Week 2 Discussion: Critic of the Arts

Required Resources
Read/review the following resources for this activity:

  • Textbook: Chapter 3, 4
  • Minimum of 1 scholarly source (in addition to the textbook)

Initial Post Instructions
Select a work of art from any of the chapters in our textbook, and write a response that analyzes the art through the lens of a descriptive critic, an interpretive critic, and an evaluative critic. What different things would these critics have to say? Use the following guidelines:

  • Descriptive Critic: Address at least 3 different elements of art and/or principles of design.
  • Interpretive Critic: This will require research so that you can understand the subject, meaning, and intent of the work.
  • Evaluative Critic: Use the standards of perfection, insight, and inexhaustibility (as described in the text).

Follow-Up Post Instructions
Respond to at least one peer. Further the dialogue by providing more information and clarification. Provide feedback on whether you agree or disagree with their criticism. Explain why. Build on their posts by providing additional insight of your own. If your peer selected the same artwork as you, make sure to address new point or develop existing points in more depth.

Writing Requirements

  • Minimum of 2 posts (1 initial & 1 follow-up)
  • Minimum of 2 sources cited (assigned readings/online lessons and an outside source)
  • APA format for in-text citations and list of references

I need a assignment for week 9 that has 2 parts 1 and 2 that has slides for my Retain. Develop, Retain and Access class



 Assignment 4: Keeping the Talent Part I – Slide Deck (Weight: 15%) Due Week 9, Day 7 

Part II – Zoom Presentation (Weight: 10%) Due Week 10, Day 7 INTRODUCTION Recruiting and retaining top talent is a key strategic goal for any organization. A strong company brand, effective leadership, and a positive workplace culture are important elements in attracting and retaining top talent. How can HR contribute to building an organization that attracts and retains top talent? ASSIGNMENT 4, PART I INSTRUCTIONS (Slide Deck) Your company has a new CHRO, who has been in the position for 6 months. One of the areas he is tasked to improve is retention of top talent. Employee turnover has been high in recent years and it is negatively affecting the company’s profitability and competitiveness. You are the VP of Talent and the CHRO has asked you to help him prepare a presentation to the Board, outlining a vision for changes to increase retention. The CHRO previously worked for Google and he subscribes to their model of a “high-freedom” company. He wants to use ideas from Bock’s Work Rules, from his book of that name, as the basis for his presentation. As a reminder, the ten Work Rules are: 1. Give your work meaning. 2. Trust your people. 3. Hire only people who are better than you. 4. Don’t confuse development with managing performance. 5. Focus on the two tails. 6. Be frugal and generous. 7. Pay unfairly. 8. Nudge. 9. Manage the rising expectations. 10. Enjoy! And then go back to No. 1 and start again. Research the topics in the list above, in relation to your workplace, or a company that interests you. Based on your findings, select the four topics where you believe that change would be most impactful. Develop recommendations for implementing changes in those four areas. Identify how the changes you are proposing will attract and retain top talent. Consider how success will be measured for each topic. Consider the most likely challenges and resistance to the changes you are proposing, and identify ways to manage and mitigate those issues.  

Virtual Preparing For Baby Interviews


Your task for this assignment is to interview one mother AND one father to ask them about their experience preparing for the birth of their first child. Please note that you do not need to interview a couple, although you can (in other words, these can be unrelated individuals who are parents to different children, or they can be a couple). Spend about 1/2 an hour interviewing each one VIRTUALLY, either by phone or via video, asking the following questions: 

1. What was your reaction when you found out you were going to be a parent?
2. Did you have any concerns, fears, or worries about you, your partner, or the baby?
3. How did your feelings change over the period of pregnancy?
4. Did you participate in any formal preparation for childbirth or parenting, such as Lamaze or parenting classes?
5. Tell me about the day your child was born.
6. How was the first month of parenting? Did you feel were you were prepared, or were there surprises?
7. What advice would you give to expectant parents?

Please take notes during your interview. When your interview is complete, write up a summary of the answers given for each question by each parent.

After the summary is complete, write a 2 to 3 page reflection on what you have learned from the interview, incorporating ideas, concepts and quotes from the text. Make sure to address how you believe the experience of these parents might affect/have affected the social and emotional development of their children in at least one paragraph.


  Reply to this discussion use references

Be sure that the responses to the  Post of peers include 2 peer reviewed references with content that demonstrates critical analysis and synthesis of references used.  

Big Data Analytics (BDA) is a set of techniques, technologies, systems, processes, procedures, and applications for analyzing large quantities of data to aid a business in better understanding its business, market, and making timely decisions (Galetsi, Katsaliaki, & Kumar, 2019). 

Healthcare has constantly been inundated with a massive quantity of complex data that comes in at a breakneck speed. Data from hospitals and healthcare providers, medical insurance, medical devices, life sciences, and health research are produced in many industries in the health sector. With the progress in technology, the use of this data for healthcare transformation is enormous. Using analytics, machine learning, and artificial intelligence over extensive data allows trends and correlations to be identified and thus offers actionable insights into improving healthcare delivery (Mehta, Pandit, & Shukla, 2019).

For instance, healthcare data management may benefit organizations in areas such as the development of effective drugs and devices for patient well-being, fraud detection in billing, and service speed, as well as society in addressing global health issues such as disease prevention, public health surveillance, and timely provision of essential medical services during emergencies. (Galetsi, Katsaliaki, & Kumar, 2019).

Potential benefit of using big data as part of a clinical system

To provide the best possible patient outcomes, nurses are critical to patient care quality and safety. Nurses need to access and analyze a large amount of data about their patients and their treatment to make educated practice choices (Glassman, 2017). However, the high volume digital flow of information being produced in healthcare complicates the equation (Wang, Kung, & Byrd, 2018). 

Big data analytics is being utilized in health care to enhance efficiency and quality, resulting in better healthcare practices and patient results. For example, it would be critical to learn more about each patient, such as if they had any other illnesses or diseases (comorbidities) that might influence their results and age, gender, educational level, and so on. The information gathered can create a more comprehensive set of evidence-based recommendations and support decision-making (McGonigle & Mastrian, 2017). 

