topic：Green human resources management in the context of economic transformation
Must be completed according to the outline given by Dr. ，also have sample papers for you to refer to
APA format ,around 2500 words
please find attached instructions on what you are supposed to write.The last two are what I tried to do.Just write from scratch and follow the grading rubric keenly.I need like 7 pages.Other instructions remain constant.
pls make no high plagiarism and no AI
COLLEGE OF EDUCATION CEDU
RESEARCH BASED ASSIGNMENT
Ms. Karoline Molaeb
GUIDELINES:
1. SUBMIT YOUR ANSWERS THROUGH PORTAL FIRST ( TO MAKE SURE THERE HAS BEEN NO PLAIGARISM)
2. Put your course code (full)
3. PRINT YOUR DOCUMENT AND SUBMIT IT TO ME BY HAND WITHIN THE DEADLINE
4. ONLY PRINTED AND SUBMITTED DOCUMENTS WILL BE GRADED
5. DON’T EXCEED COUNT LIMIT
6. WRITE YOUR NAME AND ID CLEALY
7. NAME THE DOCUMENT BY YOUR UNIVERSITY IDs
8. SUBMIT ON TIME
9. DON’T USE AI
10. ANY PLAGIARIZED SUBMISSION IS A ZERO
CASE STUDY:
Sweden (Social Democracy):
Sweden, located in Northern Europe, is renowned for its social democratic model characterized by a robust welfare state and extensive government intervention in the economy. The Swedish Social Democratic Party (SAP), founded in 1889, has played a central role in shaping the country’s political landscape. After World War II, Sweden embarked on an ambitious path of social reforms under Prime Minister Tage Erlander, implementing policies such as universal healthcare, comprehensive education, and generous social benefits.
The Swedish model emphasizes equality, social cohesion, and collective responsibility. High taxes fund expansive social programs, ensuring access to healthcare, education, childcare, and unemployment benefits for all citizens. The labor market is characterized by strong unionization, collective bargaining, and a commitment to gender equality.
Despite its success, Sweden faces challenges such as demographic shifts, immigration integration, and fiscal sustainability. In recent years, debates have emerged regarding the efficiency of public services, the role of private sector involvement, and the balance between social protection and economic growth.
United States (Liberalism):
The United States, situated in North America, is a leading proponent of liberalism, emphasizing individual liberty, free markets, and limited government intervention. Rooted in Enlightenment principles, American liberalism traces its origins to the Founding Fathers and the Constitution, which enshrines rights such as freedom of speech, religion, and assembly.
Liberalism in the U.S. has fostered a dynamic economy, technological innovation, and cultural diversity. Free-market capitalism drives entrepreneurship, wealth creation, and global economic dominance. However, the pursuit of individual interests has led to disparities in wealth, healthcare access, and educational opportunities.
American is reflected in the two-party political system, with the Democratic Party advocating for social welfare programs and regulatory oversight, while the Republican Party promotes fiscal conservatism and deregulation. Ideological debates center on issues such as healthcare reform, environmental protection, and social justice.
North Korea (Communism):
North Korea, officially known as the Democratic People’s Republic of Korea (DPRK), is located on the Korean Peninsula in East Asia. Established in 1948 under the leadership of Kim Il-sung, North Korea adopted a communist ideology based on Juche, a doctrine of self-reliance, nationalism, and state control.
Communism in North Korea is characterized by central planning, state ownership of the means of production, and strict government control over all aspects of society. The ruling Workers’ Party of Korea (WPK) exercises absolute authority, suppressing dissent, and promoting a cult of personality around the Kim family.
Despite its isolation and economic sanctions, North Korea maintains a highly militarized society and nuclear arsenal, prioritizing defense over economic development. The regime’s human rights abuses, political purges, and pervasive propaganda have drawn international condemnation and scrutiny.
Cuba
Cuba has been a one-party socialist state since Fidel Castro seized power in 1959. It depended on Soviet aid until the collapse of the USSR in 1991. Today, Cuba is still ruled by a Castro — Fidel’s brother Raul took over in 2008 at the age of 76. Raul has introduced essential economic reforms, allowing private enterprise to develop, but is determined to ensure that Cuba remains a socialist country.
Socialism has ensured full employment and delivered a health service with one of the highest ratios of doctors to population in the world. However, poverty is widespread, partly as a result of US economic sanctions, and even doctors are forced to supplement their meagre incomes by taking on other jobs, such as driving taxis at night. The Cuban economy and social services are hugely dependent on aid from Venezuela and the bloated public sector is notorious for encouraging waste and corruption — a guaranteed job provides little incentive to work hard, and often underpaid workers supplement their income by stealing work supplies and selling them on the black market. Raul Castro is due to retire in 2018, so at that point Cuba will face a crossroads — will it continue to cling to socialism, struggling along with microeconomic reforms which allow a limited private sector to exist, or will it embrace capitalism, potentially reaping large economic benefits but abandoning its ideology and revolutionary heritage?
China
China has been under Communist Party control since 1949, when Mao Tse-Tung led the party to victory in the civil war. Maoism was a uniquely Chinese ideology aimed at developing socialism within the peasantry rather than the proletariat, as China lacked an urban proletariat. Mao’s Great Leap Forward was a failed attempt to modernise agriculture and industry using a rural commune system, causing a famine in which some 20 million people died. In the late-1960s, Chinese society was rocked by the Cultural Revolution, which saw Mao imposing his authority on the country and encouraging the victimisation of ‘liberal elites’ within the Communist Party.
Following Mao’s death in 1976, China’s leaders changed direction. Private enterprise was encouraged and China regularly enjoyed growth rates of more than 10% in the 1990s and 2000s. Today, much of China remains rural and poor, but more than 1 million Chinese are millionaires and China is the second-biggest economy in the world.
However, capitalism has not been allowed to operate unchecked in China. It is directed by the state, which also owns many companies. The Communist Party has also made it clear that, while it is willing to allow economic liberalisation, it will not tolerate political dissent. The 1989 Tiananmen Square massacre of protesting students, China’s treatment of Tibet, and the massive internet censorship imposed by the Great Firewall of China, all show that human rights are routinely ignored in order to ensure stability.
China’s new premier took power in 2012 and faces various challenges. The country’s growth rate is currently 7.5%, high by global standards but disappointing compared to the eye-wateringly high rates which the Chinese have become accustomed to. China’s one child policy has produced an ageing population that will need to be paid for and a shortage of women, which affects Chinese men looking for wives. The Communist Party will be most worried by the widespread frustration with the repressive nature of politics and society, and the growing anger about endemic corruption within government at a local and national level. If the Chinese leadership cannot maintain brisk economic growth then calls for political reform could grow even more strident.
After reading the case studies answer the below questions
1. Analyse the positives and negatives of socialism and its branches in Cuba, China, and North Korea (three for each at least). Include examples from the text. Examine why is China the most successful of the three socialist countries? (Discuss origin of communism in China and the way it was modified to adapt to the modern world) 250 WORDS NOT MORE ( 10PTS) use updated latest information -2023-2024
2. Compare and contrast the social welfare systems in Sweden and the United States, considering factors such as healthcare, education, and unemployment benefits. Discuss how each country’s ideological framework influences the design and effectiveness of their social welfare programs. 250 WORDS NOT MORE ( 10PTS) use updated latest information -2023-2024
3. In your opinion what is the most successful ideology which was discussed in class and why (? Give specific country examples (at least three). ( 10 PTS) use updated latest information -2023-2024
250 WORDS NOT MOREASC 202: INTRODUCTION TO POLITICAL SCIENCE
COLLEGE OF EDUCATION CEDU
RESEARCH BASED ASSIGNMENT
Ms. Karoline Molaeb
GUIDELINES:
1. SUBMIT YOUR ANSWERS THROUGH PORTAL FIRST ( TO MAKE SURE THERE HAS BEEN NO PLAIGARISM)
2. Put your course code (full)
3. PRINT YOUR DOCUMENT AND SUBMIT IT TO ME BY HAND WITHIN THE DEADLINE
4. ONLY PRINTED AND SUBMITTED DOCUMENTS WILL BE GRADED
5. DON’T EXCEED COUNT LIMIT
6. WRITE YOUR NAME AND ID CLEALY
7. NAME THE DOCUMENT BY YOUR UNIVERSITY IDs
8. SUBMIT ON TIME
9. DON’T USE AI
10. ANY PLAGIARIZED SUBMISSION IS A ZERO
CASE STUDY:
Sweden (Social Democracy):
Sweden, located in Northern Europe, is renowned for its social democratic model characterized by a robust welfare state and extensive government intervention in the economy. The Swedish Social Democratic Party (SAP), founded in 1889, has played a central role in shaping the country’s political landscape. After World War II, Sweden embarked on an ambitious path of social reforms under Prime Minister Tage Erlander, implementing policies such as universal healthcare, comprehensive education, and generous social benefits.
The Swedish model emphasizes equality, social cohesion, and collective responsibility. High taxes fund expansive social programs, ensuring access to healthcare, education, childcare, and unemployment benefits for all citizens. The labor market is characterized by strong unionization, collective bargaining, and a commitment to gender equality.
Despite its success, Sweden faces challenges such as demographic shifts, immigration integration, and fiscal sustainability. In recent years, debates have emerged regarding the efficiency of public services, the role of private sector involvement, and the balance between social protection and economic growth.
United States (Liberalism):
The United States, situated in North America, is a leading proponent of liberalism, emphasizing individual liberty, free markets, and limited government intervention. Rooted in Enlightenment principles, American liberalism traces its origins to the Founding Fathers and the Constitution, which enshrines rights such as freedom of speech, religion, and assembly.
Liberalism in the U.S. has fostered a dynamic economy, technological innovation, and cultural diversity. Free-market capitalism drives entrepreneurship, wealth creation, and global economic dominance. However, the pursuit of individual interests has led to disparities in wealth, healthcare access, and educational opportunities.
American is reflected in the two-party political system, with the Democratic Party advocating for social welfare programs and regulatory oversight, while the Republican Party promotes fiscal conservatism and deregulation. Ideological debates center on issues such as healthcare reform, environmental protection, and social justice.
