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Liem

From Medical Tourism to Globalization of Health Services

I recall having a non-emergent dental procedure while I was a student. Even though I have dental insurance, I still need to spend a lot. So I postponed the dental procedure until the summer when I visited my parents in China. It costs about ten percent of what it would cost in the United States. Even with the additional cost of the flight and hotel, it is still much cheaper than in the United States. Since the cost is much less expensive in China, this was pretty common in the Chinese American community to travel back for medical service. For example, an annual physical checkup that includes a chest X-ray, an ultrasound, and an EKG costs about $30-$40 in China.

  I didn’t realize there was a term for this phenomenon called “medical tourism” until today, after reading Chapter 14 of the book. The Global Healthcare Manager. (Michael, 2019)

Medical tourism, according to the CDC (nd), is when a person goes to another country for medical treatment. World Tourist Organization defined that as “a form of tourism activity that includes the utilization of evidence-based medical therapeutic resources and services (WTO 2018).  

 Medical tourism attracts millions of Americans each year. Mexico, Canada, central and south America, India, Singapore, and Thailand are popular destinations for medical tourists from the United States. Medical services provided usually include diagnosis, treatment, cure, prevention, and rehabilitation. Medical tourism is growing in popularity, with estimates estimating that up to 750,000 Americans would seek medical treatment abroad in 2007( Horowitz 2007). 

  At the same time, as Chinese people get richer, a growing number of individuals are traveling to the United States for medical treatment, particularly to world-class medical institutions such as MD Anderson, Johns Hopkins, Cleveland Clinic, and Mayo Clinic. Actually, one of my friends has a company that handles this kind of business. He assists Chinese customers by setting up appointments, booking flights and hotels, and arranging trips, among other things. For example, several novel chemotherapies have been authorized by the FDA but are not accessible in China; the only option to get the medicine is to seek treatment in the United States. Some cutting-edge clinical trials are exclusively done at the NIH, and patients must participate in these trials in order to get therapy.

 Medical tourism and the international healthcare marketplace are examples of future trends in global health. Many challenges, such as the balance of quality/safety and cost, policy and regulation, and insurance coverage for overseas medical services, must yet be addressed.

 

Reference: 

Centers for Disease Control and Prevention. (n.d.). Medical tourism: Travel to another country for medical care. Centers for Disease Control and Prevention. Retrieved May 4, 2022, from https://wwwnc.cdc.gov/travel/page/medical-tourism#:~:text=Medical%20tourism%20is%20when%20a,South%20America%2C%20and%20the%20Caribbean.

Horowitz, M. D., Rosensweig, J. A., & Jones, C. A. (2007). Medical tourism: globalization of the healthcare marketplace. MedGenMed : Medscape general medicine9(4), 33.

World Tourism Organization and European Travel Commission (2018) . Exploring Health Tourism – Executive Summary. Madrid: UNWTO;2018. doi:10.18111/9789284420308  

Olayin

The topic I chose to discuss this week Globalization of Healthcare: Influence on health status, future trends, and key considerations of global health management.

Globalization of healthcare has contributed to health advancements through the use of new health knowledge, it can be explained according to( NIH) as how people are becoming interconnected and interdependent. The world is becoming a global village and as such there are several new trends that are evolving.

INFLUENCE ON HEALTH STATUS  Globalization makes it easier for for people to access healthcare easily, for instance with virtual healthcare a patient is allowed to see a doctor or attend doctors visit through the help of virtual healthcare. Virtual healthcare or virtual appointment is when a patient stays in the comfort of their home and is attended to by a doctor through the use of a computer or a smart phone. This also serves time of travelling to the doctors office and also helps reducing of overcrowding in the doctors office. Another influence oh health status is that it encourages digital healthcare, this is a system in which a patient is able to access his healthcare records online through a password and user name given by the doctors office.

 FUTURE TRENDS OF HEALTHCARE ;Shortage of healthcare worker is a trend that is affecting the healthcare industry and will also continue. Nearly 1 in every 5 workers had quit their job during to Covid19 the pandemic. Taking my job as a case study when Covid19 broke out a lot of my colleague left the job out of fear. A lot of nurses also left the job due to the risk involved. Others left and went to a different field.  According to World Health Organization(WHO) estimates a projected shortfall of 18 million healthcare workers by 2030.

Another important trend digitization of healthcare Despite remarkable breakthroughs in health sciences, healthcare services are lagging behind in digitization in comparison with other industries. The introduction of digital technologies is expected to substantially transform the healthcare sector in the next two decades (Hamid 2019). 

Global health management  relates to navigating medical trends on a local or international basis, it focuses on the management aspect of healthcare, it deals with the billing, insurance

References

 Hamid Yeganeh 2019 An analysis of emerging trends and transformations in global healthcare College of Business, Winona State University, Winona, Minnesota, USA

Globalization and Health PMC NCBI https://www.ncbi.nlm.nih.gov

discussion

2.4 Hypothesis Testing

Regardless of the details of a particular study, be it correlational, experimental, or descriptive, all quantitative research follows the same process of testing a hypothesis. This section provides an overview of this process, including a discussion of the statistical logic, the five steps of the process, and the two ways we can make mistakes during our hypothesis test. Some of this material may be a review from statistics class, but it forms the basis of our scientific decision-making process and thus warrants repeating.

The Logic of Hypothesis Testing

Chapter 1 discussed several criteria for identifying a “good” theory, one of which is that theories have to be falsifiable. In other words, research questions should have the ability to be proven wrong under the right set of conditions. Why is this so important? This will sound counterintuitive at first, but by the standards of logic, when data run counter to a researcher’s theory, that is more meaningful than when data support the theory.

For example, suppose we hypothesize that growing up in a low-income family puts children at higher risk for depression. If the data fit this pattern, our prediction might very well be correct. It is also possible, however, that these results are due to a third variable—perhaps low-income families grow up in more stressful neighborhoods, and stress turns out to increase a person’s depression risk. Or, perhaps our sample accidentally contained an abnormal number of depressed people. This is why we are always cautious in interpreting positive results from a single study. Yet now, imagine that we test the same hypothesis and find that those who grew up in low-income families show a lower rate of depression. This is still a single study, but it suggests that our hypothesis may have been off-base.

Another way to think about this is from a statistical perspective. As the chapter discussed earlier, all measurements contain some amount of random error, which means that any pattern of data could be caused by random chance. This is the primary reason that research is never able to “prove” a theory. We will learn (or recall) from the study of statistics that at the end of any hypothesis test, we calculate a 
p value
, representing the probability of observing our results—or results that are even more extreme—due entirely to random chance. Conceptually, we are calculating the probability that we are wrong rather than the probability that we are right in our predictions. And the bigger the effect, the smaller this probability will generally be. So, as strange as it seems, the ideal result of hypothesis testing is to have a small probability of being wrong.

This focus on falsifiability carries over to the way we test our hypotheses, in that the goal is to reject the possibility of results being due to chance. The starting point of a hypothesis test is to state a null hypothesis, or the assumption that the variables have no real effect in the overall population. This is another way of saying that observed patterns of data are due to random chance. In essence, we propose this null in hopes of minimizing the odds that it is true. Then, as a counterpoint to the null hypothesis, we propose an alternative hypothesis that represents the predicted pattern of results. This part is a little confusing, because the word alternative actually refers to the hypothesis in which we are interested. The term is employed because, in statistical jargon, the alternative hypothesis represents the predicted deviation from the null. These alternative hypotheses can be directional, meaning that we specify the direction of the effect, or nondirectional, meaning that we simply predict an effect.

Say we want to test the hypothesis that people like cats better than dogs. We would start with the null hypothesis, that people like cats and dogs the same amount (i.e., no difference). The next step is to state the alternative hypothesis (that is, our actual hypothesis), which in this case is that people will prefer cats. Because we are predicting a direction (cats more than dogs), this hypothesis is directional. The other option would be a nondirectional hypothesis, or simply stating that people’s cat preferences differ from their dog preferences. (Note that we have avoided predicting which one people like better, what makes it nondirectional.)

Finally, these three hypotheses can also be expressed using logical notation, as shown below. The letter H is used as an abbreviation for “hypothesis,” and the Greek letter µ is a common abbreviation for the mean, or average.

Conceptual Hypothesis: People like cats better than dogs.

Null Hypothesis: H0: µcat = µdog

the “cat” mean is equal to the “dog” mean;

people like cats and dogs the same

Nondirectional Alternative Hypothesis: H1: µcat ≠ µdog

the “cat” mean is not equal to the “dog” mean;

people like cats and dogs different amounts

Directional Alternative Hypothesis: H1: µcat > µdog

the “cat” mean is greater than the “dog” mean;

people like cats more than dogs

Why distinguish between directional and nondirectional hypotheses? A statistics class provides a more detailed answer, but it is important to note that this decision will have implications for the level of statistical significance. In essence, nondirectional hypotheses are less precise: “I think there is a difference,” versus “I believe cats are the preferred pet!” Because we always want to minimize the risk of coming to the wrong conclusion, we have to be more conservative with a nondirectional test. In this context, being conservative means needing a bigger group difference to feel confident in the results.

In the cats-versus-dogs example, a larger difference in ratings would be needed to support the claim that people like cats and dogs different amounts than would be needed to support the claim that people like cats more than dogs. The goal of all this statistical and logical jargon is to place hypothesis testing in the proper frame. The most important thing to remember is that hypothesis testing is designed to reject the null hypothesis, and statistical tests tell us how confident to be in this rejection.

Five Steps to Hypothesis Testing

Now that we understand how to frame a hypothesis, what does a researcher do with this information? Framing a hypothesis is the first step of a five-step process of testing a hypothesis. This section walks through an example of hypothesis testing from start to finish, that is, from an initial hypothesis to a conclusion about the hypothesis. Using a fictitious study, we will test the prediction that married couples without children are happier than those with children in the home. This example is inspired by an actual study by Harvard social psychologist Dan Gilbert and his colleagues, described in a news article at 
http://www.telegraph.co.uk/news/1941195/Marriage-without-children-the-key-to-bliss.html
. The hypothesis may seem counterintuitive, but Gilbert’s research suggests that people tend to both overestimate the extent to which children will make them happy and underestimate the added stress and financial demands of having children in the house.


Step 1—State the Hypothesis

The first step in testing this hypothesis is to spell it out in logical terms. Remember that we want to start with the null hypothesis that the presence of children in a home has no effect. So, in this case, the null hypothesis would be that couples are equally happy with and without children. Or, in logical notation, H0: µchildren = µno children (i.e., the mean happiness rating for couples with children equals the mean happiness rating for couples without children). From there, we can spell out our alternative hypothesis; in this case, we predict that having children will make couples less happy. Because this is a directional hypothesis, we write H1: µchildren < µno children (i.e., the mean happiness rating for couples with children is lower than the mean happiness rating for couples without children).


Step 2—Define Variables

Once we have an idea of the conceptual relationship that we want to test, we need to translate these concepts into measurable variables. As the chapter has discussed more than once, the decisions we make at this stage will trickle down and influence every subsequent step of the research process. For our current example, we will need to find a way to define the concept of “happiness,” as well as decide our criteria for “couples with / without children.” We have encountered happiness as an example before, so it seems fairly straightforward to define it based on participants’ responses to a happiness scale. But what does it mean for a couple to have children? Do the children need to be of a certain age, or would the study include everyone from parents of newborns to empty-nesters whose children are away at college? These types of decisions need to be made carefully, to ensure that we are controlling outside influences that might interfere with our hypothesis test. For example, couples who survive the trials and tribulations of raising a toddler without getting divorced may come to develop a more realistic set of expectations for their everyday happiness, compared to the parents of newborns or the parents of college students.


Step 3—Collect Data

The next step is to design and conduct a study that will test our hypothesis. The next three chapters will elaborate on this process in great detail, but the general idea is the same regardless of the design. In this case, the most appropriate design would be correlational because we want to predict happiness based on whether people have children. It would be impractical and unethical to randomly assign people to have children, so an experimental design is not possible in this case. One way to conduct our study would be to survey married couples about whether they had children and ask them to rate their current level of happiness with the marriage. Suppose we conduct this study and end up with the data in Figure 2.4.

Figure 2.4: Sample data for the “children and happiness” study

A bar graph indicating that the average happiness rating of those with children is 2, while for those with no children it is 5.7. Both bars have a thin vertical line extending a small amount above and below the top of the bar.

As the figure shows, the results suggest an average happiness rating of 5.7 for couples without children, compared to an average happiness rating of 2.0 for couples with children. These groups certainly look different—and encouraging for our hypothesis—but we need to be sure that the difference is big enough that we can reject the null hypothesis.


Step 4—Calculate Statistics

The next step in our hypothesis test is to calculate statistical tests to decide how confident we can be that the results are meaningful. Researchers have a wide variety of statistical tools at their disposal and different ways to analyze all manner of data. These tools can be broadly grouped into descriptive statistics, which describe the patterns and distribution of measured variables, and inferential statistics, which attempt to draw inferences about the population from which the sample was drawn. Researchers use inferential statistics to make decisions about the significance of the data. Statistics courses cover many of these in detail, and we will discuss a few examples throughout this book. All of these different techniques share a common principle: They attempt to make inferences by comparing the relationship among variables to the random variability of the data. As the chapter discussed earlier, people’s measured levels of everything from happiness to heart rate can be influenced by a wide range of variables. The hope in testing our hypotheses is that differences in our measurements will primarily reflect differences in the variables we are studying. In the current example, we would want to see that differences in happiness ratings of the married couples were influenced more by the presence of children than by random fluctuations in happiness. Regardless of which statistic a researcher chooses to test the hypothesis, the resulting value will be translated into a measure of statistical significance, and this provides a key piece of information for the final decision.


Step 5—Make a Decision

Finally, we are able to draw a conclusion about our experiment. Based on the outcome of our statistical test (i.e., step 4), we will make one of two decisions about our null hypothesis:


Reject null:
 decide that the probability of the null being correct is sufficiently small; that is, results are due to differences in groups

or


Fail to reject null:
 decide that the probability of the null being correct is too big; that is, results are due to chance

Given the mean difference in Figure 2.4, and the small amount of error, our statistical test would certainly be significant, and we could be confident in rejecting the null hypothesis. At long last, we can express our findings in plain English: Couples with children are less happy than couples without children.

Having walked through this five-step process, we note an important fact. When it comes to analyzing data, to test hypotheses, researchers actually rely on a computer program for part of this process—Step 4 in particular. In these modern times, computing even a simple means comparison by hand is rare. Software programs such as SPSS, SAS, and Microsoft Excel can take a table of data, compute the mean difference, compare it to the variability, and calculate the probability that the results are due to chance. However, because these calculations happen behind the scenes, it is very important to understand the process. By understanding how the software operates, researchers can reach informed conclusions about their research questions. Otherwise, they risk making one of two possible errors in the hypothesis test, discussed in the next section.

Errors in Hypothesis Testing

In the children and happiness study, we concluded with a reasonable amount of confidence that our hypothesis was supported. Still, what if we made the wrong decision? Because our conclusions are based on interpreting probability, there is always a chance that we draw the wrong conclusion. In interpreting our hypothesis tests, we risk two potential errors, referred to as Type I and Type II errors.

Type I errors occur when the results are due to chance, but the researcher mistakenly concludes that the effect is significant. In other words, no effect of the variables exists in the population, but some quirk of the sample makes the effect appear significant. This error can be viewed as a false positive—researchers get excited over results that are not actually meaningful. In our children and happiness study, a Type I error would occur if children had no effect on happiness in the real world, but some quirk of chance made our “no children” group happier than the “children” group. For example, our sample of childless couples might accidentally contain a greater proportion of people with happy personalities or greater job stability or simply more marital satisfaction from the start.

Fortunately—although this error seems worrisome—we can generally compute the probability of making it. Our alpha level sets the bar for how extreme our data must be to reject the null hypothesis. At the end of the statistical calculation, a p value tells us how extreme the data actually are. When we set an alpha threshold of, say, 0.05, we are attempting to avoid a Type I error; our results will only be statistically significant if the effect outweighs the random variability by a big-enough amount. If the p value falls below our predetermined alpha level, we decide that the risk of a Type I error is sufficiently small and can therefore reject the null hypothesis. If, however, the p value is greater than (or even equal to) our alpha cutoff, we decide that the risk of Type I error is too high to ignore and will therefore fail to reject the null hypothesis.

Type II errors occur when the results are significant, but the researcher mistakenly concludes that they are due to chance. In other words, an effect of the variables does exist in the population, but some quirk of the sample makes the effect appear nonsignificant. This error can be viewed as a false negative—researchers miss results that actually could have been meaningful. In our children and happiness experiment, a Type II error would occur if couples without children really were happier than couples with children but some flaw in the experiment kept us from detecting the difference. For example, if our measures of happiness were poorly designed, people might vary in how they interpreted the items, and this source of error could make it difficult to spot an overall difference between the groups.

Although this error sounds disappointing, the good news is researchers have some fairly easy ways to avoid or minimize it. The key factor in reducing Type II error is to maximize the power of the statistical test, or the probability of detecting a real difference. In fact, power is inversely related to the probability of a Type II error—the higher the power, the lower the chance of Type II error. Power is analogous to the sensitivity, or accuracy, of the hypothesis test; it is under the researcher’s control in three main ways. First, as the section Reliability and Validity discussed it is important to make sure that measures are capturing what the researcher thinks they are. If the happiness scale actually captures something like narcissism, then this will cause problems for the hypothesis about the predictors of happiness. Second, it is important to be careful throughout the process of coding and analyzing data. Small mistakes&nbs

discussion

Discussion 1 (250 words)

How does a researcher develop a research question for a research study? What might guide a researcher in identifying a specific topic for study?

Discussion 2 (250 words)

There are several databases that can be used to search for background sources. Conduct an online search and find at least two databases that provide access to peer-reviewed publications. Identify the name of each database, and provide a link if available. Include a summary of the content within each. Describe at least one strength and one weakness of each database.

Textbook

Staines, Gail M. Social Sciences Research, (3rd Edition). Rowman & Littlefield Publishing Group, 2019.

Discussion

 

Ascertain the importance of strategic planning for an organization.

  • Suggest one strategy to structure the strategic planning session for a midsize nonprofit health organization that is competing with several for-profit facilities in the area. Then determine your approach to communicate the mission, vision, and value statements for the strategic planning. Provide a rationale for your response.

Discussion

 

It can be postulated that there are two scenarios when it comes to price setting by providers and provider organizations. Providers refer to those practitioners eligible to bill third-party payers for the services they provide to patients. Provider organizations are facilities where care is delivered to patients. The first scenario is that providers and provider organizations are considered “price takers,” in that the rates of reimbursement are set by the payers with little to no input from providers and organizations. The second scenario is that providers and organizations set their own prices and that payers are expected to pay these rates. These strategies will be explored in this week’s discussion assignment.

Briefly discuss what is meant to be a price setter or price taker, the strategies employed in both approaches, and a clear listing of the pros and cons associated with each price setting strategy. After weighing the pros and cons of each, which approach do you feel best meets the needs of the key stakeholders?

Discussion

Project 5: Problem/Solution Essay

WHAT WE’RE DOING
Writing a essay that identifies a
problem in technology, explains why
it’s a problem, and offers a
solutionto fix it.

HOW WE’RE DOING IT
An essay of at least 1200 words
which uses at least six sources from
which you draw information

WHY WE’RE DOING IT
To practice research skills in
finding information
To practice developing your ideas
with information you’ve
gathered
To discover and critically think
about important ideas
To develop ethical thinking and
responsibility 
To synthesize ideas from
material you’ve read
To practice argumentation and
thesis-based writing
To communicate your thinking in
a clear and effective way

WHEN WE’RE DOING IT
Writing Center Draft -11:59 pm, 8
Apr.
Teacher Draft -11:59 pm, 29 Apr.
Final Draft – 11:59 pm, 11 May

WHAT IT HAS TO DO
Identify a problem in technology
Explain, in detail, why this
problem is a problem
Discuss possible solutions for the
problem
Advocate for one or more
solutions to the issue
Be at least 1200 words long (you
can have more).
Use at least six sources in the
essay – these sources must be
explicitly referenced and cited
in-text. (You may use more.)
Have a works cited page – all
sources must be put on the
works cited page.

HOW I’LL GRADE IT

50 points

WHAT IT’S WORTH
250 points, or 25% of your course
grade.

50 points

50 points

50 points

Assignment features an effective argumentative thesis
statement, clearly and effectively explains and expresses the
problem at hand, and supports the assertion that the problem
is a problem.
Assignment clearly and effectively advocates for a solution to
the problem, supporting the solution with thoughtful and
logical reasoning

Assignment conforms to standard edited American English
and MLA standard guidelines of citation and formatting.

NOTES TO SELF

A FEW NOTES
Drafts sent to the writing center
and to me recieve 5 Low-Risk
Writing points each.
Because this paper is the final
essay of the semester, it will not
be accepted late.
Assignments not following the
instructions will receive an
automatic zero.

Assignment clearly and effectively organizes the paper in a
logical and reasonable way that makes sense to the reader

Assignment effectively integrates credible sources in support
of the arguments, with appropriate attribution and in-text
citation.

25 points

Rather than having a revision
opportunity, you’ll submit a
draft to me for feedback
before it is graded for a final
draft. 

25 points
Assignment works toward clarity of language, ensuring that
each topic and each sentence are easily understandable
and adheres to academic conventions of style, avoiding slang
and casual language

POTENTIAL TOPICS
· Vulnerability of national infrastructure to hacking
· Laws not keeping up with technological advances
· Corporate espionage and patent theft by other countries
· Filter bubbles and echo chambers
· Corporate censorship versus freedom of speech (should
Facebook be able to censor what people say on their
platform?)
· Right to the internet/major sites needed for modern life
· Lack of transparency with algorithms
· Automation and artificial intelligence leading to
unemployment
· The ecological/environmental impact of our technological
addictions
· Government collection of data versus the 4th amendment
· Foreign powers attempting to undermine democracy
through online trolls/bots
· Fake news/deep fakes
· Securing elections from hackers
· Forcing companies to build back doors into software and
hardware
· Online radicalization
· Accessibility of technology
· Monopolies/Consolidation of power in giant tech companies
· Censorship of the internet in other countries
· Ethics of automated employment (should robots enjoy
protections the way people do?)
· Responsibilities of social media companies for what is
posted by their users
· Toxic communities on social media
· Net neutrality
· Mass surveillance
· Private data collection and sales by companies
· Virtual assistants and privacy concerns
· Bias in artificial intelligence
· Privacy for genetic data and ancestry databases

Discussion

Prior to beginning work on this discussion forum, read Chapter 2 of your Meeting the Ethical Challenges of Leadership: Casting Light or Shadow course text.

This discussion forum focuses on analyzing Case Study 2.1 (The Bad Boy of the Pharmaceutical Industry) from your textbook. In at least one paragraph, supported by evidence from your text and from other research:

  • Describe the shadow casters you see in Martin Shkreli.
  • Explain if rapid success increases the probability that leaders will fall victim to shadow casters.
  • Appraise if Turing Pharmaceutical, as well as other companies that follow the same business model, engaged in price gouging, or are these firms serving the interests of their investors?
  • Describe any learning outcomes you had from this assignment.

Discussion

1 hour ago

Rachelle Britton

RE: Week 5 Discussion

Top of Form

Week 5 Discussion

· Describe some of the specific challenges (for example, risks of employees going to various websites, viruses, and legal implications) associated with BYOD policies.

Some challenges organizations might face with their bring your device policies are a lack of control of the personal device if it is lost or stolen. Not having administrative rights and what the employee does personally on their device might be against company policy on corporate-owned devices.

· Recommend methods organizations can use to address the challenges associated with BYOD policies.

Organizations should have a long-term plan to maintain their security objectives, with the proper controls to meet those objectives. Wireless devices should be one of the areas covered in the policy along with BYOD. The policy must address encryption, firewalls, network security, and termination of access for these devices. The plan should clearly outline the rules and practices associated with their BYOD policy. Organizations can provide training to any colleague who has signed up for BYOD and have them attest that they understand the policy. The content of the policy should contain an overview of the policy, the purpose of the policy, what is in scope, and who the targeted audience should be.

References:

 William Stallings. 2019. Effective Cybersecurity: A Guide to Using Best Practices and Standards. 


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Discussion

5/10/22, 9:00 AM Chapter 5-Protecting Your System: Physical Security, from Safeguarding Your Technology, NCES Publication 98-297 (National Center for Edu…

https://nces.ed.gov/pubs98/safetech/chapter5.asp 1/6

Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10
Table of Contents Glossary of Terms

CHAPTER 5

Protecting Your System:
Physical Security

CHAPTER 5 IN A NUTSHELL:
Introduction to Physical Security
Commonly Asked Questions
Policy Issues
Physical Security Countermeasures
Physical Security Checklist

Introduction to Physical Security
Most people think about locks, bars, alarms, and uniformed guards when they think about security. While these countermeasures are
by no means the only precautions that need to be considered when trying to secure an information system, they are a perfectly logical
place to begin. Physical security is a vital part of any security plan and is fundamental to all security efforts–without it, information
security (Chapter 6), software security (Chapter 7), user access security (Chapter 8), and network security (Chapter 9) are considerably
more difficult, if not impossible, to initiate. Physical security refers to the protection of building sites and equipment (and all information
and software contained therein) from theft, vandalism, natural disaster, manmade catastrophes, and accidental damage (e.g., from
electrical surges, extreme temperatures, and spilled coffee). It requires solid building construction, suitable emergency preparedness,
reliable power supplies, adequate climate control, and appropriate protection from intruders.

Commonly Asked Questions
Q. How can I implement adequate site security when I am stuck in an old and decrepit facility?
A. Securing your site is usually the result of a series of compromises– what you need versus what you can afford and implement.
Ideally, old and unusable buildings are replaced by modern and more serviceable facilities, but that is not always the case in the real
world. If you find yourself in this situation, use the risk assessment process described in Chapter 2 to identify your vulnerabilities and
become aware of your preferred security solutions. Implement those solutions that you can, with the understanding that any steps you
take make your system that much more secure than it had been. When it comes time to argue for new facilities, documenting those
vulnerabilities that were not addressed earlier should contribute to your evidence of need.

Q. Even if we wanted to implement these physical security guidelines, how would we go about doing so?
A. Deciding which recommendations to adopt is the most important step. Your risk assessment results should arm you with the
information required to make sound decisions. Your findings might even show that not every guideline is required to meet the specific
needs of your site (and there will certainly be some variation based on need priorities). Once decided on, however, actually initiating a
strategy is often as simple as raising staff awareness and insisting on adherence to regulations. Some strategies might require basic
“‘handyman”‘ skills to install simple equipment (e.g., key locks, fire extinguishers, and surge protectors), while others definitely demand
the services of consultants or contractors with special expertise (e.g., window bars, automatic fire equipment, and alarm systems). In
any case, if the organization determines that it is necessary and feasible to implement a given security strategy, installing equipment
should not require effort beyond routine procedures for completing internal work orders and hiring reputable contractors.

Determining
countermeasures often
requires creativity:
don’t limit yourself to
traditional solutions.

Q. What if my budget won’t allow for hiring full-time security guards?
A. Hiring full-time guards is only one of many options for dealing with security monitoring activities. Part-time staff on watch during
particularly critical periods is another. So are video cameras and the use of other staff (from managers to receptionists) who are trained
to monitor security as a part of their duties. The point is that by brainstorming a range of possible countermeasure solutions you can
come up with several effective ways to monitor your workplace. The key is that the function is being performed. How it is done is
secondary–and completely up to the organization and its unique requirements.

Guidelines for security
policy development can
be found in Chapter 3.

Policy Issues
Physical security requires that building site(s) be safeguarded in a way that minimizes the risk of resource theft and destruction. To
accomplish this, decision-makers must be concerned about building construction, room assignments, emergency procedures,
regulations governing equipment placement and use, power supplies, product handling, and relationships with outside contractors and
agencies.

The physical plant must be satisfactorily secured to prevent those people who are not authorized to enter the site and use equipment
from doing so. A building does not need to feel like a fort to be safe. Well-conceived plans to secure a building can be initiated without
adding undue burden on your staff. After all, if they require access, they will receive it–as long as they were aware of, and abide by, the
organization’s stated security policies and guidelines (see Chapter 3). The only way to ensure this is to demand that before any person

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is given access to your system, they have first signed and returned a valid Security Agreement. This necessary security policy is too
important to permit exceptions.

As discussed more
completely in Chapter
2, a threat is any action,
actor, or event that
contributes to risk

Physical Threats (Examples)
Examples of physical threats include:

Natural events (e.g., floods, earthquakes, and tornados)
Other environmental conditions (e.g., extreme temperatures, high humidity, heavy rains, and lightning)
Intentional acts of destruction (e.g., theft, vandalism, and arson)
Unintentionally destructive acts (e.g., spilled drinks, overloaded electrical outlets, and bad plumbing)

A countermeasure is a
strp planned and taken
in opposition to another
act or potential act.

Physical Security Countermeasures

The following countermeasures address physical security concerns that could affect your site(s) and equipment. These strategies are
recommended when risk assessment identifies or confirms the need to counter potential breaches in the physical security of your
system.

Countermeasures come in a variety of sizes, shapes, and levels of complexity. This document endeavors to describe a range
of strategies that are potentially applicable to life in education organizations. In an effort to maintain this focus, those
countermeasures that are unlikely to be applied in education organizations are not included here. If after your risk
assessment, for example, your security team determines that your organization requires high-end countermeasures like
retinal scanners or voice analyzers, you will need to refer to other security references and perhaps even need to hire a reliable
technical consultant.

Create a Secure Environment: Building and Room Construction:17

Don’t arouse unnecessary interest in your critical facilities: A secure room should have “low” visibility (e.g., there should not be
signs in front of the building and scattered throughout the hallways announcing “expensive equipment and sensitive
information this way”).

Select only those
countermeasures that
meet percuived needs
as indentified during
risk assessment
(Chapter 2) and support
security policy (Chapter
3).

Maximize structural protection: A secure room should have full height walls and fireproof ceilings.

Minimize external access (doors): A secure room should only have one or two doors–they should be solid, fireproof, lockable,
and observable by assigned security staff. Doors to the secure room should never be propped open.

Minimize external access (windows): A secure room should not have excessively large windows. All windows should have locks.

Maintain locking devices responsibly: Locking doors and windows can be an effective security strategy as long as appropriate
authorities maintain the keys and combinations responsibly. If there is a breach, each compromised lock should be changed.

Investigate options other than traditional keyhole locks for securing areas as is reasonable: Based on the findings from your risk
assessment (see Chapter 2), consider alternative physical security strategies such as window bars, anti-theft cabling (i.e., an
alarm sounds when any piece of equipment is disconnected from the system), magnetic key cards, and motion detectors.

Recognize that some countermeasures are ideals and may not be feasible if, for example, your organization is housed in an
old building.

Be prepared for fire emergencies: In an ideal world, a secure room should be protected from fire by an automatic fire-fighting
system. Note that water can damage electronic equipment, so carbon dioxide systems or halogen agents are recommended. If
implemented, staff must be trained to use gas masks and other protective equipment. Manual fire fighting equipment (i.e., fire
extinguishers) should also be readily available and staff should be properly trained in their use.

Maintain a reasonable climate within the room: A good rule of thumb is that if people are comfortable, then equipment is usually
comfortable–but even if people have gone home for the night, room temperature and humidity cannot be allowed to reach
extremes (i.e., it should be kept between 50 and 80 degrees Fahrenheit and 20 and 80 percent humidity). Note that it’s not
freezing temperatures that damage disks, but the condensation that forms when they thaw out.

Be particularly careful with non-essential materials in a secure computer room: Technically, this guideline should read “no eating,
drinking, or smoking near computers,” but it is quite probably impossible to convince staff to implement such a regulation. Other
non-essential materials that can cause problems in a secure environment and, therefore, should be eliminated include curtains,
reams of paper, and other flammables.

Don’t say it if you don’t mean it–instituting policies that
you don’t bother to enforce makes users wonder
whether you’re serious about other rules as well.

Guard Equipment:

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Locking critical
equipment in secure
closet can be an
excellent security
strategy findings
establish that it is
warranted.

Keep critical systems separate from general systems: Prioritize equipment based on its criticality and its role in processing
sensitive information (see Chapter 2). Store it in secured areas based on those priorities.

House computer equipment wisely: Equipment should not be able to be seen or reached from window and door openings, nor
should it be housed near radiators, heating vents, air conditioners, or other duct work. Workstations that do not routinely display
sensitive information should always be stored in open, visible spaces to prevent covert use.

Protect cabling, plugs, and other wires from foot traffic: Tripping over loose wires is dangerous to both personnel and equipment.

Keep a record of your equipment: Maintain up-to-date logs of equipment manufacturers, models, and serial numbers in a secure
location. Be sure to include a list of all attached peripheral equipment. Consider videotaping the equipment (including close-up
shots) as well. Such clear evidence of ownership can be helpful when dealing with insurance companies.

Maintain and repair equipment: Have plans in place for emergency repair of critical equipment. Either have a technician who is
trained to do repairs on staff or make arrangements with someone who has ready access to the site when repair work is needed.
If funds allow, consider setting up maintenance contracts for your critical equipment. Local computer suppliers often offer
service contracts for equipment they sell, and many workstation and mainframe vendors also provide such services. Once
you’ve set up the contract, be sure that contact information is kept readily available. Technical support telephone numbers,
maintenance contract numbers, customer identification numbers, equipment serial numbers, and mail-in information should be
posted or kept in a log book near the system for easy reference. Remember that computer repair technicians may be in a
position to access your confidential information, so make sure that they know and follow your policies regarding outside
employees and contractors who access your system.

Who needs a Maintenance Contract?

“Percussive maintenance” is the
fine art of pounding on a piece

of sensitive electronic
equipment until it returns to

proper working order.

Rebuff Theft:18

Identify your equipment as yours in an overt way: Mark your equipment in an obvious, permanent, and easily identifiable way.
Use bright (even fluorescent) paint on keyboards, monitor backs and sides, and computer bodies. It may decrease the resale
value of the components, but thieves cannot remove these types of identifiers as easily as they can adhesive labels.

Losing a computer to
theft has both financial
costs (the replacement
value of the equipment)
and information costs
(the files contained on
the hard drive).

Identify your equipment as yours in a covert way: Label the inside of equipment with the organization’s name and contact
information to serve as powerful evidence of ownership.

Make unauthorized tampering with equipment difficult: Replace regular body case screws with Allen-type screws or comparable
devices that require a special tool (e.g., an Allen wrench) to open them.

Limit and monitor access to equipment areas: Keep an up-to-date list of personnel authorized to access sensitive areas. Never
allow equipment to be moved or serviced unless the task is pre-authorized and the service personnel can produce an authentic
work order and verify who they are. Require picture or other forms of identification if necessary. Logs of all such activity should
be maintained. Staff should be trained to always err on the cautious side (and the organization must support such caution even
when it proves to be inconvenient).

Attend to Portable Equipment and Computers:19

Never leave a laptop computer unattended: Small, expensive things often disappear very quickly–even more quickly from public
places and vehicles!

While the X-ray conveyor belt is the preferred way of transporting a laptop through airport security (compared to subjecting
the computer to the magnetic fields of walk-through or wand scanners), it is also a prime place for theft. Thieves love to
“inadvertently” pick up the wrong bag and disappear while passengers are fumbling through their pockets to find the loose
coins that keep setting off the metal detectors. Use the X-ray conveyor belt, but never take your eyes off your laptop!

Require laptop users to
read the recommended
travel guidelines that
should come with the
equipments’s
documentation.

Store laptop computers wisely: Secure laptops in a hotel safe rather than a hotel room, in a hotel room rather than a car, and in a
car trunk rather than the back seat.

Stow laptop computers appropriately: Just because a car trunk is safer than its back seat doesn’t mean that the laptop won’t be
damaged by an unsecured tire jack. Even if the machine isn’t stolen, it can be ruined all the same. Stow the laptop and its battery
safely!

Don’t leave a laptop computer in a car trunk overnight or for long periods of time: In cold weather, condensation can form and
damage the machine. In warm weather, high temperatures (amplified by the confined space) can also damage hard drives.

It Really Happens!

Jack’s briefcase was his life. Well, maybe it wasn’t his whole life, but it definitely contained the better part of his professional life. It
held his grade book, his lesson plans, his master’s thesis–all very important things in the world of a middle school teacher.

And it wouldn’t be an exaggeration to say that Jack sure was surprised when his life (the briefcase) went up in flames one
afternoon in the school cafeteria. He couldn’t explain it, but nonetheless he found himself sitting in front of the district technologist
trying to do exactly that–explain why his briefcase caught on fire and ruined, among more important things to him, the spare
battery he was carrying for the school’s laptop computer.

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“So,” the technologist asked, “you’re saying that you’re surprised that your briefcase caught on fire? Well, let me tell you, I’m glad
that it was only your bag that was damaged. Didn’t you know that the exposed terminals of a battery can cause a spark? Didn’t
you know that any piece of metal, even a paper clip, can serve as the conduit? That’s all it takes: an improperly stored battery, a
paper clip and anything combustible–and wham, you’ve got yourself a fire. Your home could have gone up in flames last night
because of it. Or your school could have this afternoon. Didn’t you know that?”

Jack almost replied that, of course, he hadn’t known about all of those dangers, and that the technologist should have warned him
about them before he had borrowed the laptop and extra battery. But instead he just shook his head sheepishly. After all, along
with his grade book, lesson plans, and master’s thesis, he had just burned a $200 dollar laptop battery that didn’t belong to him.

Regulate Power Supplies:

Be prepared for fluctuations in the electrical power supply: Do so by (1) plugging all electrical equipment into surge suppressors
or electrical power filters; and (2) using Uninterruptible Power Sources (UPSs) to serve as auxiliary electrical supplies to critical
equipment in the event of power outages.

Pay attention to the
manufacturer’s
recommendations for
storing portable
computer batteries–
they carry live charges
and are capable of
igniting fires if not
handled properly.

Protect power supplies from environmental threats: Consider having a professional electrician design or redesign your electrical
system to better withstand fires, floods, and other disasters.

Select outlet use carefully: Although little thought generally goes into plugging equipment into an outlet, machines that draw
heavily from a power source can affect, and be affected by, smaller equipment that draws energy from the same outlet.

Guard against the negative effects of static electricity in the office place: Install anti-static carpeting and anti-static pads, use anti-
static sprays, and encourage staff to refrain from touching metal and other static-causing agents before using computer
equipment.

Protect Output:

Keep photocopiers, fax machines, and scanners in public view: These types of equipment are very powerful tools for
disseminating information–so powerful, in fact, that their use must be monitored.

Assign printers to users with similar security clearances: You don’t want employees looking at sensitive financial information
(e.g., staff salaries) or confidential student information (e.g., individual records) while they are waiting for their documents to print.
It is better to dedicate a printer to the Director of Finance than to have sensitive data scattered around a general use printer.
Don’t hesitate to put printers in locked rooms if that is what the situation demands.

Label printed information appropriately: Confidential printouts should be clearly identified as such.

Demand suitable security procedures of common carriers when shipping/receiving confidential information: Mail, delivery,
messenger, and courier services should be required to meet your organization’s security standards when handling your
confidential information.

Dispose of confidential waste adequately: Print copies of confidential information should not be placed in common dumpsters
unless shredded. (Comparable requirements for discarding electronic copies of confidential information can be found in Chapter
6.)

It Really Happens!

Dr. Hamilton was everything that a school district could ask for. She was a great visionary, a trusted leader, and an excellent
superintendent… but she was terrible with the piles of paper she kept on her desk. Luckily for her and the district, she had an
equally competent secretary. Lucy was always one step ahead of Dr. Hamilton with the paperwork. She knew where to find the
latest draft of the letter to the Board. She knew which form needed to be completed by when. She knew how many copies of the
monthly report needed to be run off.

One afternoon, Dr. Hamilton came running out of her office to Lucy’s desk, “You haven’t shredded those papers I gave you this
morning yet, have you?”

As was always the case, Lucy had, of course, completed the task shortly after it had been handed to her. She told Dr. Hamilton
so, and asked what was the matter.

“I think that I accidentally gave you my only copy of the speech I’m giving to the Chamber of Commerce tonight,” the distraught
woman replied, knowing that she’d never be able to reproduce the outline in time for the meeting.

“Don’t worry,” Lucy said, beaming with pride that her forethought was about to again pay off, “I make backup copies of every sheet
of paper you give me before I turn on that paper shredder. Let’s look in my filing cabinet.”

Dr. Hamilton let out a deep sigh of relief–Lucy had again saved the day. Suddenly, however, the astute superintendent paused,
“What do you mean you make copies of everything I give you before you turn on the paper shredder?”

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5/10/22, 9:00 AM Chapter 5-Protecting Your System: Physical Security, from Safeguarding Your Technology, NCES Publication 98-297 (National Center for Edu…

https://nces.ed.gov/pubs98/safetech/chapter5.asp 5/6

Physical Security Checklist
While it may be tempting to simply refer to the following checklist as your security plan, to do so would limit the effectiveness of the
recom-mendations. They are most useful when initiated as part of a larger plan to develop and implement security policy throughout an
organization. Other chapters in this document also address ways to customize policy to your organization’s specific needs–a concept
that should not be ignored if you want to maximize the effectiveness of any given guideline.

Security Checklist for Chapter 5
The brevity of a checklist can be helpful, but it in no way makes up for the detail of the text.

Check Points
for Physical Security

Create a Secure Environment: Building and Room Construction

1. Does each secure room or facility have low visibility (e.g., no unnecessary signs)?

2. Has the room or facility been constructed with full-height walls?

3. Has the room or facility been constructed with a fireproof ceiling?

4. Are there two or fewer doorways?

5. Are doors solid and fireproof?

6. Are doors equipped with locks?

7. Are window openings to secure areas kept as small as possible?

8. Are windows equipped with locks?

9. Are keys and combinations to door and window locks secured responsibly?

10. Have alternatives to traditional lock and key security measures (e.g., bars, anti-theft cabling, magnetic
key cards, and motion detectors) been considered?

11. Have both automatic and manual fire equipment been properly installed?

12. Are personnel properly trained for fire emergencies?

13. Are acceptable room temperatures always maintained (i.e., between 50 and 80 degrees Fahrenheit)?

14. Are acceptable humidity ranges always maintained (i.e., between 20 and 80 percent)?

15. Are eating, drinking, and smoking regulations in place and enforced?

16. Has all non-essential, potentially flammable, m

Discussion

What happens in October Birds is very similar to what happened to us during Covid-19. It’s incredibly scary to read in the first chapter how quickly the potential of spreading infection increases. Reading how the initial doctor who was infected had multiple layovers, stopped at different shops and bars, and hotel rooms was scary on his journey to Texas. I have gone on international trips and had several layovers on those trips and now realizing how easy it can be to infect so many people at once then those people going home to their destinations is to infect others. From this reading I learned how important it is to stay isolated if you are sick. I do believe that we have learned social distance from Covid however, I do not think people will take it as seriously as it needs to be. To best stop the spread we need to prioritize quarantine.

From the lectures we’ve learned that infections can spread quickly but to read that within a matter of 1 chapter the number of infections went from 7 to 571 – an incredible rise in numbers within 1 day. Similar to our situation, this viral infection directly impacted the lungs filling them with fluid making it hard to breathe and describes the shortage of ventilators and supplies for children. This book has shown the importance of keeping logs and records as a healthcare professional seeing patients. For example, the school nurse who kept a log of all the students she saw the day the young girl came in coughing. This was helpful in contact tracing and expresses the importance of notifying the possibly infected as soon as possible

Those that are infected are not taking their illness seriously. One lady went to a coffee shop and risked the exposure of everyone there but when confronted by the doctor at the cafe, she broke into tears because she didn’t realize how impactful her selfish decision was and it was risky for those around her that she didn’t stay in isolation.

Other similarities seen are that they discuss shutting down the cities however, the mayor is debating the potential loss of revenue and that it’s understandable because businesses won’t be able to pay their employees and then those employees won’t be able to pay rent.

It was really sorrowful reading Nabil’s death. It’s hard to imagine what would be done in this situation; I don’t know if I would have the tolerance to bury my partner. Knowing the alternative would be him sitting in a body bag in someone’s fridge sounds horrific. It forces me to wonder how people cope with their loved ones’ deaths in their own homes during our pandemic. I wouldn’t be surprised if there were family members currently buried in backyards in San Francisco, especially since the book revealed that the body collection team wouldn’t be available to pick up until the next morning.

The character situation that related to me most was the holistic doctor because she genuinely wants to help people and do it the natural way. It was relieving to read that she had some formal medical training yet, she still chose to heal people in her own way. I really enjoyed reading about the home remedies she had for the sick daughter and the priest because I too try to heal things like a cough or sore throat naturally using herbs and roots like ginger. I have a backyard full of plants and vegetables that I love to incorporate in my diet.

October Birds was very relatable to our Covid-19 it was hard for me to find differences. One that I would like to note is that they wanted to start with shutting down schools before anything else.

Discussion

  1. Research a policy about reducing fossil fuel use in a US state or commonwealth, municipality, or region of your choosing. Choose one that was not covered in the lesson. For example, in the lesson we talked about Governor Newson’s initiatives to limit gas-fueled cars or reduce fossil fuel use. Make sure you look through the lesson – you cannot choose one we already covered. You may want to choose an area you are familiar with – you have lived there or have family there. Or you may choose a place you want to visit. Think about places outside of California – that way we get the greatest diversity of responses.
  2. State the policy and explain it. Give your opinion. What non-renewable resources does it target? How does it propose reducing them? Why this resource? What is the timeline for reduction? Why this particular resource? Be detailed and thorough so we can understand it.
  3. Analyze the policy. Knowing what you know about environmental problems, will this policy be effective? Or is it just a first step? Is it aggressive enough? What do you think about the approach? Is it likely to work or not? These are examples of questions to answer when you analyze the policy.

