Running Head: Pepper Family Case Study 1
Pepper Family Case Study 15
Pepper Family Case Study
Instructor Name
Course
Date
Client's demographical information
Olivia Pepper is a 30-year-old African American woman who is married with three children (ages 2, 6, and 8). Olivia is a Baptist and is receiving several financial need scholarships which allows her to attend school without working. She has two residential treatments, once as an adolescent for alcohol use and the second when she was 24 for depression and alcohol use. She has had two DUI's, one at 16 and the second at 22. Olivia has previously taken Zoloft and Wellbutrin, and has gone to family counseling as a teenager. Olivia is currently pursuing her Master’s degree and has a 3.8 overall GPA. She has been referred to the University Counseling Center from her professor for erratic behaviors, which include failing two classes and having a sporadic attendance, being late, and smelling of alcohol on more than one occasion. Olivia's peers have reported that she wants to meet at the local bar and is never engaged in learning.
Olivia grew up with loving parents who worked hard. Her mother left when she was 14 and that is when she started to drink. She has been in a “funk” on and off her whole life and reports that most days she just doesn’t want to get out of bed and face the day. She is overwhelmed and sleeps 10-12 hours a day, isolates herself from her family, and avoids going to school. She has attempted suicide once with a drug overdose on Wellbutrin with alcohol. Olivia is currently attending AA meetings regularly and reports that church and AA help her get out of bed in the morning. She has started to drink again and sneaks drinks into her lemonade so that her family does not know. Her husband is angry and wants her to quit school, and Olivia is concerned for her 8-year-old daughter who is exhibiting similar behaviors as her.
Olivia's demographic information paints a vivid picture of her life. She has faced many challenges in her life, from her mother leaving when she was 14 to her father passing away two years ago from drinking. She is under a lot of stress with having to care for her three children and still trying to pursue her degree. She has dealt with depression and alcohol use, attempted suicide, and has had two, (DUI's Shenoy,2019). Olivia has had to find different coping mechanisms to get her through her day, and while church and AA have been helpful, she has resorted to drinking again, which is causing her to struggle in her classes. Her family dynamics are strained with her husband wanting her to quit school and her 8-year-old daughter exhibiting similar behaviors. It is clear that Olivia is in need of support and guidance to help her get through the current struggles that she is facing.
Analysis of the Client's presenting problem
Olivia is struggling with depression and alcohol misuse. .
This document discusses pilot studies. It defines a pilot study as a small-scale trial of a research project that covers preparation, tool construction, data collection, analysis and reporting. The objectives of a pilot study are to test elements of the research proposal to improve any issues and prevent costly mistakes in a larger study. A pilot study helps refine concepts and relationships between variables and improves approaches to the target population. It assesses the adequacy of methods, instruments, staff materials and identifies potential problems. The document outlines advantages like improving sampling frames and questionnaires, and disadvantages like introducing biases. It notes limitations like lack of hypothesis testing or generalizability beyond the pilot criteria.
Presentation conveys process of conducting Pilot Study in Social Sciences, Pilot Study in Commerce and Management. steps in pilot study, reasons to conduct pilot study and its importance is also mentioned.
Milieu therapy is a scientific approach to structuring the environment to effect behavioral changes and improve psychological health. It involves manipulating aspects of a client's surroundings, like their hospital experience, to be therapeutic. The goal is for clients to learn adaptive coping skills, interpersonal skills, and stress management techniques that can generalize to other areas of their lives, ultimately achieving autonomy. Nurses play an important role in milieu therapy by helping design therapeutic physical environments, coordinating teams, and facilitating trust-building discussions.
Social Case work in De-addiction CentreZaeem Jifri
A presentation on social case work in De-Addiction Center.
Addiction is a psychological and physical inability to stop consuming a chemical, drug, activity, or substance, even though it is causing psychological and physical harm.
This document discusses a study on the quality of life of adolescent children of alcoholics. It provides background information on alcohol consumption rates in India and Tamil Nadu. The abstract indicates that alcoholism and its effects on family members, including children, are quite problematic and can affect their quality of life. The document then reviews literature on factors that can influence the quality of life of children of alcoholics, such as parental relationships, social support, and whether the children themselves develop alcohol problems. It finds that while parental alcoholism may negatively impact children's development, outcomes are diverse and not all children of alcoholics struggle socially or with substance abuse issues themselves.
This document discusses pilot studies. It defines a pilot study as a small-scale trial of a research project that covers preparation, tool construction, data collection, analysis and reporting. The objectives of a pilot study are to test elements of the research proposal to improve any issues and prevent costly mistakes in a larger study. A pilot study helps refine concepts and relationships between variables and improves approaches to the target population. It assesses the adequacy of methods, instruments, staff materials and identifies potential problems. The document outlines advantages like improving sampling frames and questionnaires, and disadvantages like introducing biases. It notes limitations like lack of hypothesis testing or generalizability beyond the pilot criteria.
Presentation conveys process of conducting Pilot Study in Social Sciences, Pilot Study in Commerce and Management. steps in pilot study, reasons to conduct pilot study and its importance is also mentioned.
Milieu therapy is a scientific approach to structuring the environment to effect behavioral changes and improve psychological health. It involves manipulating aspects of a client's surroundings, like their hospital experience, to be therapeutic. The goal is for clients to learn adaptive coping skills, interpersonal skills, and stress management techniques that can generalize to other areas of their lives, ultimately achieving autonomy. Nurses play an important role in milieu therapy by helping design therapeutic physical environments, coordinating teams, and facilitating trust-building discussions.
Social Case work in De-addiction CentreZaeem Jifri
A presentation on social case work in De-Addiction Center.
Addiction is a psychological and physical inability to stop consuming a chemical, drug, activity, or substance, even though it is causing psychological and physical harm.
This document discusses a study on the quality of life of adolescent children of alcoholics. It provides background information on alcohol consumption rates in India and Tamil Nadu. The abstract indicates that alcoholism and its effects on family members, including children, are quite problematic and can affect their quality of life. The document then reviews literature on factors that can influence the quality of life of children of alcoholics, such as parental relationships, social support, and whether the children themselves develop alcohol problems. It finds that while parental alcoholism may negatively impact children's development, outcomes are diverse and not all children of alcoholics struggle socially or with substance abuse issues themselves.
Common psycological cases in clinical practiceWafa sheikh
The document discusses common psychological cases seen in clinical practice such as depression among adolescents, adults, and the elderly as well as generalized anxiety disorder and panic attacks. It presents a case study of a 15-year-old adolescent named Faisal experiencing severe depression and anxiety and recommends a treatment plan of cognitive behavioral therapy and the antidepressant fluoxetine to address his conditions. Guidelines for diagnosing and treating adolescent depression are provided, including the effectiveness of cognitive behavioral therapy and SSRIs like fluoxetine, either alone or in combination.
The document discusses addiction as both a psychological and physiological disorder caused by triggers and circumstances that initiate addictive behaviors which are further reinforced by physiological dependence. Treatment addresses both the psychological and biological aspects through programs like Alcoholics Anonymous and emphasizes the role of spirituality. Careful examination of the original spiritual vision and intent of AA is important and points to a different understanding of addiction.
This document discusses factors that contribute to drug abuse and ways to address the problem. It provides examples of individuals who abuse drugs, like Jhan and Tina, and explains what led them to drug use. Key contributing factors discussed include family problems, peer pressure, curiosity, and using drugs to cope with problems or feel enjoyment. The document recommends preventing drug abuse through education, counseling, parenting support, and promoting healthy activities as alternatives to drug use.
Individual Treatment Plan· · Due Dec 01, 559 PM · POINTS 20.docxdirkrplav
Individual Treatment Plan
·
· Due Dec 01, 5:59 PM
· POINTS 20
Write a 1,050- to 1,750-word treatment plan based on a hypothetical client case provided by your instructor.
Follow the steps and discuss all of the main areas listed in the University of Phoenix Material: Guidelines for Writing a Treatment Plan.
Submit your plan via the Assignment Files tab
Individual Treatment Plan Case Scenarios Pick OneVan
Van is a 43-year old Asian American male who is married with two young sons. He lives with his spouse and sons in the San Francisco area. He and his wife left Vietnam for the United States 7 years ago, and they own and operate a small nail salon and spa. Van was raised in a poor family and has little formal education. Aside from routine business conflicts, Van and his wife have gotten along quite well in their marriage and have always been supportive of each other. This changed abruptly last year when his oldest son, age 9, accused him of physical and sexual abuse. Because he described ongoing abuse while at school, Van’s son’s claim was reported to the state by one of his teachers. Since then, Van has had to make several court appearances, and this matter has put tremendous strain on the entire family. Although he denies the claims, Van has started to abuse alcohol since the accusation was made, and he will not talk to his oldest son or his wife. He does not use alcohol daily but is a binge drinker, consuming a large amount of whiskey two to three times per week and becoming very intoxicated. Van has never seen a therapist but is now court-ordered to seek psychological evaluation and treatment. He feels wrongly accused of these acts, although he admits that he has used physical punishment on both boys in the past. He believes that physical punishment is accepted in his native culture but is not understood in the United States. At this point, his marriage has suffered, as has his relationship with both sons. He has been unable to function at work since being accused of sexual abuse. While both of Van’s sons used to be excellent students, their grades have fallen, and the oldest son has behavior problems. Roy
Roy is a single 37-year old African American male who is a part-time factory worker and lives with a roommate in an urban apartment in California. He has never been married, but he currently has a girlfriend. He has a high school education. He has chronic low back pain, blaming this on his job duties, which require some heavy lifting. He is involved in physical therapy and medical management for his condition. At work, Roy has had several incidents in which he became extremely angry with a coworker. In one incident, his supervisor observed his behavior, which he noted was physically threatening to the coworker. His behavior has been documented by his supervisor twice already, which has led to some job insecurity for Roy. Roy has been using high doses of Vicodin prescribed by his doctor for chronic pain. He is a smoker and uses alcoh.
Alcoholism is defined as a chronic disease characterized by impaired control over drinking and obsession with alcohol despite negative consequences. There are several subtypes of alcoholism including young adult, young antisocial, functional, intermediate familial, and chronic severe. Theories of alcoholism include psychodynamic perspectives focusing on oral fixations and sublimation as well as behavioral perspectives involving classical and operant conditioning where positive reinforcement of drinking behaviors can lead to addiction over time. Genetic and environmental factors both contribute to risk of developing alcoholism.
Complete your treatment plan template ( I WILL COMPLETE THIS)for Eli.docxskevin488
Complete your treatment plan template ( I WILL COMPLETE THIS)for Eliza based on LAST WEEKS assignments findings. Additionally, write and submit a 700-1,050-word essay that includes the following:
The treatment theory you would use and why.
A description of how you would address any mental health, medical, legal, and substance use issues that the client exhibits in the case study through the lens of your counseling theory of choice.
Include at least three scholarly sources in your paper.
Submit the paper and the treatment plan to your instructor.(I WILL COMPLETE THE ATTACHED TREATMENT PLAN) I JUST WANTED YOU TO HAVE IT FOR REFERENCE, PLUS THE PAPER YOU WROTE LAST WEEK.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful
CLASS TEXTBOOK REFERENCE:
Schwitzer, A. M., & Rubin, L. C. (2014).
Diagnosis and treatment planning skills: A popular culture approach
(2nd ed.). Los Angeles, CA: Sage Publications. ISBN-13: 9781483349763
Here is the example BPS for eliza
PCN-610 Eliza D Psychosocial Example
Name: Eliza Doolittle Date: ********* DOB: ********
Age: 18 Start Time: 1:15p End Time: 2:00p
Identifying Information:
The client is a Caucasian female with average height and slender build. The client stated that she is currently a freshman in college, majoring in engineering. The client also stated that her family resides in a small town approximately two hours away.
Presenting Problem:
At the onset of the session, the client stated that she had come to counseling as a result of being caught in a campus dorm with alcohol (it is an alcohol-free campus). Concerning the incident, the client stated “the RAs were called because my friends were being too loud in my dorm. When they arrived, they saw us with alcohol, and we got in trouble.” The client stated that her friends in the dorm were intoxicated but she was not, adding, “I was just buzzed” and adding that she was drinking “because they were” and “it’s just something to do.”
Life Stressors:
The client identified school as a life stressor, adding “things came easy to me in high school, I just figured it would be the same in college”. The client went on to state that, in addition to the difficulty in increased study requirements, she had struggles in making friends, stating, “a lot of my friends from high school have either gone to college somewhere else or are doing other things,” although the client denied feeling lonely.
Substance Use:
Yes
No
The client denied having a drug or alcohol problem, adding that she tried marijuana once in high school but “I didn’t like how it made me feel” and had not taken it since. The client stated that she was introduced to alcohol in HS when “friends asked me to drink it with them.” The client .
This document presents a case study of a 19-year-old woman with a history of self-harm, substance abuse, and volatile relationships. She has been cutting herself and taking overdoses in response to arguments with her boyfriend or mother. Her mental state examination finds her distraught and suicidal. She likely meets criteria for emotionally unstable personality disorder (EUPD), also known as borderline personality disorder, characterized by impulsivity, unstable moods, and chaotic relationships. Treatment would involve risk assessment, calming her down, and possibly admission to prevent self-harm. Long-term therapies like dialectical behavior therapy are recommended over medication, which generally has limited effectiveness for EUPD.
The document discusses various topics related to alcohol and drug abuse including:
- Alcohol is widely used but can lead to alcoholism which impacts an estimated 10-15 million Americans each year.
- Both small and large amounts of alcohol can impact physical and mental health, with too much often leading to problems.
- Drug and alcohol abuse is a serious public health issue, especially among youth.
- Signs of alcoholism and withdrawal symptoms are described.
- Binge drinking, especially among young people, can negatively impact brain development and function.
- Drug abuse is defined and commonly abused drugs are listed along with potential harms.
- Alcohol and drug abuse in the workplace lowers productivity and increases costs to employers
Obesity, Weight Loss Surgery and AddictionJulie Dostal
Obesity, Weight Loss Surgery and Addiction: What every bariatric patient should know about their risk for addiction post operatively. Why are bariatric patients at risk? What can one do to prevent addiction after surgery? What is "addiction transfer?"
William Hamel is a 32-year-old Caucasian male seeking treatment for alcohol and cocaine abuse issues. He has a history of medical and psychiatric hospitalizations related to his substance use as well as physical and sexual abuse as a child. He is unemployed and his substance use has negatively impacted his relationships and led to legal issues. He meets criteria for alcoholism and cocaine abuse and requires a structured residential treatment program to address his substance use disorders and related mental health issues.
There are lots of reasons why you might want to stop drinking alcohol. For some people, it’s a lifestyle change - to say goodbye to hangovers, sleep better, lose excess weight and have more energy. It might even be for a challenge, to buddy someone else who is giving up alcohol, or to raise money for charity.
For other people, stopping drinking can be essential for medical reasons. Perhaps because of an alcohol-related medical condition like liver disease, or because they start taking medication that reacts badly with alcohol.
Whatever your reason, the good news is that anyone can stop drinking. And if you’re thinking about removing alcohol from your life, you’re not alone.
Alcohol Addiction Treatment - An Ultimate Guide to Overcome Your AddictionInspire Change Wellness
>> Psychological Conditions Depicting Alcohol Addiction.
