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case study 3


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 3

Case 3: Knee Pain

A 15-year-old male reports dull pain in both knees. Sometimes one or both knees click, and the patient describes a catching sensation under the patella. In determining the causes of the knee pain, what additional history do you need? What categories can you use to differentiate knee pain? What are your specific differential diagnoses for knee pain? What physical examination will you perform? What anatomic structures are you assessing as part of the physical examination? What special maneuvers will you perform?

Diagram, timeline  Description automatically generated with medium confidence

Case Study #3

Instructions for Case Study – Am I a Girl or a Boy? An Unusual Case of Ambiguous Gender

This is ONE case study is composed of four (4) parts.

Tell the story; in a 250-350 words summary/paragraph (all four parts combined), communicate what you have learned about this case. Concentrate on the important parts, the concept. Do not assume that the reader knows anything about the case study.


Five points (5 pt.) will be subtracted for every 1-50 point(s) that you go over or under the allowed number of words.

Your case study will automatically be submitted to http://turnitin.com/ (a plagiarism prevention site). YOU DO NOT HAVE TO SIGN UP FOR AN ACCOUNT. High percentages on the similarity report (10% and greater) might be considered plagiarism and can result in a grade of zero (0). For information on plagiarism and citation go to http://www.usg.edu/galileo/skills/unit08/credit08_03.phtml and http://plagiarism.org/

· Write in narrative/essay format.

· Always define the concept discussed.

· Do not use quotes.

· Turn in one page; single-spaced (Microsoft Word file). Do NOT turn in a PAGES file.

· Use at least two additional references (three total – the handout is one) and list them at the end of your summary. Use an acceptable format, e.g., MLA or APA style. The references are NOT part of the 250 – 350 words.
Eight (8) points

(see rubric) will be subtracted if you do not have references or use any of the sources listed below.

· Do not use sources such as Wikipedia, ask.com, online dictionaries, and encyclopedia. Do NOT use my PowerPoint slides.

· Do not include sources (references) within the body of your summary (no in-text citation

· Do not use presentations (Prezi) from the internet (they are summaries of the handout). Do NOT use Course Hero as a source.

· Use a Spell Checker (Microsoft Word) and Grammarly to check for grammar, punctuation, etc. See “How to Sign Up for Grammarly” in the Case Study #3 folder in iCollege, Unit 10. Points will be subtracted for Grammarly scores below 90.
Failure to check your spelling and grammar can cause you up to 12 points

· Submit a Microsoft Word file in iCollege; in the Dropbox in Unit 9, Case Study #3 – Cellular Respiration, or click on Assessments on the navigation bar, followed by Assignments, then Case Study #3 – Girl or Boy.

· Turn in by 11:59 pm on Monday, April 25, 2022.

Late submission will result in a grade of zero (0).

case study 3

Episodic/Focused SOAP Note Exemplar

Focused SOAP Note for a patient with chest pain


CC: “Chest pain” 

HPI: The patient is a 65 year old AA male who developed sudden onset of chest pain, which began early this morning.  The pain is described as “crushing” and is rated nine out of 10 in terms of intensity. The pain is located in the middle of the chest and is accompanied by shortness of breath. The patient reports feeling nauseous. The patient tried an antacid with minimal relief of his symptoms.

PMH: Positive history of GERD and hypertension is controlled

FH: Mother died at 78 of breast cancer; Father at 75 of CVA.  No history of premature cardiovascular disease in first degree relatives.

SH : Negative for tobacco abuse, currently or previously; consumes moderate alcohol; married for 39 years 

General–Negative for fevers, chills, fatigue
Cardiovascular–Negative for orthopnea, PND, positive for intermittent lower extremity edema 
Gastrointestinal–Positive for nausea without vomiting; negative for diarrhea, abdominal pain
Pulmonary–Positive for intermittent dyspnea on exertion, negative for cough or hemoptysis  


VS: BP 186/102; P 94; R 22; T 97.8; 02 96% Wt 235lbs; Ht 70”

General–Pt appears diaphoretic and anxious

Cardiovascular–PMI is in the 5th inter-costal space at the mid clavicular line. A grade 2/6 systolic decrescendo murmur is heard best at the

second right inter-costal space which radiates to the neck.

A third heard sound is heard at the apex. No fourth heart sound or rub are heard. No cyanosis, clubbing, noted, positive for bilateral 2+ LE edema is noted.

Gastrointestinal–The abdomen is symmetrical without distention; bowel

sounds are normal in quality and intensity in all areas; a

bruit is heard in the right para-umbilical area. No masses or

splenomegaly are noted. Positive for mid-epigastric tenderness with deep palpation.

Pulmonary— Lungs are clear to auscultation and percussion bilaterally

Diagnostic results: EKG, CXR, CK-MB (support with evidenced and guidelines)


Differential Diagnosis:

1) Myocardial Infarction (provide supportive documentation with evidence based guidelines).

2) Angina (provide supportive documentation with evidence based guidelines).

3) Costochondritis (provide supportive documentation with evidence based guidelines).

Primary Diagnosis/Presumptive Diagnosis: Myocardial Infarction

This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

© 2019 Walden University

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© 2019 Walden University

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Case Study #3

Page 1“Am I a Girl, or a Boy?” by Leslie G. Wooten-Blanks

Leslie G. Wooten-Blanks
Biology Department
Clafl in University, Orangeburg, SC

Am I a Girl, or a Boy? An Unusual
Case of Ambiguous Gender


Part I – An Ambiguous Beginning

Being a third year medical student at the University of Florida, you have just begun your rotation in the obstetrics
wing of Shand’s Hospital in Gainesville, Florida. You’re excited to have this as your fi rst rotation because it has long
been a dream of yours to become a pediatrician.

Th ere’s a full moon the evening of your fi rst night shift in labor and delivery (L&D). A petite Latina woman comes in
with her husband. From the chart, you see that Mrs. Santiago is 40 weeks pregnant and her chart has the pregnancy
code “Gravida 4, Para 2” (shortened to G4 P2). Everything appears to be in order and you begin to talk to the couple
about the baby. You ask them if they know whether they are having a boy or a girl. Th ey tell you no, they want it to
be a surprised, like with their other children. Th e attending MD, Dr. Jackson, reviews Mrs. Santiago’s chart and asks a
few questions.

“Mrs. Santiago, I see here in your chart that you are 31 years old and that you were born in Santo Domingo. I love the
Dominican Republic. It is such a beautiful country. My wife and I went there last winter and had a wonderful time.”
Dr. Jackson looks through the chart some more and turns to you and asks: “How far apart are the contractions?”

“About three minutes,” you respond.

Dr. Jackson continues, “Ok, Mrs. Santiago, we are getting close. We are going to move into the delivery room now.”

