VOLUME 21, NUMBER 1 CLINICAL JOURNAL OF ONCOLOGY NURSING 79CJON.ONS.ORG
A
Detecting Distress
Introducing routine screening in a gynecologic cancer setting
Moira O’Connor, BA(Hons), MSc, PhD, Pauline B. Tanner, RN, RM, CertOnc, SBCN, Lisa Miller, MBBS, DCH, FRACGP, FAChPm, FRANZCP,
Kaaren J. Watts, BA(Hons), PhD, and Toni Musiello, BA(Hons), MA, PhD
ALONGSIDE PHYSICAL SYMPTOMS AND SIDE EFFECTS of treatment, cancer results
in psychological, social, and practical challenges, which can contribute to
patient distress (Carlson, Waller, Groff, Giese-Davis, & Bultz, 2013). The
International Psycho-Oncology Society highlights distress as a critical factor
affecting patients’ well-being and recommends that distress be named the
sixth vital sign in oncology (Holland, Watson, & Dunn, 2011). The report-
ed prevalence rates of psychological distress in patients with cancer range
from 35%–49% (Carlson, Groff, Maciejewski, & Bultz, 2010). However, the
actual rates of distress are thought to be much higher because of underdetec-
tion. Clinician assessments have been shown to be inferior to gold-standard
methods, such as validated screening tools and clinical interviews (Werner,
Stenner, & Schüz, 2012), and distress is often missed by clinicians (Mitchell,
Vahabzadeh, & Magruder, 2011).
Distress encompasses a range of issues, including psychological, spiritual,
and existential distress, as well as juggling roles and having financial concerns
and practical problems, such as needing help with accommodation or travel.
Distress is associated with poorer physical and psychological quality of life
(Carlson et al., 2010). Detecting distress in patients with cancer can result in
early intervention, which helps avoid patients struggling with unmet or com-
plex needs (Faller et al., 2013). Identifying distress early could also reduce the
financial burden on health services (Han et al., 2015). Healthcare profession-
als (HCPs) must recognize distress so it can be adequately managed (Werner
et al., 2012); to do this, HCPs need to screen all patients systematically.
Several organizations and professional bodies state in their standards
for quality cancer care that psychosocial support should include routine
screening for distress, followed by appropriate referrals targeted to the needs
identified by patients (Holland et al., 2011; Werner et al., 2012). Despite this,
uptake of routine distress screening in clinical oncology settings has been
suboptimal (Mitchell, Lord, Slattery, Grainger, & Symonds, 2012). Many
barriers exist to the successful implementation of routine distress screen-
ing in clinical settings, including a lack of training, clinicians’ perception of
limited skills and confidence in identifying distress, and inadequate referral
resources (Absolom et al., 2011). A shortage of private space has also been
identified (Ristevski et al., 2013). Many HCPs believe that addressing distress
will take too much time. However, appropri ...
Detecting Distress in Gynecologic Cancer Patients Worksheet.docxstudywriters
1) A study assessed distress levels in 62 gynecologic cancer patients using the Distress Thermometer and Problem List. 66% of patients scored 4 or higher on the Distress Thermometer, indicating follow up was needed. The top reported problems were nervousness, worry, fears, fatigue, and sleep problems.
2) Staff perceptions of using distress screening tools were also examined through interviews. While screening helped identify patient needs, staff noted high levels of distress required referral to appropriate services.
3) Both quantitative and qualitative data provided insight into the prevalence and types of distress experienced by gynecologic cancer patients, as well as challenges in implementing distress screening in a clinical setting.
Applying and Sharing Evidence Discussion.docxwrite22
This document discusses implementing routine distress screening for gynecologic cancer patients using the Distress Thermometer and Problem List. A study found that 66% of patients screened had moderate to high distress levels. The top problems identified were nervousness, worry, fatigue and sleep issues. Healthcare providers saw benefits for patients in validating their concerns and opening discussion. They also felt it enhanced holistic care. However, finding time for screening in busy clinics was challenging.
Changes in quality of life among jordanian colorectal cancer patients a quali...Alexander Decker
The document summarizes a qualitative study that explored how a colorectal cancer diagnosis and treatment impacted patients' quality of life in Jordan. Ten Jordanian patients diagnosed with colorectal cancer participated in semi-structured interviews. Analysis of the interviews identified four main categories reflecting changes in patients' quality of life: 1) perceptions of quality of life such as diminished physical fitness and treatment side effects, 2) cancer as a source of distress through emotions, outlook on the future, and lost confidence, 3) changing roles like dependencies and altered responsibilities, and 4) changes in social life including isolation and disrupted family life. The study provides insight into how colorectal cancer affected patients' lives physically, psychologically, and socially.
This multi-year study analyzed end-of-life discussions at a cancer center over four years. On average, 113 patients expired each year, with 60 expiring seven or more days after admission. Lung cancer was the most common cause of death. While palliative care consultations occurred for only 25.5% of patients on average, the study found no correlations between variables like timing of discussions, location, attendance, and palliative care involvement. Without interventions between years, the study could not measure performance improvement directly. Future research would require implementing interventions to gauge their impact over multiple years.
Running head CRITIQUE QUANTITATIVE, QUALITATIVE, OR MIXED METHODS.docxtodd271
Running head: CRITIQUE QUANTITATIVE, QUALITATIVE, OR MIXED METHODS DESIGN
5
CRITIQUE OF QUANTITATIVE, QUALITATIVE, OR MIXED METHODS DESIGN
Critiquing Quantitative, Qualitative, or Mixed Methods Studies
Adenike George
Walden University
NURS 6052: Essentials of Evidence-Based Practice
April 11, 2019
Critique of Quantitative, Qualitative, or Mixed Method Design
Both quantitative and qualitative methods play a pivotal role in nursing research. Qualitative research helps nurses and other healthcare workers to understand the experiences of the patients on health and illness. Quantitative data allows researchers to use an accurate approach in data collection and analysis. When using quantitative techniques, data can be analyzed using either descriptive statistics or inferential statistics which allows the researchers to derive important facts like demographics, preference trends, and differences between the groups. The paper comprehensively critiques quantitative and quantitative techniques of research. Furthermore, the author will also give reasons as to why qualitative methods should be regarded as scientific.
The overall value of quantitative and Qualitative Research
Quantitative studies allow the researchers to present data in terms of numbers. Since data is in numeric form, researchers can apply statistical techniques in analyzing it. These include descriptive statistics like mean, mode, median, standard deviation and inferential statistics such as ANOVA, t-tests, correlation and regression analysis. Statistical analysis allows us to derive important facts from data such as preference trends, demographics, and differences between groups. For instance, by conducting a mixed methods study to determine the feeding experiences of infants among teen mothers in North Carolina, Tucker and colleagues were able to compare breastfeeding trends among various population groups. The multiple groups compared were likely to initiate breastfeeding as follows: Hispanic teens 89%, Black American teens 41%, and White teens 52% (Tucker et al., 2011).
The high strength of quantitative analysis lies in providing data that is descriptive. The descriptive statistics helps us to capture a snapshot of the population. When analyzed appropriate, the descriptive data enables us to make general conclusions concerning the population. For instance, through detailed data analysis, Tucker and co-researchers were able to observe that there were a large number of adolescents who ceased breastfeeding within the first month drawing the need for nurses to conduct individualized follow-ups the early days after hospital discharge. These follow-ups would significantly assist in addressing the conventional technical problems and offer support in managing back to school transition (Tucker et al., 2011).
Qualitative research allows researchers to determine the client’s perspective on healthcare. It enables researchers to observe certain behaviors and experiences amo.
The document discusses three research studies on the relationship between the type of cancer surgery information provided by physicians and the amount of anxiety experienced by patients. The first study found that patients who received more information about radiation therapy through an educational video reported less anxiety at the end of treatment compared to those who did not view the video. The second study found that breast cancer patients offered a choice in surgery and their husbands reported better psychosocial adjustment than those not offered a choice. The third study found no difference in psychiatric morbidity between patients who chose or did not choose their breast cancer treatment. Overall, two of the three studies supported the idea that more information from physicians is related to lower patient anxiety, while one study did not find a significant relationship.
Where’s the evidence that screening for distress benefits cancer patients?James Coyne
“The case against screening for distress.” A presentation delivered as part of an invited debate with Alex Mitchell at the International Psycho Oncology Conference, Rotterdam, November 7, 2013
the influence of age and coping mechanism on the resilience of cancer patient...musa nuwa
This document summarizes a study presented at the 9th International Nursing Conference on the influence of age and coping mechanisms on the resilience of cancer patients undergoing chemotherapy. The study found that coping mechanisms had a significant positive effect on patient resilience, explaining 44.9% of resilience, while age did not have a significant influence. Good coping skills are needed for patients to adapt positively to cancer treatment and remain resilient despite challenges. The results indicate that resilience is dynamic and influenced by both internal and external factors.
Detecting Distress in Gynecologic Cancer Patients Worksheet.docxstudywriters
1) A study assessed distress levels in 62 gynecologic cancer patients using the Distress Thermometer and Problem List. 66% of patients scored 4 or higher on the Distress Thermometer, indicating follow up was needed. The top reported problems were nervousness, worry, fears, fatigue, and sleep problems.
2) Staff perceptions of using distress screening tools were also examined through interviews. While screening helped identify patient needs, staff noted high levels of distress required referral to appropriate services.
3) Both quantitative and qualitative data provided insight into the prevalence and types of distress experienced by gynecologic cancer patients, as well as challenges in implementing distress screening in a clinical setting.
Applying and Sharing Evidence Discussion.docxwrite22
This document discusses implementing routine distress screening for gynecologic cancer patients using the Distress Thermometer and Problem List. A study found that 66% of patients screened had moderate to high distress levels. The top problems identified were nervousness, worry, fatigue and sleep issues. Healthcare providers saw benefits for patients in validating their concerns and opening discussion. They also felt it enhanced holistic care. However, finding time for screening in busy clinics was challenging.
Changes in quality of life among jordanian colorectal cancer patients a quali...Alexander Decker
The document summarizes a qualitative study that explored how a colorectal cancer diagnosis and treatment impacted patients' quality of life in Jordan. Ten Jordanian patients diagnosed with colorectal cancer participated in semi-structured interviews. Analysis of the interviews identified four main categories reflecting changes in patients' quality of life: 1) perceptions of quality of life such as diminished physical fitness and treatment side effects, 2) cancer as a source of distress through emotions, outlook on the future, and lost confidence, 3) changing roles like dependencies and altered responsibilities, and 4) changes in social life including isolation and disrupted family life. The study provides insight into how colorectal cancer affected patients' lives physically, psychologically, and socially.
This multi-year study analyzed end-of-life discussions at a cancer center over four years. On average, 113 patients expired each year, with 60 expiring seven or more days after admission. Lung cancer was the most common cause of death. While palliative care consultations occurred for only 25.5% of patients on average, the study found no correlations between variables like timing of discussions, location, attendance, and palliative care involvement. Without interventions between years, the study could not measure performance improvement directly. Future research would require implementing interventions to gauge their impact over multiple years.
Running head CRITIQUE QUANTITATIVE, QUALITATIVE, OR MIXED METHODS.docxtodd271
Running head: CRITIQUE QUANTITATIVE, QUALITATIVE, OR MIXED METHODS DESIGN
5
CRITIQUE OF QUANTITATIVE, QUALITATIVE, OR MIXED METHODS DESIGN
Critiquing Quantitative, Qualitative, or Mixed Methods Studies
Adenike George
Walden University
NURS 6052: Essentials of Evidence-Based Practice
April 11, 2019
Critique of Quantitative, Qualitative, or Mixed Method Design
Both quantitative and qualitative methods play a pivotal role in nursing research. Qualitative research helps nurses and other healthcare workers to understand the experiences of the patients on health and illness. Quantitative data allows researchers to use an accurate approach in data collection and analysis. When using quantitative techniques, data can be analyzed using either descriptive statistics or inferential statistics which allows the researchers to derive important facts like demographics, preference trends, and differences between the groups. The paper comprehensively critiques quantitative and quantitative techniques of research. Furthermore, the author will also give reasons as to why qualitative methods should be regarded as scientific.