North Korea (Communism):
North Korea, officially known as the Democratic People’s Republic of Korea (DPRK), is located on the Korean Peninsula in East Asia. Established in 1948 under the leadership of Kim Il-sung, North Korea adopted a communist ideology based on Juche, a doctrine of self-reliance, nationalism, and state control.
Communism in North Korea is characterized by central planning, state ownership of the means of production, and strict government control over all aspects of society. The ruling Workers’ Party of Korea (WPK) exercises absolute authority, suppressing dissent, and promoting a cult of personality around the Kim family.
Despite its isolation and economic sanctions, North Korea maintains a highly militarized society and nuclear arsenal, prioritizing defense over economic development. The regime’s human rights abuses, political purges, and pervasive propaganda have drawn international condemnation and scrutiny.
Cuba
Cuba has been a one-party socialist state since Fidel Castro seized power in 1959. It depended on Soviet aid until the collapse of the USSR in 1991. Today, Cuba is still ruled by a Castro — Fidel’s brother Raul took over in 2008 at the age of 76. Raul has introduced essential economic reforms, allowing private enterprise to develop, but is determined to ensure that Cuba remains a socialist country.
Socialism has ensured full employment and delivered a health service with one of the highest ratios of doctors to population in the world. However, poverty is widespread, partly as a result of US economic sanctions, and even doctors are forced to supplement their meagre incomes by taking on other jobs, such as driving taxis at night. The Cuban economy and social services are hugely dependent on aid from Venezuela and the bloated public sector is notorious for encouraging waste and corruption — a guaranteed job provides little incentive to work hard, and often underpaid workers supplement their income by stealing work supplies and selling them on the black market. Raul Castro is due to retire in 2018, so at that point Cuba will face a crossroads — will it continue to cling to socialism, struggling along with microeconomic reforms which allow a limited private sector to exist, or will it embrace capitalism, potentially reaping large economic benefits but abandoning its ideology and revolutionary heritage?
China
China has been under Communist Party control since 1949, when Mao Tse-Tung led the party to victory in the civil war. Maoism was a uniquely Chinese ideology aimed at developing socialism within the peasantry rather than the proletariat, as China lacked an urban proletariat. Mao’s Great Leap Forward was a failed attempt to modernise agriculture and industry using a rural commune system, causing a famine in which some 20 million people died. In the late-1960s, Chinese society was rocked by the Cultural Revolution, which saw Mao imposing his authority on the country and encouraging the victimisation of ‘liberal elites’ within the Communist Party.
Following Mao’s death in 1976, China’s leaders changed direction. Private enterprise was encouraged and China regularly enjoyed growth rates of more than 10% in the 1990s and 2000s. Today, much of China remains rural and poor, but more than 1 million Chinese are millionaires and China is the second-biggest economy in the world.
However, capitalism has not been allowed to operate unchecked in China. It is directed by the state, which also owns many companies. The Communist Party has also made it clear that, while it is willing to allow economic liberalisation, it will not tolerate political dissent. The 1989 Tiananmen Square massacre of protesting students, China’s treatment of Tibet, and the massive internet censorship imposed by the Great Firewall of China, all show that human rights are routinely ignored in order to ensure stability.
China’s new premier took power in 2012 and faces various challenges. The country’s growth rate is currently 7.5%, high by global standards but disappointing compared to the eye-wateringly high rates which the Chinese have become accustomed to. China’s one child policy has produced an ageing population that will need to be paid for and a shortage of women, which affects Chinese men looking for wives. The Communist Party will be most worried by the widespread frustration with the repressive nature of politics and society, and the growing anger about endemic corruption within government at a local and national level. If the Chinese leadership cannot maintain brisk economic growth then calls for political reform could grow even more strident.
After reading the case studies answer the below questions
3. In your opinion what is the most successful ideology which was discussed in class and why (? Give specific country examples (at least three). ( 10 PTS) use updated latest information -2023-2024
LEADERSHIP THEORIES IN PRACTICE
However, your own observation and experiences may suggest these theories are not always so easily found in practice. Not that the potential isn’t there; current evidence suggests that leadership factors such as emotional intelligence and transformational leadership behaviors, for example, can be highly effective for leading nurses and organizations.
Yet, how well are these theories put to practice? In this Discussion, you will examine formal leadership theories. You will compare these theories to behaviors you have observed firsthand and discuss their effectiveness in impacting your organization.
To Prepare:
Review the Resources and examine the leadership theories and behaviors introduced.
Identify two to three scholarly resources, in addition to this Module’s readings, that evaluate the impact of leadership behaviors in creating healthy work environments.
Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.
Chapter 1, “Frameworks for Becoming a Transformational Leader” (pp. 2–19 ONLY)
Chapter 6, “Shaping Your Own Leadership Journey” (pp. 182-211)
Links to an external site.
Seminars in Oncology Nursing, 39(1). https://doi.org/10.1016/j.soncn.2022.1513
Neville K. et al. (2020) provided a profound insight into the necessity of interprofessional collaboration within integrated care settings. The study highlighted that healthcare leaders must foster an environment where different professionals can work synergistically, transcending traditional disciplinary boundaries. Such collaboration is not only essential for patient-centered care but also for the professional development of the healthcare staff.
Valentijn P. et al. (2013) emphasized the importance of person-centered leadership grounded in empathy and a deep understanding of individual patient needs. This approach involves engaging patients as active participants in their care, which can lead to improved health outcomes and patient satisfaction.
Application of Leadership Skills at HH Treatment Center
One specific example of William’s leadership is her initiative to implement regular interdisciplinary case conferences(Broyles L et al., 2013). These meetings included professionals from various specialties within the healthcare team, such as physicians, nurses, social workers, and mental health counselors. In these conferences, team members discussed patient cases in depth, sharing their unique perspectives and formulating comprehensive care plans. This practice enhanced the quality of patient care and created a learning environment where staff could gain insights from each other’s expertise.
Another example of William’s person-centered leadership is her involvement in patient feedback sessions (Stanhope V. et al.,2015). She ensures that patients’ voices are heard and acted upon, leading to tangible changes in care delivery. For instance, based on patient suggestions, Williams facilitates redesigning the treatment center’s communal spaces to be more welcoming and therapeutic. This change increased patient engagement and created a more positive atmosphere throughout the center.
Effectiveness and Impact of Leadership Practices
The improved clinical outcomes and the increased satisfaction among both patients and staff can measure the effectiveness of William’s leadership skills. Under her leadership, HH Treatment Center reported higher treatment adherence rates and decreased hospital readmissions. Additionally, staff turnover decreased, indicating a more satisfied and committed workforce (www.oaksintegratedcare.org)
Applying the insights from Neville, K. et al. (2020) and Valentijn, P. et al. (2013) within the context of HH treatment centers illustrates the positive impact of collaborative and person-centered leadership in an integrated care environment. William’s leadership fosters a culture of mutual respect and continual learning, benefiting patients and empowering staff members to perform at their best.
Conclusion
The scholarly resources provided a theoretical framework through the leadership of Williams at HH Treatment Center. Her ability to incorporate interprofessional collaboration and person-centered care has significantly improved patient care.
References
Broyles, L. M., Conley, J. W., Harding Jr, J. D., & Gordon, A. J. (2013). A scoping review of interdisciplinary collaboration in addictions education and training. Journal of addictions nursing, 24(1), 29-36.
Neville, K., & Foley, M. (2020). The economic impact of the opioid use disorder epidemic in America: Nurses’Nurses’ call to action. Nursing Economics, 38(1), 7–51.
Stanhope, V., Tondora, J., Davidson, L., Choy-Brown, M., & Marcus, S. C. (2015). Person-centered care planning and service engagement: a study protocol for a randomized controlled trial. Trials, 16, 1-11.
Valentijn, P. P., Schepman, S. M., Opheij, W., & Bruijnzeels, M. A. (2013). Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. International journal of integrated care, 13.
www.oaksintegrated care.or
Response 2
Marlyn Diaz
Introduction
According to the American Nursing Association (2023), they act as role models and influence their healthcare organizations at all levels. Nurse leaders can motivate their coworkers, set a tone for safety, create a cordial work environment, and increase morale and job retention. A Nurse leader is best identified by their actions instead of their position in an organization. “Leaders in nursing inspire and influence others to achieve their maximum potential.” There are different styles of leadership that a nurse leader may elect to deliver with the team. The three main leadership styles will be discussed in this post, along with a QUESTION of a leader I have encountered with such styles or behaviors.
Leadership Styles
Singh & Alomari (2023) state that the three main leadership styles are transformational, transactional, and autocratic. These leadership styles “focused on people management that play a significant role in determining desired outcomes.” The transformational leadership style empowers the followers by giving them a sense of autonomy and responsibility; therefore, commitment and efficiency will increase. Transformational leaders must have the skills to facilitate growth and transform evidence into practice. According to Specchia et al., transformational style positively correlates with nurses’ job satisfaction (2021). The second type of leadership is the transactional style. This type of leadership is best employed during a high-stress situation for the employees, and their basic needs must be met (Singh & Alomari, 2023). These leaders motivate employees with rewards and punishment “for achieving or failing to achieve” the organization’s demands. Specchia et al. highlight that this type of leadership does not foster trust between the followers and the leader (2021). The last type of leadership discussed here is the autocratic style. This is an authoritarian type of leadership in which the employees are discouraged from apportioning any input (Singh & Alomari, 2023). This style is highly structured, and staff must be considered competent enough to provide adequate input. For this reason, low team morale and nursing resentment are typical outcomes. This can lead to poor nursing performance, patient care, and patient outcomes.
