Personal Portfolio Pdf final

Nicholle Macadangdang
HSC 4700
Spring 2016

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Contents Page
Section Page
Contents Page..............................................................................................................................i
Introduction................................................................................................................................ii
I - Technical Report
i) Four Case Scenarios .................................................................................................................3
ii) Five Journal Article Summaries..............................................................................................10
iii) Professional Interview..........................................................................................................21
iv) Five Scientific Journals from Health Science Courses ............................................................24
v) Three Samples Work from Upper Division Courses................................................................27
II - Career Search
i) Job Advertisement .................................................................................................................51
ii) Cover Letter ..........................................................................................................................53
iii) Resume ................................................................................................................................55
iv) Personal Essay......................................................................................................................59
III - Systems Analysis
i) Systems Analysis Chart...........................................................................................................61
IV - Papers
i) Legacy Role Paper ..................................................................................................................63
ii) Alumni Role Paper.................................................................................................................65
V - Health Philosophy
i) My Philosophy........................................................................................................................69

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Introduction
This portfolio showcases what I have learned through obtaining my bachelor’s degree
and my ability to find a career in health sciences. In this personal portfolio, there are
summaries, journals, and chosen samples of my works. The case scenarios are my problem
solving and analyzing skills on certain situations involving healthcare and public health. The
articles are demonstrating that I can extract information in order to use the information or
share the information based on what I read in the journals. The peer-reviewed articles, are
articles that I have read and analyzed through different research papers in courses. The samples
of my work involved my best works based on what I learned through my courses.
I also show my ability to find a particular job that describes what I want to do with my
degree and my plans in achieving my career in health administration. This portfolio is to present
potential employers and health organizations my ability to perform their requirements and
duties based on my expertise and knowledge.

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Macadangdang, Nicholle - HSC 4700 Spring 2016
Case Scenario #6
Understanding the importance of balanced nutrition for youngsters, describe the strategies you
would put forth to encourage parents to feed their children healthy food.
1. Parents should do research: The first thing parents should do is educate themselves on
how to eat healthy. Eating healthy should not just be towards children but also the parents
themselves. Parents may talk to a nutritionist or even their child’s school to find out more
information on children’s nutrition. Another place parents can go to is Choosemyplate
government website for information on nutrition.
2. Parents should be in control: In order for parents to feed their children healthy food,
they need to make sure they decide what is in the home’s refrigerator and pantries.
Children tend to tell their parents what they want to eat and sometimes children may want
to eat something less nutritious (i.e. McDonalds chicken nuggets). When parents decide
what foods and drinks to have in their household, they take better charge of their
children’s diet.
3. Start Small: Children are typically picky eaters and do not like certain tastes or textures
of fruits and vegetables. Parents should make an effort of having their child slowly
adding vegetables as part of their meals. For example, parents should add carrot sticks to
a meal that is simple to eat and pick up. Another example is using blended vegetables and
adding it to pasta sauce for children to eat.
4. Be a role model: Young children will tend to follow their parents in some their eating
habits. Parents should be aware of what they eat around their children when going out on
restaurants. For example, if parents often eat out for burgers and fries with their children,
they should be aware of what they order and choose a healthy alternative (i.e. a chicken
salad and apples with yogurt dip). Children will want to try out what Mom and Dad eat
when the parents choose healthier dishes.
5. Have children help with food preparation: Having children be useful in kitchen, will
help them learn about food and encourage healthy eating. Parents can let their child
choose a healthy recipe and maybe choose vegetables they like. Children will become
more interested in what goes into their meal, gain knowledge from goes into their diet,
and know how important it is to eat healthy for their bodies to grow.
6. Mood and Brain development: Children with a diet high in sugar, fats, and
carbohydrates may get moody and angry. The mood swings may often be from what the
child eats, which then should make the parent think about what the child should be
eating. Eating healthy will also improve a child’s brain through being more attentive and
not having a delay in brain development.
7. A healthier child: Children with a healthier diet will become healthier physically.
Children who eat healthy will not face dental issues, like cavities due to an excess sugar
diet. Children who eat healthy will also not have to face major health problems when they
are older like heart disease or diabetes. Children with a healthy diet are also physically fit
and grow up well because they are consuming the necessary nutrients for growth.

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Case Scenario #3
You want to ensure that all senior adults at an adult facility you manage remain alert and
cognitively functional for a long time. Discuss your approach to achieving this goal.
1. Monitor Patients: Senior adults may not be aware of any changes that may happen to
them cognitively. Nurses and Doctors can help with their alertness just by asking their
name when they need medication or when they stop by doing patient rounds. When
physicians and nurses ask simple questions to the older adults, they should monitor the
patient’s reactions and responses.
2. Look for Signs: Family members are usually first to see if there are any changes to their
loved ones living in an adult facility. Family members should look for signs of memory
loss no matter how small or if it was a matter of forgetfulness. In addition to the doctors
and nurses monitoring the patient's cognitive function, family members should also ask
questions, such as an important date or a name of their child. They should help the patient
keep track and record the times where the patient may not remember something or may
see more forgetful than usual.
3. Brochures and Information Booklets: Senior adults admitted to an adult facility should
information on mental health provided from their designated doctor and people who will
help aide the patient. The family of the older adult should also receive information on
alertness and cognitive function to recognize what the signs of memory loss or trouble
remembering or understanding might be.
4. Senior Adults and Brain Activities: The program or activities director should make
brain training and mental exercising an important part of an older adult’s lifestyle.
Activities such as reading, painting, and word and math puzzles. Having older adults
engaged with activities that help their brain, will keep their mind stimulated and keep
alert.
5. Exercise for Older Adults: Older adults that keep a daily exercise routine does not only
help their bodies physically but also mentally. Seniors will keep physically and mentally
fit in order to maintain great health. Exercising is known to reduce mental stress. I think
exercise is important for older adults to maintain to reduce stress because being placed in
an unfamiliar environment and seeing family everyday may be stressful for some seniors
and exercising has the ability to engage in physical activity and keep that oxygen into the
brain. This activity even applies to older adults undergoing rehab in a facility. For
example, swelling in the legs through diabetes is something common for some seniors
who have diabetes, they would have to walk around the halls of the facility to reduce
swelling, which is also a type of exercise.
6. Communication: Communication for senior adults in the facility is very important for
alertness and cognitive function. Seniors should make an effort to create a social network
and not be alone. Working in a nursing home and rehabilitation facility, I have seen
patients who will not have many family members visit and at times I know that some
patients love talking and have someone listen to their stories. I think it is ideal to create
an environment for the seniors to talk and make friends which will keep them stimulated
and feel good.

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Case Scenario # 7
What do you think are the most important health issues facing developing nations of the world
today? These are nations primarily in Central America, Asia, Africa and South America.
1. Water Quality: People in developing nations are in need of a clean water source. In
places where the economic environment is poor, people do have a place to get readily
accessible clean water. Developing countries would not have enough places to get clean
water, that people would have to travel far to obtain clean water. Some people would
often use contaminated water to clean themselves or use water that is used by sewers or
streams that are contaminated by trash and waste. Without accessible clean water, people
in developing countries are more susceptible to diseases. Oftentimes, the source of most
diseases in rural and developing areas are from unclean water.
2. Sanitization and Poor Living Conditions: Having experienced travelling in a
developing country, in the Philippines, there were instances of awful sanitization and
living qualities. The one thing I noticed being in a developing country outside of the
major cities, there was poor sanitization. The low-income communities often lived in
shanties made out of rubble and trash (broken plastic or metal sheets from old or
destroyed buildings. The poor would also live right by major highways with just a small
bed mat made out of dry braided grass. Some people lived in cemeteries, like in
mausoleums of their ancestors because families could not afford homes. People did not
have access to places where they could shower or have clean water. Most people had to
travel long distances to get access to basic needs with no money. A lot of the poor would
squat in areas that were very dirty just to beg or sell what they are able to sell. I think
that most developing nations have this issue for a majority of the poorly dense low-
income populations and the unsanitary living conditions.
3. Communicable Diseases: A major health issue to developing countries are
communicable diseases. Populations in low socioeconomic areas are more at risk of
having diseases like malaria, HIV/AID, and tuberculosis, hepatitis B, and dengue, to
name several diseases. These diseases are usually from lack of clean water, poor
sanitation, and lack of sexual education. People, in developing areas, are more exposed
to communicable diseases that they spread rapidly. With high populations that have
diseases, the low-income communities have little to no resources to help aid the sick or
have access to medication. I think these diseases need to be constantly addressed by
developing nations to prevent death. Also, I think that diseases can be at low-risk if the
developing nation put the effort in helping the poor communities gain access to better
water and sanitation, clinics, and medical aid.
4. Lifestyle and Diet: The developing nations are finding ways to help the population have
better nutrition and trying to aim for people to be healthy. Unfortunately, in developing
countries there are still people dying from heart diseases, diabetes, or cancer. Most
developing countries are trying to be more modern and urbanize, it might be to attract
more tourists or improving their nation. Industrializing the developing nations, may lead
their people to be less active and more passive and sedentary because everything can be
delivered or food can be retrieved through take out than eating in. People may be inactive
because recreation areas are being used to build bigger buildings or stores. People who