Discussion

Crime, Law, and Deviance

Chapter 7

LO 7-1 Examine the history of race, crime, and deviance

LO 7-2 Analyze stock theories of race, crime, and deviance

LO 7-3 Apply the matrix lens to the relationships among race, crime, and deviance

LO 7-4 Formulate transformative narratives of crime and deviance

2

Coates, The Matrix of Race

SAGE Publishing, 2018.

A History of Race, Crime, and Punishment

Deviance – All actions or behaviors that defy social norms

Seriousness ranges from criminal activity to violating social expectations

Example: violating fashion “rules” vs. stealing

Deviance defines a significant portion of our national character

3

Coates, The Matrix of Race

SAGE Publishing, 2018.

Building a Foundation of Whiteness

English colonists arrived in America with notions of race and gender bias

All women typically received harsher punishments than their male counterparts for violating sexual or marriage taboos

White privilege – Refers to the laws, practices, and behaviors which preserve and (re)create societal benefits people indentified as white

White normative structures – Those norms and institutions that obscure the racial intent of such laws

4

Coates, The Matrix of Race

SAGE Publishing, 2018.

Legislating White Privilege

Racial consciousness – The awareness of race shared by members of a group and wider society

Colonial laws linked white racial consciousness to laws

Example: U.S. Naturalization Law of 1790

Slave Codes

Jim Crow Laws (1880s–1960s)

5

Coates, The Matrix of Race

SAGE Publishing, 2018.

A Legacy of Racial Profiling

Racial profiling – Use of law enforcement to target people of color for extensive and invasive policing, often with no evidence of criminal activity

People of color are most likely to be profiled, imprisoned, and sentenced

6

Coates, The Matrix of Race

SAGE Publishing, 2018.

Sociological Stock Theories of Crime
and Deviance

Fall into two broad categories

Biosocial theories of deviance

Ecological perspectives

7

These standard stories have a common thread- they place the source of deviance at the micro, or personal, level. Therefore, either the individual, their community, culture, or environment are at odds with societal norms. And by implication if the individual, their community, culture or environment could just be reformed, fixed, adjusted or rehabilitated, then the deviance would be reduced or non-existent.

7

Coates, The Matrix of Race

SAGE Publishing, 2018.

Biosocial Theories of Deviance

Cesare Lombroso – Founder of modern criminology, 19th century

Believed biological indicators were associated with more primitive form of human being

Suggested that Africans, Asians, and Native Americans were especially prone to crime and deviance

Biological determinism – Holds that behavior is innately impacted by some component of a person’s physiology

8

Coates, The Matrix of Race

SAGE Publishing, 2018.

Ecological Perspectives on Crime

Ecological approach – Situates human behavior within the social structure external to the individual

Four derivatives of the ecological approach

Social disorganization

Culture of poverty

Cultural conflict

Broken windows

9

Coates, The Matrix of Race

SAGE Publishing, 2018.

Social Disorganization

Social disorganization links crime to neighborhood ecological patterns

Example: communities with large levels of immigration or migration produce rapid community changes that may lead to disruption

10

Coates, The Matrix of Race

SAGE Publishing, 2018.

Culture of Poverty

Culture of poverty approach – Poverty seen as a set of choices

Linked to unwed mothers who were blamed for perpetuating crime and deviance

Differential association theory – Differences in criminal involvement among groups resulted from their different definitions of criminality

11

Coates, The Matrix of Race

SAGE Publishing, 2018.

Broken Windows Theory

Broken windows theory – Argues that a significant way of decreasing crime was to halt vandalism

While fixing broken windows may increase community pride, researchers have not found that it sufficiently explains lower levels of crime and deviance

12

Coates, The Matrix of Race

SAGE Publishing, 2018.

The Spaces and Places of Crime
and Deviance

General strain theory – Racism produces stressful events and environments.

Leads to negative emotions, which leads to criminal activity

Systemic racism – Occurs when a system of inequality based upon race, often within institutional settings, is often associated with differential outcomes in crime and deviance

13

These negative emotions may be buffered by factors such as coping mechanisms, family and peer support, as well as self-esteem

13

Coates, The Matrix of Race

SAGE Publishing, 2018.

The Structure and Context of Crime
and Deviance

Prison-industrial complex – Policies that target and greatly expand the U.S. inmate population

“Get tough on crime”

“War on Drugs”

14

New interpretations of structural inequalities argue that racism, differential education funding, and a lack of opportunities may lead to a culture of poverty

14

Coates, The Matrix of Race

SAGE Publishing, 2018.

The Structure and Context of Crime
and Deviance

People of color are more likely than whites to be incarcerated

Girlfriend theory – Suggests that women are minor players caught up in criminal actions of their boyfriends

Black women are twice as likely to be incarcerated than their white counterparts

15

Homicide is the leading cause of death for black males between the ages of 15-24 and the second leading cause of Hispanic males in the age group

15

Coates, The Matrix of Race

SAGE Publishing, 2018.

The Structure and Context of Crime and Deviance

United States is the only industrialized western democracy that still sanctions the death penalty

Currently, 54% of those on death row are either black or Latino

Black men are eight times more likely to be homicide victims or offenders than their white counterparts

16

Coates, The Matrix of Race

SAGE Publishing, 2018.

Identifying Types of Crime

Differential labeling – Some individuals and groups are systematically declared deviant by virtue of being in that particular group

17

Example: in the U.S., it is believed that blacks, Hispanics and other disadvantaged groups are more prone to crime, violence, disorder, welfare and likely to live in undesirable communities

17

Coates, The Matrix of Race

SAGE Publishing, 2018.

Identifying Types of Crime

Hate crimes – Use of violence and intimidation to further stigmatize and marginalize disenfranchised people

In 2014 the FBI reported a total of 5,479 hate crimes across the country

63% of these were against people; remaining target property

LGBT people of color are more likely to be victimized than their white counterparts

18

Coates, The Matrix of Race

SAGE Publishing, 2018.

Violence Against Women

Most common type of violent crime on college campuses is the rape of women

One in 1 in 5 women and 1 in 71 men will be raped at some point in their lives

Poverty is correlated with rape victimization

19

Coates, The Matrix of Race

SAGE Publishing, 2018.

White Collar Crime

White collar crime is “crime committed by a person of respectability and high social status in the course of his or her occupation”

Bernie Madoff stole $64.8 billion from investors

More examples include corporations such as Rite Aide, K-Mart, Xerox, and Tyco

20

Coates, The Matrix of Race

SAGE Publishing, 2018.

Transforming the Narrative of
Race, Crime, and Deviance

In 2016 alone, 24,000 inmates in 12 states and 29 prisons held protests

Resistance – Conscious and unconscious attempt by individuals and groups to challenge the dominant values of society

21

Coates, The Matrix of Race

SAGE Publishing, 2018.

Scientific Advances

Scientific advances have aided current and past criminal investigations

Innocence Project has tracked 344 convictions have been overturned by new DNA evidence in 17 years

Of these, 215 were African American, 105 were white, 25 were Latinos and 2 were Asian Americans

22

Coates, The Matrix of Race

SAGE Publishing, 2018.

Alternatives to Incarceration

In 2010, the U.S. Supreme Court ruled that sentencing juveniles in homicide cases to life without parole was both cruel and unusual

Community service

Clemency for non-violent drug offenses

23

Coates, The Matrix of Race

SAGE Publishing, 2018.

Emphasizing Choice

Individual agency – For some people there is a “poverty of opportunities”

The prevalence of one type of crime is determined by the resources available within a particular community

This directly impacts the kind of choices that people make

24

Discussion


Culture in Nursing


Library Assignment Content

Research Paper:

Write a three-page paper about a specific health belief system that is common to a population.

1. Include the origins of the health beliefs.

2. Discuss the health implications of the health beliefs (e.g., are they a potentially harmful?).

3. How will you integrate the health beliefs into your nursing care?

Submission Instructions:

· The paper is to be clear and concise and students will lose points for improper grammar, punctuation and misspelling.

· The paper should be formatted per current APA and 3-5 pages in length, excluding the title, abstract and references page. Incorporate a minimum of 3 current (published within last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work.

· Complete and submit the assignment before 11:59 PM ET Saturday 21,2022

Discussion


Topic:
Does democracy require equality of income or wealth? Discuss why democracy might make a country more or less egalitarian?

Be sure to make connections between your ideas and conclusions and the research, concepts, terms, and theory we are discussing this week. Initial Post: minimum of 2 scholarly sources (must include your textbook for one of the sources)

Text Book:

Title: The Struggle for Democracy, 2018 Elections and Updates Edition Revel Access Code

Authors: EDWARD S. GREENBERG, Benjamin I. Page

Publisher: Pearson

Publication Date: 2018-12-31

Edition: 12th

APA Citation

Greenberg, E. S & Page, B. I. (2018). The Struggle for Democracy, 2018 Elections and Updates Edition. (12th ed.). Pearson.

This textbook is available as an e-book and can be accessed from the module view.

Discussion

Part A

Please complete the following:

From football teams to Fortune 500 companies, recruiting superior talent is essential to fueling a team’s successful growth, as you see from Coach’s story of getting John Riggins to rejoin the team formerly known as the Washington Redskins. However, convincing someone to join your team can be a tricky business. This week, we look at ways to effectively recruit with key insights that’ll help you convince someone that they need to join your team! Imagine you’re preparing to recruit someone to be part of your team. Name three things you would try to do or use in your sales pitch to close the deal. Why do YOU think those things would help you land your recruit?

Part B – Please respond to the following:

  • From the case study, determine the challenges faced by the Help Desk at Bank USA and suggest strategies to mitigate them.
  • Using the data on call volume in the case, select a forecasting model to forecast the short-term demand. Justify why this model was selected over other forecasting models. Support your position.

discussion

Prompt

Discuss the essential hardware components of the data communication model and explain the importance of software (i.e., layers of the Internet model) to an implementation of a functioning network.

Guidelines

You are required to post an initial response to the discussion question. Your post should be of substance. There should be at least two paragraphs that address the topic. Use APA format for any quotations or citations you use to support your answer.

DISCUSSION

WRITE 175-265 WORDS

Consider the differences between marketing in for-profit and nonprofit health care organizations, then differentiate between the two on the issues below, responding to the following in a minimum of 175 words:

• Strategic goals of the organizations

• Variation in access to the capital market

• Strategic marketing differences between these two types of organizations

• Quality attributes of the two types of organizations

• The management of pricing and volume

Discussion

Planning for a Training Session

Sonya Hatfield

South University Online

Dr. Mirza

PMC6601

May 9, 202

Planning for a Training Session

Introduction

Planning refers to looking ahead and developing strategies to achieve desired goals and objectives, facilitate actions, and solve issues. It is an activity carried out systematically to determine when, how, and who is supposed to perform particular tasks. For example, planning for Walmart’s training session will consider the company’s available physical and human resources to coordinate and execute the training session effectively.

Statement of Need

Walmart Inc is a retailer operating supermarkets, grocery stores, discount and department stores, neighborhood markets, and hypermarkets (Khabibullaev, 2022, p. 281-292). The organization’s stores provide consumables and grocery, wellness and health, entertainment and office, technology, and apparel at low prices to improve the living standards of its consumers. The company markets its products under different licensed brands and private labels, including Parent’s Choice, George, Equate, and Wonder Nation. Additionally, it merchandises its products through various e-commerce portals in Africa, the US, China, Canada, and Central America. Walmart has discovered that its markets are becoming increasingly competitive; therefore, it seeks to provide a training sessions to its employees to equip them with the required tools and language for managing business operations successfully to help the company remain competitive.

According to Veile et al. (2019), businesses depend on their employees to develop and implement procedures and practices supporting the business goals. Competitors tend to imitate the product offering and strategies, but they cannot replicate their human resources. Therefore, training employees to equip them with knowledge can help any organization set itself apart from its competitors. The training session will help Walmart obtain a competitive edge that competitors will not imitate easily. Proper training session planning will help the organization achieve the training objectives and overcome uncertainties.

Objectives of Planning the Training Session

Businesses must improve their game to remain relevant and competitive in the overly competitive corporate world. A part of it involves effective planning, which outlines achieving strategic plans. Planning helps an organization obtain a competitive advantage and remove confusion and uncertainties. For example, planning for the training session includes assessing the training needs, addressing logistical requirements, organizing materials, identifying the goals and objectives of the training program, developing and evaluating the budget, and communicating important information to the stakeholders.

Project Stakeholders

The stakeholders of this project are the individuals who will be impacted by the project during its life cycle and whose input can directly affect the project outcome (Kolasa & Modrzejewska, 2020, p.545). They include the project team, executives, project manager, facilitators for the training program, and the employees. These are the people whose objectives should be satisfied because they have the power break or do the project.

The company employees will be the attendees of the training, and their willingness to attend the training will be essential in determining whether to plan for it. Also, the employees can suggest the areas they need further training, which can impact the planning process. The project manager will lead the project team in planning the training session. The project team will execute the planning under the project manager’s leadership. The company executives include the top management, who direct strategies in the organization and control the resources required to execute the project. Additionally, the project managers can help in emphasizing the importance of the employee training session to encourage the workers to participate. The training facilitators can aid in decision-making, and they can help determine factors related to the training.

Project Scope

The scope establishes the project boundary conditions and baseline that people cannot compromise without receiving consent from the approving managers. The project scope involves identifying the project team, resources, tasks, timeline, and budget. Every good project has a timeline that every person should follow. The project will be completed within two months. The project manager should have identified the venue, set the training date, determined the facilitators, and developed and examined the budget.

The project manager will establish whether the current project team is enough to prepare and plan well for the training session. Also, the project manager, with the help of the project team, will draft the budget indicating all the costs of obtaining the required resources. Further, the project team will identify the facilitators based on the objectives and goals of the training. The facilitators will be in charge of determining the training materials and requirements. This will help the project team prepare well for the required equipment, tools, seating arrangements, machines, environmental conditions, and lighting for enhancing proper practice or demonstration. The facilitators will be needed to prepare well for the training session to provide a high standard of training.

To prepare the trainees, the project team, with the help of the executives, will use different techniques to motivate and gear up the employees to prepare them to learn. The team will distribute the session plan or outline a month before the training session. Also, the project team will distribute precession activities and expectation questionnaires which will help in customizing the session.

References

Khabibullaev, A. S. U. (2022). Experiences of Foreign Countries in the Use of Marketing Research in Retail Trade and Their Application in the Context of Uzbekistan. International Journal of Multicultural and Multireligious Understanding9(3), 281-292.

Kolasa, I., & Modrzejewska, D. (2020, July). How Information System Project Stakeholders Perceive Project Success. In Science and Information Conference (pp. 542-554). Springer, Cham.

Veile, J. W., Kiel, D., Müller, J. M., & Voigt, K. I. (2019). Lessons learned from Industry 4.0 implementation in the German manufacturing industry. Journal of Manufacturing Technology Management.

Discussion

1

Lisa

Quality Models and Methods: Types, principles, and processes

When speaking about quality you may hear people refer to Quality Assurance (QA) or Quality Improvement (QI) which often are used interchangeably and refer to how well something is either working or how well a job is done. Total quality is “a philosophy or an approach to management that can be characterized by its principles, practices, and techniques. Its three principles are customer focus, continuous improvement, and teamwork. Each principle is implemented through a set of practices, the practices are supported by a wide array of techniques that make the practice effective.

Some continuous quality improvements methods are :

Performance management – the methodologies, metrics, processes and systems used to monitor and manage the business performance of an enterprise

Six sigma- a statistical term referring to the goal of achieving zero defects or failures. Six Sigma quality is considered a rate of less than 3.4 defects per million opportunities, which translates to a process that is 99.99966 percent defect free. The use of Six Sigma is encouraged in health services organizations as a way of achieving high reliability through use of rigorous and disciplined approach of process improvement tools, methods, and statistical analysis

Lean-is used to remove wasted effort from healthcare processes without compromising quality

Three principles of total quality:

Customer-focused quality- means that key patient and other customer requirements and expectations are identified and drive improvement efforts. Defining customers and stakeholders is a prerequisite to determining their requirements. 

Continuous improvement- may also be expressed through managers’ execution of their managerial functions. Managing by fact and depending on performance data to inform decisions is requisite to this principle.

Teamwork – referring to cross functional or interdisciplinary project teams. Healthcare organizations seeking to make changes in complex processes or activities that involve more than one discipline or work area often use a team approach. Quality improvement is fundamentally a team process in which significant and lasting improvements rely on the “knowledge, skills, experience, and perspectives of different individuals”

Resources

Patrice Spath. (2017). Applying Quality Management in Healthcare : A Systems Approach, Fourth Edition: Vol. Fourth edition. Health Administration Press.

Maren

 The Centers for Medicare and Medicaid Services (2021) defined quality improvement as ”the framework used to systematically improve care. Quality improvement seeks to standardize processes and structures to reduce variation, achieve predictable results, and improve outcomes for patients, healthcare systems, and organizations.” A quality improvement (QI) approach, also called continuous quality improvement (CQI), emphasizes the ongoing improvement of processes to enhance the quality of the outputs, for example, by limiting defect outcomes. Examples of process improvements in operating rooms are preoperative checklists, sponge counts, and team briefings to prevent negative results or surgical complications (Spath, 2017).
     The role of the management is to set organizational goals on how human, financial, material and intellectual resources are protected, assigned, and used. Furthermore, the goals involve how activities in the organization are created, carried out, coordinated, and developed. The manager’s views and strategies differ regarding the organizational position and responsibilities, such as team, project, department or organization-wide. How managers in health services describe and arrange quality in their daily activities is often affected by their own experiences. A manager with an education in health services administration background focuses, for example, on the importance of organizational structures and stakeholder relationships; this leads to numerous ways quality concerns may be stated and addressed in healthcare organizations. Quality improvement is essentially a team process dependent on knowledge, skills, understanding and views of different individuals.   
     Managers have to show continuous improvement in their daily activities to attain the same in their organizations. The principle of constant improvement is dependent on the manager’s performance in their managerial practices. Therefore, managing facts regarding performance data is essential. For example, by watching the patient transportation system, the supervisor is immediately alerted when a problem appears and can quickly react and address the issue. He can reassign staff to increase available employees and reduce the response time. He analyzes problems by comparing the total number of transports with the average response time. With the daily data, he can identify documented concerns and address them quickly, improving employee accountability and enhancing patient relations. The manager also reviews the statistics to analyze any problems that need to be solved directly by the managers. Furthermore, he reviews the monthly stats with the administrators, as annual statistics are also used for the budgeting process (Spath, 2017).
      According to W. Edwards Deming’s System of Profound Knowledge, the four components of theories of systems, the concept of knowledge, understanding variation, and psychology of change are necessary for quality improvement in the health care system. Organizations cover several departments, people, and functions working collectively to achieve a common goal, such as the quality of care and customer service. Leadership has to optimize the system as a whole. Therefore, leaders have to gain knowledge of the scenario through small tests. The knowledge is essential to adjust and enhance the system. Furthermore, it is vital to encourage anticipated variation and prevent adverse deviation. Finally, leaders have to comprehend the motivation of employees and offer skill training to change and succeed (Roehrs, 2018). As Roehrs (2018) stated, “The aim of leadership should be to improve the performance of man and machine, to improve quality, to increase output, and simultaneously to bring pride of workmanship to people.”

 

References:

Centers for Medicare and Medicaid. (2021). Quality Measurement and Quality Improvementhttps://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Quality-Measure-and-Quality-Improvement-

Roehrs, S. (2018, September 25). Building of profound knowledge. Current Problems in Pediatric and Adolescent Health Care. Volume 48, Issue 8,P. 196-197, https://www.sciencedirect.com/science/article/abs/pii/S1538544218300865

Spath, P. (2017). Applying Quality Management in Healthcare: A Systems Approach, Fourth Edition: Vol. Fourth edition. Health Administration Press.

Discussion

This discussion forum focuses on analyzing Case Study 3.2 (Cultivating Character from Crooked Timber) from your textbook. In at least one paragraph, supported by evidence in your text and from other research, respond to at least three of the five bullet points below.

  • Explain if you agree with Brooks that modern Western culture makes the self the center of the universe.
  • Explain the value of viewing humans as “crooked timber”. What might be the dangers of this perspective?
  • Describe if humility is the foundation for character development. Why or why not?
  • Explain which provisions of the Humility Code you agree with and take issue with.
  • Do you recall other prominent leaders who struggled to develop their character while wrestling with their weaknesses? How did they cope with their flaws, and what virtues did they develop?

discussion

Prompt

Discuss the process of a mail sender using a two-tier architecture sending mail to a receiver using a three-tier architecture.

Initial Post

You are required to post an initial response to the discussion question. Your post should be of substance. There should be at least two paragraphs that address the topic. Use APA format for any quotations or citations you use to support your answer.

Discussion

Prior to beginning work on this assignment, read Chapters 1 and 2 of your Meeting the Ethical Challenges of Leadership: Casting Light or Shadow course text.

Leadership is a complex topic. Up until now, the majority of your studies have focused on ethical leadership forms, but ethical leadership is only one part of a much larger leadership picture. There is also a dark side to leadership and to truly understand the ethical side of leadership, you need to understand the dark side.

In your paper,

  • Summarize your impressions of the different dark leadership theories.
  • Discuss why leaders cast shadow instead of light.
  • Describe ethical dilemmas that you have encountered as a leader or a follower.
    • Explain ways that you have resolved these dilemmas.
  • Explain your thoughts about this week’s reading, and what you learned that will transfer to future ethical decisions.
  • Describe your thoughts and observations about the moral choices made by a public figure and how these choices fit the lesson.

The Dark Leadership Theory paper

Carefully review the Grading Rubric (Links to an external site.) for the criteria that will be used to evaluate your assignment.

DISCUSSION

Subject : Apple or PC? Which is more popular?   We are only discussing computers, not mobile devices (no phones or tablets).   Give me your opinions, not what’s out on the Internet.   Can you back up your suggestion?

Comments :  

In my opinion PC computers are very popular but depends in many factors,primarily the budget.PC computers are more affordable and can be found around 40% cheaper than MAC,easier to upgrade and compatible with more software.Mac (APPLE) is a high-end machine that looks and performs great.I ve used both operating systems and all depends on the user.Each system has its strengths and weaknesses.Most people are ok with spending a bit more on a MAC because they know Apple makes good products.The most noticeabe difference between one and the other is in the user interfaces.While many computer users will say one or the other is the best,this is a matter of personal preference.Traditionally PCs have had the upper hand when it comes to gaming because more publishers developed games for the PC platform.PC also provided more powerful processors and speed.PCs are manufactured and distributed by hundreds of manufactures.Definitely for me Windows 10 is the more flexible operating system and comes optimized for touch on supported touch-screen laptops. 

 Personally, I like pcs better than Apple. In my opinion, Apple is mostly known for its iPhones rather than its computer systems. Pc is used by a wide variety of people, whether it’s gamers, educators, business people, etc. I think pcs are more budget-friendly and more efficient, they have access to many more different apps, for example, Apple does not come with Word, Excel, etc you have to download it and pay for it separately. I also think pcs are better for gamers, on Macbooks most games are not downloadable. Pcs also have more variety, many of the new laptops are touch screens, and most can change into a tablet if you’d like, I think they are more versatile, promoting their products over a broad spectrum to businesses, hospitals, and students, and many more. You never go into a library or office and see all the apple products as they are very expensive and less budget-friendly to maintain. I also think getting a hold of a pc is easier, they sell in many stores as for Apple, they are in select stores and are sold out often. 

Discussion

Power, Politics, and Identities

Chapter 8

LO 8-1 Explain contemporary political identities

LO 8-2 Evaluate stock sociological theories regarding power, politics, and identity

LO 8-3 apply the matrix approach to U.S. political history

LO 8-4 formulate alternatives to the matrix of race and politics

2

Coates, The Matrix of Race

SAGE Publishing, 2018.

Contemporary Political Identities

Politics – All of the processes, activities, and institutions having to do with governance

Political identities – Political positions, based on the interests and perspectives of social groups

Represent race, gender, sexuality, language, region, and class

3

The results of political elections are dependent on how well candidates can navigate political identities

3

Coates, The Matrix of Race

SAGE Publishing, 2018.

Regional Differences

Political identities vary by region in the United States

Among all groups, those living in the South or the Northeast, there is a stronger likelihood that they will view reality through the lens of race

People living in the West are more likely to view class as central to their identity

4

Coates, The Matrix of Race

SAGE Publishing, 2018.

Political Disenfranchisement

Disenfranchisement – Revocation of the right to vote

Differs regionally

People with criminal records are disenfranchised

Hispanics and African Americans are more likely to be disenfranchised

5

Coates, The Matrix of Race

SAGE Publishing, 2018.

The Role of Race, Class, and Gender

The highest levels of non-voters are associated with the lowest levels of education and income

Being eligible to vote and actually voting are two separate things

Women, across all racial groups, are more likely to vote than men

In the last two presidential elections, black women have been the most likely to vote

6

Coates, The Matrix of Race

SAGE Publishing, 2018.

Analyzing the 2016 Presidential Election

Voting patterns associated with education were evident in the presidential election of 2016

52% of people with college degrees voted for Clinton

52% of people without college degrees voted for Trump

Trump obtained 67% of non-college white’s vote

7

Coates, The Matrix of Race

SAGE Publishing, 2018.

Analyzing the 2016 Presidential Election

Voting patterns associated with race were also evident in the presidential election of 2016

Trump captured 58% of the White, non-Hispanic vote

Clinton secured 80% of Black voters

8

Coates, The Matrix of Race

SAGE Publishing, 2018.

Political Sociology

Political sociology – Study of government, political behaviors, institutions and processes that occur between the state, society and its citizens

The study of power, politics, and identity

9

Coates, The Matrix of Race

SAGE Publishing, 2018.

The Pluralist Approach

Pluralism – Posits that power within society is decentralized, widely shared, diffuse and fragmented

Because no single group is dominant, democratic equilibrium is established

Two types of groups associated with the pluralistic model

Insider groups

Outsider groups

10

Coates, The Matrix of Race

SAGE Publishing, 2018.

The Pluralist Approach

Pluralistic approach presumes that power is dispersed equally among insiders

In reality, power tends to be coalesced among a very few

11

Coates, The Matrix of Race

SAGE Publishing, 2018.

Power Elite Model

The Power Elite model – Suggests that power is concentrated among elites who control the resources of significant institutions

Three realms with elite members

High ranking politicians

Heads of major corporations and directors

High ranking military personnel

12

Coates, The Matrix of Race

SAGE Publishing, 2018.

The Class Approach to Power

The class approach model to power assumes that the type of economic system a society has determines the kind of political structures that evolve

In the United States those who control the economic production control the political processes

13

Coates, The Matrix of Race

SAGE Publishing, 2018.

Critical Race Theory

Critical race theory aims to transform the relationship between race, racism, and power

Theme #1: reject, significantly challenge or re-interpret the stock socio-political theories

Theme #2: mainstream ideas, reflected disproportionately by white scholars, stress the importance of linking structural conditions to the self-interests of leaders, activists, or even regions to understand ethnic identity and the conflict that often occurs

Theme #3: the political realities that reaffirm racial hierarchies are normal

14

Coates, The Matrix of Race

SAGE Publishing, 2018.

Critical Race Theory

Critical race theorist Kimberlé Williams Crenshaw (1993) coined the term “intersectionality”

Identity politics – A political process or structure that relies upon people of specific religions, racial and ethnic groups, or social backgrounds to form exclusive political alliances

15

Intersectionality:

Explained that the experiences that people face represent intersecting and interacting spheres that shape structural and representational aspects of our being

Argued that political processes were best understood through this lens

15

Coates, The Matrix of Race

SAGE Publishing, 2018.

Applying the Matrix of Race to U.S. Political History

The original intent of the U.S. government was to diminish the conflict between the “haves and have-nots” (Madison 1788)

Power – The ability to acquire scarce resources

The political institution regulates power

16

Coates, The Matrix of Race

SAGE Publishing, 2018.

Building a Nation’s Identity

Previous to the Civil War the southern colonies of Maryland, Virginia, the Carolinas and Georgia were staunch supporters of slavery

Economies relied on slave labor for profitability

Ultimately, the northern elites determined that free labor was more productive than slave labor

Our current Senate and House of Representatives are a direct result of how to count slaves within the population

17

Coates, The Matrix of Race

SAGE Publishing, 2018.

Building a Nation’s Identity

Great Compromise of 1787

Determined that slaves counted as three-fifths of a person when determining state representatives, as well as presidential electors and taxes

18

– Also included two governing bodies, wherein population would determine how many seats each state would hold in the House of Representatives, and the Senate would have two from each state

18

Coates, The Matrix of Race

SAGE Publishing, 2018.

Building a Nation’s Identity

Citizenship – Reflects the legal process countries use to regulate national identity, membership and rights

1790 Naturalization Act – Granted citizenship to “free white aliens” with two years’ residence

Withheld from all non-whites, slaves, and women

19

Coates, The Matrix of Race

SAGE Publishing, 2018.

Sovereign Peoples

Native Americans considered sovereign nationals

Independent and held authority over their own citizens and remaining land

Did not pay taxes to the United States and did not vote

Native Americans did not become citizens of the United States until 1924

20

Coates, The Matrix of Race

SAGE Publishing, 2018.

Immigration

U.S. immigration policies were intentional regarding race

1921 Emergency Quota Act – Limited the numbers of immigrants to the United States by imposing quotas based on the country of birth

1965 Immigration and Nationality Act – Committed the United States to accepting immigrants of all nationalities on roughly equal terms

21

Coates, The Matrix of Race

SAGE Publishing, 2018.

Civil War and Its Aftermath

De jure – Political practices and processes that were enacted as formal laws

De facto – Political practices and processes that, although not enshrined into laws, were carried out in practice by various entities

22

Coates, The Matrix of Race

SAGE Publishing, 2018.

Post Civil War De Jure Laws

Poll taxes – Two-year tax that had to be paid in advance in order to register to vote

Literacy tests – Required a person seeking to vote to read and interpret a section of the state constitution to county court

Grandfather clauses – Permitted anyone whose grandfather was qualified to vote prior to the Civil War

23

Coates, The Matrix of Race

SAGE Publishing, 2018.

Post Civil War De Facto Practices

In 1917 the U.S. Supreme Court ruled that segregation laws were unconstitutional

However, de facto practices reinforced segregation

Restrictive covenants – Bared the resale to purchasers of a race different than the original homeowner

Redlining – Happens when mortgage lending for certain areas is influenced/determined by race

24

Coates, The Matrix of Race

SAGE Publishing, 2018.

The Rise of Coalitional Politics
and Social Movements

Coalitional politics – Represents political alliances of various identity groups whose purpose is to establish a specific political agenda

25

Example: Black Civil Rights Movement (1955-1968)

Utilized a series of well-orchestrated nonviolent protests and civil disobedience to force dialogues between activists and political institutions

25

Coates, The Matrix of Race

SAGE Publishing, 2018.

Social Movement Victories

1964 Civil Rights Act – Officially banned discrimination based on race, color, religion, sex or national origin in employment practices

1965 Voters Rights Act – Ended voting discrimination and extended federal protections to minorities

26

Coates, The Matrix of Race

SAGE Publishing, 2018.

Social Movement Victories

Immigration and Nationality Services Act – Removed racial and national barriers and opened immigration to black immigrants from Africa and the Western hemisphere

1968 Fair Housing Act – Ended discrimination in the sale and rental of housing

27

Coates, The Matrix of Race

SAGE Publishing, 2018.

Building Alternatives to the Matrix of Race and Politics

Political activism – Involves various types of actions that go beyond voting

May be as simple as writing blogs, posting on the internet, or getting involved in a letter writing campaign

28

Ex: A Day without Immigrants, February 13, 2017, staged in major cities across the country as a response to President Trump’s executive orders tightening immigration restriction

28

Coates, The Matrix of Race

SAGE Publishing, 2018.

Creating Change

Sanctuary cities

When undocumented immigrants arrested, they are not deported but must serve time associated with any crimes committed

29

Discussion

2

2

Turkey’s research

Perceived Risk and Mental Health Problems among Healthcare Professionals during COVID-19 Pandemic: Exploring the Mediating Effects of Resilience and Coronavirus Fear

Background

In Turkey, during the time of the COVID-19 pandemic, there were high risks of healthcare professionals evolving signs of mental health complications because of them being on the frontline in fighting against the virus (Yıldırım, Arslan & Özaslan,2020). The research involved recruiting two hundred and four healthcare professionals, with 50 percent of the recruited being females with a minimum age of thirty-two. The purpose of the study was to examine the interceding roles of resilience and fear of coronavirus in the connection between mental health problems and perceived risk among all healthcare professionals treating patients nonstop. Method. The method used for the study is the participation method, and the participants were healthcare professionals who took the role of in the inpatient clinics, outpatients, and intensive care unit. Results. The results of the study showed that there was a significant perceived risk forecasted in coronavirus fear, but there was a non-important analyst of resilience. Coronavirus had a complete mediation on the consequence of supposed risk on resilience, and there was a 29 percent variation in coronavirus fear.

Italian research

Mental Health Conditions of Italian Healthcare Professionals during the COVID-19 Disease Outbreak

Background

The disease in Italy represented a risk in relation to mental distress. Therefore, there was a need to investigate the healthcare professionals’ psychological health during the pandemic outbreak (Bettinsoli et al.,2020). The research was based on assessing the current mental distress of the participants and the coping approaches during the virus outbreak. The front-liners were asked to report how they recall feeling before the outbreak. The purpose of the study was to examine the psychological condition of the medical personnel before and during the outbreak of coronavirus in Italy. The methods used were questionnaires and participation, and they distributed the questionnaires online to all healthcare personnel living in various Italian regions. Results. The research outcome showed that thirty-three percent of the healthcare professionals met the psychiatric indisposition threshold. After the study, it was found that the participants viewed their psychological conditions to have worsened during the coronavirus outbreak rather than before the outbreak. This perception was a fact among female health professionals.

Spanish research

Symptoms of Posttraumatic Stress, Anxiety, Depression, Levels of Resilience and Burnout in Spanish Health Personnel during the COVID-19 Pandemic

Background

Spain had the highest number of infected health workers with COVID-19 in the world. They aimed to analyze the posttraumatic stress, anxiety, and depression during the period of the virus (Yıldırım, Arslan & Özaslan,2020). They analyzed several associations such as burnout, work, and others on the variation of COVID-19—the purpose of the research. The purpose was to analyze the symptoms presented to health workers in Spain with posttraumatic stress, depression, and anxiety during the COVID-19 pandemic. Methods. Several methods were used during the examination, such as using participants who were the health workers. There was also measurement of variables and instruments. The researchers collected data through the use of demographic variables. Results. The study’s findings were as follows; there were gender variations in the symptoms of the three disorders. There were differences in the depersonalization burnout scale between men and women. Women are mostly and positively linked to posttraumatic stress, anxiety, and depression, and age is negatively and significantly linked to the three symptoms.

Analysis & Conclusion

For discussion part

Both three studies had a similar objective and goal: to examine and analyze the mental health of healthcare personnel before and during the outbreak of the coronavirus pandemic. Both studies focused more on the mental well-being of female healthcare workers. Both three studies emphasized their research on how Covid-19 impacted the lives and the mental health of the health workers. Moreover, the three studies were focused on certain ages; not all health workers on the frontline were participants in the study. However, there were differences in the study with some similarities since these are three different countries. In Italy, their examinations were on the associations between psychological distress with mental health and perceptions of infection; in Spain, their analysis was based on associations between burnouts, resilience, demographics, and work with COVID-19 variables. In contrast, Turkey’s examination was on the mediation roles of resilience and the fear of coronavirus relating to the perceived risk and the problems with their mental health.

Health personnel was greatly affected by the outbreak of the coronavirus pandemic because they were on the frontline trying to save the lives of the infected people. It was a challenging time all over the world, and thus, cases of increasing mental health problems were widespread. Many health workers had these underlying issues before the pandemic, but witnessing people die before themselves increased the cases. They take care of people without having someone to take care of them; thus, the research was necessary, and if the results were used to improve their health, it would be better than just mere research.

References

1. Bettinsoli, M. L., Di Riso, D., Napier, J. L., Moretti, L., Bettinsoli, P., Delmedico, M., … & Moretti, B. (2020). Mental health conditions of Italian healthcare professionals during the COVID‐19 disease outbreak. Applied Psychology: Health and Well‐Being12(4), 1054-1073.

2. Luceño-Moreno, L., Talavera-Velasco, B., García-Albuerne, Y., & Martín-García, J. (2020). Symptoms of posttraumatic stress, anxiety, depression, levels of resilience, and burnout in Spanish health personnel during the COVID-19 pandemic. International journal of environmental research and public health17(15), 5514.

3. Yıldırım, M., Arslan, G., & Özaslan, A. (2020). Perceived risk and mental health problems among healthcare professionals during COVID-19 pandemic: Exploring the mediating effects of resilience and coronavirus fear. International Journal of Mental Health and Addiction, 1-11.

Discussion

 

Let’s use this discussion to demonstrate the connection between data modeling and database design. This discussion is going to help you as your team works on ER modeling and database design phases of your project.

  1. Define E-R diagram. What does it represent?
  2. What is the purpose of normalization and what is the outcome?
  3. What is the relationship between an E-R diagram and a set of normalized relations?
  4. What is the purpose of a Primary Key and a Foreign Key?
  5. Give an example of a Primary Key and an Foreign Key showing two related tables. Use the following notation:
    • TABLENAME(Primary Key, Attribute 1, Attribute 2, Attribute 3, Foreign Key……)

Around 250 words

Discussion

This discussion forum focuses on analyzing Case Study 4.2 (Poisoning Flint, Michigan) from your textbook. In at least one paragraph, supported by evidence in your text and from other research, respond to at least three of the five bullet points below.

  • Explain if this is a case of administrative evil in action. Why or why not?
  • Discuss if you think that the residents of Flint were treated differently because they are poor and African American.
  • Describe how much blame the governor should accept for the crisis.
  • Explain if governors should be able to appoint emergency managers who have the power to override the decisions of local elected officials.
  • Describe what steps the state and federal government should take to repair the damage done to Flint and its residents, including children.

Discussion

Assume that you have been  hired by a small veterinary practice to help them prepare a contingency  planning document. The practice has a small LAN with four computers and  Internet access. Prepare a list of threat categories and the associated  business impact for each. Identify preventive measures for each type of  threat category. Include at least one major disaster in the plan.

DISCUSSION

Part 1

This week’s learning content introduces the many ways informatics is used in health care administration and operations to improve patient outcomes. This discussion invites you to examine informatics applications up close.

 

Respond to the following in a minimum of 175 words:

· What ideas in medical informatics presented in this week’s learning material excited and inspired you about the ways data can be used to improve health care? Explain the idea and provide examples.

· How can these applications of health data and information be used at an organization where you have worked?

PART 2

Respond to two classmate’s posts 80 word minimun

R1

Accurate data in healthcare is vital which can mean the difference between life and death to patients. Patient data are collected in many ways not just limited to patient interview or medical records, data can also be collected to medical devices either wearable devices or e-diaries among others. These data are captured for a range of reasons and stored in various databases across the healthcare system. Data allows doctors to serve patients in rural areas and other locations where vigorous medical infrastructure may not exist, Data also support and quickly intervene on high risk and high-cost patients, reduce costs of treatment, forecast outbreak epidemic, evade avoidable diseases, and expand the quality of life in general. Health data can be used to benefit individuals, public health and medical research and development. The utilization of health data is categorized as both primary or secondary. Primary purpose is when data is utilized to deliver health care to individual from whom it was collected while secondary use is when health data is used outside of healthcare delivery for that individual.

R2

What I saw over the years is that many medical records were physically locked away in secure locations prior to the Affordable Care Act, requiring medical professionals to maintain and protect them from theft which has been happening so frequently now in days. In some ways, this physical method of record storage has an impact on patient safety. Because the information is physical rather than virtual in other words digital there is a risk of it being lost due to human error or natural disasters, identity theft, or tampering by anyone with malicious intent. These dangers are mitigated to some extent by modern health informatics. Secure data storage is provided by electronic health record systems, which encrypt and secure patient data using advanced computing technologies. To help the situation, medical professionals must document their work in a specific way to ensure proper compensation for medical treatments provided under Medicare or Medicaid plans. They must confirm that patients received treatment before storing and recording the patient’s medical history on the appropriate electronic forms which is super important. Incorporating informatics into this process improves the flow of data between healthcare providers and government agencies. It also improves patient data standardization, making it easier for future healthcare professionals to streamline their own practices. Finally, informatics allows for faster file submission, resulting in faster reimbursement for health providers and faster notification of covered treatments for patients.

discussion

3.3 Archival Research

Slightly further along the continuum of control is archival research, which involves drawing conclusions by analyzing existing sources of data, including both public and private records. Sociologist David Phillips (1977) hypothesized that media coverage of suicides would lead to “copycat” suicides. He tested this hypothesis by gathering archival data from two sources: front-page newspaper articles devoted to high-profile suicides and the number of fatalities in the 11-day period following coverage of the suicide. By examining these patterns of data, Phillips found support for his hypothesis. Specifically, fatalities appeared to peak three days after coverage of a suicide, and a greater degree of publicity was associated with a greater peak in fatalities.

Pros and Cons of Archival Research

Nirvana lead singer, Kurt Cobain, performing on stage.

AP Photo

Copycat suicides often peak 3 days after media coverage of a high profile suicide, such as when Nirvana’s Kurt Cobain killed himself in 1994.

It is difficult to imagine a better way to test Phillips’s hypothesis about copycat suicides. A researcher could never randomly assign people to learn about suicides and then wait to see whether they killed themselves. Nor could someone interview people right before they commit suicide to determine whether they were inspired by media coverage. Archival research provides a test of the hypothesis by examining data that already exist and, thereby, avoids most of the ethical and practical problems of other research designs. One key element of archival research is that it neatly sidesteps issues of participant reactivity, or the tendency of people to behave differently when they are aware of being observed. Any time research is conducted in a laboratory, participants know they are part of a study and may not behave in a completely natural manner. In contrast, archival data involves making use of records of people’s natural behaviors. The subjects of Phillips’s study of copycat suicides were individuals who decided to kill themselves, who had no awareness that they would be part of a research study.

Archival research is also an excellent strategy for examining trends and changes over time. For example, much of the evidence for global warming comes from observing upward trends in recorded temperatures around the globe. To gather this evidence, researchers dig into existing archives of weather patterns and conduct statistical tests of the changes over time. Psychologists and other social scientists also make use of this approach to examine population-level changes in everything from suicide rates to voting patterns over time. These comparisons can sometimes involve a blend of archival and current data. For example, a great deal of social-psychology research has been dedicated to understanding people’s stereotypes about other groups. In a classic series of studies known as the “Princeton Trilogy,” researchers documented the stereotypes held by Princeton students for 25 years (1933 to 1969). Social psychologist Stephanie Madon and her colleagues (2001) collected a new round of data but also conducted a new analysis of the previous archival data. These new analyses suggested that, over time, people have become more willing stereotype other groups, even as the stereotypes themselves have become less negative.

One final advantage of archival research is that once a researcher gains access to the relevant archives, it requires relatively few resources. The typical laboratory experiment involves one participant at a time, sometimes requiring the dedicated attention of more than one research assistant for an hour or more. After researchers assemble data from the archives, though, conducting statistical analyses is a relatively simple matter. In a 2001 article, the psychologists Shannon Stirman and James Pennebaker used a text-analysis computer program to compare the language of poets who committed suicide (e.g., Sylvia Plath) with the language of similar poets who had not committed suicide (e.g. Denise Levertov). In total, these researchers examined 300 poems from 20 poets, half of whom had committed suicide. Consistent with Durkheim’s theory of suicide as a form of “social disengagement,” Stirman and Pennebaker (2001) found that suicidal poets used more self-references and fewer references to other people in their poems. The impressive part of the study is this: Once they had assembled their archive of poems, their computer program took only seconds to analyze the language and generate a statistical profile of each poet.

Overall, however, archival research is still relatively low on the continuum of control. Researchers have to accept the archival data in whatever form they exist, with no control over the way they were collected. For instance, in Stephanie Madon’s (2001) reanalysis of the “Princeton Trilogy” data, she had to trust that the original researchers had collected the data in a reasonable and unbiased way. In addition, because archival data often represent natural behavior, it can be difficult to categorize and organize responses in a meaningful and quantitative way. The upshot is that archival research often requires some creativity on the researcher’s part—such as analyzing poetry using a text-analysis program. In many cases, as we discuss next, the process of analyzing archives involves developing a coding strategy for extracting the most relevant information.

Content Analysis—Analyzing Archives

In most examples so far, the data come in a straightforward, ready-to-analyze form. That is, it is relatively simple to count the number of suicides, track the average temperature, or compare responses to questionnaires about stereotyping over time. In other cases, the data can come as a sloppy, disorganized mass of information. How does someone who wants to analyze literature, media images, or changes in race relations on television accomplish the analysis? These types of data can yield incredibly useful information, provided the researcher can develop a strategy for extracting it.

Mark Frank and Tom Gilovich—both psychologists at Cornell University—were interested in whether cultural associations with the color black affected behavior. In virtually all cultures, the term “black” is associated with evil—the bad guys wear black hats; people have a “black day” when things turn sour; and some are excluded from social groups by being “blacklisted” or “blackballed.” These associations appear to be independent of any culture-specific prejudices regarding race or skin color. Frank and Gilovich (1988) wondered whether “a cue as subtle as the color of a person’s clothing” (p. 74) would influence aggressive behavior. To test this hypothesis, they examined aggressive behaviors in professional football and hockey games, comparing teams whose uniforms were black to teams who wore other colors. Imagine for a moment being a researcher for this study. Professional sporting events contain a wealth of behaviors and events. How would information about the relationship between uniform color and aggressive behavior be extracted?

