This document appears to be a portfolio submitted by a student named Cameron Smith for a health science course. The portfolio contains several sections, including a technical report with case scenarios, journal reviews, an interview, and samples of previous work. It also includes a career search section, systems analysis, papers on legacy and alumni roles, and a statement of philosophy. The document provides strategies for students to succeed in college by avoiding procrastination and recommends ways for neighborhood residents to conserve water during a drought, such as reducing shower time, limiting lawn watering, using spray nozzles, recycling water, and hand washing dishes.
This portfolio contains samples of work from a Health Science student's senior seminar class including case scenarios analyzing healthcare problems and proposing solutions, summaries of journal articles, resumes, cover letters, and other assignments showcasing the student's knowledge and preparation for a career in occupational therapy focusing on mental health and rehabilitation. The portfolio is intended to demonstrate the student's understanding of issues in the healthcare field and ability to think critically to address problems.
The document is a portfolio containing samples of work completed by a student named Alissa Piazza for their Senior Seminar class, including case studies, journal article summaries, a system analysis chart, papers, and a training certificate.
The portfolio demonstrates the student's ability to think critically and manage multiple projects simultaneously while staying organized, skills developed throughout their undergraduate career studying Health Science. While the specific field they want to enter is unclear, they know they want to work with people and have strong collaboration skills.
The article discusses medical errors that occur in hospitals and how root cause analysis can help prevent errors, noting that the most common errors reported by Florida's Agency for Health Care Administration involved unnecessary surgeries. It provides examples of strategies hospitals can implement to reduce errors, such as having surgeons sign the body part being operated on, staff training to prevent patient suicide, and clear prescribing of medications to avoid administration of the wrong drug or dose.
This document provides information about the Clinical Peer Teaching program for first year medical students during their Intensive Clinical Experience placements. It introduces the program coordinator and useful contacts. The program aims to support first year students and give senior students teaching experience. Students will have tutorials on history taking and vital signs. Suggested activities are provided to help students make the most of their placements. Common hospital terms and frequently asked questions are also addressed.
This document contains a practice exam for the CXC Social Studies exam. It includes multiple choice and essay questions covering topics like culture, government, economics, and consumer issues in the Caribbean. Students must choose two questions from Section A, one from Section B part 1, and one from Section B part 2 to answer for the test. The exam is 2 hours and 40 minutes long.
This document provides an instructor's manual for the textbook "Internet Marketing: Strategy, Implementation and Practice, Fourth Edition" by Dave Chaffey. The manual includes lesson plans, activities, and answers for instructors adopting the textbook. It covers topics such as defining internet marketing, the opportunities and differences between digital and traditional media, developing an internet marketing strategy, and assessing digital channel performance. The manual is intended to supplement the textbook and provide additional teaching materials for instructors.
This document discusses the career path of a dietitian. It begins by defining a dietitian as someone who translates nutritional science into providing optimal nourishment for people. It then outlines the educational requirements, which typically involves a bachelor's degree in nutrition or dietetics, passing an examination, and completing a 1,200 hour internship. The duties of a dietitian are also summarized, such as assessing nutritional needs, developing meal plans, and promoting better nutrition. Statistics about wages and educational costs are presented, showing average salaries of $72,320 in California but requiring $7,000 in college costs and $34,000 for internships. Potential career flexibility and use of technology in the future are also mentioned.
Hospital catering plays an essential role in patient care and recovery by providing nutritious and good quality meals. It requires careful planning and coordination between various departments to assess patient dietary needs and ensure meals are procured, prepared and delivered appropriately. Key roles include catering managers who plan menus and oversee operations, dietitians who advise on nutritional needs, and nursing staff who provide input on patient requirements. Maintaining high standards of hygiene is also vital in hospital kitchens due to patients having lower immunity.
This portfolio contains samples of work from a Health Science student's senior seminar class including case scenarios analyzing healthcare problems and proposing solutions, summaries of journal articles, resumes, cover letters, and other assignments showcasing the student's knowledge and preparation for a career in occupational therapy focusing on mental health and rehabilitation. The portfolio is intended to demonstrate the student's understanding of issues in the healthcare field and ability to think critically to address problems.
The document is a portfolio containing samples of work completed by a student named Alissa Piazza for their Senior Seminar class, including case studies, journal article summaries, a system analysis chart, papers, and a training certificate.
The portfolio demonstrates the student's ability to think critically and manage multiple projects simultaneously while staying organized, skills developed throughout their undergraduate career studying Health Science. While the specific field they want to enter is unclear, they know they want to work with people and have strong collaboration skills.
The article discusses medical errors that occur in hospitals and how root cause analysis can help prevent errors, noting that the most common errors reported by Florida's Agency for Health Care Administration involved unnecessary surgeries. It provides examples of strategies hospitals can implement to reduce errors, such as having surgeons sign the body part being operated on, staff training to prevent patient suicide, and clear prescribing of medications to avoid administration of the wrong drug or dose.
This document provides information about the Clinical Peer Teaching program for first year medical students during their Intensive Clinical Experience placements. It introduces the program coordinator and useful contacts. The program aims to support first year students and give senior students teaching experience. Students will have tutorials on history taking and vital signs. Suggested activities are provided to help students make the most of their placements. Common hospital terms and frequently asked questions are also addressed.
This document contains a practice exam for the CXC Social Studies exam. It includes multiple choice and essay questions covering topics like culture, government, economics, and consumer issues in the Caribbean. Students must choose two questions from Section A, one from Section B part 1, and one from Section B part 2 to answer for the test. The exam is 2 hours and 40 minutes long.
This document provides an instructor's manual for the textbook "Internet Marketing: Strategy, Implementation and Practice, Fourth Edition" by Dave Chaffey. The manual includes lesson plans, activities, and answers for instructors adopting the textbook. It covers topics such as defining internet marketing, the opportunities and differences between digital and traditional media, developing an internet marketing strategy, and assessing digital channel performance. The manual is intended to supplement the textbook and provide additional teaching materials for instructors.
This document discusses the career path of a dietitian. It begins by defining a dietitian as someone who translates nutritional science into providing optimal nourishment for people. It then outlines the educational requirements, which typically involves a bachelor's degree in nutrition or dietetics, passing an examination, and completing a 1,200 hour internship. The duties of a dietitian are also summarized, such as assessing nutritional needs, developing meal plans, and promoting better nutrition. Statistics about wages and educational costs are presented, showing average salaries of $72,320 in California but requiring $7,000 in college costs and $34,000 for internships. Potential career flexibility and use of technology in the future are also mentioned.
Hospital catering plays an essential role in patient care and recovery by providing nutritious and good quality meals. It requires careful planning and coordination between various departments to assess patient dietary needs and ensure meals are procured, prepared and delivered appropriately. Key roles include catering managers who plan menus and oversee operations, dietitians who advise on nutritional needs, and nursing staff who provide input on patient requirements. Maintaining high standards of hygiene is also vital in hospital kitchens due to patients having lower immunity.
The document discusses patient counseling, which involves providing information, advice, and assistance to help patients appropriately use their medications. The objectives of patient counseling are to improve patient understanding of their illness and medications, enhance medication adherence, and improve health outcomes. Effective counseling requires strong communication skills, both verbal and non-verbal. Barriers to counseling can include environmental factors, semantics, negative attitudes, and time constraints. The pharmacist's role is to counsel patients on medication names, uses, dosages, side effects and more to optimize treatment.
Alexander the Great of Macedonia invaded parts of India in his conquests and encountered King Porus of the kingdom of Punarnava, who had a powerful army that included war elephants; however, Alexander outmaneuvered Porus by crossing the Chenab River downstream at night and launching a surprise attack on Porus's forces the next day, causing confusion among the elephants and defeating Porus, who was captured; impressed by Porus's valor, Alexander released him and returned his kingdom when Porus replied that he should be treated "like a king" after Alexander asked how he wanted to be treated following his defeat.
The document discusses various topics related to nutrition including food, nutrients, vitamins, and minerals. It defines food and nutrition, and explains that food provides nutrients that the body uses for growth, repair, energy, and maintenance. It classifies foods by origin, chemicals, and functions. It also describes important macronutrients like carbohydrates, proteins, and fats, and micronutrients like various vitamins and minerals. It provides details on the functions, sources, and deficiency diseases of specific vitamins and minerals.
This is the presentation I gave to the executives on what I accomplished during my summer as an intern with InfoPrint Solutions Company. Though there were so many small pieces I worked on, my focus for the presentation was some of the larger components of my internship.
The document discusses hospital catering services. It provides details on core objectives and services of a catering department including menu planning, material management, costing, and food safety. It outlines the roles and responsibilities of catering staff. The document also discusses challenges around staffing and proposes remedial measures. Key performance indicators for evaluating catering services are presented. The conclusion emphasizes the importance of identifying patient nutritional needs, effective communication, and continual quality improvement.
1) The document is a research study conducted by Olivia Dutta on the impact of promotional activities on consumers and customer satisfaction with Pepsi cola.
2) The primary objective was to study the effect of promotions on consumers and secondary objectives included promotional strategies, brand awareness, consumer perceptions and repurchase intentions.
3) Findings related to promotions found consumer preference, low awareness of some brands, and success of discount schemes. Findings on customer satisfaction related to taste, availability and service to dealers.
4) Recommendations included promoting less known brands more, avoiding invalid promotion codes, improving service, and focusing on lost customers.
Internship Project Power Point PresentationDavid Mugerwa
David N. Mugerwa completed an 80-hour internship at Olney Adventist Preparatory School in Maryland, serving on the curriculum and public relations committees. He updated the school website, published newsletters, took photos for marketing materials, and helped promote standardized test scores. Through this experience, Mugerwa improved his technical and collaboration skills and believes he gained valuable experience for a future career in educational administration.
The document provides an overview of Samsung's history and operations in India. It details Samsung's entry into the Indian market in 1995 and its subsequent expansion, including establishing manufacturing facilities and R&D centers. It also outlines Samsung's product portfolio, core values and vision, and some of its key achievements in India such as becoming the largest mobile brand and a leader in product categories like LED TVs and refrigerators.
This document summarizes an internship at Abu Dhabi EHS (Abu Dhabi Environment Health and Safety Center) where the intern engaged in tasks like writing emails and calls, creating PowerPoints and proposals, research, design work, translation, and more. The internship helped them learn about asking questions when unsure, being professional, organizing work, learning through observation, and presentation techniques. The environment and employees were described positively and the intern believes the experience will help them get a job in the future. Suggestions are made for Zayed University to provide more internship preparation and job application support.
This document provides an overview of tourism marketing. It discusses key concepts like the marketing concept, target markets and segmentation. Tourism marketing aims to achieve growth in tourism by satisfying tourists and earning profits. The tourism product is complex as it involves many industries and consumer preferences vary widely. Marketing strategies for tourism consider characteristics like the product being intangible and consumption happening instantly. The document also covers SWOT and PEST analysis for tourism marketing and the economic importance of marketing.
This document discusses factors that influence tourism demand, including price and non-price factors. It defines key concepts like tourism demand, demand for travel to a destination, and demand for tourism products. It also explains important demand elasticities like price elasticity, income elasticity, cross price elasticity, and marketing elasticity. The document provides examples and discusses the policy implications of understanding these concepts and estimating elasticities of demand for tourism products and destinations.
The document discusses various nutritional disorders including obesity, starvation, kwashiorkor, marasmus, anorexia nervosa and bulimia nervosa. It defines key terms like calorie and essential nutrients. For each disorder, it describes the etiology, clinical manifestations, pathophysiology, nursing management and prevention. Specifically, it provides details on the signs and symptoms of kwashiorkor and marasmus, how they differ in morphology and nutritional content of foods to prevent protein deficiency. The nursing management of eating disorders focuses on helping clients develop normal eating behaviors and self-image.
Nestlé is the world's largest food company and produces many popular confectionery brands like Kit Kat, Polo, and Fox candies. The internship report discusses Nestlé's history starting in 1866, its expansion globally, research and development efforts, business review including its large milk collection network in Pakistan, and marketing strategies. It also examines the 4Ps of marketing for Nestlé confectionery products and provides recommendations to improve the business.
There has been a global increase in tourism over the last 60 years due to factors like increased disposable income, more paid holidays, and cheaper travel. Popular destinations include cities, beaches, and mountain areas for their culture, recreation, and scenery. Tourism is important for many economies, but can negatively impact the environment if not managed properly. Ecotourism is an alternative that involves small-scale tourism to benefit local environments and communities in a sustainable way.
This document discusses a group project on kitchen design. It lists the group members and topics to be discussed, including the definition of a kitchen, history of kitchens, kitchen design principles, and components like cabinets, ventilation, and plumbing. The topics provide an overview of kitchen fundamentals from functions to styles to layouts and systems.
The document discusses key concepts in nutrition including that optimal nutrition is important for health promotion and certain nutrients are essential for well-being. It defines nutrition, dietetics, and the role of registered dietitians. It also addresses different types of nutrition like optimal nutrition, undernutrition, malnutrition, and overnutrition.
The counseling process involves 5 main steps: 1) Relationship building where the counselor engages with the client to understand their issues. 2) Problem assessment where information is collected about the client's situation. 3) Goal setting where specific outcomes are defined that the client wants to achieve. 4) Intervention where the counselor provides support depending on their theoretical approach. 5) Evaluation, follow-up, termination or referral where progress is reviewed and the counseling relationship is closed or the client is referred elsewhere for additional support. The overall process is a structured dialogue where the counselor helps the client identify and overcome problems through increased self-understanding and new skills.
Patient counseling involves providing patients with information about their medications, including how to take them properly, potential side effects, and lifestyle changes. The goal is to improve patient understanding and adherence to treatment regimens. Effective counseling establishes a relationship of trust, assesses the patient's needs and concerns, and ensures they comprehend key points about managing their condition and medications. The counseling process involves private discussions that cover topics like dosage, benefits, interactions, and storage in a way patients can understand.
Here is a draft narrative essay about Jane's experience with her parents' divorce:
Jane's World Turned Upside Down
Jane thought she had the perfect life - a big house in the suburbs, the latest toys and clothes, and parents who loved her. But at just 10 years old, her world came crashing down when her parents told her they were getting divorced. She didn't really understand what was happening at first. All she knew was that her family was breaking apart.
Over the next few months, Jane watched her parents argue more and more. Her dad moved out of the house. Her mom cried a lot. Jane tried to be strong, but inside she felt scared and confused. Why didn't her parents
Cliffs Notes from the Journal of Financial Planning & Counseling milfamln
This document provides an overview and summary of a webinar on summarizing research articles from the Journal of Financial Counseling and Planning (JFCP). The webinar aims to discuss key findings and implications from JFCP articles published between 2004-2013 on various personal finance topics. It outlines the objectives, benefits of producing and consuming research, and summarizes several articles on topics like money management, saving, and retirement planning in 3 sentences or less. The webinar also includes polls to engage participants and discussions on applying research findings to practice.
