questions
General Instructions
Advanced practice nurses apply continuous quality improvement (CQI) processes to improve client-centered outcomes. Select one of the following client-centered care initiatives that you would like to improve in your practice area: client clinical outcomes, client satisfaction, care coordination during care transitions, or specialty consultations for clients.   
Include the following sections:
1. Application?of?Course?Knowledge: Answer all questions/criteria with explanations and detail.
·   
a.  Identify the selected client-centered care initiative and describe its application to your future practice.  
b.  Select one CQI framework that can be applied to the selected initiative. Explain each step of the framework. 
c.  Describe how the framework can improve client-centered care for the selected initiative. 
d.  Describe how you would involve interprofessional team members in the CQI process.  

Answer
1. Introduction
Through the tumultuous climate of the United States health care environment, acute care has emerged as a focus of treatment. Advanced practice nurses (APNs) are progressively introduced into the system equipped with potent skills, sheer competence, and autonomy to provide excellence of service and care for the patients. APNs do not merely attend to the patients’ health illnesses and disease conditions but also investigate and implement plans for the prevention of illness and the promotion of healthier living. They strive to bridge the gap in quality of care available between conventional primary care and specialist services by creating a comprehensive care delivery system centered on the patients. Since the 1960s, patient-centered advanced practice nursing care has been the vision and hallmark of nursing practice today. APNs use their metaparadigm knowledge in application to care for patients and establish comfort and trust within the healer/healee relationship. Despite being trained in pathophysiology and the extant medical model, advanced practice nurses awaken each day with knowledge that the patient is a unique, dynamic individual, the locus of control for the nurse’s actions. Subsequently, plans to improve upon this type of care were investigated through the review of an article titled “Improving Client-Centered Care Initiatives in Advanced Practice Nursing”. This article examines 4 research-informed initiatives that have the potential to improve care outcomes and systems for APN care from the US and globally. That two respondents sought out to examine the advancement and outcomes of care systems truly indicates the spirit of APN initiatives for the betterment of society. Methodology involved examination of care systems in 2 different developed countries, comparing results to determine best efficacious methods and to incorporate ideas of quality care leadership into present and future initiatives. These initiatives are parallel to the moral and inner directive of all APNs and directly reflect how APNs would seek to improve care provided to themselves as clients. As a profession largely consisting of second career adults who are intrinsically motivated and often times highly advanced academically, APNs themselves are a unique client group and an often overlooked one at that. An aggregate systems theory serves to build frameworks and initiatives to improve care delivery for all types of clients, including the providers themselves. With a solid foundation of theoretical frameworks and research infusion, these initiatives serve to improve health, augment nurse and system outcomes, and change the face of nursing as we now know it. In an effort to align with the vision of a global society, the methods in which this research was initiated are undoubtedly impressive. An era of increased nursing professional involvement and participation in national and international policy has seen the development of nursing research and quality care initiatives based on evidence-based practice and utilizing comparative methods. This research is an exemplar and has the potential to shape future care systems both locally and abroad.
1.1. Background and Context
APNs practice has grown significantly over the years. This growth has been stimulated by the continuing shortage of physicians, the growth of managed care, and a clear and consistent, well-documented record of safe and effective practice. Managed care has evolved through models such as health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point of service (POS) plans. APNs are recognized for their ability to provide cost-effective care and are employed in a variety of settings to assist in cost saving measures. As health care reform is once again on the forefront of American politics, it is evident that APNs currently practicing or those that will practice in the future, must be prepared to navigate through and affect change within the complex health care system. This poses a profound challenge to those APNs who have been educated and honed their practice in a context largely removed from today’s health care system. It is a stimulation to define practice and move it closer to the ideals of APN and improve patient outcomes.
The first graduate program for advanced practice nursing (APN) (nurse practitioner, nurse midwifery, nurse anesthesia, clinical nurse specialist) was developed by the University of Colorado in 1965 (Dimeo, 2008). The program was established to prepare nurses in the primary care role to meet the needs of the medically underserved. At that time, the IOM had defined primary care as the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community (IOM, 1996). Primary care should be the first element of a continuing healthcare process and the system of family and community should be a partnership between the patient and the provider working to promote health and prevent disease. Primary care provider should be the coordinator for any specialty care or hospitalizations and the patient should be provided care that is cost-efficient and meets the needs of the patient. Today, APNs are providing primary care in outpatient and community-based settings, and have come closer to achieving these goals of primary care. They are educated to provide a full range of services to meet the needs of their patients.
