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Unit 12 – Managing Absenteeism, Reducing Turnover, Retaining Staff & Dealing with Disruptive Staff Problems

Reading Assignment: Chapter 20 & 21 in Sulliva

Assignment 1: Can you recall instances where an employee’s leaving has benefited the organization? Describe what happened.

Assignment 2: Have you voluntarily left a job? What was the reason? Was there more than one reason? What reason did you give your supervisor?

Yes, to continue my study in the U.S

He refused at the first, but he agreed when he knew I would get bachelor degree.

Assignment 3: What suggestions to improve retention and reduce voluntary turnover would you recommend to administration of the organization where you work or have clinical experiences?

Give examples of ways to reduce voluntary turnover.

Assignment 4: Are you familiar with the signs and symptoms of substance abuse? Have you seen someone exhibit these characteristics? What signs or symptoms did they exhibit? What happened?

Assignment 5: Have you ever experienced bullying or seen others bullied? How did you or they handle it?

Yes, while working in x-ray department. Patients want to be seen first, and the ER system tells urgent first.

Assignment 6: Please read the New York Times article “Fear in the Workplace: The Bullying Boss” by Benedict Carey, June 24, 2004.

Assignment 7: Please read the New York Times article “Business; Running a Hospital like a Factory, in a Good Way” by Andrea Gabor, February 22, 2004.

Assignment 8: Please read the New York Times article “New York Jails Pose Biggest Test for Health Firm with Mixed Past” by Eric Lipton, September 25, 2000.

UNIT 13- Health Care Ethics and the Near Future

Reading Assignment: Chapter 10 Page 283

Assignment 1: Review Question B

Assignment 2: Review Question F

Assignment 3: Case Study – Page 260

Assignment 4: In the News – Page 267

Assignment 5: Please read the New York Times article, ”Ethical Questions arise as

Genetic Testing of Embryos Increases” by Gina Kolata, February 3, 2014.

Assignment 6: Please read the New York Times article,” A New Form of Stem-Cell Engineering Raises Ethical Questions”, by Carl Zimmer, March 21, 2017.

Genetic Counseling and Testing

· The science of genetics, discovered by Austrian botanist and priest Gregor Mendel, is the study of heredity and its variations.

· Genetics describes the biological influence that patients have on their offspring

· Genetic counseling is performed by geneticists.

· Genetic counselors meet with the couple usually before the pregnancy occurs to discuss the potential for passing on a defective gene.

· There are over 6,000 genetic disorders that have been identified as having a genetic factor, including: Tay - Sachs disease, Sickle-Cell Anemia and Cystic Fibrosis.

· Other common genetic diseases include:

· Down ’s syndrome, Phenylketonuria (PKU), Hemophilia, Huntington’s Chorea, Muscular Dystrophy, Fanconi’s Anemia, Neimann-Pick Disease, Gaucher Disease, Maple Sugar Urine Disease, Glycogen Storage Disease, and Cooley’s or Mediterranean Anemia.

· www.geneticdiseasefoundation.org

· Prenatal Screening

· In the future, physicians will be able to test parents to see if it is possible that they will give birth to a genetically impaired infant – BUT what is to be done with this information?

· Depending how paternalistic we are we may choose to:

· Not allow them to have children

· Suggest strongly that they do not have children

· Refuse to pay medical expenses

· Leave it up to the parents to take the risk.

· Ethically should we test for genetic diseases in the fetus for conditions that may show up late in life such as Huntington’s chorea?

· Patient’s feel they have the right to be informed of their medical conditions.

· Methods for genetic testing during pregnancy include:

· Chronic Villi Sampling

· Amniocentesis

· Genetic Testing of Newborns

· 3-5% of newborns have a hereditary or congenital disorder and one-fourth if all hospitalizations and deaths among babies are due to these disorders.

· Almost all states have passed laws requiring PKU testing in infant’s immediately after birth and before discharge from the hospitals.

· PKU is an amino acid defect that is treatable with dietary restrictions that must be started immediately to prevent mental retardation.

· Ethical questions regarding Genetic Testing

· Do parents have the right to be informed of all the results of a genetic test?

· What if there is the case of “misidentified paternity?” in which the testing indicates that the biological father us someone other than the man who believes he is the father?

