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Topic 7 DQ 1May 2-4, 2022

Describe one internal and one external method for the dissemination of your evidence-based change proposal. For example, an internal method may be the hospital board, and an external method may be a professional nursing organization. Discuss why it is important to report your change proposal to both of these groups. How will your communication strategies change for each group?

REPLY TO DISCUSSIONKKKokila Krishnaswamy

Posted Date

May 2, 2022, 10:19 PM

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Dissemination is the communication of clinical, research and theoretical findings for the purpose of transitioning new knowledge to the care of the patient. It is important to transform the evidence change to different level. If not change would not occur and innovations would be adapted. Dissemination is most successful if multiple methods are used. 

Internal dissemination is sharing information results within the organization while external dissemination includes individuals or groups outside the organization (Sarver. McNett,2019).  My evidence-based proposal is focusing prevention and early diagnosis of obesity related disease such as diabetes. 

Internal method of dissemination is the organization board, contains key stakeholders who makes major decisions. Patients are the main stakeholders because it involves behavioral and cultural change. Other members are nurses, physicians, providers, and other professionals involved in patient care (Novins, Green, Legha & Aarons, 2013). The communication could be more personal way, face to face which creates opportunities for questioning and instant feedback.  

External dissemination could be done through a professional nursing organization.  ANA is the best platform where more nurses and nursing leaders involved in evidence-based research project. Print materials and pear review articles are used to support the evidence practice. It may be presented in face-to-face conferences (Ashcraft, L.E, Quinn D.A & Brownson R.C, 2020).

Reference:

Ashcraft, Laura Ellen, et al. “Strategies for Effective Dissemination of Research to United States Policymakers: A Systematic Review – Implementation Science.” BioMed Central, BioMed Central, 15 Oct. 2020, https://implementationscience.biomedcentral.com/articles/10.1186/s13012-020-01046-3#citeas

Novins, Douglas K, et al. “Dissemination and Implementation of Evidence-Based Practices for Child and Adolescent Mental Health: A Systematic Review.” Journal of the American Academy of Child and Adolescent Psychiatry, U.S. National Library of Medicine, Oct. 2013, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3922894/.

response

(Christopher)Identify the eight key components of e-Commerce business models

The textbook (Laudon&Traver, 2021)  lists the eight key components as:

Value proposition – is the need the product or service offered by the business fills. This is the fundamental reason a customer would buy your product or service in the first place.

Revenue model – the actual way the business makes money off the product or service. For example, directly selling the good/service or offering a subscription.

Competitive environment – describes the state of the market for the good or service offered. is there a large amount of potential consumers with only a few existing businesses offering? or are there few potential customers and a large amount of competitors? 

Market opportunity – what’s the size and viability of the intended market? is there a large amount of people with the relevant unfulfilled need? does that group have money enough to be relevant themselves?

Competitive advantage – can you produce a good or service at a lower opportunity cost then your competitors? For example can your produce shirts cheaper then another shirt company? 

Market strategy – How a business plans to actually attract customers and get into a chosen market, can involve things such as marketing and demographic analytics.

Organizational development – The structure(s) of the organization necessary for the execution of the business model. this can include managerial structures, or in larger organizations enterprise architecture. 

Management team – This refers to the core personnel required to run the business smoothly at managerial/directorial level. 

Describe two major B2C business models

Content provider – This a model where the business provides a platform on which content (videos, music, movies…etc) get posted and customers can then then view said content. a content provider can make money through advertising (as by design there will be many eyes on the platform for an extended period) or can hybridize with a subscription model and charge customers a fee to access the content. One prominent example of this model is Youtube, which allows users to post videos on its site and makes money through advertising.

Transaction broker – This business model offers the service of performing a transaction on behalf of a customer. This model makes money by charging a fee for performing the transaction. A common example would be ticket sellers, they don’t actually own the tickets most of the time they simply facilitate their purchase and charge a fee for the convenience. 

Describe two major B2B business models

Exchanges – this is a platform on which a mass of supplier can meet and sell to a select number of large buyers. The platform makes money by charging transaction fee’s and/or charging membership fees. an important aspect of this model is being able to effectively know a market and to court participants (Wang et al, 2022).

E-distributers – This is a model where a company directly sells products to other companies via the web/internet. this model makes money through the direct sales of goods (selling a product for more than it cost to make) to other businesses. 

 

 

 

 

Laudon, K. C., & Traver, C. G. (2021). e-Commerce 2021: Business, technology, and society (16th ed.). Pearson.

Wang, J., Zhang, Q., & Hou, P. (2022). Fixed Fee or Proportional Fee? Contracts in Platform Selling Under Asymmetric Information. International Journal of Electronic Commerce26(2), 245–275. https://doi.org/10.1080/10864415.2022.2050584

Response

Katelyn Chandler

Posted Date

May 6, 2022, 10:00 PM

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When implementing an evidence-based practice, one is hoping to improve an organization. In healthcare, evidence-based solutions aim at improving quality care and retaining staff. Additionally minimizing the cost of healthcare is important to consider when implementing new practices. Evaluating the likability and the success of an intervention is important before adopting the new change into policy, therefore this process should be completed carefully. For this reason, it is important to implement a technique to better measure the effectiveness of the change in the acute care setting. 

A method that would allow for better insight on the effectiveness of my selected interventions is collecting data over the last year to determine the number of staff who have left over the last 6 months to a year and retrieve the new data three months to six months following the intervention implementation. This would allow one to determine the interventions may be favorable. Additionally, a survey after trialing the intervention may allow for more insight on the likelihood of those staying due to the interventions and those who believe the interventions would be unsuccessful long term. Also, collecting data on the number of hospital-acquired infections and the rough estimate of the amount lost over 6 months with the new interventions compare the months leading up to the implementation of selected interventions.

Response

The dissemination of an evidence-based change proposal can occur through many ways and the goal is to spread knowledge and the associated evidence-based interventions. However, there are internal and external methods for the dissemination of my evidence-based change proposal on heart failure (HF) patients’ compliance to medication and lifestyle changes to prevent hospitalization. An internal method is sharing the evidence-based change proposal with the cardiac clinic organization where I am precepting. It is important to report my change proposal to the cardiac clinic as it will increase the reach of evidence, increase the motivation to use and apply evidence, and increase the ability to use and apply evidence to educate HF patients on compliance to prevent hospitalization (Effective Health Care, 2019). An external method is sharing the evidence-based change project with the American Association of Heart Failure Nurses (AAHFN).

In addition, it is important to report my change proposal to AAHFN as this specialty organization is dedicated to advancing nursing education, clinical practice and research to improve heart failure patient outcomes (American Association, n.d.). It is also important to know how the communication strategies change for each group. For the cardiac clinic, some communication strategies that can be used are tailoring the message, targeting the message to audience segments (e.g., nurses, doctors, patients), using narratives, and framing the message which helps to convey the message in alternative ways (e.g., what is gained or lost by taking an action or making a choice) (Effective Health Care, 2019). For the AAHFN, the communication strategies that can be used are communicating uncertainty as this helps determine whether preventive services and treatments should be implemented and for whom, and communicating evidence with the association members can help make informed decisions (Effective Health Care, 2019).

References:

American Association of Heart Failure Nurses. (n.d.). About AAHFN. https://www.aahfn.org/page/about

Effective Health Care Program, Agency for Healthcare Research and Quality. (2019). Communication and dissemination strategies to facilitate the

response

(francis)This process can be broken down into the receiver and the sender. On the sender side we have the 2-tier architecture, this will be using its software to interface with its server, this server will use a web protocol (SMTP) to transmit to the receiver’s sever. This server will then accept the message.

      At the receiver side the data will be assigned a protocol either IMAP or SMTP and the packet will be sent to the server computer. This will be accessed by the receiver through a HTTP(S) request to the web-based email application. That request will display the email on the receiver’s computer.

References

Holtz, M. (2020, December 8). A beginners guide to email protocols: SMTP, POP3, and IMAP. Liquid Web. 
https://www.liquidweb.com/kb/a-beginners-guide-to-email-protocols-smtp-pop3-and-imap/

Parameters:

Use APA format for any quotations or citations you use to support your answer. 150 words atleast.

Response

 Vital Signs: Crip Culture Talks Back, is about “a national disability arts community that explores disability as the experience of a politically disenfranchised constituency. Consists of interviews and clips of performance pieces from a variety of artistic formats including: performance art, fiction, poetry, stand-up comedy, drama, personal anecdotes and scholarly research. Pursues a definition of a culture of disability through questions of architectural inaccessibility, political activism, mainstream representations of disability in literature, film, art and television, and in a narrative of shared struggle to gain access.”  One can look at documentary as an enactment of disability pride.  In the documentary, Mary Duffy notes that ‘those big words those doctors used-they didn’t have any that fit ted me properly. I felt, even in the face of such opposition, that my body was the way it was supposed to be. It was right for me, as well as being whole, complete and functional.’ The documentary is raw, edgy, irreverent, angry, and creative.  David Mitchel and Sharon Snyder of  NYU sees the documentary as an effective learning catalyst that disability is not a personal tragedy, but something to embrace and celebrate.  Do you agree or disagree about their conclusions about the film?  Did you learn anything new? Did it reinforce ideas of disabilty pride? 

Response

Melissa Sanchez

Posted Date

May 10, 2022, 9:09 AM

UnreadReplies to Melissa Sanchez

Independent variables are what researchers expect will influence dependent variables and dependent variables are what happens because of the independent variable (National Library of Medicine, n.d.). Essentially, independent, and dependent variables are like a cause and effect. The independent variables that need to be collected for evaluation of the EBP project are the elements that are being selected to provide change which are new clinic guidelines for managing hepatitis C virus (HCV) patients in rural Arizona. Implementation of clinic guidelines is the independent variable because it is a variable that can be changed or controlled. The dependent variables would be the components being measured which are HCV medication compliance, insurance authorizations times, and specialty pharmacy fulfillment. The outcomes of the dependent variables are dependent upon the change implemented by the clinic guidelines. 

response

What is e-Commerce and how does it differ from e-Business?

E-commerce and E-business are two different yet interconnected terms and knowing the distinction can be quite important. According to the textbook,  E-commerce strictly refers to the buying and selling of goods through a digital medium such as the web (Laudon&Traver, 2021). E-bay is a good example of e-commerce with users using the website to barter on and purchase goods. E-business is a more general term which encompasses not only e-commerce but various other services and activities a business may engage in via the web, internet, or other digital medium. Consider a service such as canvas, it is more than simply a singular good sold to a school or business it is a suite of services that can be accessed by more than just the purchaser and even facilitate further e-commerce (purchase of textbooks for instance). 

What are some of the major types of e-Commerce.

There are four main types of e-commerce (Masterclass staff, 2022) : business to business, business to consumer, consumer to consumer and consumer to business. I will discuss the first three.

Business to business: this is essentially online wholesale where one business sells to another. an example would be amazon business, which is a unique amazon platform that allows a business to register an account to but supplies and inventory.

Consumer to consumer: This refers to when consumers can sell goods to one another via a digital medium, usually a website. E-bay is probably the most famous example, a site where one consumer posts a good and others bid on it.

Business to consumer: This is when a business advertises its goods digitally and consumers can then remotely (digitally) purchase those goods. an example would be first party transactions on amazon, where amazon uses it’s website to display and sell its own products to consumers.

 Identify the eight major e-Commerce technologies.

· Ubiquity

· Global reach

· Universal Standards: This is unique to e-commerce as no other form of commerce has a set of standards built into the very architecture of the medium, such as HTML for instance.

· Richness

· Interactivity

· Information density: In terms of scale this is unique to e-commerce as no other platform besides the internet and the web contains even a fraction of the sheer amount of information available. in terms of e-commerce this can include information such as product and seller history/reviews.

· Personalization/Customization: there is not another medium which allows a business to so widely and easily customize and personalize the consumers experience. through social technology and automation each consumer can have there advertisements and shopping experience uniquely tailored to them.

· Social Technology

sources cited

Laudon, K. C., & Traver, C. G. (2021). e-Commerce 2021: Business, technology, and society (16th ed.). Pearson

Masterclass Staff, (2022, February 18). All About E-Commerce: Pros and Cons of E-Commerce. MasterClass. Retrieved May 5, 2022, from https://www.masterclass.com/articles/ecommerce-explained#4-types-of-ecommerce

Response Parameters

Here is a sample of a peer response that properly uses a source. The date is not within 36 months as this is just a sample.

After reading your post, I will assume that search engine optimization is best practice #1 for an e-commerce business. SEO is certainly one of the things a business needs to ‘optimize’ if they want to be successful. With it, a company can significantly increase traffic, search rankings, and revenue (Zhang & Cabage, 2017). Without it, the company will more than likely fail. How do we support SEO and other technical features through a seamless application for users and developers? Part of Enterprise Architecture is supporting the organization so they can effectively achieve current and future objectives. If one of the objectives is to grow online sales, then SEO is one part of that process. Does the company have the architecture framework as well as the implementation methodology in place to support this direction? This is crucial to continue to lead the organization in a direction to maximize ROI and increase profits.

References

Zhang, S., & Cabage, N. (2017). Search Engine Optimization: Comparison of Link Building and Social Sharing. The Journal of Computer Information Systems, 57(2), 148-159. doi:10.1080/08874417.2016.1183447

Scholarly sources should be from current peer-reviewed journal articles (published within the last 36 months) and support your content. So, one of your sources for each of your main posts needs to be published in a valid scholarly journal within the last 36 months—older will not “count” as your supporting source. However, you may include older sources, in addition to more current ones, to further support your posts.

The Proposal requires you to propose a solution that will be supported with sources, as you will be asking to be funded. The discussions allow you to practice this approach. Scholarly sources carry more weight, as they have been validated. Wikipedia, for example, is not a valid source for an academic environment. 

Response

Marie Blase

Posted Date

May 10, 2022, 4:01 AM

UnreadReplies to Cilisha Mattison

When performing research projects, it is important to have independent and dependent variables to determine what may influence the outcome of the research project. Independent variables are usually what will influence the dependent variables, and the dependent variable is what happens as a result of the independent variable. In my research project of improving COVID-19 vaccination rate, the independent variable was how my targeted population received their news or information regarding COVID-19 and the COVID-19 vaccine, and the dependent variable is refusal to receive the COVID-19 vaccine. It is important for me to find out the reasons why my targeted population is refusing to be vaccinated against COVID-19 as it will further guide the interventions needed for a successful capstone project. 

Response

Jaspreet Kaur

Posted Date

May 5, 2022, 6:08 PM

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It is important to know how to evaluate the effectiveness of an evidence-based practice (EBP) project. My evidence-based project is educating heart failure patients on compliance of medication and lifestyle changes to prevent hospitalization. Encouraging patient education, stressing on the importance of lifestyle management, educating about medication compliance, and involving other additional staff to ensure that the patients has follow-up appointments scheduled has decreased the readmission rate by 50% (Nair et al., 2020). The way that the HF medication and lifestyle compliance can be evaluated is by assessing the improvement of symptom management and quality of life, decrease hospitalization, and decrease overall mortality associated with the disease (Malik et al., 2021).

Some other ways the HF condition can be monitored is by evaluating routine lab work as ordered by the physician. For example, a comprehensive laboratory analysis including assessment for anemia, iron deficiency, renal dysfunction, and liver dysfunction is needed to help elucidate the severity of HF (Malik et al., 2021). Patient’s medical record and meetings amongst nursing staff and other direct healthcare providers can also help assess and evaluate the HF patient’s condition if the EBP project is effective or not. The HF patient can also keep track of their own symptoms and lifestyle changes through the use of a diary that can help the nursing staff to evaluate the patient’s condition during follow-up visits. The patient can be educated to keep a HF diary (e.g., to monitor weight) and the documented entries can be discussed during follow-up visit (Unverzagt et al., 2017).  

References:

Response

Replies to Katelyn Chandler

The goal of implementing an evidence-based practice project is to ensure a positive change to the targeted population. For my capstone project, my targeted population are those who have not received that COVID-19 vaccine, as my project is focused on improving the COVID-19 vaccination rate. One way I will evaluate whether my project made a difference is through comparison. After implementation of my interventions of promoting further education and facts to the targeted population, as well as providing hospital staff of possible scenarios in which patients may state their reasons for not getting vaccinated and ideas of how to respond while promoting the benefits of the vaccine, there will be comparison of the number of appointments schedule for the COVID-19 vaccine prior to the intervention and after the intervention. The results of the comparison will determine if my interventions were successful. 

Response

Steve Thomas

Posted Date

May 5, 2022, 10:05 PM

UnreadReplies to Katelyn Chandler

Developing an evaluation plan is a fundamental part of EBP to find out the achievements, and the reason for the evaluation is to assess the impact of the recommend the program and to determine effectiveness of the research finding in the inpatient hospital settings (Melnyk & Finout-Overholt, 2015). The rationale of the evaluation is to find out the success of the plan, and validate the desired outcome. The effectiveness of the new falls prevention program can be evaluated by first, count the number of falls and the number of occupied bed days on a pilot unit over a three months period of time. To be able to count falls properly, people in the unit need to agree on what counts as a “fall” (AHRQ, 2021). We then examine our rates every month and look at the trend over time. Input the following information:  How are they changing? Are they improving or getting worse? Can we relate changes in the fall rate to changes in practice? (AHRQ, 2021). A g-chart will be used in order to measure data scientifically. This is a chart for attributes data. It is used to count the number of events between rarely-occurring errors or nonconforming incidents. The g-chart creates a picture of a process over time. Each point represents the number of units between occurrences of a fall event. The g-chart will be used to see if the process is stable and how the interventions have affected the fall events.

References:

response

(Alexandria)E-commerce is when a business uses the internet, web or apps on a mobile device to run their business. E-business is process done digitally through a firm. Sometimes E-commerce and e-business go hand in hand depending on the business. Once a formal transaction is done between a customer and the business, it is considered e-commerce. Etsy is an e-commerce business site where small business owners can place their items for sale on Etsy, and buyer can pay for their items. Bingo.com is one of the “top 25 e-businesses according to an extensive survey conducted by Bain & Company”. Bingo.com allows people to play bingo for points that they can turn in for prizes.

 

Business-to-consumer e-commerce is when a business uses the internet, web or mobile phone apps to reach their buyers. An example of this would be Hopper. They have a mobile app that consumers can use to find flights, hotels and car rentals for the cheapest price. You can input where you want to travel and it will tell you the best time of the year to go for the cheapest prices. They also send out specials for cheaper prices.

Consumer-to-consumer e-commerce is when a consumer wants to sell their items to other consumers. A good example for this is eBay. People can sell their items on Ebay by setting up a bid or just putting a set price on their items. They can then ship their items to you.

Social e-commerce would be when someone wants to sell their items to other people using a social network. A good example of this would be Facebook and it is probably one of the largest social e-commerce business. People can use Facebook marketplace to buy other consumers items and even small business use Facebook to sell their items.

 

The eight major e-commerce technologies are: ubiquity, global reach, universal standards, social technology, personalization customization, information density, interactivity, and richness. Ubiquity is unique because e-commerce is available to anyone for anywhere. It gives people the opportunity to buy things on the go. Global Reach gives people from all over the world the opportunity to use e-commerce technology. There are tons of users world-wide that use e-commerce. E-commerce businesses have the opportunity to use richness because they can change their messages based of the consumers/customers of the technology they use. This gives them the opportunity to word things differently towards their customers and have a higher selling power.

 

Reference

Bingo.com Acknowledged by Bain & Company and The Globe and Mail As A Top eBusiness; Bingo.com Included Among Bain & Company’s E25: Hottest dot-com Innovations. (2000, June 23). Business Wire, 2086.

Laudon, K. C., & Traver, C. G. (2021). E-Commerce 2021: Business, Technology, and Society (16th Edition). Pearson Education (US). https://bookshelf.vitalsource.com/books/9780136931720

response

(Brittany)The Women of Gawain and the Green Knight

When looking back at the literature writings we have discussed earlier in the semester, we have noticed how women characters were very few and far between. When they were mentioned in these literature writings, they were background figures mentioned every now and then and not meant to be of much importance to the stories. But as we progress through the literature writings from the Middle Ages, it is all starting to change for the better. This week while reading Gawain and the Green Knight we have noticed some of these changes happening throughout the story for women characters.

The women character roles we have previously covered were mentioned only as mothers or brides of the men characters in the story. But in the literature writing Gawain and the Green Knight , the women’s roles have drastically changed from being ornamental figures to instrumental figures within the story. The women in this reading are depicted as having a major role in the way the story unfolds. Lady Bercilak and Morgan le Fay are introduced to us when Gawain enters a castle, he comes across in his journey to find the Green Knight. Lady Bercialk is the host’s wife and is described as being young, and beautiful and exquisitely dressed, while Morgan le Fay is described as being an older woman with some mystery to her as she is covered with clothing only allowing her lips and nose to be exposed. In his stay at this castle, he makes a deal with the host. The deal was for Gawain to relax and stay in bed for a few days while the host and his men will go out for a hunt and when they return, they will exchange what each has won for the day. Over the course of the three days Lady Bercilak enters Gawain’s room, tempting him and putting his virtues to the test. She uses her beauty and takes advantage of Gawain in order to control their interactions and he ultimately gives in and receives kisses from Lady Bercilak and her green garter that she promises is magical and will protect him from injury or death. We do not encounter Morgan la fay again until the end of the story when Gawain meets the Green Knight and receives the pay back that was promised to him from a year ago. After the Green Knight attempts to behead Gawain three times, this is when Gawain realizes that he gets away with only a scratch on the back of his head and the importance behind Morgan la Fays character is revealed. The Green Knight then reveals himself as Bertilak and how Morgan la Fay played a crucial role in why Gawain lives on. Bertilak is the servant of Morgan la Fay and she is the one who orchestrated all of the events starting a year ago when the Green Knight entered King Arthur’s castle. All of this was an attempt to try and scare Queen Guinevere.

After reading this story we can realize how much the women’s roles in literature writings have changed for the better. There are two main women characters we encounter in the story, and they have a major role in how and why the story happened. Lady Bertilak uses her wit and beauty to seduce Gawain and Morgan la Fay is the mastermind of all the events from the Green Knight to Gawain confessing his sins and living. This is crucial for women as a whole because women deserve recognition for being strong independent beings and for being capable of doing the things men can do. All beings should be treated equally no matter the color or gender. We are all capable of doing great things when we put our minds to it.

 

References:

“Author Anonymous (c.1390) – Sir Gawain and the Green Knight.” Poetry In Translation | A. S. Kline’s Open Access Poetry Archive, www.poetryintranslation.com/PITBR/English/GawainAndTheGreenKnight.php.

response

Springer Series on Rehabilitation

Myron G. Eisenberg, PhD, Series Editor
Veterans Affairs Medical Center, Hampton, VA
Thomas E. Backer, PhD, Consulting Editor

Human Interaction Research Institute, Los Angeles, CA

2003 Psychology of Disability, 2nd ed.
Carolyn L. Vash, PhD, and Nancy M. Crewe, PhD

2003 The Handbook of Rehabilitation Counseling
T. F. Riggar, EdD, and Dennis R. Maki, PhD, CRC, NCC, Editors

1998 Medical Aspects of Disability: A Handbook for the Rehabilitation
Professional, 2nd ed.
Myron G. Eisenberg, PhD, Robert L. Glueckauf, PhD, and Herbert H.
Zaretsky, PhD

1997 Rehabilitation Counseling: Profession and Practice
Dennis Maki, PhD, and Ted Riggar, EdD

1994 Personality and Adversity: Psychospiritual Aspects of
Rehabilitation
Carolyn L. Vash, PhD

1991 Treating Families of Brain-Injury Survivors
Paul R. Sachs, PhD

1991 Disability in the United States: A Portrait From National Data
Susan Thompson-Hoffman, MA, and Inez Fitzgerald Storck, MA, Editors

1988 Family Interventions Throughout Chronic Illness and Disability
P. W. Power, SdD, CRC, NCC, A. E. Dell’Orto, PhD, CRC, and
M. B. Gibbons, RN, MS, CPNP

1986 Applied Rehabilitation Counseling
T. F. Riggar, EdD, Dennis R. Maki, PhD, and Arnold Wolf, PhD

1985 Handbook of Private Sector Rehabilitation
Lewis J. Taylor, PhD, CRC, Marjorie Golter, MS, CRC, Gary Golter, MA,
and Thomas E. Backer, PhD, Editors

1984 Chronic Illness and Disabilities Through the Life Span:
Effects on Self and Family
Myron G. Eisenberg, PhD, Lafaye C. Sutkin, PhD, and
Mary A. Jansen, PhD

1982 Behavioral Approaches to Rehabilitation
Elaine Greif, PhD, and Ruth G. Matarazzo, PhD

1982 Disabled People as Second-Class Citizens
Myron G. Eisenberg, PhD, et al.

1981 The Psychology of Disability
Carolyn L. Vash, PhD

Carolyn Vash, PhD, is a psychologist whose
current professional interests span theoretical
and philosophical psychology, humanistic
psychology, psychology of the arts, and the
psychology of religion. She conducts a limited
consulting practice based in Altadena, Califor-
nia but devotes most of her time to writing.
She has previously worked as a rehabilitation
psychologist, administrator, researcher, and
educator. In addition to the first edition of
Psychology of Disability, she has had two
other books published by Springer Publishing
Company. Their titles were The Burnt-Out

Administrator (1980) and Personality and Adversity (1994). Her next book
examines the nature of consciousness through lenses provided by the most
ancient of wisdom teachings and the most recent conceptions of complex-
ity science.

Nancy Crewe, PhD, is a rehabilitation psy-
chologist and professor at Michigan State Uni-
versity where she coordinates the master’s
degree program in rehabilitation counseling.
Prior to taking that position she spent 16 years
as a faculty member and clinician in the De-
partment of Physical Medicine and Rehabili-
tation at the University of Minnesota. Her
research interests have revolved around psy-
chological and social aspects of spinal cord
injury. She won the American Rehabilitation
Counseling Association’s 1997 Research
Award for Life Stories of People With Long-
Term Spinal Cord Injury. Previous books in-

clude Employment After Spinal Cord Injury (1978), written with G. T. Athels-
tan and A. S. Bower, and Independent Living for Physically Disabled People
(1983), edited with Irving K. Zola. Current interests include narrative psychol-
ogy, spirituality and disability, and complexity science.

Psychology
of Disability
Second Edition

Carolyn L. Vash,PhD
Nancy M. Crewe, PhD

Copyright  2004 by Springer Publishing Company, Inc.