After the delivery room is set up and the epidural is in place, Mrs. Santiago has noticeably calmed down but is feeling
the urge to push. Dr. Jackson asks you to check her cervix, and then he checks it. “What do you think?” he asks.

You reply, “100% eff aced and dilated 9 centimeters.”

He says, “I’d say it is more like 10 centimeters. She is completely eff aced and dilated. Mrs. Santiago, when you feel the
next contraction, go ahead and start pushing.”


1. What does “G4 P2” mean in Mrs. Santiago’s chart?
2. How many other naturally born children has Mrs. Santiago had?
3. What is eff acement?
4. What is dilatation?


Page 2“Am I a Girl, or a Boy?” by Leslie G. Wooten-Blanks

Part II – It’s Time to Push
After about an hour of pushing, the baby has crowned and is moving fairly quickly through the birth canal. You think,
“Th is isn’t so bad after all; maybe I should consider becoming an obstetrician.”

Finally, with one last push, the baby is delivered. Dr. Jackson says, “Congratulations! It’s a…” Th en Dr. Jackson
becomes very quiet.

You look at the baby and think to yourself, “It’s a girl… wait. If you look this way, it’s a boy. Hang on. Is this baby a
boy or a girl?”

After some deliberation, the otherwise totally healthy baby is identifi ed as a girl. Dr. Jackson explains that sometimes
the presence of excessive hormones associated with the pregnancy can cause swelling of the baby’s genitalia. Since the
delivery was uncomplicated, Mrs. Santiago and baby Maria Esperanza Santiago go home from the hospital.

As you continued through medical school and your residency, you sometimes refl ected on the case and wondered what
had happened to that little girl.

Six years later…

You were very lucky to have the opportunity to begin a new practice of pediatrics based in Mercy Hospital in Miami.
As you walk to the door of the exam room, you are reviewing your next patient’s paperwork. You think, “Maria
Esperanza Santiago… where have I heard that name before?”

Th e new patient is a healthy six-year-old girl accompanied by her attentive parents. Th e very precocious little girl
immediately tells you that she is on a tee ball team and is ready to play in her fourth game after she leaves the offi ce.
She’s very proud to tell you that she is the star player even though she is a girl.

You tell Mrs. Santiago, “Maria needs a couple of vaccinations, but everything looks great. Th e nurse will be in soon.”
Turning to your new patient, you say, “Maria, good luck at that game. Don’t let the boys pick on you! Girls are great
ball players, too.”

In the following years, you get to know Maria and her parents, but everything changes just before Maria’s 12th birthday.
Th e Santiagos show up at your offi ce a few months before Maria’s regularly scheduled yearly exam. In the exam room,
Mrs. Santiago is crying and Mr. Santiago is holding his cap in his hands. Maria is just staring at the fl oor in front of
her feet. You ask the Santiagos the reason for the visit, “Is Maria not feeling well?” Mr. and Mrs. Santiago look at each
other back and forth and then look at Maria. Finally, Mrs. Santiago blurts out, “Que ha crecido un pene.”

Bewildered, you ask, “Excuse me? My Spanish is not perfect so maybe I misunderstood what you just said. Did you
just say that Maria has grown a penis?”

“Yes! What is happening? Is she a guevedoce?” Mrs. Santiago exclaims.

It is at this moment that you make the connection between your fi rst experience in L&D at Shand’s years ago and now.
You think, “Could this possibly be the same child with ambiguous genitalia? She is the right age.”

“Mrs. Santiago, if she is, fi nding out will require only one test.” You turn to speak with Maria. “Maria, do you know
what chromosomes are?”

Maria replies, “Yes, I learned a little about chromosomes from my health teacher. I know humans have 46
chromosomes and two of them decide whether you are a boy or a girl.”

You explain, “Right. I’m going to order a special test called a karyotype. A karyotype reveals the number and types of
chromosomes of an individual. As humans, we have 46 chromosomes. Of those 46 chromosomes, two of them are
diff erent and determine whether a person is male or female. Th ey are called the sex chromosomes and we represent


Page 3“Am I a Girl, or a Boy?” by Leslie G. Wooten-Blanks

them as X or Y. Normally, a female will have two X chromosomes and a male will have one X and one Y chromosome.
We will take a sample of your blood and determine which chromosomes you have.”

Maria looks confused and asks, “But until just a little while ago, I looked like a girl. I don’t understand.”

“Well, Maria, there is a diff erence sometimes between what you see and what your chromosomes are. What you see is
called your phenotype. When you were younger, you looked like a girl. We would say that you were a phenotypic girl.
A karyotype will indicate whether you have two X chromosomes or an X and a Y chromosome. Although I am sure
you have many questions right now, I’m going to have a karyotype done on your cells and we will talk more after the
results are back.”

The Karyotype

Karyotyping reveals that Maria is 46,XY. Chromosomally, Maria is male. Yet she was identifi ed to be female at birth
and has lived as a female until now. Maria’s parents may be right. She may indeed be a guevedoce.


1. Maria’s karyotype is 46,XY. What would a normal female karyotype be?
2. Describe the diff erence between phenotypic and chromosomal sex.
3. Is Maria a true hermaphrodite?
4. What is a guevedoce?

Figure 1. Maria’s Karyotype.

Source: Karyotype of a human male courtesy of National Human Genome Research Institute, http://www.


Page 4“Am I a Girl, or a Boy?” by Leslie G. Wooten-Blanks

Part III – Changing Lives

You bring the Santiagos back into your offi ce once the test results come back so that you can discuss the results with
the entire family.

You tell Maria, “Remember what we said about chromosomes? If an individual has two X chromosomes, they are
normally girls—and those with an X and a Y are boys. Your results came back and you have an X and a Y.”

“Th en I am a boy? Why did the doctors say that I am a girl when I was born? What happened to me?” she asks.

You reply, “Early in development of a fetus, boys and girls look the same. After a while, they begin to look diff erent.
Th is is one reason why you can’t tell if a fetus is a boy or girl by ultrasound until 16 weeks into the pregnancy. Before
that point, it cannot be determined just by looking. However, if some cells were taken from the fetus and karyotyping
was performed, as it was done on you last week, it would show whether the baby was XX or XY. If your karyotype
had been done when you were born, it would have shown that you are a boy. You have very low levels of a key
enzyme called 5--reductase. It made your private parts look kind of in-between a girl and a boy when you were born.
But when you got old enough to go through puberty, you began to make enough testosterone to jump start your
development into a male.”

Maria blurts out, “Am I going to turn back into a girl?”

You answer, “You don’t have to worry; you won’t turn back into a girl. You always were a boy, but your body just didn’t
show it until now.”

“Well, I guess that explains why I was always better at tee ball when I was little.”