Types of Leaderships Encountered
In the current organization I am working for, I have encountered these three types of leadership. Depending on the situation, my manager has displayed these three types of leadership. Overall, the administration tries to follow a transformational style of leadership where the staff nursing input is considered to improve morale, working conditions, and patient care. During our quarterly meetings, our manager will discuss topics with the team, such as increased nurse burnout due to short-staffing, and ask for input on what can be done to help us. Some inputs discussed, such as having a CAN in the unit when acuity is high to help care, were employed immediately. This made the team feel heard and supported, and work morale improved. Other times, leadership has been autocratic, such as when the staff wanted to update the current vacation requests and grants rules. Management would not hear any input and stated that nothing could be done. Staff continue to be dissatisfied because it is challenging to approve your vacation request if you have no seniority. It goes to them if someone with seniority requests the exact dates as you. Therefore, there is no guarantee that you will get any PTO approved. There have been times when leadership has been transactional. Again, during the short staffing period, they would offer incentives to have nurses pick up extra shifts. This resulted in neutral feelings as it was optional for nurses to pick up.
Conclusion
Three types of leadership are most used in nursing. According to Specchia et al. (2021), the ideal leadership style for nursing is transformative, as the leader welcomes input from staff and not only supports but empowers staff to be autonomous (Singh & Alomari, 2023). In my organization, management has utilized these three types of leadership depending on the situation. Given the staff’s response to these leadership styles, transformative is the most welcomed by staff.
References
American Nursing Association. (2023). Leadership in nursing: Qualities & why it matters. https://www.nursingworld.org/content-hub/resources…
Links to an external site.
.
Singh, K., & Alomari, A. (2023). Leadership styles and transformational leadership skills among nurse leaders in Qatar, a cross?sectional study. Nursing Open, 10(6), 3440-3446. https://doi.org/10.1002/nop2.1636
Specchia, M. L., Cozzolino, M. R., Carini, E., Pilla, A. D., Galletti, C., Ricciardi, W., & Damiani, G. (2021). Leadership Styles and Nurses’ Job Satisfaction. Results of a Systematic Review. International Journal of Environmental Research and Public Health, 18(4). https://doi.org/10.3390/ijerph18041552
S.M R
Introduction
Effective leadership plays a crucial role in shaping the quality of care and overall performance in healthcare settings. Through insights gleaned from scholarly research, two primary aspects of leadership emerge: the influence of leadership style on quality of care measures and the significance of leadership effectiveness in healthcare (Broome & Marshall, 2021). By evaluating the effectiveness of these leadership approaches through real-life experiences, we can gain and highlight the importance of adept leadership in fostering positive outcomes and cultivating a conducive work environment in healthcare settings.
Key Insights
The scholarly resources I selected shed light on two key insights regarding leadership in healthcare settings. Firstly, Sfantou et al.’s (2017) systematic review emphasizes the pivotal role of leadership style in influencing the quality of care measures. This study highlights the direct correlation between leadership approach and various aspects of care delivery, including patient outcomes, safety, and satisfaction. Effective leadership styles, particularly transformational leadership, are associated with improved quality of care and organizational performance, underscoring the significance of leadership in shaping the healthcare environment.
Secondly, Restivo et al.’s (2022) systematic review and meta-analysis underscore the importance of leadership effectiveness in healthcare. The synthesis of evidence from diverse studies demonstrates a positive association between effective leadership and healthcare outcomes, including patient care, staff satisfaction, and organizational performance. Effective leaders exhibit key characteristics such as vision, communication skills, team building, and strategic decision-making, contributing to enhanced patient care quality and safety. These insights highlight the critical role of leadership in driving positive outcomes in healthcare settings and emphasize the need for investing in leadership development initiatives to foster a culture of effective leadership and improve the overall quality of care.
Leadership Examples
For my selected leader, I chose a charge nurse named Brian, with whom I used to work in the emergency department. Brian is an astounding leader and demonstrates these identified skills. He epitomized transformational leadership qualities in the face of challenging and dynamic situations. One particular incident that showcased Brian’s leadership occurred during a busy weekend shift when the ED experienced an abnormal surge of patients due to the closing down of a nearby hospital. In addition to this, we were also short-staffed that day. Despite the chaos and high-stress environment, Brian remained calm, composed, and focused on ensuring the smooth operation of the department while delivering quality patient care.
Firstly, he demonstrated exemplary communication skills by swiftly coordinating with the ED team to triage and prioritize patients based on the severity of their injuries. He effectively delegated tasks to nurses, physicians, and support staff, ensuring everyone understood their roles and responsibilities (Restivo et al., 2022). Secondly, he exhibited flexibility and adaptability in his leadership approach. Recognizing the need for additional resources and staff, he made the difficult decision to go on diversion after acknowledging the staff would not be able to provide efficient and safe care if more patients came in and acknowledging that management and administration could not provide us with additional staff. Brian was able to lead by example by actively participating in patient care activities alongside his team members. He also remained positive despite the critical circumstances we were all under. He remained visible and accessible throughout the shift, offering guidance, support, and reassurance to staff members experiencing heightened stress and fatigue (Sfantou et al., 2017).
Skill Effectiveness and Implementation Into the Workplace
As a result of Brian’s transformational leadership, the ED team successfully managed the surge of patients with efficiency and effectiveness. Despite the overwhelming workload, morale remained high, and staff members felt supported and empowered to deliver optimal care under challenging circumstances. Additionally, Brian’s leadership during the crisis fostered a sense of camaraderie and unity within the ED team. The experience catalyzed collaboration, innovation, and continuous improvement as team members recognized the importance of working together cohesively to overcome adversity and deliver outstanding patient care (Restivo et al., 2022). Brian’s adept utilization of transformational leadership behaviors and skills proved instrumental in navigating the challenges of a short-staffed, busy day and fostering resilience and teamwork within the emergency department. His ability to inspire, empower, and lead by example exemplifies the transformative impact of effective leadership in high-pressure healthcare environments.
Conclusion
In conclusion, exploring leadership in healthcare settings underscores leaders’ critical role in shaping organizational dynamics and patient care outcomes. The insights from scholarly research emphasize the significance of leadership style and effectiveness in driving positive change and fostering a conducive work environment. Specific examples illustrated how adept leadership behaviors and skills, such as transformational leadership and effective communication, can improve the quality of care, staff morale, and organizational performance.
Respond using and cite from text attached
Shakir:Week 2 – Case Conceptualization
Client and Theory:
Dale and Person-Centered Theory
Presenting Problem:
Dale, 52 years old, White male, prison guard, ex-police officer, divorced, estranged father of an adult son, currently married, exhibits racist views and actions. In mandated therapy by the employer. His beliefs and actions are causing hardships for him in both his professional and personal life.
Hypothesis:
The client is living incongruently to his abilities and it’s creating difficulties in various aspects of his life. The client’s life has been shaped by a desire to please those around him, especially his father. This acceptance of the parents’ negative social ideology and discriminatory constructs during his formative years, are incongruent to his innate self. Congruent individuals are those who trust their view of the world and trust their basic positive nature (Hazler, 2022).
The client is demonstrating his true desire to assist others, through the examples of his employment selections, as both a police and correctional officer. Through self-actualization of the person-centered theory the client can begin to hone in on his inner resources to take fundamental steps towards a positive congruent shift. Self-actualizing has the ability to create positive development in people (Hazler,2022). The client’s life has arrived at a point, where he is now being forced to explore, reflect and create change.
Treatment Goals:
The goals for the client will be to join and assist him as he explores the roots of his anger, prejudices and discriminating actions. Reflecting upon past decisions has the ability to allow him to immerse into a state of self-actualization. Self-actualization is the driving force in the positive development of the individual. It propels the individual away from the control of others and towards autonomy (Hazler, 2022). Through these steps, the client will begin to explore inwardly without the inherited beliefs that have caused tremendous turbulence within his life.
According to the person-centered theory, everyone has the ability to learn, adjust and grow in positive directions (Hazler, 2022). The client has the chance to course correct his past aggressions, to possibly gain trust and admiration from not only his peers, but his son.
Intervention / Techniques:
The intervention methods used in this case conceptualization will be aligned with the Person-Centered theory.
Intervention 1: Active Listening
Active listening in a counseling session delivers empathy for the client by being attentive and compassionately listening (Hazler, 2022). This approach would deliver a positive therapeutic alliance, which would assist the client with relaxing, trusting and begin the process of revealing his inner self, thoughts and ideas. Dale would greatly benefit from having an active listener, due to the immense pressure is receiving from his external world. His professional career is in jeopardy as a result of his actions.
Intervention 2: Reflection of Content and Feelings
The primary steps in extending empathy within a session are recognition and reflection of the actual words and feelings being shown by the client (Hazler, 2022). These steps will allow for recognizing the body language and feelings that Dale has compartmentalized or has made an attempt to express in possibly negative actions.
I would like to guide the client to reflect upon his innermost feelings about being a parent, and of his current estranged relationship with his son. The possible reflection of a loved one has the ability to allow the client to reach his sincerest essence as a person. While allowing the client to be open and vulnerable, can allow the work to go beyond his overall persona. As stated, “At its most powerful, reflection can also bring together complex elements of the client’s world that draw a much more accurate picture of the client as a whole than the individual elements provide separately” (Hazler, 2022).
Expected Outcome:
The goal in utilizing the person-centered theory with the client, is to provide empathy as the client sets out to explore his inner self. Since this work can be challenging for this client, it’s important to express encouragement through active listening and being aware of the physical movements that may occur. “Counselors who accurately reflect content and feelings act like a mirror by helping clients see what they are expressing so that clients can revise and expand perceptions of themselves based on counselor reflections” (Hazler, 2022).
The expected outcome after aligning with the person-centered theory, the client will begin to shift towards self-actualization. This would prove to provide significant breakthroughs within the client’s life. These changes will allow Dale the opportunity to define his own reality and become more aware of his former self. The participation in self-actualization can move individuals away from the constructed thoughts, beliefs and control of others, and move them towards self-determination (Hazler, 2022). The outcome should demonstrate unique momentum towards being a more balanced, caring and loving individual.
