Bright Academic Experts

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  • Ethical Dilemma_Comment 1

    Ethical Dilemma in Practice

    While working on a cardiac unit, I experienced an ethical dilemma that continues to influence how I approach end of life discussions. One of my patients had a rapidly declining condition. As her health worsened, she became confused and eventually lost the capacity to make her own medical decisions. Before this decline, she had expressed that she did not want aggressive life prolonging measures and did not want to continue returning to the hospital as her condition progressed. Once she lost decision making capacity, however, her family insisted that she remain a full code and continue receiving all possible life saving treatments.

    This situation created tension between respect for patient autonomy and the authority of surrogate decision makers. Ethically, patient autonomy requires honoring previously expressed wishes. In practice, once a patient no longer has decision making capacity and formal documentation is limited or unclear, families often assume control over medical decisions. In this case, the family requested continued hospitalization and aggressive interventions even as her condition declined further with each admission.

    The care team attempted to have direct conversations with the family. We reviewed her prior statements and explained the likely progression of her disease. We discussed what aggressive measures would realistically involve and how they might impact her comfort and quality of life. Despite these discussions, the family continued to push for full treatment. The patient was repeatedly brought back to the hospital against what she had previously communicated she wanted.

    This experience highlighted the emotional complexity that often accompanies surrogate decision making. (Childers, 2021) describe how family members may override a patients expressed wishes due to grief, denial, or fear. Their work emphasizes that surrogate decisions are frequently influenced by emotional distress rather than the patients previously stated preferences. That framework helped me better understand what we were seeing in this case. The familys insistence on aggressive care appeared rooted in difficulty accepting her decline rather than intentional disregard for her autonomy.

    At the same time, the situation created moral distress within the team. (Hwu and Pai, 2025) found that nurses often experience ethical strain when they believe care being delivered does not align with what a patient would have chosen. That description matched how many of us felt. We were legally required to follow surrogate decision making authority, yet it felt inconsistent with the patients earlier wishes.

    The situation was eventually managed through interdisciplinary involvement. Ethics consultation and palliative care were brought in to facilitate structured discussions. Eventually the focus shifted more toward comfort oriented measures, but it required repeated conversations rather than a single intervention. The resolution was gradual and emotionally complex for everyone involved.

    This experience reinforced the importance of early advance care planning. As a registered nurse, I recognize that one of my responsibilities is to initiate clear conversations about goals of care before capacity is lost. Encouraging documentation of advance directives and discussing realistic disease trajectories may prevent similar conflicts. It also reminded me that ethical dilemmas in practice are rarely simple. They require balancing autonomy, beneficence, family dynamics, and legal standards while maintaining compassion for everyone involved.

    References

    Childers , J. (2021, June 9). shes not ready to give up yet!: When a family member overrides the patients medical decisions. Journal of pain and symptom management.

    Hwu, L.-J., & Pai, H.-C. (2025, April 24). Exploring ethical dilemmas and coping strategies in nursing: A FOCUS Group Study of nurses and nursing students. Nursing & health sciences.

    Requirements: Make a Comment

  • Week_5_Comment 2_Path

    GI & Endocrine

    Brandy Fields

    St. Thomas University

    NUR 502

    Dr. Morgan

    February 12, 2026

    GI & Endocrine

    Gastroesophageal reflux disease or GERD as it is most referred is the backward flow of gastric contents from the stomach into the esophagus. The gastric contents can go beyond the esophagus extending into the oral cavity, larynx, or lungs causing esophagitis and inflammation of the other affected mucosal surface (Azer & Goosenberg, 2025). Individuals older than fifty years of age, body mass index greater than thirty, alcohol consumption, lack of physical activity, and the consumption of foods high in fat or acidic contribute to the formation of GERD (Azer & Goosenberg, 2025). The underlying pathophysiology to GERD lies in abnormalities in the lower esophageal sphincter. Relaxation of the lower esophageal sphincter, the presence of hiatal hernias, decreased pressure, and obesity contribute to GERD (Dlugasch & Story, 2023).

