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Ethical Research

This weeks readings describe unethical research of the past, such as the study of syphilis among African-American men in which treatment was withheld, and the study in which live cancer cells were injected into elderly patients. Controversial research continues today, even if few cases display such obvious breaches of ethics as these examples.

In preparation for this Discussion, select a current, relatively high-profile case involving research ethics??"preferably one that you have followed in the media. (If none comes to mind, do research on the Internet to familiarize yourself with recent cases.) As you review the case, consider the ethical principles, addressed in the readings by Ioannidis (2005) and Wolf, Walden, and Lo (2005), which demonstrate important ethical principles, which might have been breached by the researchers and/or organization(s). Also, consider the concerns expressed by researchers in the readings by Yakov, Shilo, and Shor (2010), Olsen, Wang, and Pang (2010), and Newcomb (2010) and the influence of culture when conducting research.

With these thoughts in mind:



Post an account of the case, addressing these points:





Briefly describe the case and the ethical issues at stake.



Of the ethical principles you learned about this week, which do you think were breached by the researchers or organizations in this case? Why do you suppose this happened?



Suggest how the research might have been conducted to avoid or minimize the ethical problems. What benefits might have been lost as a result? Why is this a good trade-off?

Reminder: Be sure to support your response with appropriate references to the Learning Resources. If you use sources other than the course Learning Resources, please follow APA (American Psychological Association) guidelines and provide a proper citation and reference for each source. Refer to the APA Pocket Guide, sent to you.

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Qualitative Research Designs

In this Discussion you will explore the phenomenological study Lived Experiences of the Time Preceding Burnout from a few different perspectives.

In preparation, recall your initial reactions to reading this article. What new ideas and questions came to you as you read the study? Now recall how this weeks reading by Hardcastle, Usher, & Holmes (2006) characterized the purposes of phenomenological research. Was this an appropriate design for exploring the articles research problem? Consider, too, how a different qualitative research design would have changed the study.

With these thoughts in mind:
Post your thoughts on the research article, addressing these points:


Identify and describe some of your initial reactions to the article. What jumped out at you? Did this article spark a desire in you to design a similar study? Why or why not?


Now evaluate the choice of this qualitative design in light of the studys research problem. Explain why it is or is not an appropriate design choice.


Identify another qualitative design the researchers might have used for this topic. Briefly describe how this would have changed the study.


Reminder: Be sure to support your response with appropriate references to the Learning Resources. If you use sources other than the course Learning Resources, please follow APA (American Psychological Association) guidelines and provide a proper citation and reference for each source. Refer to the APA Pocket Guide, sent to you.





There are faxes for this order.

1) Define and elaborate on the Needs Hierarchy Theory, and the Two-Factor Theory. Discuss the similarities and differences between the two. [with at least 3 similarities, and 3 differences]
(30 marks)


2) You are the boss of a local building construction firm. You have just been awarded a terrace house construction project. Despite the fact that it is a small scale project, you want to implement some safety measures, as well as improve on the working conditions of your site workers. Based on materials of this course, write up a plan in the form of an essay about how you would take note of lighting, noise, temperature and humidity, and work schedule to minimise workplace accidents and improve motivation of the workers.
[Hint: you should also use materials from the employee safety and health issues topic, as well as materials from the motivation topic. For the working conditions, please use key terms, e.g., intensity of light. Remember to apply a Asian perspective to your response. Come up with at least 10 well-elaborated points.]

Write a research paper that supports the following paragraph/statement.

Patient -centered care (also know as patient and family centered care has distinct characteristics and attributes and has demonstrated cost and quality outcomes. Patient centered care improved patient satisfaction, quality of care and health outcomes while reducing healthcare costs and disparities in healthcare.

Introduction - sets the context for the argument for the above statement, introduces theoretical perspectives or frameworks, defines the key terms and sets out the central content.

Evidence - Literature that supports the contention that support the statement is current, comprehensive and supportive the perspective that the above statement is true, comprised of interdisciplinary literature.
(Use literature from 2005 - now)
Body of paper - Contains test that amplifies or extends your contention and point of view,

Conclusion restate the argument and summarize points of evidence.

Tina?s Story- Case Study
Tina is a 23 year old black female. She is currently separated from her husband of five years. She is currently employed by two companies, one at which she works Monday- Thursday mornings, and the other on Wednesday ? Friday evenings, and all day Saturday and Sunday. However, she hasn?t shown up for work on a consistent basis for the last four weeks, and not at all in the last two days.
Once an energetic, active, healthy female who loved to exercise at the local gym three days a week, Tina now spends most of her time in her apartment. She hasn?t been to the gym in over four weeks, and her body movements that used to be quick and marked are now slow and sluggish. Even though she hasn?t changed her eating habits, Tina has been losing weight.
Joe, Tina?s husband, left her for another woman approximately four weeks ago. When she found out, Tina immediately locked herself in her room and cried herself to sleep. That night, she slept for about twelve hours straight, but that was the last time she had a long stretch of true sleep. Since then, Tina?s sleep habits have been very erratic; sometimes she will sleep for a few hours in the day, some in the evening. She finds herself unable to sleep longer than four hours at a time; as a result, she is constantly fatigued.
When she is awake and able to think clearly, which isn?t 100% of the time, Tina is fixated on where she went wrong in her marriage. She feels that if Joe left her for another woman, it must be because she must not be good enough, just like she wasn?t good enough for her own father to stay at home when she was seven?he left her and her mother, so she must not have been good enough back then, either.
Tina thought that when she married Joe right out of high school, it would be so wonderful. She had such great plans for the two of them...they would both work their way through college and be successful. But it didn?t work out that way, and Tina had to work two jobs just to keep food on the table and the rent paid, because Joe felt it more important to hang out with his friends all day long. If only she had worked harder, or been prettier, or sexier. That must be a lot of it, Tina thinks. She isn?t pretty enough, or hard working enough, or good enough, or sexy enough, which is why Joe left her. She was always so tired from working so much, that it was all she could do to crawl in the bed to sleep, much less give Joe the sex he wanted so often.

Tina believes that because of whom she is and what she has done, no one will ever love her and she will never have a relationship again. She keeps saying over and over how worthless she feels, and that her working all the time must have contributed to the downfall of the marriage. The company kept telling her that if she did just a little more, stayed a little longer, worked a little harder, that she would be promoted, which is why she kept pushing herself as she did. Unfortunately, Tina couldn?t balance the roles, and lost her husband as a result. She feels like a failure, and that she will always be a failure at life and at love.
Tina thought that she and Joe had many friends, but when Joe left, the friends stopped calling and coming to visit, leaving her alone with her sadness. Shortly after Joe left, she called a few girlfriends, but they eventually tired of her constant complaining and wanting sympathy and stopped answering her calls. As a result, Tina has no one to talk to. It would have been nice to talk to her sister, but her sister committed suicide four years ago after becoming deeply depressed over a broken relationship. Tina has thought about suicide too, but she isn?t at the point to do anything about it?yet.
Read Tina?s story below carefully. Using her story as a guide, write a comprehensive discussion of Major Depressive Disorder. Use examples from her story to illustrate the important points to know about this disorder. In your discussion, be sure to include the following points:
? How it is described and diagnosed in the multiaxial system, including identifiable symptoms? (Discuss each of the five axes.) Include examples from the multiaxial system.
? How each theoretical perspective/approach could explain Tina?s behavior and support Tina?s diagnosis? Using examples for each approach.
? Which treatments would be recommended according to each theoretical perspective and the related prognosis for recovery? With examples to each.
? Social perceptions about the disorder

Needs a strong theis statement, and conclude with a restatement of the thesis. Must address the paper with critical thought. Most use at least three Ashford library references from ProQuest.

This paper should be of master's level.

I would like a short introduction, an abstract and clear thesis statement.

My audience does not seem to have a sense of the connection between Western Philosophical thoughts, behavioral and social/psychological factors in the delivery of public health in this 21st century.

I would like to incorporate such theorist as Erikson, Freud and for philosophers such men as Emile Durkhim, Franz Boas, Popper and Michel Foucault

I would fax you some information later today.

Franz Boas is considered one of the preeminent figures in modern anthropology. Boas, who had trained in mathematics, physics, and geography, brought a scientific rigor to the previously haphazard approach to anthropology. Specifically, he coupled Darwin?s ideas about biological change as a response to environmental pressures with his own studies of culture and in doing so, arrived the idea that cultures, too, were distinctive entities created by specific environments and histories. Boas is also responsible for the principle of ?cultural relativism,? which can be understood as the idea that behavior and beliefs should be evaluated in the context of their own culture.