1.2. Purpose of the Work
This comprehensive work was generated to improve “client” people-centered treatment initiatives within the context of advanced practice nursing. Towards that goal, the methods to improve client-centered treatment within a current APN practice were investigated. These methods are supported through amendments to the current system of care, use of direct and indirect clinical interventions, as well as involving clients in health education and promotion. The foundation for this work comes from research stating that Dimatatis et al. (1999) found that clients diagnosed with chronic conditions tend to be more compliant and satisfied with their treatment when they perceive the medical system to be more aligned with their own values and treatment preferences. This study serves to combine practice wisdom with scientific evidence to these ends.
2. Application of Course Knowledge
2.1. Selected Client-Centered Care Initiative
2.2. Importance of the Initiative in Future Practice
3. Continuous Quality Improvement (CQI) Framework
3.1. Selection of CQI Framework
3.2. Explanation of Each Step in the Framework
4. Improving Client-Centered Care
4.1. Enhancing Client Clinical Outcomes
4.1.1. Point 1: Implementing Evidence-Based Practices
4.1.2. Point 2: Monitoring and Evaluating Treatment Plans
4.2. Increasing Client Satisfaction
4.2.1. Point 1: Enhancing Communication and Education
4.2.2. Point 2: Addressing Client Preferences and Needs
4.2.3. Point 3: Ensuring Timely and Responsive Care
4.3. Coordinating Care Transitions
4.3.1. Point 1: Establishing Effective Communication Channels
4.3.2. Point 2: Collaborating with Interprofessional Teams
4.3.3. Point 3: Implementing Care Transition Protocols
4.4. Facilitating Specialty Consultations
4.4.1. Point 1: Identifying Appropriate Referral Criteria
4.4.2. Point 2: Streamlining Consultation Processes
4.4.3. Point 3: Ensuring Seamless Integration of Specialty Care
5. Involving Interprofessional Team Members
5.1. Importance of Interprofessional Collaboration in CQI
5.2. Roles and Responsibilities of Team Members
5.3. Strategies for Effective Team Engagement
6. Conclusion

Question
Discharge Resources for Chronic Cardiorespiratory Issues

Answer
1. Introduction
Perhaps the most compelling reason why patients with chronic medical conditions are frequently readmitted to the hospital is the lack of professional care available to them once they are discharged.
One study found that there was a mismatch between what patients and physicians said about what level of functionality the patient should be at before discharge. Phase I of the study showed that the physician thought 63% of patients could be independent in taking care of their illness, while only 37% of the patients said they could. This disparity in perception of the patient’s ability to take care of his/her illness mostly results in premature discharge of the patient.
One reason for readmission is that chronic medical illnesses are often not resolved at hospital discharge. This is evident because one-third of patients have a recurrence of the same illness within 2 weeks of hospital discharge. The reasons for patients leaving the hospital before their illness is adequately resolved are manifold. Usually, the patient and the doctor feel that they can take care of the remaining illness at home.
Chronic medical illnesses account for a greater percentage of patient conditions and diseases that contribute to hospital readmission. Although the acute treatment received by the patient in the hospital is often excellent, chronic medical conditions are often not resolved and the patients are frequently left without proper care. They often must fend for themselves in managing their chronic medical conditions, and their illnesses often become exacerbated, leading to a resumption of acute treatment.
1.1. Definition of chronic cardiorespiratory issues
According to the Respiratory Resource Centre in Ottawa, chronic illness is defined as the presence of an illness that is prolonged, does not often resolve, and is rarely cured completely. Cardio-respiratory diseases are chronic illnesses and are considered to be the leading health problem in Canada. They affect the heart and lungs and can greatly impact the patient’s quality of life. Some examples of cardio-respiratory diseases are hypertension, heart disease, stroke, asthma, and diabetes. The management of these diseases is vital to the patient’s overall health and well-being. Although chronic cardio-respiratory diseases are often managed in the community setting, there are also a significant number of patients who require care in the acute care setting. The burden of health care utilization in Canada continues to grow, as there are increasing numbers of patients being admitted to the hospital with acute exacerbations of their chronic diseases. This is particularly true for respiratory diseases. With the burden of health care utilization comes an increasing demand for efficient resource utilization as well as an increased focus on health system outcomes. The fluctuating nature of chronic diseases means that coping with these illnesses can be difficult for patients. A common problem for patients dealing with an exacerbation of their cardio-respiratory disease is the inability to return to their baseline level of function. This is often due to muscle deconditioning and/or a decrease in dyspnea tolerance. These patients often require additional support and resources to help them regain their independence and previous level of functioning. Failure to do so can greatly impact a patient’s quality of life. With an aging population and an increasing emphasis on keeping patients out of hospitals, it is important to help patients learn self-management skills and be as independent as possible. The ultimate goal is to prevent further exacerbations of their diseases and to help them maintain their highest level of function.
