates with their doctor based on what their needs are. They also have to make appointments regularly to effectively monitor the pregnancy and prepare for birth. Keeping track of the appointments will help expectant mothers receive their care on time.

6. Nutritional Counseling and Information: I think showing expectant mothers of eating healthy while pregnant will also help with a healthy pregnancy. The counseling would help mothers find out what to eat and drink during pregnancy and postpartum. For example, women who are overweight may get diabetes or women who are underweight can have a premature birth. Expectant mothers should know what they can eat and what to avoid. This would make expectant mothers be aware of what they eat and make sure what they put in their body will not harm the baby.

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7. Promote Classes: The facility should promote classes to help aid and support mothers into taking care of the baby. The classes can be breastfeeding classes and childbirth classes. This will help mothers be prepared and ready from pregnancy to motherhood. The classes will help promote prenatal care to gain knowledge for mothers to make an effort to want to have a safe and healthy pregnancy and birth.

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Five Journal Article Summaries

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Macadangdang, Nicholle – HSC 4700 Spring 2016 TITLE: Medical Error Prevention and Root Cause Analysis Medical error is defined the failure of a planned action to be completed as intended or the

use of a wrong plan to achieve an aim. These errors can occur when the correct action does

proceed or is an error of execution. The problem with medical errors is not knowing if the events

are preventable, could the patient be saved or could the health provider do something different to

prevent a medical error. According to the Joint Commission, the causes of medical error can be

from suicide to high radiotherapy. The study focuses on Florida’s Agency for Health Care

Administration (AHCA) and their incident report on hospital errors and ways to prevent these

errors. The AHCA reported that the most common medical errors came from surgeries that were

unrelated to the patients’ medical needs. Knowing how to prevent errors and mistakes, will

reduce medical errors.

On surgeries, surgeons can prevent errors on doing a patient’s procedure on the wrong

body part by having the surgeon sign the area they will be operating in. Another example is

every person taking part of the surgery to have a brief meeting and discuss what will happen and

what happens to the patient post-surgery. For preventing patient suicide, the staff must have

training in an event of a patient suicide and follow procedures in keeping the patient safe. For

example, the staff must keep monitoring the patient and have a safe environment for the patient.

Another preventive measure is on medication errors; patients often get the wrong medication or

dose of medication. To prevent this error, prescribers should write medication out clearly, staff

should always ask about the medication of the patient if something is unclear, and administer

medication that is properly labeled according to the patient. Another error prevention is on

patient falls. The elderly is the highest risk for patient falls for reasons that are due to a mental

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illness or intoxication. The appropriate way for staff to decrease patients falls is to train in fall

risk assessments and to have clear communication between staff and patient.

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Macadangdang, Nicholle – HSC 4700 Spring 2016 TITLE: Determinants of Internet use as a preferred source information on personal health. Today, people manage their own health through using the Internet and diagnosing

themselves with the information that is available to them with a click of a search button. People

get health information from the media or from friends and family who found information from

health-related websites. There are different reasons why people choose to obtain health

information than seeking a physician. The article studied five areas in online health information:

accessibility of the internet and information, quality of content, user characteristics, information

consulted in the internet, and impact of learning and action based on information online. The

research hypothesis of the article describes four factors to understand why people prefer the

internet to obtain health information. The four factors are beliefs, intentions, demographics, and

satisfaction. The methodology of the study focused on 36,000 participants who went on a health

website that has information on illness prevention and health promotion.

The data that was collected from the participants used a questionnaire given on the

website. The majority of the people who participated in the questionnaire were 66% women and

93% over 30 years of age. The studies’ findings were that people who went on the health website

had a common motivating factor on wanting to prevent illness either for themselves or for a

friend or family member. The results were that the usefulness of the site in finding particular

health information was a significant importance. Unfortunately, the study did not find

correlations in their five areas which were reasons that people sought after health information

online than health professionals. Other findings that were significant to the study were that

women were more likely to consult online health than men. According to the authors, a main

reason why people use online health information is to adopt a healthier lifestyle. People want to

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use health sources readily available to them through the internet and try to compare the

information they have found through other sites for credibility.

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Macadangdang, Nicholle – HSC 4700 Spring 2016 TITLE: The Role of Spirituality in Health and Mental Health

Spirituality and religiosity are two areas that medical professionals rarely introduce to

their patients. Spirituality focuses on personal values and connections, while religiosity focuses

on religious practices like going to church. Mental health, health, and spirituality have origins

that date back to the medieval era where prayers and blood cleanings were done by the church. In

the 1960s nursing studies went into holistic healthcare, where the patients were given spiritual

health methods. In the 90s, in the Diagnostic and Statistical Manual of Mental Disorders (DSM-

IV), spirituality was added and had an emergence of spiritual needs connected to mental health.

A benefit of health professionals adding spirituality into the practice consist of connecting

religion with health through treating depression or other mental health problems. A disadvantage

to spirituality and health is that spirituality cannot be measured and most professionals remain

distant from the subject and choose more empirical evidence. In the study, by the National

Center for Complementary and Alternative Medicine, spirituality and religiosity were studied on

physicians and patients in different health issues.

In cardiovascular health, two groups of older adults 60 years of age, who are extrinsically

involved and intrinsically involved in religion had different results on blood pressure reactivity.

The group who was intrinsically involved, meaning the person said prayers or mantras, had

decreased blood pressure and ventilator assistance. In chronic health issues spiritualty and health

were related in adapting and coping with the illness. In cancer, people who used spirituality

during their diagnosis and treatment, helped to be more positive and control their fears. In mental

health, spirituality is different from having health issues because mental health is contributed to

many other reasons and issues. For example, in psychiatric disorders, spirituality is a tool for

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social support and decision making. Culture is also a role in spirituality and is often categorized

through different beliefs and how their views on health and coping.

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Macadangdang, Nicholle – HSC 4700 Spring 2016

TITLE: Cultural Meanings of Death and Dying

Different cultures have different attitudes and beliefs towards death and dying, Ethnicity

and race also contribute to the different attitudes to death, grieving, and palliative care. In the

United States, the densely minority populated groups are in Hawaii, New Mexico, California, D.C.,

and Texas. These areas are where more than half the population are minorities, who are either

Hispanic, African American, Native Americans and Asian American. These populations have

cultures that have similar themes and attitudes towards the end of life that are cultural sensitivity,

cultural knowledge, and cultural skills. Cultural sensitivity helps with trust and respect for cultural

differences between providers and patients. Cultural knowledge is for providers to have an

understanding pf different cultural attitudes, beliefs, and practices. Cultural skills apply to what

the patient believes in about death and end-of-life choices.