Freud's theories on human development broke down Victorian barriers and led to more open discussion of sexuality and sexual problems. His focus on childhood influenced attitudes toward child rearing and welfare. His theories and observations influenced the social sciences, particularly in terms of his premise that an family relationships provide the foundation for later social interaction and relationships.

Popper is primarily known for his influence as a philosopher of science. He was also a leading contributor to current thought in social and political philosophy. Popper is perhaps best known for his assertion that a hypothesis or theory is scientific only if it is falsifiable. He also argued that a rigorously critical approach can and should be applied to government and social policy. He believed that an open society could only evolve if individuals could critically evaluate policies and actions, which could then be changed based on the critique.

Michel Foucault is best known for his critical studies of various social institutions, most notably psychiatry, medicine, the human sciences, and the prison system. Foucault wrote extensively on the various constructs of power, and the relationships between power, knowledge, and communication.

when the paper is finish you can e-mail it to me at [email protected]

PLEASE NOTE: For some unexplained reason you get the incorrect email address for me. Correspondence must be forwarded to this email address: [email protected]
Do not just reply to address that comes up on receipt of my email

The goal of this 1500 word essay is to demonstrate the various ways in which classical modernity can be understood. The theorist?s perspective will be that of Emile Durkheim.

QUESTION: How does Durkheim understand the difference between modern societies and pre-modern ones? What new problems do modern societies face and how might they be addressed?
This essay needs to give a simple but informed synopsis of Durkheim?s work with a focus on division of labour. Avoid going into too much detail regarding Durkheim?s work on suicide and the role of crime in society as this is not the focus of this essay.

Critically engage with Durkheim?s work and if secondary theorist is used to contrast etc please use Marx?s theories. Provide a summation of what Durkheim is saying & evaluate what is compelling or weak about his arguments.
Put forward a strong and relevant argument
Include at least three academic sources.
In addressing the topic the following should influence content:
? An explanation of social solidarity
? Explain what social facts are and why Durkheim puts so much emphasis on them
? Explain why Durkheim sees modern societies as unique and how is modern society different from the pre-modern era
? Explain how Durkheim measures social solidarity and why laws are important to this discussion
? Explain the difference between restitutive and repressive forms of punishment and how these forms of punishment are related to the difference between mechanical and organic solidarity.
? In the context of this work explain the difference between normal and pathological relationships and give examples of pathological states that are exclusive to modernity.
The essay will need to:
Critically engage with the authors by identifying their strengths and weaknesses
Provide illustrative examples
Have an introduction that sets out what will be argued in a clear and concise fashion
Have a conclusion that does more than sum up the arguments.

PLEASE NOTE: For some unexplained reason you get the incorrect email address for me. Correspondence must be forwarded to this email address: [email protected]
Do not just reply to address that comes up on receipt of my email

Over the past three weeks you have developed most of the components of a marketing program for Tide laundry detergent. Now it is time to add the last few sections. The final plan should include:
? Definition of marketing (U1 DB)
This week the discussion board assignment was to research the definition of marketing. The sources that I used to help me understand the definition were Collins Dictionary of Business (2006), Dictionary of Business (2006), Dictionary of Economics (2009), and my text book Marketing (2010). I was able to gain a better understanding as to how important it is for people in businesses and in corporations to have the knowledge to make use of the four ?P?s? in marketing which are product, price, promotion, and place. The four ?P?s? can make or break a business or corporation.
After researching the sites listed above, I was able to form my own interpretation of marketing. My understanding is that businesses and corporations look for and research what consumers want or need. They then need to get the attention of the consumers by investing in advertisement. They do this by television ads, newspapers, internet, and etc.. By putting the product or service out to the consumers with eye catching ads will increase sales and help with the success of the company.
? Introduction of Tide laundry detergent (U1 DB)
See above DB
? Situation Analysis - marketing environment forces impacting Tide laundry detergent (U1 IP)
Principles of Marketing
One of the primary issues that the soap and laundry detergent is the issue of pollution in the manufacture of the product. Whether from a desire to avoid running afoul of government fines and regulation, to avoid litigation from issues related to pollution or to avoid bad public relations or ?ecotage? (actual sabotage by environmental radicals) this issue is probably the number one issue that the industry has to deal with. A case study in illustrates this well. In 1960's and 1970's, environmentalist activist Jim Phillips (the ?Fox) engaged in what would now be considered eco-terrorism when he limed over sewage pipes of the Aurora, Illinois Armour-Dial soap factory operation there when it dumped raw sewage into the local Fox River. His 7 year battle against the soap and meat packing plant brought enough heat and publicity to cause the state of Illinois to sue Armour-Dial in 1975 for violation of Illinois anti-pollution laws. The plant then starting treating the raw sewage and stopped its dumping (Hoekstra, 2001).
The 1970s marked the beginning of this type of environmental sensitivity (and sensitivity to public opinion on the issue). The Proceedings of the 4th World Conference on Detergents in 1999 noted with relief that the 1992 Rio de Janeiro United Nations Conference on Environment and Development acknowledged that chemicals had improved living standards (Sedlak, 1999, 80). What the industry was opposed to in 1999 and what is very important for today is to combat the difference between consumer goods and bulk chemicals. The difference between the two would determine how governments would apply environmental laws and regulations to the soap industry. By extension, the need to make this distinction and to promote knowledge of the industry's role in environmental responsibility and the positive impact it has on the marketing of the product (ibid, 82). Obviously, this industry's companies that are perceived as responsible have a marketing edge over those who do not. Marketing strategies must emphasize this responsibility and separate responsible companies from polluters.
Interestingly, public sensitivity to the issue of allergens in detergents and soaps also began in the 1960's as well and regarding the immediate effects of the manufacturing process. The first adverse affects were reported in the professional literature in 1969 when reports of a 1967 respiratory allergy outbreak among 28 workers in an epidemic in a detergent plant. Tests indicated that the cause of the allergic reactions was due to the inhalation of enzyme powder. This particular cause of allergic reactions from soap materials is now unusual (Kanerva, 2000).
Much more common are dry skin reactions to soap and this can be differentiated by marketing distinctions as well. In such situations, it can be beneficial to discourage purchases of perfumed soap and the use of neutral brands such as Dove, Basis, Aveeno or Neutrogena dry skin soaps (. To avoid classification with such allergens, as well, many things can be done to avoid or deal with soaps to prevent allergic reaction. Such alternatives can be emphasized so that a positive market image of soap or detergent, since allergies are complex and not always the cause of one irritant, whether chemical or otherwise. Also, one can direct attention to non-irritant products that the particular soap and detergent company produces that can also do the job ("Skin reactions," 2005).
While it is necessary to mollify public opinion and government regulation and law, one must know the problems that one has ownership over and make sure that the finger is getting pointed in the right direction for the right reason. In this way, we can use our knowledge of the physiological and psychological needs of customers to market and portray the product in a correct way and in the proper perspective.
Finally, there is the issue of product changes dictated by various changes in washing machines. These changes have been dictated by energy and water conservation issues that have altered the design of the machines. In the early 1990s, washing machines began incorporated micro controllers for the timing process to improve water and energy usage. These had proven reliable, so a lot of cheaper machines now incorporated these micro controllers, rather than the old mechanical timers ("Washing machine," 2011).
In this way, the washing models were Energy Star certified is an international standard for energy efficient consumer products that ranges over most Western countries, including the EU. Devices carrying the Energy Star logo, usually use 20%?30% less energy than required by federal standards ("Energy star," 2010). To give some example of the way that the technology is developing, the University of Leeds made a concept washing machine that uses only about a cup (less than 300ml) of water to do a full wash. This machine leaves clothes virtually dry, using less than 2% of the water and energy otherwise used by conventional machines. The technological importance requires 20 kilos of re-usable plastic chips for each load. In addition to saving water, it could make laundry detergent obsolete (Poulter, 2008).
A washing machine that functioned without laundry detergent would make the product obsolete. For now, this is not a reality, but with reduced amounts of detergent being needed, other strategies will be needed to market the detergents, including niche markets, marketing to customers with older machines or to foreign markets might be necessary to retain market share or reorganize a company to transfer reliance on to its other soap products to keep the company up and running.
Marketing challenges are not just due to competition. Rather, the process is very dynamic, including psychological, physiological, technological and other challenges that have made the market highly centralized, capital intensive and competitive among a few large companies for the majority of the market share. Innovative strategies will be needed to remake the product for a new century when people have new needs and new technologies to accomplish the age-old job of keeping oneself and their personal environment clean.
? Marketing Strategy - target market(s) and positioning (U2 DB & U2 IP)
See above IP
For week two discussion board we are instructed to describe the model of consumer buyer behavior for the product that we chose in week one and explain how the process works in the real world. I chose laundry detergent using Tide as the product
When purchasing a product there several processes, which consumers must go through. The first of these steps is ?need?. Laundry detergent is a necessity in most homes. Being able to wear clean, fresh smelling, and stain free clothes is what the consumers want and need.
The second step would be information search. This is where the consumer will ask themselves which brand to buy. Should they stay with their usual brand or try something new. Making a decision may come from getting information about the product that you have in mind from family, friends, or neighbors who might have used it themselves.
The third step will be evaluation of different purchase options. Consumers usually have a brand preference that they have had a good history with, a particular brand, or their friends may have had a reliable history with one. I was always a user of Tide. While working for Proctor and Gamble, I was able to learn more about the product and passed that information on to family and friends, giving them the opportunity to switch over.
Step four will be purchase decision. After going through the evaluation process consumers will be able to reach their final decision. Some ways of saving money after making that decision is to check different stores for better costs and check online for saver coupons.
The last step would be post purchase behavior. Manufacturers want consumers to be fully satisfied with the purchase of their product, it is just as important for manufacturers to advertise so consumers feel comfortable that they own a product from a strong and reputable organization. The consumer will be reassured that they have the latest advertised product.
Culture influence in laundry detergent such as Tide is through advertising, word of mouth, and customer satisfaction. Proctor and Gamble are constantly working on new products that will draw the attention of current customers and new ones who may choose their products over the competitors. Like clothing fads, laundry detergents need to keep up with consumers wants and needs, this year?s laundry detergent may not be what the consumers want next year.
? Tide?s overview and strategies to consider (U3 DB)
In marketing there are four categories that a product or service can fit into. These categories are convenience, shopping. specialty, or unsought. Convenience products are purchased by consumers on a regular basis, items used in their everyday lives, such as food, personal care and household cleaning products. Because these items have a high purchase volume, they are sold at lower prices. Shopping products are purchased and consumed less frequently than convenience products. Usually the consumer will shop around to find the better buy because these items are more expensive. Specialty products have a much higher price tag so consumers are more selective. Consumers usually know what they want, what product in particular they are looking for and where they need to go to purchase it. Unsought products are unplanned purchases that occur as a result of a marketer?s action. These actions could be promotional, persuasion, or special discounts.
The product that I have chosen is Tide laundry detergent manufactured by Proctor and Gamble. I would classify it as a convenience product because it can be purchased at most grocery or retail stores anytime they need it.
Tide is the world's largest selling detergent brand and will continue to use television ads as a way of getting the attention of current and prospective customers, doing side-by-side stain comparisons. The company will strive to open up, prepare and use the deep connections people have with its products. Tide has products that will suit all customers want and needs. They will continue to add new and more advanced products each year.
Branding is the promise you make to your customers. It lets them know what they can expect from your product, and it differentiates what you are offering from that of your competitors. Tide offers a website and a toll free number so that customers can contact them with any questions or concerns that they may have. Retail stores will authorize Proctor and Gamble to set up displays with promotional pricing to help raise sales and offer savings to the customers. I believe that by continuing with the eye catching television ads and producing top quality products will keep Tide at the top with laundry detergent sales.
? Pricing Strategy (U4 DB) Not written yet
? Distribution Channels (U3 IP)
Tide Detergent Distribution Channels
Tide Distribution Channel Analysis
The reliance on multichannel distribution channels and the marketing systems that support them are critical to the overall Proctor & Gamble supply chain network performance as inventory planning and forecasting are predicated on the requirements of channel partners (de Leeuw, Fransoo, 2009). P&G concentrates on creating a unified network that can quickly take customer demand as forecasted by channel partners, capture it, and create a production plan based on the many inputs from channel partners. This is the essence of their supply chain strategy and one that relies heavily on a highly synchronized multichannel management system as the process-based foundation of company-wide collaboration (de Leeuw, Fransoo, 2009). P&G relies heavily on sales portals to better serve their reseller and channel partners with the latest product, pricing, promotional strategies and delivery plans by product area (Noorani, Setty, 2007). As Tide is the leading brand for P&G in many of its distribution channels, the company must continually refine the core processes that are relied on for serving resellers in order to continually grow the sales of this flagship brand (Wong, 2010). The reliance on sales portals within P&G has continued to be highly effective in attaining the challenging multichannel management goals the company has (Noorani, Setty, 2007).
Customer Needs
The typical Tide customer is female, over 50 years of age, Caucasian, middle income ($30K - $60K) and often have limited college education. All of these factors have been captured from the website Quant cast, which interpolates demographics of websites. The figure to the right shows an analysis of Tide.com.
Source: http://www.quantcast.com/tide.com/demographics