1.2. Importance of discharge resources for patient independence
Success in reducing acute healthcare usage occurs when the patient is able to comfortably and confidently manage their health condition using the recommended treatment and symptom management techniques, without the need for unscheduled visits to a healthcare facility. This is commonly referred to as self-management. High-quality self-management has positive outcomes for the patient and reduces cost to the healthcare system. In order for self-management to occur, a patient must understand their condition and the actions which must be taken to manage it, the patient must have confidence in their ability to take these actions, and the patient must have the necessary resources to carry the actions out.
The importance of discharge resources for patient independence cannot be underestimated. In the context of chronic cardiorespiratory issues, it has been shown that far more attention needs to be focused on the patient’s discharge planning in an effort to impede the reoccurrence of symptoms and decrease the likelihood of hospital readmission. A strong, consistent factor in the literature is the profound effect that the implementation of effective discharge planning can have on the patient’s quality of life without increasing the economic burden on the already strained healthcare system. The goal of discharge planning is to reduce the time the patient spends being acutely ill (that is, time spent in hospital or with a doctor visit) and to help the patient manage his or her own health effectively. The means in which this is achieved is varied but the implications of its success are profound and far-reaching.
1.3. Impact of readmission on reimbursement and hospitals
An important factor that drives the push for quality improvement is the Medicare perspective payment system, where hospitals that treat a higher proportion of low-income patients with multiple chronic conditions will be expected to lose a significant amount of their Medicare payment. It is estimated that payment reductions can be up to 3% of the reimbursement value in 2015 and 2017 (Haveman, 2013). This can create financial strain on already resource-poor safety-net hospitals. Readmission can result in financial penalization of the hospital. In 2012, 2,200 hospitals received penalties ranging from 1% to discharge 1.5 billion in total (Martin & Lassman, 2013), and in 2013, this increased to 2,600 hospitals (Health policy, 2013). This extra money can be crucial for a hospital already struggling with poor reimbursement to put into patient services, and in the current day and age, in a very money-driven healthcare environment, financial penalties due to increased readmission rates may act as an incentive for hospitals to improve the care they provide to reduce readmission rates. On the contrary to reduced reimbursement, for a patient who is readmitted, Medicare will pay for readmission services with an additional DRG payment for the readmission if it takes place within the same DRG window. This may sound like a benefit for the hospital; however, any additional payment will not offset the amount that was lost due to the initial admission.
1.4. Implications of readmission on patients
Soon after discharge from a hospital, the average chronically ill patient has a 20% chance of being readmitted to the hospital within 30 days and a 57% chance within 1 year. These rates have changed little in the past 30 years and readmission remains a common and expensive occurrence. Factors associated with readmission to the hospital include those related to the nature of the illness, the quality of patient care, characteristics of the patient, and the structure of the health care system. Although many readmissions are for medical issues similar to the previous admission, some patients are readmitted for conditions that are complications of medical treatments and some are readmitted for unrelated new medical issues. Given the nature of chronic illnesses and the link between patient functional status and hospital readmission, it is important to consider the effect of readmission on patients’ ability to live in the community and gain independence. High rates of hospital readmission can prevent a patient from leaving the cycle of frequent hospitalization and institutionalization, leading to worsening functional status and increased morbidity. Although this phenomenon has been recognized anecdotally, it is difficult to measure the impact of hospital readmission on patient independence and the ability to live in the community. Improved understanding of the factors that lead to hospital readmission, changes in the care of patients at risk of readmission, and development of interventions to prevent readmission are essential steps to reducing the high rates of hospital readmission and improving the health of chronically ill patients.
2. Discharge Resources for Patient Independence
2.1. Home healthcare services
2.2. Medical equipment and supplies
2.3. Rehabilitation and therapy programs
2.4. Education and self-management resources
3. Preventing Readmission
3.1. Care coordination and transitional care programs
3.2. Medication management and adherence support
3.3. Telehealth and remote monitoring solutions
3.4. Follow-up appointments and outpatient services
4. Impact of Readmission on Reimbursement
4.1. Medicare’s Hospital Readmissions Reduction Program
4.2. Financial penalties for excessive readmissions
4.3. Importance of quality improvement initiatives
4.4. Strategies for reducing readmission rates
5. Implications of Readmission on Hospitals
5.1. Increased healthcare costs
5.2. Overburdened healthcare resources
5.3. Negative impact on hospital reputation
5.4. Importance of patient satisfaction and outcomes
6. Implications of Readmission on Patients
6.1. Physical and emotional toll on patients
6.2. Financial burden of additional healthcare expenses
6.3. Disruption of daily life and routines
6.4. Importance of patient education and empowerment
7. Conclusion
7.1. Recap of discharge resources and their impact
7.2. Importance of preventing readmission for patient well-being and healthcare system sustainability

Question
Security Screening/TSALinks to an external site.