All rights reserved

No part of this publication may be reproduced, stored in a retrieval system, or transmitted in
any form or by any means, electronic, mechanical, photocopying, recording, or otherwise,
without the prior permission of Springer Publishing Company, Inc.

Springer Publishing Company, Inc.
536 Broadway
New York, NY 10012-3955

Acquisitions Editor: Sheri W. Sussman
Production Editor: Sara Yoo
Cover design by Joanne Honigman

04 05 06 07 08/5 4 3 2 1

Library of Congress Cataloging-in-Publication Data

Vash, Carolyn L.
Psychology of disability / Carolyn L. Vash, Nancy M. Crewe.—2nd ed.

p. cm.—(Springer series on rehabilitation)
Includes bibliographical references and index.
ISBN 0-8261-3342-8
1. People with disabilities—Psychology. 2. People with disabilities—

Rehabilitation. I. Crewe, Nancy M. II. Title. III. Series.
HV3011.V37 2003
362.4’048’019—dc21 2003052980

Printed in the United States of America by Integrated Book Technology.

Contents

Foreword Roberta B. Trieschmann, PhD vii
Preface ix
Introduction xi

Part I The Disability Experience

1. The Person: Reactions to Disablement 3

2. The World: People With Disabilities in a Handicapping World 26

3. Surviving: Living Independently 46

4. Loving: The Family 64

5. Pairing: Sexuality and Intimacy 85

6. Working: Getting Educated and Employed 107

7. Playing: Friendship and Recreation 129

8. Transcending: Disability as Growth Experience 146

Part II Interventions

9. The Long Arm of the Law 165

10. Individual Differences 193

11. Psychogogic Approaches 221

12. Peer Counseling and Related Services 251

13. Psychotherapeutic Approaches 267

14. Looking Ahead 281

References 301

Index 321

v

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Foreword

What a gift this second edition of Psychology of Disability is! Such wisdom,
such clarity, such practicality. What a gift to have the opportunity to experi-
ence the partnership of Carolyn Vash and Nancy Crewe, each a recognized
leader in the field of rehabilitation of persons with physical disabilities. Each
woman has decades of valuable and practical experience in the counseling
psychology and vocational rehabilitation arenas, giving them personal experi-
ence with thousands of individuals who have faced the challenges of surviving
the draconian financial web of social legislation, individuals who have coped
with the psychosocial issues of relationships in a society that does not openly
embrace those with disabilities, and individuals who have found satisfaction
and contentment from life in the family, the workplace, and community.

Life for people with disabilities has changed dramatically since 1945 when
the United States was flooded with individuals injured in WWII and those
who had survived the polio epidemics of the 1940s and 1950s. This influx
of people challenged the notion that individuals with impairments should not
expect to participate in society fully and publicly and should be content to
remain at home, cared for by family. Thus the fields of medical and vocational
rehabilitation evolved and gained great credibility in the 1960s through major
infusions of federal funds for state departments of vocational rehabilitation,
rehabilitation research and training centers in major medical schools, and
training programs for psychologists and vocational rehabilitation counselors
in universities. In this era, the professionals were viewed as the fount of all
wisdom regarding disability, but unfortunately this “wisdom” was sometimes
nothing more than ivory-tower philosophical speculation, especially when it
came to the process of adjusting psychologically to disability. Although most
professionals were very well intentioned and sincerely desired to help, their
personal knowledge of the disability process was limited to textbooks and
offices. In the hospitals, many physicians took a “father knows best” attitude,
but despite helpful medical knowledge, this paternalistic attitude grated. Thus,
the disability rights movement arose in the early 1970s in order to give people
with disabilities a greater voice in their own rehabilitation planning and
service delivery system. Eventually, federal and state governmental policies
shifted to include those with disabilities in the overall right to have equal
opportunity in the community and at work, and with regard to health care
services.

vii

viii Foreword

It is helpful to place the changes in the lives of those with disabilities in
the context of the changes occurring in American society. In the 1950s and
even early 1960s, America was a country in which the interests and attitudes
of the White, Anglo-Saxon, Protestant—and, we should add, male—group
dominated. However, in the last forty years, this country has evolved into a
celebration of multicultural diversity so that people with disabilities are one
of many groups expecting full participation in society. But this book becomes
an opportunity not only to celebrate our multicultural diversity, but also to
celebrate our unity. Each chapter addresses issues that are relevant to every-
one. People with disabilities have the same needs, hopes, and dreams as the
readers of this book. And this book addresses issues that are crucial to all
of our lives and presents some of the challenges that a person with disability
may face which the reader may or may not face. The abiding message is
that we are all part of the family of man, all welcome, and that the ways in
which we are the same are vastly greater than the ways in which we are
different. The beauty of this book is in its essential humanity.

Both Drs. Vash and Crewe began their careers in the 1960s, somewhat
prior to the advent of the disability rights movement, and thus they have had
the opportunity to observe and participate in the almost dramatic changes at
the societal level leading to the inclusion of people with disabilities in all
phases of community life. Furthermore, each of them has had a profound
impact on the attitudes of two generations of rehabilitation professionals
through their research, publications, lectures, and involvement in policy ori-
ented conferences and reports. Thus, this book represents a most beautiful
integration of their decades of professional and personal experience and the
wisdom that accrues with such seniority.

Roberta B. Trieschmann, PhD

Preface
to the Second Edition

Two eventful decades have passed since the printing of the first edition of
this book. The disability rights movement has grown and come of age. Its
achievements include taking a key role in the creation and passage of stunning
legislation, particularly the Americans with Disabilities Act. Although attitu-
dinal and social barriers remain, people with disabilities have more opportuni-
ties and greater basis for optimism than they did a generation ago.

Technology has developed remarkably and presented new opportunities
for overcoming functional limitations. Legislation has made illegal the kinds
of overt discrimination that used to be commonplace. Health care systems
have evolved, offering improved medical and rehabilitation care but also
creating economic barriers that limit access for uninsured people, including
many with disabilities. In contrast to our rapidly changing society, human
nature changes slowly. The writings of David, Socrates, and Shakespeare
reveal thoughts and feelings that are immediately understandable to twenty-
first century readers.

Consistent with this observation, differing degrees of change were neces-
sary in the parts of the book that deal with human emotions, thoughts, and
behaviors and the parts that discuss the environment in which people live.
One of the ways in which the world has changed is in the language that we
use. Terminology has evolved from words like crippled to handicapped to
disabled. “Person first” terminology is currently most widely accepted because
it is seen to focus on the whole person rather than on the disability as his or
her defining characteristic. On the other hand, some disability activists are
calling for a return to the earlier custom of referring to a disabled person. They
maintain that it accurately represents their identification with the disability
community and their disability pride. We still prefer the person first approach
and have generally used it throughout the book, but not slavishly. Both
rationales have merit, and both are presently acceptable styles.

Another change involves the burgeoning body of research related to the
psychology of disability. Several significant journals are focused on disability
research, and other journals occasionally include relevant articles. Further,
the Internet provides both direct access to quantities of information and ready

ix

x Preface to the Second Edition

entrée to material published in traditional formats. The second edition has
taken advantage of these expanded resources and put additional emphasis on
research citations.

The book still represents an effort to share the authors’ decades of personal
and professional experiences with disability. The first author has lived for
some 50 years as a severely disabled individual, and the second author is
experiencing disability as a concomitant of aging. Both authors have been
enriched by careers as rehabilitation psychologists, educators, and researchers.
The collections of people who have interacted with us in any of these roles
and thus contributed directly or indirectly to the content of the book are too
numerous to acknowledge individually. Nevertheless we want to express
our deep appreciation to our families, colleagues, and customers who may
recognize their influence in our work.

Introduction

It has been said that everyone is like all of the other people in the world in
some ways, like those in similar groups in some ways, and like no other
person who has ever lived in some ways (Leong, 1996). Dangers inhere in
acknowledging the validity of the concept “the psychology of disability,”
since, in the past, it has led to unhelpful exaggerations of the perceived
differences between people with disabilities and those without. The fact is,
human beings are more alike than different, regardless of variances in their
physical bodies, sensory capacities, or intellectual abilities. To illustrate, a
disabled person is said to experience a sense of loss over the functional
abilities that an illness or injury has destroyed. Similarly, a nondisabled
person may experience a sense of loss over something she or he once had
and now has lost. The stimulus is different, but the sense of loss, the fear
that life will be painful or meaningless without the lost element, are virtually
the same. Viewed in this light, the psychology of disability is little different
from the psychology of being human.

The definition of the psychology of disability underlying the material in
this book is considered here to be largely, though not entirely, the study of
how human organisms respond to a set of stimulus conditions associated
with disability. Stated somewhat differently, it is a study of normative re-
sponses from (psychologically) normal organisms to abnormal stimuli.

Some of these abnormal stimuli are biological, such as being paralyzed.
Some are environmental, such as inaccessible entrances. Others are social,
such as having a salesperson ask your companion, not you, what size you
wear. Not being able to get a job is an economic example. Some stimuli are
obvious, such as a restroom door you can’t get through, while others are
subtle, like people not using the work “handicapped” when you are around.
Some are pleasant, such as being allowed to enter an airplane first. Some
are unpleasant, such as not being able to use the restroom on a long flight.
Pages could be filled with such examples, which in itself illustrates the
unusual stimulus situation the disabled person is in: a continual flow of
perceptions and experiences that cannot be validated by the majority of people
around one. Thus, isolation and lack of consensus for one’s ideas and feelings
are added to the list of unusual stimulus conditions. And so it goes.

Following from this, the psychology of disability becomes bifurcated as
an applied science. One branch is a rather typical applied behavioral science,

xi

xii Introduction

embodied in a group of professionals who use the findings of research and
clinical experience to help people with disabilities cope with, adapt to, and
adjust to other unusual stimuli. The other branch is embodied in an activist
movement by a group of people determined to alter the stimulus conditions
because the world needs “treatment” more than the people with disabilities.

This latter branch emerged slowly after World War II, when medical
science found ways to save wounded soldiers who then returned, significantly
disabled, to a society that felt it owed them something. Acknowledging a
debt and paying it are two different things, however, and little progress was
made. The civil rights movement pointed the way, with special impetus
flowing from the 1965 Watts riots. A segment of the African American
population in south central Los Angeles engaged in violent, self-destructive
behavior for six days; somehow, one of the results of it was that blacks all
over the country, other racial minorities, women, people with disabilities,
and multitudes of other groups who had accepted powerlessness and half-
filled cups all of their lives began to scream. They saw more clearly that
society, even an indebted one, is not going to fix itself for you. The folks
with the problem must come up with the solution. They also rediscovered
the Constitution. Everyone had known all along that African Americans were
deprived regularly of their constitutional rights, but whoever thought that
people with disabilities were? The “expectation explosion” became a chain
reaction, and “consciousness raising” tried to ensure that everyone’s expecta-
tions were as high as they should be.

Prior to this paradigm shift, virtually all of the emphasis in rehabilitation
was on modifying the “patient” to fit into the world as it was. Patients
were modified by medicine, surgery, physical therapy, occupational therapy,
psychotherapy, vocational counseling, social casework, prosthetic and or-
thotic devices, education, training, and much, much more. Family homes
were remodeled, occasionally at public expense, but to expect all housing to
be built to be accessible to people with disabilities would have been viewed
as an idealistic delusion. The motto was, “If a round peg doesn’t fit in a
square hole, you square the peg, you don’t ream out the hole.”

Some changes have taken root. The “other half” of the psychology of
disability has become the politics of disability. This is only right; it’s not
good for people, psychologically speaking, to be deprived of their constitu-
tional rights. If the applied psychology of disability is to be a helpful discipline,
then it must tend to the business of altering destructive stimulus conditions,
as well as modifying disabled individuals and their responses.

Scope and Purpose

The Psychology of Disability is intended to serve as a textbook or collateral
reading source for students engaged in the study of the psychological aspects

Introduction xiii

of disability, as well as a general resource for rehabilitation professionals in
the full spectrum of allied health and vocational service disciplines. The
material is presented in two parts, which might be labeled “What it’s like to
be disabled” and “what people who are inclined to help can do.”

Part I, “The Disability Experience,” is an effort to admit the reader into
sundry corners of the experiential worlds of people with disabilities. It is a
phenomenological accounting of the ways in which disabled people confront
and are confronted by the world and of how they go about the business of
living under the sometimes peculiar circumstances disability can generate.
It attempts to present the psychological experience from the perspectives of
people who have disabilities; the inner states and processes, the interpersonal
situations and interactions, and the behavioral mechanisms and patterns that
emerge. The eight chapters of Part I chronicle both the objective and subjective
experiences associated with being a disabled person in a handicapping world
and how these affect the basic life functions of surviving, living, working,
playing, and—for some at least—transcending both the disability and the
more troubling aspects of the world.

Part II, “Interventions,” is a response to the problems and sources of
psychological pain that are exposed by the discussions in Part I. It describes
some major ways in which changes can be wrought; some are designed to
improve the world, and others are intended to help disabled individuals react
constructively to the conditions life has proffered. Interventions aimed at
changing the world traditionally were not thought of as psychological services,
but they may have a profound effect on the psychological well-being of an
individual. Transcending disability is much easier if basic survival and quality
of life issues have been addressed by the society, so Chapter 5 deals with
disability-relevant legislation and policy. The remaining five chapters are
devoted to intervention strategies used by psychologically trained profession-
als (for example, psychologists, rehabilitation counselors, social workers,
psychiatrists, speech pathologists), other rehabilitation professionals (for ex-
ample, nurses, occupational therapists, physical therapists, physicians), peer
providers (for example, peer counselors), and social/behavioral scientists.
Four of these chapters deal with ways to help disabled people improve the
quality of their lives by working on themselves (as opposed to changing the
world). The last deals with the future, touching on some of the current and
critical issues for people with disabilities in America. These include the
growing interest in racial and ethnic diversity, aging, and technology. The
chapter ends with an exploration of spirituality and disability.

Unavoidably, the choice of subject matter and manner of presentation
reflect the authors’ belief systems regarding what the psychology of disability
is all about, thus determining the issues considered important enough to
include, the programs viewed as successful, and the policy decisions sug-

xiv Introduction

gested. Moreover, the authors’ personal and professional experiences have
been preponderantly weighted in the area of physical disabilities; therefore,
the selected issues and case examples may reflect this experiential loading
despite conscious efforts to the contrary.

The Issues

The commonality of experience among people with different types of disabili-
ties is great because all of them share the processes of being devalued as a
result of having a disability and learning to accept all that disablement entails.
It may be too sweeping a statement, but devaluation and acceptance seem
to constitute the underlying cause and inherent solution to most of the specific
psychological problems associated with disability. The form of disability,
however, does shape the manifest problems, so it is necessary to examine
the specific ways in which various impairments impact people’s lives. For
example, deafness or even blindness may impede a person’s participation in
a conversation, whereas severe physical disability might prevent one from
attending the gathering at all.

Probing further, although sensory, motor, and internal disabilities have
significantly different impacts, they all reflect bodily dysfunctions, as opposed
to impaired mental processes. With disabilities such as these, one can adopt
rather comfortably the definition stated earlier: the psychology of disability
is the study of normative responses from psychologically normal organisms
to abnormal stimuli. Naturally, there are exceptions; people who could not
be considered “psychologically normal” become disabled, too, and occasion-
ally the disablement proves to be the stress that pushes a vulnerable individual
into neurosis or psychosis. More to the point, many people have disabilities
that are explicitly psychological in nature, such as mental retardation or
mental illness. While it would not be reasonable to assert that they are
“psychologically normal organisms,” it is still true that many of the psycholog-
ical problems experienced are not due to the mental disabilities per se, but
to such abnormal stimuli as being devalued in the eyes of others. In this
light, it is important to focus on abnormalities in stimulus situations before
ascribing abnormality to the psyches of disabled individuals, even when the
disability is mental in nature. Although the “letter” of the definition must be
altered somewhat to accommodate this portion of the disabled population,
the “spirit” of the definition is equally applicable.

Devaluation and acceptance: these are considered the pivotal variables in
adjusting to life when it is complicated by disability. Let us look at each in
more detail.

Introduction xv

Devaluation

Following close behind outright oppression in terms of psychologically dam-
aging consequences is devaluation, that is, being regarded as a lesser being,
inferior, not very capable, not very useful, possibly burdensome, unaesthetic,
and, generally, one down. People with disabilities consistently experience
devaluation in the eyes of others, and their own. This is true regardless of
the nature of the disability, whether it impairs physical, sensory, or mental
functioning. The phenomenon was illustrated powerfully at a rehabilitation
conference held in California a number of years ago. Dr. William Rader—
psychiatrist, psychodramatist, and public performer par excellence—began
an arousing display of the tragic, even deadly, effects of communication
misfires between helpers and helpees with a simple routine. He addressed
the audience, alternately standing up and then sitting in a wheelchair, all the
while challenging them to deny that their perceptions of his competence
fluctuated as he stood and sat, stood and sat. There was much discussion
afterward, and virtually all in attendance, from able-bodied to very severely
disabled, acknowledged that their views of his competence had changed, had
alternated dizzyingly as he stood and sat; that he had appeared more credible,
more worthy of attention when he stood. It was an emotionally draining
experience for many. It was a confrontation of prejudice they had ignored
or denied for a long time. Why such an impact from recognizing that one
does, indeed, devalue people with disabilities? Can it be changed? Probably
not, unless it is first acknowledged and examined in every aspect.

The first line of inquiry addresses whether such prejudice is biologically
based. Does the human species instinctively shun damaged organisms because
their perpetuation could threaten the survival of the species? The anthropologi-
cal observation that numerous primitive tribes leave aged or injured members
to die because efforts to save them would endanger larger numbers is familiar
to many. Is it possible that biological mechanisms which once operated for
species protection have not caught up with an affluent and technologically
advanced civilization that has rendered them anachronistic? No one knows.

The second line of inquiry is psychosocial, but the content is similar.
People tend to shun, be prejudiced against, or devalue individuals who are
different. This is more so if the difference occurs at the low end of the
distribution, that is, if the individual has less of something than most people
have. But people who are too beautiful or too brilliant or too rich, or extraordi-
narily kind come in for their share of suspicion and punishment as well. This
phenomenon may have biological substrates also, since it appears to have
been “learned” by almost every culture on earth. Can people learn to tolerate
a wider range of differences? How?

xvi Introduction

The third line of inquiry is politicoeconomic. In an affluent, technologically
advanced society, saving lives and improving the quality of life for those
saved but left damaged is not going to threaten the survival of the species.
It can, however, reduce the sum total of goods available for the rest. Despite
substantial advances in the past 25 years, people with disabilities, especially
severe ones, are still viewed as a group of “takers” who don’t put much back
into the system, into the family, the community, or the larger society.

Considering materialistic values only, this may be a valid notion. If severely
disabled individuals lack the inner resources or miss the strokes of fortune
leading to jobs paying enough to support high-cost needs, then the issue is
not whether the public pays, but how. Should there be a tax-supported welfare
system or should the person be subsidized through an employer who, in turn,
passes the cost on to the public in increased prices for goods and services?
In terms of the long-run impact on the purses of the people, there may be
little difference. In terms of the psychological well-being of the disabled
people affected, the difference may be great.

Even in pragmatic terms, people with disabilities may contribute by serving
as the impetus for technological innovations that then are adopted and benefit
the population at large. One of the amusing objections offered to providing
accommodations to a worker with a disability is that “if he gets it, everyone
will want one.” And if everyone should get it (e.g., an ergonomically designed
chair or more flexible working hours), and if morale and productivity improve
as a result, where is the harm?

If one looks beyond the material to spiritual values, the issue becomes
meaningless. If one has faith, or at least adopts the belief, that the purpose
of life is spiritual development rather than materialistic acquisition, then
sharing of goods with those unable to produce their own is not inconsistent
with enlightened self-interest. The reason for this is an associated faith that we
are all parts of the same universal spirit, wherein selfishness and unselfishness
become, paradoxically, the same. Just as one must “selfishly” pursue one’s
own development—and sometimes deny others—if one is to become a truly
beneficial influence for others, so must one also pursue the removal of
hindrances to others’ development, because to do otherwise is ultimately to
impair one’s own. There is no reason to believe that people with disabilities
put less into this system than anyone else.

Over the years relatively little investment has been made in the provision
of psychological services to people with disabilities. In addition to the public’s
frugality, disabled individuals may be motivated to handle adjustment issues
on their own. A great deal of help and dependency are accepted because
there is no other choice consonant with survival. To need still further help,

Introduction xvii

implying emotional as well as physical dependency, is unacceptable, so the
need is denied. Beyond this, the social sanctions against getting psychological
or psychiatric help interfere with asking, even when the need is recognized.

In addition, it is not easy to relate psychological services to savings of
public dollars. Physical restoration can demonstrably reduce the lifelong
medical costs for which the public pays. Vocational rehabilitation can reduce
welfare costs and get some tax money coming into the system as well. Since
physical restoration and vocational rehabilitation can produce those benefits,
who is going to worry about feelings?

Again, such a position is shortsighted. Apart from humanistic concerns
about quality of life, it is possible that s

Response

A growing number of new technologies are widely available with in nursing field that could improve the quality of care, reduce costs, and enhance working conditions. Analyzing the determination of potential users of technology is the first stage in the successful implementation of new technologies. 

Information technology plays a crucial role in the practice of evidence-based medicine by allowing health care practitioners to access and evaluate clinical evidence by formulating their patient treatment strategies. This involves an analysis of a large amount of complex information. Communication is the greatest strength that reflect the use of EBP and exemplary nursing practice.  This capstone experience facilitated and wonderful learning experiences that focuses on quality improvement in my workplace (Marlin Lynn, Bently Poole & Lynda, 2016). 

The new technology for my project change is telemedicine consultation through video conference. This practice is on exists in my clinical outpatient setup. The aim of the change practice is further establishment of consultation to the required specialty expertise at distance to reduce the health access disparities to the sub-urban population.  

The uptake of new technology is clearly perceived advantages for the patients and families, considerably saving time.  Electronic communication of patients’ history and lab results could be more helpful in detecting the early symptoms of life-threatening diseases such as coronary artery diseases and CVA.  Lack of resources is sometimes mentioned as a problem. The main set back is personal contact with patient and colleagues are substantially reduced (Fleuren, M.A, Bekkema. N et al; 2011).

Response

Foremost, it’s essential to bring all the stakeholders to implement change in any organization. Their input is critical when it comes to the implementation stage, where the same individuals will be required to act on the identified intervention (Ceschi, Demerouti, Sartori, & Weller, 2017). When one seeks to introduce change in a hospital set up, the department that is likely to be affected should be given the priority when it comes to providing ideas and opinions on that. Other than the department, one must also seek the contribution of shareholders, those who don’t actively engage in day to day running of the institution but have very critical roles in the management. 

Depending on the type of change, external and internal forces must be all reading from the same script to guarantee the intended change’s success. When one seeks to convince the shareholders, the best thing is to have an apparent and elaborate proposal that should be accompanied by a comprehensive concept note that should bring out the ideal clearly with no iota of ambiguities. Additionally, there is a need to work on a method that can bridge the gap between the managers and the internal stakeholders to enhance proper coordination when implementing the intended change (Chebbi, Yahiaoui, Sellami, Papasolomou, & Melanthiou, 2019). 

References

Ceschi, A., Demerouti, E., Sartori, R., & Weller, J. (2017). Decision-Making Processes in the Workplace: How Exhaustion, Lack of Resources, and Job Demands Impair Them and Affect Performance. Frontiers in psychology, 1-14.

response

 

Urine is viewed as a waste product excreted from the body after a short time in the bladder. However, the quality and composition of urine have future implications and should inform an individual of the next cause of action. Barasch et al. (2018) indicate that the physical characteristics of urine can be an essential element in informing the body’s wellness. That means assessing the urine pH is critical in maintaining the bladder’s health. Therefore, the physical characteristics of urine can report the malfunctions in the kidney, which should then trigger a medical examination to improve its well-being.

      The role of urine microbiota in the quality and composition of urine is a topic of concern. According to Barasch et al. (2018), is concerned of whether pathological changes in the microbiota can affect the quality of urine and subsequent bladder infections. From my experience, the urinary system has the sole purpose of excreting urine. There has never been a concern on whether the quality of urine can talk about body wellness. Therefore, is it right to use the physical characteristics of urine to dictate the foods and drinks we take since urine is based on what people eat and drink?

References

Barasch, J., Bavendam, T., Birder, L., Buffington, T., Campeau, L., & Dmochowski, R. et al. (2018). Urine: Waste product of biologically active tissue?. Neurourology And Urodynamics37(3), 1162-1168. https://doi.org/10.1002/nau.2341

    • 3

    RESPONSE

    Brian Barela

    Posted Date

    Apr 27, 2022, 9:33 PM

    Unread

    During the development of a project change proposal, many considerations must be taken into account. These considerations may include financial, quality, and clinical information, that should be thought of. When creating a change proposal, a major hurdle can be related to the financial aspect of implementation or creation. The proposal will take potentially a large amount of labor induced costs, in addition to the cost of supplies. Many changes are welcome in healthcare because they can improve care quality and save costs (Al-Abri, 2007).  This can work against the proposal if it is not within the budget. However, the change can result in overall cost savings for the healthcare system if implemented. If my communication change is implemented it can result in a potential savings for the hospital as it can result in a lower length of stay, increased safety, and increased patient satisfaction. Quality in healthcare is also an important aspect as it directly effects the patient care and outcome. If the quality of communication is good the continuity of care will be good, and the care will be better than if there was a loss of communication. This in turn directly affects the clinical aspects of care. Without necessary communication care will be poor. If the plan is implemented the communication will improve, and patient care should be better compared to before.

    Reference

    Al-Abri R. (2007). Managing change in healthcare. Oman medical journal22(3), 9–10. https://www.ncbi.nlm.nih.gov/pmc/

    Response

     Our textbook authors’ focus is on transcendence and disability.  The implication in that focus is that disability is something one needs to transcend.  What are your immediate reaction to that statement?   I ask because disability is an identity.  Should we look to transcendence of an identity as a goal?  Or should the focus be on acceptance?  Or is there something I am missing?   