The overall value of quantitative and Qualitative Research
Quantitative studies allow the researchers to present data in terms of numbers. Since data is in numeric form, researchers can apply statistical techniques in analyzing it. These include descriptive statistics like mean, mode, median, standard deviation and inferential statistics such as ANOVA, t-tests, correlation and regression analysis. Statistical analysis allows us to derive important facts from data such as preference trends, demographics, and differences between groups. For instance, by conducting a mixed methods study to determine the feeding experiences of infants among teen mothers in North Carolina, Tucker and colleagues were able to compare breastfeeding trends among various population groups. The multiple groups compared were likely to initiate breastfeeding as follows: Hispanic teens 89%, Black American teens 41%, and White teens 52% (Tucker et al., 2011).
The high strength of quantitative analysis lies in providing data that is descriptive. The descriptive statistics helps us to capture a snapshot of the population. When analyzed appropriate, the descriptive data enables us to make general conclusions concerning the population. For instance, through detailed data analysis, Tucker and co-researchers were able to observe that there were a large number of adolescents who ceased breastfeeding within the first month drawing the need for nurses to conduct individualized follow-ups the early days after hospital discharge. These follow-ups would significantly assist in addressing the conventional technical problems and offer support in managing back to school transition (Tucker et al., 2011).
Qualitative research allows researchers to determine the client’s perspective on healthcare. It enables researchers to observe certain behaviors and experiences amo.
The document discusses three research studies on the relationship between the type of cancer surgery information provided by physicians and the amount of anxiety experienced by patients. The first study found that patients who received more information about radiation therapy through an educational video reported less anxiety at the end of treatment compared to those who did not view the video. The second study found that breast cancer patients offered a choice in surgery and their husbands reported better psychosocial adjustment than those not offered a choice. The third study found no difference in psychiatric morbidity between patients who chose or did not choose their breast cancer treatment. Overall, two of the three studies supported the idea that more information from physicians is related to lower patient anxiety, while one study did not find a significant relationship.
Where’s the evidence that screening for distress benefits cancer patients?James Coyne
“The case against screening for distress.” A presentation delivered as part of an invited debate with Alex Mitchell at the International Psycho Oncology Conference, Rotterdam, November 7, 2013
the influence of age and coping mechanism on the resilience of cancer patient...musa nuwa
This document summarizes a study presented at the 9th International Nursing Conference on the influence of age and coping mechanisms on the resilience of cancer patients undergoing chemotherapy. The study found that coping mechanisms had a significant positive effect on patient resilience, explaining 44.9% of resilience, while age did not have a significant influence. Good coping skills are needed for patients to adapt positively to cancer treatment and remain resilient despite challenges. The results indicate that resilience is dynamic and influenced by both internal and external factors.
A systematic review of the effectiveness of problem-solving approaches toward...Jackie Gold
This systematic review examined the effectiveness of problem-solving approaches for symptom management in cancer care. Seven studies published between 1975-2009 were included. All studies used randomized controlled designs and showed positive effects of problem-solving approaches in reducing symptomatic problems for participants. However, the methodological quality of studies varied, with 14% rated as good quality, 43% as fair quality, and 43% as poor quality. While problem-solving approaches show potential for symptom management, more rigorous research is needed to identify the most effective problem-solving protocols.
This document reports on a study that evaluated factors associated with delayed patient appraisal of colorectal cancer symptoms. The study used a cross-sectional mixed methods design to collect data through 252 patient interviews and medical record reviews. Structural equation modeling tested relationships between symptoms, financial barriers, cognitive barriers, and delays in patients seeking care. The results found that experiencing cognitive barriers directly predicted longer delays in care-seeking. Financial barriers and symptoms were also found to indirectly influence delays through increasing cognitive barriers like symptom minimization. This suggests that financial concerns can impact how patients interpret their symptoms.
This study assessed outcomes of physical therapy and surgery for 150 patients with neurogenic thoracic outlet syndrome (NTOS) using patient-reported measures. 40 patients (27%) had satisfactory improvement with a 6-week physical therapy trial, while 90 (60%) underwent surgery after physical therapy failed. Patients who underwent surgery had greater reductions in disability scores and better patient-rated outcomes compared to those who received only physical therapy. However, pre-treatment factors did not reliably predict who would benefit from each treatment. This study provides information on contemporary outcomes for physical therapy and surgery for NTOS.
This study compared outcomes for head and neck cancer patients based on age. Younger patients (≤40 years old) had significantly better 5-year survival rates (65%) than middle-aged (41-64 years old, 52%) or older patients (≥65 years old, 38%). Younger patients also developed fewer recurrent tumors or new primary tumors. However, the reasons for the differences in outcomes based on age are unclear. The study aimed to analyze outcomes while controlling for other factors like smoking history, tumor stage, and treatment received to better understand the independent impact of age.
This document discusses evidence-based practice and how it applies to assessing clinical intervention studies. It begins by listing the learning objectives for Lecture c, which include explaining how evidence-based medicine can be applied to intervention studies. The document then discusses how the best evidence for assessing interventions comes from randomized controlled trials (RCTs) or systematic reviews of RCTs. It provides examples of RCTs and outlines key questions one should ask to critically appraise an intervention study, such as whether the results are valid and can be applied to patient care.
Evaluating the Quality of Life and Social Support in Patients with Cervical C...CrimsonpublishersTTEH
Aims: Purposes of this descriptive correlational research were to 1) describe quality of life and social support and 2) look at the correlation of certain factors and quality of life in women with cervical cancer after treatment. Methods: Fifty-three women diagnosed with cervical cancer who were followed up after finished the treatments at the Gynecological outpatient department of a university hospital in 2016.They were asked to fill 3 questionnaires; 1) the general information; 2) Social support; and 3) Functional Assessment of Chronic Illness Therapy (FACT-Cervix). Alpha Cronbach’s coefficients for the social support was .73 and for the FACT-Cervix was .91. Data were analyzed by descriptive statistic and Spearman Rank Test.Result: Results showed that participants’ age was ranged from 30 to 86, mean=55.15 (SD=10.05). Social support was about 29 to 59, mean=48.23 (SD=6.76). Symptom distress was from 0 to 9, mean=3.36 (SD=2.83). For quality of life was diverted from 75 to159, mean=126.02 (SD=21.09). The results discovered that there was no correlation between age and social support with the quality of life, however, there was negative correlation between symptom distress and quality of life with r=-.40 at p=0.003.Conclusion: This study disclosed that social support for this women’s group could not help to improve their quality of life. Their symptom distress seems to have a direct effect on their QOL. Thus, the healthcare team needs to alleviate patients’ distress in order to improve the quality of life in cervical cancer survivors.
The Impact of Patients’ Disease-Labels on Disease Experience Living Longer ...semualkaira
Advances in oncology have resulted in prolonged disease trajectories, also for patients with incurable cancer. This has induced discussions about the ‘right’ medical terminology. The impact of choosing a specific disease-label on well-being can be high.
The Impact of Patients’ Disease-Labels on Disease Experience Living Longer ...semualkaira
Advances in oncology have resulted in prolonged disease trajectories, also for patients with incurable cancer. This has induced discussions about the ‘right’ medical terminology. The impact of choosing a specific disease-label on well-being can be high.
Urology practices may be well positioned to serve as medical homes according to a new study. Researchers examined data on urology practices and other specialties and found that urology practices outperformed other surgical and medical specialties on structural elements of the medical home model such as care coordination and quality improvement. Nearly three-quarters of urology practices meet standards for medical home recognition compared to just half of other specialty practices. Additionally, a new care coordination system for patients with hematuria was found to improve quality of care by decreasing time to evaluation completion and increasing efficiency through reducing total urology visits. Finally, regions with lower physician density were found to have higher mortality rates for renal cancer, suggesting decreased access to care impacts
Physician density may correlate to worse urologic cancer outcomes according to a study examining cancer mortality rates. The study analyzed cancer mortality rate data from the CDC and found significantly higher renal cancer mortality rates in areas with low physician density. Additionally, there was a negative association between median family income and bladder and renal cancer mortality rates. The study compared counties with the highest and lowest mortality rates for prostate, bladder, and renal cancers and found those with high rates had significantly lower physician population densities and higher rates of residents without health insurance compared to low mortality rate counties.
Physician density may correlate to worse urologic cancer outcomes according to a study examining cancer mortality rates. The study analyzed cancer mortality rate data from the CDC and found significantly higher renal cancer mortality rates in areas with low physician density. Additionally, there was a negative association between median family income and bladder and renal cancer mortality rates. The study compared counties with the highest and lowest mortality rates for prostate, bladder, and renal cancers and found those with high rates had significantly lower physician population densities and higher rates of residents without health insurance compared to low mortality rate counties.
Physician density may correlate to worse urologic cancer outcomes according to a study examining cancer mortality rates. The study analyzed cancer mortality rate data from the CDC and found significantly higher renal cancer mortality rates in areas with low physician density. Additionally, there was a negative association between median family income and bladder and renal cancer mortality rates. The results suggest that easier access to medical care through higher physician availability may help reduce cancer mortality by enabling earlier detection and treatment.
Participation of the population in decisions about their health and in the pr...Pydesalud
Póster presentado por Lilisbeth Perestelo en el congreso Summer Institute for Informed Patient Choice (SIIPC14) celebrado del 25 al 27 de junio de 2014 en Dartmouth, Hanover (EEUU). Web: http://siipc.org
Contacto: lperperr@gobiernodecanarias.org
This meta-analysis examined 17 studies involving 9,454 subjects to determine the prevalence of treatment need for temporomandibular disorders (TMD) in adult nonpatient populations. The analysis found that the prevalence of TMD treatment need was estimated to be 15.6% according to the fixed effect model and 16.2% according to the random effects model. Criteria used to estimate treatment need and the location of the study strongly influenced the estimates. Estimates based on clinical TMD signs were higher than those based on self-reported symptoms. Younger subjects aged 19-45 had higher estimates of treatment need than older subjects aged 46 and over. The treatment need for TMD in the general adult population is substantial and
Human Papillomavirus Vaccination Intentions And Uptake In College WomenKimberly Williams
This study examined factors that influence college women's intentions to receive the HPV vaccine and actual uptake of the vaccine. The researchers surveyed 447 undergraduate women who either did not intend to get the vaccine, intended to get it, or had already received it. They found that negative perceptions of the vaccine's health consequences, a doctor's recommendation, positive attitudes toward the vaccine, and social norms were associated with intentions to get vaccinated. A doctor's recommendation, social norms, and perceptions of HPV susceptibility uniquely predicted who had already been vaccinated, beyond other factors. This suggests social influences may be especially important in motivating young women to get the HPV vaccine after forming an intention.
Trevillion, K., Byford, S., Cary, M., Rose, D., Oram, S., Feder, G.docxturveycharlyn
Trevillion, K., Byford, S., Cary, M., Rose, D., Oram, S., Feder, G., . . . Howard, L. M. (2014). Linking abuse and recovery through advocacy: An observational study. Epidemiology and Psychiatric Sciences, 23(1), 99-113. http://dx.doi.org.saintleo.idm.oclc.org/10.1017/S2045796013000206 Retrieved from https://saintleo.idm.oclc.org/login?url=https://search-proquest-com.saintleo.idm.oclc.org/docview/1494106370?accountid=4870
Linking abuse and recovery through advocacy: an
observational study
K. Trevillion1*, S. Byford2, M. Cary2, D. Rose3, S. Oram1, G. Feder4, R. Agnew-Davies5 and
L. M. Howard1
1 Section of Women’s Mental Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK
2 Centre for the Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry,
King’s College, London, UK
3 Service User Research Enterprise, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK
4 School of Social and Community Medicine, University of Bristol, Bristol, UK
5 Domestic Violence Training Ltd, Surbiton, Surrey, UK
Aims. High numbers of psychiatric service users experience domestic violence, yet limited interventions exist for these
victims. We piloted a domestic violence intervention for community mental health services to explore the feasibility of a
future cluster randomized controlled trial.