References:
Hazler, R. (2022). Adlerian theory. In D. Capuzzi & M. D. Stauffer (Eds.), Counseling and psychotherapy: Theories and interventions (7th ed., pp. 139-160). American Counseling Association
response 2 Lindsay:
Case of Anna Johnson: Person-Centered Theory
Presenting Problem: “The client’s mom Ms. Johnson contacted [Behavioral Health Services of Virginia] seeking mental health assistance and intervention for their child Anna Johnson. The client is a single 12-year-old Latino female living in a nuclear family with 1 brother and 1 sister. The client is attending experiencing Tuckahoe Middle School in the 6th grade. The client currently does not have an Individual Education Plan but has a school counselor. The client has not had services before the conceptualization. The client is showing signs of Anxiety, depression, and ADHD but has potential signs of Autism as well. The signs for both disorders closely co-exist interchangeably and the speculation from the mother includes that the client is having anger outbursts, shuts down, and is having a delay in social skills. The mother also states that Anna is on Adderall XR 10mg and she needs new medication since the new Adderall medication isn’t working and she believes that the medication is not helping manage the symptoms. The mother also reports that Anna is pacing, needs constant prompting socially, and needs to be watched” (Chambers, 2024).
Hypothesis:
“The client has also shown symptoms of anxiety and depression according to her mom as well as lack of eye contact, negative thoughts, lack of engagement with the siblings and other family members, lack of speaking, and body language that indicates discomfort such as arms crossed, zoning out, and having to be prompted 2-3x daily every month by teachers as well as friends according to the mother”(Chambers, 2024). Anna’s mom explains that Anna is constantly doubting herself as she handles challenges in her life. Anna’s mom believes she may be suffering from self-esteem problems from social media as well as social comparison. Ms. Johnson explained how she believes that Anna has body dysmorphia and is always being critical to herself. Anna believes she has low self-esteem and self-image due to bullying as well as not doing well in school, so she said that it makes her lack confidence in herself. Ms. Johnson suggests that the issue is that “school makes her feel like she isn’t smart when in reality she is and she isn’t aware of this. However, I believe Anna is not only good at school, but is a very intelligent person although she just isn’t very self-aware as well as she has trouble expressing herself and seeing that potential and growth within her. Ms. Johnson believes that Anna doesn’t recognize herself as a motivated person. Anna believes that she lacks the ability to improve, to trust herself, and the capability to change how she views herself to benefit her well-being. According to Hazler (2022), The first principle [of a person-centered perception] is “to treat clients as trustworthy, or there will be no reason to allow them to take a leadership role in the helping relationship”. Ms. Johnson claims that Anna needs some self-direction and needs to be deeply heard by the counselor to improve the quest of her quality of life and to help Anna trust in herself. The second principle emphasizes that self-actualization is the “driving force in the positive development of the individual. It clearly moves the individual away from control by others based on conditions of worth and toward autonomy and self-control.” (Hazler, 2022). Anna can improve her life with confidence most importantly within herself but also through the eyes of a counselor and support from her family and friends. However, Anna believes that she has to constantly meet her mother’s expectations as they are very high for her especially when it comes to her making friends and doing well in school which makes it hard for her to accept all aspects of herself, especially success. Anna fears that she will never be able to come to terms with herself in a positive light and that she will continue to be depressed about school and not connecting with herself and others.
Goals:
The main goal for Anna is to achieve congruence. What this goal means is that “Individuals can and must rely on themselves for direction and strength” (Hazler, 2022). Anna has ideas about herself that are very negative which impacts the way she views the world as well as her traits. Anna and her family are working on trying to better herself and showing Anna that she can handle life obstacles on her own and that she is going to need to make decisions even though she might not like it because that is what comes with growth. Anna has to learn to use these skills to manage and maintain her well-being, so she does not fall into depression repeatedly. Anna’s goal is that she wants to get help and obtain a better self-image instead of being insecure and nervous. Anna’s mother wants Anna to least appear to others that she is secure within herself and eventually work towards loving herself. However, Anna is embarrassed that her mom is forcing her to pretend that she is okay with others and would desire to work with a therapist on not judging herself, meeting her goals, and improving her own personality traits without the opinions of others to pave the way for her (specifically her mother) but to talk to someone about the issues and have them trust that she can find her own way. “[Congruence] begins with the counselor demonstrating trust in [Anna’s words], values, and ability to make productive decisions. Rather than trying to “show her the way,” the counselor will trust in her ability to find the better way and will be her professional companion along the way even as she makes missteps and then works to adjust them. Through active listening, demonstrating empathy, showing understanding, and recognizing the difficulties” (Hazler, 2022).
Intervention/Techniques:
Intervention 1: The intervention method that would be beneficial would be Genuineness and Self-Disclosure. Using this intervention can be helpful because the counselor “will work with her situation, see her inner strength, trust in her willingness and ability to move in positive directions”, “The result is an environment that is supportive of the potential for progress and striving for more self-actualization” (Hazler, 2022). I believe this might be a useful approach because it focuses on how to encourage the client even when situations can be frustrating, which is helpful to Anna when she shuts down. Anna needs to be comfortable discussing her internal conflicts as well as having someone help her stay positive during a hard time. It would be beneficial for Anna’s growth because she would have to face the reality that with her disorders, she would have to work extra hard on how to be more in tune with her thought processes. Anna’s family has provided Anna with constructive criticism and is continuing to do so that way Anna can know that she is struggling and needs extra guidance because sometimes she is not as self-aware as she and others would like her to be (Chambers, 2024).
Intervention 2: Another intervention that would be beneficial for Anna would be Active Listening. “After putting themselves in the best possible position to listen, counselors must then hear and see what is communicated by words and action to turn the bits and pieces into a holistic picture” (Hazler, 2022). The idea is to always have a good listening ear to be able to gather as much information as possible to see how one can approach the situation at hand. I believe this might be a useful approach because Anna doesn’t feel heard by her mother and so this technique could encourage her to be more open with her problems (because her mother problem-solves and makes decisions for her and doesn’t allow her to just vent). The counselor can then reflect on what was said, give thought-provoking follow-up questions to Anna, and then point out to Anna some patterns within her behavior so that Anna can then make a decision based off the feedback and hopefully become more capable of self-improvement.
Expected Outcome:
The goal of person-centered therapyis so that the “individual is working together for the purpose of self-actualization growth rather than towards overcoming the illness” (Hazler, 2022). Anna hopefully will take away from the session that she is able to see her own strengths and trust in herself as well as also be able to engage in more social behaviors that help with her ADHD, anxiety, depression, and potential Autism. The main goal is for Anna to reach a point where she feels as if she can understand her problem areas as well as learn a solution-focused way to help herself in a positive light. The person-centered approach emphasizes a belief that this ability to grow in positive directions is available to everyone” (Hazler, 2022).
Touchstones are projects that illustrate your comprehension of the course material, help you refine skills, and demonstrate application of knowledge. You can work on a Touchstone anytime, but you must complete this unit’s assessments before you submit it. Once you’ve submitted a Touchstone, it will be graded and counted toward your final course score.
Touchstone 2: Special Occasion Speech
ASSIGNMENT: For this touchstone, you will deliver a 3–5 minute special occasion speech on a topic of your choice. The speech can be for any context, but the purpose must be to commemorate an occasion. See the following list of example occasions for inspiration.
Introducing a keynote speaker at a conference
Introducing a new employee at a company meeting
The Speech to Secure Goodwill
Welcoming new employees during an orientation session
Celebrating staff at a company retreat
The Speech of Presentation or Acceptance
Presenting an award for academic work (paper, research, report)
Accepting an award for original creative work
The Commemorative Speech: Dedications and Eulogies
Delivering a commemorative speech for the dedication of a new building
Delivering a eulogy at a funeral
The Inspirational Speech
Motivating your work team to take on a new challenge
Giving a toast at a wedding or other party
Delivering a speech at a graduation
……
In order to foster learning and growth, all work you submit must be newly written specifically for this course. Any plagiarized or recycled work will result in a Plagiarism Detected alert. Review Touchstones: Academic Integrity Guidelines for more about plagiarism and the Plagiarism Detected alert. For guidance on the use of generative AI technology, review Ethical Standards and Appropriate Use of AI.
Touchstone Support Videos
Step 1: Select a Special Occasion Topic
Your speech should be for a special occasion. You may use a special occasion from the list above, or choose one of your own. Consider the following brainstorming techniques as you generate your speech topic:
Word Association
Clustering
Freewriting
Refer back to the following lessons for support:
Choosing and Developing a Good Topic
Step 2: Consider Purpose, Thesis, and Audience
Identify your purpose, thesis, and audience. Imagine your audience and how you would want to convey your message to this audience.
As you plan your speech and consider the purpose, ask yourself the following questions:
What do you want your audience to know?
What do you want your audience to think?
What do you want your audience to feel?
What do you want your audience to do?
As you plan your speech and consider the thesis, ask yourself the following questions:
What is the most important message of your speech?
Why should/will your audience care about your message?
2c. Audience
When planning your special occasion speech, it is important to know about the audience and to adapt the message to the audience. You want to prepare an audience-centered speech, or a speech focusing on the audience.
What is the correct context for the speech? Where and when will it be given?
Who is the audience and what are their characteristics?
Why has the audience come to hear the speech?
What are the interests of the audience?
What does the audience know about your topic?
How will the audience likely react to your speech?
Refer back to the following lessons for support:
Context: Situation, Environment, Culture, and Bias
The Purpose and Thesis Statement
Best Practices in Public Speaking
Step 3: Create Notes
Create notes or bullet points that you can refer to while presenting your speech. You should not read your speech word-for-word from your notes.
Ensure that the language you use is consistently clear and appropriate to the audience, which helps the audience connect with you and your topic. Explain any technical jargon you use where necessary. Cognitive psychologists and linguists suggest that word choice has significant framing effects on the perceptions, memories, and attitudes of speakers and listeners.
Refer back to the following lesson for support:
Your Audience’s Group Membership and Physical Context
Before filming, review the rubric to ensure that you understand how you will be evaluated.
Step 7: Film Speech
Step 8: Review Video
Step 9: Review Checklist and Requirements
Step 10: Submit
Upload your video using the blue button at the top of this page.
Refer to the checklist below throughout the writing process. Do not submit your Touchstone until it meets these guidelines.
? I have selected a special occasion speech topic.
? My speech includes a purpose and a thesis.
? I have considered my audience.
? I have used language that is appropriate to my audience.