Competence in informatics enables nurses to communicate, manage knowledge, reduce error, and enhance decision-making at the point of care by using information and technology (Glassman, 2017). Thus, healthcare providers seek appealing IT products that may combine organisationally reliable resources with a high level of patient experience, improve corporate performance and perhaps even create new, more profitable business models powered by data. (Wang, Kung, & Byrd, 2018).

Potential challenge or risk of using big data as part of a clinical system 

The most frequently reported challenges include data management, security, and privacy. Because of the fast creation of new kinds of data and the ease with which data can be transferred and shared, data privacy has become more relevant in recent years (Galetsi, Katsaliaki, & Kumar, 2019).

Healthcare big data analytics, maybe more than other fields, is prone to integrity and privacy breaches. The utilization of private health information (PHI) is required for big data analytics in health care. Practitioners must guarantee that such data do not contain any patient-specific information and preserve confidentiality (McGonigle & Mastrian, 2017).

While most nations have laws to safeguard patients’ data from improper use, this merely requires healthcare practitioners to avoid collecting specific identifying characteristics. Even in the United States, HIPAA permits hospitals to deviate from the regulations if they have a compelling reason—which seems difficult to comprehend in healthcare big data gathering. Additionally, informed consent may be receiving less scrutiny from patients and doctors. Medical devices/implants used in healthcare emit wireless readings that may be intercepted. For instance, when a patient is driving through a weigh station, toll bridge, parking lot, or border crossing, their data may be read without their knowledge or permission (Strang & Sun, 2020).

Strategy to mitigate the challenges or risks of using big data 

Encryption may be a solution to this prevalent big data privacy issue in the healthcare sector as software and hardware develop to make it quicker and cheaper. For example, as computing power increases, encryption methods will grow faster, allowing for more real-time usage. Additionally, a government-managed security clearance network may establish a link between healthcare devices/implants and an external system (Strang & Sun, 2020). 

Legislation governing data protection varies by the nation since each country safeguards medical and health-related data differently. Data generated through interactions with recognized professionals, such as lawyers, physicians, professors, researchers, accountants, investment managers, and project managers, or through online consumer transactions, is governed by laws requiring informed consent and drawing on the Fair Information Practice Principles (FIPP) legislation (Strang & Sun, 2020).

Most industrialized nations have laws to safeguard individual privacy in big healthcare data, such as the HIPAA rules under the Privacy Rule of 2003 in the United States. For example, HIPAA mandates healthcare providers to erase 18 different identifiers from patient data, such as birthdates, vehicle serial numbers, picture URLs, and voice prints (Strang & Sun, 2020).



 Given the following business scenario, create a Crow’s Foot ERD using a specialization hierarchy if appropriate. Two-Bit Drilling Company keeps information on employees and their insurance dependents. Each employee has an employee number, name, date of hire, and title. If an employee is an inspector, then the date of certification and certification renewal date should also be recorded in the system. For all employees, the Social Security number and dependent names should be kept. All dependents must be associated with one and only one employee. Some employees will not have dependents, while others will have many dependents. 

 Make sure that the file is saved as ch5_problem1_deleon.doc



 Given the following business scenario, create a Crow’s Foot ERD using a specialization hierarchy if appropriate. Tiny Hospital keeps information on patients and hospital rooms. The system assigns each patient a patient ID number. In addition, the patient’s name and date of birth are recorded. Some patients are resident patients who spend at least one night in the hospital, and others are outpatients who are treated and released. Resident patients are assigned to a room. Each room is identified by a room number. The system also stores the room type (private or semiprivate) and room fee. Over time, each room will have many patients. Each resident patient will stay in only one room. Every room must have had a patient, and every resident patient must have a room. 

Make sure that the file is saved as ch5_problem2_deleon.doc



 Given the following business scenario, create a Crow’s Foot ERD using a specialization hierarchy if appropriate. Granite Sales Company keeps information on employees and the departments in which they work. For each department, the department name, internal mail box number, and office phone extension are kept. A department can have many assigned employees, and each employee is assigned to only one department. Employees can be salaried, hourly, or work on contract. All employees are assigned an employee number, which is kept along with the employee’s name and address. For hourly employees, hourly wages and target weekly work hours are stored; for example, the company may target 40 hours/week for some employees, 32 for others, and 20 for others. Some salaried employees are salespeople who can earn a commission in addition to their base salary. For all salaried employees, the yearly salary amount is recorded in the system. For salespeople, their commission percentage on sales and commission percentage on profit are stored in the system. For example, John is a salesperson with a base salary of $50,000 per year plus a 2 percent commission on the sales price for all sales he makes, plus another 5 percent of the profit on each of those sales. For contract employees, the beginning date and end date of their contracts are stored along with the billing rate for their hours. 

Make sure that the file is saved as ch5_problem3_deleon.doc



Modify the design shown in Figure 4.35 to include these business rules:

  • An employee could be staff, a professor, or an administrator.
  • A professor may also be an administrator.
  • Staff employees have a work-level classification, such as Level I or Level II.
  • Only professors can chair a department. A department is chaired by only one professor.
  • Only professors can serve as the dean of a college. Each of the university’s colleges is served by one dean.
  • A professor can teach many classes.
  • Administrators have a position title.

Given that information, create the complete ERD that contains all primary keys, foreign keys, and main attributes. 

SEE ATTACHED FILE : https://cnow.apps.ng.cengage.com/ilrn/books/co3ds13h/Images/image044.gif

Make sure that the file is saved as ch5_problem4_deleon.doc



 Tiny College wants to keep track of the history of all its administrative appointments, including dates of appointment and dates of termination. (Hint: Time- variant data is at work.) The Tiny College chancellor may want to know how many deans worked in the College of Business between January 1, 1960, and January 1, 2018, or who the dean of the College of Education was in 1990. Given that information, create the complete ERD that contains all primary keys, foreign keys, and main attributes.

Make sure that the file is saved as ch5_problem5_deleon.doc



 Some Tiny College staff employees are information technology (IT) personnel. Some IT personnel provide technology support for academic programs, some provide technology infrastructure support, and some provide support for both. IT personnel are not professors; they are required to take periodic training to retain their technical expertise. Tiny College tracks all IT personnel training by date, type, and results (completed versus not completed). Given that information, create the complete ERD that contains all primary keys, foreign keys, and main attributes. 

