Communication is used to inform, to persuade and to analyze. In this assignment, you will persuade the reader of your point of view by supporting a thesis with objective facts and credible evidence.

In the week 2 forum, you selected your topic for this paper. You will take a stance on this issue and support your stance with credible evidence in your body paragraphs.

For this assignment, you have traditional and creative options. Choose what will challenge your writing and what would be appropriate for your topic and field:

• Traditional 5 paragraph essay with 1 paragraph introduction, 3 body paragraphs, and 1 paragraph conclusion.
• Op-ed newspaper article.
• Blog post.
• Letter/proposal to stakeholders.
• Press release.
• Letter to the editor.
• Presidential address.
• Election speech (written only).
• Application for a position related to the topic.
• Defense attorney’s opening statement.
• Case brief.
• Advocacy statement.
• Call to action paper.

Guidelines:

In order to persuade the audience to accept the position you are advocating in this paper, you will use different kinds of appeals:

• ethos (which involves the credibility of the speaker, writer, or authority being cited);
• logos (which involves facts, statistics, and logic); and
• pathos (which involves emotions).

A good persuasive argument uses credible sources, objective evidence, and emotional “hooks” to make use of logos, ethos, and pathos respectively.

Be sure your thesis statement is very clear.  It should be a single complete sentence, including both a subject and a predicate, that combine to make claim. Example: “The USA should be more competitive in establishing a presence on Mars.”  

Your introduction paragraph should include a “hook” to grab the reader’s attention.  The thesis statement is typically seen in the first paragraph. Your body paragraphs will support the thesis. You should use credible sources and cite them according to the style of your discipline. Your conclusion should reiterate the strongest points from your paper and give the audience something to consider, moving forward.

Requirements:

• PURPOSE:   To persuade
• AUDIENCE:   The applicable audience for the type of document you’ve chosen to write.
• LENGTH:   500 – 750 words (Times New Roman font)
• SOURCES:   A minimum of 3 with at least 1 from the library, and at least 1 from a professional journal or organization
• FORMAT:   The citation style that is appropriate for your discipline
• DUE:   SUNDAY 11:55 pm EST of Week 5
• SUBMIT:   In ASSIGNMENTS submit your essay by uploading your Word file

Use only third person (he/she/they) for a more professional tone. Avoid first person (I, my, us, we) and second person (you and your) in your essay.

 

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Respond using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, and evidence.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Statistical Methods in Qualitative Research 

  

Statistical Method

What is measured by this method

Circumstances for Use

Examples of use in Research Studies

 

Qualitative Content Analysis

Analyzes narrative data, and in-depth interviews. Can evaluate large volumes of data with   intent to identify recurring themes and patterns. Attempts to break down   elements of data into clusters. May be concurrent or sequential (Polit &Beck,   2017).

Good method for evaluating personal histories, perspectives,   experiences. Best method for studying personal, sensitive situations (Sauro,   2015).

Examples of this methodology include evaluation of the experience of a   rape victim, what it feels like to have an abortion, how it feels to have   lived through a disaster.

 

Ethnographic analysis

Evaluates cultural phenomena, patterns, perspectives. Requires   “participant observer” technique. No preconceived hypothesis. May take months or years to complete. Maps and flowcharts are tools to help   illustrate findings (Polit & Beck, 2017).

Method to “acquire a deep understanding of the culture being studied”   (Polit & Beck, 2017 p. 538).

An example of ethnographic analysis could include a research study   with ethnographers integrating with Native Americans living on a reservation   while observing everyday life seeking to extrapolate overlying cultural   issues.

 

Phenomenologic Analysis

Attempts to understand the   essence of experiencing a particular phenomenon by observation, interviews,   and outside research. Descriptive analysis 

Method for understanding individual perspectives of experiencing a   certain phenomenon. Seeks to extrapolate commonalities and themes among   subjects (Sauro, 2015). 