Frank and Gilovich (1988) solved this problem by examining public records of penalty yards (football) and penalty minutes (hockey) because these represent instances of punishment for excessively aggressive behavior, as recognized by the referees. In addition, in both sports, the size of the penalty increases according to the degree of aggression. These penalty records were obtained from the central offices of both leagues, covering the period from 1970 to 1986. Consistent with the researchers’ hypothesis, teams with black uniforms were “uncommonly aggressive” (p. 76). Most strikingly, two NHL hockey teams changed their uniforms to black during the period under study and showed a marked increase in penalty minutes with the new uniforms. One equally compelling alternative explanation is that, rather than the teams acting more aggressive in black uniforms, referees perceived them to be more aggressive while wearing black uniforms. Both explanations are consistent with the idea that cultural associations can affect behavior.

Even this analysis, however, is relatively straightforward because it involved data that were already in quantitative form (penalty yards and minutes). In many cases, the starting point is a jumbled mess of human behavior. In a pair of journal articles, psychologist Russell Weigel and colleagues (1980; 1995) examined the portrayal of race relations on prime-time television. To do so, they had to make several critical decisions about what to analyze and how to quantify it. The process of systematically extracting and analyzing the contents of a collection of information is known as content analysis. In essence, content analysis involves developing a plan to code and record specific behaviors and events in a consistent way. We can break this plan down into a three-step process.


Step 1—Identify Relevant Archives

Before we develop our coding scheme, we have to start by finding the most appropriate source of data. Sometimes the choice is fairly obvious: To compare temperature trends, the most relevant archives will be weather records. To track changes in stereotyping over time, the most relevant archive is questionnaire data assessing people’s attitudes. In other cases, this decision involves careful consideration of both the research question and practical concerns. Frank and Gilovich decided to study penalties in professional sports because these data were both readily available (from the central league offices) and highly relevant to their hypothesis about aggression and uniform color.

Because these penalty records were publicly available, the researchers were able to access them easily. But if the research question involved sensitive or personal information—such as hospital records or personal correspondence—researchers would need to obtain permission from a responsible party. Say we wanted to analyze the love letters written by soldiers serving overseas and then try to predict relationship stability. Given the personal, even intimate nature of these letters, we would need permission from each person involved before proceeding with the study. However researchers manage to obtain access to private records, protecting the privacy and anonymity of the people involved is paramount. This would mean, for example, using pseudonyms and/or removing names and other identifiers from published excerpts of personal letters.


Step 2—Sample From the Archives

In Weigel’s research on race relations, the most obvious choice of archives comprised snippets of both television programming and commercials. Yet this decision was only the first step of the process. Should the researchers examine every second of every program ever aired on television? Naturally not; instead, their approach was to take a smaller sample of television programming. Chapter 4 (4.3) will discuss sampling in more detail, but the basic process involves taking a smaller, representative collection of the broader population to conserve resources. Weigel and colleagues (1980) decided to sample one week’s worth of prime-time programming from 1978, assembling videotapes of everything broadcast by the three major networks at the time (CBS, NBC, and ABC). The research team narrowed its sample by eliminating news, sports, and documentary programming because the hypotheses centered on portrayals of fictional characters of different races.


Step 3—Code and Analyze the Archives

Content analysis’ third and most involved step is to develop a system for coding and analyzing the archival data. Even a sample of one week’s worth of prime-time programming contains a near-infinite amount of information. In the race-relations studies, Weigel et al. elected to code four key variables: (1) the “total human appearance time,” or time during which people were onscreen; (2) the “Black appearance time,” in which Black characters appeared onscreen; (3) the “cross-racial appearance time,” in which characters of two races were onscreen at the same time; and (4) the “cross-racial interaction time,” in which cross-racial characters interacted. In the original (1980) paper, these authors reported that Black characters were shown only 9% of the time, and cross-racial interactions only 2% of the time. Fortunately, by the time of their 1995 follow-up study, the rate of Black appearances had doubled, and the rate of cross-racial interactions had more than tripled. However, depressingly little change occurred in some of the qualitative dimensions that they measured, including the degree of emotional connection between characters of different races.

This study also highlights the variety of options for coding complex behaviors. The four key ratings of “appearance time” consist of simply recording the amount of time that each person or group is onscreen. In addition, the researchers assessed several abstract qualities of interaction using judges’ ratings. The degree of emotional connection, for instance, was measured by having judges rate the “extent to which cross-racial interactions were characterized by conditions promoting mutual respect and understanding” (Weigel et al., 1980, p. 888). As Chapter 2 (2.2) explained, any time researchers use judges’ ratings, it is important to collect ratings from more than one rater and to make sure they agree in their assessments.

A researcher’s goal is to find a systematic way to record the observations most relevant to the hypothesis. This is particularly true for quantitative research, where the key is to start with clear operational definitions that capture the variables of interest. This involves both deciding the most appropriate variables and the best way to measure these variables. For example, if someone who analyzes written communication might decide to compare words, sentences, characters, or themes across the sample. A study of newspaper coverage might code the amount of space or number of stories dedicated to a topic, while a study of television news might code the amount of airtime given to different positions. The best strategy in each case will be the one that best represents the variables of interest.

Qualitative versus Quantitative Approaches

Archival research can represent either qualitative or quantitative research, depending on the researcher’s approach to the archives. Most of the examples in this section represent the quantitative approach: Frank and Gilovich (1988) counted penalties to test their hypothesis about aggression, and Stirman and Pennebaker (2001) counted words to test their hypothesis about suicide. However, the race-relations work by Weigel and colleagues (1980; 1995) represents a nice mix of qualitative and quantitative research. In the initial 1980 study, their primary goal was to document the portrayal of race relations on prime-time television, learning from the ground up (i.e., qualitative). In the 1995 follow-up study, though, the researchers primarily wanted to determine whether these portrayals had changed over a 15-year period. That is, they tested the hypothesis that race relations were portrayed in a more positive light (i.e., quantitative). Another way in which archival research can be qualitative is to study open-ended narratives, without attempting to impose structure upon them. This approach is commonly used to study free-flowing text, such as personal correspondence or letters to the editor in a newspaper. A researcher approaching these from a qualitative perspective would attempt to learn from these narratives, without attempting to impose structure via the use of content analyses.

Discussion

 

Discussion Guidelines Reminders: 

Be mindful of the tone and length of your posts.  Please avoid overly personal and overly lengthy comments.  See ranges posted below.   

To prepare for your first post, watch the following video on executive function. 
Executive function was briefly introduced in Chapter 1, then more thoroughly discussed in Chapter 7 (section 7.1.3). It is addressed again in Chapter 8, as well as several other chapters.  

https://youtu.be/efCq_vHUMqs

In your first post, respond to one of the following prompts: 

  1. Describe something new you learned, or something you found especially interesting, in the video. 
  2. Do you recall any childhood games you played that may have served to enhance executive function?  If so, what specific games? What aspects of the games do you believe served to help in executive function development?  For example, Manis (2020) mentions the game, Simon Says.

Scoring: 

  • Your first post is worth 30 points. To earn full points, first posts should be thoughtful, substantive comments, in the range of 75-100 words

Discussion

Discussion: Pros and Cons of Interest Groups, Lobbyists, and Corporations

Option 1: What are the pros and cons of lobbyists as a tool for special interest groups? Should former members of Congress be allowed to become lobbyists? Explain your answer.

Initial Post: minimum of 2 scholarly sources (must include your textbook for one of the sources)

Textbook: Chater 7, 8

Title: The Struggle for Democracy, 2018 Elections and Updates Edition Revel Access Code

Authors: EDWARD S. GREENBERG, Benjamin I. Page

Publisher: Pearson

Publication Date: 2018-12-31

Edition: 12th

APA Citation

Greenberg, E. S & Page, B. I. (2018). The Struggle for Democracy, 2018 Elections and Updates Edition. (12th ed.). Pearson.

This textbook is available as an e-book and can be accessed from the module view.

The Struggle for Democracy, 2018 Elections and Updates Edition Revel Access Code

Discussion

Using in-text referencing and a reference list, submit your initial discussion post.

Discuss your individual critical analysis of the posted article with in-text referencing to support your thoughts and ideas and with a reference list.

Critique the posted QI article and respond to the following items:

1.      Analyze and discuss why a QI project was needed.

2.      What initial steps were assessed by the QI team? Discuss their findings including the data.

3.      Why was the focus of the QI project on a specific population?

4.      Analyze the QI model used for this project. Name and discuss an alternative QI model that could have been used in this project.

5.      Evaluate the findings of the QI project. Were the findings relevant? How did the RNs utilize and integrate the findings into their nursing practice?

6.      What is your cosmic question?

Discussion

DQ1:    Please answer the following Discussion Question. Please be certain to answer the three questions on this week DQ and to provide a well-developed and complete answer to receive credit. Your main discussion answer needs to be at least 3 paragraphs in length with 3 references to justify your answer. 

       1. A person of Mediterranean descent may have low blood levels of hemoglobin.

a.   Describe why this is true and why nurses need to be aware of these differences in hemoglobin levels.

b. Explain how hemoglobin levels may affect a person’s health.

DQ2:  Please answer the following Discussion Question. Please be certain to answer the three questions on this week DQ and to provide a well-developed and complete answer to receive credit. Your main discussion answer needs to be at least 3 paragraphs in length with 3 references to justify your answer. 

  1. What is the difference between intrinsic and extrinsic values?
  2. Give an example of a belief system.
  3. Give an example of a ethical issues you have been involved in your workplace.

DQ3:  Please answer the following Discussion Question. Please be certain to answer the three questions on this week DQ and to provide a well-developed and complete answer to receive credit. Your main discussion answer needs to be at least 3 paragraphs in length with 3 references to justify your answer. 

  1. What is empowerment in Nursing?
  2. Describe types of power in Nursing.
  3. How does a good leader use their power?

Discussion

Example of Project Control Problems

Philosophies of Controlling Projects

Levers for Controlling Projects

Philosophy of project
control
The management style
the manager employs
in following a plan and
dealing with problems
or changes in the plan.

Dogmatic philosophy
A philosophy of
project control that
emphasizes strict
adherence to the
project plan, with
little tolerance for
deviations.

Laid-back philosophy
A philosophy of project
control that allows
for project problems
or change issues to
be dealt with as they
arise, on an ad hoc
basis.

Pragmatic philosophy
A compromise
between the dogmatic
and laid-back
philosophies that
sticks to a plan but
is flexible enough to
allow for changes.

Discussion

 

Some organizations have implemented bring your own device (BYOD)  policies. This enables organizations to save money on equipment costs  because employees are now using their personal computers. At the same  time, BYOD policies also present challenges for organizations. Now  organizations are in the business of supporting personal computers.

Go to Basic Search: Strayer University Online Library  to locate and integrate at least two quality, academic resources (in  addition to your textbook) on BYOD policies and the challenges  associated with them. You may also use government websites, such as Cybersecurity from the National Institute of Standards and Technology.

Please respond to the following in a post of at least 200 words:

  • Describe some of the specific challenges (for example, risks of  employees going to various websites, viruses, and legal implications)  associated with BYOD policies.
  • Recommend methods organizations can use to address the challenges associated with BYOD policies.
  • Provide full citations and references, formatted according to Strayer Writing Standards. 
    • For assistance and information, please refer to the Strayer Writing  Standards link in the left-hand menu of your course. Check with your  professor for any additional instructions.

In 60 to 75 words, please respond to at least one other post. Choose to respond to those who have few or no responses.

Discussion

The book “October Birds” by Jessica Smartt Gullion published in 2014 is a fictional book that describes the possible scenarios in a pandemic. In its 143 pages, Gullion describes a town in Texas that tries to maintain control during a pandemic. The author has an experience as an epidemiologist and puts her knowledge into what she thinks the challenges for the health system would be during a pandemic. Even though the book is fictional, it is pretty close to what we encountered when we just started the global pandemic.

The viruses share a lot of similarities. That’s one of the reasons that H7N1 and COVID-19 don’t differ much from each other. Especially in the way, the book describes the first one. While reading the book, the reader can’t really differentiate one from the other. Memorial Hospital represents every hospital in the world as well as the bureaucracy that they have to deal with.

The city of Dalton represents the whole world dealing with emergency management and the healthcare system. The whole city struggles to control the outbreak of infected people as same as happened when COVID-19 started around the world. The book scarily reflects how the world reacted during the pandemic and the problems they had as well.

The shortage of health workers, medicine, and food as well as the struggles that the companies and businesses were exactly how the book described them. The only difference that I don’t think was the same was the vaccination requirements since kids weren’t the first ones to get vaccinated and also another difference was the explosion of the bomb outside the vaccination center. I think that situation is more an analogy of the protests that the antivaccination people did around the world and how this segment of the population reacted to the mask requirements.

I thought this book was just telling the reality of the pandemic. It’s incredible that the book was written before the pandemic and that almost if not all of it is exactly what we all encountered when the global pandemic happened. For weeks, Covid-19 was spreading quickly, people were afraid of the uncertainty. Hospitals and Institutions were full in their capacity with not so many supplies and equipment, shortage of healthcare personnel, and the stress and circumstances under which the healthcare workers were working. The most important as well as the hard part was the decision of who was treated and who wasn’t.

Dr. Cromwell considered this. He nodded and wished that he had thought of it.

“Save the ventilators for the healthy patients. Patients who are the most likely to survive the H7N1.” Dr. Kiriarti said.

“I am not comfortable with this.” a young pulmonologist at the table spoke up, “Denying treatment? What is this, the Memorial eugenics program?

“We have to deny treatment, one way or another,” Cromwell said. “No one likes it. No one is happy about it. But what choice do we have?” (Gullion, 64). This probably was one of the hardest parts for healthcare professionals as well for people who didn’t have the economic means.

The author succeeds in making the characters of the book close to reality. The struggles and the huge emotional rollercoaster that these characters faced in the book are probably the same as people did and felt during Covid-19.

One of the main characters, Dr. Eliza Gordon made me think of the situations that most women that have families and careers deal with in everyday life. She represents every single mom that is a nurse, a doctor, a teacher, a driver, etc. In the book, she is trying to make things work the way she wants them so it can be more effective but the bureaucracy that she faces in the healthcare system and in the city makes her rethink her choices. She is a mom, a mom that wants to spend time with her kid but because of her busy carrier at Memorial Hospital and also because of H7N1, she barely sees her kid or husband. She decides to quit her job and dedicate more time to her family. Julia Campos, Lucy, Valarie, Cassandra, and a lot of women in the book are trying to survive the epidemic, and deal with bureaucracy, along with the fact that most of them have families. The idea of kids running at the Memorial Hospital because the schools and daycares are closed, makes me have a better appreciation for women that are mothers and trying to compete with men in the professional world either if they’re bus drives or doctors.

I definitely think that COVID-19 prepared us a little bit more. Institutions and people are adjusting to a new way of working and functioning. A lot of people are working from home and most of them are not planning to go back to an office. People that have to be physically at work are also trying to make changes after the pandemic. Even with all of these changes after COVID-19, I don’t think we will be completely prepared for another pandemic. We have so much division between us. The bureaucracy, sadly, is not changing for the better. The healthcare system still doesn’t have the capacity to deal with pandemics. They don’t have enough supplies and equipment but they also don’t have enough healthcare workers. We’re also more divided as a community, if we don’t learn how to change our individualistic mentality for a more community-oriented mentality we’re never going to be prepared for the next or more global pandemics.

“Cassandra? Do you know the difference between terror and horror?” He fingered the black beads of the rosary in his hand.

She assumed that he asked rhetorically, and didn’t answer.

“They are not the same thing. When a person feels terror, the response is to run. In the movie with the chainsaw character in the room, everyone flees. It is fear of immediate bodily harm. Horror is different. When you see horror, you can’t leave. You are glued to the spot, your mouth hanging open in shock, your blood cold, filled with dread. You can’t help but look, even though you want to turn away. It’s worse for parents. They don’t worry as much about their own safety. It’s the kids that get them. Tell a parent of a gruesome crime against a child, they’ll dwell on it for days. Sometimes they never really get it out of their head. This, Cassandra, “ He held his arms out wide, the rosary dangling between his fingers, “this is horror.” (Gullion, 120)

Discussion

In a growing global marketplace, companies can provide products, services, and jobs that promote economic development around the world.  However, as globalization has prompted firms to shift jobs abroad (offshoring or offshore outsourcing), some governments (and employees) have become increasingly concerned with protecting jobs and industries at home.  Additionally, the past few years, the global economy has experienced a tightening of the global supply chain, impacting product availability and prices of goods, causing governments to question their reliance on foreign markets to supply goods and raw materials.   What are your views on these issues?  Should an interwoven global economy continue to expand or should countries take steps to protect themselves?  Explain your view?  Just a page.

Discussion

 

Watch the video featuring Larry Burns in this module. Then consider this: Larry Burns’ vision for the future of computer enhanced cars was first described in 2005.  

How much of this vision have we realized today? Identify the players in this progress (people, companies, etc.) and discuss how object-oriented programming has factored in that development.  How do you see object-oriented programming enabling current and future trends in the automotive industry?

Around 200 Words

Discussion

After reviewing both videos on communication and how everyone can incorporate better ways to handle the various situations reflect on the following;  

1.  Describe two takeaways gained from listening to the TED Talk on establishing better ways to communicate? 

2. Reflect on how watching the videos and reviewing the articles on nursing attire increase your knowledge and awareness? 

Discussion

Think about the last time you utilized a mobile application or attempted to build your own mobile website.  What planning process did you go through before you began your project?  You may have considered the steps or tasks you needed to perform.  You may also have considered the resources and platforms needed for your outcome.  For example, which model fits your business domain needs?  Do you have time constraints that will make completing the web application/site difficult within a reasonable period of time?  You may also have considered the myths that surround developing mobile apps and the difficulties generally associated with mobile app development.

  • Why is mobile development difficult?  Explain
  • How does design & utility make a difference between good vs great websites? Explain
  • How is deciding between a mobile application vs a mobile website an important consideration by developers? Explain.

  • You must apply and use the basic citation styles of APA.
  • Do not claim credit for the words, ideas, and concepts of others.
  • Use in-text citation and list the reference of your supporting source following APA’s style and formatting
  • Do not copy and paste information or concepts from the Internet and claim that is your work.  It will be considered Plagiarism and you will receive a zero for your work.

discussion

To prepare for this discussion, read the instructor guidance and watch the videos 

Creating Your Research Proposal

 (Links to an external site.)
 and 

How to Write a Research Proposal? 11 Things to Include in a Thesis Proposal

 (Links to an external site.)
. Your initial post should be 250 to 300 words. Utilize a minimum of two peer-reviewed sources that were published within the last 10 years and are documented in APA style, as outlined in the Writing Center.

The purpose of this discussion assignment is to familiarize you with the purpose and components of a research proposal, and to allow an opportunity for you to get some feedback on your ideas for the Final Paper.

In your initial post,

· Briefly describe the purpose of a research proposal and its components.

· Present your research question and/or hypothesis.

· Give some background information on the topic, including citing one or two previous related studies with their references.

· Name the research design you would like to use.

· Defend why you feel it is the most appropriate way to study your research question.

· Discuss potential ethical issues that might arise and what you would do to address them.

Document your sources in 
APA style (Links to an external site.)
, with in-text citations and references listed at the end of the post. For additional guidance see the 
Citing Within Your Paper (Links to an external site.)
 and 
Formatting Your References List (Links to an external site.)
 resources from the Writing Center.

Discussion

P R A C T I C E I M P R O V E M E N T

Nicole S. C
Improvemen
ORCID iden

Brittany J. Ko
Services, Wa

Michael S. U
Professor, Ea

For correspo
WakeMed H
Raleigh, NC

J Emerg Nur
Available onl
0099-1767

Copyright �
All rights rese
https://doi.or

666 JO

DO NO HARM: A MULTIFACTORIAL APPROACH
TO PREVENTING EMERGENCY DEPARTMENT
FALLS—A QUALITY IMPROVEMENT PROJECT

Authors: Nicole S. Cook, BSN, CEN, CCRN, TCRN, Brittany J. Komansky, MHA, BSN, RN, CEN, and
Michael S. Urton, DNP, APRN, AGCNS-BC, Raleigh and Greenville NC

Earn Up to 8.0 Hours. See page 722.

Contribution to Emergency Nursing Practice

� The current literature indicates that emergency depart-
ment falls may be difficult to prevent and predict, how-
ever there is a significant gap in available research on
this topic.

� This article contributes to the existing literature by
describing a unique, multifactorial approach to emer-
gency department fall prevention to include data review,
fall risk assessment, remote video monitoring, exit alarm
strategy, fall prevention culture, and communication.

� Key implication for emergency nursing practice found in
this article: a multifactorial fall prevention program is
necessary, as no single intervention can address all po-
tential causes of patient falls in the emergency depart-
ment.

Abstract

Introduction: Patient falls in the emergency department are
a unique patient safety issue because of the often challenging
nature of the environment. As there are a variety of potential
causative factors for patient falls in the emergency department,

ook, Member, Cardinal Chapter-446, is Trauma Performance
t Coordinator, WakeMed Health & Hospitals, Raleigh, NC.
tifier: http://orcid.org/0000-0001-6672-1546.

mansky, Member, Cardinal Chapter-446, is Director, Emergency
keMed Health and Hospitals, Raleigh, NC.

rton is CNS Concentration Director and Clinical Assistant
st Carolina University, Greenville, NC.

ndence, write: Nicole S. Cook, BSN, CEN, CCRN, TCRN,
ealth and Hospitals, Trauma Services, 3000 New Bern Ave,
27610; E-mail: nicook@wakemed.org.

s 2020;46:666-74.
ine 4 June 2020

2020 Emergency Nurses Association. Published by Elsevier Inc.
rved.
g/10.1016/j.jen.2020.03.007

URNAL OF EMERGENCY NURSING

this project employed a multifactorial approach to prevent pa-
tient falls in a Level 1 trauma center emergency department
(adult only) in an urban tertiary care teaching hospital.

Methods: This project was a single-unit quality improvement
intervention that compared postintervention monthly unit-level
data to historic monthly rates on the same unit. The intervention
was multifaceted with patient-level, nurse-level, and unit-level
interventions employed. A task force was convened to review
and identify specific departmental gaps related to fall preven-
tion, complete a retrospective review of departmental patient
falls to determine causative factors, and implement interven-
tions to reduce ED falls. A comprehensive program consisting
of an ED-specific fall risk assessment tool, remote video moni-
toring (RVM), stretcher alarms, and a robust patient safety cul-
ture, among other interventions, was implemented. Patient falls
and falls with injuries were tracked as an outcome measure.

Results: After data driven analysis of causation, selection of
key interventions, staff education, and sustained focus for 2
years, the department experienced a 27% decrease in falls
and a 66% decrease in falls with injuries.

Discussion: A multifactorial approach was an effective strat-
egy to decrease patient falls in the emergency department.

Key words: Emergency; Fall; Multifactorial; Remote video
monitoring; Safety

Introduction

Patient falls are a safety concern for emergency departments
across the country. These events contribute to hospital ad-
missions, increased patient morbidity and mortality, and
in addition, to increased health care costs.1,2 High patient
volumes and the wide variety of patient acuities in the emer-
gency department make it difficult to predict and prevent
patient falls. Additional factors that have been implicated
in ED falls include long distances to restrooms, acute illness

VOLUME 46 � ISSUE 5 September 2020

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

Q1 FY15 Q2 FY15 Q3 FY15 Q4 FY15 Q1 FY16 Q2 FY16 Q3 FY16 Q4 FY16

Fa
ll

Ra
te

(e
ve

nt
s/

10
00

v
is

its
)

Fall Rate

FWI Rate

FIGURE 1

Baseline adult emergency department falls and falls with injuries, October 2014 to September 2016. Rate ¼ events/(Adult ED Visits/1000). FWI, falls with injuries; Q1, quarter
1; Q2; quarter 2; Q3; quarter 3; Q4, quarter 4; FY, fiscal year.

Cook et al/PRACTICE IMPROVEMENT

states, intoxication, and departmental crowding.1,2 As there
are a wide variety of factors potentially leading to ED falls, it
stands to reason that there could be a wide variety of inter-
ventions that may aid in preventing ED falls. Unfortunately,
most fall prevention literature is related to inpatient falls,
with limited ED-related literature and available screening
tools.

The purpose of this article was to provide an
example of how a comprehensive, ED-based fall preven-
tion initiative was created and implemented, including
the following components: triage-based fall risk assess-
ment, application of new monitoring technologies,
improved post event analysis, and awareness and recog-
nition activities.

Background

The National Database of Nursing Quality Indicators de-
fines a patient fall as a sudden, unplanned descent to the
floor (or other unintended surface), with or without injury.3

The organization tracks and reports both falls and fall-
related injuries to National Database of Nursing Quality In-
dicators as part of its quality improvement efforts. In the
inpatient setting, both falls and falls with injury (FWI) rates
are reported as the number of events per 1,000 patient days
(number of events/patient days x 1,000).3 In the emergency
department, fall and FWI rates are reported as the number
of events per 1,000 patient visits.3

September 2020 VOLUME 46 � ISSUE 5

This quality improvement project was conducted in an
adult emergency department, Level 1 trauma center in an
urban tertiary care teaching hospital that sees approximately
89,000 adults (aged 18 years and older) per year. It is part of
a 3-hospital system with 3 additional stand-alone emergency
departments and a separate children’s emergency depart-
ment. As the largest emergency department within the sys-
tem, this emergency department’s policies and clinical
practices serve as the basis for much of the entire organiza-
tion’s ED operations.

Although systemwide efforts to eliminate preventable
hospital-acquired adverse events had resulted in some suc-
cess in reducing patient falls and FWI, a unit-level analysis
identified emergency departments as a significant contrib-
utor of fall events for the organization. From October
2014 through September 2016 (Figure 1) the adult emer-
gency department averaged 62 falls per year for a rate of
0.75 falls per 1,000 visits with approximately 15% of these
falls resulting in injury (FWI rate 0.09 injury falls/1,000
visits). During this time, falls from patients in emergency
departments across the organization contributed 8.4% of
the total system falls.

Reducing the number of ED falls was identified as a crit-
ical focus for reducing overall system falls and improving pa-
tient safety outcomes. Given the relative size and patient
volume of the adult emergency department in comparison
to the other emergency departments within the system,
unit-level leadership decided that initiating a quality improve-
ment project within the adult emergency department would

WWW.JENONLINE.ORG 667

PRACTICE IMPROVEMENT/Cook et al

provide the best opportunity for program implementation
and evaluation of outcomes.

Review of Key Evidence

In emergency departments, falls may be difficult to predict
and prevent with the acute nature of patient visits and the
brief, episodic encounters.4-6 A review of the current
literature surrounding ED fall incidence and ED fall
prevention revealed a significant gap in the research
surrounding this topic. Most of the research done on the
topic of fall prevention has been focused on inpatient
hospital settings, including the design of fall risk
assessment tools and recognition of fall prevention
interventions.2,5,7 In many hospitals, these inpatient tools
have been applied to the ED setting despite lack of valida-
tion in these populations owing to lack of an ED-specific
alternative.8 It has only been in the last few years that
small-scale and retrospective studies have been conducted
in ED populations resulting in new insight and potential
screening tools specifically for the ED setting.8,9

Recommendations for effective fall prevention pro-
grams generally include key elements such as (1) population
identification, (2) risk factor screening, and (3) an individu-
alized, comprehensive plan of care.8,10,11 In addition, pro-
grams are encouraged to incorporate a multifactorial
approach, working to address individual risk, environmental
considerations, and staff knowledge and engagement along
with policies and equipment that support fall prevention ac-
tivities.10,12

Recent ED-based studies and improvement projects
seem to indicate that modified versions of inpatient fall pre-
vention tools and policies can be effective in the ED setting
but there is a strong need for high-quality research on (1) at-
risk populations in the emergency department, (2) ED-
specific fall risk prevention activities, and (3) application
of new technologies for screening, monitoring and prevent-
ing falls in the emergency department.4,7

Methods

This project was a single-unit quality improvement inter-
vention that compared postintervention monthly unit-
level data to historic monthly rates on the same unit. The
intervention was multifaceted with patient-level, nurse-
level, and unit-level interventions employed. Statistical anal-
ysis of the pre and postintervention fall rates was conducted
to establish if the changes were statistically significant

668 JOURNAL OF EMERGENCY NURSING

(a ¼ 0.05). As this work was consistent with a quality
improvement project and was not considered research, the
work was exempt from Institutional Board Review.

At the start of this project, a fall prevention task force
was convened, composed of emergency management, emer-
gency nurses, and other emergency staff. The objectives of
the task force were to (1) conduct a comprehensive review
of adult ED falls to identify trends, (2) identify the ED-
specific gaps/needs related to fall prevention, and (3) imple-
ment interventions to reduce ED falls and FWI. The team
worked with a clinical nurse specialist (CNS) with expertise
in patient safety and fall prevention to provide consultation
and to assist with the improvement initiative.

The ED fall prevention task force met biweekly in addi-
tion to several small group meetings with ED clinical staff to
better understand the unique challenges and current gaps in
the ED fall prevention practices. An in-depth, retrospective
review of fall data helped the task force to better identify the
specific characteristics of the ED falls (eg, age, sex, diagnosis,
timing, fall risk). A tour of the adult emergency department
was conducted with the task force and CNS consultant to
review concerns and challenges related to the environment
and workflow. These findings were summarized and
presented to ED leadership, the system falls committee,
and adult ED nursing staff as an initial step to generate in-
terest in the topic and encourage engagement from clinical
staff.

The key fall prevention barriers identified by the task
force were (1) departmental volume and acuity, (2) unit
layout and flow (eg, line of sight, shared bathrooms), and
(3) the lack of an ED-specific fall risk assessment tool. In
addition to these challenges, the task force recognized the
need for a strong fall prevention culture on the unit, backed
by an engaged and supportive leadership team. Given the
varied factors identified and recommendations found in
fall prevention literature, a multifactorial approach to
preventing falls, including risk assessment, unit culture,
electronic medical record (EMR) updates, and novel patient
monitoring interventions was initiated.

Interventions

DATA REVIEW

Although chart review and data analysis may not be thought
of as an intervention, the success of this fall prevention
initiative depended heavily on the initial analysis of ED falls
data. Though many patients are identified as being “high
risk” for falling, the reality is that most do not fall. Having
additional information may aid staff to better predict falls.

VOLUME 46 � ISSUE 5 September 2020

FIGURE 2

KINDER 1 fall risk assessment tool, reprinted with permission from Alexander et al.22

Cook et al/PRACTICE IMPROVEMENT

In addition to establishing baseline fall rates for the adult
emergency department, chart reviews were completed to
identify common factors and trends related to the falls.
Where appropriate, findings were used to guide changes
to care and operations based on identified factors. For
example, although no significant time-of-day trends were
noted, it was found that a disproportionate number of
intoxicated patients had fallen, which highlighted the need
for changes to the monitoring and bed assignment for these
patients.

FALL RISK ASSESSMENT

During the retrospective chart review it was calculated that
the Morse Fall Scale (MFS)13 had a specificity of 91% (low
rate of false negatives) but only a 23% sensitivity (high fall
risk score and went on to fall). Given the poor sensitivity of

September 2020 VOLUME 46 � ISSUE 5

the MFS for patients in this emergency department, a litera-
ture search was conducted by the CNS to identify available
ED-specific fall risk assessment tools. At the time, only 2 vali-
dated fall screening tools had been created for the ED envi-
ronment—the KINDER 18 (Figure 2) and the Memorial
ED Fall Screening Tool.9 There were no published studies
reporting the sensitivity or specificity of either tool, but adult
ED leadership and key clinical staff reviewed both tools for
potential use in the organization and the KINDER 1 was
selected as a potential replacement for the MFS for adult pa-
tients in emergency departments across the system.

REMOTE VIDEO MONITORING

Although still a relatively new technology, video monitoring
has been effective in reducing falls in the inpatient
setting.14-17 Remote video monitoring (RVM) was

WWW.JENONLINE.ORG 669

PRACTICE IMPROVEMENT/Cook et al

identified as a potential means to address the department’s
challenging layout and to assist with the high volume and
acuity. The organization had recently introduced 36
RVM devices to the inpatient setting, and following
discussions with nursing leadership, 2 were assigned to the
adult emergency department. These devices (Avasys
TeleSitter, Avasure, Belmont, MI) were nonrecording,
mobile video cameras that were monitored remotely by
hospital staff (max 12:1 monitor-to-staff ratio). The devices
had the capability to communicate directly with the patient
or staff via a speaker in addition to the ability to sound a
local alarm if needed. RVM could be initiated without
physician order on any patient that was identified at high
risk for falling. The 2 RVM devices allowed for monitoring
400 to 450 patients per month (20%-25% of high fall-risk
patients). Patient selection was based on the KINDER 1
score along with evaluation of the clinical team and nursing
leadership and consideration of patient risk factors (eg, age,
diagnosis, bed placement), staffing, and department acuity.

EXIT ALARM TECHNOLOGY

Bed (or stretcher) alarms are an intervention with mixed fall
prevention effectiveness18 and can contribute to alarm fa-
tigue.19 However, with the bay-based nature of the ED
layout and challenges with patient monitoring, bed alarms
were identified as a potential benefit for a comprehensive
fall prevention program. At the time of this improvement
project, the organization was in the process of purchasing
new stretchers (Stryker Prime Series, Stryker, Kalamazoo,
MI) and integrated bed exit alarm technology was a feature
that was considered and ultimately purchased. Following
equipment introduction and staff education, bed alarms
were then incorporated into the plan of care for those pa-
tients identified as a fall risk during triage.

FALL PREVENTION CULTURE

Although a successful fall prevention program requires policies
and resources, it is the engagement, knowledge, and commit-
ment of the staff and leadership that will sustain improvement.
There were a variety of actions that were used to engage staff
and generate buy-in and excitement regarding fall prevention.
One activity was the creation of the “Catch a Falling Star”
recognition program to recognize staff who had played a vital
role in preventing a patient fall or injury.Staff were nominated
by their peers or management team and were recognized on a
unit display board, presented with a certificate, and given a
small token of appreciation. In addition, milestone celebra-
tions were held on the unit and signage that indicated the

670 JOURNAL OF EMERGENCY NURSING

date of the last fall event was placed in the department and
visible to staff, patients, and families.

COMMUNICATION

Poor communication is one of the most common contribu-
tors to adverse patient safety events.20 Documentation of
the KINDER 1 began the communication about fall risk
between the triage nurse and the primary nurse and trig-
gered a fall prevention plan of care. In addition, changes
were made to the existing EMR to better communicate
fall risk and fall history. Flowsheets were created for docu-
menting the specifics of a patient fall, which then triggered
an alert within the EMR in the form of a red banner across
the top of the chart alerting staff that the patient had fallen
during their current encounter. On subsequent encounters,
the alert would populate to notify staff that the patient had
fallen during a previous encounter.

Results

With regard to fall risk assessment, screening of patients was
consistent at more than 95% compliance using both the
MFS (preimprovement) and the KINDER 1 (postimprove-
ment). These assessments were all completed during the
initial triage or by the primary registered nurse in the case
of a direct ED admission. During the year following the
change to KINDER 1, more than 80,000 patients were
assessed with KINDER 1 with 31% reported as positive
(ie, high fall risk). This was compared to the 10% of MFS
screens that resulted in a high-risk assessment. Using these
results and the patient fall data, the organization’s KINDER
1 sensitivity was calculated at 68% (pre-MFS ¼ 23%) and
the specificity 68% (pre-MFS ¼ 91%).

Outcome measures included both the adult ED fall
rate (adult ED falls per 1,000 patient visits) and the adult
ED FWI rate (adult ED injury falls per 1,000 patient
visits). Baseline data were reported for the 8 quarters
(January 2015 to September 2016) before the project’s
implementation. The implementation timeframe was
identified as January 2017 to June 2017. The postimple-
mentation time period was identified as July 2017 to June
2019. A t test (equal variance, 2-tailed) was conducted on
the pre- and postintervention data (fall rate and FWI rate)
to determine the statistical significance (a ¼ 0.05) of the
changes in fall rates following the improvement program.

Figure 3 displays the results of the adult ED fall rate
over these time frames. Figure 4 displays the adult ED injury
fall rate for the same time. Following implementation of the

VOLUME 46 � ISSUE 5 September 2020

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

Q2
FY15

Q3 Q4 Q1
FY16

Q2 Q3 Q4 Q1
FY17

Q2 Q3 Q4 Q1
FY18

Q2 Q3 Q4 Q1
FY19

Q2 Q3

Fa
ll

Ra
te

(e
ve

nt
s/

10
00

v
is

its
)

Fall Rate Mean Falls Rate

Pre-implementa�on Post-implementa�onInterven�on

FIGURE 3

Adult ED fall rates pre and post improvement. Rate ¼ falls/(adult ED visits/1000). Improvement activities included: ED task force (Q2-17), data analysis (Q2-17), staff recog-
nition program (Q2-17), KINDER 1 tool implementation (Q2-17), remote video in emergency department (Q3-17), and new ED stretcher with bed alarms (Q3-17). Q1,
quarter 1; Q2; quarter 2; Q3; quarter 3; Q4, quarter 4; FY, fiscal year.

Cook et al/PRACTICE IMPROVEMENT

improvement project, the fall rate decreased from 0.73 falls
per 1,000 visits (pre) to 0.55 falls per 1,000 visits (post),
representing a 25% decrease (t ¼ 1.41, P ¼ 0.18). The
injury rate decreased from 0.09 FWI per 1,000 visits (pre)
to 0.03 FWI per 1,000 visits (post), which was a 66%
decrease in injuries (t ¼ 2.29, P < 0.05). These decreases
represented 27 fewer falls and 10 fewer injuries over the
24-month postimplementation period despite a 3% increase
in adult ED volume over this time frame.

Discussion

As previously noted there has been a distinct lack of litera-
ture related to ED-specific fall prevention programs and in-
terventions. Available fall risk assessment tools have either
been inpatient-specific (not been validated for use in the
emergency department) or ED-specific tools that have not
been fully validated. As a result of this lack of evidence,
this patient safety initiative incorporated interventions
that were previously studied for use in the inpatient setting.
However, by incorporating these interventions into a multi-
factorial fall prevention program to address the unique
nuances of the ED setting we hope to fill this need for
ED-specific fall prevention literature.

September 2020 VOLUME 46 � ISSUE 5

Understanding the underlying trends and patient safety
gaps found in the fall events was a crucial initial step in this
initiative. This knowledge laid the foundation for an effec-
tive fall prevention program. Once the key implicating fac-
tors were identified, interventions were chosen from the
existing literature and implemented.

The use of RVM, although not new to the organization,
was a new approach in the emergency setting. The
utilization of RVM provided nurses with an additional
means of ensuring that high-risk falls patients were still
visibly monitored and communicated with, and that the
nurse was alerted when needed. Use of RVM was encour-
aged for patients determined to be at risk for falling, such
as intoxicated or altered patients or any patient who might
benefit from continuous monitoring. If all RVMs were in
use, exit alarms were available on all ED stretchers as were
constant-observer staff, providing nurses with multiple
monitoring strategies.

Implementation ofthe KINDER1 notonlyenabled staff
to assess patients with an ED-specific tool, but also contrib-
uted to the overall fall prevention culture. Staff appreciated
the fact that the KINDER 1 allowed for nursing judgment,
and it reinforced the belief that staff were empowered to assess
for and prevent patient falls. By selecting “nursing judgment”
on the KINDER 1, triage staff were able to identify patients

WWW.JENONLINE.ORG 671

0

0.02

0.04

0.06

0.08

0.1

0.12

0.14

0.16

0.18

0.2

Q2
FY15

Q3 Q4 Q1
FY16

Q2 Q3 Q4 Q1
FY17

Q2 Q3 Q4 Q1
FY18

Q2 Q3 Q4 Q1
FY19

Q2 Q3

In
ju

ry
F

al
l R

at
e

(e
ve

nt
s/

10
00

v
is

its
)

Injury Fall Rate Mean FWI Rate

Pre-Implementa�on Post-Implementa�onInterven�on

FIGURE 4

Adult ED injury fall rates pre and post improvement. Rate ¼ injury falls/(adult ED visits/1000). Improvement activities included: ED task force (Q2-17), data analysis (Q2-17),
staff recognition program (Q2-17), KINDER 1 tool implementation (Q2-17), remote video in emergency department (Q3-17), and new ED stretcher with bed alarms (Q3-17).
Q1, quarter 1; Q2; quarter 2; Q3; quarter 3; Q4, quarter 4; FY, fiscal year; FWI, falls with injuries.

PRACTICE IMPROVEMENT/Cook et al

who they felt were most in need of additional monitoring
during their visit. By implementing this methodology, nurse
leaders were able to keep the RVM in use and prioritize the
needs of patients with the highest risk for falling.

Creation of a unit-based culture of fall prevention in a
high-volume, high-acuity emergency department can be
difficult and requires commitment and constant vigilance
and encouragement from the department’s leaders. With
strong organizational and unit-based leadership support this
project was implemented and ingrained into the culture of
the adult emergency department. This culture was fostered
and encouraged by the Catch a Falling Star Program, imple-
mentation of the KINDER 1, and unit-based celebrations
when milestones such as a year without FWI were achieved.

As the fall rate within the department began to decline,
staff recognized that ED falls were indeed more preventable
than they previously believed, which further reinforced the
fall prevention culture. Although the reduction in falls (27
less falls, t ¼ 1.41, P ¼ 0.18) may not be statistically signif-
icant, the impact of this program can be measured by other
means. For example, without a fall, you cannot have a fall-
related injury. Although it may be difficult to quantify,
avoiding the associated legal and financial costs, in addition
to the increased morbidity and mortality associated with
fall-related injuries, is a significant and positive impact for
this patient safety initiative.

672 JOURNAL OF EMERGENCY NURSING

FINANCIAL CONSIDERATIONS

The purpose of this article was not to make a business case
for a particular set of interventions but rather to explore a po-
tential multifactorial approach to fall prevention in a setting
not often studied. Two technologies (RVM and exit alarm
technology) were included in this discussion, both represent-
ing significant potential cost to an organization. In the case
of RVM, organizations would need to consider the potential
up-front cost of the video monitors, software licensing, and
ongoing payroll for monitoring staff. Although exit alarms
on stretchers may represent significant additional expense,
there are a variety of companies that produce portable, single
patient-use exit alarms that could be implemented in the
emergency department. Regardless of the initial and ongoing
financial investment, organization savings were found to be
present in costs associated with reduction of falls and FWI21

in addition to far more significant savings related to reduced
constant observer (or “sitter”) personnel costs.14,15

Limitations

There were limitations to this project that could restrict
generalizability and replication in other organizations. The
potential for unreported or unobserved falls, in addition

VOLUME 46 � ISSUE 5 September 2020

Cook et al/PRACTICE IMPROVEMENT

to misclassification of fall events may affect data reliability.
Staff education regarding the fall prevention initiative and
interventions was disseminated, however no measurement
of the effect of this education on staff perception of patient
falls and project engagement was collected. The lack of vali-
dated, tested ED-specific fall prevention tools and interven-
tions was a limiting factor in the creation of this program.
The type of emergency department (adult only Level 1
trauma center) may be a limiting factor in the generaliz-
ability of the findings to other ED populations.

Key Implications for Emergency Nursing Practice

Patient falls in the emergency department can be difficult to
anticipate and prevent owing to the challenging ED setting
and patient population. In order to create an effective ED
fall prevention program, a thorough investigation into
unit-specific contributing factors is imperative. Once
contributing factors are identified, appropriate interventions
can be determined and implemented. Given the multiple
factors present in most falls, a multifactorial approach to
fall prevention is necessary. Fostering a robust fall preven-
tion culture is of utmost importance to ensure staff buy-in
and program sustainability. The continued success of this
particular program is attributed to the fact that fostering a
strong fall-prevention culture remains a high priority item
for unit leadership, with continued emphasis on staff educa-
tion and celebrations of unit successes.

Conclusion

Preventing falls and fall-related injuries in the ED setting is of
high importance owing to the implications of increased
admission rates, length of stay, health care costs, and
morbidity and mortality rates.1,7,8,12 Patients present to the
emergencydepartmenttogetbetter,nottoexperiencefurther
injury or harm. However, nurses often consider patient falls
in the emergency department to be an unavoidable occur-
rence related to the unpredictable, fast-paced nature of the
setting. A closer analysis of patient fall events shows that
many of these events could have been prevented with the
appropriate screening, staff knowledge, and available equip-
mentand resources.This improvement projectdemonstrated
that a multifactorial fall prevention approach may allow
emergency departments to better address this complicated
problem. By closely examining the existing adult ED fall
data, targeted interventions were implemented to improve
the staff and department capabilities related to patient safety

September 2020 VOLUME 46 � ISSUE 5

and fall prevention. These efforts resulted in a 27% decrease
in adult ED patient falls and a 66% decrease in FWI. Novel
interventions and technologies such as RVM, stretchers with
exit alarms, and EMR updates coupled with staff education
and the creation of a culture of fall prevention awareness
created a sustainable fall prevention program.

Author Disclosures

Conflicts of interest: none to report.

REFERENCES

1. Hwang U, Morrison RS. The geriatric emergency department. J Am
Geriatr Soc. 2007;55(11):1873-1876. https://doi.org/10.1111/j.1532-
5415.2007.01400

2. Terrell KM, Weaver CS, Giles BK, Ross MJ. ED patient falls and result-
ing injuries. J Emerg Nurs. 2009;35(2):89-92. https://doi.org/10.1016/
j.jen.2008.01.004

3. Staggs VS, Davidson J, Dunton N, Crosser B. Challenges in defining and
categorizing falls on diverse unit types: lessons from expansion of the
NDNQI falls indicator. J Nurs Care Qual. 2015;30(2):106-112

Discussion

The purpose of this week’s discussion is to actively discuss with your classmates the topic of your first marketing decision. Before you can make your first marketing decision, you need to understand who your customer is. In the lesson from this week, the following statement was made: The customer is the most important resource to any new start-up. It was initially proposed for you to think about. Now, you need to put your thoughts into action. Do you agree or disagree with this statement? Defend your position.