Th e Santiagos have several questions about Maria’s future development. You explain that Maria will develop like a
normal male with two exceptions: lack of a full beard, and will probably not experience a receding hairline. Maria
will develop more masculine characteristics just like all other boys with larger muscles and a deeper voice. No one will
know that Maria is any diff erent at all. Also, Maria has a decreased risk of having prostate cancer when he is older.

“How could this happen? How can Maria be a guevedoce? Manuel and I are not related to one another,” Mrs. Santiago
points out.


1. Why is it important in this story that the parents are from the Dominican Republic?
2. Why did Mrs. Santiago bring up that she and her husband are not related to one another?
3. What is the normal function of 5--reductase reductase and what does it have to do with this disorder?
4. What would lab results reveal about the testosterone and dihydrotestosterone levels in Maria at puberty?
5. As the pediatrician, what advice would you give the Santiagos? If you were Mr. or Mrs. Santiago, what would

you do to help Maria acclimate to a new life? How would you encourage Maria’s decisions?


Page 5“Am I a Girl, or a Boy?” by Leslie G. Wooten-Blanks

Part IV – The 13-Year-Old Checkup
For the 13-year-old checkup with the Santiagos, you are anxious to see what has happened in the last year. As you
enter the examination room, you are greeted by a young man wearing a baseball cap. Maria now goes by the name
Mario Manuel Santiago and is playing short stop on his school’s junior varsity baseball team. He is very excited to tell
you that they will be going to the state tournament next weekend. You tell him how proud you are of him. Mr. and
Mrs. Santiago seem very proud of him as well.

You notice that Mario has begun to grow a mustache and his voice is deeper this year. You ask Mr. and Mrs. Santiago
to leave the room so that you may talk to Mario alone for a few moments. Once the parents are out of the room, you
ask Mario how the adjustment has gone.

Mario replies, “At fi rst, I didn’t know what to do. I was very confused. But my family moved to a diff erent town to
make my adjustment easier. I like it at my new school, but some of the kids found out that I sort of used to be a girl. I
got bullied some, but my teachers stood up for me. Some of the kids called me a hermaphrodite. I looked that up on
the internet and found out that I’m not really a hermaphrodite. I’m a boy that just looked like a girl when I was born.
Now that I am on the baseball team and helped the team make it to the state tournament, most of the students like
me, but some still don’t. My parents said that if it is too hard on me, we can always move back to where they are from.
You know, the Dominican. But I like Florida.”

Later in your offi ce you speak with Mr. and Mrs. Santiago. Th ey tell you that they had driven back to meet you for
this visit, but they have moved to Tampa to get away from Miami in order to help Mario with his adjustment. Mrs.
Santiago tells you, “I called my mother in Santo Domingo to tell her what had happened and after asking some
questions we found out that Manuel and I are second cousins. We were shocked, but that made Mario’s condition
make more sense.”

You reply, “How has Mario’s adjustment been?”

Mr. Santiago begins, “I had to go to the principal’s offi ce more than once about Mario getting bullied. Mario stood
up for himself, though. His big brother, Josef, has helped a lot, too. Th is has been diffi cult on our family, though. We
never thought this would happen in our lives. We are trying to get Mario’s birth certifi cate changed to show that he is
male now so there is no question for him to answer when he plays sports.”


1. Should Mario’s birth certifi cate be changed to reveal his sex as male instead of female? Why or why not?


Page 6“Am I a Girl, or a Boy?” by Leslie G. Wooten-Blanks

Licensed image in title block © Alexey Afanasyev – Fotolia.com, ID# 8176652. Case copyright held by the National Center for Case Study
Teaching in Science, University at Buff alo, State University of New York. Originally published March 26, 2012. Please see our usage guidelines,
which outline our policy concerning permissible reproduction of this work.

Epilogue: The Clinical Signifi cance of 5--Reductase Defi ciencies
Th e case of guevedoces was originally studied in the early 1970s when several cases of the disorder were discovered
in the Dominican Republic. Th e endocrinologist who did the study was Dr. Julianne Imperato-McGinley, an
endocrinologist at Cornell Medical College. After analyzing the data, it was determined that the disorder was due
to a defi ciency in 5--reductase, the enzyme responsible for converting testosterone to DHT. It was found that this
decrease in 5--reductase leads to having a smaller than normal prostate gland and a signifi cantly decreased chance of
having benign prostatic hypertrophy (BPH) and prostate cancer. Men generally express their highest levels of DHT in
the prostate. A class of drugs was subsequently developed to block the formation of DHT, 5--reductase inhibitors
(ARIs). Use of these drugs stops the prostate from growing. ARIs like fi nasteride and dusteride block the formation of
DHT and are used in the treatment of BPH. It is also used to treat hair loss.


Information about testosterone and DHT

Androgens—Eff ects of testosterone and dihydrotestosterone

Dihydrotestosterone: An Introduction

Information on intersex conditions

Intersex [MedLine Plus]

Donohoue, P.A. 2011. Disorders of sex development (intersex). Chapter In: Kliegman, R.M., Behrman, R.E., Jenson,
H.B., Stanton, B.F., eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Saunders Elsevier.

Allen, L. 2009. Disorders of sexual development. Obstet Gynecol Clin North Am. 36: 25–45.

Intersex Society of North America

Information on guevedoces

Th e “Guevedoces” of the Dominican Republic

Marks, L. 2004. 5--reductase: History and clinical importance. Reviews in Urology 6(Suppl 9): S11–S21.

Conis, E. 2006. Th e case of the ex-girls. LA Times, Men’s Health Special Edition. Oct. 6, 2006.

Information on BPH and prostate cancer

Prostate Disease

Prostate Cancer Overview

Information of ARIs in the treatment of BPH and prostate cancer

Marks, L. 2004. 5--reductase: History and clinical importance. Reviews in Urology 6(Suppl 9): S11–S21.

Hudak, S.J., Hernandez, J., Th ompson, I. 2006. Role of 5--reductase inhibitors in the treatment of prostate cancer.
Clinical Interventions in Aging 1(4): 425–431.

case study 3

Episodic/Focused SOAP Note Template


Patient Information:

Initials, Age, Sex, Race


CC (chief complaint) a BRIEF statement identifying why the patient is here – in the patient’s own words – for instance “headache”, NOT “bad headache for 3 days”.

HPI: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES Mnemonic to complete your HPI. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form not a list. If the CC was “headache”, the LOCATES for the HPI might look like the following example:

Location: head

Onset: 3 days ago

Character: pounding, pressure around the eyes and temples

Associated signs and symptoms: nausea, vomiting, photophobia, phonophobia

Timing: after being on the computer all day at work

Exacerbating/ relieving factors: light bothers eyes, Aleve makes it tolerable but not completely better

Severity: 7/10 pain scale

Current Medications: include dosage, frequency, length of time used and reason for use; also include OTC or homeopathic products.

Allergies: include medication, food, and environmental allergies separately (a description of what the allergy is ie angioedema, anaphylaxis, etc. This will help determine a true reaction vs intolerance).