For this segment of consumers, price and availability are the most important key buying factors followed by trusting the retailer they are purchasing the product from (Wong, 2010). For P&G, their multichannel strategy must include in-depth training for each member of their supply chain, from the large-scale distributors and CPG consolidators to the retailers in the indirect area of their multichannel selling strategy framework. The direct accounts including the high volume retailers that span pure transaction-based business models (Wal-Mart) to mid-market selling including Target, P&G needs to create channel strategies that match the needs of these partners and their entire distribution channels accordingly. The distribution of detergent resellers by segment is shown in Figure 1, Sales of Detergent by Distribution Channel. This analysis further underscores the need for having a highly effective multichannel strategy.

Figure 1: Sales of Detergent by Distribution Channel
Source:
IBISWorld Industry Report 32561
Soap & Cleaning Compound Manufacturing
in the US September 2011 Sophia Snyder

In devising how many total channel partners would be needed, the best approach would be to evaluate how many retailers are selling detergent today, and then calculate how many of those would be needed to keep the sales rate of Tide at a competitive level. According to the latest U.S. Census there are 1,051 distributors alone selling detergent in the U.S. to 5,614 retailers across all channel types. For Tide to gain sustain its growth as a brand with industry-leading market share, it needs to be sold in at least 50% of the distribution outlets and at least 70% of retail outlets. P&G Has extensive experience in creating distribution channels that can efficiently serve this many members of a distribution channel (Weitz, Wang, 2004). P&G will also need to unify them and keep them updated on key trends using portal-based Internet technology as well (Noorani, Setty, 2007).
Recommendation for a Channel Organization
Based on this analysis the best possible strategy for P&G to continue taking with Tide is to invest heavily in multichannel selling and multichannel distribution. Only by doing this will the company be able to continually increase its market share and meet the core requirements of its customers, which are to be the leader in price, availability and quality over the long-term.
You will now add the Abstract, Introduction, Conclusion, and the Integrated Marketing Communications Mix, including:
? Overview of integrated marketing communications
? Promotion Mix Strategy - explain if you will use a push or pull strategy or both and why
? Message Strategy - decide what general message will be communicated to your target market across all promotional tools
? Promotion Mix - choose at least three (3) promotional tools (advertising, sales promotion, personal selling, public relations or direct marketing). For each include:
o Why this promotional tool was chosen.
o Which forms of the promotional tool you will use and why (for example, in advertising you can use TV, radio, magazine, etc. and in direct marketing you can use direct mail, telemarketing, catalogs, etc.).
o Discussion of how your message strategy will be implemented using this promotional tool and the execution style

The four elder in Thomas King's novel Green Grass, Running Water tell us that the world is "bent" and that they are out to "fix" it. This task is to explore the ways in which American Indian literature helps us imagine ways to fix those bent things in the world and explain your findings to someone who matters to you or who matters in your world. I?d suggest starting with an issue, idea, sate of being, or someone component of the human experience that you feel is bent, either in the world around you or, perhaps, even in your own life. This component can be found in a whole range of possibilities. It can be political, social, cultural, educational, literary, environmental, spiritual, psychological, or most anything else.

Please read the file that I uploaded!

the readings that this paper should include (write in the upload files) discuss colonization and decolonizations. I want to make a connection with Korea and Japan in this paper for the topic. In the early of 1900, Korean suffered from Japanese colonial rule until 1945 with the defeat of the Imperial of Japan at the end to World War ?. But if the writer cannot write about that, I do not mind the other topic that the writer choose!!!

And Please do not use too hard vocabulary!! my previous order had many difficult vocabulary to understand, even for American!