Conducting interviews with persons who have experienced   hallucinations, with the intent to understand their perspective and   experience of the phenomenon, is an example of this method of research.

 

Grounded Theory Analysis

Aim is to provide theories and explanations for phenomena based on   previously coded information Uses interviews and previous accepted research. Unlike Qualitative content analysis, which   seeks to break down information, Grounded theory strives to put information   back together (Polit & Beck, 2017).

Method for development of theories, Could be used meta-analyses or   systematic reviews.

An example of a grounded theory analysis is” Beck’s (2002) model of   mothering twins” as cited in Polit & Beck (2017).

 

Focus Group Analysis 

Analyzes group data in relation to a specific topic. Group interviews, recordings, and field   notes .are instruments for conducting this type of research.

May be used for evaluation of a potential survey tool, consensus on a   new product. Researchers seek to   extrapolate recurring themes.

An example of a focus group analysis might be to evaluate perceptions   of a new product being marketed to test for general consensus of its   desirability. 

Quasi-statistics: a tabulation of the frequency with which certain themes or insights are supported by the data

Qualitative content analysis: analysis of the content of narrative data to identify prominent themes and patterns among the themes

Domain analysis: 1st of 4 levels of data analysis, domains are units of cultural knowledge, are broad categories that encompass smaller ones. Ethnographers identify rational patterns among terms in the domains are used by members of the culture. Ethnographer focuses on the cultural meaning of terms and symbols used in a culture

Taxonomic analysis: second level of data analysis, ethnographers decides how many domains the analysis will encompass. Taxonomy is then developed to illustrate the internal organization of a domain and the relationship among the subcategories of the domain

Taxonomy: a system of classifying and organizing terms

Componential analysis: relationships among terms in the domains are examined; ethnographer analyzes data for similarities and differences among cultural terms in a domain.

Theme analysis: cultural themes are uncovered; domains are connected in cultural themes, which help to provide a holistic view of the culture being studied. The discovery of cultural meaning is the outcome.

Holistic approach: researchers view the text as a whole and try to capture is meanings 

Selective approach: researchers highlight or pull out statements or phrases that seem essential to the experience under study 

Detailed approach: researchers analyze every sentence 

Hermeneutic circle: signifies a methodological process in which to reach understanding, there is continual movement between the parts and the whole of the text being analyzed 

Exemplars: illuminate aspects of a paradigm case or theme

Substantive codes: substance of the topic under study is conceptualized through substantive codes. Substantive codes are either open or selective

Open coding: used in the first stage of the constant comparative analysis, 

captures what is going on in the data. May be actual words stated by participant. In open coding, 

data are broken down into incidents and their similarities and differences are examined. Raw  

data interpreted 

Three Levels of Open Coding: Levels I, II, III

Level I codes: in vivo codes, derived directly from the language of the 

substantive area and have vivid imagery 

Level II codes: Researchers constantly compare new level one codes to 

previously identified ones and then condense them into broader level II 

codes

Level III codes: theoretical constructs, most abstract, add scope beyond local 

meanings

Core category: pattern of behavior that is relevant and/or problematic for participants

Selective coding: can have 3 levels of abstraction, researchers code only those data that are related to the core variable

Basic social process (BSP): evolves over time in two or more phases, all BSP’s are core variables, but not all core variables have to be BSPs

Emergent fit: prevents individual substantive theories from being “respected little islands of knowledge”

Axial coding: analyst codes for context

Paradigm: used as an analytical strategy to help integrate structure and process

Central category: core category, which is the main theme of the research 

Initial coding: pieces of data (words, lines, segments, incidents) are studied so the researcher begins to learn what the participants view as problematic 

Focused coding: the analysis is directed toward using the most significant codes from the initial coding

Congruent methodological approach: analyzes interaction data in the same manner as a group or individual data 

Sociograms: can be used to understand the flow of conversation as it goes around the members of the focus group