PMHx: include immunization status (note date of last tetanus for all adults), past major illnesses and surgeries. Depending on the CC, more info is sometimes needed

Soc Hx: include occupation and major hobbies, family status, tobacco & alcohol use (previous and current use), any other pertinent data. Always add some health promo question here – such as whether they use seat belts all the time or whether they have working smoke detectors in the house, living environment, text/cell phone use while driving, and support system.

Fam Hx: illnesses with possible genetic predisposition, contagious or chronic illnesses. Reason for death of any deceased first degree relatives should be included. Include parents, grandparents, siblings, and children. Include grandchildren if pertinent.

ROS: cover all body systems that may help you include or rule out a differential diagnosis You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe.

Example of Complete ROS:

GENERAL:  No weight loss, fever, chills, weakness or fatigue.

HEENT:  Eyes:  No visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat:  No hearing loss, sneezing, congestion, runny nose or sore throat.

SKIN:  No rash or itching.

CARDIOVASCULAR:  No chest pain, chest pressure or chest discomfort. No palpitations or edema.

RESPIRATORY:  No shortness of breath, cough or sputum.

GASTROINTESTINAL:  No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

GENITOURINARY:  Burning on urination. Pregnancy. Last menstrual period, MM/DD/YYYY.

NEUROLOGICAL:  No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL:  No muscle, back pain, joint pain or stiffness.

HEMATOLOGIC:  No anemia, bleeding or bruising.

LYMPHATICS:  No enlarged nodes. No history of splenectomy.

PSYCHIATRIC:  No history of depression or anxiety.

ENDOCRINOLOGIC:  No reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

ALLERGIES:  No history of asthma, hives, eczema or rhinitis.


Physical exam: From head-to-toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History. Do not use “WNL” or “normal.” You must describe what you see. Always document in head to toe format i.e. General: Head: EENT: etc.

Diagnostic results: Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines)



Differential Diagnoses (list a minimum of 3 differential diagnoses).Your primary or presumptive diagnosis should be at the top of the list. For each diagnosis, provide supportive documentation with evidence based guidelines.


This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.


You are required to include at least three evidence based peer-reviewed journal articles or evidenced based guidelines which relates to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 6th edition formatting.

© 2019 Walden University

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Case Study #3

Rubric for Case Studies: 

Criteria Level 4 Level 3 Level 2 Level 1


10 points

Defined the 
concept an related 
terms studied 

6 points

Defined the 
concepts studied, 
but left out related 

3 points

Concept not 
defined and left 
out some related 

0 points

No definition of 
concepts and related 


20 points

Summarized the 
case and stated 
the problems

15 points

Summarized the 
case and stated 
some of the 

10 points

Summarized case 
and left out the 
most of the 

0 points

No summary of the 


10 points

Provided relevant 
solutions to the 

6 points

Provided solutions 
to the problems 
but the solution 
were only 
somewhat relevant 

3 points

Provided solutions 
but the solutions 
were not relevant 

0 points

No solutions to the 


4 points

Two references 
present and 
references were 

3 points

Two references 
present but the 
references were 
not correctly 

2 points

Only one reference 
present and 
reference is not 

0 points

No references 

Mechanics of

6 points

Clear sentences, 
good transition, 
and no problems 
with spelling, 
punctuation, or 

4 points

Clear sentences, 
good transition, 
but problems with 
punctuation, or 

2 points

Clear sentences, 
no good transition, 
and problems with 
punctuation, or 

0 points

Awkward  sentences, 
no good transition, 
and problems with 
punctuation, or 

Overall Score
Level 4

45 or more
Level 3

40 or more
Level 2

35 or more
Level 1

0 or more

Superior Good Acceptable Needs Improvement


Case Study #3

 I need a case study written with no more than 350 words, based on the information provided. Attached will be the instructions, rubric, and reading which the information will be based off of. I need this done ASAP

Case Study 3

case study 3

Continue working with the case described in week 3. Prepare a memorandum targeting the following:

1. What staff arrangements are available to meet the needs of out of the facility appointments?

2. What staff arrangements are needed to:

Case Study 3


Case Study: The Stagecoach Scandal

Henry Wells and William G. Fargo structured a joint-stock company, Wells, Fargo & Company, on March 18, 1852, to provide express banking services to California during the California Gold Rush. They offered banking and express delivery of gold and anything else valuable. In 1858, the company expanded its services into overland mail and was awarded a government contract to carry mail from the southeast to California for the U.S. Post Office in their famous six-horse stagecoach. Over time, Wells Fargo developed new banking concepts and changed the way people banked. In the 1980s Wells Fargo became the seventh-largest bank in the nation and launched its online service.

Wells Fargo began cross-selling all services including credit cards, mortgages, and treasury management. They persuaded each retail customer to buy an average of six products, roughly twice the level of the previous decade. It was an aggressive sales culture with daily mandatory quotas, and employees began reporting that sales goals were unrealistic and unobtainable. A former New Jersey employee called an ethics hotline and sent an email to human resources in 2013, flagging unethical sales activities he was being instructed to do, and was subsequently terminated. There were deficiencies with a decentralized organization resulting in constrained corporate control. The local business units would address any issues only locally. For instance, if something was wrong, the chief risk officer in the retail bank would report it to the head of the retail bank only and they would handle the issue. It would never reach the corporate level.

In 2016, the Wells Fargo account fraud scandal came to light, and they announced that a $185 million fine would be paid to federal regulators and the city of Los Angeles to settle allegations that their employees had created millions of fake financial accounts for customers in order to get bonuses. Over five thousand employees were dismissed due to their conduct over a span of five years that lead to the $185 million payout. The conduct dated back to at least 2011 and involved more than 1.5 million checking and savings accounts and about 500,000 credit card accounts, with many customers getting hit with unexpected fees, according to federal officials. The year before the scandal came to light, the company made $20 billion.

Wells Fargo reconfigured incentives at the branch level to emphasize customer service instead of cross-selling metrics, and product sales goals were eliminated. The company also developed new procedures for verifying account openings and introduced additional training and control mechanisms to prevent violations. They also now spend more money on compliance. A third party helped them design a short survey for employees to determine needs and address issues. Senior leadership now visits local branches to interact with team members and address any needs. Now, if something happens at the local branch level, the chief risk officer reports to the corporate chief risk officer as well.

Appropriate training of relevant individuals can help them to identify what is causing lower sales and then recommend a solution. Wells Fargo bred a culture of unethical behavior, setting unrealistic sales goals for its employees and encouraging them to game the system in order to keep their jobs. That is why training, compensation management, and career development are all important in preventing these types of situations.

Case Study #3

I need a case study written with no more than 350 words, based on the information provided. Attached will be the instructions, rubric, and reading which the information will be based off of. It is due by 11:59 tonight.