    Acid clearance can be another contributing factor if there is an impairment of peristalsis and lack of bicarbonates in salvia to neutralize acid. Delayed gastric emptying and increased intra-abdominal due to pressure changes further contribute to the development of GERD. Overtime repeated exposure of the esophageal lining to acidic gastric contents or chyme led to inflammation of the esophagus or esophagitis. Patients may report symptoms of heartburn, regurgitation of food, nausea, dry cough, or the sensation of a lump in the throat (Dlugasch & Story, 2023). Barrett esophagus, strictures, ulcerations, chronic laryngitis, asthma exacerbation, and esophageal cancer can potentially arise due to GERD. (Dlugasch & Story, 2023).

    Evidence-Based Guidelines

    A symptom-based approach is recommended for patients with classic GERD with the absence of major complications. Classic symptoms such as heartburn or regurgitation can be managed with the use of an eight-week trial of a premeal proton-pump inhibitor therapy (Katz et al., 2021). Symptoms such as gastrointestinal bleeding, unexplained weight loss, and persistent vomiting may warrant further diagnostic evaluation. Endoscopy, esophageal pH monitoring, and esophagus manometry are among diagnostic implementations in the treatment and management of GERD. In addition to the pharmacological approach, patients should be educated on lifestyle modifications that can assist in the management of symptoms (Dlugasch & Story, 2023). Maintaining a high fowler position after eating, weight reduction, eating small frequent meals, and the avoidance of late-night meals can assist in the management of GERD (Dlugasch & Story, 2023).

    Advance Nurse Practice and Patient Education

    Symptoms and other contributing factors are the greatest indicator of complicated or uncomplicated GERD. As mentioned above, patients with uncomplicated GERD will be present with the classic symptoms of heartburn and regurgitation. In those cases, where there are no other symptoms or correlations to disorder progression, the NP can render treatment. Patients presenting with more advanced symptoms such as gastrointestinal bleeding, unexplained weight loss, or anemia warrant referral or endoscopic evaluation. Patients should be provided with clear directions on medication administration to include the importance of timing to meals. Patients should also be encouraged to manage weight and make food choices that decrease the risk of symptom flare ups.

    References

    Azer, S. A., & Goosenberg, E. (2025, July 6). Gastroesophageal reflux Disease (GERD). StatPearls – NCBI Bookshelf.

    Dlugasch, L., & Story, L. (2023). Applied Pathophysiology for the advanced practice nurse. Jones & Bartlett Learning.

    Katz, P. O., Dunbar, K. B., Schnoll-Sussman, F. H., Greer, K. B., Yadlapati, R., & Spechler, S. J. (2021). ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. The American Journal of Gastroenterology, 117(1), 2756.

    Requirements: Make a Comment with references

  • Time and stress management skills assessment

    Good evening, I have completed the assessments to use for the paper.

    Attached Files (PDF/DOCX): NUR 531 Time Management Self-Assessment.pdf, NUR 531 Stress Management Self-Assessment.pdf, module 2 journal.pdf

    Note: Content extraction from these files is restricted, please review them manually.

  • Week 5_Comment 1_Path

    GI & Endocrine

    Pathophysiology of Gastroesophageal Reflux Disease (GERD)

    Gastroesophageal reflux disease (GERD) is a chronic disease because of retrograde masses of gastrointestinal fluid discharging to the esophagus, which leads to symptoms or damage to the mucosa. The dysfunction of the lower esophageal sphincter (LES) is the most prevalent pathophysiologic process that can be a temporary lower esophageal sphincter relaxation (TLESR), a reduction in LES tone, or morphologic abnormalities, including a hiatal hernia (Katz et al., 2022), when the process of refluxing of acidic substances of the stomach into the esophagus starts as a result of inadequately high pressure in the LES overcoming the defensive mechanisms against it, such as esophageal peristalsis and salivary buffering.

