how you think the cost-benefit analysis in the statement from page 27 of Feldstein (2006) affected efforts to repeal/replace the ACA. Then, explain how analyses such as the one portrayed by the Feldstein statement may affect decisions by legislative leaders in recommending or positioning national policies (e.g., Congress’ decisions impacting Medicare or Medicaid).
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 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
Practicum Discussion: Culturally aware nurses recognize that states of health are revealed differently across cultures and ethnicities. Culture and ethnic background will affect the way each individual responds to health, illness, and death (Stanhope & Lancaster, 2016). These nurses are also aware of their own biases, which may affect the care they provide to others (Stanhope & Lancaster, 2016). Because most nurses work in institutions with individual patients, they are accustomed to delivering culturally competent care on a one-on-one basis. When a public health nurse deals with a population, he or she must consider how the population culture affects the ways in which the community nurse may interact. This can be with regard to the provision of education or mass health care needs such as those required in a foodborne illness, if mass vaccinations are needed for a communicable disease outbreak, or if education is required to prevent heart disease. In addition to understanding the nuances of the culture of a population, community health nurses must understand the role genetics play in health. Some disorders, such as glaucoma and diabetes, have a genetic link, as do some cancers, such as breast and ovarian.
Please discuss the following questions in your Practicum Discussion:
I need a positive argument based in this discussion question. Respond to this argument in one or more of the following ways:
Ask a probing question, substantiated with additional background information, evidence or research.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional research.
Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
Use references
Mission, Vision, and Personal Goals
I have been a nurse for five years and spent a great deal of time thinking about my future role in nursing. I debated the pros and cons from the available list of master’s degree specialty tracks in nursing. At first, I thought that I might do nursing leadership as I enjoy leadership, but I changed my mind after realizing that I could lead change in any master’s degree role. I am passionate about psychiatry and decided on the psychiatric mental health nurse practitioner specialty track.
Over the course of a few months, I researched different universities and was drawn to Walden University. I liked that they offered a master’s degree in my specialty track as many universities have moved to the doctorate level. Also, I noticed that Walden had all the required accreditations that I was looking for in a university. After reading the Walden School of Nursing (SON) mission and vision statement, I realized that we have commonalities. According to the Walden University SON (2012), their mission is to thoroughly prepare graduates to transform society. The mission statement speaks to me as I would like to transform individuals and the community by providing high quality, cost effective, and relevant care.
Also, the Walden University program outcomes state that graduates will “apply their learning to specific problems and challenges in their workplace and professional settings” (Walden University, 2011, para. 5). This statement aligns with my objectives. I would like to earn more than a degree; I would like to apply knowledge gained, synthesize new practices, and implement it into nursing practice.
Incorporation of Social Change
Positive social change is a process for improving the daily lives of individuals, communities, and society. According to Walden University (2011), positive social change results in an enhancement of human and social conditions. I concur with this position and I would like to do the same in my community. I have taken my nursing practice as far as I can with my current education and scope. My plan for positive social change in my future practice is to look at an individual holistically to figure out how I can address social conditions preventing effective treatment. For example, “stable housing has been linked to recovery from addictions” (Knickman & Kovner, 2015, p. 165). This statement validates an existing hypothesis synthesized in my daily nursing practice. A lack of housing for chemically dependent individuals results in frequent inpatient readmissions. Positive social change will occur if the above-mentioned social condition can be addressed.
References
Knickman, J. R., & Kovner, A. R. (2015). Health Care Delivery in the United States (11th ed.). New York, NY: Springer Publishing.
Walden University. (2011). Student publications: Vision, mission, and goals. Retrieved from http://catalog.waldenu.edu
Walden University College of Health Sciences. (2012). About the school. Retrieved from http://www.waldenu.edu/colleges-schools/school-of-nursing/about
Identify a population-based problem of interest, (HIV and STI/STD rates in Washington DC). After reviewing topical information in Healthy People 2020 and The Community Guide to Preventive Services, identify relevant outcomes related to this problem that will help guide your plans for intervention.
Suicide is the taking of own life which is a “tragic reaction to stressful life situations (Suicide and suicidal thoughts, 2015).” The national institute of health reported ages 10-24 year olds in 2014 was the second leading cause of death with a total count of 5,504 deaths in the US (Advancing research to prevent youth,n.d.). Erickson’s stages of development for the adolescent shows the teen must successfully concur the two stages of development – identity vs. identity confusion and intimacy vs isolation (Miller, 2017). Teens who are struggling with the first and second stage will become socially isolated (Miller,2017). Erikson’s theory predicts “when adolescents are unable to successfully answer the questions of identity during this stage of development, they may experience feelings of inadequacy and despair, which can eventually lead to depression (Miller,2017). Depression left untreated can lead to suicide.