Case Study 3

Please first read chapter 10 of your textbook. Then read the following case study entitled “Akamai’s Localization Challenge”. When you have finished reading the case study, please answer the case questions listed below.

The Case Study can be found here: Case Study – Akamai Localization Challenge.pdf Download Case Study – Akamai Localization Challenge.pdf

Read the Case Study, then In 2-3 pages (1.5 spaced lines) answer the following questions:

  1. What should Akamai localize (and in response to what?); 
  2. How should Akamai balance local integration with global responsiveness?;
  3. How should Akamai organize and staff its activities in order to strike the right balance of local responsiveness and global integration? 

Please be sure to justify your answers using information from the case.

Case Study 3

Uber Case Study

Student’s Name

Institutional Affiliate



To address the ethical concerns facing Uber’s management, this paper provides some relevant and practical answers. The biggest criticisms of the firm in the media are connected to public safety, which is addressed in this report to help improve the company’s goodwill and image. To combat the developing Uber Ethical Issues, management must examine all parts of the company’s business practices. Despite the company’s rapid development and expansion, there are endless claims and concerns about its service.

Uber Technologies Inc. is based in San Francisco, California. Uber is the world’s biggest online transportation service provider. UBER’s online transportation services are made possible through its smartphone app, which users may use to book a journey. These requests will be sent to registered Uber drivers who are not on a trip and are nearby. Uber’s online transportation services were accessible in 58 countries and 300 cities as of May 28, 2015. The company’s great profitability and ideal business strategy attracted many entrepreneurs who later began copying it. The worldwide market calls it UBERification (Angrist, 2017).

Though the corporation has successfully penetrated most local markets worldwide, it has faced several claims and litigation. The management division of UBER ignored ethical responsibility and a proper code of conduct, which eventually backfired in many local marketplaces. Recent research shows that neglecting corporate obligations and current Uber ethical difficulties makes it difficult to dominate the global market.

As stated before in this research on UBER ethical difficulties, the corporation has faced several lawsuits from various countries. The key Uber ethical concerns that are destroying the company’s image are outlined here.


Driver Safety

Concerns about driving safety have been addressed often among Uber drivers. The main security threats were from other local drivers, assault, and customer misbehaviour, robbery, etc. Customers have damaged taxis, but the corporation has provided no major help to Uber drivers. Listed below are recent occurrences that bolster the case for Uber drivers’ lack of protection.

The client (a Florida doctor) allegedly attacked the Uber driver on January 1, 2016. Bystanders videotaped the event, which went viral on social media. Although the local authorities intervened and placed the doctor on administrative leave, the Uber Company management has taken no meaningful measures.

A inebriated customer reportedly assaulted an Uber driver in California on November 3rd, 2015. The video went viral, and the guy lost his job as a corporate manager at Taco Bell (Glöss, 2016). In this situation, too, Uber has shown no assistance for its driver.

Passenger security

According to a New York Times story, several Uber drivers have been accused of sexual attacks on customers. The lack of due diligence in hiring drivers was the main cause of these sad incidents. The corporation hasn’t specified any standards or rules for becoming an Uber driver. Various Uber drivers have been charged for rape, sexual harassment, sexual assault, verbal abuse, stalking, etc (Saadah &Mubah, 2017). These Uber ethical concerns have harmed the company’s image globally. Other violent acts including assault, overcharging, profanity, and drunk driving have harmed the company’s image. Several recent occurrences have shown Uber’s ethical concerns.

In January 2016, an Uber driver was arrested in Chicago for abducting an intoxicated passenger. He was also charged with rape for attempting to sexually abuse her in a hotel room.

In Chicago, another passenger accused an Uber driver of sexual assault. According to a London news article, an Uber driver was charged with sexual assault after asking a passenger to perform oral sex.

Unethically Taking a competitor’s drivers.

Uber has hired independent contractors who utilize fake identities on their burner phones. They use it to order new cars from key rivals (For instance, Lyft). During the ride, the independent contractors test the driver’s allegiance to the Uber Company. Currently, drivers are given the sign-up kit if agreed.

According to a CNN Money article, roughly 177 Uber workers booked and cancelled around 5500 trips in a month. Lyft accuses Uber of serious business ethical violations. Lynch Company on Uber has charged the purpose to harm its operation. According to Lyft, the process of ordering and canceling a trip wastes the drivers’ money, effort, time, and so on.

Unjust Leadership

Travis Kalanick, Uber’s initial CEO, admitted to sabotaging Lyft’s finance strategy. Investors were misled and misled to avoid investing in Lyft’s venture capital. That Kalanick called the firm Boob-er (implying that the company has worked as a chick magnet for him) is also a shame to the Uber leadership (Leighton, 2016).

This decision implies that management and leadership must modify their tone and strategy to meet the current Uber ethical problem. Travis Kalanick’s actions and demeanor were unethical. His personality was not a model for the massive economic enterprise.

Inconsiderate hiring and unethical employee behavior

Uber’s management is infamous for its careless hiring practices and subsequent unethical behavior from its staff. As previously discussed, the company’s management hired independent contractors and brand advocates to recruit drivers to Uber. It was done by giving drivers different credit cards so that a competitor’s account could be formed. Uber’s management dubbed the agenda/plan Supplying Long-Term Operations Growth (SLOG) (Jiang, 2018).

Increasing reports throughout the globe suggest that most Uber workers are immoral. The significant indulgence in unethical behaviors including booking and cancelling competitor firms’ orders reveals Uber’s unscrupulous leadership and staff. Due to Uber’s actions, major competitors like Lyft have to incur huge losses due to unnecessary pick-up and return to other clients in case of fake and unsuccessful orders.

Uber ethical issues: suggestions

Employees’ unethical behavior

If Uber’s management wants to keep the firm going, it should promote ethical behavior among its workers. Uber’s executives should stop using fake accounts to order and cancel trips from competitors. Rather than harming others’ businesses, the organization should concentrate on improving service delivery and customer pleasure. The current mentality will eventually undermine the company’s business.

Safe Passenger

The huge number of allegations and lawsuits against Uber drivers globally demonstrates Uber’s ethical difficulties of passenger safety. Customers are opting for safer online transport providers due to drivers committing serious crimes like rape and sexual assault. Providing passengers with contemporary technological technology that allows them to call the police control center and their family in times of crisis will help safeguard clients and boost customer satisfaction (Wyman, 2017). Passenger safety is a potential Uber ethical problem.

Driver Safety

Assaults against drivers are as common as assaults on passengers. The company’s operations demonstrate that it has never properly supported drivers in difficulties. Drivers should be protected by security measures. Installing adequate internet cams in the cab will ensure driver safety. The firm should know that any kind of assault is prohibited and should be penalized. To reduce Uber Ethical Issues, the firm should help drivers who have been assaulted or abused.