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live in cities in developing countries do not bother to walk and just use cars as
transportation. As for low income populations in urban areas of the developing countries,
they do not have access to healthy diets and eat what they can afford and will fill them up
fast. They are more exposed to unhealthy fast food joints with what they can afford that is
cheap and filling. Low income populations may not be able to farm to grow vegetables
and fruit due to a growing industrialized country, they have to resort to what they can
afford. Poor populations have no access to nutrition and will often be at a higher risk of
scurvy and lack other essential vitamins.

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Case Scenario #2
You manage a facility which deals with expectant and postpartum mothers. You want to ensure
that all expectant mothers who come to the facility have access to prenatal care. How will you
ensure they have the knowledge, resources, information and access to prenatal care?
1. Information Sessions: Information sessions will help expectant mothers be more aware
of the effects of receiving prenatal care. The mothers will think about the next steps to
ensure they have a healthy pregnancy and birth. The session will provide them
knowledge on how important it is to follow pre-natal care. Postpartum mothers can attend
sessions that will help them learn how to take care of their baby and providing materials
that the baby will need.
2. Access to Information Online: Sometimes mothers will not have time to attend
information sessions. By having the facility post recordings of the lecture, the expectant
mothers will be able to learn what they have missed in the session. The facility should
also post links to health sheets for pregnant mothers and have an appointment link to
have an easily accessible way to make an appointment.
3. Monitoring of Current Resources: The facility has to make sure we have enough
resources to provide the expectant mothers their needs. The facility should cater to what
the expectant and the postpartum want like more check-ups, visitations with doctors, or
more supplies for the mother in postpartum (i.e. diapers or formula). Knowing that the
facility has enough resources, those resources will be readily available to the mothers.
4. Plan for Physician Care: When expectant mothers go into a facility, they should not
only receive information, but also see a doctor. It is important to have expectant mothers
to regularly see their physician as part of prenatal care. The facility should stress about
coming into the facility to seek a doctor’s advice and aid for expectant mothers. For
example, expectant mothers communicate with their doctor if they have complications
during pregnancy or request certain things during/at birth It must be stressed to see a
physician to monitor the mother’s pregnancy, plans for birth, and any supplements to
take. Expectant mothers also need to get tested and monitored to ensure a healthy
pregnancy. If mothers cannot see a doctor physically, then the possibility of having an
online appointment through webcam may suffice.
5. Keeping Track of Appointments: Scheduling appointments to expectant mothers is
important part of their prenatal care. The mothers need to have a relationship with their
doctors to make sure the mother communicates with their doctor based on what their
needs are. They also have to make appointments regularly to effectively monitor the
pregnancy and prepare for birth. Keeping track of the appointments will help expectant
mothers receive their care on time.
6. Nutritional Counseling and Information: I think showing expectant mothers of eating
healthy while pregnant will also help with a healthy pregnancy. The counseling would
help mothers find out what to eat and drink during pregnancy and postpartum. For
example, women who are overweight may get diabetes or women who are underweight
can have a premature birth. Expectant mothers should know what they can eat and what
to avoid. This would make expectant mothers be aware of what they eat and make sure
what they put in their body will not harm the baby.

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7. Promote Classes: The facility should promote classes to help aid and support mothers
into taking care of the baby. The classes can be breastfeeding classes and childbirth
classes. This will help mothers be prepared and ready from pregnancy to motherhood.
The classes will help promote prenatal care to gain knowledge for mothers to make an
effort to want to have a safe and healthy pregnancy and birth.

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Five Journal Article Summaries

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Macadangdang, Nicholle – HSC 4700 Spring 2016
TITLE: Medical Error Prevention and Root Cause Analysis
Medical error is defined the failure of a planned action to be completed as intended or the
use of a wrong plan to achieve an aim. These errors can occur when the correct action does
proceed or is an error of execution. The problem with medical errors is not knowing if the events
are preventable, could the patient be saved or could the health provider do something different to
prevent a medical error. According to the Joint Commission, the causes of medical error can be
from suicide to high radiotherapy. The study focuses on Florida’s Agency for Health Care
Administration (AHCA) and their incident report on hospital errors and ways to prevent these
errors. The AHCA reported that the most common medical errors came from surgeries that were
unrelated to the patients’ medical needs. Knowing how to prevent errors and mistakes, will
reduce medical errors.
On surgeries, surgeons can prevent errors on doing a patient’s procedure on the wrong
body part by having the surgeon sign the area they will be operating in. Another example is
every person taking part of the surgery to have a brief meeting and discuss what will happen and
what happens to the patient post-surgery. For preventing patient suicide, the staff must have
training in an event of a patient suicide and follow procedures in keeping the patient safe. For
example, the staff must keep monitoring the patient and have a safe environment for the patient.
Another preventive measure is on medication errors; patients often get the wrong medication or
dose of medication. To prevent this error, prescribers should write medication out clearly, staff
should always ask about the medication of the patient if something is unclear, and administer
medication that is properly labeled according to the patient. Another error prevention is on
patient falls. The elderly is the highest risk for patient falls for reasons that are due to a mental

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illness or intoxication. The appropriate way for staff to decrease patients falls is to train in fall
risk assessments and to have clear communication between staff and patient.

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TITLE: Determinants of Internet use as a preferred source information on personal health.
Today, people manage their own health through using the Internet and diagnosing
themselves with the information that is available to them with a click of a search button. People
get health information from the media or from friends and family who found information from
health-related websites. There are different reasons why people choose to obtain health
information than seeking a physician. The article studied five areas in online health information:
accessibility of the internet and information, quality of content, user characteristics, information
consulted in the internet, and impact of learning and action based on information online. The
research hypothesis of the article describes four factors to understand why people prefer the
internet to obtain health information. The four factors are beliefs, intentions, demographics, and
satisfaction. The methodology of the study focused on 36,000 participants who went on a health
website that has information on illness prevention and health promotion.
The data that was collected from the participants used a questionnaire given on the
website. The majority of the people who participated in the questionnaire were 66% women and
93% over 30 years of age. The studies’ findings were that people who went on the health website
had a common motivating factor on wanting to prevent illness either for themselves or for a
friend or family member. The results were that the usefulness of the site in finding particular
health information was a significant importance. Unfortunately, the study did not find
correlations in their five areas which were reasons that people sought after health information
online than health professionals. Other findings that were significant to the study were that
women were more likely to consult online health than men. According to the authors, a main
reason why people use online health information is to adopt a healthier lifestyle. People want to

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use health sources readily available to them through the internet and try to compare the
information they have found through other sites for credibility.