This document discusses data collection and management. It defines data collection as gathering information in a systematic way to answer research questions. It describes qualitative and quantitative methods of data collection, including interviews, participant observation, and questionnaires. Guidelines are provided for developing questionnaires, including using simple language, asking one concept per question, and phrasing questions neutrally. The document also explains that data management is organizing, storing, and sharing research data. It emphasizes the importance of data management for increasing research impact, avoiding duplication, and ensuring integrity.
The document describes how to transfer the peer instruction technique of using clickers to an asynchronous online environment. It provides examples of online prompts that pose questions to students along with answer choices. Students first privately select their response, then discuss their reasoning in an online threaded discussion. Afterward, students are surveyed on the question again. This allows instructors to assess changes in understanding and observe student thinking. The benefits listed include promoting student engagement, improving learning through discussion, providing feedback to instructors, and engaging students in active learning.
The document discusses patient counseling, which involves providing information, advice, and assistance to help patients appropriately use their medications. The objectives of patient counseling are to improve patient understanding of their illness and medications, enhance medication adherence, and improve health outcomes. Effective counseling requires strong communication skills, both verbal and non-verbal. Barriers to counseling can include environmental factors, semantics, negative attitudes, and time constraints. The pharmacist's role is to counsel patients on medication names, uses, dosages, side effects and more to optimize treatment.
Alexander the Great of Macedonia invaded parts of India in his conquests and encountered King Porus of the kingdom of Punarnava, who had a powerful army that included war elephants; however, Alexander outmaneuvered Porus by crossing the Chenab River downstream at night and launching a surprise attack on Porus's forces the next day, causing confusion among the elephants and defeating Porus, who was captured; impressed by Porus's valor, Alexander released him and returned his kingdom when Porus replied that he should be treated "like a king" after Alexander asked how he wanted to be treated following his defeat.
The document discusses various topics related to nutrition including food, nutrients, vitamins, and minerals. It defines food and nutrition, and explains that food provides nutrients that the body uses for growth, repair, energy, and maintenance. It classifies foods by origin, chemicals, and functions. It also describes important macronutrients like carbohydrates, proteins, and fats, and micronutrients like various vitamins and minerals. It provides details on the functions, sources, and deficiency diseases of specific vitamins and minerals.
This is the presentation I gave to the executives on what I accomplished during my summer as an intern with InfoPrint Solutions Company. Though there were so many small pieces I worked on, my focus for the presentation was some of the larger components of my internship.
The document discusses hospital catering services. It provides details on core objectives and services of a catering department including menu planning, material management, costing, and food safety. It outlines the roles and responsibilities of catering staff. The document also discusses challenges around staffing and proposes remedial measures. Key performance indicators for evaluating catering services are presented. The conclusion emphasizes the importance of identifying patient nutritional needs, effective communication, and continual quality improvement.
1) The document is a research study conducted by Olivia Dutta on the impact of promotional activities on consumers and customer satisfaction with Pepsi cola.
2) The primary objective was to study the effect of promotions on consumers and secondary objectives included promotional strategies, brand awareness, consumer perceptions and repurchase intentions.
3) Findings related to promotions found consumer preference, low awareness of some brands, and success of discount schemes. Findings on customer satisfaction related to taste, availability and service to dealers.
4) Recommendations included promoting less known brands more, avoiding invalid promotion codes, improving service, and focusing on lost customers.
Internship Project Power Point PresentationDavid Mugerwa
David N. Mugerwa completed an 80-hour internship at Olney Adventist Preparatory School in Maryland, serving on the curriculum and public relations committees. He updated the school website, published newsletters, took photos for marketing materials, and helped promote standardized test scores. Through this experience, Mugerwa improved his technical and collaboration skills and believes he gained valuable experience for a future career in educational administration.
The document provides an overview of Samsung's history and operations in India. It details Samsung's entry into the Indian market in 1995 and its subsequent expansion, including establishing manufacturing facilities and R&D centers. It also outlines Samsung's product portfolio, core values and vision, and some of its key achievements in India such as becoming the largest mobile brand and a leader in product categories like LED TVs and refrigerators.
This document summarizes an internship at Abu Dhabi EHS (Abu Dhabi Environment Health and Safety Center) where the intern engaged in tasks like writing emails and calls, creating PowerPoints and proposals, research, design work, translation, and more. The internship helped them learn about asking questions when unsure, being professional, organizing work, learning through observation, and presentation techniques. The environment and employees were described positively and the intern believes the experience will help them get a job in the future. Suggestions are made for Zayed University to provide more internship preparation and job application support.
This document provides an overview of tourism marketing. It discusses key concepts like the marketing concept, target markets and segmentation. Tourism marketing aims to achieve growth in tourism by satisfying tourists and earning profits. The tourism product is complex as it involves many industries and consumer preferences vary widely. Marketing strategies for tourism consider characteristics like the product being intangible and consumption happening instantly. The document also covers SWOT and PEST analysis for tourism marketing and the economic importance of marketing.
This document discusses factors that influence tourism demand, including price and non-price factors. It defines key concepts like tourism demand, demand for travel to a destination, and demand for tourism products. It also explains important demand elasticities like price elasticity, income elasticity, cross price elasticity, and marketing elasticity. The document provides examples and discusses the policy implications of understanding these concepts and estimating elasticities of demand for tourism products and destinations.
The document discusses various nutritional disorders including obesity, starvation, kwashiorkor, marasmus, anorexia nervosa and bulimia nervosa. It defines key terms like calorie and essential nutrients. For each disorder, it describes the etiology, clinical manifestations, pathophysiology, nursing management and prevention. Specifically, it provides details on the signs and symptoms of kwashiorkor and marasmus, how they differ in morphology and nutritional content of foods to prevent protein deficiency. The nursing management of eating disorders focuses on helping clients develop normal eating behaviors and self-image.
Nestlé is the world's largest food company and produces many popular confectionery brands like Kit Kat, Polo, and Fox candies. The internship report discusses Nestlé's history starting in 1866, its expansion globally, research and development efforts, business review including its large milk collection network in Pakistan, and marketing strategies. It also examines the 4Ps of marketing for Nestlé confectionery products and provides recommendations to improve the business.
There has been a global increase in tourism over the last 60 years due to factors like increased disposable income, more paid holidays, and cheaper travel. Popular destinations include cities, beaches, and mountain areas for their culture, recreation, and scenery. Tourism is important for many economies, but can negatively impact the environment if not managed properly. Ecotourism is an alternative that involves small-scale tourism to benefit local environments and communities in a sustainable way.
This document discusses a group project on kitchen design. It lists the group members and topics to be discussed, including the definition of a kitchen, history of kitchens, kitchen design principles, and components like cabinets, ventilation, and plumbing. The topics provide an overview of kitchen fundamentals from functions to styles to layouts and systems.
The document discusses key concepts in nutrition including that optimal nutrition is important for health promotion and certain nutrients are essential for well-being. It defines nutrition, dietetics, and the role of registered dietitians. It also addresses different types of nutrition like optimal nutrition, undernutrition, malnutrition, and overnutrition.
The counseling process involves 5 main steps: 1) Relationship building where the counselor engages with the client to understand their issues. 2) Problem assessment where information is collected about the client's situation. 3) Goal setting where specific outcomes are defined that the client wants to achieve. 4) Intervention where the counselor provides support depending on their theoretical approach. 5) Evaluation, follow-up, termination or referral where progress is reviewed and the counseling relationship is closed or the client is referred elsewhere for additional support. The overall process is a structured dialogue where the counselor helps the client identify and overcome problems through increased self-understanding and new skills.
Patient counseling involves providing patients with information about their medications, including how to take them properly, potential side effects, and lifestyle changes. The goal is to improve patient understanding and adherence to treatment regimens. Effective counseling establishes a relationship of trust, assesses the patient's needs and concerns, and ensures they comprehend key points about managing their condition and medications. The counseling process involves private discussions that cover topics like dosage, benefits, interactions, and storage in a way patients can understand.
Here is a draft narrative essay about Jane's experience with her parents' divorce:
Jane's World Turned Upside Down
Jane thought she had the perfect life - a big house in the suburbs, the latest toys and clothes, and parents who loved her. But at just 10 years old, her world came crashing down when her parents told her they were getting divorced. She didn't really understand what was happening at first. All she knew was that her family was breaking apart.
Over the next few months, Jane watched her parents argue more and more. Her dad moved out of the house. Her mom cried a lot. Jane tried to be strong, but inside she felt scared and confused. Why didn't her parents
Cliffs Notes from the Journal of Financial Planning & Counseling milfamln
This document provides an overview and summary of a webinar on summarizing research articles from the Journal of Financial Counseling and Planning (JFCP). The webinar aims to discuss key findings and implications from JFCP articles published between 2004-2013 on various personal finance topics. It outlines the objectives, benefits of producing and consuming research, and summarizes several articles on topics like money management, saving, and retirement planning in 3 sentences or less. The webinar also includes polls to engage participants and discussions on applying research findings to practice.
This document discusses data collection and management. It defines data collection as gathering information in a systematic way to answer research questions. It describes qualitative and quantitative methods of data collection, including interviews, participant observation, and questionnaires. Guidelines are provided for developing questionnaires, including using simple language, asking one concept per question, and phrasing questions neutrally. The document also explains that data management is organizing, storing, and sharing research data. It emphasizes the importance of data management for increasing research impact, avoiding duplication, and ensuring integrity.
The document describes how to transfer the peer instruction technique of using clickers to an asynchronous online environment. It provides examples of online prompts that pose questions to students along with answer choices. Students first privately select their response, then discuss their reasoning in an online threaded discussion. Afterward, students are surveyed on the question again. This allows instructors to assess changes in understanding and observe student thinking. The benefits listed include promoting student engagement, improving learning through discussion, providing feedback to instructors, and engaging students in active learning.
Micro teaching and exploring community resourcesEr Animo
Micro-teaching involves teaching brief lessons to small groups to gain experience and receive feedback, which is analyzed for self-evaluation. It is effective for focused learning compared to other techniques. Community resources are abundant educational materials outside the classroom that facilitate hands-on learning. Teachers can link with community experts, places, and natural areas to bring real-world examples into lessons. While planning is needed, using these resources makes learning more engaging and helps students appreciate their community.
This document summarizes a presentation on designing results-oriented service projects using a theory of change approach. It outlines the key components of a theory of change including inputs, outputs, outcomes, and impact. It then provides examples of how Rotary members have applied this approach to specific projects, including a "Computers for Learning" project and an "Adopt-a-Village" project. The presentation emphasizes establishing clear assumptions and using a theory of change framework to better understand how activities lead to long-term change and impact.
This module aims to provide students with knowledge and tools to understand consumer behavior. It will explore both conscious and unconscious motivations for purchases. Students will learn frameworks for analyzing customer needs and how to apply this by partnering with organizations. The module goals are to demonstrate critical knowledge of consumer behavior theories and concepts, and to apply this knowledge by proposing solutions to achieve customer satisfaction. Students will be assessed through two coursework assignments, including a written report and individual presentation analyzing primary research with a partner organization.
Community Teaching Work Plan ProposalPlanning and Topic1. LynellBull52
Community Teaching Work Plan Proposal
Planning and Topic
1. Primary Prevention/Health Promotion
Planning Before Teaching:
Grand Canyon University.
Estimated Time Teaching Will Last:
4 hours
Location of Teaching:
Paradise Park, 17648 N 40th St, Phoenix, AZ 85032, United States
Supplies, Material, Equipment Needed:
4 Bar Soap, 5 Liters Detergents, 3 Liters Antiseptic disinfectant liquid, Public Address System, 6 Troughs, and 20 litres of tap water, 5 buckets, posters, and charts of different dirty surfaces, display table, measuring cup, and a measuring jug.
Estimated Cost:
$200.00
Community and Target Aggregate:
Children, Youths and Young parents or recent parents
Topic:
Primary Prevention/Health Promotion
Identification of Focus for Community Teaching (Topic Selection):
· Primary Prevention/Health Promotion
Epidemiological Rationale for Topic (Statistics Related to Topic):
Data source; National Outbreak Reporting System (NORS), CDC/NCEZID and CSTE
URL: https://www.healthypeople.gov/2020/data-search/Search-the-Data?nid=4485
Year
2012
2013
2014
2015
2016
2017
Total
513
64
81
15
177
492
Nursing Diagnosis:
Stomachaches related to dirty food as a result of eating unwashed fruits
Stomachaches related to dirty food as a result of not washing hands
Stomachaches related to dirty food as a result of infected surfaces.
Readiness for Learning:
Most members are complaining or constant stomachaches and diarrhea, wants to be helped on how to manage it.
Learning Theory to Be Utilized:
Behaviorism earning theory
FS-2.3 - Reduce the number of outbreak-associated infections due to Shiga toxin-producing E. coli O157, or Campylobacter, Listeria, or Salmonella species associated with fruits and nuts
How Does This HP2020 Objective Relate to Alma Ata’s Health for All Global Initiatives
Alma Ata’s Health for All Global Initiatives under declaration (IV) states that; The people have the right and duty to participate individually and collectively in the planning and implementation of their health care. Therefore, by having this learning program, people will learn collectively and willfully how they can plan and implement their own healthcare.
Develop Behavioral Objectives (Including Domains), Content, and Strategies/Methods:
Behavioral Objective
and Domain
Example: A healthy food will be chosen by Third-grade students in each of the five food groups by the end of the presentation. (Cognitive Domain)
Content
(be specific)
Example:The Food Pyramid has five food groups which are….
Healthy foods from each group are….
Unhealthy foods containing a lot of sugar or fat are….
Strategies/Methods
(label and describe)
Example – Interactive poster presentation of the Food Pyramid. After an explanation of the poster and each food category, allow students to place pictures of foods on the correct spot on the pyramid. Also, have the class analyze what a child had for lunch by putting names of foods on the poster and discussing what food group still needs to ...
This document provides guidance on writing effective grant and dissertation proposals. It discusses key elements to include such as an abstract, research design, methodology, significance, staffing needs, time frame, budget, letters of endorsement, and dissemination of results. The main points are:
1) An abstract should summarize the proposed work in an clear, economical way for reviewers.
2) A proposal should include the research purpose and goals, design, methods, significance, and time frame. It should demonstrate organizational skills and that necessary resources and support are secured.
3) Explaining how the study benefits others and contributes new knowledge can strengthen the case for funding.