     (textbook author) Vash, C and Crewe, N. (2003). Psychology of Disability. Springer Publishing

    Response

    The topic of my evidence-based project focuses on hospital-acquired infections, (HAI), and am focusing on patients on a long-term stay, like post-operative patients. I want to know how the infection is gotten, the most predominant cases, and what means it spreads. Hospital-acquired infections (HAIs) are nosocomial acquired illnesses that are neither present nor incubating when a patient is admitted to a hospital. Catheter-associated urinary tract infections, central line-associated bloodstream infections, surgical site infections, ventilator-associated pneumonia, hospital-acquired pneumonia, and Clostridium difficile infections are among the infections that might occur. Productive cough, shortness of breath, stomach discomfort, rebound tenderness, changed mental status, palpitations, suprapubic pain, polyuria, dysuria, and costovertebral angle tenderness are all signs of infection (Monegro & Hariharan, 2019). 

    To address the problem, I intend to adopt an educational process on prevention, using hand sanitizer, hand washing, use of appropriate PPE, and placing appropriate isolation tags on patient’s door even when it is just been suspected. The risk of hospital-acquired illnesses is determined by the facility’s infection control policies, the patient’s immunological condition, and the community’s presence of various pathogens. Immunosuppression, advanced age, duration of hospital stays, various underlying comorbidities, frequent trips to healthcare institutions, mechanical ventilatory support, recent invasive surgeries, indwelling devices, and a stay in an intensive care unit are all risk factors for HAI ICU (Intensive Care Unit) (Monegro & Hariharan, 2019). Cleaning and disinfecting the environment is an important part of infection control programs because it ensures that rooms and equipment are safe for patients. While proper hand hygiene has gotten adequate attention, hospital cleaning has typically been relegated to the “too difficult basket” and under-resourced (Fernando et al., 2017). 

    Reference 

    Fernando, S. A., Gray, T. J., & Gottlieb, T. (2017). Healthcare-acquired infections: prevention strategies. Internal Medicine Journal47(12), 1341–1351. https://doi.org/10.1111/imj.13642 

    Response

    Katherine Shepherd

    Posted Date

    Apr 27, 2022, 8:16 PM

    Unread

    Although EBP has been associated with a higher quality of care and improved patient outcomes, organizations continue to face challenges and barriers in implementing and sustaining a culture of EBP (Echevarria et al., 2017). These barriers include lack of knowledge and skills by health care providers, resistance to EBP, time, misunderstanding of EBP, and lack of financial commitment (Echevarria et al., 2017). This writer’s proposed change revolving around the mental health treatment stigma that some veterans have is no exception to the barriers that one may face when implementing EBP change. Financially speaking, there would be no direct increase in cost with the implementation of this project, however, it would take up the time of health care professionals who implement the educational intervention. The argument could be made that the financial cost will indirectly come from the time of the professionals. A quality aspect of this project includes the potential for an increased quality in patient care by means of connecting those suffering from mental illness with treatment options that may have otherwise been overlooked. EBP changes should include innovation, shared decision making, and quality and safety (Echevarria et al., 2017). The quality of treatment that veterans receive stands to be improved with the implementation of this project. There are also clinical aspects to take into account as well, as health care professionals participating in this change project will need to be acutely aware of mental health signs and symptoms, as well as communication strategies when talking with veterans who may have stigma. This change proposal will have a direct impact on clinical factors, and has the propensity to improve patient care by more aptly recommending mental health treatment to those who need it.

    Response

    Many new technologies are becoming available within nursing care, such as home dialysis equipment or new infusion pumps that change the nursing staff’s daily routines. In addition, all kinds of technologies that support distant care, such as telecare technology, have consequences for nursing practice. Another development is the introduction of electronic information systems such as electronic patient records. Technologies are aimed at increasing the quality of care, reducing healthcare costs or solving workforce problems.

    Health care facilities have become gradually dependent on information technology to computerize almost all aspects of patient care. In the United States, as of 2015, electronic health record (EHR) systems had been installed in 96% of hospitals. The use of EHR system in the healthcare can improve the implementation process and the outcomes of the evidence-based programs. The electronic health record system keeps all the records regarding the patient’s medical history as well as all the diagnosis. The EHR plays important role in the healthcare organization. And it should be implemented in the healthcare organization. Computers have become embedded in clinical workflow processes, and any disruptions to access the computer system were found to have severe consequences to hospital operations, finance, patient safety, providers, and especially the clinical staff. I do plan to use EHR the reason to implement an evidence-based downtime readiness and recovery plan was recognized early to ensure meaningful and enhanced management of computer systems and more importantly to guarantee safe patient care. As well as it helps to accurate, up-to-date, and complete information about patients, enabling quick access to patient records, and reducing costs through decreased paperwork, improved safety, reduced duplication of testing, and improved health.

    References

    response

    Number 1 post: PG

    What is the role of gallbladder?

    Gallbladder is an organ that located underneath the liver. Liver produces bile and the gallbladder stores bile, which is essential for digestion of fat (Johns Hopkins Medicine, n.d.). The liver produces bile about 800 to 1000 milliliters (about 27 to 37 ounces) everyday, which is yellow, brownish, or olive-green liquid; “Liver discharges the bill into small canals that guide to the common bile duct and then lead to the gallbladder in order to store and concentrate the bile between the meals time or fasting; gallbladder release bile to digest fat after consuming fatty food”(NCBI, 2010, 2018, 2021). Therefore, main role of the gallbladder is holding bile and release it into the duodenum that is the first part of small intestine after consuming fatty meal.

    How do gallstones form?

    According to O’Dougherty& Galhoun (2019), “components of bile are cholesterol, bile salts certain fats, water, and bile pigment (bilirubin). Gallstones exist when component of bile remain in the gallbladder and stored in it and bile become solid and place in the bile duct and block the secretion of bile to the duodenum and cause the gallbladder to become inflamed that is calling cholecystitis” Low fat diet recommend for people who have gallbladder issues such as the Mediterranean diet (fish instead of fried chicken. Brown rice instead of a white-flour roll. A handful of nuts instead of chips. Olive oil instead of butter. And plenty of vegetables and fruit) in order to prevent an existing of gallstones (Efron, n.d.).

     Thus, excessive produce of bile and store in the gallbladder lead to form gallstones. 

    Why does the patient have referred pain?

    Patient is suffering of sharp pain due to block the outflow of bile, when gallstones travel through the duct to the stomach, they block bile duct and cause the gallbladder to spasm. Pain usually is sharp in the upper right side and under the ribs or center of the abdomen (Efron, n.d.). Pain might radiate to the right shoulder and severe pain may last 30 minutes to several hours, and pain increases with breathing (Johns Hopkins Medicine 2022).

    Would you expect her to have nausea and vomiting? Defend your answer.

    The answer is yes, nausea or vomiting may occur due to severe pain in patients with acute cholecystitis. According to John Hopkins medicine (n.d., 2022), “symptoms that happen in patient with acute cholecystitis are sever pain, nausea and vomiting, fever, chills, jaundice, and intolerance of fatty food. Diagnostic tests are ultrasound, CT or CAT scan, blood tests, ERCP, and treatment in acute cholecystitis is cholecystectomy” (Gallbladder removal).

    Number 2 post: AB

    1. What would you expect her sodium level would be, high or low?  Defend your answer.

    Diabetes insipidus is a disease process in which the body losses the function of retaining water (Hui et al., 2022). The kidneys are responsible for regulating fluid volume and electrolytes. One hormone that assists in this process is the antidiuretic hormone (ADH) or vasopressin. When fluid volume decreases in the blood, it affects the concentration and therefore the osmolality. This signals the release of ADH which binds to receptors on the kidneys to stimulate the conservation of water. However, in diabetes insipidus ADH level is diminished, or the kidneys are desensitized to it. The result is that there is a large loss of fluid volume through urination. This leads to different electrolyte imbalances such as hypernatremia (Breault, 2019). The fluid volume in lost in the blood, the concentration of sodium increase.

    2. Her osmolarity is elevated. Why?

    Osmolarity is a laboratory study which evaluates the concentration of a given solution (Dlugasch & Story, 2019, pp. 7). High osmolarity means that the concentration of solute is high. In diabetes insipidus, fluid volume is diminished in the vascular system due to lack of fluid retention and increased urination. This leads to an increase in solute concentration of the blood. Thus, osmolarity is elevated.

    3. Compare and contrast central vs. nephrogenic Diabetes Insipidus.

    As mentioned previously, diabetes insipidus is the result of decreased levels of ADH or decreased sensitivity to ADH. Central diabetes insipidus is when hypothalamus does not produce an adequate amount of ADH needed for the body to function (Hui et al., 2022). In nephrogenic diabetes insipidus, there is an adequate level of ADH in the system, but the kidneys have become desensitized to the hormone and stop responding.

    4. Explain the mechanism of dDAVP.

    Treatment of central diabetes insipidus involves the administration of dDAVP. This medication is a synthetic equivalent to ADH but differs in two key areas (Garrahy & Thompson, 2020). First, ADH is has a short half life whereas dDAVP has a six to eight hours half-life. This allows for less frequent administration of this medication. Secondly, ADH affects the blood vessels and causes constriction, whereas dDAVP does not.

    response

     Number 1 post: RW

    According to the National Institute of Health, Osteoarthritis is a degenerative joint disease, in which the tissues in the joint break down over time.  It is the most common type of arthritis and is more common in older people.  People with osteoarthritis usually have joint pain and, after rest or inactivity, stiffness for a short period of time.  The most commonly affected joints include the hands, knees, hips, neck and lower back.  Osteoarthritis affects each person differently.  For some reason, osteoarthritis is relatively mile and does not affect day-to-day activities.  For others, it causes significant pain and disability.  Joint damage usually develops gradually over years, although it could worsen quickly in some people. (2019).  

         Osteoarthritis is a disease of articular cartilage and subchondral bone in diarthrodial joints.  It was believed that OA was exclusively a degenerative disease of the cartilage, however, latest evidence has proven that OA is a multifactorial entity, involving multiple derangements.  It is also known that the cartilaginous tissue is not the only one involved.  Given its lack of vasculature and innervation, the cartilage, by itself is not capable of producing inflammation or pain at least on early stage of the disease.  hence, the source of pain is mainly derived from changes to the non-cartilaginous components of the joint, like the joint capsule, synovium, subchondral bone, ligaments, and peri-articular muscles.  As the disease advances, these structures are affected and changes including bone remodeling, osteophyte formation, weaking of periarticular muscles, laxity of ligaments, and synovial effusion can become evident. (Mora et al., 2018).  

         Osteophytes are thought to stabilize an osteoarthritic joint, thereby preventing structural progression.  Meagre longitudinal data suggest, however, that they are associated with an increased risk of structural progression.  Large osteophytes do not affect the risk of structural progression.  They are strongly associated with malalignment to the side of the osteophyte, and any relation they have with progression is partly explained by the association of malalignment with progression.  Osteophytes are so common as a radiographic feature of osteoarthritis that they have been used to define the presence of disease.  they most often appear as they margin of the joint, originally as outgrowths of cartilage and subsequently undergo endochondral ossification.  Growth factors such as transforming growth factor beta potentiate their growth. (Felson et al., 2013).

         NSAIDS are widely used to alleviate the symptoms of OA.  It remains controversial as to what effects these agents have on the progression of OA.  In vitro studies showed several types of NSAIDS inhibited the synthesis and protected the chondrocytes against apoptosis, while others had no effects.  Preliminary clinical trials revealed some NSAIDs such as indomethacin had a negative influence on joint structure, other NSAIDs such as diclofenac and naproxen had no acceleration of radiographic damage to OA within 2-years of treatment.  So far, there are no convincing data to show the widely used NSAIDs and recommended selective COX-2 inhibitor have favorable effects of cartilage.  Therefore, it is necessary and valuable to clarify the effects of these NSAIDs on cartilage in patients with OA using validated non-invasive methods such as MRI. (Ding, 2002).

         Obesity is widely acknowledged as a risk factor for both incidence and progression of osteoarthritis and has a negative influence on outcomes.  Loss of at least 10 pounds of body weight, coupled with exercise, is recognized as a cornerstone in the management of obese patients with osteoarthritis, and can lead to significant improvement in symptoms, pain relief, physical function, and health-related quality of life. (Bliddal etal., 2014).

         According to the CDC, there is no cure for OA, so doctors usually treat OA symptoms with a combination of therapies, which may include increasing physical activity, physical therapy with muscle strengthening exercises, weight loss, medications, supportive devices such as crutches, or canes and surgery.  In addition to these treatments, people can gain confidence in managing their OA with self-management strategies.  These strategies help reduce pain and disability so people with osteoarthritis can pursue the activities that are important to them. (2020).

     Number 2 post: RB

    A 30-year-old female presents with muscle weakness and fatigue. Abnormal electromyography testing and a positive increase in ACTH receptor test is reported. Her final diagnosis is Myasthenia Gravis.

    Described the normal synaptic transmission at the neuromuscular junction (NJM).

                To be able to understand how the neuromuscular junction works (NMJ) understanding what is normal to abnormal and the role of neurotransmitter in the generation of muscle contraction needs to be understood. The brain has several neurotransmitters including, acetylcholine, norepinephrine, dopamine, and serotonin the brain is an organ with millions of neurons and an extensive circuitry that allows receiving and transmitting signals from the environment in response to stimuli (Dlugasch & Story , 2021). Neurotransmitter modulators such as Acetylcholine receives signals from the cerebral cortex which then binds to nicotinic acetylcholine receptor on muscle cell membrane that resulted in muscle contraction (action potentials). The neuromuscular junction has three main parts; presynaptic membrane which is the membrane of an axon terminal, post synaptic membrane the membrane of the skeletal muscle also known as motor end plate, and synaptic cleft gap between pre and post synaptic membrane. Our brain sense a signal in the form of action potential from the cerebral cortex (upper motor neuron) this then activates the lower motor neuron through the axon terminals to the muscle fibers where innervation happen, the NMJ is the area where motor neuron meets the skeletal muscle fiber when the lower motor neuron is activated there is an influx of calcium ions into the presynaptic membrane followed by the release of acetylcholine into the synaptic cleft Acetylcholine binds to nicotinic receptors this leads to the generation of an action potential which eventually resulted in muscle contraction (Omar, Marwaha, & Bollu, 2021). Myasthenia Gravis is an immunologically mediated disorders affecting the end plate region of the postsynaptic neuromuscular junction, this is analogous to having a gatekeeper where an individual will be check (action potential) whether the command from the king/ authority (cerebral cortex) will be allowed to enter the kingdom (muscle contraction), any disturbances or discrepancy of information will disallow/inhibit the contraction.

    Why is ACTH increased?

                Anticholinergic antibodies can also activate the classical pathway of the classical pathway complement pathway this is a family of small proteins that work in an enzymatic cascade to fight off bacterial infections the activation of CCP causes inflammation and destruction of the muscle cells. ACTH is a peptide hormone that binds to corticotrope cells that is being release when the hypothalamus detects stressful stimuli such as infection and acts on inflammatory state and due to thymoma.

    Explain why the patient with myasthenia gravis cannot generate consistent action potentials in the muscle fiber.

                Myasthenia gravis results in the weakness of the voluntary skeletal muscle because of inadequate nerve stimulation (Dlugasch & Story , 2021). It is a rare, autoimmune neuromuscular junction disorder. When the motor neuron releases acetylcholine the normal pathophysiology is the binding with nicotinic acetylcholine receptor on the muscle cell membrane to create muscle contraction in MG there is a hypersensitivity which causes cytotoxic injury at the end plate of the neuromuscular junction which inhibits the binding of acetylcholine resulting in lysis or death of the host cells the antibodies from the B-cells inappropriately makes antibodies that bind to nicotinic receptors on the muscle cells arresting the binding or resulted in the inability of the nicotinic receptors to bind with acetylcholine preventing the muscle from contracting.

    Treatment for the patient involves pyridostigmine-what does this drug do and how would it benefit our patient?

                Pyridoxine or neostigmine is an acetylcholinesterase inhibitors which acts to degrades acetylcholine thereby preventing the acetylcholinesterase from breaking down resulting in the increased of acetylcholine around the muscle cells and this helps to counteract the effect of acetylcholine antibodies receptors, this helps counteracts the effect of acetylcholine antibodies, thereby minimizing the effect or sign and symptoms of myasthenia gravis, additionally immunosuppressive drugs such as prednisone can be utilized and for those individual who fails to react with medications a surgical intervention can be done or what we call thymectomy. There is no treatment with myasthenia gravis supportive and prevention of myasthenia crisis which is life-threatening is the goal of treatment.

    Response

    Stakeholders are crucial entities that play a role in an organization’s performance or operations or those affected by the actions undertaken by the organization (Chebbi et al., 2019). In healthcare, stakeholders also comprise individuals, corporations, or any other entity that has a vested interest in medical decisions or evidence upon which the clinical decision is based. Stakeholders play an important role in ensuring the successful implementation of my evidence-based project. Internal stakeholders play a major role in facilitating its successful implementation by providing their skills and knowledge and providing appropriate leadership in the organization to allow for the proposed change. In the healthcare setting, internal stakeholders are mainly within the organization, and they include various cadres of employees, including healthcare professionals, administrators, and other individuals that play clinical and non-clinical roles. Nurses are the primary care providers, and they play a major role in translating the evidence into actual practice while caring for the patients. Nurses work in multidisciplinary teams made up of anesthesiologists, pharmacists, physicians, physiotherapists, and other health specialists directly involved in the provision of healthcare services. The organization’s management structure plays a critical role in providing the necessary leadership and framework that would facilitate the adoption of the proposed change. For this reason, the support of an organization’s management is crucial to ensure the successful implementation of an evidence-based project (Ceschi et al., 2017). 

    Response

    Quality aspect is linked to the hospital financial aspect in many ways than one. When effects of nursing burnout and shortage surface, increase financial responsibility is placed on the hospitals. Thus, improving quality of care by ways of retaining staff will also require financial support from the hospital but spare the hospitals budget in the long term. A clinical component would be to educate the staff within the medical surgical unit, where my preceptor and many staff experience short staffing and increased burnout daily. The proposal of increasing the length of preceptorships may directly impact the clinical side as patients may find their nurses are more confident and indirectly impact the financial aspect by decreasing hospital acquired infections and wounds. Quality care will likely be increased, and more patients will desire to revisit the hospital during their time of need, thus increasing the funding to hospitals, an indirect impact. By implementing the selected interventions, nurses may desire to stay at the facility, indirectly impacting the financial side and improving patient care. 

    REPLY

    • MS

    response

    Number 1 post: NB

    My concerns with ML’s current regimen are the use of controlled substances, for a prolonged period. These drugs are intended for short-term use because they can cause dependency (Visovsky, Zambroski, Hosler, 2019). Since this patient has been taking benzodiazepines (BZN) for what appears to be several years, she will need to be reevaluated and gradually tapered off the medication. Stopping the medication abruptly can lead to physical withdrawal symptoms. The plan would be to taper her off the controlled drugs and prescribe NSAIDs such as Motrin and Tylenol instead. I would also try other non-pharmacological treatments such as physical therapy.  

    ML has a history of cigarette smoking and alcohol use. Since she will continue taking gabapentin for her nerve pain, she will need to be monitored closely as alcohol interacts with gabapentin and can decrease its effectiveness. Both alcohol and cigarette smoking, can lead to an increased risk of benzodiazepine dependence and put the patient at an increased risk of heart attack and stroke.  Another concern I have is her communication with managing medications, this may be difficult, especially with transitioning care. Ineffective communication due to the language barrier can result in medication discrepancies (Science Direct, 2021)

    Regarding ethical concerns, I believe that beneficence exemplifies the concept of the moral obligation to act in the best interests of others. As healthcare providers, we must practice beneficence in our clinical settings daily by making selections and decisions about how to best care for our patients without causing harm or breaking the law.

    The attached sample pain contract provided by Pinnacle Interventions Pain and Spine Consultants (Ko, Murray, 2020) is appropriate, and will be signed by the provider and Ms. ML and will be kept in her records. 

                  Pinnacle Interventions Pain and Spine Consultants (Ko, Murray, 2020)

    To ensure safe prescribing, it is important to check the state-run prescription monitoring programs to avoid having multiple prescriptions being filled. Specific information must be included on a legal prescription such as the patient’s name, date, name of the medication, route, dose, quantity to be dispensed, frequency, duration, and signature of the prescriber as well as the DEA number. The pharmacy is also required to provide information about the drug and how it is to be given (Visovsky, Zambroski, Hosler, 2019). Since ML is Latino, having this information in her native language would be valuable.

    If the current list of medication was to be continued, a handwritten prescription for the controlled substances must be presented to the pharmacy.  Emergency prescriptions may be called into the pharmacy if followed by a valid written prescription within 7 days, stating that a previously placed prescription was called in (Trevor, 2015). In some states such as TN, gabapentin is considered a controlled substance and cannot be called into the pharmacy. Losartan and Atorvastatin can be called into the pharmacy.

    To prevent multiple prescriptions from being filled I would immediately document the prescription information into the state-run prescription monitoring programs such as California’s prescription drug monitoring program (PDMP) and The Ohio Automated RX Reporting System (OARRS) databases that are used to monitor controlled prescription drugs dispensed to patients. According to Jenni (2020), reporting must happen within five minutes of prescription.

     Refill for C-III, C-IV, and C-V can be done within 6 months after initial prescriptions.  Both California and Ohio allow nurse practitioners prescriptive authority for drugs falling into schedule II, III, IV, or V (Med Source Consultants, 2018).

    Number 2 post: BW

    In this week’s discussion, a Hispanic female patient presents with chronic ailments requesting a six-month supply of her current medication list. The first concern that I have with this patient’s medication regimen is that the patient is taking a benzodiazepine, gabapentin, Norco, and states that she periodically drinks alcohol. I would want to have a discussion with her regarding her amount of drinking and if she concurrently takes her medications when drinking. Another consideration regarding the patient’s reported pain, an X-ray of the shoulder would be helpful in understanding if there is something wrong with the patient’s musculoskeletal system. My ethical standards regarding this case would be that I would want to teach the patient the correct laws that I am bound to being a nurse practitioner in the state she is residing in. According to Rosenthal et al., (2021) “The patient must understand the risks and benefits of using opioids to treat chronic, noncancer pain” (p. 192). A lack of understanding on the patient’s part if she cannot get her medication filled as requested could make a poor outcome for patient satisfaction in my healthcare practice. 

    Pain Contract

    If this patient wants to continue using narcotic medications that I will be prescribing her, it will be prudent to have a pain contract with the patient. A pain contract is an agreement between me and the patient that shows the standards of care between the two parties. An example of a pain contract used in regards to opioid medication was used in a study performed by McCann et al., (2018). In the McCann (2018) study, it was found that having a structure that shows the amount of time between visits, the appropriate amount of opioid medication prescribed per visit is within limits for the safety of the patient and prescriber. An example of a pain contract is to have an agreement that states to continue to be prescribed opioids from this prescriber, at each visit, a contract will be written regarding the use and timing of prescription fillings with an agreement for the patient to either wean off of opioid medications or to stay at the current medication dose. The contract will then be signed and reviewed at each scheduled visit (McCann et al., 2018). Having this structure will help set the boundary and limitations for the prescriptions. An example of a pain contract can be found here by clicking this link https://www.aafp.org/dam/AAFP/documents/patient_care/pain_management/agreement.pdf

    Registry

    To help ensure the safety of practice, updating a controlled medication through a prescription registry is required. In the state of California, a resource is called the controlled substance utilization review and evaluation system, otherwise known as the CURES system (State of California, 2022). The state that I live in is Arizona. Arizona has a registry that is called the Arizona State Board of Pharmacy Controlled Substances Prescription Monitoring Program (CSPMP) (Arizona State Board of Pharmacy, 2022). 

    Refills

    In order to refill this patient’s prescriptions, there will be different laws that the patient is not used to. According to Prevention Solutions (2022) “Under federal law, prescriptions for Schedule II substances cannot be refilled, and can only have a 30 day supply. Prescriptions for Schedule III and IV controlled substances can be refilled up to five times in six months” (para. 6). The patient is taking Norco which is a class II medication and diazepam which is a class IV medication. These rules will apply for this patient. To refill the Norco, the medication will need to be ordered through an electronic system, no paper prescription is allowed (Prevention Solutions, 2022). When the medication is prescribed, the order needs to have all pertinent information related to the use of the medication to show that the medication is needed for a legitimate reason and that all of the correct patient information is detailed. In a controlled state such as Texas, nurse practitioners must maintain a prescriptive authority agreement or protocol with a physician (American Medical Association [AMA], 2022). 

    Protocol for Furnishing Controlled Substances

    To prescribed schedule II and III controlled substances in a restricted state, there are protocols for nurse practitioners to follow with a patient-specific approach. In the state of California, which is a restricted practice state for nurse practitioners, California Legislative Information (2022) states the following:

    The furnishing or ordering of drugs or devices by a nurse practitioner occurs under physician ans surgeon supervision. Physician and surgeon supervision shall not be constued to require the physical presence of the physician, but does include (1) collaboration on the development of the standardized procedure, (2) approval of the standardized procedure, and (3) availability by telephonic contact at the time of patient examination by the nurse practitioner (para. 6). 

    response

    Number 1 post: YL

    A 70-year-old woman is in your office complaining of recently having trouble maintaining her balance after taking diazepam (valium). She occasionally takes diazepam when she feels anxious and has trouble sleeping. She has a 15-year history of taking diazepam.

    Q1. Explain the cause of this patient’s difficulty in maintaining her balance?

    In Cornett et al. (2021), metabolism and elimination of diazepam is accomplished through CYP2C19 and CYP3A4 in the liver. It presents with hepatic toxicity after long-term use of oral diazepam due to the first-pass effect.

    Q2. Diazepam experiences a significant first-pass effect. What is the first-pass effect, and how can first-pass metabolism be circumvented?

    According to Burchum & Rosenthal (2021), first-pass effect is the rapid hepatic inactivation of certain oral drugs when passed through the hepatic portal vein. If the capacity of the liver to metabolize a drug is extremely high, the drug could be completely inactivated on its first pass via liver. In order to circumvent the first-pass effect, the authors continue to explain that a drug normally undergoes rapid hepatic metabolism could be administered parenterally to bypass the liver in order to reach therapeutic effect before being metabolized.

    A 75-year-old woman develops symptoms of a cold and buys an over-the-counter cold medication at the grocery store. The medication contains diphenhydramine, acetaminophen, and phenylephrine. She takes the recommended adult dose but soon after taking the medication she becomes very confused and disoriented.

    Q3. What is likely causing the signs of confusion?