Discussion

Week 2 Discussion: Connection Between Our Culture and the News Media

Option 2: Many experts see the media as biased and more like infotainment. In fact, many people have turned to social networks as an outlet for news instead of CBS, NBC, FOX, CNN and other news stations. Do you see this as an issue? Do you see the news as biased or unbiased? Should there be more restrictions on the news stations?

Initial Post: minimum of 2 scholarly sources (must include your textbook for one of the sources).

Be sure to make connections between your ideas and conclusions and the research, concepts, terms, and theory we are discussing this week.

Textbook: Chapter 5, 6

Title: The Struggle for Democracy, 2018 Elections and Updates Edition Revel Access Code

Authors: EDWARD S. GREENBERG, Benjamin I. Page

Publisher: Pearson

Publication Date: 2018-12-31

Edition: 12th

APA Citation

Greenberg, E. S & Page, B. I. (2018). The Struggle for Democracy, 2018 Elections and Updates Edition. (12th ed.). Pearson.

This textbook is available as an e-book and can be accessed from the module view.

The Struggle for Democracy, 2018 Elections and Updates Edition Revel Access Code

discussion

To prepare for this discussion, read the instructor guidance, and Sections 
2.2

2.3

2.4
, 3.3, “Steps” in Section 
3.4

3.5

4.3
, and 
Chapter 5
 of the Newman (2016) textbook.

In contrast to qualitative designs, which are all basically non-experimental and descriptive, quantitative research designs may be either experimental or non-experimental. Within the non-experimental category, descriptive and correlational research are sub-categories.

Using the University of Arizona Global Campus Library databases, look for a scholarly/peer-reviewed quantitative research study on the topic you selected in Week 1. In your initial post,

· Appraise the differences between experimental and non-experimental research.

· Differentiate between a correlational study and an experimental study.

· State the hypothesis being tested in the selected quantitative research study.

· Identify the major variables and categorize them as independent or dependent.

· Describe the methods and results of the study.

· Determine whether the study is descriptive, correlational, or experimental, and explain why it fits this classification.

Discussion


Leadership

Turnitin Assignment Content

1.

Top of Form

*********** INDIVIDUAL ASSIGNMENT***********

For this research paper describe the importance of leadership style as a Nursing Leader.

Requirements:

Word Count—Minimum 1500-1800 words

References—Minimum 3 reviewed references, the oldest being no more than 5 years old.

*********APA FORMAT IS REQUIRED **************

Bottom of Form

discussion

2.2 Reliability and Validity

Each of the three types of research designs—descriptive, correlational, and experimental—has the same basic goal: to take a hypothesis about some phenomenon and translate it into measurable and testable terms. That is, whether researchers use a descriptive, correlational, or experimental design to test predictions about income and happiness, they still need to translate (or operationalize) the concepts of income and happiness into measures that will be meaningful for the study. Unfortunately, the sad truth is that research measurements will always be influenced by factors in addition to the conceptual variable of interest. Answers to any set of questions about happiness will depend both on actual levels of happiness and the ways people interpret the questions. The meditation experiment may have different effects, depending on people’s experience with meditation. Even describing the percentage of Republicans voting for independent candidates will vary according to characteristics of a particular candidate.

These additional sources of influence can be grouped into two categories: random and systematic errors. Random error involves chance fluctuations in measurements, such as when a participant misunderstands the question, or shows up in a terrible mood after walking through a blizzard to get to the study. Although random errors can influence measurement, they generally cancel out over the span of an entire sample. That is, some people may overreact to a question while others underreact. Heavy snowfall might put one person in a terrible mood and make another appreciate the joy of winter. While both of these examples would add error to a dataset, they would cancel each other out in a sufficiently large sample.

Systematic errors, in contrast, are those that systematically increase or decrease along with values of the measured variable. For example, people who have more experience with meditation may consistently show more improvement in a meditation experiment than those with less experience. Or, people who have higher self-esteem may score higher on a measure of happiness than those with lower self-esteem. In this case, the happiness scale does not do a good job of homing in on the concept of “happiness” and will end up instead assessing a combination of happiness and self-esteem. These types of errors can cause more serious trouble for a researcher’s hypothesis tests because they interfere with the attempts to understand the link between two variables.

In sum, the measured values of a variable reflect a combination of the true score, random error, and systematic error, as the following conceptual equation shows:

Measured Score = True Score + (Random Error + Systematic Error)

For example:

Happiness Score = Actual Happiness + (Misreading the Question + Self-Esteem)

So, if our measurements are also affected by outside influences, how do we know whether our measures are meaningful? Occasionally, the answer to this question is straightforward; if we ask people to report their weight or their income level, these values can be verified using objective sources. Many research questions within psychology, however, involve more ambiguity. How do we know that our happiness scale is accurate? The problem is that we have no way to objectively verify happiness beyond people’s self-reports of their own happiness. What researchers need, then, are ways to assess how close they are to measuring happiness in a meaningful way. This assessment involves two related concepts: reliability, or the consistency of a measure; and validity, or the accuracy of a measure. This section examines both of these concepts in detail.

Reliability

The consistency of time measurement by watches, cell phones, and clocks reflects a high degree of reliability. People think of a watch as reliable when it keeps track of the time consistently—an hour should take the same amount of time to pass, 24 times per day. Likewise, the scale is reliable when it gives the same value for weight in back-to-back measurements—an individual’s weight should be the same if he steps off the scale and right back on, provided he stays away from the fridge in the meantime.

Reliability is defined as the extent to which a measured variable is free from random errors, and it is best understood as the degree of consistency in research measurements. As the chapter discussed previously, researchers’ measures are never perfect, and five main sources of random error threaten reliability:

1. Transient states, or temporary fluctuations in participants’ cognitive or mental state; for example, some participants may complete a study after an exhausting midterm or after a fight with their significant others.

2. Stable individual differences among participants; for example, some participants are habitually more motivated or happier than other participants.

3. Situational factors in the administration of the study; for example, an experiment conducted in the early morning may make everyone tired or grumpy.

4. Bad measures that add ambiguity or confusion to the measurement; for example, participants may respond differently to a question about “the kinds of drugs you are taking.” Some may take this to mean illegal drugs, whereas others interpret it as prescription or over-the-counter drugs.

5. Mistakes in coding responses during data entry; for example, a handwritten “7” could be mistaken for a “4.” (Happily, these types of errors have been minimized by the increasing role of computers in data collection. If someone clicks the number “7” in an online survey, the computer will record it as a “7” almost every time.)

Researchers naturally want to minimize the influence of all of these sources of error, and the text will touch on techniques for doing so throughout. However, researchers are also resigned to the fact that all measurements contain a degree of error. The goal, then, is to develop an estimate of how reliable measures are. Researchers generally estimate reliability in three ways.

1. Test–retest reliability refers to the consistency of the measure over time—much like the examples of a reliable watch and a reliable scale. A fair number of research questions in the social and behavioral sciences involve measuring stable qualities. For example, if someone were to design a measure of intelligence or personality, both of these characteristics should be relatively stable over time. An individual score on an intelligence test today should be roughly the same as the score when tested again in five years. A person’s level of extroversion today should correlate highly with his or her level of extroversion in 20 years. The test–retest reliability of these measures is quantified by simply correlating measures at two time points. The higher these correlations are, the higher the reliability will be. This makes conceptual sense as well; if measured scores reflect the true score more than they reflect random error, then this will result in increased stability of the measurements.

2. Inter-item reliability refers to the internal consistency among different items on a measure. Think back to the last time you completed a survey. Did it seem to ask the same questions more than once? (Chapter 4 [4.1] will discuss this technique.) The repetition is included because a single item is more likely to contain measurement error than the average of several items will—remember that small random errors tend to cancel out each other. Consider the following items from Sheldon Cohen’s Perceived Stress Scale (Cohen, Kamarck, & Mermelstein, 1983):

· In the last month, how often have you felt that you were unable to control the important things in your life?

· In the last month, how often have you felt confident about your ability to handle your personal problems?

· In the last month, how often have you felt that things were going your way?

· In the last month, how often have you felt difficulties were piling up so high that you could not overcome them?

Each of these items taps into the concept of feeling “stressed out,” or overwhelmed by the demands of life. One standard way to evaluate a measure like this is by computing the average correlation between each pair of items, a statistic referred to as Cronbach’s alpha. The more these items tap into a central, consistent construct, the higher the value of this statistic is. Conceptually, a higher alpha means that variation in responses to the different items reflects variation in the “true” variable being assessed by the scale items. Alpha levels range from zero to one, with higher numbers indicating more internal consistency. As a general rule, researchers want this index to be above 0.70 to have any confidence in the measure.

3. Interrater reliability refers to the consistency among judges observing participants’ behavior. The previous two forms of reliability were relevant in dealing with self-report scales; interrater reliability is more applicable when the research involves behavioral measures, which involve direct and systematic recording of observable behaviors. Imagine a researcher is studying whether alcohol consumption makes people behave more aggressively. One way to tackle this hypothesis would be to have a group of judges observe participants after drinking and rate their levels of aggression. In the same way that using multiple scale items helps to cancel out the small errors of individual items, using multiple judges cancels out the variations in each individual’s ratings. In this case, people could have slightly different ideas and thresholds for what constitutes aggression. To determine how much these differences matter, the researcher can evaluate the judges’ ratings by calculating the average correlation among the ratings. The higher the alpha values, the more the judges agree in their ratings of aggressive behavior. Conceptually, a higher alpha value means that variation in the judges’ ratings reflects real variation in levels of aggression.

Validity

Recall the watch and scale examples. Perhaps some people set their watch 10 minutes ahead to avoid being late. Or perhaps certain individuals adjust their scale by 5 pounds to boost either their motivation or self-esteem. In these cases, the watch and the scale may produce consistent measurements, but the measurements are not accurate. It turns out that the reliability of a measure is a necessary but not sufficient basis for evaluating it. Put bluntly, measures can be (and have to be) consistent, but they might still be worthless. The additional piece of the puzzle is the validity of measures, or the extent to which they accurately measure what they are designed to measure.

Whereas reliability is threatened more by random error, validity is threatened more by systematic error. If the measured scores on the happiness scale reflect, say, self-esteem more than they reflect happiness, this would threaten the validity of the scale. The previous section explained that a test designed to measure intelligence ought to be consistent over time. And, in fact, these tests do show very high degrees of reliability. However, several researchers have cast serious doubts on the validity of intelligence testing, arguing that even scores on an official IQ test are influenced by a person’s cultural background, socioeconomic status (SES), and experience with the process of test-taking (for discussion of these critiques, see Daniels et al., 1997; Gould, 1996). For example, children growing up in higher SES households tend to have more books in the home, spend more time interacting with one or both parents, and attend schools that have more time and resources available—all of which correlate with scores on IQ tests. Thus, because all of these factors could increase scores on an intelligence test, they amount to systematic error in the measure of intelligence and, therefore, threaten the validity of a measured score on an intelligence test.

Researchers have two primary ways to discuss and evaluate the validity, or accuracy, of measures: construct validity and criterion validity.

Researchers evaluate construct validity based on how well the measures capture the underlying conceptual ideas (i.e., the constructs) in a study. These constructs are equivalent to the “true score” discussed in the previous section. That is, how accurately does the bathroom scale measure the construct of weight? How accurately does an IQ test measure the construct of intelligence relative to other things? The validity of measures can be assessed in a couple of ways. On the subjective end of the continuum, researchers can evaluate construct validity by assessing the face validity of the measure, or the extent to which it simply seems like a good measure of the construct. The items from the Perceived Stress Scale have high face validity because the items match what we intuitively mean by “stress” (e.g., “How often have you felt difficulties were piling up so high that you could not overcome them?”). However, if we were to measure an individual’s speed at eating hot dogs and then state it was a stress measure, the participant might be skeptical because hot-dog eating speed would lack face validity as a measure of stress.

Although face validity is nice to have, it can sometimes (ironically) reduce the validity of the measures. Imagine seeing the following two measures on a survey of attitudes:

1. Do you dislike people whose skin color is different from yours?

2. Do you ever beat your children?

On the one hand, these are extremely face-valid measures of attitudes about prejudice and corporal punishment—the questions very much capture our intuitive ideas about these concepts. On the other hand, even people who do support these attitudes may be unlikely to answer honestly because they recognize that neither attitude is popular. In cases like this, a measure low in face validity might end up being the more accurate approach. Chapter 4 will discuss ways to strike this balance.

On the less subjective end, researchers can evaluate construct validity by examining measures’ empirical connections to both related and unrelated constructs. Imagine for a moment that we are developing a new measure of liberal political attitudes. If we think about a person who describes herself as liberal, she is likely to support gun control, equal rights, and a woman’s right to choose. And, she is less likely to be pro-war, anti-immigration, or anti-gay rights. Therefore, we would expect our new liberalism measure to correlate positively with existing measures of attitudes toward guns, affirmative action, and abortion. This pattern of correlations taps into the metric of convergent validity, or the extent to which our measure overlaps with conceptually similar measures. But, we would want to ensure that the new measure captures something distinct from other constructs. In this case, we might want to demonstrate that we have developed a true measure of political attitudes, which does not simply correlate with religious beliefs. That is, we would want to show that liberal political views could be independent of religion. This hypothesized lack of correlations taps into the metric of discriminant validity, or the extent to which a measure diverges from unrelated measures.

To take another example, imagine someone wanted to develop a new measure of narcissism, usually defined as an intense desire to be liked and admired by other people. Narcissists tend to be self-absorbed but also very attuned to the feedback they receive from other people—especially feedback about the extent to which people admire them. Narcissism somewhat resembles self-esteem but differs enough; perhaps it is best viewed as high and unstable self-esteem. So, given these facts, a researcher might assess the discriminant validity of the measure by making sure it does not overlap too closely with measures of self-esteem or self-confidence. This approach would establish that the narcissism measure stands apart from these different constructs. The researcher might then assess the convergent validity of the measure by making sure that it does correlate with things like sensitivity to rejection and need for approval. These correlations would place the measure into a broader theoretical context and help to establish it as a valid measure of the construct of narcissism.

Portrait of a businessman.

Jupiterimages/Stockbyte/Thinkstock

Criterion validity can be used to predict a future behavioral outcome like management success.

Criterion validity involves evaluating the validity of measures based on the association between measures and relevant behavioral outcomes. The “criterion” in this case refers to a measure that can be used to make decisions. For example, if someone developed a personality test to assess an individual’s management style, the most relevant metric of its validity is whether it predicts a person’s actual behavior as a manager. That is, we might expect people scoring high on this scale to be able to increase the productivity of their employees and to maintain a comfortable work environment. Likewise, if someone developed a measure that predicted the best careers for graduating seniors based on their skills and personalities, then criterion validity would be assessed using people’s actual success in these various careers. Whereas construct validity is more concerned with the underlying theory behind the constructs, criterion validity is more concerned with the practical application of measures. As might be expected, researchers are more likely to use this approach in applied settings.

That said, criterion validity is also a useful way to supplement validation of a new questionnaire. For example, a questionnaire about generosity should be able to predict people’s annual giving to charities, and a questionnaire about hostility ought to predict hostile behaviors. To supplement the construct validity of the narcissism measure, a researcher might examine its ability to predict the ways people respond to rejection and approval. Based on the definition of the construct, the researcher might hypothesize that narcissis

Discussion

 Initial Postings: Read and reflect on the assigned readings for the week. Then post what you thought was the most important concept(s), method(s), term(s), and/or any other thing that you felt was worthy of your understanding in each assigned textbook chapter.

Your initial post should be based upon the assigned reading for the week, so the textbook should be a source listed in your reference section and cited within the body of the text. Other sources are not required but feel free to use them if they aid in your discussion.

Also, provide a graduate-level response to each of the following questions:

  1. Despite increases in diversity training programs, outcomes are not consistently leading to increases of diversity within upper management. What might be the reason for this phenomenon and how might it be addressed? 

[Your post must be substantive and demonstrate insight gained from the course material. Postings must be in the student’s own words – do not provide quotes!]

 [Your initial post should be at least 450+ words and in APA format (including Times New Roman with font size 12 and double spaced) 

Book: 

 Robbins, S. P., & Judge, T. (2022). Essentials of organizational behavior. Student Value Edition. Pearson 15th Edition.  

discussion

3:09 PM (CT)

Assignment Details

Assignment Description

Graduate Programs Discussion Boards

Discussion Boards (DB) are a key component of online learning. They foster active participation of learners and dialog with fellow learners and instructors. Graduate­level courses
require learners to create original posts to course DBs and to engage in dialogue by responding to posts created by others throughout the course. Original posts and responses
should be substantive, and if references are made to the works of others, APA guidelines for in­text citations and references apply.

Minimum Weekly DB Expectations

Post an original and thoughtful Main Post to the DB prompt.
Respond to at least 2 other posts from learners and/or the instructor (Response Posts).
The first contribution (Main Post or Response Post) must be posted before midnight (Central time) on Friday of each week.
Two additional responses are required after Friday of each week.
For DB assignment prompts with a Part One and Part Two, Part One should be addressed in the first week of the unit with a Main Post and minimum of 2 Response
Posts, and Part Two should be addressed in the second week of the unit with a Main Post and a minimum of 2 Response Posts.

More on DBs

At the end of each unit, DB participation is assessed based on level of engagement and the quality of the contribution to the discussion. DBs allow learners to learn through
sharing ideas and experiences as they relate to course content. Because it is not possible to engage in two­way dialogue after a conversation has ended, no posts to the DB are
accepted after the end of the unit. Learners must demonstrate an appropriate depth of understanding of course content to receive credit for having submitted substantive posts.
Typically, this is achieved with 3–4 strong paragraphs for Main Posts and 2–3 strong paragraphs for Response Posts.

Watch the following LinkedIn Learning Videos to help you with the assignments in this Unit.

The news media seems to regularly report on organizations, government, and individuals who lose data storage devices such as hard drives or USB drives and other digital
systems such as laptops, smart phones, etc.

What do you think is an organization’s responsibility to ensure protection and proper destruction of any sensitive or personal information regarding employees, customers,
etc.?
How do you dispose of sensitive automated information? Do you think this is sufficient to protect your information or that of your organization? Why or why not?
Discuss your understanding of how disk encryption can help protect data in case the hardware is lost or stolen.
Do you think this is enough to protect the data? Explain your answer.

The following grading rubric will be used for this assignment. 

In your own words, post a substantive response to the Discussion Board question(s) and comment on other postings.  Your response should address the DB
question(s) and move the conversation forward.  You will be graded on the quality of your postings, including mastery of the concept as well as critical thinking. 
If asked for your opinion, do not simply state that it is a good or bad idea; elaborate on your reasons and argument. Include enough detail to substantiate your
thinking as well as your position on the questions or comments.

For assistance with your assignment, please use your text, Web resources, and all course materials.

Reading Assignment
Ciampa, Part 5 (Enterprise Security), Module 15 (Risk Management and Data Privacy)
Ciampa, Part 2 (End Point Security), Module 5 (Mobile, Embedded and Specialized Device Security
Ciampa, Part 4 (Network Security), Module 9 (Network Security Appliances and Technologies)

Assignment Objectives
Make decisions related to company data security, and explain the impact of those decisions on an organization

Other Information
There is no additional information to display at this time.

Legend
Extra Credit View Assignment Rubric

Unit 3 ­ Discussion Board 

Assignment Overview

Unit:  Threat Management
Due Date:  Tue,5/17/22
Grading Type:  Numeric
Points Possible:  60
Points Earned: 
Deliverable Length:  See Assignment Details

Type:  Discussion Board

Go To:

Looking for tutoring? Go to Smarthinking

Assignment Details
Learning Materials
Reading Assignment

My Work:

Online Deliverables: Discussion Board

3:09 PM (CT)

Assignment Details

Assignment Description

Graduate Programs Discussion Boards

Discussion Boards (DB) are a key component of online learning. They foster active participation of learners and dialog with fellow learners and instructors. Graduate­level courses
require learners to create original posts to course DBs and to engage in dialogue by responding to posts created by others throughout the course. Original posts and responses
should be substantive, and if references are made to the works of others, APA guidelines for in­text citations and references apply.

Minimum Weekly DB Expectations

Post an original and thoughtful Main Post to the DB prompt.
Respond to at least 2 other posts from learners and/or the instructor (Response Posts).
The first contribution (Main Post or Response Post) must be posted before midnight (Central time) on Friday of each week.
Two additional responses are required after Friday of each week.
For DB assignment prompts with a Part One and Part Two, Part One should be addressed in the first week of the unit with a Main Post and minimum of 2 Response
Posts, and Part Two should be addressed in the second week of the unit with a Main Post and a minimum of 2 Response Posts.

More on DBs

At the end of each unit, DB participation is assessed based on level of engagement and the quality of the contribution to the discussion. DBs allow learners to learn through
sharing ideas and experiences as they relate to course content. Because it is not possible to engage in two­way dialogue after a conversation has ended, no posts to the DB are
accepted after the end of the unit. Learners must demonstrate an appropriate depth of understanding of course content to receive credit for having submitted substantive posts.
Typically, this is achieved with 3–4 strong paragraphs for Main Posts and 2–3 strong paragraphs for Response Posts.

Watch the following LinkedIn Learning Videos to help you with the assignments in this Unit.

The news media seems to regularly report on organizations, government, and individuals who lose data storage devices such as hard drives or USB drives and other digital
systems such as laptops, smart phones, etc.

What do you think is an organization’s responsibility to ensure protection and proper destruction of any sensitive or personal information regarding employees, customers,
etc.?
How do you dispose of sensitive automated information? Do you think this is sufficient to protect your information or that of your organization? Why or why not?
Discuss your understanding of how disk encryption can help protect data in case the hardware is lost or stolen.
Do you think this is enough to protect the data? Explain your answer.

The following grading rubric will be used for this assignment. 

In your own words, post a substantive response to the Discussion Board question(s) and comment on other postings.  Your response should address the DB
question(s) and move the conversation forward.  You will be graded on the quality of your postings, including mastery of the concept as well as critical thinking. 
If asked for your opinion, do not simply state that it is a good or bad idea; elaborate on your reasons and argument. Include enough detail to substantiate your
thinking as well as your position on the questions or comments.

For assistance with your assignment, please use your text, Web resources, and all course materials.

Reading Assignment
Ciampa, Part 5 (Enterprise Security), Module 15 (Risk Management and Data Privacy)
Ciampa, Part 2 (End Point Security), Module 5 (Mobile, Embedded and Specialized Device Security
Ciampa, Part 4 (Network Security), Module 9 (Network Security Appliances and Technologies)

Assignment Objectives
Make decisions related to company data security, and explain the impact of those decisions on an organization

Other Information
There is no additional information to display at this time.

Legend
Extra Credit View Assignment Rubric

Unit 3 ­ Discussion Board 

Assignment Overview

Unit:  Threat Management
Due Date:  Tue,5/17/22
Grading Type:  Numeric
Points Possible:  60
Points Earned: 
Deliverable Length:  See Assignment Details

Type:  Discussion Board

Go To:

Looking for tutoring? Go to Smarthinking

Assignment Details
Learning Materials
Reading Assignment

My Work:

Online Deliverables: Discussion Board

Discussion

 

Questionnaire:

  1. 1-What are Genes?
  2. 2-Describe what a chromosome is and how are present normally in human beings?
  3. 3-Concepts for: Euploid cells, Diploid Cells, Aneuploid Cells? What is a Polyploidy?
  4. 4-What is a Trisomy and an example of it?
  5. 5-What means Homozygous and heterozygous in Mendelian Heritance?
  6. 6-Which are special features of X Linked genetic diseases?
  7. 7-What is a risk factor?
  8. Also, what is a congenital disease?
  9. Epigenetics and Mental Health.
  10. 10-DNA Methylation: why is important?

Discussion

OCTOBER BIRDS

Social Fictions Series

Series Editor
Patricia Leavy
USA

The Social Fictions series emerges out of the arts-based research
movement. The series includes full-length fiction books that are
informed by social research but written in a literary/artistic form
(novels, plays, and short story collections). Believing there is much to
learn through fiction, the series only includes works written entirely in
the literary medium adapted. Each book includes an academic
introduction that explains the research and teaching that informs the
book as well as how the book can be used in college courses. The
books are underscored with social science or other scholarly
perspectives and intended to be relevant to the lives of college
students—to tap into important issues in the unique ways that artistic
or literary forms can.

Please email queries to pleavy7@aol.com

International Editorial Advisory Board

Carl Bagley, University of Durham, UK
Anna Banks, University of Idaho, USA
Carolyn Ellis, University of South Florida, USA
Rita Irwin, University of British Columbia, Canada
J. Gary Knowles, University of Toronto, Canada
Laurel Richardson, The Ohio State University (Emeritus), USA

October Birds
A Novel about Pandemic Influenza, Infection
Control and First Responders

By

Jessica Smartt Gullion
Department of Sociology and Social Work, Texas Woman’s University, USA

SENSE PUBLISHERS
ROTTERDAM / BOSTON / TAIPEI

A C.I.P. record for this book is available from the Library of Congress.

ISBN 978-94-6209-588-5 (paperback)
ISBN 978-94-6209-589-2 (hardback)
ISBN 978-94-6209-590-8 (e-book)

Published by: Sense Publishers,
P.O. Box 21858, 3001 AW Rotterdam, The Netherlands
https://www.sensepublishers.com/

Printed on acid-free paper

All rights reserved © 2014 Sense Publishers

No part of this work may be reproduced, stored in a retrieval system, or transmitted in any form or by
any means, electronic, mechanical, photocopying, microfilming, recording or otherwise, without written
permission from the Publisher, with the exception of any material supplied specifically for the purpose
of being entered and executed on a computer system, for exclusive use by the purchaser of the work.

v

TABLE OF CONTENTS

Acknowledgments vii

Preface ix

Introduction xiii

Chapter 1 1

Chapter 2 23

Chapter 3 33

Chapter 4 45

Chapter 5 61

Chapter 6 103

Chapter 7 121

Chapter 8 137

Afterword 141

About the Author 145

vii

ACKNOWLEDGMENTS

A project of this scope does not happen in isolation. First and
foremost, I would like to thank Sense Publishers Social Fiction
Series Editor Patricia Leavy for her support of this book. Its
publication came about by a strange synchronicity that will be a story
I’ll tell forever. Thank you also to Peter de Liefde and everyone at
Sense Publishers.

The initial draft of this story was written during National
Novel Writing Month (www.nanowrimo.org). I have to give a big
thanks to all of the folks involved in that project. Because of your
work I’ll never be a ‘one day’ novelist again.

Thanks to my first readers, Dona Perkins and Elrena Evans.
Finally, thanks to Greg, Renn, and Rory. You are my love

and my light.

ix

PREFACE

October Birds was born in the overlapping space between science
and art.

In 2003, in the wake of 9/11 and the anthrax letters, I was
hired to be the Chief Epidemiologist of one of the largest county
public health departments in Texas. The funds for my position
originated through federal concern over bioterrorism, and I was
tasked with planning and preparing for bioterror response. Luckily, it
didn’t happen.

Overtime, bioterrorism seemed less an immediate threat, and
public health became increasingly concerned with emerging and
reemerging infectious diseases. The SARS outbreak was a
frightening realization of what could happen. Ease of world travel,
coupled with a susceptible population, are kindling for a new
infectious disease. People were put into isolation and quarantine, and
public health legal powers were used to a level many of us have
never seen.

SARS died out, but while the experience was fresh, public
health professions wondered what would have happened had the
SARS fire blazed more widely.

Another likely scenario to consider, similar in nature to
SARS, was pandemic influenza. A pandemic is a world-wide disease
outbreak. Our statistical models, based in part on SARS and on the
1918 Spanish Flu pandemic, were frightening. I spent a good portion
of my work days strategizing and writing response plans for coping
with such a catastrophe.

And then it happened.
In the spring of 2009, I began to receive reports of unusual flu

activity. A new strain of flu, an Influenza A (H1N1) – dubbed ‘swine
flu’ by the press – emerged in Texas and California. Was this the
pandemic we’d prepared for? We had no idea how deadly this flu
would be. Fortunately, it turned out to be relatively mild, but we had
no way to predict that. For a while, public health responded as if our
fears had materialized. We took many of the actions portrayed in
October Birds. While our goal was to prevent as much illness and

PREFACE

x

death as possible, we were accused of over-response and our actions
criticized.

While a work of fiction, October Birds is grounded in real-
life public health practice, sociological research, and emergency
management. The novel a/r/tographical research, a sociological
inquiry within the science/art intersection. This novel is an
accumulation of my knowledge and experiences with infectious
disease outbreaks. I draw on scientific literature from medical,
infection control, public health, and sociology journals. I also draw
on personal experience. Many of the scenarios in the novel, while
fictionalized, are based on actual events. But October Birds is more
than a story – it is also a sociological theory of community-level
response to health threats. Using fiction as a mode of representation,
I hope to reach a larger audience than I could by focusing on a
traditional academic one, a goal important to me as an applied
sociologist.

I believe that in writing social fiction, we also engage in the
writing of social theory. This work is a representation of my
theorizing on community-level health threats, from the perspective of
public health, hospitals, and emergency services.

A community-level health threat is one in which every
member of the community is theoretically susceptible. While
pathology may vary person-to-person, all residents are threatened. I
have fourteen years’ experience as an applied sociologist, helping
communities cope with such threats. I have worked on outbreaks of
vaccine-preventable disease (such as whooping cough and rubella),
food borne outbreaks (including contaminated vegetables and peanut
butter), contaminated medical devices, flesh-eating bacteria, and
other diseases. I have also run and managed shelters for people
fleeing natural disasters (including Hurricane Katrina), and have
assisted in disaster recovery. Four years ago, I joined the sociology
faculty at Texas Woman’s University. While I am actively engaged
in a research agenda on community-level health threats, I have
shifted my focus from infectious disease to environmental health
threats, such as from toxins in the air and water, and I research and
teach on these issues.

OCTOBER BIRDS

xi

October Birds takes place in the fictional city of Dalton,
Texas. Using a hypothetical population of 115,000, I conducted
statistical modeling to project morbidity and mortality rates similar to
the 1918 Spanish Flu pandemic. Each chapter is equivalent to about
one week of the outbreak. Dalton has one hospital – Memorial – and
I used my knowledge of mid-sized regional hospitals to construct it.
The number of beds, ventilators, and negative air-flow rooms is
about what is typical for this size hospital. Patient overflow, shelters,
and points of dispensing medication are all likely to be found in most
disaster plans.

Dalton has a city health department with infectious disease
and disaster professions. Most cities are not so well-staffed in reality,
but it was necessary for the story. It is more likely that this size
department would serve an entire county or perhaps even region of a
state.

While I find the technical details interesting, it is the social
interactions which make community-level health threats interesting.
The medical sociology literature is ripe with research on power and
dominance in the medical profession, patterns which play out in the
novel. Clashes between licensed healthcare professionals and
traditional healers are well-documented in the literature as well. No
matter how prepared a community is for disaster, things go wrong.
Professionals and volunteers responding to the event become
overwhelmed and they burn out. Their mental health is often
overlooked in the midst of the response. These themes and others are
explored in the novel.

Fiction was used in the very first sociology course I took, and
I use fiction in courses I teach today. Through fiction, we can
imagine alternatives to our current social structure. We can explore
what happens when the structures that seem concrete crumble around
us. We can answer the question: ‘What if?’ using sociological
research and practice.

This novel can be read as a supplementary text in a number of
disciplines, including sociology (such as in courses on collective
behavior or medical sociology); nursing, public health, and health
studies; emergency management; and psychology (in courses on
critical incident stress management and crisis counseling). It can also

PREFACE

xii

be used interdisciplinarily in courses on qualitative research methods.
I hope it will also be read simply for pleasure, and instill the
question: ‘What if?’ What if a devastating pandemic does emerge?
How will we respond as a society? The question is real. Recent
reports on Pro-MED (the Program for Monitoring Emerging
Diseases, www.promedmail.org) on avian influenza in Asia hint at
the possibility of a new pandemic. How will we respond?

Jessica Smartt Gullion

xiii

INTRODUCTION

“What’s next on the board?”
Dr Stratford leaned against the large U-shaped desk and

looked for his nurse. The heart patient (chief complaint: chest pain,
history of stent) had been referred to the on-call cardiologist and the
attempted suicide (chief complaint: drug overdose) sat moaning to
the hospital psychologist about how her boyfriend had dumped her
via text message. Her throat still sounded hoarse from the stomach
pumping. He tried not to be rough with them, the suicides, but it
really pissed him off, having to spend time saving someone who
wanted to die while other patients waited for his attention, scared,
hurting, or just plain ready to get out of the emergency room and on
with their lives.

“You’ve got a five year old with a fever in exam room one.
Adult male complaining of vomiting and jaundiced in room two.
Wait till you see his eyes, they’re freakishly yellow. His wife’s all
upset, she’s being belligerent. I can’t get a good history from her.
Her English is terrible,” the nurse said. He opted for the kid.

The child lay still on the exam table, folded into a curl on his
side, his eyes closed. His mother swiveled on the rolling stool,
turning her hips from side to side, holding on to his hand. Dr
Stratford liked working with kids. He had almost become a
pediatrician, but he loved the adrenaline and drama of the emergency
room even more.

“You look like you don’t feel well,” Dr Stratford said. The
boy opened his eyes and stared at him. They were an old man’s eyes,
dark and tired. His cheeks and ears had a bright scarlet hue.

“He’s been running a fever all day. A hundred and three at
the highest,” the mother said. She placed her palm on the boy’s
forehead for emphasis.

“Any other symptoms? Coughing? Sore throat?”
“No, nothing.” She shot Dr Stratford a concerned look, and

then her eyes darted away, not wanting to prolong eye contact with
the doctor. A lot of people did that.

INTRODUCTION

xiv

“Hey buddy. Can you sit up?” Dr Stratford put his
stethoscope in his ears and warmed up the base with his hands while
the boy reluctantly, and rather dramatically, sat up in a slouch.

“Just breath in normally,” Dr Stratford said. The boy’s lungs
sounded clear. Healthy. No problems with the heart, that sounded
fine. He looked into the boy’s eyes. “Watch my finger without
moving your head.” The boy’s eyes followed, up, down, to either
side.

“Can you touch your chin to your chest? Like this?” Dr
Stratford demonstrated. The boy bent his neck. “Does that hurt at all?
No?

“What about your tummy? Does your tummy hurt?” The boy
shook his head no. “Can you lay down? Let me check it?”

The boy lay back and curled himself into a ball. Dr Stratford
gently rolled him onto his back and straightened out his legs.

“I just don’t know what’s wrong with him. He’s been acting
really tired all day. He says nothing hurts, but then there’s this fever.
I don’t know what to do.”

“It sounds like you are doing all of the right things. Does this
hurt?” He palpitated the boy’s abdomen. Everything felt fine. No
obstructions. No abscesses. “Does it hurt when you go potty? When
you pee?” The boy shook his head.

“I’m going to move your legs around, ok? Do they hurt? Does
it hurt when you walk?” He bent the boy’s legs at the knee and then
pushed them into his abdomen. The boy had no signs of meningitis.
His cell phone rang. “Excuse me for just a minute,” he said to the
mother.

“Your patient over in room two is not looking so hot,” the
nurse told him. “His wife is demanding you get in there.”

“Ok,” he replied. He hung up on her. The man could wait.
“Did they give him any fever medicine in triage?” he asked

the mother.
“No,” she said. That irritated him. A child with fever; they

were supposed to give Tylenol, start to make him comfortable
instead of making him suffer while waiting to be seen.

“Alright. We’ll get him some Tylenol and some Motrin. I
want you to give him both, alternating every three hours. Tylenol.

OCTOBER BIRDS

xv

Wait three hours. Motrin. Wait three hours. Then Tylenol again. Ok?
If he doesn’t get better in a couple of days, see his pediatrician.” He
watched the boy curl himself up again. “This looks like a viral
infection, nothing serious, but keep an eye on him. If he gets worse,
bring him back. If he develops any more symptoms, call your
pediatrician or just bring him back. We are here to help. The nurse
will bring you a print out of instructions, things to watch for. Do you
have any questions?”

“No, I don’t think so. I was really worried about meningitis.
You don’t think it’s meningitis?”

“No. He doesn’t have signs of it.”
“Thank you for looking at him.”
“I’ll have the nurse bring you some medicine and then you

can take him home, ok?”
Outside the exam room, Dr Stratford pumped the alcohol-

based hand sanitizer from the wall-mounted container and cleaned
his hands. A burning sensation reminded him of the small cut he’d
gotten earlier, scraped it while scrambling on the heart patient. An
intense burning sensation. He found his nurse working a crossword
puzzle. “If it’s not too much trouble, get the kid in exam one four
mills each of Tylenol and Motrin.”

“Four mills each? That seems high,” she said.
He glared at her.
“Besides,” she continued, “we only have infant Tylenol, not

children’s. You’ll have to order it from pharmacy.” She filled a word
in to her puzzle.

He took a deep breath and told himself to relax. “Are you
telling me that we are an emergency room and we can’t give a kid
with a fever some Tylenol?”

“That’s right,” she said, looking up from her puzzle. “You’ll
have to order it from pharmacy.”

“I have worked in this emergency room for fifteen years,” he
said, his voice rising. “And in that time I have seen thousands of kids
with fevers and I have given them all Tylenol. And now you are
telling me that that is not how things work in my ER?” He realized
he had caught the attention of most of the people in the room. “Get
the kid the Tylenol. Now.”

INTRODUCTION

xvi

The nurse sat debating for a moment whether or not to fight
with him, rolled her eyes, and stormed off in search of the medicine.

“What a bitch.”
Dr Stratford looked up to see his friend, Benjamin Cromwell.

“She’s new,” Stratford said.
“Where’d they get her?” Dr Cromwell asked him.
“Who knows? Damn nursing shortage. They’ll scrape the

bottom of the barrel for whatever they can get,” Dr Stratford said.
Frankly, the whole thing sickened him. He missed the days when
nurses did what they were told. Nowadays they questioned him,
double-guessed him, constantly.

Finished with the boy, he started to check on his patient in
exam two.

The ambulance bay doors burst open. Two EMTs rushed in,
pushing a man on a gurney. “He’s crashing!” one of them yelled.
“Respiratory distress. We intubated him in the box.”

Dr Stratford ran after them, his adrenaline rising.

1

CHAPTER 1

Dalton, Texas
Total infected = 1

Total dead = 0

“I have Japanese Encephalitis,” a woman on the phone told her.

“Really? Have you been to a doctor?” Eliza scratched the
letters JE on her purple notepad and began to take the report.

“No, I just think, I mean, I am pretty sure that’s what I have.”
“Ok. Why do you think that? Have you traveled outside of the
country recently?”

“No, I think I must be the first person to get it in the United
States. I looked up my symptoms on the internet and that sounds
exactly like what I have.”

Eliza rubbed her temples and tried not to sigh audibly into the
phone. She hated people who self-diagnosed. Especially off of the
internet. No one ever diagnosed themselves with something benign.
No, they were all dying of something exotic that would awe their
friends. “You really need to go to the doctor for a diagnosis,” she
said.

“Can you just do a blood test for me?”
“What are your symptoms?” Eliza asked.
“Well, I’ve had this really bad headache off and on for a few

weeks now and my muscles all hurt. Oh, and I’ve been nauseated.”
“Have you had a fever?”

“No.”
“There are a lot of things that can cause those symptoms. It is

important that you see a doctor because the doctor can find out what
is going on and can help you.” She drew spirals down the side of her
paper. She smelled coffee; Geoff must be in. She could always trust
Geoff to brew a pot.

“Oh. Ok. So you can’t just test my blood?”
“If your doctor decides that you might have Japanese

Encephalitis, we will be happy to work with them to get your blood
tested for it. But I need to talk with the doctor about that first.” She
wanted to add, and leave me alone, you kook, but didn’t.

CHAPTER 1

2

“Oh, Ok. Well, thanks.”
The voice really didn’t sound thankful. Eliza hung up the

phone and went to get some coffee. On the way down the hall she
noticed that her cup had mold at the bottom.

For the last few years, Dr Elizabeth Gordon had worked as
Chief Epidemiologist of the City of Dalton Public Health
Department. She headed up the Disease Investigation Unit. She had
two investigators, Geoffrey Robins, who she thought was wonderful,
and Julia Campos, who she wished would quit. She was indifferent
about Lucy, her administrative assistant. The Disease Investigation
Unit conducted reports on communicable disease (fortunately not
sexually transmitted ones – Eliza hated dealing with STDs – that was
handled by another division). Most of their time was spent talking
with people about their food poisoning or tracking down children
with pertussis. The investigators interviewed the patients, asked them
questions about their illness, where they thought they got sick, who
else they might have exposed, and whatnot. Eliza did not like to talk
to members of the general public, and avoided talking to patients
whenever possible. She talked to the healthcare providers, the
doctors, the nurses, the people working in the labs; that was more her
element. They spoke the same language and she didn’t have to
explain everything to them. And they didn’t assume they were all
dying of some tropical disease.

Geoff was already at the sink, rinsing out his own cup.
“Morning, Dr E.”

“Morning,” she replied. “Why is it that every crazy person in
this city has my phone number?”

He laughed. “It’s too early for crazy.”
“Amen to that.”
“So what’s on the agenda for today, boss?” he asked.
“I still have to pull the lab reports off the server,” she said.

“Did you call Evers Elementary back about their kindergartener with
pertussis?”

“Yeah, I finished that one up yesterday. The kid has been
treated and everyone in the family all received antibiotics. The
school nurse was supposed to have sent a letter home to parents

OCTOBER BIRDS

3

yesterday. I’ll call her this morning to make sure it actually went
out.”

Eliza stirred a spoonful of fat-free hazelnut flavored creamer
into her coffee and wished she was at home, asleep. Sophie woke her
up crying at 3am after she wet the bed. Poor Sophie had pee all over
herself, even in her hair, and Eliza had to give her a bath. Sophie
cried. Afterward, Eliza let her crawl up into bed with her. Her
husband Steven slept through the whole ordeal.

Back at her desk, 134 emails waited for Eliza to read them.
Most were junk, she just deleted them, but it was time consuming
nonetheless. One caught her attention: a Pro-MED posting, someone
wanting information on an outbreak in Indonesia. Pro-MED is an
international email list public health folks used for reporting and
discussing disease outbreaks. She told her boss that she monitored it
to keep tabs on outbreaks in other parts of the world that could
impact the citizens of Dalton, but really, she just thought it was
interesting. Unusual diseases in Dalton almost always originated in
another country, brought back as an unfortunate vacation souvenir.
Eliza liked travel medicine; it gave her a chance to see real cases of
unusual diseases. Most of their travel-related disease cases came
from the university. The anthropology department was particularly
prone to tropical disease. Those kids liked to backpack through the
most primitive conditions they could find, but they hated taking their
malaria pills. The pills gave them gastrointestinal problems, and who
wanted to be sick on vacation? Many of them came home with a
raging case of malaria as a result. This report, however, was not on
malaria. It was a request for information on a rumor: a large number
of people in Jakarta were reportedly sick with pneumonia, and they
were dropping like flies.

That was how SARS started. Rumors back and forth on Pro-
MED. A bunch of patients in China with pneumonia. High mortality.
Cause unknown. The Chinese government denying anything was
going on. She forwarded the email to Jack over in the Public Health
Preparedness Division, with a brief note, “Job Security?”

CHAPTER 1

4

The small clapboard house sat in a field just outside of town. At first
glance, the yard appeared a tangle of overgrown foliage. Cassandra
didn’t like carefully planted columns and rows; she sprinkled the
seeds out and just let the plants grow as they would. Nature doesn’t
exist on our terms, she firmly believed that. She only pulled plants
that she couldn’t use – she hated the term weed and all the evil it
implied – when they threatened to kill off her medicinal herbs.

An old cattle fence surrounded the property, rusted and
sagging in places. The gate hung open, propped with a large clay pot
filled with flowering cacti, the pot painted in blues and yellows. She
wanted to be welcoming to her patients without actually advertising
her clinic. Because many of her patients were not in the US legally,
she didn’t want to draw attention from the wrong sorts, people who
wanted to send the immigrants home. Plus there were always issues
with the biomedical community. They didn’t approve of her and
certainly didn’t want her taking their business. While she had not had
any trouble here in Dalton, a curandera in Ogden was arrested and
prosecuted for practicing medicine without a license.

In the kitchen, Cassandra hung freshly cut herbs upside down
from a shower curtain rod that hung along the length of the ceiling.
She had opened the windows, and a cool breeze came in, filling her
house with their scent. The October nights had grown cooler; this
was likely to be the last harvest before winter. She tied the plants to
the pole with lengths of satin ribbon. It was a pretty decoration, but
functional too. Once the herbs dried, she would take them down and
put them in jars, for making teas and poultices.

A battered emerald Oldsmobile turned into the drive, kicking
up a dust storm. She watched the car approach, wiped her hands off
on her apron, and went out on the front porch to greet the passengers.
A small Hispanic woman with a river of long black hair got out of
the car, walked around to the passenger side and took a child out of a
car seat in the back. The child laid her head on her mother’s
shoulder, curling up into a comma on her chest.

Cassandra walked down the steps and over to them. Green
mucus caked the child’s upper lip. The girl sniffed hard, sucking
some of it back into her nose. “Poor little thing. What is wrong with
your baby?” Cassandra asked.

OCTOBER BIRDS

5

“Oh, so sick,” the woman said. “So sick. Amelia say to come
to you, that you could help? She say you help her to get pregnant,
where her womb was too cold for baby.”

“Of course, come inside and I will take a look at her. Amelia
is a good friend.” Cassandra relied on word-of-mouth, and had no
lack of business. Word spread quickly through the immigrant
communities when traditional healers were available.