>> Alcohol Addiction Treatment in 3 steps.
>> Alcohol Addiction Treatment through Group Therapies.
>> Social Life and Alcohol Addiction Treatment.
mental health and its benefits to indiv.miki08maws
The document discusses mental health and well-being. It defines mental health as a state of well-being where an individual can cope with stress and work productively. It notes several factors that can be detrimental to mental health, such as family problems, peer pressure, and financial issues. The document also discusses enhancing skills like social skills and problem solving to prevent mental health issues. It describes depression and signs like changes in sleep, appetite, and mood. It discusses eating disorders like anorexia and bulimia as well as substance abuse issues. Finally, it prompts the reader to consider ways to improve their own mental health as an adolescent.
S.N. is a 15-year-old female who was brought to a facility by her uncle for evaluation of bipolar disorder type 1. She has a history of risky behaviors like substance use and unsafe sexual encounters. Her current medications are not effective and she is non-compliant. The treatment plan aims to simplify her medication regimen to improve compliance and provide psychotherapy and education to support her safety, well-being and recovery.
Alcoholism is characterized by compulsive and uncontrolled consumption of alcohol that is detrimental to one's health, relationships, and social standing. It is considered a disease. Early signs of alcohol abuse include drinking alone, using alcohol to cope, and escalating consumption. Long-term effects include physical and mental health problems like liver disease, heart problems, and increased risk of certain cancers. Treatment options include support groups, therapy, and some pharmacological interventions. Prevention emphasizes drinking responsibly and moderation.
Alcoholism is defined as excessive and repetitive drinking of alcohol that harms the drinker or others physically, mentally, socially, legally, or economically. It is considered a disease by most clinicians. Risk factors include family history, peer pressure, low self-esteem, and easy availability of alcohol. Alcoholism can cause health issues like liver disease and heart problems. It also impacts families by increasing intimate partner violence, child abuse/neglect, and risk of the children later developing alcohol use disorders. During lockdowns, initially alcoholism cases decreased due to lack of availability but then increased as unemployment rose and liquor became gradually available again, triggering withdrawal symptoms and related issues.
You will present information on the AAC Tobii Dynavox I Seri.docxlillie234567
You will present information on the AAC Tobii Dynavox I
Series device and SNAP Core First Software.
The following objectives should be met:
1. Identify the AAC Device and communication APP
2. Discuss/demonstrate its function, use specs, and the
population it is best suited for
3. Identify research, evidence of efficacy, list pros and
cons of the device/app
4. Use 3D visuals and video of demonstrating how it is
used
5. Steps the individual that it is best suited for needs to
take for improvement.
6. Roles of the speech pathologist and who they would
collaborate with.
7. Resources
8. At least 8-10 slides with slide transcript
.
The document outlines an implementation plan for adding blood pressure monitoring capabilities to Fitbit's existing apps and website. Key elements of the plan include:
1) Developing extensions to Fitbit's existing apps for iOS, Android, and the website to display and track blood pressure readings over time.
2) Validating the functionality and data integration across all platforms through individual testing, regression testing, and end-to-end cross-platform testing.
3) Conducting ongoing evaluation of customer feedback, bug reports, and usage metrics to continuously improve the new blood pressure feature.
Task· This is an individual task. · The task focuses on areas .docxlillie234567
Task
· This is an individual task.
· The task focuses on areas studied to date, requiring you to show knowledge and application in the parts stated.
· You should upload a single, correctly formatted document which may also include any relevant tables and diagrams
Continuing with the marketing plan you developed for the Midterm Assessment, complete it with according with the topics discussed in class during the 2nd part of the course with following points (but not exclusively)
1. Distribution Channels:
· Markets with direct sales (if any)
· Markets with distributors (if any)
· Markets with agents (if any)
2. Pricing Strategy:
· Pricing strategies per channel
· Take a product and show how should you fix the price according the channel
3. Communication Strategy
· Business Magazines
· Trade Shows
· Digital Tools
4. Any other factor you consider key for your marketing plan
Formalities:
· Wordcount: 2.000 words
· Cover, Table of Contents, References and Appendix are excluded from the total wordcount.
· Font: Arial 12,5 pts.
· Text alignment: Justified.
· Harvard style in-text citations and bibliography
It assesses the following learning outcomes:
1. Have an in-depth understanding of B2B market opportunities.
2. Identify and differentiate between the different and unique challenges of business markets
3. Apply and analyze the different B2Bsystems and processes
4. Have a systematic understanding of how theoretical concepts can be applied in business markets.
5. Critically appreciate B2B marketing strategy assessments and developments.
6. Apply and assess the tools for B2Bmarketing strategy development and implementation
Rubrics
Learning Descriptors
Fail Below 60%
Marginal Fail 60-69%
Fair 70-79 %
Good 80-89%
Exceptional 90-100%
Purpose & Understanding
KNOWLEDGE & UNDERSTANDING
15%
Very poor coverage of central purpose, goals, research questions or arguments with little relevant information evident. Virtually no evidence of understanding or focus.
Minimal understanding of purpose of the study; factual errors evident. Gaps in knowledge and superficial understanding. A few lines of relevant material.
Reasonable understanding and clearly identifies the purpose, goals, research questions or argument.
Reflect partial achievement of learning outcomes.
A sound grasp of, and clearly identifies, the purpose, goals, research questions or argument. Some wider study beyond the classroom content shown.
Effectively describes and explains the central purpose, arguments, research questions, or goals of the project; explanation is focused, detailed and compelling. Recognition of alternative forms of evidence beyond that supplied in the classroom.
Content
KNOWLEDGE & UNDERSTANDING
15%
Content is unclear, inaccurate and/or incomplete. Brief and irrelevant. Descriptive. Only personal views offered.
Unsubstantiated and does not support the purpose, argument or goals of the project. Reader gains no insight through the content of the project.
Limi.
Common psycological cases in clinical practiceWafa sheikh
The document discusses common psychological cases seen in clinical practice such as depression among adolescents, adults, and the elderly as well as generalized anxiety disorder and panic attacks. It presents a case study of a 15-year-old adolescent named Faisal experiencing severe depression and anxiety and recommends a treatment plan of cognitive behavioral therapy and the antidepressant fluoxetine to address his conditions. Guidelines for diagnosing and treating adolescent depression are provided, including the effectiveness of cognitive behavioral therapy and SSRIs like fluoxetine, either alone or in combination.
The document discusses addiction as both a psychological and physiological disorder caused by triggers and circumstances that initiate addictive behaviors which are further reinforced by physiological dependence. Treatment addresses both the psychological and biological aspects through programs like Alcoholics Anonymous and emphasizes the role of spirituality. Careful examination of the original spiritual vision and intent of AA is important and points to a different understanding of addiction.
This document discusses factors that contribute to drug abuse and ways to address the problem. It provides examples of individuals who abuse drugs, like Jhan and Tina, and explains what led them to drug use. Key contributing factors discussed include family problems, peer pressure, curiosity, and using drugs to cope with problems or feel enjoyment. The document recommends preventing drug abuse through education, counseling, parenting support, and promoting healthy activities as alternatives to drug use.
Individual Treatment Plan· · Due Dec 01, 559 PM · POINTS 20.docxdirkrplav
Individual Treatment Plan
·
· Due Dec 01, 5:59 PM
· POINTS 20
Write a 1,050- to 1,750-word treatment plan based on a hypothetical client case provided by your instructor.
Follow the steps and discuss all of the main areas listed in the University of Phoenix Material: Guidelines for Writing a Treatment Plan.
Submit your plan via the Assignment Files tab
Individual Treatment Plan Case Scenarios Pick OneVan
Van is a 43-year old Asian American male who is married with two young sons. He lives with his spouse and sons in the San Francisco area. He and his wife left Vietnam for the United States 7 years ago, and they own and operate a small nail salon and spa. Van was raised in a poor family and has little formal education. Aside from routine business conflicts, Van and his wife have gotten along quite well in their marriage and have always been supportive of each other. This changed abruptly last year when his oldest son, age 9, accused him of physical and sexual abuse. Because he described ongoing abuse while at school, Van’s son’s claim was reported to the state by one of his teachers. Since then, Van has had to make several court appearances, and this matter has put tremendous strain on the entire family. Although he denies the claims, Van has started to abuse alcohol since the accusation was made, and he will not talk to his oldest son or his wife. He does not use alcohol daily but is a binge drinker, consuming a large amount of whiskey two to three times per week and becoming very intoxicated. Van has never seen a therapist but is now court-ordered to seek psychological evaluation and treatment. He feels wrongly accused of these acts, although he admits that he has used physical punishment on both boys in the past. He believes that physical punishment is accepted in his native culture but is not understood in the United States. At this point, his marriage has suffered, as has his relationship with both sons. He has been unable to function at work since being accused of sexual abuse. While both of Van’s sons used to be excellent students, their grades have fallen, and the oldest son has behavior problems. Roy
Roy is a single 37-year old African American male who is a part-time factory worker and lives with a roommate in an urban apartment in California. He has never been married, but he currently has a girlfriend. He has a high school education. He has chronic low back pain, blaming this on his job duties, which require some heavy lifting. He is involved in physical therapy and medical management for his condition. At work, Roy has had several incidents in which he became extremely angry with a coworker. In one incident, his supervisor observed his behavior, which he noted was physically threatening to the coworker. His behavior has been documented by his supervisor twice already, which has led to some job insecurity for Roy. Roy has been using high doses of Vicodin prescribed by his doctor for chronic pain. He is a smoker and uses alcoh.
Alcoholism is defined as a chronic disease characterized by impaired control over drinking and obsession with alcohol despite negative consequences. There are several subtypes of alcoholism including young adult, young antisocial, functional, intermediate familial, and chronic severe. Theories of alcoholism include psychodynamic perspectives focusing on oral fixations and sublimation as well as behavioral perspectives involving classical and operant conditioning where positive reinforcement of drinking behaviors can lead to addiction over time. Genetic and environmental factors both contribute to risk of developing alcoholism.
Complete your treatment plan template ( I WILL COMPLETE THIS)for Eli.docxskevin488
Complete your treatment plan template ( I WILL COMPLETE THIS)for Eliza based on LAST WEEKS assignments findings. Additionally, write and submit a 700-1,050-word essay that includes the following:
The treatment theory you would use and why.
A description of how you would address any mental health, medical, legal, and substance use issues that the client exhibits in the case study through the lens of your counseling theory of choice.
Include at least three scholarly sources in your paper.
Submit the paper and the treatment plan to your instructor.(I WILL COMPLETE THE ATTACHED TREATMENT PLAN) I JUST WANTED YOU TO HAVE IT FOR REFERENCE, PLUS THE PAPER YOU WROTE LAST WEEK.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful
CLASS TEXTBOOK REFERENCE:
Schwitzer, A. M., & Rubin, L. C. (2014).
Diagnosis and treatment planning skills: A popular culture approach
(2nd ed.). Los Angeles, CA: Sage Publications. ISBN-13: 9781483349763
Here is the example BPS for eliza
PCN-610 Eliza D Psychosocial Example
Name: Eliza Doolittle Date: ********* DOB: ********
Age: 18 Start Time: 1:15p End Time: 2:00p
Identifying Information:
The client is a Caucasian female with average height and slender build. The client stated that she is currently a freshman in college, majoring in engineering. The client also stated that her family resides in a small town approximately two hours away.
Presenting Problem:
At the onset of the session, the client stated that she had come to counseling as a result of being caught in a campus dorm with alcohol (it is an alcohol-free campus). Concerning the incident, the client stated “the RAs were called because my friends were being too loud in my dorm. When they arrived, they saw us with alcohol, and we got in trouble.” The client stated that her friends in the dorm were intoxicated but she was not, adding, “I was just buzzed” and adding that she was drinking “because they were” and “it’s just something to do.”
Life Stressors:
The client identified school as a life stressor, adding “things came easy to me in high school, I just figured it would be the same in college”. The client went on to state that, in addition to the difficulty in increased study requirements, she had struggles in making friends, stating, “a lot of my friends from high school have either gone to college somewhere else or are doing other things,” although the client denied feeling lonely.
Substance Use:
Yes
No
The client denied having a drug or alcohol problem, adding that she tried marijuana once in high school but “I didn’t like how it made me feel” and had not taken it since. The client stated that she was introduced to alcohol in HS when “friends asked me to drink it with them.” The client .
This document presents a case study of a 19-year-old woman with a history of self-harm, substance abuse, and volatile relationships. She has been cutting herself and taking overdoses in response to arguments with her boyfriend or mother. Her mental state examination finds her distraught and suicidal. She likely meets criteria for emotionally unstable personality disorder (EUPD), also known as borderline personality disorder, characterized by impulsivity, unstable moods, and chaotic relationships. Treatment would involve risk assessment, calming her down, and possibly admission to prevent self-harm. Long-term therapies like dialectical behavior therapy are recommended over medication, which generally has limited effectiveness for EUPD.
The document discusses various topics related to alcohol and drug abuse including:
- Alcohol is widely used but can lead to alcoholism which impacts an estimated 10-15 million Americans each year.
- Both small and large amounts of alcohol can impact physical and mental health, with too much often leading to problems.
- Drug and alcohol abuse is a serious public health issue, especially among youth.
- Signs of alcoholism and withdrawal symptoms are described.
- Binge drinking, especially among young people, can negatively impact brain development and function.
- Drug abuse is defined and commonly abused drugs are listed along with potential harms.
- Alcohol and drug abuse in the workplace lowers productivity and increases costs to employers
Obesity, Weight Loss Surgery and AddictionJulie Dostal
Obesity, Weight Loss Surgery and Addiction: What every bariatric patient should know about their risk for addiction post operatively. Why are bariatric patients at risk? What can one do to prevent addiction after surgery? What is "addiction transfer?"
William Hamel is a 32-year-old Caucasian male seeking treatment for alcohol and cocaine abuse issues. He has a history of medical and psychiatric hospitalizations related to his substance use as well as physical and sexual abuse as a child. He is unemployed and his substance use has negatively impacted his relationships and led to legal issues. He meets criteria for alcoholism and cocaine abuse and requires a structured residential treatment program to address his substance use disorders and related mental health issues.
There are lots of reasons why you might want to stop drinking alcohol. For some people, it’s a lifestyle change - to say goodbye to hangovers, sleep better, lose excess weight and have more energy. It might even be for a challenge, to buddy someone else who is giving up alcohol, or to raise money for charity.
For other people, stopping drinking can be essential for medical reasons. Perhaps because of an alcohol-related medical condition like liver disease, or because they start taking medication that reacts badly with alcohol.
Whatever your reason, the good news is that anyone can stop drinking. And if you’re thinking about removing alcohol from your life, you’re not alone.
Alcohol Addiction Treatment - An Ultimate Guide to Overcome Your AddictionInspire Change Wellness
>> Psychological Conditions Depicting Alcohol Addiction.
>> Alcohol Addiction Treatment in 3 steps.
>> Alcohol Addiction Treatment through Group Therapies.
