What is Unknowing? It’s a way of being open to what you may not know.What is Unknowing? It’s a way of being open to what you may not know.

LESSON:
Nursing’s Ways of Knowing and Theories of Knowledge
Since the dawn of modern nursing in Florence Nightingale’s day, nurses have sought to understand the art and science of nursing. A good place to start in our quest to understand nursing is to begin with a concept called ways of knowing (Alligood, 2014). These phenomena are not unique to nursing; all disciplines and all beings are informed by ways of knowing.

Ways of knowing contribute to our mastery of nursing practice; while theories of knowledge (Epistomology, Ontology and Axiology), hold philosophical tenants about what knowledge is and how our beliefs about it direct our scientific inquiries (research). Nurse theorist, Carper (1978) identified four fundamental patterns of knowing in nursing. She described these patterns (or ways of knowing) as (a) empirics, (b) aesthetics, (c) ethics, and (d) personal knowing. A pattern of knowing is a notion similar to a way of knowing, but it’s personal, inside a being or patterns among groups of beings (such as nurses).

Ways of knowing in nursing incorporate knowledge that is systematically organized into general laws and theories in order to describe, explain, and predict phenomena of special concern to nursing. Since Carper developed her model, other nurse theorists, Patricia Munhall and Christopher Johns, have added two more important ways of knowing; Unknowing and Socio-Political Knowing, respectively (Heath, 1998). It is most important to consider how you as a nurse have developed mastery in your practice within the context of these six Ways of Knowing.

What is Unknowing? It’s a way of being open to what you may not know. This is used by nurses all of the time when they ask patients and families questions and listen with an open mind so as to find out what’s going on for them. An example of being ‘unknowing’ would be to ask a patient what’s most important to them right now; and then of course to listen with the intent of helping them get what they need.

Socio/Political Knowing is about issues of power, whose voice is heard, whose voice is silent and this helps nurses understand when and how they might act in relation to others in the landscape of health care.

Beyond ways of knowing among beings and groups in disciplines, there are theories of knowledge, a philosophical examination of what knowledge is and how it comes about. The most commonly recognized theories of knowledge are categorized in three areas: epistemology, ontology, and axiology. Some would argue that nursing knowledge emerges at the intersection of these theories of knowledge, as illustrated in this simple Venn diagram.

Theories of Knowledge

• Epistemology is the study of empirical knowledge, typically resulting from scientific inquiry. It is organized according to what we believe to be true (or factual), and when applied to nursing, best connects with the science of nursing. Epistemology encompasses empirical knowledge and also teleological knowledge, the process of knowledge (interpolation and extrapolation), and additional contributions to knowledge.

• Ontology is the study of reality and being. Knowledge in ontology unfolds according to what we experience and take ourselves to be. Ontological knowledge focuses on application and is often attributed to the art of nursing or aesthetics. An ontological question commonly asks, “What is it like to ‘be’ in (some phenomenon, such as pain or caring for a chronically ill person or anything we experience as beings?” A researcher whose philosophy of knowledge bends toward ontology is interested in beings experience in the world.

• Axiology is the philosophical study of value. Studies within the philosophy of axiology examine ethical dilemmas and questions.

In nursing practice, nurses search for knowledge within the various philosophies of knowledge. For example, empirical information is important to know facts, numbers, trends and processes. Nurses also seek knowledge of ontology when reading qualitative studies and inquiring about a client’s experience and personal meaning. Nurses also inquire within the philosophy of axiology to address ethical dilemmas. Carper, however, described another pattern called personal knowing. As nurses, we know that epistemology benefits from additional contributions to knowledge, such as logical reasoning (inductive and deductive), reasoning by analogy, the influence of chance, and imagination in science, intuition, and discussion as a stimulus. These additional sources of knowledge contribute to personal knowledge.

In future courses, you will learn more about the scientific method, an important element of inquiry. As Doctors of Nursing Practice, you will examine research studies to determine their worth in serving as foundational evidence for practice change. While there are many elements to consider in critiquing knowledge generated from research, for now it is good to recognize the basic philosophical underpinnings of knowledge development. Take this information in hand and consider it as you build your discussion and interactions in the threads this week.