    The confusion is mostly likely caused by drug sensitivity due to her age. In Burchum & Rosenthal (2021), they explain that the rates of hepatic drug metabolism tend to decline with advanced age, and alternations in receptor properties may underlie altered sensitivity to some medications. Also, the confusion could be caused by the drug interactions with other drugs the woman is taking. If the woman is taking the MAO inhibitor in the past 14 days, a dangerous drug interaction would occur.

    Q4. How is warfarin metabolized? Does warfarin cross the placental barrier?

    In Patel et al (2022), warfarin is hepatic metabolism, primarily through the CYP2C9 enzyme. Warfarin has two different pregnancy categories depending on the presence of a mechanical heart valve. Warfarin was listed as a Category D drug for pregnant women with a mechanical heart valve and Category X for all other indications in pregnant women. In the article, the authors explain that warfarin crosses the placental barrier causing fetal plasma levels similar to maternal values. Warfarin can cause bleeding in the fetus and use during pregnancy is commonly associated with spontaneous abortion, stillbirth, preterm birth, neonatal death, skeletal and CNS defects. In pregnant women with a high risk for thromboembolism from mechanical heart valves, the benefits and risks of warfarin therapy should undergo careful evaluation. Some professionals recommend avoiding warfarin use during the first trimester and close to delivery.

    Q5. Explain the hepatic drug metabolism of children 1 year and older. How do they compare with the hepatic drug metabolism of infants and adults?

    As Burchum & Rosenthal (2021) explain, hepatic drug metabolism of children 1 year and older is similar to those in adults, but the metabolize drugs rate are faster than adults until age two years then gradually declines. So, increase or reduction in dosing interval may be needed for drugs that are eliminated by hepatic metabolism.

    Unlike children one year older and adults, the authors state that the drug-metabolizing capacity of newborns is low, so neonates are especially sensitive to drugs that are eliminated majorly by hepatic metabolism. As a result, when these drugs are utilized, dosages must be reduced. The liver increases its capacity to metabolize many drugs about one month after birth and with compete maturation about one year old.

    Q6. Explain protein binding in the neonate.

    In Burchum & Rosenthal (2021), they state that binding of drugs to albumin and other plasma proteins is limited due to the following reasons: the amount of serum albumin is very low; endogenous compounds such as fatty acid or bilirubin compete with drugs for available binding sites. The authors illustrate that protein-binding capacity reaches adult values within 10 to 12 months.

    Number 2 post: BI

    A 70-year-old woman is in your office complaining of recently having trouble maintaining her balance after taking Diazepam (valium). She occasionally takes Diazepam when she feels anxious and has trouble sleeping. She has a 15-year history of taking Diazepam.

     

    Q1. Explain the cause of this patient’s difficulty in maintaining her balance?

    The long history of Diazepam (valium) administration and the patient’s age are contributing factors causing the patient difficulty maintaining balance. Diazepam, which is included in the class of Benzodiazepines is a potent drug used to treat various conditions like muscle spams, alcohol withdrwal and anxiety, but can also cause sedation (Scholefield, 2021). Furthermore,with increasing age  the patients has a predisposition of having to higher fat levels and lower lean body mass. Diazepam is a lipid-soluble drug. Therefore, an increase in body fat serves as a reservoir for the drug and causes a slow-release effect. This effect causes an extended half-life and a higher volume of distribution of Diazepam (Scholefield, 2021). 

     

    Q2. Diazepam experiences a significant first-pass effect. What is the first-pass effect, and how can first-pass metabolism be circumvented?

    The first-pass effect is the phenomenon of drug metabolism that occurs before the drug enters the body’s systemic circulation. This phenomenon occurs in the liver as the intestine absorbs the drug via the hepatic portal vein (Scholefield, 2021).To avoid the first-pass effect, medications must not be administered thru the oral route but instead administered via sublingual intravenous, intramuscular aerosol and inhalation routes. This way allows drugs to be absorbed directly into the systemic circulation (Scholefield, 2021).  

     

    A 75-year-old woman develops symptoms of a cold and buys an over-the-counter cold medication at the grocery store. The drug contains diphenhydramine, acetaminophen, and phenylephrine. She takes the recommended adult dose but soon after taking the medication, she becomes very confused and disoriented.

     

    Q3. What is likely causing the signs of confusion?

    Diphenhydramine is an H1 antagonist drug that can cause marked sedation and cause confusion, and disorientation to elderly patients.

     

     A 26-year-old woman who has never been pregnant is seeking preconception care as she plans to pursue pregnancy in a couple of months. Currently, she has no symptoms to report, and on review of body systems, there were no concerns. However, her past medical history is significant for a history of rheumatic fever as a child. She subsequently underwent valve replacement with a mechanical heart valve. She is followed by a cardiologist who has already evaluated her cardiac function and she has received clearance from her cardiologist to pursue pregnancy. Records from her cardiologist include a recent cardiac echocardiography report that reveals an average ejection fraction indicating normal cardiac function.

     

    She has no alterations in her daily activities related to her heart. She has no other significant medical or surgical history. She is a non-smoker, drinks occasionally but has stopped as she attempts to conceive, and does not use any non-prescription drugs.

     

    Current Medications: Her current medications include only prenatal vitamins, which she has begun in anticipation of pregnancy, and warfarin. She has no known drug allergies.

     

    Vital Signs: On examination, her pulse is 80 beats per minute, blood pressure is 115/70 mm Hg, respiratory rate is 18 breaths per minute, and she is afebrile.

    Measurements: Weight = 152 pounds, Height = 5′5 ″, BMI= 25.29

     

    Q4. How is warfarin metabolized? Does warfarin cross the placental barrier?

    Warfarin is metabolized by the cytochrome p450 system, primarily by CYP2C9 f(Scholefield, 2021).  

    Warfarin can cross the placental barrier and cause bleeding disorders in the fetus (Scholefield, 2021).  

     Q5. Explain the hepatic drug metabolism of children one year and older. How do they compare with the hepatic drug metabolism of infants and adults?

    Drugs are slowly metabolized by neonatal and elderly compared to young adults (Scholefield, 2021). However, children can metabolize medications faster because their  basic metabolic rate is higher compared to elderly. In addition, their liver enzymes are capable of almost metabolizing every drug. Because of their capacity to metabolize drugs fast, drug levels must be adjusted according to their response.

     Furthermore,  the metabolic clearance in children is affected by the activity of enzymes that metabolize drugs, hepatic blood flow and perfusion, active transport process and plasma protein binding.

    The speed of metabolizing drugs in infant is lower compared to adults. In addition, neonates lack in phase II conjugating system while older people have significant depression of hepatic oxidative metabolism (Scholefield, 2021).  

    Q6. Explain protein binding in the neonate.

    Drug binding to plasma protein is an essential factor in determining drug distribution. The plasma protein with the best binding capacity is albumin (Scholefield, 2021). The protein binding of drugs in a neonate is generally reduced compared to adults. Furthermore, the bilirubin concentrations in a neonate and fatty acids are higher. The impact of reduced plasma protein binding in neonates affects protein-bound drugs significantly and have a narrow therapeutic range effect (Scholefield, 2021).

     

    response

    DQ1 Yirlem Traditional Chinese medicine has played an instrumental role in shaping the health care system. One of its underlying principles is the human body, which reacts to natural elements such as earth and water. The focus of traditional Chinese medicine is to balance the internal body organs and nature.

    Traditional Chinese medicine aims to achieve a balance between health and diseases. Its primary objective is to balance internal body organs and external elements such as water and earth (Fontaine, 2018). Another critical aspect of traditional Chinese medicine is that bodies are directly related to natural ingredients. The human body also possesses the ability to heal itself from various diseases.

    The traditional Chinese physicians believe that the body organs play an integral role in the healing process. However, they focused on prevention instead of cure (Zu & Zhang, 2020). The process of balancing the yin and the yang plays a critical role in combating diseases that affect people. Therefore, traditional healers have adopted measures to encourage people to embrace disease prevention. The goal of traditional Chinese medicine is to balance the human body and natural elements. 

    DQ2 Christ Curanderismo is a healing tradition that is usually found within Latin American cultures (Fontaine, 2019, p. 104). It comes from the Spanish word for healing which is “curar.” In this practice, illnesses can be classified as either coming from a natural or a supernatural source (Fontaine, 2019, p. 104). Natural illnesses can include anything from genetic disorders, infections, or improper self-care (Fontaine, 2019, p. 104). Whereas, supernatural illnesses can resemble natural illnesses yet have been caused by either evil spirits or by a hex placed on the patient (Fontaine, 2019, p. 105). It is believed that these types of illnesses cannot be cured using western medicine treatments (Fontaine, 2019, p. 105). 

    Practitioners of Curanderismo are called “Curanderos” or “Curanderas” (Fontaine, 2019, p. 105). Curanderos can practice this tradition only if they have been given the gift of healing by God, which can either be passed on through inheritance or through a special calling to this particular practice (Fontaine, 2019, p. 105). There are three levels of care within this field, the material, mental, and spiritual (Fontaine, 2019, p. 105). 

    The most common level of care is the material level (Fontaine, 2019, p. 105). The healers that specialize in this level usually use both physical and supernatural objects, cleansing rituals, prayers and invocations in order to remove the evil spirits and purify the patient and their environment (Fontaine, 2019, p. 105). As a nurse in a predominantly hispanic area, knowledge and understanding of this belief can help me better serve my patients. It can help me communicate better as well as understand what some of their worries or concerns may be stemming from. 

    DQ#3 Tatiana Crisis intervention aims to return individuals to their normal functioning before the crisis (James & Gilliland, 2016). I will explain to the client that I want to understand her reason for the decision and resolve it. I define the problem first before venturing into possible solutions. I will clearly explain that my role is to support the client through the challenge and determine whether she can choose a different path that does not lead to her death and sadness to her family and friends. In this case, I will have to explain to the client that AIDS is a manageable disease that millions of people live with worldwide. I will emphasize to her the value that she holds as a human being who has people who love and support her. I will also explain that the diagnosis is not the end of life but just a small hurdle to overcome.

    I will then move to provide alternatives for the client. In her case, I will explain that if she accepts that she has the disease, she can move forward to having a better life. Having a better life will include beginning and sticking with medications and seeking medical help to ensure that she is healthy in every aspect. If she accepts this, I will create a plan of care that will ensure that she goes for her medication and adheres to it. I will also include a counselor to help her with the difficult period. I will also encourage her to inform her family and close friends about her condition and get support. The plan has to be approved by the patient, which includes getting a commitment that she will follow the plan. If I fail to get the patient’s approval, I will take necessary measures, including making a follow-up to try and convince her and following the Tarasoff guidelines to ensure the safety of those around her (Adi & Mathbout, 2018).

    DQ#4 Yirlem Crisis intervention refers to the time-limited measures taken to provide immediate stability to those in crisis. These interventions can be provided online or face-to-face. Each approach comes with advantages and disadvantages that result in some people preferring one approach over the other (Swan & Hamilton, 2020). Face-to-face crisis intervention is considered the better approach because it enhances confidentiality and allows therapists to factor in non-verbal cues in their assessment and therapy.

    Confidentiality is an important aspect of therapy. Patients are more likely to talk about their problems when they feel that the information is protected and will not be shared with others. Even though encryption programs are designed to maintain the confidentiality of these sessions, James and Gilliland (2016) maintain that no assurance can be given that other people cannot access this information. The lack of guaranteed confidentiality makes face-to-face crisis interventions more appealing. Therapists who meet their patients physically record and store patient data in confidential documents that only they can access.

    Face-to-face crisis intervention is more effective because it enhances confidentiality and allows therapists to use and interpret non-verbal cues to evaluate the patients’ behavior and responses to the intervention. Even with the use of video in online services, questions about ethicality and counselor competence are yet to be answered. Despite the growth of online interventions, face-to-face interventions remain the primary type, often supplemented by online measures.

    response

    Number 1 Post: BW

    The medication regimen for Eric Johnson will require multiple drugs to treat the patient’s illnesses. The patient’s diagnoses are pneumonia, chlamydia, and seasonal allergies. 

    Q1. What are the recommended medications to start this specific patient on? Please provide the drug class, generic & trade name, and the initial starting dose. 

    For this specific patient, the medication of choice to treat chlamydia and pneumonia will be doxycycline (Vibramycin) and loratadine (Claritin) for seasonal allergies. The dose schedule for doxycycline (Vibramycin) will be 100mg PO twice daily for seven days (Rosenthal et al., 2021, p. 764). For the patient’s seasonal allergies, loratadine (Claritin) 10 mg will be taken PO every day for allergy relief. 

    Q2. Discuss the mechanism of action of each of the drugs.

    The reasoning to choose doxycycline over azithromycin for the treatment of the patient’s chlamydia is that there can be better effectiveness with the doxycycline than the azithromycin. The mechanism of action of doxycycline is done by inhibiting protein synthesis. According to Mizushima et al., (2021) “The treatment with doxycycline 100 mg twice daily for 7 days was superior to that with azithromycin 1 g (para. 4). Doxycycline is a long-acting tetracycline. According to Rosenthal et al., (2021) “The tetracyclines suppress bacterial growth by inhibiting protein synthesis” (p. 676). The way that doxycycline inhibits protein synthesis is by binding to the 30S ribosomal subunit which inhibits transfer RNA to the messenger RNA-ribosome complex in the bacterial cell (Rosenthal et al., 2021, p. 676). 

    The reasoning behind prescribing loratadine (Claritin) to this patient is to help the patient have relief of symptoms without the sedating effects of other antihistamines. According to Sighu & Akhondi (2021) “Loratadine selectively inhibits H1-receptors primarily located on respiratory smooth muscle cells, vascular endothelial cells, the gastrointestinal tract, and immune cells” (para. 4). This allows loratadine to manage allergic rhinitis and urticaria without the sedating effects of first-generation antihistamines.  

    Q3. Discuss the side effect profile of each medication you listed. 

    With doxycycline, there are multiple side effects that the patient will need to be taught. Doxycycline can cause hepatotoxicity and gastrointestinal irritation. The irritation of the GI tract can cause nausea, vomiting, diarrhea, and possibly esophageal ulcers (Rosenthal et al., 2021, p. 677). 

    With loratadine, the side effects are rare but may include “headaches, dizziness, and GI distress” (Sidhu & Akhondi, 2021, para. 10). While it is rare, there is the potential for lethargy with the use of loratadine. For this purpose, the patient must know not to take any other CNS depressant medications that could affect the patient’s lethargy (Sidhu & Akhondi, 2021).  

    Q4. Are there any interactions between any of the medications you prescribed?

    There are no known drug interactions between loratadine and doxycycline. Loratadine should not be taken with alcohol or other CNS depressant medications such as narcotics and barbiturates (Rosenthal et al., 2021). Doxycycline should not be used with antacids and magnesium laxatives because of nonabsorbable chelates with metal ions and doxycycline (Rosenthal et al., 2021). Doxycycline should also not be given with digoxin or warfarin because of increased GI absorption that increases INR levels and increased digoxin levels (Rosenthal et al., 2021). 

    Q5. What other non-pharmacological interventions would be suggested?

    The patient will need to rest and drink fluids while the doxycycline combats pneumonia and chlamydia. For the patient’s fever, the patient will be educated on the use of acetaminophen (Tylenol) for fever reduction. The patient should be told to not consume more than 4000 mg of acetaminophen per 24 hour period to reduce liver toxicity (Rosenthal et al., 2021, p. 502). One suggestion of a non-pharmacological intervention for the treatment of the patient’s allergies will be to include the use of local honey for the treatment of the patient’s seasonal allergies. In a study performed by Munstedt & Manle (2020), it was found that the use of local honey can relieve seasonal allergic rhinitis. According to Munstedt & Manle (2020) “Another cohort study of 23 patients showed that after regular consumption of local honey 12 patients (52.2%) were free of complaints after treatment while in nine patients (39.1%) the situation improved considerably” (p.584). While the patient has already been tested for chlamydia, it will be important to educate this patient on talking with his sexual partner and to potentially treat the partner as well. McDonagh et al., (2020) explain, “A recent review identified patient barriers to testing including lack of knowledge, perceived low risk, embarrassment, fear and stigma and facilitators including increased awareness and self-sampling” (p. 571). This patient should be educated on the potential risks of not treating this infection and how to not be reinfected with the disease in the future.  

    Number 2 Post: JZ

    For this week’s case study, we are reviewing a case of a 21-year-old male, with a history of seasonal allergies, who comes into the clinic with complaints of a stuffy nose, shortness of breath, fever 102 at home, a productive cough, and urinary burning with clear penile discharge. He admits to unprotected sex. His current vital signs are BP 125/75, HR 116, Temp. 102.5, O2 94%. He has no known drug allergies. After a clinic workup with rapid testing and a chest x-ray, he is diagnosed with pneumonia, chlamydia, and seasonal allergies.

    The recommended medications to start this patient on depending on the patient’s comorbidities and risk factors. Being a young adult, with no known chronic health conditions other than seasonal allergies, an oral antibiotic for his pneumonia treated in the outpatient setting could be used at this time. For healthy patients who are appropriate for outpatient treatment, the recommended first-line treatment is with a macrolide class medication such as azithromycin (Zithromax) targeting the most common causal pathogen S. pneumoniae (Grief & Loza, 2018). Azithromycin is an antibiotic, which is available in 250 mg, 500 mg, or 600 mg tablet forms. For mild community-acquired pneumonia, 500 mg PO as a single dose on day 1, then 250 mg PO on days 2-5, with a total dose of 1.5 g (Lippincott Williams & Wilkins, 2021). Azithromycin binds to the 23S portion of the 50S bacterial ribosomal subunit. It inhibits bacterial protein synthesis by preventing the transit of aminoacyl-tRNA and the growing protein through the ribosome (Iqbal, 2022). Side effects include liver concerns and GI issues – nausea, vomiting, diarrhea, jaundice, and clay-colored stools.

    Moreover, to treat this patient’s chlamydia, doxycycline (Oracea) could be given, which is an antibiotic that is from the tetracycline class. Oral tablets are available in 50 mg, 75 mg, 100 mg, or 150 mg tablets. Dose for adults and children aged 8 and weighing 45 kg or more is 100 or 120 mg PO every 12 hours on day 1, then 100 or 120 mg PO daily as a single dose or in two divided doses (Lippincott Williams & Wilkins, 2021). The bacteriostatic action of tetracyclines, like doxycycline, is intended to stop the growth of bacteria by allosterically binding to the 30S prokaryotic ribosomal unit during protein synthesis (Patel & Parnar, 2022). Side effects include GI issues – nausea, vomiting, diarrhea, bloating, constipation, clay-colored stool, hives, and itching, among others.

    For this patient’s seasonal allergies, he complains of a stuffy nose and cannot remember what he formerly used for his allergies. As a practitioner, I would call the patient’s pharmacy or check with his doctor if it formerly provided the patient with relief. I would use caution in recommending medication as Sudafed as this medication could raise his heart rate further, and due to the fever, he already has an elevated heart rate. He could try fluticasone (Flonase) which is of the corticosteroid class. The patient can initially use 2 sprays (100 mcg) in each nostril once daily, as needed for symptom control (Lippincott Williams & Wilkins, 2021). Fluticasone is a steroid that works to reduce the chemical causes of inflammation, decreasing swelling in the nasal passages. Side effects include hypersensitivity reactions such as facial swelling, itching, and skin rash.

    For his fever, acetaminophen (Tylenol) could be used at home. Controlling his fever could also reduce his heart rate once his temperature is controlled. Acetaminophen is an analgesic of the para-aminophenol derivative class, which can also be used for mild pain. The adult dose is 325-650 mg PO every 4-6 hours. Acetaminophen inhibits the synthesis of prostaglandins in the central nervous system, leading to its analgesic and antipyretic effects (Anderson & Nappe, 2021). Side effects include liver injury or failure, as well as skin or allergic reactions.

    For the drugs described, it is important for the practitioner to note that azithromycin when taken with acetaminophen can cause a drug interaction. It slows the metabolism of acetaminophen. So, caution needs to be used in treating this patient’s fever. As an alternative, Ibuprofen or Motrin can be used as well. With doxycycline, a drug interaction can occur when taking doxycycline and penicillin together. It decreases the bactericidal action of penicillin. Drugs such as warfarin can decrease the action of acetaminophen. So, it is important for the practitioner to fully assess and reconcile the patient’s medications to avoid such interactions.

    Non-pharmacological therapies that could be recommended could be for the patient to use a humidifier to help his nasal congestion, drink plenty of fluids, and to wear a condom during sexual intercourse. Education could benefit this patient, especially on symptoms of Sexually Transmitted Diseases and how to prevent the spread. If the patient continues to have seasonal allergies, seeing an Allergist could help. If the patient has not seen a specialist for his allergies, and just his Primary Care Physician – placing a referral could assist as well. All of these actions could help this patient work towards improved health.

    Response

     There are numerous questions that I pose in the PPT. Questions about the impact of a disability,  marriage, parenting while having a disability, and more.  Did this week videos help answer some of those questions for you?  What questions do you still have? 

    response

    DQ#1 Tatiana: Yoga is an ancient practice that has been passed down over many generations for over five centuries ago. The term yoga encompasses aspects such as ‘yuj,’ which means unite, to symbolize the union of a person’s soul with the universal soul, leading to a state of consciousness (Fontaine, 2019). Yoga is related to health and illness. For instance, the World Health Organization defines health as a state of complete, mental, physical, and social well-being and not merely the absence of disease or infirmity; hence, it is evident that health is a multidimensional state (Yoga, 2021). Hence, it can be achieved by using a holistic approach to meet the needs of each of the dimensions.

    Yoga is an appropriate intervention that guarantees positive outcomes in each dimension. Besides, yoga is a union of yama, asana, niyama, pratyahara, pranayama, dharana, Samadhi and dhyana (Yoga, 2021). Intense practice of such dimensions leads to self-realization. In this manner, yoga is a holistic way of life that leads to a state of complete social, physical, spiritual, and mental wellbeing. Yoga is used as a therapeutic intervention for modern diseases such as obesity, stress, hypertension, diabetes, chronic obstructive pulmonary disease, and coronary heart disease; besides, Studies show the significant role of yoga as a non-pharmaceutical intervention is essential in the treatment of such conditions (Kumar Taneja, 2014). To alleviate sickness or symptoms, yoga helps decrease stress, anxiety and lower the levels of salivary cortisol, including rennin levels. It also keeps epinephrine and norepinephrine levels in balance. Hence, effectively managing sicknesses such as coronary heart diseases, hypertension, and diabetes.

    DQ#2: Christian: Several activities and actions are used as complementary medications and they have abilities to yield the best possible results. One of them is meditation, and it is defined as the process of taking the mind away from the stressful points of life to focus only on that, which is helpful. In the former years, meditation was used as a spiritual activity to help the mind understand the mysteries of spiritual and religious aspects. Today, meditation is one of the major recommendations given by healthcare providers as the primary process for relieving the body of stress and bringing mental and physical healing to the whole body. 

    Meditation can take place in different forms including guided meditation, yoga, prayers, mantra meditation, Qi gong, mindfulness meditation, and Tai Chi among others. All these forms of meditation must have specific elements that include focused breathing, relaxed breathing, a quiet setting, a comfortable position, and an open attitude. The meditations can also be done in different formats including breathing deeply, scanning the body, repeating a mantra, walking and meditating, reading and reflecting, and placing focus on love and gratitude (Farias et al., 2020). Practicing any of these elements for a continuous period helps the body to remain healthy and scholars have argued that it can bring healing to people suffering from conditions such as anxiety, cancer, asthma, depression, chronic pain, high blood pressure, heart disease, tension headaches, and sleep problems (Kreplin et a., 2018). 

    Meditation mainly works by improving the ability of the body to fight infections and diseases. A clouded mind cannot fight infections as it leads to a weaker immune system. However, a peaceful and calm mind leads to a strengthened body that can fight any condition developing from other parts of the body.

    DQ#3: Lisdiana:   In this scenario, when there is widespread worry about who may have sprayed graffiti outside the school compound, I would first examine material from various groups that appear to have an understanding of what is going on (Braga & Weisburd, 2006). I’ll choose a few people, primarily student leaders, and ask them if they’ve detected any questionable behaviour from any individual or organization. Because the graffiti appears to be familiar to me, I would examine it and compare it to what I observed at the recent drive-in meeting. I’ll also quiz the librarian to learn more about the physical copy she chose.

      The cases have now made their way to Hometown High School (Braga, 2006). After scanning the numerous pieces of information, I gathered and analyzed the data in an attempt to determine what may be the root cause of this graffiti appearing on various structures. I’ll look at the parallels between the physical copy labels and the material they appear to represent. The contents will take me to the computer screen’s owner.

                The third stage is to decide how to respond to the information acquired. As my first suspect, I’ll send the student with the computer screen name to interview him. Then I’ll summon the new student who appears suspicious based on his attire. I’ll ask the two to tell me where they were at the time of the crime. I’ll question about their associates, and if any of them does not have an alibi, they’ll be among my suspects, who will be brought before the disciplinary committee and punished ( Braga, 2006).

                When attempting to analyze the issue, consider if the reaction was successful in resolving the problem. Assume there is a need to implement more safeguards to prevent similar crimes from occurring in the future (Santos, 2014). I will advise the school to install new security lights in strategic locations across the school grounds. Installing surveillance cameras and increasing school security will also aid in the prevention of such crimes.

    DQ#4: Yirlem: The five stages of the Kübler-Ross model denote the gradual acceptance of the loss, and the transition between the featured patterns is necessary to cope with the emotional distress. The text states: “a series of five stages—denial, anger, bargaining, depression, and acceptance—that people go through as they come to grips with their own imminent death” (James & Gilliland, 2017, p.380). The first stage is denial, and the individual strives to reject his condition or fact of the loss with logical arguments. The second stage is anger, and the person starts blaming his life or specific circumstances (Kübler-Ross, (2015). The third stage involves the individual’s willingness to delay or postpone the situation. The fourth and final stages denote the depression that ends with the acceptance of reality, and it can be acceptance of the loss or inevitable fact, like a terminal stage of a disease that has no cure.

    There are different types of loss, and they depend on the specific situation and people, and the death of family members is not the only cause of these affections. The reading argues: “People commonly associate certain losses with strong feelings of grief” (Crowell, 2022). In turn, it can be a loss of a friend, child, parents, partner and the death of friends or family members. It is necessary to admit that the loss of a job, position, things, home and abilities is also a common type of grief. People share unique experiences and relationships, and their ends can be the cause of these negative emotions. For instance, the death of a favorite pet is also a type of loss, though it does not share the standard concept of friendship or kinship.