4) Including a realistic budget, clear
The Importance of Nutrition Free Essay Example. Food and Nutrition Essay | Food And Drink Preparation | Food & Wine. Nutrition essay.docx - Nutrition | Course Hero. Nutrition Essay. Write a short essay on Balance Diet | Essay Writing | English - YouTube. ⚡ Food and nutrition essay topics. American Food and Nutrition Essay .... Personal Nutrition Essay — Improving your diet. Sports Nutrition Essay Example | Topics and Well Written Essays - 1000 .... Nutrition Essay | Essay on Nutrition for Students and Children in .... Food Topics: Top-100 for Interesting A+ Writing | Free Guide. Why nutrition is important. 10 Lines on National Nutrition Week for Students and Children in .... 225 Top Nutrition Research Topics and Ideas for Students. nutrition essay updated | Dietary Fiber | Nutrition. Nutrition Month Essay 2017. Basic Principles For A Good Nutrition Worksheet - Free Esl Printable .... ⛔ Health and nutrition essay topics. 63+ Outstanding Nutrition Essay .... Personal Nutrition Essay - — Essay Writing About Nutrition 2019. Nutrition Assignment Free Essay Example. Food Essay | Essay on Food for Students and Children in English - A .... Personal Nutrition Essay : An International Publication for Nutrition .... personal nutrition essay.
This document provides information about an internship seminar on professional development and social entrepreneurship held in Washington D.C. during the summer of 2014. The seminar aims to help students develop professional skills and an understanding of social entrepreneurship through collaborative exercises, discussions, and hands-on learning. Key topics that will be covered include developing a professional portfolio, writing skills, intercultural competence, social entrepreneurship theories, networking, and presentation skills. The seminar will be held on Wednesdays from 11am to 1pm. Grades will be based on attendance, professionalism, participation in class activities and assignments, presentations, and a final professional portfolio. The goal is for students to gain practical skills and insights for building
Midterm Student Feedback: Reflecting on Lessons Learned and Best PracticesDoug Holton
This document discusses midterm student feedback (MSF) services, including:
1. A brief history of MSF and similar programs since the 1970s.
2. Common varieties of MSF programs and processes used.
3. The benefits of MSF for faculty, students, and faculty developers in improving teaching and learning.
4. Key design decisions for developing an effective MSF program, such as survey questions, conducting feedback sessions, analyzing and reporting results, and scaling the program.
1-archival data might be acquired from 3 different locations tha.docxdorishigh
1-
archival data might be acquired from 3 different locations that are the following:
1-records: such as absentee, sick leave or vacation record; sales records; employee figures ...etc
2-documents: training manuals and materials; evaluation plans; and job aids ...etc
3- Existing databases: census data, department of labor data; vital statistics as birth, death, marriage, divorce ...etc
Some advantages of archival data are:
- are easily collectable. reviewing records and documents and using databases doesn't require participants to do anything different.
- May provide quantitative data. Records, document, and databases can provide data for evaluation questions that focus on quantity or frequency.
-Allow for the creation of new variables and scales.
Some disadvantages of archival data are:
-Aggregation. Records may be too aggregated to provide useful data.
-Changes over time. Definitions of terms and variables or data collection methods may have changed over time.
-Time consuming. if there are many documents to review, the task can be tedious and costly in term of time.
2-
observation can be a useful method for addressing evaluation questions concerning an employee's or group's behavior or actions before, during,or after a training program or other organization initiatives.Observing people and environments is particularly helpful in studying processes, relationships among people, and the context of certain events and environments. In addition, observation data can provide important information for answering specific evaluation questions for many kinds of evaluations.
3-
There are several choices to be made when considering how to collect and record observation data. one can need qualitative observations, and where qualitative data are required, the evaluators simply writes down detailed information in the form of a narrative as they are observing. the purpose of qualitative observations is to describe. while the interpretations of observations are left to the data analysis phase.
another choice to use for the observation methods is the video recording of someone's performance to collect that kind of data. the evaluator positions a video camera to record the individual's actions.
a third technique used for collecting observation methods is the use of still photographs. here the evaluator may decide to take photographs of the organization's environment, the employee's workspace, employees performing some tasks or interactions among employees.
The fourth method that can be used for that is the use of checklist or rating form. the evaluator develops a list of questions or items that will guide the observation.
4 while responding to a likert scale, some people feel compelled to put a mark somewhere in between numbers on the scale, for example between the 2 and the 3. this scale allows the responses of varying degrees to each specific survey item. it is important to provide these descriptions so that the respondents can provide their opini ...
How to write my CBAR and basic writing tips.pptxJocelynDFastidio
This document provides guidance on various aspects of conducting action research and writing an action research proposal, including:
- The key parts of an action research or collaborative action research proposal, such as the context/rationale, research questions, types of action research, and significance.
- Best practices for using quotations, paraphrases, and summaries when incorporating other authors' work, including how to properly attribute sources.
- Tips for writing hypotheses, assumptions, research questions, and determining the significance and scope/limitations of a study.
- Examples are provided to illustrate proper paraphrasing, summarizing, and distinguishing hypotheses from assumptions. The document aims to equip readers with the necessary skills for engaging
Scanned by CamScanner1-archival data might be acquired.docxkenjordan97598
Scanned by CamScanner
1-
archival data might be acquired from 3 different locations that are the following:
1-records: such as absentee, sick leave or vacation record; sales records; employee figures ...etc
2-documents: training manuals and materials; evaluation plans; and job aids ...etc
3- Existing databases: census data, department of labor data; vital statistics as birth, death, marriage, divorce ...etc
Some advantages of archival data are:
- are easily collectable. reviewing records and documents and using databases doesn't require participants to do anything different.
- May provide quantitative data. Records, document, and databases can provide data for evaluation questions that focus on quantity or frequency.
-Allow for the creation of new variables and scales.
Some disadvantages of archival data are:
-Aggregation. Records may be too aggregated to provide useful data.
-Changes over time. Definitions of terms and variables or data collection methods may have changed over time.
-Time consuming. if there are many documents to review, the task can be tedious and costly in term of time.
2-
observation can be a useful method for addressing evaluation questions concerning an employee's or group's behavior or actions before, during,or after a training program or other organization initiatives.Observing people and environments is particularly helpful in studying processes, relationships among people, and the context of certain events and environments. In addition, observation data can provide important information for answering specific evaluation questions for many kinds of evaluations.
3-
There are several choices to be made when considering how to collect and record observation data. one can need qualitative observations, and where qualitative data are required, the evaluators simply writes down detailed information in the form of a narrative as they are observing. the purpose of qualitative observations is to describe. while the interpretations of observations are left to the data analysis phase.
another choice to use for the observation methods is the video recording of someone's performance to collect that kind of data. the evaluator positions a video camera to record the individual's actions.
a third technique used for collecting observation methods is the use of still photographs. here the evaluator may decide to take photographs of the organization's environment, the employee's workspace, employees performing some tasks or interactions among employees.
The fourth method that can be used for that is the use of checklist or rating form. the evaluator develops a list of questions or items that will guide the observation.
4 while responding to a likert scale, some people feel compelled to put a mark somewhere in between numbers on the scale, for example between the 2 and the 3. this scale allows the responses of varying degrees to each specific survey item. it is important to provide these descriptions so that the respondents.
Group 5 part 1 students name borong pang, chenzhi ssuser47f0be
- The document discusses potential problems with Kumon's offline learning centers during the COVID-19 pandemic, including safety risks for students and teachers from in-person instruction and the impact on learning from switching to online formats.
- Issues addressed include maintaining rental costs for unused centers, potential compensation costs if students or teachers contract COVID-19 at a center, and protecting Kumon's reputation by ensuring safety.
- Kumon transitioned courses online during the pandemic to follow public health policies and guidelines while still aiming to support students' learning.
Social Media, Research Ethics and Your Research - Research Week 2014 Presenta...Natacha Suttor
Social media platforms (like Facebook, LinkedIn and Twitter) represent incredible potential for researchers to conduct research and recruit survey participants. This presentation looks at current and emerging issues in conducting research on social media and recruiting participants using social media channels.
This is a Research Training co-presentation I delivered with ECU's Research Ethics Officer during ECU's Research Week 2014. It's an updated version of the 2013 presentation.
The document provides tips for writing essays for Reddit. It outlines a 5-step process: 1) Create an account, 2) Complete a form with assignment details, 3) Review bids from writers and choose one, 4) Review the completed paper and authorize payment, 5) Request revisions to ensure satisfaction. Writers are promised original, high-quality work or a full refund.
Break the "Rules"_ Facilitators Guide_aug2018Bev Matthews
This document provides a facilitator's guide for running a "breaking the rules" session to encourage nurses and midwives to challenge existing rules and ways of working. The guide includes suggestions for preparing for the session, templates for materials, and a slide-by-slide facilitation guide. The session is designed to get participants thinking about rules that inhibit great care and teamwork and generate ideas for rules they would break, challenge, or change. Participants discuss their ideas and categorize them on a poster. They then agree on permissions they will take and next steps in an action plan. The overall aim is to empower nurses and midwives to lead improvements by breaking outdated rules.
The document provides guidance on planning and writing reports by outlining the key sections of a report and explaining the importance of planning. It describes the typical sections of a report including introduction, methods, findings, discussion and conclusion. Examples are provided of content that could be included in each section to help the reader understand what type of information belongs in each part of the report.
2. PRELUDE PAGE #
TITLE PAGE 1
TABLE OF CONTENTS 2-3
INTRODUCTION 4
I – TECHNICAL REPORT
CASE SCENARIOS
-Case Scenario #1 5-6
-Case Scenario #2 7-8
-Case Scenario #3 9-10
-Case Scenario #4 11-12
-Case Scenario# 5 13-14
JOURNAL REVIEWS
-Journal Review #1 15-17
-Journal Review #2 18-20
-Journal Review #3 21-23
-Journal Review #4 24-26
HEALTHCARE PROFESSIONAL INTERVIEW
-Healthcare Professional Interview Paper 27-29
NAMES OF JOURNALS
-Names of 5 Scientific Journals 30
SAMPLES OF PREVIOUS WORK
-CHRP 31-42
-Empirical Article Report 43-48
-Research Paper 49-57
II – CAREER SEARCH
JOB ADVERTISEMENT
-Job Advertisement 58-59
COVER LETTER
-Cover Letter 60
RESUME
-Resume 61-62
PERSONAL ESSAY
2
3. -Personal Essay 63
III – SYSTEMS ANALYSIS
SYSTEMS ANALYSIS CHART
-Systems Analysis Chart 64
IV – PAPERS
LEGACY ROLE
-Legacy Role Paper 65
ALUMNI ROLE
-Alumni Role Paper 66-68
V – PHILOSOPHY
STATEMENT OF PHILOSOPHY
-Statement of Philosophy 69
3
4. Introduction
This portfolio is a compilation of some of my best work as a health science
undergraduate at California State University, East Bay. The extensive time and effort needed to
succeed as a student are reflected in the various pieces included and allow the portfolio to serve
as a milestone in my career path. For convenience, future employers may quickly move between
easily defined sections and can embellish in a thorough attention to detail. Defined sections
include a technical report - comprising real-world case scenarios, reviews of scientific journals,
the interview of a healthcare professional, list of 5 scientific journals, and samples of previous
work. Next, a career search section will be found – including job advertisement, cover letter,
resume, and personal essay addressing readiness for employment. A systems analysis section
includes a real-world hierarchy of a healthcare system to demonstrate understanding of how
organizations intricately piece together to form a working unit. The legacy and alumni role
section includes papers demonstrating knowledge of the rationale behind the health science
undergraduate program and my commitment for furthering my medical career. Finally, the
statement of philosophy section will be found and represents my personal commitment to
applying lessons learned in the health science program to my own life in an attempt to live
healthy and well.
4
5. Cameron Smith 10/03/2015, HSC 4700
Case Scenario #1: As the health educator on campus, you know that students procrastinate in
accessing the resources they need on campus like academic advising, career planning, attending
instructor office hours, buying required text books, etc. What strategies would you develop to
assist students succeed in college?
1) Extra Credit Incentive: Students often procrastinate until a due date or problem approaches
and see no benefits of early intervention actions. If instructors were to offer extra points to
students that had their materials early, proof that they had at least ordered them, or attended
office hours, the benefits would be more tangible to students. Instructors could also offer extra
credit for those that complete assignments earlier than the due date. By encouraging all freshman
instructors to agree with this policy, students will begin to habituate visiting office hours and
academic advising offices. This will best prepare them for a successful college career.
2) Develop Engaging Assignments: Students are much less likely to procrastinate if they find
the activity or assignment to be engaging and relatable to real world issues. Assignments that
may be deemed useful in students’ chosen career fields or that can be beneficial to the
development of a particular skill keep interest high. Video assignments and opportunities for
fieldwork also provide stimulation. Instructors that practice this should theoretically teach more
enthusiastic students with more passion towards their chosen major.
3) Provide Less Barriers: Classes that offer outside learning opportunities should provide more
support and guidance to their students. Students who try to take advantage of these opportunities
feel discouraged because the application processes are lengthy and tedious. Many programs
require various hurdles before approval is given, which can benefit those who are truly ready, but
can deter those who are simply thinking about applying. Departments should advertise
opportunities to give students the best learning environment possible.
4) Offer Group Pricing: If supplies such as textbooks or lab materials were offered at a
discounted group price, students would be encouraged to band together earlier to get cheaper
pricing. Also, this encourages new peer relationships, which can lead to study groups that can
ensue throughout the course. Professors can foster this by having a bookstore employee briefly
visit their class to explain group pricing, as well as inquiring about student interest.
5) Due Date Windows: When given a long-term assignment, provide a one to two week window
in which only certain students present their assignment each day. Students are chosen at random,
which necessitates that all students have the assignment done or risk losing points. Variations of
this method could include simply checking that students have at least begun an assignment or are
working at the correct pace needed to finish. Professors that implement this idea will see higher
compliance and motivation to complete the assignment sooner. Students are discouraged from
procrastinating on this type of assignment.
6) Free Coffee and Snacks: Instructors or advisors could find ways to offer free coffee and
snacks at times that students would normally be spending wandering around campus. To avoid
lines of students simply looking for freebies, punch cards could be distributed that would be
stamped upon arrival and 10 minutes later. Although realistically, it would be tough to watch
everyone, the rationale would be that if students were willing to spend time in the intended area,
they would at least attempt to be productive. Variations could include longer times between
stamps or more stringent provisions for proof of productivity, such as completed homework or
5
6. even a few minutes of speaking to an advisor. These services could be provided at the AACE,
office hours and SCAA to encourage students to visit. They also could be provided during the
study nights offered in the Unions at Dead Week.
7) Lottery: Students are encouraged to attend office hours and career advising seminars by
receiving a prize if they are every fourth student to walk in the door. For events that are most
useful and beneficial for the students, the prizes can be more valuable and less frequent to
encourage attendance. The benefit for the instructor or advisor is that they could give away fewer
incentives, as opposed to the previous suggestion, while still giving students a reason to come.
To see if a student won or not, they would have to wait until the end of the meeting and thus
accomplished some degree of productivity. AACE or SCAA can assist in this plan by donating
some of their advertising materials (i.e. pens, notebooks, wristbands). They can also be
advertised on billboards around school to encourage attendance.
6
7. Cameron Smith, 10/10/15, HSC 4700
Case Scenario #2: To ensure residents in your neighborhood save water due to the continuing
California drought, what strategies would you recommend?