? I have filmed a video of myself presenting my speech.
? The video of my speech is 3–5 minutes in length.
? I have reviewed the video and I can be easily heard and seen.
? In my speech, I am focused on connecting with the audience, only looking at my notes occasionally.
? I have adhered to all the requirements.
? I have read through the rubric and I understand how my Touchstone will be evaluated.
Touchstones are projects that illustrate your comprehension of the course material, help you refine skills, and demonstrate application of knowledge. You can work on a Touchstone anytime, but you must complete this unit’s assessments before you submit it. Once you’ve submitted a Touchstone, it will be graded and counted toward your final course score.
Touchstone 2: Special Occasion Speech
ASSIGNMENT: For this touchstone, you will deliver a 3–5 minute special occasion speech on a topic of your choice. The speech can be for any context, but the purpose must be to commemorate an occasion. See the following list of example occasions for inspiration.
Type of Special Occasion SpeechExamplesThe Speech of Introduction
Celebrating staff at a company retreat
The Speech of Presentation or Acceptance
Presenting an award for academic work (paper, research, report)
Accepting an award for original creative work
The Commemorative Speech: Dedications and Eulogies
The Inspirational Speech
Motivating your work team to take on a new challenge
Inspiring your work team with a vision for the future
Other Speeches: Farewells, Toasts, and After-Dinner Remarks
Giving a toast at a wedding or other party
Delivering a speech at a graduation
Clustering
Freewriting
Doing a Little Homework
Step 2: Consider Purpose, Thesis, and Audience
2a. Purpose
As you plan your speech and consider the purpose, ask yourself the following questions:
What do you want your audience to think?
What do you want your audience to feel?
What do you want your audience to do?
Your thesis statement should clearly articulate the purpose and main points of your speech. Defining a thesis is essentially constructing the structural outline of your speech. When you have defined a thesis, you have essentially articulated to yourself what your speech will say, what position you will take up, and what the speech’s purpose is.
As you plan your speech and consider the thesis, ask yourself the following questions:
What is the most important message of your speech?
Why should/will your audience care about your message?
2c. Audience
The audience is the target of your speech, and effectively communicating your theme to them is the goal of good public speaking. As such, you should always keep the audience in mind both before and during your time on stage.
What is the correct context for the speech? Where and when will it be given?
Why has the audience come to hear the speech?
What does the audience know about your topic?
How will the audience likely react to your speech?
Refer back to the following lessons for support:
The Purpose and Thesis Statement
Best Practices in Public Speaking
How to Use Your Knowledge of the Audience
Create notes or bullet points that you can refer to while presenting your speech. You should not read your speech word-for-word from your notes.
Step 4: Use Clear Language
Ensure that the language you use is consistently clear and appropriate to the audience, which helps the audience connect with you and your topic. Explain any technical jargon you use where necessary. Cognitive psychologists and linguists suggest that word choice has significant framing effects on the perceptions, memories, and attitudes of speakers and listeners.
Your Audience’s Group Membership and Physical Context
Step 5: Practice Speech
Practice presenting your speech. Aim for a speech that is 3–5 minutes in length.
Step 6. Review Rubric
Step 7: Film Speech
Film yourself presenting the speech. Be sure that you can be easily seen and heard, and direct your speech to the camera.
Step 8: Review Video
Review your video to ensure that you can be seen and heard. Refilm as needed.
Step 9: Review Checklist and Requirements
Review the checklist and requirements to ensure that your Touchstone is complete.
California Missions SLO Exercise (ASSIGNMENT)
1. Read/view a set of primary sources, including art works, related to the founding and development of the Spanish mission system in California
2. Analyze and synthesize primary and secondary sources in response to a historical thesis or question.
3. Articulate a cause or consequence of the event represented by the sources.
4. Describe one historical personality involved in this event and explain his or her significance in this event.
Write your answers directly into Canvas. Do not send back any files.
Here is the nuts-and-bolts video on the SLO exercise that was recorded in 2019. This video was recorded with the Camtasia software and it does include the closed-captioning feature. Just click the “CC” icon on the YouTube viewer to access the subtitles.
**NOTE: For this exercise, you are encouraged to bring in any information that you’ve learned about the historical period/topic from lecture, textbook, primary source documents, films and other sources. The term “secondary sources” refers to outside materials, including readings from “Between the Conquests.”**
Formal Instructions:
Read/view the attached set of primary sources, (the Father Duran and Indian laborer drawings, and the Father Jayme and La Perouse documents)
Address the following thesis statement: How do these sources prove that the policies of the Spanish Crown and Franciscan officials directly contributed to the cultural destruction of the California native populations as the mission system was being established? Explain in at least 5-6 sentences (based on your analysis of the primary and secondary sources) how the sources prove the thesis statement?
Articulate a cause or consequence of the California Mission system represented by the sources. Name and describe one cause or consequence of an event discussed in these sources in at least 5-6 sentences:
Describe one historical personality involved in this event ( the California Mission system) and explain his or her significance in this event. Name one person involved in this event. Why was that person significant? Compose your answer in at least 5-6 sentences:
History 115 SLO Assessment: Set of Primary Source Documents
Source #1: Father Narciso Duran and Child, Mission San Jose (1844 painting)
Source #2 Father Luis Jayme criticizes the behavior of Spanish Soldiers (1772)
With reference to the Indians, I wish to say that great progress would be made if there was anything to eat and the soldiers would set a good example. We cannot give them anything to eat because what Don Pedro has given is not enough to last half a year for the Indians from the Californias who are here. Thus little progress will be made under present conditions. As for the example to be set by the soldiers, no doubt some of them are good exemplars and deserve to be treated accordingly, but very many of them deserved to be hanged on account of the continuous outrages which they are committing in seizing and raping the women. There is not a single mission where all the gentiles have not been scandalized, and even on the roads, so I have been told. Surely, as the gentiles themselves state, they are committing a thousand evils, particularly those of a sexual nature. The fathers have petitioned Don Pedro concerning these points, but he has paid very little attention to them. He has punished some, but as soon as they promised him that they would work at the presidio, he turned them loose. That is what he did last year, but he does not even punish them or say anything to them on this point. I suppose that some ministers will write you about the cases which have occurred at other missions. I shall speak only of Mission San Diego. At one of these Indian villages near the mission of San Diego, which said village is very large, and which is on the road that goes to Monterey, the gentiles therein many times have been on the point of coming here to kill us all, and the reason for this is that some soldiers who were carrying the mail to Monterey turned their animals into the fields and they ate up their crops. Three other Indian villages about a league or a league and a half from here have reported the same thing to me several times. For this reason on several occasions where Father Francisco Dumetz or I have gone to see these Indian villages, as soon as they us they fled from their villages and fled to the woods or other remote places, and the only ones who remained in the villages were some men and some very old women. The Christians here have told me that many of the gentiles of the aforesaid villages leave their huts and the crops which they gather from the lands around their villages, and go to the woods and experience hunger. They do this so that the soldiers will not rape their women as they have already done so many times in the past. No wonder the Indians here were bad when the mission was first founded. To begin with, they did not know why they (the Spaniards) had come, unless they intended to take their lands away from them. Now they all want to be Christians because they know that there is a God who created the heavens and earth and all things, that there is a Hell, and Glory, that they have souls, etc., but when the mission was first founded they did not know these things; instead they thought they were like animals, and when the vessels came at first, they saw that most of the crews died; they were very loathe to pray, and they did not want to be Christians at all; instead they said that it was bad to become a Christian and then they would die immediately. No wonder they said so when they saw how most of the sailors and California Indians died, but now, thanks be to the Lord, God has converted them from Sauls to Pauls. They all know the natural law, which so I am informed, they have observed as well or better than many Christians elsewhere. They do not have any idols; they do not go on drinking sprees; they do not marry relatives; and they have but one wife. The married men sleep with their wives only. The bachelors sleep together and apart from the women and the married couples. If a man plays with any woman who is not his wife, he is scolded and punished by his captains. Concerning those from the Californias I have heard it said that they are given to sexual vices, but among those here I have not been able to discover a single fault of that nature. Some of the first adults whom we baptized, when we pointed out to them that it was wrong to have sexual intercourse with a woman to whom they were not married, told me that they already knew that, and that among them it was considered to be very bad, and so they do not do so at all. “the soldiers,” they told me, “are Christians and, although they know that God will punish them in Hell, do so, having sexual intercourse with our wives. We,” they said, “although we did not know that God would punish us for that in Hell, considered it to very bad, and we did not do it, and even less now that we know that God will punish us if we do so.” When I heard this, I burst into tears to see how these gentiles were setting an example for us Christians.
Source #3 Jean Francois La Perouse Describes the Mission Indians of Carmel (1786)
The color of these Indian, which is that of Negores; the house of the missionaries; their storehouses;…the appearance of the ground on which the grain in trodden out; the cattle, the horses, everything in short, brought to our recollection a plantation at Santo Domingo or any other West Indian island. The men and women are collected by the sound of a bell; a missionary leads them to work, to the church, and to all their exercises. We observed with concern that the resemblance is so perfect that we have seen both men and women in irons, and others in the stocks. Lastly, the noise of the whip might have struck our ears, this punishment also being administered. Corporal punishment is inflicted on the Indians of both sexes who neglect the exercises of piety, and many sins, which in Europe are left to Divine justice, are here punished by irons and the stocks. And lastly, it must be observed that the moment an Indian is baptizes, the effect is the same as if he had pronounced a vow for life. If he escapes to reside with his relations in the independent villages, he is summoned three times to return; if he refuses, the missionaries apply to the governor, who sends soldiers to seize him in the midst of his family and conduct him to the mission, where he is condemned to receive a certain number of lashes with the whip. They have so little courage that they never make any resistance to the three or four soldiers who so evidently violate the rights of men in their persons. The custom is kept up because theologians have decided that they could not in conscience administer baptism to men so inconstant unless the government would in some measure serve as their sponsor and answer for their perseverance in the faith. Punishments are adjudged by Indian magistrates, called caciques. There are three in each mission…These caciques are like the overseers of a plantation: passive beings, blind performers of the will of their superiors. Their principal function…is to maintain order and the appearance of attention. Women are never whipped in public, but in an enclosed and somewhat distant place that their cries may not excite a too lively compassion, which might cause the men to revolt. The latter, on the contrary, are exposed to the view of all their fellow citizens, that their punishment may serve as an example. They usually ask pardon for their fault, in which case the executioner diminishes the force of his lashes, but the number is always irrevocable. An hour after supper, they take care to secure all the women whose husbands are absent, as well as the young girls above the age of nine years, by locking them up, and during the day they entrust them to the care of elderly women. All these precautions are still inadequate, and we must have seen men in the stocks and women in irons for having eluded the vigilance. These Indians have no knowledge of a God or of a future state… The missionaries, persuaded from their prejudices and perhaps from their experience that the reason of these men is scarcely ever developed, consider this a just motive for treating them like children, and admit only a very small number to the communion… The government is a true theocracy for the Indians, who believe that their superiors have immediate and continual communication with God, and that they cause him to descend every day on the altar. By virtue of this opinion, the holy fathers live in the midst of the villages with the greatest security. Their doors are not shut, even in the night.
