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Class Discussion

QUESTION 1) Did you ever notice, when watching a TV show or a film, that the agent of emotion is neither the story line nor the visual effects, but the music? The musical score tells us when to cry or get really scared. Indeed, the idea that sound is the most powerful external stimulus we experience is a principal theme of this book. We are affected not so much by what we see as by what we hear.

Let’s test this assertion by viewing a portion of a classic Hollywood thriller, Psycho (1960). We all know the famous “murder in the shower” scene, so let’s move on to the next murder, the one on the stairs. Here, Norman Bates (dressed as his mother) murders investigating detective Milton Arbogast as he ascends a set of stairs that he really shouldn’t. Director Alfred Hitchcock charged composer Bernard Herrmann with creating appropriately terrifying music, and Hermann obliged, using his tried and true techniques. First, the music begins with suspenseful, quiet string tremolos and a rise in pitch to build tension. Suddenly, screeching strings cut loose again, an effect created by means of a technique Hector Berlioz had created 130 years earlier (col legno, with the wood; see Chapter 18). The violinists strike the strings, not with the horsehair of the bow, but with its wooden stick. Attacking violently and playing with the highest volume adds to the shocking effect. Watch the scene now, and tell us, does it frighten you?

https://www.youtube.com/watch?v=Qo-ZNyP7N2Y

QUESTION 2) Now watch the scene again, but turn down the volume to zero. What about now, are you frightened by what you see?

Class Discussion

 During the last Class Week session, we discussed the leasing and purchasing of vehicles. It was also mentioned that in these times auto dealers are often offering long-term loans by which to purchase vehicles, even perhaps as long as seven years.

Discuss if you think it is ever justifiable to take out a seven year auto loan. What are the advantages and disadvantages to this and, in the end, does it generally make sense?

Every one is required to make a posting. You may also post back and forth responding to what anyone says, but you are not required to do this. Please keep in mind that some will do this exercise later in the Course after the regular schedule of Class Session 8. Thus, depending on your own personal interest for this topic, you may come back to this Forum later to read more comments that will have been posted at that time.
 

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    Class Discussion

    There are two essay questions in this test (see below).  Please write your answers outside of Canvas, then copy-paste your text into the appropriate answer boxes inside this exam.  

    I expect detailed, long answers for each of them.  This is an open-book, open-note test.  Also, note that there is no time limit on this test, I will also be checking your work for proper grammar, spelling, and plagiarism.

    · Question 1: Design a research program to identify target publics for a campaign to reduce teen pregnancy in the District of Columbia. Be as detailed as possible. 

    · Question 2: For the campaign to reduce teen pregnancy, design a communication campaign using the ROPE process that doesn’t use any media relations programming

    Please Attach each individual sources to each question

    Class Discussion

    Modern Music Essay Assignment Week 12

    By week 12, please consider the modern music you are familiar with from movies, television, video games, and other media.

    In almost any form of media, we are constantly bombarded with sound, the majority of which is music. Composers are given the difficult task of writing music that will affect how the viewer feels about any given moment in a movie, television show, video game, or any number of forms of media. How do they accomplish this? What elements of music do they employ? What must they consider as they are writing? Why do they make their choices?

    Choose and submit the title of a movie, television show, video game, etc. to me via e-mail for approval. Following my approval, you may begin your three-page essay, due on the last day of the course. You essay should explore how the music was used to enhance the viewer’s experience using the elements of music discussed throughout this course. Please make yourself familiar with the rubric found in the syllabus.

    Class Discussion

    Gerontologic nursing

    Chapter 3: Legal and Ethical Issues

    Professional Standards

    Health care providers have a general obligation to live up to accepted or customary standards of care

    Federal and state statutes require nursing facilities to have written health care and safety policies

    Sources of Law

    Statutes are laws created by legislation and are enacted at the federal and state level

    Health Insurance Portability and Accountability Act of 1996 (HIPAA)

    In some states failure by clinicians to report suspected incidents of mistreatment is a misdemeanor punishable by fine or penalty

    Sources of Law

    HIPAA

    Health Insurance Portability and Accountability Act

    1996

    Increase a person’s ability to get health care coverage when the person begins a new job

