Case Study: End of Life Decisions George is a successful attorney in his mid-fifties. He is also a legal scholar, holding a teaching post at the local university law school in Oregon. George is also actively involved in his teenage son’s basketball league, coaching regularly for their team. Recently, George has experienced muscle weakness and unresponsive muscle coordination. He was forced to seek medical attention after he fell and injured his hip. After an examination at the local hospital following his fall, the attending physician suspected that George may be showing early symptoms for amyotrophic lateral sclerosis (ALS), a degenerative disease affecting the nerve cells in the brain and spinal cord. The week following the initial examination, further testing revealed a positive diagnosis of ALS. ALS is progressive and gradually causes motor neuron deterioration and muscle atrophy to the point of complete muscle control loss. There is currently no cure for ALS, and the median life expectancy is between 3 and 4 years, though it is not uncommon for some to live 10 or more years. The progressive muscle atrophy and deterioration of motor neurons leads to the loss of the ability to speak, move, eat, and breathe. However, sight, touch, hearing, taste, and smell are not affected. Patients will be wheelchair bound and eventually need permanent ventilator support to assist with breathing. George and his family are devastated by the diagnosis. George knows that treatment options only attempt to slow down the degeneration, but the symptoms will eventually come. He will eventually be wheelchair bound and be unable to move, eat, speak, or even breathe on his own. In contemplating his future life with ALS, George begins to dread the prospect of losing his mobility and even speech. He imagines his life in complete dependence upon others for basic everyday functions and perceives the possibility of eventually degenerating to the point at which he is a prisoner in his own body. Would he be willing to undergo such torture, such loss of his own dignity and power? George thus begins inquiring about the possibility of voluntary euthanasia. © 2020. Grand Canyon University. All Rights Reserved. Name NURS 55200_Organization Case Study Part I_ Worksheet All items on worksheet are to be addressed in sufficient detail to provide you and the reader with a clear picture of the organization. Remember confidentiality and anonymity.Key: ¥ =area to be filled Student Name_______________________________________ Level of the Organization → Dimension ↓ Macro Meso Micro Organization Description—size, type ¥ 485 bed medical center Offers medical services to a diverse population There are both inpatient and outpatient services Design & Structure ¥ Functional design Functions constitute departments Departments constitute a manager/leader and staff M, V, V, ¥ Mission-In collaboration with our academic partners, our mission is to advance healthcare to improve the health ...

1. Case Study: End of Life Decisions
George is a successful attorney in his mid-fifties. He is also a
legal scholar, holding a teaching post at the local university law
school in Oregon. George is also actively involved in his
teenage son’s basketball league, coaching regularly for their
team. Recently, George has experienced muscle weakness and
unresponsive muscle coordination. He was forced to seek
medical attention after he fell and injured his hip. After an
examination at the local hospital following his fall, the
attending physician suspected that George may be showing early
symptoms for amyotrophic lateral sclerosis (ALS), a
degenerative disease affecting the nerve cells in the brain and
spinal cord. The week following the initial examination, further
testing revealed a positive diagnosis of ALS.
ALS is progressive and gradually causes motor neuron
deterioration and muscle atrophy to the point of complete
muscle control loss. There is currently no cure for ALS, and the
median life expectancy is between 3 and 4 years, though it is
not uncommon for some to live 10 or more years. The
progressive muscle atrophy and deterioration of motor neurons
leads to the loss of the ability to speak, move, eat, and breathe.
However, sight, touch, hearing, taste, and smell are not
affected. Patients will be wheelchair bound and eventually need
permanent ventilator support to assist with breathing.
George and his family are devastated by the diagnosis. George
knows that treatment options only attempt to slow down the
degeneration, but the symptoms will eventually come. He will
eventually be wheelchair bound and be unable to move, eat,