This link provides an overview of TSA airport security screening.
Aviation Security Manual (Doc 8973 – Restricted)/ICAO Links to an external site.
The ICAO Aviation Security requirements are the basis for international aviation security for all countries that signed the agreement, including the United States. Examine the security requirements for foreign carriers flying to U.S. airports.
Global Aviation Security Plan: Doc 10118 (PDF)/ICAOLinks to an external site.
This document addresses the need to guide all aviation security enhancement efforts through a set of 
internationally agreed priority actions.
Choose one of the regulations and discuss its effects on the aviation industry’s security. Also, compare or contrast one of these other regulations to the one you chose.

answer
1. Introduction
The quest for maximized security has seen the implementation of various security regulations and their subsequent up/downgrading as security intelligence changes. The events of September 11th, 2001, led to the implementation of stricter security regulations in the USA and internationally. The events of September 11th are notable for an extreme exogenous shock in security intelligence on an airline terrorist threat. This provides an excellent opportunity to apply economic analysis on the effects of an aviation security regulation with a variable level of security protection. An integral part of this study was the decision to choose a specific regulation because the aviation industry is extremely broad and the effects of security regulations can be quite specific to a certain part of the industry. Therefore, it is possible that different security regulations will have differing effects on different airline services. This concept is explored in more detail in sections to. The regulation that has been chosen is the Aviation Security Service Charge (ASSC). This regulation has a very broad effect on the industry but it particularly affects airlines and air passengers. Therefore, discussion on the effects of this regulation can be applied to various different airline services. A brief overview of the broad effects of this regulation will be provided in the next section.
Aviation and the aviation security regulations have been the subject of considerable controversy and debate. The industry has been compelled to install various security measures and mechanisms to protect the nations travelling on air transportation. The interests of aviation security and the economic health of the industry have to be addressed in the decision-making process on how new regulations are to be implemented. This paper will examine the effects of aviation security regulations on the aviation industry. The importance of aviation security regulations as an extraordinary government intervention on the industry is that its effects are seen throughout all the different parts of the industry. Security regulations can be considered as an additional input to the production of air travel, something which is added with the expectation that it will produce a certain level of quality or safety in the service. An analysis of regulations on the aviation industry provides a good opportunity to explore the economic effects of public policies on a specific industry. Aviation security regulations provide an interesting case for applying regulatory economics. It is one of the few instances in which the prime focus of cost-benefit analysis has been shifted from economic efficiency towards the maximization of security measures at any cost.
1.1 Importance of Aviation Security Regulations
The Air Transport Association (2007) underscores the importance of civil aviation to the economic health of the global economy, comprising nearly $370 billion US in direct economic impact and generating, in total, $1.2 trillion of economic activity. It sustains more than 33 million jobs. In light of this significance, the industry is a prime target for disruption, which may come in many forms, from civil unrest to acts of terrorism. The events of September 11, 2001, served as a rude awakening to the industry, bringing about a realization that the global aviation system was vulnerable to a small band of zealots armed with nothing more than a few box cutters. The ensuing changes to the US aviation security regulations were both swift and far-reaching when the Congress enacted the Aviation and Transportation Security Act (ATSA) (Transportation Security Administration, 2008), resulting in the greatest change to the governance of aviation security since its inception. ATSA was the first attempt to implement a fully integrated system of security with the intention to federalize airport security, and it marked a significant move away from a reactive, “firefighting” approach to security. Prior to this, security in the US was the responsibility of the individual airlines, but the events of 9/11 served as proof that this was ineffective and did little more than pose a minor deterrent to anyone attempting to breach security. ATSA allocated funds to the tune of $4.8 billion to be spent on security measures, a number dwarfed by the $65 billion estimate of economic impact 9/11 had on the aviation industry. The regulation created a comprehensive system of civil aviation security, providing both the requirements and the means. These new regulations were expected to have both positive and negative effects on the industry and its various sectors.