Thank you!!!!!!!!!

Complete all of the assigned reading for Unit 2 and review your answers to the questions that accompany each reading. Select one of the issues described in this unit and make this issue the focus of Assignment 2. Locate additional resources that describe your selected issue and the advocacy strategies that address it. Helpful sources will appear online in journals, books, and newspapers.

After reviewing your selected resources, describe the situation as follows:

1.Identify the issue or problem from the advocate's perspective.
2.Note the causes and results of the problem.
3.Describe the solution that the advocate(s) identified.
4.Describe the strategies that were used to advocate for change.
5.Describe the outcomes (if any) of the actions taken.
Then evaluate the advocates' definition of the issue/problem, the steps they took to address the issue/problem, and the outcomes of their advocacy by answering the following questions:

Did the advocates thoroughly identify the causes and results of the issue or problem?
Were the solutions exhaustive, possible, and practical?
Were the actions carried out as planned? If not, what barriers were encountered?
Could these barriers have been surmounted in different ways?
Did the outcomes match the advocates' objectives?
Were there any unintended outcomes? What might have been done differently?
Your essay should be about 2000 words and should critically evaluate the situation based on what you learned from these accounts of advocacy and from the material provided in the readings for Unit 2. Remember to provide scholarly support for any claims made in your essay and to document your sources correctly using APA format. (See http://owl.english.purdue.edu/owl/resource/560/05/ for details on APA documentation style.)

Assignment 2 will be evaluated for:

accurate representation of ideas presented in the course materials;
appropriate use of a variety of additional resources;
evaluative thinking (address the questions listed above and discuss the strengths, weaknesses, and gaps in the advocates' arguments); and
clarity of writing, including:

organization
sentences
grammar
mechanics
style
vocabulary
spelling
documentation
(See the Write Site and Library Help Centre for writing assistance and resources.)

Please note that the word limit for this essay is a guideline only. Stay as close as possible to the suggested length, but do use as many (or as few) words as you need to fully address each question.

Health Issues/Policy Analysis Paper
Guidelines and Grading Criteria

This purpose of the assignment is to explore health needs or problems within communities and to explore what health problems are for that particular community. Discussions with community leaders and experts provide what health problems priorities they perceive exist for that particular community and the plans and policies in place to improve the health disparities. The student relates the health determinants and the epidemiological concepts to the identified health disparities in their communities to provide leadership in the development of policy to affect health outcomes.

After reviewing information provided in course content about Healthy People 2020 and the list of national concerns, the student consults with three (3) to five (5) local authorities and experts in his/her home community to discern the individuals perceptions about their own community problems. Students need to obtain the national list from Healthy People 2020 web site and ask authorities in their communities to describe how community problems compare to national top three health problems.

Interview a variety of individuals in positions of leadership who have knowledge of the communitys health problems and challenges. Conduct the interviews with public health officials, community leaders, school officials, local council members, state representatives, etc. but include a cross section of the community, one nurse leader, or other health care providers.

Write a paper that details each community authoritys perceptions of the top three health concerns. The paper specifies the individual interviewed, the credentials, his/her perspectives of community needs, and why the individual feels these conditions are problematic. The use of first person in this assignment is acceptable. Many community leaders indicate common health concerns, but list in a separate section each individuals concerns. The student identifies at least nine (9) problems. The problems may certainly be the same or similar, but these must be listed according to the community leader who identified the issues as problematic. Differentiate each of the leaders policies for improving the health disparities, and then examine the effects of legal and regulatory processes on nursing practice, healthcare delivery, and outcomes

Investigate and report on the epidemiological information associated with the top three (3) problems identified including a list of resources and statistics from an epidemiology web site. The student needs to tie the community health concerns with the concepts of epidemiology in order to develop a cogent plan of action for the Advanced Practice Nurse to use when developing strategies to address the identified problems.

Then assess specific ways an Advanced Practice Nurse could make an impact on one of the problems. These impacts are specific to the chosen area of practice, i.e. FNP, CNS, ACNP, Management & Leadership, and Education and should include information about how the nurse might make a difference in addressing one of these problems.

Papers should be 6-8 pages in length, excluding title and reference pages using APA format. Points will be deducted for papers that either exceed or do not include 6-8 pages of text. The file containing the paper should be submitted in the assignment section and named with the STUDENTS last name and assignment name.

There are faxes for this order.

Customer is requesting that (researchpro) completes this order.

Your research paper should include the following:
a. A title page
b. A well-developed thesis statement that addresses a concisely worded essential question about a sociological concept of your choice. Thesis Topic is The skills sets needed to get a job to be successful and do the main social inequality that we may face based on money, class and gender and sex make a difference in the workplace?
c. A summary analysis of various authors? perspectives concerning the central question or theme.
d. Own perspective based on your consideration and application of these ideas within the
dynamic environments of college, career, and life.
e. Appropriate citation style (in-text) and reference page according to the conventions of the
American Psychological Association (APA). It should conform to all APA citation and paper format rules.
f. Your reflective narrative think about and discuss in a paragraph the following statement. This response will allow you to ?think about thinking? (metacognition) and how you should approach a research paper in other courses.

The purpose of this paper is to understand one nurse theorist in more depth and discuss how their theory relates to your practice. Nursing theorist is Hildegard Peplau.

Nurse Theorist: Overview of nurse theorist and contributions to nursing
Nurse theory concepts: Clearly identifies key concepts of nursing theory
Metaparadigm definitions: Clearly identifies metaparadigm concepts from this theoritical perspective
Conceptual model: Conceptual model included and discussed
Why chose this theorist" Clearly model is included and discussed
Putting this theory into prectice: Clearly applies theoritical concepts to own nursing practice
References: Use 3 references from multiple sources including original author
Turnitin Score
Writing Skills - APA format, snetence structure, grammer

Information on Peplau's theory
Peplau - Interpersonal Process

Person: organism that lives in an unstable equilibrium and strives to reduce tension generated by needs

Environment: existing forces outside the orgnism in the context of culture

Health/Illness: forward movement of personality in direction of creative, constructive, productive, personal, and community living. Disease - no or backward movement.

Nursing: therapeutic interpersonal process involving the interaction between individuals who have a common goal. Roles- stranger, resource person, teacher, resource person, teacher, leader, surrogate, counselor.

Hi,

I have enclosed the instructions as well as the rubric my professor gave to me for the annotated bibliography I am to have completed. There is a list of topics you can choose along with directions of how it is supposed to look. Listed below is the course description. The bibliography must be done in APA format. This course is for a Masters in Education. If you have any further questions please let me know.

Thank you for your help.



Course Description

This course is designed specifically as a foundation course for Special Education Teachers and is highly useful for mainstream teachers as well. Using a developmental perspective, the course focuses on reciprocal influences of biological, cognitive, and social-emotional dimensions of behavior in general and behavior problems in particular. Within this framework we will delineate the cumulative and reciprocal influences of the context of development of behavior problems in children. Attention will be given to the role of the school in the prevention and management of such behavior problems toward maximization of learning and social-emotional



Assignment Description



Annotated Bibliography




The purpose of this assignment is to provide you with an opportunity to conduct an in-depth literature review of research surrounding a topic of interest that relates to the issues we will be discussing in class this semester. This assignment is worth 102 points and is due for Session 3.



Possible topics include the following:

Nature vs. nurture controversy

Conduct disorder

Antisocial behavior

Externalizing and internalizing behaviors

Delinquency

Oppositional Defiant Disorder

Juvenile and Adult incarceration
Social maladjustment

Parent psychopathology

Risk factors

Social construction of problem behaviors

Resilience

Wrap-around

Intervention strategies

Or another topic of interest




Task:

? Select topic of interest

? Establish parameters for your search- Hint: some topics will have thousands of resources so you will want to determine, at the outset, what areas of the topic you wish to explore; do not simply ignore key information because you think you have enough resources

? Conduct a review of the literature surrounding the selected topic- thoroughly research the topic

? Determine which resources best fit your topic

? For each article reviewed that meets your parameters, record each resource in APA format and include an annotations for the resource

? Divide your reference material into chapters or key headings- i.e., organize references by like themes

? Bind your annotated bibliography in some fashion with dividers between sections/chapters (e.g., three-ring binder, notebook, spiral bound)- loose papers will not be accepted

? Be prepared to present your topic and give a summary of the information you collected in class



Note: You need to complete a thorough, not an exhaustive, search of the literature. In other words, you do not need to review every article ever written about your selected topic. You do, however, need to review enough articles to give you a thorough understanding of all aspects of the topic.