2. speak, or even breathe on his own.
In contemplating his future life with ALS, George begins to
dread the prospect of losing his mobility and even speech. He
imagines his life in complete dependence upon others for basic
everyday functions and perceives the possibility of eventually
degenerating to the point at which he is a prisoner in his own
body. Would he be willing to undergo such torture, such loss of
his own dignity and power? George thus begins inquiring about
the possibility of voluntary euthanasia.
© 2020. Grand Canyon University. All Rights Reserved.
Name
NURS 55200_Organization Case Study Part I_ Worksheet
All items on worksheet are to be addressed in sufficient detail
to provide you and the reader with a clear picture of the
organization. Remember confidentiality and anonymity.Key: ¥
=area to be filled
Student Name_______________________________________
Level of the Organization →
Dimension ↓
Macro
Meso
Micro
Organization Description—size, type
¥ 485 bed medical center
Offers medical services to a diverse population
There are both inpatient and outpatient services
Design & Structure
¥ Functional design
Functions constitute departments
Departments constitute a manager/leader and staff
M, V, V,
¥ Mission-In collaboration with our academic partners, our
mission is to advance healthcare to improve the health of our

3. patients and communities, promote health equity and develop
the next generations of healthcare leaders.
Vision- Our vision is to be the preeminent healthcare provider
known for improving the health and wellness of our
communities, providing exemplary care for our patients and
advancing the knowledge to do so.
Values- Compassion:
We will treat our patients and their families with kindness and
compassion and strive to better understand and respond to their
needs.
Accountability:
We will hold ourselves accountable as an organization and as
individuals to act ethically and responsibly in everything we do,
to be excellent stewards of our resources and to be transparent
in our actions.
Respect:
We will act with respect, openness and honesty in our dealings
with patients, families and coworkers. We will work
collaboratively to promote the well-being of the communities
we serve and to advance patient care, education and research.
Excellence:
We will work as a team to leverage best practices and
innovation in providing the highest-quality care for our patients
and families. We will devote ourselves to continuously i mprove
in everything we do.
Some departments have their own mission and vision aligning
with those of the hospital.
Improved health and wellbeing is at the core of the functional
units and the activities of the stakeholders
Environmental Assessment: include population served
demographics, SWOT or SOAR analysis, in this nursing
assignment help

4. The hospital serves an increasingly diverse population that
includes US and non-US citizens. A significant segment of this
population includes students.
The issue of healthcare that is prominent in the wider discourse
in the US has significant implications for the hospital.
Political trends touching on healthcare, such as the uncertainty
over the Affordable Care Act as pertains to the current US
administration are a source of concern to top leaders at the
hospital.
The It department is under the process of upgrading the
hospital’s nursing informatics function in a bid to mirror the
success of such a system at a nearby hospital.. This initiative,
however, is undermined by inadequate funding.
The state enacted new regulations that might make it easier for
nurses from other states to operate in the hospital. This is
viewed as a job threat by the existing nursing staff.
Current Issues being addressed at each level of the
organization—what data/outcomes/reports are being viewed as
priority?
¥
A four-phase implementation plan is used. Currently the
hospital is at phase three, which requires the hospital to:
•Implement newly developed strategies to address health-related
needs (Year 2 & 3)
• Provide guidance to ensure that all new health-related and
community benefit initiatives are intentional in demonstrating
how they are addressing the health-related needs and the impact
the initiatives have on our community.
• Align with the hospital’s and other stakeholders’ budgetary
processes, ensuring there are sufficient resources to support the
implementation of new health-related and community benefit
initiatives.