Methods. Quasi-experimental controlled design within five Community Mental Health Teams (three intervention and
two control teams). The intervention comprised domestic violence training for clinicians’ and referral to domestic violence
advocacy for service users. Clinicians’ (n = 29) domestic violence knowledge, attitudes and behaviours were assessed
before and 6 months post-training. Service users’ (n = 34) safety behaviours, unmet needs, quality of life and frequency/
severity of abuse were examined at baseline and 3 months follow-up. Process evaluation data were also collected.
Results. Clinicians receiving the intervention reported significant improvements in domestic violence knowledge, atti-
tudes and behaviours at follow-up (p < 0.05). Service users receiving the intervention reported significant reductions in
violence (p < 0.001) and unmet needs at follow-up (p < 0.05).
Conclusions. Interventions comprising domestic violence training for clinicians and referral to domestic violence advo-
cacy may improve responses of psychiatric services. Low rates of identification among teams not receiving training
suggest that future trials using service user outcomes are unlikely to be feasible. Therefore, other methods of evaluation
are needed.
Received 30 October 2012; Revised 14 March 2013; Accepted 18 March 2013; First published online 30 April 2013
Key words: Community mental health services, Domestic violence, intervention studies.
Introduction
Domestic violence – threatening behaviour, violence or
ab ...
An emergency department quality improvement projectyasmeenzulfiqar
The document discusses improving vital sign documentation during triage in emergency departments. It aims to investigate factors affecting vital sign data quality during measurement and documentation, and provide recommendations for improvement. A literature review found that timely and accurate vital sign documentation is important for identifying deteriorating patients. However, studies on nursing workflows and documentation of vital signs are limited. The objective is to study nurses' vital sign documentation process through a questionnaire of nurses and analysis of the data. Results showed teamwork and quality improvement efforts like education and training can enhance compliance with vital sign documentation standards during triage. Recommendations include departments addressing challenges in measurement time and reviewing results to improve performance.
Evidence-Based Practices & Nursing
Introduction
Normally, PICOT format is helpful in formulation of questions in an evidenced based clinical practice. PICOT generated questions generally fall under for main categories of clinical practices. These include; therapy, prevention, diagnosis, etiology as well as Prognosis. The essential elements in PICOT questions. The PICOT format is valuable in addressing research questions comprehensively. Five elements are normally addressed including; population, intervention, comparison, outcome and time as well (Riva, Malik, Burnie, Endicott, & Busse, 2012).
Summary of Case Study
The ever increasingly high incidence of breast cancer conditions has posed serious challenges in the nursing profession. Provision of appropriate healthcare to the cancer patients has been lacking leading to adverse effects of the proliferation of cancerous cells which further worsen the conditions of the patients. As primary care, clinicians have the responsibility to stressing providing healthcare services within healthcare facilities as well as monitoring treatment in home based facilities to help manage cancer condition. Most cancer patient need clinicians who practice evidence-based clinical practices (Riva, Malik, Burnie, Endicott, & Busse, 2012).
Research Question
In cancer patients receiving chemotherapy, will they have better white blood cell count monitoring with a follow-up at home versus follow-up at a health care facility during their treatment?
PICOT Format
1) P-Population: Patients aged 18-60 years-old, breast cancer who have not received chemotherapy in the past six months are subjected to the treatment. Patients with other serious health conditions such as heart diseases were excluded in the study. 30 patients, with 15patients stationed at the healthcare facility while the other 15 patients receiving home-based care, are expected to take part in the study.
2) I -Intervention: The patients will receive dosage based on the age, sex and health general body health as well as the stage of cancer cells proliferation in the body. The patients are required take the prescribed drugs at regular intervals. The subjects will be subjected to treatment under the same during the research study.
3) C-Comparison: All the subject regardless of variations in their level of dose requirement will be subjected to the same treatment for the same duration, 3months. Standardized treatment will be given to subjects with no extreme variations in their level of dose requirement and would be used as an active control group. Using this strategy, it will be possible to minimize the non-specific effects due to a group of the patient receiving treatment within the healthcare.
4) O-Outcome: The response in chemotherapy treatments will be check by examining the numbers of defective cancerous cells in the body tissues. The patients will report to the theatre in order to be examined by an oncologist. The results will be recorded i ...
Multidisciplinary Approach to Prostate Cancer and Changes in Treatment Decisi...CrimsonpublishersCancer
In order to demonstrate the impact of multi-disciplinary care in the community oncology setting, we evaluated treatment decisions following the initiation of a dedicated genitourinary multi-disciplinary clinic (GUMDC).
This article, "Casting a Wider Net in Behavioral Health Screening in Primary Care" found that the ORS identified more clients for behavioral healthcare consultation than the PHQ-9. A first step toward the upcoming RCT with PCOMS in an integrated setting.
Milestones Navigating Late Childhood to AdolescenceFrom the m.docxjessiehampson
Milestones: Navigating Late Childhood to Adolescence
From the movie, Lila, Eight to Thirteen in this week's materials, identify 2–3 developmental milestones Lila reaches, and assess whether or not you think she successfully navigates her way through them as she prepares for adolescence. Support your assertions with evidence from your text and this week's materials.
.
Migration and RefugeesMany immigrants in the region flee persecu.docxjessiehampson
Migration and Refugees
Many immigrants in the region flee persecution and then return after they are liberated. For example, 700,000 Jews were allowed to leave the former Soviet Union and enter Israel in the 1990s. There has also been a migration of Palestinian people. Discuss the following:
Why do you think that Israel is such an important place for the Jews?
What is the importance of the area to the Palestinians?
What do you think the impact would be on you and your families if you participated in such long-distance migration?
No references needed, need response within 3 hours!
.
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This study compared outcomes for head and neck cancer patients based on age. Younger patients (≤40 years old) had significantly better 5-year survival rates (65%) than middle-aged (41-64 years old, 52%) or older patients (≥65 years old, 38%). Younger patients also developed fewer recurrent tumors or new primary tumors. However, the reasons for the differences in outcomes based on age are unclear. The study aimed to analyze outcomes while controlling for other factors like smoking history, tumor stage, and treatment received to better understand the independent impact of age.
This document discusses evidence-based practice and how it applies to assessing clinical intervention studies. It begins by listing the learning objectives for Lecture c, which include explaining how evidence-based medicine can be applied to intervention studies. The document then discusses how the best evidence for assessing interventions comes from randomized controlled trials (RCTs) or systematic reviews of RCTs. It provides examples of RCTs and outlines key questions one should ask to critically appraise an intervention study, such as whether the results are valid and can be applied to patient care.
Evaluating the Quality of Life and Social Support in Patients with Cervical C...CrimsonpublishersTTEH
Aims: Purposes of this descriptive correlational research were to 1) describe quality of life and social support and 2) look at the correlation of certain factors and quality of life in women with cervical cancer after treatment. Methods: Fifty-three women diagnosed with cervical cancer who were followed up after finished the treatments at the Gynecological outpatient department of a university hospital in 2016.They were asked to fill 3 questionnaires; 1) the general information; 2) Social support; and 3) Functional Assessment of Chronic Illness Therapy (FACT-Cervix). Alpha Cronbach’s coefficients for the social support was .73 and for the FACT-Cervix was .91. Data were analyzed by descriptive statistic and Spearman Rank Test.Result: Results showed that participants’ age was ranged from 30 to 86, mean=55.15 (SD=10.05). Social support was about 29 to 59, mean=48.23 (SD=6.76). Symptom distress was from 0 to 9, mean=3.36 (SD=2.83). For quality of life was diverted from 75 to159, mean=126.02 (SD=21.09). The results discovered that there was no correlation between age and social support with the quality of life, however, there was negative correlation between symptom distress and quality of life with r=-.40 at p=0.003.Conclusion: This study disclosed that social support for this women’s group could not help to improve their quality of life. Their symptom distress seems to have a direct effect on their QOL. Thus, the healthcare team needs to alleviate patients’ distress in order to improve the quality of life in cervical cancer survivors.
The Impact of Patients’ Disease-Labels on Disease Experience Living Longer ...semualkaira
Advances in oncology have resulted in prolonged disease trajectories, also for patients with incurable cancer. This has induced discussions about the ‘right’ medical terminology. The impact of choosing a specific disease-label on well-being can be high.
The Impact of Patients’ Disease-Labels on Disease Experience Living Longer ...semualkaira
Advances in oncology have resulted in prolonged disease trajectories, also for patients with incurable cancer. This has induced discussions about the ‘right’ medical terminology. The impact of choosing a specific disease-label on well-being can be high.
Urology practices may be well positioned to serve as medical homes according to a new study. Researchers examined data on urology practices and other specialties and found that urology practices outperformed other surgical and medical specialties on structural elements of the medical home model such as care coordination and quality improvement. Nearly three-quarters of urology practices meet standards for medical home recognition compared to just half of other specialty practices. Additionally, a new care coordination system for patients with hematuria was found to improve quality of care by decreasing time to evaluation completion and increasing efficiency through reducing total urology visits. Finally, regions with lower physician density were found to have higher mortality rates for renal cancer, suggesting decreased access to care impacts
Physician density may correlate to worse urologic cancer outcomes according to a study examining cancer mortality rates. The study analyzed cancer mortality rate data from the CDC and found significantly higher renal cancer mortality rates in areas with low physician density. Additionally, there was a negative association between median family income and bladder and renal cancer mortality rates. The study compared counties with the highest and lowest mortality rates for prostate, bladder, and renal cancers and found those with high rates had significantly lower physician population densities and higher rates of residents without health insurance compared to low mortality rate counties.
Physician density may correlate to worse urologic cancer outcomes according to a study examining cancer mortality rates. The study analyzed cancer mortality rate data from the CDC and found significantly higher renal cancer mortality rates in areas with low physician density. Additionally, there was a negative association between median family income and bladder and renal cancer mortality rates. The study compared counties with the highest and lowest mortality rates for prostate, bladder, and renal cancers and found those with high rates had significantly lower physician population densities and higher rates of residents without health insurance compared to low mortality rate counties.
Physician density may correlate to worse urologic cancer outcomes according to a study examining cancer mortality rates. The study analyzed cancer mortality rate data from the CDC and found significantly higher renal cancer mortality rates in areas with low physician density. Additionally, there was a negative association between median family income and bladder and renal cancer mortality rates. The results suggest that easier access to medical care through higher physician availability may help reduce cancer mortality by enabling earlier detection and treatment.
Participation of the population in decisions about their health and in the pr...Pydesalud
Póster presentado por Lilisbeth Perestelo en el congreso Summer Institute for Informed Patient Choice (SIIPC14) celebrado del 25 al 27 de junio de 2014 en Dartmouth, Hanover (EEUU). Web: http://siipc.org
Contacto: lperperr@gobiernodecanarias.org
This meta-analysis examined 17 studies involving 9,454 subjects to determine the prevalence of treatment need for temporomandibular disorders (TMD) in adult nonpatient populations. The analysis found that the prevalence of TMD treatment need was estimated to be 15.6% according to the fixed effect model and 16.2% according to the random effects model. Criteria used to estimate treatment need and the location of the study strongly influenced the estimates. Estimates based on clinical TMD signs were higher than those based on self-reported symptoms. Younger subjects aged 19-45 had higher estimates of treatment need than older subjects aged 46 and over. The treatment need for TMD in the general adult population is substantial and
Human Papillomavirus Vaccination Intentions And Uptake In College WomenKimberly Williams
This study examined factors that influence college women's intentions to receive the HPV vaccine and actual uptake of the vaccine. The researchers surveyed 447 undergraduate women who either did not intend to get the vaccine, intended to get it, or had already received it. They found that negative perceptions of the vaccine's health consequences, a doctor's recommendation, positive attitudes toward the vaccine, and social norms were associated with intentions to get vaccinated. A doctor's recommendation, social norms, and perceptions of HPV susceptibility uniquely predicted who had already been vaccinated, beyond other factors. This suggests social influences may be especially important in motivating young women to get the HPV vaccine after forming an intention.
