Case Study Questions

Students shall complete this assignment using complete sentences in paragraph format following APA guidelines. Submit in a word the case study, associated questions, and answers to each question with rationale, into Moodle. Case studies are due by Sunday night at 23:59pm EST of the assigned week. The answers to the case studies will be available after the Deadline. Please review the grading rubric prior to submitting your assignment.





Public Health Advocacy

Bridgette is an instructor at the Riverwood Nursing College. She is trying to figure out how to integrate more lessons on advocacy in her nursing leadership course. In order to be effective and not simply provide information, Bridgette wants to make sure that the curriculum would encourage her students to participate in and get involved in the political advocacy activities that are important to nurses and in alignment with nursing values. It was also important that it their participation didn’t seem overwhelming to the nursing students. After spending hours researching online and reaching out to colleagues for ideas, Bridgette has called you for your thoughts.


1. You suggest that Bridgette explain to the students that the nursing profession has a long history of advocacy and that they shouldn’t be discouraged. What information would be important for Bridgette to share with her students about the history of advocacy that would help nursing students understand the historical impact of nursing advocacy? Explain your rationale for selecting your answer.

A. Lillian Wald and her classmate Mary Brewster started the Henry Street Settlement while they were still students in the New York Hospital diploma program.

B. Nursing organizations used political advocacy and established position statements in order for nurses to view patients holistically and to legally include all aspects of family, community, and work environment in their care.

C. Before women in the United States gained the right to vote in 1920, nurses sought legislation that would define nursing practice, and they advocated for the protection of the public by prohibiting anyone who was not professionally trained from calling him- or herself a nurse.

D. Early nursing leaders often spoke about the importance of nurses informing consumers about what nursing care is, including why and how it prevents illness, manages symptoms, treats disease, and transforms the health of communities.


2. You also suggest that Bridgette explain why advocacy in nursing is so important by using examples provided by the Institute of Medicine (IOM). Which example provides the best explanation. Explain your rationale for selecting your answer.

A. Abiding by their suggestion that high-quality nursing practice includes advocacy as an essential aspect of patient care.

B. Using their blueprint for how the nursing profession should advocate to improve the health of the nation, lead change in healthcare delivery, and increase the educational preparation of the nursing workforce.

C. Advancing the Culture of Health by addressing key social determinants of health and empowering support mechanisms to help people live healthier lives.

D. Providing access to archival data and support for those interested in historical research.


3. The last piece of advice you provide Bridgette is to require that students develop an advocacy project that advocated for changes within the profession. What is an acceptable advocacy project that would satisfy the project requirement? Explain your rationale for selecting your answer.


A. Organizing a recruitment drive for underrepresented minorities into nursing schools.

B. Creating an informational website about the importance of rural public health nursing.

C. Writing letters to Congressmen supporting healthcare reform initiatives.

D. Publishing a newsletter for student nurses that keeps them informed about current trends in nursing.


CHAPTER 2 CASE STUDY: The Politics of Healthcare

Representatives from various healthcare interest groups are participating in a summit to discuss the rising costs of healthcare and how best to ensure patient safety and quality of care while determining the best ways to decrease costs. Senator Carlson, the Chair of the Congressional Committee presiding over the summit has asked representatives from each group to present what they can do to reduce healthcare costs without compromising patient safety or care.



1. In an effort to minimize collusion and to offer an opportunity for different interest groups to interact in a more collaborative fashion, Senator Carlson asked that the seating chart ensure that interest group representatives were seated next to other interest group representatives that were closely aligned in specific issues. The assistant in charge of the seating chart was surprised when Senator Carlson insisted on changing the seating assignments for Pharmaceutical Research and Manufacturers of America (PhRMA). Which grouping would most likely prompt the change request? Explain your rationale for selecting your answer.