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TITLE: The Role of Spirituality in Health and Mental Health
Spirituality and religiosity are two areas that medical professionals rarely introduce to
their patients. Spirituality focuses on personal values and connections, while religiosity focuses
on religious practices like going to church. Mental health, health, and spirituality have origins
that date back to the medieval era where prayers and blood cleanings were done by the church. In
the 1960s nursing studies went into holistic healthcare, where the patients were given spiritual
health methods. In the 90s, in the Diagnostic and Statistical Manual of Mental Disorders (DSM-
IV), spirituality was added and had an emergence of spiritual needs connected to mental health.
A benefit of health professionals adding spirituality into the practice consist of connecting
religion with health through treating depression or other mental health problems. A disadvantage
to spirituality and health is that spirituality cannot be measured and most professionals remain
distant from the subject and choose more empirical evidence. In the study, by the National
Center for Complementary and Alternative Medicine, spirituality and religiosity were studied on
physicians and patients in different health issues.
In cardiovascular health, two groups of older adults 60 years of age, who are extrinsically
involved and intrinsically involved in religion had different results on blood pressure reactivity.
The group who was intrinsically involved, meaning the person said prayers or mantras, had
decreased blood pressure and ventilator assistance. In chronic health issues spiritualty and health
were related in adapting and coping with the illness. In cancer, people who used spirituality
during their diagnosis and treatment, helped to be more positive and control their fears. In mental
health, spirituality is different from having health issues because mental health is contributed to
many other reasons and issues. For example, in psychiatric disorders, spirituality is a tool for

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social support and decision making. Culture is also a role in spirituality and is often categorized
through different beliefs and how their views on health and coping.

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TITLE: Cultural Meanings of Death and Dying
Different cultures have different attitudes and beliefs towards death and dying, Ethnicity
and race also contribute to the different attitudes to death, grieving, and palliative care. In the
United States, the densely minority populated groups are in Hawaii, New Mexico, California, D.C.,
and Texas. These areas are where more than half the population are minorities, who are either
Hispanic, African American, Native Americans and Asian American. These populations have
cultures that have similar themes and attitudes towards the end of life that are cultural sensitivity,
cultural knowledge, and cultural skills. Cultural sensitivity helps with trust and respect for cultural
differences between providers and patients. Cultural knowledge is for providers to have an
understanding pf different cultural attitudes, beliefs, and practices. Cultural skills apply to what
the patient believes in about death and end-of-life choices.
In the article the study shows a model that provides practitioners to build a better
understanding to different cultural areas: communication, space, biological variations, time,
environmental control, and social organizations. Practitioners should be aware of the variety of
communication styles in minority patients because communication makes a big impact in
identifying and solving problems. Minority groups have a high context culture where the
communication is focused on experiences and nonverbal cues. Space varies among minority
groups. Latinos and Middle Eastern groups like closer distances, while Asian groups like distances.
Biological variations apply to food, physical appearance, and development. Time is based on past,
present, and future. Hispanics and Native Americans view time as present and rhythmic. Social
organizations are networks or support groups which deal with cultural values and beliefs.
Cultural considerations of death and dying are important to understand the patient and the
family’s satisfaction. In the event of delivering bad news, practitioners should be aware of the

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families’ culture in how they want to hear bad news. For example, in the Japanese culture, they
believe language is very powerful and prefer not to speak of illness or death openly. Many cultures
have different beliefs and meanings regarding death. Native Americans have a belief that the living
and dead are ever present and exist as a continuing cycle. Chinese view death in different religions
that consists of ancestor worship and is not discussed due to the belief of misfortune. Death rituals
are part of the grieving and bereavement process for the family and also a rite of passage for the
deceased. Hispanic rituals involve religious prayer and family gatherings. Native Americans do
not leave the body of the deceased until burial. Asian Indian Hindus do cremation and mourning
last up to 10 to 16 days.
Advance directives and palliative care are common in Western institutions and do always
agree with non-Western groups due to the different beliefs of death. The advance directives are
wishes and end-life decisions that the patient wants and is control of. Most minorities are not
familiar with advance directives and decide with the patient as a group. Palliative care for patients
include their needs and cultural needs. The palliative care, to name a few, are pain management,
support, and spiritual/religious care. Culturally sensitive communication is helpful to make sure
the patient and family have all their needs met and that the practitioners are considerate of the
family’s beliefs and culture.

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TITLE: Exploring young people’s beliefs and images about sun safety.
Melanoma is a type of cancer that is from high sun exposure. The cancer is a prevalent
health issue concerning young people in Australia. The increase of sun exposure in young people
is the reason melanoma rates are high, due to young people not using protective measures in sun
exposure. Another reason for the increase in sun exposure is because of the constant change in
fashionable trends where the extremes are either pale to tan in accordance to what model they
idolize. A young person’s concern on appearance and attractiveness is easily influenced in this
age group. The study explains the behaviors and attitudes of young people through the Theory of
Planned Behavior. The theory is that a person’s decision to perform a behavior is determined
through social norm, attitudes, and behavioral control. Social norms, in the theory, follow the
expectations of certain groups and individuals. Attitudes are influenced through beliefs.
Behavioral control are people’s views about issues that affect behaviors.
The study uses focus groups to share views on sun protection in young people in
Australia. The research questions of the study discuss the sun protection behaviors of young
people, what motivation young people have to use sun protection and characteristics of people
who do or do not have tans. The participants of the study are both female and male with the age
group of 12-30 years of age that are both in school and work. The sample was 145 people which
were grouped into 22 focus groups for five months. The study groups varied in gender and ages.
The procedure of the study focused on one-hour group sessions that involved the research
questions on sun safety and tanning. The analysis of the discussions was audio-recorded and
transcribed according to the Theory of Planned Behavior. The discussions were grouped in
common beliefs and new beliefs.

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The results of the focus groups focused on reporting sun safety measures and the
participants’ view on sun safety. According to the article, the focus groups believed that
advantages to sun protection was preventing skin cancer and sunburn. The disadvantages to sun
protection was that people did not fine sun protection fashionable or permanent. People rather
use shade than sunscreen for sun protection. Groups that affected people’s views on sun
protection were family, friends, and health professionals. These groups approved using sun
protection, while other groups disapproved of sun safety. The focus groups were also influenced
by celebrities who tanned or promoted by sun protection. Groups had barriers on why people
were not using sunscreen due to being lazy on reapplication and sunscreen being too expensive.
The focus groups thoughts on tanning were that people who are tanned are healthier or attractive.
As for pale, untanned people, the groups found them unhealthy and shy.

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Healthcare Professional Interview with Mary Suarez
Interview:
 My informational interview was with Mary Suarez.
 Mary Suarez is a Registered Nurse.
 She works in Redlands Community Hospital, a non-profit hospital.
1. What is your education and experience?
 Bachelors in Science Degree in Nursing from California State University, San
Bernardino.
 Her work experience includes working as a Nursing Supervisor at a Skilled
Nursing facility and a Staff Registered Nurse.
2. Why did you choose your career?
 Mary was first influenced by her mother because she is a long time Registered
Nurse. Mary saw how rewarding it was for her mother to medically aid people
and be supportive. She took interest in wanting to help heal people and help aid
their medical needs, which eventually made her pursue nursing.
3. What Department of the Hospital Do You Work in?
 At the Redlands Community Hospital, Mary works in the Medical-Surgical and
Pediatrics (Med-Surg/Peds) Unit.
 She has been working in that unit for three years.
4. What are your duties as a Registered Nurse?
As a registered nurse in the Medical Surgical and Pediatrics Unit, Mary does (to name
several):
 Provide care to patients after illness, injury, or surgery
 Assess the needs of patient and develop a plan of care.

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 Monitor patients and maintain patient safety
 Manage pain of patients
5. What do you like most about your job?
 Because I work in the pediatrics unit, I look forward to meeting my small patients
and talking with them.
 I also like meeting with a child’s parent(s) to help better assess the needs of their
child.
6. What do you like least about this job?
 The only thing that I like least about the job is working long hours where I am not
able to see my family as often.
7. Any Advice for graduates and people pursuing the Health Science field?
 Choose a career you want to do and create a five-year road map leading up to
what you want to become.
 Do your research/ continue your knowledge, there are many ways to get a job in
the health field.
 Network with people and shadow people who have careers you are interested in
and learn from them.