Angrist, J. D., Caldwell, S., & Hall, J. V. (2017). Uber vs. taxi: A driver’s eye view (No. w23891). National Bureau of Economic Research.

Cramer, J., & Krueger, A. B. (2016). Disruptive change in taxi business: The case of Uber. America Economic Review, 107(5), 176-82.

Glöss, M., McGregor, M., & Brown, B. (2016, May). Designing for labour: Uber and the on-demand mobile workforce. In Proceedings of the 2017 CHI conference on human factors in computing systems (pp. 1632-1643).

Jiang, S., Chen, L., Mislove, A., & Wilson, C. (2018, April). On ride sharing competition and accessibility: Evidence from Uber, lyft, and taxi. In Proceedings of the 2018 World Wide Web Conference (pp. 863-872).

Leighton, P. (2016). Professional self-employment, new power and the sharing economy: Some cautionary tales from Uber. Journal of Management & Organization, 22(6), 859-874.

Saadah, K., Yasmine, S. E., & Mubah, A. S. (2017). Digital collaborative consumption and social issues: The clash of taxi and Uber driver in Surabaya and Taipei. Masyarakat, Kebudayaan dan Politik, 30(4), 333-343.

Wallsten, S. (2015). The competitive effects of sharing economy: how is Uber changing taxis. Technology Policy Institute, 22, 1-21.

Wyman, K. M. (2017). Taxi regulation in the age of Uber. NYUJ Legis. & Pub. Pol’y, 20, 1.

Case Study 3

Running head: UBER’S MORAL PROBLEM 1





Course title:

Date of submission:

Ethical Egoism

What the company does is that it uses applications to receive ride requests and then sends out these requests to the driver who transports them to their final destination. This extremely useful asset comes with many challenges at hand. The biggest of the mall is driver safety. There has been much harassment of drivers related to the company (Reid, 2020).

Ethical Egoism is selfish and believes in enriching oneself over others. Ethical Egoism is about self and zeroes regard for others. Since ethical Egoism is about self-satisfaction, then by taking care of self-interest, one is doing a moral thing based on the theory.

A guilty conscience is when one feels like they have not done the right thing. In the context of Egoism, guilt is not taking care of self-interest. Based on psychological Egoism, one should not do the impossible, such as altruism.

From my case scenario standpoint, I think Uber has an ethical egoism problem, and it shows not to care and believes in enriching oneself over others. It is always about self and zeroes regard for others; in many case scenarios, the client from Florida allegedly attacked the Uber driver on January 1, 2016. The whole action was videotaped by bystanders, which went viral on social media(Glöss, McGregor,  Brown, 2016, May). Although the local authorities intervened and placed the doctor on administrative leave, the Uber Company management has taken no meaningful measures. Based on this theory, uber was taking care of self-interest on their side; hence they were on the right side.




However, Uber has brought up very good reforms to don’t feel very selfish to the public (Reid, 2020). They have decided to use the corporate compliance policy o things like how they classify workers, such as how they call them independent contractors. Uber has plans to classify them as employees where the drivers would have different employment protection benefits(Glöss, McGregor,  Brown, 2016, May).

I am afraid I have to disagree with this approach to judging ethical problems, and here is the reason. Even though morality is not universal in the manifestation of its practices, we must understand that many of its foundations rest on social consciousness. We are social beings, and we need each other as a species to survive. The interest of subsistence is one of the fundamental motors of group life. In this respect, ethical selfishness contradicts this interest, which is practically natural in character.

The individual’s interest is in the interest of the species and vice versa. If at all times I act only for my good, sooner or later, I will begin to draw borders that go beyond what is allowed. A true moral judgment rests on the contextual idea of ​​the individual within the species (Glöss, McGregor,  Brown, 2016, May).

It is not natural for an individual to live alone, to try by all means to solve their problems without the support of anyone; Nor is it natural that you intend to act exclusively for your good at all times. This contradicts their social nature. Morality is universal as a practice in its diversity of manifestations and addresses the need to think of oneself and others as a regulatory factor that promotes the possibility of harmonious and more just life.





Social Group Relativism

In a case scenario, Uber’s management was infamous for its careless hiring practices and subsequent unethical behavior from its staff. As previously discussed, the company’s management hired independent contractors and brand advocates to recruit drivers to Uber. It was done by giving drivers different credit cards to form a competitor’s account. Management dubbed the agenda/plan Supplying Long-Term Operations Growth (Robinson, Smyth, Woodman, and Donzella, 2021).

From my perspective, I think Uber used the concept of utilitarianism. This is because The principle of utilitarianism is that “the end justifies the means,” whereas deontology is based on the idea that “the end does not justify the means.” At the same time, utilitarianism is a teleological moral theory. Utilitarianism uses distinct methods to determine if we do it right or bad. We should look at our maxims, or intentions, of the particular activity.

As much as it is being said, I think uber is trying as much as possible to impact different communities that view will serve to increase stakeholder management. They aim to improve in “improving relationships protectively” (Robinson, Smyth, Woodman, and Donzella, 2021).

I agree with this approach to judging ethical problems, and here is the reason. It places a strong focus on neutrality. When making a choice, one should analyze everything from a ‘God’s eye’ perspective and treat everyone equally (Jiang, Chen, Mislove, amp and Wilson, 2018, April). Utilitarianism is an unbiased moral theory because of its emphasis on neutrality, which means it regards everyone’s status and interests to be equal. Act Utilitarianism is pragmatic and focuses on the outcomes of a decision.


Robinson, J., Smyth, J., Woodman, R., & Donzella, V. (2021). Ethical considerations and moral implications of autonomous vehicles and unavoidable collisions. Theoretical Issues in Ergonomics Science, 1-18.

Reid, E. (2020). Book review: mean girl: Ayn Rand and the culture of greed by Lisa Duggan. LSE Review of Books, 1-3.

Glöss, M., McGregor, M., & Brown, B. (2016, May). Designing for labor: Uber and the on-demand mobile workforce. In Proceedings of the 2017 CHI conference on human

factors in computing systems (pp. 1632-1643).

Jiang, S., Chen, L., Mislove, A., & Wilson, C. (2018, April). On ride-sharing competition and accessibility: Evidence from Uber, Lyft, and taxi. In Proceedings of the 2018 World Wide Web Conference (pp. 863-872).


Last assignment CASE STUDY feedback.

Thank you for handing in your assignment before the due date as that allowed me to start marking early. It is evident that you invested time and energy in this final work, unfortunately, it can’t be awarded with a Pass; my feedback below should make clear why that’s the case.

The assignment starts with the case study of Anton. The issues where Anton are presenting with are first addressed. Unfortunately, this reads too much like an iteration of the case scenario from the Assessment Guide. It is also really short in light of the 30% weight that is attached to the first assessment task. You should have focussed on the main physical health issue that is present in Anton’s case — the risk of developing metabolic syndrome — and how the other issues are impacting on this; one of the most important is the use of Risperdal, so we wanted you to think carefully about the impact of this antipsychotic on the risk of developing metabolic syndrome as well as its effect on potency. 

