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Case study 4


Case Study #1

Steven Jenkins


HMGT 495

07 April 2022

An Overview of Estelle v. Gamble and how the 1976 Supreme Court Ruling Pertains to the Provision of Intimate Healthcare

The Supreme Court’s Estelle v. Gamble case of 1976 was considered the foundation in terms of consideration of the type of proof that is important in confirming the violation of the prisoner’s Eighth Amendment rights. In this case, Gamble who is involved in the case against the curt unloaded cotton bales from a truck as per the labor as part of the daily routines in the prison. Unfortunately, he suffered injury after the bale fell onto his back. He never stopped working despite the condition of his back and this led to the severity of the injury ad was later examined and sent back to the cell (Nowotny et al., 2018). The pain increased ad he later found himself in the prison hospital where he was ultimately examined by the doctor and given pain medications.

Months later, he was in and out of the hospital as a result of the nonstable severe pain and the migraine. He could endure the pain and sometimes refused to take part in the daily routines within the prison. He found himself on the wrong hand after he refused to work in the farm and was even denied the chance to access the doctor for about three days. He later drafted a prosecutor complaint with no legal representation as he alleged that the prison had violated his eighth amendment right (Nowotny et al., 2018). His argument about the prison’s failure to sufficiently initiate the treatment of his back constituted a cruel and unusual form of punishment. The case ended up in the Supreme Court of the United States.

The ruling is based on the principle of equivalence that is present in the jurisprudence associated t the care of the prisoners. Following the ruling, it is acknowledged that the rights of the prisoners to be provided with healthcare are enshrined in the eighth amendment of the constitution (Nowotny et al., 2018). The principle of equivalence is indirectly included in the rights of the prisoners towards access to healthcare.

The challenges encountered during the delivery of healthcare services within the correctional environment

The challenges in the provision of healthcare in the prison are associated with the barriers to healthcare. The perceptions expressed by the healthcare providers and other correctional staff are considered to be barriers. There are healthcare providers who are resistant to engaging in advance care planning (ACP) discussions due to the worry about the possibility of triggering the fears of death amongst the inmates. Others are opposed to this because it means an increase in the workload and learning of the new processes. Trust is absent among the prisoners toward healthcare providers and other staff hence affecting the activities aimed at promoting the ACP (Macleod et al., 2020). The absence of trust presumed by the healthcare providers is associated with the fears that ACP discussions are approaches used by the state to ensure a speedy dying process.

The challenges faced when offering healthcare services to the female inmates that might be lacking in the male prisons

Women offenders often have particular health needs that are associated with risky sexual behaviors, drug use behaviors before imprisonment, and the risk of infectious diseases like HIV, tuberculosis, and other breathing illnesses. The female offenders are at high risk of suffering from health issues. There is limited access to treatment for drug-related health issues. Currently, the majority of females receive fewer healthcare services compared to their male counterparts. The type of healthcare services provided to female offenders can be described as mediocre (Tsegaye, 2020). The reports that have been received from the female offenders indicate that the medical professionals offering services to them are under-skilled and most of the time withhold medical care and fail to show concern or care for their specific needs. This deficiency in the accessibility to healthcare services is an indication of the severe healthcare needs of the female offenders compared to the male offenders.

At present, the correctional facilities that host women offer prenatal and postpartum treatment. Nevertheless, these services are not typically needed and are provided based on the request of the inmates or when there is a clinical indication (Ekaireb et al., 2018,). The shortcomings in the response to pregnancy-associated health problems are common in female prions.

The framework to be applied in strategic planning

The prison institution always limits the availability of healthcare and in many prisons, women have to wait for long in lines under strenuous conditions caused by their health. Therefore, the policy framework is focused on ensuring that women offenders are accommodated in place physically separate from the accommodation for the male inmates. It is also important to ensure that there are gender-responsive policies (Tsegaye, 2020). The prisons must develop such policies to ensure that the specific needs of the female inmates are addressed. The policies should also be developed based on the consideration of the necessity to have all the aspects of healthcare for example mental ad physical health.


Ekaireb, R., Ahalt, C., Sudore, R., Metzger, L., & Williams, B. (2018). “We take care of patients, but we don’t advocate for them”: advance care planning in prison or jail. Journal of the American Geriatrics Society66(12), 2382–2388. https://doi.org/10.1111/jgs.15624.