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Five Scientific Journals from
Health Science Courses

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Journal 1:
American College of Obstetricians and Gynecologists (the College) and the Society for
Maternal–Fetal Medicine, Aaron B. Caughey, Alison G. Cahill, Jeanne-Marie Guise, Dwight J.
Rouse, Safe prevention of the primary cesarean delivery, American Journal of Obstetrics and
Gynecology, Volume 210, Issue 3, March 2014, Pages 179-193, ISSN 0002-9378,
http://dx.doi.org/10.1016/j.ajog.2014.01.026.
Summary: The authors studied women and their types of births. They explain reasons for the
causes of why cesarean procedures are performed, rates of morbidity and mortality of
cesareans, and important stages of labor that must be monitored.
Journal 2:
Briggs, A.M., Cross, M.J., Damian, G.H., Sanchez-Riera, L., Blyth, F.M., Woolf, A.D., & March, L.
Musculoskeletal Health Conditions Represent a Global Threat to Healthy Aging: A Report for the
2015 World Health Organization World Report on Ageing and Health
The Gerontologist (2016) 56 (Suppl 2): S243-S255 doi:10.1093/geront/gnw002
Summary: This study is on musculoskeletal health and maintaining an active lifestyle and
interventions for older adults.
Journal 3:
Puia, D. M. (2013). The cesarean decision survey. Journal of Perinatal Education, 22(4), 212-225.
doi:10.1891/1058-1243.22.4.212
Summary: In a 2013 study, Puia’s focus was on a pregnant woman's decision on a cesarean
section. The author researches further into a woman’s decision of a birthing method and
describes their explanation as to why the woman would choose a cesarean delivery.

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Journal 4:
Solove, D. (2013, April 1). HIPAA turns 10: analyzing the past, present and future impact.
Retrieved May 10, 2015, from
http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_050149.hcsp?dDocNa
me=bok1_050149
Summary: This article gives an overview of what provoked the need for the HIPAA privacy rules.
It and reviewed both side of the argument to enforce the plan. It also brings up questions that
were asked about the necessity of the rules and if they would be helpful or hindering.
Journal 5:
Young-Shin, L., Baek, J., Kyeongra, Y., & Saunjoo, Y. (2012). Relationships Between Physical
Activity and Awareness and Treatment Status Among Adults With Low Femoral Bone Density in
the United States. American Journal Of Health Promotion, 27(1), 2-9.
Summary: The purpose of the study is to see the correlation of physical activities and low bone
density in adults.

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Three Samples from Upper
Division Courses

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2015 Summer Quarter, Healthcare Law and Ethics
Negligence Scenario
Case Study Research
California State University East Bay

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Introduction
The standard of care for a physician is the level of caution that a provider exercises for a
patient (Standard of care law & legal definition, 2015). In some cases, the standard of care of a
physician should be “minimally competent” where that different outcomes do not equate to
bad standard of care (Moffet & Moore, 2011). However, when a physician fails to meet the
standard of care where the patient has suffered injury or even death, the physician is liable of
the damages and is called negligent (Farnsworth & Sheppard, 2010).
The case of the patient Ms. Campbell and Dr. Yang describes a situation where Dr. Yang
is a physician researcher of the Pancreatic Cancer Study that treats enrolled patients with
pancreatic cancer an investigational new drug called Compound P. After examining patients of
the study taking the drug, Dr. Yang notices the treatment is working on the patients. Because
Ms. Campbell has pancreatic cancer, Dr. Yang decides to help her with treating her with
Compound P with her consent, even though Ms. Campbell was not eligible for the treatment or
study. When starting the treatment, Ms. Campbell has a fever and rash. The doctor gives her
Restol instead of Prednisone, which gives Ms. Campbell a more severe rash, high fever, and
difficulty breathing. This event causes Ms. Campbell to pass away three days after taking Restol.
The family sues the doctor for using an off-label drug on Ms. Campbell.
The state where this case happened has a rule that where a plaintiff shows evidence of
an off-label use the defendant can show that the off –label use is not negligence per se. This
research will discuss the differences between negligence and negligence per se how these two

30
legal issues relate to the scenario. The research will also discuss ethical issues pertaining to the
beneficence and non-maleficence.
Method
There was a focus on understanding how negligence is in the case of Dr. Yang and
figuring out when the negligence occurred. The topics for research was based on standard of
care, patient safety, medical negligence, and medical malpractice. The research of standard of
care and duty helped as a reminder of what the physician must do to care for the patient. There
was also research on legal cases that involved medical negligence particularly the Hall v. Hilburn
case and other cases that relates to the scenario. The cases aided with the understanding of
negligence and legal aspect the event that occurred. Searching the pharmaceutical drugs
Prednisone and Restol also helped to understand what the drugs are and how they affected or
would affect Ms. Campbell.
The process of organizing the research consisted of knowing the issue and event that
occurred between Dr. Yang and Ms. Campbell, finding where Dr. Yang was negligent, and how
Dr. Yang did not perform his duty on his patient. This organization helped map out what type of
literature the research would discuss. Researching on negligence and cancer patients helped to
see how some doctors treated the cancer patients. This would relate to ethical issues with the
duty of the physician and the rights of patient. There was also searching on the phase II of the
new drug Compound P and how effective the drug was during the study. In the process of
searching for the literature, the databases used were PubMed, CINHAL, law dictionary sites,
and government websites.
Result

31
To comprehend both legal side and medical side to this case, there has to be an
understanding of the differences between negligence and negligence per se and the treatment
and medication the patient was given. Knowing the legal doctrines involved in this case helps to
know how this case would be in court and understanding the medical side to the case will
discuss the consequences to the patient’s treatment and how the claim of negligence may be
formed.
Negligence is when a sensible person does not do their responsibility in giving care
during an incident (Negligence, n.d.). Negligence can end in accidents where there can be harm
to a person. Negligence is connected to the standard of care from what health professionals do
for their duty to patients. In case of negligence there are four different parts to have the
plaintiff prove negligence (Moffet & Moore, 2011). The four parts to negligence, according to
Moffet and Moore, are “duty, breach of duty, harm, and causation” (Moffet & Moore, 2011).
The physician or health professional that is clamied to be negligent has a duty to the harmed
patient (“Negligence”, n.d.). The breach of duty and harm is when the health professional does
the “negligent” action that is outside of standard of care (Moffet & Moore, 2011). The
causation is the consequences of the harm from negligence (“Negligence”, n.d.). These four
parts are needed for the jury to decide on the negligent claim (Farnsworth & Sheppard, 2010).
Negligence per se which is a principle on an intervention on a claim of negligence on a
person being sued with negligence (“Negligence per se”, n.d.). This principle like negligence
may be different in each state. With negligence per se, the jury do not have to decide on a
health professional’s possible negligence through this principle (“Negligence per se”, n.d.). The
actions of the health professional are still determined by the jury whether there was a violation

32
of the statues (Negligence per se, n.d.). The ways that negligence per se can be refuted is by
three parts: “violation of law, intent of law, and protected class” (“Negligence per se in a
personal injury case”, n.d.). The violation and intent of laws are clear to where a law is
dishonored and to what intent the law was for (“Negligence per se in a personal injury case”,
n.d.). For example, in the case negligence per se is used for the Rule 55 that off-label use of a
drug can be used. The protected class means that laws are protected for everyone and if a
physician denies treatment and care to a person, then that physician dishonors a “federal law”
(“Negligence per se in a personal injury case”, n.d.).
The medical side to the case discusses the certain types of medication that Dr. Yang
prescribed to Ms. Campbell and how the treatment shows possible negligence. Dr. Yang
prescribed Ms. Campbell Compound P to help her live longer and treat her pancreatic cancer,
but what is Compound P? The Compound P is an investigational new drug that can be initiated
and conducted by a physician, which approved by the U.S. Food and Administration and
Institutional Review Board that Dr. Yang researches on his PCS study (“Investigational new
drug”, 2014). The drug is also in Phase II meaning the drug helps cancer patients by shrinking
the cancer in the body or a disappearance of the cancer (“Clinical trials: what you need to
know”, 2014). The study of the Compound P also relates to the longevity of the person taking
the drug if the drug gives the person more months to live (“Clinical trials: what you need to
know,” 2014). This is the information that needs to be understood about the pancreatic case
study and what outcome Compound P is supposed to give to the enrolled patients.
Compound P was aiding Dr. Yang’s patients and he hoped that the drug would help Ms.
Campbell, but the outcome was unfortunate one. It is possible that Dr. Yang may have made a