Make sure that the file is saved as ch5_problem6_deleon.doc



The FlyRight Aircraft Maintenance (FRAM) division of the FlyRight Company (FRC) performs all maintenance for FRC’s aircraft. Produce a data model segment that reflects the following business rules:

  • All mechanics are FRC employees. Not all employees are mechanics.
  • Some mechanics are specialized in engine (EN) maintenance. Others are specialized in airframe (AF) maintenance or avionics (AV) maintenance. (Avionics are the electronic components of an aircraft that are used in communication and navigation.) All mechanics take periodic refresher courses to stay current in their areas of expertise. FRC tracks all courses taken by each mechanic—date, course type, certification (Y/N), and performance.
  • FRC keeps an employment history of all mechanics. The history includes the date hired, date promoted, and date terminated. Given those requirements, create the Crow’s Foot ERD segment.

Make sure that the file is saved as ch5_problem7_deleon.doc

Assignment: Anti-Oppressive Social Work Practice Week 6 6051


Mercedes Diaz 

Walden University

SOCW 6051: Diversity, Human Rights, and Social Justice

Instructor Sherlina Thomas

July 11,2021

Assignment: Anti-Oppressive Social Work Practice

Anti-oppressive social work means critically reflecting on your own cultural identities and how the social environment impacts these identities. Acknowledging power and privilege can be uncomfortable; however, with values of multiculturalism and social justice, social workers are committed to engaging in their own personal work and addressing social barriers clients may experience. Social workers view clients from a strengths-based perspective utilizing client strengths to support their goals, rather than pathologizing clients from the lens of the dominant culture.

For the past six weeks, you have learned about the social construction of social identities, structural inequality based on dominant and non-dominant groups, and oppressions based on sex, class, and race. While readings have continuously pointed out white privilege as the dominant group privilege, you also know that privilege is not equally distributed in groups. Intersecting identities creates unique experiences for clients. For this assignment, you draw from what you have been learning during the first part of this course and discuss strategies for anti-oppressive social work practice.

By Day 7

Submit a 2- to 3-page APA formatted paper in which you:

  • Explain the potential impact of      white privilege on clients from both dominant and minority groups      (consider impact of both positive and negative stereotypes).
  • Explain how intersecting      identities might impact an individual’s experience (for example,      race/ethnicity and gender, race/ethnicity and class, race/ethnicity and      ability, race/ethnicity and sexual orientation, race/ethnicity and class).
  • Providing specific examples,      explain how a social worker might utilize cultural strengths when working      with clients.
  • Describe 2-3 social work skills      and how a social worker might use them to engage in anti-oppressive work.
  • Support ideas in paper      with at least 2-3 course resources (please reference      specific chapters, not the entire textbook) and at least one additional      peer-reviewed article from the Walden library (not assigned in this      course) to support your ideas.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

  • Please save your Assignment      using the naming convention “WK6Assgn+last name+first initial.(extension)”      as the name.

Follow Rubric Please

Responsiveness to Directions

32.4 (27%) – 36 (30%)

Paper fully addresses all instruction prompts.


32.4 (27%) – 36 (30%)

Paper demonstrates an excellent understanding of all of the concepts and key points presented in the text(s) and Learning Resources. Paper provides significant detail including multiple relevant examples, evidence from the readings and other sources, and discerning ideas. Paper demonstrates exemplary critical thought.

Competency Advance Human Rights and Social, Economic, and Environmental Justice -Knowledge

5.4 (4.5%) – 6 (5%)

Student demonstrates knowledge of oppressive structures and an excellent understanding of the impact of privilege.

Competency Advance Human Rights and Social, Economic, and Environmental Justice –Cognitive/Affective Process

5.4 (4.5%) – 6 (5%)

Student demonstrates excellent critical thought related to effects of intersecting identities, use of cultural strengths, and identification of skills to apply when practicing anti-oppressive social work.


32.4 (27%) – 36 (30%)

Paper is well organized, uses scholarly tone, follows APA style, uses original writing and proper paraphrasing, contains very few or no writing and/or spelling errors, and is fully consistent with graduate-level writing style. Paper contains multiple, appropriate and exemplary sources expected/required for the assignment.




and need to chapter from the book about the subject 


LO1 Compare ways in which change impacts on an organization’s strategy and operations.

      P1 Compare different organizational examples where there has been an impact of change on an organization’s strategy and operations

M1 Assess the different drivers for change in each of the given examples and the types of organizational change they have affected

 LO1 & LO2

D1 Draw conclusions and recommendations with valid justifications for planning effectively for change and applying change impact analysis.

   LO2 Evaluate the influences that drivers of change have on organization behavior.

      P2 Evaluate the ways in which internal and external drivers of change affect leadership, team and individual behaviors within an organization.

P3 Evaluate measures that can be taken to minimize negative impacts of change on organizational behavior.

M2 Apply appropriate theories and models to critically evaluate organizational response to change.

      LO3 Determine how barriers to change influence leadership decision-making.

D2 Critically evaluate the use of force field analysis in the context of meeting organizational objectives.

       P4 Explain different barriers for change and determine how they influence leadership decision-making in a given organizational context.

M3 Use force field analysis to analyses the driving and resisting forces and show how they influence decision-making



    LO4 Apply a range of leadership approaches to a change initiative.

    D3 Critically evaluate the effectiveness of leadership approaches and models of change management.

     P5 Apply different leadership approaches to dealing with change in a range of organizational contexts.

   M4 Evaluate the extent to which leadership approaches can deliver organizational change effectively applying appropriate models and frameworks.


HMGT 372

The final project for this course is an analysis of the legal and or ethical issues involved in the below health care scenario. See questions to be answered at end of this factual scenario below. I have also provided, after the formatting requirements for the paper, two articles that will aid you in your analyzing the scenario and writing your paper.  

The two articles to base the analysis of your paper are entitled:

Clinical Ethics Issues and Discussion and

A Framework for Thinking Ethically

This is the final paper for the class and must be double spaced and be approximately 4-5 pages in 12 point New Times Roman font. Include a cover page [not counted as a page] which should have student name and title of your paper. See more formatting requirements later in these paper instructions.

NOTE: For this paper it is unnecessary to do any research beyond the two articles I furnished with this assignment. Both are after the specific paper requirements.  You may use all the articles in the class also. To do internet research would only be wasting your valuable time.