Cassandra smiled and led them up to the house. The mother
introduced herself, Maria, and sat her daughter down on the sofa.

The girl was about two years old, her cheeks flushed with
fever. Cassandra went in the kitchen to make some tea. With the fall,
the number of children coming to see her always increased. Colds
with fever. Ear infections. Allergies. “She is coughing?” Cassandra
called back to Maria.

“Yes, cough and running nose, so much runny nose.”
“How is she sleeping?”
“She is not sleeping so good. She has too much runny nose.”
Cassandra took a large piece of ginger root out of her

refrigerator. She used a bit of it to make the tea and wrapped the rest
in plastic wrap. She let the root steep for five minutes while she
talked to the mother, and then put an ice cube in the cup so the drink
would not burn the child’s mouth.

“How long have you been in Dalton?” Cassandra asked. She
watched as the girl considered the tea.

“A few months. My husband’s brother, he has been here
many year. My husband, he has been to America a few times, he has
come for work. This is our first time come though.”

“And what do you think of America?”
“Oh, American, this is fine.” She played with the hem of her

skirt. “I miss Guatemala though. You know, Guatemala, I work as
accountant, I learn English. But here, here they listen you have an
accent, you know? They think that you dumb, stupid for bad English.
Hard finding work.” She held the cup up to her daughter’s lips. “I try
taking her to the Departamento de Salud, to see doctor. That was,
how you say, not a good idea. No help. No fixing her.”

Cassandra nodded. She’d heard lots of complaints about the
health department.

CHAPTER 1

6

“I tell my husband, this America, it’s not so good, we go back
to Guatemala. But he say we should try. There is much opportunity,
he say. I don’t know. I think it is not what we thought. Like poor. I
never knew America has poor people. But here we are. Not like I
thought at all.” She shrugged.

She fed the drink to her daughter slowly. The girl did not
complain, but seemed to like it.

Cassandra sat next to the girl and took her head in her hands.
She whispered prayers and fluttered her fingers over the girl’s
eyelids. Then she placed her hands over the girl’s chest, again with
whispered prayers. She picked up an egg that she had sat in a bowl
on the coffee table. Holding the egg in her right hand, she formed the
sign of the cross repeatedly over the girl’s forehead and chest. “In the
name of the Father, the Son, and the Holy Spirit,” she said. She
cracked the egg into the bowl. The vibrant yellow yolk swelled with
the girl’s fever.

“I will give you this root. Cut off a small piece, like this,
see?” Cassandra held up the bit that she had used to make the tea.
“Peel it first. Put the piece in a cup of boiling water. Once the water
is cool, give it to her to drink. Give it to her at least four times every
day. It should fix her right up, but if she isn’t feeling any better by
tomorrow afternoon, you bring her back, ok?”

Maria nodded. “Thank you, thank you so much.”
She went back to the kitchen for a bottle of liquid Echinacea

with a small dropper attached to the lid. “When she is done drinking
the tea, give her one dropper of this.” She filled the dropper and held
it to the girl’s mouth. When the girl opened her mouth, Cassandra
squirted it inside. The girl grimaced. “It tastes awful. But it will make
her stronger.”

“What can I give you, to thank you?” Maria asked.
Cassandra believed that to deny people her healing abilities

because they had no money was morally wrong. She let people pay
what they could, what they thought her services were worth. Some
could give her nothing, they had nothing themselves. It didn’t bother
her. She had a gift from God and God gave it to her to help people,
not to make money off of them. In turn, the community supported
her. They made sure she had everything she needed to survive. Some

OCTOBER BIRDS

7

would insist on giving her money or food, or other items. She found
curious gifts left on her front porch like precious orphans. Once a
man gave her three chickens for curing his arthritis

Discussion

1

Statistical analysis

Hypothesis

As mentioned earlier, this study is aimed to investigate the psychological impact of the COVID-

19 pandemic on the healthcare workers in Riyadh, Saudi Arabia. Based on an extensive review of the

literature, the following hypothesis is developed and would be investigated throughout the research project.
Ho:There is no significant relationship between the COVID-19 pandemic and psychological impact on

healthcare workers in Riyadh, Saudi Arabia.
H1:There is a significant relationship between the COVID-19 pandemic and psychological impact on

healthcare workers in Riyadh, Saudi Arabia.

DASS-21:

2

Statistical analysis of the data

Data were fed to the computer and analyzed using IBM SPSS software package
(Armonk, NY: IBM Corp). Qualitative data were described using number and percent.
The Kolmogorov-Smirnov test was used to verify the normality of distribution.
Quantitative data were described using mean, standard deviation. Significance of the
obtained results was judged at the 5% level.

The used tests were

1 – Chi-square test
For categorical variables, to compare between different groups

2 – Monte Carlo correction
Correction for chi-square when more than 20% of the cells have expected count less

than 5

3

Table (1): Distribution of the studied cases according to demographic
characterizes of participants (n = 379)

Demographic characterizes of
participants No. %

Gender
Male 217 57.3

Female 162 42.7

Marital Status
Single 191 50.4

Married 179 47.2

Divorce 9 2.4

Occupational
Physician (Consultant) 66 17.4

Physician (Specialist) 53 14.0

Physician (Resident) 55 14.5
Physician (Internship) 26 6.9

Nurse (Specialist) 52 13.7

Nurse (technician) 21 5.5
Supportive staff 106 28.0

Sector of the healthcare system of your
hospital

MOH (Ministry of Health) 169 44.6
Government sector 161 42.5

Private sector 49 12.9

4

Table (2): Distribution of the studied cases according to DASS-21 severity
categories of participants (n = 379)

Q DASS-21 severity categories of participants

Did not
apply to me

at all

Applied to
me to some
degree, or

some of the
time

Applied to
me to a

considerable
degree or a
good part of

time

Applied to
me very
much or

most of the
time

No. % No. % No. % No. %
Stress

1 Found it hard to wind down 106.0 28.0 149.0 39.3 88.0 23.2 36.0 9.5
6 I tended to over-react to situations 156.0 41.2 120.0 31.7 78.0 20.6 25.0 6.6
8 I felt that I was using a lot of nervous energy 130.0 34.3 130.0 34.3 78.0 20.6 41.0 10.8
11 I found myself getting agitated 156.0 41.2 116.0 30.6 79.0 20.8 28.0 7.4
12 I found it difficult to relax 107.0 28.2 147.0 38.8 80.0 21.1 45.0 11.9

14 I was intolerant of anything that kept me from getting on with what I was doing 163.0 43.0 129.0 34.0 63.0 16.6 24.0 6.3

18 I felt that I was rather touchy 198.0 52.2 107.0 28.2 52.0 13.7 22.0 5.8
Anxiety

2 I was aware of dryness of my mouth 174.0 45.9 118.0 31.1 48.0 12.7 39.0 10.3
4 I experienced breathing difficulty 216.0 57.0 84.0 22.2 61.0 16.1 18.0 4.7
7 I experienced trembling 231.0 60.9 89.0 23.5 42.0 11.1 17.0 4.5

9 I was worried about situations in which I might panic and make a fool of myself 182.0 48.0 109.0 28.8 58.0 15.3 30.0 7.9

15 I felt I was close to panic 203.0 53.6 107.0 28.2 45.0 11.9 24.0 6.3

19 I was aware of the action of my heart in the absence of physical exertion 198.0 52.2 107.0 28.2 57.0 15.0 17.0 4.5

20 I felt scared without any good reason 196.0 51.7 110.0 29.0 50.0 13.2 23.0 6.1
Depression

3 I Couldn’t seem to experience any positive feeling at all 144.0 38.0 132.0 34.8 75.0 19.8 28.0 7.4

5 I found it difficult to work up the initiative to do things 120.0 31.7 154.0 40.6 70.0 18.5 35.0 9.2

10 I felt that I had nothing to look forward to 195.0 51.5 113.0 29.8 47.0 12.4 24.0 6.3
13 I felt down-hearted and blue 187.0 49.3 107.0 28.2 49.0 12.9 36.0 9.5

16 I was unable to become enthusiastic about anything 163.0 43.0 128.0 33.8 58.0 15.3 30.0 7.9

17 I felt I wasn’t worth much as a person 222.0 58.6 85.0 22.4 45.0 11.9 27.0 7.1
21 I felt that life was meaningless 217.0 57.3 85.0 22.4 48.0 12.7 29.0 7.7

5

Table (3): Distribution of the studied cases according to level of DASS-21
severity categories of participants (n = 379)

DASS-21 severity categories of
participants No. %

Stress
Normal (0 – 10) 169 44.6

Mild (11 – 18) 99 26.1
Moderate (19 – 26) 68 17.9

Severe (27 – 34) 32 8.4

Extremely severe (35 – 42) 11 2.9

Total Score 13.70 ± 10.14
Anxiety

Normal (0 – 6) 170 44.9

Mild (7 – 9) 28 7.4

Moderate (10 – 14) 77 20.3
Severe (15 – 19) 36 9.5

Extremely severe (20 – 42) 68 17.9

Total Score 10.29 ± 9.36
Depression

Normal (0 – 9) 177 46.7

Mild (10 – 12) 51 13.5
Moderate (13 – 20) 86 22.7

Severe (21 – 27) 32 8.4

Extremely severe (28 – 42) 33 8.7

Total Score 11.69 ± 9.99

SD: Standard deviation

6

Table (4): Relation between stress and demographic characterizes of
participants (n = 379)

Stress

χ2 p
Demographic

characterizes of
participants

Normal
(0 – 10)

(n = 169)

Mild
(11 – 18)
(n = 99)

Moderate
(19 – 26)
(n = 68)

Severe
(27 – 34)
(n = 32)

Extremely
severe

(35 – 42)
(n = 11)

No. % No. % No. % No. % No. %
Gender

Male 113 66.9 52 52.5 30 44.1 18 56.3 4 36.4
14.051* 0.007*

Female 56 33.1 47 47.5 38 55.9 14 43.8 7 63.6
Marital Status

Single 78 46.2 49 49.5 38 55.9 21 65.6 5 45.5
9.723

MCp=
0.231 Married 87 51.5 49 49.5 27 39.7 11 34.4 5 45.5

Divorce 4 2.4 1 1.0 3 4.4 0 0.0 1 9.1
Occupational

Physician (Consultant) 35 20.7 12 12.1 12 17.6 5 15.6 2 18.2

17.248
MCp=
0.817

Physician (Specialist) 22 13.0 17 17.2 10 14.7 4 12.5 0 0.0
Physician (Resident) 27 16.0 11 11.1 11 16.2 3 9.4 3 27.3
Physician (Internship) 9 5.3 11 11.1 4 5.9 2 6.3 0 0.0
Nurse (Specialist) 20 11.8 17 17.2 7 10.3 6 18.8 2 18.2
Nurse (technician) 9 5.3 7 7.1 2 2.9 2 6.3 1 9.1
Supportive staff 47 27.8 24 24.2 22 32.4 10 31.3 3 27.3

Sector of the healthcare
system of your hospital

MOH
(Ministry of Health)

79 46.7 47 47.5 28 41.2 11 34.4 4 36.4
6.173

MCp=
0.622 Government sector 71 42.0 37 37.4 31 45.6 15 46.9 7 63.6

Private sector 19 11.2 15 15.2 9 13.2 6 18.8 0 0.0

c2: Chi square test MC: Monte Carlo
*: Statistically significant at p ≤ 0.05

7

Table (5): Relation between anxiety and demographic characterizes of
participants (n = 379)

Anxiety

χ2 p
Demographic

characterizes of
participants

Normal
(0 – 6)

(n = 170)

Mild
(7 – 9)

(n = 28)

Moderate
(10 – 14)
(n = 77)

Severe
(15 – 19)
(n = 36)

Extremely
severe

(20 – 42)
(n = 68)

No. % No. % No. % No. % No. %
Gender

Male 113 66.5 19 67.9 38 49.4 16 44.4 31 45.6
15.347* 0.004*

Female 57 33.5 9 32.1 39 50.6 20 55.6 37 54.4
Marital Status

Single 68 40.0 16 57.1 44 57.1 21 58.3 42 61.8
18.777*

MCp=
0.008* Married 98 57.6 12 42.9 32 41.6 12 33.3 25 36.8

Divorce 4 2.4 0 0.0 1 1.3 3 8.3 1 1.5
Occupational

Physician (Consultant) 43 25.3 5 17.9 9 11.7 2 5.6 7 10.3

35.690*
MCp=

0.042*

Physician (Specialist) 27 15.9 3 10.7 8 10.4 7 19.4 8 11.8
Physician (Resident) 30 17.6 2 7.1 11 14.3 4 11.1 8 11.8
Physician (Internship) 5 2.9 3 10.7 7 9.1 5 13.9 6 8.8
Nurse (Specialist) 16 9.4 5 17.9 11 14.3 7 19.4 13 19.1
Nurse (technician) 7 4.1 2 7.1 5 6.5 1 2.8 6 8.8
Supportive staff 42 24.7 8 28.6 26 33.8 10 27.8 20 29.4

Sector of the healthcare
system of your hospital

MOH
(Ministry of Health)

77 45.3 14 50.0 35 45.5 16 44.4 27 39.7
7.284 0.506

Government sector 76 44.7 9 32.1 29 37.7 13 36.1 34 50.0
Private sector 17 10.0 5 17.9 13 16.9 7 19.4 7 10.3

c2: Chi square test MC: Monte Carlo
*: Statistically significant at p ≤ 0.05

8

Table (6): Relation between depression and demographic characterizes of
participants (n = 379)

Depression

χ2 p
Demographic

characterizes of
participants

Normal
(0 – 9)

(n = 177)

Mild
(10 – 12)
(n = 51)

Moderate
(13 – 20)
(n = 86)

Severe
(21 – 27)
(n = 32)

Extremely
severe

(28 – 42)
(n = 33)

No. % No. % No. % No. % No. %
Gender

Male 118 66.7 36 70.6 33 38.4 12 37.5 18 54.5
27.842* <0.001*

Female 59 33.3 15 29.4 53 61.6 20 62.5 15 45.5
Marital Status

Single 80 45.2 22 43.1 48 55.8 18 56.3 23 69.7
13.253

MCp=
0.068 Married 94 53.1 28 54.9 34 39.5 14 43.8 9 27.3

Divorce 3 1.7 1 2.0 4 4.7 0 0.0 1 3.0
Occupational

Physician (Consultant) 38 21.5 7 13.7 13 15.1 2 6.3 6 18.2

25.370
MCp=
0.344

Physician (Specialist) 25 14.1 9 17.6 15 17.4 2 6.3 2 6.1
Physician (Resident) 29 16.4 6 11.8 9 10.5 5 15.6 6 18.2
Physician (Internship) 13 7.3 3 5.9 7 8.1 3 9.4 0 0.0
Nurse (Specialist) 19 10.7 7 13.7 14 16.3 7 21.9 5 15.2
Nurse (technician) 11 6.2 0 0.0 5 5.8 3 9.4 2 6.1
Supportive staff 42 23.7 19 37.3 23 26.7 10 31.3 12 36.4

Sector of the healthcare
system of your hospital

MOH
(Ministry of Health)

85 48.0 25 49.0 31 36.0 14 43.8 14 42.4
7.939 0.439

Government sector 73 41.2 18 35.3 41 47.7 12 37.5 17 51.5
Private sector 19 10.7 8 15.7 14 16.3 6 18.8 2 6.1

c2: Chi square test MC: Monte Carlo
*: Statistically significant at p ≤ 0.05

discussion

2.3 Scales and Types of Measurement

One of the easiest ways to decrease error variance and thereby increase reliability and validity is to make smart choices when designing and selecting measures. Throughout this book, we will discuss guidelines for each type of research design and ways to ensure that measures are as accurate and unbiased as possible. This section examines some basic rules that apply across all three types of design. We first review the four scales of measurement and discuss the proper use of each one; we then turn our attention to three types of measurement used in psychological research studies.

Scales of Measurement

Whenever researchers perform the process of translating conceptual variables into measurable variables (i.e., operationalization; see Chapter 1, section 1.2), they must ensure that their measurements accurately represent the underlying concepts. In Chapter 1, the discussion of validity explained that this accuracy is a critical piece of hypothesis testing. For example, if researchers develop a scale to measure job satisfaction, then they need to verify that this is actually what the scale is measuring.

However, measurement accuracy has an additional, subtler dimension: We also need to be sure that the numbers used in our chosen measurement accurately reflect the underlying mathematical properties of the concept. In many cases in the natural sciences, this process is automatically precise. When we measure the speed of a falling object or the temperature of a boiling object, the underlying concepts (speed and temperature) translate directly into scaled measurements. In the social and behavioral sciences, though, this process is trickier; researchers have to decide carefully how best to represent abstract concepts such as happiness, aggression, and political attitudes. As researchers take the step of scaling variables, or specifying the relationship between a conceptual variable and numbers on a quantitative measure, they have four different scales to choose from, presented below in order of increasing statistical power and flexibility.


Nominal Scales

Nominal scales are used to label or identify a particular group or characteristic. For example, we can label a person’s gender as male or female, and we can label a person’s religion as Catholic, Protestant, Buddhist, Jewish, Muslim, Hindu, etc. In experimental designs, researchers can also use nominal scales to label the condition to which a person has been assigned (e.g., experimental or control groups). The assumption in using these labels is that members of the group have some common value or characteristic, as defined by the label. For example, everyone in the Catholic group should have similar religious beliefs, and everyone in the female group should be of the same gender.

Research studies commonly represent these labels using numeric codes in a data file, such as 1 to indicate females and 2 to indicate males. However, these numbers are completely arbitrary and meaningless—that is, males do not have more gender than females. We could just as easily replace the 1 and the 2 with another pair of numbers or with a pair of letters or names. Thus, the primary limitation of nominal scales is that the scaling itself is arbitrary, which prevents us from using these values in mathematical calculations. One helpful way to appreciate the difference between this scale and the next three is to think of nominal scales as qualitative, because they label and identify, and to think of the other scales as quantitative, because they indicate the extent to which someone possesses a quality or characteristic. The next sections explore these quantitative scales in more detail.


Ordinal Scales

First-, second-, and third-place winners stand on a podium.

HasseChr/iStock Editorial/Thinkstock

An ordinal scale can place these three women in first, second, and third, but it cannot tell you how far apart they finished in their race.

Researchers use ordinal scales to represent ranked orders of conceptual variables, such that higher numbers reflect increasing magnitude of the underlying variable. For example, beauty contestants, horses, and Olympic athletes are all ranked by the order in which they finish—first, second, third, and so on. Likewise, movies, restaurants, and consumer goods are often rated using a system of stars (i.e., 1 star is poor; 5 stars is excellent) to represent their quality. In these examples, we can draw conclusions about the relative speed, beauty, or deliciousness of the rating target. Even so, the numbers used to label these rankings do not necessarily map directly to differences in the conceptual variable. The fourth-place finisher in a race is rarely twice as slow as the second-place finisher; the beauty-contest winner is not three times as attractive as the third-place finisher; and the boost in quality between a four-star and a five-star restaurant is not the same as the boost between a two-star and three-star restaurant. Ordinal scales represent rank orders, but the numbers do not have any absolute value of their own. This type of scale, then, is more powerful than a nominal scale but still limited in that it does not allow performance of mathematical operations. For example, if an Olympic athlete finished first in the 800-meter dash, third in the 400-meter hurdles, and second in the 400-meter relay, we might be tempted to calculate her average finish as second place. Unfortunately, the properties of ordinal scales prevent us from doing this sort of calculation, because the conceptual distance between first, second, and third place would be different in each case. (That is, the runner might have won the 800-meter dash by 5 seconds, but the 400-meter relay by less than a second.) To perform any mathematical manipulation of variables requires one of the next two types of scale.


Interval Scales

Interval scales represent cases where the numbers on a measured variable correspond to equal distances on a conceptual variable. For example, temperature increases on the Fahrenheit scale represent equal intervals—warming from 40 to 47 degrees is the same increase as warming from 90 to 97 degrees. Interval scales share the key feature of ordinal scales—higher numbers indicate higher relative levels of the variable—but interval scales go an important step further. Because these numbers represent equal intervals, we are able to add, subtract, and compute averages. That is, whereas we could not calculate the athlete’s average finish, we can calculate the average temperature in San Francisco or the average age of participants.


Ratio Scales

Ratio scales go one final step further, representing interval scales that also have a true zero point, that is, the potential for a complete absence of the conceptual variable. Physical measurements, such as length, weight, and time represent ratio scales, because it is possible to have a complete absence of any of these. Most behavioral measures also represent ratio scales, as it is possible to have zero drinks per day, zero presses of a reward button, or zero symptoms of the flu. Temperature in degrees Kelvin is measured on a ratio scale because 0 degrees Kelvin indicates an absence of molecular motion. (In contrast, 0 degrees Fahrenheit is merely a center point on the temperature scale.) Contrast these measurements with many of the conceptual variables featured in psychology research—no such things as zero attitude toward gun control or zero self-esteem exist. The big advantage of having a true zero point is that it allows us to add, subtract, multiply, and divide scale values. When we measure weight, for example, it makes sense to say that a 300-pound adult weighs twice as much as a 150-pound adult. Likewise, it makes sense to say that having two drinks per day is only one-fourth as many as having eight drinks per day.


Choosing and Using Scales of Measurement

The take-home point from the discussion of these four scales of measurement is twofold. First, researchers should always use the most powerful and flexible scale possible for their conceptual variables. In many cases, no choice is possible; time is measured on a ratio scale and gender is measured on a nominal scale. But some cases permit researchers a bit more freedom in designing their study. For example, if someone were interested in correlating weight with happiness, the researcher could capture weight in a few different ways. One option would be to ask people their satisfaction with their current weight on a seven-point scale. However, the resulting data would be on an ordinal or interval scale (see discussion below), and the degree to which the researcher could manipulate the scale values would be limited. Another, more powerful option, would be to measure people’s weight on a bathroom scale, resulting in ratio-scale data. Whenever possible, it is preferable to incorporate physical or behavioral measures. But it is also preferable—actually, required—to represent data accurately. Most variables in the social and behavioral sciences do not have a true zero point and must therefore be measured on nominal, ordinal, or interval scales.

Second, researchers should always be aware of the limitations of their measurement scale. As discussed above, these scales lend themselves to different amounts of mathematical manipulation. It is not possible to calculate statistical averages with anything less than an interval scale and not possible to multiply or divide anything less than a ratio scale. What does this mean for researchers? If they have collected ordinal data, they are limited to discussing the rank ordering of the values (e.g., the critics liked Restaurant A better than Restaurant B). If they have collected nominal data, they are limited to describing the different groups (e.g., percentages of Catholics and Protestants).

One prominent grey area for both of these points is the use of attitude scales in the social and behavioral sciences. If we were to ask people to rate their attitudes about the death penalty on a seven-point rating scale, would the scale be ordinal or interval? This consideration turns out to be a contentious issue in the field. From the conservative point of view, these attitude ratings constitute only ordinal scales. We know that a 7 indicates more endorsement than a 3 but cannot say that moving from a 3 to a 4 is equivalent to moving from a 6 to a 7 in people’s minds. From the more liberal point of view, these attitude ratings can be viewed as interval scales. A researcher’s perspective is often driven by practical concerns—treating these as equal intervals allows us to compute totals and averages for our variables. Chapter 4 will return to this issue in discussing the creation of questionnaire items. For now, a good guideline is to assume that these individual attitude questions represent ordinal scales by default.

Types of Measurement

Each of the four scales of measurement can be used across a wide variety of research designs. In this section, we shift gears slightly and discuss measurement at a more conceptual, less mathematical level. The types of dependent measures used in psychological research studies can be grouped into three broad categories: behavioral, physiological, and self-report.


Behavioral Measurement

As mentioned earlier, behavioral measures are those that involve direct and systematic recording of observable behaviors. If a research question involves the ways that married couples deal with conflict, the researcher could include a behavioral measure by observing the way participants interact during an argument. Do they cut one another off? Listen attentively? Express hostility? Behaviors can be measured and quantified in one of four primary ways, as the scenario of observing married couples during conflict situations illustrates:

· Frequency measurements involve counting the number of times a behavior occurs. For example, researchers could count the number of times each member of the couple rolled his or her eyes as a measure of dismissive behavior.

· Duration measurements involve measuring the length of time a behavior lasts. For example, researchers could quantify the length of time the couple spends discussing positive versus negative topics as a measure of emotional tone.

· Intensity measurements involve measuring the strength or potency of a behavior. For example, researchers could quantify the intensity of anger or happiness in each minute of the conflict using ratings by trained judges.

· Latency measures involve measuring the delay before onset of a behavior. For example, researchers could measure the time between one person’s provocative statement and the other person’s response.

John Gottman, a psychologist at the University of Washington, has been conducting research along these lines for several decades, observing body language and interaction styles among married couples as they discuss an unresolved issue in their relationship (read more about this research and its implications for therapy on Dr. Gottman’s website, 
http://www.gottman.com/
). What all of these behavioral measures provide is an unobtrusive way to measure the health of a relationship. That is, the major strength of behavioral responses is that they are typically more honest and unfiltered than responses to questionnaires. As Chapter 4 will discuss, people are sometimes dishonest on questionnaires to convey a more positive (or less negative) impression.

Behavioral responses offer a particular benefit for researchers interested in unpopular attitudes, such as prejudice and discrimination. If we were to ask people the extent to which they dislike members of other ethnic groups, they might not admit to these prejudices. Alternatively, a researcher could adopt the approach used by Yale psychologist Jack Dovidio and colleagues and measure how close people sat to people of different ethnic and racial groups, using this distance as a subtle and effective behavioral measure of prejudice (see 
http://www.yale.edu/intergroup/
 for more information). But the primary downside to using behavioral measures may be evident: We end up having to infer the reasons that people behave as they do. Suppose that in one of these experiments, European-American participants, on average, sit farther away from African-Americans than from other European-Americans. This could—and often does—indicate prejudice; however, for the sake of argument, the farthest seat from the minority group member might also be the comfortable recliner with great lighting next to the window. To understand the reasons for behaviors, researchers have to supplement the behavioral measures with either physiological or self-report measurements.


Physiological Measurement

Physiological measures are those that involve quantifying bodily processes, including heart rate, brain activity, and facial muscle movements. If we were interested in the experience of test anxiety, we could measure heart rates as people complete a difficult math test. If we wanted to study emotional reactions to political speeches, we could measure heart rate, facial muscles, and brain activity as people view video clips. These types of measures’ big advantage is that they are the least subjective and controllable. It is incredibly difficult for people to control their heart rate or brain activity consciously, making these a great tool for assessing emotional reactions. However, as with behavioral measures, we also need some way to contextualize physiological data.

The best example of this shortcoming is the use of the polygraph, or lie detector, to detect deception. The lie-detector test involves connecting a variety of sensors to the body to measure heart rate, blood pressure, breathing rate, and sweating. All of these are physiological markers of the body’s fight-or-flight stress response, and the test’s goal is to measure whether someone shows signs of stress while being questioned. But here is the problem: Being falsely accused is also stressful. A trained polygraph examiner must place all of the accused’s physiological responses in the proper context. Is the individual stressed throughout the exam or only stressed when asked whether he pilfered money from the cash box? Is the person stressed when asked about her relationship with her spouse because she killed him or because she was having an affair? The examiner has to be extremely careful to avoid false accusations based on misinterpretations of physiological responses. (For a recent commentary on the use of the polygraph in the courtroom, see 
http://www.thedailybeast.com/articles/2015/02/04/the-polygraph-has-been-lying-for-90-years.html
). The same cautions apply to using these measures in psychological research: Does heart rate increase because participants are stressed by a political message, or because the experiment is taking too long, and they are late to another appointment? The researcher should always include additional measures in the study to help sort out the reasons behind physiological change.


Self-Report Measurement

A man and a woman completing paperwork at a polling station.

Digital Vision/Photodisc/Thinkstock

A self-report measure might be used to determine how likely voters are to support a candidate.

Self-report measures are those that involve asking people to report on their own thoughts, feelings, and behaviors. If we were interested in the relationship between income and happiness, we could simply ask people to report their income and their level of happiness. If we wanted to know whether people were satisfied in their romantic relationships, we could simply ask them to rate their degree of satisfaction. The major advantage of these measures is that they provide access to internal processes. That is, if we want insight into why people voted for their favorite political candidate, the only option is to ask them. However, as the text has suggested already, people may not necessarily be honest and forthright in their answers, especially when dealing with politically incorrect or&nbsp

Discussion

  Nursing Leadership and Management class.

Please be certain to answer the three questions on this week DQ and to provide a well-developed and complete answer . Your main discussion answer needs to be at least 3 paragraphs in length with 3 references to justify your answer. Use APA format.

  1. Describe the difference between a Manager and a leader.
  2. What are attributes you admire in a leader?
  3. What leadership attributes do you see in yourself?

Discussion

  Culture in Nursing Class

1.  A nurse on a surgical unit mentions that she would like to know more about various cultures and how to take care of patients with diverse cultural backgrounds.

a.   How could you use the Andrews/Boyle TIP Model to support her wish to provide culturally competent care?

b. Give an example of how the surgical nurse might use the Andrews/Boyle TIP Model in her everyday practice.

 

  • Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. 
  • All replies must be constructive and use literature where possible.

Discussion

Prior to beginning work on this discussion forum, read Chapter 1 of your Meeting the Ethical Challenges of Leadership: Casting Light or Shadow course text.

Complete Self-Assessment 1.1 (Destructive Leader Behavior Scale) from your textbook. In at least one paragraph, supported by evidence from your text and from other research:

  • Report the results of the assessment.
    • Do not provide the leader’s name. You may identify the individual by position only.
  • Explain what the score of the destructive leadership scale reveals about the chosen leader.
  • Describe how you can use this information in your real-world experience.

discussion

Discussion 1 (100 words)

Select one of the assigned poems for this week. Identify three key images that most reveal that poem’s subject. How does the poem’s use of imagery help reveal that subject?

Keep in mind that imagery can convey more than just visual images. Seek details that help describe the other four senses, as well. How can incorporating descriptions of sound, touch, taste, and smell, add to the imagery in a piece of writing, as well? What impact might that have on a poem?

use poem below


Metaphors

I’m a riddle in nine syllables,
An elephant, a ponderous house,
A melon strolling on two tendrils.
O red fruit, ivory, fine timbers!
This loaf’s big with its yeasty rising.
Money’s new-minted in this fat purse.
I’m a means, a stage, a cow in calf.
I’ve eaten a bag of green apples,
Boarded the train there’s no getting off.

https://allpoetry.com/Metaphors

Discussion

 Initial Postings: Read and reflect on the assigned readings for the week. Then post what you thought was the most important concept(s), method(s), term(s), and/or any other thing that you felt was worthy of your understanding in each assigned textbook chapter.

Your initial post should be based upon the assigned reading for the week, so the textbook should be a source listed in your reference section and cited within the body of the text. Other sources are not required but feel free to use them if they aid in your discussion.

Also, provide a graduate-level response to each of the following questions:

  1. You are working as a manager of a financial planning office where you require your employees to have a presence on social media. One of your financial advisors posts to his Twitter account that he needs $500 to pay his rent for the month. Would you punish him? Why or why not? 

[Your post must be substantive and demonstrate insight gained from the course material. Postings must be in the student’s own words – do not provide quotes!]

 [Your initial post should be at least 450+ words and in APA format (including Times New Roman with font size 12 and double spaced). 

Book:  

Title: Essentials of Organizational Behavior, Student Value Edition

ISBN: ISBN:13: 9780135468890

Authors: Stephen P. Robbins, Timothy A. Judge

Publisher: Pearson

Edition: 15TH

Discussion

Class,

From the humdrum of the mid-2000s web apps, Apple radically changed the mobile world with the iPhone, offering well-designed apps of their own and curating apps that were accepted into the App Store.  That influence has been far reaching, prompting Google to push their boundaries and develop material design, a design language that has become the distinctive hallmark of Android apps.  When compared to the web world where some popular apps could get away with mediocre design, why do mobile apps face a higher design bar? 

  • When compared to the web world where some popular apps could get away with mediocre design, why do mobile apps face a higher design bar?
  • Compare and contrast native mobile app design versus standard desktop app design.  Discuss considerations for choosing one over the other.  Elaborate on main advantages vs disadvantages.

  • You must apply and use the basic citation styles of APA.
  • Do not claim credit for the words, ideas, and concepts of others.
  • Use in-text citation and list the reference of your supporting source following APA’s style and formatting
  • Do not copy and paste information or concepts from the Internet and claim that is your work.  It will be considered Plagiarism and you will receive a zero for your work.
  • Use this link to access the Discussion Board

discussion

This discussion board includes a video and a math question.

· Post by answering course related questions and doing as directed: 

0. Watch the 
Mindset Theory 
video Practice

· List a skill that you learned that required a great deal of practice. Could you have learned that skill without practice? How can you apply this to your math course?

1. Probability evolved out of practical application, and as noted in our textbook, probability arose from the gaming rooms of western Europe!  Additionally, it is noted that probability is practically found in every field.  Find how probability will play a role in your chosen career path and share with the class.

· Use the web to do your investigation and post should be shared in paragraph form with a minimum of 50 words, and insert a photo(s) within the post (not a link) referencing your discovery.

discussion

Main Post

· Reflect on strategies that you can pursue in developing portfolios or portfolio elements that focus on academic achievements.

· Review one or more samples from your own research of resources focused on portfolio development.

Post an explanation of at least two strategies for including academic activities and accomplishments into your professional development goals. Then, explain how those goals may align with the University’s emphasis on social change. Be specific and provide examples.

Supported by at least three current, credible sources. Apa format

Then peer responses:

apa and two credible sources

Respond to at least two of your colleagues’ posts by offering additional ideas regarding academic achievements to include or offering alternative ways of presenting the current achievements.

Peer 1

An academic portfolio is a snapshot of one’s research, accomplishments, licensures, and professional work.  The portfolio is a way to house many important aspects of our career in one central place.  This is important while seeking initial employment or when you are looking for advancement (Phillips, 2022).  A resume is only a quick summary of your history and accomplishments while a portfolio can give potential employers a more intimate look at your success.  Portfolios can include things like actual competencies and certificates as well as letters of recommendation.  This gives you a much larger platform to introduce yourself and set the stage for how you would really fit the position that is open.  In a world where competition is fierce, anything that gives you a leg up is certainly worth pursuing. 

Things to include in my own academic portfolio would be my academic progression.  I have advanced from LPN to Associate of Art’s degree to Bachelor of Science in Health and Wellness to Registered Nurse to BSN and now onto MSN.  I have created a focus on health maintenance and disease prevention within the community by doing several things: First, I have established a working relationship between our clinic and the schools by creating health-based classes that I teach during after school programs.  Second, I have advertised health promoting behaviors such as skin checks, sunscreen use, and tick identification at local health fairs. 

I believe that all of my own accomplishments align with Walden’s view on social change.  The basis of social change is creating change within your community through education (Walden University, n.d.).  My pursuit of further education has given me the opportunity to network with people and create these educational events within my own community.

Peer 2

Having a professional portfolio is essential. The professional portfolio showcases the nurse’s skills, achievements, and professional experience (Burns, 2018). Having a solid academic foundation is critical and helps determine placement for competitive jobs. Having a well-rounded portfolio shows academic achievements and accomplishments in professional development.

Academic Strategies

A strategy to build a strong portfolio is to start with academic accomplishments. Academic achievements are a reflection of the skill transferred from the classroom to clinical practice (McMillan et al., 2014). As nurses, we dedicate a great deal of time to our education, so showcasing our educational accomplishments in our portfolio is critical. Adding educational achievements such as academic awards, diplomas, and degrees gives us an advantage and proves that learning has occurred and educational requirements have been met (Casey & Egan, 2013).

Professional Goals  

When your dream job is on the line and your application is within several other candidates, it is vital to stand out. Showing evidence of past professional experiences is critical in achieving professional developmental goals. Your professional portfolio represents you as a practitioner and exhibits your skills and past experiences during your nursing career. This information can land you the job or make you stand out from other applicants. Providing evidence of skills, knowledge, and experience is a strategy that can support career changes and meet professional requirements (Casey & Egan, 2013).

Social Change. Walden University caught my attention because of its strong focus on social change. Walden’s goal is to empower students to make a difference by providing several opportunities for professionals to transform themselves into scholar-practitioners to contribute to positive social changes (Walden University, 2022). Walden’s emphasis on social change aligns with my goals because it gives us the platform, education, and experience to prepare ourselves to be strong and successful professionals. Walden university’s (2022) mission is to transform professionals into scholar-practitioner with the ultimate goal of affecting positive social change. Positive social change has always been a goal of mine. I genuinely enjoy helping others and making the world a better place.

discussion

To write about self

· Reason why I chOse the school for my masters

· Still currently enrolled

· Been in medical field for over 17 years

· Worked as volunteer during covid outbreak

· Getting my masters in order to open an outpatient clinic to give back to my community YOU CAN ADD GOOD STUFF ALSO

discussion

To prepare for this discussion, read the instructor guidance, Chapter 12 by Levitt (2016), and Sections 
3.1

3.2
, “Pros and Cons of Observational Research” and “Types of Observational Research” in 
Section 3.4
 of the Newman (2016) textbook. View the following videos: 

Different Qualitative Approaches

 (Links to an external site.)
 and 

When to Use a Qualitative Research Design? Four Things to Consider

 (Links to an external site.)
.

Then, determine from the list below your assigned qualitative research design based on the first letter of your last name:

· A-F: Ethnography

· G-L: Grounded theory

· M-R: Narrative research

· S-Z: Phenomenology

Using the 
Research Methods (Links to an external site.)
 research guide’s list of suggested articles, look for information about your assigned qualitative research design. You may also search the Library databases for articles about the research design. In your initial post:

· Evaluate the features of the design and what kinds of research topics it is suitable for.

· Explain the data collection and data analysis methods used in the design.

· Cite at least one scholarly/peer-reviewed article about the design and one published research study that used the design, for a total of at least two scholarly/peer-reviewed journal articles.

discussion

Prompt: Take the opportunity to engage with classmates on all matters regarding Java. Asking for and providing assistance are solid ways to build your coding skills. You are required to provide at least one of the following:

· A question regarding how to accomplish a certain task from this week’s assignment or NEXT WEEK’s project (look ahead as there are no extensions beyond the last day of class).  Start planning your project now.

· A response that aids a student’s aforementioned question

· An interesting article with a brief synopsis that details an interesting aspect or capability of Java

· A link to, and a short description of a tool, technique, plug-in, IDE, and any other useful resource you run across

discussion

Each student has been assigned to a group and each group is to research an industry. The group will then pick two publicly traded companies within the industry to investigate, noting both the similarities and the differences of the companies.  The companies must provide a similar type of product.  Please note how the industry influences these similarities and differences.  

Example:  you might choose the oil industry and pick Exxon-Mobil and Chevron.  These are both major oil companies.  You might choose the Auto Industry and choose GM and Toyota.  Both are publicly traded companies on US stock exchanges.

Your companies MUST be publicly traded.  There are a number of resources online that can help you find publicly traded companies.  Some of these are Yahoo Finance, CNN money, CNBC, Bloomberg and many more.  The library has an assignment guide to help you with your research.



No two groups may use the same industry. Industries will be assigned on a first requested, first assigned basis. SO, send me an email with your group’s choice of industry as soon as you decide and I will let the rest know what is no longer available.

You and your group decide which companies within your industry to analyze. The two companies must provide similar products or services, but may be different in size. In other words, compare apples to apples and oranges to oranges.

Some suggested industries are below, but there are many more you can choose from:

1. Airline

2. Oil

3. Pharmaceutical

4. Auto

5. Computer/Information Technology

6. Steel

7. Retail

8. Entertainment

9. Agriculture

10, Banking/Finance

11. Health Care

12. Trucking

13. Railroads

14. Communications

15. Defense/Aerospace

Each group will turn in a written paper of five to ten pages.  The paper must to cover all 14 points listed below. (first 12 and two from second list).  Each paper must include a cover page and a works cited page in addition to the five to ten pages required.  Grammar and spelling are important and will be considered in your grade, but your paper will be assessed based on how well you explain the material.  Remember that all work should be in your own words—NO QUOTES or COPYING.   

Each group should include a power point presentation of 5 to 10 slides that supports your paper with bullet points, graphs, or pictures – NO PARAGRAPHS on the slides.   If you do something creative and innovative in your presentation, you and your group can earn extra credit.

REQUIRED FOR ALL PROJECTS:

Briefly explain the importance of each item.   Some items can be covered in one or two sentences; some will require more detail. 

1. An explanation of the industry and the companies within it, as they exist currently.

2. A brief history of the industry and the companies you are investigating.

3. The type of product/products that is provided by this industry/companies and the type of customers. 

4. What influence the industry/companies have on the US economy and conversely, the influence of the economy on the industry/companies.

5. How the industry/companies and their decisions have a bearing on the lives of the average American.

6. The form of competition found in this industry (pure competition, monopolistic, oligopoly, monopoly)

7. The published mission or vision statement of each corporation.

8. The most recent fiscal year’s sales, expenses, and net profit for each company and how those figures compare with the industry as a whole.

9. The price per share of common stock for each corporation at the end of the fiscal year and for the first 2-3 quarters of the current fiscal year. Be sure to compare the same time periods. 

10. Pick at least three financial ratios and compare each company to the industry standards.  Are the companies better or worse than the industry standard? 

11. A brief discussion on the amount of government regulation for this industry.

12. The types of jobs or careers most frequently found in this industry and the amount of education/training needed for those jobs/careers.

PICK AT LEAST TWO OR MORE ITEMS from the following list to include in your presentation.  It is preferable to use those items that best apply to your industry or companies.  These items need to be discussed in more detail than those above. 

1. Any serious ethical problems/questions faced by the industry.  Explain how each company dealt with those problems/questions.

2. Whether or not the industry/companies are involved in international trade and global business – in what way?  and with which countries?

3. Any major mergers or diversifications that have/had a serious bearing on the industry.

4. A comparison of the levels of management within the two companies and the styles of management of the two companies.

5. The use of a Total Quality Program or a Just in Time Inventory system within the companies.

6. An overview of the production/operations process within the companies.

7. The development and implementation of the human resource process.

8. The presence and importance of unions in the industry.

9. The presence and importance of small business in the industry and any use of franchising.

10. The importance and use of technology within the industry and how each company uses technology. 

11. Marketing strategies used by each company and the industry including the research and development of new products, how each arrives at pricing decisions, and how products are distributed.

12. The importance and type of advertising and promotions used by the companies/industry.

13. The governmental agencies (other than IRS) that have a bearing on this industry and how each company deals with this regulation.

14. Any other major issue that applies to your industry.  (TO USE THIS CATEGORY AS ONE OF YOUR TWO, YOU MUST CLEAR IT WITH YOUR INSTRUCTOR).


In order to make an A, groups need to do something creative or add extra value to the paper or presentation.  All basic requirements for the paper and presentation must be completed before added value will be considered.  See your instructor for more information.

Your group should: 

· Set a goal that is Realistic; Measurable; Specific

· Develop a time frame for work due.

· Develop rules for what to do if someone does not turn in work to the group on time.

· Exchange contact information outside of the classroom.

· Pick an industry with at least two publicly traded companies 

discussion

2

Melis

Risk management is a vital part of any healthcare setting, typically in a healthcare setting, there is a position dedicated to risk management practices. Effective risk management includes identifying areas where various types of risks may occur and identifying what outcomes may occur. If needed plans will be put into action – in my facility we call it a plan of action. When an item is deemed high risk – either something that could affect patient safety or noncompliant with federal and state regulations – a plan is put together with steps outlined to minimize the risk. Identifying risks comes from “near misses & good catches” (Catalyst), these are things that occur over the course of a workday that could have resulted in some kind of negative impact. Risk management professionals will use this information to decide if action needs to be taken. A common example of this is needlestick injuries. There are safety devices that can be implemented to limit the number of needlestick injuries within the healthcare setting. So if there are a few reports of near misses – meaning it almost happened – where a staff member may have sustained a needlestick injury, then the management team should implement some of these safety devices to limit that risk – this is also in compliance with OSHA (federal regulations). An example that I have come across was the placement of a paper towel machine, it was across the bathroom. Meaning patients are walking across the bathroom to get paper tows dripping water that they could potentially slip on – RISK!! So to eliminate this I worked with our facilities director to move all the paper towel holders by the sink. In addition, risk management has a lot to do with federal and state regulations, which outline acceptable and unacceptable actions. So risk management professionals have to understand these guidelines and apply them to their healthcare setting. There is a legal risk for noncompliance, as well as a safety risk. The idea around risk management is that you are making the setting a safer place for patients and staff and ensuring compliance with regulations. 

Catalyst, N. E. J. M. (n.d.). What is risk management in healthcare? NEJM Catalyst. Retrieved from https://catalyst.nejm.org/doi/full/10.1056/CAT.18.0197 

Healthcare executives’ role in emergency management. American College of Healthcare Executives. (n.d.). Retrieved from https://www.ache.org/about-ache/our-story/our-commitments/policy-statements/healthcare-executives-role-in-emergency-management

Lisa

· Risk Management: Risk management in healthcare includes both the clinical and administrative systems and their processes and reports which are used to detect, monitor, assess, mitigate, and prevent risks. By utilizing risk management, healthcare organizations proactively and systematically safeguard patient safety as well as the organization’s assets, market share, accreditation, reimbursement levels, brand value, and community standing (Catalyst, 2018).

· Terms-The American College of Healthcare Executives believes healthcare executives should actively participate in disaster planning and preparedness activities. In doing so they ensure their emergency operations plan fits within the overall community plans and anticipates the approach to risks an organization might face (Catalyst, 2018).