33
clinical error in overestimating Ms. Campbell’s other health problems and how Compound P
would affect those problems. Oyebode’s article on clinical errors and negligence dicusses that
clinical errors occur when there is a failure of execution or a planned action (Oyebode, 2013).
There is also a term on a type error called reckless disregard where the risk would not be
perceived as a big issue (Webb, 2015). Before Ms. Campbell agreed to try Compound P, her
pancreatic cancer was in a state of a poor prognosis. This would mean that the cancer was
spreading through Ms. Campbell’s body and the cancer worsening. Ms. Campbell had other
health problems which did not allow her to be part of the Pancreatic Case Study or take
Compound P, so why would Dr. Yang give a patient a new drug that was not permissible for Ms.
Campbell? It is possible that Dr. Yang may have made a clinical error in overlooking Ms.
Campbell’s other health problems and how Compound P would affect the problems. The health
problems would affect Ms. Campbell’s reaction to a new drug; however, it is unknown whether
Dr. Yang knew that Ms. Campbell had health problems that would be affected when taking a
new drug just for pancreatic cancer.
Discussion
The focus on the event that had occurred to Ms. Campbell is wanting to know how Dr.
Yang is negligent for prescribing her an off label drug that worsen her allergic reaction to
Compound P. The condition for the negligence had to occur starting with duty, breach of
standard care maltreatment, and consequence of maltreatment (Moffet & Moore, 2011). This
situation would question Dr. Yang’s standard of care where he was expected to treat the
patient with skills and knowledge of the treatment and do no harm to the patient (Pandit &

34
Pandit, 2009). It is true that Dr. Yang showed beneficence in wanting to help and show
compassion to Ms. Campbell’s condition, but it is possible that he may been overestimating the
effect of the drug to her poor condition (Pence, 2015). Moreover, Dr. Yang gave a drug that Ms.
Campbell originally was ineligible to receive Compound P due to other health problems that
would possibly harm her than heal her. This issue was not addressed as to whether taking
Compound P would have been a bad treatment for Ms. Campbell due to her other health
problems besides pancreatic cancer.
For the situation of Ms. Campbell and Dr. Yang, Ms. Campbell’s family sues Dr. Yang for
negligence for giving Ms. Campbell an off-label drug Restol for her allergic reaction that
occurred after she had taken Compound P that caused her death. After Dr. Yang prescribed
Compound P to Mrs. Campbell and undergoes the treatment, she develops only a rash and
fever with no difficulty breathing, which is a possible sign of an allergic reaction to Compound
P. The doctor prescribes Restol that treats heartburn, and nausea, for her allergic reaction
instead of Prednisone (“Restol”, n.d.). Prednisone is a medication that treats severe allergic
reactions and arthritis (“Prednisone: MedlinePlus drug information”, 2010). Ms. Campbell did
not have asthma or trouble breathing when she started Compound P, but a rash and fever. Dr.
Yang giving Ms. Campbell Restol that did not help her allergic reaction to Compound P, it
worsens her condition which caused her death that would have been prevented is she was
given a medication like Prednisone.
Although there is a state law that a physician is not negligent for using an off-label drug,
like Restol, negligence occurred for the physician not giving Ms. Campbell the medication she
needed for her allergic reaction. As mentioned before, Restol did not alleviate her symptoms

35
but worsen her fever, rash, and difficult breathing. Although Dr. Yang may have had good
intentions to give Ms. Campbell the Restol, he thought it was effective than Predisone, the
medication did not necessarily aid her rash and fever.
The ethical issues that may pertain to this case are beneficence and non-maleficence.
Beneficence is the having the physician do an “act with the patient’s best interest” (Graber et.
al., 2015). This ethical principle is a good principle to have for a physician since it shows that the
doctor is compassionate (Pence, 2015). Dr. Yang shows compassion to Ms. Campbell when
wanting help her with her poor condition in pancreatic cancer. The physician wanted to give
Ms. Campbell a chance to relieve her symptoms of pancreatic cancer. Woien states that
nonmaleficence means that “there is no evil or harm” done to people (Woien, 2008). The
principle discusses that physicians should not have situations where their patients are left in a
poorer state since their last meeting (Pence, 2015). The issue of maleficence in this scenario is
to possibly show that Dr. Yang presented nonmalificence to Ms. Campbell by prescribing her an
off-label medication that did not help her rash or fever. It is also possible that Dr. Yang may not
have paid enough attention to Ms. Campbell’s allergic reaction to the experimental drug. The
medicine worsens her state of fever and difficult breathing and hastened her death. Although it
is not known how she died, it is possible that taking the wrong drugs and the off-label drug
prescribed by Dr. Yang harmed her.
Conclusion
It is important to know all sides of a case that presents what happened to a patient.
There are many ways to turn to when it comes to learning and understanding legal, medical,

36
and ethical views of a scenario on negligence. Understanding the differences of negligence and
negligence per se brings out possibilities on whether or not Dr. Yang may be negligent. The
ethical arguments of beneficence and nonmaleficence demonstrates how Dr. Yang treated and
cared for the patient. The case of a possible negligence of Dr. Yang might be a possible long
process for Ms. Campbell’s family in proving negligence under the state also having a
negligence per se rule.

37
References
Clinical trials: What you need to know. (2014). Retrieved from
http://www.cancer.org/treatment/treatmentsandsideeffects/clinicaltrials/whatyouneedt
oknowaboutclinicaltrials/
Farnsworth, E. A., & Sheppard, S. (2010). An introduction to the legal system of the United
States. (4th ed.). Oxford: Oxford University Press.
Graber, A. D., Bhandary, A., & Rizzo, M. (2015). Ethical practice under accountable care. HEC
Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues. doi:
10.1007/s10730-015-9280-x
Investigational new drug application. (2014, October). Retrieved from
http://www.fda.gov/drugs/developmentapprovalprocess/howdrugsaredevelopedandap
proved/approvalapplications/investigationalnewdrugindapplication/default.htm
Moffett, P., & Moore, G. (2011). The Standard of Care: Legal History and Definitions: the Bad
and Good News. Western Journal of Emergency Medicine, 12(1), 109–112.
Oyebode F. (2013). Clinical errors and medical negligence. Medical Principles Practice. doi:
2013;22:323-333
Pandit, M. S., & Pandit, S. (2009). Medical negligence: Coverage of the profession, duties, ethics,
case law, and enlightened defense - a legal perspective. Journal of the Urological Society
of India, 25(3), 372–378. doi:10.4103/0970-1591.56206
Pence, G. E. (2015). Medical ethics: accounts of ground-breaking cases. (7th ed.). New York, NY:
McGraw-Hill Education.

38
Prednisone: MedlinePlus drug information. (2010, September 1). Retrieved from
http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601102.html
Restol. (n.d.). Retrieved from http://www.medicatione.com/?c=drug&s=restol
Standard of care law & legal definition. (2015). Retrieved from
http%3A%2F%2Fdefinitions.uslegal.com%2Fs%2Fstandard-of-care%2F
Webb, J. (2015, March 10). Pharmacy dispensing errors: Claims study emphasizes need for
systematic vigilance. Retrieved from http://drugtopics.modernmedicine.com/drug-
topics/news/dispensing-errors-claims-study-emphasizes-need-systematic-vigilance-
pharmacy?page=full
Woien, S. (2008). Life, death, and harm: Staying within the boundaries of nonmaleficence. The
American Journal of Bioethics, 8(11), 31-32.