A. The Joint Commission (JC) and the Pharmaceutical Research and Manufacturers of America (PhRMA)

B. U.S. Chamber of Commerce and Pharmaceutical Research and Manufacturers of America (PhRMA)

C. American Medical Association (AMA) and the Pharmaceutical Research and Manufacturers of America (PhRMA)

D. Medical Technology Association (MTA) and the Pharmaceutical Research and Manufacturers of America (PhRMA)


2. A representative from the American Hospital Association (AHA) addressed the summit as the primary advocacy group for the hospital industry. Given this groups’ interests, what would you expect the representative to propose with regard to cost-saving measures? Explain your rationale for selecting your answer.


A. Expanding the use of technology in the provision of care

B. Restructuring the financing of patient care

C. Streamlining the process of care

D. Investing in the dissemination of healthcare research to provider institutions


3. While most interest groups presented specific examples with exact dollar amounts for areas of concession, the American Medical Association (AMA) representative was more philosophical, proposing that the issue of healthcare costs would best be addressed by allowing the healthcare professionals to direct health care instead of the federal government or the insurance companies. What historical event would the representative most likely choose to support their position? Explain your rationale for selecting your answer.


A. The constant changes in the balance of power between political parties creates confusion in the provision and financing of health care.

B. Passage of federal insurance programs (i.e., Medicare and Medicaid) caused a rapid increase in gross domestic product healthcare expenditures.

C. The Affordable Care Act proved that when healthcare policy is part of a political agenda, the healthcare policy with the greatest chance of succeeding is pushed, regardless of merit.

D. The failures of federalism prove that involvement of the federal government in healthcare matters is expensive, inconsistent and ineffective.


CHAPTER 3 CASE STUDY: Stakeholder Analysis and Identification

Opioid-based medications are often used to treat pain attributed to a variety of diseases, however the treatment does not come without significant side effects. Addiction, accidental overdose, and theft of the medication are just the tip of the iceberg of issues related to opioid use. Joyce is a registered nurse and a member of the Government Affairs team of the ANA-California Chapter and is preparing her team to undertake a stakeholder analysis to build support for legislation that would approve the use of cannabis-based medications as a substitute for opioid-based pain medication in California hospitals.



1. Joyce sent an email to the Government Affairs team asking each member to provide the names of organizations to include in a stakeholder analysis. One of the team members replied with the names of four organizations which support the therapeutic use of cannabis in hospitals. Joyce agrees with three of the organizations, however rejects one of them. Which organization would Joyce most likely reject? Explain your rationale for selecting your answer.


A. California-Pacific Annual Conference of the United Methodist Church

B. California Cannabis Industry Association

C. Los Angeles County AIDS Commission

D. San Francisco Medical Society


2. As the final list of organizations is compiled, Joyce and her team are ready to begin to analyze the stakeholders. What question must the team answer to begin the first part of a stakeholder analysis? Explain your rationale for selecting your answer.


A. Which groups exert the most influence with the California legislature regarding cannabis use?

B. What groups are most likely to take an opposing position?

C. How central other stakeholders are to the organization?

D. Which stakeholder group has the resources to provide toolkits and advocacy expertise?


3. After a long and exhausting effort, the ANA-California Chapter initiative effort has been successful. Effective January 1 of next year, hospitals may substitute the use of opioid-based medications with cannabis-based medications. Los Angeles County General administrators immediately develop policies to allow for the change, however initial implementation is disorganized and ineffective. The CEO of Los Angeles County General has called a meeting of administrators to determine why the implementation has failed and is determined to correct the issue. Based on the information provided in this question, what is the most likely reason that implementation of the new policy has been difficult? Explain your rationale for selecting your answer.


A. Questions regarding the dispensing of cannabis-based medications were left unanswered.

B. The hospital did not secure buy-in of the nursing staff.

C. Administrators did not account for the patient’s right to refuse medication.

D. Important stakeholders were left out of policy development.

Case Study Questions

The discussion topic for this week is a case study provided in your Alligood text on pages 112-113.  After reading this case study, answer the questions provided in Critical Thinking Activities at the end. Number your responses accordingly.