Source #4: Indian neophytes were responsible for plowing acres of mission property
# 1 andrea
Pulmonary Function Case Study
D.R. is a 27-year-old man, who presents to the nurse practitioner at the Family Care Clinic complaining of increasing SOB, wheezing, fatigue, cough, stuffy nose, watery eyes, and postnasal drainage—all of which began four days ago.
According to the case study information, how would you classify the severity of D.R. asthma attack?
Asthma has a classification system according to the severity of the attack using the colors of a traffic light. The green zone is when the patient is asymptomatic, and the peak flow measurement is at least at the 80% level. The yellow zone is when the peak flow measurement is in the 50% -80% range and is indicative of asthma getting worse and being poorly controlled (Leik, 2021). Mr. D.R. did exactly what the asthma zones protocol requires when he began his Albuterol Inhaler after 24 hours of being in the yellow zone and also when he began measuring his peak flow regularly. In the ‘red zone’ the person’s asthma symptoms are more extreme, and they have a lot of trouble breathing. Their symptoms are not relieved from quick relief meds, they are not able to perform regular tasks normally. Usually in the red zone, the peak flow is less than 50% of the person’s best. Although Mr. D.R.’s peak flow rates are not as low as less than 50%, I would say he has entered into the Red Zone based on his other findings. A person is considered as having entered the red zone after 24 hours of being in the yellow zone, without improvement. This is congruent with Mr. J.D.’s case.
Name the most common triggers for asthma in any given patients and specify in your answer which ones you consider applied to D.R. on the case study.
The most common triggers for asthma exacerbation are exposure to allergens, irritants, weather changes, and common upper respiratory viral infections (Rogers & Brashers, 2023). Exercise can induce some asthma attacks. Women have reported pre-menstrual exacerbations (Duglasch &Story, 2024). Some common indoor allergens that can trigger asthma are dust mites, mold, and pet dander or fur, while the usual outdoor allergies that can trigger asthma are pollens and molds. Another cause for asthma attacks can be extreme emotional stress, like intense anger, crying, and laughter (Duglasch & Story, p. 269). I think that Mr. D.R.’s asthma exacerbation might’ve been caused by an upper respiratory virus like the common cold, according to his symptoms of cough, fatigue, stuffy nose, and nasal drainage.
Based on your knowledge and your research, please explain the factors that might be the etiology of D.R. being an asthmatic patient.
Asthma’s general etiological factors include having a parent with asthma, a severe respiratory illness in childhood, allergic condition, or exposure to industrial dusts or chemical irritants. Allergen exposure, living in an urban area, exposure to pollution, tobacco smoke, obesity, recurrent respiratory tract infections, GERD, and the use of acetaminophen all impact gene expression that can increase the risk of developing asthma (Rogers & Brashers, 2023). However, I didn’t see anything in the case study that would indicate the specific etiology of Mr. D. R.’s asthma.
Fluid, Electrolyte and Acid-Base Homeostasis Case Study
Ms. Brown is a 70-year-old woman with type 2 diabetes mellitus who has been too ill to get out of bed for 2 days. She has had a severe cough and has been unable to eat or drink during this time.
Based on Ms. Brown admission’s laboratory values, could you determine what type of water and electrolyte imbalance does she has?
I think that Ms. Brown might have hypovolemia / dehydration from the water loss from the polyuria that accompanies hyperglycemia and decreased fluid and food intake. Her serum sodium, potassium, and chloride are showing as higher than normal because of the decrease in fluid volume. Her Ph indicates acidosis. Another cause of high k+ is that Potassium shifts from the intracellular fluid to the extracellular in metabolic acidosis (Rogers & Brashers, 2023). Her Ph and the fact that she is hyperglycemic also points to metabolic acidosis.
Describe the signs and symptoms to the different types of water imbalance and described clinical manifestation she might exhibit with the potassium level she has.
Serum potassium (K+) cannot shift up or down much without serious implications. 3.5-5.0 being the normal range, Ms. Brown has a reading of 5.6, which is high (hyperkalemia). Since K+ is a key element of electrical conduction in the body, the nervous, skeletal, cardiac, respiratory, and GI systems can be affected by imbalances (Dlugasch & Story, 2024). Neuromuscular symptoms can include paresthesia, muscle cramps, weakness/fatigue, hyperreflexia, flaccid paralysis, and anxiety. Cardiovascular symptoms can include EKG changes and dysrhythmias from delayed conduction, bradyarrhythmia, asystole, ventricular tachycardia & fibrillation, and even cardiac arrest. There is diaphragm weakness that can lead to respiratory depression and arrest. The GI symptoms can be nausea, vomiting, diarrhea, and cramping (Dlugasch & Story, 2024).
In the specific case presented which would be the most appropriate treatment for Ms. Brown and why?
Ms. Brown could benefit from Lactated Ringer’s intravenous fluids since polyuria occurs with hyperglycemia and this can deplete fluid volume. Administration of isotonic IV fluids replace fluids when there has been a loss, such as in dehydration (Dlugasch & Story, 2024). Also, the lactate is converted to bicarbonate ions in the liver and will act to increase the PH to a normal value, also aiding the correction of the acidosis. A rapid- acting Insulin to correct her hyperglycemia would be appropriate. Insulin also promotes K+ to reenter the cell, so insulin deficits (which happen in Diabetic Keto-acidosis) is often accompanied by hyperkalemia (Rogers & Brashers, 2023). The cause of metabolic acidosis can be the keto-acidosis that occurs from hyperglycemia (Leik, 2014).
What the ABGs from Ms. Brown indicate regarding her acid-base imbalance?
Her Ph indicates acidemia. When the pH and paCO2 change in the same direction (which normally should not), the primary problem is metabolic (Sood et al., 2014). Considering her hyperglycemia, Diabetic Keto-acidosis is most likely which is a type of metabolic acidosis. Her O2 level is below normal, and this might likely be due to whatever the respiratory illness is that is causing her to cough severely.
Based on your readings and your research define and describe Anion Gaps and its clinical significance.
Anion Gaps refer to a method of diagnosis for metabolic acidosis that indicates the underlying cause. This test measures for albumin, sulfates, and phosphates, anions which are not usually measured. Normally, the sum of the cations is about the same as the sum of anions in the extracellular fluid. The sum of the bicarbonate and chloride are subtracted from the sum of sodium and potassium. A normal anion gap range is 3-10 mEq/L. Conditions of metabolic acidosis (as in Ms. Brown) like keto-acidosis, will result in an increased anion gap (Dlugasch & Story, 2024).
#2 MelissaPulmonary Function
Assessment of D.R.’s Asthma Attack Severity
The data presented in the case study supports the diagnosis of mild chronic asthma attack in the patient. His primary symptoms have been present for four days and include shortness of breath (SOB), wheezing, exhaustion, coughing, stuffy nose, watery eyes, and postnasal discharge. Moreover, he has had nocturnal symptoms for three nights in the last week, and his peak flow rates have fluctuated between 65% and 70% of his normal baseline. It is suggestive of mild chronic asthma that he has been using the lowest possible peak flow rate range in the morning. The fact that his albuterol inhaler is no longer as effective as it once was and that he must use the nebulizer so often implies that his symptoms have worsened beyond the control of his current medication.
Common Triggers for Asthma
While everyone’s asthma is different, some of the most common triggers include weather conditions, respiratory infections, occupational exposures, allergens, environmental factors, and exercise. Asthmatics are more vulnerable to the effects of meteorological extremes, such as cold air or excessive humidity. This information should be considered in a thorough evaluation, even if it is not included in the case study. Asthma symptoms may be worsened by viral respiratory illnesses like the flu or the common cold. According to Rudd (2019), D.R.’s four-day history of symptoms may point to a viral infection as the cause of his asthma attacks. Workplace exposures to irritants or allergens might trigger asthma symptoms in certain people. The provider needs to ask if in D.R.’s job he is exposed to such things.
Allergens such as dust mites, pollen, mould, and pet dander are among the substances that might set off asthma attacks. It is possible that D.R. has been exposed to allergens since he has watery eyes, postnasal discharge, and a stuffy nose. Asthma symptoms may be exacerbated by being exposed to irritants such as cigarette smoke, air pollution, or strong odours. To determine if these elements have a role in D.R.’s health, it is crucial to gather information about his surroundings (Tanday, 2021). Particularly in cases when asthma is poorly managed, physical exertion might bring on symptoms. If D.R. is trying to control his exercise-induced asthma symptoms, he may be using albuterol nebulizer treatment.
Etiology of D.R.’s Asthma
In most cases, both hereditary and environmental variables interact to bring about the onset of asthma. Possible components that contribute to D.R.’s condition include inadequate asthma control, allergen sensitization, environmental exposures, genetic predisposition, and viral respiratory infections. A worsening of symptoms may occur if the patient does not comply to the treatment plan for asthma, which includes taking medicine as prescribed and avoiding triggers. It is possible that D.R.’s lack of control is due to his dependency on regular albuterol nebulizer treatment.