Incubation: process of living the data, a process in which researchers must try to understand their meanings, find their essential patterns, and draw legitimate, insightful conclusions

Conceptual files: physical files in which coded excerpts of data relevant to specific categories are placed

Themes: involves the discovery nor only of commonalities across participants but also of natural variation and patterns in the data

Metaphors: figurative comparisons used to evoke a visual or symbolic analogy

Quasi-statistics: involves a tabulation of the frequency with which certain themes or relations are supported by the data

Qualitative content analysis: can vary in terms of an emphasis on manifest content or latent content and in the role of induction

Managing Qualitative Data

Computer-assisted qualitative data analysis software (CAQDAS): a program that can take uploaded data files, code the narratives, retrieve information, and display text for analysis

Within a qualitative data analysis there is not statistical tests, because qualitative research is based on thoughts, open ended questions, interpretations and interviews not numerical values. Data within qualitative research is understood and analyzed during the entirety of the process. “Researchers interpret the data as they read and reread them, categorize and code them, inductively develop a thematic analysis, and integrate the themes into a unified whole,” (Polit & Beck, 2017, p.549). There is not a step by step understanding of how the process occurs of interpreting the data, researchers “live” within the data by understanding the meanings, looking for patterns, draw valid, discerning conclusions. An additional importance of understanding of the facts is having the inventiveness to find the “aha” meaning of the information and discovery of the meanings of the facts gained (Polit & Beck, 2017). 

The importance of the interpretation is just as important as the validity of the data. Thorough and sensible researchers have a high standard of their data interpretation by dissecting themselves, peers and outside reviewers. It is vital that the qualitative researchers consider possible different explanations or meanings other than their own (Polit & Beck, 2017).

It is important nurses to understand statistical data because this is a large part of the work nurses base the practice on is evidence based, which means understanding the research behind the reason of the practice is important to understand. According to Hayat, it is important to understand the difference between statistical significance and clinical importance, researchers tend to use statistics to claim proof and scientific breakthrough. Significance testing can be used to decide which data may be considered evidence to support a practice change (2010). “Judgment and subjectivity are necessary and part of the decision-making process. Statistical significance is not a measure of importance; it is a subjective and qualitative construct. Researchers conducting quantitative analyses should quantify the magnitude of an effect. The value of the data collected should be assessed by examining study design, bias, and confounding variables, as well as meaningfulness of the results to the topic under study,” (Hayat, 2010, p.222). Nurses must consider this and have an understanding when utilizing statistical methods to base their practice changes. 

References

Hayat, M. J. (2010). Understanding Statistical Significance. Nursing Research, 59(3), 219–223

Polit, D.E. & Beck, C.T. (2017). Nursing Research: Generating and Assessing Evidence for Nursing 

Practice 10th ed. Philadelphia, PA: Wolters Kluwer

Sauro, J., (2015. October 13). Five types of qualitative methods, Retrieved from https://flic.kr/p/4PXXCYp.

By: Casey Hoffman, Tami Frazier, Sarah Pudenz, and Elizabeth Wilson

 

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Respond  of your colleagues who were assigned to a different case than you. Explain how you might apply knowledge gained from your colleagues’ case studies to you own practice in clinical settings.

                                               Main Post

                                  Sleep/Wake Disorders

The patient is an obese 70-year-old female with a chief complaint of “being sad.” Her husband passed away several years ago due to coronary artery disease (CAD). She lives at home alone and has a home health aide help her. Her son comes to visit her often. She was feeling well until her hearing began to diminish in both ears. Her mobility has declined, so she has not been able to get out as much. She is often lonely at home. She has daily crying spells, is often very tired, has good insight to her illness, and wants to get better. 

Three Questions to Ask the Patient and Why            

The case study mentioned that the patient is a candidate for cochlear implants, but it is a long way off. Thus, my first question to ask the patient is what is preventing her from getting cochlear implants?  