>> Social Life and Alcohol Addiction Treatment.
mental health and its benefits to indiv.miki08maws
The document discusses mental health and well-being. It defines mental health as a state of well-being where an individual can cope with stress and work productively. It notes several factors that can be detrimental to mental health, such as family problems, peer pressure, and financial issues. The document also discusses enhancing skills like social skills and problem solving to prevent mental health issues. It describes depression and signs like changes in sleep, appetite, and mood. It discusses eating disorders like anorexia and bulimia as well as substance abuse issues. Finally, it prompts the reader to consider ways to improve their own mental health as an adolescent.
S.N. is a 15-year-old female who was brought to a facility by her uncle for evaluation of bipolar disorder type 1. She has a history of risky behaviors like substance use and unsafe sexual encounters. Her current medications are not effective and she is non-compliant. The treatment plan aims to simplify her medication regimen to improve compliance and provide psychotherapy and education to support her safety, well-being and recovery.
Alcoholism is characterized by compulsive and uncontrolled consumption of alcohol that is detrimental to one's health, relationships, and social standing. It is considered a disease. Early signs of alcohol abuse include drinking alone, using alcohol to cope, and escalating consumption. Long-term effects include physical and mental health problems like liver disease, heart problems, and increased risk of certain cancers. Treatment options include support groups, therapy, and some pharmacological interventions. Prevention emphasizes drinking responsibly and moderation.
Alcoholism is defined as excessive and repetitive drinking of alcohol that harms the drinker or others physically, mentally, socially, legally, or economically. It is considered a disease by most clinicians. Risk factors include family history, peer pressure, low self-esteem, and easy availability of alcohol. Alcoholism can cause health issues like liver disease and heart problems. It also impacts families by increasing intimate partner violence, child abuse/neglect, and risk of the children later developing alcohol use disorders. During lockdowns, initially alcoholism cases decreased due to lack of availability but then increased as unemployment rose and liquor became gradually available again, triggering withdrawal symptoms and related issues.
Similar to Running Head Pepper Family Case Study 1Pepper Family Case .docx (18)
You will present information on the AAC Tobii Dynavox I Seri.docxlillie234567
You will present information on the AAC Tobii Dynavox I
Series device and SNAP Core First Software.
The following objectives should be met:
1. Identify the AAC Device and communication APP
2. Discuss/demonstrate its function, use specs, and the
population it is best suited for
3. Identify research, evidence of efficacy, list pros and
cons of the device/app
4. Use 3D visuals and video of demonstrating how it is
used
5. Steps the individual that it is best suited for needs to
take for improvement.
6. Roles of the speech pathologist and who they would
collaborate with.
7. Resources
8. At least 8-10 slides with slide transcript
.
The document outlines an implementation plan for adding blood pressure monitoring capabilities to Fitbit's existing apps and website. Key elements of the plan include:
1) Developing extensions to Fitbit's existing apps for iOS, Android, and the website to display and track blood pressure readings over time.
2) Validating the functionality and data integration across all platforms through individual testing, regression testing, and end-to-end cross-platform testing.
3) Conducting ongoing evaluation of customer feedback, bug reports, and usage metrics to continuously improve the new blood pressure feature.
Task· This is an individual task. · The task focuses on areas .docxlillie234567
Task
· This is an individual task.
· The task focuses on areas studied to date, requiring you to show knowledge and application in the parts stated.
· You should upload a single, correctly formatted document which may also include any relevant tables and diagrams
Continuing with the marketing plan you developed for the Midterm Assessment, complete it with according with the topics discussed in class during the 2nd part of the course with following points (but not exclusively)
1. Distribution Channels:
· Markets with direct sales (if any)
· Markets with distributors (if any)
· Markets with agents (if any)
2. Pricing Strategy:
· Pricing strategies per channel
· Take a product and show how should you fix the price according the channel
3. Communication Strategy
· Business Magazines
· Trade Shows
· Digital Tools
4. Any other factor you consider key for your marketing plan
Formalities:
· Wordcount: 2.000 words
· Cover, Table of Contents, References and Appendix are excluded from the total wordcount.
· Font: Arial 12,5 pts.
· Text alignment: Justified.
· Harvard style in-text citations and bibliography
It assesses the following learning outcomes:
1. Have an in-depth understanding of B2B market opportunities.
2. Identify and differentiate between the different and unique challenges of business markets
3. Apply and analyze the different B2Bsystems and processes
4. Have a systematic understanding of how theoretical concepts can be applied in business markets.
5. Critically appreciate B2B marketing strategy assessments and developments.
6. Apply and assess the tools for B2Bmarketing strategy development and implementation
Rubrics
Learning Descriptors
Fail Below 60%
Marginal Fail 60-69%
Fair 70-79 %
Good 80-89%
Exceptional 90-100%
Purpose & Understanding
KNOWLEDGE & UNDERSTANDING
15%
Very poor coverage of central purpose, goals, research questions or arguments with little relevant information evident. Virtually no evidence of understanding or focus.
Minimal understanding of purpose of the study; factual errors evident. Gaps in knowledge and superficial understanding. A few lines of relevant material.
Reasonable understanding and clearly identifies the purpose, goals, research questions or argument.
Reflect partial achievement of learning outcomes.
A sound grasp of, and clearly identifies, the purpose, goals, research questions or argument. Some wider study beyond the classroom content shown.
Effectively describes and explains the central purpose, arguments, research questions, or goals of the project; explanation is focused, detailed and compelling. Recognition of alternative forms of evidence beyond that supplied in the classroom.
Content
KNOWLEDGE & UNDERSTANDING
15%
Content is unclear, inaccurate and/or incomplete. Brief and irrelevant. Descriptive. Only personal views offered.
Unsubstantiated and does not support the purpose, argument or goals of the project. Reader gains no insight through the content of the project.
Limi.
Team ProjectMBA687What it is…The team project in MBA68.docxlillie234567
Team Project
MBA687
What it is…
The team project in MBA687 gives you, the learner and person who is one course away from an MBA:
The opportunity to demonstrate that you can work as a member of a high-functioning team to complete a complex analysis, synthesis and presentation task.
The opportunity to demonstrate mastery of the knowledge and skills that you have acquired through the MBA program.
Where to find information in the syllabus, 1
Page 6
Group Case Study
Prior to the start of Unit 7, students will be assigned into groups of no more than 4 students per group. Each group will be assigned to complete a case study chosen by the instructor from 20 cases located in Appendix C. The 20 case materials can be found in the required textbook (see Appendix C for relevant page numbers). Group case studies should follow the same requirements as the writing assignments stated above. Group case studies are due in Unit 7. Earlier submissions are encouraged.
Also from Page 6
Writing Assignments
Writing assignments must be APA compliant and include a title page, appropriate citations, and references.
Where to find information in the syllabus, 2
Appendix C (Page 24)
This was the list from which your team selected its case
Pages 43-45
This is the rubric (grading guide) that the instructor will use to evaluate and grade the team’s submission.
General outline for the submission
This submission is much like one that you would present in a workplace situation. Imagine that you are presenting your findings on the case to senior management of your company, or to the board of directors.
For your paper, use the outline found in Table 2, page C-6 of your text.
Strategic Profile and Case Analysis Purpose
Situation Analysis
A. General environmental analysis
B. Industry analysis
C. Competitor analysis
D. Internal analysis
III. Identification of Environmental Opportunities and Threats and Firm Strengths and Weaknesses (SWOT Analysis)
Strategy Formulation
A. Strategic alternatives
B. Alternative evaluation
C. Alternative choice
Strategic Alternative Implementation
A. Action items
B. Action plan
Parts I, II and II
Parts I, II and III are much like the introduction, external analysis and internal analysis that you did for your individual project.
The author provides a list of things that you can consider about the external analysis of the industry in Table 3 (C-7)
The author discusses industry analysis (C-6), competitor analysis (C-7) and industry analysis (C-8). It will be helpful to review these areas, even though you have done your individual projects.
In the following pages, the author suggests many tools that you can use to analyze the company and its industry.
Strategy in the paper, 1
Strategy formulation
This is your team’s recommendations for the company
Recommendations should be either business level strategy alternatives or corporate level strategy alternatives.
Recommendations should be based on and sup.
T he fifteen year-old patient was scheduled for surgery on t.docxlillie234567
T he fifteen year-old patient was
scheduled for surgery on the right
side of his brain to remove a right tem-
poral lobe lesion that was believed to be
causing his epileptic seizures.
The surgery began with the sur-
geon making an incision on the left
side, opening the skull, penetrating the
dura and removing significant portions
of the left amygdala, hippocampus and
other left-side brain tissue before it was
discovered that they were working on
the wrong side.
The left-side wound was closed,
the right side was opened and the pro-
cedure went ahead on the right, correct
side.
The error in the O.R. was revealed
to the parents shortly after the surgery,
but only as if it was a minor and incon-
sequential gaffe.
The patient recuperated, left the
hospital, returned to his regular activi-
ties and graduated from high school
before his parents could no longer deny
he was not all right. After a thorough
neurological assessment he had to be
placed in an assisted living facility for
brain damaged individuals.
When the full magnitude of the
consequences came to light a lawsuit
was filed which resulted in a $11 mil-
lion judgment which was affirmed by
the Supreme Court of Arkansas.
A circulating nurse has a le-
gal duty to see that surgery
does not take place on the
wrong side of the body.
The preoperative documents
failed to identify on which side
the surgery was to be done.
It was below the standard of
care for the circulating nurse
not to notice that fact and not
to seek out the correct infor-
mation.
SUPREME COURT OF ARKANSAS
December 13, 2012
Operating Room: Surgical Error Blamed, In
Part, On Circulating Nurse’s Negligence.
Surgical Error Blamed, In Part, On
Circulating Nurse’s Negligence
The Court accepted the testimony
of the family’s nursing expert that a
circulating nurse has a fundamental
responsibility as a member of the surgi-
cal team to make sure that surgery is
done on the correct anatomical site,
especially when it is brain surgery.
The circulating nurse is supposed
to understand imposing terms like se-
lective amygdala hippocampectomy
and know the basics of how it is sup-
posed to be done.
Hospital policy called for the sur-
geon, the anesthesiologist, the circulat-
ing nurse and the scrub nurse or tech to
take a “timeout” prior to starting a sur-
gical case for final verification of the
correct anatomical site.
The circulating nurse should have
available three essential documents, the
surgical consent form, the preoperative
history and the O.R. schedule.
The full extent of the error, that is,
a full list of the parts of the brain that
were removed from the healthy side,
should have been documented by the
circulating nurse, and failure to do so
was a factor that adversely affected the
patient’s later medical course, the pa-
tient’s nursing expert said. Proassur-
ance v. Metheny, __ S.W. 3d __, 2012 WL
6204231 (Ark.
Study Participants Answers to Interview QuestionsParticipant #1.docxlillie234567
Study Participants Answers to Interview Questions
Participant #1:
1. What are the disparities between jail and youth rehabilitation for African American offenders?
a. African Americans will be imprisoned more than their white counterparts who will be given rehabilitation, institutional racism exists, and the system will spend more man hours and time dealing with white offenders than black offenders.
2. What are some social issues that African American juveniles are faced with?
a. Sociocultural stigmas, single-parent households, inadequate educational systems, poor role models, and single-parent households
3. Why are African American male juveniles not offered other means of rehabilitative punishments?
a. The New Jim Crow is our correctional system, which seeks to fill jail cells by incarcerating more black and Latino people who are then utilized as enslaved people in the system for huge corporations and the US Government. The system indicates they are not receptive and will not change.
4. What effects does the existing jail and punishment system have on this population?
a. Demeaning and discouraging—we should fund educational aid, mental health services, and instruction. Providing people with helpful tools, role models, and direction will also help them become contributing members of society
Participant #2:
1. Youth rehabilitation centers should provide mechanisms to prevent offenders from committing crimes but in order to effectively do that the differences amongst AA juveniles and other races must be addressed, while jail just allows for a separation from society to think about the crime.
2. African American male juveniles are faced with a predetermined
perception of being criminals as well as a lack of resources in their communities to educate them on the different career paths & trades that exist.
3. The funding doesn’t exist to provide other rehabilitative opportunities in AA communities.
4. The existing punishment system allows offenders to be separated from the public but it doesn’t provide them with any resources to be successful once their time is complete. Not addressing the underlying issues of how they entered the system as well as how to they can live a successful life after now being labeled as a criminal normally results in repeat offenders.
Participant #3:
1. The youth aren’t getting the proper guidance, mental healthcare and attentiveness in jail. They’re already “written off” which leads to them believing what they’re being taught and increasing the likelihood of them becoming repeat offenders. In youth rehab, you’re given a second chance, you’re being taught how to manage your mental and emotional state. You are being prepared for the world.
2. Prejudice. Are seen as thugs, no good. Etc. don’t have proper resources to get them back on their feet. Difficulty getting jobs, getting into school once released.
3. Unsure, but I’m sure it’s race.
4. You can become in.
STUDENT REPLIES
STUDENT REPLY #1 Vanessa Deleon Guerrero
When conducting surveillance, you are closely monitoring a person’s activities. Investigators or detectives watch their every move, at home, work, where they eat, shop all while being unnoticeable. When detectives conduct surveillance, they still need to ensure that they are respecting the person’s privacy. For example, detectives will not take photos of the person while they are in the shower. If the person is outside or in an area that has public view, then they can take photos of that person. They must conduct their surveillance in an orderly manner, without causing panic to the public in order to ensure public safety.
Private companies such as Facebook, Instagram or twitter are used for people to express themselves. However, what is posted on their social media becomes public and they make their lives public for everyone to see. If someone posted that they were just at a park where a shooting happened, law enforcement can use that to interview them because it puts them at the scene of the crime. However, private companies, for example like phone companies should not use data like text messaging for their benefit. They should not be allowed to read their customers’ messages or listen in on their phone calls. That is a true invasion of privacy.
Reference
Brandl, S. (2018). Criminal investigation (4th ed.). Thousand Oaks, CA: SAGE Publications.
Bedi, M. (2016). The curious case of cell phone location data: Fourth Amendment doctrine mash-up Links to an external site... Northwestern University Law Review, 110(2), 507–524
STUDENT REPLY #2 Danielle Berlus
Hello everyone, when I think of surveillance, I think of all the places that they put cameras like the ones at streetlights that catch you speeding or when they are looking for a suspect and they look to facial recognition devices. I think it is hard to balance what is expected to be private. I don't think anything is private anymore except possibly the bathrooms and even then, someone maybe recording you. Our cell phones I think are being monitored by so many companies and even those who want to steal our personal data as well.
"The government tracks movements through the acquisition of cell phone location data: historical cell phone location data, real-time cell phone location data, and actively "pinging" a cell phone for location data. Cell phone providers store location data as the normal part of their business of providing service. Police, in turn, can request that cell phone providers hand over this location data for a suspect over a set period of time. This information is classified as historical cell phone location data. This data stands in contrast to real-time location data. Whereas the former focuses on past locations, real-time data provides locations as they actually occur. Here, cell phone providers, upon request, give police contemporaneous data on the location of the nearest cell tower for tracking p.
Student Name
BUS 300 Public Relations
[Insert Instructor’s Name]
Month Date Year
BUS300 PR Plan Part 2 Outline
This paper will be a revised and expanded version of Developing a Public Relations Plan, Part 1 assignment in Week 4. Your paper should have a section with the bolded headers below. Ensure you have a section that discusses each of these:
Mix Media
In this section, you will describe the mix of media you would use to implement your public relations campaign and explain in detail your objectives for each media form. Include traditional and twenty-first- century integrated marketing communication strategies in your discussion. (This section should be at least three paragraphs).