In the article the study shows a model that provides practitioners to build a better

understanding to different cultural areas: communication, space, biological variations, time,

environmental control, and social organizations. Practitioners should be aware of the variety of

communication styles in minority patients because communication makes a big impact in

identifying and solving problems. Minority groups have a high context culture where the

communication is focused on experiences and nonverbal cues. Space varies among minority

groups. Latinos and Middle Eastern groups like closer distances, while Asian groups like distances.

Biological variations apply to food, physical appearance, and development. Time is based on past,

present, and future. Hispanics and Native Americans view time as present and rhythmic. Social

organizations are networks or support groups which deal with cultural values and beliefs.

Cultural considerations of death and dying are important to understand the patient and the

family’s satisfaction. In the event of delivering bad news, practitioners should be aware of the

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families’ culture in how they want to hear bad news. For example, in the Japanese culture, they

believe language is very powerful and prefer not to speak of illness or death openly. Many cultures

have different beliefs and meanings regarding death. Native Americans have a belief that the living

and dead are ever present and exist as a continuing cycle. Chinese view death in different religions

that consists of ancestor worship and is not discussed due to the belief of misfortune. Death rituals

are part of the grieving and bereavement process for the family and also a rite of passage for the

deceased. Hispanic rituals involve religious prayer and family gatherings. Native Americans do

not leave the body of the deceased until burial. Asian Indian Hindus do cremation and mourning

last up to 10 to 16 days.

Advance directives and palliative care are common in Western institutions and do always

agree with non-Western groups due to the different beliefs of death. The advance directives are

wishes and end-life decisions that the patient wants and is control of. Most minorities are not

familiar with advance directives and decide with the patient as a group. Palliative care for patients

include their needs and cultural needs. The palliative care, to name a few, are pain management,

support, and spiritual/religious care. Culturally sensitive communication is helpful to make sure

the patient and family have all their needs met and that the practitioners are considerate of the

family’s beliefs and culture.

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Macadangdang, Nicholle – HSC 4700 Spring 2016

TITLE: Exploring young people’s beliefs and images about sun safety.

Melanoma is a type of cancer that is from high sun exposure. The cancer is a prevalent

health issue concerning young people in Australia. The increase of sun exposure in young people

is the reason melanoma rates are high, due to young people not using protective measures in sun

exposure. Another reason for the increase in sun exposure is because of the constant change in

fashionable trends where the extremes are either pale to tan in accordance to what model they

idolize. A young person’s concern on appearance and attractiveness is easily influenced in this

age group. The study explains the behaviors and attitudes of young people through the Theory of

Planned Behavior. The theory is that a person’s decision to perform a behavior is determined

through social norm, attitudes, and behavioral control. Social norms, in the theory, follow the

expectations of certain groups and individuals. Attitudes are influenced through beliefs.

Behavioral control are people’s views about issues that affect behaviors.

The study uses focus groups to share views on sun protection in young people in

Australia. The research questions of the study discuss the sun protection behaviors of young

people, what motivation young people have to use sun protection and characteristics of people

who do or do not have tans. The participants of the study are both female and male with the age

group of 12-30 years of age that are both in school and work. The sample was 145 people which

were grouped into 22 focus groups for five months. The study groups varied in gender and ages.

The procedure of the study focused on one-hour group sessions that involved the research

questions on sun safety and tanning. The analysis of the discussions was audio-recorded and

transcribed according to the Theory of Planned Behavior. The discussions were grouped in

common beliefs and new beliefs.

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The results of the focus groups focused on reporting sun safety measures and the

participants’ view on sun safety. According to the article, the focus groups believed that

advantages to sun protection was preventing skin cancer and sunburn. The disadvantages to sun

protection was that people did not fine sun protection fashionable or permanent. People rather

use shade than sunscreen for sun protection. Groups that affected people’s views on sun

protection were family, friends, and health professionals. These groups approved using sun

protection, while other groups disapproved of sun safety. The focus groups were also influenced

by celebrities who tanned or promoted by sun protection. Groups had barriers on why people

were not using sunscreen due to being lazy on reapplication and sunscreen being too expensive.

The focus groups thoughts on tanning were that people who are tanned are healthier or attractive.

As for pale, untanned people, the groups found them unhealthy and shy.

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Professional Interview

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Healthcare Professional Interview with Mary Suarez

Interview:

My informational interview was with Mary Suarez.

Mary Suarez is a Registered Nurse.

She works in Redlands Community Hospital, a non-profit hospital.

1. What is your education and experience? Bachelors in Science Degree in Nursing from California State University, San

Bernardino. Her work experience includes working as a Nursing Supervisor at a Skilled

Nursing facility and a Staff Registered Nurse.

2. Why did you choose your career? Mary was first influenced by her mother because she is a long time Registered

Nurse. Mary saw how rewarding it was for her mother to medically aid people and be supportive. She took interest in wanting to help heal people and help aid their medical needs, which eventually made her pursue nursing.

3. What Department of the Hospital Do You Work in? At the Redlands Community Hospital, Mary works in the Medical-Surgical and

Pediatrics (Med-Surg/Peds) Unit. She has been working in that unit for three years.

4. What are your duties as a Registered Nurse?

As a registered nurse in the Medical Surgical and Pediatrics Unit, Mary does (to name several):

Provide care to patients after illness, injury, or surgery

Assess the needs of patient and develop a plan of care.

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Monitor patients and maintain patient safety

Manage pain of patients

5. What do you like most about your job? Because I work in the pediatrics unit, I look forward to meeting my small patients

and talking with them.

I also like meeting with a child’s parent(s) to help better assess the needs of their child.

6. What do you like least about this job?

The only thing that I like least about the job is working long hours where I am not able to see my family as often.

7. Any Advice for graduates and people pursuing the Health Science field? Choose a career you want to do and create a five-year road map leading up to

what you want to become. Do your research/ continue your knowledge, there are many ways to get a job in

the health field.

Network with people and shadow people who have careers you are interested in and learn from them.

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Five Scientific Journals from Health Science Courses

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Journal 1:

American College of Obstetricians and Gynecologists (the College) and the Society for Maternal–Fetal Medicine, Aaron B. Caughey, Alison G. Cahill, Jeanne-Marie Guise, Dwight J. Rouse, Safe prevention of the primary cesarean delivery, American Journal of Obstetrics and Gynecology, Volume 210, Issue 3, March 2014, Pages 179-193, ISSN 0002-9378, http://dx.doi.org/10.1016/j.ajog.2014.01.026.

Summary: The authors studied women and their types of births. They explain reasons for the causes of why cesarean procedures are performed, rates of morbidity and mortality of cesareans, and important stages of labor that must be monitored.