Trevillion, K., Byford, S., Cary, M., Rose, D., Oram, S., Feder, G.docxturveycharlyn
Trevillion, K., Byford, S., Cary, M., Rose, D., Oram, S., Feder, G., . . . Howard, L. M. (2014). Linking abuse and recovery through advocacy: An observational study. Epidemiology and Psychiatric Sciences, 23(1), 99-113. http://dx.doi.org.saintleo.idm.oclc.org/10.1017/S2045796013000206 Retrieved from https://saintleo.idm.oclc.org/login?url=https://search-proquest-com.saintleo.idm.oclc.org/docview/1494106370?accountid=4870
Linking abuse and recovery through advocacy: an
observational study
K. Trevillion1*, S. Byford2, M. Cary2, D. Rose3, S. Oram1, G. Feder4, R. Agnew-Davies5 and
L. M. Howard1
1 Section of Women’s Mental Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK
2 Centre for the Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry,
King’s College, London, UK
3 Service User Research Enterprise, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK
4 School of Social and Community Medicine, University of Bristol, Bristol, UK
5 Domestic Violence Training Ltd, Surbiton, Surrey, UK
Aims. High numbers of psychiatric service users experience domestic violence, yet limited interventions exist for these
victims. We piloted a domestic violence intervention for community mental health services to explore the feasibility of a
future cluster randomized controlled trial.
Methods. Quasi-experimental controlled design within five Community Mental Health Teams (three intervention and
two control teams). The intervention comprised domestic violence training for clinicians’ and referral to domestic violence
advocacy for service users. Clinicians’ (n = 29) domestic violence knowledge, attitudes and behaviours were assessed
before and 6 months post-training. Service users’ (n = 34) safety behaviours, unmet needs, quality of life and frequency/
severity of abuse were examined at baseline and 3 months follow-up. Process evaluation data were also collected.
Results. Clinicians receiving the intervention reported significant improvements in domestic violence knowledge, atti-
tudes and behaviours at follow-up (p < 0.05). Service users receiving the intervention reported significant reductions in
violence (p < 0.001) and unmet needs at follow-up (p < 0.05).
Conclusions. Interventions comprising domestic violence training for clinicians and referral to domestic violence advo-
cacy may improve responses of psychiatric services. Low rates of identification among teams not receiving training
suggest that future trials using service user outcomes are unlikely to be feasible. Therefore, other methods of evaluation
are needed.
Received 30 October 2012; Revised 14 March 2013; Accepted 18 March 2013; First published online 30 April 2013
Key words: Community mental health services, Domestic violence, intervention studies.
Introduction
Domestic violence – threatening behaviour, violence or
ab ...
An emergency department quality improvement projectyasmeenzulfiqar
The document discusses improving vital sign documentation during triage in emergency departments. It aims to investigate factors affecting vital sign data quality during measurement and documentation, and provide recommendations for improvement. A literature review found that timely and accurate vital sign documentation is important for identifying deteriorating patients. However, studies on nursing workflows and documentation of vital signs are limited. The objective is to study nurses' vital sign documentation process through a questionnaire of nurses and analysis of the data. Results showed teamwork and quality improvement efforts like education and training can enhance compliance with vital sign documentation standards during triage. Recommendations include departments addressing challenges in measurement time and reviewing results to improve performance.
Evidence-Based Practices & Nursing
Introduction
Normally, PICOT format is helpful in formulation of questions in an evidenced based clinical practice. PICOT generated questions generally fall under for main categories of clinical practices. These include; therapy, prevention, diagnosis, etiology as well as Prognosis. The essential elements in PICOT questions. The PICOT format is valuable in addressing research questions comprehensively. Five elements are normally addressed including; population, intervention, comparison, outcome and time as well (Riva, Malik, Burnie, Endicott, & Busse, 2012).
Summary of Case Study
The ever increasingly high incidence of breast cancer conditions has posed serious challenges in the nursing profession. Provision of appropriate healthcare to the cancer patients has been lacking leading to adverse effects of the proliferation of cancerous cells which further worsen the conditions of the patients. As primary care, clinicians have the responsibility to stressing providing healthcare services within healthcare facilities as well as monitoring treatment in home based facilities to help manage cancer condition. Most cancer patient need clinicians who practice evidence-based clinical practices (Riva, Malik, Burnie, Endicott, & Busse, 2012).
Research Question
In cancer patients receiving chemotherapy, will they have better white blood cell count monitoring with a follow-up at home versus follow-up at a health care facility during their treatment?
PICOT Format
1) P-Population: Patients aged 18-60 years-old, breast cancer who have not received chemotherapy in the past six months are subjected to the treatment. Patients with other serious health conditions such as heart diseases were excluded in the study. 30 patients, with 15patients stationed at the healthcare facility while the other 15 patients receiving home-based care, are expected to take part in the study.
2) I -Intervention: The patients will receive dosage based on the age, sex and health general body health as well as the stage of cancer cells proliferation in the body. The patients are required take the prescribed drugs at regular intervals. The subjects will be subjected to treatment under the same during the research study.
3) C-Comparison: All the subject regardless of variations in their level of dose requirement will be subjected to the same treatment for the same duration, 3months. Standardized treatment will be given to subjects with no extreme variations in their level of dose requirement and would be used as an active control group. Using this strategy, it will be possible to minimize the non-specific effects due to a group of the patient receiving treatment within the healthcare.
4) O-Outcome: The response in chemotherapy treatments will be check by examining the numbers of defective cancerous cells in the body tissues. The patients will report to the theatre in order to be examined by an oncologist. The results will be recorded i ...
Multidisciplinary Approach to Prostate Cancer and Changes in Treatment Decisi...CrimsonpublishersCancer
In order to demonstrate the impact of multi-disciplinary care in the community oncology setting, we evaluated treatment decisions following the initiation of a dedicated genitourinary multi-disciplinary clinic (GUMDC).
This article, "Casting a Wider Net in Behavioral Health Screening in Primary Care" found that the ORS identified more clients for behavioral healthcare consultation than the PHQ-9. A first step toward the upcoming RCT with PCOMS in an integrated setting.
Similar to VOLUME 21, NUMBER 1 CLINICAL JOURNAL OF ONCOLOGY NURSING 79CJO.docx (20)
Milestones Navigating Late Childhood to AdolescenceFrom the m.docxjessiehampson
Milestones: Navigating Late Childhood to Adolescence
From the movie, Lila, Eight to Thirteen in this week's materials, identify 2–3 developmental milestones Lila reaches, and assess whether or not you think she successfully navigates her way through them as she prepares for adolescence. Support your assertions with evidence from your text and this week's materials.
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Migration and RefugeesMany immigrants in the region flee persecu.docxjessiehampson
Migration and Refugees
Many immigrants in the region flee persecution and then return after they are liberated. For example, 700,000 Jews were allowed to leave the former Soviet Union and enter Israel in the 1990s. There has also been a migration of Palestinian people. Discuss the following:
Why do you think that Israel is such an important place for the Jews?
What is the importance of the area to the Palestinians?
What do you think the impact would be on you and your families if you participated in such long-distance migration?
No references needed, need response within 3 hours!
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Min-2 pagesThe goal is to develop a professional document, take .docxjessiehampson
Min-2 pages
The goal is to develop a professional document, take a stake in your company (its a t-shirt and apparel company; see attached) as a business owner, and develop a business plan with the aim of securing financing to expand one’s business for an established firm.
Complete the following: (using the business plan working document)
10.0 Financials Plan
*Annotated plan has additional details if you have questions or need explanation
.
Mingzhi Hu
First Paper
3/5/2020
POLS 203
Application of Realism Theory on Civil war in Syria and International Relations
International relation can be best understood through the various schools of thought or
rather theories. They are significant in giving a comprehensive detail of the constructs that make
international relations. Realism theory still remains one of the most influential tools in
understanding events related to international relations. This is because it provides a pragmatic
approach in examining current events in the sphere of international relations (Maghroori, pg. 17).
Realism is divided into three subdivisions, seeking to explain causes of state conflict. This
include classical realism that argues that the conflict comes from the nature of man, neorealist
which associates conflict the elements of the state, and neoclassical realism which associates it to
both human nature and elements of the state. This school of thought is grounded on some
fundamental principles that make the core of its arguments.
The first assumption in realism is the idea that a country, usually referred to as a state,
serves as the main actor in international relations. It acknowledges the fact that there are other
actors like individuals and organizations, which have limited influence (Maghroori 11).
Secondly, the state is considered a unitary player, which is expected to work harmoniously, with
regard to matters of national interest. In addition, realists believe that the people who make
decisions are rational players, since this rationality is required in pursuing the interest of the
nation. In essence, the leaders are believed to understand these assumptions regardless of their
Laci Hubbard-Mattix
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But selfish
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What do you mean by "work harmoniously"
Laci Hubbard-Mattix
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It is not clear what this sentence means.
political position, so ensure their sustainability and continuity. Consequently, it is assumed that
states exist in an anarchy context, where there is no single international leader. In this
theorization, the role of nature in influencing human action is not ignored. It asserts that nature
influence people to continue acting in repetitive tendencies. In this assumption, it comes out that
people desire power because of the egoistic nature. The innate selfishness of human beings,
mistrust and their thirst for power explains the unpredicted consequences that can result from
their actions (Maghroori 20). Such human tendencies can explain the unending wars among
nations. Bearing the fact that nations are governed by human beings, their nature contributes
largely to their behavioral tendencies, which in turn influence its security.
Realist therefore assume that leaders have the responsibility to promote the security of
their country in all fronts. This can be realized through consta.
Miller, 1 Sarah Miller Professor Kristen Johnson C.docxjessiehampson
Miller, 1
Sarah Miller
Professor Kristen Johnson
CHID 230
2 April 2019
The Myth of Disability as Isolating in Tim Burton’s Edward Scissorhands
Jay Timothy Dolmage discusses the common disability myths that condition our
understanding of disability in his work Disability Rhetoric. He argues that these myths create the
perception that disabled people are “others”, through the portrayal of them as lesser, surplus, or
improper (Dolmage, 31). One of the myths that Dolmage examines is disability as isolating or
individualizing, which is perpetrated through narratives of disabled people living in isolation,
rarely having romantic relationships or friendships, and often being left alone at the end
(Dolmage, 43). This myth can be seen in the film Edward Scissorhands, directed by Tim Burton.
Edward is a human being created by an inventor, yet the inventor’s death before his completion
leaves him with scissor blades for hands. Edward lives in a gothic mansion atop a hill,
completely in isolation until local Avon saleswoman Peg Boggs visits. She is initially frightened
by his appearance, yet decides to take him home with her upon the realization that he is
harmless. Edward’s disability causes his transition into society to be largely unsuccessful, as he
is objectified and used by other people for their benefit, and at the end of the film he is forced to
return to living in isolation after their perception of him turns to one of fear and scorn.
Edward’s isolation from society is symbolically portrayed through many film design
techniques. The mansion in which he lives at the beginning and the end of the film starkly
contrasts the community in which the able-bodied society lives. The mansion is gothic, dark, and
partially in ruins, whereas the rest of the houses are brightly colored in pinks, yellows, and
Miller, 2
greens, all with perfectly manicured green lawns. His appearance also separates him from the
rest of society, as he has very pale skin, dark under-eyes, black untamed hair, and wears gothic
industrial clothes. The able-bodied individuals often wear colorful or light clothes and appear
quite “ordinary”. The contrast created between Edward and society through set, clothing,
makeup, and hair design work to portray Edward and his disability as unusual, creepy, and
“other”. Peg even attempts to “normalize” his appearance by giving him different clothes to wear
and attempting to cover his scars with makeup, in the hopes that it will ease his transition into the
community. This film phenomenon is discussed by Martin F. Norden in his book The Cinema of
Isolation: A History of Physical Disabilities in the Movies. He argues that filmmakers will
separate disabled characters from their able-bodied peers not only through the storyline, but also
through a number of design elements. He also states that this technique allows filmmakers to
reflect an able-bodied point of view and reduce d.
Migrating to the Cloud Please respond to the following1. .docxjessiehampson
"Migrating to the Cloud" Please respond to the following:
1. Imagine that you are a CIO and you have been tasked to examine the process of moving from one host server or storage location to another. Predict two foreseen challenges of migrating an application to the cloud in a live migration and high- availability setting. Propose a preventative measure or a solution for each of these challenges.