Government Relations
In this section you will describe the government relations tactics you would use as part of your public relations campaign, and explain in detail how these tactics will help you achieve your objectives. In great detail explain how these tactics will help you achieve your objectives. (This section should be at least two paragraphs).
Community Relations
In this section please explain in detail how you can take advantage of community relations to generate positive publicity for your organization. (This section should be at least two paragraphs).
News Release
Draft a news release that you will use in your public relations campaign (Chapter 15). Explain in detail how the content, style, and essentials of your news release will help you persuade the public to your point of view. Use information from Chapter 15 as support. Describe the key elements of writing to consider when responding to a public relations crisis or scandal. (Your news release should be similar to the example provided in the book).
Crisis Management
In this section you will explain the five planning issues related to crisis management that can be employed to mitigate the scandal or risks (Chapter 17). (This section should be at least four to five paragraphs).
Additional Requirements
Remember to Include in-text citations when presenting information from other sources. You should begin your search for sources in the Strayer Library. Use a minimum of three credible, relevant, and appropriate sources. After you conclude the paper, you will need a separate page that includes your references. Include a sources page at the end of your paper.
Please ensure you proofread your paper and summarize when providing in-text citations.
1. Enter your first source entry here.
2. Enter your second source entry here.
3. Enter your third source entry here.
image1.png
BUS 300 Public Relations
Dr. Tenielle Buchanan
October 30, 2022BUS300 PR Plan Part 1 Outline
Your paper should have a section with the bolded headers below. Ensure you have a section that discusses each of these:
Name of organization
The United States-based publication Rolling Stone magazine is a news magazine that covers articles on current events relating to music, contempo.
Statistical Process Control 1 STATISTICAL PROCESS .docxlillie234567
Statistical Process Control 1
STATISTICAL PROCESS CONTROL
by XXXXXXXX
Student ID: 2XXXXXXX
University of Northampton
(Amity Global Institute Pte Ltd, Singapore)
Managing Operations and The Supply Chain
Dr. Melvin Goh
BSOM046
BSOM046-SUM-1920-ES1-Statistical Process Control
18 Oct XXXX
Word Count: 1600 (± 50)
Statistical Process Control 2
Table of Content
1. Introduction………………………………………………………………….3
2. Literature Review……………………………………………………………3
3. Methodology…………………………………………………………………5
4. Case Study Analysis…………………………………………………………9
5. Recommendation…………………………………………………………….15
6. Conclusion…………………………………………………………………...17
7. References……………………………………………………………………18
8. Appendix……………………………………………………………………..22
Statistical Process Control 3
STATISTICAL PROCESS CONTROL
INTRODUCTION
This report will provide a literature review of the concept and relevance of statistical process
control (SPC) from its inception until the present day. A case study of Waterside’s Leather
Limited (WLL) using the temperature data of its combined effluent discharge over one hundred
and twenty days will be conducted, and a recommendation will also be proposed.
LITERATURE REVIEW
Man has always tried to imitate and better his competitors to develop a better and cheaper
product or service. This idea was as crucial for the hunter-gatherer as it is for the manufacturing
industry after many millennia. This awareness led to the requirement of apprentices having to
follow in the footsteps of the master craftsmen for many years until they could become masters
in their craft. However, this was not a scientifically tabulated and monitored process.
Bradford and Miranti (2019) state that “it was in 1924 that Walter A. Shewhart introduced the
use of control charts to evaluate data distribution patterns to determine whether manufacturing
processes remain under control at Bell Telephone Laboratories”. He also introduced the terms
of variation in the process which comprises of common cause and special cause variation
(Subhabrata and Marien, 2019).
SPC is a technique for controlling processes to distinguish causes of variation and signal for
corrective action (Chen 2005 cited in Avakh and Nasari 2016). While some say that “SPC is
the use of statistically based tools and techniques principally for the management and
Statistical Process Control 4
improvement of processes” (Stapenhurrst, 2005), others say that “SPC is not really about
statistics or control, it is about competitiveness” (Oakland and Oakland, 2018).
Figure 1: A typical Control Chart
(Graph from https://learning.oreilly.com/library/view/nonparametric-statistical-process/9781118456033/c02.xhtml#head-2-
18)
The USA War Department used these methods to enhance the quality of products during World
War II. W.E Deming used Shewhart’s cycle in his quality training in Japan in 1950 but made
a new version stress.
Student 1 Student Mr. Randy Martin Eng 102 MW .docxlillie234567
Student 1
Student
Mr. Randy Martin
Eng 102 MW
6 December 2010
The Tragedy of Othello
The “Devil” throughout the ages has been referred to by many names; accuser, adversary,
enemy, and thief among others, no matter what title is given he is universally accepted as the
purest and ultimate form of evil. In William Shakespeare’s play, The Tragedy of Othello,
Shakespeare uses the element of drama of character to create a villain that embodies absolute
wickedness, a human form of the author of evil. The character Shakespeare creates to serve as
the ultimate antagonist is none other than “honest Iago.” Iago’s character is the best
representation of an elusive villain whose clever abilities to deceive and persuade bring
catastrophic destruction like that of an unexpected, nearly invisible black ice. Shakespeare uses
the character to advance the theme that mankind has the ability to be influenced and even driven
to engage in repulsive and devastatingly horrendous acts towards to each other. Iago himself is
driven and influences the actions Casio, Othello, and Rodrigo.
Spurred by jealousy and the pain of an injured pride Iago observes the man who was
granted/appointed the position he believed to have deserved and conceives a plan for taking
Cassio(this man) out. The character Cassio is deceived and manipulated by Iago in two manners.
First Iago sets up Cassio to betray himself and be demoted and then later uses Cassio as a pawn
to play into an even greater and more elaborate act of revenge against Othello.
Giving into anger and jealousy, Iago devises a plan to crush Cassio and satiate the pain of
Student 2
being passed over, Shakespeare writes:
I: With as little
a web as this will I ensnare as great a fly as Cassio. Ay, smile upon her, do!
I will gyve thee in thine own courtship…
If such tricks as these strip you out of your lieutenantry, (2.1.162-4)
Critic August Schlegel notes, “…he spreads his nets with a skill which nothing can escape.” The
devastation of being passed over for the position drove Iago to exact revenge on the unknowing
bystander, Cassio. Pride is a powerful internal motivator that takes a tremendous toll on those
who allow it contribute to their actions or control their thoughts. It is easy to give into the
feelings of being wronged and turn an evil eye rather than applauding another in their success.
More commonly found in relationships is the mentality of if I can’t have him nobody will.
With ease and grace Iago is able to show Cassio false sympathy and gain trust that allows
him to direct Cassio’s actions, by creating false hope. Shakespeare writes:
I: …, I could heartily wish this had not
befall’n; but since it is as it is, mend it for your own good.(2.3.270-1)
I: I tell you what you
shall do. Our general’s wife is now the general...
confess yourself freely to her; importune her help
to put you in your place again. She is of so free, .
Sophia Pathways for College Credit – English Composition II
SAMPLE TOUCHSTONE AND SCORING
Logan Stevens
English Composition II
December 20, 2019
Where’s the Beef?: Ethics and the Beef Industry
Americans love their beef. Despite the high rate of its consumption, in recent years
people in the United States have grown increasingly concerned about where their food comes
from, how it is produced, and what environmental and health impacts result from its production.
These concerns can be distilled into two ethical questions: is the treatment of cattle humane and
is there a negative environmental impact of beef production? For many, the current methods of
industrial beef production and consumption do not meet personal ethical or environmental
standards. Therefore, for ethical and environmental reasons, people should limit their beef
consumption.
The first ethical question to consider is the humane treatment of domesticated cattle. It
has been demonstrated in multiple scientific studies that animals feel physical pain as well as
emotional states such as fear (Grandin & Smith, 2004, para. 2). In Concentrated Animal Feeding
Operations (CAFOs), better known as “factory farms” due to their industrialized attitude toward
cattle production, cattle are often confined to unnaturally small areas; fed a fattening, grain-based
diet; and given a constant stream of antibiotics to help combat disease and infection. In his essay,
“An Animal’s Place,” Michael Pollan (2002) states that beef cattle often live “standing ankle
Comment [SL1]: Hi Logan! This is a great title.
Comment [SL2]: It will help strengthen your opening
sentence to include some sort of facts or statistics about
beef consumption in America.
Comment [SL3]: Throughout your essay, you talk about
more than just limiting the consumption of beef. How could
you strengthen your Thesis Statement to connect all of
those points?
Sophia Pathways for College Credit – English Composition II
SAMPLE TOUCHSTONE AND SCORING
deep in their own waste eating a diet that makes them sick” (para. 40). Pollan describes
Americans’ discomfort with this aspect of meat production and notes that they are removed from
and uncomfortable with the physical and psychological aspects of killing animals for food. He
simplifies the actions chosen by many Americans: “we either look away—or stop eating
animals” (para. 32). This decision to look away has enabled companies to treat and slaughter
their animals in ways that cause true suffering for the animals. If Americans want to continue to
eat beef, alternative, ethical methods of cattle production must be considered.
The emphasis on a grain-based diet, and therefore a reliance on mono-cropping, also
contributes to the inefficient use of available land. The vast majority of grain production (75-
90% depending on whether corn or soy) goes to feeding animals rather than humans, and cattle
alone .
STORY TELLING IN MARKETING AND SALES – AssignmentThe Ethic.docxlillie234567
STORY TELLING IN MARKETING AND SALES – Assignment
The Ethics of Storytelling
Assignment Description:
During the past week in class, we learned that all brand stories need to have a strong ethical foundation. Brands need to create and distribute messages that are honest and convey their corporate values.
FOR THIS ASSIGNMENT, “CHOOSE ANY 1” OF THE FOLLOWING SHORT VIDEOS TO WRITE ABOUT:
· “Apple 2013 Christmas commercial”
https://www.youtube.com/watch?v=03KQTCEM08k
· “WestJet Christmas Miracle”
https://www.youtube.com/watch?v=zIEIvi2MuEk&t=9s
For the video you choose, answer the following questions about the story that is being told:
(minimum 350 words, combine 1 to 5)
1. Does this story affirm the company’s core values? Why or why not?
2. Does this story foster trust with each and every stakeholder? Why or why not?
3. Does this story help build relationships? Why or why not?
4. Does this story showcase diverse and inclusive behaviors?
5. Does this story honor the company’s commitments and promises to its customers? Why or why not?
Note: Write a minimum of 350 words for above 5 questions, conveying your own thoughts and views.
image1.png
CHCCCS023 Learner Guide Version 1.1 Page 1 of 59
CHCCCS023
Support independence and
wellbeing
Learner Guide
CHCCCS023 Learner Guide Version 1.1 Page 2 of 59
Table of Contents
Unit of Competency ..................................................................................................................... 5
Application ...................................................................................................................................... 5
Unit Sector ...................................................................................................................................... 5
Performance Criteria ....................................................................................................................... 6
Foundation Skills ............................................................................................................................. 8
Assessment Requirements .............................................................................................................. 9
1. Recognise and support individual differences.......................................................................... 12
1.1 – Recognise and respect the person’s social, cultural and spiritual differences ........................ 13
Individual differences .................................................................................................................... 13
Social differences .......................................................................................................................... 13
Cultural differences ....................................................
STEP IV CASE STUDY & FINAL PAPERA. Based on the analysis in Ste.docxlillie234567
STEP IV: CASE STUDY & FINAL PAPER
A. Based on the analysis in Step III, choose which theory best applies to this situation. Add any arguments justifying your choice of these ethical principles to support your decision.
Consequentialism (Utilitarian) Theory
Deontology Theory
Kant’s Categorical Imperative Principle
Social Contract Theory
Virtue Ethics Theory
NAME THE THEORY HERE: Deontology Theory
B. Explain your choice above: THIS AREA SHOULD BE 4-7 sentences or roughly 100-200 words.
Deontology is an approach to Ethics that focuses on the rightness or wrongness of actions themselves I choose this because ethical actions based on normative theories can be effective in developing better privacy practices for organizations. A business should be able to admit to making a mistake. This is especially important to shareholders, employees, and other stakeholders.It is important for businesses to operate with transparency. Consumers need to be able to trust what businesses present to them.
C. Your decision: What would you do? Why? List the specific steps needed to implement your defensible ethical decision. THIS AREA SHOULD BE 2 OR MORE PARAGRAPHS (250-350 words).
Deontology is a theory of ethics that suggests that actions can either be bad or good when judged based on a clear set of rules. So what I would do is set these rules in place. Businesses/companies should uphold the ethical standard of respect. People personal data shouldn’t be treated as ends rather than means. Companies should keep personal data about their customers/users and should be expected to keep this information private out of respect for these individual’s privacy.
Another rule, Businesses/companies should uphold complete transparency. This builds not only trust, but help builds a relationship with the users/customers. And if they don’t enclosed information the company’s actions would be considered unethical and wrong. Another rule is that there should always be accountability. A business/company should always be able to admit to making a mistake. This is especially important to shareholders, and stakeholders. They should be able to own up to missteps even when this could have serious consequences. With these rules emplaced it would be more ethical.
D. What longer-term changes (i.e., political, legal, societal, organizational) would help prevent your defined dilemma in the future? THIS AREA SHOULD BE 2 OR MORE PARAGRAPHS (250-350 words).
My dilemma is the misuse of personal information and data. Not just in social media but, also companies and business. One of the obvious ways to stop this dilemma is to make it that companies aren’t allowed to collect and store our personal data. User data can legally be sold as long as legal conditions for its collection and sale have been met and there isn’t any regulation against it. Our data is being sold for profit. This shouldn’t be allowed. There should be laws and regulations against that. They are the only ones benefiting.
Step 1Familiarize yourself with the video found here .docxlillie234567
Step 1:
Familiarize yourself with the video found here:
Link to Who Leads Us? video
AND the website associated with the video, located here:
Who Leads Us?
AND the website of your Representative in the United States House:
The US House of Representatives
Step 2:
After learning about Reflective Democracy across the United States it is time to learn about how it affects you. Begin by examining yourself and your surrounding community. How would you describe your cultural background? How would you describe the cultural background of your US Representative? How would you describe the cultural background of the district that he or she represents (and that you are a part of)? Compare and contrast the culture of the district to the culture of your Representative. Compare and contrast the culture of your Representative and your culture. Compare and contrast your culture with the culture of the district that you live. Where do you see the greatest differences between cultures? What are some advantages and disadvantages of these cultural differences? How would you work to bridge the divide between cultures? (SR 1)Step 3:
Find a policy issue that your Representative has taken a stand on. Explain that issue in detail. Once you have explained the issue, provide information on where your representative stands on the issue. Where do you stand on the issue? What do you believe should be done? What might be another alternative solution? Thinking about your ideas on the issue who might object to your viewpoint and what might their objections be? Once you’ve laid out their objections, respond to them, and explain, with logic, why your perspective is correct and your opponents’ objections are mistaken. (PR 1 and PR 2)Step 4:
Now that you have officially staked out a policy position, you need to think about how to get it put into action. Who in the government, and who in your community. do you believe should be involved? What specific actions should you (and those in the community) take? Why is it important to get your community involved and what will be the benefits of activating people to the cause? (SR 2)Step 5:
Let’s assume that you are successful in your efforts, and you achieve your policy goal. What do you believe will be the consequences of putting this policy into practice? How far reaching do you think the consequences will be for your community? Your state? Your country? What do you think will be the effects over the short term? Over the long term? Be sure to mention both positive and negative consequences that might result? (PR 3)
.