1) Shower Usage: Bathrooms use a relatively high proportion of water in comparison to the rest
of a home. Showers represent a significant portion of this usage and by trimming time spent in
the shower, even by a few minutes, many gallons can be saved. An idea would be to pass out 5
minute timers to residents of the neighborhood, or in a more cost effective manner, suggest
residents set a timer on their cell phone. A pamphlet with shower usage statistics pertaining to
water usage, as well as ideas for reduction such as replacing a showerhead to one with a low
flow, could be distributed door to door.
2) Limit Watering: Residents wishing to water their lawn could reduce their usage to only
certain days and times of the week, agreed upon by members of the community. Applying spray
nozzles to hoses would limit the constant flow of water that traditional hoses sacrifice. For those
who choose not to water at all, a contest could be carried out in which the home with the
brownest lawn would win a prize or certificate. Members of the community could meet to decide
the times when watering would be acceptable, and by talking to local hardware stores, a deal to
provide discounted or free spray nozzles for hoses may be reached.
3) Car Washing: For those wishing to wash their car, spray nozzles would again decrease water
usage as opposed to a traditional hose spout. Ideas such as using a bucket of water to rinse, or
even going to a car wash where recycled water is used could also save. Members of the
community could spread ideas such as these by holding a monthly meeting, distributing flyers, or
simply by word of mouth when passing by someone washing their car outside.
4) Recycling Water: Residents could recycle water by placing a bucket underneath a sink or
showerhead as they wait for water to heat up. This water that would normally go to waste could
be utilized for things such as the previously mentioned car washing or lawn/plant watering. Ideas
such as these could be emailed to residents that opted for them, posted on telephone poles or by
word of mouth. Also, residents that save water in this matter could help and offer some to
neighbors if they cannot find a way to use all of it.
5) Dishwashing: By hand washing dishes, residents could save many gallons of water when
compared to using a dishwasher. This could be best accomplished by using a small amount of
water to get soap to bubble and only rinsing once all dishes have been scrubbed. Traditional
dishwashing, in which the water runs the entire time would not be as efficient and may come
close to dishwasher water usage. Residents could also limit dish usage in general by buying
paper plates and disposable utensils. These could be distributed in small quantities at community
meetings, or coupons for cheaper pricing could be handed out. Residents could also band
together to purchase in bulk and save even more money.
6) Laundry Efficiency: By washing larger loads when doing laundry, fewer loads are needed,
and thus less water is used. Residents could also wash less laundry by wearing clothing that does
not need washing as frequently, such as jeans or coats, for longer between washes. Residents
could learn about ideas such as these by attending community meetings, through email or by
word of mouth.
7) Repairing Leaks: Leaks can waste large quantities of water over time, no matter how small
they may seem. Identifying and putting a stop to them can substantially conserve water usage.
Members of the community that may be plumbers or even just have knowledge about repairing
7
8. leaks could volunteer. Plumbers could offer free evaluations not only in an attempt to help the
community, but also to boost demand for their work. Those that are weary about paying for
repairs could minimize smaller leaks by simply placing plumbers tape around them or by turning
off sources of leaks sooner.
8
9. Cameron Smith, 10/17/15, HSC 4700
Case Scenario #3: Commuters in your neighborhood have been trying to find ways to go to work
using environmentally friendly and sustainable ways. What ideas would you give them?
1) Bike to Work: Riding a bicycle to work can have numerous benefits not only for the
environment, but also for your health. Bicycles have no emissions and actually help the cyclist
stay in great physical shape. Traffic jams are nearly nonexistent when on a bicycle and
commutes can actually be faster than driving in many city situations. Employers could encourage
this method of commuting by offering free water and snacks once employees arrive; building
bicycle racks, or by offering a raffle with small incentives to those with choose to ride.
Community meetings will help spread the idea and spark interest in this method of commuting to
work. Employers will be notified by inviting a member of the management to the meeting, or by
posting flyers in employee common areas at work.
2) Join A Carpool: Carpools can be quite beneficial to all parties involved, as it allows normal
fuel/maintenance/parking costs to be divided among all individual passengers. Traffic congestion
is reduced by the amount of passengers present, as the cars that they would typically be driving
are off the road. Some bridges and toll roads allow special lanes for carpoolers at discounted
pricing and during peak traffic times, carpool/hov lanes can be utilized, resulting in a faster
commute. Employers can encourage this method of commuting by posting sign-up sheets in the
break room, holding appreciation events (i.e. a potluck) for members of carpools, or even
offering a company vehicle to use. Community meetings will help spread the idea and spark
interest in this method of commuting to work. Employers will be notified by inviting a member
of the management to the meeting, or by posting flyers in employee common areas at work.
3) Jog/Walk: Though it may seem cumbersome for many, it can be very rewarding both
physically and environmentally. Walking and jogging keep the body in great shape, so it can be
great for those who may work in sedentary, office-type jobs. Pollution is completely nonexistent,
as well as traffic jams, so commute times can be much more predictable. Individuals could find
out about ideas such as this via a company mass email, or by flyers posted in the break room.
Employers could encourage this mode of commuting by offering free coffee or snacks to
walkers/joggers, or by offering bonuses/incentives to those who give up their assigned parking
spot, it applicable. Community meetings will help spread the idea to employers and employees
alike. Employers will be notified by inviting a member of the management to the meeting, or by
posting flyers in employee common areas at work.
4) Take Public Transit: Public transit can be highly efficient in that commute times are mostly
predicable, special lanes in the city or on the highway are able to be utilized, pricing when
compared to driving can be much cheaper, and attention can be redirected from the usual task of
driving to catching up on more work or personal matters. Pollution still exists, but is still lower
than that produced by driving individually, since many people utilize it. Some government and
workplace programs exist that allot credits that can be used for the purchase of public transit
vouchers/tickets. This idea for commuting can spread by posting signs in workplace common
areas, via mass email, or simply by word of mouth. Appreciation events for employees that can
be cheap for the company can include potlucks for those that utilize this method, or even
bracelets/wristbands. Community meetings will further help spread the idea and employers will
be notified by inviting a member of the management to the meeting, or by being presented a
9
10. PowerPoint from a member of the community.
5) Fuel Efficient Vehicles: By trading in an inefficient or older vehicle, for a more fuel efficient
one, commuters can not only save money on their commutes, but for certain vehicles,
government incentives can be quite rewarding. Many electric/hybrid vehicles receive rebates and
discounts that can dramatically lower the price of a vehicle and some even come with special hov
stickers that allow individual drivers to utilize carpool/hov lanes. Individuals interested in this
method could spread the word to others in the workplace via word of mouth, at a community
meeting, or by posting deals for cheap vehicles in workplace common areas. Employers will be
notified by inviting a member of the management to the meeting, via email, or by being
presented a PowerPoint from a member of the community.
6) Work Longer Days: By adopting a longer workday, you not only avoid traffic jams during
peak times, but you could also eliminate a workday from the week. By encouraging people to
speak with management, a typical 40-hour workweek could become a 4-day workweek by
working 4 ten-hour days, rather than 5 eight-hour days. If time spent at work would still be
equivalent, productivity would theoretically be the same, while spending less time driving to and
from work. Ideas such as this could be presented at a community meeting to spread the idea and
spark interest in this method of commuting to work. Employers will be notified by inviting a
company management representative to the meeting, or via email
7) Effects of Erratic Driving: Driving that includes excessive speed; abrupt maneuvers or quick
launches from a stop can have huge impacts on fuel economy. By teaching others about these
effects, fuel economy gains can be great. Commuters can learn more about these benefits via
word of mouth, or by flyers passed out at a community meeting. Employers will be notified by
inviting a company management representative to the meeting, or via email.
10
11. Cameron Smith, 10/24/15, HSC 4700
Case Scenario #4: Understanding the importance of balanced nutrition for youngsters, describe
the strategies you would put forth to encourage parents to feed their children healthy food.
1) Plan Meals: By cooking meals as your appetite arises, convenience is likely to dictate over
healthiness. Parents can ensure a healthier intake for their own diet as well as their own by
planning meals ahead of time. This allows for all necessary food groups to be involved, cuts back
on the excessive amounts of sodium and fat that convenience foods offer, and makes mealtimes
less stressful. In this method, parents also teach their children that meals are only at certain
times, rather than every time the appetite arises, helping eliminate eating out of boredom or
excessive eating. Schools will be notified and community meetings will seek to bring
representatives from parents and school officials. One designated representative from each group
will be tasked with spreading the ideas via email, telephone, or word of mouth.
2) Practice What You Preach: During early childhood, a parent is one of their child’s largest
role models. By modeling healthy eating habits early on, children are better set to also adopt
them and aren’t as apt to make bad food decisions later on in life. Parents can model this
behavior by not excessively snacking between meals, consuming plenty of fruits and vegetables,
eating smaller portions and watching junk food intake, such as soda and candy. The school nurse
will be notified so that the school health office can administer flyers to parents at community
meetings or mail them out to homes. Representatives for parents and school faculty can be tasked
with spreading the word to those that they represent.
3) Cooking Together: By allowing a child to contribute to the process of food preparation, they
feel more involved and are curious to try what they helped create. Parents can make this fun by
allowing their child to use cookie cutters, making smiley faces in food, or by simply encouraging
their imagination, such as renaming or creating stories for foods. In general, healthy foods can
involve more preparation, which involves more time and effort spent, leading to a sense of
accomplishment. Many children may even find a new hobby in food preparation. Schools will be
contacted to spread information about this method and flyers can be distributed to parents upon
school approval via mail or at parent-teacher meetings.
5) Strike A Balance: Eating healthy food all the time, especially for children, is an unrealistic
goal. By striking a balance between healthy food and junk food, goals can be more attainable and
not seem like such a punishment. Healthy food should comprise most of the diet however to
ensure proper growth and development for the rest of a child’s life. Parents can set certain days
in which children can eat out at fast food restaurants, allow sweets only after certain meals or
times, and can simply purchase less junk food, so that it’s not as readily available. Ideas such as
this can be spread by seeking parents and faculty members to join a committee to represent the
larger group, which can then distribute them via word of mouth, flyers, email or door-to-door.
6) Introduce Dipping: Healthy foods may not always be the tastiest foods, hence why children
can be so apprehensive about consuming them. By introducing dips, such as peanut butter, salsa,
or ranch, children may find foods such as vegetables more delightful. Parents can experiment
with different dips during meals to encourage new habits. Schools will be notified either via
email or phone that ideas such as these need to be spread to parents. Upon approval, community
meetings can be assembled, with representatives from each group (parents and faculty members)
that can further spread the word. Also, members of the school faculty could pass out flyers when
11
12. parents pick up their children after class.
7) Don’t Force Habits: Children can be very stubborn, especially when telling them that they
need to consume their fruits or vegetables. By adopting a more laid back approach and simply
placing these items on a plate alongside foods that they already love, children may become
curious and try them. Parents can facilitate this method by serving small amounts of healthy food
on their children’s plate, in the hopes that the child will finish what is on their plate before
reaching for more of the food that they already love. Schools can become aware of ideas such as
these by either emailing, calling, or meeting with school administrators to present a PowerPoint.
Upon approval, a community meeting or parent-teacher conferences can help further spread the
word.
12
13. Cameron Smith, 10/31/15, HSC 4700
Case Scenario #5: As a manager of a nursing home downtown, your assistants tell you that most
seniors at the facility appear depressed and living very stressful and disturbed lives. Describe
how you would address this problem.
1) Needs Assessment: To first get a sense of what the residents seem to be lacking, a needs
assessment would be conducted. Depending on the size of the community living in the nursing
home, either all residents could participate, or a sample that is large enough to be representative
of the population, as a whole would be selected. A mixture of quantitative and qualitative
questions would be asked to not ensure complete accuracy and to extract enough information
from the residents. The assessment could be offered as a questionnaire, with staff on hand to
properly listen to key points and take notes from residents.
2) Evaluation: After completion of the needs assessment, the results would be analyzed for
changes that need to be made. Proper implementation would entail taking into account
everyone’s concerns and finding ways to help ameliorate them. Ideas such as the following could
be potentially beneficial, depending on the needs and concerns of residents. Needs assessments
should be conducted on regular intervals to ensure ideas have been effective.
3) Karaoke: Oftentimes in nursing homes, residents can be objectified and forgotten as actual
people with personalities. In this activity, residents that are able to sing can remember their
younger selves and liven the atmosphere, whereas residents that aren’t able to can still enjoy the
fun and music as well. The idea can be implemented by tasking assistants to buy the materials
needed (if within the budget), or by utilizing existing materials, such as computers or television
screens to display lyrics. To get a sense of which songs to include, assistants could conduct a
survey among the residents.
4) Entertainment Hour: Residents sometimes lose touch with the outside world and all the
great things that it has to offer. By offering a time slot in the day with snacks and drinks other
than those offered daily (while still within the constraints of dietary restrictions) and an
entertainer, such as a magician, storyteller, or singer, residents can reclaim some of the things
they used to enjoy. To help implement this idea, assistants could be tasked with finding snack
and drink ideas for those with each type of dietary restriction that haven’t been offered before, or
that are rarely offered and purchase them if within the budget. If not within the budget, assistants
could instead volunteer to bring goods from home for a potluck-type experience. The entertainer
could be found by tapping into any employee connections, or even by asking for an employee
that would like to volunteer.
5) Children: Residents will often see the same faces day in and day out, with little to no contact
with their loved ones in many cases. Children are thus a group that they become isolated from,
and it becomes easier to feel their age with every passing day. By petitioning a local elementary
school or preschool for volunteers to donate handmade cards or letters to residents, they can feel
more connected to the world and feel that they truly matter. Alternatively, if any employees have
children, they could volunteer to bring them by to visit residents (while within the constraints of
resident safety and comfort).
6) Lively Atmosphere: The atmosphere of a nursing home can become quite dreary for those
that must live there for long periods of time or indefinitely. By decorating common areas as well
as rooms in which residents agree (to not upset them, especially those with Alzheimer’s), the
13
14. change of atmosphere can have a positive effect on their attitude. Choosing warm, welcoming
colors, blowing up balloons, and using seasonal appropriate decorations, residents can be
reminded that they are at home. This idea can be implemented in many different ways, and can
be decided upon during an employee meeting or via surveys in break rooms. Employees can
volunteer to bring in decorations, or can vote on which decorations to buy (while keeping within
the budget).
7) Outdoor Activities: Along the lines of the previous suggestion, residents can often become
depressed or have anxiety due to their never-changing environment. By allotting time for outside
activities such as having a picnic, bird watching, storytelling, or even a simple walk, residents
can be reminded that their environment doesn’t have to be static. This idea can be quite simple to
implement, as it costs little to no money. Events such as a picnic can be substituted for an indoor
meal, and can be implemented ahead of time by cleaning tables outside, setting up an umbrella
for shade, and gathering necessary supplies. Employees can vote on which activities to include at
a staff meeting, and the director can offer suggestions such as the ones given.