2. Imagine that you are the CIO for a midsized organization in this industry. Determine, in 10 or less steps, the timeline for a live migration to the cloud in your organization. Determine the three greatest risks in this deployment.
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Mike, Ana, Tiffany, Josh and Annie are heading to the store to get.docxjessiehampson
Mike, Ana, Tiffany, Josh and Annie are heading to the store to get some snacks. Mike has $1, Ana has $2, Tiffany has $3, Josh has $4, and Annie has $5.
What's the average (mean) amount of cash the five kids have? What's the median? A few days later, Annie's family won the lottery, and the kids go together to the store to get some snacks again. This time Mike has $1, Ana has $2, Tiffany has $3, Josh has $4, and Annie has wad of cash totaling $5,000.
What's the average (mean) amount of cash the five kids have this time? What's the median?
From part a, how have the mean and the median changed?
Which one - the mean or the median - is a better reflection of how much money they have together? Take you time before answering.
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Michelle Wrote; There are several different reasons why an inter.docxjessiehampson
Michelle Wrote;
There are several different reasons why an intervention fails, such as the wrong intervention being selected or trying to solve the wrong problem. It is important that when performing and intervention that every thing have been severely observed and taken into consideration. I worked with an organization that was a travel agency, and they operated off of the commission that was collected from the booking that are processed, but they also provided a discount to the members that was taken out of the commission total. The issue was that when they initially opened the department there was no budget plan done and no guidelines were given, the agents were told to use discretion, and all though the department was a huge success in booking reservations they were still failing, because they were not withholding enough commission for the organization to operate under. Where the intervention process failed is that they never had formal training, which would have been a focus group to define the exact percentage to give to customer and the amount the organization needed to cover their overhead. During the meeting process there should have been definite guidelines to lead employees and managers from the accounting department so that the employees did not need to play the guessing game. Although they had the meeting nothing changed, because the problem was not solved with the employees and managers and was not addressed by the accounting department. The business is now in danger of folding because of the poor communication practices.
William Wrote:
Although what I am going to talk about is not my workplace but the place that I volunteer my time to sit on the board of directors for a non profit agency. As a board member we oversee the agency as a whole but we also break down into small committee groups to address needs as they arise. One of the committees that I am on is the planning committee. A change that was implemented by administration, program staff, and the board was all departments would start entering all their own data. At the time the agency had two data entry personal that was entering all agency data. So the change we made was that instead of hiring another data entry person we would require all programs to enter their own data into the collection software. This ended up being a failure that could have been huge had we not pulled reports the first two quarters of the year. What we found was some programs were right on target with getting their information entered with the first quarter. The Executive Director addressed this with staff. When the second quarter reports were pulled the data did not get any better. As an agency this failed due to program staff just did not have the appropriate time to take on more data entry. The agency ended up where we should have to start off, hiring another data entry staff member. I will say with this failure it actually turned into a very positive experience over all.
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Midterm Lad Report 7
Midterm Lab Report
Introduction
Cellular respiration refers to all the metabolic processes and chemical reactions that take place in living organisms, particularly at the cellular level. These processes focus on the extraction of energy from nutrients. It is also responsible for converting the biochemical energy into 'adenosine triphosphate' (ATP) by the breakdown of sugars in the cells (Bennet 58). Cellular respiration is also responsible for the process by which cells release chemical energy required for conducting cellular activities. The reactions and processes facilitate the release of waste products from the cells. This experiment seeks to conduct a study of the processes and reactions involved during cellular respiration. The experiment will include several activities, such as having a study on the amount of Carbon dioxide produced during the experiment.
The number of levels of the growth of a yeast medium as a dependent variable will also be monitored during the experiment. There are other several independent variables associated with the experiment. These independent variables include sugar and temperature, among others, and their role in the experiment were also monitored. The experiment design involved the use of airtight balloons capped over reaction chambers that were used to collect the Carbon dioxide produced during the experiment. The reaction chambers contained sugars and yeast medium, which facilitated the reactions. Thermometers and pH scale were used to monitor the changes in temperature and acidity levels during the experiment. The paper involves a lab design that institute steps such as arranging the bottles used on the experiment. Notably, a proper arrangement to make sure that all the carbon dioxide released during the respiration process is well tapped in the bottles for correct lab results
Methodology
The actual procedure for experimenting involved taking measurements and recording of all observations made during the experiment. For accurate results, measures were taken three times, and a mean measurement was calculated and recorded. Winzler asserts that the mean obtained from the measurements should be used to calculate the standard deviation, which in turn facilitated the calculation of uncertainty (276). Below are the steps for conducting the experiment. It is essential to read the instructions carefully safety and accuracy during the experiment. Notably, all the lab and experiment results were well observed and thus making sure that there are limited errors in the whole process.
Consequently, all the steps required in the lab report were also clearly followed to help in getting the correct data and even not to affect the whole experiment process. The experiment involved setting the apparatus as per the set standard and the requirement. As per this concept, all the apparatus were set in a proper way to avoid vague results. Notably, to get the correct measurement and results, it is import.
MicroEssay Identify a behavioral tendency that you believe.docxjessiehampson
MicroEssay
Identify a behavioral tendency that you believe you have inherited (one that is determined, at least in part, by your genetic make-up). Explain the ways you think this trait has been affected by your environment by applying the different types of gene x environment correlations to your example (passive, evocative, and active)? What does this suggest about the nature-nurture debate?
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MILNETVisionMILNETs vision is to leverage the diverse mili.docxjessiehampson
MILNET
Vision
MILNETs vision is to leverage the diverse military experience of Crawford employees to create awareness opportunities that help forester an appreciation, understand, and respect for the military culture and members we serve
Benefits
· Know our Members
· Support recruiting and retention
· Facilitate transition from military to Crawford
· Centralized source to connect with peer veterans
· Provide Member Experience, Marketing, and other Crawford initiatives and expert knowledge base.
MILNET Leadership Team (Volunteer position)
· Event & Volunteer Lead- Plan and execute mandatory enterprise events
· Technology Lead- Maintain MILNET budget throughout the year and reports overview or expenses monthly
· MILNET Spouse Lead- Ensures connect of sites are up to date/accurate, to include Veteran/Military Spouse Registration
· Secretary-Manages relationships by identifying opportunism for partnership
· Communications/Marketing Lead- Communicates to the MILNET community regularly via multiple channels (Email, Internal Social) regarding upcoming events, announcement, and other communications.
Background
Grandfather Air force
Parents- Army
Myself- Army
Spouse Army
Skills
Knowledgeable
Passionate
Qualified
Education
-Associates Accounting
-Bachelor’s in business and HR
-MRA w/ HR concentration
1 – Paragraph for each question (Professional answers)
Question 1- What is your visions of MILNET?
Question 2-How would your selection impact the Leadership Team?
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midtermAnswer all question with proper number atleast 1 and half.docxjessiehampson
midterm
Answer all question with proper number atleast 1 and half page
APA FORMAT SIZE 12
1. Why is culture important to political scientists?
2. How is political science an interdisciplinary major?
3. How can politics be treated as a science?
4. Describe how modern liberalism differs from classical liberalism and explain how modern conservatism related to classical liberalism?
5. Explain how nationalism can be dangerous to a nation. Use both theoretical ideas and concrete examples to support your claims
6.
Evaluate the "end of ideology" argument by considering the facts that fit and contradict this view on today's world
7. What are the means by which power is institutionalized? What makes for good institutions? Provide examples from the United States and one other country
8. Identify the purposes of constitutions and explain why they are necessary
9. Describe how the principle of separation of powers is manifested in the U.S. Constitution and explain how this principle has evolved over time in the United States.
10. Bonus Question: What are the 10 Bill of Rights
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Midterm QuestionIs the movement towards human security a true .docxjessiehampson
Midterm Question
Is the movement towards human security a true paradigm shift? In answering this question make sure to consider which of the authors whom you have read in Weeks one to four of the course support your view and which do not. *The sole use of attached readings is required for the midterm*
Midterm Assignment – Instructions (Read Carefully)
In university courses, assignments (or assessments) are meant to give students the opportunity to demonstrate what they have been learning in the course – and give instructors evidence that such learning is occurring within the classroom. Because of these objectives, it is imperative to incorporate the specifics of what you’ve been studying in the course into your writing assignments. You accomplish this by answering the Midterm question in the assessment via the course objectives and readings from the course. The midterm will cover the following objectives:
1. Describe the role of rapid globalization in changing perceptions of security
2. Identify key threats to human security (food security, personal security, environmental security)
3. Apply the concepts of human security
4. Compare and contrast traditional international relations approaches to security with the doctrine of human security.
Additional Instructions
To answer the Midterm question you will write an analytical essay. The analytical essay is a practical approach to solving a problem. So think of this essay question as you would an assignment from your boss: “I need you to take a look at this problem and solve it for me using things from your IR toolkit (what you have learned, or know). Present a well-written, concise answer to me in four pages. I need it by tomorrow morning.” This is how it happens in the real world, and this is what we want to prepare you to do. To achieve this structure of the essay please keep the following tips in mind:
1. Remember that the analytical essay is highly-structured. Each paragraph should look like the others in terms of style and substance. Writing to the limit of four pages is an art and something you need to learn to do. So, don’t write fewer than four pages and don’t write more. You may need to write over just a little and then edit away the extra parts of the essay to reach the concise four pages.
2. Review your submission and make sure that you have covered the requirements of the assignment using only material from the lessons and readings.
Format for the Essay:
1. Do not use a cover page. Instead, create a header with your name, assignment name, and date. To do this in Word, go to “insert” and then “header.” Do the same thing to insert a ‘footer’ and include page numbers. If you need help, use the ‘help’ function to learn more within Word.
2. Your submission should be four pages (no more, no less) and look like this:
a. Introduction: Introduce your topic & include a thesis. To help you set up your analytical essay include three reasons why you agree or disagree with the midterm quest.
MGT/526 v1
Wk 2 – Apply: Organizational Analysis
MGT/526 v1
Page 2 of 2
Wk 2 – Apply: Organizational AnalysisInstructions
Complete the worksheet based on your chosen organization. Use Business Source Complete and your selected company’s website, annual report, and other available sources. Part 1: Organization Information
Organization
Define your chosen company and its industry.
Mission and Vision
Identify the mission and vision of the organization.
Mission
Vision
Organizational Initiatives
Outline 1-2 major initiative for this organization. What are they currently doing to support these initiatives?
Organizational Plans
Describe the plans employed by the organization. Determine which types of managers create each type of plan.
Type of Plan
Description
Type of Manager
SWOT Analysis
There are various factors within the external environment of an organization that impacts its strategy.
Analyze the organization’s SWOT analysis. Identify the internal and external factors. Include a link to the SWOT analysis in the Reference section of this worksheet.
Internal Factors
External Factors
Part 2: Evaluation
Evaluate if the mission, vision, planning process, and SWOT analysis meets the current needs of the organization. Include the following in your evaluation:
· Describe the unmet need, (not limited to product or service, can be new demographic, new mode of delivery, etc.).
· Analyze your competitive advantages.
· Based upon the SWOT analysis, is there another business that is doing something similar that can be referred to? Provide examples.
· If there is not another business, describe how what you’re doing is a unique product or service offering.
· Propose a competitive business initiative to address the unmet need.
· Create a high-level timeline and operational steps necessary to implement your solution. References
Include a link to theSWOT analysis.
Copyright 2020 by University of Phoenix. All rights reserved.
Copyright 2020 by University of Phoenix. All rights reserved.
COUN 6785: Social Change in Action:
Prevention, Consultation, and Advocacy
Social Change Portfolio
M. Negrón
Contents
Introduction
Scope and Consequences
Social-ecological Model
Theories of Prevention
Diversity and Ethical Considerations
Advocacy
INTRODUCTIONAdressing Teen Pregnancy in Pittsburg, California
In more recent years, there has been an effort in my community to address teen pregnancy due to its growing rates. Over the years teen pregnancy rates have continued to rise in Contra Costa County as well as surrounding counties. Unfortanately, the town I come from is a small town within Contra Costa County so resources are limited. In order to address teen pregnancy there needs to be easier access to resources to prevent teen pregnancy from occurring. Teen pregnancy can lead to a number of different problems such as low socioeconomic status, greater chance of contracting a sexually transmitted infec.