Statistical application and the interpretation of data is importan.docxlillie234567
Statistical application and the interpretation of data is important in health care. Review the statistical concepts covered in this topic. In a 800-1,000 words paper, discuss the significance of statistical application in health care. Include the following:
1. Describe the application of statistics in health care. Specifically discuss its significance to quality, safety, health promotion, and leadership.
2. Consider your organization or specialty area and how you utilize statistical knowledge. Discuss how you obtain statistical data, how statistical knowledge is used in day-to-day operations and how you apply it or use it in decision making.
Three peer-reviewed, scholarly or professional references are required.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
RUBRICS:
1, Application of statistics in health care is described in detail. The significance to quality, safety, health promotion, and leadership is described thoroughly for all criteria. Strong information and rationale is provided to fully illustrate the application of statistics, and its significance, to health care and the specific areas.
2, Application of statistical knowledge to organization or specialty area is thoroughly discussed. How statistical data are obtained, used in day-to-day operations, or applied in decision making is described in detail. The ability to understand and apply statistical data is clearly demonstrated.
3, Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.
4, Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.
5, Writer is clearly in command of standard, written, academic English
6, Paper Format (use of appropriate style for the major and assignment)
Compañías utilizando la Inteligencia Artificial
La Inteligencia Artificial es un campo donde se combina las ciencias de las computadoras y bases de datos para ayudar a resolver problemas o para simular Inteligencia Humana. Comprende varios subcampos donde se utilizan varios métodos en los cuales se pueden mencionar los más comunes que son: las maquinas aprendiendo o Machine Learning y el aprendizaje profundo o Deep Learning. Estos métodos o disciplinas están comprometidas con los Algoritmos de la Inteligencia Artificial que buscan crear sistemas expertos que pueden hacer predicciones o clasificaciones basadas en una data introducida por un usuario. Algunas de las funciones primarias de la Inteligencia Artificial varían entre razonar, aprender, resolver problemas, toma de decisiones y principalmente entender el comportamiento humano. Este concepto esta formado por dos tipos de acercamientos, el primero es el acercamiento humano y el acercamiento ideal. Cuando hablamos del acercamiento humano, estamos emprendiendo sistemas que piensan y actúan como humanos. El acercami.
SOURCE: http://eyeonhousing.org/2013/09/24/property-tax-remains-largest-revenue-source/
Property tax comes from housing. More new construction means more property taxes collected. The
better (so more expensive the home) the more property taxes collected. Defaults, foreclosures can
drive down house values and reduce property taxes. You are simply trying to understand some
forecasting regarding the future (maybe near-term future) of property taxes to be collected. CERNIK
Property Tax Remains Largest Revenue Source
According to the latest data from the Census Bureau, taxes paid by homeowners and other real
estate owners remain the largest single source of revenue for state and local governments. At
34%, property taxes represent a significantly larger share than the next largest sources: individual
income taxes (24%) and sales taxes (21%).
State and local government property tax collections continue to increase on a nominal basis.
From the third quarter of 2012 through the end of the second quarter of 2013, approximately
$479 billion in taxes were paid by property owners. This was a small increase from the
previous trailing four-quarter record of $477 billion, set last quarter.
The modest changes throughout the Great Recession in nominal state and local government
property tax collections are due in large part to lagging property assessments and the ability of
local jurisdiction to make annual adjustments to tax rates. In general, declining property values
are not reflected in the system until a few years after the decline occurs. Once assessments are
updated, property tax authorities can adjust rates thus maintaining a desired level of collection.
http://eyeonhousing.org/2013/09/24/property-tax-remains-largest-revenue-source/
http://www.census.gov/govs/qtax/
http://eyeonhousing.files.wordpress.com/2013/09/piechart.png
As state and local government property tax collections increased in recent years, the share of
local tax collections due to property taxes fell from a high of 37.4% in the second quarter of
2010 to the current share of 33.5%. The average share for property taxes since 2000 is 32.4%.
The changing share of local collections is due predominantly to fluctuations in all other tax
receipts. State and local individual income tax, corporate income tax, and sales tax collections
are very responsive to changing economic conditions. For example, in the second quarter of 2009
state and local governments collected $76 billion in individual income tax. In the second quarter
of 2013, the most recent, state and local governments collected $114 billion in individual income
tax. The dramatic 50% increase in state and local individual income tax receipts is due to
improving economic conditions, rising incomes, and higher rates in several states.
http://eyeonhousing.files.wordpress.com/2013/09/chart_13.png
The S&P/Case-Shiller House Price Index – National Index grew by 7.1% on a n.
Sophia Pathways for College Credit – English Composition I
Are you ready to write Touchstone 4?
The essay below provides an example of an advanced level argumentative essay. As you read through
the essay, notice how the author effectively incorporates elements of argument, has a strong thesis
statement which takes a stand on one side of a debatable topic, and utilizes the classical model of
argumentation with effective incorporation and utilization of support.
______________________________________________________________________
Marcus Bishop
English Composition I
March 15, 2018
Teenage Sleep and School Start Times
John, an average teenager, tries to get to school on time in the mornings. He sets two
alarms on his phone and often skips a shower or breakfast, or both, so that he doesn’t miss the
school bus that stops at his corner at 7:00 AM. Once at school, John joins his sleep-deprived
peers in mad dashes to their first classes. School is on, whether students are prepared to learn
or not. According to numerous studies, the average U.S. teenager gets between 7 and 7.25
hours of sleep a night, while his body needs between 9 and 9.5 hours. With the average start
time for high school in the U.S. 8:03 AM (Croft, Ferro, and Wheaton, 2015), it’s not a great leap
to conclude many high school students are sleep-deprived. High schools should implement later
start times to maintain healthy biological functions and to maximize learning for teenagers.
Comment [SL1]: While the sentence structure is a bit
repetitive, this introduction does a good job of engaging the
reader with the average teenager and providing the
necessary background information for the reader to fully
understand the importance of the thesis.
Comment [SL2]: This is a well written thesis statement. It
takes a clear position on one side of a debatable topic. It is
concise, yet provides adequate detail so that the reader
knows what your key points within the essay will likely be.
Sophia Pathways for College Credit – English Composition I
Sleep deprivation in teens affects their health, including issues like mood and behavior,
increased anxiety or depression, use of caffeine, tobacco, or alcohol, and even weight gain. Lack
of sleep increases the likelihood that teens across all socio-economic spectrums will be unable
to concentrate and will suffer poor grades in school as a result. In addition, teens, already in a
high risk category as new drivers, are more susceptible to “drowsy-driving incidents.” (Richter,
2015). These are all compelling reasons to consider changes in school start times for teenagers.
Our internal body clocks – what scientists call circadian rhythm - regulate biological
processes according to light and dark. When our eyes tell us it’s dark, we begin to tire, and
when our eyes tell us it’s light, we begin to waken. Adults often refer to themselves as a
“morning person” or a “night person” because t.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
Running Head Pepper Family Case Study 1Pepper Family Case .docx
1. Running Head: Pepper Family Case Study 1
Pepper Family Case Study 15
Pepper Family Case Study
Instructor Name
Course
Date
Client's demographical information
Olivia Pepper is a 30-year-old African American woman
who is married with three children (ages 2, 6, and 8). Olivia is a
Baptist and is receiving several financial need scholarships
which allows her to attend school without working. She has two
residential treatments, once as an adolescent for alcohol use and
the second when she was 24 for depression and alcohol use. She
has had two DUI's, one at 16 and the second at 22. Olivia has
previously taken Zoloft and Wellbutrin, and has gone to family
counseling as a teenager. Olivia is currently pursuing her
Master’s degree and has a 3.8 overall GPA. She has been
referred to the University Counseling Center from her professor
2. for erratic behaviors, which include failing two classes and
having a sporadic attendance, being late, and smelling of
alcohol on more than one occasion. Olivia's peers have reported
that she wants to meet at the local bar and is never engaged in
learning.
Olivia grew up with loving parents who worked hard.
Her mother left when she was 14 and that is when she started to
drink. She has been in a “funk” on and off her whole life and
reports that most days she just doesn’t want to get out of bed
and face the day. She is overwhelmed and sleeps 10-12 hours a
day, isolates herself from her family, and avoids going to
school. She has attempted suicide once with a drug overdose on
Wellbutrin with alcohol. Olivia is currently attending AA
meetings regularly and reports that church and AA help her get
out of bed in the morning. She has started to drink again and
sneaks drinks into her lemonade so that her family does not
know. Her husband is angry and wants her to quit school, and
Olivia is concerned for her 8-year-old daughter who is
exhibiting similar behaviors as her.
Olivia's demographic information paints a vivid
picture of her life. She has faced many challenges in her life,
from her mother leaving when she was 14 to her father passing
away two years ago from drinking. She is under a lot of stress
with having to care for her three children and still trying to
pursue her degree. She has dealt with depression and alcohol
use, attempted suicide, and has had two, (DUI's Shenoy,2019).
Olivia has had to find different coping mechanisms to get her
through her day, and while church and AA have been helpful,
she has resorted to drinking again, which is causing her to
struggle in her classes. Her family dynamics are strained with
her husband wanting her to quit school and her 8-year-old
daughter exhibiting similar behaviors. It is clear that Olivia is
in need of support and guidance to help her get through the
current struggles that she is facing.
Analysis of the Client's presenting problem
Olivia is struggling with depression and alcohol
3. misuse. She is currently failing two of her courses and her
attendance has been sporadic. According to her professor, she
has been smelling of alcohol after lunch and is not engaged in
learning, and instead is more interested in what is next to drink.
Her intake paperwork reveals that she has a history of alcohol
misuse, two residential treatments for alcohol use and
depression, and two DUI's.
Olivia has reported that she feels overwhelmed and
exhausted all the time, and has difficulty getting out of bed and
facing her day. She is sleeping 10-12 hours a day and is
isolating herself from her family. She also reports that her
husband was recently fired from his job, which has caused a
great deal of stress in the home and has led to him asking her to
quit school and work until he finds a new job. She has reported
that she has been in a "funk" her entire life and has experienced
feelings of worthlessness. She has a history of alcohol misuse,
which she began engaging in as a coping mechanism after her
mother left when she was 14. She has also attempted suicide in
the past due to her depression and alcohol misuse, which has
caused her to seek help in the form of attending AA meetings.
Olivia is currently exhibiting a number of signs and
symptoms of depression, including feelings of worthlessness,
difficulty getting out of bed and facing her day, sleeping 10-12
hours a day, and isolating herself from her family. She has also
reported that she is struggling with alcohol misuse, which is
likely a maladaptive coping mechanism to deal with her
depression. Her two DUI's and two residential treatments for
alcohol use and depression are further evidence of her struggles
with alcohol. Additionally, her husband's recent job loss has
likely exacerbated her depression and alcohol misuse, leading to
her current difficulty with her studies.
Overall, Olivia is presenting with depression and
alcohol misuse. Her current symptoms of depression and alcohol
misuse are likely a result of her past experiences, her current
situation, and her maladaptive coping strategies which she has
employed to deal with her symptoms. Additionally, her
4. husband's recent job loss and the resulting stress it has caused is
likely further exacerbating her symptoms.
Client's diagnoses using the DSM-5-TR
Olivia presents with a constellation of symptoms that are
consistent with a diagnosis of Major Depressive Disorder,
Recurrent, Moderate. According to the DSM-5-TR, this is a
mental disorder characterized by five or more of the following
symptoms, present during the same two-week period and reflect
a change from previous functioning; at least one of the
symptoms must be either; depressed mood or loss of interest or
pleasure: depressed mood most of the day, nearly every day,
markedly diminished interest or pleasure in all, or almost all
activities most of the day, nearly every day, significant weight
loss when not dieting, or weight gain, or decrease or increase in
appetite nearly every day, insomnia or hypersomnia nearly
every day, psychomotor agitation or retardation nearly every
day, fatigue or loss of energy nearly every day, feelings of
worthlessness or excessive or inappropriate guilt nearly every
day, diminished ability to think or concentrate, or
indecisiveness, nearly every day, recurrent thoughts of death,
recurrent suicidal ideation without a specific plan, or a suicide
attempt or a specific plan for committing suicide, (Himes,2020).
In addition, Olivia meets criteria for Alcohol Use
Disorder, Moderate. According to the DSM-5-TR, this is a
pattern of alcohol use leading to clinically significant
impairment or distress, as manifested by at least two of the
following, occurring within a 12-month period: Alcohol is often
taken in larger amounts or over a longer period than was
intended, there is a persistent desire or unsuccessful efforts to
cut down or control alcohol use. A great deal of time is spent in
activities necessary to obtain alcohol, use alcohol, or recover
from its effects. Craving, or a strong desire or urge to use
alcohol. Recurrent alcohol use resulting in a failure to fulfill
major role obligations at work, school, or home. Continued
alcohol use despite having persistent or recurrent social or
interpersonal problems caused or exacerbated by the effects of
5. alcohol (Himes,2020). Important social, occupational, or
recreational activities are given up or reduced because of
alcohol use. Recurrent alcohol uses in situations in which it is
physically hazardous. Alcohol use is continued despite
knowledge of having a persistent or recurrent physical or
psychological problem that is likely to have been caused or
exacerbated by alcohol.
Olivia also meets criteria for Post-Traumatic Stress Disorder,
Mild. According to the DSM-5-TR, this is a mental disorder that
can occur in people who have experienced or witnessed a
traumatic event. It is characterized by avoidance of stimuli
associated with the trauma, increased arousal, and negative
alterations in cognitions and mood. Symptoms include the
following: exposure to traumatic event involving actual or
threatened death, serious injury, or sexual violence, persistent
re-experiencing of the traumatic event, such as flashbacks or
nightmares, avoidance of reminders of the trauma, such as
people, places, conversations, or activities, persistent negative
alterations in cognitions and mood, such as negative beliefs
about oneself or the world, or persistent inability to experience
positive emotions, increased arousal, such as difficulty
sleeping, hypervigilance, exaggerated startle response, or
problems with concentration, (Borlaug,2020).
Assessments used to approach the diagnosis
The first assessment that should be used to approach
the diagnosis of Olivia is the Patient Health Questionnaire-9
(PHQ-9). The PHQ-9 is a depression scale that evaluates the
severity of depression and can help diagnose major depressive
disorder. It is a nine-item self-report that asks questions about
the frequency of symptoms experienced over the past two
weeks. The score from the PHQ-9 can range from 0-27 and can
help to determine the severity of depression, (Borlaug,2020).
The second assessment is the Alcohol Use Disorders
Identification Test (AUDIT). This is a 10-item self-report
6. questionnaire that evaluates the severity of alcohol
consumption. The AUDIT assesses the quantity and frequency
of alcohol consumption, the problems associated with alcohol
use, and the alcohol related consequences. The score from the
AUDIT can range from 0-40 and can help to diagnose any level
of alcohol use disorder (Raskin,2022).