    Acid exposure causes tissue injury to the esophageal mucosa, which causes inflammation or erosive esophagitis or morbidities, including Barrett’s esophagus. Acid and pepsin affect the integrity of the epithelia and activate esophagus chemoreceptors, which leads to heartburn and regurgitation symptoms (Katz et al., 2022). GERD is a widespread disease globally, and its prevalence is rising among most regions, which is causing a substantial burden and reduced quality of life worldwide (Dirac et al., 2020). Knowledge of these mechanisms aids in the early detection and proper management when dealing with clinical practice

    Evidence-Based Diagnosis and Management (ACG 2022)

    The American College of Gastroenterology (ACG) (2022) guideline claims that uncomplicated GERD can be diagnosed clinically, and patients who show common symptoms, including heartburn and regurgitation, without alarm features (Katz et al., 2022). First-line therapy should include an 8-week trial of a proton pump inhibitor (PPI) and should be taken once daily before meals. Endoscopy is implied in case of alarm symptoms, such as dysphagia, gastrointestinal bleeding, anemia, weight loss, or persistent vomiting.

    Nonpharmacologic measures are highly advised and comprise loss of weight among overweight patients, head of the bed elevation, not taking food 2-3 hours before bedtime, and quitting tobacco (Katz et al., 2022). The change in diet must be made on a case-by-case basis, depending on the triggers of the symptoms. The pharmacologic management is mainly based on PPIs that are of better quality in their acid suppression and healing the mucosa than H 2 receptor antagonists. The minimum dose of therapy should be used, and it needs to be re-evaluated periodically (Katz et al., 2022).

    Implications for Advanced Nursing Practice

    Nurse practitioners (NPs) are important in giving a clear cut between the case of uncomplicated GERD and the one that needs referral. The patients who are sensitive to empiric PPI therapy and not alarming do not need urgent endoscopy. Nevertheless, the alarm symptoms, recurrent symptoms despite the best therapy, or the risk factors of the esophagus of Barrett make it necessary to refer to gastroenterology and potentially perform endoscopy (Katz et al., 2022). Since GERD (Dirac et al., 2020) is a global issue with a high and increasing incidence, advanced practice nurses should implement evidence-based practices to guarantee the prompt detection of complications and prevention of needless operations.

    Patient Education and Adherence Strategies

    Patient education is the key to adherence and outcomes improvement. The patients should be educated that they should take the PPIs 30-60 minutes before eating to reach their peak effect (Katz et al., 2022). Sustainable lifestyles change programs, in particular, weight management, are needed because obesity is a risk factor that can be changed to influence the occurrence and development of GERD (Dirac et al., 2020). Adherence is enhanced through follow-up visits, instructions, and assessments of realistic expectations. Patient-centered counseling and evidence-based management are the only ways in which nurse practitioners can reduce the symptom burden and eradicate the long-term complications.

    References

    Dirac, M. A., et al. (2020). The global, regional, and national burden of gastro-esophageal reflux disease in 195 countries and territories, 19902017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet Gastroenterology & Hepatology, 5(6), 561581.

    Katz, P. O., et al. (2022). ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. American Journal of Gastroenterology, 117(1), 2756.

    Requirements: Make a Comment with references

  • Psychology Question

    Remember, outside sources are not permitted, nor is the use of ChatGPT, Bard, or other forms of AI (with the exception of the editor function in Word).

    Thoroughly summarize Sutherland’s article. I define a thorough summary to mean a minimum of three well developed paragraphs, with each paragraph being composed of a minimum of five sentences. As part of your submission, make sure to tell me where Sutherland locates the cause of deviance and criminality.

    If you are going to include a brief quote from the article use quotation marks, otherwise the words should be your own. Do not plagiarize or you will receive a zero.

    Spelling, grammar, and punctuation count. Proofread your work prior to submission.

    The assignment is worth up to ten points.

    Required Text: Patricia A. Adler & Peter Adler, Constructions of Deviance: Social Power,Context, and Interaction, 8th ed. (2016). Wadsworth: Belmont, CA. A link to purchase or rent the text via Amazon appears on the course site.