See if you can correctly place the Theories of Knowledge in the exercise below.

Theories of Knowledge
Ways of KnowingTheories of Knowledge

Drag and drop the terms related to different Theories of Knowledge.

Transcript

Framing the Practice Question
The PICOT approach is a method for framing practice questions in nursing. The problem/etiology statement that you wrote in week one sets the stage for interventional designs. In other words, from your distinct problem/etiology statment you will develop a PICOT question that lends itself to your search for evidence to support the claim that the problem exists and that the intervention can possibly be an effective address to an improvement in the problem situation.

The PICOT statement serves to formulate a clear practice question. According to Melnyk and Fineout-Overholt (2011), the practice question should include (a) the population to which you will address the intervention; (b) the intervention that addresses the etiology; (c) the comparison (what is happening now; (d) the expected outcome having tried the intervention; and (e) the time frame in which you will conduct this project.

As a side note, while the PICOT lends itself to quantitative approach to your project, the PICoT lends itself to a qualitative approach to an EB project such that the elements become (a) the population of interest; (b) the phenomena of interest; (c) the context of interest; and (d) the time frame. As a student in this program, focus your attention and development on the PICOT approach.

The PICOT format can be used to answer different types of practice questions (e.g., intervention, diagnosis or diagnostic tests, prognosis or prediction, etiology, and meaning). Many of you will be formulating intervention type questions for your DNP projects. For example, let’s say that you have identified that there is a high incidence of ventilator-associated pneumonia in adult patients in the intensive care unit in your hospital and you want to know if implementing an evidence-based practice intervention from the literature will lead to a decreased incidence rate.

If you were to set up a PICOT using this practice situation, your question might then be narratively stated as: “For mechanically ventilated adult patients in the intensive care unit (P), does the use of the Institute for Healthcare Improvement (IHI) ventilator-associated pneumonia (VAP) bundle (I) compared to standard care (C) lead to a decreased VAP rate (O) within 2 months (T)?”

Begin with week 1 problem statement (problem and etiology) and then write the letters PICOT down the vertical side of a page and fill in your ideas for the Population, Intervention, Comparison, Outcome and Timeline. Using the example above, your page would look this way:

Starting with your problem statement you had noted that There are high incidence of VAP (problem)/ related to, inconsistent practices of elevating head of bed, over-sedation, lack of standardized prevention practices (etiology).

P = Ventilator dependent ICU patients on x unit in x organization
I = IHI VAP prevention bundle***
C = Standard care without this prevention bundle
O = Reduced incident rate of VAP for ICU patients
***(NOTE that this intervention is directly aimed at the etiology as stated in our week 1 problem statement).

Summary
In summary, the scientific underpinnings for advanced nursing practice (Zaccagnini & White, 2017) provide a foundation for merging nursing theory, nursing research, and evidence-based practice. The expected outcomes of such scientific underpinnings for advanced nursing practice are then driven by a quest for quality improvement in healthcare (Nelson, Batalden, & Godfrey, 2007) that leads to healthcare value by design at the microsystem, mesosystem, and macrosytem levels (Nelson, Batalden, Godfrey, & Lazar, 2011).

QUESTIONS:

From the perspective of your practice change interest (clinical outcomes, safety and quality, leadership or health policy) consider the specific ways of knowing as they have played into your awareness of the need for practice change?

Further, consider how intuitive/personal or ‘unknowing’ knowing dimensions of practice integrate with broader social, cultural and theoretical dimension to create meaning and inform ideas for practice change.

Give two specific examples from your practice. For example, let’s say that your practice change interest is in the way treatment decisions are made in end-of-life care for elderly patients. Which ‘Ways of Knowing’ have played primarily in to your observations and insights about this problem?

Examples of integration with broader social and cultural dimensions in this scenario of treatment decisions in end-of-life care: how does your intuitive/personal knowing integrate with what patients and families say about their experiences? What do you know about the cost of care, access to care or quality of care relative to the issue?