Macleod, A., Nair, D., Ilbahar, E., Sellars, M., & Nolte, L. (2020). Identifying barriers and facilitators to implementing advance care planning in prisons: a rapid literature review. Health & justice8(1), 1-11. https://doi.org/10.1186/s40352-020-00123-5

Nowotny, K. M., & Kuptsevych‐Timmer, A. (2018). Health and justice: framing incarceration as a social determinant of health for Black men in the United States. Sociology Compass12(3), e12566. https://doi.org/10.1111/soc4.12566

Tsegaye, T. (2020). What Are the Challenges of Women in Incarceration? The Case of Dessie Correctional Center, Amhara Region, Ethiopia. GRIN Verlag.

Case Study 4

  1. Provide an overview of Estelle vs. Gamble and how that 1976 Supreme Court ruling pertains to the provision of inmate health care.
  2. Examine the challenges of providing health care in a correctional environment.
  3. What are the challenges of providing health care to a female offender population that may not exist in a male prison?
  4. What framework would you apply to the strategic planning? Why? (HINT: Remember all the available frameworks that you learned in the previous classes as well as in this class to make a correct choice; justify the final choice through the collaborative ).
  5. Identify what information and evidence you have to apply to the strategic process steps. Identify appropriate evidence you still need to correctly use the strategic planning process. (HINT: make sure to list all types of evidence you need)
  6. Identify appropriate evidence you still need to correctly use the strategic planning process. (HINT: make sure to list all types of evidence you need)
  7. Identify the sources of the needed evidence. Offer the stakeholders able to provide you with the evidence you are seeking.
  8. Develop decision-making matrix and identify appropriate solutions to the case. Read more about decision-making matrix.
  9. List potential implementation challenges and offer ways to offset them. 

case study 4

PMHNP PRAC 6645 Clinical Skills 

Self-Assessment Form

Desired Clinical Skills for Students to Achieve

Confident (Can complete independently)

Mostly confident (Can complete with supervision)

Beginning (Have performed with supervision or need supervision to feel confident)

New (Have never performed or does not apply)

Comprehensive psychiatric evaluation skills in: 

Recognizing clinical signs and symptoms of psychiatric illness across the lifespan

Mostly confident 

Differentiating between pathophysiological and psychopathological conditions 

Mostly confident 

Performing and interpreting a comprehensive and/or interval history and physical examination (including laboratory and diagnostic studies) 

Mostly confident 

Performing and interpreting a mental status examination 

Performing and interpreting a psychosocial assessment and family psychiatric history 

Mostly confident 

Performing and interpreting a functional assessment (activities of daily living, occupational, social, leisure, educational).

Mostly confident 

Diagnostic reasoning skill in:

Developing and prioritizing a differential diagnoses list


Formulating diagnoses according to DSM 5 based on assessment data 

Mostly confident 

Differentiating between normal/abnormal age-related physiological and psychological symptoms/changes


Pharmacotherapeutic skills in:

Selecting appropriate evidence based clinical practice guidelines for medication plan (e.g., risk/benefit, patient preference, developmental considerations, financial, the process of informed consent, symptom management) 


Evaluating patient response and modify plan as necessary 

Mostly confident 

Documenting (e.g., adverse reaction, the patient response, changes to the plan of care)

Mostly confident 

Psychotherapeutic Treatment Planning:

Recognizes concepts of therapeutic modalities across the lifespan


Selecting appropriate evidence based clinical practice guidelines for psychotherapeutic plan (e.g., risk/benefit, patient preference, developmental considerations, financial, the process of informed consent, symptom management, modality appropriate for situation) 


Applies age appropriate psychotherapeutic counseling techniques with individuals, families, and/or groups

Mostly confident 

Develop an age appropriate individualized plan of care

Mostly confident 

Provide psychoeducation to individuals, family, and/or groups

Mostly confident 

Promote health and disease prevention techniques

Mostly confident 

Self-Assessment skills:

Develop SMART goals for practicum experiences 


Evaluating outcomes of practicum goals and modify plan as necessary 

Mostly confident 

Documenting and reflecting on learning experiences

Mostly confident 

Professional skills:

Maintains professional boundaries and therapeutic relationship with clients and staff


Collaborate with multi-disciplinary teams to improve clinical practice in mental health settings 

Mostly confident 


Identifies ethical and legal dilemmas with possible resolutions



Demonstrates non-judgmental practice approach and empathy


Practices within scope of practice


Selecting and implementing appropriate screening instrument(s), interpreting results, and making recommendations and referrals:

Demonstrates selecting the correct screening instrument appropriate for the clinical situation 

Mostly confident 


Implements the screening instrument efficiently and effectively with the clients


Interprets results for screening instruments accurately



Develops an appropriate plan of care based upon screening instruments response


Identifies the need to refer to another specialty provider when applicable


Opportunities for growth:

The test for mental disorders and behavioral disorders is difficult to administer. The PMHNP must be competent to use psychosocial assessment, mental status evaluation, diagnostic tests, and physical examination to determine the differential diagnosis and rule out the psychopathology diagnosis (Chambers & Ryder, 2018). However, there are some areas where I need to improve, such as distinguishing between pathophysiological and psychopathology variables when attempting to prioritize psychopathological diagnosis. As a registered nurse, I have experience caring for patients suffering from behavioral and mental illnesses. I’ve realized that diagnosing and managing psychopathological conditions necessitates broad knowledge and assessment skills. This is due to the fact that the ability and competency of the clinician in assessment is required for the diagnosis and treatment of psychopathological disorders (Price & Reichert, 2017).

To improve on the aforementioned weaknesses, I must constantly broaden my psychiatric knowledge and assessment skills and apply everything I learn during clinical shifts. Interpreting a patient’s mental status reports has also proven to be a weakness of mine. However, I must take advantage of every opportunity to improve on this weakness during clinical rotations. Furthermore, by enrolling in the facility’s training program, I will continue to broaden my knowledge, particularly in research and clinical site assessment skills. Overall, I plan to participate in activities that will help me improve my personal and professional skills, as well as my PMHNP skills and knowledge, in order to promote evidence-based quality and safe care (Krautter et al., 2017).

Possible goals and objectives for this practicum experience.

1. Goal: At the end my practicum project, I need to have developed vast advanced mental status assessment skills.

a. Objective: identify potential mental and behavioral disorders using mental status exam

b. Objective: perform mental status exam on all patient encounters

c. Objective: interpret results of mental status examination

2. Goal: Develop autonomous skills and knowledge of assessing psychiatric problems towards the end of this project.

a. Objective: apply advanced assessment skills in making and prioritizing psychiatric differential diagnosis.

b. Objective: Develop psychiatric differential diagnosis for patient encounters using patient’s concerns, physical assessment and laboratory results.

c. Objective: make necessary diagnosis by demonstrating advanced techniques in performing focused assessment.

3. Goal: By the end of the practicum, to have developed appropriate psychiatric screening knowledge and skills and the use of instruments.

a. Objective: demonstrate advanced techniques in implementing psychiatric screening instruments.

b. Objective: Understand various psychiatric screening methods by applying advanced knowledge of practice.

c. Objective: interview my patients using effective communication skills and advanced interviewing technique

Case Study 4

 Based on this case, what can be done to facilitate the integration of shipping into intraregional supply chains? 

two to three reference and 250 to 300 words 

Case Study 4

Case Study 4

Please Read the article “Keeping plagiarism at bay in the Internet age” and answer the questions below.

1. How would you define “plagiarism”?

2. What are some ways that students can avoid plagiarism?

3. Suppose you are a professor and you discovered that a student copied an online source without giving proper credit. How would you handle this case? Would you report the student to the university’s academic standards committee? Why or why not?

4. What is self-plagiarism and how to students avoid this type of plagiarism?

Case Study 4

Integrity and the Research Report


Ethical Issues in Preparing the Research Report

  • Principles to follow
  • Justice—who will be the author(s)
  • Authorship based on contribution
  • If equal contribution, typically alphabetical order for presentation or publication.
  • Scientific integrity —accurate and honest reporting


Writing the Research Report

  • Presentation should be honest an written with integrity
  • Avoid plagiarism—not giving another person credit for their work
  • How to indicate another’s work
  • Quotation marks
  • Indented material


Scientific Fraud

  • Data Falsification
  • Fabricating the data
  • Not fully reporting data
  • Plagiarism
  • Presenting ideas or elements of another’s work as your own
  • Deliberate vs. non-deliberate (naive) = it’s all plagiarism
  • Ignorance & sloppiness are not legitimate excuses.
  • Cite sources of your ideas when you use the exact words (include quotation marks and page number) and when you paraphrase.