The third assessment is the Attention Deficit
Hyperactivity Disorder (ADHD) scale. This is a seven-item self-
report questionnaire that evaluates the presence of symptoms
associated with ADHD. The score from the ADHD scale can
range from 0-14 and can help to diagnose any level of ADHD
(Raskin,2022).
In addition to the assessments listed above, it is also
important to obtain a thorough family history, a mental status
exam, and any other relevant information that can help to
provide a better understanding of Olivia's situation. It is also
important to note any co-occurring diagnoses such as anxiety or
substance use disorders.
The assessments listed above can help to identify any
issues Olivia may be facing and can provide a better
understanding of her current mental health. It is important to
use a combination of assessments to gain a comprehensive
understanding of Olivia's situation and to provide the best
treatment possible, (Bradley,2022).
Mental health theory application
In this case, cognitive theory is one of the mental
health theories that could be applied to Olivia’s situation.
Cognitive theory focuses on the individual’s thoughts and
beliefs and how they affect behavior. According to cognitive
theory, Olivia’s thoughts and beliefs about herself, her life, and
her abilities are impacting her behavior in a negative way. She
believes that she is not capable of completing her degree and is
overwhelmed by her current life situation. This is leading her to
make poor decisions, such as drinking and isolating herself
from family and friends. (Bradley,2022)
The cognitive theory suggests that by changing her
7. thought patterns, Olivia can change her behavior. To do this,
she needs to identify her negative thought patterns and replace
them with more positive, realistic thoughts. For example,
instead of believing that she is incapable of completing her
degree, she can focus on her past successes and the progress she
has made. She can also focus on the positive aspects of her life,
such as her loving family, and create concrete plans to help her
achieve her goals.
By using cognitive theory, Olivia can begin to challenge
her negative thoughts and develop more positive, healthier
beliefs. This will help her to make better decisions and move
forward with her life in a more positive direction. With the help
of her therapist and other supportive individuals, Olivia can
take the steps necessary to make positive changes in her life and
move towards her future goals, (Torous,2018).
Treatment interventions
The treatment intervention in this case would be a
Cognitive Behavioral Therapy (CBT) approach with a focus on
self-regulatory strategies. This approach is designed to help the
client identify and modify maladaptive thoughts and behaviors
that are associated with her current struggles. The client's
strengths include her intelligence, drive, and dedication to her
studies. She also has a strong interest in helping those in similar
circumstances to her own. Her weaknesses include her self-
regulatory abilities, her tendency to isolate herself, and her high
stress levels. Her social support systems include her husband,
her children, her faith, and her peers at school.
The long-term goal of the treatment intervention is for
Olivia to increase her self-regulation skills and to have better
control over her emotions and behaviors so that she can
successfully complete her studies and achieve her goals.
Additionally, she should be able to manage her stress levels and
find healthier coping strategies for her negative emotions
The short-term goals and treatment objectives are to
identify and modify Olivia's maladaptive thoughts and
behaviors that are associated with her current struggles,
8. (Torous,2018). This includes identifying her triggers and
helping her develop better coping strategies when faced with
them. Additionally, she should learn how to manage her stress
levels, control her emotions, and become more engaged in her
studies. She should also learn to recognize and regulate her
alcohol use. Finally, she should become more social and
develop healthier relationships with her peers and family.
(Torous,2018)
Treatment Timeline
Time
Description
Week 1.
Intake assessment
Psychoeducation on substance use, depression, anxiety and
stress
Cognitive Behavioral Therapy to address irrational thoughts
Psychoeducation on the importance of sleep hygiene
Education on the importance of self-care
Week 2
Group therapy for substance use
Individual therapy to address depression and anxiety
Couples therapy to address marital issues
Family therapy to address parenting and family dynamics
Week 3
Stress management skills
Mindfulness training
Relaxation training
Assertiveness training
Week 4
Continuing individual therapy
Continuing couple’s therapy
Continuing family therapy
Continuing group therapy
Week 5
Continuing individual therapy
Continuing couple’s therapy
9. Continuing family therapy
Continuing group therapy
Exploring relapse prevention strategies
Week 6
Continuing individual therapy
Continuing couple’s therapy
Continuing family therapy
Continuing group therapy
Exploring relapse prevention strategies
Discharge planning
Systems theory perspective
At the micro level, Olivia’s family systems theory
includes her husband and children. The primary focus of the
treatment should be on the dynamics of the family system and
how each member’s role and behavior affects the entire family.
Treatment should address the family’s stressors, such as the
husband’s unemployment, Olivia’s depression and alcohol use,
and the children’s emotional and academic needs (Raskin,2022).
At the mezzo level, Olivia’s extended family and
community should be considered. Treatment should include
communication between family members, and possibly family
therapy. Additionally, the family should be connected to
community resources, such as AA, financial assistance, and
educational support.
At the macro level, Olivia’s social environment should
be considered. Treatment should focus on the larger social
issues that may be impacting her and her family, such as
poverty, racism, and lack of social support. Additionally,
Olivia’s access to health care and mental health services should
be addressed.
Ethical Dilemmas
One potential ethical dilemma in Olivia's case is the
issue of her husband wanting her to quit school and work
instead. According to the NASW Code of Ethics, social workers
10. should “promote the right of clients to self-determination and
assist clients in their efforts to identify and clarify their goals”
(2018). By encouraging Olivia to pursue her educational goals,
social workers should strive to empower her and help her reach
her goals. In addition, social workers should strive to provide a
safe and supportive environment for her in which to discuss her
goals and make decisions about her future. Finally, social
workers should be mindful of the potential power imbalance
between Olivia and her husband, and strive to ensure that all
decisions are made in Olivia's best interests.
Client’s Diversity Needs
Olivia and her family come from a diverse background
that should be taken into consideration when providing
treatment. As an African American woman married with three
children, Olivia has the additional stress of being a single
parent with financial need scholarships and no job. In addition,
her religious affiliation is Baptist, which can also impact how
she perceives her life and her relationship with her family and
community. Olivia's two residential treatments for alcohol use,
two DUIs, and previous mental health issues should also be
taken into account when providing treatment (Kelly,2019).
When addressing the diversity needs of Olivia and her
family, it is important to use a culturally sensitive and trauma-
informed approach. This includes using language that is
respectful and understanding of her cultural background and
experiences. It is also important to recognize that Olivia and her
family may have faced racism, microaggressions, and other
forms of oppression (Kelly,2019). The counselor should also be
aware of the potential for the family to have experienced
generational trauma and should use culturally sensitive
approaches when exploring this topic. Finally, the counselor
should take into consideration the family's religious background
and how this may impact their views on alcohol use and other
issues.
Evaluation of the Client’s Progress
11. When evaluating Olivia's progress, I will use a
variety of approaches. I will use a combination of both
qualitative and quantitative measures, such as self-report
questionnaires, interviews, and observations. I will also use
standardized assessments, such as the Beck Depression
Inventory, to help measure her progress. Additionally, I will use
qualitative measures, such as interviews and observations, to
gain a deeper understanding of her progress. I will also use
measures such as her academic performance, attendance, and
her alcohol use. By using a combination of both qualitative and
quantitative measures I will be able to get a more
comprehensive picture of Olivia's progress. Furthermore, I will
also use self-report questionnaires to more accurately measure
her progress. This will allow me to get more detailed feedback
from her, which will be invaluable in helping her make
progress. Additionally, I will also use family interviews and
assessments to gain a better understanding of her family
dynamics and how this may be impacting her progress. By using
a combination of measures and approaches, I will be able to
accurately measure Olivia's progress and make the necessary
changes to help her succeed.
References
Shenoy, E. S., Macy, E., Rowe, T., & Blumenthal, K. G. (2019).
Evaluation and management of penicillin allergy: a review.
Jama,
321(2), 188-199.
12. Himes, C. P., Ganesh, R., Wight, E. C., Simha, V., & Liebow,
M. (2020, December). Perioperative evaluation and management
of endocrine disorders. In
Mayo Clinic Proceedings (Vol. 95, No. 12, pp. 2760-
2774). Elsevier.
Borlaug, B. A. (2020). Evaluation and management of heart
failure with preserved ejection fraction.
Nature Reviews Cardiology,
17(9), 559-573.
Bradley, L., Noble, N., & Hendricks, B. (2022). DSM-5-TR:
Salient Changes.
The Family Journal, 10664807221123558.
Raskin, J. D., Maynard, D., & Gayle, M. C. (2022).
Psychologist attitudes toward DSM-5 and its alternatives.
Professional Psychology: Research and Practice.
Bernet, W., & Baker, A. J. Proposal for Parental Alienation
Relational Problem to be Included in “Other Conditions That
May Be a Focus of Clinical Attention” in DSM-5-TR.
Torous, J., Nicholas, J., Larsen, M. E., Firth, J., & Christensen,
H. (2018). Clinical review of user engagement with mental
health smartphone apps: evidence, theory and improvements.
Evidence-based mental health,
21(3), 116-119.
Kelly, M., & Coughlan, B. (2019). A theory of youth mental
health recovery from a parental perspective.
Child and Adolescent Mental Health,
24(2), 161-169.
Levis, B., Benedetti, A., & Thombs, B. D. (2019). Accuracy of
Patient Health Questionnaire-9 (PHQ-9) for screening to detect
major depression: individual participant data meta-analysis.
13. bmj,
365.
Costantini, L., Pasquarella, C., Odone, A., Colucci, M. E.,
Costanza, A., Serafini, G., ... & Amerio, A. (2021). Screening
for depression in primary care with Patient Health
Questionnaire-9 (PHQ-9): A systematic review.
Journal of affective disorders,
279, 473-483.
Effectiveness of Aerobic Exercise on Ambulatory Blood
Pressure in Hypertensive Patients
Presented by
Chinyere Christiana Pamugo
14. 1
DNP 965: Final Oral Presentation
December 13, 2022
A Direct Practice Improvement Project Presented in Partial
Fulfillment
of the Requirements for the Degree
Doctor of Nursing Practice
2
Investigator’s background
Registered Nurse for XXX years
15. 3
Topic’s background
Many individuals are unaware of the symptoms for
hypertension, which makes it a top priority to educate patients
and their families.
In the United States, over 37 million individuals are affected
(Centers for Disease Control and Prevention [CDC], 2021; Krist
et al., 2021).
The American College of Cardiology and the American Heart
Association guidelines for hypertension management and
definition of HTN defines it as having a blood pressure at or
above 130/80 mmHg (The American College of Cardiology
Foundation and the American Heart Association, 2018). At the
same time, stage 2 HTN is blood pressure at or above
140/90mmHg (CDC., 2021).
4
Topic’s background
Complications of the condition include myocardial infarction,
16. heart failure, chronic renal disease, and stroke (Ghatage et al.,
2021).
American Heart Association Task Force (AHA) published new
guidelines to help manage the increase of the disease (Wang et
al., 2019).
Purpose statement
The purpose of this quantitative, quasi-experimental project was
to determine if or to what degree the translation of Saco-Ledo et
al.’s research on aerobic exercise would impact ambulatory
blood pressure when compared to current practice among adult
hypertensive patients in a primary care clinic in southwest
Texas over four weeks
6
problem statement
It was not known if or to what degree the translation of Saco-
Ledo et al.’s research on aerobic exercise would impact
ambulatory blood pressure when compared to current practice
among adult hypertensive patients
17. 7
Identified problem
At the clinical site, there were no standardized guidelines for
clinicians to educate hypertensive patients regarding
implementing daily physical activity as a blood pressure
management mechanism.
Collaboration with the medical director and some of the nursing
staff showed an increase of 37.1% in diagnosed HTN patients
within the past six months. The clinic’s findings corresponded
with the health statistics from the Texas Department of State
Health Services (2022), as the county ranks 22 in the States
with diagnosed hypertensive patients
8
Significance of the project
Implementing a recommended evidence-based strategy by the
AHA guideline regarding aerobic exercise
Commodore-Mensah et al. (2018) state that the financial prices
are significant, approximately $131-198 billion annually
This project could help decrease the financial costs associated
with the disease
Hypertensive persons incur an extra $2000 yearly in healthcare
expenditures compared to non-hypertensive persons
(Commodore-Mensah et al., 2018).
9
18. Clinical question
To what degree does the translation of Saco-Ledo et al.’s
research on aerobic exercise would impact blood pressure when
compared to current practice among adult hypertensive patients
in a primary care clinic in southwest Texas?
The independent variable was the translation of Saco-Ledo et
al.’s research regarding aerobic exercise, and the dependent
variable is blood pressure
10
Theoretical underpinnings
Dorothy Orem’s self-care deficit theory (Orem, 1995).
Kurt Lewin’s change model (Lewin, 1947).
Unfreezing
Change or Movement
Refreezing
Based on the theory, self-care is that patients must engage in to
maintain and improve their quality of health (Orem, 1995).
Utilizing this theory, the nurses do not see their patients as
inactive or receiving health services; instead, they consider
them strong and reliable to participate in daily activities and
decision-making processes (Orem, 1995). Three nursing systems
are defined in Orem’s nursing theory; they include wholly
compensatory, partially compensatory, and supportive-educative
strategies (Khademian et al., 2020).
The chosen change is Lewin’s change model. It was selected
because it is a way to describe the process change versus
guiding the activities that will be conducted.
19. 11
review of the Literature
Prevention of Hypertension
Systolic Blood Pressure Management
Diastolic Blood Pressure Management
Ambulatory Blood Pressure Management
Aerobic Exercise Health Intervention
Pre-Aerobic State
Post-Aerobic State
Ambulatory Blood Pressure Management
Effect of Exercise on Blood Pressure
Health Literacy Level
Self-Efficacy
Lifestyle Modification
12
clinical Question
To what degree does the implementation of American Heart
Association guideline aerobic exercise would impact blood
pressure when compared to current practice among adult
hypertensive patients in a primary care clinic in southwest
Texas?
The independent variable is the American Heart Association
guideline regarding aerobic exercise, and the dependent variable
is blood pressures.
20. 13
Methodology
Quantitative methodology
Using numerical data
It is objective, systematic, and focused data analysis strategies
(Guetterman & Fetters, 2018).
Data can be replicated (Creswell & Creswell, 2018).
In this project, the project manager will evaluate the AHA
guidelines and its impact on the blood pressures of HTN
patients. The dependent variable will be measured four weeks
before and post project intervention. This methodology is the
most appropriate because other investigators can replicate the
data (Creswell & Creswell, 2018).
A qualitative methodology was not selected because this method
is often thematic and subjective, and findings are produced
using the participants' words verbatim (Creswell & Creswell,
2018). In this project, the project manager will not seek to
understand the participants' behaviors, feelings, or lived
experiences (Creswell & Creswell, 2018
14
Project design
Quasi-experimental design
Determines the effect that the independent variable has on the
dependent variable (Creswell & Creswell, 2018).
Participants are not randomly assigned (Creswell & Creswell,
21. 2018).
Project manager will manipulate the independent variable
For this project, the dependent variable (blood pressure) will be
measured at two different times (once before the intervention
and one after the intervention (Creswell & Creswell, 2018). A
correlational design was not the most appropriate for this
project. It is a non-experimental design where the independent
and dependent variables are measured and assessed for their
correlation relationship (Creswell & Creswell, 2018).