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PLANT PRESENTATION AND PAPER

This assignment includes a a Paper essay ( no longer than 6 doubled spaced pages) Regarding The “Brazilian Nut” also known as Bertholletia excelsa, and a brief powerpoint presentation based on the paper written. The presentation can be summarized in a method that includes each of the points ((attached to this Question below)) because it has already been included in the paper. *FILE ATTACHED*

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PLANTSPREZI.docx
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PMTClass82018

Global Management

Assignment 2: Discussion – Global Management
This assignment is designed to integrate the reflection of personal experience and the information covered in the textbook. Assuming you are Ludmilla responding to a recent email from Juanita, answer the following questions:

Besides cultural differences, what other factors might affect human resource management with this international office?
What abilities will help Juanita succeed and potentially fail in this assignment as an expatriate?
What has been the reason for the high failure rate of expatirate managers in Uzbekistan? What can Ludmilla do to increase the success of expats?
Since Uzbekistan has been significantly influenced by Russia for over 70 years, from Hofstede’s perspective, what impact has culture had on appraisal systems, self- managing teams, and systems for gathering suggestions from workers?

It has been a year since Juanita finished her degree and about two years since she has been promoted to HR Director status. As part of her training her boss has offered to send her to their HQ in Uzbekistan for one year. The office is staffed with several Americans and English speaking Uzbeks. She has spent some time studying the people and culture and thinks this will be an “adventure of a lifetime”. Of course, she knows that it will be a very different world for her. She intends to be a student of the culture and apply all that she has learned in the last few years.

Juanita has asked for a week to do research on the culture and how it has impacted the way their organization fulfills their mission. This is a former Soviet country that is populated with mostly Ukrainians, Kazakhs, Uzbeks and Tajiks. She has learned that they think of themselves as European but are primarily Muslim in their religious beliefs but motivated by pursuing material wealth.

As she contemplates how little she knows about this country and its people, some anxiety begins to creep in along with the excitement of the challenge of the unknown. To ensure she is reasonably well prepared before she goes, she decides to communicate with the Uzbek Director, Ludmilla Kovalenko.

Ludmilla, is Ukranian and has offered to provide her insights into the areas Juanita is interested in. In her first email she told Ludmilla that she will be sending some emails with questions related to the cultural context and other issues that may impact how work gets done and the mission accomplished.

What We Have to Lose Theodore Dalrymple

What We Have to Lose Theodore Dalrymple

Whenever we learn of events of world-shaking significance, of catastrophes or massacres, we are inclined not only to feel ashamed (all too briefly) of our querulous preoccupation with our own minor tribulations but also to question the wider value of all our activities. I do not know whether people who are faced by death in a few seconds’ time see their lives flash before them, as they are said to do, and pass final judgment upon them; but whenever I read something about the Khmer Rouge, for example, or the genocide in Rwanda, I reflect for a time upon my own life and dwell a little on the insignificance of my efforts, the selfishness of my concerns, the narrowness of my sympathies.

So it was when I first learned of the destruction of the two towers of the World Trade Center. I was settling down to write a book review: not of a great work, but of a competent, conscientious, slightly dull biography of a minor historical figure. Could any activity have been less important when set beside the horrible fate of thousands of people trapped in the then flaming—and soon collapsing—buildings? A book review, compared to the deaths of over 300 firemen killed in the course of their duty, to say nothing of the thousands of others? What was the point of finishing so laboriously insignificant a task as mine?

In my work as a doctor in a prison, I save a few lives a year. When I retire, I shall not in my whole career have saved as many lives as were lost in New York in those few terrible moments, even counting the time I spent in Africa, where it was only too easy to save human life by the simplest of medical means. As for my writing, it is hardly dust in the balance: my work amuses a few, enrages some, and is unknown to the vast majority of people in my immediate vicinity, let alone to wider circles. Impotence and futility are the two words that spring to mind.