Annotated Bibliography Rubric

6
3
0

? All readings address selected topic
? Most readings address selected topic
? Readings do not address selected topic

? Thorough and accurate review of literature
? Accurate review of literature; missing some information related to topic
? Review of literature missing significant information; inaccurate review of literature

? Annotation provided for each article

? Annotation not provided for each article reviewed

? Annotations accurately summarize articles; key information identified
? Most annotations accurately summarize articles; some key information missing
? Annotations do not accurately summarize articles; significant amount of information missing

? Annotations of sufficient length

? Annotations insufficient length (too long or too short)

? Annotations contain purpose stated in articles reviewed

? Annotations do not contain purpose stated in articles reviewed

? Articles and abstracts divided into chapters by theme
? Most articles and abstracts divided into chapters by theme
? Articles and abstracts not divided into chapters by theme

? Themes accurately reflect information collected
? Most themes accurately reflect information collected
? Themes do not accurately reflect information collected


? APA style reference included for each entry
? APA style reference not included for each entry

? Fewer than 2 errors in APA style reference
? 2-5 errors in APA style reference
? More than 5 errors in APA style reference

? Two or fewer spelling and/or grammatical errors
? 3-5 spelling and/or grammatical errors
? More than 5 spelling and/or grammatical errors


? Person-first language used throughout
? Person-first language not used throughout

? Bibliography well organized

? Bibliography not well organized

? Professional presentation

? Unprofessional presentation

? Annotated bibliography bound

? Annotated bibliography not bound

? Cover page included

? No cover page included

? Dividers between sections/chapters

? No dividers between sections/chapters

? In-class presentation and summary of information collected

? No in-class presentation and summary of information collected




Total Points /102

4 different topics 3 pages each.

1. Describe the major trends in terrorism in recent years.
2. Assess the issue surrounding the use of psychological versus strategic or rational choice to analyzing terrorist movements.
3. Predict the most important trends in terrorism.
4. discuss the major organizational patterns of current terrorist groups and how these organizations may or may not change in the future.

Your paper will be based on 3 parts: 1) a brief summary of the book( The five peolpe you meet in heaven by Mitch album) and what you have learned from it 2) its relevance to developmental psychology and a through discussion of that topic from your text books Life -span development by Santrock 3) how the book applies to your life and psychological outlook. This is NOT a research paper and should not written as or be looked upon as one. I am looking for HOW you can apply what you have learned in class to both developmental psychology and your life.

We will pay more for this order - [email protected]

Whoever is available and able to complete this order in a timely manner. If these writers are not available please select someone familiar with APA style as well as writing Psychology critiques.

Critique of Abnormal Psychology article "Selective attention to angry faces in clinical social phobia". (From the Journal of Abnormal Psychology- Volume 113(1) February 2004 p 160-165.

- APA format w/ footnotes
- 3 pages
- follow critique format
1. Summary of significant contributions of the article to the current literature and understanding of the topic under discussion.
2. Does the article agree or disagree with the general perspective or opinions current in the field about the topic?
3. An Evaluation of the methodology of the Empirical study
A. Were the subjects randomly selected and/or assigned to the "experimental group" in this study?
B. Were appropriate control groups used in the research design? Have all confounding variables been controlled for? Have all significant variables been included in the overall design of the study?
C. Were appropriate methods of assessment used in measuring a particular aspect of the topic studied?
D. Are All competing hypothesis effectively eliminated as possible explanations for the outcome of the study?

4. If the answer to any of the questions is no, what would you do to remediate the situation?
5. What did you gain from the study?
There are faxes for this order.

This is a Masters level essay for a Children and Development course (development meaning international aid not genetic or psychological). The essay topic is "To support children in the South requires a different concept of childhood" with reference to child-focused development interventions. I will be e-mailing a list of works that would be helpful if you could incorporate and to give a general idea of the direction of the paper. I would like the James & Prout, Boyden, and Kessel & Siegel to be used in the essay. As for the essay structure, I do not need footnotes but do need an introduction and conclusion. Also, headings and sub-headings would be useful. Please e-mail me ([email protected]) with any questions.

Choose a film or book of interest. Make sure the book or film has content that can be meaningfully explored through application of psychological theory and research.

Approach the subject matter from different perspectives, i.e., psychoanalytical, biological, learning, cognitive, or socioculturalemotion, to explain motivation, personality, the development of the individual over the life span, health and stress, psychological disorders and treatment.

Apply psychological theory in the exploration of the book "Frankenstien" by Mary Shelley.You could approach the subject matter from different perspectives, i.e., psychoanalytical, biological, learning, cognitive, or sociocultural. You could discuss the role emotion, memory, or motivation plays in the character's development, consider the role of genetics or the importance of the environment, and such influences as racism and sexism, etc.
deal with emotion, motivation, personality, the development of the individual over the life span, health and stress, psychological disorders and treatment, so that you have a more complete idea of the different concepts that could be applied.
Try to find articles on the web or in the library that provide additional support for your interpretation.

Concentrating on Erving Goffman's well known book "stignma", what is a stigma, according to Goffman, and what are two examples that show different ways that people can react to stigmas? How does Goffman's more contemporary perspective reflect or differ from the ideas of Mead and Simmel?

POSITION PAPER- CRITICAL ANALYSIS OF A MAJOR ISSUE IN EDUCATION

Discuss current theoretical perspectives, social, ethical and most importantly pedagogical implications for the following issue,

Individualizing education for students with special needs.

The paper should address the considerations listed and should be supported with recent (1999-2005) relevant literature.

Please make sure that it is a critical analysis of theoretical perspectives, social & political issues of this issue and pedagogical considerations and implications are discussed. This is in the marking criteria!!

If you could also please include some reference to australian system....

I will fax some info over....
There are faxes for this order.

Topic:
"From a 21st century perspective, has psychologist Sigmund Freud's "Oedipal Complex" enhanced the reputation of Sophocles's Oedipus Rex or taken away from it? In other words, which one will continue to capture our imaginations: the psychosexual theory or the literary work?"

Bascially, who make Oedipus famous in 21st century, Freud or Sophocles?

Compose a 1000-1250 word literary analysis in response. Support with quotations and paraphrases from Oedipus Rex, along with research compiled from 3-5 secondary sources. No more than one website as source.
In MLA style.

Please use this source:
Hartocollis, Peter. "Origins and Evolution of the Oedipus Complex as conceptualized by Freud." Psychoanalytic Review 92.3 Jun 1 2005. page 315-334.

Also use these sources if they are relevant:
Eastman, Jennifer. "Freud, The Oedipus Complex, and Greece or the silence of Athena." Psychoanalytic Review 92.3 Jun 1 2005. page 335.

Canham, Hamish. "The Relevance of the Oedipus myth to fostered and adopted children." Journal of Child Psychotherapy 29.1 2003. page 5-19.

Finally, use one or two secondary source to support "Oedipus Rex" the literary work.

1. In class, it was seen how attachment is a complex process which has been researched greatly. Explain Ainsworth?s study on attachment in infancy and the various stages of attachment she discovered.

2. Dynamics of parenting changes when a child enters early childhood. Discuss the changes in parenting and family dynamics in this developmental period and give examples of the various parenting styles discussed in class.

3. The development of play is crucial during the period of childhood. Explain the term ?peer? as it relates to childhood and discuss the development and purpose of play at this stage.

4. Moral development in early childhood was a topic that was extensively discussed in class. Compare and contrast the stages of both Piaget and Kolberg relating to moral development and how this may impact a child?s overall development.

5. List and describe the characteristics of Middle Childhood. How can the need for achievement have an effect on the development of a child?s self esteem?

6. Adolescence is a period of increased physical, emotional and cognitive growth. Explain the major physiological changes that both male and female adolescents experience and how these changes can impact their psychological well being.

This research is for my dissertation which is an applied study where I'm creating a marriage preparation program for adult children of divorce using Positive Psychology (PP) and Structural Family Therapy (SFT) (sometimes called structural couples therapy).
I need a short (apx 1 paragraph) review of 5-7 studies from psychological journals that show how positive psychology and structural family therapy techniques/interventions support/improve couples attachment, communicate skills, decrease divorce rate etc. I'm hoping for studies that show the effectiveness of Positive Psychology (PP) and structural family therapy (SFT) techniques for couples in romantic relationships or married couples... it would AMAZING if you could find studies that show the effectiveness of one of those therapies for adult children of divorce... Things you can search to find appropriate studies would be:

1. Positive Psychology and adult children of divorce
2. Adult romantic relationships and structural couples therapy or structural family therapy
3. Structural family therapy and married couples
4. Effectiveness of positive psychology methods with adult children of divorce or married couples or couples
5. Positive Psychology interventions/methods/techniques and couples communication/Marriage preparation/Attachment/Marriage enrichment etc.
6. Structural Family Therapy interventions/methods/techniques and couples communication/Marriage preparation/Attachment/Marriage enrichment etc.