    Help maintain continuous health coverage when a change of job occurs

    Limits the use of preexisting conditions

    Sources of Law

    Every state in America has mechanisms for reporting elder mistreatment

    Adult Protective Services (APS) programs exist in each state

    Standards of care for nursing homes are based on policy stipulated in the Nursing Home Reform Act of 1987 (Omnibus Budget Reconciliation Act, 1987)

    Many states currently have mandatory reporting laws for elder mistreatment in which nurses & health care practitioners are required by law to report suspected cases

    Elder Abuse

    Categories of Elder Mistreatment

    3 basic categories of elder mistreatment

    Domestic treatment – older persons home – by child, spouse, In-law)

    Institutional mistreatment – contractual arrangement & suffer abuse – LTC facilities, assisted living, rehabilitation or hospital

    Self neglect or self abuse – are mentally competent enough to understand the consequences of their own decisions – that threaten their own safety

    Institutional Mistreatment

    The types of mistreatment that occur in nursing homes likely mirror those in domestic settings

    Physical abuse

    Sexual abuse

    Neglect

    Financial abuse

    Psychological abuse

    Researchers have also speculated that shortages of staff, inadequate training of staff & staff burnout may be precipitating factors in mistreatment of nursing home residents

    Institutional Mistreatment

    Delay in reporting incidents

    Residents afraid of retribution

    Family members may fear having to find a new nursing home

    Staff may fear losing their jobs

    Facing recrimination by other staff members

    Want to avoid adverse publicity

    Assessment

    Ideally the older adult and any suspected abuser should be interviewed separately

    Maintaining a nonjudgmental approach will enable the nurse to obtain more accurate data

    The physical symptoms of elder mistreatment are often difficult for clinicians to discern because older adults may suffer from chronic and acute illness that mask or mimic the presence of mistreatment

    Assessment

    Their self reporting may be questioned for accuracy or they may be unable to express the mistreatment situation due to

    Amnesia

    Aphasia – total or partial loss of ability to speak or understand language

    Agnosia – inability to recognize common people and things

    Apraxia – inability to perform simple task

    It is often difficult to determine whether the older adult’s worsening physical condition is a result of the natural progression of illness or mistreatment

    Because some frail older individuals are prone to underlying conditions that give rise to trauma, such as instability of poor gait and poor vision resulting in falls, it may be difficult to differentiate accidental from willful injuries

    Types of Elder Mistreatment

    Physical abuse

    Psychological / emotional abuse

    Sexual abuse

    Financial exploitation

    Caregiver neglect

    Self neglect

    Abandonment

    Institutional mistreatment

    Physical Abuse

    Intentional infliction of physical injury or pain

    Hitting

    Shaking

    Pushing

    Improper use of physical

    restraints

    Signs & symptoms

    Bruises

    Black eye

    Bone fractures

    Injuries in various stages of healing

    Reports of being hit or mistreated

    Psychological / Emotional Abuse

    Infliction of anguish, pain or distress

    Yelling / verbal attacks

    Swearing

    Name calling

    Belittling

    Signs & symptoms

    Emotional upset

    Agitation

    Extreme with drawl

    Sexual Abuse

    Any form of nonconsensual sexual intimacy

    Rape

    Molestation

    Sexual harassment

    Signs & symptoms

    Genital bruising

    Unexplained sexually transmitted disease

    Financial Exploitation

    Taking advantage of an older person for monetary or personal benefit

    Unexplained monetary expenditures

    Lack of money for personal necessities

    Theft

    Fraud

    Signs & symptoms

    Unexplained inability to pay bills

    Inability to purchase necessity items such as food

    Caregiver Neglect

    Intentional (active) or unintentional (passive) failure to meet needs necessary for elder’s physical & mental well being

    Failure to provide adequate food, clothing, shelter, medical care, hygiene or social stimulation