8) Auction: Residents can participate in an auction to stimulate socialization, gain a sense of
decision-making and to simply have fun. Auction items can be purchased from a dollar store,
handcrafted by employees/volunteers or can be intangible, such as a storytelling from an
employee. Money for the auction need not be real and can be provided via a Monopoly currency,
or pennies donated by employees. Auction items can be voted on in a staff meeting and ideas can
come from both residents (via survey or word of mouth) and employees.
9) Games and Puzzles: As residents age, their brain function if not properly stimulated can
decline at a very rapid rate. By offering games such as BINGO, Dominoes, Yahtzee, or mildly
challenging puzzles, their brains can be stimulated and they can have fun and can socialize with
other residents or assistants in ways they don’t normally get to. This idea can be implemented by
voting on which games/puzzles to include during staff meetings, or by polling residents.
Depending upon which games/puzzles are chosen, a budget can be made for purchasing them, or
employees can be asked for donations of games/puzzles they no longer use.
14
15. Foodborne Illness
Medical technology has advanced at a steady pace as society has become more
technologically dependent and discovers innovative approaches in the preservation of health. In
spite of this rapid advancement however, food safety has not followed suit and consequently,
foodborne illness continues to occur and pose danger to public health. Various reasons for this
trend exist and could potentially include an increase in global travel and food supply, changes in
food preference, increased consumption of restaurant food, and an ever-changing microbe
population. (Alexander, L.L., 2012, p.3)
The most common culprits in inducing foodborne illness have been identified as
infectious agents such as bacteria, viruses, or in more rare instances, parasites. Heavy metals and
toxins found in nature, especially those found in ocean life also contribute. (Alexander, L.L.,
2012, p.3) Changes in food preference, such as an increase in fruit and vegetable consumption,
have fueled the spread of such agents, as they are more prone to harboring them.
One of the most obvious indicators of foodborne illness has been identified as
gastrointestinal problems, which includes diarrhea, vomiting, and cramps. (Alexander, L.L.,
2012, p.4) These symptoms are encountered when food or water has been contaminated with the
aforementioned bacteria or parasites and then ingested. Viruses are an exception, as they can
survive for longer periods of time and are thus spread differently - primarily through the fecal-
oral route.
Proper knowledge of emerging trends in foodborne illness is chief in both the prevention
and treatment of such illness. Knowledge is obtained as increasing encounters with infectious
agents occur and are reported to public health agencies in a timely fashion. As trends are
identified, the proper measures can be taken to curtail further spread and inform medical
15
16. professionals. As agents within the medical field, practitioners and medical staff have the ability
to intervene earlier when equipped with this knowledge and correctly diagnose and treat patients
before serious illness can occur.
Issues that can complicate identification and thus proper knowledge of trends can include
under-reporting, difficulties in recognizing symptoms, inabilities to identify mode of
transmission, the emergence of novel pathogens, and misdiagnoses. (American Medical
Association, American Nurses Association, 2004, p.3) When practitioners and medical staff
become aware of these issues in identification, they can more readily prepare to encounter them
and avoid contributing such difficulties.
16
17. References
Alexander, L. L. (2012). Foodborne Illness. [PDF document]. Retrieved from
http://www.netce.com/coursecontent.php?courseid=879
American Medical Association, American Nurses Association—American Nurses
Foundation, Centers for Disease Control and Prevention, Center for Food Safety
and Applied Nutrition Food and Drug Administration, Food Safety and Inspection
Service U.S. Department of Agriculture. Diagnosis and management of foodborne
illnesses: a primer for physicians and other health care professionals. MMWR.
2004;53(RR4):1-33.
Centers for Disease Control and Prevention. Preliminary FoodNet data on the incidence
of infection with pathogens transmitted commonly through food—10 states, 2009.
MMWR. 2010;59(14):418-422.
17
18. Burnout: Impact on Nursing
Originally coined in the 1940’s, the term burnout referred to the point at which a jet or
rocket engine ceased to possess the ability to operate. The term later was applied to humans to
describe a complete loss of energy, purpose, and motivation as a result of working. (Edelwich,
Brodsky, 1980) Burnout can occur in nearly any job setting, but has been found to be most
prevalent in settings that require high levels of helping others, such as the medical field. Within
the medical field, Nursing has been identified as a branch with very high prevalence, mostly due
to the nature of the work environment.
The work environment for Nurses places them in high levels of patient interaction and
can often include stressful situations that need to be diffused in a time-efficient manner.
Overtime and extended shifts are commonplace within the field and such high levels of human
interaction leave little time for self-reflection and coping. Hierarchy among those in the medical
field can also create tension, as Physicians often dominate decision making, leaving less room
for autonomy. (Alexander, L.L., 2012) Nurses that work in skilled nursing facilities and hospitals
have been found to possess the highest rates of job dissatisfaction, mostly attributable to
inadequate staffing, coworker conflicts, and low pay. (Alexander, L.L., 2012)
Consequences of chronic burnout can be severe and can impact the well being of both
Nurses and patients. Personal consequences for Nurses can include diminished social support
outside of work, substance abuse, and feelings of depression. These consequences interact with
workplace performance and subsequently create professional consequences. Workplace
attendance, productivity, and quality of patient care often diminish and can place patient safety in
danger. (Alexander, L.L., 2012) Nursing shortages interact with professional consequences, due
to the fact that staff is not large enough to compensate when burnout occurs.
18
19. The current crop of baby boomers that are approaching retirement and thus a point in
which health problems are generally more prevalent, highlights the issues involved with the
current burnout among Nurses. Inadequate staffing will continue to fuel burnout as workloads
increase and perpetuate a cycle in which Nurses are forced to leave their jobs due to
dissatisfaction. (Buerhaus, Auerbach, & Staiger, 2009) With fewer Nurses available to provide
care, patient outcomes will suffer, and place more strain on the medical field than is already
present. As a future member of the medical field, my responsibilities in combating burnout
among Nurses is to be aware of the strain placed upon them and offer help and compassion when
possible. The medical field operates most efficiently when all members that contribute to patient
care can successfully perform their job, and by helping others understand the prevalence, the
level of burnout can be minimized.
19
20. References
Alexander, L. L. (2012). Burnout: Impact on Nursing. [PDF document]. Retrieved
from https://www.netcegroups.com/827/Course_3143.pdf
Buerhaus P, Auerbach D, Staiger D. The recent surge in nurse employment: causes and
implications. Health Aff. 2009;28(4):w657-w668.
Edelwich J, Brodsky A. Burn-out: Stages of Disillusionment in the Helping Professions.
New York, NY: Springer; 1980.
20
21. What Healthcare Professionals Should Know About Exercise
Obesity has achieved epidemic status in today’s society, as Americans focus more on
their busy lives than on taking care of their health. Despite widespread knowledge of the benefits
of exercise, the vast majority of Americans participate either too little or not at all. (Centers for
Disease Control and Prevention, 2008, p. 1) Physicians have the opportunity to intervene and
influence patients to reach exercise goals, however most are ill equipped to offer practical advice
on the subject. (White, J. J., 2010)
Various reasons exist for a lack of exercise and Physicians need to be aware of how to
deal with each as they arise. Reasons most often include a lack of interest, busy schedules, lack
of time, fear of injury, lack of proper techniques and methods, and lack of access to facilities or
equipment. To help patients overcome these burdens, the United States Preventative Services
Task Force recommends that Physicians begin by identifying obese patients and offering both
counseling and behavioral interventions. (White, J. J., 2010) Adequate counseling is established
as at least 1-2 sessions per month for higher risk patients, while all patients, regardless of risk
should be counseled for at least 5 minutes every appointment.
In terms of patient safety, those over the age of 35 that have been primarily sedentary for
an extended period of time should be cleared before beginning an exercise regimen. (The
President’s Council on Physical Fitness and Sports, 2008) In most other cases, the willingness
alone should be sufficient to begin exercise, with a physical exam just to confirm overall health.
After safety has been established, Physicians should focus attention on both short term and long
term goals that are reasonable yet effective. With proper goals, patients should be able to see
results within the short term including moderate weight loss and strength gain, and should
continually improve endurance and motivation in the long term. (White, J. J., 2010) A proper
21
22. exercise regimen should also identify all barriers to exercise so that both the Physician and
patient can work together to overcome them as they arise.
As a future member of the healthcare field, I need to be conscious of both my own level
of exercise and risk for obesity as well as my patients. I can focus on eating healthier and finding
realistic ways to incorporate exercise into my daily life by setting both short and long terms
goals. Those who are passionate about something tend to pass it on easier to others than those
who don’t tend to care. Patients are more likely to listen to someone that understands struggles
and limitations and that can help them move past them. In order for the obesity epidemic to stop
growing, healthcare providers need to possess a complete picture of the situation and understand
factors beyond the scientific and statistical ones so thoroughly stressed, beginning with the
aspect of being human.
22
23. References
White, J. J. (2010). What Healthcare Professionals Should Know About Exercise. [PDF
document]. Retrieved November 22, 2015, from
http://www.netce.com/coursecontent.php?courseid=994
Centers for Disease Control and Prevention. (2008) Prevalence of Self-Reported
Physically Active Adults—United States, 2007. Retrieved November 22, 2015,
from http://www.cdc.gov/nccdphp/dnpa/physical/stats/leisure_time.htm.
The President’s Council on Physical Fitness and Sports. Fitness Fundamentals:
Guidelines for Personal Exercise Programs. (2008) Retrieved November 22, 2015,
from http://www.fitness.gov/be-active/physical-activity-guidelines-for-americans/
23
24. Basic of Bacterial Resistance
With the advent of antibiotics in the early 1940’s, humankind gained the ability to
successfully combat infectious diseases that previously ended in death for those afflicted. In a
similar fashion however, bacteria was also able to evolve, and resistant strains began appearing
shortly thereafter. Resistance continues to be an increasingly large threat due to an over abundant
usage of antibiotics for most medical-related needs. When used correctly, the technique of
specific therapy is applied, and implies that the infecting agent has an identified susceptibility to
the drug being used. (Shenold, C., 2011) Empiric, or broad-spectrum therapy is typically when
resistance problems begin to arise though, due to the lack of knowledge of the infecting agent.
This lack of knowledge dictates usage of an antibiotic that can disrupt normal intestinal bacteria
and allow resistant bacteria to flourish. (Shenold, C., 2011)
Resistant bacteria often begin flourishing in large, populous areas, where contact between
people is high and thus allows easier spreading. Compounding this is society’s ability to travel
rapidly between areas in a short amount of time, as evident in the relatively minimal amount of
diverse strains. Nearly 85% of strains encountered in the hospital setting include Staphylococcus
aureus, Enterococcus, Escherichia coli, and Pseudomonas aeruginosa, all of which can be
commonly encountered in everyday life. (Stokowski, L., 2010)
Despite a strict set of guidelines enacted to detect, prevent, and control resistant bacteria
by the Centers for Disease Control (CDC), proliferation still continues due to societal preference
for antibiotic misusage. When prescribed and used to eradicate infection, patients often stop
usage when symptoms have subsided, allowing remaining bacteria to continue living and thus
build resistance. In certain areas of the world, antibiotics are available without prescription,
allowing those who may not even need them to treat themselves and also enabling bacteria to
24
25. grow resistance. Farmers have found that antibiotics can enhance growth in animals, thus leading
to larger profits, but the similar misusage again allows for resistance to form among bacteria and
can be spread to humans upon consumption. (Stokowski, L., 2010) Finally, many people upon
falling ill demand some form of drug treatment, and are often wrongly prescribed antibiotics.
As an active, contributing member of the medical field, I will no doubt encounter patients
with antibiotic resistant bacteria, as well as patients that misuse antibiotics and the accompanying
Physicians that prescribe them. I need to be aware of the dangers of such bacteria, due to the
serious health implications they pose, and help coach others of the precautions necessary when
dealing with them. Failure to do so can result in an unsafe workplace, and can contribute to a
much more dangerous epidemic among all members of society. Future research should focus on
methods of controlling antibiotic usage better and limiting availability of new antibiotics to a
slower pace.
25
26. References
Shenold, C. (2011). Basics of Bacterial Resistance. [PDF document]. Retrieved
November 26, 2015, from http://www.netce.com/courseoverview.php?
courseid=1029
Stokowski, L. (2010). Antimicrobial Resistance: A Primer. Retrieved November 26,
2015, from http://www.medscape.com/viewarticle/729196
26
27. HSc 4700 - HEALTHCARE PROFESSIONAL
INTERVIEW (50 pts)
Date of Interview: 10/23/15
Healthcare Professional’s Name: Nancy Cook
Professional Title: Nurse Practitioner, Registered Nurse (POM/Pre-Op)
Affiliated Institution: Kaiser Permanente
Contact Phone: (510) 454-7600 E-mail: Nancy.E.Cook@kp.org
1. Please introduce yourself and state the purpose of the interview.
My name is Cameron Smith and I am a graduating senior at Cal State East Bay majoring in
health sciences. I am doing this interview to learn about your professional training for this job,
your work experiences and hopefully, get some career tips as I prepare to enter the work
environment. This interview is also a partial fulfillment of the requirements of my final course in
the health sciences program.
2. Please tell me how you were professionally trained for this position?
I began my training by first receiving my BSN or Bachelors of Science in Nursing. Within about
a year, I got my first job as an RN (Registered Nurse), working part time at a hospital. I began
my program to become an NP (Nurse Practitioner) after about 8 years as an RN, working
primarily in the ICU (intensive care unit). The NP program focused on Adult and Acute Care,
which is no longer offered, but has since been replaced with gerontology.
3. Is there anything else that may have helped you get this job, like an internship, volunteer
work, or any other special skills you have?
I attended school in a relatively rural part of Kentucky, where RNs were highly needed at the
time; so becoming an RN and subsequently an NP were not too competitive. In fact, they almost
had to compete for me since the need for nurses was so immense. The job market for nurses isn’t
quite as readily open as it was, since the field is now booming with new nurses, but when I was
going to school, there was a severe shortage.
4. What are your job duties and responsibilities?
I actually have duties that pertain to an RN as well as an NP. As you may already know, PAs
(Physician Assistants) and NPs have a lot of overlap in job duties, with one major difference
being that to become an NP, one must have first been an RN. Even as a current NP, I still retain
the title of an RN, and subsequently retain certain job duties pertaining to an RN. As only an RN,
my job duties and responsibilities used to entail things such as administering medications,
cleaning patients, assessing and monitoring the condition of patients, carrying out the MD’s
(Medical Doctor) orders, alerting MDs if and when problems arose, conducting tests and also
looking at results. Additionally, as part of my work in the ICU as an RN, my responsibilities that
differentiated me from an average RN would be my role as an RNFA (Registered Nurse First
Assist). I learned to scrub in and assist MDs when needed, which was a great benefit since many
RNs don’t get to experience this. When I became an NP, I left behind duties such as
cleaning/turning patients, but still retain duties such as assessing patients and have expanded
former duties such as carrying out the MD’s orders by now working to write my own orders, and
27
28. make informed plans and decisions. This is not to say that I make these types of decisions
completely independently however, as I still have to work with my supervising MD in unison. I
also adopted new duties in my dual role as an RN/NP in that I work to get patients safely to
surgery, interview and obtain medical history, conduct a review of systems, which is also known
as a current health status, order medications to either stop or start before and after surgery, and
address concerns or work to pull in the correct consults if needed to ensure a safe surgery.