39
2015 Spring Quarter, Health Legislation and Governmental Programs
TO: Betty Boss, Supervisor
FROM: Nicholle Macadangdang, Health Administration Assistant
DATE: May 25, 2015
SUBJECT: Patient Medicaid Eligibility
A patient seeking care in Imperial Unlimited, but is currently uninsured. It is apparent that
the patient needs insurance in order to receive care. The patient may be eligible for the
Medicaid program. We must find out whether or not the patient can qualify for Medicaid and
notify the patient about this program. I have gathered information on Medicaid that will provide
information on the program the requirements for the patient.
What is Medicaid?
Medicaid was passed in 1965 as a health insurance for low income people, elderly, and
people with disabilities. (“Medicaid timeline”, 2015).The program is in a partnership with the
federal government and the states (“What is Medicare and what is Medicaid?” 2014). With
federal-state aid, Medicaid helps people who are uninsured and those who do not have enough
health coverage. The program differs in cost and coverage in each state. Medicaid coverage
and costs can be made through the use of private insurances or can be paid directly through the
program (“How to qualify for Medicaid and CHIP health care coverage,” 2015). Today, all 50
states have Medicaid, and over the years the program has expanded to include pregnant
women, children, parents, and poor seniors (Paradise, Lyons, & Rowland, 2015).
Benefits of Medicaid
The federal-state union of Medicaid allows states to form their own Medicaid with
specific type’s services, how long a service can last, and the amount of services. The services
of the program have both mandatory and optional benefits (“What is Medicare/Medicaid?”
2015). The mandatory benefits, to name a few, involve home health services, physician
services, outpatient hospital services, and family planning services (Benefits Medicaid.gov.,
2015). Optional benefits, that vary from state to state, can be clinic services, optometric
services, transportation services, rehabilitation and physical therapy services, and prescribed
drugs (“What is Medicare/Medicaid?,” 2015).
In California the Medicaid program is called Medi-Cal that provides the mandatory
benefits and optional benefits that the state has to offer. Medi-Cal is no different from Medicaid
but has additions to the program for recipients. Some of the optional benefits are emergency
services, outpatient care, prescription drugs, mental and substance abuse services, and
rehabilitation services, and children services (“Medi-Cal benefits,” 2015). There is also dental,
wellness and disease prevention, and vision benefits with eye exams every year (“Blue Cross
and Blue Shield's benefit plan,” 2015).

40
Eligibility
To partake in Medicaid, there are federal laws that cover certain groups, such as required
eligibility groups, in the states. States also have specific rules for their Medicaid programs apart
from the federal laws each has to follow (“Eligibility Medicaid.gov”, 2015). Requirements to
participate in Medicaid depends on age, citizenship status, and disability. Initially, the eligibility for
the Medicaid program was only for low income people such as pregnant women, children, people
who have disabilities, and the elderly (Paradise, 2015). Under the Affordable Care Act, the
program was expanded to have eligible nonelderly adults (Wachino, Artiga, Rudowitz, 2014).
People who are eligible for Medicaid are families who have children under six years of age
that are 133% of the Federal poverty level (FPL) (“What is Medicare/Medicaid?,” 2015). An
example of a family eligible for Medicaid from the 2014 Federal poverty level is $19, 790 for a
family of three (Paradise, 2015). Other eligible recipients are pregnant women who have income
below 133% and Social Security recipients (“General Medicaid requirements,” 2015) Medicare
recipients for the elderly qualify for Medicaid as a dual eligibility (“What is Medicare/Medicaid?”
2015). Nonelderly adults, under 65 years of age, qualify for the program by having a national
minimum income of 138% of the federal poverty level which is $11,670 (Paradise, 2015).
As mentioned previously, states may have different requirements for gaining eligibility into
Medicaid. For example, California has a Medicaid program called Medi-Cal that has different
eligibility requirements apart from the federal requirements. To be able to qualify for Medi-Cal are
families who have low income, pregnant women who have low income, women with low income
who have been screened for breast or cervical cancer the elderly, people who are in SSI
programs, disabled and blind people. (“San Diegans for healthcare coverage, a coalition for
health,” 2015). In the expanded Medi-Cal, adults that are childless, from the ages of 19 to 64
years can be in the program and use the services offered (“Medi-Cal: Covering more
Californians,” 2014).
Medicaid is a program that will definitely help people and families who are uninsured and
are need of medical coverage. With the right requirements and information that is needed from
patient, we will be able to determine whether the patient is eligible and understand what we must
do to get the patient into Medicaid.
Sincerely,
Health Administrator, Imperial Unlimited
e:nmacadangdang@horizon.csueastbay.edu

41
References
Benefits medicaid.gov. (2015). Retrieved from http://www.medicaid.gov/medicaid-chip-program-
information/by-topics/benefits/medicaid-benefits.html
Blue Cross and Blue Shield's benefit plan. (2015). Retrieved from
https://www.fepblue.org/en/benefit-plans/so-benefit-tables/

42
2015 Summer Quarter, Health Systems Management
Hurricane Katrina
Case Study
Julia Sosa, Maribel Gonzales, Nicholle Macadangdang, Gilleo Rose
California State University, East Bay
Health Science 4600- Summer

43
Introduction
Hurricane Katrina occurred in August 29, 2005 that affected people in “Louisiana,
Mississippi, and Alabama” (“Hurricane Katrina,” 2009). FEMA said that Hurricane Katrina was a
calamitous “natural disaster” (“A decade of progress through partnerships in Louisiana,” 2015).
The hurricane was a “127 miles per hour Category 3 storm” (“Hurricane Katrina statistics fast
facts,” 2015). The damages of Katrina were assessed at “$108 billion” (“A decade of progress
through partnerships in Louisiana,” 2015). This research will consist of the impact on hospitals
in New Orleans from the Hurricane Katrina. The paper will focus on preparedness plans the
hospitals before and after the major disaster and what can hospitals do for future disasters like
Hurricane Katrina.
Situation
Many people in the Gulf Coast were affected by the hurricane that they were forced to
leave their homes or evacuated from hospitals (“Addressing the health care impact of hurricane
Katrina,” n.d.). The infrastructure of healthcare was greatly impacted from Hurricane Katrina
that caused many challenges from the loss of power and electricity, massive flooding, and lack
of patient care (“Addressing the health care impact of hurricane Katrina,” n.d.). These
challenges are an important part of the healthcare infrastructure that needed the most
attention for many people after the hurricane.

44
The massive floods all around New Orleans was an issue for public health. The flood
worsens due to the failed levee system that was supposed to hold flood waters from entering
communities (Taylor, 2007). The flood brought “damage to drinking water” and also impaired
many sanitation structures like waste facilities (“Addressing the health care impact of hurricane
Katrina,” n.d.). There was also unworkable “sewage systems” that backed up all plumbing
(Rodriguez & Aguirre, 2006). In hospitals, the lack of clean water nor having the proper
decontamination would mean an increase spread of diseases. The attention for hospitals and
healthcare is to stop the spread of disease and infection during an event of a hurricane.
Emergency generators, in hospitals, are to deliver electricity for “36 hours” (Taylor,
2007). Unfortunately, after Hurricane Katrina, hospitals in New Orleans did not have enough
fuel to run the generators (Rodriguez & Aguirre, 2006). The lack of power brought high
temperatures and “100%” humidity” made conditions very difficult for health professionals
(Taylor, 2007). The loss of electricity was also challenging for physicians and nurses to care for
very ill patients who needed radiology and machines to aid them (Taylor, 2007).
The lack of patient care in the New Orleans hospitals brought upon from extreme
conditions needed great attention due to the lack of medications, food, running water and
electric systems (Rodriguez & Aguirre, 2006). Many patients did not have their regular
medication like “diabetic medication or asthma medication” (“Addressing the health care
impact of hurricane Katrina,” n.d.). Because of the lack of electricity, seriously ill patients were
“hand ventilated” by the medical professionals (Taylor, 2007). These conditions were very

45
difficult for hospitals in New Orleans especially when most hospitals were not prepared for a
big hurricane like Hurricane Katrina.
Before hurricane Katrina hit many hospitals believed they were well prepared for any
disaster. They were prepared by having a comprehensive disaster plan with regular updates.
They were also fully staffed, however, they relied on federal agencies in order to continue
running in case of emergencies (Grush, 2012). Although, it seemed like hospitals were well
prepared for hurricane Katrina, it was not the case.
After hurricane Katrina there were some changes done to health care facilities and
health care personnel in order to be well prepared for other disasters. One of the changes was
setting leadership roles among the personnel. One main issue during hurricane Katrina was the
lack of leadership skills and decision making among the personnel. This caused ineffective
medical response because it could not be determined whether, federal, state, or local officials
were in charge (O’reilly, 2010). The second change that was made was, to make sure health
care facilities are stocked enough with the necessary medical supplies, including supplies that
will meet the caregiver’s basic needs in case of an emergency. During hurricane Katrina the lack
of medical supplies caused a lack of nutrition, hygiene products, and clean linens among
caregivers and patients (Eckert, 2006). The third change that happened after hurricane Katrina
was making sure hospitals had auxiliary power that will run air conditioning and water in case
water supplies get disrupted (The Advisory Board Company, 2012).