· The mother is often told “quietly” about the misidentified paternity

· 1-10% of all people may have misidentified paternity.

· Does the person have the right to have children who are likely to be impaired?

· If a woman is carrying a child with severe neural tube defect –spinal bifida?

· Is society ever justified in requiring people to submit to genetic screening and counseling?

· Does the small number of people with the potential for a genetic disease it genetic condition justifies the expense of testing all babies?

· Should the public funds be used to pay for genetic testing when the parents are unable to pay?

· Genetic science has allowed us to think in terms of a post humanism society, a world of cyborgs, and new creations

· What are the ethical concerns that would forbid the movement toward a post human society (if any)?

· The promise

· Genetic screening

· Cloning

· Xenotransplantation without rejection (transplantation of non human organs

· Eugenics

· Gene therapy

· Somatic gene therapy

· Germ line therapy

· Cloning

· Genetic pharmacy

· Growth hormone has been used to treat conditions such as dwarfism

· Stem cells – develop into the body’s specialized tissues known as embryonic stem cells. “regenerative medicine”

· The promise

· Immortality

· Re-engineering humans

Eugenics

· Historical framework

· Eugenics is the practice of altering or controlling genetic makeup of offspring or the purpose of improving a population or matching the natural endowment of a group to certain social functions.

· Eugenics can be done in two ways:

· One can stop the reproduction of certain diseases and dispositions

· Or intervene directly in the genetic material of an individual after birth

· There is the possibility of catastrophic mistakes for both the individual and society.

· Eugenics also raises the problem of chance.

· How much chance can we morally and safely eliminate?

· Positive eugenics

· Improve the genetic pool of humanity by selecting positive attributes

· Negative eugenics

· We could eliminate genetic diseases

· Potential

· If one could create a society of happy, healthy, productive, handsome/beautiful, creative citizens

Genetically Altered Food Stuffs

· U.S. agriculture is in the forefront of genetically altering foods

· Some say that, in fact, there is no “natural” corn left

· Many in the United States and Europe are protesting the use of these foods

· Pros and cons for the use of genetically altered foods

· Reasonable public policies

Genetic Engineering

· The ability to alter the basic structure if life to correct a malfunction us the goal of genetic engineering.

· The new trait, as developed through genetic engineering, would then be passed on to future generations.

· Genetic engineering raises the possibility of direct genetic intervention into human beings.

· We must be very sure that our attempts to improve the hand that nature deals us do not end up making things worse.

· The modification of somatic cells (body cells that do not affect the genetic makeup of one’s children) raises some moral questions, but the modification of germ line cells brings us back to the whole issue of eugenics.

· Cloning

· Moral and ethical concerns are raided by critics who say that manipulating the human genetic code is “playing G-d.”

· A clone is a group of genetically identical cells that come from a single common cell.

· Cloning is the exact replication of a parent or cell.

· In 1997, a sheep called Dolly was cloned by a Scottish scientist.

· One if the stongest arguments against human cloning us the effect it may have on human dignity.

· Should we be able to control the creation of human beings?

· Should we be able to limit the production of defective human beings?

· “Defective” could have a different meaning depending who supplies the definition.

· The three reasons given to oppose cloning are:

· Health risks from the mutation of genes

· Emotional risks

· The risk of abusing the technology

· Gene Therapy

· Is when a needed gene us spliced onto the DNA of body cells to control the production of a particular substances is still in its infancy.

· Ethical questions include:

· Should gene therapy be used to create healthier fetuses?

· Should companies develop tests to predict mental illness?

· Should drugs be developed to turn average sized children into basketball players?

· Human Stem Cell Research

· Stem cells are considered to be the master cells in the body that can generate specialized cells.

· In 1998, Dr. James A, Thompson, University of Wisconsin researcher, became the first person to isolate stem cells.

· Stem cell research is facing significant controversy in the U.S. due to moral and ethical issues and this has resulted in limited federal dollars available for certain types of research.

· These cells can grow into any cell or tissue in the body is extracted form the inner mass of an embryo.

· They are composted of 100-300 cells that are small enough to fit on the head of a needle.

· These cells are considered to be the building blocks of a new era of regenerative medicine in which the body can heal itself.