Microsoft Word Editing Version 1.0Software Requirement Speci.docxjessiehampson
This document provides a software requirements specification for Microsoft Word 2016. It includes an introduction, purpose, scope, definitions, and overview. Use cases are defined for signing in, opening, creating new files, saving, saving as, exporting, printing, and changing fonts. Requirements cover performance, usability, supportability, configurability, and recoverability. The 8 use cases are then described in more detail with normal and alternate flows and screenshots.
Microsoft Windows implements access controls by allowing organiz.docxjessiehampson
Microsoft Windows implements access controls by allowing organizations to define users, groups, and object DACLs that support their environment. Organizations define the rules, and Windows enables those rules to be enforced.
Answer the following question(s):
Do you think access controls are implemented differently in a government agency versus a typical information technology company? Why or why not?
2. Do you think access controls differ among private industries, such as retail, banking, and manufacturing? Why or why not?
.
MGT520
Critical Thinking Writing Rubric - Module 10
Exceeds
Expectation
Meets Expectation Below Expectation Limited Evidence
Content, Research, and Analysis
21-25 Points 16-20 Points 11-15 Points 6-10 Points
Requirements Exceeds
Expectation -
Includes all of the
required
components as
specified in the
assignment.
Meets Expectation-
Includes most of
the required
components as
specified in the
assignment.
Below Expectation-
Includes some of
the required
components as
specified in the
assignment.
Limited Evidence -
Includes few of the
required
components as
specified in the
assignment.
21-25 Points 16-20 Points 11-15 Points 6-10 Points
Content Exceeds
Expectation -
Demonstrates
substantial and
extensive
knowledge of the
materials, with no
errors or major
omissions.
Meets Expectation-
Demonstrates
adequate
knowledge of the
materials; may
include some
minor errors or
omissions.
Below Expectation-
Demonstrates fair
knowledge of the
materials and/or
includes some
major errors or
omissions.
Limited Evidence -
Fails to
demonstrate
knowledge of the
materials and/or
includes many
major errors or
omissions.
25-30 Points 19-24 Points 13-18 Points 7-12 Points
Analysis Exceeds
Expectation -
Provides strong
thought, insight,
and analysis of
performance
management
system, concepts
and applications.
Meets Expectation-
Provides adequate
thought, insight,
and analysis of
performance
management
system, concepts
and applications.
Below Expectation-
Provides poor
thought, insight,
and analysis of
performance
management
system, concepts
and applications.
Limited Evidence -
Provides little or no
thought, insight,
and analysis of
performance
management
system, concepts
and applications.
13-15 Points 10-12 Points 7-9 Points 4-6 Points
Sources Exceeds
Expectation -
Sources go above
and beyond
required criteria,
and are well
chosen to provide
effective
substance and
perspectives on
the issue under
examination.
Meets Expectation-
Sources meet
required criteria
and are adequately
chosen to provide
substance and
perspectives on the
issue under
examination.
Below Expectation-
Sources meet
required criteria,
but are poorly
chosen to provide
substance and
perspectives on the
issue under
examination.
Limited Evidence -
Source selection
and integration of
knowledge from
the course is
clearly deficient.
Mechanics and Writing
5 Points 4 Points 3 Points 1-2 Points
Demonstrates Exceeds Meets Expectation- Below Expectation- Limited Evidence -
MGT520
Critical Thinking Writing Rubric - Module 10
college-level
proficiency in
organization,
grammar and
style.
Expectation -
Project is clearly
organized, well
written, and in
proper format as
outlined in the
assignment. Strong
sentence and
paragraph
structure; contains
no errors in
grammar, spelling,
APA style, or APA
citations and
references..
Midterm PaperThe Midterm Paper is worth 100 points. It will .docxjessiehampson
Midterm Paper
The Midterm Paper is worth 100 points. It will consist of a 500 word written description and analysis of a work of art using terminology from Chapters 2-5.
For this assignment, you are to discuss the form, content, and subject matter of a work of art chosen from the list provided. This is an exercise in recognizing visual elements and principles of design in works of art and demonstrating an understanding of how they relate to each other to create meaning. This paper is about looking and seeing. This is not a research paper; you will not need to do additional research. Please follow the outline provided below.
First: Select a work of art
Select one of the following listed works of art:
Circle of Diego Quispe Tito.
The Virgin of Carmel Saving Souls in Purgatory
. Late 17th century. Fig. 1.22, pg. 17.
Henri Matisse.
Large Reclining Nude
. 1935. Fig. 4.24, pg. 85.
Faith Ringgold.
Tar Beach
. 1988. Fig. 13.18, pg. 219.
Henry Ossawa Tanner.
The Banjo Lesson
. 1893. Fig. 21.15, pg. 373
Andy Warhol.
Marilyn Diptych
. 1962. Fig. 24.23, pg. 447.
Format
Describe the use of each visual element and principle of design in the order they are listed in the outline. You can simply list each term and address how it is used in the painting. If you write in paragraph form be sure to identify each term clearly. Any term not addressed will receive 0 points. Provide specific examples. For example, don’t just say “there are lines,” give specific examples of how line is used in the piece you’ve selected.
Papers should be 500 words minimum (not including images), double-spaced, 10 or 12 point, with 1" margins. The preferred format is Microsoft Word (.doc or .docx). If these formats are not available, other acceptable formats are ASCII (.txt), rich text format (.rtf), Open Office (.odt), and PDF. Make sure you proofread your papers for incorrect grammar, spelling, punctuation, and other errors.
The Midterm Paper is due at 11:59 pm CT Sunday of Week 4.
Midterm Paper Outline
Introduction (First Paragraph)
In the first paragraph, called the introduction, you will include:
An identification of the work of art you selected: The name of the artist, title (which is underlined or italicized every time you use the title in your paper), date, and medium.
Your initial interpretation of the subject based on your initial observations.
Description
Describe how each of the following is used in the piece you selected.
Visual Elements
:
Line: what types of lines do you see in the piece? Provide examples.
Shape: what types of shapes do you see? Provide examples.
Mass: How is mass implied?
Space: How is the illusion of space created in the piece?
Time and Motion: Are time and motion evident in tis piece? How so?
Light: How is light used here?
Color: How does the artist use color?
Texture: How does the artist create the illusion of texture, or incorporate actual texture
Principles of Design
Unity and Variety: In what way is this pi.
Miami Florida is considered ground zero for climate change, in parti.docxjessiehampson
Miami Florida is considered ground zero for climate change, in particular rising seas will not only drown coastal sections of the city but will disrupt our local supply of drinking water.
Based on what you have learned so far from this class, discuss the following:
Explain where the drinking water from South Florida primarily comes from and why would rising sea levels disrupt this supply?
What efforts can be made and are being made to mitigate the effects of rising seas on our drinking water?
If you were a local politician, what advice would you give to state and federal officials on the best way to ensure residents in South Florida had a steady supply of drinking water for many years to come?
.
MGT230 v6Nordstrom Case Study AnalysisMGT230 v6Page 2 of 2.docxjessiehampson
MGT/230 v6
Nordstrom Case Study Analysis
MGT/230 v6
Page 2 of 2
Nordstrom Case Study Analysis
Nordstrom—“High Touch” with “High Tech”
How does Nordstrom stay profitable despite dips in consumer spending, changing fashion trends, and intense competition among retailers? One answer: Acute attention to detail and well-laid plans.
All in the Family
The fourth generation of family members that runs Nordstrom has brought the store’s time-honored and successful retail practices into a new era. “Nordstrom, it seems, is that rarity in American business: an enterprise run by a founding family that hasn’t wrecked it,” says one business writer. The company provides a quality customer experience via personalized service, a compelling merchandise offering, a pleasant shopping environment, and increasingly better management of its inventory.
Secret of Success
The secret of this company’s success lies in its strategic planning efforts and the ability of its management team to set broad, comprehensive, and longer-term action directions, all of which are focused on the customer experience. The current generation of Nordstrom family members was quick to spearhead an ultramodern multimillion-dollar, Web-based inventory management system. This upgrade helped the company meet two key goals: (1) correlate purchasing with demand to keep inventory as lean as possible, and (2) give customers and sales associates a comprehensive view of Nordstrom’s entire inventory, including every store and warehouse.
Demand Planning
Instead of relying on one-day sales, coupon blitzes, or marking down entire lines of product, Nordstrom discounts only certain items. “Markdown optimization” software assists in planning more profitable sale prices. According to retail analyst, Patricia Edwards, this helps Nordstrom calculate what will sell better at different discounts and forecast which single items should be marked down. If a style is no longer in demand, the company can ship it off to its Nordstrom Rack outlet stores. It’s all part of Nordstrom’s long-term investment in efficiency. “If we can identify what is not performing and move it out to bring in fresh merchandise,” says Pete Nordstrom, “that’s a decision we want to make.”
Inventory Planning
Although inventory naturally fluctuates, Nordstrom associates can easily locate any item in another store or verify when it will return to stock. Customers on their smart phones and associates behind sales counters see the same thing—the entire inventory of Nordstrom’s stores is presented as one selection, which the company refers to as perpetual inventory. “Customer service is not just a friendly, helpful, knowledgeable salesperson helping you buy something,” says Robert Spector, retail expert and author of The Nordstrom Way. “Part of customer service is having the right item at the right size at the right price at the right time. And that’s something perpetual inventory will help with.”
The upgraded inventory management system was an .
THE SACRIFICE HOW PRO-PALESTINE PROTESTS STUDENTS ARE SACRIFICING TO CHANGE T...indexPub
The recent surge in pro-Palestine student activism has prompted significant responses from universities, ranging from negotiations and divestment commitments to increased transparency about investments in companies supporting the war on Gaza. This activism has led to the cessation of student encampments but also highlighted the substantial sacrifices made by students, including academic disruptions and personal risks. The primary drivers of these protests are poor university administration, lack of transparency, and inadequate communication between officials and students. This study examines the profound emotional, psychological, and professional impacts on students engaged in pro-Palestine protests, focusing on Generation Z's (Gen-Z) activism dynamics. This paper explores the significant sacrifices made by these students and even the professors supporting the pro-Palestine movement, with a focus on recent global movements. Through an in-depth analysis of printed and electronic media, the study examines the impacts of these sacrifices on the academic and personal lives of those involved. The paper highlights examples from various universities, demonstrating student activism's long-term and short-term effects, including disciplinary actions, social backlash, and career implications. The researchers also explore the broader implications of student sacrifices. The findings reveal that these sacrifices are driven by a profound commitment to justice and human rights, and are influenced by the increasing availability of information, peer interactions, and personal convictions. The study also discusses the broader implications of this activism, comparing it to historical precedents and assessing its potential to influence policy and public opinion. The emotional and psychological toll on student activists is significant, but their sense of purpose and community support mitigates some of these challenges. However, the researchers call for acknowledging the broader Impact of these sacrifices on the future global movement of FreePalestine.
Andreas Schleicher presents PISA 2022 Volume III - Creative Thinking - 18 Jun...EduSkills OECD
Andreas Schleicher, Director of Education and Skills at the OECD presents at the launch of PISA 2022 Volume III - Creative Minds, Creative Schools on 18 June 2024.
Gender and Mental Health - Counselling and Family Therapy Applications and In...PsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
How to Manage Reception Report in Odoo 17Celine George
A business may deal with both sales and purchases occasionally. They buy things from vendors and then sell them to their customers. Such dealings can be confusing at times. Because multiple clients may inquire about the same product at the same time, after purchasing those products, customers must be assigned to them. Odoo has a tool called Reception Report that can be used to complete this assignment. By enabling this, a reception report comes automatically after confirming a receipt, from which we can assign products to orders.
CapTechTalks Webinar Slides June 2024 Donovan Wright.pptxCapitolTechU
Slides from a Capitol Technology University webinar held June 20, 2024. The webinar featured Dr. Donovan Wright, presenting on the Department of Defense Digital Transformation.