    Response

     Length: A minimum of 850 words per post, not including references

    Citations: At least one high-level scholarly reference in APA per post from within the last 5 years

    Response

    Family and Disability

    COUN 2020

    Major Components of Family Unit

    Affect

    How the family deals with feelings – moods, acknowledgement of feelings

    Communication

    How the family talks and communicates ideas and concepts – clearness, respectfulness, and patterns of interactions with others)

    Structure/Organization

    Hierarchy

    Boundaries

    Flexibility

    2

    Age of Onset Plays Critical Role

    Infancy

    Toddler

    Youth

    Young Adult

    Adult

    Old Age

    3

    Disability disrupts the homeostatic balance of the family unit

    Changes in

    Schedules

    Duties

    Plans

    Roles

    Subjective Burden

    Powerful grieving process as well as intense emotions. The personal suffering experienced by family members in response to their relative’s illness.

    4

    With or without support, the family must progress through essentially the same stages of adjustment as the person who is disabled.

    SHOCK, PAIN, ANXIETY, LIFE HAS ALTERED, MUST DEAL WITH PEOPLE’S PERCEPTION, THEIR REACTION, GUILT, RELATIONSHIPS CHANGE

    5

    The Whole Family

    Vash and Crewe contend that “ although only one member of the family “owns” the disability, all family members are affected and, to some extent, handicapped by it”

    Characteristics of Healthy Family

    Commitment

    Togetherness

    Appreciation and admiration of an individual

    Communication

    Spiritual well-being

    Coping with crisis/stress

    What else?

    7

    Emotional stability is the prime requisite for coping with any catastrophic change, in order to neutralize adverse reactions and facilitate the adjustment process. A loving nature, the ability to accept “what is” and proceed from there, and belief in one’s own power to influence the future are crucial aspects of the emotional armamentarium needed

    The ability to grasp the medical and other facts of the situation, to foresee and prepare for problems that may arise in the future, and to creatively devise and implement solutions to them, plus a working knowledge of the outer resources that exist in the community are exceedingly important intellectual resources to draw upon, both in times of crisis and later when the crisis stage has passed

    Such as assertiveness, persuasiveness, diplomacy, and

    emotional supportiveness

    Enmeshment

    Disengagement

    Adaptaion

    Family and Disability

    Guilt

    Coalition/subsystem

    Boundaries

    Resources

    E

    8

    Marriage

    Marriage’s established after disablement have a statistically higher high chances of non-divorce than marriages that occur before disabling event happens.

    What could explain this?

    9

    Child Rearing

    Should individuals with disabilities attempt to raise children?

    How can discipline be maintained?

    Can a disabled parent serve as an appropriate role model?

    Parents with intellectual disabilities

    There is a stigma against individuals with a disability raising a child. The stigma raises in part from the concept of parentification. Parentification is when a child takes on inappropriate care giving duties

    Parentification may happen, but it’s usually the result of the lack of resources and support

    “Have ’em, love ’em, and leave ’em alone!”

    Buck and Hohmann’s findings (1983) that the children of reasonably well-adjusted disabled parents differ from children of nondisabled parents mainly in that they are more affectionate and appreciative toward their parents and more responsible or mature than the typical child of the same age

    10

    response

     

    Chris:

    As for the meaning of health, practitioners of alternative medicine practitioners view health as a whole in which the person’s body, mind, emotions, and spirituality all affect one another and must therefore be in balance and harmony with one another (Fontaine, 2019, p. 9). Whereas, conventional practitioners may view it as the absence of disease and general well-being (Fontaine, 2019, p. 9).  

    When it comes to the curative process, conventional medicine mainly focuses on the disease itself and results in fixing or treating conditions through drugs, surgery, or radiation (Fontaine, 2019, p. 10). Unlike alternative medicine, which looks at all the possible conditions that may be blocking the life force from flowing properly through the body and seeks to restore the balance and harmony that is missing (Fontaine, 2019, p. 10). Lastly, conventional medicine mainly focuses on the prevention of disease as their basis for promoting health (Fontaine, 2019, p. 10). Whereas, alternative medicine focuses on the overall long-term lifestyle of the patient in all areas of their lives such as their emotional, spiritual, physical, social, and mental well-being (Fontaine, 2019, p. 10). 

    Having taken the differences that both conventional and alternative medicine base their practice, research, and theories, I believe they both can be helpful and can contribute in helping a person achieve their optimal health. I find both of them to be useful in order for me to provide the best nursing care for my patients. Not always is it best to quickly satisfy any rash demands or needs my patients may be calling out for, but rather, take into consideration any other internal/external circumstance or condition that may be causing the sudden reactions or requests. 

    Response

     

    • Length: A minimum of 180 words per post, not including references
    • Citations: At least one high-level scholarly reference in APA per post from within the last 5 years

    response

    (Brittany)Lysistrata is a play that is staged during what seems to be a never ending Peloponnesian War between Athens and Sparta, where there was little to no hope for peace. Lysistrata, who is a strong willed powerful woman, is the main female character and the director of all the action packed into the play. Lysistrata is tired of the constant state of war that is causing them to lose many men of their state, leaving their wives behind and decides to take things into her own hands and try for peace. She gathers women from around the cities in the state and demands they withhold any sexual acts from their husbands as a means of a negotiation. Although the women are reluctant at first, they agree and swear an oath with a bottle of wine. As time goes on there is continued debate between the men and the women and Lysistrata notices some of her women are starting to become desperate for sex. She is able to get them all back on board and continue on with their plan. Once she rallies her troops back in order she notices one of the woman’s husband, Cinesias, appearing desperate for sexual acts. Myrrhine, Cinesias’s wife, reminds him of the terms they are on and leaves him to gather items they need at their home. With the ongoing back and forth between the men and women, the men then decide to attempt a peace treaty. Lysistrata brings in a beautiful naked young woman called Peace. As the men are mesmerized by Peace standing in front of them Lysistrata takes this time to remind everyone of the poor decisions they have made and after sometimes of arguments they overcome their struggles and dissimilarities and reconcile, ending the play with them in Acropolis celebrating with song and dance. 

    While this play takes place in a time when women did not have any opinion or play in anything that happened in this male-dominated state, Lysistrata took it upon herself to make a voice for every woman in her state. As this play was written by a male in times of a male dominant world, it seems to reflect how women were seen in the eyes of a man back then. I admire Lysistrata to stand up for women and make a difference in their state. She did what she thought possible to be able to bring peace back to the land and for women to stop losing their husbands in war. I do not particularly agree with how she went about it because even in todays society women are sometimes viewed as a sexual prize rather than a strong human being trying to make a difference. I see Lysistrata as a hero in the play. She and her troops stayed strong for what they believed in and were able to stop the war and get their ultimate prize of peace in the cities. If I were to rename this play I think I would rename it “ The Warrior of the Women’s Voice” . Lysistrata was a strong and powerful woman of her time and stood up for women to have opinions and rights of their time. She did not like the way women were pushed aside when it came to being heard and helping make decisions. She rallied her women troops and made a huge statement and ultimately won their battle amongst the men and were granted the peace they have been wishing for.

     

    References: 

    “Lysistrata, by Aristophanes.” Free EBooks | Project Gutenberg, www.gutenberg.org/files/7700/7700-h/7700-h.htm.

    Response

    1. Beat

    Human Capital and Diversity

    According to the speaker Ricardo Fernandez working from home is the future. Millennials are happy with working from home even if means working longer hours and to work together as a team, managing a remote team requires a lot of relationship building skills and effort.

    Something to build inclusivity and intimacy in the company would be Meeting a few times a year. This is necessary to create empathy and value long distance working relationships even more. Annual or quarterly meetings and or activities can be something to look forward to. Some of the skills managing a global team would be enhanced communication and having Culture awareness and inclusivity. (Fernandez, 2017)

    Sourcing within your own back yard about different traditions can be a great approach into learning more. For example, we have a worker from Lithuania. Very outspoken person. Takes a stand when talking, really commanding presence. The problem was that she was talking over people all the times. If someone else spoke, she would speak even louder. Kindly letting that person know this behavior is coming off a certain way can cause awareness. Best universal mode for communicating with everyone would be verbally face to face to get a sense of how that individual person speaks. Asking if there are some accommodations.

    One book that has always stuck by me through the years and which I have found to be helpful is how to make friends and influence people. In the end, it is always best to Know your audience, always relate to your audience in ways that build everlasting connections.

    References:

    Youtube. (2017, June 15). Managing Cross Cultural Remote Teams [Video] Youtube. https://www.youtube.com/watch?v=QIoAkFpN8wQ

    Carnegie, D., & Press, G. (2016). How to win friends and influence people. GENERAL PRESS.

    2. John

    This video touches on a topic near and dear to me, as I work with international partners in my current position with the U.S. Army’s Command, Control, Computers, Communications, Cyber, Intelligence, Surveillance and Reconnaissance (C5ISR) Center. 

    Beyond the complexity of “teleworking” we all have faced in; international bilateral discussions between nations have shifted to virtual as well. As an example, just in the past two months we have had 4 virtual international with both English and non-English speaking allies. As my supervisor stated in one of these meetings, “even with ongoing pandemic, American researchers need to be plugged in with their international colleagues to understand state-of-the-art technology across the globe (Lafontaine, 2022)”. 

    Part of my responsibility in my position is to ensure our Leadership is prepared, to include understanding the cultural differences prior to entering these meetings. I have a cheat book I’ve compiled from the CIA with a bunch of useful facts on countries. Yes, the CIA  stores a variety of information on their public website for each country which has a highlight about the people and society of that country to include audio samples of the langue and national anthems (CIA, 2022). The State Department has fact sheets as well, but I have found the CIA database to be more useful. Unless I have someone (either professional or friend) with direct knowledge of the culture we are dealing with, I always reference the CIA database.

    Prior to a bilateral engagement, I always ensure not only my senior leadership has a hard copy of the CIA Fact Sheet, but I have a meeting to brief him as well. Beyond the scope of the meeting, I ensure he has simple things such as pronunciations correct. I work with my counterparts at the working levels in partner nations to ensure on both ends, this is correct.

    As you may assume, with countries whose primary language is English, things are generally smoother. During a recent discussion with France, I needed to mute our (US) side and remind our briefers to talk slowly and ensure to annunciate words. But even with countries such as England, as discussed in the video my team was all baffled when the term “Tea book” was used. After a good bit, we realized that a tea-book is a notebook, would the English know what a notebook is if we said it? It’s a note I made to be aware of for future meetings. 

    Dealing with cross-culture discussions is difficult, even in person. The virtual aspect has added a new dimension. While this is not anything bad, it is important to be aware how your actions may be taken from a different cultures point of view.

    Bibliography

    CIA. (2022, March 10). The World Factbook. Retrieved from CIA: https://www.cia.gov/the-world-factbook/

    Lafontaine, D. (2022, Jan 6). US, French Army advance C5ISR research partnerships. Retrieved from U.S. Army: https://www.army.mil/article/253115/us_french_army_advance_c5isr_research_partnerships

    response

    (Matthew) I figured out the code for my project, but I am not sure where I am supposed to compile my code into a .class file. Also, once I do that how do I run it to make sure it works properly? I think i Understand most of the actual code concepts but I’m having a hard time figuring out what I’m supposed to do after writing it. Can anybody give me advice, tips, or tools to figure these things out?

    (Write a response in reference to the programming work)

    response

    Number 1 post: JZ

    For our Week 3 discussion, I have reviewed a case of a 57-year-old African American female who is obese and presents to the clinic with high blood pressure (146/92)She exhibited high blood pressure recently at a health fair (168/99), then on several occasions soon after (145/90, 150/89, 140/88)She has a family history of hypertension and diabetes, so she is also at risk of such conditions. She had a previous episode of high blood pressure (135/95) five years ago, in which lifestyle modifications were recommended. Unfortunately, she was non-compliant in following recommendations for diet and keeping a daily blood pressure (BP) log at home. Her LDL and triglycerides were elevated then, but she failed to repeat labs. She presents today with a similar presentation. She has high blood pressure (146/92), BMI 36.6 (obese), and an elevated lipid profile (LDL 138, HDL 48, Triglycerides 170). 

    The first line of treatment recommended by the JNC8 would be for patients less than 60 years old to initiate a thiazide diuretic or calcium channel blocker (CCB) (Philippine Academy of Family Physicians [PAFP], n.d.). With her family history, being obese, and being an African American – having high-risk factors for diabetes, I probably would wait to begin a thiazide until ordering glucose or a1c if appropriate. The use of thiazides as antihypertensive agents can be associated with metabolic adverse events, including hyperglycemia – although it can decrease cardiovascular events, it may still be used in small doses in patients with hypertension and diabetes (Scheen, 2018). It is very patient-specific, and further assessment would be needed. As for the American Heart Association (AHA) / American College of Cardiology (ACC) guidelines, they focus on earlier diagnosis of hypertension. If blood pressure is >130/80, drug therapy is not recommended until >140/90 with risk factors for stroke prevention. With her high lipid profile, obesity, the risk for heart disease and diabetes, and her current BP 146/92, drug therapy may be more appropriate. Five years ago, diet, exercise, and weight loss may have been recommended with her past BP 135/95, but more is needed now. The ACC/AHA hypertension treatment guidelines are comprehensive, covering all aspects including diagnosis, evaluation, and monitoring, secondary causes, as well as drug and non-drug treatments. (Flack & Adekola, 2020).

    My recommended medication to start this patient would be a drug called Amlodipine. Amlodipine is an antihypertensive drug that is in the calcium channel blocker drug class, which is also known as the generic amlodipine besylate or Norvasc trade name, with the initial starting dose for adults being 5 mg po daily (Lippincott Williams & Wilkins, 2021). This medication blocks the calcium from entering the cardiac muscle and dilates or widens the coronary arteries. This, therefore, decreases blood pressure and the oxygen demand on the heart (Lippincott Williams & Wilkins, 2021). As stated earlier, some may consider a thiazide diuretic, but I would consider a monotherapy until I assess her diabetes risk and a potential for hyperglycemia. We could also titrate the dose every 7-14 days, with a maximum of 10 mg po daily. But education would need to be provided again to this patient, and a provider judgment on compliance. Perhaps she is willing if she attended a health fair and took more interest in her health, as well as taking blood pressures soon after at her local drug store, as she reported. If she agreed to keep a BP log this time, I would reassess her in 14 days and her log and titrate her dose if appropriate. The nice part about this medication is its long half-life as well, of 30-50 hours, so with a history of non-compliance, she would only need to take it once a day as well.

    As for side effects with Amlodipine – the most important is edema. Education is also suggested to discuss symptoms of edema, especially in the hands and feet. In an obese patient, sometimes this can be difficult, but reporting any associated symptoms with the edema as further weight gain, shortness of breath, or pitting edema, should be immediately reported. A patient can also experience a headache, fatigue, dizziness, palpitations, nausea, abdominal pain, or rash (Lippincott Williams & Wilkins, 2021). But monitoring for further hypotension is essential. Especially when starting the first dose. 

    Interactions with Amlodipine could occur if the patient were taking other medications. She reports not taking any other medicines, but she should be aware of potential interactions if new drugs are introduced. As Clarithromycin – it may increase amlodipine concentration, Sildenafil – may increase hypotension, and Simvastatin – may increase myopathy, so dosage shouldn’t exceed 20 mg daily if prescribed for cholesterol (Lippincott Williams & Wilkins, 2021). This would be incredibly important, especially if a provider planned to address her high cholesterol or elevated lipid profile with drug therapy.

    Lastly, as discussed earlier, non-pharmacological interventions can be addressed with this patient. Lifestyle modifications could help tremendously, and the patient should be encouraged to continue to work on her diet, exercise, and lose weight. Perhaps a referral to a Registered Dietician (RD) to build up her support team. The RD could discuss the DASH (Diet Approaches to Stop Hypertension) diet, which consists of fruits and vegetables, fish, poultry, lean meats, beans, nuts, whole grains, and low-fat dairy (National Heart, Lung, and Blood Institute [NIH], n.d.). As well as a low sodium diet, keeping sodium to 1500 mg per day to help with her hypertension.  Overall, continued support in using all these approaches can help this patient reach optimal health.

    Number 2 post: NB

    1. Please briefly discuss the first-line treatment recommendations from JNC8 and the AHA/ACC for a patient with no other major comorbidities. 

    The JNC 8 panel recommends using medications that show the best results of decreasing cardiovascular risk. They have advised that the first-line treatments should be limited to 4 classes of medications which include, thiazide-type diuretics, calcium channel blockers (CCBs), angiotensin receptor blockers (ARBs), and angiotensin-converting enzymes (ACE) inhibitors. It is also suggested that thiazide-type diuretics should be the initial therapy for most patients. Although ACE inhibitors, ARBs, and CCBs are acceptable alternatives, thiazide-type diuretics continue to have the best evidence of efficacy (AJMC, 2014)

    Q2. What are the recommended medications to start this specific patient on? Please provide the drug class, generic & trade name, and initial starting dose. 

    Studies have shown that in an Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) ACE inhibitors led to worse cardiovascular outcomes than thiazide-type diuretics or CCBs in patients with African ancestry (AJMC, 2014).

    Thiazide Diuretic. Hydrochlorothiazide (HCTZ) (Microzide)12.5 mg PO daily.

    Calcium Channel Blocker: Amlodipine (Norvasc) 2.5 -10 mg PO daily

    Lipitor is a medication that is used to lower high cholesterol in individuals at risk of developing cardiac vascular disease. Elevated cholesterol levels are one of the six primary risk factors for developing cardiovascular disease (Texas Heart Institute, 2020). 

    HMG-CoA Reductase inhibitor (Statin): Lovastatin (Lipitor) 20 mg daily in the evening

    Q3. Please discuss the mechanism of action of each of the drugs you listed.

    HCTZ (Thiazide diuretics): Inhibits sodium chloride transport in the distal convoluted tubule.

    – Lower blood pressure by increasing urine output by preventing water, sodium, potassium, and chloride from going through the walls of the nephron to be reabsorbed into the blood.

    – Dilate arterioles by relaxing the smooth muscles in these blood vessel walls.

    Amlodipine (CCB): Inhibits calcium influx into arterial smooth muscle cells

    -Decrease BP by relaxing the vascular smooth muscle in the coronary and systemic arteries leading to decreased peripheral resistance

    Lovastatin (Statins): – Inhibits HMG-CoA reductase, the enzyme responsible for cholesterol

     – Increased production of LDL receptors in the liver

    – Increase uptake of LDL from the plasma

    – Decreased very-low-density lipoprotein (VLDL) secretion

    Q4.  Please discuss the side effect profile of each medication you listed. 

    HCTZ: Hypokalemia, hypocalcemia, hyponatremia, muscle weakness due to loss of sodium, pancreatitis

    Amlodipine: hypotension, bradycardia, peripheral edema, constipation, and gingival hyperplasia

    Lovastatin: Elevated liver transaminases, Headaches, Myopathy

    Q5. Are there any interactions between any of the medications you prescribed?

    No interactions were noted between the recommended prescribed medications.

    Q6. What other non-pharmacological interventions would be suggested?

    Drug therapy is one of the components of the management of hypertension, however, lifestyle changes are equally as important (Clayton, Willihnganz, 2017). 

    Increased healthy (DASH) diet with reduced sodium intake, (1500 mg daily)

    Physical activity and weight loss

    Smoking cessation

    Potassium supplement 3500 -5000 mg daily

    Limited alcohol consumption

    These interventions are paramount for reducing morbidity and mortality associated with hypertension.

    Response

     

    • Length: A minimum of 180 words per post, not including references
    • Citations: At least one high-level scholarly reference in APA per post from within the last 5 years

    response

    Analyses of Social Issues and Public Policy, Vol. 6, No. 1, 2006, pp. 1–17

    Race and Media Coverage of Hurricane
    Katrina: Analysis, Implications, and Future
    Research Questions

    Samuel R. Sommers,∗ Evan P. Apfelbaum, Kristin N. Dukes,
    Negin Toosi, and Elsie J. Wang
    Tufts University

    We analyze three aspects of media depictions of Hurricane Katrina, focusing on the
    relationship between race and coverage of the crisis. Examination of media lan-
    guage use explores the debate surrounding the terms “refugees” and “evacuees”—
    as well as descriptions of “looting” versus “finding food”—in light of the pre-
    dominantly Black demographic of the survivors in New Orleans. Assessment of
    the story angle indicates a disproportionate media tendency to associate Blacks
    with crime and violence, a propensity consistent with exaggerated and inaccurate
    reports regarding criminal activity in Katrina’s aftermath. A review of new media
    sources such as mass e-mails identifies stereotypical depictions of storm survivors
    that both converge and diverge from coverage found in more traditional media out-
    lets. Psychological explanations, implications for public attitudes and behavior,
    and future research questions are explored.

    Upon seeing the first images of New Orleans in the aftermath of Hurricane
    Katrina, Americans began to ask why there had not been better preparation for the
    storm and what could be done to prevent similar catastrophes in the future. Almost
    as immediately, people also took note of one unmistakable aspect of these images,
    namely that the overwhelming majority of individuals depicted on rooftops, at
    the Superdome, and in front of the Convention Center was Black. Accordingly,
    race-related questions about Katrina began to emerge as well: Why did race seem
    to covary with ability and willingness to evacuate before the storm? In what ways
    did the race of the displaced residents of New Orleans affect public perceptions of

    ∗Correspondence concerning this article should be addressed to Samuel R. Sommers, De-
    partment of Psychology, Tufts University, 490 Boston Avenue, Medford, MA 02155 [e-mail:
    sam.sommers@tufts.edu].

    Note: Authors are listed alphabetically, with the exception of the first author.

    1

    C© 2006 The Society for the Psychological Study of Social Issues

    2 Sommers et al.

    the crisis? And, perhaps most controversially, to what extent did the race of these
    individuals influence governmental preparations for and responses to the storm?

    The focus of this article is on another, related series of questions concerning the
    relationship between race and media coverage of Katrina. Media portrayals have
    the potential to both shape and reflect societal attitudes (see Entman & Rojecki,
    2001; Gandy, 1998; Gerbner & Gross, 1976; Gilens, 1997), and their examina-
    tion therefore has broader implications concerning the psychological tendencies
    alluded to by the questions above. As such, the coverage of Katrina provides a
    unique, real-world opportunity to consider the relationship between race, popular
    media, and the general public. We focus on three specific aspects of this media
    coverage. First, we consider media language use, including two of the hallmark
    controversies of the Katrina coverage: debate regarding the use of “refugees” to
    describe survivors of the storm, and the widely circulated photo captions that de-
    scribed a Black man as “looting” and a seemingly comparable White couple as
    “finding food.” Second, we examine issues of story angle, particularly the media’s
    disproportionate—and, in retrospect, exaggerated—focus on reports of violent
    crime in New Orleans after the storm. Third, we explore first-person accounts
    circulated through “new” media outlets such as mass e-mails and weblogs, com-
    paring aspects of this coverage with that of more traditional media outlets. For
    each topic we offer analysis using psychological research and consider practical
    implications, all in the effort to identify new links between theory and real-world
    events and to generate avenues for future investigation.

    Language Use

    Describing the survivors. Much of the media controversy to emerge in the
    aftermath of Katrina focused on issues of language. Most notably, debate raged
    regarding the language used to describe the displaced survivors (Prince, 2005).
    Indeed, in the first days after the storm, the most common description for these
    individuals was “refugees” (“Media abounds,” 2005), a word infrequently used
    to describe American citizens still within the borders of the United States (Fen-
    ton, 2005; Kirgis, 2005). Within a week, President Bush decried use of the term,
    and many news organizations made formal announcements of a shift to the more
    traditional “evacuees,” “survivors,” or “victims.”

    To more closely examine this issue we conducted a Google News search for
    stories appearing in the two weeks after the storm (meaning that at least half of
    our sampling window occurred after the “refugee” controversy exploded and after
    some organizations disavowed use of the term). Our search revealed 2,830 stories
    about Katrina using the word “evacuee,” compared to 1,040 using “refugee,” a
    difference that might be expected given the dubious applicability of the latter
    term. Thus, “evacuee” was the more popular word by a ratio of 2.7 to 1. The
    unprecedented nature of the Katrina crisis renders comparisons problematic, but

    Race and Media Coverage 3

    in a crude effort at such an analysis, we conducted a similar search for stories
    about Hurricane Rita, a storm that made landfall on the Gulf Coast three weeks
    after Katrina. This search revealed 1,510 stories that used “evacuee,” compared
    to only 257 references to “refugee.” This ratio of 5.9 to 1 is more than twice that
    observed for Katrina stories, suggesting that, by one comparison at least, “refugee”
    was used disproportionately more often in stories about Hurricane Katrina.

    There are many potential explanations for this difference. Perhaps media out-
    lets learned that they could prevent controversy by avoiding the word “refugee,”
    and they adhered to this strategy when covering Rita. The damage and displace-
    ment caused by Katrina was unprecedented in recent U. S. history; perhaps the
    unique circumstances of the crisis rendered “refugee” more applicable (Pesca,
    2005). Others, however, proposed a more controversial explanation. Even though
    initial media reports made virtually no mention of race in describing the scene
    in New Orleans (Shafer, 2005),1 the images transmitted from the Superdome and
    Convention Center left no doubt that the overwhelming majority of victims re-
    maining in the city was Black. To some public figures, the most parsimonious
    explanation for the unusual use of “refugee” was the demographic composition
    of those affected by the hurricane. Jesse Jackson and Al Sharpton, for instance,
    argued that the use of “refugee” was racially biased, as it depicted the primarily
    Black population in outgroup terms and implied that the victims were less than
    full citizens (“Calling Katrina,” 2005).

    Was the unique language used to describe victims of Katrina influenced, at
    least in part, by race? Linguist Geoffrey Nunberg has provided compelling evidence
    in the affirmative. Nunberg (2005) examined Nexis wire service articles in the
    first week after Katrina and found that those using “evacuee” (56%) outnumbered
    those using “refugee” (44%). This 1.3 to 1 ratio is even lower than that of our
    analysis, presumably due to the different time frame of Nunberg’s study (as well
    as potential differences in search engines). Most interestingly, in articles in which
    either “evacuee” or “refugee” appeared within 10 words of “poor” or “Black,”
    “refugee” was the more popular term by a statistically significant margin of 68% to
    32%. This result cannot be accounted for by the race-neutral explanations identified
    above. Rather, these data support the conclusion that race played some role in the
    use of “refugee” in the coverage of Katrina.2

    1 This tendency to resist addressing race is an interesting one in and of itself (see Kurtz, 2005).
    Shafer (2005) argues that it resulted from media concerns about avoiding the appearance of racism, a
    conclusion consistent with recent psychological research regarding the general reluctance of Whites
    to mention race in describing others, even when it is obvious and diagnostic information (Norton,
    Sommers, Apfelbaum, Pura, & Ariely, in press).