Case Scenario

A 72 year old woman was admitted to the Neurological Intensive Care Unit following a cerebral hemorrhage which left her with severe brain damage and ventilator dependent. One year before this event, the patient and her husband had drawn up “living wills” with an attorney. She was diagnosed by her treating physician as being in a permanent unconscious condition. The patient’s living will specified that the patient did not want ventilator support or other artificial life support in the event of a permanent unconscious condition or terminal condition.

The patient’s husband is her legal next of kin and the person with surrogate decision-making authority. When the living will was discussed with him, he insisted that the patient had not intended for the document to be used in a situation like the present one. Further discussion with him revealed that he understood that the patient would not be able to recover any meaningful brain function but he argued that the living will did not apply because her condition was not imminently terminal. He further indicated that he did not consider his wife to be in a permanent unconscious condition.  The immediate family members (the couple’s adult children) disagreed with their father’s refusal to withdraw life support.

The treatment team allowed a week to pass to allow the husband more time to be supported in his grief and to appreciate the gravity of his wife’s situation.  Nevertheless, at the end of this time, the husband was unwilling to authorize withdrawal of life support measures consistent with the patient’s wishes as expressed in her living will. End of scenario.

You paper should have 3 major sections. Each is numbered 1, 2 and 3. Questions to be discussed based on the facts above. You must weave into your discussion the relevant facts from above scenario to support your discussion in discussion areas 2 and 3 below. And for discussion area 3 you must weave into your discussion the ethics philosophy you pick for each issue from the article A Framework for Thinking Ethically. A penalty will be deducted if you fail to use appropriate headings in your paper. 

1. Three Legal/Ethical Issues. Just list the three most important legal/ethics issues in this scenario that you will discuss. They must be three separate, different and distinct issues. Pay particular attention to the article I furnished with this assignment. No explanation needed, just state them 1, 2, 3.

2. Discussion of Three Legal/Ethical Issues.  Discuss the three most important ethical/legal issues you listed above. Must use the relevant facts in the scenario to support your discussion of the legal/ethical issues.

          Must use headings below.  Headings will be:

           Legal/Ethical Issue 1 [state the issue] then discussion

           Legal/Ethical Issue 2 [state the issue] then discussion

           Legal/Ethical Issue 3 [state the issue] then discussion

      For each legal/ethical issue above discuss

            a. Why each is a legal /ethical issue?

            b. Discuss each issue in the context of the scenario facts and

            c. Define the concepts you use

3. How I would Handle Each Issue.  First, in this section and for each issue, as a health care provider, how would you handle each of the three issues discussed above and why?  Must use the relevant facts in the scenario to support your positions. Secondly for each issue, using the article in these requirements, entitled “A Framework of Thinking Ethically” fully discuss the specific ethics philosophy that would epitomize your handling of each issue. Fully define the specific ethics philosophy used and weave the ethics philosophy into your discussion. See article below entitled A Framework for Thinking Ethically. 

Must use headings below.  Headings will be:

Handling of Legal/Ethical Issue #1 (followed by the discussion)

Handling of Legal/Ethical Issue #2 (followed by the discussion)

Handling of Legal/Ethical Issue #3 (followed by the discussion)

[A penalty will be deducted if you fail to use appropriate headings in your paper. ]

This is an independent paper and you are on the honor system not to discuss or consult with any students or other individuals about this paper. You may use the information we have discussed in the class, the articles in the class, and the two articles I have furnished below. Just so you know, all you need to read to analyze the questions for your paper are the two articles I have furnished with this assignment and information in the class.

All you need to read to analyze the questions for this paper are the two articles below entitled:

Clinical Ethics Issues and Discussion & A Framework for Thinking Ethically

The paper must be:

  • Late submission – No late assignment 4 papers will be accepted. Paper is due Sunday in the last week of class no later than 11:59pm EST.

Paper must be in narrative format not outline or bullets. 

  • Double spaced and be 4-5 pages in 12 point New Times Roman font. [No deduction if paper exceeds a page or so.  Thus 3 and half page paper will be penalized.]
  • Must cite to source of all your  facts in the text of your paper in APA format. 
  • You can cite directly to the original source. Here are the links to the sources where the University received copyright permissions for the materials:
  • Clinical Ethics and Law:http://depts.washington.edu/bioethx/topics/law.html
  • A Framework for Ethical Decision Making:https://www.scu.edu/ethics/ethics-resources/ethical-decision-making/a-framework-for-ethical-decision-making/
  • Include a cover page [not counted as a page] which should have student name and title of your paper [Provide a short name for the legal responsibility the specific health care organization has for one type of patient right in a specific setting ] 
  • A the end of the paper a list of references [not counted as a page]    
  • Be prepared using word-processing software and saved with a .doc, .docx, or .rtf extension. No pdf.
  • Be uploaded to your Assignments Folder by 11:59 p.m. EST on the due date.    
  • The paper is to be posted in Assignment #4 drop box.

Grading rubric for assignment is with assignment in Assignments area of class.

Background articles to support the issues you will discuss in the paper. 

Article One of Two

Clinical Ethics Issues and Discussion Article

Relationships: I. clinical ethics, law & risk management

  1. Definitions and sources of authority

In the course of practicing medicine, a range of issues may arise that lead to consultation with a medical ethicist, a lawyer, and/or a risk manager. The following discussion will outline key distinctions between these roles.

  • Clinical ethics may be defined as:  a discipline or methodology for considering the ethical implications of medical technologies, policies, and treatments, with special attention to determining what ought to be done (or not done) in the delivery of health care. 
  • Law may be defined as: established and enforceable social rules for conduct or non-conduct; a violation of a legal standard may create criminal or civil liability.
  • Risk Management may be defined as: a method of reducing risk of liability through institutional policies/practices.

Many health care facilities have in-house or on-call trained ethicists to assist health care practitioners, caregivers and patients with difficult issues arising in medical care, and some facilities have formally constituted institutional ethics committees. In the hospital setting, this ethics consultation or review process dates back to at least 1992 with the formulation of accreditation requirements that mandated that hospitals establish a “mechanism” to consider clinical ethics issues.