You make a strong plea in the care plan for the need of optimising physical exercise and healthy nutrition. The directions that are shared here are sound and supported by evidence from the literature. What is missing here, however, is a discussion on how these would precisely halt the development of metabolic syndrome. Similar to the first section, there is no reflection here on what should be done with the administration of Risperdal; should this antipsychotic be continued, or should we stop it or lower its dose, or consider a different antipsychotic, so that the risk of metabolic syndrome would be mitigated and Anton not any longer experiences impotency…?

A referral to an exercise therapist and a dietician would indeed benefit Anton’s physical health, as well as a sexual therapist to optimise his sexual life. However, again nothing is considered here regarding the use of Risperdal and which professional consequently should become involved.

Anton would indeed benefit from support to get over his cannabis use. But just one support group for this suffices, so why not considering as a second support group one that could help Anton getting his life back on track in terms of employment or education?

The outcome scenario provides some idea what could happen to Anton in case his care plan would be adequately implemented.

Now over to the case of Cat.

As this whole unit has been on physical health of people with a mental illness, we expected that you would have a primary focus on the physical health issues where the people in the case studies present with. In the case of Cat that was her disordered eating behaviours. The first section should have revolved around that: what underlies these behaviours and how are the other health issues impacting upon. Vital in this case was giving insight regarding weight and BMI: how much does Cat weight now, what is her BMI, and what does this BMI tell us (a little over 17, meaning that she is in the category of ‘moderately underweight’ and that therefore treatment in the community should be favoured over hospitalisation).

In light of the purpose of this assignment, we were not interested in how to manage the mental health of the people form the case studies. The text spent on talk therapy should have remained limited to one or two sentences. The focus should have been put on how Cat could be helped in overcoming her eating disorder, by first having eye for how her immediate physical health issues should be targeted. Her physical health is at a direct risk due to binging and purging (which actually can be life-threatening in case she continues with this) and electrolyte balance; this should have been discussed first. Then the focus should have been put on how Cat could be assisted with gaining weight so that her BMI would get in between the “healthy” parameters once again. Once this has been done, then the focus could be switched to how Cat could get her life back on track, and only then a form of psychotherapy can be brought in.

Text spent on the professionals to who Cat should be referred to remains too limited. Just a community therapist (what is such a profession about; a social worker….?) and psychologist would not suffice. She should be referred to a GP for monitoring her health and the introduction of a dietician would help her in gaining weight and maintaining a healthy diet.

Community support in the form of assistance to overcome methamphetamine use would be a good choice as well as assistance for eating disorders. 

The outcome scenario should have had a focus on how Cat could be assisted in overcoming her disordered eating behaviours.

Writing and referencing are done competently; just a few hiccups here and there which are identified in inline comments.

Throughout the unit we have emphasised the need of addressing physical health in the three assignments. That meant that with this last assignment you should have had a core focus on targeting and optimising the physical health of the persons from the case studies. What the main physical health issues were in these cases, was even mentioned in the title of the case scenarios. The lack of reflection on the risk of metabolic syndrome in the case of Anton, and preventing a further worsening of Cat’s weight and physical health, has led me to decide to fail your assignment; it simply does not adequately target the assessment tasks and therefore can’t be awarded with a Pass. Hope to see you back in a future unit!

Case Study 3

Case Study 3

Scientific fraud is one example of an unethical research practice.

Please read the article below and discuss the questions that follow.

From the New York Times

November 2, 2011

By Benedict Carey


A well-known psychologist in the Netherlands whose work has been published widely in professional journals falsified data and made up entire experiments, an investigating committee has found. Experts say the case exposes deep flaws in the way science is done in a field, psychology, that has only recently earned a fragile respectability.

Joris Buijs/Pve

The psychologist Diederik Stapel in an undated photograph. “I have failed as a scientist and researcher,” he said in a statement after a committee found problems in dozens of his papers.

The psychologist, Diederik Stapel, of Tilburg University, committed academic fraud in “several dozen” published papers, many accepted in respected journals and reported in the news media, according to a report released on Monday by the three Dutch institutions where he has worked: the University of Groningen, the University of Amsterdam, and Tilburg. The journal Science, which published one of Dr. Stapel’s papers in April, posted an “editorial expression of concern” about the research online on Tuesday.

The scandal, involving about a decade of work, is the latest in a string of embarrassments in a field that critics and statisticians say badly needs to overhaul how it treats research results. In recent years, psychologists have reported a raft of findings on race biases, brain imaging and even extrasensory perception that have not stood up to scrutiny. Outright fraud may be rare, these experts say, but they contend that Dr. Stapel took advantage of a system that allows researchers to operate in near secrecy and massage data to find what they want to find, without much fear of being challenged.

“The big problem is that the culture is such that researchers spin their work in a way that tells a prettier story than what they really found,” said Jonathan Schooler, a psychologist at the University of California, Santa Barbara. “It’s almost like everyone is on steroids, and to compete you have to take steroids as well.”

In a prolific career, Dr. Stapel published papers on the effect of power on hypocrisy, on racial stereotyping and on how advertisements affect how people view themselves. Many of his findings appeared in newspapers around the world, including The New York Times, which reported in December on his study about advertising and identity.

In a statement posted Monday on Tilburg University’s Web site, Dr. Stapel apologized to his colleagues. “I have failed as a scientist and researcher,” it read, in part. “I feel ashamed for it and have great regret.”

More than a dozen doctoral theses that he oversaw are also questionable, the investigators concluded, after interviewing former students, co-authors and colleagues. Dr. Stapel has published about 150 papers, many of which, like the advertising study, seem devised to make a splash in the media. The study published in Science this year claimed that white people became more likely to “stereotype and discriminate” against black people when they were in a messy environment, versus an organized one. Another study, published in 2009, claimed that people judged job applicants as more competent if they had a male voice. The investigating committee did not post a list of papers that it had found fraudulent.

Dr. Stapel was able to operate for so long, the committee said, in large measure because he was “lord of the data,” the only person who saw the experimental evidence that had been gathered (or fabricated). This is a widespread problem in psychology, said Jelte M. Wicherts, a psychologist at the University of Amsterdam. In a recent survey, two-thirds of Dutch research psychologists said they did not make their raw data available for other researchers to see. “This is in violation of ethical rules established in the field,” Dr. Wicherts said.

In a survey of more than 2,000 American psychologists scheduled to be published this year, Leslie John of Harvard Business School and two colleagues found that 70 percent had acknowledged, anonymously, to cutting some corners in reporting data. About a third said they had reported an unexpected finding as predicted from the start, and about 1 percent admitted to falsifying data.