    2 This analysis also raises the important question of whether the influence of race is separable
    from the influence of socioeconomic status (SES). Compared to social psychological investigations of
    race-related stereotypes and attitudes, far fewer studies have examined the specifics of people’s beliefs
    regarding SES. Still, many of the analyses offered in this article could also be used to support the
    contention that SES colors media depictions, a conclusion we address again below.

    4 Sommers et al.

    The “refugee” debate was not the only language controversy to emerge. In
    early September, two news service photographs taken in front of a flooded grocery
    store received a great deal of television attention and achieved wide circulation on
    the Internet (“Loot loops,” 2005; Ralli, 2005). In one of the photos, a Black male
    was shown in waist-high water, carrying a carton of soft drinks and a full garbage
    bag. The other photo showed a White couple carrying food and drinks through
    similar floodwaters. Although nearly identical in composition, the photos were
    released with markedly different captions. The first caption—for the photo with
    the Black subject—began with “A young man walks through chest deep flood
    water after looting a grocery store . . .” The caption for the second photo read,
    “Two residents wade through chest-deep water after finding bread and soda from
    a local grocery store.” That comparable photos could carry such different captions
    was attributed by some to the major difference between the images: the race of
    the parties depicted.3 Although anecdotal in nature—and therefore not amenable
    to the type of analysis conducted above regarding the use of “refugee”—these
    competing photo captions are certainly consistent with the conclusion that race
    played some role in language use during coverage of Katrina.

    Analysis, implications, and future questions. Given empirical evidence of the
    influence of race on perception and judgment in a wide range of domains (for
    review, see Fiske, 1998), it would be quite surprising if similar effects did not
    occur with media depictions. Race is one of the most salient characteristics people
    perceive when encountering others (Ito & Urland, 2003; Montepare & Opeyo,
    2002). Interacting with—or even viewing faces of—Black individuals has been
    found to activate stereotypical associations regarding criminality, hostility, and
    other negative characteristics, and this process often occurs automatically—outside
    a perceiver’s conscious awareness—and absent explicitly prejudicial attitudes (e.g.,
    Devine, 1989; Eberhardt, Goff, Purdie, & Davies, 2004; Fazio, Jackson, Dunton,
    & Williams, 1995; Greenwald & Banaji, 1985).

    Perhaps exposure to Black individuals also renders more accessible con-
    structs sometimes associated with “refugee,” such as “stigmatized,” “poor,” or
    “outgroup.” Consider the analysis of Mike Pesca (2005) of NPR, who wrote that
    even though legal definitions of “refugee” did not apply to Katrina (see Kirgis,
    2005), the word seemed “apt” for other reasons. Automatic associations regard-
    ing the category African American may have played a role in beliefs that, in this
    instance, “refugee” just felt like the right word. Pesca (2005) draws analogies be-
    tween New Orleans and refugee scenes in Haiti and Kosovo (e.g., “the dynamic

    3 This controversy suggests that at least some of the influence of race is distinct and separable
    from that of SES. The individuals in the two photos are not distinguishable in terms of SES, but are
    clearly members of different racial groups. Although it was almost certainly a combination of race and
    SES that had an influence on media coverage of Katrina, we believe that these effects would not have
    been the same were the survivors in New Orleans mostly poor White individuals.

    Race and Media Coverage 5

    I witnessed was clearly of the dirty masses on one side and the soldiers and po-
    lice on the other”), but even more common were media comparisons to Africa
    or the “Third World” (Street, 2005; Wa Ngugi, 2005). Indeed, any overlap in as-
    sociations between “Black” and “refugee”—as suggested by Nunberg’s (2005)
    analyses—would have rendered the latter term more likely to surface in the minds
    of journalists covering Katrina. In this manner, pernicious intent or racial antipa-
    thy would not have been required in order for race to impact media coverage, and
    journalists’ denials of such influence would hardly preclude the possibility that
    bias occurred.

    However, it remains elusively difficult to determine whether race has affected
    judgment in any particular instance (Norton, Sommers, Vandello, & Darley, 2006).
    People are often unaware of the extent to which race has been influential, render-
    ing unreliable their self-reports on the matter (Nisbett & Wilson, 1977; Shafir,
    Simonson, & Tversky, 1993). Moreover, in a culture where motivations to avoid
    appearing prejudiced are pervasive (Dunton & Fazio, 1997; Plant & Devine, 1989),
    few social category labels are as aversive as that of “racist” (Crandall, Eshelman,
    & O’Brien, 2002; Sommers & Norton, 2006) and people are remarkably facile
    at recruiting race-neutral justifications for potentially biased behavior (Norton,
    Vandello, & Darley, 2004). The justifications provided by the two caption writers
    for the Katrina photos illustrate the difficulty inherent in attempts to identify the
    influence of race. A spokesperson for the Associated Press, which published the
    photo caption of the Black individual, explained that the reporter “saw the person
    go into the shop and take the goods, and that’s why he wrote ‘looting’ in the cap-
    tion” (“Loot Loops,” 2005). The photographer who wrote the caption regarding
    the White individuals explained, “I believed . . . that they did simply find them,
    and not [sic] ‘looted’ them in the definition of the word . . . they picked up bread
    and cokes that were floating in the water. They would have floated away anyhow”
    (“Loot Loops,” 2005). Standing alone, either explanation is plausible. In fact, had
    only one of the captions been published, it is likely that no one would have ques-
    tioned the motivation behind it. But the rare presence of a comparison group in
    this instance led to the caption controversy and enables us to at least consider the
    possibility that race played a role.

    We suggest that the explanations for these captions, though likely honest,
    are just as unreliable as typical self-report accounts for social judgment. Theory
    suggests that encountering the Black individual outside the grocery store would
    have activated associations such as “thief,” “immoral,” or “needy,” rendering the
    construct “looting” more accessible. Indeed, researchers have demonstrated that
    perceivers have a lower threshold for labeling an ambiguous behavior as criminal
    or threatening when an actor is Black as opposed to White (e.g., Correll, Park, Judd,
    & Wittenbrink, 2002; Duncan, 1976; Eberhardt, et al., 2004; Sagar & Schofield,
    1980; Wittenbrink, Gist, & Hilton, 1997). By the same token, the journalist who
    photographed the White individuals ruminated on the circumstances leading up to

    6 Sommers et al.

    their possession of the items, and decided to give his subjects the benefit of the
    doubt. Would he have exerted the same effort if the individuals had been Black?
    Or would he have been more likely to rely instead on stereotypical and heuristic
    thought processes? Of course, these are empirical questions.

    Moving beyond the Katrina context, there are other interesting questions re-
    garding the language used by media to describe individuals of different races.
    For instance, is the qualifier “alleged” used more often to refer to White versus
    non-White criminal suspects? Does race covary with the use of other phrases with
    subtle differences in connotation such as “suspect,” “detainee,” and the recently
    ubiquitous “person of interest?” The real-world repercussions of such variations in
    media language use are also important considerations, as media coverage not only
    reflects, but also shapes public perception. For example, Dunn, Moore, and Nosek
    (2005) have shown that subtle variations in the words used to describe violent ac-
    tions have a significant impact on individuals’ attitudes toward terrorism, as well
    as their actual memory for events. In the case of Katrina, one might ask whether
    exposure to the same photo labeled with either a caption of “looting” or “finding
    food” could affect participants’ willingness to donate to relief efforts (see Iyengar
    & Morin, 2006). The factors predicting differential media language use—as well
    the attitudinal and behavioral consequences of this language—are issues that merit
    closer empirical investigation.

    Story Angle

    Focus on violent crime. Related to how language is used to depict events
    is the broader question of which aspects of a story the media focuses on—or
    whether a story is deemed newsworthy at all in the competitive marketplace of
    information. With regard to Katrina, one story emphasis in the days after landfall
    was the outbreak of violent crime throughout New Orleans. “Looting” comprised
    one aspect of this coverage, but beyond property crimes, a great deal of attention
    was also paid to what was described as a “violent crime wave” within the city
    of New Orleans, particularly among evacuees at the Superdome and Convention
    Center (Loney, 2005). Reports described sniper fire aimed at rescuers, rampant
    homicide, and roving gangs of youths committing rapes against teenage victims
    and even babies (Pierre & Gerhart, 2005; Rosenblatt & Rainey, 2005).

    One set of questions psychologists could ask concerns the deindividuation
    processes contributing to these acts. But another interesting aspect of these behav-
    iors is that, in retrospect, many of them did not happen at all, or at least not to
    the extent that media and local officials led the public to believe. With regard to
    allegations reported by CNN and other outlets on September 1 that gunfire directed
    at helicopters halted a hospital rescue mission, “National Guard officials on the
    ground at the time now say that no helicopters came under attack and that evac-
    uations were never stopped because of gunfire” (Pierre & Gerhart, 2005). That

    Race and Media Coverage 7

    same week, the New Orleans Times-Picayune reported that 40 murder victims
    had been found in a freezer at the Convention Center; one month later a govern-
    ment spokesperson reported that four bodies were found, and only one appeared
    to be that of a murder victim (“Auditing the early,” 2005; Rosenblatt & Rainey,
    2005). Finally, although sexual assaults often go underreported even under normal
    circumstances, only one such assault (with an adult, not child victim) has been
    confirmed at the Convention Center or Superdome, hardly supporting allegations
    of a sexual assault wave (“Auditing the early,” 2005).

    It is difficult to prove that the largely Black population in question led to
    this focus on—and overestimation of—violence, but other media analyses are
    consistent with the proposition that race was at least a contributing factor. Entman
    and Rojecki (2001) have chronicled a wide array of evidence demonstrating that
    media coverage of Blacks disproportionately emphasizes violent crime, and that
    this coverage is more likely to focus on race when a suspect is Black as opposed
    to White (see also Dixon & Linz, 2000). Biases are also evident in the public’s
    memory for media representations. In one study, when participants presented with
    crime stories and photographs were asked to reconstruct the faces they had seen,
    they selected features that were more Afrocentric than those of the original suspect,
    particularly when the crime was violent (Oliver, Jackson, Moses, & Dangerfield,
    2004).4 Findings such as these are consistent with the more general tendency of
    social perceivers to fall victim to illusory correlations: overestimations of the co-
    occurrence of distinctive events and distinctive group memberships (Hamilton &
    Gifford, 1976).

    Analysis, implications, and future questions. Much of the analysis above re-
    garding race and language use also applies to story angle. Automatic associations
    between “Black” and “criminal” likely color the perceptions of journalists and
    news producers even if they do not harbor explicit prejudice. Moreover, beliefs
    about which stories will interest an audience may also be affected by race. For
    instance, the extent to which a Black suspect at-large is viewed as a greater public
    safety threat than a White fugitive may influence the coverage his story receives.
    Such portrayals can then bias public perceptions, reinforcing preexisting beliefs
    about race and crime (e.g., Correll et al., 2002; Oliver et al., 2004). Coverage of Ka-
    trina may have had even more immediate behavioral consequences. Stories about
    violent crime deterred some individuals from rescue efforts (Pierre & Gerhart,

    4 This association between prototypical Black features and stereotypes of criminality (see Dixon
    & Maddox, 2005; Maddox & Gray, 2002) is yet another interesting topic that would require too much
    of a tangent to address presently in sufficient detail. This issue was at the center of controversy in 1994
    when the cover of Time magazine featured a mug shot of O. J. Simpson with heightened contrast and
    darkened skin tone. The magazine’s editorial staff explained the motivation behind the alteration as
    “aesthetic,” although many criticized it as an attempt to portray Simpson in a more threatening light
    by preying upon stereotypical associations with skin tone (Sturken & Cartwright, 2000).

    8 Sommers et al.

    2005) and could have affected people from outside the region as well, rendering
    them less willing to make donations or more likely to minimize the hardships ex-
    perienced by evacuees (for potential example, see “Barbara Bush,” 2005). Media
    focus on crime also may have affected government officials. Several state and
    local governments ran criminal background checks on victims of Katrina who re-
    located to their jurisdiction, often as soon as these individuals stepped off a plane
    or bus (“Authorities hunt,” 2005), a move criticized by some as unprecedented and
    inappropriate (“ACLU criticizes,” 2005; Foley, 2005).

    The unique aspect of the Katrina coverage, though, is that much of the reported
    information about violent crime turns out to have been false. Yes, the lack of re-
    liable channels of communication was unprecedented in contemporary America,
    obstructing the media’s ability to obtain and confirm information. But this was not
    the case at the Superdome and Convention Center, where operations were carried
    out by the National Guard and where reports should have been more easily con-
    firmable.5 Moreover, communication issues did not lead to similarly misleading
    coverage in storm-affected areas with largely White populations. Perhaps most
    tellingly, the inaccuracies regarding the behavior of the storm survivors seemed
    to err in the same direction, portraying these individuals more negatively, more
    violently, more stereotypically; there were few if any stories that depicted the pre-
    dominantly Black population in a more positive or generous light than the facts
    warranted (Britt, 2005; Rosenblatt & Rainey, 2005). These observations suggest
    that demographic factors such as race contributed to the nature of the inaccurate
    reporting. As the editor of the Times-Picayune postulated, “If the dome and Con-
    vention Center had harbored large numbers of middle-class White people, it would
    not have been a fertile ground for this kind of rumormongering” (Britt, 2005).

    Another consideration related to story angle involves whether the media deem
    an event worthy of news coverage in the first place. In the case of Katrina, coverage
    was extensive. In fact, many pundits credit the media with goading governmental
    agencies out of their apparent inaction in the immediate aftermath of the storm,
    as well as “redeeming” a news institution that had become increasingly defer-
    ential and preoccupied with melodramatic human interest stories in recent years
    (Carr, 2005; Kurtz, 2005). But other recent news items suggest that race can play
    a role in determining whether a story even receives media attention in the first
    place. Consider, for example, the spate of missing woman cases that have recently
    captured media and public attention in the United States. The disappearances of
    Chandra Levy, Laci Peterson, and Natalee Holloway, received extensive cover-
    age. One characteristic these cases share is that they involve young White women.
    Similar disappearances of non-White women have not received comparable atten-
    tion. The disappearance of Tamika Huston, a 24-year-old from South Carolina,

    5 Indeed, much of the false information reported appears to have originated from government
    officials who had not taken the time to confirm the rumors (Pierre & Gerhart, 2005).

    Race and Media Coverage 9

    was covered by local television stations, but efforts by her family to draw wider
    media attention were largely ignored (Mankiewicz, 2005). LaToyia Figueroa was
    pregnant at the time she went missing in Philadelphia, yet her case received a
    fraction of the coverage devoted to the disappearance of Laci Peterson (O’Connor,
    2005). Such discrepancies are not limited to missing persons stories: the March
    2005 school shooting that killed 10 Native American students on a reservation
    outside Minneapolis received far less attention than similar school shootings with
    predominantly White victims, such as the 1999 murders at Columbine High School
    in suburban Denver (Teng, 2005).

    When pressed to explain these disparities, journalists and executives often ex-
    plain that they are simply covering the stories that interest the audience (O’Connor,
    2005). This may be the case: Perhaps viewers feel greater empathy toward vic-
    tims who are similar to them, or toward young White victims in general; perhaps
    they also experience more fear and threat in response to Black criminals. But
    regardless of whether media decisions about story angle and newsworthiness in-
    fluence or merely reflect the attitudes of the public, the conclusion that race can
    affect these decisions is problematic. To no real surprise, journalists and media
    executives underestimate the potential role of race in these judgments, as illus-
    trated by this vehement denial from the former president of NBC News: “Let
    me make this clear: Race is not a factor in who we cover or how we cover it”
    (Mankiewicz, 2005). Comparisons of the coverage of stories involving individuals
    of different races—crude as they may be—converge with psychological theory to
    suggest otherwise. But the extent to which race influences such decisions, and the
    circumstances under which this influence is strongest, have yet to be identified
    empirically.

    “New Media” Reporting

    Web-based first-person accounts. In the 21st century the term “media” has
    been expanded to refer to outlets other than newspaper, magazine, radio, and tele-
    vision. In the 2004 U. S. presidential campaign, for example, weblogs (or “blogs”)
    were a popular source of news and analysis, and several candidates maintained
    official blogs (Rice, 2003). As such, it seems appropriate to consider the coverage
    of Hurricane Katrina in the “new media,” including weblogs, listservs, on-line
    bulletin boards, and mass e-mails. Evidence of the influence of race in these me-
    dia would not be surprising; these are typically products of individual writers and
    it is well documented that contemporary individuals exhibit subtle and explicit
    racial bias despite norms of egalitarianism. In fact, White supremacists and others
    espousing overtly racist ideologies responded to Katrina with a barrage of e-mails
    and postings warning that Black evacuees would start crime sprees across the
    country, blaming the victims for their fate, and proposing strategies for sending
    aid that would exclusively target White survivors (“Racists stir,” 2005).

    10 Sommers et al.

    But one did not have to frequent extremist web sites to find accounts of Katrina
    tinged by race. In the aftermath of the storm, several mass e-mails began circulating
    as ostensibly first-person accounts from New Orleans and beyond. Many described
    survivors in an unflattering as well as stereotypical light. Consider, for example,
    excerpts from an account of the behavior of evacuees at a Texas rest area:

    Last Friday, my dad, who works for TxDOT, answered a call for TxDOT employees to go
    help with the refugees at this rest stop. These buses from New Orleans start pulling in. . . .
    As they get off the bus, they are greeted and shown to the restrooms—where they pee all
    over the walls, floors, mirrors, etc. They did not even flush the toilets. Left the restrooms in
    a HORRIBLE mess. . . . He and my mom said the people were HORRIBLE. Nasty, filthy
    mouthed, ungrateful. . . . Why the hell can’t they line up themselves and help unload all
    these trucks and cars full of FREE stuff? Okay, let them have a day or two of rest but then
    put those folks to work taking care of themselves. Why the hell should any of them want
    to get a job when they can lay around all day in free air conditioned stadiums where they
    don’t have to spend a dime and they have TV, entertainment and education and great food?

    (“Rest stop,” 2005)

    The Texas Department of Transportation (TxDOT) was unable to confirm these
    allegations, and the supervisor of the rest stop refuted them, particularly the alleged
    incidents in the restroom (“Rest stop,” 2005). Again, it is not surprising that there
    exists an e-mail that describes the survivors of Katrina so negatively, and one
    such account hardly indicates a general media bias. But it is noteworthy that this
    account shares some characteristics exhibited by the traditional media coverage
    reviewed above. The full e-mail consistently refers to survivors as “refugees,”
    at one point using quotation marks to make sarcastic reference to “evacuees.”
    Although the focus of this e-mail is not on violent tendencies among the survivors,
    the depiction is consistent with stereotypes, suggesting that the individuals were
    dirty, ungrateful, lazy, and manipulative.

    Another circulated e-mail does focus on issues of crime and violence, in
    addition to casting aspersions on the survivors’ work ethic and general sense of
    morality:

    Let me tell you a few things about the wonderful group of evacuees we received here in
    Utah . . . the National Guard removed from their person; 43 handguns . . . 20 knives, one
    man had 100000 dollars in cash, 20 pounds of Marijuana, 10 pounds of Crack, 15 pounds
    of Methamphetamines, 10 pounds of various other controlled substances including Heroin.
    Upon their arrival here in Salt Lake City, two people immediately deplaned and lit up a
    joint. . . . It was discovered that parents were using their kids to carry loads of looted jewelry
    (price tag still on), and other items. . . . By the second night in the shelter, there was one
    attempted rape of a relief worker, sales of drugs on going and a gang had begun to rebuild. . . .
    This past Saturday, workforce services held a job fair. 85 of the 582 evacuees attended. 44
    were hired on the spot. 24 were asked back for a second interview. Guess the others had no
    desire to work.

    (“Utah evacuees,” 2005)

    Public safety officials and the Governor of Utah immediately and categorically
    denied these allegations (Dethman, 2005; “Hurricane Katrina,” 2006; “Utah evac-
    uees,” 2005). It is difficult to estimate just how many similar “fir

    response

    chapter 4

    How the Poor Became Black

    The Racialization of American Poverty
    in the Mass Media

    martin gilens

    Race and poverty are now so closely entwined that it is hard to
    believe there was a time when discussions of American poverty

    neglected blacks altogether. African Americans have always been dispro-
    portionately poor, but black poverty was ignored by white society
    throughout most of our history.

    In the following pages, I analyze over 40 years of news media cover-
    age of poverty in order to trace changes in racial images of the poor. I
    ‹nd that until the mid-1960s, poverty appeared overwhelmingly as a
    “white problem” in the national news media. But in a very brief period
    beginning in 1965, the media’s portrayal of American poverty shifted dra-
    matically. Although the true racial composition of the American poor
    remained stable, the face of poverty in the news media became markedly
    darker between 1965 and 1967.

    The most obvious explanations for the news media’s changing racial
    portrayal of the poor—the civil rights movement and the urban riots of
    the mid-1960s—played a role, but cannot account for the nature or tim-
    ing of the shifts in media images. Nor is this change in the media’s por-
    trayal of poverty merely a re›ection of the increasing visibility of African
    Americans in the news more broadly.

    Instead, the changing racial images of the poor in the mass media are

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    best understood as re›ecting two very different processes that converged
    in the mid-1960s. First, the stage was set by a series of historical changes
    and events that made black poverty a less remote concern for white
    Americans. These included the migration of African Americans from the
    rural South to the urban North, the increasing representation of blacks
    among AFDC bene‹ciaries, the civil rights movement, and the riots of the
    mid-1960s. But these changes only created the environment in which
    racial portrayals of poverty were transformed. The proximate cause of
    that transformation was the shift in the moral tone of poverty coverage
    in the news. As news stories about the poor became less sympathetic, the
    images of poor blacks in the news swelled.

    The association of African Americans with the “undeserving poor” is
    evident not only in the changing media coverage of poverty during the
    mid-1960s, but throughout the period studied. From the early 1950s
    through the early 1990s, images of poor blacks increased when the tone
    of poverty stories became more critical of the poor and decreased when
    coverage became more sympathetic. Similarly, images of African Ameri-
    cans were most numerous in news stories about the least sympathetic
    subgroups of the poor. As I discuss below, these differences in the racial
    portrayal of the poor cannot be accounted for by true changes in the
    racial composition of the poverty population or by racial differences
    across subgroups of the poor. Rather, the media’s tendency to associate
    African Americans with the undeserving poor re›ects—and reinforces—
    the centuries-old stereotype of blacks as lazy.

    Real-world changes in social, economic, and political conditions
    combined with existing racial stereotypes to shape the media’s coverage
    of welfare and poverty over the past decades. But this coverage has in
    turn shaped social, economic, and political conditions as states have dis-
    mantled and reformulated their welfare policies in response to the 1996
    PRWORA reforms. American democracy is far from perfect. But public
    policies do re›ect—if inconsistently and incompletely—the public’s pref-
    erences (Monroe 1979; Page and Shapiro 1983; Wright, Erikson, and
    McIver 1987; Monroe and Gardner 1987; Shapiro and Jacobs 1989; Stim-
    son, Mackuen, and Erikson 1995). In the case of welfare, however, citi-
    zens’ preferences have been shaped by media portrayals that exaggerate
    the extent to which poverty is a “black problem” and that systematically
    associate African Americans with the least sympathetic subgroups of the
    poor. Other chapters in this volume ably document the many ways in
    which welfare reform has been infused with racial considerations and
    re›ective of racial biases. In this chapter, I show how distorted news cov-

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    erage of poverty has helped to generate a citizenry that views welfare and
    poverty through a racial lens.

    African Americans: The Once-Invisible Poor

    The American public now associates poverty and welfare with blacks.
    But this was not always the case. The “scienti‹c” study of poverty in
    America began around the end of the nineteenth century. During this
    period social reformers and poverty experts made the ‹rst systematic
    efforts to describe and analyze America’s poor (e.g., Warner 1894; Hap-
    good 1902; Lee 1902; Hunter 1904; Hollander 1914). Racial distinctions
    were common in these works, but such distinctions usually referred to
    the various white European “races” such as the Irish, Italians, and Poles;
    this early poverty literature had little or nothing to say about blacks.1 The
    Great Depression, of course, brought the topic of poverty to the forefront
    of public attention. But as the American economy faltered and poverty
    and unemployment increased, white writers and commentators remained
    oblivious to the sufferings of the black poor.2

    The economy grew dramatically after the war, and living standards
    rose quickly. In contrast with the depression, poverty seemed like a dis-
    tant problem during the postwar years. Poverty was “rediscovered,”
    however, in the 1960s. Stimulated by the publication of John Kenneth
    Galbraith’s The Af›uent Society (in 1958) and Michael Harrington’s The
    Other America (in 1962), the American public and policymakers alike
    began once more to notice the poor. During the 1960 presidential cam-
    paign John Kennedy is said to have been shaken by the grinding poverty
    he saw in West Virginia, where a lack of both education and job oppor-
    tunities had trapped generations of poor whites in the primitive condi-
    tions of rural poverty (Patterson 1994, 126). And early in his presidency
    Kennedy inaugurated a number of antipoverty programs focusing on
    juvenile delinquency, education and training programs for those lacking
    marketable skills, and federal assistance for depressed regions of the
    country. But the poverty programs of the early 1960s, and the popular
    images of the poor that went along with them, were just as pale in com-
    plexion as those of the turn of the century. Attention to poor blacks was
    still quite limited both in the mass media and, apparently, among
    Kennedy administration staffers.3 If there was a dominant image of
    poverty at this time, it was the white rural poor of the Appalachian
    coal‹elds.

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    Background Conditions for the Racialization of Poverty

    Popular images of poverty changed dramatically, however, in the mid-
    1960s. After centuries of obscurity, at least as far as white America was
    concerned, poor blacks came to dominate public thinking about poverty.
    Two decades-long changes helped to set the stage for the “racialization”
    of popular images of the poor. The ‹rst was the widespread migration of
    rural southern blacks to northern cities. At the turn of the twentieth cen-
    tury, over 90 percent of African Americans lived in the South, and three-
    quarters of all blacks resided in rural areas (Meier and Rudwick 1970,
    213). Blacks had been leaving the South at a slow rate for decades, but
    black out-migration from the South grew tremendously during the 1940s
    and 1950s before tapering off during the 1960s. As a consequence of this
    migration, African Americans, who only accounted for 2 percent of all
    northerners in 1910, comprised 7 percent by 1960, and, perhaps more
    importantly, made up 12 percent of the population in urban areas
    (Turner 1993, 249, 251).