Health professionals can utilize primary, secondary, and tertiary methods to help with health prevention of suicide. “ Primary suicide prevention aims to reduce the number of new cases of suicide in the general population. Secondary prevention aims to decrease the likelihood of a suicide attempt in high-risk patients and Tertiary suicide prevention occurs in response to completed suicides and attempts to diminish suicide contagion (Ganz, n.d.).”
In general, if a true emergency is occurring 9-1-1 should always be the first line to call for help. When teens are struggling through thoughts of despair and potential suicide the communities do have resources to reach out to. As followed are some of the resources: Transitional Age youth support- Mental health services: (360)918-7860; Crisis Line: (360)586-2800; National Suicide Prevention Lifeline: (800)273-Talk (community youth services, n.d.).
As the nurse it is our duty to obtain a precise assessment of the teen through thorough questions and observations. The nurse should be mindful of some risk factors which place this age group at higher risk are as followed: a previous suicide attempt, mental disorders- schizophrenia/social anxiety, substance abuse, abused or mistreated, history found in family, hopelessness, lack of social support, access to means or methods for suicide (Preventing Teen Suicide, n.d.). A main nursing intervention in assisting a suspected depressed teen is to show active listening and presence.
Advancing Research to Prevent Youth Suicide. (n.d.). Retrieved October 17, 2017, from https://prevention.nih.gov/programs-events/pathways-to-prevention/workshops/suicide-prevention
Ganz, D., Braquehais, M. D., & Sher, L. (n.d.). Secondary Prevention of Suicide. Retrieved October 17, 2017, from http://journals.plos.org/plosmedicine/article?id=10.1371%2Fjournal.pmed.1000271
(n.d.). Retrieved October 17, 2017, from http://www.communityyouthservices.org/p_suicide_prevention.shtml
Miller, R. (2017, June 13). Erik Erikson’s Theory About Adolescent Depression. Retrieved October 17, 2017, from https://www.livestrong.com/article/560899-erik-eriksons-theory-about-adolescent-depression
Preventing Teen Suicide. (n.d.). Retrieved October 17, 2017, from https://teens.webmd.com/preventing-teen-suicide#1
Suicide and suicidal thoughts: Take action to prevent a tragedy. (2015, August 28). Retrieved October 17, 2017, from http://www.mayoclinic.org/diseases-conditions/suicide/basics/definition/con-20033954
health 3 quest 1
Population Affected by Disabilities.
Rural and Migrant Health.
Read chapter 21 and 23 of the class textbook (attached) Once done, answer the following questions.
-Mention and discuss the differentiation between the medical model and social construct definitions of disability.
-Identify and discuss selected health care and social issues that influence the ability of people with disabilities to live and thrive in the community.
-Mention and discuss the characteristics of rural community health nursing practice.
-Mention and describe the features of the health care system and population characteristics common to rural aggregates.
Guidelines: APA format word document, Arial 12 font. A minimum of 2 evidence-based references (besides the class textbook) no older than 5 years must be used, A minimum of 700 words is required (excluding the first and reference page).
Youth suicide is the third leading cause of death for persons between 15-24 years of age, and almost 4,600 youth deaths each year are the result of suicide for a person 10-24 years of age (Smischney, Chrisler, & Villarruel, 2014). Learning of these numbers is very discouraging considering that suicide can be prevented by recognition and implication of interventions. Adolescents may present to family, friends, or teacher’s signs of suicidal behavior such as talk of suicide, threat of suicide, or risky behavior. Sometimes the adolescent may not display warning signs before committing suicide. It is important to identify risk factors that can lead to suicide. Risk factors that contribute to suicidal ideation are biological, environmental, and psychological factors (Smischney et al., 2014).
Biological risk factors include gender, ethnicity, and sexual orientation. The male gender is 4 times greater to attempt suicide that results in death, whereas female adolescents experience higher rates of depression. Native American or Alaska Natives that are between the ages of 15-24 are at a 2.4 percent higher rate than the national average. Suicidal ideation is higher amongst gay and bisexual male adolescents than heterosexual male adolescents. This may due to the adolescent’s parents or friends lack of approval or support (Smischney et al., 2014).
Environmental risk factors that contribute to suicide include family stress and conflict such as divorce, death of a loved one, academic failure, and abuse. During adolescence, peer relationships greatly contribute to suicide. Adolescents who suffer from poor social skills, low self-esteem, and lack support from their peers are at greater risk for suicidal ideation (Smischney et al., 2014).
Psychological risk factors contributing to adolescent suicide include mental health problems, psychiatric disorders, poor coping skills, and substance abuse. Mental health disorders include anxiety, depression, post-traumatic stress disorder, and schizophrenia. Alcohol is often experienced with by adolescents. Female adolescents are 3 times more likely to attempt suicide and male adolescents are 17 times more likely to attempt suicide when alcohol is involved (Smischney et al., 2014).