5. What do you enjoy most about this job?
That’s quite the question, but if I had to start somewhere and be completely honest, I’d have to
say working with people and truly making a difference in people’s lives. By working here in
POM (Perioperative Medicine), I frequently see people in a very unsure and insecure time in
their lives, so having the ability to help alleviate any fears or concerns they may have is a great
feeling. I feel that the nursing profession in general has the ability to truly get through to patients
in a way that other branches of the medical field may not always be able to. Nursing has at its
core a warm and nurturing way, and patients are so grateful when I am able to get on their level.
6. What do you enjoy least about this job?
There’s not too much that I dislike about this job, other than the fact that we as NPs are
somewhat stuck in between the roles of RNs and MDs. Similar to PAs, the line can often blur as
we straddle the line sometimes and it can be hard for MDs to accept us in the field, since our
duties overlap quite a bit. In fact, together with PAs we are often referred to as a “Physician
Extended,” since depending on who and where we work for, we can have almost complete
independence to practice, with minimal input from the supervising MD. Here at Kaiser however,
I would more closely identify with the term “Mid-Level Provider,” since I work as an
intermediate between an RN and MD, in the context of RNs carrying out orders and decisions
and an MD making fully independent decisions.
7. What would be your recommendations for graduates like myself who are interested in a
job like this one?
I know that you stated earlier your interest in the PA field, but I urge you to fully look at all of
your options in the medical field before you commit. NPs often overlap in job duties with PAs,
so you may find that the work that I do is something that interests you if you explored it. The
requirements for entry into the medical field can vary vastly between professions, so I urge you
to also take this into consideration and be aware of time commitments involved with programs
and the prerequisites needed, including experience and type of degree.
8. Any career tips you would like to offer me?
I would highly advise shadowing as much as you can. Though most people look at a paid job as
the only way to get experience in the medical field, it’s often overlooked that providers are often
very happy to take students under their wing and you don’t have to have a degree to shadow, just
an interest in the field. In this way, you can more fully explore the medical system and become
very well rounded. Shadowing can also lead to great networking opportunities, which are
invaluable not only in your search for references when applying to schools or programs, but also
in your professional medical career later down the road. Another benefit is that shadowing can be
a great way to get your foot in the door and can lead to entry-level jobs or future connections
when searching for a job. I also realize that this time right now can seem quite stressful, as it can
28
29. seem like a monumental task to land the perfect job after college, or to find the perfect graduate
program. I encourage you to not sweat the little stuff though and focus on just getting your foot
in the door and the rest will all work itself out.
29
30. List of 5 Scientific Journals
Journal of General Internal Medicine
American Journal of Public Health
Military Medicine
The Journal of Bone & Joint Surgery
Journal of General Internal Medicine
30
31. A Glimpse Into the Increasing Prevalence of Post Traumatic Stress Disorder Among
Female Veterans
Cameron Smith
California State University East Bay
Section 02
Winter 2015
31
32. Introduction
Violent crimes and traumatic events are reported quite frequently throughout the news
media in today’s society. Although the events themselves are deemed newsworthy, the aftermath
in terms of survivor’s mental health is often neglected. Rates of disorders such as depression and
Post Traumatic Stress Disorder have soared in recent decades, especially in the wake of current
overseas conflicts, Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF).
Close to 40,000 veterans since 2003 have been officially diagnosed with PTSD, while as many
as 1 in 5 present symptoms. (Facts | Anxiety and Depression Association of America, ADAA)
Rates among the various demographics of veterans fluctuate, although females have been
identified as an increasing concern. According to the United States Department of Veterans
Affairs (VA), prevalence of PTSD in the general population for females is around 10%,
compared to only 4% in males. Emerging research has found that female veterans are
increasingly being diagnosed with PTSD, while many others display symptoms. The actual
number of female veterans however, has been hard to determine since utilization of VA mental
health services is much lower when compared to males. (Washington, Davis, Der-Martirosian &
Yano, 2013) The research conducted in this paper seeks to find a scientific basis for the divide
and explores the current research. The question then becomes, why have female veterans
returning from OEF and OIF been suffering increasing rates of PTSD? This paper implores that
the evolving role of females in combat situations as well as increasing rates of sexual
assault/abuse and a general predisposition in brain chemistry all intermingle.
Method
Research was conducted in both CINAHL and Academic Search Premier by first utilizing
keywords, such as “PTSD”, “veterans”, “mental health”, “veterans affairs”, “trauma,”
32
33. “violence,” “war,” and “readujustment.” Upon conducting research it became apparent that
certain groups were more vulnerable than others in the prevalence of PTSD. An early research
question was, why do some veterans face a higher risk for developing PTSD than others? One
group that seemed to stand out more than the others however was female veterans. Many articles
contained research that had noted female veterans with higher than average rates of PTSD or
symptoms associated with PTSD. At this point, I narrowed my search to studies based on female
veterans and rates of PTSD.
A surprising lack of knowledge about this population led to many speculations, while
some articles simply went off on tangents that did not tie into my main topic. After searching
through numerous articles, I identified the need for studies that had been conducted more
recently, as the most amount of information pertaining to this population would be available. I
then decided that the current overseas conflicts, OEF and OIF were the best place to center my
research, since studies pertaining to them would be the most relevant.
In order to be considered a potential source for the literature review, the source had to
contain information both about female veterans in the current overseas conflicts and any
additional information that might contribute to an explanation as to why the rates were so high.
A common thread became combat exposure, sexual assault and abuse and a general
predisposition in brain chemistry.
Literature Review
In recent years, the amount of women in the U.S. military has steadily been increasing.
According to Maguen, Ren, Jeane, Bosche, Marmar, and Seal, “women…compose 12.65% of
the total number of US military personnel who have served in Operation Enduring Freedom
[OEF; principally in Afghanistan] and Operation Iraqi Freedom [principally in Iraq]). With an
33
34. increase of women in the military comes an increasing veteran population as well. By the time
they have become veterans, many have experienced trauma through combat and even sexual
assault. For this reason, “both depression and PTSD [post-traumatic stress disorder] have been
cited as major problems among female veterans.” (Luxton, Skopp, & Maguen, 2010)
Post-traumatic stress disorder is defined as a “chronic, disabling condition caused by
witnessing or being involved in a horrifying trauma, such as combat or sexual assault. Symptoms
include intrusive, recurrent recollections of the trauma; heightened autonomic reactivity: sleep
disturbances: impaired concentration and memory: and ‘numbing’ symptoms characterized by
anhedonia, restricted emotional affect, social detachment, and isolation.” (Murdoch, Polusny,
Hodges, & O’Brien, 2004)
In the past, “ample research has examined female veterans who served in Vietnam, the
first Gulf War, and female veterans of multiple eras seeking Department of Veterans Affairs
(VA) health care, [however] relatively little has been published on female OEF and OIF
veterans.” (Maguen, Ren, Jeane, Bosche, Marmar, & Seal, 2010) One theory that explores
gender differences states that “women and men vary in their expression of mental health
symptoms, with women more often receiving internalizing diagnoses, such as depression, and
men receiving more externalizing diagnoses, such as alcohol and substance use disorders.”
(Maguen, Ren, Jeane, Bosche, Marmar, & Seal, 2010) With women gaining progressively
expanding roles in the military, the current conflicts overseas provide a great opportunity to
study why rates of PTSD and depression have been soaring.
Throughout most of history, women have played somewhat of a supporting role to men in
terms of military service. “Beginning with the War of Independence (1775-1783)…wives,
mothers, and daughters frequently accompanied male relatives to the battlefield in order to
34
35. perform care taking roles such as cooking, washing clothes, and attending to the wounded.”
(Chaumba & Bride, 2010) As time progressed, women’s roles gradually expanded, especially in
World War II, when “women with special skills, such as female pilots flew military aircraft [and]
…in the 1990’s [when] roles expanded to include flying combat aircraft, serving on ships, and
driving convoys, tasks that may increase exposure to combat trauma.” (Chaumba & Bride, 2010)
When looking at combat exposure, research has found that “women, compared to their male
counterparts, might be at higher risk for PTSD following CE (combat exposure)” (Luxton,
Skopp, Maguen, 2010) Researchers from this study however recognized that there are other
factors that come into play which may contribute to the higher risk for PTSD and depression, and
that potential future research could focus on levels of social support as a predictor. (Luxton,
Skopp, Maguen, 2010)
With the expanding role of women in combat roles, combat trauma has been identified as
one of the strongest predictors for the development of PTSD and depression. (Luxton, Skopp,
Maguen, 2010) Increasing combat exposure has been tied to the fact that “although the
Department of Defense (DOD) does not permit the assignment of female service members to
combat infantry or special operations units at this time, traditional front and rear lines are
nonexistent in the OEF/OIF conflicts. Women on operational deployments to OEF/OIF are
performing regular duties in a combat environment where they are exposed to hostile situations
and military attacks.” (Luxton, Skopp, Maguen, 2010) This increasing exposure has led to “roles
that expose them to potentially traumatic events such as injury, seeing the dead, dying or
wounded.” (Chaumba & Bride, 2010)
Specific demographics have also been identified as predictors for the development of
PTSD and depression as well. One study noted, “Women were more likely to be young, black,
35
36. single, and veterans of the Air Force.” (Maguen, Ren, Jeane, Bosche, Marmar, & Seal, 2010)
The same study noted that age, specifically women over 30 years, was significantly correlated
with a diagnosis of PTSD. An interesting discovery from this study found that men’s rates of
PTSD were quite the opposite, in that younger men were at a greater risk than older men. The
researchers hypothesized that “women who are older may have more established family and
community lives and may have a more difficult time deploying and then reintegrating after
returning from war.” (Maguen, Ren, Jeane, Bosche, Marmar, & Seal, 2010)
A more recent study found that certain other demographics were also correlated with
higher PTSD risk. These demographics included “being uninsured, having an annual household
income below the federal poverty level...fair or poor health status, disability…history of sexual
assault in the military, and positive screening test for depression and anxiety disorder.”
(Washington, Davis, Der-Martirosian, Yano, 2013) In terms of health care, the same study found
that “the vast majority of women veterans screening positive for PTSD received their healthcare
in community settings.” (Washington, Davis, Der-Martirosian, Yano, 2013) This finding
becomes relevant when one considers that “most veteran research is conducted in Veterans
Health Administration (VA) healthcare settings.” (Washington, Davis, Der-Martirosian, Yano,
2013) According to the researchers of this study, this “[leads] to a gap in information about the
vast majority of women veterans for conditions that are associated with military service.”
Treatments are also affected in that “when patients do receive treatment they are more likely to
receive medications than empirically validated psychological treatments. As treatments have
been developed through study of primarily male veterans, the results may not always apply to
female veterans.” (Freedy, Magruder, Mainous, Frueh, Geesey, & Carnemolla, 2010)
Based on the previously cited studies, future research could thus focus on “building
36
37. gender-specific results…to develop gender-sensitive mental health services within the VA and
related military primary care systems. (Freedy, Magruder, Mainous, Frueh, Geesey, &
Carnemolla, 2010) The same researchers also suggested that “in the appropriate clinical setting,
primary care professionals should screen adult patients for the potential presence of traumatic
life events and mental health symptoms…both appropriate psychotropic medications and
empirically validated psychological approaches should be considered.”
Although combat exposure has been a main focus of many PTSD studies, sexual assault
has been found to be a potent predictor for development among women veterans. According to
one study, “rates of sexual harassment range from 24% to 78% among women in the military,
while sexual assault ranges from 3% to 41%” (Chaumba & Bride, 2010) Sexual assault rates
fluctuate so vastly because “reports of sexual assault vary among active-duty, reserve and
veteran females. Whereas reserve and active duty women have reported comparable rates of
sexual trauma 2% and 3% respectively, female veterans reported rates as high as 41%”
(Chaumba & Bride, 2010) The researchers postulated that the lower rates among active duty and
reserve women could be due to underreporting. In line with such high rates of harassment and
assault come even more astounding rates, “women with military sexual assault history were 9
times more likely to have PTSD, while female veterans with childhood sexual assault histories
were 7 times more likely to have PTSD, and those with civilian sexual assault histories were 5
times more likely to have PTSD.” (Chaumba & Bride, 2010) For this reason, it is encouraging
that the VA mandated that “all veterans, regardless of sex, be screened for military sexual
trauma.” (Murdoch, Polusny, Hodges, and O’Brien, 2004) A problem with this directive
however, has been compliance, as many clinicians have tight schedules and do not always abide
by it.
37
38. Results
A common thread among research pertaining to increasing rates of PTSD in the female
military veteran community is the higher prevalence of combat exposure and sexual
assault/abuse than in the past. According to Chaumba & Bride (2010), women with higher levels
of war-zone exposure were 7 times [more] likely to have current PTSD than those with less
exposure…[and] women with military sexual assault history were 9 times more likely to have
PTSD.” In a study conducted by Murdoch, Polusny, Hodges & O’Brien, “30% of females
experienced at least some combat exposure [while the] in service sexual assault [rate stood at]
71%” These rates represent a significant portion of female veterans and provide a meaningful
basis for consideration.
A study conducted by Luxton, Skopp, & Maguen (2010) found that increasing trauma
rates might not quite be the key to the question of increasing rates of PTSD among female
veterans. They found that “women are more likely to meet criteria for PTSD compared to men,
and this vulnerability is not explained by higher risk or more severe traumatic events. Data
therefore suggests that there might be differential risk factors for PTSD based on gender.”
Among the general population for instance, “women are at much higher risk for depression than
men.” (Luxton, Skopp, & Maguen, 2010)
Some studies that support the theory of Luxton, Skopp, & Maguen (2010) have found
that certain demographic groups do correlate with higher rates. Washington, Davis, Martirosian,
& Yano (2013) found that “younger age, being a racial/ethnic minority, being uninsured, having
an annual household income below the federal poverty level, period of military service, fair or
poor health status, disability, and diagnosed depression” all correlated with higher rates. Maguen,
Ren, Bosch, Marmar & Seal (2010) also found age to be a significant factor, along with being
38
39. “divorced, separated, or widowed.”
Discussion
The research conducted gave rise to a clearer picture of why rates of PTSD among female
veterans of the recent OEF and OIF wars have been climbing. Levels of increasing combat
exposure and sexual assault/abuse are in fact potent predictors in the development of PTSD,
however they are not the sole causes.