Ethics has been described as beginning where the law ends. The moral conscience is a precursor to the development of legal rules for social order.  Ethics and law thus share the goal of creating and maintaining social good and have a symbiotic relationship as expressed in this quote:

[C]onscience is the guardian in the individual of the rules which the community has evolved for its own preservation.  William Somerset Maugham

The role of lawyers and risk managers are closely linked in many health care facilities. Indeed, in some hospitals, the administrator with the title of Risk Manager is an attorney with a clinical background. There are, however, important distinctions between law and risk management. Risk management is guided by legal parameters but has a broader institution-specific mission to reduce liability risks. It is not uncommon for a hospital policy to go beyond the minimum requirements set by a legal standard. When legal and risk management issues arise in the delivery of health care, ethics issues may also exist. Similarly, an issue originally identified as falling within the clinical ethics domain may also raise legal and risk management concerns.

To better understand the significant overlap among these disciplines in the health care setting, consider the sources of authority and expression for each.

Ethical norms may be derived from:

  • Law
  • Institutional policies/practices
  • Policies of professional organizations
  • Professional standards of care, fiduciary obligations

Note: If a health care facility is also a religious facility, it may adhere to religious tenets. In general, however, clinical ethics is predominantly a secular professional analytic approach to clinical issues and choices.

Law may be derived from:

  • Federal and state constitutions (fundamental laws of a nation or state establishing the role of government in relation to the governed)
  • Federal and state statutes (laws written or enacted by elected officials in legislative bodies, and in some states, such as Washington and California, laws created by a majority of voters through an initiative process)  
  • Federal and state regulations (written by government agencies as permitted by statutory delegation, having the force and effect of law consistent with the enabling legislation)
  • Federal and state case law (written published opinions of appellate-level courts regarding decisions in individual lawsuits)
  • City or town ordinances, when relevant

Risk Management may be derived from law, professional standards and individual institution’s mission and public relations strategies and is expressed through institutional policies and practices.

  1. Conceptual Models 

Another way to consider the relationship among the three disciplines is through conceptual models:

  1. Linear
  2. Distinctions
  3. Interconnectedness
  4. Orientation to law for non-lawyers
  5. Potential legal actions against health care providers

There are two primary types of potential civil actions against health care providers for injuries resulting from health care:  (1) lack of informed consent, and (2) violation of the standard of care. Medical treatment and malpractice laws are specific to each state.

  1. Informed Consent. Before a health care provider delivers care, ethical and legal standards require that the patient provide informed consent. If the patient cannot provide informed consent, then, for most treatments, a legally authorized surrogate decision-maker may do so.  In an emergency situation when the patient is not legally competent to give informed consent and no surrogate decision-maker is readily available, the law implies consent on behalf of the patient, assuming that the patient would consent to treatment if he or she were capable of doing so. 

Information that must be conveyed to and consented to by the patient includes: the treatment’s nature and character and anticipated results, alternative treatments (including non-treatment), and the potential risks and benefits of treatment and alternatives. The information must be presented in a form that the patient can comprehend (i.e., in a language and at a level which the patient can understand) and that the consent must be voluntary given. An injured patient may bring an informed consent action against a provider who fails to obtain the patient’s informed consent in accordance with state law.

From a clinical ethics perspective, informed consent is a communication process, and should not simply be treated as a required form for the patient’s signature. Similarly, the legal concept of informed consent refers to a state of mind, i.e., understanding the information provided to make an informed choice.  Health care facilities and providers use consent forms to document the communication process. From a provider’s perspective, a signed consent form can be valuable evidence the communication occurred and legal protection in defending against a patient’s claim of a lack of informed consent.  Initiatives at the federal level (i.e., the Affordable Care Act) and state level (e.g., Revised Code of Washington § 7.70.060)  reflect approaches that support shared decision-making and the use of patient decision aids in order to ensure the provision of complete information for medical decision-making.

  1. Failure to follow standard of care. A patient who is injured during medical treatment may also be able to bring a successful claim against a health care provider if the patient can prove that the injury resulted from the provider’s failure to follow the accepted standard of care. The duty of care generally requires that the provider use reasonably expected knowledge and judgment in the treatment of the patient, and typically would also require the adept use of the facilities at hand and options for treatment.  The standard of care emerges from a variety of sources, including professional publications, interactions of professional leaders, presentations and exchanges at professional meetings, and among networks of colleagues. Experts are hired by the litigating parties to assist the court in determining the applicable standard of care.

Many states measure the provider’s actions against a national standard of care (rather than a local one) but with accommodation for practice limitations, such as the reasonable availability of medical facilities, services, equipment and the like. States may also apply different standards to specialists and to general practitioners. As an example of a statutory description of the standard of care, Washington State currently specifies that a health care provider must “exercise that degree of care, skill, and learning expected of a reasonably prudent health care provider at that time in the profession or class to which he belongs, in the State of Washington, acting in the same or similar circumstances.”  

    III.            Common clinical ethics issues: medical decision-making and provider-patient communication

There are a number of common ethical issues that also implicate legal and risk management issues. Briefly discussed below are common issues that concern medical decision-making and provider-patient communication.

If a patient is capable of providing informed consent, then the patient’s choices about treatment, including non-treatment, should be followed. This is an established and enforceable legal standard and also consistent with the ethical principle of respecting the autonomy of the patient. The next two sections (Surrogate decision-making; Advance directives) discuss how this principle is respected from a legal perspective if a patient lacks capacity, temporarily or permanently, to make medical decisions. The third section briefly introduces the issue of provider-patient communication, and highlights a contemporary dilemma raised in decisions regarding the disclosure of medical error to patients.

  1. Surrogate decision-making

The determination as to whether a patient has the capacity to provide informed consent is generally a professional judgment made and documented by the treating health care provider. The provider can make a determination of temporary or permanent incapacity, and that determination should be linked to a specific decision. The legal term competency (or incompetency) may be used to describe a judicial determination of decision-making capacity. The designation of a specific surrogate decision-maker may either be authorized by court order or is specified in state statutes.

If a court has determined that a patient is incompetent, a health care provider must obtain informed consent from the court-appointed decision-maker. For example, where a guardian has been appointed by the court in a guardianship action, a health care provider would seek the informed consent of the guardian, provided that the relevant court order covers personal or health care decision-making.