Contiguity Of Various Message Forms - Rupam Chandra.pptx
VOLUME 21, NUMBER 1 CLINICAL JOURNAL OF ONCOLOGY NURSING 79CJO.docx
1. VOLUME 21, NUMBER 1 CLINICAL JOURNAL OF
ONCOLOGY NURSING 79CJON.ONS.ORG
A
Detecting Distress
Introducing routine screening in a gynecologic cancer setting
Moira O’Connor, BA(Hons), MSc, PhD, Pauline B. Tanner, RN,
RM, CertOnc, SBCN, Lisa Miller, MBBS, DCH, FRACGP,
FAChPm, FRANZCP,
Kaaren J. Watts, BA(Hons), PhD, and Toni Musiello,
BA(Hons), MA, PhD
ALONGSIDE PHYSICAL SYMPTOMS AND SIDE EFFECTS
of treatment, cancer results
in psychological, social, and practical challenges, which can
contribute to
patient distress (Carlson, Waller, Groff, Giese-Davis, & Bultz,
2013). The
International Psycho-Oncology Society highlights distress as a
critical factor
affecting patients’ well-being and recommends that distress be
named the
sixth vital sign in oncology (Holland, Watson, & Dunn, 2011).
The report-
ed prevalence rates of psychological distress in patients with
cancer range
from 35%–49% (Carlson, Groff, Maciejewski, & Bultz, 2010).
However, the
actual rates of distress are thought to be much higher because of
underdetec-
2. tion. Clinician assessments have been shown to be inferior to
gold-standard
methods, such as validated screening tools and clinical
interviews (Werner,
Stenner, & Schüz, 2012), and distress is often missed by
clinicians (Mitchell,
Vahabzadeh, & Magruder, 2011).
Distress encompasses a range of issues, including
psychological, spiritual,
and existential distress, as well as juggling roles and having
financial concerns
and practical problems, such as needing help with
accommodation or travel.
Distress is associated with poorer physical and psychological
quality of life
(Carlson et al., 2010). Detecting distress in patients with cancer
can result in
early intervention, which helps avoid patients struggling with
unmet or com-
plex needs (Faller et al., 2013). Identifying distress early could
also reduce the
financial burden on health services (Han et al., 2015).
Healthcare profession-
als (HCPs) must recognize distress so it can be adequately
managed (Werner
et al., 2012); to do this, HCPs need to screen all patients
systematically.
Several organizations and professional bodies state in their
standards
for quality cancer care that psychosocial support should include
routine
screening for distress, followed by appropriate referrals targeted
to the needs
identified by patients (Holland et al., 2011; Werner et al.,
3. 2012). Despite this,
uptake of routine distress screening in clinical oncology settings
has been
suboptimal (Mitchell, Lord, Slattery, Grainger, & Symonds,
2012). Many
barriers exist to the successful implementation of routine
distress screen-
ing in clinical settings, including a lack of training, clinicians’
perception of
limited skills and confidence in identifying distress, and
inadequate referral
resources (Absolom et al., 2011). A shortage of private space
has also been
identified (Ristevski et al., 2013). Many HCPs believe that
addressing distress
will take too much time. However, appropriate recognition and
discussion of
emotions can reduce consultation times (Butow, Brown, Cogar,
Tattersall, &
Dunn, 2002).
Roth et al. (1998) developed a single-item Distress
Thermometer (DT),
which the National Comprehensive Cancer Network (Vitek,
Rosenzweig, &
KEYWORDS
gynecologic cancer; oncology; distress
screening; Distress Thermometer
DIGITAL OBJECT IDENTIFIER
10.1188/17.CJON.79-85
4. BACKGROUND: Cancer results in a wide range of
challenges that contribute to patient distress. De-
tecting distress in patients can result in improved
patient outcomes, and early intervention can avoid
patients having unmet needs.
OBJECTIVES: The aims were to determine the
prevalence of distress in patients with gynecologic
cancers, identify specific problems, and explore
staff perceptions of distress screening.
METHODS: A mixed-methods design was used.
Quantitative data were collected on distress
levels and problems. Qualitative interviews were
conducted with healthcare professionals.
FINDINGS: Sixty-six percent of women scored 4 or
greater on the Distress Thermometer, which was
used as the indicator for follow-up or referral. A
third reported low distress, and the same propor-
tion was highly distressed. The top five problems
5. identified by participants were nervousness, worry,
fears, fatigue, and sleep problems.
80 CLINICAL JOURNAL OF ONCOLOGY NURSING
VOLUME 21, NUMBER 1 CJON.ONS.ORG
DETECTING DISTRESS
“Some patient worries
can be allayed by
active listening, but
high anxiety levels
need referral.”
Stollings, 2007) paired with a Problem List (PL). The DT takes
one
to five minutes to complete. A meta-analysis by Ma et al.
(2014)
found the DT to be a valid tool for detecting distress in patients
with a cancer diagnosis. The DT is not a diagnostic tool
(Tavernier,
2014), but when combined with clear referral pathways, it
provides
an ideal way to streamline care (Snowden et al., 2011).
In 2006, the Australian Senate conducted an inquiry into gy-
necologic cancer in Australia (Parliament of Australia, 2006).
The
report highlighted the urgent need for appropriate and timely re-
ferral pathways, including psychosocial referrals. Screening was
also prioritized in models of care of the Western Australian
(WA)
Gynaecological Collaborative and the WA Psycho-Oncology
6. Collaborative (Department of Health, WA, 2008a, 2008b).
Despite this emphasis, screening has not been formally imple-
mented in a clinical setting in WA, and the practical
implications
of applying such a screening program remain unclear. Snowden
et al. (2011) stated that the DT has been validated sufficiently
and
that additional research should focus on its use in clinical
settings
to understand the complexities of implementation (Fitch, 2011).
The current study investigated the impact of screening for dis-
tress in patients with gynecologic cancer in WA.
The aims were to (a) establish the prevalence and level of dis-
tress and determine specific problems identified by patients and
(b) explore staff perceptions of the process of using the DT and
PL and referring patients.
Methods
A mixed-methods design was used. The current study was ap-
proved by the King Edward Memorial Hospital and Curtin
University human research ethics committees. Quantitative
data were collected on the DT and PL in a cross-sectional study.
Qualitative interviews were conducted with HCPs.
The setting was a WA public women’s and newborns’ tertiary
teaching hospital, King Edward Memorial Hospital, which is the
direct referral pathway for women with gynecologic
malignancies
in the state. It offers the full range of services for inpatients and
outpatients.
Sample
Sixty-two patients with gynecologic cancer in the pre-
admission clinic, where women are seen prior to surgery, partic-
ipated in the study during a six-month period. Women were in-
7. cluded if they were aged 18 years or older, were diagnosed with
a
gynecologic cancer, and were able to comprehend and complete
the DT and PL. Women who were aged younger than 18 years,
had not received a gynecologic cancer diagnosis, were unable to
comprehend or complete the DT and PL, or were unable to give
informed consent were excluded. The median age was 58 years,
and the range was 25–94 years (see Table 1). Six oncology
HCPs
were interviewed—three nurses, two social workers, and one
physiotherapist.
Procedure
At the pre-admission clinic, the research officer (RO) visited
each
patient, explained the research project, provided written infor-
mation, and invited patients to participate. If the patient agreed
to participate, she signed the consent form and was asked to
com-
plete the DT and PL on her own or with the RO. Following com-
pletion, the patient had a consultation with an oncology nurse
on
duty and, if necessary, the social worker who was present in the
weekly clinic. DTs and PLs were evaluated by the oncology
nurses
who could triage and refer women to appropriate interventions
according to distress and psychosocial management guidelines
(National Breast Cancer Centre and National Cancer Control
Initiative, 2003). The DT has a single item scored from 0 (no
dis-
tress) to 10 (high distress), and the PL has 39 problems in five
domains with “yes” or “no” responses.
At the completion of the project, HCPs were approached di-
rectly by the RO, consented, and interviewed at a time
convenient
8. to them. These interviews were conducted by a trained
interview-
er with extensive experience working with vulnerable
populations.
Interviews were digitally recorded.
Analysis
Data were entered into SPSS®, version 22.0. Descriptive
statistics
were used to describe the DT scores and problems identified. To
examine between-group differences, Pearson chi-square test for
independence and a one-way analysis of variance (ANOVA)
were
used. A Pearson product–moment correlation coefficient was
used to look at the correlation between the number of problems
and distress score.
Qualitative data from interviews conducted with HCPs were
analyzed using directed content analysis (Hsieh & Shannon,
2005) because the focus was on how distress screening worked
in clinical practice. Deductive category application was used;
the
text was read, and salient points were highlighted before
develop-
ing the categories, using the interview questions as a guide. The
analysis was undertaken by two of the authors. Rigor for the
study
was ensured by employing transparency, consistency, neutrality,
applicability, and credibility (Emden and Sandelowski, 1998).
An
VOLUME 21, NUMBER 1 CLINICAL JOURNAL OF
ONCOLOGY NURSING 81CJON.ONS.ORG
9. CJON.ONS.ORG
audit trail of decisions was maintained, and the team met to dis-
cuss emerging themes and reach agreement.
Findings
Twenty-one participants scored from 0–3 on the DT, 20 partic-
ipants scored from 4–6, and 21 participants scored from 7–10.
For additional descriptive statistics, see Table 2. Of the prob-
lems identified on the PL, 207 were physical, 53 were practical,
24 were familial, 147 were emotional, and 2 were spiritual (see
Figure 1).
Pearson chi-square test for independence indicated a signif-
icant association between age group (three categories: aged 40
years or younger, aged 41–64 years, and aged 65 years or older)
and the three different distress score categories (0–3, 4–6, and
7–10) (x2 = 10.181 [4, N = 62], p = 0.04, Cramer’s V = 0.29 [a
medi-
um effect]). Nine participants aged 40 years or younger scored
in
the 7–10 range on the DT, compared to 10 participants aged
from
41–64 years and 3 participants aged 65 years or older.
On average, patients aged younger than 40 years listed 8.31
problems (SD = 4.7), ranging from 2–19; patients aged 41–64
years
listed 8.42 problems (SD = 6.35), ranging from 0–22; and
patients
aged 65 years or older listed 5.89 problems (SD = 5.18),
ranging
from 0–16. A one-way ANOVA showed no significant
differences
between age groups on the number of problems listed (F[2, 54]
10. =
1.2, p = 0.31).
A Pearson product–moment correlation coefficient was used
to determine the relationship between distress scores (continu-
ous) and number of problems. A strong positive association was
found between the two variables (r = 0.53, n = 57, p < 0.0005),
with high levels of distress associated with a greater number of
problems.
A Pearson chi-square test revealed significant differences be-
tween the specific types of gynecologic cancers and the three
dis-
tress levels (x2[8] = 21.41, p = 0.006, Cramer’s V = 0.42 [a
large
effect]). A larger proportion of participants with a diagnosis of
cervical cancer scored in the 7–10 range on the DT (n = 10),
com-
pared to participants diagnosed with another gynecologic cancer
(endometrial = 4, uterine = 4, ovarian = 3, vulvar = 0).
The main themes that emerged from qualitative data were
benefits to patients and staff, challenges faced, and the impact
of routine screening on services. Overall, HCPs indicated little
impact on services. No increase in overall referrals or referrals
to
the social work department was noticed, and no extra need for
counseling was identified.
Patient Benefits
Several perceived benefits to the patients were found, mainly
around validating patients’ concerns and issues: “includes ques-
tions they may not have been expecting (allows them to think
more broadly),” “gives patients permission [to talk] and
includes
questions not usually asked (sexual concerns),” and “normalizes
11. TABLE 1.
SAMPLE CHARACTERISTICS (N = 62)
CHARACTERISTIC n
Age (years)
Younger than 41 13
41–55 12
56–70 20
71–85 14
86–100 3
Cancer diagnosis
Cervical 12
Endometrial 9
Ovarian 17
Uterine 19
Vulvar 4
Missing data 1
Time since cancer diagnosis
2 months or less 38
12. 2–12 months 16
12 months to 2 years 4
More than 2 years 4
Education
No formal education 1
Primary school 5
High school 27
Diploma, certificate, or trade qualification 18
University degree 7
Missing data 4
Occupation
Paid employment 1
Pensioner 5
Self-funded retiree 27
Other 18
Missing data 11
82 CLINICAL JOURNAL OF ONCOLOGY NURSING
13. VOLUME 21, NUMBER 1 CJON.ONS.ORG
DETECTING DISTRESS
patient concerns (interview focused on the patients’ needs).” It
was also seen as a way of introducing a conversation about con-
cerns by offering the patient a prompt and an ice breaker. As
stat-
ed by one participant, “[Patients are] stoic, not wanting to be a
burden, don’t expect help . . . struggle on until crisis.”