Journal 2:

Briggs, A.M., Cross, M.J., Damian, G.H., Sanchez-Riera, L., Blyth, F.M., Woolf, A.D., & March, L. Musculoskeletal Health Conditions Represent a Global Threat to Healthy Aging: A Report for the 2015 World Health Organization World Report on Ageing and Health The Gerontologist (2016) 56 (Suppl 2): S243-S255 doi:10.1093/geront/gnw002

Summary: This study is on musculoskeletal health and maintaining an active lifestyle and interventions for older adults.

Journal 3:

Puia, D. M. (2013). The cesarean decision survey. Journal of Perinatal Education, 22(4), 212-225. doi:10.1891/1058-1243.22.4.212

Summary: In a 2013 study, Puia’s focus was on a pregnant woman's decision on a cesarean section. The author researches further into a woman’s decision of a birthing method and describes their explanation as to why the woman would choose a cesarean delivery.

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Journal 4:

Solove, D. (2013, April 1). HIPAA turns 10: analyzing the past, present and future impact. Retrieved May 10, 2015, from http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_050149.hcsp?dDocName=bok1_050149

Summary: This article gives an overview of what provoked the need for the HIPAA privacy rules. It and reviewed both side of the argument to enforce the plan. It also brings up questions that were asked about the necessity of the rules and if they would be helpful or hindering.

Journal 5:

Young-Shin, L., Baek, J., Kyeongra, Y., & Saunjoo, Y. (2012). Relationships Between Physical Activity and Awareness and Treatment Status Among Adults With Low Femoral Bone Density in the United States. American Journal Of Health Promotion, 27(1), 2-9.

Summary: The purpose of the study is to see the correlation of physical activities and low bone density in adults.

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Three Samples from Upper Division Courses

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2015 Summer Quarter, Healthcare Law and Ethics

Negligence Scenario

Case Study Research

Nicholle Macadangdang

California State University East Bay

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Introduction

The standard of care for a physician is the level of caution that a provider exercises for a

patient (Standard of care law & legal definition, 2015). In some cases, the standard of care of a

physician should be “minimally competent” where that different outcomes do not equate to

bad standard of care (Moffet & Moore, 2011). However, when a physician fails to meet the

standard of care where the patient has suffered injury or even death, the physician is liable of

the damages and is called negligent (Farnsworth & Sheppard, 2010).

The case of the patient Ms. Campbell and Dr. Yang describes a situation where Dr. Yang

is a physician researcher of the Pancreatic Cancer Study that treats enrolled patients with

pancreatic cancer an investigational new drug called Compound P. After examining patients of

the study taking the drug, Dr. Yang notices the treatment is working on the patients. Because

Ms. Campbell has pancreatic cancer, Dr. Yang decides to help her with treating her with

Compound P with her consent, even though Ms. Campbell was not eligible for the treatment or

study. When starting the treatment, Ms. Campbell has a fever and rash. The doctor gives her

Restol instead of Prednisone, which gives Ms. Campbell a more severe rash, high fever, and

difficulty breathing. This event causes Ms. Campbell to pass away three days after taking Restol.

The family sues the doctor for using an off-label drug on Ms. Campbell.

The state where this case happened has a rule that where a plaintiff shows evidence of

an off-label use the defendant can show that the off –label use is not negligence per se. This

research will discuss the differences between negligence and negligence per se how these two

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legal issues relate to the scenario. The research will also discuss ethical issues pertaining to the

beneficence and non-maleficence.

Method

There was a focus on understanding how negligence is in the case of Dr. Yang and

figuring out when the negligence occurred. The topics for research was based on standard of

care, patient safety, medical negligence, and medical malpractice. The research of standard of

care and duty helped as a reminder of what the physician must do to care for the patient. There

was also research on legal cases that involved medical negligence particularly the Hall v. Hilburn

case and other cases that relates to the scenario. The cases aided with the understanding of

negligence and legal aspect the event that occurred. Searching the pharmaceutical drugs

Prednisone and Restol also helped to understand what the drugs are and how they affected or

would affect Ms. Campbell.

The process of organizing the research consisted of knowing the issue and event that

occurred between Dr. Yang and Ms. Campbell, finding where Dr. Yang was negligent, and how

Dr. Yang did not perform his duty on his patient. This organization helped map out what type of

literature the research would discuss. Researching on negligence and cancer patients helped to

see how some doctors treated the cancer patients. This would relate to ethical issues with the

duty of the physician and the rights of patient. There was also searching on the phase II of the

new drug Compound P and how effective the drug was during the study. In the process of

searching for the literature, the databases used were PubMed, CINHAL, law dictionary sites,

and government websites.

Result

31

To comprehend both legal side and medical side to this case, there has to be an

understanding of the differences between negligence and negligence per se and the treatment

and medication the patient was given. Knowing the legal doctrines involved in this case helps to

know how this case would be in court and understanding the medical side to the case will

discuss the consequences to the patient’s treatment and how the claim of negligence may be

formed.

Negligence is when a sensible person does not do their responsibility in giving care

during an incident (Negligence, n.d.). Negligence can end in accidents where there can be harm

to a person. Negligence is connected to the standard of care from what health professionals do

for their duty to patients. In case of negligence there are four different parts to have the

plaintiff prove negligence (Moffet & Moore, 2011). The four parts to negligence, according to

Moffet and Moore, are “duty, breach of duty, harm, and causation” (Moffet & Moore, 2011).

The physician or health professional that is clamied to be negligent has a duty to the harmed

patient (“Negligence”, n.d.). The breach of duty and harm is when the health professional does

the “negligent” action that is outside of standard of care (Moffet & Moore, 2011). The

causation is the consequences of the harm from negligence (“Negligence”, n.d.). These four

parts are needed for the jury to decide on the negligent claim (Farnsworth & Sheppard, 2010).

Negligence per se which is a principle on an intervention on a claim of negligence on a

person being sued with negligence (“Negligence per se”, n.d.). This principle like negligence

may be different in each state. With negligence per se, the jury do not have to decide on a

health professional’s possible negligence through this principle (“Negligence per se”, n.d.). The

actions of the health professional are still determined by the jury whether there was a violation

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of the statues (Negligence per se, n.d.). The ways that negligence per se can be refuted is by

three parts: “violation of law, intent of law, and protected class” (“Negligence per se in a

personal injury case”, n.d.). The violation and intent of laws are clear to where a law is

dishonored and to what intent the law was for (“Negligence per se in a personal injury case”,

n.d.). For example, in the case negligence per se is used for the Rule 55 that off-label use of a

drug can be used. The protected class means that laws are protected for everyone and if a

physician denies treatment and care to a person, then that physician dishonors a “federal law”

(“Negligence per se in a personal injury case”, n.d.).