    As we’ll see below, the racialization of public images of the poor
    occurred fairly suddenly and dramatically between 1965 and 1967.
    Clearly there is no simple connection between the growth of African
    American communities in northern cities and public perceptions of the
    poor as black. Nevertheless, the growth of the black population in the
    North was one link in a chain of events that led to the dramatic changes
    in how Americans thought about poverty.

    A second change that paved the way for the racialization of poverty
    images was the changing racial composition of AFDC, the nation’s most
    conspicuous program to aid the poor. As established in 1935, the ADC
    program (as it was then called) allowed individual states considerable
    discretion to determine both the formal rules governing ADC eligibility
    and the application of those rules. As a result, African Americans were
    disproportionately excluded from ADC. In 1936, only 13.5 percent of
    ADC recipients were African American, despite blacks’ much higher rep-
    resentation among poor single mothers (Turner 1993, 108). Over the next
    three decades, however, the proportion of blacks among ADC recipients
    rose steadily (‹g. 4.1). This increase resulted from a variety of in›uences,
    both legislative and economic. For example, the establishment of Social
    Security Survivors’ Bene‹ts in 1939 removed proportionately more white
    than black widows from the ADC rolls, thereby increasing the percentage
    of blacks among those remaining.4 In addition, an increase in the federal
    matching-grant contribution to the ADC program from one-third to one-

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    half of total state ADC expenditures encouraged some states to expand
    their coverage or to begin participating in the ADC program for the ‹rst
    time (Turner 1993).

    As ‹gure 4.1 shows, the percentage of African Americans among
    ADC/AFDC recipients increased steadily from about 14 percent in 1936
    to about 45 percent in 1969, after which point the proportion of blacks
    declined slowly until it reached 36 percent in 1995.5 During the middle to
    late 1960s, then, African Americans made up a very substantial minority
    of AFDC recipients. Consequently, as the welfare rolls expanded sharply
    in the late 1960s and early 1970s, the public’s attention was drawn dis-
    proportionately to poor blacks. Yet the pattern of growth of African
    American welfare recipients shown in ‹gure 4.1 also makes clear that the
    sudden shift in images of poverty during the 1960s cannot be attributed to
    any sudden change in the makeup of the welfare population. The pro-
    portion of blacks among AFDC participants had been growing steadily
    for decades. Like black migration to the North, the changing racial com-
    position of the welfare rolls constituted a background condition that con-
    tributed to the changes in public perceptions of the poor, but it did not
    serve as a precipitating cause of those changes. After all, the proportion
    of blacks among welfare recipients was almost as high in 1960 as it was
    in 1967, yet public concern in 1960 was still focused on poor whites, in
    particular, the poor rural whites of Appalachia.

    how the poor became black

    105

    Fig. 4.1. The percentage of blacks among ADC/AFDC recipients, 1935–95

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    Proximate Events in the Racialization of Poverty

    Gradual demographic changes in residential patterns and welfare receipt
    by African Americans helped lay the groundwork for the changes to
    come in how Americans viewed the poor. The more proximate events
    that contributed to these changes were a shift in focus within the civil
    rights movement from the ‹ght for legal equality to the battle for eco-
    nomic equality, and the urban riots that rocked the country during the
    summers of 1964 through 1968.

    Black protests against racial injustice had been sporadic in the early
    decades of the twentieth century and had largely died out during World
    War II. But in the mid-1950s, the modern civil rights movement began a
    concerted and sustained effort to force an end to the injustice and indig-
    nities of racial segregation. In December 1955 Rosa Parks was jailed for
    refusing to vacate her seat on a segregated bus. Ms. Parks’s quiet protest
    began the Montgomery bus boycott, led by a previously unknown young
    black minister named Martin Luther King Jr. The eventual success of the
    yearlong bus boycott led to a decade of demonstrations, protests, and sit-
    ins, throughout the South, all pressing the demand for legal equality and
    an end to racial segregation.

    The struggles of the early civil rights movement were for equal rights,
    black enfranchisement, and an end to legal segregation. These efforts
    produced their most signi‹cant successes with the passage of the 1964
    Civil Rights Act and the 1965 Voting Rights Act. In the second half of the
    1960s, civil rights leaders shifted their attention from legal inequality to
    economic inequality. Although the battle for black enfranchisement in
    the South had a long way to go, the ‹rst large urban uprisings during the
    summer of 1964, and the greater number of ghetto riots during the sum-
    mers to follow, shifted both the geographical and programmatic focus of
    the struggle for racial equality.

    Of course, racial economic inequality was hardly a new concern to
    civil rights leaders. In 1963, the National Urban League called for a
    “crash program of special effort to close the gap between the conditions
    of Negro and white citizens,” and released a ten-point “Marshall Plan for
    the American Negro.” In the same year, Martin Luther King issued a sim-
    ilarly conceived “G.I. Bill of Rights for the Disadvantaged” (Davies 1996,
    56ff.). But these early efforts were almost wholly overshadowed by the
    struggle for basic civil rights in the South.

    In 1966, however, Martin Luther King and the Southern Christian
    Leadership Conference (SCLC) focused their attention on the plight of

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    the black urban poor of the northern ghettos. With help from the AFL-
    CIO and the United Auto Workers, King and the SCLC organized
    demonstrations and rent strikes in Chicago to dramatize the dire eco-
    nomic conditions facing so many urban blacks. King called for a variety
    of measures aimed at improving the lot of Chicago’s black population:
    Integrating the de facto segregated public schools, reallocating public ser-
    vices to better serve minority populations, building low-rent public hous-
    ing units, and removing public funds from banks that refused to make
    loans to blacks (Brooks 1974; Bloom 1987).

    For all his efforts, King achieved little in Chicago. But the concern
    with northern urban blacks’ economic problems exempli‹ed by the
    Chicago Freedom Movement, and the 1968 Poor People’s March on
    Washington helped to focus public attention on the problem of black
    poverty.

    At least as important as the shifting focus of civil rights leaders were
    the ghetto riots themselves. Poor blacks, for so long invisible to most of
    white America, made their presence known in the most dramatic way
    possible. During the summer of 1964 riots broke out in Harlem,
    Rochester, Chicago, Philadelphia, and New Jersey. Five lives were lost
    and property damage was estimated at six million dollars (Brooks 1974,
    239). Civil rights leaders attempted to respond to these disturbances, but
    much of their attention, and the rest of the country’s as well, was still
    focused on the South. The Voting Rights Act had been passed, but much
    work remained in actually registering black voters. Mississippi, in partic-
    ular, had been staunchly resisting blacks’ efforts to vote.

    To press for voting rights in Mississippi, the leading civil rights orga-
    nizations united to mobilize local blacks and out-of-state volunteers for
    the Freedom Summer of 1964. Nine hundred volunteers, many of them
    white college students from the country’s elite universities, joined the
    effort to register Mississippi’s blacks. White Mississippi responded with
    violence. Twenty-seven black churches were burned that summer in Mis-
    sissippi, and 30 blacks were murdered between January and August 1964
    (Brooks 1974, 245). But the nation’s attention was grabbed by the murder
    of three young civil rights workers, James Chaney, Andrew Goodman,
    and Michael Schwerner, the ‹rst a black Mississippian, the other two
    white New Yorkers. The three disappeared while returning from an
    investigation of the burned-out Mt. Zion Methodist Church in Neshoba
    County, Mississippi. Only after a six-week search by the FBI were their
    bodies found, buried in an earthen dam.

    Despite the riots, news coverage of race relations during the summer

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    of 1964 was dominated by the events in Mississippi. But in the next few
    years, ghetto uprisings and the militant voices of Malcolm X, Stokely
    Carmichael, and the Black Panthers would become increasingly central
    ‹xtures in the struggle for racial equality. In August 1965, the Los Ange-
    les neighborhood of Watts exploded. A six-day riot left 34 people dead
    (all but 3 of them black), 900 injured, and nearly 4,000 arrested (Sitkoff
    1993, 187). The Watts riots were followed that summer by more distur-
    bances in Chicago, and in Spring‹eld, Massachusetts. The summers of
    1966 and 1967 saw even more rioting, as blacks took to the streets in lit-
    erally dozens of American cities. In 1967 alone, rioting led to at least 90
    deaths, more than 4,000 injuries, and nearly 17,000 arrests (Sitkoff 1993,
    189).

    Portrayals of Poverty in the News Media

    It is clear that the black poor were ignored by white Americans through
    most of our history, including the ‹rst two-thirds of the twentieth cen-
    tury, and equally clear that blacks now ‹gure prominently in public per-
    ceptions of the poor. Unfortunately, pollsters did not think to ask about
    perceptions of the racial composition of the poor until recently. But we
    can examine changes in the way the poor have been portrayed in the
    mass media. While we cannot assume that media portrayals necessarily
    re›ect popular beliefs, changing images of the poor in the news can tell us
    both how news professionals thought about the poor during different
    time periods, and what sort of images of poverty the public was being
    exposed to through the mass media. Since we have good reason to think
    that media portrayals have a strong impact on public perceptions (see
    below), news images provide at least some evidence of how the American
    public viewed the poor. At the very least, media coverage will tell us
    something about the aspects of poverty (or the subgroups of the poor)
    that played a prominent role in public discussion of these issues during
    different periods.

    To assess changes in news media portrayals of poverty, I examined
    three weekly newsmagazines: Time, Newsweek, and U.S. News and
    World Report. I chose these magazines because they are widely read,
    national in scope and distribution, and have been published continuously
    for many decades. They also contain large numbers of pictures, an espe-
    cially important consideration in studying the racial portrayal of the
    poor. To the extent that our interest lies in the perceptions of the racial

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    Sanford F. Schram, Joe Soss, and Richard C. Fording, Editors
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    The University of Michigan Press, 2003

    composition of the poor that magazine readers are likely to form, the pic-
    tures of poor people are far more in›uential than the textual information
    these magazines contain. First, the typical reader of these magazines
    looks at most, if not all, of the pictures, but reads far fewer of the stories.
    Thus, even a subscriber who does not bother to read a particular story on
    poverty is quite likely to see the pictures of poor people that it contains
    (Kenney 1992). Second, while speci‹c information about the racial
    makeup of the poor is found periodically in these newsmagazines, such
    information is quite rare. Between 1960 and 1990, less than 5 percent of
    poverty-related stories had any concrete information on the racial com-
    position of the poor, or any subgroups of the poor such as AFDC recipi-
    ents or public housing tenants.6 Finally, research on the impact of news
    stories and the process by which readers (or television viewers) assimilate
    information suggests that people are more likely to remember pictures
    than words, and more likely to form impressions based on examples of
    speci‹c individuals than on abstract statistical information.7

    To assess media portrayals of poverty, I ‹rst identi‹ed every poverty-
    related story in these three magazines published between 1950 and 1992.
    Using the Readers’ Guide to Periodical Literature, a set of core topics,
    including “poor,” “poverty,” “welfare,” and “relief,” were developed. In
    each year, stories indexed under these topics as well as cross-references to
    related topics were collected. In all, 1,256 stories were found under 73 dif-
    ferent index topics. (See Gilens 1999 for details of the topics and number
    of stories indexed under each.) It is important to note that the stories
    selected for this analysis were only those that focused directly on poverty
    or related topics. Many stories with a primary focus on race relations,
    civil rights, urban riots, or other racial topics also included discussions of
    poverty, but in these contexts readers would expect to ‹nd coverage of
    black poverty in particular, and might not draw conclusions about the
    nature of American poverty in general. By excluding race-related stories,
    however, this analysis provides a conservative estimate of the extent to
    which African Americans populate media images of the poor.

    To determine the racial content of news magazine coverage of
    poverty, each poor person pictured in each of these stories was identi‹ed
    as black, nonblack, or undeterminable. In all, there were pictures of 6,117
    individual poor people among the 1,256 poverty stories, and of these race
    could be determined for 4,388, or 72 percent (poor people for whom race
    could not be determined are excluded from the results reported below).8

    The percentage of blacks among pictures of the poor was similar at each
    magazine, ranging from a low of 52 percent at U.S. News and World

    how the poor became black

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    The University of Michigan Press, 2003

    Report to a high of about 57 percent at Time.9 Combining the coverage
    of poverty from the three magazines, over half (53.4 percent) of all poor
    people pictured during these four-and-a-half decades were African Amer-
    ican. In reality, the average percentage of African Americans among the
    poor during this period was 29.3 percent.10

    Magazine portrayals overrepresent African Americans in pictures of
    the poor, but the degree of overrepresentation of blacks was not constant
    throughout this period. The thick line in ‹gure 4.2 shows the variation in
    the percentage of African Americans pictured in poverty stories in Time,
    Newsweek and U.S. News and World Report between 1950 and 1992.
    (Adjacent years with small numbers of poverty stories are combined to
    smooth out the random ›uctuations that result when the percentage of
    blacks is calculated from a small number of pictures.) Images of poverty
    in these magazines changed quite dramatically in the mid-1960s. From the
    beginning of this study through 1964, poor people were portrayed as pre-
    dominantly white. But starting in 1965 the complexion of the poor turned
    decidedly darker. From only 27 percent in 1964, the proportion of African
    Americans in pictures of the poor increased to 49 percent and 53 percent
    in 1965 and 1966, and then to 72 percent black in 1967. Nor did the por-
    trayal of the poor return to its previous predominantly white orientation.
    Although there have been important declines and ›uctuations in the
    extent to which blacks were overrepresented in pictures of poverty
    (which we’ll explore shortly), African Americans have dominated news
    media images of the poor since the late 1960s. In the period between 1967
    and 1992, blacks averaged 57 percent of the poor people pictured in these
    three magazines.

    Early Newsmagazine Coverage of Poverty: 1950–64

    The 1950s contained both few stories on poverty and few pictures of
    blacks in the stories that were published. Between 1950 and 1959, only 18
    percent of the poor people pictured in these magazines were African
    American. The increased attention to poverty in the early 1960s was
    accompanied by some increase in the proportion of blacks among the
    poor, but this racialization of poverty images was quite modest com-
    pared with what was to come.

    Newsmagazine coverage of poverty was generally rather sparse
    between 1960 and 1963. The poverty stories that did appear during this
    period were primarily in response to the Kennedy administration’s
    antipoverty initiatives, which included a new housing bill, the revival of

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    The University of Michigan Press, 2003

    the depression-era food stamp program, and federal aid for distressed
    areas. These policy-focused stories were illustrated almost exclusively
    with pictures of poor whites.

    A second theme in media coverage of poverty during 1960–63 was
    welfare abuse and efforts to reduce it. Some of these stories focused on
    Senator Robert Byrd’s 1962 investigation into welfare fraud in Washing-
    ton, D.C. Pictures of poor blacks and poor whites were both found in
    these strongly antiwelfare stories.

    Newsmagazine coverage of poverty in the early 1960s presaged later
    coverage in two ways. First, stories on new policy initiatives tended to be
    both neutral in tone and dominated by images of whites, a pattern that
    was repeated in coverage of the Johnson administration’s War on
    Poverty three years later. In contrast, the more critical stories about exist-
    ing programs, such as reports on the Byrd committee’s investigation of
    welfare abuse, were more likely to contain pictures of blacks. Once
    again, this pattern is repeated in the later 1960s as largely negative “‹eld
    reports” from the War on Poverty programs start to appear in the media.

    The quantity of poverty coverage in the news expanded dramatically
    beginning in 1964 and reached its height between 1965 and 1969. The
    impetus for this growth in coverage was the Johnson administration’s
    War on Poverty, announced in January 1964. Almost four-‹fths of all
    poverty-related stories published in 1964 dealt explicitly with the War on

    how the poor became black

    111

    Fig. 4.2. Percentage African Americans in newsmagazine pictures of the poor,
    1950–92, compared with true percentage

    Race and the Politics of Welfare Reform
    Sanford F. Schram, Joe Soss, and Richard C. Fording, Editors
    http://www.press.umich.edu/titleDetailDesc.do?id=11932
    The University of Michigan Press, 2003

    Poverty, as did a majority of the poverty-related articles appearing in
    1965 and 1966. By 1967, stories about urban problems and urban redevel-
    opment became an important component of poverty coverage, but stories
    on welfare, jobs programs, and other aspects of the War on Poverty con-
    tinued to account for most of the poverty-related news coverage.

    For our purposes, the most signi‹cant feature of news stories on
    poverty in 1964 was the strong focus on the War on Poverty on the one
    hand, and the continued portrayal of the poor as predominantly white. A
    good example of this overall tendency is the most substantial poverty
    story of the year, a 12-page cover story called “Poverty, U.S.A.” that
    Newsweek ran on February 17. The cover of the magazine showed a
    white girl, perhaps eight or ten years old, looking out at the reader from
    a rustic shack, her hair disheveled and her face covered with dirt. As this
    picture suggests, the story had a strong focus on Appalachia, but it
    pro‹led a variety of poor people from around the country. Of the 54 poor
    people pictured in this story, only 14 were black.11

    This story was typical of War on Poverty coverage during 1964 in its
    substantial focus on rural poverty, in its emphasis on images of poor
    whites, and in its generally neutral tone. Like this story, most of the early
    coverage of the War on Poverty consisted of descriptions of its programs,
    pro‹les of Johnson’s “poverty warriors,” and accounts of poverty in
    America, most often illustrated with examples of individual poor people.
    Clearly, the expansion of news coverage that accompanied the War on
    Poverty did not coincide with the racialization of poverty images. At its
    inception at least, the War on Poverty was not portrayed by the news
    media as a program for blacks.

    The Racialization of Poverty in the News: 1965–67

    The year 1965 saw another large jump in media attention to poverty, and
    a clear turning point in the racialization of poverty images in the news.
    The percentage of blacks among pictures of the poor jumped from 27 per-
    cent in 1964 to 49 percent in 1965. One factor that clearly does not explain
    the racialization of poverty in the news during this period is true change
    in the proportion of blacks among the poor. As the thin line in ‹gure 4.2
    shows, the true percentage of blacks among the poor increased only mar-
    ginally between the early and late 1960s (from 27 percent to 30 percent),
    while the percentage of blacks found in news magazine portrayals of the
    poor more than doubled during this period.

    Nor can the dramatic change in the racial portrayal of poverty be

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    Sanford F. Schram, Joe Soss, and Richard C. Fording, Editors
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    The University of Michigan Press, 2003

    attributed to a broader increase in the representation of African Ameri-
    cans in the news. It is true that the proportion of black faces in the major
    weekly newsmagazines increased steadily from only 1.3 percent in the
    1950s to 7.2 percent in the 1980s (Lester and Smith 1990).12 But a close
    look at the mid-1960s shows no evidence of a sudden shift in the overall
    racial mix of newsmagazine photographs. In fact, the overall proportion
    of African Americans among people pictured in Time and Newsweek
    actually declined slightly between 1964 and 1965.13

    response

    (Harry)Dante’s Inferno is the first of the three-part epic poem, Divine Comedy, written by Dante Alighieri. The Inferno depicts Dante’s journey through Hell, accompanied and guided by the ancient Roman poet Virgil. In his poem, Dante describes Hell’s topography consisting of nine circles, each representing the seriousness of the sin committed by its offenders, these sins are categorized (by the Catholic Church), grouped, and commonly known as the nine deadly sins. Each level of Hell represent places of torment where the first level is home to less serious offenders, and increase in severity in each circle. As they go deeper into each level, our characters, Dante and Virgil encounter offenders within each ring of hell who have committed more serious offenses and the sins are more egregious. We find that the lowest part of hell houses the betrayers, and punishment here is more severe. Punishment in the poem is handed out in a poetic justice fashion Dante calls contrapasso. In this last (deepest) level or ring of Hell the betrayers of Julius Caesar: Brutus and Cassius are prime tenants, along with Judas, who had betrayed Jesus.

    As I read this poem, I can agree with how Hell was organized, and as it sits currently, those guilty of child sexual abuse could reside along with those who are being tortured in the second circle: Lust. But Dante seemed to portray these sins as less severe. But personally, I think that those guilty of committing child sexual abuse  should be in the ninth circle of Hell, along with those committing treachery because what is child sexual abuse if not treachery! It is treacherous against the innocent children, who fall betrayed by those who they must respect and obey (adults or those older then they), it is an act of treason to the victim who may have trusted the person committing such a heinous act. But after much contemplation, I still cannot agree with this placement. Child sexual abuse and child sexual assault is, in a very real way, equal to those types of betrayals. The innocence of a child makes those crimes so bad that I feel so uncomfortable writing about. As defined on their website, child sexual abuse includes: any sexual act between an adult and a minor, or between two minors, when one exerts power over the other, forcing, coercing or persuading a child to engage in any type of sexual act, non-contact acts such as exhibitionism, exposure to pornography, voyeurism, and communicating in a sexual manner by phone or Internet. In Dante’s world, those guilty of child sexual assault are far more wicked than those guilty of other sexual sins, and even worse than those guilty of aberrant sexual behavior (as it was understood at the time). Therefore, these sinners would have their very own special place below the ninth circle.

    For sinners tormented in the tenth circle, the torture must be as gruesome as the act committed by the sinners. For someone who has committed such a abominable act as is child sexual abuse, assault, and/or rape would suffer eternally having to be flash frozen to the point where every member of there body is about to fall off, but only to be flash-burned alive, to the point of almost dying, but yet their flesh be medium-rare.  They would have to cut off their sexual members and be force-fed them, over and over again; and all while watching innocent children play. Not that we would be trying to rehabilitate them, but they would learn to associate their lust for innocent children with unconscionable pain, as they inflicted on their victims. As described by Gaby Hinsliff in her article, victims of child sexual abuse are often times shaped by the act committed against them and the effects and usually deal with these symptoms for the rest of their lives. Victims of the aforementioned abuse may display a wide range of emotional and mental disorders, and are likely prone to have a pervasive and negative belief of themselves. It is now commonly believed they suffer from a complex form of post-traumatic stress disorder (PTSD) which keeps them from effectively understanding and managing their feelings, trusting people, and many feelings of guild, and inadequacy; all of this holding them back from living a fruitful life. Over 40% of victims having issues with relationships and specifically intimacy (Hinsliff).

    Many of the victims perceive the abuse as punishment, so it would be fitting that the ones to supervise and/or deal out the punishment should be their victims. The punishment described above would only be part 1 of a series of torture the perpetrators of such evil acts would have to endure. For the next series of the punishment, the victims of the perpetrators would perpetrate their own form of torture (justice). As soon as the sinners were done with part one of being forced-fed their sexual organs, Satan would have them healed and present them with their victims, and as soon as they make eye contact, a meat grinder would be placed in their pubic area. I personally have not had to endure this type of abuse, but I have a few acquaintances that are still attempting to recover from such atrocities.

     

    Works Cited

    “Child Sexual Abuse Statistics – Darkness to Light.” Darkness2Light.Com, Darkness2Light, https://www.d2l.org/wp-content/uploads/2017/01/all_statistics_20150619.pdf.

    Hinsliff, Gaby. “’It Never Stops Shaping You’: The Legacy of Child Sexual Abuse – and How to Survive It.” The Guardian, Guardian News and Media, 28 June 2018, https://www.theguardian.com/uk-news/2018/jun/28/it-never-stops-shaping-you-the-legacy-of-child-sexual-abuse-and-how-to-survive-it.

    “The Project Gutenberg eBook of the divine comedy, hell, by Dante Alighieri.” www.gutenberg.org/files/1001/1001-h/1001-h.htm.

    response

    Part One

    Select an interest group from 
    the List of National Interest Groups (Links to an external site.)
     website.

    Part Two

    In a short paper, please answer the following five questions:

    1. What is the purpose of this organization?  

    2. Does this group primarily support one party, or do they endorse candidates from both major parties? Make sure to cite examples from the website under the endorsements and positions tabs to provide evidence for your claims.

    3. You can find a link to the group’s official website in the upper left-hand side of the group’s page in the database. Peruse the website, and to the best of your ability, explain the prototypical group member (e.g. the member’s occupation, the member’s gender, the member’s partisanship, etc.)

    4. Do members receive any specific benefits from joining the group? If you cannot find evidence of this on the website, just mention that you are unable to find information about benefits.

    5. Explain how the concepts from this week’s lesson and assigned reading apply to this particular group.

    Formatting

    1. Save your paper as: LASTNAME_FIRSTNAME PLSC1

    2. The paper should be 1-2 double-spaced pages using Times New Roman font. One inch margins should be used.

    3. Submit to the relevant assignment submission box as a Word Document (doc or docx).

    Response

     discuss the condition encompassing clinical experiences and critique the post.  

    • Length: A minimum of 180 words per post, not including references
    • Citations: At least one high-level scholarly reference in APA per post from within the last 5 years
    • 12

    response

    Number 1 post: WR

      For novice Advanced Practice Registered Nurses, utilizing a structured higher order thinking process to determine all the differential diagnosis possibilities seems critical, or at least until one has enough experience that the process is ingrained. The process of determining differential diagnosis leads the practitioner towards formulating an accurate conclusion about how to diagnose when the symptoms of multiple conditions are present concurrently. The process of narrowing down the possibilities can be overwhelming depending on the situation. Research may yield hundreds of articles spanning decades.

    Using a combination of processes and strategies in determining the differential diagnosis will improve efficiencies, timeliness, patient safety, and treatment effectiveness. The APRN shall perform a physical examination, produce a list of possible interim differential diagnoses, conduct diagnostic tests, and/or refer to specialty providers. There are benefits to performing the physical examination and obtaining a health history. These activities will generate a more comprehensive list of symptoms and physical findings. In urgent situations, this may not be feasible and counterproductive in life threatening situations. The test results will help to confirm provisional differential diagnoses and possibly uncover conditions that were not previously considered. Diagnostic tests and interventions require time, access, money, and insurance coverage, and in some cases pose health risks to the patient.

    It is an expectation that the practitioner continuously evaluates when and if sufficient data is available to make a formal diagnosis, and to ensure the benefits of testing outweigh the risks to the patient. The provider may also send the patient out for a referral as part of the process when he/she has exhausted all of the possibilities in their scope of knowledge/experience. One provider is quoted as saying “I am far more concerned about doing too little than doing too much. It’s the scan, the test, the operation that I should have done that sticks with me—sometimes for years” (Balogh, Miller, & Ball, 2015).