To be prepared management needs to:

· Maintain a Relevant/Current Emergency/Disaster Plan- Using the National Response Framework and Hospital Preparedness Program

· Address the Safety of Staff/Patients/Families

· Focus the Plan to Address the Most Likely Scenarios

· Develop an Incident Command System

· Assess Resource Availability

· Plan for Continuity of Operations

· Develop Protocols to Ensure Appropriate Resource Allocation

· Design Appropriate Communication and Coordination Protocols for Both Internal and External Audiences

· Enhance Disease Surveillance and Reporting

· Planning -Managers acknowledge that anticipating uncertainty is challenging to recognize. By using data and industry knowledge, and including all stakeholders, healthcare risk managers can uncover threats and potentially compensatory events that otherwise would be hard to guess (Healthcare executives’ role in emergency management. 2020). This is where reporting comes in handy so that we can learn from mistakes.

· Patient safety – When mistakes or adverse events are avoided due to luck or intervention, “near misses” and “good catches” occur. These are often the best way to identify and prevent risk. Healthcare providers should develop a culture that encourages reporting so that prevention measures and best practices can be instituted (Healthcare executives’ role in emergency management. 2020).

· Regulations.- Regulatory bodies, such as The Joint Commission, Federal, state, and other oversight bodies mandate reporting of certain types of incidents including sentinel events, medication errors, and medical device malfunctions. Incidents such as wrong-site or patient surgery, workplace injuries, and medication errors need to be documented and reported (Healthcare executives’ role in emergency management. 2020).

Resources

Catalyst, N. E. J. M. (2018). What is risk management in healthcare? NEJM Catalyst. Retrieved April 22, 2022, from 
https://catalyst.nejm.org/doi/full/10.1056/CAT.18.0197
 

Healthcare executives’ role in emergency management. American College of Healthcare Executives. (n.d.). Retrieved April 22, 2022, from 
https://www.ache.org/about-ache/our-story/our-commitments/policy-statements/healthcare-executives-role-in-emergency-management

discussion

Walden 2

Leila Walden

Dr. Christie Rinck

HUN 1020

3/28/2022

Looking Deeper- Contextual Analysis 2

Kara Walker is an artist known for her paper silhouettes based on topics in race, gender, sexuality, and violence. Kara was born in Stockton, California in 1969, but was raised in Atlanta, Georgia from 13 years old. She attended the Atlanta College of Art where she received an Bachelor’s in Fine Arts, and then Rhode Island School of Design where she received a Master’s in Fine Arts (Biography).

Kara was introduced to art at a very young age by her father, Larry Walker, who became a big motivator to her future career. “Walker says some of her earliest memories were watching her father draw and thinking that she also wants to be able to do that for her job,” (Rinck, 2022). Larry Walker was an artist and a chair in the art department at the University of the Pacific, although he was not the only inspiration to Kara’s artistic ambitions. When she and her family moved to Atlanta, she began to recognize issues of race, and after receiving art degrees, she began working on art forms that would raise awareness of slavery, violence, and sex (Britannica).

In this contextual analysis, I will discuss one particular piece of art by Kara Walker called A Subtlety. This was Kara Walker’s first large scale public project, and one that she notes to be one of her most ambitious. A Subtlety was built in an abandoned Domino Sugar factory. This factory was dripping in molasses. It seeped through the wood and pillars of the building, and at other times in the year, molasses would come out from under the floor and the walls. This was the result of the sugar from the refining process leaking into the air and into the wood of the factory. Kara does not focus her project on any of the factory’s recent history, but instead focuses on the overall troubled history of the sugar industry especially relying on slave labor (Rinck, 2022). The factory displaying A Subtlety was in Williamsburg, New York and was demolished only months after Kara Walker created this thought-provoking piece.

A picture containing colonnade  Description automatically generated

https://www.npr.org/2014/05/16/313017716/artist-kara-walker-draws-us-into-bitter-history-with-something-sweet

As one might be able to guess, A Subtlety was a sculpture built from a form of sugar called Marzipan, or sugar paste. Its creation was much more complicated than just sugar, however. A Subtlety is considered a full round sculpture, or a three-dimensional piece. This means that the viewer could walk around the piece, seeing different proportions, articulations, focal areas, and dimensions. She created the three-dimensional look by adding layers of foam, shaving them, and then adding sugar to the surface (Rinck, 2022). A Subtlety sculpture is around 70 feet long and 35 feet tall, and it depicts a “mammy sphinx” completely naked except for a scarf around her head, with bare breasts and genitalia exposed. The term mammy means mother, or protector, but it also was a derogatory term used for black nannies in charge of white children in the early Southern U.S. Walker created this piece to represent this idea of an over-dramatized and sexualized African woman’s body, and the body that would have been laboring in the Southern sugar plantations. Kara goes on to add this same symbolism in the left hand of the sculpture, where the “mammy sphinx” is holding a thick sign, or a symbol of fertility and ridicule in some cultures.

This figure also disrupts the idea that black woman can’t be sexual on their own terms, and that they need to suppress their right to be sexual. Walker not only creates this to be fierce symbolism of oppression and sexuality, but she also adds symbolism of power and strength. The “mammy sphinx” is both political and complex. It has been a representation of sexuality throughout history, but Walker also uses it in a way to show the difference between what is considered the ideal white woman and the unattractive black woman, showing the oppression that women have seen for years and the power and strength they possess (Rinck, 2022).

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https://www.npr.org/2014/05/16/313017716/artist-kara-walker-draws-us-into-bitter-history-with-something-sweet

The social angle that I most apply to this sculpture is colonialism. A Subtlety incorporates this theme of race, sex, and history throughout every aspect of the sculpture, including the materials used to build it. Sugar was a luxury product, and the “backbreaking toil and dangerous labor” required to manufacture refined sugar was given to slaved laborers. The factory workers who worked in the assembly-line were generally slave children, who had to work night and day to keep up sugar production at its highest efficiency (Muhammad, 2019). Sugar itself was even highly racially stigmatized, and the kind of sugar you used would be tied to your race. It was seen that Europeans would consume crystallized white sugar, whereas brown sugar was consumed by dark-skinned, usually African, people (Rinck, 2022).

Kara Walker created A Subtlety inspired by her own experience as an African American woman living in the Southern U.S, which goes to show that the piece contains many social, cultural, and historical implications. This piece has major historical implications in the way that it represents the dark history of sugar and slavery. It reminds people about what was and what never should be again. It also contains major cultural and social implications, especially for African American women, as it raises awareness to the idea that women today are still sexualized, still powerful and still strong. Although the sculpture was only up for a few months, it had a major impact on the way people view sugar production not only as racial, but also a reminder on how humans should treat each other moving forward.

The aspect of A Subtlety that I will go more into depth on is the full round technique that Kara Walker uses. As mentioned before, a full round sculpture is one that is created to be three-dimensional and can be looked at from any angle. This also means that the viewer has to walk all the way around in it order to see the whole piece, as well as see how different aspects of the piece play with the overall theme. Artists may use this technique to encourage the viewer to follow the parts of the sculpture that seem to disappear or lead to the next aspect (Rinck, 2022).

Kara Walker had many aspects of A Subtlety that could not be seen at a first glance, including the brown sugar babies surrounding the sculpture, the importance of the exposed genitalia, bare breasts, and sphinxlike structure of the main sculpture. The full round technique played important roles in pushing the viewer to become a part of the piece, experiencing it in real life and not just from one angle. I think this full round technique could also symbolize looking for a deeper meaning. While the piece is of a “mammy sphinx” it also represents history, race, and sex, things that may not be recognized at first glance.

The second piece I chose to compare to A Subtlety was The Statue of Liberty. This statue is one that I’m sure most have heard of and many have seen. I chose this piece as another example of a full-round sculpture technique, but also as a representation of forgotten history and deeper meaning.

Statue Of Liberty National Monument (U.S. National Park Service)

https://www.nps.gov/stli/index.htm

The Statue of Liberty was created by French sculptor Fredric-Auguste Bartholdi and Alexandre-Gustave Eiffel. It was given to the United States as a gift of friendship and was dedicated by President Cleveland in 1886. This statue is on a small island, Liberty Island, in Upper New York Bay. It is known to symbolize freedom and democracy, although many forget its true origin and first symbol (History.com Editors).

The Statue of Liberty was given as a gift from the French towards the end of the American Civil War to celebrate the United States building an efficient democracy. It was a joint effort, as the French built the statue, and the Americans built the pedestal- creating a symbol of friendship between the French and Americans. It’s not often that we speak about this Franco-American friendship, but I thought this symbol was an interesting one to bring up as a comparison to other forgotten history (Symbolism).

I think the Statue of Liberty can represent postcolonialism, the opposite of A Subtlety. The Statue of Liberty represents new times, liberty, and freedom, and I find it interesting that it was also created towards the end of the war that also began the end of slavery in the United States, another definition of a new time. I see it as representing new friendships, that with the French, and the African Americans.

Post colonialism refers to changes in culture, which I believe the Statue of Liberty represents perfectly. Not only was this statue created at the end of the Civil War, but it was also created at the same time as the centennial of the Declaration of Independence, another major contributor to the changes in culture for America. We all know that the American Civil War had major social, cultural, and historical implications. The first being the beginning of the end of slavery, which was social, cultural, and historical. While the Statue of Liberty was not created because of the end of slavery, it still represents the idea that new friendships, freedoms, and liberties can be created through the combined efforts of people with different backgrounds.

Statue of the Liberty

https://www.wonders-of-the-world.net/Statue-of-Liberty/Photos-of-statue-of-Liberty.php

The Statue of Liberty represents the opposite of what A Subtlety does, and I think that’s why both have such major impacts today. The Statue of Liberty represents what should be, what could be, and the history that change is entirely possible. A Subtlety, on the other hand, shows that just because change happened once, doesn’t mean that the issue was resolved, or that it can’t be resolved further.

Both impact the idea of postcolonialism, and that there should be a change of culture. Women of all races should be treated with respect and should be allowed to express themselves in whatever way they want. Friendships should be built across races and peoples, and the history of those friendships should not be forgotten. This symbolism contained in art has such an incredible impact on people and how they view history as well as how they move forward in their being. It inspires people to change their behaviors and thoughts for the better and pushes those who experience things like racism and sexism to take a stand or reach out. In the case of these two art pieces, both symbols, one of friendship and one of slavery, represent times in American history where times changed. Hopefully both pieces can be a reminder to us to remember our history and make some not so subtle changes going forward in standing united with all peoples.

Word Count: 1772

References:

“Biography.” Kara Walker, http://www.karawalkerstudio.com/biography.

Britannica, The Editors of Encyclopaedia. “Kara Walker”. Encyclopedia Britannica, 22 Nov. 2021, https://www.britannica.com/biography/Kara-Walker.

History.com Editors. “Statue of Liberty.” History.com, A&E Television Networks, 2 Dec. 2009, https://www.history.com/topics/landmarks/statue-of-liberty.

Muhammad, Khalil Gibran. “The Barbaric History of Sugar in America.” The New York Times, The New York Times, 14 Aug. 2019, https://www.nytimes.com/interactive/2019/08/14/magazine/sugar-slave-trade-slavery.html.

Rinck, Christie. “Representation and Power in Art.” Kara Walker’s “A Subtlety”: Lectures and Readings, 2022, https://usflearn.instructure.com/courses/1643138/pages/kara-walkers-a-subtlety-lectures-and-readings?module_item_id=24621757.

“Symbolism of the Statue of Liberty.” Wonders of the World, https://www.wonders-of-the-world.net/Statue-of-Liberty/Symbolism-of-the-statue-of-Liberty.php.

Discussion

Definitions of Maturity Stages and Dimension Variables in the Middle Manager Best Practices Arc

Maturity Stages

1. Technology implementation competence and recognition: This first stage represents the middle manager’s capacity to learn, conceptualize, and articulate key issues relating to cogni- tive business technological skills, organizational interactions, management value systems, project management ethics, and management presence.

2. Multiplicity of business implementation of technology: Indicates the middle manager’s ability to integrate multiple points of view during technical project implementations. Using these new perspectives, the middle manager augments his or her skills with business implementation with technology career advancement, expands his or her management value system, is increasingly motivated to act ethically during projects, and enhances his or her management presence.

3. Integration of business implementation of technology: Maturing middle managers accumulate increased understand- ing of how business and technology operate together and affect one another. They gain new cognitive skills about technology and a facility with how the organization needs to interact, expand their management value system, perform business/technology actions to improve ethics about busi- ness and technology, and develop effective levels of manage- ment presence.

4. Stability of business/technology implementation: Middle manag- ers achieve stable integration when they implement projects using their cognitive and technological ability; have organi- zation interactions with operations; have management values with their superiors, peers, and subordinates; possess project ethics; and have the management presence appropriate for performing job duties, not only adequately, but also competi- tively (with peers and higher-ranking executives in the orga- nization hierarchy).

5. Technology project leadership: Leadership is attained by the middle manager when he or she can employ cognitive and technological skills, organization interactions, management, a sense of business ethics, and a sense of management presence to compete effectively for executive positions. This middle manager is capable of obtaining increasingly executive-level positions through successful interviewing and organization performance.

Performance Dimensions

1. Business technology cognition: Pertains to skills specifically related to learning, applying, and creating resources in busi- ness and technology, which include the necessary knowledge of complex operations. This dimension essentially establishes the middle manager as “operationally” proficient with tech- nology and forms a basis for movement to more complex and mature stages of development when managing technology projects.

2. Organizational interactions: This focuses on the middle man- ager’s knowledge and practice of proper relationships and management interactions during technology projects. This pertains to in-person interactions, punctuality of staff, work completion, conflict resolution, deference, and other protocols in technology projects.
3. Management values: Measures the middle manager’s ability

to articulate and act on mainstream corporate values credited with shaping technology project work ethic: independent ini- tiative, dedication, honesty, and personal identification with technology project goals, based on the philosophy of manage- ment protocol of the organization.

4. Project ethics: Reflects the middle manager’s commitment to the education and professional advancement of other persons in technology and in other departments.

5. Management presence: Involves the middle manager’s view of the role of a project-based manager during a technology project implementation and the capacity to succeed in tandem with other projects. Aspects include a devotion to learning and self-improvement, self-evaluation, the ability to acknowl- edge and resolve business conflicts, and resilience when faced with personal and professional challenges during technology implementations.

Figure 12.7 shows a graphic view of the middle management tech- nology best practices arc. Each cell in the arc provides the condi- tion for assessment. The complete arc is provided in Table 12.4. The challenge of the middle management best practices arc is whether to emphasize executive management concepts (more organizationally intended) or event-driven concepts (project oriented). This arc focuses on project implementation factors and deals with best practices that can balance executive pressures with implementation realities. I sug- gest that senior middle managers, at the director level, who do not participate in implementation, set their best practices, based on the CEO maturity arc. Indeed, creating a separate arc for upper manage- ment would contain too many overlapping cells.

Summary

The formation of best practices to implement and sustain ROD is a complex task. It involves combining traditional best practice methods (i.e., what seems to work for proven organizations and individuals)

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with developmental theory on individual maturation. The combina- tion of these two components provides the missing organizational learning piece that supports the attainment of ROD. Another way of comprehending this concept is to view the ROD arc as the over- arching or top-level model. The other maturity arcs and best practices

towArd best prACtICes333

represent the major communities of practice that are the subsets of that model. This is graphically depicted in Table 12.5.

Thus, the challenge is to create and sustain each community and, at the same time, establish synergies that allow them to operate together. This is the organizational climate created at ICAP, where the execu- tive board, senior and middle managers, and operations personnel all formed their own subcommunities; at the same time, all had the abil- ity for both downward and upward communication. In summary, this particular model relies on key management interfaces that are needed to support ROD.

discussion

May 2

Andrea May

Dr. Rinck

Introduction to Humanities

14 March 2022

Not So Subtle

Kara Walker was from Stockton, California and was born in 1969. She was inspired by her father to become an artist while also being inspired by obstacles on who she was as a person. One of her works, entitled A Subtlety, especially expressed her views on the obstacles she faced when she moved to Georgia. The statue I have chosen is called Attendant to the King of Hell by an unknown sculptor in Korea to compare it to A Subtlety by Kara Walker. A Subtlety explored the social angles of colonialism, post-colonialism, race and ethnicity and gender and sexuality.

Growing up, Kara Walker’s father was a painter and a professor. From witnessing this, Kara was inspired to take on becoming an artist as a part of her daily life as a career. However, because of the work that her father encountered, her family moved to Atlanta, Georgia when she was 13 years of age. There, she witnessed the profound impact of racism that became prevalent in the American South. She encountered moments of what is now known as the Klu Klux Klan around the years of the 1980s. In school, she was called profanities due to her race. As she grew as an artist, she became particularly interested in showcasing her experiences and standpoint on the racism she faced and read about. For her masters in art, she received the MacArthur Genius Grant in 1997 and used it to express more of herself through her art and along with it, her views on racism. An idea standing beside the works she created was the thoughts of other people being full of fears and longings, and that people were trying to steal the power that other people held within them. The ongoing theme of her work was that of melodrama, outrageous characters, pain, guts, glory, research and histeria (Fig. 4). In past works these themes went from silhouettes expressing racism’s effects to her creation called A Subtlety (“A Subtlety”).

Kara Walker’s A Subtlety explores the social angles involving colonialism, post-colonialism, race and ethnicity, and gender and sexuality. The work incorporated a sugar paste that was from sugar cane as well as corn syrup. The sugar paste, called marzipan, that was holding up the large sculpture was a symbol of slave trade. Marzipan was devoured in the medieval era after the main course as a fondant during the time of King Henry II. The piece was made out of 35 tons of sugar. The sugar was harvested by child workers during the slave trade, which were presented at the bottom of A Subtlety with children made out of brown sugar into statue form. The children at the bottom of the work dripped and oozed as a result of the sun in the Domino Sugar Factory (Fig. 1). The work was made to be ephemeral, which means that it would only last a short while for the exhibition. This was due to Kara Walker’s intention of showing how black lives had been neglected in the presence of slave owners in history. The sphinx was a representation of how women’s bodies were not their own and was a large reason as to why Kara had overly sexualized it based in the form of the body A Subtlety (Fig. 2). The formation of the body was inspired by the sphinxes in Egypt. Kara had researched many different components on sugar prior to the building of the statues. For example, the type of sugar that a person would consume back when slave labor was occuring had to do with their race. Europeans would consume crystal white sugar, while dark skinned people would consume brown sugar. The head of the Sphinx was inspired by the Mammy character which stood for a woman that would be political, asexualized, a protector, but would be an undesired woman on top of that. It was manifested in the movie called “Gone with the Wind.” Putting the Mammy character on the sphinx’s body expressed that they can be sexual as well, according to Kara. (“A Subtlety”) The meaning of A Subtlety to me meant that being oppressed for the meaning of the color of skin only leads to destruction of people, and does not lead to peace. It may lead to feelings of shame between individuals, and maybe an extreme frustration within to bridge the gap between the misunderstandings of people who may still think of colored skin as something to be segregated when there should be unity.

In comparison to the work that I chose, which was called Attendant to the King of Hell, and A Subtlety both had their similarities and differences. For instance, in A Subtlety and Attendant to the King of Hell (Fig. 3) both show an ephemeral quality. For example, the sugar in A Subtlety only lasted for a short amount of time for the exhibition for Kara, but in Attendant to the King of Hell, it held the message for the short lives that people lead because it discusses what may happen to someone after they die. Physically, both statues depict their eyes being open as well as front facing. Although the ethnicities are different between the two works, both have the social angles of race and ethnicity as well as gender playing a part in the messages they are trying to express. A Subtlety discusses slave trade and it’s impact while Attendant to the King of Hell discusses the after life and is based in Korea. On another note, the attendant figure from Attendant to the King of Hell physically doesn’t last a brief time like A Subtlety does because it is made of wood. There is no known artist for the attendant statue, but it was created in the 19th century. The full description of Attendant to the King of Hell comes from Buddhist beliefs such as trying to mitigate the punishments of the people who had passed away by the usage of prayer. On top of the usage of the statues in the subsidiary halls for Buddhists, paintings of the King of Hell would hold the same meanings for them. In the wooden figure depicted in figure 3, he is holding a scroll. Within the scroll holds the names of humans and how they are judged and it is recorded. The demographic background of the statue dates back to Korean folk sculpture artwork. It contains a mixture of religion with the beliefs held, is dressed in robes, and lacquered hat of a Confucian scholar official. (Korea) I discovered the artwork of Attendant to the King of Hell on a website called Jstor. What spoke to me about the artwork was that I am interested generally in Asian culture and different beliefs held. I think that having the belief of helping to save a passed beloved family member by prayer helps them to have peace afterwards.

In summary, A Subtlety depicts the social angles of race and ethnicity, post-colonialism, colonialism, and gender and sexuality and it thoroughly goes over the impacts of slave trade. Slave trade even lasted years after slavery ended and had an impact on Kara when she moved to Georgia. The inspiration from her father of being an artist drove Kara to become an artist and helped to express these firmly held beliefs she had on the topic of oppression against people who were black. Attendant to the King of Hell was another statue discussed and had many similarities as well as differences. Both shared the same social angles like that of gender, race and ethnicity being held in the messages. Both had an ephemeral quality, but it was not a physical quality, in the Attendant to the King of Hell it was in the message of life not lasting forever that made it brief, while in A Subtlety the physical statue was brief in how long it lasted because it was made of sugar that would soon ooze and turn into molasses.

(Word Count: 1309)

Figure 1:
https://www.nytimes.com/2014/05/12/arts/design/a-subtlety-or-the-marvelous-sugar-baby-at-the-domino-plant.html

Figure 2:
https://www.nytimes.com/2014/05/12/arts/design/a-subtlety-or-the-marvelous-sugar-baby-at-the-domino-plant.html

Figure 3:
https://www-jstor-org.ezproxy.lib.usf.edu/stable/community.15649675?searchUri=%2Faction%2FdoBasicSearch%3FQuery%3Dattendant%2Bto%2Bthe%2Bking%2Bof%2Bhell%26so%3Drel&ab_segments=0%2Fbasic_search_gsv2%2Fcontrol&refreqid=fastly-default%3Adb5776a20049dac1c8781012dff70af8&seq=1

Figure 4:
https://studiomuseum.org/article/silhouettes-relieved-kara-walkers-new-drawings

Works Cited

“Kara Walker ‘A Subtlety.’” https://usflearn.instructure.com/courses/1643138/pages/kara-walkers-a-subtlety-lectures-and-readings?module_item_id=24621757. Accessed 14 Mar. 2022.

Korea. Attendant to the King of Hell. https://jstor.org/stable/community.15649675. The Minneapolis Institute of Art;Minneapolis, Minnesota, USA;Gift of funds from Fred and Ellen Wells;97.122.2;http://www.artsmia.org/.

discussion

Fleming Mwashako Mwalugho

Sheffield Hallam

Research

Introduction

High sodium content is a global issue. Most countries have enacted laws to help curb the sodium content in food. However, some of the enactments are not fully enforced exposing the food industry to high food sodium especially in processed food and in certain cuisines. It is now established that high salt content leads to an increase in blood pressure and greatly increases the risk for cardiovascular diseases. According to (Du et al., 2022) cardiovascular diseases are one of the leading causes of death in most western countries accounting for more than 30% of the deaths. It is widely accepted that the consumption of high sodium foods is above the Food Standard Agency (FSA) recommended levels in the United Kingdom.

The WHO targets a 30% of salt reduction by 2025 with an adult consumption recommendation of fewer than 5 grams of salt per day. The United Kingdom set a target to reduce salt content for more than 85% of food categories ten years ago and this resulted in more than 20% reduction in high blood pressure and cardiovascular disease-related deaths. In China, intake of sodium is very high ranging from 12-14g/d, this is accompanied by the increase in the consumption of sauces like soy sauce which account for the highest rates, and processed food that also has high sodium content. This is also witnessed in the UK where most urban populations indulge in foreign cuisines. In developed countries, it is estimated that processed foods account for more than 75% of the salt consumed (Tan et al., 2019). Studies have shown that Chinese food, ingredients, and accompaniments in the United Kingdom contain higher levels of sodium than recommended by the FSA 2024 (Tan et al., 2019). Further in a study that was conducted in 2017 most UK products met the FSA standards but only 13% of Chinese products met the recommended FSA standards for sauces and Ingredients. Studies have demonstrated that it is possible to reduce salt content in Chinese food. Following the enactment of policies in past on salt regulation in the UK, there is a substantial decrease in the sodium content in Chinese cuisines this is in comparison to china where the same products are consumed. The most important strategy in reducing salt consumption is identifying the amount of salt consumed and how it is consumed. The aim of the study was to establish the sodium content in Chinese meal components, ingredients, and sauces and to determine if they are in line with the FSA 2024 standards. The final report provides actual values of salt content and helps in reviewing targets and informing consumer decisions. This was achieved by systematically collecting data on sodium levels on the UK processed Chinese products and comparing the sodium values against the UK FSA 2024 standard on salt content.

Literature review

He & MacGregor (2018) in a research on the relationship between high salt intake and cardiovascular diseases propose that a high level of sodium in food is highly detrimental and takes a toll on the life of a person. They explain that high sodium in foods increases the risk of hypertension which is dangerous, especially for people with comorbidities. The above argument is further supported by Bandy et al (2021) in research on U.K food safety and sodium levels found that high sodium levels increased the risk of cardiovascular diseases, hypertension, renal diseases, and stroke by 55% in a sample population of 1045 on a study conducted between 2019 and 2021. A study conducted by (Barton et al., 2011) raised blood pressure accounted for 47% of strokes and this is linked to evidence that high consumption levels of salt consumed in diets is the leading cause for high blood pressure.

Elsewhere Rippin et al., (2019) in a research on the effects of high sodium levels in energy foods in the UK by use of urinary sodium surveys, also found that the risk of hypertension and stroke was increased by 49% in a study sample size of 2200 drawn from various age groups. Additionally, the study also revealed, that 76% of the sodium taken was drawn from processed foods. The above therefore creates the need to investigate sodium levels in foods in the UK if they are in line with the F.S.A 2024 standards.

Antúnez et al., (2019) in a research on the F.S.A guidelines and standards on foods, explains various standards. Among the main findings is that there are various subcategories of targets to be met by food manufacturers by 2024. For instance, slices of bacon are set at 1035 sodium (2.59g of sodium) per 100 grams of bacon and 430mg sodium (1.08g sodium) per 100 grams of sausages. Tan et al., (2019) in research on the same, support the above findings by further giving more targets as set out by the F.S.A. further, the author lists and explains the targets like meat pies with a target of 370 mg sodium (0.93 sodium) per 100 gram of meat pie and standard of 320mg sodium (0.8g salt) for meat-based pasties by 2024.

Menyanu, Russell & Charlton (2019) further in their discussion they expound more on the above standards by discussing several standards and their anticipated importance. Among the foods standards the writers discuss are the above and more such as pizza, soups, crisps, snacks and biscuits. Sampling the standards, the target for biscuits is 220 mg sodium (0.55g salt) and for children’s main meals is 685 mg sodium (1.71g salt) per 100 mg of their food. The authors further posit that the above targets are part of the campaign started in 2003 by the F.S.A to reduce salt intake to 6mg per day per person by 2024.

Zhang et al., (2020) in research on Chinese processed foods, argues that Chinese processed foods are among the most popular cuisines in the U.K. additionally the writer argues that Chinese foods are four-fold saltier and higher in sodium in the U.K. Tan et al., (2019) further agree with the above by discussing that Chinese foods have high salt levels with an average of 13 g per day. Additionally, he explains that Chinese products such as sauces account up to 6% of total salt levels.

He et al., (2018) in their research reaffirms the above findings through research on Chinese salt and sodium levels research conducted in 2018-2019. In the study findings, the Chinese cuisine had more salts than the U.K foods. Specifically, from the researcher’s findings on instant noodles, of 10 sampled, 4 had more salt levels as compared to 2 of the U.K noodles. Additionally, 8 out of 11 food groups in China had more salt and sodium content compared to the same sampled in the UK. On average the writer affirms that Chinese products mostly non-processed had 4.5 times more salt than those from U.K. The comparison was done largely on non-processed and large groups of processed foods with little focus on processed foods.

In the longitudinal study conducted by (Ni Mhurchu et al., 2010) there was high sodium content in the food served in UK households. More than 50% of the salt consumed was added as table salt (Ni Mhurchu et al., 2010). The other 50% was mainly salt added at the point of processing ready meals. With the increase in ready meal consumption, there has been a substantial increase in dietary sodium levels in the UK (Ni Mhurchu et al., 2010). The intake of Chinese food from supermarkets has also increased over time reducing the gains that were instituted by the FSA in 2004.

In the UK the FSA recommends the reduction of salt intake to 6 grams in adults, it is also estimated that 75% of salt intake is derived from the consumption of processed foods retailed in supermarkets such as Tesco and Sainsbury with 27.5% and 16% respectively. This project was aimed at assessing the salt content in Chinese food, sauces, ingredients, and accompaniments sold in the above supermarkets.

Methodology

Data collection

The chosen method for this study was a systematic sampling of main Chinese food from two outlets, Tesco and Sainsbury. The outlets were chosen based on the number of Chinese cuisines available on their menu. One of the advantages of using systematic sampling is its convenience and the ability to single out samples and access the desired sample size and characteristics (Elfil & Negida, 2017). However, this is limiting as it may not be representative of the entire population. Further, there was a risk of data manipulation which was countered by ensuring the data was collected randomly (Elfil & Negida, 2017)..

A systematic survey was conducted in Tesco and Sainsbury with a primary goal of establishing the mean average sodium concentration in the main Chinese cuisine categories that contribute to salt in the diet bearing in mind most Chinese food uses soy products and other refined oils (Diez-Simon et al., 2020). Data was collected to include mainly Chinese cuisines, however, there was data from Thai and Japanese cuisines that had similar formulations. The data include quality ranges from top middle and bottom, this also included chilled, frozen, and ambient cuisines from across all the categories. For each cuisine, the data also included the weight of the product, price, brand name, serving size, and the amount of salt/100g. Not all products had salt contents, therefore, those that had nil or missing data were rounded up to zero for consistency.

Data analysis

The data was collected and stored in an excel datasheet. It was then imported to the Statistical Package for Social Sciences (SPSS) version 26, where descriptive and inferential statistics were conducted. Out of the 49 observations surveyed, the Chinese ready meal was 82 % followed by the Chinese ready sauces which were 8% of the total product category, and lastly, the Japanese ready sauces and Thai ready meal sauces had 2% each. Descriptive statistics were used to measure the mean value, frequency, standard deviation, and median.

An independent t-test was used to investigate if the mean of the two unrelated groups statistically differed where Salt g/100g was used as the dependent variable and the product subcategory was used as the independent variable. Seven observations were used to conduct the T independent t-test which produced 46 observations as the degrees of freedom. The total number of observations in Tesco was 23 while the total number of observations in Sainsbury’s was 25.

ANOVA test was used to determine the analysis of variance where more Chinese products were selected (89%) as compared to other products from Japan and Thai cuisines. Further, the One-way ANOVA analysis involved three groups that include the complete Chilled meal, complete ambient meal, and complete frozen meal. The product subcategories were used as the independent variable and the Salt g/100g was used as the dependent variable. A subsequent post hoc test was done to detect any significant difference in means between the groups. The average salt content was measured against the FSA 2024 guidelines on sauce-based foods (≤6 g/100 g). (Reference)

Results

Below are the results as analyzed using the SPSS 26 statistical tool. They included descriptive and inferential analysis.

Statistics

Product category

Product sub-category

Outlets

Product Name

Brand name

Brand type

Quality range

N

Valid

49

49

49

49

49

49

49

Missing

0

0

0

0

0

0

0

Table 1.1: frequencies product category

The total number of valid observations was 49 with 0 missing values for all product categories.

Product category

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Chinese ready meal

42

85.7

85.7

85.7

Chinese ready sauces

4

8.2

8.2

93.9

Japanese ready sauces

1

2.0

2.0

95.9

Japanese ready meals

2

4.1

4.1

100.0

Total

49

100.0

100.0

Table 1.2: frequencies product subcategory

There were four categories of Chinese cuisine processed foods products (n=4). There were 8.2% (n=4) Chinese ready sauces, 85.7% (n=42) Chinese ready meals, 4.1% (n=2) Japanese ready meal and 2% (n=1) Japanese ready sauces.

Table 1.3: product subcategories

Product sub-category

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

chilled meal , complete

27

55.1

55.1

55.1

Ambient meal complete

20

40.8

40.8

95.9

frozen meal complete

2

4.1

4.1

100.0

Total

49

100.0

100.0

There were three subcategories of the product which included Chilled meal, ambient meal, and frozen meal. There were 55.1% (n=27) Chilled meals, 40.8% (n=20) ambient meals, and 4.1% (n=2) frozen meals.

Table 1.3: frequencies_ Brand name

Brand name

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

1

25

51.0

51.0

51.0

2

24

49.0

49.0

100.0

Total

49

100.0

100.0

There were two brand names included Sainsbury’s and Tesco. There were 25 Sainsbury’s outlets accounting for 51% and 24 Tesco outlets representing the other half.

Table 1.4: frequencies quality range

Quality range

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Basic

2

4.1

4.1

4.1

Middle

46

93.9

93.9

98.0

Top

1

2.0

2.0

100.0

Total

49

100.0

100.0

Across all products, 4.1% (n=2) were basic range quality, 93.9% (n=46) mid-range quality and 2% (n=1) top range quality product.

Table 2: independent T test _ product category

Group statistics

Independent sample t Test

Group Statistics

Brand name

N

Mean

Std. Deviation

Std. Error Mean

Salt g/100g

1

23

1.488696

1.9117681

.3986312

2

24

.971563

.9326120

.1903686

Independent Samples Test

Levene’s Test for Equality of Variances

t-test for Equality of Means

F

Sig.

t

df

Sig. (2-tailed)

Mean Difference

Std. Error Difference

95% Confidence Interval of the Difference

Lower

Upper

Salt g/100g

Equal variances assumed

4.027

.051

1.186

45

.242

.5171332

.4358778

-.3607698

1.3950361

Equal variances not assumed

1.171

31.606

.250

.5171332

.4417545

-.3831310

1.4173973

The independent T-test indicated a difference in the salt content t (46) =1.253, p=0.043. The salt g/100g did not differ significantly between Tesco branded products (M=1.49, SD=1.91) and Sainsbury’s branded products (M=0.97, SD=0.93).

Further, the independent sample t-test was run where Salt g/100g was used as the dependent variable while product-subcategory was used as the independent variable. The total number of observations in Tesco was 23 while the total number of observations in the Sainsbury’s is 25. The mean of Tesco is 1.49 with a standard deviation of 1.91, while the mean of is 0.0953 with a mean of 0.953 with a standard deviation of 0.918 (Refer to table 2).

Table 3: One-way Anova

Descriptive

Salt g/100g

N

Mean

Std. Deviation

Std. Error

95% Confidence Interval for Mean

Minimum

Maximum

Lower Bound

Upper Bound

chilled,meal ,complete

27

.994352

.9232977

.1776887

.629107

1.359596

.0800

4.6000

Ambient meal complete

18

1.645000

2.1124289

.4979043

.594514

2.695486

.2000

8.0000

frozen meal complete

2

.550000

.0707107

.0500000

-.085310

1.185310

.5000

.6000

Total

47

1.224628

1.5003789

.2188528

.784100

1.665155

.0800

8.0000

ANOVA

Salt g/100g

Sum of Squares

df

Mean Square

F

Sig.

Between Groups

5.523

2

2.761

1.239

.299

Within Groups

98.029

44

2.228

Total

103.552

46

Results for One-Way ANOVA for the measure of salt content g/100g

The Chilled meal, ambient meal and frozen meal identified were not significant F (2, 44) = 1.24, p = 0.299. The degree of freedom between the groups is 2, and the degree of freedom within the group is 45. The mean of the Chilled meal is 0.99g and the standard deviation is 0.923. The mean of the ambient meal is 1.65g and the standard deviation is 2.11.

The mean of the frozen meal was 0.55g and the standard deviation is 0.07. The sum of squares between the groups is 5.52 and the sum of squares within the group was 98.03. The p-value is 0.26 which is greater than 0.05 thus we fail to reject the null hypothesis and conclude there is no significant difference in the means of the salt content across the three product subcategories.

Multiple Comparisons

Dependent Variable: Salt g/100g

Tukey HSD

(I) Product sub-category

(J) Product sub-category

Mean Difference (I-J)

Std. Error

Sig.

95% Confidence Interval

Lower Bound

Upper Bound

chilled,meal ,complete

Ambient meal complete

-.6506481

.4541927

.333

-1.752284

.450988

frozen meal complete

.4443519

1.0938409

.913

-2.208740

3.097443

Ambient meal complete

chilled,meal ,complete

.6506481

.4541927

.333

-.450988

1.752284

frozen meal complete

1.0950000

1.1125404

.591

-1.603447

3.793447

frozen meal complete

chilled,meal ,complete

-.4443519

1.0938409

.913

-3.097443

2.208740

Ambient meal complete

-1.0950000

1.1125404

.591

-3.793447

1.603447


A subsequent Tukey post hoc test demonstrated that the subcategories of the products were more likely to have a high salt content in the Ambient meal (M = 1.65, SD = 2.11) than in the chilled meal (M = 0.99, SD = 0.92). However, there were no significant differences in the amount of salt intake in Frozen meals (M = 0.54, SD = 0.06) and either Ambient meals or chilled meals.

Moreover, there was no significant difference between the three subcategories. There was no significant difference in the amount of salt in chilled meals and Ambient meals (p=0.33), there was no difference between the chilled milled and the Frozen meal (p=0.91) and there was no difference between Ambient meals and the Frozen meal (p=0.59).

Table 4: Salt

Salt g/100g

Tukey HSDa,b

Product sub-category

N

Subset for alpha = 0.05

1

frozen meal complete

2

.550000

chilled,meal ,complete

27

.994352

Ambient meal complete

18

1.645000

Sig.

.479

Means for groups in homogeneous subsets are displayed.

a. Uses Harmonic Mean Sample Size = 5.063.

b. The group sizes are unequal. The harmonic mean of the group sizes is used. Type I error levels are not guaranteed.

As represented in the table above, there is one subset. The Ambient meal (M = 1.645), chilled milled (M = 0.994) and frozen meal (M=0.55) fall under one subset. Therefore, the three conditions did not differ from each other.

Figure 1: histogram

Table 5: Pearson test

Correlations

Product category

pack size g

Product retail price £

Salt g/100g

salt grams per serving

Weight of serving g

Product category

Pearson Correlation

1

-.054

-.048

.192

.229

.109

Sig. (2-tailed)

.713

.745

.197

.126

.476

N

49

49

49

47

46

45

pack size g

Pearson Correlation

-.054

1

.201

-.316*

-.005

.272

Sig. (2-tailed)

.713

.166

.031

.974

.071

N

49

49

49

47

46

45

Product retail price £

Pearson Correlation

-.048

.201

1

-.069

-.067

-.052

Sig. (2-tailed)

.745

.166

.646

.659

.733

N

49

49

49

47

46

45

Salt g/100g

Pearson Correlation

.192

-.316*

-.069

1

.473**

-.211

Sig. (2-tailed)

.197

.031

.646

.001

.165

N

47

47

47

47

46

45

salt grams per serving

Pearson Correlation

.229

-.005

-.067

.473**

1

.409**

Sig. (2-tailed)

.126

.974

.659

.001

.006

N

46

46

46

46

46

44

Weight of serving g

Pearson Correlation

.109

.272

-.052

-.211

.409**

1

Sig. (2-tailed)

.476

.071

.733

.165

.006

N

45

45

45

45

44

45

*. Correlation is significant at the 0.05 level (2-tailed).

**. Correlation is significant at the 0.01 level (2-tailed).

The coefficient of correlation

According to the Pearson test table above, the coefficient of correlation between the product category and the salt was 0.192, between the product category and the salt in grams was 0.229 and between the weight of serving and the product category was 0.109. The coefficient of correlation between the pack size and the product retail price was 0.201, between the pack size and the weight of serving was 0.272. The coefficient of correlation between the product category and the pack size was -0.54. The coefficient of correlation between the product category and the product retail price was – 0.048. The coefficient of correlation between the salt and the pack size was -0.316, between pack size and salt grams per serving was -0.005. The coefficient of correlation between the pack size and the weight of serving was 0.272. The coefficient of correlation between the product retail price and the salt was 0.069, between product retail price and the salt per serving was -0.067.

Figure 2: scatter plot between the salt g/100g and the weight of serving g.

According to the figure above, the line depicts a negative slope thus there was an inverse relationship between the amount of salt and the pack size.

Figure 3. scatter plot between the salt g/100g and the weight of serving g.

According to the figure above, the line depicts a negative slope thus there was an

discussion

3.1 Qualitative and Quantitative Methods

Chapter 1 explained that researchers generally take one of two broad approaches to answering their research questions. Quantitative research is a systematic and empirical approach that attempts to generalize results to other contexts, whereas qualitative research is a more descriptive approach that attempts to gain a deep understanding of particular cases and contexts. Before we discuss specific examples of descriptive designs, it is important to understand that these can represent either quantitative or qualitative perspectives. This section contrasts the two approaches in more detail.

Chapter 1 used the analogy of studying traffic patterns to contrast qualitative and quantitative methods—a qualitative researcher would likely study a single busy intersection in detail. This example illustrates a key point about this approach: Qualitative researchers are focused on interpreting and making sense out of what they observe rather than trying to simplify and quantify these observations. In general, qualitative research involves a collection of interviews and observations made in a natural setting. Regardless of the overall approach (qualitative or quantitative), data collection in the real world results in less control and structure than it does in a laboratory setting. But whereas quantitative researchers might view reduced control as a threat to reliability and validity, qualitative researchers view it as a strength of the study. Conducting observations in a natural setting makes it possible to capture people’s natural and unfiltered responses.

As an example, consider two studies of the ways people respond to traumatic events. In a 1993 paper, psychologists James Pennebaker and Kent Harber took a quantitative approach to examining the community-wide impact of the 1989 Loma Prieta earthquake (near San Francisco). These researchers conducted phone surveys of 789 area residents, asking people to indicate, using a 10-point scale, how often they “thought about” and “talked about” the earthquake during the three-month period after its occurrence. In analyzing these data, Pennebaker and Harber discovered that people tend to stop talking about traumatic events about two weeks after they occurred but keep thinking about the event for approximately four more weeks. That is, the event is still on people’s minds, but they decide to stop discussing it with other people. In a follow-up study using the 1991 Gulf War, the same researchers found that this conflict leads to an increased risk of illness, measured via an increase in visits to the doctor (Pennebaker & Harber, 1993). The goal of the study was to gather data in a controlled manner and test a set of hypotheses about community responses to trauma.

Contrast Pennebaker and Harber’s approach with the more qualitative one taken by the developmental psychologist Paul Miller and colleagues (2012), who used a qualitative approach to study the ways that parents model coping behavior for their children. These researchers conducted semistructured interviews of 24 parents whose families had been evacuated following the 2007 wildfires in San Diego County and an additional 32 parents whose families had been evacuated following a 2008 series of deadly tornadoes in Tennessee. Because of a lack of prior research on how parents teach their children to cope with trauma, Miller and colleagues approached their interviews with the goal of “documenting and describing” (p. 8) these processes. That is, rather than attempt to impose structure and test a strict hypothesis, the researchers focused on learning from these interviews and letting the interviewees’ perspectives drive the acquisition of knowledge.

A mother and daughter sit on a couch talking to a therapist with a clipboard.

Lisafx/iStock/Thinkstock

Paul Miller’s research, which involved a series of semi-structured, qualitative interviews, attempted to document and describe a phenomenon rather than test a theory.

Qualitative and quantitative methods also differ quite strikingly in how they approach analyses of the data. Because all quantitative methods have the goal of discovering findings that can be generalized—that apply across different contexts—all quantitative studies must translate phenomena into numerical values and conduct statistical analyses. So, for example, Pennebaker and Harber’s (1993) study of coping with trauma measured the concrete value of “visits to the doctor,” and then compared changes in this number over time. In contrast, because qualitative methods have the goal of learning and interpreting phenomena from the ground up, qualitative studies focus on discovering the underlying meaning of phenomena in their own right. So, for example, Miller and colleagues’ 2012 study of coping focused on “documenting and describing” the ways that parents teach children to cope and learning from a critical evaluation of the interview content. At risk of oversimplifying: Quantitative methods gloss over some of the richness of experience in order to discover knowledge that can be generalized, while qualitative methods sacrifice the ability to generalize in order to capture the richness of experience.

As one final example of this contrast, consider the way that each approach would analyze the content of an interview. Interviewing people can be a very effective way to understand their experiences and can form the basis for many of the descriptive designs we cover in this chapter. A qualitative researcher would likely conduct a smaller number of interviews (perhaps only one, for a case study), due to the time required for analysis. The researcher would read each interview in depth and then start to identify themes that appeared across the entire set. These themes would serve as the basis for understanding people’s experiences. (For an excellent deep dive into different theoretical approaches to interview analysis, see Smith [2008].) By comparison, a quantitative researcher would conduct a larger number of interviews, because quantitative text analysis can be very fast. Rather than read each interview, the researcher could input the text of these interviews into a software program, which could count and categorize the overall sentiment of the language people used. These counts and categories would then serve as the basis for quantifying people’s experiences on a larger scale.