    Requirements: as needed

  • Moral Injury & Psychedelic Recovery

    Abstract

    Background: Moral injury is increasingly recognized as a distinct, functionally impairing clinical syndrome characterized by severe moral emotions, moral cognitions, relational disruption, and adverse shifts in beliefs about self, others, humanity, and life meaning. Contemporary models emphasize that moral injury is not fully explained by fear-based trauma constructs and may not remit with standard evidence-based treatments for PTSD or depression when moral emotions, self-condemnation, betrayal-based distrust, and loss of belonging remain central. This manuscript is grounded in current moral injury theory and clinical guidance, including the revised definitional and treatment considerations articulated in Litz and Walkers contemporary overview, and it integrates an extensive curated body of peer-reviewed research supplied by the author as part of the project materials.

    Objective: To present a rigorously anonymized, clinician-authored case study examining moral injury as the primary clinical construct and evaluating psychedelic-assisted therapy as a plausible intervention pathway for moral repair processes, with careful attention to mechanism, phenomenology, functional outcomes, and limitations of inference.

    there are dozens of relevant research articles included in the attached files.

    Methods: This is an anonymized longitudinal single-case study written from a dual-role perspective. The author is both the clinician providing clinical conceptualization and the veteran whose experience constitutes the case material. Narrative clinical material is organized across a structured timeline and mapped onto contemporary moral injury domains, with explicit attention to subtype-relevant processes (shame-related internalizing phenomena and trust-violation-related externalizing phenomena). The manuscript synthesizes and prioritizes the large set of peer-reviewed sources provided in the accompanying documents, supplemented by additional primary literature as needed. Intervention exposure is described across three psychedelic-assisted modalities discussed in the papers framework: MDMA, ketamine, and classical psychedelics, with attention to preparation, set and setting, risk mitigation, and integration.

    Authorship is collaborative. The commissioning writer (Active Orders Writer) will be included as an official co-author on the manuscript and formally credited on any potential submission or publication in accordance with journal authorship standards and contribution criteria.

    Findings and Clinical Interpretation: The case illustrates a moral injury trajectory marked by enduring self-condemnation, moral rumination, alienation, threatened or lost belonging, demoralization, and disruption in life meaning. Following structured psychedelic-assisted work and integration, the narrative describes clinically salient shifts consistent with theorized moral repair mechanisms: reduced rigidity of self-censure, increased tolerance for moral complexity, enhanced capacity for self-forgiveness, re-engagement with valued and valuing relationships, and movement from isolation toward prosocial connection. Subjective experiences of awe and self-transcendence are interpreted using psychologically operational constructs rather than metaphysical claims, emphasizing meaning reconstruction, emotional processing, and changes in self-referential narratives. Where relevant, the manuscript links these changes to empirically discussed mechanisms in psychedelic science (for example, altered self-referential processing, increased cognitive and affective flexibility, and broadened capacity for corrective relational learning), while avoiding causal overreach.

    Best-Practice Implications: The paper translates the case into a veteran-focused clinical framework emphasizing screening, contraindications, differential risk considerations, preparation and harm reduction, competent facilitation of altered states, and integration oriented toward moral repair rather than symptom suppression alone. Special attention is given to risks of spiritual bypassing, retraumatization, and ethical hazards when working with highly shame-laden or betrayal-based presentations.

    Limitations and Conclusions: As a single case with dual-role authorship, conclusions are necessarily circumscribed. The manuscript explicitly addresses expectancy effects, self-report bias, and generalizability limits, and it frames outcomes as hypothesis-generating rather than definitive proof. Nonetheless, the case provides a detailed, theory-aligned illustration of how psychedelic-assisted therapy may support moral injury recovery processes when integrated with disciplined preparation, relationally grounded integration, and a clinically coherent moral repair model. The manuscript concludes by identifying testable clinical and research directions for assessing moral injury outcomes (including functional impairment) in future observational studies and controlled trials.

    Keywords: moral injury, potentially morally injurious events, veterans, moral repair, shame, betrayal, social-functional model, psychedelic-assisted therapy, MDMA, ketamine, psilocybin, awe, self-transcendence, integration, functional impairment

    Of note: Remove any references to Miltary Unit (Army Rangers) and use “special operations Forces Unit aka SOF” and refer to “Rangers” as SOF Operators.