Plagiarism (continued)

Example of a Correctly Cited Direct Quote

“Informed by developments in case law, the police use various methods of interrogation — including the presentation of false evidence (e.g., fake polygraph, fingerprints, or other forensic test results; staged eyewitness identifications), appeals to God and religion, feigned friendship, and the use of prison informants” (Kassin & Kiechel, 1996, p. 125).


Plagiarism (continued)

Example of Plagiarism

(No Citation Accompanying Paraphrased Material)

Research investigations of deceptive interrogation methods to extract confessions are important because police use false evidence (e.g., fake test results) and false witnesses when interrogating suspects. Interrogators also pressure suspects by pretending to be their friends.


Plagiarism (continued)

Example of Paraphrased Material with Correct Citation

Research investigations of deceptive interrogation methods to extract confessions are important because police use false evidence (e.g., fake test results) and false witnesses when interrogating suspects (Kassin & Kiechel, 1996). Kassin and Kiechel also state that interrogators pressure suspects by pretending to be their friends.


Case Study 4


  1. Detached Retina

Mr. Gray, a 65-year-old man, was in an automobile accident in which he suffered a concussion. Soon after he was released, he noticed what he described as a “gray spot” in his field of vision. At first he ignored it, thinking it would go away, but the spot seemed to darken and spread over his visual field. He didn’t report any pain with the problem. On calling his physician, he was advised to go to the nearest hospital immediately. A detached retina was diagnosed.

After treatment, he regained most of his normal sight back. Five years later, he began having problems again. The central area of his visual field was becoming blurred, and he was losing his depth perception. An initial eye examination revealed neovascularization in both eyes.

  • Question 1:  Relate the patient history and circumstances of the injury and the signs and symptoms related to the pathophysiology of this condition.
  • Question 2: Discuss the treatments available for the patient.
  • Question 3: Relate the symptoms and signs to those of macular degeneration.
  • Question 4: Discuss the treatment available and the prognosis for recovering his normal vision.

Resources to assist you:




  1. Cardiovascular Accident

Mr. Quinn, age 64 years, developed a severe headache several that has not responded to acetaminophen. Now his speech is slurred, and his right arm and the right side of his face feel numb. He is very anxious and is transported to the hospital. Mr. Quinn has a history of smoking and arteriosclerosis, and there is family history of CVA and diabetes. Assessment at the hospital indicated weakness on the right side, including facial asymmetry and a blood pressure of 220/110 Hg mm. A CT scan showed damaged tissue on the left side of the brain, and an angiogram indicated narrowing of the carotid arteries and middle cerebral arteries, with occlusion of the left middle cerebral artery.

  • Question 1:  Discuss the pathophysiology related to CVA due to thrombus vs. embolus. Describe the stages in the development of an atheroma.
  • Question 2: Explain the predisposing factors in this case, and relate Mr. Quinn’s initial signs to the pathological changes.
  • Question 3: Discuss the treatments available after first aid for stroke patients and the patient’s prognosis.

Resources to help you:




  1. Parkinson Disease

Mr. Nimmo, age 66, has noticed excessive fatigue, muscle aches, and weakness in his legs for some time. His hands were shaking slightly, although his wife reported that the shaking appeared to stop when he fell asleep. Some unintentional head movements were also apparent. He remembers that his grandfather died in his mid-60s after suffering for years from a condition with similar symptoms. After several tests and the elimination of some other neuromuscular conditions, a diagnosis of Parkinson’s disease was made for Mr. Nimmo.

  • Question 1: Discuss the pathophysiology of Parkinson’s disease and how it differs from other neuromuscular conditions affecting older adults.
  • Question 2: Discuss the usual progression of the disease as the pathophysiology develops further. Indicate additional manifestations that will be noticeable.
  • Question 3: Describe the complications that frequently develop, including the rationale for each and the early indications of each problem.
  • Question 4: Discuss the treatments available to this patient.
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