5. • Pilot and implement new strategies to address the gaps in
services and programs to address the health-related needs of the
community.
¥
The nursing informatics function helps in the collection,
processing and analysis of data on the various projects under
implementation. This information is available via a web portal
based on access levels and involves statistics such as clinical
errors, satisfaction rate, and financial data.
¥
Staff members track their progress and the progress of the wider
organization through the portal and in meetings. Reports are
generated frequently and avaled on the portal for timely access.
Culture
¥The hospital’s culture is underpinned by quality care and
maintaining close ties with patients and stakeholders of the
hospital and views the various stakeholders as a family. This
culture is visible in the hospital’s mission, vision, and values as
well as day-to-day practices. The value of compassion is
explicitly stated as a leading tenet of the hospital’s practices.
The hospital also organizes annual events in addition to other
frequent events to signify and enhance the close relationships
among the various stakeholders. Employees are especially proud
of the way the hospital’s leadership treats them with respect.
¥
All departments align with the wider organizational culture
¥
the staff are committed to the values of the hospital
Standing Committees/ Teams/ Groups; Communication
¥There are nine committees at the hospital as follows:
Audit and Risk Committee - 6 members
Emergency Executive Committee - 8 members
Main Tender Board - 6 members
Executive Committee - 11 members
Finance Committee 9 members
Human Resources Committee 7 members

6. Public Complaints Committee - 5 ,members
Supporting Services Development Committee 9 members
Staff Appeals Committee 12 members
The committees are dominated by internal members of the
hospital, mainly those who have worked at the institution for an
extended period. The hospital has a difficult time in comparing
the implementations of the decisions of all the committees due
to inadequate collaboration among the various committees. This
limitation points to poor communication. Although the
committees tap technology to enhance communication, there are
cases where the process is ineffective. For instance, the IT
department complained of underfunding and the resulting
inability to acquire or develop the systems necessary to ensure a
successful nursing informatics program.
¥
¥
Decision Making
¥The top-down approach to decision making is the predominant
approach used at the hospital. Most decisions are made at the
top level and passed to staff at lower levels. Top leaders at the
hospital make largely strategic decisions. Lower-level staff are
not significantly involved in making strategic decisions, but
they make decisions related to the daily operations of the
institution. This approach to decision-making is inadequate
because it ignores the value of some stakeholders in making
effective decisions.
¥
Middle-level managers make decisions affecting their
departments with some input from their subjects
¥
Lower-level staff are not significantly involved in making
strategic decisions, but they make decisions related to the daily
operations of the institution.
Leadership Style

7. ¥
The top leaders use a transactional approach to leadership. This
is evidenced by the reward system that offers benefits to those
who perform as expected.
¥There are differences in the styles of leadership used by some
leaders at the lower level compared to top leadership.
Transformational leadership is common at this level and leaders
seek to influence the followers by presenting transformational
ideas. This approach is positively received by the employees as
they view those leaders who use this approach as effective.
¥
Nurses use their role in the hospital to influence others
Learning Organization Assessment
¥
The hospital is a Magnet designated learning institution. Some
of the elements that underscore this observation include
transformational leadership in some areas of the hospital,
exemplary professional practice, structural empowerment and
empirical quality results.
¥
Departments offer training and development programs
¥
Nurses are enrolled in programs that enhance their knowledge
on latest developments in their field
Change/Adaptability Assessment
¥
Change is constantly occurring in the instituti on. The research
and design center brings new ideas and knowledge that inform
new strategies adopted by the hospital. The institution is also
constantly assessing the changes in the environment and
adjusting to these changes, including the increasing diversity of
its client and staff base.
¥
Departments introduce changes from time to time as deemed

8. necessary.
¥
Nurses are encouraged to upgrade their skills and knowledge
through continuous learning and training programs.
Power & Political Assessment
¥
Top leaders draw their power from their position.
The board constitutes a diverse mix of stakeholders from both
within and outside the hospital.
Nursing is at the core of the operations of the hospital and it
drives the mission, vision and values.
¥The leaders who use transformational leadership, mainly at the
lower level of the hospital, are held in high regard and thought
of as being exemplary. These leaders also seem to know the
most about the hospital due to their interactions with the daily
operations and the strategic elements of the entity.
¥Nurses play a critical role in the hospital because they interact
with the patients.
Sources Used (1 point each for fourth and subsequent individual
consulted--up to a total of 5 points) & Documentation (position
of the person, topic of consult, and information garnered)
(attach)
¥ Front office staff
Clinical nurse manager
¥