46
Challenge
The challenges Hurricane Katrina brought forth upon the New Orleans Medical system is
overwhelming. Not only did it affect thousands of people but it affected the medical systems
needed to treat them. “Physical access to healthcare facilities was hampered across the Gulf
Coast following the storm...rising floodwaters made it progressively more difficult to maintain
standards of care” (Lister, 2005). And as the water kept rising, more people needed to be
relocated to field hospitals increasing the chances of being electrocuted by downed power
lines, and increasing the chances of waterborne diseases. In addition, the medical professionals
were simply inundated with too much people to take care of. It was so much that they had to
prioritize and set up triage centers outside the flood zone using helicopters (Lister, 2015).
Everything from transporting patients to standards of care, all had to be reevaluated for this
large-scale scenario in order to alleviate the heavily impacted medical systems.
Poverty played a devastating role in the amount of people that can be insured. More
than one in five residents were left uninsured - estimated roughly at 900,000 people, leaving
this to be one of the highest uninsured cities in the United States (Rudowitz, 2006). And this
was before the onset of the hurricane and the implementation of the Affordable Care Act.
What this means is that if the majority of those people received care without insurance, it is
possible they are even in more debt than before. This is a huge challenge that needed attention
and fortunately, funding from various governments and donations nationwide helped to
alleviate some of the financial burdens.
Hurricane Katrina absolutely wrecked the city’s economy. According to the Bureau of
Labor Statistics, roughly 80% of the city was flooded and estimated damages ranges up to $200

47
billion, declaring Hurricane Katrina to be the worst hurricane to ever hit the United States
(Dolfman et al., 2007). Furthermore, 6 out of every 10 jobs were lost, with $2.9 billion lost in
wages. (Dolfman et al., 2007). Tourism generated the most profit for New Orleans which in
turn, took the biggest hit as $382.7 million were lost in wages - shockingly exceeding that of the
health care and social services sector, which lost $377.8 million in wages (Dolfman et al., 2007).
Solution
The magnitude of a geographical environmental disaster tends to transpire with little to
no advance warning; therefore, it is essential for hospitals to have an effective, systematic plan
for evacuation in the event of a disaster through an emergency operations plan this is a system
that entails “who will do what, as well as when, and with what resources and by what
authority- before, during, and immediately after an emergency” (FEMA, 1996). The strategy to
respond effectively in determining the evacuation plan must first be communicated with all
stakeholders, otherwise, responding effectively ultimately involves prevention, preparedness,
response and recovery. In addition, to coordinating and communicating the mass evacuation
plan with multiple hospitals and/or other healthcare facilities, county emergency management,
state department of health, fire rescue and law enforcement.
More importantly, our hospital JMNG will have the capability to withstand the
unpredictability of a public health impact amongst an affected population. Our hospital will be
sizeable with a bed count of 800 and will require a substantive initial budget of 50 million for
the first 72 hours which will provide, alternate medical treatment sites or affiliated facilities
that can be established by our hospital or set up by county, regional, state or federal partners

48
to provide alternate medical care. In addition to, including mass fatality planning in the event
there are significant fatalities associated with a catastrophic disaster. This reinforces the need
for coordination with local Emergency Management and Medical Examiner’s. Logistically, we
will provide local Emergency Management with a situation report on our status. For this reason,
quality of care during the need of transport regardless of the type of transport provided all
patients must be transported with sufficient medications and supplies (Bandages, IV Solutions
and Gases) to last a minimum of 96 to 120 hours. Additionally, food and water supplies should
be provided to each patient and attending staff members. At the same time, water, fuel and
power must be available for the facility to continue to provide care for patients that cannot be
moved. Facilities should have a minimum fuel supply to run generators. If this supply drops
below 50%, arrangements should be made to have fuel replenishments (Evacuation, 2015).

49
References
Addressing the health care impact of hurricane Katrina. (n.d.). Retrieved from
http://kff.org/medicaid/issue-brief/addressing-the-health-care-impact-of-hurricane/
A decade of progress through partnerships in Louisiana. (2015, August 18). Retrieved from
http://www.fema.gov/decade-progress-through-partnerships-louisiana#
Dolfman, M., Wasser, S., & Bergman, B. (2007, June). The effects of hurricane katrina on the
new orleans economy. Retrieved August 25, 2015, from
http://www.bls.gov/opub/mlr/2007/06/art1full.pdf
Eckert, S. (2006). Preparing for disaster. American Nurse Today. Retrieved from
http://www.americannursetoday.com/preparing-for-disaster/
Evacuation. (n.d.). Retrieved August 27, 2015, from
http://www.calhospitalprepare.org/evacuation
Federal Emergency Management Agency. SLG 101:Guide for All-Hazard Emergency
Operations Planning. http://www.fema.gov/plan/gaheop.shtm, 1996.
Grush, L. (2012). New Orleans hospitals better prepared for Isaac after chaos of Katrina. Fox
News. Retrieved from
http://www.foxnews.com/health/2012/08/29/new-orleans-hospitals-better-prepared-
for-isaac-after-chaos-katrina/
Hurricane Katrina. (2009). Retrieved from http://www.history.com/topics/hurricane-katrina
Hurricane Katrina statistics fast facts. (2015, August 24). Retrieved from
http://www.cnn.com/2013/08/23/us/hurricane-katrina-statistics-fast-fac

50
Lister, S. (2005, September 21). Hurricane katrina: The public health and medical response.
Retrieved August 25, 2015, from http://fpc.state.gov/documents/organization/54255.pdf
O’Reilly, B. (2010). Katrina’s legacy: Rethinking medical disaster planning. Amednews.com.
Retrieved from
http://www.amednews.com/article/20100906/profession/309069941/4/
https://www.advisory.com/daily-briefing/2012/08/30/katrina-taught-new-orleans-
hospita s-how-to-prepare-for-isaac
Rodriguez, H., & Aguirre, B. E. (2006). The impact of Hurricane Katrina on the medical and
healthcare infrastructure: A focus on disaster preparedness, response, and resiliency.
Retrieved from http://udspace.udel.edu/handle/19716/2380
Rudowitz, R. (2006, September). Health care in new orleans before and after hurricane katrina.
Retrieved August 25, 2015, from
http://content.healthaffairs.org/content/25/5/w393.full
Taylor, I. L. (2007). Hurricane Katrina’s impact on Tulane’s teaching hospitals. transactions of
the American clinical and climatological association, 118, 69–78.