Primary, secondary, and tertiary heath prevention measures can be taken to prevent suicide. Primary prevention can be implemented by addressing the topic of suicide with adolescents, identifying risk factors of suicide, and talking about ways to avoid risk factors that can lead to suicide. Secondary prevention can be done by addressing risk factors that the adolescent is experiencing and implementing healthy and effective interventions. This will help to reduce the chance of the adolescent following through with the act of suicide. Tertiary prevention should include providing support and resources to the adolescent, as well ensuring safety. Measures should be taken to prevent the adolescent from attempting and succeeding at suicide.
The Suicide Prevention Resource Center is a resource that provides contact information and suicide prevention plans specific for each state. This information can be accessed through the website http://www.sprc.org/states. Adolescents can also contact the National Suicide Prevention Lifeline 24/7 by calling 1-800-273-8255, or going online to https://suicidepreventionlifeline.org/. Both of these resources offer support to those who are experiencing a suicidal crisis. As a nurse if you suspect a depressed adolescent is in immediate danger of harming themselves, immediate intervention should be implemented such as ensuring the safety of the adolescent. If the nurse is physically present at the adolescent’s side, taking the adolescent to a safe environment and informing a physician is important to prevent harm or injury. If the nurse is talking with the adolescent over the phone and the adolescent is posing immediate danger to themselves, proper authorities should be notified and full detail of the adolescent’s location and situation should be provided.
References
National Suicide Prevention Lifeline, (n.d.). Get help. Retrieved from https://suicidepreventionlifeline.org/
Smischney, T. M., Chrisler, A., & Villarruel, F. A., (2014). Risk factors for adolescent suicide: Research brief. Retrieved from https://reachmilitaryfamilies.umn.edu/sites/default/files/rdoc/Adolescent%20Suicide.pdf
Suicide Prevention Resource Center, (2017). Organizations: States. Retrieved from http://www.sprc.org/states
Vulnerable population is a group or groups that are more likely to develop health-related problems, have more difficulty accessing health care to address those health problems, and are more likely to experience a poor outcome or shorter life span because of those health conditions. There are a number of characteristics, traits, or circumstances that enhance the potential for poor health. Healthy People 2020 (U.S. Department of Health and Human Services [USDHHS], 2010) has identified certain groups as more vulnerable to health risks, including the poor, the homeless, the disabled, the severely mentally ill, the very young, and the very old (Maurer & Smith, 2013). The most important factor associated with health status is economic status. Poverty drastically increases a person’s or group’s vulnerability to poor health status.
Not all people who are at risk for poor health would be considered vulnerable. To be considered vulnerable, a person or group generally has aggravating factors that place them at greater risk for ongoing poor health status than other at-risk persons. For example, a middle-aged obese man with a sedentary lifestyle and hypertension would be considered at risk for cardiac problems. If that man also had an income below the poverty level, no health insurance, and stressors related to living conditions, he would be more likely to be vulnerable to ongoing poor health status than a man with similar risk factors but with an adequate income and health insurance (Maurer & Smith, 2013).
Children, pregnant women, elderly people, malnourished people, and people who are ill or immunocompromised, are particularly vulnerable. Poverty – and its common consequences such as malnutrition, homelessness, poor housing and destitution – is a major contributor to vulnerability (WHO, 2017). Vulnerability may arise from individual, community, or larger population challenges and requires different types of policy interventions—from social and economic development of neighborhoods and communities, and educational and income policies, to individual medical interventions (Health Affairs).
Children and the elderly must have someone to advocate for them and as I nurse I am honored to be able to stand in the gap to assist this population of my community. For both groups due to the lack of knowledge when it comes to medical termination, procedures, and making sense of the medical language, we as nurses need to make sure that the families of these individual have the full picture of what is going on in terms of their health care. Break down information in laymen’s terms to where individuals can understand so that they can make informed decisions about their health care.
I would advocate for more affordable health care and easier access to health care for children and the elderly to help reduce the co-morbidity and mortality rates. Because it has shown that early access to quality medical care can help reduce an individual’s susceptibility illness, which will in turn reduce the mortality rate. For example, children one of our more vulnerable populations, providing early vaccination and screening for children can reduce and or prevent certain illnesses.
References
Health Affairs. Vulnerable People, Groups, And Populations: Societal View. (October 18, 2017). http://content.healthaffairs.org/content/26/5/1220.full
Maurer, F.A. & Smith, C.M. (2013). Community/public health nursing practice (5th ed.). St. Louis, MO: Elsevier Saunders.
World Health Organization. (October 18, 2017). http://www.who.int/environmental_health_emergencies/vulnerable_groups/en/
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:
Guidelines:
In order to persuade the audience to accept the position you are advocating in this paper, you will use different kinds of appeals:
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:
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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