Yet even as I think such self-regarding thoughts, an image recurs in my mind: that of the pianist Myra Hess playing Mozart in London’s National Gallery even as the bombs were falling during the Second World War. I was born after the war ended, but the quiet heroism of those concerts and recitals, broadcast to the nation, was still a potent symbol during my childhood. It was all the more potent, of course, because Myra Hess was Jewish, and the enemy’s anti-Semitism was central to its depraved view of the world; and because the music she played, one of the highest peaks of human achievement, emanated from the very same land as the enemy’s leader, who represented the depths of barbarism.

No one asked, “What are these concerts for?” or “What is the point of playing Mozart when the world is ablaze?” No one thought, “How many divisions has Myra Hess?” or “What is the firepower of a Mozart rondo?” Everyone understood that these concerts, of no account in the material or military sense, were a defiant gesture of humanity and culture in the face of unprecedented brutality. They were what the war was about. They were a statement of the belief that nothing could or ever can vitiate the value of civilization; and no historical revisionism, however cynical, will ever subvert this noble message.

I recall as well a story told by the philosopher Sir Karl Popper, an Austrian refugee who made his home in Britain. Four cultivated men in Berlin, as they awaited their expected arrest by the Gestapo, spent their last night together—possibly their last night on earth—playing a Beethoven quartet. In the event, they were not arrested; but they too had expressed by their action their faith that civilization transcends barbarism, that notwithstanding the apparent inability of civilization at the time to resist the onslaught of the barbarians, civilization was still worth defending. Indeed, it is the only thing worth defending, because it is what gives, or should give, meaning to our lives.

Of course, civilization is not only an attachment to the highest peaks of human achievement. It relies for its maintenance upon an infinitely complex and delicate tissue of relations and activities, some humble and others grand. The man who sweeps the streets plays his part as surely as the great artist or thinker.

Civilization is the sum total of all those activities that allow men to transcend mere biological existence and reach for a richer mental, aesthetic, material, and spiritual life.

An attachment to high cultural achievement is thus a necessary but not sufficient condition of civilization—for it is said that concentration-camp commandants wept in the evening over Schubert lieder after a hard day’s mass murder—and no one would call such men civilized. On the contrary, they were more like ancient barbarians who, having overrun and sacked a civilized city, lived in the ruins, because they were still far better than anything they could build themselves. The first requirement of civilization is that men should be willing to repress their basest instincts and appetites: failure to do which makes them, on account of their intelligence, far worse than mere beasts.

I grew up in secure and comfortable circumstances, give or take an emotional problem or two; but an awareness of the fragility of civilization was instilled early, though subliminally, by the presence in London during my childhood of large numbers of unreconstructed bomb sites that were like the gaps between the rotting teeth in an old man’s mouth. Often I played in small urban wildernesses of weeds and rubble, and rather regretted their gradual disappearance; but even so, I could hardly fail to see, in the broken fragments of human artifacts and in the plasterwork with wallpaper still attached, the meaning of the destruction that had been wrought before I was born.

Then there were the bomb shelters, in which I passed a surprising number of childhood hours. They were ubiquitous in my little world: in the school playgrounds and the parks, for example. That entry to them was forbidden made them irresistibly attractive, of course. Their darkness and fungal dampness added to their attraction: they were pleasantly frightening; one never quite knew who or what one might find in them. Had I been inclined to smoke, instead of being instantly sickened by nicotine, that is where—like so many of my friends—I would have learned to do so. And many a first sexual exploration took place in those inauspicious surroundings.

Despite the uses to which we put them, however, we were always aware of the purpose for which they had been built. Somehow, the shades of those who had sheltered in them, not so very long before, were still present. The Blitz was within every adult’s living memory: my mother’s apartment building had been bombed, and she woke one morning with half of it gone, one of her rooms now open directly to the air. In my house, as in many other households, there was a multivolume pictorial history of the war, over which I pored for entire mornings or afternoons, until I knew every picture by heart. One of them was ever present in my mind when I entered a bomb shelter with my friends: that of two young children, both blind, in just such a shelter, their sightless eyes turned upward to the sound of the explosions above them, a heartrending look of incomprehension on their faces.