The medical side to the case discusses the certain types of medication that Dr. Yang

prescribed to Ms. Campbell and how the treatment shows possible negligence. Dr. Yang

prescribed Ms. Campbell Compound P to help her live longer and treat her pancreatic cancer,

but what is Compound P? The Compound P is an investigational new drug that can be initiated

and conducted by a physician, which approved by the U.S. Food and Administration and

Institutional Review Board that Dr. Yang researches on his PCS study (“Investigational new

drug”, 2014). The drug is also in Phase II meaning the drug helps cancer patients by shrinking

the cancer in the body or a disappearance of the cancer (“Clinical trials: what you need to

know”, 2014). The study of the Compound P also relates to the longevity of the person taking

the drug if the drug gives the person more months to live (“Clinical trials: what you need to

know,” 2014). This is the information that needs to be understood about the pancreatic case

study and what outcome Compound P is supposed to give to the enrolled patients.

Compound P was aiding Dr. Yang’s patients and he hoped that the drug would help Ms.

Campbell, but the outcome was unfortunate one. It is possible that Dr. Yang may have made a

33

clinical error in overestimating Ms. Campbell’s other health problems and how Compound P

would affect those problems. Oyebode’s article on clinical errors and negligence dicusses that

clinical errors occur when there is a failure of execution or a planned action (Oyebode, 2013).

There is also a term on a type error called reckless disregard where the risk would not be

perceived as a big issue (Webb, 2015). Before Ms. Campbell agreed to try Compound P, her

pancreatic cancer was in a state of a poor prognosis. This would mean that the cancer was

spreading through Ms. Campbell’s body and the cancer worsening. Ms. Campbell had other

health problems which did not allow her to be part of the Pancreatic Case Study or take

Compound P, so why would Dr. Yang give a patient a new drug that was not permissible for Ms.

Campbell? It is possible that Dr. Yang may have made a clinical error in overlooking Ms.

Campbell’s other health problems and how Compound P would affect the problems. The health

problems would affect Ms. Campbell’s reaction to a new drug; however, it is unknown whether

Dr. Yang knew that Ms. Campbell had health problems that would be affected when taking a

new drug just for pancreatic cancer.

Discussion

The focus on the event that had occurred to Ms. Campbell is wanting to know how Dr.

Yang is negligent for prescribing her an off label drug that worsen her allergic reaction to

Compound P. The condition for the negligence had to occur starting with duty, breach of

standard care maltreatment, and consequence of maltreatment (Moffet & Moore, 2011). This

situation would question Dr. Yang’s standard of care where he was expected to treat the

patient with skills and knowledge of the treatment and do no harm to the patient (Pandit &

34

Pandit, 2009). It is true that Dr. Yang showed beneficence in wanting to help and show

compassion to Ms. Campbell’s condition, but it is possible that he may been overestimating the

effect of the drug to her poor condition (Pence, 2015). Moreover, Dr. Yang gave a drug that Ms.

Campbell originally was ineligible to receive Compound P due to other health problems that

would possibly harm her than heal her. This issue was not addressed as to whether taking

Compound P would have been a bad treatment for Ms. Campbell due to her other health

problems besides pancreatic cancer.

For the situation of Ms. Campbell and Dr. Yang, Ms. Campbell’s family sues Dr. Yang for

negligence for giving Ms. Campbell an off-label drug Restol for her allergic reaction that

occurred after she had taken Compound P that caused her death. After Dr. Yang prescribed

Compound P to Mrs. Campbell and undergoes the treatment, she develops only a rash and

fever with no difficulty breathing, which is a possible sign of an allergic reaction to Compound

P. The doctor prescribes Restol that treats heartburn, and nausea, for her allergic reaction

instead of Prednisone (“Restol”, n.d.). Prednisone is a medication that treats severe allergic

reactions and arthritis (“Prednisone: MedlinePlus drug information”, 2010). Ms. Campbell did

not have asthma or trouble breathing when she started Compound P, but a rash and fever. Dr.

Yang giving Ms. Campbell Restol that did not help her allergic reaction to Compound P, it

worsens her condition which caused her death that would have been prevented is she was

given a medication like Prednisone.

Although there is a state law that a physician is not negligent for using an off-label drug,

like Restol, negligence occurred for the physician not giving Ms. Campbell the medication she

needed for her allergic reaction. As mentioned before, Restol did not alleviate her symptoms

35

but worsen her fever, rash, and difficult breathing. Although Dr. Yang may have had good

intentions to give Ms. Campbell the Restol, he thought it was effective than Predisone, the

medication did not necessarily aid her rash and fever.

The ethical issues that may pertain to this case are beneficence and non-maleficence.

Beneficence is the having the physician do an “act with the patient’s best interest” (Graber et.

al., 2015). This ethical principle is a good principle to have for a physician since it shows that the

doctor is compassionate (Pence, 2015). Dr. Yang shows compassion to Ms. Campbell when

wanting help her with her poor condition in pancreatic cancer. The physician wanted to give

Ms. Campbell a chance to relieve her symptoms of pancreatic cancer. Woien states that

nonmaleficence means that “there is no evil or harm” done to people (Woien, 2008). The

principle discusses that physicians should not have situations where their patients are left in a

poorer state since their last meeting (Pence, 2015). The issue of maleficence in this scenario is

to possibly show that Dr. Yang presented nonmalificence to Ms. Campbell by prescribing her an

off-label medication that did not help her rash or fever. It is also possible that Dr. Yang may not

have paid enough attention to Ms. Campbell’s allergic reaction to the experimental drug. The

medicine worsens her state of fever and difficult breathing and hastened her death. Although it

is not known how she died, it is possible that taking the wrong drugs and the off-label drug

prescribed by Dr. Yang harmed her.

Conclusion

It is important to know all sides of a case that presents what happened to a patient.

There are many ways to turn to when it comes to learning and understanding legal, medical,

36

and ethical views of a scenario on negligence. Understanding the differences of negligence and

negligence per se brings out possibilities on whether or not Dr. Yang may be negligent. The

ethical arguments of beneficence and nonmaleficence demonstrates how Dr. Yang treated and

cared for the patient. The case of a possible negligence of Dr. Yang might be a possible long

process for Ms. Campbell’s family in proving negligence under the state also having a

negligence per se rule.

37

References

Clinical trials: What you need to know. (2014). Retrieved from

http://www.cancer.org/treatment/treatmentsandsideeffects/clinicaltrials/whatyouneedt

oknowaboutclinicaltrials/

Farnsworth, E. A., & Sheppard, S. (2010). An introduction to the legal system of the United

States. (4th ed.). Oxford: Oxford University Press.