Mrs. Walsh, a woman in her 70s, was in critical condition after repeat coronary artery bypass graft (CABG) surgery. Her family lived nearby when Mrs. Walsh had her first CABG surgery. They had moved out of town but returned to our institution, where the first surgery had been performed successfully. Mrs. Walsh remained critically ill and unstable for several weeks before her death. Her family was very anxious because of Mrs. Walsh’s unstable and deteriorating condition, and a family member was always with her 24 hours a day for the first few weeks.The nurse became involved with this family while Mrs. Walsh was still in surgery, because family members were very anxious that the procedure was taking longer than it had the first time and made repeated calls to the critical care unit to ask about the patient. The nurse met with the family and offered to go into the operating room to talk with the cardiac surgeon to better inform the family of their mother’s status.One of the helpful things the nurse did to assist this family was to establish a consistent group of nurses to work with Mrs. Walsh, so that family members could establish trust and feel more confident about the care their mother was receiving. This eventually enabled family members to leave the hospital for intervals to get some rest. The nurse related that this was a family whose members were affluent, educated, and well informed, and that they came in prepared with lists of questions. A consistent group of nurses who were familiar with Mrs. Walsh’s particular situation helped both family members and nurses to be more satisfied and less anxious. The family developed a close relationship with the three nurses who consistently cared for Mrs. Walsh and shared with them details about Mrs. Walsh and her life.The nurse related that there was a tradition in this particular critical care unit not to involve family members in care. She broke that tradition when she responded to the son’s and the daughter’s helpless feelings by teaching them some simple things that they could do for their mother. They learned to give some basic care, such as bathing her. The nurse acknowledged that involving family members in direct patient care with a critically ill patient is complex and requires knowledge and sensitivity. She believes that a developmental process is involved when nurses learn to work with families.She noted that after a nurse has lots of experience and feels very comfortable with highly technical skills, it becomes okay for family members to be in the room when care is provided. She pointed out that direct observation by anxious family members can be disconcerting to those who are insecure with their skills when family members ask things like, “Why are you doing this? Nurse ‘So and So’ does it differently.” She commented that nurses learn to be flexible and to reset priorities. They should be able to let some things wait that do not need to be done right away to give the family some time with the patient. One of the things that the nurse did to coordinate care was to meet with the family to see what times worked best for them; then she posted family time on the patient’s activity schedule outside her cubicle to communicate the plan to others involved in Mrs. Walsh’s care.When Mrs. Walsh died, the son and daughter wanted to participate in preparing her body. This had never been done in this unit, but after checking to see that there was no policy forbidding it, the nurse invited them to participate. They turned down the lights, closed the doors, and put music on; the nurse, the patient’s daughter, and the patient’s son all cried together while they prepared Mrs. Walsh to be taken to the morgue. The nurse took care of all intravenous lines and tubes while the children bathed her. The nurse provided evidence of how finely tuned her skill of involvement was with this family when she explained that she felt uncomfortable at first because she thought that the son and daughter should be sharing this time alone with their mother. Then she realized that they really wanted her to be there with them. This situation taught her that families of critically ill patients need care as well. The nurse explained that this was a paradigm case that motivated her to move into a CNS role, with expansion of her sphere of influence from her patients during her shift to other shifts, other patients and their families, and other disciplines”Critical thinking activities.

1. Discuss the clinical narrative provided here using the unfolding case study format to promote situated learning of clinical reasoning (Benner, Hooper-Kyriakidis, & Stannard, 2011).2. Regarding the various aspects of the case as they unfold over time, consider questions that encourage thinking, increase understanding, and promote dialogue, such as: What are your concerns in this situation? What aspects stand out as salient? What would you say to the family at given points in time? How would you respond to your nursing colleagues who may question your inclusion of the family in care?3. Using Benner’s approach, describe the five levels of competency and identify the characteristic intentions and meanings inherent at each level of practice.