Studies that show that couples who are being treated with positive psych interventions or Structural family therapy methods can communicate better, are more bonded, have healthier relationships, have more long term-successful relationships etc. Studies, for example, where communication skills were tested before and after PP and SFT treatment and were improved after treatment OR studies that show a correlation between PP, SFT and couples communication, attachment, divorce, marriage preparation, adult children of divorce, adult romantic relationship.

The reviews MUST include 1. the demographics of the participants 2. whether the study was successful 3. in what way it was successful (i.e they communicated better, they reported feeling closer etc) and 4. what method/theory/technique was used.

Every sentence written has to have a reference from the study. If its an exact quote (don't make them all exact quotes), the reference must have the journal page # and when its in your own words, just the authors last name with the year.

If you are questioning whether the study fit with what I'm asking, please email me and let me know so I can determine whether it will work.

If you have any questions what so ever, please email me, as I know I have very detailed requirements and they are all very important to the satisfaction of the paper.

There are faxes for this order.

art & science clinical skills: 28 A guide to taking a patient's history
Lloyd H, Craig S (2007) A guide to taking a patient's history. Nursing Standard. 22,13, 42-48. Date of acceptance: August 24 2007
Surnmary
This article outlines the process of taking a history from a patient, including preparing the environment, communication skills and the importance of order. The rationale for taking a comprehensive history is also explained.
Authors
Hilary Lloyd is principal lecturer in nursing practice, development and research. City Hospitals Sunderland NHS Foundation Trust, Sunderland, and Stephen Craig is senior lecturer in nursing, Northumbria University, Newcastle upon Tyne.
Email: [email protected]
Keyyyords
Assessment; Communication; History taking
These keywords are based on the subject headings from the British Nursing Index. This article has been subject to double-blind review. For author and research article guidelines visit the Nursing Standard home page at www.nursing-standard.co.uk. For related articles visit our online archive and search using the keywords.
TAKING A PATIENT history is arguably the most important aspect of patient assessment, and is increasingly being undertaken by nurses (Crumbie 2006). The procedure allows patients to present their account ofthe problem and provides essential information for the practitioner.
Nurses are continually expanding their roles, and with this their assessment skills. It is likely that history taking will be performed by a nurse practitioner or specialist nurse, although it can be adapted to most nursing assessments. The history is only one part of patient assessment and is likely to be undertaken in conjunction with other information gathering techniques, such as the single assessment process, and nursing assessment.
History taking for assessment of healthcare needs is not new. Many nursing theorists have examined health deficits (Henderson 1966, Roper etal 1990, Orem 1995), all of which rely on careful assessment of patients' needs. Other nursing theorists identified interaction theories (Peplau 1952, Orlando 1961, King 1981), which sought to develop the relationship between the patient and the nurse through systematic assessment of health.
This article provides the reader with a framework in which to take a full and comprehensive history from a patient.
Preparing the environment
The first part of any history-taking process and, indeed, most interactions with patients is preparation ofthe environment. Nurses can encounter patients in a variety of environments: accident and emergency; general wards; department areas; primary care centres; health centre clinics and the patient's home. It is important that the environment in practical terms is accessible, appropriately equipped, free from distractions and safe for the patient and the nurse (Crouch and Meurier 2005).
Respect for the patient as an individual is an important feature of assessment, and this includes consideration of beliefs and values and the ability to remain non-judgemental and professional (Rogers 1951). Respect also involves maintenance of privacy and dignity; the environment should be private, quiet and ideally, there should be no interruptions. When this is not possible the nurse should do everything possible to ensure that patient confidentiality is maintained (Crouch and Meurier 2005).
It is essential to allow sufficient time to complete the history. Not allowing enough time can result in incomplete information, which may adversely affect the patient's care.
Communication
The importance of taking a comprehensive history cannot be overestimated (Crumbie 2006). The nurse should be able to gather information in a systematic, sensitive and professional manner. Good communication skills are essential.
Introducing yourself to the patient is the first part of this process. It is important to let patients tell their story in their own words while using active listening skills. It is also important not to appear rushed, as this may interfere with the patient's desire to disclose information (Hurley 2005). Developing a rapport with the patient includes being professionally friendly, showing interest and actively using both non-verbal and verbal communication skills (Mehrabian 1981) (Box 1).
Practitioners should avoid the use of technical terms or jargon and, whenever possible, use the patient's own words.
42 december 5 :: vol 22 no 13 :; 2007
NURSING STANDARD
Examples of non-verbal and verbal communication skills
Crumbie 2006). Many books and articles also suggest that the history should be taken in a set order (Douglas eta/2005. Shah 2005), however, it is not necessary to adhere to these rigidly. Open questions It is important to use appropriate questioning techniques to ensure that nothing is missed when taking a history from a patient. Always start with open-ended questions and take time to listen to the patient's story. This can provide a great deal of information, although not necessarily in a systematic order. Examples of open questioning include: 'Tell me about your health problems.'' and 'How does this affect you?'
Closed questions Once the patient has completed his or her 'story' move on to clarify and focus with specific questions. Closed questions provide extra detail and sharpen the patient's story. Examples of closed questioning include:'When did it begin?' and 'How long have you had it for?' Clarification Clarification involves recalling back to the patient your understanding of the history, symptoms and remarks. Summarising the history back to the patient is necessary to check that you have got it right and to clarify any discrepancies. Finally, asking the patient, 'Is there anything else?' gives him or her a final opportunity to add any further information.
In general, interviewing skills develop through practice. Some helpful points of guidance to consider include (Morton 1993):
? Encouraging participation and agreement. ? Offering prompts and general leads. ? Focusingthediscussion. ? Placingsymptomsorproblemsinsequence. ? Using pauses effectively.
? Makingobservationsthatencouragethe patient to discuss symptoms.
? Reflecting.
History-taking sequence
? The presenting complaint.
Non-verbal
Eye contact Interested posture Nodding of head Hand gestures Clothing Facial gestures
(Mehrabian 1981)
Consent
Verbal
Appropriate language Avoid jargon and technical terms Pitch Rate and intonation Volume
Before any healthcare intervention, including history taking, informed consent should be gained from the patient. It can be obtained using various methods. However, both the Nursing and Midwifery Council's (NMC.2004) Code of Professional Conduct and the Department of Health's (DH 2001) Good Practice in Consent Implementation Guide state that patients can only provide consent if they are able to act under their own free will, have an understandingof what they have agreed to and have enough information on which to base a decision.
The ability of the patient to give consent to history taking is important. Consent is governed by two acts of parliament: the Mental Capacity Act 2005 in England and Wales and the Adults with Incapacity (Scotland) Act 2000 in Scotland. There is currently no equivalent law on mental capacity in Northern Ireland. In addition, each health trust will ha ve a local policy that the nurse should follow. The NMC (2007a) and DH (2007a) websites provide further information on the Mental Capacity Act 2005 and consent.
The history-taking process
There are some general principles to follow when gathering information from patients. Introductions As stated earlier, always begin with preparing the environment, introducing yourself, stating your purpose and gaining consent. Once this has been completed, it is best to begin by establishing the identity of the patient and how he or she would like to be addressed (Hurley 2005). The first information to be gathered as with any history is basic demographic details, such as name, age and occupation.
Order and structure The general structure of history taking follows the process outlined in Box 2. There is a consensus in medical and nursing texts that it is important to have a logical and systematic approach (Douglas etal2005,
? ? ? ? ? ? ? ? ? ?
Past medical history. Mentai health. Medication history. Famiiy history. Sociai history. Sexuai history. Occupationai history. Systemic enquiry. Further information from a third party. Summary.
NURSING STANDARD
december 5 :: vol 22 no 13 :: 2007 43
(Adapted from Douglas et al 2005)
art & science clinical skills: 28
Taking the history
Ifthe structure advised by Douglas etal (2005) is used, history taking should start with asking the patient about the presenting complaint. The presenting complaint To elicit information about the presenting complaint start by using an open question, for example: 'What is the problem?' or 'Tell me about the problem?'. This should provide a breadth of valuable information from the patient, but not necessarily in the order that you would like. The patient should then be asked more specific details about his or her symptoms, starting with the most important first. It is important to concentrate on symptoms and not on diagnosis to ensure that no information is missed. Most textbooks provide a list of cardinal symptoms - those symptoms that are most important to that body system - a n d should be asked about to ensure that a full history is obtained from the patient. Box 4 provides a list of examples ofthe cardinal symptoms for each body system.