The following three sections examine three specific examples of descriptive designs—case studies, archival research, and observational research. Because each of these methods has the goal of describing attitudes, feelings, and behaviors, each one can be used from either a quantitative or a qualitative perspective. In other words, qualitative and quantitative researchers use many of the same general methods but do so with different goals. To illustrate this flexibility, each section concludes with a paragraph that contrasts qualitative and quantitative uses of the particular method.

discussion

3.2 Case Studies

At the 1996 meeting of the American Psychological Association, James Pennebaker—now chair of the psychology department at the University of Texas—delivered an invited address, describing his research on the benefits of therapeutic writing. Rather than follow the normal approach to an academic conference presentation, showing graphs and statistical tests to support his arguments, Pennebaker told a story. In the mid-1980s, when Pennebaker’s lab was starting to study the effects of structured writing on physical and psychological health, one study participant was an American soldier who had served in the Vietnam War. Like many others, this soldier experienced difficulty adjusting to what had happened during the war and consequent trouble reintegrating into “normal” life. In Pennebaker’s study, he was asked to simply spend 15 minutes per day, over the course of a week, writing about a traumatic experience—in this case, his tour of duty in Vietnam. At the end of this week, as might have been expected, this veteran felt awful, revisiting unpleasant memories over a decade old. But over the next few weeks, amazing things started to happen: The soldier slept better; he made fewer visits to his doctor; he even reconnected with his wife after a long separation.

Pennebaker’s presentation was a case study, which provides a detailed, in-depth analysis of one person over a period of time. Although this case study was collected as part of a larger quantitative experiment, case studies are usually conducted in a therapeutic setting and involve a series of interviews. An interviewer will typically study the subject in detail, recording everything from direct quotes and observations to his or her own interpretations. We encountered this technique briefly in Chapter 2 (2.1), in discussing Oliver Sacks’s case studies of individuals learning to live with neurological impairments.

Pros and Cons of Case Studies

Case studies in psychology are a form of qualitative research and represent the lowest point on our continuum of control. Because they involve one person at a time, without a control group, case studies are often unsystematic. That is, the participants are chosen, rather than selected randomly, because they tell a compelling story or because they represent an unusual set of circumstances. Studying these individuals allows for a great deal of exploration, which can often inspire future research. However, it is nearly impossible to generalize from one case study to the larger population. In addition, because the case study includes both direct observation and the researcher’s interpretation, a researcher’s biases run the risk of influencing the interpretations. For example, Pennebaker’s personal investment in demonstrating that writing has health benefits could have led to more positive interpretations of the Vietnam veteran’s outcomes. However, in this particular case study, the benefits of writing mirror those seen in hundreds of controlled experimental studies involving thousands of people, so we can feel confident in the conclusions from the single case.

Case studies have two distinct advantages over other forms of research. First is the simple fact that anecdotes are persuasive. Despite Pennebaker’s nontraditional approach to a scientific talk, the audience came away utterly convinced of the benefits of therapeutic writing. And although Oliver Sacks studied one neurological patient at a time, the collection of stories in his books sheds very convincing light on the ability of humans to adapt to their circumstances. Second, case studies provide a useful way to study rare populations and individuals with rare conditions. For example, from a scientific point of view, the ideal might be to gather a random sample of individuals living with severe memory impairment due to alcohol abuse and conduct some sort of controlled study in a laboratory environment. This approach could allow us to make causal statements about the results, as Chapter 5 (5.4) will discuss. But from a practical point of view, such a study would be nearly impossible to conduct, making case studies such as Sacks’s interviews with William Thompson the best strategy for understanding this condition in depth.

Examples of Case Studies

Throughout the history of psychology, case studies have been used to address a number of important questions and to provide a starting point for controlled quantitative studies. For example, in developing his theories of cognitive development, the Swiss psychologist Jean Piaget first studied the way that his own children developed and changed their thinking styles. Piaget proposed that children would progress through a series of four stages in the way that they approached the world—sensorimotor, preoperational, concrete operational, and formal operational—with each stage involving more sophisticated cognitive skills than the previous stage. By observing his own children, Piaget noticed preliminary support for this theory and later was able to conduct more controlled research with larger populations.

Perhaps one of the most famous case studies in psychology is that of Phineas Gage, a 19th-century railroad worker who suffered severe brain damage. In September of 1848, Gage was working with a team to blast large sections of rock to make way for new rail lines. After a large hole was drilled into a section of rock, Gage’s job was to pack the hole with gunpowder, sand, and a fuse and then tamp it down with a long cylindrical iron rod (known as a “tamping rod”). On this particular occasion, it seems Gage forgot to pack in the sand. So, when the iron rod struck gunpowder, the powder exploded, sending the 3-foot long iron rod through his face, behind his left eye, and out the top of his head. Against all odds, Gage survived this incident with relatively few physical side effects. However, everyone around him noticed that his personality had changed—Gage became more impulsive, violent, and argumentative. Gage’s physician, John Harlow, reported the details of this case in an 1868 article. The following passage offers a strong example of the rich detail that is often characteristic of case studies:

He is fitful, irreverent, indulging at times in the grossest profanity (which was not previously his custom), manifesting but little deference for his fellows, impatient of restraint or advice when it conflicts with his desires. A child in his intellectual capacity and manifestations, he has the animal passions of a strong man. Previous to his injury, although untrained in the schools, he possessed a well-balanced mind, and was looked upon by those who knew him as a shrewd, smart businessman, very energetic and persistent in executing all his plans of operation. In this regard his mind was radically changed, so decidedly that his friends and acquaintances said he was “no longer Gage.” (pp. 339–342)

Different angles of Phineas Gage’s skull, with an iron rod going through it.

Everett Collection

Various views show an iron rod embedded in Phineas Gage’s (1823–1860) skull.

Gage’s transformation ultimately inspired a large body of work in psychology and neuroscience that attempts to understand the connections between brain areas and personality. The area of his brain destroyed by the tamping rod is known as the frontal lobe, now understood to play a critical role in impulse control, planning, and other high-level thought processes. Gage’s story is a perfect illustration of the pros and cons of case studies: On the one hand, it is difficult to determine exactly how much the brain injury affected his behavior because he is only one person. On the other hand, Gage’s tragedy inspired researchers to think about the connections among mind, brain, and personality. As a result, we now have a vast—and still growing—understanding of the brain. The story illustrates a key point about case studies: Although individual cases provide only limited knowledge about people in general, these cases often lead researchers to conduct additional work that does lead to generalizable knowledge.

Qualitative versus Quantitative Approaches

Case studies tend to be qualitative more often than not: The goal of this method is to study a particular case in depth, as a way to learn more about a rare phenomenon. In both Pennebaker’s study of the Vietnam veteran and Harlow’s study of Phineas Gage, the researcher approached the interview process as a way to gather information and learn from the bottom up about the interviewee’s experience. However, a case study can certainly represent quantitative research. This is often the case when researchers conduct a series of case studies, learning from the first one or the first few and then developing hypotheses to test on future cases. For example, a researcher could use the case of Phineas Gage as a starting point for hypotheses about frontal lobe injury, perhaps predicting that other cases would show similar changes in personality. Another way in which case studies can add a quantitative element is for researchers to conduct analyses within a single subject. For example, a researcher could study a patient with brain damage for several years following an injury, tracking the association between deterioration of brain regions with changes in personality and emotional responses. At the end of the day, though, these examples would still suffer the primary drawback of case studies: Because they examine a single individual, researchers find it difficult to generalize findings.

Research: Thinking Critically

Analyzing Acupuncture

Follow the link below to a press release from the Peninsula College of Medicine and Dentistry. This short article reviews recent research from the college, suggesting that acupuncture treatment might be of benefit to patients suffering from “unexplained” symptoms. As you read the article, consider what you have learned so far about the research process, and then respond to the questions below.


http://www.sciencedaily.com/releases/2011/05/110530080513.htm

Think about it:

1. In this study, researchers interviewed acupuncture patients using open-ended questions and recorded their verbal responses, which is a common qualitative research technique. What advantages does this approach have over administering a quantitative questionnaire with multiple-choice items?

2. What are some advantages of adding a qualitative element to a controlled medical trial like this?

3. What would be some disadvantages of relying exclusively on this approach?

discussion

3.4 Observational Research

A baby asleep in his mother’s arms.

Rayes/Photodisc/Thinkstock

Observational research can be used to measure an infant’s attachment to a caregiver.

Moving further along the continuum of control, we come to the descriptive design with the greatest amount of researcher control. Observational research involves studies that directly observe behavior and record these observations in an objective and systematic way. Your previous psychology courses may have explored the concept of attachment theory, which argues that an infant’s bond with his or her primary caregiver has implications for later social and emotional development. Mary Ainsworth, a Canadian developmental psychologist, and John Bowlby, a British psychologist and psychiatrist, articulated this theory in the 1960s. They argued that children can form either “secure” or a variety of “insecure” attachments with their caregivers (Ainsworth & Bell, 1970; Bowlby, 1963).

To assess these classifications, Ainsworth and Bell developed an observational technique called the “strange situation.” Mothers would arrive at their laboratory with their children for a series of structured interactions, including having the mother play with the infant, leave him alone with a stranger, and then return to the room after a brief absence. The researchers were most interested in coding the ways in which the infant responded to these various episodes (eight in total). One group of infants, for example, was curious when the mother left but then returned to playing with toys, trusting that she would return. Another group showed immediate distress when the mother left and clung to her nervously upon her return. Based on these and other behavioral observations, Ainsworth and colleagues classified these groups of infants as “securely” and “insecurely” attached to their mothers, respectively.

Research: Making an Impact

Harry Harlow

In the 1950s, U.S. psychologist Harry Harlow conducted a landmark series of studies on the mother–infant bond using rhesus monkeys. Although contemporary standards would consider his research unethical, the results of his work revealed the importance of affection, attachment, and love on healthy childhood development.

Prior to Harlow’s findings, it was believed that infants attached to their mothers as a part of a drive to fulfill exclusively biological needs, in this case obtaining food and water and avoiding pain (Herman, 2007; van der Horst & van der Veer, 2008). In an effort to clarify the reasons that infants so clearly need maternal care, Harlow removed rhesus monkeys from their natural mothers several hours after birth, giving the young monkeys a choice between two surrogate “mothers.” Both mothers were made of wire, but one was bare and one was covered in terry cloth. Although the wire mother provided food via an attached bottle, the monkeys preferred the softer, terry-cloth mother, even though the latter provided no food (Harlow & Zimmerman, 1958; Herman, 2007).

Further research with the terry-cloth mothers contributed to the understanding of healthy attachment and childhood development (van der Horst & van der Veer, 2008). When the young monkeys were given the option to explore a room with their terry-cloth mothers and had the cloth mothers in the room with them, they used the mothers as a safe base. Similarly, when exposed to novel stimuli such as a loud noise, the monkeys would seek comfort from the cloth-covered surrogate (Harlow & Zimmerman, 1958). However, when the monkeys were left in the room without their cloth mothers, they reacted poorly—freezing up, crouching, crying, and screaming.

A control group of monkeys who were never exposed to either their real mothers or one of the surrogates revealed stunted forms of attachment and affection. They were left incapable of forming lasting emotional attachments with other monkeys (Herman, 2007). Based on this research, Harlow discovered the importance of proper emotional attachment, stressing the importance of physical and emotional bonding between infants and mothers (Harlow & Zimmerman, 1958; Herman, 2007).

Harlow’s influential research led to improved understanding of maternal bonding and child development (Herman, 2007). His research paved the way for improvements in infant and child care and in helping children cope with separation from their mothers (Bretherton, 1992; Du Plessis, 2009). In addition, Harlow’s work contributed to the improved treatment of children in orphanages, hospitals, day care centers, and schools (Herman, 2007; van der Horst & van der Veer, 2008).

Pros and Cons of Observational Research

Observational designs are well suited to a wide range of research questions, provided the questions can be addressed through directly observable behaviors and events. For example, researchers can observe parent–child interactions, or nonverbal cues to emotion, or even crowd behavior. However, if they are interested in studying thought processes—such as how close mothers feel to their children—then observation will not suffice. This point harkens back to the discussion of behavioral measures in Chapter 2 (2.2): In exchange for giving up access to internal processes, researchers gain access to unfiltered behavioral responses.

To capture these unfiltered behaviors, it is vital for the researcher to be as unobtrusive as possible. As we have already discussed, people have a tendency to change their behavior when they are being observed. In the bullying study by Craig and Pepler (1997) discussed at the beginning of this chapter, the researchers used video cameras to record children’s behavior unobtrusively. Imagine how (artificially) low the occurrence of bullying might be if the playground had been surrounded by researchers with clipboards!

If researchers conduct an observational study in a laboratory setting, they have no way to hide the fact that people are being observed, but the use of one-way mirrors and video recordings can help people to become comfortable with the setting. Researchers who conduct an observational study out in the real world have even more possibilities for blending into the background, including using observers who are literally hidden. For example, someone hypothesizes that people are more likely to pick up garbage when the weather is nicer. Rather than station an observer with a clipboard by the trash can, the researcher could place someone out of sight behind a tree, or perhaps sitting on a park bench pretending to read a magazine. In both cases, people would be less conscious of being observed and therefore more likely to behave naturally.

One extremely clever strategy for blending in comes from a study by the social psychologist Muzafer Sherif et al. (1954), involving observations of cooperative and competitive behaviors among boys at a summer camp. For Sherif, it was particularly important to make observations in this context without the boys realizing they were part of a research study. Sherif took on the role of camp janitor, which allowed him to be a presence in nearly all of the camp activities. The boys never paid enough attention to the “janitor” to realize his omnipresence—or his discreet note-taking. The brilliance of this idea is that it takes advantage of the fact that people tend to blend into the background once we become used to their presence.

Types of Observational Research

Several variations of observational research exist, according to the amount of control that a researcher has over the data collection process. Structured observation involves creating a standard situation in a controlled setting and then observing participants’ responses to a predetermined set of events. The “strange situation” studies of parent–child attachment (discussed above) are a good example of structured observation—mothers and infants are subjected to a series of eight structured episodes, and researchers systematically observe and record the infants’ reactions. Even though these types of studies are conducted in a laboratory, they differ from experimental studies in an important way: Rather than systematically manipulate a variable to make comparisons, researchers present the same set of conditions to all participants.

Another example of structured observation comes from the research of John Gottman, a psychologist at the University of Washington. For nearly three decades, Gottman and his colleagues have conducted research on the interaction styles of married couples. Couples who take part in this research are invited for a three-hour session in a laboratory that closely resembles a living room. Gottman’s goal is to make couples feel reasonably comfortable and natural in the setting to get them talking as they might do at home. After allowing them to settle in, Gottman adds the structured element by asking the couple to discuss an “ongoing issue or problem” in their marriage. The researchers then sit back to watch the sparks fly, recording everything from verbal and nonverbal communication to measures of heart rate and blood pressure. Gottman has observed and tracked so many couples over the decades that he is able to predict, with remarkable accuracy, which couples will divorce in the 18 months following the lab visit (Gottman & Levenson, 1992).

Naturalistic observation, meanwhile, involves observing and systematically recording behavior in the real world. This can be conducted in two broad ways—with or without intervention on the part of the researcher. Intervention in this context means that the researcher manipulates some aspect of the environment and then observes people’s responses. For example, a researcher might leave a shopping cart just a few feet away from the cart-return area and track whether people move the cart. (Given the number of carts that are abandoned just inches away from their proper destination, someone must be doing this research all the time.) Recall an example from Chapter 1 (the discussion of ethical dilemmas in section 1.5) in which Harari et al. (1995) used naturalistic observation to study whether people would help in emergency situations. In brief, these researchers staged what appeared to be an attempted rape in a public park and then observed whether groups or individual males were more likely to rush to the victim’s aid.

The ABC network has developed a hit reality show that mimics this type of research. The show, What Would You Do?, sets up provocative situations in public settings and videotapes people’s reactions. An unwitting participant in one of these episodes might witness a customer stealing tips from a restaurant table, or a son berating his father for being gay, or a man proposing to his girlfriend who minutes earlier had been kissing another man at the bar. Of course, these observation “studies” are more interested in shock value than data collection (or Institutional Review Board [IRB] approval; see Section 1.5), but the overall approach can be a useful strategy to assess people’s reactions to various situations. In fact, some of the scenarios on the show are based on classic studies in social psychology, such as the well-documented phenomenon that people are reluctant to take responsibility for helping in emergencies.

Alternatively, naturalistic studies can involve simply recording ongoing behavior without any attempt by the researchers to intervene or influence the situation. In these cases, the goal is to observe and record behavior in a completely natural setting. For example, researchers might station themselves at a liquor store and observe the numbers of men and women who buy beer versus wine. Or, they might observe the numbers of people who give money to the Salvation Army bell-ringers during the holiday season. A researcher can use this approach to compare different conditions, provided the differences occur naturally. That is, researchers could observe whether people donate more money to the Salvation Army on sunny or snowy days, or compare donation rates when the bell ringers are different genders or races. Do people give more money when the bell-ringer is an attractive female? Or do they give more to someone who looks needier? These are all research questions that could be addressed using a well-designed naturalistic observation study.

Finally, participant observation involves having the researcher(s) conduct observations while engaging in the same activities as the participants. The goal is to interact with these participants to gain better access and insight into their behaviors. In one famous example, the psychologist David Rosenhan (1973) was interested in the experience of people hospitalized for mental illness. To study these experiences, he had eight perfectly sane people gain admission to different mental hospitals. These fake patients were instructed to give accurate life histories to a doctor but lie about one diagnostic symptom. They all claimed to hear an occasional voice saying the words “empty,” “hollow,” and “thud.” Such auditory hallucinations are a symptom of schizophrenia, and Rosenhan chose these words to vaguely suggest an existential crisis.

Once admitted, these “patients” behaved in a normal and cooperative manner, with instructions to convince hospital staff that they were healthy enough to be released. In the meantime, they observed life in the hospital and took notes on their experiences—a behavior that many doctors interpreted as “paranoid note-taking.” The main finding of this study was that hospital staff tended to view all patient behaviors through the lens of their initial diagnoses. Despite immediately acting “normally,” these fake patients were hospitalized an average of 19 days (with a range from 7 to 52) before being released. All but one was diagnosed with “schizophrenia in remission” upon release. Rosenhan’s other striking finding was that treatment was generally depersonalized, with staff spending little time with individual patients.

A nurse distributing treatments to patients in a psychiatric hospital.

RENARD/BSIP/Superstock

Psychologists David Rosenhan’s study of staff and patients in a mental hospital found that patients tended to be treated based on their diagnosis, not on their actual behavior.

In another example of participant observation, Festinger, Riecken, and Schachter (1956) decided to join a doomsday cult to test their new theory of cognitive dissonance. Briefly, this theory argues that people are motivated to maintain a sense of consistency among their various thoughts and behaviors. So, for example, a person who smokes a cigarette despite being aware of the health risks might rationalize smoking by convincing herself that lung-cancer risk is really just genetic. In this case, Festinger and colleagues stumbled upon the case of a woman named Mrs. Keach, who was predicting the end of the world, via alien invasion, at 11 p.m. on a specific date six months in the future. What would happen, they wondered, when this prophecy failed to come true? (One can only imagine how shocked they would have been had the prophecy turned out to be correct.)

To answer this question, the researchers pretended to be new converts and joined the cult, living among the members and observing them as they made their preparations for doomsday. Sure enough, the day came, and 11 p.m. came and went without the world ending. Mrs. Keach first declared that she had forgotten to account for a time-zone difference, but as sunrise started to approach, the group members became restless. Finally, after a short absence to communicate with the aliens, Mrs. Keach returned with some good news: The aliens were so impressed with the devotion of the group that they decided to postpone their invasion. The group members rejoiced, rallying around this brilliant piece of rationalizing, and quickly began a new campaign to recruit new members.

As these examples illustrate, participant observation can provide access to amazing and one-of-a-kind data, including insights into group members’ thoughts and feelings. This approach also provides access to groups that might be reluctant to allow outside observers. However, the participant approach has two clear disadvantages over other types of observation. The first problem is ethical; data are collected from individuals who do not have the opportunity to give informed consent. Indeed, the whole point of the technique is to observe people without their knowledge. Before an IRB can approve this kind of study, researchers must show an extremely compelling reason to ignore informed consent, as well as extremely rigorous measures to protect identities. The second problem is methodological; the approach provides ample opportunity for the objectivity of observations to be compromised by the close contact between researcher and participant. Because the researchers are a part of the group, they can change the dynamics in subtle ways, possibly leading the group to confirm their hypothesis. In addition, the group can shape the researchers’ interpretations in subtle ways, leading them to miss important details.

Another spin on participant observation is called ethnography, or the scientific study of the customs of people and cultures. This is very much a qualitative method that focuses on observing people in the real world and learning about a culture from the perspective of the person being studied—that is, learning from the ground up rather than testing hypotheses. Ethnography is used primarily in other social-science fields, such as anthropology. In one famous example, the cultural anthropologist Margaret Mead (1928) used this approach to shed light on differences in social norms around adolescence between American and Samoan societies. Mead’s conclusions were based on interviews she conducted over a six-month period, observing and living alongside a group of 68 young women. Mead concluded from these interviews that Samoan children and adolescents are largely ignored until they reach the age of 16 and become full members of society. Among her more provocative claims was the idea that Samoan adolescents were much more liberal in their sexual attitudes and behaviors than American adolescents.

Mead’s work has been the subject of criticism by a handful other anthropologists, one of whom has even suggested that Mead was taken in by an elaborate joke played b

discussion

9:26 AM (CT)

Assignment Details

Assignment Description

Graduate Programs Discussion Boards

Discussion Boards (DB) are a key component of online learning. They foster active participation of learners and dialog with fellow learners and instructors. Graduate­level courses
require learners to create original posts to course DBs and to engage in dialogue by responding to posts created by others throughout the course. Original posts and responses
should be substantive, and if references are made to the works of others, APA guidelines for in­text citations and references apply.

Minimum Weekly DB Expectations

Post an original and thoughtful Main Post to the DB prompt.
Respond to at least 2 other posts from learners and/or the instructor (Response Posts).
The first contribution (Main Post or Response Post) must be posted before midnight (Central time) on Friday of each week.
Two additional responses are required after Friday of each week.
For DB assignment prompts with a Part One and Part Two, Part One should be addressed in the first week of the unit with a Main Post and minimum of 2 Response
Posts, and Part Two should be addressed in the second week of the unit with a Main Post and a minimum of 2 Response Posts.

More on DBs

At the end of each unit, DB participation is assessed based on level of engagement and the quality of the contribution to the discussion. DBs allow learners to learn through
sharing ideas and experiences as they relate to course content. Because it is not possible to engage in two­way dialogue after a conversation has ended, no posts to the DB are
accepted after the end of the unit. Learners must demonstrate an appropriate depth of understanding of course content to receive credit for having submitted substantive posts.
Typically, this is achieved with 3–4 strong paragraphs for Main Posts and 2–3 strong paragraphs for Response Posts.

Watch the following LinkedIn Learning Videos to help you with the assignments in this Unit.

Library Research Assignment

Describe in your own words, what is a directory service (such as Microsoft Active Directory, Novell, e­Directory, etc.)?
Under what circumstances would you recommend its implementation for a client?
Why do you think an organization would continue to use directory services that have known security flaws?
What is LDAP and what are its security vulnerabilities?

The following grading rubric will be used for this assignment. 

In your own words, post a substantive response to the Discussion Board question(s) and comment on other postings.  Your response should address the DB
question(s) and move the conversation forward.  You will be graded on the quality of your postings, including mastery of the concept as well as critical thinking. 
If asked for your opinion, do not simply state that it is a good or bad idea; elaborate on your reasons and argument. Include enough detail to substantiate your
thinking as well as your position on the questions or comments.

For assistance with your assignment, please use your text, Web resources, and all course materials.

Reading Assignment
Ciampa, Part 2 (End Point Security), Module 3 (Threats and Attacks on Endpoints)
Ciampa, Part 2 (End Point Security), Module 4 (Endpoint and Application Security)

Assignment Objectives
Compare internal and external information security solutions for a given situation

Other Information
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Extra Credit View Assignment Rubric

Unit 2 ­ Discussion Board 

Assignment Overview

Unit:  Vulnerabilities
Due Date:  Tue,5/3/22
Grading Type:  Numeric
Points Possible:  60
Points Earned: 
Deliverable Length:  See Assignment Details

Type:  Discussion Board

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Assignment Details
Learning Materials
Reading Assignment

My Work:

Online Deliverables: Discussion Board

9:26 AM (CT)

Assignment Details

Assignment Description

Graduate Programs Discussion Boards

Discussion Boards (DB) are a key component of online learning. They foster active participation of learners and dialog with fellow learners and instructors. Graduate­level courses
require learners to create original posts to course DBs and to engage in dialogue by responding to posts created by others throughout the course. Original posts and responses
should be substantive, and if references are made to the works of others, APA guidelines for in­text citations and references apply.

Minimum Weekly DB Expectations

Post an original and thoughtful Main Post to the DB prompt.
Respond to at least 2 other posts from learners and/or the instructor (Response Posts).
The first contribution (Main Post or Response Post) must be posted before midnight (Central time) on Friday of each week.
Two additional responses are required after Friday of each week.
For DB assignment prompts with a Part One and Part Two, Part One should be addressed in the first week of the unit with a Main Post and minimum of 2 Response
Posts, and Part Two should be addressed in the second week of the unit with a Main Post and a minimum of 2 Response Posts.

More on DBs

At the end of each unit, DB participation is assessed based on level of engagement and the quality of the contribution to the discussion. DBs allow learners to learn through
sharing ideas and experiences as they relate to course content. Because it is not possible to engage in two­way dialogue after a conversation has ended, no posts to the DB are
accepted after the end of the unit. Learners must demonstrate an appropriate depth of understanding of course content to receive credit for having submitted substantive posts.
Typically, this is achieved with 3–4 strong paragraphs for Main Posts and 2–3 strong paragraphs for Response Posts.

Watch the following LinkedIn Learning Videos to help you with the assignments in this Unit.

Library Research Assignment

Describe in your own words, what is a directory service (such as Microsoft Active Directory, Novell, e­Directory, etc.)?
Under what circumstances would you recommend its implementation for a client?
Why do you think an organization would continue to use directory services that have known security flaws?
What is LDAP and what are its security vulnerabilities?

The following grading rubric will be used for this assignment. 

In your own words, post a substantive response to the Discussion Board question(s) and comment on other postings.  Your response should address the DB
question(s) and move the conversation forward.  You will be graded on the quality of your postings, including mastery of the concept as well as critical thinking. 
If asked for your opinion, do not simply state that it is a good or bad idea; elaborate on your reasons and argument. Include enough detail to substantiate your
thinking as well as your position on the questions or comments.

For assistance with your assignment, please use your text, Web resources, and all course materials.

Reading Assignment
Ciampa, Part 2 (End Point Security), Module 3 (Threats and Attacks on Endpoints)
Ciampa, Part 2 (End Point Security), Module 4 (Endpoint and Application Security)

Assignment Objectives
Compare internal and external information security solutions for a given situation

Other Information
There is no additional information to display at this time.

Legend
Extra Credit View Assignment Rubric

Unit 2 ­ Discussion Board 

Assignment Overview

Unit:  Vulnerabilities
Due Date:  Tue,5/3/22
Grading Type:  Numeric
Points Possible:  60
Points Earned: 
Deliverable Length:  See Assignment Details

Type:  Discussion Board

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Looking for tutoring? Go to Smarthinking

Assignment Details
Learning Materials
Reading Assignment

My Work:

Online Deliverables: Discussion Board

discussion

using formal APA writing convention, using the 7th Edition.


Plagiarism free work…. Thank you

To Prepare:

· Review the Resources and reflect on the various strategies presented throughout the course that may be helpful in disseminating effective and widely cited EBP.

· This may include unit-level or organizational-level presentations, poster presentations, and podium presentations at organizational, local, regional, state, and national levels, as well as publication in peer-reviewed journals.

· Reflect on which type of dissemination strategy you might use to communicate EBP.

By Day 3 of Week 9

Post: two dissemination strategies you would be most inclined to use and explain why. Explain which dissemination strategies you would be least inclined to use and explain why. Identify at least two barriers you might encounter when using the dissemination strategies, you are most inclined to use. Be specific and provide examples. Explain how you might overcome the barriers you identified.

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Top of Form

The purpose of the ISO/IEC 27000 is diverse. In simple terms, the ISO 27000 Suite of Security Standards is developed to help enterprises manage the risks of cyber-attacks and internal data security threats. There are additional vulnerabilities in technology solutions as a business expands, and these weaknesses may not be visible at first. All firms that use networked technology face a constant threat from cybercriminals, and securing your data may be difficult. 

As it stands, Companies may also use the ISO 27000-series standards to help develop effective and economical solutions that can help secure personal information, business information, and intellectual property. ISO 27001 is now the only standard that can be audited, making it the most popular of the other measures. A company does not have to rely only on ISO 27001 to improve its operations’ security (Alexei, 1). For example, ISO 27005 advises on performing risk assessments for your information security, and ISO 27032 provides general guidelines on ways to enforce cyber security measures as effectively as possible. It creates a foundation for the safe sharing of information and protecting personal data, compassionate data. As a result, accidents will be less likely to occur, saving both time and money in reacting to them.

Source List

· ALEXEI, A. (2021). Ensuring information security in public organizations in the Republic of Moldova through the ISO 27001 standard.

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Discussion

The CEO Best Practices Technology Arc

Similar to the chief IT executive arc, the CEO best practices arc is an instrument for assessing the technology best practices of CEOs. The arc evaluates a CEO’s strategic uses of technology and leader- ship by using a grid that charts competencies ranging from conceptual knowledge about technology to more complex uses of technology and business and how they are integrated in strategic business planning.

As with all arc models, the CEO version measures five principal stages of a CEO’s maturity with respect to business applications of technology: conceptual, structural, executive values, executive eth- ics, and executive leadership. Each dimension or sector is measured in five stages of maturation that guide the CEO’s executive growth managing technological dynamism. The first stage is being reflec- tively aware about their conceptual knowledge of technology and what it can do for the organization. The second is other centered- ness, by which CEOs become aware of the multiplicity of business uses of technology and the different views that can exist inside and outside the organization. The third is integration of business use of technology; a CEO can begin to combine how business plans foster the need for technology. The fourth is implementation of business/ technology process, meaning that the CEO understands how busi- ness applications and technology are used together and is resilient to nonauthentic sources of emerging technologies. Stage four rep- resents an ongoing commitment to implementing both technology and business applications. The fifth refers to strategic uses of tech- nology; CEOs have reached a stage at which their judgment on using technology and business is independent and can be used to self-educate. Thus, as CEOs grow in knowledge of business uses of technology, they can become increasingly more understanding of the multiplicity of uses, can become more integrated in how they conceptualize technology, can manage its implementation from an executive position, and can apply strategies to support new applica- tions of technology in the organization.

Definitions of Maturity Stages and Dimension Variables in the CEO Technology Best Practices Arc

Maturity Stages

1. Conceptual knowledge of technology: This first stage represents the CEO’s capacity to learn, conceptualize, and articulate key issues relating to business uses of technology, organizational structures available, executive value methods, executive ethi- cal issues surrounding technology, and leadership alternatives that are needed to be successful with technology applications.

2. Multiplicity of business perspectives of technology: This stage indicates the CEO’s ability to integrate multiple points of view from management, staff, and consultants about technol- ogy applications in business. Using these new perspectives, the CEO augments his or her conceptual skills with technol- ogy, has an expanded view of what organizational structures might work best, expands his or her executive values about technology uses, is increasingly aware of the ethical dilemmas with technology, and enhances his or her leadership abilities.

3. Integration of business uses of technology: Maturing CEOs accu- mulate increased understanding of how technology can sup- port the business, provide more competitive advantage, and have a more integrated understanding of how to use their conceptual skills about technology, of the alternative organi- zational structures available, of how to combine their business executive value and ethical systems, and how to develop effec- tive levels of executive leadership.

1. Implementation of business/technology process: CEOs achieve integration when they can regularly apply their conceptual knowledge of technology, organization structures, executive values and ethics about technology, and executive leadership, appropriate for performing their job duties, not only ade- quately, but at a level that provides a competitive advantage for the organization.

2. Strategic uses of technology: Leadership is attained by the CEO when he or she can employ conceptual skills, develop new organizational structures as necessary, establish new values and ethics that are appropriate for the organization, and create a sense of executive presence to lead the organiza- tion strategically. This CEO is capable of having new vision about how business and technology can be expanded into new endeavors.

Performance Dimensions

1. Technology concepts: Concerns conceptual skills, specifically related to understanding how technology can be used in the business. This dimension essentially establishes the CEO as technically proficient, conceptually, and forms a basis for movement to more complex and mature stages of business/ technology development.

2. Organizational structures: The knowledge of the alternative organizational structures that can support the application of emerging technology in corporate settings with regard to roles, responsibilities, career paths, and organizational report- ing alternatives.

3. Executive values: Measures the CEO’s ability to articulate and act on mainstream technological values credited with shaping the work ethic: independent initiative, dedication, honesty, and personal identification with career goals, based on the philosophy of the management protocol of the organization.

4. Executive ethics: Reflects the CEO’s commitment to the edu- cation and professional advancement of the behavior of the organization as it relates to business uses of technology.

5. Executive leadership: Involves the CEO’s view of the role of an executive in business, and the capacity to succeed in tan- dem with his or her organizational resources. Aspects include a devotion to organizational learning and self-improvement, self-evaluation, the ability to acknowledge and resolve busi- ness/technology conflicts, and resilience when faced with per- sonal and professional challenges.

Figure 12.6 shows a graphic view of the CEO technology best practices arc. Each cell in the arc provides the condition for assess- ment. The complete arc is provided in Table 12.2.

Middle Management

Middle management, which comprises a number of tiers, is perhaps the most challenging of best practices to define. In Chapter 3, I strati- fied the different types of positions that make up middle managers into three tiers: directors, line managers, and supervisors. What is most important at this point is to determine the set of technology best practices for managers so that they can effectively operate under ROD. That is, technology best practices must be designed to contain the insights and skills for effective management of technology. This must include

1. Working with IT personnel

2. Providing valuable input to the executive management team,

including the CEO

3. Participating and developing a technology strategy within

their business units

4. Effectively managing project resources, including technical

staff

5. Leading innovative groups in their departments

6. Incorporating technology into new products and services

7. Developing proactive methods of dealing with changes in technology

8. Investigating how technology can improve competitive advantage.

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As with CEO research, there are myriad best practices that have been offered as a method of dealing with the subject of technology management. Unfortunately, these practices usually are vague and intermingle management levels and departments; that is, it is diffi- cult to know whether the best practice is for the chief IT executive, the CEO, or some other level of management. We know from the research from Bolman and Deal (1997) that middle managers feel torn by conflicting signals and pressures they get from both senior management and the operations that report to them: “They need to understand the difference in taking risks and getting punished for mistakes” (p. 27). According to Bolman and Deal (1997), best prac- tices for middle managers need to cover the following areas:

1. Knowledge management
2. Alignment
3. Leadership and commitment 4. Organization
5. Human resources
6. Opportunity management

7. Leveraging
8. Performance assessment

Their study covered more than 400 companies in the eight areas of concern. I extracted 10 middle management-related best practices from their study results and concluded that middle managers need to

1. Understand how to take a strategy and implement it with technology; that is, they need to create tactics for completing the project.

2. Establish team-building measures for linking technology with daily operations of the staff.

3. Foster the aggregation and collaboration of business unit assets to form peer groups that can determine joint efforts for implementing new technologies.

4. Stimulate their staffs using innovative strategies of value propositions and reward systems.

5. Create multifunctional teams that can focus on particu- lar aspects of how technology affects their specific area of expertise.

6. Follow common project management practices so that mul- titier and department projects can be globally reviewed by senior management.

7. Form project teams that can respect and perform on an action basis; that is, teams that are action oriented.

1. Understand how to communicate with, and use, IT staff on projects.

2. Have a systematic process for gathering intelligence relating to pertinent technology developments.

3. Understand that customers are the drivers for technology tools provided by the organization.

On reviewing the different aspects of middle manager best practices with technology research, it appears that there are two focal points: (1) those best practices that address the needs of senior management, the CIO, and the CEO; and (2) those that are geared toward the management of the staffs who need to implement emerging technol- ogy projects.

This makes sense, given that the middle manager, notwith- standing whether a director, line manager, or supervisor, needs to deal with executive productivity-related issues as well as staff implementation ones. They are, as Bolman and Deal (1997) state, “torn” by these two competing organizational requirements. Table 12.3 represents the combined list of technology-based best practices organized by executive best practices and implementation best practices.

Table 12.3 exemplifies the challenge that middle managers have in balancing their priorities. In accordance with the research, the best practices mentioned are implemented using methods of knowledge management, alignment, leadership and commitment, human resources, opportunity management, leveraging, and per- formance assessment. As with the other best practices, the middle manager technology best practices are limited because they do not address the specific needs of ROD, particularly organizational learning theories (with the exception of knowledge management). This shortfall is integrated into another developmental arc model that combines these theories with the preceding definitions of best practices.

discussion

Week 2 – Discussion Forum

2727 unread replies.2727 replies.

Your initial discussion thread is due on Day 3 (Thursday) and you have until Day 7 (Monday) to respond to your classmates. Your grade will reflect both the quality of your initial post and the depth of your responses. Refer to the Discussion Forum Grading Rubric under the Settings icon above for guidance on how your discussion will be evaluated.

Sentinel Event [WLOs: 1, 2] [CLOs: 1, 2, 3, 5]

Prior to beginning work on this discussion, read through the following webpages and resources to understand the purpose of documenting sentinel events as well as methods and reporting requirements:

·
Sentinel Event Policy and Procedures (Links to an external site.)

·
PSNet Search (Links to an external site.)

· Sentinel Events


Download Sentinel Events

·
Sentinel Events (SE) (Links to an external site.)

·
Topic 6: Understanding and Managing Clinical Risk (Links to an external site.)

Your initial discussion post must be a minimum of 250 words. All referenced materials must include citations and references in APA format. Please see directions for including APA Style elements on these Writing Center pages:
APA: Citing Within Your Paper (Links to an external site.)
and
Formatting Your References List (Links to an external site.)
.

Sentinel events occur in nearly all health care organizations. According to the Maine Department of Human Services,

facilities that are vigilant about identifying and reporting errors…foster an organizational culture where staff members feel comfortable reporting patient safety concerns without fear of reprisal. Healthcare facilities that embrace this safety-focused culture look at adverse events as opportunities to learn and improve. (2018, p. 5)

You are assigned a sentinel event topic based on the first initial of your last name (see table below). Based on your assigned topic, research a sentinel event, or create your own scenario. You will use this sentinel event for other assignments later in class.

Operation/post-operation complication events

From a health care provider perspective (e.g., hospital, physician’s practice, long-term care, hospice, home health, surgery center, etc.), write a brief description of the sentinel event in your own words.

In addition, address the following:

· Identify the sentinel event, who was involved, what occurred, and where it occurred.

· Describe the applicable accrediting agency’s requirements for reporting the event (e.g., OSHA, ACHA, CMS, CDC, CLIA, The Joint Commission [TJC], AHCA, state agencies).

· Discuss the probable cause that may have contributed to the sentinel event (e.g., process failure, human error, policy error, systems error, technology failure, etc.).

· Create a recommendation that will reduce the risk of future events from occurring.

Guided Response: By the end of Day 7, review your classmates’ posts and respond to two of your fellow classmates. Choose two different topics from the one you were assigned. Recommend one quality improvement process that you would put into place to avoid future occurrences and explain its use. Your responses to your classmates should be substantive and a minimum of 100 words.

Reference

Department of Health and Human Services, Division of Licensing and Certification. (2018).
Sentinel events CY2018: Annual report to the Maine State Legislature (Links to an external site.)
[Report]. https://www.maine.gov/dhhs/dlc/medical-facilities/sentinelevents/documents/Sentinel-Event-Annual-Report-2018-3-19.pdf

Discussion

Pressure Injury Management

©2020 American Association of Critical-Care Nurses
doi:https://doi.org/10.4037/ajcc2020810

Background Hospital-acquired pressure injuries dispropor-
tionately affect critical care patients. Although risk factors
such as moisture, illness severity, and inadequate perfu-
sion have been recognized, nursing skin assessment data
remain unexamined in relation to the risk for hospital-
acquired pressure injuries.
Objective To identify factors associated with hospital-
acquired pressure injuries among surgical critical care
patients. The specific aim was to analyze data obtained
from routine nursing skin assessments alongside other
potential risk factors identified in the literature.
Methods This retrospective cohort study included 5101
surgical critical care patients at a level I trauma center and
academic medical center. Multivariate logistic regression
using the least absolute shrinkage and selection operator
method identified important predictors with parsimonious
representation. Use of specialty pressure redistribution
beds was included in the model as a known predictive
factor because specialty beds are a common preventive
intervention.
Results Independent risk factors identified by logistic
regression were skin irritation (rash or diffuse, nonlocal-
ized redness) (odds ratio, 1.788; 95% CI, 1.404-2.274; P < .001),
minimum Braden Scale score (odds ratio, 0.858; 95% CI,
0.818-0.899; P < .001), and duration of intensive care unit
stay before the hospital-acquired pressure injury devel-
oped (odds ratio, 1.003; 95% CI, 1.003-1.004; P < .001).
Conclusions The strongest predictor was irritated skin, a
potentially modifiable risk factor. Irritated skin should be
treated and closely monitored, and the cause should be
eliminated to allow the skin to heal.(American Journal of
Critical Care. 2020;29:e128-e134)

Risk FactoRs FoR
Hospital- acquiRed
pRessuRe injuRy in
suRgical cRitical
caRe patients
By Jenny Alderden, PhD, APRN, CCRN, CCNS, Linda J. Cowan, PhD, APRN,
RN, FNP-BC, CWS, Jonathan B. Dimas, BSN, RN, CCRN, Danli Chen, MSTAT,
Yue Zhang, PhD, Mollie Cummins, PhD, RN, and Tracey L. Yap, PhD, RN,
WCC, CNE

1.0 HourC E
This article has been designated for CE contact
hour(s). See more CE information at the end of
this article.

e128 AJCC AMERICAN JOURNAL OF CRITICAL CARE, November 2020, Volume 29, No. 6 www.ajcconline.org

www.ajcconline.org AJCC AMERICAN JOURNAL OF CRITICAL CARE, November 2020, Volume 29, No. 6 e129

The relationship between
hospital-acquired pressure
injuries and skin status
remains mostly unexamined
in the critical care population.

P
atients admitted to the intensive care unit (ICU) are twice as likely as other acute care
patients to have a hospital-acquired pressure injury (HAPI) develop.1 A pressure injury
(PI) is defined as localized damage of the skin or underlying tissue as a result of pres-
sure or pressure in combination with shear.2 Patients who undergo surgery and who
are older than 65 years have a higher risk than younger patients of acquiring a PI in the

hospital.3,4 In the United States, PI costs attributed to patients exceed $26.8 billion annually,5
and having a HAPI develop results in a median 4-day increase in the length of stay.6

Determining the factors associated with HAPI
development in critical care patients is necessary to
enable risk-based preventive measures. Although
HAPIs are associated with known risk factors such
as decreased mobility, surgery duration, vasopressor
infusion, excessive moisture, altered perfusion, and
history of a prior PI, the relationship between HAPIs
and skin status remains mostly unexamined in the
critical care population.4,7-18 Assessing skin status
(including turgor, excessive dryness, irritation, skin
tears, and the loss of subcutaneous tissue) to iden-
tify potential HAPI prevention interventions is
particularly essential when caring for older patients
because of age-related changes. Such changes include
thinning skin, decreased subcutaneous tissue, flatten-
ing of the dermal-epidermal junction (decrease in rete
ridges), structural disorganization of collagen fibers
in the dermis, loss of vertical capillary loops, and
loss of elasticity.2

Using informatics to analyze the vast amounts
of electronic health record (EHR) data, such as skin
assessment data, routinely produced during care
delivery is an excellent way to identify risk factors
for HAPI development. Critical care nurses routinely
conduct head-to-toe skin assessments every 12 hours
and document changes in condition in the EHR. How-
ever, these large-scale real-world data have not been
fully examined in relation to HAPIs in the surgical
critical care setting.

The unprecedented quantities and diverse sources
of data collected during care delivery make this an
opportune time to conduct HAPI research. The pur-
pose of our study was to identify factors associated
with HAPI development among surgical critical care
patients. Our specific aim was to examine data
obtained from routine nursing skin assessments along
with other previously reported HAPI risk factors.

Methods
Design and Sample

This was a retrospective cohort study. We included
data from surgical critical care patients admitted con-
secutively to the surgical ICU (SICU) or cardiovascu-
lar surgical ICU (CVICU) at our study site, an urban
level I trauma center and academic medical center,
from 2014 through 2018. We included patients with
a PI present on
admission to the
hospital because
patients with prior
PIs are at increased
risk for subsequent
HAPIs.16 We did not
count community-
acquired PIs as
HAPIs because they
were not acquired in the hospital. However, if patients
with a community-acquired ulcer had a HAPI develop,
that subsequent PI was included in the analysis because
it was hospital acquired. The exclusion criterion was
a stay of less than 24 hours because of inadequate time
for a HAPI to be considered a facility-acquired PI.

Data Collection
Data were obtained via EHR query and retrieved

from our institution’s enterprise data warehouse for
critical care data. For patients with multiple hospital
admissions, we limited data collection to the first
SICU or CVICU admission. A biomedical informat-
ics team performed the query. Query results were
validated by a critical care nurse who verified infor-
mation obtained (including date and time stamps)

About the Authors
Jenny Alderden is an assistant professor and Mollie
Cummins is a professor, University of Utah College of
Nursing, Salt Lake City. Linda J. Cowan is associate
director, VISN 8 Patient Safety Center of Inquiry, James
A. Haley Veterans’ Hospital and Clinics, Tampa, Florida.
Jonathan B. Dimas is a PhD candidate, University of Utah
College of Nursing, and a clinical nurse and analyst,
University of Utah Health, Salt Lake City. Danli Chen is
a biostatistician II and Yue Zhang is an associate profes-
sor, Division of Epidemiology, University of Utah, Salt
Lake City. Tracey L. Yap is an associate professor, Duke
University School of Nursing, Durham, North Carolina.