If, however, a physician determines that a patient lacks the capacity to provide informed consent, for example, due to dementia or lack of consciousness, or because the patient is a minor and the minor is legally proscribed from consenting, then a legally authorized surrogate decision-maker may be able to provide consent on the patient’s behalf.  Most states have specific laws that delineate, in order of priority, who can be a legally authorized surrogate decision-maker for another person. While these laws may vary, they generally assume that legal relatives are the most appropriate surrogate decision-makers. If, however, a patient has previously, while capable of consenting, selected a person to act as her decision-maker and executed a legal document known as a durable power of attorney for health care or health care proxy, then that designated individual should provide informed consent.

In Washington State, a statute specifies the order of priority of authorized decision-makers as follows: guardian, holder of durable power of attorney; spouse or state registered partner; adult children; parents; and adult brothers and sisters. If the patient is a minor, other consent provisions may apply, such as: court authorization for a person with whom the child is in out-of-home placement; the person(s) that the child’s parent(s) have given a signed authorization to provide consent; or, a competent adult who represents that s/he is a relative responsible for the child’s care and signs a sworn declaration stating so.  Health care providers are required to make reasonable efforts to locate a person in the highest possible category to provide informed consent. If there are two or more persons in the same category, e.g., adult children, then the medical treatment decision must be unanimous among those persons.  A surrogate decision-maker is required to make the choice she believes the patient would have wanted, which may not be the choice the decision-maker would have chosen for herself in the same circumstance. This decision-making standard is known as substituted judgment. If the surrogate is unable to ascertain what the patient would have wanted, then the surrogate may consent to medical treatment or non-treatment based on what is in the patient’s best interest.

Laws on surrogate decision-making are slowly catching up with social changes. Non-married couples (whether heterosexual or same sex) have not traditionally been recognized in state law as legally authorized surrogate decision-makers. This lack of recognition has left providers in a difficult legal position, encouraging them to defer to the decision-making of a distant relative over a spouse-equivalent unless the relative concurs. Washington law, for example, now recognizes spouses and domestic partners registered with the state as having the same priority status.  

Parental decision-making and minor children. A parent may not be permitted in certain situations to consent to non-treatment of his or her minor child, particularly where the decision would significantly impact and perhaps result in death if the minor child did not receive treatment. Examples include parents who refuse medical treatment on behalf of their minor children because of the parents’ social or religious views, such as Jehovah’s Witnesses and Christian Scientists.  The decision-making standard that generally applies to minor patients in such cases is known as the best interest standard.  The substituted judgment standard may not apply because the minor patient never had decision-making capacity and therefore substituted judgment based on the minor’s informed choices is not able to be determined. It is important to note that minors may have greater authority to direct their own care depending on their age, maturity, nature of medical treatment or non-treatment, and may have authority to consent to specific types of treatment. For example, in Washington State, a minor may provide his or her own informed consent for treatment of mental health conditions, sexually transmitted diseases, and birth control, among others. Depending on the specific facts, a health care provider working with the provider’s institutional representatives could potentially legally provide treatment of a minor under implied consent for emergency with documentation of that determination,  assume temporary protective custody of the child under child neglect laws, or if the situation is non-urgent, the provider could seek a court order to authorize treatment.

  1.  Advance directives

The term advance directive refers to several different types of legal documents that may be used by a patient while competent to record future wishes in the event the patient lacks decision-making capacity.   The choice and meaning of specific advance directive terminology is dependent on state law. Generally, a living will expresses a person’s desires concerning medical treatment in the event of incapacity due to terminal illness or permanent unconsciousness. A durable power of attorney for health care or health care proxy appoints a legal decision- maker for health care decisions in the event of incapacity. An advance health care directive or health care directive may combine the functions of a living will and durable power of attorney for health care into one document in one state, but may be equivalent to a living will in another state. The Physician Orders for Life Sustaining Treatment (POLST) form is a document that is signed by a physician and patient which summarizes the patient’s wishes concerning medical treatment at the end of life, such as resuscitation, antibiotics, other medical interventions and artificial feeding, and translates them into medical orders that follow patients regardless of care setting. It is especially helpful in effectuating a patient’s wishes outside the hospital setting, for example, in a nursing care facility or emergency medical response context.  This relatively new approach is available in about a dozen states, although the programs may operate under different names: POST (Physician Orders for Scope of Treatment), MOST (Medical Orders for Scope of Treatment), MOLST (Medical Orders for Life-Sustaining Treatment), and COLST (Clinician Orders for Life-Sustaining Treatment).  The simple one page treatment orders follow patients regardless of care setting. Thus it differs from an advance directive because it is written up by the clinician in consultation with the patient and is a portable, actionable medical order.  The POLST form is intended to complement other forms of advance directives. For example, Washington State recognizes the following types of advance directives: the health care directive (living will), the durable power of attorney for health care, and the POLST form. Washington also recognizes another legal document known as a mental health advance directive, which can be prepared by individuals with mental illness who fluctuate between capacity and incapacity for use during times when they are incapacitated.

State laws may also differ on the conditions that can be covered by an individual in an advance directive, the procedural requirements to ensure that the document is effective (such as the number of required witnesses) and the conditions under which it can be implemented (such as invalidity during pregnancy).

Advance directives can be very helpful in choosing appropriate treatment based upon the patient’s expressed wishes. There are situations, however, in which the advance directive’s veracity is questioned or in which a legally authorized surrogate believes the advance directive does not apply to the particular care decision at issue. Such conflicts implicate clinical ethics, law and risk management.

  1. Provider-patient communications: disclosing medical error

Honest communication to patients by health care providers is an ethical imperative. Excellent communication eliminates or reduces the likelihood of misunderstandings and conflict in the health care setting, and also may affect the likelihood that a patient will sue.

One of the more contentious issues that has arisen in the context of communication is whether providers should disclose medical errors to patients, and if so, how and when to do so. Disclosure of medical error creates a potential conflict among clinical ethics, law and risk management. Despite a professional ethical commitment to honest communication, providers cite a fear of litigation as a reason for non-disclosure. Specifically, the fear is that those statements will stimulate malpractice lawsuits or otherwise be used in support of a claim against the provider.  An increase in malpractice claims could then negatively affect the provider’s claims history and malpractice insurance coverage.  