    Signs & symptoms

    Dehydration

    Malnutrition

    Unattended or untreated health problems

    Listlessness

    Decubitus ulcers

    Urine burns

    History of being left alone

    Self Neglect

    Personal disregard or inability to perform self care

    Poor hygiene

    Unkempt home environment

    Signs & symptoms

    Malnutrition

    Fungal skin & nail infection

    Insect & rodent infestation in the home

    Abandonment

    Desertion or willful forsaking of an elder

    Dropping off an elder adult in the emergency department

    Desertion

    Signs & symptoms

    An older adult left inappropriately alone

    Institutional Mistreatment

    When older adult has a contractual arrangement & suffers abuse or neglect

    May be any combination of the afore mentioned

    Signs & symptoms

    Can be any of the signs & symptoms of the other examples of abuse

    Characteristics of Older Adults at Risk

    Difficult to obtain

    Several characteristics are more common among victims

    Sex

    Age

    Race

    Low socioeconomic status

    Low educational levels

    Impaired functional or cognitive status

    History of domestic violence

    Stressful events

    Depression

    Interventions

    Health care workers must be aware of local elder mistreatment reporting laws in their state

    Many states have mandatory reporting laws & health care professionals must report suspected cases

    In cases were abuse is suspected an older adult may benefit from a hospital admission to allow the healthcare team to carefully assess & formulate a plan of care

    Documentation

    Excellent documentation is extremely important in elder mistreatment cases

    Objective documentation

    Unbiased manner

    Physical indicators that are clearly documented will assist in discussing & planning goals

    Photo documentation is especially warranted in cases where there is evidence of physical or sexual abuse

    Residents Bill of Rights

    Most facilities have developed a contract for new residents to sign at the time of admission

    Called admission agreement

    This agreement sets forth the rights, obligations and expectations of each party

    It is a way to inform residents of a facility’s rules, regulations and philosophy of care

    See Box 3 – 1 on page 37 “Residents Bill of Rights”

    Unnecessary Drug Use & Chemical & Physical Restraints

    The OBRA requires that nursing facility residents be free of unnecessary drugs of all types, chemical restraints and physical restraints

    Chemical restraints

    Drugs that are used to limit or inhibit specific behaviors or movements

    Physical restraints

    Are appliances that inhibit free physical movement

    Limb, vest, waist

    Wheelchairs, geriatric chairs & side rails may also be restraints

    Unnecessary Drug Use & Chemical & Physical Restraints

    The nurse must carefully document the behavior or condition that led to the order for a restraint

    Residents receiving antipsychotic drugs must have an indication for the use of the drug

    Reasons must be documented in the physician’s order and chart / care plan

    Advanced Medical Directives

    Documents that permit people to set forth in writing their wishes and preferences regarding health care

    Used to indicate their decisions if the time should come when they are unable to speak for themselves

    An advance directive is not operative until the patient is no longer capable of decision making

    Living Wills

    Are intended to provide written expressions of a patient’s wishes regarding the use of medical treatments in the event of a terminal illness or condition

    The patient’s wishes regarding the withholding or with drawl of life support

    Living Will

    Not effective until:

    The attending physician has the document and the patient has been determined to be incompetent

    The physician has determined the patient has a terminal condition or a condition such that any therapy provided would only prolong dying

    The physician has written the appropriate orders in the medical record

    Durable or General Power of Attorney

    May designate someone else to make health care decisions at a time in the future when they may be rendered incompetent

    The role of the designated surrogate in this situation is to make the decisions that most closely align with the patient’s wishes, desires and values

    Conflicts

    Families may disagree with the directives of a family member

    Often family members express the desire to have more care than is requested by a patient

    The law upholds the expressed desires of a patient over those of the family

    But families may try to exert influence to bring about a decision that is sometimes contrary to the patient’s expressed wishes

    POLST

    Physician Orders for Life Sustaining Treatment

    Process of communicating health care wishes during a medical crisis or decline in health

    Include:

    Cardiopulmonary resuscitation (CPR)

    Medical interventions

    Artificially administered nutrition

    See Table 3.1 on page 42

    See Figure 3.2 on page 42

    PSDA

    Patient Self-Determination Act

    Came into effect 12/1/1991

    To ensure that patients are given information about the extent to which their rights are protected under state law

    Requires hospitals, nursing facilities and other health care providers who receive federal funds such as Medicare or Medicaid to give patients written information explaining their legal options for refusing or accepting treatment should they become incapacitated