    Number 2 post: PG

    It is intriguing to come to a hospital setting with multiple symptoms of a disorder or condition one may encounter without knowing what is going on in the body. For example, many individuals may experience a headache or stomach ache, which could cause the symptoms one is experiencing. As healthcare providers, one must determine the logical cause of the disease or disorder to make a differential diagnosis due to similar symptoms associated with many conditions. The purpose of this discussion is to explore Differentiate Diagnosis (DD) and three types of differential diagnosis strategies used in the clinical setting. The three types are 1) inductive reasoning, 2) deductive reasoning, and 3) clinical reasoning. Furthermore, the risks and benefits of the three types of DD processes are discussed.

    Jain (2017) mentioned differential diagnosis as making a list of possible diseases to help guide one in looking for the condition in the patient. Cadet et al. (2019) informed the differential diagnosis includes a thorough workup for the arrival of the diagnosis. Gheorghiu and Barkley (2017) indicated that nurses should know associated risks with the assessment and history in the diagnosis. For example, heart failure or kidney failure may be diagnosed with diabetes. Nonetheless, Dlugasch and Story (2021) discussed that differential diagnosis is essential and that a multidisciplinary approach is beneficial in the treatment plan of care. Health history, interviews, effective communication, physical assessment, screenings, lab tests, biopsies, radiology, ultrasounds, scans, or blood work helps guide the diagnosis (Dlugasch & Story, 2021). Moreover, if an essential element is left out, an individual may not be diagnosed correctly (Cadet et al., 2019)

    A healthcare provider may use strategies including deductive, inductive, or clinical reasoning to arrive at a diagnosis (Reinoso et al., 2018). Deductive reasoning involves starting with the general input and moving toward the specific diagnosis (Reinoso et al., 2018). However, this may cause problems because the hypothesis begins early, as the chief complaint, and the information gathered is tested against the idea (Reinoso et al., 2018). On the other hand, in inductive reasoning, the health provider may start with the specific and move toward the general. Moreover, the reason starts with input from observations that matches a set pattern or an algorithm to confirm the hypothesis (Reinoso et al., 2018). Reinoso et al. (2018) mentioned this type of reasoning tool might be helpful with expert-derived algorithms related to statistically essential cases. However, a disadvantage to this type of reasoning could be that it may be somewhat confusing to novice Advanced Practices Nurses (Reinoso et al., 2018). Finally, in clinical reasoning, the health care provider critically thinks through the symptoms, lab tests, or presentations to arrive at a diagnosis (Reinoso et al., 2018). However, the problem with clinical reasoning per Reinoso et al. (2018) is that one may confuse clinical reasoning with clinical decision making (slightly differently).

    In closing, the differential diagnosis may involve the presentation of familiar diseases or disorders. Therefore, healthcare providers like Advanced Practice Nurses should follow an orderly strategy in determining the differential diagnosis. Methods may include interviewing the client, effective communication, health history, physical exam, labs, blood work, biopsies, scans, x-rays, and collaboration with other experts in determining the differential diagnosis and treatment plan. Also, deductive, inductive, and clinical reasoning may be helpful avenues in selecting a differential diagnosis.

    Number 3 post: JL

    The function of cells affects the way our body operates, and any alterations or dysfunctions cause disease manifestation and progression. Cells are the building blocks of our body that form organs, tissues, and organ systems (Dlugasch & Story, 2021). Cells group together to form tissues which then form together to produce organs and then communicate to develop organ systems. Their communication and purpose are vital to their survival. Basic cell components include the cell membrane, cytoplasm, and organelles (including the nucleus) which each play a part in the structure and function of each cell (Dlugasch & Story, 2021). The cytoplasm is the liquid portion of the cell that supports the organelles and where the work transpires. Organelles are responsible for the work that maintains life. The nucleus is considered the control center containing genetic information and is responsible for regulating growth, metabolism, and reproduction (Dlugasch & Story, 2021). The cell membrane is the fatty layer around the cell that serves as a boundary that is semipermeable. The human body functions, reproduces, exchanges material, and thrives because of cells.

    Case Study Wk1-15-year-old male presents after ingestion of windshield wiper fluid

    Windshield wiper fluid becomes toxic when ingested due to its composition of ethylene glycol which is an alcohol that is colorless, odorless, and sweet. The toxicity of this alcohol is mediated by its metabolites, glycolic acid, and oxalate (Ahmed et al., 2020). Ethylene glycol is absorbed through the gastrointestinal tract rapidly after ingestion with serum concentrations peaking soon after consumption (Iqbal et al., 2021). Neurological and gastrointestinal symptoms manifest early while renal failure and death occur if not treated promptly. Ethylene glycol poisoning causes a high anion gap, metabolic acidosis, and an elevated osmolal gap but in some cases the osmolal gap is almost normal which can delay treatment and diagnosis (Ahmed et al., 2020). Some patients present with cognitive deficits and unremarkable physical signs. Ethylene glycol levels are send out labs so a thorough history if available and extensive in-house labs are essential to initial treatment and detection. Unfortunately, providers must use overall suspicion of ingestion as a cause for preliminary treatment and diagnosis due to uncorrelated lab values and findings. An elevated osmalal gap of more than 10mOSm/kg indicates the presence of solutes in the serum which suggests toxic alcohols (Ahmed et al., 2020). Often, the anion gap is normal but the osmolal gap is high, but as ethylene glycol is metabolized the accumulation of toxic acids leads to an increase in anion gap and a decrease in osmolal gap (Sugunaraj et al., 2017). Hypernatremia exists due to the increased osmolal gap and systemic acidosis, causing high sodium levels, which is treated with sodium bicarbonate. Ethylene glycol is first oxidized by alcohol dehydrogenase and then to glycolaldehyde, which is then oxidized by aldehyde dehydrogenase to glycolic acid, which is the primary cause for the associated metabolic acidosis (Iqbal et al., 2021). Early detection and treatment coupled with extensive diagnostic studies are essential to reverse the effects of ingesting this toxic alcohol.

     

    Number 4 post: RV

    Part 1- Cellular Biology

    The basic configuration of all living things is what we called, cells. The human body is composed of trillions of cells. Moreover, they provide structure for the body, take nutrients from food, convert them into energy, and carry out specialized functions. Cell morphology is the division of science dealing and allocating with the cell’s structure and is elemental in recognizing cells’ size, shape, design, and form. Cells are the most straightforward and vital unit of all living/biological organisms. In biology, cell morphology relates to the morphological structures of the cell(s) and associates the underlying context of this basic unit of life.

    Additionally, it employs microscopy to classify the shape, pattern, structure, form, color, texture, and size (Cell morphology. Bruker, 2021). For instance, cell morphology pertains to the shape of bacteria if cocci, bacilli, spiral, and the size of bacteria. It is essential to determine cell morphology in bacterial taxonomy and grouping.

     

    There are three categories in cell morphology: fibroblastic, epithelial-like cells, and lymphoblast-like cells. Fibroblastic cells have elongated in shapes, epithelial-lie cells are polygonal in form with more regular dimensions, and lymphoblast-like cells are spherical (Cell morphology. Thermo Fisher Scientific – U.S., n.d.). Morphological characteristics play an essential key role in identifying and diagnosing cancer cells. Morphological analysis may be helpful to screen cancer cell populations and stem cells (Prasad & Alizadeh, 2018). For instance, normal cells have regular, ellipsoid shapes, while cancer cells are often irregular and contoured. One of the most critical structures in a cell is the nucleus. The nucleus is a cell’s center and is the unique organelle found in a eukaryotic cell. It is where almost all DNA replication and RNA synthesis occurs (U.S. National Library of Medicine, 2021). Likewise, cell morphology is also essential in cell motility and ultimately tumor invasiveness.

     

    CASE STUDY: A 72-year-old male presents with a reduced ejection fraction, D/T left ventricular hypertrophy.

    Left ventricular hypertrophy (LVT) means that the heart’s main pump (left ventricle) has become thick and enlarged. The heart muscle may not get sufficient oxygen supply, and the heart could not pump enough as it supposed to be (Kosaraju et al., 2021). High blood pressure or other heart problems such as cardiomyopathy or aortic valve stenosis are typically affected by high blood pressure.

     

    Cellular adaptation refers to transformations constructed by a cell in response to adverse environmental changes. Its reversible reactions allow cells to survive and continue to function adequately. Hypertrophy is an increase in cell size. Therefore, if enough cells in organ atrophy, the entire organ will decrease in size.

     

    Cell death happens physiology in the form of apoptosis or pathologically in the states of necrosis if the cell cannot adapt to the adverse environmental changes (Cellular changes and adaptive responses – knowledge @ amboss. ambossIcon, n.d.). Pathologic hypertrophy is due to increased workload and is in cardiac muscle because of hypertension. Unlike most other cells in the body, heart muscle cells don’t divide. Additionally, many adult cells can’t divide, the body can’t replace lost cells, which causes disease (ScienceDaily, 2018).

     

    Atrophy– occurs due to tissue degeneration caused by decreased work demands on the cell—a decrease in protein synthesis and cell content. Hypertrophy– occurs when cells increase in tissue size (not the number) via enlargement of cells, leading to an increase in the affected organ size. Hyperplasia– An increase in the number of cells (not the size of the cells), increased tissue mass, prominent to the rise in the affected organ/tissue size. Dysplasia, also called atypical hyperplasia, occurs when cells transform into disordered growth of cells of a different size, shape, and appearance. Severe dysplasia often becomes irreversible and develops into a carcinoma site. Metaplasia– occurs when another less mature cell type replaces one adult cell. For example, due to a Vitamin A deficiency (Dlugash & Story, 2021).

     

    Response

    Write a 750-800 word Response to Perceived Discrimination” (Poyrazil & Lopez, 2017)

    ** I upload the reading file.

    • a month ago
    • 12

    Response

    Directions: provide responses to the two sections below. each response 1-2 pages in length (not including the information already present in this document which is approximately 1 page). You are expected to support your assertions, ideas, or opinions with at least two scholarly or professional resources where appropriate using current APA style and formatting.

    Section I: Leadership and Collaboration Experience

    Briefly describe an instance where you were required to lead and motivate a team of professionals to collaborate. It does not need to be in a health care setting. If you have not lead a team of professionals before, use a different example.

    Next, analyze your approach to the challenge using specific examples. It is not important whether or not your efforts were successful. What is important is the approach you take to appraising your leadership and collaboration decisions and actions. Do the following:

    Analyze your leadership of the project. Consider the following:

    · What was the purpose or shared vision of the team?

    · The effectiveness of your leadership approach and style. Did you get “buy in” from stakeholders?

    · Decision making processes and outcomes? What were your good decisions? What would you have done differently?

    · How did you communication your vision, values, decisions, information, et cetera?

    Analyze your approach to fostering collaboration and motivation among stakeholders. Consider:

    · How well you facilitated member or participant collaboration and engagement with one another. Did participants communicate effectively?

    · Actions you took to motivate people to realize your vision or tactics. Did the team or participants feel motivated and energized by you? Why or why not?

    Response

     discuss the condition encompassing clinical experiences and critique the post.  

    • Length: A minimum of 150 words per post, not including references
    • Citations: At least one high-level scholarly reference in APA per post from within the last 5 years
    • 12

    Response

    Response 1 Assignment

    Due: September 26

    Length: 500-750 words (2-3 double spaced pages)

    In this second formal writing assignment, you will write a reasoned and objective response to one of the essays we have worked with (NOT TANNEN). This does not mean saying, “This is not my experience, so it is not true.” In fact, at no time should you reference your own life. Instead, your response should take one of two paths: exploring how the essay has transformed your understanding of theand using the ideas as a lens for understanding something OR complicating the argument by offering conflicting evidence, uncovering assumptions, or explaining the limitations of the article.

    One is affirming, i.e. generally favorable to an argument or idea, and includes taking an idea/claim and using it to understand something else. If there is something in one of the essays that sparked an “ah-ha!” moment for you, work with that for a moment. For example, I noted that you could use Tannen’s idea of “marked” to think about other things people can’t control, but which mark them in some way – e.g. use of language or disability. Is there some connection you can make between one of the essay’s claims or main ideas and the world outside the text? Similarly, and also a “lens” type response is to expand on the argument. That does NOT mean just give more evidence for what he’s already proven. It is rather to take his ideas another step. So for instance, Carr claims tech is changing our thinking and we see this in our reading habits. Do we also see this in our communication habits or use of language?

    The other path is more critical – i.e. generally not favorable to an argument or idea, and includes uncovering assumptions in a writer’s thinking or limitations to their argument. When you brainstorm for your response, you should find weak points in the argument, a part that doesn’t make complete sense or seems wrong for some reason. Such places are the easiest to enter into a critical conversation with the author about the subject of his or her article.Very few well-reasoned responses are of the simply “yes, this is true” or “no, this is completely false” type. Rather, your response should focus on pointing out things that the author might have missed, questioning an unstated assumption or bias, or developing a point the author makes but spends little time on. For example, Tannen suggests that men have the option to be unmarked in their lives, and she gives a lot of good examples. However, not all men have the option to be unmarked – some men are black, or indiginous, or disabled, or fill in the blank. While it is true that men often do have the ability to be unmarked, Tannen’s argument doesn’t account for how gender intersects with race and other visible marking factors.

    You will need to showcase the distinction between claims and evidence in order to write an analytical response; your response should focus on the claims of the argument. You can’t really argue with good evidence, but you can argue with assumptions and claims.

    You will need to have a works cited page at the end of your paper. At this point in the semester, you don’t need to worry overmuch about the precise formatting of your works cited page although this would be an excellent time to practice MLA formatting. If you use internal quotes in your response, you will need to place the page number of the quotation or paraphrase in parenthesis, e.g. (140).

    General Anatomy of a Response

    Introduction: give larger context for the argument, introduce the text and authors and their main claim. Your thesis is your response. Try using a dependent clause construction to get a good structure. Example: Although Tannen shows that all women are marked in some way, her suggestion that men always have a choice doesn’t consider other ways people are marked. OR Example: Tannen’s concept of being marked is not only useful for understanding gender norms, it is also really helpful to explain how people’s accents also mark them in public.

    Body paragraph 1: a brief summary of the main points of the essay you are responding to

    Body paragraph 2-??: Follow your thesis. What do you need to explain to make that an “explained statement’? Do that.

    Conclusion: If you have been overly critical, don’t forget to acknowledge how the argument does work even as it has limitations. If you have done a lens, be sure to wrap yourself back around to Tannen’s main argument. Take a moment to acknowledge the “so what?” question – why does anyone care about this? What is at stake in this discussion?

    Criteria for Evaluation:

    • Identification of the author/title of essay, major point, and significance of topic

    • Ability to summarize/paraphrase the points/claims of the essay as needed

    • Ability to respond constructively to one or more points in the essay

    • Understanding of the difference between claim and evidence

    • Ability to respond to a claim and link the response to the larger argument (the so what question)

    • Proper paragraph structure

    • Use of proper mechanics (grammar, punctuation, syntax)

    Response

    discuss the condition encompassing clinical experiences and critique the post

    • Length: A minimum of 180 words per post, not including references
    • Citations: At least one high-level scholarly reference in APA per post from within the last 5 years
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    Response

    Anatomy
    of a

    Response

    Paging Dr Barlow

    Steps and Structure

    The Assignment

    Remember to check with

    the assignment for details.

    Always default to the

    specifications there.

    The Text, Claim, and Type

    If you have a choice of texts for

    your response, you should decide

    which to work with.

    Within the text, you should also

    choose the claim to think about.

    You also need to choose a

    response type.

    Objectively

    Once you know what you are writing

    about, it’s time to think about your

    response.

    Form one to two sentences that

    sum up your response.

    The Paper

    Based on your response, plan a

    paper that backs up your points.

    Anatomy of a Response

    Paging Dr Barlow

    Know Choose Think Plan

    The Assignment

    Remember to check with

    the assignment for details.

    Always default to the

    specifications there.

    The Text, Claim, and Type

    If you have a choice of texts for

    your response, you should decide

    which to work with.

    Within the text, you should also

    choose the claim to think about.

    You also need to choose a

    response type.

    Objectively

    Once you know what you are writing

    about, it’s time to think about your

    response.

    Form one to two sentences that

    sum up your response.

    The Paper

    Based on your response, plan a

    paper that backs up your points.

    Anatomy of a Response

    Paging Dr Barlow

    Know Choose Think Plan

    Forming a Response
    What is it you are trying to say about the text?

    Are you affirming, critiquing, evaluating?

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    Forming a Thesis

    The concept of X is
    useful as Author

    demonstrates, but it
    also helps explain Y.
    Although concept X
    helps us think about
    Y, it can also be used

    to evaluate Z.

    Affirming Types

    Although X is true
    in some ways, it

    doesn’t take Y into
    account.

    Author’s argument
    assumes X to be

    true. However, if X
    is not true, Y.

    Critical Types

    Anatomy Breakdown

    Introduction: Identify the text you are responding to,
    end with thesis

    Paragraph 2: A brief summary of the text/claim
    Body Paragraphs: Back up your claim –

    what do you need to say/prove to make your point?
    Conclusion: Culminate your response

    Address the “so what” question

    Anatomy Breakdown

    Introduction:
    Identify the text you are responding to

    End with your thesis

    Anatomy Breakdown

    Paragraph 2:
    A brief summary of the text/claim

    Don’t include the full summary.

    Focus on the parts you are dealing with.

    Anatomy Breakdown

    Body Paragraphs:

    Back up your claim.

    What do you need to say/prove to make your point?

    Anatomy Breakdown
    Conclusion:

    Culminate your response

    Finalize your evaluation

    Address the “so what” question

    Do not repeat yourself.

    Each details means

    something about the person.

    There is no “norm”.

    How someone uses language

    – correctly or not, with certain

    idioms, certain accents –

    marks a person.

    An invisible disability is one

    that is not obvious to others.

    Their needs (because

    invisible) mark them.

    Women Language Use Invisible Disability

    Using an Idea as a Lens
    The concept of marked

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    In a racially homogenous

    environment, all men have the

    option of being unmarked,

    but if one person is black and

    others are white….

    How someone uses language

    – correctly or not, with certain

    idioms, certain accents –

    marks a person regardless of

    sex.

    A man in a wheelchair, using

    a cane, or needing any help is

    judged by others.

    In fact, it might even be

    worse for men.

    Race Language Use Disability

    Exploring Limitations
    Men have the option of being unmarked.

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    Response

    Exploring
    Limitations

    Paging Dr Barlow

    An Objective-Critical Response

    Achtung!

    You cannot adequately respond without a

    good understanding of the text!

    Review Reading With Renee – Close Reading

    and Summary Writing

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    Semi-Objective

    You evaluate an argument

    based on a set of criteria or

    metrics.

    You determine the criteria.

    You explain the criteria.

    You evaluate the argument.

    Semi to Objective

    You contextualize an argument or

    compare it to other experts or

    writers, and then usually evaluate it.

    You find context/comparisons.

    You compare/contrast.

    (Usually) you evaluate based on that

    comparison.

    Objective-Creative

    You take a main idea of claim from

    the essay and apply it to another

    subject or topic.

    You select a claim or idea that is

    interesting or transferable.

    You apply that idea to something

    else.

    You show how this idea is relevant

    outside of the boundaries of the

    original argument.

    Objective-Critical

    You define limits to an author’s

    argument or uncover

    assumptions, and show how that

    hurts their argument.

    You evaluate an argument for

    limitations in scope.

    You explain how the limitation

    hurts the “big argument”.

    Ready Responses

    Paging Dr Barlow

    Eval. Comp. Lens Limits

    What it is NOT
    Avoid these issues!

    Straw-man fallacy

    A logical fallacy that sets up an

    argument different than the

    original (i.e. not an accurate

    summary) to defeat.

    Puffer-fish moment

    An emotional reaction that sets

    you up to rant and stand on a

    soap-box lecturing, rather than

    creating an argument.

    Drive-by

    A laundry list of points that you

    make against the text without

    any real target.

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    Identifying assumptions

    An assumption is a belief upon which an

    argument or statement is based.

    All statements are based upon assumptions,

    even the most boring ones.

    “Tomorrow I will grade papers.”

    “The doctor will probably give her Amoxicillin”

    Identifying assumptions opens the door to

    problems in the argument, points of

    contention, or limitations to the argument.

    So what is it?

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    Exploring Limitations

    A limitation is the boundary of an argument’s

    validity.

    No argument in academics is boundless, i.e.

    true in all places, at all times, for all people.

    When you explore the limitations of an

    argument, you are showing how it isn’t true in

    all places/times using examples and logic.

    So what is it?

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    Let’s begin with Tannen.
    Recall how we used the idea of “marked” as a

    lens!

    Each details means

    something about the person.

    There is no “norm”.

    How someone uses language

    – correctly or not, with certain

    idioms, certain accents –

    marks a person.

    An invisible disability is one

    that is not obvious to others.

    Their needs (because

    invisible) mark them.

    Women Language Use Invisible Disability

    Using an Idea as a Lens
    The concept of marked

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    In a racially homogenous

    environment, all men have the

    option of being unmarked,

    but if one person is black and

    others are white….

    How someone uses language

    – correctly or not, with certain

    idioms, certain accents –

    marks a person regardless of

    sex.

    A man in a wheelchair, using

    a cane, or needing any help is

    judged by others.

    In fact, it might even be

    worse for men.

    Race Language Use Disability

    Exploring Limitations
    Men have the option of being unmarked.

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    The assumption that new kinds of

    thinking (ala Carr) are artificial?

    The idea that the wealth gap is as

    bad in the US as elsewhere?

    Limitations on the similarities

    between rural and urban

    communities?

    What limits
    will you
    explore?

    See you there!

    Next time: The Anatomy of a Response

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    Response

     RE: Week 11 DiscussionCOLLAPSEOverall Rating:

    Response

    1. CRITERIA 1

    Analyze one’s own leadership qualities and actions relative to a specific experience.

    a. The experience you speak to is being a nurse supervisor in a long term care facility. As the nurse supervisor it was your responsibility to make work flows, assist staff, and providing relief when short staffed. To achieve the next level of performance clearly analyze your own qualities and actions that relate to this specific experience. How did you lead? How did you ensure workflows were consistently practices and successfully practiced? Analysis is examining in detail the context of the actions, please ensure you do this so we fully understand how your leadership and motivational techniques worked with the staff to foster collaboration on the project or topic. You mention communicating personal visions, values, decisions, and information via a direct approach. What else? Please analyze your actions to achieve the next level of performance. Please also remember to HIGHLIGHT any changes in your next submission. 

    2. CRITERIA 2

    Analyze one’s own leadership and motivational techniques used to foster collaboration among stakeholders.

    a. You mention that you involved the staff in the decision making through behavioral and strategic leadership principles. Expand on this- transparency and shared decision making are important, but why? You spoke to motivation of the team through recognition and how this increased employee moral, what type of recognition in relation to the example? What did you say? How did you say it? Please also make sure you HIGHLIGHT any changes you make to this section in your next submission.  

    3. CRITERIA 3

    Analyze actions taken in response to an ethical dilemma, using an ethical code.

    a. I do not see that you discussed an ethical dilemma using the ethical code. 

    4. CRITERIA 4

    Convey clear meaning in active voice, with minimal issues in grammar, usage, word choice, spelling, or mechanical errors.

    a. Overall your APA is improving and your writing is clear. Please do make sure APA headers follow proper formatting. I am noticing you are writing at a surface level, to ensure you meet scoring guide criteria, it is important that you do more than speak to a situation, you want to analyze it. Analysis is examining in detail the context of the actions or situation asked for. Thus it is important you do this and bring in scholarly sources to help you achieve scholarly voice. You also have 2 References listed on your reference page, but no in-text citations? 

    5.

    Response

    You will learn from this article “How do the organism (The Individual), The Environment, and the Task) affect motor Learning. Pick two or three items (Topics, Quotes, meanings, emotions, or statements) that caught your interest and/or attention and describe why they caught your interest or attention. Reflections bring meaning and understanding to your life.
      • 11

      response

      Number 1 post: DM

      Telehealth would be good on global scale because it would allow poor countries access to health care and would help patients have access to inpatient care while at the same time reducing virus transmission, and protecting patients and healthcare workers. Healthcare providers can have access to more providers and patients can have consults from any where in the world. This is a benefit for the patient because is gives them access to the best care. Patients have access to the best providers in the world and they can work together to improve the patient outcomes. Some of the benefits of telehealth is it can offer a range of care. Services can include primary, consultations, specialty care, e-ICU’s, pre-surgical consults, remote patient monitoring, urgent care and chronic care management. It makes it easier to follow up with patients after discharge, because it gives you more access to providers, and prevent readmissions and get a quick start on problems and prevent the patient from having to go back to hospital. It gives the patient a large network of care, and if things are not working than have access to more providers who can maybe offer to advice on the patients care. It will decrease burnout because you can have more flexible hours and more providers to see patients. Telehealth is the future and it will allow more patient to have access to care and slow down the disease process. (Treewatcher.2019.)

      Number 2 post: BT

      Over the last several decades, technology has grown to epic proportions especially in the area of communication. People have access to the internet 24/ 7, which avails people to communicate, perform research, review publications, have access to medical records, and consult with healthcare professionals. Consultation can occur between physician or nurse with a patient or between numerous healthcare professionals to discuss the care and management of a patient.

      Much of this untethered access to healthcare is now being legislated to protect patient privacy, as lawmakers are trying to catch-up with the technology. There are obvious benefits with telehealth, such as access to healthcare in rural communities where otherwise many patients would not have any access. Healthcare professionals can keep in touch with their patients even when overseas, on vacation, for example. One can attend a medical seminar on the other side of the world without physically traveling there. Classes and continuing education courses can be taken online.  A radiologist can view and read diagnostic films online and write a of his findings without the need to go to the hospital or clinic.

      One example of telemedicine benefits involved children in rural Nashville. In 2010, 44 children were brought to the ED by ambulance for asthma-related illnesses. In 2011, with the use of telehealth, many of these children were able to access a physician without the need to take an expensive trip to the hospital (Minich-Pourshadi, 2012).

      Telehealth has limitations. It circumvents the patient-physician relationship. Non-verbal clues such as a patient grimacing when describing their pain level may not be picked-up by a doctor or NP that is on the phone with them. Then there are initial cost barriers, such as equipment, training, and data privacy protections issues. One study found that some nurses had fears of changes, which was a barrier. Then there are also usability concerns, especially for older patients that may not have skills to properly use computer equipment (Koivunen & Saranto, 2018).