1.2 Overview of the Chosen Regulation
The current and ongoing regulation that is being investigated is the Secure Flight programme that was put forward by the Transportation Security Administration. The programme is an initiative that was decided upon after the events of 9/11 and the commission report which raised concerns about the security of the flying public. The programme was decided upon after TSA was forced to endure a variety of tasking security issues; the program itself is a performance-based programme aimed at increasing the overall security effectiveness for the entire US aviation system. This includes a consolidation of the various watch lists that are now being used for passenger identification and putting it into a thorough and comprehensive system that allows a discrepancy-free identification of passengers that require additional screening and those that are a legitimate threat. This system will be done by comparing passenger information against government lists of suspected terrorists. This is seen as a crucial step for following the events of 9/11 where the commission found that the use of aliases by terrorists was a primary method of eluding detection by watchlist systems to gain access to an aircraft. This requirement is directly related to the ICAO recommendation that requires member states to provide a means to match passenger information with names listed on criminal watch lists.
There are two key pieces of regulation which have a massive influence over the aviation industry and are aimed solely at improving the safety and security of the aviation industry both in the United States and globally. The two Title 49 of Code of Federal Regulations, which is a regulation that controls domestic aviation in the United States and the Chicago convention, which is an agreement that the United States and 185 other nations have signed which aims to achieve the highest common standards in security and safety in aviation through regulations that are uniform in their form and application.
2. Impact on Security Measures
2.1 Strengthening Passenger Screening Procedures
2.2 Enhancing Baggage Security Checks
2.3 Implementing Advanced Technology for Threat Detection
3. Influence on Airport Operations
3.1 Increased Security Personnel and Training Requirements
3.2 Enhanced Access Control Systems
3.3 Heightened Surveillance and Monitoring
4. Effects on Airlines and Carriers
4.1 Compliance with Security Regulations
4.2 Financial Implications of Security Upgrades
4.3 Collaboration with International Partners
5. Comparison with Other Security Regulations
5.1 Similarities between Chosen Regulation and TSA Screening
5.2 Contrasting Approaches to Security Measures
5.3 Shared Objectives and Cooperation among Regulators
6. Conclusion
6.1 Overall Impact on Aviation Industry Security
6.2 Continuous Adaptation to Evolving Threats

Question
Within the Discussion Board area, write 400–600 words that respond to the following questions with your thoughts, ideas, and comments. This will be the foundation for future discussions by your classmates. Be substantive and clear, and use examples to reinforce your ideas.
Over the years, there has been much debate over the classification of employment-at-will employees. Employment-at-will is a term that refers to the protection that is applied to the employment relationship, such that the employer or the employee has the right to terminate the employment relationship at any time. There are different modifications to employment-at-will that vary at the state level. With your classmates, please discuss the following:
Does employment-at-will have better protections for employees or employers? Why or why not?
Choose a state and describe its modifications to employment-at-will. Do you agree with these modifications? Why or why not?

Answer
1. Introduction
This doctrine of discharge has been the most controversial of all employment-at-will issues. Its principal contribution has been to narrowly limit lawsuits for wrongful termination. Discharging an employee for a particularly bad reason does not make it wrongful discharge. According to one author, the reason might be “so bad, so hypocritical, or so small minded, that only the judge or the jury can be trusted to a fair decision.” This is not in today’s legal system. While the judge or jury might have the authority to decide the issue, there must first be an establishing a valid claim or cause of action. Employment-at-will supporters believe that the rule adequately balances the rights of employers and employees, without legislative limits on discharges.
The rule in employment-at-will states that if an employee has no specific term of employment, the employer can fire the employee for good cause, no cause, and even cause morally wrong, without being liable for wrongful discharge. The employee is granted the same legal right; he can quit on the spot, for good cause, no cause, and cause morally wrong. In general, the employment-at-will doctrine should not affect the employee’s unemployment compensation rights.
The doctrine of employment-at-will is a legal rule that was established in the nineteenth century. It has been adopted by all fifty states. According to this doctrine, either the employer or the employee may end the employment relationship at any time, with or without cause, giving rise to a claim for damages. Typically, courts have said that the employment relationship can be treated as “at-will” unless the employee can show the existence of an employment contract to the contrary.