Graber, A. D., Bhandary, A., & Rizzo, M. (2015). Ethical practice under accountable care. HEC

Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues. doi:

10.1007/s10730-015-9280-x

Investigational new drug application. (2014, October). Retrieved from

http://www.fda.gov/drugs/developmentapprovalprocess/howdrugsaredevelopedandap

proved/approvalapplications/investigationalnewdrugindapplication/default.htm

Moffett, P., & Moore, G. (2011). The Standard of Care: Legal History and Definitions: the Bad

and Good News. Western Journal of Emergency Medicine, 12(1), 109–112.

Oyebode F. (2013). Clinical errors and medical negligence. Medical Principles Practice. doi:

2013;22:323-333

Pandit, M. S., & Pandit, S. (2009). Medical negligence: Coverage of the profession, duties, ethics,

case law, and enlightened defense - a legal perspective. Journal of the Urological Society

of India, 25(3), 372–378. doi:10.4103/0970-1591.56206

Pence, G. E. (2015). Medical ethics: accounts of ground-breaking cases. (7th ed.). New York, NY:

McGraw-Hill Education.

38

Prednisone: MedlinePlus drug information. (2010, September 1). Retrieved from

http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601102.html

Restol. (n.d.). Retrieved from http://www.medicatione.com/?c=drug&s=restol

Standard of care law & legal definition. (2015). Retrieved from

http%3A%2F%2Fdefinitions.uslegal.com%2Fs%2Fstandard-of-care%2F

Webb, J. (2015, March 10). Pharmacy dispensing errors: Claims study emphasizes need for

systematic vigilance. Retrieved from http://drugtopics.modernmedicine.com/drug-

topics/news/dispensing-errors-claims-study-emphasizes-need-systematic-vigilance-

pharmacy?page=full

Woien, S. (2008). Life, death, and harm: Staying within the boundaries of nonmaleficence. The

American Journal of Bioethics, 8(11), 31-32.

39

2015 Spring Quarter, Health Legislation and Governmental Programs

TO: Betty Boss, Supervisor FROM: Nicholle Macadangdang, Health Administration Assistant DATE: May 25, 2015 SUBJECT: Patient Medicaid Eligibility

A patient seeking care in Imperial Unlimited, but is currently uninsured. It is apparent that the patient needs insurance in order to receive care. The patient may be eligible for the Medicaid program. We must find out whether or not the patient can qualify for Medicaid and notify the patient about this program. I have gathered information on Medicaid that will provide information on the program the requirements for the patient.

What is Medicaid?

Medicaid was passed in 1965 as a health insurance for low income people, elderly, and people with disabilities. (“Medicaid timeline”, 2015).The program is in a partnership with the federal government and the states (“What is Medicare and what is Medicaid?” 2014). With federal-state aid, Medicaid helps people who are uninsured and those who do not have enough health coverage. The program differs in cost and coverage in each state. Medicaid coverage and costs can be made through the use of private insurances or can be paid directly through the program (“How to qualify for Medicaid and CHIP health care coverage,” 2015). Today, all 50 states have Medicaid, and over the years the program has expanded to include pregnant women, children, parents, and poor seniors (Paradise, Lyons, & Rowland, 2015).

Benefits of Medicaid

The federal-state union of Medicaid allows states to form their own Medicaid with specific type’s services, how long a service can last, and the amount of services. The services of the program have both mandatory and optional benefits (“What is Medicare/Medicaid?” 2015). The mandatory benefits, to name a few, involve home health services, physician services, outpatient hospital services, and family planning services (Benefits Medicaid.gov., 2015). Optional benefits, that vary from state to state, can be clinic services, optometric services, transportation services, rehabilitation and physical therapy services, and prescribed drugs (“What is Medicare/Medicaid?,” 2015).

In California the Medicaid program is called Medi-Cal that provides the mandatory benefits and optional benefits that the state has to offer. Medi-Cal is no different from Medicaid but has additions to the program for recipients. Some of the optional benefits are emergency services, outpatient care, prescription drugs, mental and substance abuse services, and rehabilitation services, and children services (“Medi-Cal benefits,” 2015). There is also dental, wellness and disease prevention, and vision benefits with eye exams every year (“Blue Cross and Blue Shield's benefit plan,” 2015).

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Eligibility

To partake in Medicaid, there are federal laws that cover certain groups, such as required eligibility groups, in the states. States also have specific rules for their Medicaid programs apart from the federal laws each has to follow (“Eligibility Medicaid.gov”, 2015). Requirements to participate in Medicaid depends on age, citizenship status, and disability. Initially, the eligibility for the Medicaid program was only for low income people such as pregnant women, children, people who have disabilities, and the elderly (Paradise, 2015). Under the Affordable Care Act, the program was expanded to have eligible nonelderly adults (Wachino, Artiga, Rudowitz, 2014).

People who are eligible for Medicaid are families who have children under six years of age that are 133% of the Federal poverty level (FPL) (“What is Medicare/Medicaid?,” 2015). An example of a family eligible for Medicaid from the 2014 Federal poverty level is $19, 790 for a family of three (Paradise, 2015). Other eligible recipients are pregnant women who have income below 133% and Social Security recipients (“General Medicaid requirements,” 2015) Medicare recipients for the elderly qualify for Medicaid as a dual eligibility (“What is Medicare/Medicaid?” 2015). Nonelderly adults, under 65 years of age, qualify for the program by having a national minimum income of 138% of the federal poverty level which is $11,670 (Paradise, 2015).

As mentioned previously, states may have different requirements for gaining eligibility into Medicaid. For example, California has a Medicaid program called Medi-Cal that has different eligibility requirements apart from the federal requirements. To be able to qualify for Medi-Cal are families who have low income, pregnant women who have low income, women with low income who have been screened for breast or cervical cancer the elderly, people who are in SSI programs, disabled and blind people. (“San Diegans for healthcare coverage, a coalition for health,” 2015). In the expanded Medi-Cal, adults that are childless, from the ages of 19 to 64 years can be in the program and use the services offered (“Medi-Cal: Covering more Californians,” 2014).

Medicaid is a program that will definitely help people and families who are uninsured and are need of medical coverage. With the right requirements and information that is needed from patient, we will be able to determine whether the patient is eligible and understand what we must do to get the patient into Medicaid.