Corresponding author: Jenny Alderden, PhD, APRN, CCRN, CCNS,
University of Utah College of Nursing, 10 S 2000 E, Salt Lake
City, UT 84112 (email: Jenny.Alderden@Nurs.Utah.Edu).

e130 AJCC AMERICAN JOURNAL OF CRITICAL CARE, November 2020, Volume 29, No. 6 www.ajcconline.org

Data from more than
5000 consecutive sur-

gical critical care
patients were analyzed

retrospectively.

via the human-readable system EHR for 30 patients,
including 15 patients with HAPIs. A practicing criti-
cal care nurse and a certified wound nurse also man-
ually reviewed medical records, including data from
the notes and images, to obtain data that were miss-
ing or unclear in the query.

Outcome Variable
The outcome variable was the development of a

HAPI of any stage (stages 1 through 4, deep tissue
injury, or unstageable) according to the National Pres-
sure Injury Advisory Panel staging guidelines.2 We
included stage 1 HAPIs in our outcome because prior
studies showed that one-third of stage 1 HAPIs detected
among surgical critical care patients worsen to stage

2 or greater.19 A certified
wound nurse verified the PIs
in our sample to differentiate
potential cases of moisture-
related skin breakdown from
true HAPIs. In cases in which a
HAPI might be confused with
another source of injury, the
certified wound nurse made
the final decision as to the

presence or absence of the HAPI. We were able to
differentiate between community-acquired PIs and
HAPIs because each PI in our EHR has a unique
identification number with a date and time stamp.

Predictor Variables
We conducted a systematic review of the litera-

ture to identify predictor variables of interest.4 Possi-
ble predictor variables included vasopressor infusions
and their durations,17 blood gas and laboratory val-
ues,18,19 surgical time,20 levels of sedation and agita-
tion,21 and total score on the Braden Scale (a common
tool used by nursing staff to assess the risk of PI devel-
opment by examining moisture, mobility, sensory
perception, and friction/shear).22

We included comprehensive nursing skin assess-
ment data. At our facility, nurses undergo annual train-
ing in head-to-toe skin assessment and PI staging.
Nurses at our facility conduct a global head-to-toe skin
assessment twice daily and document the following
changes: excessively moist skin, excessively dry skin,
thin epidermis with loss of subcutaneous tissue, and
the presence of irritation (defined as a rash or diffuse,
nonlocalized, blanchable redness). Nurses also doc-
ument the presence of a skin tear. Table 1 lists the
predictor variables included in our analysis.

For patients who had a HAPI develop, we col-
lected data only for events occurring at least 24 hours

before HAPI detection. We chose this time frame to
capture events predictive of a HAPI rather than events
occurring at the same time as a HAPI.

Analysis
Analysis was conducted with R, version 3.6.1

(R Foundation for Statistical Computing).23 We sum-
marized and compared the distributions of potential
prediction factors by HAPI status with a χ2 test for
categorical factors and a 2-sample t test (or its non-
parametric alternative, the Mann-Whitney U test)
for continuous and ordinal variables. We performed
multivariable logistic regression analysis with the least
absolute shrinkage and selection operator (LASSO)24
to identify the subset of potential predictors most
informative for predicting the likelihood of a HAPI
developing. The final model for outcomes was based
on the optimal penalty term using 10-fold cross-
validation criteria.

By imposing some penalty in the regression
model fitting, the LASSO approach can shrink the
coefficients of unimportant predictors to 0 while
retaining prominent predictors. A predictor has
predictability on the outcome only if its coefficient is
nonzero. The final models, therefore, include all
important predictors with parsimonious representa-
tion, enhanced interpretability, and improved pre-
diction precision. In this study, the variable specialty
bed was forced into the model as a known predic-
tion factor (even though our general SICU and
CVICU bed is a low-air-loss mattress) because some
of our patients were placed on other types of specialty
rental beds (eg, bariatric beds or specialty prone
positioning beds) because of body habitus or clini-
cal condition.25

Results
Sample

The initial query produced 5102 patients. We
excluded 1 patient from the analysis because of incom-
plete demographic data, so the final sample size
was 5101. Demographic data are shown in Table 1.

Pressure Injury Outcomes
Of the 5101 patients in our sample, 399 (8%) had

at least 1 HAPI develop. Of the 399 patients with a
HAPI, 110 (28%) had a stage 1 HAPI develop; 182
(46%), stage 2 HAPI; 6 (2%), stage 3 HAPI; 1 (< 1%),
stage 4 HAPI; 33 (8%), unstageable HAPI; 62 (16%),
deep tissue injury; and 5 (1%), mucosal PI. Of the
110 stage 1 HAPIs, 44 (40%) worsened to a more
severe stage during the SICU or CVICU stay. The
most common PI location was the coccyx (n = 153

www.ajcconline.org AJCC AMERICAN JOURNAL OF CRITICAL CARE, November 2020, Volume 29, No. 6 e131

Pull quote

[38%]), followed by the buttocks (n = 62 [16%]),
sacrum (n = 47 [12%]), extremity excluding heel
(eg, arms or legs; n = 46 [12%]), head or face
(n = 40 [10%]), other location (n = 32 [8%]), back
(n = 10 [3%]), and heel (n = 9 [2%]).

Pressure Injury Predictors
Univariate relationships between potential pre-

dictor variables and HAPI development are presented
in Table 1. From the soft-thresholding property of the

LASSO in linear models, the estimated regression
coefficient is biased toward 0. To mitigate these bias
problems, we report a more unbiased estimation of
regression coefficients from unpenalized multivari-
ate logistic regression using the selected factors in
the LASSO (Table 2).

Discussion
The purpose of our study was to identify risk fac-

tors for HAPI development among SICU and CVICU

Variable

No. (%) of patientsa

P
All

(N = 5101)
With no HAPI

(n = 4702)
With a HAPI

(n = 399)

Table 1
Potential predictor variables and development of
hospital-acquired pressure injury

Abbreviations: HAPI, hospital-acquired pressure injury; ICU, intensive care unit.
a Unless otherwise indicated in first column.
b Irritated skin is defined as a rash or diffuse, nonlocalized, blanchable redness, not over a bony prominence.
c Riker Sedation-Agitation Scale.
d Calculated as weight in kilograms divided by height in meters squared.

Demographic data
Age, mean (SD), y 58 (17) 59 (16) 58 (16) .24
Sex, male 3302 (65) 3040 (65) 262 (66) .73
Race, White 4256 (83) 3934 (84) 322 (81) .14
Ethnicity, non-Hispanic 4452 (87) 4112 (87) 340 (85) .17
Length of hospital stay, mean (SD), d 12 (11) 11 (9) 28 (20) <.001
Length of ICU stay before HAPI, mean (SD), d 5 (7) 5 (6) 13 (13) <.001
Laboratory data, mean (SD)
Maximum lactate, mg/dL 4.0 (3.7) 3.9 (3.6) 5.6 (4.8) <.001
Maximum serum creatinine, mg/dL 1.9 (1.9) 1.8 (1.9) 2.7 (2.1) <.001
Maximum serum glucose, mg/dL 231 (148) 227 (141) 280 (210) <.001
Minimum hemoglobin, g/dL 8.9 (2.6) 9.1 (2.6) 7.7 (2.2) <.001
Minimum albumin, g/dL 3.1 (0.8) 3.2 (0.8) 2.7 (0.7) <.001
Minimum Pao

2
, mm Hg 54 (40) 55 (41) 47 (32) <.001

Minimum arterial pH 7.27 (0.11) 7.27 (0.10) 7.23 (0.13) <.001
Maximum Paco

2
, mm Hg 52 (14) 52 (13) 55 (16) <.001

Skin status
Thin epidermis/subcutaneous tissue loss 888 (17) 792 (17) 96 (24) <.001
Excessively dry skin 351 (7) 296 (6) 55 (14) <.001
Skin tear 641 (13) 534 (11) 107 (27) <.001
Excessively moist skin 816 (16) 712 (15) 104 (26) <.001
Irritated skinb 1394 (27) 1176 (25) 218 (55) <.001
Community-acquired pressure injury present at

admission
167 (3) 120 (3) 47 (12) <.001

Duration of surgery, mean (SD), h
Longest single surgery 3.0 (2.6) 3.0 (3.2) 3.3 (2.5) .08
Total surgical time 3.7 (3.4) 3.6 (3.3) 4.6 (4.7) <.001
Duration of vasopressor infusion, mean (SD), h
Norepinephrine 9 (36) 7 (33) 30 (62) <.001
Epinephrine 8 (35) 7 (31) 23 (61) <.001
Phenylephrine 1 (8) 1 (14) 2 (20) .01
Dopamine 1 (14) 6 (13) 23 (19) .12
Vasopressin 11 (55) 9 (51) 37 (86) <.001
Other potential predictors
Minimum Braden Scale score, mean (SD) 13 (3) 13 (3) 12 (3) <.001
Minimum Riker score,c mean (SD) 2.8 (1.2) 2.87 (1.19) 2.15 (1.22) <.001
Admission body mass index,d mean (SD) 30.1 (12.4) 30.1 (12.5) 30.2 (10.7) .89
Nonstandard bed (eg, bariatric bed or other) 1390 (27) 1234 (26) 156 (39) .73
Comorbid diabetes 1756 (34) 1579 (34) 177 (44) <.001

e132 AJCC AMERICAN JOURNAL OF CRITICAL CARE, November 2020, Volume 29, No. 6 www.ajcconline.org

patients. Identifying risk factors is useful to improve
our understanding and care planning for patients
considered high risk and to recognize factors that
are potentially modifiable. In our study, candidate
predictor variables included the duration of vaso-
pressor infusion, blood gas values, surgery duration,
Braden Scale scores, nursing skin assessment data, and
laboratory values. In multivariable LASSO regression,
the most informative predictors for HAPI risk were
length of SICU or CVICU stay, the minimum Braden
Scale score, and skin irritation (defined as a rash or
diffuse, nonlocalized, blanchable redness).

A longer hospital stay is an established risk fac-
tor for HAPI because patients with longer stays gen-
erally experience a higher severity of illness and
longer exposure times than do patients with shorter
stays.9,10,14 Consistent with the results of prior stud-
ies, in our study the duration of ICU stay before HAPI
was an independent predictor for HAPI development,
although the effect was small.7,17,26

The Braden Scale, developed in 1987 for residents
of long-term care facilities,22 was found in a recent
meta-analysis to be a poor predictor of HAPI among
surgical patients.27 In our study, patients with lower

Braden Scale scores (ie, at
greater risk) were 14%
more likely to have a
HAPI develop than were
patients with higher Bra-
den Scale scores. The
clinical relevance of this
finding is uncertain
because the mean (SD)
minimum Braden Scale

score was 13 (3) in patients without a HAPI and
was 12 (3) in patients with a HAPI. On a scale with
possible scores ranging from 6 to 23, this absolute
difference is relatively small and the corresponding

standard deviation is large, so this finding may not
be actionable at a clinical level.28 Black29 specu-
lated that the lack of clinical utility of the Braden
Scale in this population is because of the dynamic
and evolving nature of critical care patients’ physio-
logical status. In the critical care population, a risk
assessment would need to be completed contem-
poraneously with changes in patient condition,
which would be difficult because of time and
workflow constraints.

The strongest predictor of HAPI was skin irrita-
tion, a potentially modifiable risk factor. In our study,
patients with skin irritation were 79% more likely
than those with no skin irritation to have a HAPI
develop. Skin irritation indicates an alteration in
skin integrity and therefore a decrease in tissue toler-
ance to mechanical and shearing forces, such as
those responsible for HAPI development.16,30 Skin
irritation may be caused by excessive skin dryness,
allergic reactions to medications, or prolonged expo-
sure to caustic substances acting as irritants, includ-
ing urine, feces, strong soaps, laundry chemicals,
and latex gloves. In all cases, skin irritation should
be treated and closely monitored and the cause
should be eliminated to allow the skin to heal.

Potential predictor variables not included in our
LASSO model merit consideration as well. Clinically
and statistically significant differences at the univari-
ate level were noted in variables measuring aspects
of perfusion, defined as the delivery of oxygen-rich
blood to tissue. The mean serum lactate level in the
HAPI group was markedly elevated, indicating tissue
hypoperfusion and hypoxia.31 Serum albumin (which
affects perfusion via colloid osmotic pressure) and
hemoglobin (oxygen-carrying capacity) were also
decreased in the HAPI group. In addition, patients
with HAPIs had clinically and statistically signifi-
cantly longer infusion durations for all vasopressors
than did patients without HAPIs.

Consistent with the results of a prior study,32
patients with HAPIs in our study experienced longer
surgical times, highlighting the importance of con-
sidering intraoperative events in HAPI risk. How-
ever, although surgical critical care patients are at
elevated risk for HAPI,3 little is known about intra-
operative factors associated with HAPI risk in the
surgical and cardiovascular surgical critical care pop-
ulation. In a study of patients undergoing urologic
procedures, duration of anesthesia and a diastolic
blood pressure of less than 50 mm Hg were predic-
tive of HAPI development, indicating that perfusion
during surgery may influence HAPI risk.33,34 Research
is urgently needed to identify intraoperative risk

Predictor variable Odds ratio (95% CI) P

Table 2
Results of LASSO logistic regressiona

Abbreviation: LASSO, least absolute shrinkage and selection operator.

a A total of 5019 patients (98%) were included in the logistic regression; 82
patients’ data were excluded from the analysis because of missing data.

b Irritated skin is defined as a rash or diffuse, nonlocalized, blanchable redness,
not over a bony prominence.

c Included in the model as a control factor because specialty beds were used
inconsistently.

Intercept 0.278 (0.147-0.523) <.001
Irritated skinb 1.788 (1.404-2.274) <.001
Minimum Braden Scale score 0.858 (0.818-0.899) <.001
Duration of stay in intensive care unit

before hospital-acquired pressure injury
1.003 (1.003-1.004)

<.001

Specialty bedc 0.816 (0.634-1.044) .11

Of the 110 stage 1 HAPIs,
44 (40%) worsened to a

more severe stage during
the patient’s stay in the

intensive care unit.

www.ajcconline.org AJCC AMERICAN JOURNAL OF CRITICAL CARE, November 2020, Volume 29, No. 6 e133

factors in surgical critical care patients33 and to
identify potentially modifiable risk factors.

Limitations
Our study was limited by its retrospective design

because we accessed only data available in the EHR.
The subjectivity of clinician interpretation is also
a limitation; individual nurses’ definitions of skin
irritation may not exactly coincide. Furthermore, we
did not differentiate medical device–related HAPIs
from other HAPIs. Other predictor variables that
have been associated with HAPI in this population
were not selected because these variables could not
be obtained from the EHR. We did not include com-
pliance with PI prevention protocols (eg, repositioning
schedules) because the EHR is not a reliable source
of information about preventive interventions. For
instance, every 2 hours our EHR prompts nursing staff
to document a position change. However, the changes
might be faithfully documented every 2 hours but not
always performed.35 Finally, our sample was from a sin-
gle site with a predominantly White population, which
may also affect the generalizability of our results.35,36

Conclusions
Our results indicate that nursing staff should

consider changes in the epidermal layer, especially
skin irritation, to be influential risk factors for HAPI.
Skin irritation should be promptly treated by elimi-
nating the cause. The SICU and CVICU patients who
had HAPI develop in our study also exhibited poor
perfusion and longer surgical times. Future research
is needed to elucidate the relationship between per-
fusion, intraoperative events, and HAPI risk.

FINANCIAL DISCLOSURES
This research was funded by an American Association of
Critical-Care Nurses–Sigma Theta Tau Critical Care Grant.
This study was also supported by the University of Utah
Population Health Research Foundation, with funding in
part from the National Center for Research Resources and
the National Center for Advancing Translational Sciences,
National Institutes of Health (grant UL1TR002538).

SEE ALSO
For more about hospital-acquired pressure injuries,
visit the Critical Care Nurse website, www.ccnonline.org,
and read the article by Schroeder and Sitzer, “Nursing Care
Guidelines for Reducing Hospital-Acquired Nasogastric
Tube–Related Pressure Injuries” (December 2019).

REFERENCES
1. Baumgarten M, Margolis DJ, Localio AR, et al. Extrinsic risk

factors for pressure ulcers early in the hospital stay: a nested
case-control study. J Gerontol A Biol Sci Med Sci. 2008;63(4):
408-413.

2. European Pressure Ulcer Advisory Panel, National Pressure
Injury Advisory Panel, Pan Pacific Injury Alliance. Prevention

and Treatment of Pressure Ulcers/Injuries: Clinical Practice
Guideline: The International Guideline 2019. 3rd ed. European
Pressure Ulcer Advisory Panel, National Pressure Injury Advi-
sory Panel, Pan Pacific Injury Alliance; 2019.

3. Chen HL, Chen XY, Wu J. The incidence of pressure ulcers
in surgical patients of the last 5 years: a systematic review.
Wounds. 2012;24(9);234-241.

4. Alderden J, Rondinelli J, Pepper G, Cummins M, Whitney J.
Risk factors for pressure injuries among critical care patients:
a systematic review. Int J Nurs Stud. 2017;71:97-114.

5. Padula WV, Delarmente BA. The national cost of hospital-
acquired pressure injuries in the United States. Int Wound
J. 2019;16(3):634-640. doi:10.1111/iwj.13071

6. Graves N, Birrell F, Whitby M. Effect of pressure ulcers on
length of hospital stay. Infect Control Hosp Epidemiol. 2005;
26(3):293-297.

7. Tayyib N, Coyer F, Lewis P. Saudi Arabian adult intensive
care unit pressure ulcer incidence and risk factors: a pro-
spective cohort study. Int Wound J. 2016;13(5):912-919.
doi:10.1111/iwj.12406

8. Slowikowski GC, Funk M. Factors associated with pressure
ulcers in patients in a surgical intensive care unit. J Wound
Ostomy Continence Nurs. 2010;37(6):619-626. doi:10.1097/
WON.0b013e3181f90a34

9. O’Brien DD, Shanks AM, Talsma A, Brenner PS, Ramachandran
SK. Intraoperative risk factors associated with postoperative
pressure ulcers in critically ill patients: a retrospective obser-
vational study. Crit Care Med. 2014;42(1):40-47. doi:10.1097/
CCM.0b013e318298a849

10. Manzano F, Navarro MJ, Roldán D, et al. Pressure ulcer
incidence and risk factors in ventilated intensive care
patients. J Crit Care. 2010;25(3):469-476. doi:10.1016/j.
jcrc.2009.09.002

11. Bly D, Schallom M. Sona C, Klinkenberg D. A model of pres-
sure, oxygenation, and perfusion risk factors for pressure
ulcers in the intensive care unit. Am J Crit Care. 2016; 25(2):
156-164.

12. Nijs N, Toppets A, Defloor T, Bernaerts K, Milisen K, Van Den
Berghe G. Incidence and risk factors for pressure ulcers in
the intensive care unit. J Clin Nurs. 2009;18(9):1258-1266.

13. Theaker C, Mannan M, Ives N, Soni N. Risk factors for pres-
sure sores in the critically ill. Anaesthesia. 2000;55(3):221-224.

14. Cox J, Roche S. Vasopressors and development of pressure
ulcers in adult critical care patients. Am J Crit Care. 2015;
24(6): 501-510. doi:10.4037/ajcc2015123

15. He M, Tang A, Ge X, Zheng J. Pressure ulcers in the intensive
care unit: an analysis of skin barrier risk factors. Adv Skin
Wound Care. 2016;29(11):493-498.

16. Coleman S, Nixon J, Keen J, et al. A new pressure ulcer con-
ceptual framework. J Adv Nurs. 2014;70(10):2222-2234.
doi:10.1111/jan.12405

17. Cox J. Predictors of pressure ulcers in adult critical care
patients. Am J Crit Care. 2011;20(5):364-375.

18. Serra R, Caroleo S. Buffone G, et al. Low serum albumin level
as an independent risk factor for the onset of pressure ulcers
in intensive care unit patients. Int Wound J. 2014; 11(5): 550-553.

19. Alderden J, Zhao YL, Zhang Y, et al. Outcomes associated
with stage 1 pressure injuries: a retrospective cohort study.
Am J Crit Care. 2018;27(6):471-476.

20. Tschannen D, Bates O, Talsma A, Guo Y. Patient-specific and
surgical characteristics in the development of pressure ulcers.
Am J Crit Care. 2012;21(2):116-125.

21. Lima Serrano M, González Méndez MI, Carrasco Cebollero
FM, Lima Rodríguez JS. Risk factors for pressure ulcer devel-
opment in intensive care units: a systematic review. Facto-
res de riesgo asociados al desarrollo de úlceras por presión
en unidades de cuidados intensivos de adultos: revisión
sistemática. Med Intesiva. 2017;41(6):339-346.

22. Bergstrom N, Braden BJ, Laguzza A, Holman V. The Braden
Scale for predicting pressure sore risk. Nurs Res. 1987;
36(4): 205-210.

23. R Core Team. R: a language and environment for statistical
computing. R Foundation for Statistical Computing; 2017.
https://www.R-project.org/

24. Tibshirani R. Regression shrinkage and selection via the
lasso. J R Stat Soc Series B Stat Methodol. 1996;58:267-288.

25. Shi C, Dumville JC, Cullum N. Support surfaces for pressure
ulcer prevention: a network meta-analysis. PLoS One. 2018;
13(2):e0192707.

e134 AJCC AMERICAN JOURNAL OF CRITICAL CARE, November 2020, Volume 29, No. 6 www.ajcconline.org

1.0 Hour Category AC E
Notice to CE enrollees:

This article has been designated for CE contact hour(s). The evaluation demonstrates your knowledge of the
following objectives:

1. Identify independent risk factors for hospital-acquired pressure injuries.
2. Describe potential treatments for skin irritation.
3. Determine the clinical relevance of stage 1 pressure injuries in the surgical and cardiovascular surgical

population.

To complete the evaluation for CE contact hour(s) for this article #A2029062, visit www.ajcconline.org and
click the “CE Articles” button. No CE evaluation fee for AACN members. This expires on November 1, 2022.

The American Association of Critical-Care Nurses is accredited as a provider of nursing continuing professional
development by the American Nurses Credentialing Center’s Commission on Accreditation, ANCC Provider Number
0012. AACN has been approved as a provider of continuing education in nursing by the California Board of Regis-
tered Nursing (CA BRN), CA Provider Number CEP1036, for 1.0 contact hour.

26. Sayar S, Turgut S, Doğan H, et al. Incidence of pressure ulcers
in intensive care unit patients at risk according to the Water-
low scale and factors influencing the development of pressure
ulcers. J Clin Nurs. 2009;18(5):765-774. doi:10.1111/j.1365-
2702.2008.02598.x

27. He W, Liu P, Chen HL. The Braden Scale cannot be used alone
for assessing pressure ulcer risk for surgical patients: a
meta-analysis. Ostomy Wound Manage. 2012;58(2):34-40.

28. Anthony D, Papanikolaou P, Parboteeah S, Saleh M. Do risk
assessment scales for pressure ulcers work? J Tissue Viabil-
ity. 2010;19(4):132-136.

29. Black J. Pressure ulcer prevention and management: a dire
need for good science. Ann Intern Med. 2015;162(5):387-388.

30. Yap TL, Rapp MP, Kennerly S, Cron SG, Bergstrom N. Com-
parison study of Braden Scale and time-to-erythema mea-
sures in long-term care. J Wound Ostomy Continence Nurs.
2015;42(5):461-467.

31. Antinone R, Kress T. Measuring serum lactate. Nurs Crit Care.
2009;4(5):56.

32. Lu CX, Chen HL, Shen WQ, Feng LP. A new nomogram score
for predicting surgery-related pressure ulcers in cardiovas-
cular surgical patients. Int Wound J. 2017;14(1):226-232.

33. Chello C, Lusini M, Schilirò D, Greco SM, Barbato R, Nenna
A. Pressure ulcers in cardiac surgery: few clinical studies,

difficult risk assessment, and profound clinical implications.
Int Wound J. 2019;16(1):9-12.

34. Connor T, Sledge JA, Bryant-Wiersema L, Stamm L, Potter P.
Identification of pre-operative and intra-operative variables
predictive of pressure ulcer development in patients under-
going urologic surgical procedures. Urol Nurs. 2010;30(5):
289-305.

35. Yap TL, Kennerly SM, Simmons MR, et al. Multidimensional
team-based intervention using musical cues to reduce odds
of facility-acquired pressure ulcers in long-term care: a paired
random

Discussion

Required Resources
Read/review the following resources for this activity:

· Textbook: Chapters 15 and 16

· Lesson

· Minimum of 1 scholarly source (in addition to the textbook)

Introduction
The Cold War ended over a decade before the 21st century began. What was supposed to be a “Brave New World” free of the threat of nuclear conflict and a long period of peace and prosperity has been less than what was expected. Yes, communism as a threat to the world and to the dominance of the United States and capitalism has come to pass, but even though the threat of war from the USSR never materialized (thankfully) a new threat did rise up to challenge the U.S. and the West for control. The rise of radical Islamic groups bent on destroying those they call infidels, especially the United States and Western Europe have caused more than a little death, destruction, and despair to a world hoping those threats had ended.

Instructions
For the initial post, address one of the following:

· Option 1: Why wasn’t the U.S. and its vastly superior intelligence and military able to stop these attacks? How effective are current measures in dealing with attack prevention? Have we really learned from past mistakes?

· Option 2: What new problems did the Iraqi War cause for the U.S. and its allies around the world? What effects has it had on the U.S. economy?

· Option 3: How much more difficult is it to battle an idea or faith, even a violent one, skewed and brutal than to defeat a nation in war like the U.S. and its allies did during World War II? Consider the role technology plays in the dissemination of faith.

· Option 4: Compare European imperialism to current globalism. How has each changed society, both in industrialized nations and developing nations? Is the claim that globalism is a form of imperialism valid?

· Option 5: Where do we go from here? Who will the best friends and the worst enemies of the United States be in the coming decades? Will we really, finally achieve that peace and prosperity we all hoped would come to pass?

Follow-Up Post Instructions
Respond to at least one peer. At least one of your responses should be to a peer who chose an option different from yours. Further the dialogue by providing more information and clarification.

Writing Requirements

· Minimum of 2 posts (1 initial & 1 follow-up)

· Minimum of 2 sources cited (assigned readings/online lessons and an outside source)

· APA format for in-text citations and list of references

Grading
This activity will be graded using the Discussion Grading Rubric. Please review the following link:

· Link (webpage): 
Discussion Guidelines (Links to an external site.)

Course Outcomes (CO): 6, 7, 8

discussion

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Discussion

Project 4: Argumentative Essay

WHAT WE’RE DOING
Writing a essay that argues about
the ethical considerations of high-
tech multi-domain weapons

HOW WE’RE DOING IT
An essay of at least 1100 words
which uses at least four sources
from which you draw information

WHY WE’RE DOING IT
To practice research skills in
finding information
To practice developing your ideas
with information you’ve
gathered
To discover and critically think
about important ideas
To develop ethical thinking and
responsibility 
To synthesize ideas from
material you’ve read
To practice argumentation and
thesis-based writing
To communicate your thinking in
a clear and effective way

WHEN WE’RE DOING IT
Writing Center Draft – 11:59 pm,25
March 
Teacher Draft – 11:59 pm, 1 April
Final Draft – 11:59 pm, 15 April

WHAT IT HAS TO DO
Answer the following question
using an argumentative thesis: Are
the weapons of multi-
domain warfare,
specifically, unmanned drones,
artificial intelligence, and online
manipulation, ethical for use?
Explain the criteria you are using to
decide whether or not something is
ethical
Explain why you believe these types
of weapons are/are not ethical (you
might think some are and some
aren’t) 
Explain when use of these types
of weapons would/would not be
ethical. 
Be at least 1100 words long (you
can have more).
Use at least four sources in the
essay – these sources must be
explicitly referenced and cited in-
text. (You may use more.)
Have a works cited page – all
sources must be put on the works
cited page.

HOW I’LL GRADE IT

40 points

WHAT IT’S WORTH
200 points, or 20% of your course
grade.

40 points

30 points

40 points

Assignment features an argumentative thesis statement and
an argument that answers the question of ethics with high-
tech multi-domain weapons, considering all aspects of the
assignment sheet.
Assignment is organized in a clear, straightforward, and
logical manner, following an appropriate organization
pattern, and without losing focus from the overall topic.

Assignment conforms to standard edited American English
and MLA standard guidelines of citation and formatting.

NOTES TO SELF

A FEW NOTES
Drafts submitted to the Writing
Center and to me are worth 10
Low-Risk Writing points each.
Late papers are penalized 10%
for each day late, including the
day it was due.
Assignments not following the
instructions will receive an
automatic zero.

Assignment uses appropriate academic style, relying on
formal language and tone, while still remaining
understandable to the reader. 

Assignment relies on credible sources that are well-
integrated and which are appropriately attributed and cited,
clearly showing where ideas came from. 

25 points

Rather than having a revision
opportunity, you’ll submit a
draft to me for feedback
before it is graded for a final
draft. 

25 points
Assignment works toward clarity of language, ensuring that
each topic and each sentence are easily understandable 

Tip: Don’t just look for sources that talk about these new kinds
of weapons.  Look for sources that can give you some guidance
about ethics and ethical considerations, even if they don’t
mention these weapons. 

Tip: This isn’t about
whether or not these
weapons are ethical for
the United States to use.
It’s whether they’re
ethical for any country to
use; remember, these
weapons could be used
against you too.

Discussion

 In chapter 16, Jacobs et al. address problem situations that may cause conflict in a group and get it off track. Choose one of these and shed further light on why this is a common issue and why/how it may lead to conflict by drawing upon Forsyth, chapter 13. In your replies, add insights to your classmates’ post, both from your personal experience and from the course materials. 

Problem situations: chronic talker, the dominator, distracter, rescuing member, negative member, resistant member, member who tries to “get the leader”, dealing with silence, dealing with sexual feelings, dealing with crying, dealing with mutually hostile members, asking a member to leave, dealing with prejudices, narrow-minded, or insensitive members.

    • 20

    Discussion

    Total word count must be 250 to 300 words in your posting. (20 points)

    Please also respond to at least two of your classmates with a meaningful reply of 150 words or greater each. (5 points each)

    Do not cut and paste, please post original work.

    Please provide references for your original postings in APA format.

    Describe three of the key principles that are a focus of the Business Continuity Institute certification.

    Discussion

     How are Electronic Health Records (EHR) and Personal Health Records (PHR) similar? How are they different? What are the benefits and challenges of each? 

    Discussion

    Discussion 1:

     

    As we close out our time together, and with Easter celebrations among Christians just concluding, the importance of Jesus Christ is at the forefront.  So I thought it interesting to mention Christmas in April.  Christians celebrate His birth.  (Even non-Christians celebrate it!)  Tim Keller is a prolific writer for believers of Christ.  Nonbelievers also like his writings as they stir thought and perspectives.  For this final time, select one of these statements from Hidden Christmas: The Surprising Truth Behind the Birth of Christ (Viking, 2016) [interview] (https://www.amazon.com/Hidden-Christmas-Surprising-Behind-Christ/dp/0735221650/?tag=thegospcoal-20) and reflect on what they mean to you, especially as you’ve been exposed to the principles of Christ and the Virtuous Business Model:

    “He is a Light for us when all other lights go out.” (15)

    “Christmas is not simply about a birth but about a coming.” (20)

    “The gospel, because it is a true story, means all the best stories will be proved, in the ultimate sense, true.” (28)

     

    “When you say, `Doctrine doesn’t matter; what matters is that you live a good life,’ that is a doctrine. It is called the doctrine of salvation by your works rather than by grace. It assumes that you are not so bad that you need a Savior, that you are not so weak that you can’t pull yourself together and live as you should. You are actually espousing a whole set of doctrines about the nature of God, humanity, and sin. And the message of Christmas is that they are all wrong.” (131)

    “If Christmas is just a nice legend, in a sense you are on your own. But if Christmas is true, then you can be saved by grace.” (133)

    • Discuss specific biblical perspectives that can be applied within the Virtuous Business Model.

    Discussion 2:

    • How would you evaluate the potential for organizational success of certain emerging technologies, and why did you select the evaluation criteria used in your answer?

    Discussion

    What is a controversial issue in the field you are studying or considering?

    Analyze this controversy using Toulmin’s terms: claim, support, and warrant.

    Does the controversy involve a claim of fact, value, or policy? What evidence do people use to support their claims regarding this controversy?

    The field you should study is ” Finance”.

    Toulmin Theory:  https://prezi.com/yur2esdpeusm/argumentative-writing/

      • 14

      Discussion

       

      The current motivation in the department I work in is low related to inadequate staffing and poor teamwork. There have been a lot of call outs over the past few months which leads to staff being mandated to stay over in order to take care of the patients that are scheduled for a procedure that day. The mandated overtime has caused a lot of stress because the nurses have already worked 10 hours and have responsibilities outside of work that are neglected because of having to stay beyond the end of their shift. The state of California has mandated patient to nurse ratios which allow us to provide the best care to our patients but with the short staffing it has forced the nurses to work beyond their scheduled time which is not abide by the rule of no mandated overtime per our union contract. I understand the patients need to be treated, but the non-emergent cases should be delayed until staffing can meet the demand. An exhausted nurse or healthcare worker can be a risk to public health and patient safety (Marquis & Huston, 2021, p. 455). 

      Poor communication in a team can lead to low morale from the team. In the department I work in there is good communication and team work only amongst certain staff members. There are certain nurses that are willing to help each other and there are other team members that want to function independently and not offer help to others. In research from Weaver et al. (2014), “Patients are safer and receive higher quality care when providers work as a highly effective team.” The communication and teamwork needs to be initiated and guided by the managers, by implementing team building skills and scenarios on how a team can function better together. There needs to be communication from the manager and leader so the staff knows what is expected from them. 

        • 10

        Discussion

        Discussion post instructions:

        Each student will be required to post two times in each discussion. The initial (first) post must be an original contribution to the conversation, with the second post being a response to something written by a classmate. A quality written post is at least 200 words without grammatical errors. A response post needs to be thoughtful, respectful and at least 100 words.

        Remember basic elements of grammar, including beginning sentences with capital letters. Avoid the casual writing style often found on social media and write on an academic level instead. Grammar is major component of this discussion course grade, as you are expected to communicate your understanding of the material and your opinions on the subject in a thoughtful, organized manner.

        The initial post is due Sunday, February 27 and the response post is due Wednesday, March 2. The discussion will automatically close at 11:59pm, March 2 and no further submissions will be allowed.

        This is worth 20 points, which are awarded after you’ve completed both components of the discussion and will be determined on how well you followed the above criteria. Remember that these have firm close dates and late submissions are not allowed.

        In your own words, and thoughtfully answer ONE of the question prompts below:

        1. What did Madison consider a faction to be and how could a faction be dangerous to a republic? How does Madison propose to deal with factions? How do you feel he would assess factions in our modern society?

        2. Given that more women than men are registered to vote and turn out to vote, why are women so underrepresented in Congress? What causes this phenomenon?

        3. Would you ever want to be president? Why or why not? Is being the President the hardest job in the world? Why or why not?

        4. Now that you’ve learned about Congress and the President, which of these institutions should take the lead in terms of crafting public policy? Which of these is a more democratic institution? Make sure to justify your answer.

        5. Thinking back to fiscal federalism, what are unfunded mandates and why are they controversial? Give some examples of these kinds of policies? Why do you think unfunded mandates proved so difficult to eliminate?

        6. Generally speaking would you rather live in a government with strong states and a weak national government or vice versa? Would you feel better represented by one over the other? 

        7. What is impeachment and why is it a critical check on the power of the executive branch? In what ways are the standards unclear? How would you define “high crimes and misdemeanors”? Have we overused the process of impeachment, and does it still mean anything today?

        We have students who represent a broad spectrum of political values, beliefs, and leanings. Be considerate and respectful when writing your response post. Acknowledge in your response post to a classmate, what you do agree with and what suggestions you would include. Even if you disagree entirely, find something positive to acknowledge!! No demeaning someone else’s politics, point of view, etc. (This is a college course with intentional civil discourse.) Civil discourse means we are thoughtfully engaging and sharing our ideas with one another. For the record, there is no “wrong” opinion in this class. I don’t expect you to have all of the answers, but I do expect you to base your conclusions for this discussion post on your recent chapter readings & lectures.

        Initial posts should be a minimum of 200 words.

        Response posts should be a minimum of 100 words. 

        discussion

        Running head: RESEARCH REPORT

        1

        RESEARCH REPORT

        4


        Children learn social skills through dramatic play

        Latoria Johnson

        EEC6678

        February 11, 2022

        Children learn social skills through dramatic play

        Introduction

        There exists a relationship of misconceptions about play-based learning. There is Criticism that academic work and play must not be mixed. Others suggest that all plays must be structured and goal-directed, not free and open-ended. Research suggests that academic work and play can be melded into a “play-based” learning curriculum.

        Moreover, experts advised that the “child-initiated” free play strategy must be used for more effective outcomes. The report would evaluate the relationship between these variables to understand how socio-dramatic play helps in social development in children.

        Problem Statement of the research

        The impact of play activities on developing social skills has been long neglected in the education system. There has been a lot of Criticism that play should not be mixed with academic work, but research shows that play helps with social skills in children.

        Literature Review

        In Vygotsky’s cultural-historical theory, play plays a significant role in early childhood development and social skills. Vygotsky believed that play promotes social and cognitive development in children. However, Vygotsky’s perception that sociodramatic play is the opposite of the prevailing belief that play is just a free activity that must be done in free time. Therefore, Vygotsky’s theory differs from other play theories, including constructional play, object-oriented exploration, and games with rules.

        According to Vygotsky’s real play activities include (a) acting and taking out rules, (b) creating an imaginary situation, and (c) following specific rules while playing a role. According to scholars, socio-dramatic play facilitates children in developing social skills, especially language and problem-solving skills (Schärer, 2017). The literature shows that young children show significant problem-solving knowledge while participating in socio-dramatic play. The literature also shows that children who participate in sociodramatic play experience a high level of engagement in their brain because it includes language, emotions, cognitive, and sensory-motor actions. Thus, it develops an effective synaptic connection.

        Social knowledge is very important to participate in play activities. Children can learn skills and attitudes needed for play by watching their teachers, parents, and other children. Similarly, playing with peers has a crucial role in social development by offering content. Children may adopt several important social skills such as sharing, talking, cooperation, and understanding their Peer’s perceptions, thoughts, and emotions (Abraham, 2015).

        It can be seen that literature shows play to be a source of enculturating mechanisms. Children learn norms, societal roles, and values. The author has argued that the context of the play is influenced by the development of sequence and the socio-cultural environment of play. Through socio-dramatic play, children also learn social values such as sharing, love, respect, etc. In addition to this, self-regulations become possible in play because children would need to follow the rules constantly monitored by others (Goldstein, 2017).

        Purpose of the Study

        The research aims to identify socio-dramatic play’s role in developing social skills in children. The research would include a systematic approach to the relationship between socio-dramatic play and social skills in children to achieve this purpose. The study would also discuss the valued shows by children while performing in socio-dramatic play. In addition to this, the literature aims to discuss the relevant literature and theories on the concerned research problem.

        Research question

        The research question is ” How does socio-dramatic play help children develop social skills?” The methodology of the research would answer this question.

        Hypothesis

        Following are hypotheses from the research papers.

        Ho: There is a direct and positive relationship between children’s sociodramatic play and social skills.

        H1: Children-directed and free play are more impactful in developing children’s problem-solving and language skills (social skills).

        References

        Abraham, J. (2015). Socio Dramatic Play: A case study. Conference: Third International Conference on Early Childhood Development.

        Goldstein, T. R. (2017). The dramatic pretend play games uniquely improve emotions. Development Science.

        Schärer, J. H. (2017). Supporting Young Children’s Learning in a Dramatic Play Environment. Journal of Childhood Studies.

        discussion

        COMMUNICATE MONOGAMY 2

        Discussion 1 ( 260) words

        Discuss some of the ways in which social policy affects what we can and cannot do in practice. Do people who work with vulnerable populations have a responsibility to advocate on behalf of the people they serve?

        Reply 1 ashley (60 words)

        Social policy has created alot of limitations on what we can and cannot do in practice.  Social policies have created laws that make things illegal to do but that dosen’t mean that people can’t be prudicje it just means that they can’t discriminate. “It may be illegal to refuse to hire a qualified woman to work on a construction crew, but once she gets there she may not be welcomed by her coworkers.”(Segal, 2015, 389) They can make relgations but those don’t mean it our beliefs change. We can still think a certain way but our actions can’t show it.

        People who work with vulnerable populationsdo have a responsibility to advocate on behalf of the people they serve but it a calm and professional way.

        Reply 2 amberlin (60 words)

        Social Policy is the foundational framework that is used to advocate on behalf of others. Without civic engagement, especially the participation of educated individuals, social change can never be achieved. The duty of social welfare advocates to rally for reform of unjust policies is an ethical obligation. According to The National Association of Social Workers’ Code of Ethics, social workers “should engage in social and political action that seeks to ensure that all people have equal access to the resources, employment, services, and opportunities they require to meet their basic human needs and to develop fully” (2021).  Social work policy advocacy is one of the means for upholding that standard.

         

        One of the ways this is accomplished is through the practice of empathy, lobbying, civic engagement and social action. Organizing letter-writing campaigns, communications with state and federal legislators, and exercising your right to vote are just a few ways to promote policy changes (Segal, 2015). While our country is founded upon the democratic values, not everyone’s voice is heard equally. Those who are born with privilege have a responsibility to support the voices and needs of minority groups. According to our textbook, “There are numerous examples of those who are privileged and powerful supporting laws that are not in their own best interests” (Segal, 2015). These practices promote social empathy, deepen understanding and create unique opportunities to strengthen the fairness of our legislative system. While there is no universal approach to correctly addressing social justice and policy issues, attempting to understand every individual’s point of view can benefit and unify communities.

        discussion

        Your initial discussion thread is due on Day 3 (Thursday) and you have until Day 7 (Monday) to respond to your classmates. Your grade will reflect both the quality of your initial post and the depth of your responses. Refer to the Discussion Forum Grading Rubric under the Settings icon above for guidance on how your discussion will be evaluated.

         Generational Work Expectations [WLOs: 2, 3, 4] [CLOs: 4, 5, 6]

        Prior to beginning this activity, read Chapter 10 in the course text and review the weekly Instructor Guidance. Also review any relevant announcements.

        Chapter 10 addresses employee attitudes, beliefs, and differing cultures, as well as suggests that an increase in job performance is reliant on job satisfaction. The authors of our text suggest that highly satisfying jobs are more complex, requiring the worker to utilize a variety of skills and to deal with unpredictable situations (i.e. teaching, managing, engineering, etc.), unlike jobs where the work is repetitive and less thought-provoking (general laborers, factory workers, and the like). However, complex jobs, often include diverse employees. In addition, the work and life-balance expectations are suggested to differ based on generations, which may likely also affect job satisfaction as well as working effectively as a team. For this discussion: 

        · Identify the generation you fall into, based on the text:  

        · The Traditionalists or Matures

        · The Baby Boomers

        · Generation X

        · Generation Y or the Millennials

        · Generation Z

        · Consider your own expectations and beliefs. Do they align with what our content suggests about the characteristics of your identified generational group?

        · Research one generation that differs from your identification and share some of the events that have shaped this generation, including their beliefs and behaviors.

        · Discuss the relationship between events within your generation versus your researched generation.

        · How might these events, that have developed our ideologies, affect a work environment that includes both generations?

        · Identify one generation that could potentially be more difficult for someone in your identified generation to effectively work with.

        · What variables may create this challenge (e.g. communication style, wellness, life balance, etc.)?

        · How does an increase in awareness, of the factors that affect what differing generations believe, positively support a healthy and productive work environment?

        Your initial post should be between 300 and 400 words. You must use at least one scholarly, peer-reviewed source that was published within the past five years. Refer to the 
        Scholarly, Peer-Reviewed, and Other Credible Sources (Links to an external site.)
         resource for guidance. Cite all information from your sources according to APA guidelines and list each of your sources at the end of your post according to APA style as shown in the 
        APA: Formatting Your References List (Links to an external site.)
         resource. Visit the 
        Writing Center (Links to an external site.)
         for support and examples.

        Guided Peer Responses: Review several of your classmates’ posts. Respond substantively to at least two of your peers’ original postings that align with a differing generation (if available).

        · What differences do you note between your generation and theirs?

        · Do you see areas within your own expectations that could be reconsidered based on your peers’ expectations?

        Discussion

         

        1. Evaluate the discussion section of the article attached and identify if the following was addressed. (Note, you need to show evidence, do not just say yes or no. Post what the researcher indicated that supports that these elements were addressed in the discussion section. Add the page number where you found them)

        a) limitations and strengths of the study variable(s) 

        b)hypothesis(es)/research questions 

        c) theoretical framework

        d) design

        e) sample  

        f) data collection procedures

        g) data analysis 

        h)generalizations 

        i)conclusions

        j)recommendations for future research 

        2. After reviewing and evaluating the  “Discussion” section of the article, discuss the strength of the evidence supports a change in current practice (If you think it does, support your answer with evidence based literature. You describe what the article indicated and find another source to support why the strength of evidence support a change in current practice). 

        3.  What is your cosmic question? (This should be based on chapter of the week. Pose a research question on discussion section of a research)

        Discussion

         Discussion: Based on your research topic, discuss one potential method you can use to collect qualitative data, even if you plan to use a quantitative design. What type of sampling would you use ( pg. 206-207). What type of qualitative data would you collect? Refer to Creswell pg 212 Figure 7.3 for data collection approaches. Based on the approach you select, discuss your methods (ie: observation checklist for observations, interview guide for interviews etc..). Provide reasoning for selecting these methods. How do you plan on analyzing this qualitative data? Refer to Creswell pg 240-252 for assistance. Lastly, provide two methods you would use to support the accuracy of your findings. Refer to Creswell pg. 258-259 for validation measures in qualitative research. 

        *SEE FILES