Sensitization and the onset of asthma symptoms may be caused by prolonged exposure to allergens. The presence of postnasal discharge and watery eyes in D.R.’s symptoms indicates that there may be an allergy component. It is crucial to investigate D.R.’s living and working environment to see whether his symptoms are being exacerbated by allergies or irritants at work or at home. Onother possible factor that might increase D.R.’s risk of developing asthma is a history of the disease in his family. This might be set off if D.R. recently had a respiratory illness. Inflammation of the airways and worsening of asthma symptoms are both caused by viruses (Chapman et al., 2020).
Ultimately, the case study indicates that D.R. may have a mild chronic asthma attack, with allergens, a viral respiratory illness, and environmental variables being possible triggers. Complex interactions between hereditary susceptibility, allergen sensitivity, and maybe insufficient asthma management contribute to the etiology. For optimal care and prevention of future exacerbations, it is necessary to conduct a comprehensive evaluation that considers environmental variables and the patient’s history.
Respond to at least two of your colleagues on 2 different days by comparing your assessment tool to their:
The Psychiatric Evaluation and Evidence-Based Rating Scales
Psychiatric Interview
There are multiple components to the psychiatric interview. While each one of the components is important, I am going to focus on the assessment, DSM-5 Diagnosis, and treatment plan. “The assessment should be a brief recapitulation of the overall clinical picture and a discussion of differential diagnosis.” (Carlat, D. J., 2017). Carlat also notes this is often the area other clinicians will focus on therefore it is important to capture all pertinent information here. In the assessment should include identifying data, current clinical picture, family, and medical history that may be associated with the current diagnosis. “The Diagnostic and Statistical Manual of Mental Disorders (DSM) provides the standard language by which clinicians, researchers, and public health officials in the United States communicate about mental disorders.” (Regier, D. A., Kuhl, E. A., & Kupfer, D. J., 2013). In the psychiatric interview, the DSM-5 is where the clinician will list all the diagnosis for the patient being interviewed. The treatment plan is where the clinician will document the plan of care for the patient. The treatment plan should include: any diagnostic testing planned (i.e., neuropsychological testing, laboratory tests), plans for medication, if you can prescribe, plans for therapy, if needed, referrals to other health care practitioners, if applicable, when you plan to see your patient again. (Carlat, D.J., 2017).
Psychometric Properties
There are multiple screening tools to diagnosis and determine the severity of depressive disorders. I chose to discuss the Beck Depression Inventory (BDI) scale. “The BDI was developed in the early 1960s to rate depression severity, with a focus on behavioral and cognitive dimensions of depression.” (Boland, R. & Verduin, M. L. & Ruiz, P., 2022). This screening tool consists of 21 questions the patient will answer based off their symptoms over the last 2 weeks. The scale is then scored and determines the severity of symptoms. The tool can be readministered to evaluate changes in symptoms over treatment. The screening tool can be administered anytime but would be most helpful and the beginning of the interview to help identify the severity of symptoms.
References:
Carlat, D. J. (2017). The psychiatric interview (4th ed.). Wolters Kluwer.
Boland, R. & Verduin, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th
ed.). Wolters Kluwer
Regier, D. A., Kuhl, E. A., & Kupfer, D. J. (2013). The DSM-5: Classification and criteria
changes. World psychiatry: official journal of the World Psychiatric Association
(WPA), 12(2), 92–98. https://doi.org/10.1002/wps.20050
Hello professor and class,
The three important elements of the psychiatric interview are chief complaint and history of presenting illness (HPI), mental status examination (MSE), and family and social history. The CC offers direction on what kind of HPI (including onset, duration, symptom progression, alleviating, and triggering factors) to gather to understand the patient’s current mental health status (Sadock et al., 2017). By understanding the patient’s CC and HPI, the provider can gain valuable insight into their mental state and help formulate differential diagnoses and an appropriate treatment plan. The MSE helps gain insight into the patient’s mental status by assessing their appearance, behaviors, speech, thought content and process, mood and affect, cognition, perception, insight, and judgments, information fundamental to developing differential diagnoses by identifying specific abnormalities and patterns that indicate certain psychiatric illnesses and informing the development of a treatment plan (Newson et al., 2020). Family and social history is important considering it influence psychopathology. Information about the family’s mental illnesses, social practices (e.g. drinking, drug use, and smoking), and significant life events (e.g. divorce) can help understand the patient’s life and aid in identifying potential stressors and differential diagnoses (Sadock et al., 2017).
The screening tool assigned is the Overt Aggression Scale-Modified (OAS-M), a tool used to assess aggression in psychiatric patients, both inpatient and outpatient (Mistler & Friedman, 2022). According to Coccaro (2020), the OAS-M is a valid and reliable tool, with an alpha coefficient of 0.88 for OAS-M Global Anger and Aggression (GAA) and 0.78 for OAS-M aggression score (AGG), demonstrating internal consistency. The tool also has high inter-rate reliability with a Kappa coefficient of 0.84 and ICC value of 0.97; high temporal stability with an ICC of 0.55; and high face validity.
The OAS-M, as described by Coccaro (2020), is relevant for patients who present with aggressive behaviors such as a history of threats, violence, agitation, or irritability. It provides healthcare professionals with a structured and standardized approach to assessing the risk of overt aggression through the assessment of physical aggression, verbal aggression, hostility, and other aggressive behaviors. The tool also guides the development of appropriate intervention by informing on the severity and nature of the patient’s aggressive behaviors. For instance, helping identify specific triggers and developing targeted and individualized interventions for the management of aggressive behaviors (Mistler & Friedman, 2022). The OAS-M tool is also used to monitor the effectiveness of the intervention in which it is administered at regular interventions to track changes in severity and nature of aggregation, helping inform any change to treatment plans and making necessary adjustments to help attain therapeutic efficacy (Coccaro, 2020).
References
Coccaro, E. F. (2020). The Overt Aggression Scale Modified (OAS-M) for clinical trials targeting impulsive aggression and intermittent explosive disorder: Validity, reliability, and correlates. Journal of Psychiatric Research, 124, 50-57. https://doi.org/10.1016/j.jpsychires.2020.01.007Links to an external site.
Mistler, L. A., & Friedman, M. J. (2022). Instruments for measuring violence on acute inpatient psychiatric units: Review and recommendations. Psychiatric Services, 73(6), 650-657. https://doi.org/10.1176/appi.ps.202000297Links to an external site.
Newson, J. J., Hunter, D., & Thiagarajan, T. C. (2020). The heterogeneity of mental health assessment. Frontiers in Psychiatry, 11, 76. https://doi.org/10.3389/fpsyt.2020.00076
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Psychiatric interview, history, and mental status examination. In Kaplan and Sadock’s Concise Textbook of Clinical Psychiatry. (4th ed., pp. 39–52). Wolters Kluwer.
MY POST
Exploring Psychiatric Assessment and the Montgomery-Åsberg Depression Rating Scale (MADRS)
Components of the Psychiatric Interview
The key psychiatric interview components were rapport-building mental state analysis, and accurate diagnosing. Initial rapport-building fosters a therapeutic partnership that encourages patients to open up. This requires creating a sympathetic, nonjudgmental space for conversation. A comprehensive examination of cognitive, emotional, and perceptual functions reveals the patient’s mental health. Structured questions, observations, and open-ended inquiries help discover mental disorders in this complete examination (Carlat, 2017). Finally, a correct diagnosis is crucial. After the mental state exam, the diagnostic evaluation and formulation procedure synthesizes the data using DSM-5 criteria. This improves comprehension and helps create customized treatment programs.
Psychometric Properties of MADRS
The Montgomery-Åsberg Depression Rating Scale (MADRS) demonstrates robust psychometric properties, affirming its reliability and validity in assessing depressive symptoms. With good internal consistency, MADRS items exhibit high correlation, ensuring homogeneity in measuring depressive constructs. Inter-rater reliability is also notable, indicating consistent ratings across different assessors. Content validity is supported by the scale’s comprehensive coverage of various depressive aspects, and construct validity is evidenced by its effectiveness in measuring depressive symptoms (Borentain et al., 2022). MADRS exhibits sensitivity to change, crucial for tracking symptom severity changes over time in clinical trials. Its criterion-related validity is affirmed through significant correlations with other established depression measures. Furthermore, the one-factor structure of MADRS underscores its simplicity and efficiency in capturing the overall severity of depression.
Application of MADRS
It’s appropriate to use the scale as nurse practitioners during psychiatric interviews. The Montgomery-Åsberg Depression Rating Scale (MADRS) proves particularly valuable within nurse practitioners’ responsibilities. Employing MADRS during the initial psychiatric assessment allows nurse practitioners to gauge the severity of depressive symptoms, establishing a crucial baseline for informed treatment planning. As care progresses, the scale becomes an effective tool for ongoing monitoring, enabling nurse practitioners to track symptom changes and assess the effectiveness of therapeutic interventions (Ntini et al., 2020). MADRS also supports collaborative care models, facilitating standardized communication with other healthcare professionals involved in a patient’s mental health management. In research settings, nurse practitioners can utilize MADRS for data collection, contributing to a more comprehensive understanding of depressive symptomatology.
MADRS use in Nurse Practitioner’s Psychiatric Assessment
The Montgomery-Åsberg Depression Rating Scale (MADRS) significantly enhances a nurse practitioner’s psychiatric assessment by providing a structured and standardized method for evaluating the severity of depressive symptoms. Utilizing MADRS during the initial evaluation establishes a quantifiable baseline, enabling tracking changes in symptomatology over time and facilitating ongoing monitoring of treatment effectiveness (Ntini et al., 2020). The scale’s comprehensive nature ensures a systematic exploration of various depressive symptoms, contributing to a more accurate and holistic understanding of the patient’s mental state. MADRS also promotes consistency and effective communication in multidisciplinary care settings, enhancing collaboration with other healthcare professionals. In research contexts, MADRS serves as a valuable tool for data collection, contributing to evidence-based practice.