9. IT officer
¥Pediatrician
Nurse
Physical therapist
Considerations to think about when filling out your worksheet
and asking others. Note: this is not exhaustive or complete (i.e.,
add more based on your curiosity and what you have read about
organizations):
Structure/Design: How many reporting levels are in the
organization hierarchy?
There are five levels in Upper Hill Hospital’s hierarchy
involving CEO, CFO, CMO, CNO, COO, Assistant Vice-
Chancellors, Directors, Managers, and staff.
Describe structure/design based on the criteria/frameworks in
your readings and from our discussions.
The hospital operates using the top-down approach as its
structure..
M, V, V and strategy information.
Mission: In collaboration with our academic partners, our
mission is to advance healthcare to improve the health of our
patients and communities, promote health equity and develop
the next generations of healthcare leaders.
Vision: Our vision is to be the preeminent healthcare provider
known for improving the health and wellness of our
communities, providing exemplary care for our patients and
advancing the knowledge to do so.
Values:
Compassion:
We will treat our patients and their families with kindness and

10. compassion and strive to better understand and respond to their
needs.
Accountability:
We will hold ourselves accountable as an organization and as
individuals to act ethically and responsibly in everything we do,
to be excellent stewards of our resources and to be transparent
in our actions.
Respect:
We will act with respect, openness and honesty in our dealings
with patients, families and coworkers. We will work
collaboratively to promote the well-being of the communities
we serve and to advance patient care, education and research.
Excellence:
We will work as a team to leverage best practices and
innovation in providing the highest-quality care for our patients
and families. We will devote ourselves to continuously improve
in everything we do.
Strategy information What issues are priority to address this
year?
Based on the 2016 analysis of the hospital, it was established
that:
1. Addressing the social determinants of health: education,
employment and income, health behaviors (e.g., smoking),
housing, family and social support, food, interpersonal violence,
transportation, and utility insecurity.
2. Improving access to care: availability of high quality
physical and mental healthcare on demand.
3. Reducing the risk of chronic disease or the impact of chronic
disease on health: asthma, cardiovascular disease (including
hypertension), diabetes, mental and behavioral health, obesity,
and sickle cell disease.
What important strategic information is being monitored on a
regular basis?
A four-phase implementation plan is used. Currently the
hospital is at phase three, which requires the hospital to:
•Implement newly developed strategies to address health-related

11. needs (Year 2 & 3)
• Provide guidance to ensure that all new health-related and
community benefit initiatives are intentional in demonstrating
how they are addressing the health-related needs and the impact
the initiatives have on our community.
• Align with the hospital’s and other stakeholders’ budgetary
processes, ensuring there are sufficient resources to support the
implementation of new health-related and community benefit
initiatives.
• Pilot and implement new strategies to address the gaps in
services and programs to address the health-related needs of the
community. Learn more at nursing essay help.
Environmental Assessment: How does your organization operate
with regard to the surrounding healthcare organizations and
environment? How does the strategic plan reflect the direction
for maintaining/succeeding/surviving (use the information and
frameworks/theories from your readings)?
Culture: “How would you describe the culture? What
indications do you have that explain the organization’s
culture?” “What is important to the people who work here?”
How doe employees organize around the mission, vision,
values, and strategic goals? What rituals does the organization
have—reward systems, recurring events, celebrations? What do
employees like about the organization?
The hospital’s culture is underpinned by maintaining close ties
with patients and stakeholders of the hospital and views the
various stakeholders as a family. This culture is visible in the
hospital’s mission, vision, and values as well as day-to-day
practices. The value of compassion is explicitly stated as a
leading tenet of the hospital’s practices. The hospital also
organizes annual events in addition to other frequent events to
signify and enhance the close relationships among the various
stakeholders. Employees are especially proud of the way the
hospital’s leadership treats them with respect.