Upon conducting research, differences in brain chemistry, such as how males and females
process trauma and stress may play a role. Whereas men tend to be more external with their
coping mechanisms, such as drinking or even seeking social support, women tend to internalize
their feelings and are often hesitant to seek help. Both men and women tend to have
misconceptions about mental health, however the research conducted revealed that women are
more often neglected in the healthcare setting and the services available to them are not always
explained. For this reason, utilization of mental health services among female veterans is lower
than for men, as their internalizing problems such as combat trauma and sexual assault/abuse are
not discovered. Rather than preventing these types of problems from spiraling into PTSD, the
diagnosis is made after many women have been left to deal with their issues on their own.
Certain demographics were also found to correlate with a higher risk for developing
PTSD. The most potent predictors among demographics tended to be age and marital status,
although correlations were found among various other groups. Age and marital status may play a
role in the development of PTSD because social support systems may be more difficult to obtain
for those who are single or those who are older. Social support has been shown to be an
extremely effective method in the prevention of PTSD symptoms, as it allows women to
externalize their feelings, rather than dealing with them on their own. Future research on the
39
40. availability of social support systems and the development of PTSD might yield interesting
results in the level of prevention provided.
Conclusion
The role of the female soldier has seen an expansive overhaul in recent times. Exposure
to an increasing level of combat trauma thus compounds problems such as sexual assault and
abuse and creates the perfect storm for development of mental health issues such as PTSD. The
general brain chemistry of females differs from that of males, which thus affects their coping
mechanisms when confronted with stress and trauma. This general difference needs to be taken
into account when sending females into war and the subsequent treatment that they receive when
returning from war. Future research could focus on why utilization rates for VA mental health
facilities are so low among female veterans as well as which types of treatment show the most
potential for prevention and recovery.
References
Chaumba, J., & Bride, B. (2010). Trauma Experiences and Posttraumatic Stress Disorder Among
Women in the United States Military. Social Work in Mental Health, 8(3), 280-303.
Retrieved February 1, 2015, from CINAHL Plus.
Chaumba, J., & Bride, B. (2010). Trauma Experiences and Posttraumatic Stress Disorder Among
Women in the United States Military. Social Work in Mental Health, 8(3), 280-303.
Retrieved March 1, 2015, from Academic Search Complete.
Conard, P., & Sauls, D. (2014). Deployment and PTSD in the Female Combat Veteran: A
Systematic Review. Nursing Forum, 49(1), 1-10. Retrieved March 1, 2015, from
Academic Search Complete.
Facts | Anxiety and Depression Association of America, ADAA. (n.d.). Retrieved February 18,
40
41. 2015, from http://www.adaa.org/living-with-anxiety/military-military-families/facts
Freedy, J., Magruder, K., Mainous, A., Frueh, B., Geesey, M., & Carnemolla, M. (2010). Gender
Differences in Traumatic Event Exposure and Mental Health Among Veteran Primary
Care Patients. Military Medicine, 175(10), 750-758. Retrieved February 1, 2015, from
CINAHL Plus.
Himmelfarb, N., Yaeger, D., & Mintz, J. (2006). Posttraumatic Stress Disorder In Female
Veterans With Military And Civilian Sexual Trauma. Journal of Traumatic Stress, 19(6),
837-846. Retrieved March 1, 2015, from Academic Search Complete.
Luxton, D., Skopp, N., & Maguen, S. (2010). Gender Differences In Depression And PTSD
Symptoms Following Combat Exposure. Depression and Anxiety, (27), 1027-1033.
Retrieved February 1, 2015, from CINAHL Plus.
Maguen, S., Cohen, B., Cohen, G., Madden, E., Bertenthal, D., & Seal, K. (2012). Gender
Differences in Health Service Utilization Among Iraq and Afghanistan Veterans with
Posttraumatic Stress Disorder. Journal Of Women's Health, 21(6), 120222070544008-
120222070544008. Retrieved March 1, 2015, from Academic Search Complete.
Maguen, S., Ren, L., Bosch, J., Marmar, C., & Seal, K. (2010). Gender Differences in Mental
Health Diagnoses Among Iraq and Afghanistan Veterans Enrolled in Veterans Affairs
Health Care. American Journal of Public Health, 100(12). Retrieved February 1, 2015,
from CINAHL Plus.
Murdoch, M., Polusny, M., Hodges, J., & O'Brien, N. (2004). Prevalence of In-Service and Post-
Service Sexual Assault among Combat and Noncombat Veterans Applying for
Department of Veterans Affairs Posttraumatic Stress Disorder Disability Benefits.
Military Medicine, 169(5), 392-394. Retrieved February 1, 2015, from CINAHL Plus.
41
42. Washington, D., Davis, T., Der-Martirosian, C., & Yano, E. (2013). PTSD Risk and Mental
Health Care Engagement in a Multi-War Era Community Sample of Women Veterans.
Journal of General Internal Medicine, 28(7), 894-900. Retrieved February 1, 2015, from
CINAHL Plus.
42
43. Empirical Article Report
1. Reference
Brambring, M. (2007). Divergent Development of Manual Skills in Children Who Are Blind or
Sighted. Journal of Visual Impairment & Blindness, 101(4), 212-225.
2. Abstract
This empirical study compared the average ages at which four children with congenital blindness
acquired 32 fine motor skills with age norms for sighted children. The results indicated that the
children experienced extreme developmental delays in the acquisition of manual skills and a high
degree of variability in developmental delays within and across six categories of fine- motor
skills.
Introduction
3. The general topic that this article investigates is how blindness effects the development of fine
motor skills in children. The skills were divided into 6 categories and comprised 32 individual
tests. The results of the research were compared to children considered to fall within the normal
limits of development.
4. A study conducted in 1997 by Hatton, titled “Development Growth Curves of Preschool
43
44. Children with Vision Impairments,” served as justification for conducting the research conducted
in this article. The study used a standardized development test to assess 186 children with vision
problems, of which 27 were fully blind. They were found to have a mean developmental delay of
13.6 months at 30 months of age. Brambring notes however that the mean age of delay alone,
“provided no information on the variability in the age at which single skills are acquired within
each developmental domain.” (Brambring, 2007, pp. 214) This information he notes, is
necessary in identifying which alternative strategies that children who are blind may use to
“compensate for their difficulties owing to the loss of vision” (Brambring, 2007, pp. 214)
5. Brambring recognized the lack of knowledge pertaining to the acquisition of fine motor skills
in children that are blind and wanted to further explore their realm of development. He was
specifically interested in finding which alternative means of learning various motor skills would
be utilized and when they would typically appear. Also of interest to Brambring was discovering
which fine motor skills would present the greatest barriers to overcome.
Method
6. The 4 participants included in the study were identified as having visual impairments, with 3
being completely blind and the other possessing only “minimal light perception.” (Brambring,
2007, pp. 215) Among the 4 participants, 2 were male and 2 were female and presented no
further impairments than those listed. They were identified as developing normally, based on an
IQ test and teacher input from their schools.
7. A major behavior of interest studied was the age at which visually impaired children acquired
44
45. manual skills. The 4 participants in the study were studied longitudinally during early
intervention home visits. Visits involved participant observation in 32 different manual tasks.
The 32 tasks were then further divided into 6 categories determined by 4 independent raters. The
mean divergences in age for the categories were determined and compared with means from data
compiled through databases pertaining to sighted children. The databases providing data on
sighted children included, “four well-known, standardized developmental tests: Bayley Scales of
Development; Denver Developmental Screening Test; Griffiths Developmental Scales; and
Entwicklungskontrolle fur Krippenkinder, a German language developmental test.” (Brambring,
2007, pp. 215)
Results
8. A significant find from the study found that “manual skills requiring the use of a tool (a
drumstick, cup, or spoon),” showed the largest divergence in development. (Brambring, 2007,
pp. 220) Researchers determined that the visually impaired children acquired these skills an
average of 2.67 times later than their sighted peers did. The results imply that compensatory
measures take longer to develop and thus hinder development when compared to more simple
tasks.
Discussion
9. Brambring was able to conclude that although children that are blind exhibit extreme delays
in many areas when compared to children in the normal range of development, the patterns of
45
46. development occur in roughly the same sequence. These delays were determined to be 14.5
months on average and coincide roughly with earlier research by Hatton indicating 13.6 months.
The development of body-related skills, such as activities of daily living, and simple-object
manipulations that involve “trial and error,” (Brambring, 2007, pp. 222) did not diverge
significantly between the two groups. He surmises that this may be due to the body providing a
reference point for body-related skills and the tactile feedback from trial and error skills
substituting for visual input. Another potential explanation for this could be the relative lack of
visual importance involved in these tasks. He concludes that early compensatory measures
adopted in these areas are more likely than for tasks involving “complex manipulative skills,”
(Brambring, 2007, pp. 222) which require higher cognitive abilities.
Your thoughts on the article
10. Why did you choose this article?
I chose this article due to the fact that I have learned quite a bit about how children normally
develop during this class, but relatively little in terms of how children can deviate. I feel that
going into the medical field after I graduate should mean that I have a good understanding of as
many different types of people and situations as I can. Children that are visually impaired may
not differ in any other ways that other children, and I’m curious to see how they compensate for
their lack of vision.
11. What did you learn from reading this article?
46
47. I learned from reading this article that although visually impaired children are at a disadvantage
when compared to their normally sighted peers, they do follow roughly the same development,
though it is simply delayed. Parents and teachers can thus help visually impaired children by
understanding this and not trying to place the same developmental expectations of normally
sighted children upon them. These children should be allowed more time to explore with tactile
and auditory means to ensure proper development.
12. Do you think the method used was an appropriate way to study the topic? Why or why not?
I think that the method used was inappropriate for this study. In terms of studying such a broad
group of people, the small sample size does not allow any conclusions to be reliably drawn. Any
correlations may have simply been present in this group of individuals only and a more
comprehensive study would be necessary to produce truly meaningful data.
13. Do you agree with the author(s)’ conclusions? Why or why not?
I agree with the author’s conclusions as they seem to coincide with the earlier research that
served as the basis for exploration. They seem to advance the available information available in
the particular field of research and provide an opportunity for future research. The conclusions
seem logical based on the data collected and he does not seem to show any bias in his opinions.
14. Do you think it was a good study? Explain your answer. In answering this question, you
47
48. may want to consider whether the method could be improved, or whether the findings are
important.
I think that the study had its strengths, but that overall it was quite weak. The fact that subjects
were chosen from a pool of 10 children used in a previous study by Brambring suggests that the
results could not be representative of the overall population of visually impaired children, since
they may act differently knowing that they are subjects. A second weakness is the small amount
of children that actually participated in the study. The 4 children studied make it difficult to draw
statistically significant conclusions, especially when considering that children from the sighted
group were actually studied. The information drawn from the sighted group comes from
information drawn from previous studies found through databases. The implications for future
research and the findings do however seem to be relevant to advancement in the field in that they
can help parents and teachers incorporate compensatory measures earlier.
48
49. Exploring Causes for Disparities Among Total Joint Replacement Surgery in African
Americans
Cameron Smith
California State University East Bay
Section 01
Fall 2015
49
50. Exploring Causes for Disparities Among Total Joint Replacement Surgery in African
Americans
Medical technology has advanced at an astonishing rate in the past century, as humans
have enjoyed some of the longest life expectancies in history. Problems that may have in the past
been deemed untreatable or physically and emotionally debilitating can now be successfully
treated. One such problem is Osteoarthritis, which continues to be one of the most common joint
disorders in the United States, especially in women and the elderly, plaguing roughly 13.9% of
adults aged 25 and up, and totaling around 26.5 million people as of 2005 (Lawrence, Felson,
Helmick, Arnold, Choi, Deyo…Wolfe, 2008). In all Characterized by a progressive loss of
articular cartilage and frequent pain, those afflicted often seek an effective treatment option that
can alleviate symptoms as necessary. In the early stages, physicians begin with noninvasive, and
relatively simple treatment options, such as medications to reduce inflammation, physical
therapy, and exercise. As symptoms worsen or when treatments prove ineffective, however, a
replacement of the entire knee joint, commonly called a Total Knee Replacement (TKR) or
Arthroplasty, is recommended. For those with osteoarthritis of the hip joint, a similar procedure,
called a Total Hip Replacement, is performed. Collectively, the procedures in their similarities
are often referred to as Total Joint Replacements (TJR). Although healing occurs quite quickly,
and symptoms can of osteoarthritis can subside almost completely, physicians can be hesitant to
recommend the surgery. Various reasons for this trend may exist, but statistics do show that
disparities occur both in the recommendations and utilization of the surgery, primarily in African
Americans, according to Figaro, Russo and Alegrante (2004).
Current internship duties at Kaiser Permanente in San Leandro, California have allowed
for careful observation in how these disparities occur in the general community. Duties in the
50
51. Perioperative Medicine (POM) department have provided many encounters with patients who
have either received or are in the process of receiving a recommendation for TJR, since the
department is responsible for clearing patients for surgeries. Observation has allowed for close
scrutiny of patient-physician interaction, with the vast number of cultures and ethnicities
encountered providing firsthand experience with the aforementioned trend. Physicians are
responsible for informing patients of the risks and benefits involved with the surgery, and are
also responsible for taking cultural belief systems into consideration when making
recommendations. Since cultures and ethnicities vary in beliefs pertaining to healthcare, the
responsibility of finding a middle ground to ensure patient satisfaction and a return to
comfortable health falls upon the physician. Real-world situations do not always allow for such
compromise to be reached; disparities, therefore continue to thrive, due to a lack of
understanding and knowledge of the procedure, patient preference for alternative forms of
treatment, and physician’s role in educating individuals and recommending the procedure.
Method
I conducted research through CINAHL, Academic Search Premier, PubMed, and
PsycINFO, by first utilizing keywords, such as “TJR”, “ethnic disparities”, “racial disparities”,
“TJR utilization,” and “TJR recommendations.” A surprising lack of research pertaining to the
topic of interest led to the decision to continue research, as it allowed for new areas of
exploration and offered the opportunity to piece together existing research to draw new
conclusions. After searching through various articles, relevant articles were identified based on
how in depth they explored disparities. If substantial portions of the article delved into disparities
and explored knowledge that other articles had not, they were chosen for inclusion. Basic
information regarding TJR was also deemed necessary so that a full picture of the situation could
51
52. be analyzed. Sources were also filtered to include only full-text articles, which were scholarly or
pier-reviewed, and published within the last 15 years.
Discussion
Patient preference is considered a significant deciding factor in whether or not patients
undergo a TJR. According to Ibrahim, the surgery is considered an elective procedure due to the
fact that it is not regularly performed in an urgent setting, and that clinical needs are not the sole
deciding factor (2013). In other words, it is necessary that the patients elect for the procedure in
order for the recommendation to be made. For this reason, many physicians tend to place the
burden of recommendation on the patient, and if they neglect to ask, the recommendation will
not be considered. According to Figaro, et al., patients only tend to prefer the surgery when they
expect pain relief, restoration of regular walking ability, and a higher sense of well-being (2004).