    Attached Files (PDF/DOCX): Moral Injury Lecture Briefing Notes_17OCT25.docx, Moral Injury_Litz_Overview 2025.pdf

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  • Discussion Two need something in 20 mins will tip

    Class, in 200-400 words, explain the influence that media has on political views and ideologies. Is this good or bad opinion? Does the media influence how individuals vote in elections? Be sure to cite in MLA. I need it in 20mins

    Requirements: 200-400

  • Sport Management

    I need a professional 4-page Wix web portfolio created for a university assignment. Requirements: Must be built on Wix (I need full access and editing control) Clean and minimal professional design No creative project galleries Strictly professional content Must follow the grading rubric exactly Pages required: Home Page Professional photo Industry-focused introduction paragraph No personal details Do NOT mention I am a student at the University of Tampa Resume Page Most recent experience first (reverse chronological order) Clean, consistent formatting Include a downloadable PDF resume button/icon References Page 3 professional references Must include: Name, Organization, Title, Phone, Email Consistent formatting across all references Contact Page Professional email Phone number LinkedIn link The design should be similar to this example: [paste Amys link here] I already have most of the content written (introduction paragraph, resume information, and references). I will provide all text and professional photos. I will send: Resume content Introduction paragraph Reference details Professional headshot PDF resume file Rubric and example link The task is mainly to design and format the website correctly according to the rubri REMOVE any PERSONAL DETAILS… NO PERSONAL PAGE THAT INCLUDES YOUR FAMILY, DOG, THIS IS STRICTLY PROFESSIONAL CONTENT Must include Home Page (5 points) Professional Photo Interesting Intro Paragraph DO NOT SAY I am a student at the University of Tampa majoring in Sport Management Include something you have done that HAS something to do with the industry Resume Page (10 points) Consistent and visually appealing Correct chronological order (Most recent material first) Include a link to your resume or PDF icon Reference Page (3 points) 3 professional contacts Consistent layout Name Organization Title Phone Email Contact Page (2 points)

  • Unit 10

    please view instructions and the scenario is scenario :Vibe Trend (VT) is a three-year-old music production company. They configure music from all over the world to be available through various media. They also create the original soundtracks for movies and television series. In the last year, they have had many client complaints that the company is not culturally sensitive regarding their artists or cannot relate well to their audiences, and some large accounts have moved over to other competitors who have a more cultural representation workforce. The CEO has tasked you as the new human resources director to address this issue. You take a look at the organization, and it seems to be populated with only white malestruly a monolithic organization! I also attached an example

  • Historical Paper #1: The Spanish Inquisition

    Write an 1,8002,000 word essays explaining an aspect of the Spanish Inquisition. Arguments should substantively use a broad range of primary source evidence from the Homza (ed.) The Spanish Inquisition, as well as secondary sources (for explaining context and method), especially from your groups bibliography (which Prof. Spohnholz has approved).

    Papers will be graded by based on:

    Historical Argument: Support for an independent, well-informed historical argument that contributes to a better understanding of the Spanish Inquisition from the perspective of at least one of our classes four central questions. You should give specific historical examples to help others understand the larger patterns in the evidence.

    Intellectual honestly and proper citations: You should cite footnotes using Chicago of Manual Style for formatting. You may use evidence collected as part of your group efforts, but the argument should be your own and you should recognize any specific intellectual debts to classmates in your citations. Intellectual dishonestly may result in a failing grade on the paper (and in the class).

    Compelling, clear and accurate writing: Papers should be completely understandable and grammatically correct, but also convey and contribute to an appreciation for historical thinking and its purpose in the world.

    Attached Files (PDF/DOCX): Unruly_Women_Performance_Penitence_and_Punishment__—-_(Appendix_2A_Historical_Compendium_and_Instructive_Manifesto_on_the_Or).pdf, dokumenpub_spanish-inquisition-1478-1614-an-anthology-of-sources.pdf

    Note: Content extraction from these files is restricted, please review them manually.