She began experiencing sadness when she began to lose her hearing and mobility. Therefore, regaining her hearing may help decrease the depression. If its financial reasons, maybe there are resources that can help her. Finding out the reason the patient isn’t getting the implants can help the provider and patient find solutions.             

The patient also mentioned that her sleep was “awful”, stating her legs “ache and jump”, she takes frequent naps during the day, and admits to snoring frequently. Thus, the second question I would ask is what are her sleeping habits like? 

Individuals who have good sleep habits sleep better. Getting better sleep can be obtained by being consistent by going to bed at the same time each night and waking up the same time each day (Centers for Disease Control and Prevention, [CDC], 2016).  Individuals can make sure the room is dark, quiet, and cool (CDC, 2016). Additionally, remove electronic devices, avoid large meals, caffeine, and alcohol can help with getting better sleep (CDC, 2016).              My third question would be what do you do when you are sad? Individuals who are depressed often have a negative view of the world and often think of themselves as worthless (This Way Up, n.d.). They often blame themselves when something bad happens and feel like they are unlucky (This Way Up, n.d.). Thus, helping individuals identify negative thinking and reframe the way they think about life can help improve depressive symptoms (This Way Up, n.d.). 

People to Speak to with Specific Questions to Ask 

The first person I would want to speak to is the patient’s son. The case study states the son visits her often so he should know the patient’s habits. First, I would ask him the same questions I asked the patient such as what is preventing the patient from getting cochlear implants, what are her sleep habits, and what does she do when she is sad? By asking the son the same questions, insight can be shown on how the son views things and how the patient views things. I would also him when he began to notice her depressive symptoms because that will help provide a timeline as to when it all began.             

The second person I would talk to is her home health aide because she is familiar with the patient. I would ask her what the patient’s home life is like such as how is she maintaining her house? Is she able to clean up after herself? How is she doing with activities of daily living? 

These questions can provide insight on the severity of the patient’s depressive symptoms. 

Physical Exams and Diagnostic Tests and How Results Would Be Used            

The first diagnostic test I would want to perform on the patient is the 9-item Patient Health Questionnaire (PHQ-9). The PHQ-9 is a screening tool for major depression (Na et al., 2018). The test is a reliable and valid measurement of depressive symptoms that also asks about the individual’s thoughts of death or self-injury within the last two weeks (Na et al., 2018). The results would be used to determine the severity of her depression. Another diagnostic test that can be performed on this patient is a polysomnography. A polysomnography is a sleep study that helps providers diagnose sleep apnea, periodic limb movement disorder, restless leg syndrome (RLS), insomnia, and nighttime behaviors (National Sleep Foundation, n.d.). The results would be used to can help determine the cause of her daytime sleepiness such as sleep apnea or RLS. I would also want to run a complete blood count (CBC) with differential on the patient. I would specifically want to obtain a red blood cell count (RBC) and white blood cell count (WBC). Thus, a CBC with differential would help determine if the patient is fatigued due to anemia or an underlying infection.

 Three Differential Diagnosis and Why

The three potential differential diagnoses include:Major Depressive DisorderPersistent Insomnia Disorder Obstructive Sleep Apnea Hypopnea The most likely differential diagnosis is major depressive disorder (MDD). The diagnostic criteria for MDD is five or more symptoms during the same 2-week period and a change from previous functioning (American Psychiatric Association, 2013).  The symptoms include: depressed mood most of the day, marked diminished interest or pleasure in all or almost all activities most of the day, significant weight loss or weight gain, insomnia or hypersomnia neatly every day, psychomotor agitation or retardation nearly every day, fatigue or loss of energy nearly every day, feelings of worthlessness or excessive or inappropriate guilt nearly every day, diminished ability to concentrate, and recurrent thoughts of death (American Psychiatric Association, 2013). The patient fits this diagnosis as evidence by depressed mood, diminished interest in activities she used to enjoy, fatigue, diminished ability to concentrate, and psychomotor retardation.