12. Committees/Teams/Communication: What are the numbers of
committees at each level of the organization and what are they?
In general, how are team or committee members chosen at each
level? Who chairs them? Are any chairs nurses? What are their
responsibilities and how effective are they (i.e., how often are
their actions/decisions accepted and implemented by the
organization)? How are decisions and information
communicated throughout the organization? How many avenues
of organizational communication are they and how
efficient/effective are they? How has technology impacted
communication—what works/doesn’t work? What needs to be
improved?
There are nine committees at the hospital as follows:
Audit and Risk Committee - 6 members
Emergency Executive Committee - 8 members
Main Tender Board - 6 members
Executive Committee - 11 members
Finance Committee 9 members
Human Resources Committee 7 members
Public Complaints Committee - 5 ,members
Supporting Services Development Committee 9 members
Staff Appeals Committee 12 members
The committees are dominated by internal members of the
hospital, mainly those who have worked at the institution for an
extended period. The hospital has a difficult time in comparing
the implementations of the decisions of all the committees due
to inadequate collaboration among the various committees. This
limitation points to poor communication. Although the
committees tap technology to enhance communication, there are
cases where the process is ineffective. For instance, the IT
department complained of underfunding and the resulting
inability to acquire or develop the systems necessary to ensure a
successful nursing informatics program.

13. Decision making: How are decisions made at each level? Who
makes the most decisions at each level, and who is listened to
most frequently?
The top-down approach to decision making is the predominant
approach used at the hospital. Most decisions are made at the
top level and passed to staff at lower levels. Top leaders at the
hospital make largely strategic decisions. Lower-level staff are
not significantly involved in making strategic decisions, but
they make decisions related to the daily operations of the
institution. This approach to decision-making is inadequate
because it ignores the value of some stakeholders in making
effective decisions.
Leadership style: Based on your readings and knowledge to the
types of leadership styles, what types do you see at each level?
How effective are they? Compare the types of leaders with the
theories from your readings.
The top leaders use a transactional approach to leadership. This
is evidenced by the reward system that offers benefits to those
who perform as expected. There are, however, differences in the
styles of leadership used by some leaders at the lower level.
Transformational leadership is common at this level and leaders
seek to influence the followers by presenting transformational
ideas. This approach is positively received by the employees as
they view those leaders who use this approach as effective.
Learning Organization: Look at the characteristics of a learning
organization from your readings and class discussion. How
many do you see operating in your organization? Is your
organization Magnet designated (or other designations that
signal a learning organization)? If it is Magnet, what are the
indications it does or does not operate as a learning
organization?

14. The hospital is a Magnet designated learning institution. Some
of the elements that underscore this observation include
transformational leadership in some areas of the hospital,
exemplary professional practice, structural empowerment and
empirical quality results.
Change: How frequently is change occurring? What is the
change process? How is change managed: How well does the
organization manage change
(https://onlyprofessors.com/tag/writing/page/19/)?
Change is constantly occurring in the institution. The research
and design center brings new ideas and knowledge that inform
new strategies adopted by the hospital. The institution is also
constantly assessing the changes in the environment and
adjusting to these changes, including the increasing diversity of
its client and staff base.
Power & Politics—Who is good at influencing and making
decisions that are carried out? Who is highly thought of? Who is
effective? Who knows the most about the organization? Who is
considered powerful? How do decisions get made? Who are the
people that get others on board with regard to the decisions?
What is the Board makeup and how are they chosen? How
powerful is nursing?
The leaders who use transformational leadership, mainly at the
lower level of the hospital, are held in high regard and thought
of as being exemplary. These leaders also seem to know the
most about the hospital due to their interactions with the daily
operations and the strategic elements of the entity. The board
constitutes a diverse mix of stakeholders from both within and
outside the hospital. Nursing is at the core of the operations of
the hospital and it drives the mission, vision and values.

15. 11