15
Instrumentation
Data source: ABPM log retrieved from the Oscar 2 device
Electronic ABP data retrieved from the electronic medical
record
Before starting the ABP project, it was imperative to ensure that
the device operated as required and was installed correctly on
the patient (Nwankwo et al., 2020).
The electronic ABP data on the device was retrieved from a
computer via a USB cable
16
Data collection
Data collected four weeks pre/post implementation
Oscar 2 device
Participants walked at home three to five times weekly for 20
22. minutes
They were instructed to continue taking their antihypertensive
medications
Tracked their process in a logbook (Mon, Wed, Fri)
Participants were re-evaluated at the clinic week four
The healthcare providers took the 24-hour ABP measurements at
two-time points: baseline without aerobic exercise in week one
and week four after the workout
In week four, the participants returned to the clinic to retake
their ABP using Oscar 2 device. Participants ambulated around
the clinic for 20 minutes wearing the Oscar 2 device. They were
monitored for their walking, whether it was intense or moderate.
The ABP measurements were taken after a 20-minute rest period
by the staff.
17
Data analysis
Descriptive data (such as age, gender, and ethnicity)
Paired Sample t-Test.
Descriptive data (such as age, gender, and ethnicity) will be
collected via the clinic’s electronic medical records (evaluated
using frequency counts and percentages)
The independent variable is nominal, and the dependent variable
is an interval level variable (Schober & Vetter, 2019). This t-
test examines the mean scores taken from the same participants
(Schober & Vetter, 2019).
23. The level of statistical significance was set to .05 to indicate
that a p-value of less than .05 will be considered statistically
significant.
18
resultsVariableDescriptive DataMSDAge56.507.92
Table 1
Descriptive Data for Age
Table 2
Descriptive Data for Gender and RaceVariableDescriptive
Datan%Gender Male330.0 Female770.0Race African
American880.0 Hispanic110.0 Caucasian110.0
Note. M = mean; SD =standard deviation
Note. n =count; % = percentage
results
VariablePre
Post
t (9)
pMSDMSDSystolic BP
(mm/Hg)152.6014.42126.1019.936.35.001
Chi-square test results showed a decrease in the mean systolic
BP level from pre (M = 152.60, SD = 14.42) to post (M =
126.10, SD = 19.93), t (9) = 6.35, p = .001. The p-value is less
than .05 which indicates that the decrease in mean systolic BP
was statistically significant. Clinical significance was supported
by the 26.50 mean decline in the systolic mean levels after the
intervention.
Table 3
24. Paired t-Test Results for Systolic Blood Pressure Levels
Note. M = mean; SD =standard deviation
results
VariablePre
Post
t (9)
pMSDMSDDiastolic BP (mm/Hg)87.3011.1978.108.452.56.031
Chi-square test results showed a decrease in the mean diastolic
BP level from pre (M = 87.30, SD = 11.19) to post (M = 78.10,
SD = 8.45), t (9) = 2.56, p = .031. The p-value is less than .05
which indicates that the decrease in mean diastolic BP was
statistically significant. Clinical significance was supported by
the 9.20-point mean decline in the systolic mean levels after the
intervention.
Table 4
Paired t-Test Results for Diastolic Blood Pressure Levels
Note. M = mean; SD =standard deviation
limitations
Small sample size
Limited time frame to conduct project (four-weeks)
Data analysis being conducted by outside statistician
25. First limitation: Small sample size
Second limitation: Limited time (four-weeks) a longitudinal
project three or more months
Third limitation: Due to the project manager’s limited
knowledge and time in conducting statistical analysis, an
outside statistician not affiliated with the project or manager
will perform the data analysis.
22
discussion
Clinical significance was demonstrated by the 26.50 mean
decline in the systolic mean and 9.20 in the diastolic mean and
9.20 in the diastolic mean levels
Based on the results, the translation of Saco-Ledo et al.’s on
aerobic exercise may improve blood pressure. One
recommendation for future projects is to conduct the project in
other medical settings, such as medical-surgical units, women’s
health, and dialysis patients.
Recommendations
The project findings showed that an educational program in
combination with aerobic exercise about hypertension can result
in systolic and diastolic blood pressure changes
Reproduce the intervention in other healthcare settings
Conduct longitudinal project (one year or longer)
For nurse managers to pay attention to the HTN risk in their
older employees (age 40 and above)
Evaluate the patient’s health stressors that can contribute to
hypertension
26. references
Centers for Disease Control and Prevention, (2021). Facts about
hypertension in the United States.
https://www.cdc.gov/bloodpressure/facts.htm
Commodore-Mensah, Y., Selvin, E., Aboagye, J., Turkson-
Ocran, R., Li, X., Himmelfarb, C., Ahima, R., & Cooper, L. A.
(2018). Hypertension, overweight/obesity, and diabetes among
immigrants in the United States: An analysis of the 2010–2016
national health interview survey. BMC Public Health, 18(1), 1-
8. https://doi.org/10.1186/s12889-018-5683-3
Creswell, J.W., & Creswell, J. D. (2018). Research design:
Qualitative, quantitative, and mixed methods approaches
(5thed.). Sage Publications.
references
Ghatage, T., Goyal, S., Dhar, A., & Bhat, A. (2021). Novel
therapeutics for the treatment of hypertension and its associated
complications: Peptide- and nonpeptide-based
strategies. Hypertension Research, 44(7), 740-755.
https://doi.org/10.1038/s41440-021-00643-z
Guetterman, T., & Fetters, M. (2018). Two methodological
approaches to the integration of mixed methods and case study
designs: A systematic review. American Behavioral Scientist,
62, 900-918.
https://doi.org/10.1177/0002764218772641
Krist, A., Davidson, K., Mangione, C., Cabana, M.,
27. Caughey, A., Davis, E., Donahue, K., Doubeni, C., Kubik, M.,
Li, L., Ogedegbe, G., Pbert, L., Silverstein, M., Stevermer, J.,
Tseng, C., & Wong, J. (2021). Screening for hypertension in
adults. JAMA, 325(16), 1650-
1656. https://doi.org/10.1001/jama.2021.4987
references
Lewin, K. (1947). Frontiers in group dynamics: concept,
method, and reality in social science; social equilibria and
social change. Human Relations, 1, 5–41.
https://doi.org/10.1177/001872674700100103
Nwankwo, T., Coleman King, S. M., Ostchega, Y., Zhang, G.,
Loustalot, F., Gillespie, C., & Merritt, R. (2020). Comparison
of 3 devices for 24-hour ambulatory blood pressure monitoring
in a nonclinical environment through a randomized trial.
American Journal of Hypertension, 33(11), 1021-
1029.https://doi.org/10.1093/ajh/hpaa117
Orem, D. E. (1991). Nursing: Concepts of practice (4th ed.).
Mosby.
Schober, P., & Vetter, T. (2019). Descriptive statistics in
medical research. Anesthesia & Analgesia, 129(6), 1445-1447.
https://doi.org/10.1213/ane.0000000000004480
Wang, D., Hatahet, M., Wang, Y., Liang, H., Bazikian, Y., &
Bray, C. (2019). Multivariate analysis of hypertension in
general US adults based on the 2017 ACC/AHA guideline: data
from the national health and nutrition examination survey 1999
to 2016. Blood Pressure, 28(3), 191-198. doi:
10.1080/08037051.2019.1593042
28. Effectiveness of Aerobic Exercise on Ambulatory Blood
Pressure in Hypertensive Patients
By Chinyere Christiana Pamugo
Grand Canyon University, Phoenix Arizona
Introduction and Problem
Variables
Descriptive Data
Results
Results (cont.)
Clinical Question(s)
Discussion
Project Limitations
Recommendations for Future Projects and Practice
Purpose of the Project
Data Analysis
The project site is a primary care clinic in urban Texas. A
convenience sample of n= 10 adult patients with HTN were
enrolled in the project. Descriptive data were collected for age,
gender, and race.
Table 1 displays the descriptive data for age. The mean age was
56.50 (SD = 7.92) ranging from 43 to 71.
References
The independent variable was the translation of Saco-Ledo et
al.’s research regarding aerobic exercise, and the dependent
variable is ambulatory blood pressure.
29. .
.
Centers for Disease Control and Prevention (CDC). (2021).
Facts about hypertension in the United States.
https://www.cdc.gov/bloodpressure/facts.htm
Krist, A., Davidson, K., Mangione, C., Cabana, M., Caughey,
A., Davis, E., Donahue, K., Doubeni, C., Kubik, M., Li, L.,
Ogedegbe, G., Pbert, L., Silverstein, M., Stevermer, J., Tseng,
C., & Wong, J. (2021). Screening for hypertension in adults.
Journal of the American Medical Association, 325(16), 1650-
1656. https://doi.org/10.1001/jama.2021.4987
Leedy, P., & Ormrod, J. (2020). Practical research: Planning
and design. Pearson Publications.
Saco-Ledo, G., Valenzuela, P., Ruiz-Hurtado, G., Ruilope, L., &
Lucia, A. (2020). Exercise reduces ambulatory blood pressure in
patients with hypertension: A systematic review and meta-
analysis of randomized controlled trials. Journal of American
Heart Association, 15(9), 1-18. doi: 10.1161/JAHA.120.018487.
Many individuals are unaware of the symptoms for
hypertension, which makes it a top priority to educate patients
and their families.
In the United States, over 37 million individuals are affected
(Centers for Disease Control and Prevention [CDC], 2021; Krist
30. et al., 2021).
Using the translation of Saco-Ledo et al.’s research on aerobic
exercise would impact ambulatory blood pressures.
At the clinical site, there were no standardized guidelines for
clinicians to educate hypertensive patients regarding
implementing daily physical activity as a blood pressure
management mechanism
It was not known if or to what degree the translation of Saco-
Ledo et al.’s research on aerobic exercise would impact
ambulatory blood pressure when compared to current practice
among adult hypertensive patients
Chi-square test results showed a decrease in the mean systolic
BP level from pre (M = 152.60, SD = 14.42) to post (M =
126.10, SD = 19.93), t (9) = 6.35, p = .001. The p-value is less
than .05 which indicates that the decrease in mean systolic BP
was statistically significant. Clinical significance was supported
by the 26.50 mean decline in the systolic mean levels after the
intervention. The results are displayed in Table 3.
The results are presented to address the clinical question related
to the impact of the AHA guidelines for aerobic exercise on
systolic and diastolic blood pressure. A paired t-test was
conducted on systolic and diastolic blood pressure at pre-and
post-implementation.. The goal was to reduce ambulatory blood
pressure after the intervention. Results are displayed in
narrative and table format.
The purpose of this quantitative, quasi-experimental project was
to determine if or to what degree the translation of Saco-Ledo et
al.’s research on aerobic exercise would impact ambulatory
blood pressure when compared to current practice among adult
31. hypertensive patients in a primary care clinic in southwest
Texas over four weeks
To what degree does the translation of Saco-Ledo et al.’s
research on aerobic exercise would impact blood pressure when
compared to current practice among adult hypertensive patients
in a primary care clinic in southwest Texas
Clinical significance was demonstrated by the 26.50 mean
decline in the systolic mean and 9.20 in the diastolic mean and
9.20 in the diastolic mean levels
Based on the results, the translation of Saco-Ledo et al.’s on
aerobic exercise may improve blood pressure. One
recommendation for future projects is to conduct the project in
other medical settings, such as medical-surgical units, women’s
health, and dialysis patients.
The first limitation was the restricted time to conduct the
project (four weeks). A longitudinal project allows one to
evaluate the trends and changes over time (Leedy & Ormrod,
2020).
The second limitation was the small sample size. The primary
problem with a small sample size was interpreting the results,
mainly related to the confidence intervals and p-values (Leedy
& Ormrod, 2020).
The project findings showed that an educational program in
combination with aerobic exercise about hypertension can result
in systolic and diastolic blood pressure changes
Reproduce the intervention in other healthcare settings
Conduct longitudinal project (one year or longer)
Nurse managers to pay attention to the HTN risk in their older
employees (age 40 and above)
Evaluate the patient’s health stressors that can contribute to
hypertension
Descriptive data (such as age, gender, and ethnicity) including
32. mean and standard deviation for age and frequencies and
percentage for gender and ethnicity.
To examine systolic and diastolic blood pressure at pre- and
post-implementation, paired sample t-tests were conducted in
IBM SPSS version 28 using a level of significance of .05.
Table 1
Descriptive Data for Age
Table 2
Descriptive Data for Gender and Race
Gender and race are displayed in Table 2. There were three
males (30.0%) and females made up 70.0% (n = 7). Race was
80.0% (n = 8) African American, 10.0% (n = 1) Hispanic, and
10.0% (n = 1) Caucasian.
Table 3
Paired t-Test Results for Systolic Blood Pressure Levels
Chi-square test results showed a decrease in the mean diastolic
BP level from pre (M = 87.30, SD = 11.19) to post (M = 78.10,
SD = 8.45), t (9) = 2.56, p = .031. The p-value is less than .05
which indicates that the decrease in mean diastolic BP was
statistically significant. Clinical significance was supported by
the 9.20-point mean decline in the systolic mean levels after the
intervention.
Table 4
Paired t-Test Results for Diastolic Blood Pressure Levels
Note. M = mean; SD =standard deviation
Note. M = mean; SD =standard deviation
Note. n =count; % = percentage
Note. M = mean; SD =standard deviation
34. (2018), in which it states that spending on prices are significant
and is approximately $131-198 billion annually. This project
potentially helps in decreasing the financial costs associated
with the disease when Dorothy Orem’s self-care deficit theory
(Orem, 1995) and Kurt Lewin’s change model (Lewin, 1947)’s
Unfreezing, Change or Movement and Refreezing are used.
Recommendations: The discovery in this projects proved that an
educational program in combination with aerobic exercise about
hypertension results in systolic and diastolic blood pressure
changes. Other recommendations include:
Reproduce the intervention in other healthcare settings
Conduct longitudinal project (one year or longer)
For nurse managers to pay attention to the HTN risk in their
older employees (age 40 and above)
Evaluate the patient’s health stressors that can contribute to
hypertension
29
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37. ACCEPTEDANDSIGNED:
________________________________________
Lisa Smith, Ph.D., RN, CNE
Dean and Professor, College of Nursing and HealthCare
Professions
_________________________________________
Date
Abstract
Hypertensionisaprevalentdiseaseaffectingmillionsofindividualsi
ntheUnitedStates.Attheprojectsite,therewerenostandardizedguide
linesforeducatinghypertensivepatientsregardingincorporatingexe
rcise(dailyphysicalactivity)asabloodpressure
(BP)managementmechanism.Thepurposeofthisquantitative,quasi
-experimentalprojectwas to determine if or to what degree the
implementation of
“theAmericanHeartAssociation’s”guidelineonaerobicexercisewo
uldimpactambulatory
bloodpressurewhencomparedtocurrentpracticeamongadulthypert
ensivepatientsinaprimarycareclinicinsouthwestTexasoverfourwe
eks.DorothyOrem’sself-
caredeficittheoryandLewin’schangemodelwere the scientific
underpinnings.Datawereretrievedfromtheclinic’selectronicmedic
alrecords of adult hypertensive patients.(
n-10) and compared at baseline and four weeks post-
implementation of the American Herat Association’s guideline
on aerobic exercise. A paired-sample
t-test showed a statistically and clinically significant
improvement in the systolic blood pressure. Based on the
results, the American Herat Association’s guideline on aerobic
exercise may improve blood
pressure.Onerecommendationforfutureprojectsistoconductthepro
jectinothermedicalsettingssuchasmedical-
surgicalunits,women’shealth,anddialysispatients.