Sincerely, Nicholle Macadangdang Nicholle Macadangdang Health Administrator, Imperial Unlimited e:nmacadangdang@horizon.csueastbay.edu

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References

Benefits medicaid.gov. (2015). Retrieved from http://www.medicaid.gov/medicaid-chip-program-information/by-topics/benefits/medicaid-benefits.html

Blue Cross and Blue Shield's benefit plan. (2015). Retrieved from https://www.fepblue.org/en/benefit-plans/so-benefit-tables/

42

2015 Summer Quarter, Health Systems Management

Hurricane Katrina

Case Study

Julia Sosa, Maribel Gonzales, Nicholle Macadangdang, Gilleo Rose

California State University, East Bay

Health Science 4600- Summer

43

Introduction

Hurricane Katrina occurred in August 29, 2005 that affected people in “Louisiana,

Mississippi, and Alabama” (“Hurricane Katrina,” 2009). FEMA said that Hurricane Katrina was a

calamitous “natural disaster” (“A decade of progress through partnerships in Louisiana,” 2015).

The hurricane was a “127 miles per hour Category 3 storm” (“Hurricane Katrina statistics fast

facts,” 2015). The damages of Katrina were assessed at “$108 billion” (“A decade of progress

through partnerships in Louisiana,” 2015). This research will consist of the impact on hospitals

in New Orleans from the Hurricane Katrina. The paper will focus on preparedness plans the

hospitals before and after the major disaster and what can hospitals do for future disasters like

Hurricane Katrina.

Situation

Many people in the Gulf Coast were affected by the hurricane that they were forced to

leave their homes or evacuated from hospitals (“Addressing the health care impact of hurricane

Katrina,” n.d.). The infrastructure of healthcare was greatly impacted from Hurricane Katrina

that caused many challenges from the loss of power and electricity, massive flooding, and lack

of patient care (“Addressing the health care impact of hurricane Katrina,” n.d.). These

challenges are an important part of the healthcare infrastructure that needed the most

attention for many people after the hurricane.

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The massive floods all around New Orleans was an issue for public health. The flood

worsens due to the failed levee system that was supposed to hold flood waters from entering

communities (Taylor, 2007). The flood brought “damage to drinking water” and also impaired

many sanitation structures like waste facilities (“Addressing the health care impact of hurricane

Katrina,” n.d.). There was also unworkable “sewage systems” that backed up all plumbing

(Rodriguez & Aguirre, 2006). In hospitals, the lack of clean water nor having the proper

decontamination would mean an increase spread of diseases. The attention for hospitals and

healthcare is to stop the spread of disease and infection during an event of a hurricane.

Emergency generators, in hospitals, are to deliver electricity for “36 hours” (Taylor,

2007). Unfortunately, after Hurricane Katrina, hospitals in New Orleans did not have enough

fuel to run the generators (Rodriguez & Aguirre, 2006). The lack of power brought high

temperatures and “100%” humidity” made conditions very difficult for health professionals

(Taylor, 2007). The loss of electricity was also challenging for physicians and nurses to care for

very ill patients who needed radiology and machines to aid them (Taylor, 2007).

The lack of patient care in the New Orleans hospitals brought upon from extreme

conditions needed great attention due to the lack of medications, food, running water and

electric systems (Rodriguez & Aguirre, 2006). Many patients did not have their regular

medication like “diabetic medication or asthma medication” (“Addressing the health care

impact of hurricane Katrina,” n.d.). Because of the lack of electricity, seriously ill patients were

“hand ventilated” by the medical professionals (Taylor, 2007). These conditions were very

45

difficult for hospitals in New Orleans especially when most hospitals were not prepared for a

big hurricane like Hurricane Katrina.

Before hurricane Katrina hit many hospitals believed they were well prepared for any

disaster. They were prepared by having a comprehensive disaster plan with regular updates.

They were also fully staffed, however, they relied on federal agencies in order to continue

running in case of emergencies (Grush, 2012). Although, it seemed like hospitals were well

prepared for hurricane Katrina, it was not the case.

After hurricane Katrina there were some changes done to health care facilities and

health care personnel in order to be well prepared for other disasters. One of the changes was

setting leadership roles among the personnel. One main issue during hurricane Katrina was the

lack of leadership skills and decision making among the personnel. This caused ineffective

medical response because it could not be determined whether, federal, state, or local officials

were in charge (O’reilly, 2010). The second change that was made was, to make sure health

care facilities are stocked enough with the necessary medical supplies, including supplies that

will meet the caregiver’s basic needs in case of an emergency. During hurricane Katrina the lack

of medical supplies caused a lack of nutrition, hygiene products, and clean linens among

caregivers and patients (Eckert, 2006). The third change that happened after hurricane Katrina

was making sure hospitals had auxiliary power that will run air conditioning and water in case

water supplies get disrupted (The Advisory Board Company, 2012).

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Challenge

The challenges Hurricane Katrina brought forth upon the New Orleans Medical system is

overwhelming. Not only did it affect thousands of people but it affected the medical systems

needed to treat them. “Physical access to healthcare facilities was hampered across the Gulf

Coast following the storm...rising floodwaters made it progressively more difficult to maintain

standards of care” (Lister, 2005). And as the water kept rising, more people needed to be

relocated to field hospitals increasing the chances of being electrocuted by downed power

lines, and increasing the chances of waterborne diseases. In addition, the medical professionals

were simply inundated with too much people to take care of. It was so much that they had to

prioritize and set up triage centers outside the flood zone using helicopters (Lister, 2015).

Everything from transporting patients to standards of care, all had to be reevaluated for this

large-scale scenario in order to alleviate the heavily impacted medical systems.

Poverty played a devastating role in the amount of people that can be insured. More

than one in five residents were left uninsured - estimated roughly at 900,000 people, leaving

this to be one of the highest uninsured cities in the United States (Rudowitz, 2006). And this

was before the onset of the hurricane and the implementation of the Affordable Care Act.

What this means is that if the majority of those people received care without insurance, it is

possible they are even in more debt than before. This is a huge challenge that needed attention

and fortunately, funding from various governments and donations nationwide helped to

alleviate some of the financial burdens.

Hurricane Katrina absolutely wrecked the city’s economy. According to the Bureau of

Labor Statistics, roughly 80% of the city was flooded and estimated damages ranges up to $200

47

billion, declaring Hurricane Katrina to be the worst hurricane to ever hit the United States

(Dolfman et al., 2007). Furthermore, 6 out of every 10 jobs were lost, with $2.9 billion lost in

wages. (Dolfman et al., 2007). Tourism generated the most profit for New Orleans which in

turn, took the biggest hit as $382.7 million were lost in wages - shockingly exceeding that of the

health care and social services sector, which lost $377.8 million in wages (Dolfman et al., 2007).