More than anything else, however, the fact that my mother was herself a refugee from Nazi Germany contributed to my awareness that security—the feeling that nothing could change seriously for the worse, and that the life that you had was invulnerable—was illusory and even dangerous. She showed us, my brother and me, photographs (some of them sepia) of her life in pre-Nazi Germany: a prosperously bourgeois existence of that time, from the look of it, with chauffeurs and large cars, patriarchs in winged collars conspicuously smoking cigars, women in feather boas, picnics by lakes, winter in the mountains, and so forth. There were photos of my grandfather, a doctor decorated for his military service during the Great War, in his military uniform, a loyal subject of the Kaiser. And then—suddenly—nothing: a prolonged pictorial silence, until my mother emerged into a new, less luxurious but more ordinary (because familiar), life.

She had left Germany when she was 17 and never saw her parents again. If it could happen to her, why not to me or indeed to anyone? I didn’t believe it would, but then neither had she or anyone else. The world, or that little part of it that I inhabited, that appeared so stable, calm, solid, and dependable—dull even—had shakier foundations than most people most of the time were willing to suppose.

As soon as I was able, I began to travel. Boredom, curiosity, dissatisfaction, a taste for the exotic and for philosophical inquiry drove me. It seemed to me that comparison was the only way to know the value of things, including political arrangements. But travel is like good fortune in the famous remark of Louis Pasteur: it favors only the mind prepared. To an extent, one brings back from it only what one takes to it: and I chose my countries with unconscious care and thereby received many object lessons in the fragility of the human order, especially when it is undermined in the abstract name of justice. It is often much easier to bring about total disaster than modest improvement.

Many of the countries I visited—Iran, Afghanistan, Mozambique—soon descended into the most terrible chaos. Their peace had always been flawed, of course: as which is not? I learned that the passion to destroy, far from being “also” a constructive one, as the famous but foolish remark of the Russian anarchist Bakunin would have it, soon becomes autonomous, unattached to any other purpose but indulged in purely for the pleasure that destruction itself brings. I remember watching rioters in Panama, for example, smashing shop windows, allegedly in the name of freedom and democracy, but laughing as they did so, searching for new fields of glass to conquer. Many of the rioters were obviously bourgeois, the scions of privileged families, as have been the leaders of so many destructive movements in modern history. That same evening, I dined in an expensive restaurant and saw there a fellow diner whom I had observed a few hours before joyfully heaving a brick through a window. How much destruction did he think his country could bear before his own life might be affected, his own existence compromised?

As I watched the rioters at play, I remembered an episode from my childhood. My brother and I took a radio out onto the lawn and there smashed it into a thousand pieces with croquet mallets. With a pleasantly vengeful fury, as if performing a valuable task, we pursued every last component with our mallets until we had pulverized it into unrecognizability. The joy we felt was indescribable; but where it came from or what it meant, we knew not. Within our small souls, civilization struggled with barbarism: and had we suffered no retribution, I suspect that barbarism’s temporary victory would have been more lasting.

But why did we feel the need to revolt in this fashion? At such a remove in time, I cannot reconstruct my own thoughts or feelings with any certainty: but I suspect that we rebelled against our own powerlessness and lack of freedom, which we felt as a wound, by comparison with what we saw as the omnipotence and complete freedom of action of the grown-ups in our lives. How we longed to grow up, so that we might be like them, free to do as we liked and give orders to others, as they gave orders to us! We never suspected that adulthood would bring its own frustrations, responsibilities, and restrictions: we looked forward to the time when our own whim would be law, when our egos would be free to soar wherever they chose. Until then, the best we could do was to rebel against a symbol of our subjection to others. If we could not be as adults were, we could at least destroy a little of the adults’ world.

I saw the revolt against civilization and the restraints and frustrations it entails in many countries, but nowhere more starkly than in Liberia in the midst of the civil war there. I arrived in Monrovia when there was no longer any electricity or running water; no shops, no banks, no telephones, no post office; no schools, no transport, no clinics, no hospitals. Almost every building had been destroyed in whole or in part: and what had not been destroyed had been looted.