Also common is a self-serving statistical sloppiness. In an analysis published this year, Dr. Wicherts and Marjan Bakker, also at the University of Amsterdam, searched a random sample of 281 psychology papers for statistical errors. They found that about half of the papers in high-end journals contained some statistical error, and that about 15 percent of all papers had at least one error that changed a reported finding — almost always in opposition to the authors’ hypothesis.

The American Psychological Association, the field’s largest and most influential publisher of results, “is very concerned about scientific ethics and having only reliable and valid research findings within the literature,” said Kim I. Mills, a spokeswoman. “We will move to retract any invalid research as such articles are clearly identified.”

Researchers in psychology are certainly aware of the issue. In recent years, some have mocked studies showing correlations between activity on brain images and personality measures as “voodoo” science, and a controversy over statistics erupted in January after The Journal of Personality and Social Psychology accepted a paper purporting to show evidence of extrasensory perception. In cases like these, the authors being challenged are often reluctant to share their raw data. But an analysis of 49 studies appearing Wednesday in the journal PLoS One, by Dr. Wicherts, Dr. Bakker and Dylan Molenaar, found that the more reluctant that scientists were to share their data, the more likely that evidence contradicted their reported findings.

“We know the general tendency of humans to draw the conclusions they want to draw — there’s a different threshold,” said Joseph P. Simmons, a psychologist at the University of Pennsylvania’s Wharton School. “With findings we want to see, we ask, ‘Can I believe this?’ With those we don’t, we ask, ‘Must I believe this?’ ”

But reviewers working for psychology journals rarely take this into account in any rigorous way. Neither do they typically ask to see the original data. While many psychologists shade and spin, Dr. Stapel went ahead and drew any conclusion he wanted.

“We have the technology to share data and publish our initial hypotheses, and now’s the time,” Dr. Schooler said. “It would clean up the field’s act in a very big way.”


1. What is your reaction to this article?

2. Which core values were violated by Stapel?

3. How do cases like Stapel’s cause possible harm to the field of psychology?

4. How would you explain to a family member that scientific misconduct is not the norm for researchers?

5. What are the appropriate penalties that should be enforced when scientific fraud is committed?

Case study 3


Quality and Safety

Ms. Amy Jones was a 55-year-old woman being treated for depression at a mental health facility. She was alert, oriented, ambulating without difficulty, and interacting appropriately with staff. The patient’s family was scheduled for a meeting with her treatment team in the afternoon. During the day Ms. Jones met with her psychiatrist, Dr. Ian Smith, in Ms. Jones’s room. When her roommate came in, Dr. Smith suggested that they complete their session in his office, and Ms. Jones accompanied him to that space. On the way she complained that she felt weak but could make it. During the session she reported that she had a headache, which Dr. Smith attributed to anxiety. He went to look for a nurse to provide medication for Ms. Jones. On his return with Ms. Mary Sullivan, a registered nurse, Ms. Jones was on the floor on her knees vomiting. A physician working across the hall came and assisted Dr. Smith and Nurse Sullivan with Ms. Jones, who was now quite somnolent, into a wheelchair. Dr. Allen, the primary care physician, ordered that Ms. Jones be given Phenergan IM for the vomiting and that the nursing staff monitor her bowel sounds. Dr. Allen reported that she was not informed of Ms. Jones’ complaints of headache or loss of bowel control. Dr. Allen thought that she was dealing with gastrointestinal symptoms so she had the nurses check for bowel sounds and softness of the patient’s belly. She reports that she received a second callback and was told bowel sounds were normal, the patient’s stomach was soft, and the patient was resting comfortably. Ms. Jones was bathed and returned to her bed. She took the prescribed Phenergan after which she vomited several more times during that shift. She was incontinent of stool once. No one considered conducting neurologic checks because the staff thought Ms. Jones was suffering from a virus.

When Ms. Jones’s family members arrived, the nurses advised them that their mother was sick and was sleeping, and would not be able to attend the meeting. The family members could not arouse the patient. The staff said that Ms. Jones had been administered Phenergan for vomiting and would be awake by evening. Family members returned that evening and found the patient still unresponsive with vomit in her mouth. The family checked Ms. Jones’ pupils and found them unequal. The family reported to the registered nurse at the desk, and another nurse checked Ms. Jones’ vital signs and reported them to be normal. The family telephoned Ms. Jones’ primary care physician, Dr. Allen, and the nurse gave him a report. Soon after this call, an ambulance transported Ms. Jones to the hospital for evaluation. Ms. Jones subsequently died at the hospital.

Ms. Jones’ daughter stated that the registered nurse did not assess her mother; on arrival in the unit, the EMT assessed Ms. Jones. Ms. Jones’ daughter did not believe that her mother had been adequately monitored from noon to 6:30 PM. She also complained that the nurses were laughing at the family’s concerns about the condition in which they found their mother.

Ms. Cherie Hoffman, a registered nurse, had been employed at the facility for 25 years. She began her career as a nursing assistant, a title she held for 7 years. She then served as a licensed practical nurse for 10 years and then as a registered nurse for the past 6 years. She was familiar with all of the policies and procedures of the facility. On the day of the event Ms. Hoffman was working as the charge nurse; she noted that it was a particularly busy day. She returned from lunch and was informed by Nurse Sullivan that Ms. Jones was ill and had vomited. She was bathed, and the staff had documented her vital signs, completed the Glucoscan, and medicated Ms. Jones with Phenergan per Dr. Allen’s order. The family was not notified of a change in Ms. Jones’ condition because they were expected for a family conference at 3 PM, and Nurse Sullivan hoped that Ms. Jones would feel better by then and could participate in the conference. Nurse Hoffman assisted Nurse Sullivan in monitoring Ms. Jones throughout the rest of the shift. Nurse Hoffman had understood that Ms. Jones had not been sleeping well and thought it would be good to let her sleep. Nurse Hoffman thought Nurse Sullivan had last assessed Ms. Jones at 7 PM.

Nurse Hoffman states she was never informed that Ms. Jones had collapsed prior to vomiting or that she had a headache, or that Ms. Jones was somnolent after the episode. She reported that Ms. Jones had a history of headaches, nausea, and dizziness, all of which had been attributed to medications.

Nurse Sullivan recalls reporting everything to Nurse Hoffman. Nurse Sullivan said she had checked bowel sounds as directed. Ms. Jones was incontinent of stool at 2 PM. and was bathed and repositioned. Around 6 PM. Nurse Sullivan straightened Ms. Jones in bed and said that Ms. Jones looked comfortable. Nurse Sullivan said that she did not feel anxious about the patient, as she thought Ms. Jones was sleeping. Ms. Jones was not on 15-minute checks, but Nurse Sullivan recalled checking on Ms. Jones frequently throughout the shift to assess for vomiting