Staff Benefits
HCPs saw the tool as adding value in their work by validating
what
they do, empowering patients to help themselves, asking more
de-
tailed questions than routine surgical admission, enhancing nor-
mal practice, offering a more holistic approach, giving guidance
on what the patients’ needs are, and avoiding missing important
issues. One nurse thought it was a good education tool for
honing
in on what is important to ask, particularly when time is
limited,
saying, “DT and PL is a good education tool to inform HCPs on
what to ask when limited amount of time.”
Another nurse talked about saving time by focusing on salient
issues: “Using DT and PL as a prompt for patients can speed up
assessment of needs by focusing on the items that matter to
them
at that moment in time.”
Challenges
Problems and barriers were perceived, mainly around time. The
tool requires knowledge, experience, time allocated, and a
sensi-
14. tive approach. Finding time in a busy pre-admission clinic is
dif-
ficult; extra time may be needed to complete the interview and
document, but that may prevent increased distress later. In ad-
dition, the HCPs developed strategies to reduce time, including
patients prioritizing issues and returning to others later, maybe
by phone.
Another issue was when to administer the DT and PL.
Participants found this difficult because patients need pain
management postoperatively, and sedation may affect them.
Participants said that ward staff should be able to administer the
DT and PL as part of the discharge process.
Discussion
Screening for distress in this setting was successful, and
patients
were receptive to completing the DT and PL. This supports pre-
vious research demonstrating that the DT was feasible among
pa-
tients with lung cancer (Lynch, Goodhart, Saunders, &
O’Connor,
2011) and acceptable for distress screening in men with prostate
cancer (Chambers, Zajdlewicz, Youlden, Holland, & Dunn,
2014).
The current study identified challenges, including timing,
access
to the social worker, and space, but the team found ways around
these barriers. The project proceeded in an iterative way, with
regular meetings to resolve emerging issues. The researchers
suc-
ceeded in securing a room to enable a social worker to be
present
for the pre-admission clinic to address patients’ needs. This
mod-
15. ified approach normalized the referral, and patients were able to
see the social worker as part of usual care during the same hos-
pital visit.
Twenty-one participants reported low distress, and the same
proportion was highly distressed. Forty-one women scored 4 or
higher, which is deemed to be the optimal cutoff (Chambers et
al.,
2014; Donovan, Grassi, McGinty, & Jacobsen, 2014) and an
indica-
tor of distress that requires follow-up. This is similar to the
57%
of women with gynecologic cancer scoring 4 or higher in a
study
by Johnson, Gold, and Wyche (2010). Twenty-one participants
scored 7 or higher, which has been suggested to be a more
appro-
priate cutoff than 4 (Lambert et al., 2014). This means that high
levels of distress are present and need monitoring. The current
findings closely mirror those from a WA study with clients of a
not-for-profit organization (Watts et al., 2015). Distress was
high-
er than reported in a study from Victoria, Australia (Williams,
Walker, & Henry, 2015). This could be partly explained by the
profile of participants; participants in the current study were all
female patients with gynecologic cancer.
Two hundred twenty-six problems were psychosocial, and 207
were physical; most problems were related to physical and emo-
tional symptoms. Nervousness, worry, and fears were the top
three
concerns. VanHoose et al. (2014) found that the greatest risk
factor
for distress was worry and suggested that worry may be a proxy
for
intensity of distress. Some worries can be allayed by active
16. listen-
ing and responding to emotions with empathy, but high anxiety
levels need referral. Sadness and loss of interest were in the top
10
concerns, which could be symptoms of depression. Fatigue,
prob-
lems with sleep and eating, and pain need to be looked at
carefully
by the team to see how they can be alleviated. The main
problems
TABLE 2.
TOP 10 INDIVIDUAL PROBLEMS IDENTIFIED
IN THE PROBLEM LIST (N = 62)
PROBLEM n
Nervousness (emotional) 39
Worry (emotional) 33
Fears (emotional) 31
Fatigue (physical symptoms) 24
Sleep (physical symptoms) 23
Sadness (emotional) 21
Treatment decisions (practical problems) 18
Eating (physical symptoms) 17
Pain (physical symptoms) 15
17. Loss of interest in usual activities (emotional) 13
VOLUME 21, NUMBER 1 CLINICAL JOURNAL OF
ONCOLOGY NURSING 83CJON.ONS.ORG
IMPLICATIONS FOR PRACTICE
ɔ Have clear referral pathways, including psychosocial
referrals, for
appropriate and timely triaging after screening.
ɔ Normalize patients' experiences with distress screening,
which
allows them to voice their concerns and needs.
ɔ Offer information on anxiety management, particularly for
younger
patients who may be more vulnerable.
identified were similar to the study by Watts et al. (2015), in
which
the problems identified most frequently were psychological and
emotional issues and difficulties with fatigue and memory. The
current findings also reflect findings from Williams et al.
(2015).
Spiritual and religious concerns were reported by only two par-
ticipants in the current study. Spiritual well-being in patients
with
cancer is associated with anxiety, depression, and fatigue
(Rabow
& Knish, 2015), so spiritual and existential fears may be
incorpo-
18. rated into these areas. One item relating to spiritual and
religious
concerns on the PL may be insufficient to capture this issue.
Group differences were seen between older and younger pa-
tients for DT score, with a significant association between age
group (40 years or younger, 41–64 years, and 65 years or older)
and the three different distress score categories. Nine partici-
pants aged 40 years or younger scored in the 7–10 range on the
DT, compared to 10 participants aged 41–64 years and 3 partici-
pants aged 65 years or older. However, no significant
differences
were seen in the number of problems between age groups. This
supports VanHoose et al. (2014), who found that patients most
at risk for distress were younger, and Johnson et al. (2010), who
found that women aged younger than 60 years were more dis-
tressed in a sample of women with gynecologic cancers.
Significant differences also were found between the specific
types of gynecologic cancers and levels of distress. This
supports
previous findings that patients with cervical cancer report worse
quality of life than the general population and patients with
other
gynecologic cancers (Korfage et al., 2009).
Snowden et al. (2011) stated that qualitative data are almost
entirely missing from the distress screening literature and few
studies investigate how HCPs use the tool. Staff in the current
study indicated high levels of satisfaction with the tool and
found
many benefits. Particularly, it normalized patients’ distress and
gave them “permission” to open up. It also proved to be a con-
versation starter. These findings mirror conclusions by Carlson,
Waller, and Mitchell (2012) and Williams et al. (2015), who
19. found
that use of the tool promoted communication between the pa-
tient and oncology team; Lynch et al. (2011), who suggested
that
the DT helped patients discuss their feelings and issues with
HCPs and recognize the coping skills they already had in place;
and Snowden et al. (2011), who highlighted the DT’s function
as a
facilitator of consultations.
A benefit mentioned by staff members in the current study
was that they felt the tool validated what they do and provided
guidance, which enhanced usual practice. The key challenge
was
finding time. However, HCPs were able to identify a range of
strategies to overcome this barrier, including making follow-up
telephone calls and prioritizing. Continuing professional devel-
opment could help staff identify ways of managing time (Heyn,
Ruland, & Finset, 2012). One HCP stated that using the DT
saves
time by focusing on salient issues, which contradicts many
HCPs’
preconceptions that use of the tool can make consultations lon-
ger. Most of the support came from the nurses who were able to
talk to the patients about their concerns, listen empathetically,
normalize fears and anxieties, and assist in finding solutions.
This
could partly explain the perception that no additional referrals
were needed. Another explanation of this observation was that
the social worker was present at the clinic, so she may have
been
perceived to be part of the clinic team. In the current study, on-
cology nurses were seen as best placed to conduct the screening,
but other models could be applied, such as screening by
oncology
social workers (BrintzenhofeSzoc et al., 2015).
20. Limitations
Uptake of referrals was not tracked because the patients were
difficult to contact. The researchers did not approach everybody
who attended the clinic because some people were seen quickly,
some were missed because of a busy environment, and, on some
days, no one was available to obtain consents. However, most
patients were approached and very few women (fewer than 5)
declined.
Conclusion
Findings will help to address the lack of systematic and
formalized
routine screening of patients for distress in WA. Screening
facili-
tates conversations, helps normalize patients’ distress, and
enables
staff to identify issues promptly so that preventive action can be
taken. This could prevent later intervention for crisis. Criticism
of
FIGURE 1.
PROPORTION OF PROBLEMS IDENTIFIED
ON THE PROBLEM LIST BY DOMAIN (N = 62)
Physical problems
Practical problems
Family problems
Emotional problems
Spiritual or religious
problems
21. �
�
�
�
�
84 CLINICAL JOURNAL OF ONCOLOGY NURSING
VOLUME 21, NUMBER 1 CJON.ONS.ORG
DETECTING DISTRESS
the DT has included that it lacks specificity in identifying
problems.
However, the current study demonstrates that the tool is useful
for
initial screening and identifying specific problems that can be
fol-
lowed up by appropriate HCPs. For oncology nurses, the key
impli-
cations are that screening is useful and acceptable, distress
levels
are high (particularly in relation to anxiety and nervousness, re-
sulting in the need for anxiety management), and younger
patients
may be more vulnerable to distress.
Moira O’Connor, BA(Hons), MSc, PhD, is a senior research
fellow in the School
22. of Psychology and Speech Pathology of the Faculty of Health
Sciences at Curtin
University in Perth; Pauline B. Tanner, RN, RM, CertOnc,
SBCN, is a cancer nurse
coordinator in the Department of Health at the Cancer and
Palliative Care Network
in Perth; Lisa Miller, MBBS, DCH, FRACGP, FAChPm,
FRANZCP, is a consultant liai-
son psychiatrist and lead clinician at Sir Charles Gairdner
Hospital in Perth; Kaaren
J. Watts, BA(Hons), PhD, is a researcher and project officer for
an independent
contractor in Scarborough; and Toni Musiello, BA(Hons), MA,
PhD, at the time of
writing, was a research psychologist in the School of Surgery at
the University of
Western Australia in Crawley, all in Australia. O’Connor can be
reached at
[email protected], with copy to [email protected] (Submitted
Novem-
ber 2015. Accepted April 20, 2016.)
The authors take full responsibility for this content. This study
was funded by the Cancer and
Palliative Care Research Evaluation Unit of the University of
23. Western Australia. The article has
been reviewed by independent peer reviewers to ensure that it is
objective and free from
bias.
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Week 6: Reading Research Literature Worksheet
32. Name:_______________________________________________
________________________
Date:________________________________________________
_________________________
Complete the following required worksheet using the required
article for the current session. Access the required article from
the assignment guidelines.
Purpose of the Study: Using information from the required
article and your own words, summarize the purpose of the
study. Describe what the study is about.
Research & Design: Using information from the required
article and your own words, summarize the description of the
type of research and the design of the study. Include how it
supports the purpose (aim or intent) of the study.
Sample: Using information from the required article and your
own words, summarize the population (sample) for the study;
include key characteristics, sample size, sampling technique.
Data Collection: Using information from the required article
and your own words, summarizeone data that was collected and
how the data was collected from the study.
Data Analysis: Using information from the required article and
your own words, summarizeone of the data analysis/ tests
performed or one method of data analysis from the study;
include what you know/learned about the descriptive or
statistical test or data analysis method.
Limitations: Using information from the required article and
your own words, summarizeone limitation reported in the study.
Findings/Discussion: Using information from the required
article and your own words, summarizeone of the authors'
findings/discussion reported in the study. Include one
interesting detail you learned from reading the study.
Reading Research Literature: Summarize why it is important
for you to read and understand research literature. Summarize
what you learned from completing the reading research