Keywords:aerobicexercise,AmericanHeartAssociationguideline,
DorothyOrem’sself-
38. caredeficittheory,hypertension,hypertension-
relatedconditions,KurtLewin’changemodel.
Dedication
I dedicate this project to God, my life's author, and finisher.
Irrespective of the unsurmountable challenges and moments of
despair, your mercy, grace, and love lead me through. Without
your divine wisdom, Almighty father, I would not have been
here this day.
To my Beloved families here and abroad, my mum, siblings,
cousins, and spouse Engr. G. O. Pamugo, I achieved this goal
because of your fervent prayers, support, and encouragement
that fortified my strength, endurance, perseverance, and
resilience not to quit to frustrations and fears. Even with my
poor health, I struggled and still made it to this day because you
all held my weak parts as I journeyed and ran the race to
success. Thank you for believing in me and investing in my
success. God bless you all. To my dad-late Chief M.E. Chukwu,
I did accomplish your dreams on me, and I know wherever your
soul is at this time, it is full of joy; rest in peace, daddy, until
we meet again.
To my elder brother in the Lord, Rev. Fr. C. Iwuagwu, words
cannot express the magnitude of gratitude I owe you for your
fatherly and brotherly love, belief in my abilities, countless
hours of encouragement, enormous -uplifts, and renewed
determination. You are a blessing and gift to our family; remain
blessed.
Acknowledgments
The fruitful journey of my Doctor of Nursing program (DNP)
was made possible by the unconditional support of
extraordinary and cherished individuals, such as Dr. Khoa and
Don Nguyen, MD, for serving as my preceptor/mentor
throughout the stages of my direct immersion project. Dr. Dawn
Robinson, my Faculty /Chair, for her unshaken patience, quick
39. feedback, and radiant positive energy, together with Dr.
Katherine McDermott and faculty in course level review,
reading countless revisions and providing knowledgeably expert
guidance to the end of this course.
To my colleagues, Jeffrey Souza, Tresa Antony, Mercy Daniel,
Lisa Johnson, Marissa Rafael, and Skyler Meyer, thank you for
your unfading support. Countless times, I felt like the world has
collapsed upon me, desperately seeking the way out in the
darkness, lo and behold, your torchlights point through the
doors of escape. I recognized each day we journeyed that the
race was worth it because you all were there pointing your
lights to the proper outlet.
To my supportive friends, Sr. Onyinyechukwu Uba, Ms.
Euphemia, Ms. Amaka, Dr. Bashiru, Calista, Sylvia, Vincent,
and Ogunbayode. Thank you for your support, encouragement,
love, and understanding, especially in moments of desolation,
sequestration, and poor communication from me due to loads of
assignments on my table.
To my preceptees, Vivian, Michael, Adaeze, Jane, Kate, Esther,
Marybeth, Florence, Ebong, Nkele, and others, your
understanding when I transfer my frustrations to you humbled
me most in my relationship with you as a preceptor. Looking
upon the "role model thing" was the driving force that propelled
me to this finishing point. You are more than welcome anytime
for more guidance in the future in your further studies.
I was also working on my post-graduate certification program in
the psychiatric mental health nurse practitioner program, and
this is where I thank Dr. Ghislaine Mogo, my preceptor, for her
tremendous patience and support.
To my spiritual family, the Daughters of Charity of the Most
Precious Blood, God gave me the best opportunity to be among
you. Mother Ofelia Marzocca, see what I have become this day
because of your decisions in the most challenging moments of
my life and humble expression of an arduous journey that would
benefit all. Thank you all, and may God reward us according to
our deeds.
41. Validity49
Reliability49
DataCollectionProcedures50
DataAnalysisProcedures52
PotentialBiasandMitigation53
EthicalConsiderations53
Limitations54
Summary55
Chapter4:DataAnalysisandResults57
Chapter 4 summarizes the collected data and how it was
analyzed. Other chapter segments include the problem
statement, clinical question, and methodology. The results are
presented in narrative form along with figures, tables. The last
section of the chapter provided a preview of Chapter 5 and its
contents.58
Descriptive Data58
Data Analysis Procedures59
Results60
Chapter5:Summary,Conclusions,andRecommendations64
At the clinical site, the project manager, Medical Director, and
clinic manager collaborated regarding the increased ambulatory
blood pressures noted within the past three months. The
standard of care at the site is through medication management
for their condition. Hence, a unanimous decision was made to
utilize a new strategy, implementing the American Heart
Association's guidelines on aerobic exercise to influence
hypertensive patients.64
Chapter 5 reintroduced the project’s topic and summarized the
project. Other chapter segments included a summary of the
project’s findings and conclusion, theoretical, practical, and
future implications. The last portion of the chapter offered
recommendations for future quality improvement projects and
clinical practices.64
Summary of theProject65
Thisquality improvement project was conducted utilizing a
quantitative methodology and quasi-experimental design in four
42. weeks. Chapter 1 presented studies such as Adam and Wright
(2020), Aung and Htay (2021), Krist et al. (2021), and Saco-
Ledo et al. (2020) related to incorporating aerobic exercise to
be included in an individual’s HTN management plan.The
project contributed to the current body of literature, such as
Aung and Htay (2021), Krist et al. (2021), and Saco-Ledo et al.
(2020), regarding aerobic exercise being included in
hypertension management. The impacted population was adults
diagnosed with hypertension in a primary care clinic. The
county’s demographics revealed that roughly 60,000 seniors 65
and older comprise the county’s populace (Data USA, 2019). In
Texas, the incidence of HTN is at 35.1%, which validates
findings from the CDC (2021) and Million Hearts (2021).65
Chapter 2 discussed Orem’s self-care deficit theory and Lewin’s
change model are the theoretical underpinnings for this quality
improvement project. Orem’s self-care theory was chosen
because it focused on the reciprocal relationship between
humans and their environment (Orem, 1995). The theory
highlighted that a human could provide self-care, and the
primary goal of the healthcare provider should assist them in
achieving an optimal level of independence (Orem, 1995). The
nursing theory comprises five constructs: universal self-care
requisites, normalcy, developmental self-care requisites, and
health deviation self-care requisite (Orem, 1995). Implementing
this theory permitted the project manager to guide the clinicians
regarding their responsibilities in providing the patient with a
transparent plan of care. This helped the HTN patients to
sustain an appropriate level of self-care (Orem, 1995).65
Lewin’s change model was selected for this quality
improvement project. It was chosen because it emphasized the
need for change for clinicians and HTN patients impacted by
restraining forces (Lewin, 1947). The change model consists of
three phases: unfreezing, change (movement), and refreezing
(Lewin, 1947). The first phase, unfreezing, began when the
project manager collaborated with the nursing manager, medical
director, and a few nursing staff to detect the increase in
43. ambulatory blood pressures in HTN patients within the past
three months. The second phase, changing (movement), began
when the project manager educated the staff to use the
implementation of the American Heart Association (AHA)
guidelines related to aerobic exercise. During the phase, the
patients were educated by the staff, clinicians were trained, and
the project was monitored. The last stage, refreezing, began
when the discussion about the AHA guidelines became infused
into the organizational culture and a daily habit in the
healthcare providers' clinical practice (Lewin, 1947).66
The project was implemented once approval was received from
Grand Canyon University IRB and the project site. It was
implemented in four weeks to examine the impact of AHA
guidelines related to aerobic exercise on ambulatory blood
pressures. The project came after collaboration with the medical
director and some nursing staff showed an increase of 37.1% in
diagnosed HTN patients within the past six months. The project
contributed to the current body of literature regarding the
impact of aerobic exercise on decreasing one’s hypertension
(Aung &Htay, 2021; Krist et al., 2021; Saco-Ledo et al., 2020).
Other areas affected by regular aerobic exercise are weight loss,
improved well-being, and decreased symptoms of depression
and anxiety (CDC, 2022).66
SummaryofFindingsandConclusion67
Implications69
The nursing field is a discipline that requires research, which
concentrates on issues that affect the nursing practice (Polit &
Beck, 2021). Nursing implications are essential in considering
when to begin a new medication, intervention, or procedure
(Polit & Beck, 2021). Healthcare providers who understand the
potential impact they could have on the clinical practice,
nursing care, and the patient allows them to provide the best
quality care (Polit & Beck, 2021). The implications discussed in
the following sections were developed on the project
findings.69
Theoretical Implications69
44. PracticalImplications71
The third implication is for clinicians to use an interactive
pictorial wheel to improve self-management in HTN patients.
This educational style using pictures can help patients discuss
their personalized approach to managing HTN without feeling
belittled or embarrassed. Furthermore, this method has been
adapted for other diseases such as asthma, heart failure, and
stroke (Gan et al., 2022). This communication style would be
beneficial for individuals with low health literacy levels. The
communication wheel would be based on medication, exercise,
weight management, diet, and complications72
Future Implications72
Recommendations72
Recommendations for Future Projects73
The “next step” in forwarding this project is for the healthcare
providers to deliver patient care using culturally competent care
for this populace. Unfortunately, many of the patients seen at
the clinic are from Black and Brown communities. As
mentioned in Chapter 1, the project site’s demographics show a
high population of Hispanics (36.72%) and Blacks (18.5%).
This confirms the statistics found by the Centers for Disease
Control and Prevention (2022), Hispanics (39%), and Blacks
(56%).73
RecommendationsforPractice74
References76
AppendixA90
GrandCanyonUniversityInstitutionalReviewBoardOutcomeDeter
minationLetter90
AppendixB91
AmericanHeartAssociationPhysicalActivityGuidelines91
AppendixC92
Permission to Use the American Heart Association Physical
Activity Guidelines92
List of Tables
50. Theprojectcontributestothenursingfieldbyofferinganevidence-
basedstrategyandevaluatinghowaerobicexercisessuchaswalkingi
mprovedambulatorybloodpressure.Theprojectprovidedvitalinfor
mationthatcouldbesharedwithothernursingstafforhealthcareprovi
dersatotherprimarycareclinics,minoritycommunities,orpopulatio
nsinsimilardiversepopulations.The project also preferred an
avenue for helping individuals and families to understand the
relationship between the disease process and its management.
Clinical Question
Saco-Ledoetal.(2020)conductedasystematicreviewandmeta-
analysis.Theauthorsclaimedthatambulatorybloodpressure(ABP)b
etterpredictscardiovasculardiseaseandmortalityinadulthypertensi
vepopulations.Aerobicexerciseplayedasignificantroleinlowering
bloodpressure,anditwasbeneficialinloweringambulatorybloodpre
ssureinHTNpatients.Thefollowingclinicalquestionthatguidedthis
quantitativeproject:Towhatdegreedidtheimplementationof“theA
mericanHeartAssociation’s”guidelineonaerobicexerciseimpacta
mbulatory
bloodpressurewhencomparedtocurrentpracticeamongadulthypert
ensivepatientsinaprimarycareclinicinsouthwestTexas?
Theindependentvariableis“theAmericanHeartAssociation’s”guid
elineregardingaerobicexercise,andthedependentvariableisambula
tory blood pressure.
Advancing Scientific Knowledge
Implementinganaerobicexerciseeducationprogramtolowerambula
torybloodpressurebyfollowingAHAguidelines,theinitiativeimpro
vedpopulationhealthoutcomesforhypertensiveindividuals.Compl
etingthisqualityimprovementprojectadvancedourunderstandingof
ambulatorybloodpressureinhypertensivepatientstoreduceormana
geambulatorybloodpressure.Theoverallgoalsofaerobicexercisewa
lkingincontrollingbloodpressureinhypertensivepatientsweretodec
reasemorbidityandincreasethepopulation'swellness, happiness
and
53. ersationwithhypertensivepatients(Lewin,1947).
Significance of the Project
The significance of the quality improvement project
wasimplementingarecommendedevidencebasedstrategyby“theAH
A’sguideline”regardingaerobicexercise.Implementingtheprojecth
elpeddecreasethehealthcarecostsassociatedwithHTNintheUnited
States.Commodore-
Mensahetal.(2018)statethatthefinancialpricesaresignificant,appr
oximately$131-
198billionannually.Hypertensivepersonsincuranextra$2,000yearl
yinhealthcareexpenditurescomparedtonon-
hypertensivepersons(Commodore-
Mensahetal.,2018).Furthermore,HTNisacrucialriskfactorinvariou
sdiseases,includingmyocardialinfarction,heartfailure,stroke,andc
hronicrenaldisease(Commodore-Mensahetal.,2018).
OnenursingimplicationrelatestoLewin’schangemodelincreatinga
ndsustainingchange.Amulti-systematicapproachmustbe
drawnfromthemodeltosupporttheimplementationoftheAmericanH
eartAssociationguidelinesregardingaerobicexerciseforhypertensi
vepatients.Themodelhighlightedtheprinciplesrelatingtopeoplech
angingfromtheonset,discussingtheirfeelingsregardingthechange,
andsupportingtheprocessviacommunicationandcollaboration(Har
risonetal.,2021).
The second nursing implication relates to the participants’
management of their disease process (hypertension). The
participants were taught the importance of including aerobic
exercise and walking (30 minutes, three times a week) in their
private daily
schedules.Theprojectmanagerevaluatedtherespondents'understan
dingandreceptivenesstonewinformationandsafetymeasuresrelated
toexercising.Rationale for the Methodology
Thequantitativemethodologywasusedtoprovideinformationthatus
esnumericaldata(Statistical
57. 2018).Beloware the words used intermittently throughout the
project
Ambulatory Blood Pressure Monitoring(ABPM)
Ambulatorybloodpressuremonitoringwasintroducedintheearly19
60sandwas usedtoassessone’sbloodpressureinreal-
time(Shackelford,2022).Ahealthcareprovidertypically
evaluatedthebloodpressureduringroutineactivitiessuchasworking
,sleeping,ordoingchores(Shackelford,2022).
The American College of Cardiology Foundation
The American College of Cardiology Foundationisanon-
profitmedicalorganizationdedicatedtoimprovingthelivesofcardio
vascularpatients(AmericanCollegeofCardiology,2022).Thiswasd
oneviacontinuousqualityimprovementmonitoring,patient-
carestrategies,paymentinnovation,andprofessionalism(American
CollegeofCardiology,2022).
American Heart Association
TheAmericanHeartAssociationwasformedin1924toestablishscien
tificresearchthatcouldofferhealthcareprovidersandpatientsmetho
dstotreatcardiacdiseaseandprevention(AmericanHeartAssociatio
n,2022).
Aerobic Exercise
Aerobicexercisereferstoanyactivityinvolvingcardiovascularcondi
tioningandpertainstorunning,briskwalking,swimming,orevencycl
ing.Thisprojectwillapplyaerobicexercisetohelphypertensivepatie