· Functionally there are three types of human stem cells:

· Totipotential stem cells

· Are seen in the first few hours after an egg is fertilized and can develop into any human cell type, including those needed for development of an embryo into a fetus.

· This is the most versatile type of stem cell

· Pluripotential stem cells

· Are present several days after fertilization and can also develop into any cell type but can not develop into a fetus.

· Multipotential stem cells

· Are derived from pluripotential stem cells and can be found in adults. These cells can only form specific types of cells to form tissues.

· Stem cells can be used to treat a variety of diseases such as:

· Diabetes

· Heart disease

· Parkinson’s Disease

· Alzheimer’s Disease

· Liver Disease

· Autoimmune disease

· In the future we will develop new techniques to grow and replace skin tissue, broken bones, and even breast tissue.

· One of the most exciting new research projects from MD Anderson Cancer Center involves programming stem cells to acct as “smart bombs” by delivering engineered genes to destroy cancer cells. Another involves using stem cells to address fertility problems.

· The ethical controversy is not about the ability to end disease, but rather the use of frozen embryos to conduct research.

· Cells are removed from frozen embryos, which are obtained in a variety of ways, including some that are discarded by in-vitro fertilization clinics.

· Some of the embryos are grown in the laboratory especially for the purpose of stem cell research, some are obtained from terminated pregnancies and a few are donated by couples who have excess embryos as a result of IVF.

· Religious groups and abortion opponents have voiced criticism since the embryos used in this research are destroyed.

· These groups believe an embryo is a living human being.

· Congress has banned all federal funding of this project, but it does not affect private stem cell research.

· A more noncontroversial approach to stem cell research is offered by researchers who use sources other than embryos.

· Blood stem cells can regenerate specialized cells to treat blood disorders such as leukemia.

· Blood stem cells come from umbilical cords.

· On October 18, 2005, Acting Governor Cody created the nations’s first umbilical cord and placental blood banks for research.

· Cord blood work is very promising and acceptable to most groups that oppose “traditional” stem cell research

· Stem cell research is in the news daily and is being used as an election platform for many candidates.

· Current status

· What are the potential benefits?

· What are the ethical concerns that would forbid the practice? (if any)

· Current level of technology requires several hundred attempts to create one’s success

· Is this acceptable when dealing with humans?

· President Obama overturned stem cell research in 2009

Genetic Testing

· Potential

· Concerns

· Prenatal testing

· Chronic villi sampling (CVS)

· Amniocentesis

· Role of society

· Role of parents

· Review the case involving the woman with Huntington’s disease genetic history – discussion board?

· What is to be done?

Human Genome Project

· Started in the early 1990’s as a research program by the federal government.

· The project was estimated to cost between $3 and $5 billion dollars.

· Completed in the year 2000.

· The purpose was to “map” and sequence, the total number of genes, estimated at 100,000, within the 23 pairs of human chromosomes or 46 chromosomes

· This complete set of genes is known as the human genome.

· It resembles a set of blueprints for the human being that is stored in the nucleus of each cell.

· Provides a better understanding of the process of human evolution.

· Provides an improved understanding of the relationship between certain genes and particular diseases.

· The application of the knowledge gained from the human genome project is likely to be in the field of recombinant DNA,

· Scientists recombine the genetic material from one organism to another for various reasons.

· Sometimes it is applied to botany where the plant could be improved in some way such as making it more resistant to frost or less susceptible to spoilage and damage.

· There a many prospects of genetic intervention in humans, to combat disease or to eliminate the propensity for disease.

· The key to posthumanism is that the cyberbog existence is not to be resisted.

· Post humanists are willing to embrace the future and see the dangers that technology raises as an ongoing marketing problem.

· In regard to ethical decision making, the world of the post humanist will still be able to rely on duty, utilitarian and virtue models to examine problems.

· Concepts such as natural rights and human rights would become obsolete.

· There is currently an astonishing list of genes identified as gene markers that are responsible for disease.

· They include the following diseases:

· Colon cancer

· Amylotropic lateral sclerosis (ALS)

· Type II (adult onset) diabetes

· Alzheimer’s Disease

· Huntington’s Disease

· Achondroplastic dwarfism