1.1 Definition of employment-at-will
The term “employment-at-will” derives from American common law and it means that an employee can be dismissed by an employer for any reason or without having to establish a wrongful cause and without notice, as long as the reason is not illegal (e.g. firing a worker because of their race, religion, or gender) and the employer does not have a contract with the employee which specifies how and under what circumstances termination can occur. The doctrine is compatible with the idea of an unfettered labor market, where firms and workers transact at arm’s length. This is undoubtedly the US labor market in many areas, particularly those involving unskilled workers. At-will employment still exists to a large extent in most American states and is important in promoting economic growth in the nation. This will be elaborated on in section 1.2, which discusses the importance of employment-at-will. The other forms of employment are “for cause” and “for term”. In a “for cause” employment, the employee can only be terminated for a specific reason. This usually only occurs when there is a collective bargaining agreement between a firm and a union. This is due to the fact that unions require employment security for their members, and in return for conceding flexibility in the labor market have negotiated contracts which make it difficult for firms to lay off or terminate employees. The most extreme example of “for term” employment is that of a tenured professor at a university, who has essentially a lifetime employment agreement and can only be dismissed for gross misconduct or financial exigency on behalf of the employer.
1.2 Importance of employment-at-will protections
Courts have often spoken of the doctrine of employment-at-will in terms of a “default rule”. That is, in the absence of an express agreement to the contrary, it will be presumed that the employer and employee intended the employment relationship to be a short-term one, terminable at any time by either party. In this respect, employment-at-will can be contrasted with a contract for a fixed term of employment, where, because of the agreement of the parties, it can be a breach of contract to terminate the employment before the expiration of the term. If it is to be analyzed as a default rule, then the starting point is to examine the respective rights of the employer and employee that will be gained, lost, or compromised by moving away from (or contracting out of) that rule. This naturally leads to the question of just what employment-at-will protections are. An alternative approach to understanding the meaning of employment in terms of default rules is to say that the choice of at-will term or fixed term of employment is itself an exercise of freedom of contract. This approach would require showing that there was some impediment or background factor which made it difficult for employers and employees to contract for short-term revocable employment, and that a change to less restrictive rules was the result of a conscious policy decision. An example of doing this type of analysis in another area of labor and employment law is the work in the US on right-to-work legislation. This showed that the implementation of laws protecting union security employment terms was the result of state action, so that a change to a less union-restrictive regime of employment terms required a repealing or invalidation of the laws. We can barely adopt the approach, but the previous study of default rules still serves as a useful foundation for understanding what employment-at-will protections are, even if the intention was not to move more towards such employment terms.
2. Protections for Employees
2.1 Right to terminate employment
2.2 Protection against wrongful termination
2.3 Legal remedies for employees
3. Protections for Employers
3.1 Right to terminate employment
3.2 Protection against employee misconduct
3.3 Flexibility in managing workforce
4. State Modifications to Employment-at-will
4.1 State X’s modifications
4.1.1 Overview of State X’s modifications
4.1.2 Specific changes to employment-at-will
4.2 Evaluation of State X’s modifications
4.2.1 Agreement with State X’s modifications
4.2.2 Disagreement with State X’s modifications
5. Conclusion

Questions
1)  From your perspective what are the major ethical and legal challenges and risks for abuse that we must keep top of mind in the collection, management, and use of information and technologies overall—and in the public arena specifically? 
2)  Suggest guidelines to help prevent unethical uses of data in general and especially in the public sector.

Answer
1. Ethical Challenges
The rapid development of information technology has led to situations of increased uncertainty and the definition on how existing rights apply to new technologies. This has led to a consideration of an information society framework for the protection of the individual in regards to privacy, data security, accountability, and the right to access on the occasion of the widespread collection and identification of personal information.
Privacy is a right that individuals and groups can have control over the extent, timing and circumstances of sharing themselves with others. The freedom from unreasonable and unwarranted intrusion into our private lives is now recognized as a fundamental human right. Data security is the right of individuals and organizations to be assured that their data and the systems processing it are secure and not accessible to third parties. Measures used to ensure data security include confidentiality (limiting access to information), integrity (maintenance of accuracy and consistency of data over its life), authenticity, and privacy.
Concerns about ethical implications of information and technology are spread out within this field, but the main concerns are concentrated around issues regarding individual rights, fairness, accountability, and the impact on society. What information should a person or an organization have the right to keep to themselves? What data about others should they be required to share? What is an equitable distribution of resources and access? How can the rights and interests of various individuals and stakeholder groups be safeguarded? And just who is being well served by information technology?