Two Pharmacological Agents and Dosing and Why 

One pharmacologic agent that can be tried is doxepin 3 mg at bedtime for insomnia. Doxepin works by boosting serotonin and norepinephrine by blocking the serotonin reuptake pump and norepinephrine reuptake pump (Stahl, 2017). At hypnotic doses, doxepin blocks histamine-1 receptors, which promotes sleep (Stahl, 2017). Doxepin is a substrate for CYP450 2D6 and has a half-life of 8-24 hours (Stahl, 2017). In the elderly, the recommended dose for insomnia is 3 mg per day (Stahl, 2017).             Another pharmacologic agent that I would like to start the patient on is bupropion (extended release) XL 150 mg daily in the morning. Bupropion is used to treat MDD and works by boosting norepinephrine and dopamine by blocking the norepinephrine reuptake pump and dopamine reuptake pump (Stahl, 2017). Bupropion inhibits CYP450 2D6, has a parent half-life of 10-14 hours, and a metabolite half-life of 20-27 hours (Stahl, 2017). Thus, since bupropion blocks the dopamine reuptake pump and norepinephrine reuptake pump, this medication is beneficial in improving symptoms of loss of happiness, joy, interest, pleasure, energy, enthusiasm, alertness, and self-confidence (Stahl, 2013). Thus, because of bupropion’s mechanism of action and the patient’s symptoms, I would want this patient to try this medication. 

Lessons Learned  

Lessons learned during this case study is that geriatric depression can be difficult to treat. They often have multiple comorbidities with the possibility of more pronounced side-effects (Stahl, 2008). Additionally, medications can have contraindications that do not previously exist prior to the patient being put on medication. Thus, providers must be aware of new and old warnings on medications in the event there are changes made to medications. I will apply this information when I am in practice by paying close attention to dosages, side effects, and potential contraindications when providing medication to the geriatric population. 

                                                  References

American Psychiatric Association. (2013). Diagnostic and statistical manual od mental disorders (5th ed.). Washington, DC: Author. Centers for Disease Control and Prevention. (2016). Tips for better sleep. Retrieved from https://www.cdc.gov/sleep/about_sleep/sleep_hygiene.htmlNa, P. J., Yaramala, S. R., Kim, J. A., Kim, H., Goes, F. S., Zandi, P. P.,…Bobo, W. V. (2018). The PHQ-9 item 9 based screening for suicide risk: a validation study of the Patient Health Questionnaire (PHQ-9)-9 item 9 with the Columbia Suicide Severity Rating Scale (C-SSRS). Journal of Affective Disorders, 232, 34-40. doi: https://doi.org/10.1016/j.jad.2018.02.045National Sleep Foundation. (n.d.). Sleep apnea. Retrieved from https://www.sleepfoundation.org/sleep-apneaThis Way Up. (n.d.). How do you feel? Retrieved from https://thiswayup.org.au/how-do-you-feel/sad/Stahl, S. M. (2008). Essential psychopharmacology online. Retrieved from https://stahlonline-cambridge-org.ezp.waldenulibrary.org/viewPdf?page=csEP_16.pdf&vol=2Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical    applications (4th ed.). New York, NY: Cambridge University Press. Stahl, S. (2017). Stahl’s essential psychopharmacology: Prescriber’s guide (6th ed.). San Diego,  CA: Cambridge University Press. 

 

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Text and materials:

Ruth M. Tappen. (2015). Nursing Research. Advanced Nursing Research: From Theory to Practice. (2nd ed.). ISBN-13: 9781284048308. ISBN-10: 1284048306. Publisher: Jones & Bartlett Learning

Section VI: Middle Range Theories

Chapter 21: Katharine Kolcaba’s Comfort Theory 

Chapter 22: Joanne Duffy’s Quality-Caring Model

 

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