Solution

The magnitude of a geographical environmental disaster tends to transpire with little to

no advance warning; therefore, it is essential for hospitals to have an effective, systematic plan

for evacuation in the event of a disaster through an emergency operations plan this is a system

that entails “who will do what, as well as when, and with what resources and by what

authority- before, during, and immediately after an emergency” (FEMA, 1996). The strategy to

respond effectively in determining the evacuation plan must first be communicated with all

stakeholders, otherwise, responding effectively ultimately involves prevention, preparedness,

response and recovery. In addition, to coordinating and communicating the mass evacuation

plan with multiple hospitals and/or other healthcare facilities, county emergency management,

state department of health, fire rescue and law enforcement.

More importantly, our hospital JMNG will have the capability to withstand the

unpredictability of a public health impact amongst an affected population. Our hospital will be

sizeable with a bed count of 800 and will require a substantive initial budget of 50 million for

the first 72 hours which will provide, alternate medical treatment sites or affiliated facilities

that can be established by our hospital or set up by county, regional, state or federal partners

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to provide alternate medical care. In addition to, including mass fatality planning in the event

there are significant fatalities associated with a catastrophic disaster. This reinforces the need

for coordination with local Emergency Management and Medical Examiner’s. Logistically, we

will provide local Emergency Management with a situation report on our status. For this reason,

quality of care during the need of transport regardless of the type of transport provided all

patients must be transported with sufficient medications and supplies (Bandages, IV Solutions

and Gases) to last a minimum of 96 to 120 hours. Additionally, food and water supplies should

be provided to each patient and attending staff members. At the same time, water, fuel and

power must be available for the facility to continue to provide care for patients that cannot be

moved. Facilities should have a minimum fuel supply to run generators. If this supply drops

below 50%, arrangements should be made to have fuel replenishments (Evacuation, 2015).

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References

Addressing the health care impact of hurricane Katrina. (n.d.). Retrieved from

http://kff.org/medicaid/issue-brief/addressing-the-health-care-impact-of-hurricane/

A decade of progress through partnerships in Louisiana. (2015, August 18). Retrieved from

http://www.fema.gov/decade-progress-through-partnerships-louisiana#

Dolfman, M., Wasser, S., & Bergman, B. (2007, June). The effects of hurricane katrina on the

new orleans economy. Retrieved August 25, 2015, from

http://www.bls.gov/opub/mlr/2007/06/art1full.pdf

Eckert, S. (2006). Preparing for disaster. American Nurse Today. Retrieved from

http://www.americannursetoday.com/preparing-for-disaster/

Evacuation. (n.d.). Retrieved August 27, 2015, from

http://www.calhospitalprepare.org/evacuation Federal Emergency Management Agency. SLG 101:Guide for All-Hazard Emergency

Operations Planning. http://www.fema.gov/plan/gaheop.shtm, 1996. Grush, L. (2012). New Orleans hospitals better prepared for Isaac after chaos of Katrina. Fox

News. Retrieved from

http://www.foxnews.com/health/2012/08/29/new-orleans-hospitals-better-prepared-

for-isaac-after-chaos-katrina/

Hurricane Katrina. (2009). Retrieved from http://www.history.com/topics/hurricane-katrina

Hurricane Katrina statistics fast facts. (2015, August 24). Retrieved from

http://www.cnn.com/2013/08/23/us/hurricane-katrina-statistics-fast-fac

50

Lister, S. (2005, September 21). Hurricane katrina: The public health and medical response.

Retrieved August 25, 2015, from http://fpc.state.gov/documents/organization/54255.pdf

O’Reilly, B. (2010). Katrina’s legacy: Rethinking medical disaster planning. Amednews.com.

Retrieved from

http://www.amednews.com/article/20100906/profession/309069941/4/

https://www.advisory.com/daily-briefing/2012/08/30/katrina-taught-new-orleans-

hospita s-how-to-prepare-for-isaac

Rodriguez, H., & Aguirre, B. E. (2006). The impact of Hurricane Katrina on the medical and

healthcare infrastructure: A focus on disaster preparedness, response, and resiliency.

Retrieved from http://udspace.udel.edu/handle/19716/2380

Rudowitz, R. (2006, September). Health care in new orleans before and after hurricane katrina.

Retrieved August 25, 2015, from

http://content.healthaffairs.org/content/25/5/w393.full

Taylor, I. L. (2007). Hurricane Katrina’s impact on Tulane’s teaching hospitals. transactions of

the American clinical and climatological association, 118, 69–78.

51

Job Advertisement

52

53

Cover Letter

54

Nicholle Macadangdang 32470 Navajo Trail

Cathedral City, California, 92234 (760) 835-0556

6/3/2016 Integra Service Connect Los Angeles, CA. 90001 Dear Recruiter,

When I was growing up, I was exposed to watching people living in the streets and being too ill to take care of themselves. As a child, I felt sympathy towards the poor and gave what little money I had to help them live. This was a motivating factor for me to want to help people as a life goal. This position will take my altruistic and helpful nature to the next level.

My background includes interning at a non-profit organization called Foundation of Osteoporosis Research and Education. I performed duties that included communication with executive directors, activity directors, and wellness nurses to participate in a national osteoporosis awareness event. I demonstrated my abilities to organize and plan based on the facility. I also recruited volunteers through Volunteer Match and aided them information on the event.

In addition to this experience, I gained a considerable amount of customer service skills. I was a part-time Starbucks barista in my university. As a Starbucks barista, my responsibilities are to meet the needs of my customers through their order and create a comfortable “second home” environment.

I am interested in this position because I want to be a part of helping the community with their healthcare needs. In healthcare, I think a portion of proving health services to patients is communication to make sure the patients are given what they need. I feel that I have the skills to effectively communicate with patients to meet their health goals and services. I also can demonstrate sound judgment and analyze solutions that best fits a patient or situation.

I am confident that I can demonstrate the duties and skills that you are seeking. I am also very open to learning new things to build upon my skills as an assistant health manager. I would appreciate the opportunity to meet with you to discuss how my qualifications will be beneficial to your organization’s success. My contact number is (760) 835-0556.

Sincerely,

Nicholle Macadangdang

55

Resume

56

Nicholle Macadangdang 32470 Navajo Trail

Cathedral City, California, 92234 (760) 835-0556

nmacadangdang@horizon.csueastbay.edu

PROFESSIONAL/DEVELOPMENTAL SKILLS Certified Nursing Assistant Certified in First Aid and CPR Proficient in Microsoft Word, Excel, and PowerPoint.

MANAGERIAL SKILLS

Strong leadership and communication skills Teamwork and goal-oriented Critical thinking and problem solver

EDUCATION California State University of East Bay, Hayward, CA Bachelor of Health Sciences in Healthcare Administration and Management, Jan. 2014-Expected graduation, June. 2016 College of the Desert, Palm Desert, CA. Licensed Certified Nursing Assistant May 2013 EXPERIENCE Foundations of Osteoporosis Education and Research Internship Event Coordinator. March 2016 - May 2016

Coordinated events with Executive Directors and Activity Directors of Nursing Care Facilities. Planned and organized events Recruited volunteers and obtained communication skills.