Many African Americans, however, are weary of the outcomes from Western Medicine, so they
often prefer to utilize alternative forms of healing. A study by Figaro et al., discovered that
natural remedies and a belief in God’s control are preferred by many and thus influence their
preference for surgery (2004). Many African Americans within the study stated that they
believed Osteoarthritis was caused by cold or dampness from their environment interacting with
their joints. Belief that Osteoarthritis was an inevitability of aging and that herbs, creams, and
other folk remedies could alleviate, if not, eradicate the disease was also found to be prevalent.
The control of God was also cited as a potential remedy, as many believed that the disease would
simply take an intended course - if they were meant to be healed, it would occur when God
willed it to happen.
Beliefs in divine intervention and natural remedies and how they intermingle with the
recommendation and subsequent decision to undergo surgery can be attributed to differences in
52
53. culture. Disparities exist due to the fact that many African Americans often misunderstand TJR
and thus neglect to opt for it. According to Figaro et al, many African Americans believe that
TJR would lead to a need for replacement within a short timeframe (2004). Also held is the
belief that surgery should be a last resort and that the surgeon may not possess the competency to
correctly perform surgery. When faced with these beliefs, many physicians do not take the time
to address them or rationalize with patients, so recommendation rates remain low. Many African
Americans are also fearful of the surgery itself and believe that complications from the surgery
are cause for concern, so the chances of their condition worsening increase.
In addition to varying cultural beliefs regarding healthcare, patient geographical location
has also been found to play a role in the observed rate disparity. As identified in a study
conducted by Hawker, Wright, Coyte, Williams, Harvey, Glazier, . . .and Badle, there exists a
gap between potential need as identified by physicians, and actual need, as identified by patients,
which widens in certain areas of the country (2001). In areas where potential need was higher,
patient utilization of TJR was higher, suggesting that actual patient need was not as influential in
the decision making process. This also suggests that in areas with identified higher potential
need, problems with overutilization may be occurring, while areas with lower potential need may
be suffering from suboptimal care. (Hawker et al., 2001) Areas with higher potential need were
found to be more populous with non African Americans, while areas with lower potential need
were often found to be areas with higher populations of African Americans. Interestingly,
Hawker also found that willingness to undergo surgery was unrelated to disease severity,
suggesting that external factors such as living circumstances, employment status, age, and social
support systems may also play a role in the disparity. (2001)
When discrepancies arise between patient beliefs, physician knowledge, and the level of
53
54. care afforded to certain geographical areas, the problem of integrating all factors into an
appropriate care plan arises. Due to the fact that TJR recommendation is treated as a team
decision between physician and patient, the recommendation cannot be made when the patient
does not desire the surgery. The role of the physician then becomes educating the patient to the
best of their knowledge in an effort to convince them of the efficacy of treatment. Patients
continue to hold their views and beliefs until the physician successfully integrates them with
those of Western Medicine, which can be quite tough due to the vast differences between them.
The responsibility of successfully improving disparity rates then relies upon the openness of both
patient and physician to the ideas of one another. The typical breakdown in communication that
instead occurs, can further fuel miscommunications, as the absence of a recommendation for
surgery can lead to the inference that it must be a last resort, and therefore quite dangerous.
Interestingly, Hausmann, Mor, Hanusa, Zickmund, Cohen, Grant…and Ibrahim found that when
physicians actually spoke to African American patients regarding beliefs they held and attempted
to clarify the goals o Western Medicine, rates for TJR utilization went up, indicating the
invaluable role physicians play. (2010)
When observing the trend of higher Osteoarthritis rates in women and the elderly, an
interesting trend begins to emerge that seems to conflict with observed racial disparities.
According to a study conducted by Dunlop, Manheim, Song, Sohn, Feinglass, Chang H., and
Chang, R., disparity rates between African Americans and Caucasians in the utilization of TJR
become almost indistinguishable in those under the age of 65. (2008) The findings may be due to
higher preference for more minor interventions in the treatment of Osteoarthritis in those who are
younger, such as Arthroscopy or drug treatments. Dunlop et al, hypothesizes that the discrepancy
between younger and older African Americans may also be related to general mistrust of
54
55. physicians in older patients, due to the Tuskegee experiments conducted by the United States
government, as well as ideals carried from times of segregation. Additionally, higher rates of
college education among younger patients may lead to more informed patients that are open to
TJR. (2008)
Conclusion
Disparities among TJR surgeries occur when belief and value systems differ between
physicians and patients, and communication to integrate those held by both parties cannot be
made. African American beliefs can be integrated with those held by physicians through working
with the assessment of natural remedies being utilized, and seeing if and how they may impact
the outcome of surgery. If conflicts are found, patients can briefly stop use or adjust amounts
used to accommodate a safe surgery. Physicians can dispel any misconceptions or fears when
they are able to take the time to understand what cultural differences may exist and address them
rather than assuming patients will always inquire about them. Future research in the area of TJR
disparities can look at ways that physicians are actively working to help patients receive the best
possible outcome from their Osteoarthritis and if they are taking time to understand cultural
differences. Additionally, further research can look into why disparities are much less prevalent
in younger patients as opposed to those over the age of 65.
55
56. References
Dunlop, D., Manheim, L., Song, J., Sohn, M., Feinglass, J., Chang, H., & Chang, R. (2008). Age
and Racial/Ethnic Disparities in Arthritis-Related Hip and Knee Surgeries. Medical Care,
46(2), 200-208. Retrieved November 15, 2015, from PubMed.
Figaro, M., Russo, P., & Allegrante, J. (2004). Preferences for Arthritis Care Among Urban
African Americans: "I Don't Want to Be Cut". Health Psychology, 23(3), 324-329.
Retrieved November 15, 2015, from CINAHL Plus.
Hanchate, A., Zhang, Y., Felson, D., & Ash, A. (2008). Exploring the Determinants of Racial
and Ethnic Disparities in Total Knee Arthroplasty. Medical Care, 46(5), 481-488.
Retrieved November 15, 2015, from PubMed.
Hausmann, L., Mor, M., Hanusa, B., Zickmund, S., Cohen, P., Grant, R., . . . Ibrahim, S. (2010).
The Effect of Patient Race on Total Joint Replacement Recommendations and Utilization
in the Orthopedic Setting. J GEN INTERN MED Journal of General Internal Medicine,
25(9), 982-988. Retrieved November 15, 2015, from Academic Search Complete.
Hawker, G., Wright, J., Coyte, P., Williams, J., Harvey, B., Glazier, R., . . . Badley, E. (2001).
Determining the Need for Hip and Knee Arthroplasty: The Role of Clinical Severity and
Patient Preferences. Medical Care, 39(3), 206-216. Retrieved November 15, 2015, from
PubMed.
Ibrahim, S. (2010). Racial variations in the use of knee and hip joint replacement: An
introduction and review of the most recent literature. Current Orthopaedic Practice, 21(2),
126-131. Retrieved November 15, 2015, from Academic Search Complete.
Ibrahim, S., & Franklin, P. (2013). Race and Elective Joint Replacement: Where a Disparity
Meets Patient Preference. Am J Public Health American Journal of Public Health, 103(4),
56
57. 583-584. Retrieved November 15, 2015, from PsycINFO.
Kremers, H., Larson, D., Crowson, C., Kremers, W., Washington, R., Steiner, C., . . . Berry, D.
(2015). Prevalence of Total Hip and Knee Replacement in the United States. The Journal
of Bone & Joint Surgery, 97(17), 1386-1397. Retrieved November 15, 2015, from
Academic Search Complete.
Lawrence, R., Felson, D., Helmick, C., Arnold, L., Choi, H., Deyo, R., . . . Wolfe, F. (2008).
Estimates of the Prevalence of Arthritis and Other Rheumatic Conditions in the United
States: Part II. Arthritis Rheum Arthritis & Rheumatism, 58(1), 26-35. Retrieved
December 5, 2015, from CINAHL Plus.
Logan, C. (2014). Total Joint Replacement: Knee and Hip. IDEA Fitness Journal, 11(10), 40-49.
Retrieved November 15, 2015, from Academic Search Complete.
57
58. Neuro Exercise Therapist
SCI-FIT - Pleasanton, CA
$20 - $27 an hour
SCI-FIT is Northern California's only progressive, post-traditional exercise therapy facility for spinal cord
injuries and neurological disorders. Located in Pleasanton, the mission of SCI-FIT is to maximize
the potential for each individual suffering from a debilitating injury or disorder by utilizing
strategic exercises and providing the proper stimulation for an optimal functional outcome.
At SCI-FIT, we have the unique opportunity to work with clients one-on-one in a thriving, energetic
atmosphere. Our clients work extremely hard and we expect our staff to work even harder to help
them reach their potential in recovery. We are looking for new trainers to add to our talented and
energetic staff. We are seeking dynamic, enthusiastic, energetic coaches and trainers who have a
passion for inspiring health and progress in others. Working with this special population is not
only extremely rewarding, but the field of neuro recovery is constantly evolving, which presents
trainers with exciting new challenges and educational opportunities.
Employment Specifics:
• Job title: Neuro Exercise Therapist
• Part time with opportunity for full time after training period.
• Salary: $20-$27 with potential for increase. Based on experience.
• Health Insurance stipend after probation period and full time status
• 12 paid time of per year after probation period and full time status
• Starting date flexible, but as soon as possible is ideal.
• Hours of operation Monday-Saturday approximately 9-5pm. Applicants schedule will be decided
upon once hired starting with a few days a week. Applicant must be available Mondays and
Saturdays to work.
Minimum Requirements:
58
59. • Bachelor's degree preferably in Kinesiology/Health/Exercise science or related field.
• Previous experience in a health-related or fitness field, personal training and or sports/strength
and conditioning at least 1 year.
• Strong passion for and commitment to your own personal health.
Desired Requirements:
• Certifications (CSCS, NASM, ACE, ACSM) a plus but not a requirement.
• Current CPR/AED certification (can be obtained within first 4 weeks of employment).
Desired Traits:
• Team player
• Strong work ethic, willingness to learn, a passion for helping people and the initiative to go above
and beyond what is expected.
• Charismatic, out-going, detail oriented, reliable, passionate, and enthusiastic.
Experience working with special populations is not necessary and the right individual will be given the
tools needed to succeed in this position by our experienced staff. Like most training positions, the
job is very physically demanding- good physical condition is a must.
Visit our website www.sci-fit.org for more information on our company and the program we offer. Also,
check our YouTube channel (Sci Fit Ca) to see examples of our clients and trainers at work.
Required education:
• Bachelors
59
60. November 29, 2015
22546 Main Street, #8
Hayward, CA 94541
(510) 512-2898
csmith93@horizon.csueastbay.edu
To Whom It May Concern:
I am writing to convey my interest in the Neuro Exercise Therapist position. I am graduating
from Cal State East Bay in December of this year, with my Bachelor of Science in Health
Science. I am also certified as a Nursing Assistant and have since adopted a high level of
enthusiasm in improving morale in life altering patient circumstances. I plan on applying to
graduate school within the next two years and would love to gain not only experience but also
effectively contribute to improving the lives of others.
I became highly motivated in working for Sci Fit after learning of your company’s commitment
to improving the lives of clients in such an innovative way. I am well aware that when
debilitating injuries occur, the hospital setting can severely hamper morale to recover and ability
to return to a fulfilling daily life. I believe that the approach of Sci Fit in helping patients work
past these circumstances helps provide a sense of accomplishment and overall well being. I
believe that my knowledge and nurturing personality along with my passion for exercise and
fitness provide a winning combination for your company and client base.
I would thoroughly love the pleasure of meeting with you to learn more about the position or any
other positions you may have available. I would be glad to provide you with any other
information upon request.
Thank you for taking time out of your busy schedule to review my offer, and I look forward to
meeting with you soon.
Sincerely,
Cameron C. Smith
60
61. Cameron Smith
22546 Main Street, #8 Hayward, CA 94541
(510) 512-2898
csmith93@horizon.csueastbay.edu
Objective
To effectively combine my medical knowledge and nurturing, energetic personality in a manner that
raises client morale and contributes to an optimal functional outcome.
Employment History
NATIONAL/ALAMO RENT-A-CAR– San Francisco, CA
Mail Courier/Driver, December 2010 - Present
• Responsible for traveling to other branches and maintaining the efficient delivery of inter-office mail
and supplies to the correct locations.
• Maintaining relationships with managers at each branch and ensuring important documents are received
by main office.
• Competing inventory for all lots in South San Francisco area.
• Maintaining a constant organization of vehicles and ensuring their availability to customers.
• Working with foreign customers and teaching various features of vehicles, and providing superior
customer service.
INSTITUTE ON AGING– San Francisco, CA
Certified Nursing Assistant, November 2014 - March 2015
• Performed activities of daily living (ADL's)
• Helped transfer and move residents
• Helped promote resident independence when opportunities were present
• Groomed and bathed residents
• Assisted with feeding and dressing residents
Education
EDEN AREA ROP – Hayward, CA
Clinical Medical Assisting Program, CMA Certificate, September 2015-Present
KAISER PERMANENTE – San Leandro, CA
62. Student Intern, Perioperative Medicine (POM), September 2015-December 2015
CALIFORNIA STATE UNIVERSITY EAST BAY – Hayward, CA
Health Sciences BS Major, September 2011 – December 2015
NCP CAREER COLLEGE – Hayward, CA
Certificate of Completion in Certified Nursing Assistant Program, July 2014-September 2014
ARROYO HIGH SCHOOL – San Lorenzo, CA
Diploma, Graduated June, 2009
Organizations
• Active member of the Delta Chi Fraternity, Hayward, CA Chapter
• Associate member of the American Academy of Physician Assistants
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63. Personal Essay
I began my studies at Cal State East Bay in 2011 and quickly decided that Health Science
would be a great major to apply my passion and expand interest in the medical field by exploring
the various health careers. I immediately felt at home as I thoroughly enjoyed learning about the
intricate nature of the human body and its functions and how the various medical careers
cooperate to promote health and wellness. I decided to pursue the path of Physician Assistant
after conducting some research for a general studies class and then stumbling upon a conference
for aspiring Physician Assistants. Upon attendance, I fell in love with the profession as the
majority of Physician Assistants I met seemed incredibly happy with life and where their careers
had taken them. Thinking upon my own propensity for helping others and my knack for medical
knowledge, I knew it was the right path for me and have been pursuing it ever since, through
shadowing Physician Assistants and other medical professionals they interact with, completing
an internship with Kaiser Permanente, and researching graduate programs and timelines.
I feel that the first logical step after leaving Cal State East Bay is to utilize my Bachelor’s
degree by obtaining a position within the medical field that allows me to thrive and fully assert
my passion for helping others. I know that I am ready to practice and further build upon the skills
that I have learned thus far in my college career by combining them with my charismatic,
innovative, and optimistic attitude to successfully contribute to a team. My place in the medical
field needs to begin with an environment in which practical knowledge and problem solving are
both valued and able to be honed in those willing to work for them.
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