I inspected the remains of the public institutions. They had been destroyed with a thoroughness that could not have been the result of mere military conflict. Every last piece of equipment in the hospitals (which had long since been emptied of staff and patients) had been laboriously disassembled beyond hope of repair or use. Every wheel had been severed by metal cutters from every trolley, cut at the cost of what must have been a very considerable effort. It was as if a horde of people with terrible experiences of hospitals, doctors, and medicine had passed through to exact their revenge.

But this was not the explanation, because every other institution had undergone similar destruction. The books in the university library had been one and all—without exception—pulled from the shelves and piled into contemptuous heaps, many with pages torn from them or their spines deliberately broken. It

was the revenge of barbarians upon civilization, and of the powerless upon the powerful, or at least upon what they perceived as the source of their power. Ignorance revolted against knowledge, for the same reasons that my brother and I smashed the radio all those years before. Could there have been a clearer indication of hatred of the lower for the higher?

In fact there was—and not very far away, in a building called the Centennial Hall, where the inauguration ceremonies of the presidents of Liberia took place. The hall was empty now, except for the busts of former presidents, some of them overturned, around the walls—and a Steinway grand piano, probably the only instrument of its kind in the entire country, two-thirds of the way into the hall. The piano, however, was not intact: its legs had been sawed off (though they were by design removable) and the body of the piano laid on the ground, like a stranded whale. Around it were disposed not only the sawed-off legs, but little piles of human feces.

I had never seen a more graphic rejection of human refinement. I tried to imagine other possible meanings of the scene but could not. Of course, the piano represented a culture that was not fully Liberia’s own and had not been assimilated fully by everyone in the country: but that the piano represented not just a particular culture but the very idea of civilization itself was obvious in the very coarseness of the gesture of contempt.

Appalled as I was by the scene in the Centennial Hall, I was yet more appalled by the reaction of two young British journalists, also visiting Monrovia, to whom I described it, assuming that they would want to see for themselves. But they could see nothing significant in the vandalizing of the piano—only an inanimate object, when all is said and done—in the context of a civil war in which scores of thousands of people had been killed and many more had been displaced from their homes. They saw no connection whatever between the impulse to destroy the piano and the impulse to kill, no connection between respect for human life and for the finer productions of human labor, no connection between civilization and the inhibition against the random killing of fellow beings, no connection between the book burnings in Nazi Germany and all the subsequent barbarities of that regime. Likewise, the fact that the Red Guards during the Cultural Revolution in China had destroyed thousands of pianos while also killing 1 million people conveyed no meaning or message to them.

If anything, they “understood” the destruction of the piano in the Centennial Hall and even sympathized with it. The “root cause” of Liberia’s civil war, they said, had been the long dominance of an elite—in the same way, presumably, that poverty is often said to be the “root cause” of crime. The piano was an instrument, both musical and political, of that elite, and therefore its destruction was itself a step in the direction of democracy, an expression of the general will.

This way of thinking about culture and civilization—possible only for people who believe that the comforts and benefits they enjoy are immortal and indestructible—has become almost standard among the intelligentsia of Western societies. The word civilization itself now rarely appears in academic texts or in journalism without the use of ironical quotation marks, as if civilization were a mythical creature, like the Loch Ness monster or the Abominable Snowman, and to believe in it were a sign of philosophical naïveté. Brutal episodes, such as are all too frequent in history, are treated as demonstrations that civilization and culture are a sham, a mere mask for crassly material interests—as if there were any protection from man’s permanent temptation to brutality except his striving after civilization and culture. At the same time, achievements are taken for granted, as always having been there, as if man’s natural state were knowledge rather than ignorance, wealth rather than poverty, tranquillity rather than anarchy. It follows that nothing is worthy of, or requires, protection and preservation, because all that is good comes about as a free gift of Nature.

To paraphrase Burke, all that is necessary for barbarism to triumph is for civilized men to do nothing: but in fact for the past few decades, civilized men have done worse than nothing—they have actively thrown in their lot with the barbarians. They have denied the distinction between higher and lower, to the invariable advantage of the latter. They have denied the superiority of man’s greatest cultural

achievements over the most ephemeral and vulgar of entertainments; they have denied that the scientific labors of brilliant men have resulted in an objective understanding of Nature, and, like Pilate, they have treated the question of truth as a jest; above all, they have denied that it matters how people conduct themselves in their personal lives, provided only that they consent to their own depravity. The ultimate object of the deconstructionism that has swept the academy like an epidemic has been civilization itself, as the narcissists within the academy try to find a theoretical justification for their own revolt against civilized restraint. And thus the obvious truth—that it is necessary to repress, either by law or by custom, the permanent possibility in human nature of brutality and barbarism—never finds its way into the press or other media of mass communication.