Aramark in California State University East Bay, Hayward, CA Student Worker for Starbucks, July 2015 - June 2016

Connected with customers through friendliness and paying attention to detail of the orders to ensure their needs are met.

Provided customer service in a timely and effective manner that customers receive quality beverages and products.

Maintained the shared goals and organization of the store’s daily objectives. VOLUNTEER EXPERIENCE Eisenhower Medical Center Emergency Department Volunteer, June 2010-2012

Made frequent rounds of all patients in the department assessing their basic needs under the guidance of registered nurses.

Restocked carts, patient rooms, and nursing stations. Assisted nurses in escorting patients from and to procedure rooms. Prepared patient beds and medical equipment needed for patients and doctor

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Personal Essay

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Personal Essay

My name is Nicholle Macadangdang. I was born and raised in Palm Springs, California. I come from a family of three, myself included. My parents are from the Philippines which makes me a first born Filipino American. I am a soon-to-be Bachelor’s of Science graduate in Health Sciences with a focus on Administration and Management. My pursuit in wanting to help people all my life turned to something I want pursue as a career. The healthcare field was an area I have always been drawn to. Healthcare is always changing and growing to help people live longer and healthier. I want to be a part of helping people through health.

I have volunteered in the Emergency Department at Eisenhower Medical Center to figure out and shadow nurses and doctors to see where I fit in the healthcare system. I also obtained my certification as a Certified Nurse Assistant while in community college. This was a stepping stone for me to be in a health care setting and experience what it is like to be part of an organization and work with nurses and doctors.

My short term goals are to find a job that best fits my career in health administration. I want to be able to interact with people and do paperwork, planning, and organizing for my future organization. I also want to attain more experience in different areas in the health care sector because I am not sure of where I would want to work in.

My long term goals are to be part of an organization in healthcare where I am a health administrator. I want to become an important role in the healthcare field through collaborating with health professionals and the community. I want to help as much people as I can in health. I want to also be part of Doctor without Borders and be a member of this organization in going around the world and help people in underdeveloped countries and supply them as much aid as we can.

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Systems Analysis Chart

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Legacy Role Paper

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Nicholle Macadangdang HSC 4700

Professor Gem Le Legacy Role

Majoring in Health Sciences was a career path goal to put myself in a field where I could help people and their health. I have experience in volunteering in a hospital and training as a nurse assistant, that my goal to work in the health care field is what I want to do in life. The general education classes of Biology, Anatomy, Statistics, and Psychology, to name a few, are important towards the type of area in health sciences a student might want to study in. I think it is important to excel in general education because a student should know certain skills and knowledge to prepare for the main focuses of their major. As an option A on health administration and management, prior to my upper division studies my general education and lower division courses helped me figure out what I wanted to do and learn what I needed to learn towards obtaining a degree on health administration.

The classes that were specifically towards my health science major were in all very helpful and useful classes. Every class I took as part of my health science major enlightened me to not stay so narrow-minded as to what I can do as a career. Prior to entering the university, I did not know there was more health careers than becoming a registered nurse, physician assistant, or general practitioner. These classes helped me become more confident in my career path and what I wanted to do. To me, the health science classes I had consisted of professors who knew their subject and were passionate about showing the students what is like to be a health professional. I learned most in classes that were making students think about certain situations or case studies on health care ethics and situational studies on hospitals and management in how best to operate a particular change in the hospital like a merger.

In most of my health science classes there was a consistency of presenting and working with other fellow students. I think that it is very important to have presentation skills because it helped me practice speaking with my peers and speaking in public. I think the group work for most of my classes were useful to not only participate with peers, but also have experience in collaborating on projects and ideas. The group work had good and bad parts to it, but it was certainly manageable when there were up to four people to a group versus six because larger groups did not have enough tasks to distribute evenly. I also liked having a class only based on interning. Gaining experience while also earning unit credits is a great way to obtain hands on experience based on what I will do as a job. In my internship class, I am constantly learning how to become an administrator and coordinator.

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Alumni Role Paper

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Macadangdang, Nicholle – HSC 4700 Spring 2016

Alumni Role

The one-day workshop I attended was in UC Berkeley and is part of the Center for Health

Leadership Association. The workshop was a free StoryCon event where people of the UC

Berkeley alumni presented their stories on health issues and how it affects our communities and

ourselves. There were about eight speakers who spoke about their experiences in their health,

community’s health, and mental health. I was drawn to one speaker her name is Smitha who

talked about her passion to study public health and how she wanted to help her homeland and

community. I was drawn to her speaking style which is why I chose her speech and what she

wanted to advocate as part of this role paper.

I related to Smitha’s story on choosing a career based on a parent’s expectations. When

she told her mother that she wanted to pursue public health, her mother was disappointed, but

Smitha did not want to stop her pursuit in helping people. I liked how she addressed how her

motherland India was a place devoted to industrializing than focusing the concerns of the

communities who live there and need health care. She wanted to be a voice to communities who

need the aid and support, that India lacks despite having large industries of pharmaceuticals. This

type of role in health care is important, to be a voice to people who cannot speak for themselves.

Awareness of a community’s health needs are also important. I think awareness is also a part of

being a health professional and making sure people have the care they need.

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My Philosophy

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Statement of Philosophy

Buddha says that “To keep the body in good health is a duty…otherwise we shall not be able to keep our mind strong and clear. I agree with Buddha that health takes on a huge role in our lives. Being healthy is a commitment and wanting to be healthy every day is a choice, a wise choice. Healthiness shows in physical to inward appearance. Staying healthy is not easy. Presently Americans are constantly battling heart disease, strokes, and obesity. A huge role to these diseases is the person’s lifestyle and how healthy they are. The solutions seem simple to say just exercise and eat right foods, but it is easier said than done. I think that maintaining health in my life is a high commitment because I want to live long and I want to set an example to other people that it pays to be in good health.

Although I am not a perfect example of health, I try every day to make the right choices into a healthy lifestyle. I think this is true for most people, to just try to be healthy by making the right choices. For example, people who strive to become healthy should start with diet. I think people should always be aware of what they eat and how much of a food they eat. I believe in a balance when it comes to food, to have an equal portion of nutrients and protein. People also should not consume things that will be bad for their body like alcohol because people can dink excessively which will hurt their health.

Exercise is also important to maintain health. It does not mean people have to go to the gym. Exercise can be many different things. The point is that exercising will not only make you healthier but also stronger and focused. People should maintain good diet and exercise to stay fit and healthy throughout their lives.

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