1.1. Privacy concerns
Privacy is the ability of an individual or group to seclude themselves or information about themselves and thereby reveal information selectively. The essay’s focus on privacy centers on the increasing move by governments and business organizations to use computers to store data about individuals. The computer has led to a growing move towards the use of personal data as computers are very effective record keepers. Using the Internet, vast amounts of personal data can be retrieved and even more personal data can be gleaned, often without the knowledge of the person concerned. This often results in the inference of information about an individual who would prefer to remain anonymous. The storing and accessing of personal data can result in damaging disclosures about an individual. There are numerous ways in which privacy stands to be eroded in the information age. For instance, electronic surveillance using powerful surveillance technologies has great potential for invasions of privacy. Data matching is a technique used to compare two sets of data, such as the list of names on a payroll and the list of names receiving welfare benefits, in order to determine if there is any correlation between the two. If data is stored on an individual in both these sets of data, it is highly likely that there will be a disclosure of personal information in such a scenario. Though data matching can be a useful tool, it can threaten privacy and in some cases can lead to discrimination. National ID cards can also have a dramatic impact on privacy with centralized databases to store personal information. An ID card often becomes a requirement to access services and without it, an individual may be denied access to services to prevent the use of someone else’s card. This may create a situation of ID apartheid for the disadvantaged who are less likely to retain possession of a card. With technology constantly advancing, there are now ID cards being developed with biometric information such as facial details and fingerprints. These details, which are unique to each individual, bring about new privacy issues. High-quality photographic and digital imaging technologies allow for the covert and high-quality capture of someone else’s biometric details, and if this information is ever captured and stored about a person who is unaware, there has been a serious privacy violation.
1.2. Data security risks
Data is a representation of the world. In some cases it is used to model complex systems or to assist in decision making. For example, climate data is used to model future climate states. Market trends are used to make financial predictions. In these cases it is often difficult to verify the data thoroughly and in general, there are many different possible uses of data. Often individual interpretations of data may vary from the actual context or intent of the data. In the case of climate models, it may be impossible to foresee whether or not an interpretation of model output is correct given that climate states are inherently unpredictable and the model itself could contain errors. High impact decisions can be made on uncertain data that can lead to the perpetuation of errors and biases. This is known as methodological bias. In other cases, the data itself may carry biases or other undesirable assumptions. An example would be the use of race as an identifier in medical decision making. Failing to account for social constructs of race and genetic variation can lead to incorrect inferences from the data and ultimately, race may become a deciding factor in choices of treatment. These cases show a variety of ways in which data and its use can lead to biased outcomes. Often the bias is unintended and is usually a result of the neglect of ethical considerations in the early stages of information system design. Owing to this, bias is an issue that overlaps with many other ethical challenges of information and technology.
Another ethical challenge involves data security. In a digital society, the collection, flow, and processing of information is done electronically. This may result in theft, unauthorized access, loss of information, and the like [23]. The security and integrity of data is essential to any information system. For example, electronic health records are becoming a standard feature of medical practices; the information in these records must remain confidential and available only to those with authorized access. Despite this, electronic health records are subject to hacking and other forms of information loss. Data breaches can result in severe consequences for affected individuals and organizations. Loss of personal information can result in identity theft or in severe cases, it may pose as a threat to personal and public safety. The loss of financial information can have harmful effects on an organization’s clients and result in an organization’s loss of revenue. Steps must be taken to ensure that the privacy and integrity of data is maintained. This means that information systems must be resistant to various forms of threat, quick to recover from data loss, and must provide fail-safes for information in transit. Making systems “highly secure” in this context is easier said than done and is not always cost effective or convenient. This is a risk-benefit issue that will be a recurring theme in dealing with ethical challenges of information and technology.
1.3. Unintended bias in algorithms
Mentions about solving the problem of bias in algorithms through ethical behavior might seem naive in the light of quick movements in the nature of production and use of algorithms. Efforts to increase ethical behavior in algorithm design may not solve the more fundamental problem of how to specify what we want, to a system, without having undesirable effects in the real world. This is a problem that is only going to get more acute. As the parts of our lives that we hand over to data analysis increase, the systems being used are going to come to be seen as controlling the opportunities open to people. A famous example, from the early days of web advertising, is that of an optician who discovered that his ads were not being shown to people in high income neighborhoods, because the analysis of who would be willing to spend money on glasses had incorrectly identified the target group. At the time all this meant was that the optician got low rates for ad space, but in general such behavior can have damaging effects and can be hard to identify, especially as it might not be clear to human decision makers what the system is doing. An improperly specified algorithm for sorting CVs according to quality destroyed prospects for minority job applicants in the US by generalizing from the fact that some of the worst CVs were from minority graduates. In other cases, a system can potentiate existing social biases by affecting decisions that are based on its predictions, as is feared in criminal sentencing if judges start to use the output of risk assessment algorithms.