54
32470 Navajo Trail
Cathedral City, California, 92234
(760) 835-0556
6/3/2016
Integra Service Connect
Los Angeles, CA. 90001
Dear Recruiter,
When I was growing up, I was exposed to watching people living in the streets and being too ill
to take care of themselves. As a child, I felt sympathy towards the poor and gave what little
money I had to help them live. This was a motivating factor for me to want to help people as a
life goal. This position will take my altruistic and helpful nature to the next level.
My background includes interning at a non-profit organization called Foundation of
Osteoporosis Research and Education. I performed duties that included communication with
executive directors, activity directors, and wellness nurses to participate in a national
osteoporosis awareness event. I demonstrated my abilities to organize and plan based on the
facility. I also recruited volunteers through Volunteer Match and aided them information on the
event.
In addition to this experience, I gained a considerable amount of customer service skills. I was a
part-time Starbucks barista in my university. As a Starbucks barista, my responsibilities are to
meet the needs of my customers through their order and create a comfortable “second home”
environment.
I am interested in this position because I want to be a part of helping the community with their
healthcare needs. In healthcare, I think a portion of proving health services to patients is
communication to make sure the patients are given what they need. I feel that I have the skills
to effectively communicate with patients to meet their health goals and services. I also can
demonstrate sound judgment and analyze solutions that best fits a patient or situation.
I am confident that I can demonstrate the duties and skills that you are seeking. I am also very
open to learning new things to build upon my skills as an assistant health manager. I would
appreciate the opportunity to meet with you to discuss how my qualifications will be beneficial
to your organization’s success. My contact number is (760) 835-0556.
Sincerely,

56
32470 Navajo Trail
Cathedral City, California, 92234
(760) 835-0556
nmacadangdang@horizon.csueastbay.edu
PROFESSIONAL/DEVELOPMENTAL SKILLS
 Certified Nursing Assistant
 Certified in First Aid and CPR
 Proficient in Microsoft Word, Excel, and PowerPoint.
MANAGERIAL SKILLS
 Strong leadership and communication skills
 Teamwork and goal-oriented
 Critical thinking and problem solver
EDUCATION
California State University of East Bay, Hayward, CA
Bachelor of Health Sciences in Healthcare Administration and Management, Jan. 2014-Expected
graduation, June. 2016
College of the Desert, Palm Desert, CA.
Licensed Certified Nursing Assistant May 2013
EXPERIENCE
Foundations of Osteoporosis Education and Research
Internship Event Coordinator. March 2016 - May 2016
 Coordinated events with Executive Directors and Activity Directors of Nursing Care Facilities.
 Planned and organized events
 Recruited volunteers and obtained communication skills.
Aramark in California State University East Bay, Hayward, CA
Student Worker for Starbucks, July 2015 - June 2016
 Connected with customers through friendliness and paying attention to detail of the orders to
ensure their needs are met.
 Provided customer service in a timely and effective manner that customers receive quality
beverages and products.
 Maintained the shared goals and organization of the store’s daily objectives.
VOLUNTEER EXPERIENCE
Eisenhower Medical Center
Emergency Department Volunteer, June 2010-2012
 Made frequent rounds of all patients in the department assessing their basic needs under the
guidance of registered nurses.
 Restocked carts, patient rooms, and nursing stations.
 Assisted nurses in escorting patients from and to procedure rooms.
 Prepared patient beds and medical equipment needed for patients and doctor

60
Personal Essay
My name is Nicholle Macadangdang. I was born and raised in Palm Springs, California. I
come from a family of three, myself included. My parents are from the Philippines which makes
me a first born Filipino American. I am a soon-to-be Bachelor’s of Science graduate in Health
Sciences with a focus on Administration and Management. My pursuit in wanting to help
people all my life turned to something I want pursue as a career. The healthcare field was an
area I have always been drawn to. Healthcare is always changing and growing to help people
live longer and healthier. I want to be a part of helping people through health.
I have volunteered in the Emergency Department at Eisenhower Medical Center to
figure out and shadow nurses and doctors to see where I fit in the healthcare system. I also
obtained my certification as a Certified Nurse Assistant while in community college. This was a
stepping stone for me to be in a health care setting and experience what it is like to be part of
an organization and work with nurses and doctors.
My short term goals are to find a job that best fits my career in health administration. I
want to be able to interact with people and do paperwork, planning, and organizing for my
future organization. I also want to attain more experience in different areas in the health care
sector because I am not sure of where I would want to work in.
My long term goals are to be part of an organization in healthcare where I am a health
administrator. I want to become an important role in the healthcare field through collaborating
with health professionals and the community. I want to help as much people as I can in health. I
want to also be part of Doctor without Borders and be a member of this organization in going
around the world and help people in underdeveloped countries and supply them as much aid as
we can.

64
HSC 4700
Professor Gem Le
Legacy Role
Majoring in Health Sciences was a career path goal to put myself in a field where I could
help people and their health. I have experience in volunteering in a hospital and training as a
nurse assistant, that my goal to work in the health care field is what I want to do in life. The
general education classes of Biology, Anatomy, Statistics, and Psychology, to name a few, are
important towards the type of area in health sciences a student might want to study in. I think
it is important to excel in general education because a student should know certain skills and
knowledge to prepare for the main focuses of their major. As an option A on health
administration and management, prior to my upper division studies my general education and
lower division courses helped me figure out what I wanted to do and learn what I needed to
learn towards obtaining a degree on health administration.
The classes that were specifically towards my health science major were in all very
helpful and useful classes. Every class I took as part of my health science major enlightened me
to not stay so narrow-minded as to what I can do as a career. Prior to entering the university, I
did not know there was more health careers than becoming a registered nurse, physician
assistant, or general practitioner. These classes helped me become more confident in my career
path and what I wanted to do. To me, the health science classes I had consisted of professors
who knew their subject and were passionate about showing the students what is like to be a
health professional. I learned most in classes that were making students think about certain
situations or case studies on health care ethics and situational studies on hospitals and
management in how best to operate a particular change in the hospital like a merger.
In most of my health science classes there was a consistency of presenting and working
with other fellow students. I think that it is very important to have presentation skills because it
helped me practice speaking with my peers and speaking in public. I think the group work for
most of my classes were useful to not only participate with peers, but also have experience in
collaborating on projects and ideas. The group work had good and bad parts to it, but it was
certainly manageable when there were up to four people to a group versus six because larger
groups did not have enough tasks to distribute evenly. I also liked having a class only based on
interning. Gaining experience while also earning unit credits is a great way to obtain hands on
experience based on what I will do as a job. In my internship class, I am constantly learning how
to become an administrator and coordinator.

66
Alumni Role
The one-day workshop I attended was in UC Berkeley and is part of the Center for Health
Leadership Association. The workshop was a free StoryCon event where people of the UC
Berkeley alumni presented their stories on health issues and how it affects our communities and
ourselves. There were about eight speakers who spoke about their experiences in their health,
community’s health, and mental health. I was drawn to one speaker her name is Smitha who
talked about her passion to study public health and how she wanted to help her homeland and
community. I was drawn to her speaking style which is why I chose her speech and what she
wanted to advocate as part of this role paper.
I related to Smitha’s story on choosing a career based on a parent’s expectations. When
she told her mother that she wanted to pursue public health, her mother was disappointed, but
Smitha did not want to stop her pursuit in helping people. I liked how she addressed how her
motherland India was a place devoted to industrializing than focusing the concerns of the
communities who live there and need health care. She wanted to be a voice to communities who
need the aid and support, that India lacks despite having large industries of pharmaceuticals. This
type of role in health care is important, to be a voice to people who cannot speak for themselves.
Awareness of a community’s health needs are also important. I think awareness is also a part of
being a health professional and making sure people have the care they need.

70
Statement of Philosophy
Buddha says that “To keep the body in good health is a duty…otherwise we shall not be
able to keep our mind strong and clear. I agree with Buddha that health takes on a huge role in
our lives. Being healthy is a commitment and wanting to be healthy every day is a choice, a wise
choice. Healthiness shows in physical to inward appearance. Staying healthy is not easy.
Presently Americans are constantly battling heart disease, strokes, and obesity. A huge role to
these diseases is the person’s lifestyle and how healthy they are. The solutions seem simple to
say just exercise and eat right foods, but it is easier said than done. I think that maintaining
health in my life is a high commitment because I want to live long and I want to set an example
to other people that it pays to be in good health.
Although I am not a perfect example of health, I try every day to make the right choices
into a healthy lifestyle. I think this is true for most people, to just try to be healthy by making
the right choices. For example, people who strive to become healthy should start with diet. I
think people should always be aware of what they eat and how much of a food they eat. I
believe in a balance when it comes to food, to have an equal portion of nutrients and protein.
People also should not consume things that will be bad for their body like alcohol because
people can dink excessively which will hurt their health.
Exercise is also important to maintain health. It does not mean people have to go to the
gym. Exercise can be many different things. The point is that exercising will not only make you
healthier but also stronger and focused. People should maintain good diet and exercise to stay
fit and healthy throughout their lives.

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