For the last decade, I have been observing close-up, from the vantage point of medical practice, the effects upon a large and susceptible population of the erosion of civilized standards of conduct brought about by the assault upon them by intellectuals. If Joseph Conrad were to search nowadays for the heart of darkness—the evil of human conduct untrammeled by the fear of legal sanction from without or of moral censure from within—he would have to look no further than an English city such as mine.

And how can I not be preoccupied with the search for the origins and ramifications of this evil when every working day I come upon stories like the one I heard today—the very day I write these words?

It concerns a young man aged 20, who still lived with his mother, and who had tried to kill himself. Not long before, his mother’s current boyfriend, a habitual drunkard ten years her junior, had, in a fit of jealousy, attacked the mother in the young man’s presence, grabbing her round the throat and strangling her. The young man tried to intervene, but the older man was not only six inches taller but much stronger. He knocked the young man to the ground and kicked him several times in the head. Then he dragged him outside and smashed his head on the ground until he was unconscious and blood ran from a deep wound.

The young man regained consciousness in the ambulance, but his mother insisted that he give no evidence to the police because, had he done so, her lover would have gone to jail: and she was most reluctant to give up a man who was, in his own words to the young man’s 11-year-old sister, “a better f—k than your father.” A little animal pleasure meant more to the mother than her son’s life; and so he was confronted by the terrifying realization that, in the words of Joseph Conrad, he was born alone, he lived alone, and would die alone.

Who, in listening to such cases day after day and year after year, as I have, could fail to wonder what ideas and what social arrangements have favored the spread of conduct so vile that its contemplation produces almost physical nausea? How can one avoid driving oneself to distraction by considering who is more to blame, the man who behaves as I have described, or the woman who accepts such behavior for the sake of a moment’s pleasure?

This brutality is now a mass phenomenon rather than a sign of individual psychopathology. Recently, I went to a soccer game in my city on behalf of a newspaper; the fans of the opposing teams had to be separated by hundreds of policemen, disposed in military fashion. The police allowed no contact whatever between the opposing factions, shepherding or corraling the visiting fans into their own area of the stadium with more security precautions than the most dangerous of criminals ever faces.

In the stadium, I sat next to a man, who appeared perfectly normal and decent, and his 11-year-old son, who seemed a well-behaved little boy. Suddenly, in the middle of the match, the father leaped up and, in unison with thousands of others, began to chant: “Who the f—k do you think you are? Who the f—k do you think you are?” while making, also in common with thousands of others, a threatening gesture in the direction of the opposing supporters that looked uncommonly like a fascist salute. Was this the example he wanted to set for his son? Apparently so. The frustrations of poverty could hardly explain his conduct: the cost of the tickets to the game could have fed a family more than adequately for a week.

After the game was over, I saw more clearly than ever that the thin blue line is no metaphor. Had it not been for the presence of the police (whose failures I have never hesitated to criticize), there would have been real violence and bloodshed, perhaps even death. The difference between an event that passed off peacefully and one that would end in mayhem, destruction, injury, and death was the presence of a relative handful of resolute men prepared to do their duty.

Despite the evidence of rising barbarism all around us, no betrayal is too trivial for the Quislings of civilization to consider worthwhile. Recently, at the airport, I noticed an advertisement for a firm of elegant and costly shirt- and tie-makers, headquartered in London’s most expensive area. The model they chose to advertise their products was a shaven-headed, tattooed monster, with scars on his scalp from bar brawls—the human type that beats women, carries a knife, and throws punches at soccer games. The advertisement is not ironical, as academic cultural critics would pretend, but an abject capitulation to and flattery of the utmost coarseness and brutality. Savagery is all the rage.