1.4. Potential for discrimination
The development of data science technology for the supporting of decision making, automatically conducted by sophisticated learning software called algorithm, should bring benefits to individuals. In addition, with the employment of data science in numerous fields now will give assessment and decision for individual’s better than hiring explicit human that may involve personal feeling of the assessor. Despite that, algorithm may yield certain decisions that are merely based on sensitive attributes, not because of the relevance with a person’s ability, skill, or other legitimate reasons. Machine learning algorithm is designed to learn from data and optimize an objective function to find a correct answer, thus the relation between an input (data regarding an individual) into an output (assessment or decision) sometimes it’s difficult to be detected and it’s called as indirect discrimination. This is a new problem in comparison to the pre-data science discrimination such as in employment opportunity, housing, provision of goods or services, and education, thus far legislation in United States, Canada and European Union do not directly proscribe indirect discrimination. Simulation study by Mitchell and Brynjolfsson (2019) reveals that altering the vocabulary in job ad postings can influence the click rates of majority group and minority group of race, where the part of minority group can be less interested in the job advertisement. This is an utilization of artificial intelligence to assess potential employees, with machine learning algorithm learning from the ad postings to the behavioral data of potential employees, it’s very likely the algorithm will replicate the ad employer’s message to the assessment result on minority group in hope to find individuals possessed the attributes shown in active ad respondents, which in reality it’s a mind conditioning in order to get job at a disadvantages price. This may eventually cause litigation to the employer if the ad respondents succeed to prove the causation of an adverse action. Another example is a case of race and ethnicity prediction using facial recognition. Although this research aims to help minority group in preventing discrimination and improving health care and social services quality, a tool that simply based on prediction without prevention to avoid creating biased results still has controversial ethical issues. High rate of predictive error can cause classification into the wrong group, and it’s not impossible the researcher release this tool first to the small number of people without noticing the tool’s effectiveness to the actual benefit. Nevertheless, it’s a decline proposal from a vendor who develops a data science system to equalize the prediction error rate with a prevailing rate. This means the system only works to a case with a crime prevalence at certain race, but this raises the question does minority group will forever have a burden for crime prevalence indication and is it true that it will benefit them.
1.5. Lack of transparency in data practices
Whether the data is being shared or analyzed, there is often a lack of clarity or oversight of the data handling and processing chain. Ultimately, many organizations want to keep their data practices undisclosed to gain a competitive advantage, or in some cases, to prevent the implementation of effective public scrutiny or consumer resistance. But often the practice is ambiguous even to those directly involved. Data is a valuable asset and its value is increased when it is shared, however data sharing practices can result in a loss of control over data once it has been released. For example, in the NHS IT outsourcing deals of the early 2000s, it was identified that the contract specifics had been unclear and this had allowed for widespread data sharing and commingling between companies and healthcare organizations, showing that even in a highly regulated industry, lack of clarity in data practices can result in a concession of data control. This loss of control can compromise the individual’s privacy and rights regarding the data in question. Often it is unclear what the data will be used for and whether there is potential for a change of data ownership that might result in future usage that is unrelated to the initial instance of data collection. In contrast to this, some instances of lack of transparency are less a result of unclear intentions and more to do with insufficient technological development in methods for data tracking and monitoring. With the increase in complexity of data storage structures and the rise of distributed systems, it is not always easy for an organization to map the journey of its own data and ensure that it does not lose oversight of its location and usage. While this benefits the data in question as it essentially becomes ‘lost’, this can be a disadvantage for the organization or individual who owns the data, as they may be unaware of any breaches of data protection legislations and their data rights.
2. Legal Challenges
2.1. Compliance with data protection laws
2.2. Intellectual property rights
2.3. Jurisdictional issues
2.4. Liability for data breaches
2.5. Legal implications of data misuse
3. Risks for Abuse in the Public Arena
3.1. Manipulation of public opinion
3.2. Surveillance and invasion of privacy
3.3. Targeted advertising and marketing
3.4. Exploitation of personal information
3.5. Cyberbullying and online harassment
4. Guidelines for Preventing Unethical Uses of Data
4.1. Clear data governance policies
4.2. Informed consent and opt-out options
4.3. Regular data audits and risk assessments
4.4. Ethical training and awareness programs
4.5. Collaboration with regulatory bodies
5. Guidelines for Preventing Unethical Uses of Data in the Public Sector
5.1. Transparent data collection and use practices
5.2. Strict adherence to data protection laws
5.3. Independent oversight and accountability mechanisms
5.4. Safeguards against data breaches and leaks
5.5. Public engagement and participation in decision-making processes