References
Borentain, S., Gogate, J., Williamson, D., Carmody, T., Trivedi, M., Jamieson, C., Cabrera, P., Popova, V., Wajs, E., DiBernardo, A., & Daly, E. J. (2022). Montgomery?Åsberg Depression Rating Scale factors in treatment?resistant depression at the onset of treatment: Derivation, replication, and change over time during treatment with esketamine. International Journal of Methods in Psychiatric Research, 31(4). https://doi.org/10.1002/mpr.1927Links to an external site.
Carlat, D. J. (2017). The psychiatric interview (4th ed.). Philadelphia Wolters Kluwer.
Ntini, I., Vadlin, S., Olofsdotter, S., Ramklint, M., Nilsson, K. W., Engström, I., & Sonnby, K. (2020). The Montgomery and Åsberg Depression Rating Scale – self-assessment for use in adolescents: an evaluation of psychometric and diagnostic accuracy. Nordic Journal of Psychiatry, 74(6), 415–422. https://doi.org/10.1080/08039488.2020.1733077Links to an external site.
Please respond to Alexis and Mathew with 2 paragraphs with references
THE PSYCHIATRIC EVALUATION AND EVIDENCE-BASED RATING SCALES
EditEdit
Assessment tools have two primary purposes: 1) to measure illness and diagnose clients, and 2) to measure a client’s response to treatment. Often, you will find that multiple assessment tools are designed to measure the same condition or response. Not all tools, however, are appropriate for use in all clinical situations. You must consider the strengths and weaknesses of each tool to select the appropriate assessment tool for your client. For this Discussion, as you examine the assessment tool assigned to you by the Course Instructor, consider its use in psychotherapy.
Part 1
CASE STUDY 1
(Required) Select the tabs to review the patient medical report. Detailed discussion questions follow below.
Identify one or two medical terms in this report. Deconstruct the components of specific medical terms to identify their meanings. In addition, please pay attention to the spelling and pronunciation of the words.
Operative Report
Expand AllPanels Collapse AllPanels
Acute cholecystitis
150 cc
100 cc
2500 cc of lactated Ringer’s
None
A partially gangrenous but mostly inflamed gallbladder with up to 1 cm thick gallbladder wall and multiple (greater than 50-100) small stones, each measuring approximately 2-4 mm
The patient was brought into the OR and placed in the supine position on the operating table. After successful endotracheal intubation, general anesthesia was safely achieved. His entire abdomen was prepped with Betadine and draped in a sterile fashion. A 2.5-cm supraumbilical transverse incision was made for placement of a Verres needle to achieve pneumoperitoneum and the intra-abdominal cavity was insufflated with CO2 with difficulty. After the fascia on each side of the midline was secured with stay sutures, a knife blade was used to open the fascia and the 10-mm trocar was placed at this site. Upon insertion of the laparoscopic camera, no bowel injury was detected. A 10-mm trocar was then placed in the epigastric position at the midline. Two 5-mm ports were placed in the right upper quadrant, one around the nipple line just below the costal margin and the other around the anterior axillary line again below the costal margin. Through one of the 5-mm ports, an endoscopic needle attached to a 60-cc syringe was inserted in order to aspirate the content within the lumen of the gallbladder, which appeared to be extremely inflamed with what appeared to be a very thick peritoneal layer around the gallbladder.
Further dissection was made with a dissector introduced through the epigastric port. When the dissection was carried out down to the level of the gallbladder neck/cystic duct junction, the inflammation of the tissue around this region was so severe that it precluded a safe dissection of this area. The operation was therefore converted from laparoscopic to open cholecystectomy.
After the instruments and trocars, as well as the camera, were withdrawn from the incision sites, a skin incision was made between the epigastric site and the superior right upper quadrant 5-mm port site. The peritoneum was safely entered through this right subcostal incision. A Michotte retractor was placed cranially in order to retract the superior part of the operative field. Prior to opening the subcostal incision, the umbilical port site was closed at the fascial layer using a figure-of-eight suture. With the Michotte retractor in place, the superior portion of the wound was retracted open and several Mikulicz pads were placed within the abdomen to push the small bowel, colon, and stomach away from the operative field. A Kelly clamp was then placed over the fundus of the gallbladder and the peritoneum was scored with electrocautery. The gallbladder was then dissected off of the liver bed using electrocautery from the fundus down toward the neck. Portions of the peritoneal layer were approximately 1-cm thick. Several neovascularizations were noted within this thickened, inflammatory layer of tissue. Hemostasis was achieved using electrocautery. Several larger vessels from the neovascularization were ligated off with suture ties. Much of the gallbladder was shelled off of this inflammatory layer on the liver bed. The cystic artery was identified and ligated and divided between sutures. The cystic duct was also identified. The cystic duct/gallbladder neck junction was clearly identified in a retrograde fashion. The bottom of the gallbladder neck was clamped with a right-angle clamp, and the cystic duct/gallbladder neck junction was ligated with 2-0 silk tie. An additional 2-0 silk tie was placed to reinforce the ligature. The gallbladder was then resected and opened on the back table and sent to pathology. After successful resection of the gallbladder, the liver bed was inspected for any site of hemorrhage. The operative field was irrigated with antibiotic-soaked solution. A JP drain was then placed within the liver bed and brought out through the inferior right upper quadrant trocar site and secured to the skin with a suture.
After adequate hemostasis was achieved and confirmed, the irrigation fluid was aspirated from the abdominal cavity and the surgical wound was closed using PDS sutures. The skin was approximated using a skin stapler. All of the wounds were dressed with sterile gauze and secured with Tegaderm dressing. The patient tolerated the procedure well and there were no complications. The patient was extubated at the end of the case. All sponge and instrument counts were correct at the end of the case.
CASE STUDY 2
Bernard Collins is a 75-year-old male who has a long history of trouble urinating, along with frequent urinary tract infections. One month ago, an IVP done on February 2, 2010 showed a distended urinary bladder with a large postvoid residual. His symptoms include hesitancy and a decrease in the strength and force of his urinary stream. Physical exam reveals the prostate to be smooth, benign, and approximately 50 g in weight. We will discuss treatment options with the patient, including a TURP, when he returns in 1 week for follow-up.
Question 1
After reviewing the Operative Report of Stephen Mulberry (Case Study 1) and provide the following in your post.
Please make a short summary of the case. What procedure was intended? Why did it have to be converted? What were the abnormal findings? Be sure to explain any medical terms used in your response.
Reviewing the operative report, identify some key diagnosis and organs investigated during the procedure.
Question 2
Review the Outpatient Office Encounter for Bernard Collins (Case Study 2) and provide the following in your post.
Explain to Bernard in a way that he can understand what has happened to his prostate gland as a result of aging.
Question 3
General questions:
Describe the primary functions performed by digestive and urinary systems.
What are the structures of the digestive system?
What are the structures of the urinary system?
Part 2
CASE STUDY 1
Outpatient Office Encounter
The patient, Mrs. Elaine Markus, is a 37-year-old woman with a history of migraine headaches and visual field disturbances.
Expand AllPanels Collapse AllPanels
Mrs. Elaine Markus is a 37-year-old woman with a history of migraine headaches and visual field disturbances. She has a left medial lower quadrant defect (an area of reduced visual function) that was noted in December of 2014 and has been stable. She recently developed a right temporal lower quadrant defect, which was first noted in September of 2019 and has had worsening symptoms in October.
An MRI in November showed a normal study of the brain including visual cortex and periventricular white matter, with a normal study of the orbits, optic nerves, and extra ocular muscles. A pituitary microadenoma (small benign tumor of the pituitary gland) of approximately 3 mm on the left side of the gland was found with no compromise of the optic chiasm. Mrs. Markus underwent further evaluation by MRI with pituitary cuts and the microadenoma was again noted left of midline causing no compression of the optic nerves nor invasion of the cavernous sinus. The microadenoma is approximately 5 mm.
Past medical history is also significant for depression, asthma, and a hiatal hernia. Her current medications include Prozac, Imitrex, and Azmacort MDI.
In summary, Mrs. Markus is a patient with an incidentally noted pituitary microadenoma on MRI. This is reportedly new when compared with prior studies. We cannot explain the new visual field disturbances except for the adenoma. A pituitary workup has been initiated and her prolactin level is mildly elevated, but this can be secondary to her medications, especially Prozac, which can cause hyperprolactinemia. Thyroid function is normal, and a growth hormone test level is pending. I will proceed to rule out hypercortisolemia and Cushing’s disease.
CASE STUDY 2
Outpatient Office Encounter
Howard Solo is a 65-year-old patient and a retired airline ground maintenance technician. He worked for 40 years for American Airlines. He complains of tinnitus and hearing loss that have worsened over the past year. An audiogram was obtained on July 24, 2009 at the time of the patient’s initial visit. This audiogram revealed an average 75 dB (decibel) hearing loss through the speech frequencies in the right ear with an average loss of 80 dB loss in the left ear.
Question 1
After reviewing the Outpatient Office Encounter of Elaine Markus (Case Study 1) and provide the following in your post.
Perform a quality assessment of the medical terminology used by identifying one or two terms that may be inaccurate or confusing within the context of the case presented.
Question 2
After reviewing the Outpatient Office Encounter of Howard Solo (Case Study 2) accomplish the following and report in your findings and comments in your post.
Discuss how you would classify the type of hearing loss that Howard has experienced. Include the degree of severity of hearing loss based on the results of the audiometry. What kind of treatment would you recommend?
Question 3
General questions:
Define the parts of the brain.
Name and define the cranial nerves I-XII.
Part 3
Your next writing assignment is a paragraph that is due at the end of this week. For this assignment, you will have an opportunity to tap into your creative side and write about something you enjoy that takes place in an imaginary world. To begin with, please read the following three selections from Chapter 14 of Common Ground (pp. 273–278).
“Escaping the Fact-Filled World”
“Why I’m a Gamer”
“With Fantasy, Opportunities are Endless”
Let’s begin this week’s discussion by sharing our impressions of these three readings with a goal that further conversation will help us determine the best approach for our own paragraph. Of the three reading selections, which one did you find yourself relating to more closely? Did any of them inspire your own memories or experiences of a fantasy activity?