When a patient reports symptoms from a specific body system, all ofthe cardinal symptoms in the system should be explored. For example, ifa patient complains of palpitations, then specific questions should be asked about chest pain, breathlessness, ankle swelling and pain in the lower legs when walking to ensure that all cardinal questions relating to the cardiovascular system have been covered.
Each symptom should be explored in more detail for clarification because this helps to construct a more accurate description of the patient's problems. Direct questions can be used to ask about:
? Onset - was it sudden, or has it developed gradually?
? Duration - how long does it last, such as minutes, days or weeks?
? Site and radiation - where does it occur? Does it occur anywhere else?
? Aggravating and relieving features - is there anything that makes it better or worse?
? Associated symptoms - when this happens, does anything else happen with it, such as nausea, vomiting or headache?
? Fluctuating-is it always the same?
* Frequency - have you had it before ?
Direct questioning can be used to ask about the sequence of events, how things are currently and any other symptoms that might be associated with possible differential diagnoses and risk factors. Negative responses are also important, and it is vital to understand how the symptoms affect the patient's day-to-day activities.
? Clarifying points by restating points raised.
? Sumniarising.
There are also some techniques that should be avoided. These are outlined by Crumbie (2006) (Box 3).
Calgary Cambridge framework
Kurtz etal (2003) refined the Calgary Cambridge Observation Guide (CCOG) model of consultation to include structuring the consultation. The CCOG is useful as it facilitates continued learning and refining of consultation skills for the teacher and practitioner and is an ideal model for both 'novice' and 'experienced' nurses. Kurtz etal {2003) suggested five stages to summarise history taking including:
Explanation and planning Giving patients information, checking that it is correct and that you both agree with the history that has been taken. Aiding accurate recall and understanding Making information easier for the patient using reflection.
Achieving a shared understanding
Incorporating the patient's perspective to encourage an interaction rather than a one-way transmission. Planning through shared decision making Working with patients to assist understanding and involving patients in the decision-making process. Closing the consultation Explaining, checking and offering a plan acceptable to the patient's needs and expectations.
Examples of unhelpful interview techniques
? ? ? * ? ? ? ? ? ? ? ?
Asking 'why' or 'how' questions.
Using probing persistent questions.
Using inappropriate or technical language.
Giving advice.
Giving false reassurance.
Changing the subject or interrupting.
Using stereotype responses.
Giving excessive approval or agreement.
Jumping to conclusions.
Using defensive responses.
Asking leading questions that suggest right answers.
Social chat: the person is expecting professional expertise.
{Crumbie 2006)
44 december 5 :: vol 22 no 13 :: 2007
NURSING STANDARD
Past medical history When a full account of the presenting complaint has been ascertained, information about the patient's past medical history should be gathered. This may provide essential background information - for example, on diabetes and hypertension, or a past history of cancer. It is important to capture the following information when taking a past medical history:
? Diagnosis. ? Dates. ? Sequence. ? Management.
Begin by using questions such as, 'What illnesses have you had?' Ensure that you have obtained a full list ofthe patient's past medical history and explore each of these in detail as with the presenting complaint. It is useful to prompt the patient by using direct questioning to ask about common major medical illnesses, such
as whether he or she has ever had tuberculosis; rheumatic fever; heart disease; hypertension; stroke; diabetes; asthma; chronic obstructive pulmonary disease; or epilepsy.
Mental health According to the NHS Confederation (2007), one in four people will experience mental health problems at one time during their life. This figure demonstrates that nurses are likely to encounter mental health issues frequently. By using skills previously highlighted, and with a supportive and professional approach, the nurse can enquire with confidence about the patient's current coping strategies, such as anxieties over health problems (suspicion of malignancy, impending surgery or test results) or more developed mental health issues, such as bipolar disorder or schizophrenia.
Further clues can be gained from the patient's prescribed medication history or previous hospital admissions. The nurse may feel anxious about enquiring about mental health issues, but it is an important part of wellbeing and should be assessed.
Medication history This is crucially important and should consider not only what medication the patient is currently taking but also what he or she might have been taking until recently. Because of the availability of so many medications without prescription, known as over-the-counter drugs, remember to ask specifically about any medications that have been bought at the pharmacy or supermarket, including homeopathic and herbal remedies. For each medication ask about: the generic name, if possible; dose; route of administration; and any recent changes, such as increase or decrease in dose or change in the amount of times the patient takes the medication.
Cardinal symptoms General health
? Change in bowel habit ? Colour of stools
Genitourinary system ? Pain on urinating
NURSING STANDARD
december 5 :: vol 22 no 13 :; 2007 45
?
? ? ? ? ?
Wellbeing Energy Appetite Sleep Weight change Mood/anxiety/stress
? ?
Blood in urine
Risk assessment for sexually transmitted infections
Cardiovascular system
? ? ? ? ?
Chest pain Breathlessness Palpitations Ankle swelling Pain in lower leg when walking
Men
Central nervous system
Urethral discharge Erectile dysfunction
? ? ? ? ? > Weakness ? Twitches > Tinnitus
?
? ? ? ?
Excessive thirst Tiredness Heat intolerance Hair distribution Change in appearance of eyes
? ? ? ? ?
Cough Wheeze Sputum Blood in sputum Pain when breathing
Headaches Dizziness Vertigo Sensations Fits/faints
Musculoskeletal ? Joint pain ? Joint stiffness ? Mobility
> Gait ? Falls
? Visual disturbance
? Memory and concentration changes
Endocrine
?
Time of day pain
Gastrointestinal system ? Dental/gum problems
Women
? Onset of menstruation
? Last menstrual period
> Timing and regularity of periods
? ? ? ? ? ? > Colic ? Abdominal pain
Tongue Difficulty in swallowing Painful swallowing Nausea Vomiting Heartburn
? ? ? ? ?
Length of periods Type of flow Vaginal discharge Incontinence
Pain during sexual intercourse
(Adapted from Douglas et ai 2005)
? ? ? ? ? ? > Change in libido
Hesitancy passing urine Frequency of micturition Poor urine flow Incontinence
Respiratory system ? Shortness of breath
art & science clinical skills: 28
Concordance with medication is an important part of taking a medication history. Finding out the level of concordance and any reasons for non- concordance can be of significance in the future treatment ofthe patient. Finally, ask about any allergies and sensitivities, especially drug allergies, such as allergy or sensitivity to penicillin. It is important to find out what the patient experienced, how it presented in terms of symptoms, when it occurred and whether it was diagnosed. Family history Some disorders are considered familial; a family history can reveal a strong history of, for example, cerebrovascuiar disease or a history of dementia, that might help to guide the management of the patient. Open questioning followed by closed questioning can be used to gather information about any significance in the patient's family history. For example, start with an open question such as: 'Are there any illnesses in the family?' Then ask specifically about immediate family - namely parents and siblings. For each individual ask about diagnosis and age of onset and, if appropriate, age and cause of death. Sociai iiistory A patient's ability to cope with a change in health depends on his or her social wellbeing. A level of daily function should be established throughout the history taking. The nurse should be mindful ofthis level of function and any transient or permanent change in function as a result of past or current illness.
Questions about function should include the ability to work or engage in leisure activities if retired; perform household chores, such as housework and shopping; perform personal requirements, such as dressing, bathing and cooking. In particular, with deteriorating health a patient may have needed to give up club or society memberships, which may lead to a sense of isolation or loss.
Nurses should consider the whole of the family when exploring a social history. Relationships to the patient should be explored, for example, is the patient married, is his or her spouse healthy, do they have children and, if so, what age are they? The health and residence to the patient should be known to understand actual and potential support networks. Other support structures include asking about friends and social networks, including any involvement of social services or support from charities, such as MIND (National Association for Mental Health) or the Stroke Association.
The social history should also include enquiry into the type of housing in which the patient lives. This should include ifthe accommodation is
owned, rented or leased, what condition it is in and whether there have been any adaptations. Alcohol In relation to the social history ask specifically about alcohol intake. The nurse should ask about past and present patterns of drinking alcohol. Ewing (1984) suggested use of the CAGE system, in which four questions may elicit a view of alcohol intake (Box 5). Hearneet al (2002) considered it to be an efficient screening tool.