There is some evidence in closed systems (one institution, one state with one malpractice insurer) that an apology coupled with disclosure and prompt payment may decrease either the likelihood or amount of legal claim.  In addition, a number of state legislatures have recently acted to protect provider apologies, or provider apologies coupled with disclosures, from being used by a patient as evidence of a provider’s liability in any ensuing malpractice litigation. It is currently too early to know whether these legal protections will have any impact on the size or frequency of medical malpractice claims. For this reason and others, it is advisable to involve risk management and legal counsel in decision-making regarding error disclosure.  

Article Two of Two

A Framework for Thinking Ethically Article

This document is designed as an introduction to thinking ethically. We all have an image of our better selves-of how we are when we act ethically or are “at our best.” We probably also have an image of what an ethical community, an ethical business, an ethical government, or an ethical society should be. Ethics really has to do with all these levels-acting ethically as individuals, creating ethical organizations and governments, and making our society as a whole ethical in the way it treats everyone.

What is Ethics?

Simply stated, ethics refers to standards of behavior that tell us how human beings ought to act in the many situations in which they find themselves-as friends, parents, children, citizens, businesspeople, teachers, professionals, and so on.

It is helpful to identify what ethics is NOT:

  • • Ethics is not the same as feelings. Feelings provide important information for our ethical choices. Some people have highly developed habits that make them feel bad when they do something wrong, but many people feel good even though they are doing something wrong. And often our feelings will tell us it is uncomfortable to do the right thing if it is hard.
  • • Ethics is not religion. Many people are not religious, but ethics applies to everyone. Most religions do advocate high ethical standards but sometimes do not address all the types of problems we face.
  • • Ethics is not following the law. A good system of law does incorporate many ethical standards, but law can deviate from what is ethical. Law can become ethically corrupt, as some totalitarian regimes have made it. Law can be a function of power alone and designed to serve the interests of narrow groups. Law may have a difficult time designing or enforcing standards in some important areas, and may be slow to address new problems.
  • • Ethics is not following culturally accepted norms. Some cultures are quite ethical, but others become corrupt -or blind to certain ethical concerns (as the United States was to slavery before the Civil War). “When in Rome, do as the Romans do” is not a satisfactory ethical standard.
  • • Ethics is not science. Social and natural science can provide important data to help us make better ethical choices. But science alone does not tell us what we ought to do. Science may provide an explanation for what humans are like. But ethics provides reasons for how humans ought to act. And just because something is scientifically or technologically possible, it may not be ethical to do it.

Why Identifying Ethical Standards is Hard

There are two fundamental problems in identifying the ethical standards we are to follow: 
1. On what do we base our ethical standards?
2. How do those standards get applied to specific situations we face?

If our ethics are not based on feelings, religion, law, accepted social practice, or science, what are they based on? Many philosophers and ethicists have helped us answer this critical question. They have suggested at least five different sources of ethical standards we should use.

Five Sources of Ethical Standards

The Utilitarian Approach
Some ethicists emphasize that the ethical action is the one that provides the most good or does the least harm, or, to put it another way, produces the greatest balance of good over harm. The ethical corporate action, then, is the one that produces the greatest good and does the least harm for all who are affected-customers, employees, shareholders, the community, and the environment. Ethical warfare balances the good achieved in ending terrorism with the harm done to all parties through death, injuries, and destruction. The utilitarian approach deals with consequences; it tries both to increase the good done and to reduce the harm done.

The Rights Approach
Other philosophers and ethicists suggest that the ethical action is the one that best protects and respects the moral rights of those affected. This approach starts from the belief that humans have a dignity based on their human nature per se or on their ability to choose freely what they do with their lives. On the basis of such dignity, they have a right to be treated as ends and not merely as means to other ends. The list of moral rights -including the rights to make one’s own choices about what kind of life to lead, to be told the truth, not to be injured, to a degree of privacy, and so on-is widely debated; some now argue that non-humans have rights, too. Also, it is often said that rights imply duties-in particular, the duty to respect others’ rights.

The Fairness or Justice Approach
Aristotle and other Greek philosophers have contributed the idea that all equals should be treated equally. Today we use this idea to say that ethical actions treat all human beings equally-or if unequally, then fairly based on some standard that is defensible. We pay people more based on their harder work or the greater amount that they contribute to an organization, and say that is fair. But there is a debate over CEO salaries that are hundreds of times larger than the pay of others; many ask whether the huge disparity is based on a defensible standard or whether it is the result of an imbalance of power and hence is unfair.

The Common Good Approach
The Greek philosophers have also contributed the notion that life in community is a good in itself and our actions should contribute to that life. This approach suggests that the interlocking relationships of society are the basis of ethical reasoning and that respect and compassion for all others-especially the vulnerable-are requirements of such reasoning. This approach also calls attention to the common conditions that are important to the welfare of everyone. This may be a system of laws, effective police and fire departments, health care, a public educational system, or even public recreational areas.

The Virtue Approach
A very ancient approach to ethics is that ethical actions ought to be consistent with certain ideal virtues that provide for the full development of our humanity. These virtues are dispositions and habits that enable us to act according to the highest potential of our character and on behalf of values like truth and beauty. Honesty, courage, compassion, generosity, tolerance, love, fidelity, integrity, fairness, self-control, and prudence are all examples of virtues. Virtue ethics asks of any action, “What kind of person will I become if I do this?” or “Is this action consistent with my acting at my best?”

Putting the Approaches Together

Each of the approaches helps us determine what standards of behavior can be considered ethical. There are still problems to be solved, however.

The first problem is that we may not agree on the content of some of these specific approaches. We may not all agree to the same set of human and civil rights.

We may not agree on what constitutes the common good. We may not even agree on what is a good and what is a harm.

The second problem is that the different approaches may not all answer the question “What is ethical?” in the same way. Nonetheless, each approach gives us important information with which to determine what is ethical in a particular circumstance. And much more often than not, the different approaches do lead to similar answers.

Making Decisions

Making good ethical decisions requires a trained sensitivity to ethical issues and a practiced method for exploring the ethical aspects of a decision and weighing the considerations that should impact our choice of a course of action. Having a method for ethical decision making is absolutely essential. When practiced regularly, the method becomes so familiar that we work through it automatically without consulting the specific steps.

The more novel and difficult the ethical choice we face, the more we need to rely on discussion and dialogue with others about the dilemma. Only by careful exploration of the problem, aided by the insights and different perspectives of others, can we make good ethical choices in such situations.

We have found the following framework for ethical decision making a useful method for exploring ethical dilemmas and identifying ethical courses of action.

A Framework for Ethical Decision Making

Recognize an Ethical Issue

  1. Could this decision or situation be damaging to someone or to some group? Does this decision involve a choice between a good and bad alternative, or perhaps between two “goods” or between two “bads”?
  2. Is this issue about more than what is legal or what is most efficient? If so, how?

Get the Facts

  1. What are the relevant facts of the case? What facts are not known? Can I learn more about the situation? Do I know enough to make a decision?
  2. What individuals and groups have an important stake in the outcome? Are some concerns more important? Why?
  3. What are the options for acting? Have all the relevant persons and groups been consulted? Have I identified creative options?

Evaluate Alternative Actions

  1. Evaluate the options by asking the following questions:
  • Which option will produce the most good and do the least harm? (The Utilitarian Approach)
  • Which option best respects the rights of all who have a stake? (The Rights Approach)
  • Which option treats people equally or proportionately? (The Justice Approach)
  • Which option best serves the community 
    as a whole, not just some members? 
    (The Common Good Approach)
  • Which option leads me to act as the sort of person I want to be? (The Virtue Approach)

Make a Decision and Test It

  1. Considering all these approaches, which option best addresses the situation?
  2. If I told someone I respect-or told a television audience-which option I have chosen, what would they say?

Act and Reflect on the Outcome

  1. How can my decision be implemented with the greatest care and attention to the concerns of all stakeholders?
  2. How did my decision turn out and what have I learned from this specific situation?

This framework for thinking ethically is the product of dialogue and debate at the Markkula Center for Applied Ethics at Santa Clara University. Primary contributors include Manuel Velasquez, Dennis Moberg, Michael J. Meyer, Thomas Shanks, Margaret R. McLean, David DeCosse, Claire André, and Kirk O. Hanson. It was last revised in May 2009. End of article.

Blockchain – Discussion

Chapter 8 introduces governance issues and potential areas in which blockchain technology can help empower citizens. Create a new thread, choose one area from the material in chapter 8 in which blockchain technology can enhance citizen engagement, and describe the current problem and how blockchain technology could resolve or improve the current situation. Write your discussion in a way that is accessible by all readers – regardless of their political beliefs. In other words, focus on blockchain, not politics. Then think of three questions you’d like to ask other students and add these to the end of your thread. The questions should be taken from material you read in Chapter 7, 8, or 9. You’re not trying to test each other, but you are trying to start a discussion.

You must do this following:

1) Create a new thread. As indicated above, choose one area from the material in chapter 8 in which blockchain technology can enhance citizen engagement, and describe the current problem and how blockchain technology could resolve or improve the current situation. Write your discussion in a way that is accessible by all readers – regardless of their political beliefs. In other words, focus on blockchain, not politics. Then think of three questions you’d like to ask other students and add these to the end of your thread. The questions should be taken from material you read in Chapter 7, 8, or 9. You’re not trying to test each other, but you are trying to start a discussion.

2) Select AT LEAST 3 other students’ threads and post substantive comments on those threads. Your comments should answer AT LEAST one of the questions posed in the thread and extend the conversation started with that thread. Make sure that you include the question in your comment so I can see what question you’re answering.

ALL original posts and comments must be substantive. (I’m looking for about a paragraph – not just a short answer.)


Need an assignment to be done until 14th of May 15:00

Assignment Instructions

• Youarerequiredtowriteandsubmita3,300-3,700words report demonstrating your understanding of contemporary leadership and management.

Section 1 (LO1, LO2):

  • Critically evaluate the contemporary definitions of leadership and
  • Examine current perspectives of the roles and responsibilities of
    both leaders and managers generally.
  • Relate your evaluation to leadership concepts, by referencing
    leadership theories and approaches.
  • Relate your analysis to three leaders from the Forbes list.

Section 2 (LO3):

  • Propose a minimum of three critical skills and behaviours required
    to be a successful 21st century leader.
  • Consider specific methods of leadership and management
    development that could develop these critical skills.
  • Recommend how to implement and evaluate these development
    interventions effectively.
  • (You may present your recommended interventions and respective evaluations in a table format for section 2).

Applying learning to the assessment

Topics covered:

Early perceptions of leadership: Great Man Theory born, or made? Trait theory; Situation and contingency theory

• Defining and distinguishing leadership and management and evaluation of the similarities and differences between leadership and management
• Critical perspectives on early theories of leadership

Seasoned Styles of Leadership and Management: Transformational, Transactional, Charismatic, Servant leadership

  • Critical comparison of contemporary theories of leadership and management
  • Identifying and analysing leadership styles
    Recent Styles of Leadership: Authentic, Empathetic, Resonant. Awakened, Agile
  • Emotional intelligence in leadership
  • Relationship between leaders and followers, leader and follower power


Applying learning to the assessment

Topics covered:

Role of the modern leader: Creating vision, shaping culture, driving change, empowering high-performing teams, embodying ethics

  • Identifying the role of the leader from an early stage of an organization to driving change.
  • Exploring cultural dimensions in shaping culture and changing making.
  • Leadership values –kindness, happiness, positive , contagious and ethical leadership.
    Leadership and Management Development: Strategies, methods, approaches, measurement.
  • Purpose of LMD , models and activities, measurement of RoI.
  • Identifying Competencies and skills of the modern leadership era.
    Agile Leadership: Agile, adaptive, resilient leaders, teams and organizations
  • Identifying types of agility, characteristics, competencies.
  • Leaders as learners, learning agility

What should be your focus?

Three leaders from the Forbes List of Most Powerful Leaders

Why are you choosing the leaders you have chosen for analysis?

  • Leadership styles
  • A particular leader
  • Contemporary skills of the 21st century
  • Leadership vs. management
  • A particular sector
  • Your own leadership styles or styles that resonate best to you

What should be your focus?

What are your analysis criteria?

  • Leader’s traits and skills
  • Leader’s style, behavior and approach
  • Leader’s values
  • Accomplishment
  • Leader-follower exchange
  • Impact
  • Sector or field of work
  • Use or source of power
  • Age, gender or other personal characteristics
  • Context

What should be your focus?

• Sections
• Sub-sections • Apendix


  • Articles or journal articles
  • Case studies
  • Real life Examples