The nurse should be wary of patients who are evasive or indignant when asked questions about alcohol consumption. A mental note should be taken to ask again at a later stage and to consider physical evidence of alcohol intake during the physical examination. Many patients do not recognise units of alcohol and will talk in measures and volume for which the nurse will have to have a mental ready reckoner to calculate the weekly alcohol consumption. The DH website provides useful guidance on this (Box 6).
Tiie CAGE system
46 december5::vol22no13::2007
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? ?
? ?
Have you ever felt the need to Cut down?
Have people Annoyed you by criticising your drinking?
Have you ever felt Guilty about your drinking?
Have you ever had a drink to steady your nerves in the morning (Eye opener)?
(Ewing 1984)
Equivaient units of aicoiioi
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A pint of ordinary strength lager, for example, Carling Black Label, Foster's = 2 units.
A pint of strong lager, for example, Stella Artois, Kronenbourg 1664 = 3 units.
A pint of ordinary bitter, for example, John Smith's, Boddingtons = 2 units.
A pint of best bitter, for example. Fuller's ESB, Young's Special = 3 units.
A pint of ordinary strength cider, for example. Woodpecker = 2 units.
A pint of strong cider, for example. Dry Blackthorn, Strongbow = 3 units.
A 175ml glass of red or white wine is around 2 units.
A pub measure of spirits = 1 unit.
An aicopop, for exampie, Smirnoff Ice, Bacardi Breezer, WKD, Reef is around 1.5 units.
(DH 2007b)
Nurses should be mindful that increased alcohol consumption might be a reaction to the health stressors affecting the patient during adjustment to recent changes in health. It could also be that the patient is drinking excessively to act as both a physical and emotional analgesic. Careful, but purposeful, questioning using a mixture ofthe skills outlined should encourage the nurse to have confidence to broach the topic of alcohol dependence. Specific questioning should include the quantity and type of alcohol consumed and where the majority ofthe drinking takes place, whether in isolation or company. Smoking It is documented that smoking causes early death in the population and no safe maximum or minimum limit, unlike alcohol, has been identified. Nurses should ask questions that identify the history ofthe patient's smoking. Traditionally questions surrounding smoking include: 'What age did you start smoking?', 'What kind of cigarettes do you smoke?', 'How many cigarettes a day do you smoke?', 'Do you use roll ups or filtered?'and 'Arethey lowor high tarcontent?'.
Patients will often be unclear about the amount they smoke, but with persistence, 'pack years' - now the standard measure of tobacco consumption -can be calculated (Prignot 1987). Pack years is a calculation to measure the amount a person has smoked over a long period. The pack year number is calculated by multiplying the number of packs of cigarettes smoked per day by the number of years the person has smoked. For example, one pack year is equal to smoking one pack per day for one year, or two packs per day for half a year, and so on.
If an individual smokes three packs per day for 20 years then this would amount to 3 packs per day X 20 years = 60 pack years.
Roll-up cigarettes are more difficult to calculate as these are made by the patient and are not a standard size. Tobacco is usually sold in grams but verbalised in ounces. Approximate tobacco amounts can be calculated (Box 7). Illicit/recreational drugs In the British Crime Survey, Roe and Man (2006) identified that just under half (45.1 %) of all 16-24-year-olds have used one or more illicit drugs in their lifetime, 25.2% have used one or more illicit drugs in the lastyearand 15.1% in the last month.
Approximate calculation of tobacco
1 ounce = 28.34 grams
2 ounces = 56.69 grams
3 ounces = 85.04 grams
A 'standard' pouch of tobacco is equivalent to 50 grams
Recreational drugs are those that are used regularly and which are a focus of a leisure activity without interrupting the user's abilities and lifestyle (Vose 2000). Drug dependence
is when recreational use reaches a level of 'tolerance'. This is the point where or when the use of the drug requires larger more regular usage to acquire the same initial effect.
Professional and appropriate behaviour by the nurse, using careful and tactful questioning, is needed to enable the patient to feel comfortable in disclosing drug use. The nurse may uncover unpleasant or illegal actions by the patient in their pursuit of obtaining drugs or being under the influence of drugs. Sexual history This can be a difficult subject to broach and it is not always appropriate to take a full sexual history (Douglas ef a/2005). Where relevant ask questions in an objective manner, but acknowledge the sensitivity ofthe subject by starting with: 'I hope you don't mind but 1 need to ask some questions about...'
In men, questions regarding sexual history can be asked as part of the genitourinary system history and should include any previous urinary tract infections, sexually transmitted infections and treatments provided. In women date of menarche, regularity and character of periods, pregnancies, live deliveries and terminations or other losses should be recorded. Women should also be sensitively asked about any infections and treatments. High-risk sexual activity, such as unprotected sexual intercourse should be addressed in both genders. In men and women
an enquiry should be made regarding libido, increased or diminished, to reflect both psychological and endocrine systems. Occupational history Taking a history should include information on previous and current employment. This is important as aspects of employment other than the job itself can influence social wellbeing if illness precludes a return to work. For example, employment in heavy industry may lead to respiratory problems or joint problems. Although occupations may date back several years, exposure to some products may have a long incubation period, such as resultant mesothelioma after asbestos exposure.
Past and current employment will also provide details of financial stability ofthe home. Retired patients may have financial limitations, as will patients who are currently unemployed. Increased anxiety can be present in patients who find themselves unable to work because of sudden illness or having to care for a relative or partner. Questions about a patient's financial condition should be unhurried and handled sensitively by the nurse. This might include discussion about social support and benefits
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art & science clinical skills: 28
because hospitalisation can alter the patient's eligibility for benefits. Systemic enquiry The final part of history taking involves performing a systemic enquiry. This involves asking questions about the other body systems not discussed in the presenting complaint. The purpose of this is to check that no information has been omitted. It involves systematic questioning of symptoms relating to cardiovascular, respiratory, gastrointestinal, genitourinary, Iocomotor and dermatological aspects and might yield important clues about the cause ofthe presenting problems. The cardinal symptoms for each system are outlined in Box 4 and questioning should focus on the presence or absence of these symptoms. It is expected at this stage to receive a negative answer to symptoms not already discussed. However, a positive response to any of the questioning should be investigated using the same method as in the presenting complaint.
It is important not to overlook the value of obtaining a collateral history from a friend or relative. If necessary, and with the patient's permission, use the telephone to obtain this
information. It might be essential in a patient presendng with an unexplained loss of consciousness or cognitive symptoms. Information from the history is essential in guiding
'the treatment and management of a patient. Alternatively, the prescribed medication history may be checked with the GP practice ifthe patient is not able to give a full history.
Conclusion
This article has presented a practical guide to history taking using a systems approach. It considered the key points required in taking a comprehensive history from a patient, including preparing the environment, communication skills and the importance of order. While this article provides the knowledge for taking a history, the best method of achieving skills in history taking is through a validated training course with competency-based assessments.
The history-taking interview should be of a high quality and must be accurately recorded (Crumbie 2006). Nurses should be familiar with the NMC Code of Professional Conduct regarding competence, consent and confidentiality (NMC 2004). The novice history taker's records should adhere to the NMC's (2007b) guidance on record keeping NS
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The Introduction is the first part of the body of the paper. It should be one paragraph that include:
Author(s) full name,
Article title
Journal name
Date of publication
The Summary is the second part of the body of the paper. It should include:
Focus of the article
Health assessment procedure and rationales discussed
Health assessment tools and/or strategies discussed
Population discussed (e.g., women, children, older adults)
Evaluate the article. Include a full one- to-two page critique that answers all of the following questions:
What was done well and what could have been improved in the article?
Did this article interest you? If so, explain why. If not, explain this reaction.
Was the health assessment strategy beneficial? Could you adopt it in your practice?
Was the health assessment strategy explained clearly?
Should more research articles be written about this area of health assessment?
What population or individuals would benefit the most from information reported in this article?
dentify the main ideas and major support points from the body of your report. Omit minor details. Summarize the benefits of proper assessment for the patient.
Follow APA formatting according to the 6th edition of the Publication Manual of the American Psychological Association. Include a Title page and References page. Follow the APA rules for margins, font type, font size, etc. Create an in-text for all information mentioned that appears in another source, even if you summarize the information. The References list should include all sources mentioned in in-text citations. Likewise, your References should only list sources that are cited in the body of the paper.