If any good comes of the terrible events in New York, let it be this: that our intellectuals should realize that civilization is worth defending, and that the adversarial stance to tradition is not the beginning and end of wisdom and virtue. We have more to lose than they know.

steps for creating methodology

Topic: steps for creating methodology
Order Description
Using Figure 1.2 in Ch. 1 of Exploring Research, create a flowchart using Microsoft® Word or a similar program that helps you identify what research design to use for your research question
2 references

basic concepts and terminology associated with nursing research and informatics

EBP and Informatics Assignment From Readings, Assignments, and Discussions, the students will be able to: 1. Recognize the basic concepts and terminology associated with nursing research and informatics. 2. Discuss the relationship between quality improvement, informatics, and evidence-based practice. Readings: http://www.amia.org/glossary McManus, R., Nemec, E., C., Ferer, D., S., & Gumpper, K., F. (2012). Suggested definitions for informatics terms: Interfacing, integration, and interoperability. American Journal of HealthSystem Pharmacy, 69(13), 1163–1165. doi:10.2146/ajhp110612 Activity: Write a one paragraph (Maximum 500 words) description of the following: Who in your workplace is responsible for implementation and ongoing maintenance of the electronic medical record (EMR)? How were nurses involved in the implementation of EMR? How is the EMR used for quality improvement in your institution or agency? Identify one recommendation for improvement in application of informatics to the practice setting. Use appropriate terminology in describing the implementation. Include discussion of one evidencebased resource (beyond readings) applying informatics in practice. (5 points) Rubric: Nurses role in informatics 1 Use in quality improvement 1 Discussion of reference 1 Terminology 1 APA citation/reference 1 Total 5

A virus that transfers DNA from one bacteria cell to another.

Which of the following are mechanisms that make a bacterial cell resistant to an antibiotic. Select all that apply.

1. A virus that transfers DNA from one bacteria cell to another.

2. A siphon that sucks antibiotics from the cell.

3. A change to a molecule that would normally bind to an antibiotic.

4. A virus that lives in a bacteria and deactivates antibiotics.

5. An enzyme (protein) that breaks down the chemical structure of an antibiotic.

6 .A pump that ejects antibiotics from the cell.

Iom report on Nursing Education

Review the Institute of Medicine (IOM) report: The Future of Nursing: Leading Change Advancing Health focusing on the following sections: Transforming Practice Transforming Education and Transforming Leadership.
Write a paper of 750-1000 words about the impact on nursing of the 2010 IOM report on the Future of Nursing. In your paper include:
Cite a minimum of three references.
APA Style an abstract is not required
NO PLAGIARISM
You are required to submit this assignment to Turnitin.

To prepare for this Discussion, review Chapter 2, “Communities Working to Achieve Health Equity,” in the Promoting Health Equity document from Week 2. Select one case study to profile in your discussion

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Efforts to improve public health occur around the world every day. However, simply attempting to fix a problem without acknowledging, and respecting, the relationship between culture and health is not likely to have long-term success. Successful interventions, such as those in the case studies presented in your resources, demonstrate organizational collaboration. They also highlight the value of cultural relativism to improve population health outcomes. Working for the people (and with the people) can make an important impact on health.

To prepare for this Discussion, review Chapter 2, “Communities Working to Achieve Health Equity,” in the Promoting Health Equity document from Week 2. Select one case study to profile in your discussion. How do the key concepts, addressed in this week’s Learning Resources, relate to the case study you selected?

Post a comprehensive assessment of the following for your case study:

  1. Briefly describe the population and health issue addressed in the case study.
  2. In what way did cultural beliefs and behaviors contribute to the health issue in these case studies?
  3. Which public health (or other) groups intervened, and how did they cooperate to improve health for this population?
  4. What measures did the organization take to ensure they respected the dignity of the individuals and their culture?
  5. How does this case study relate to our class resources addressing culture and collaboration?

Note: Initial postings must be 250-350 words (not including references).

LINK TO CASE STUDIES: 

https://class.waldenu.edu/bbcswebdav/institution/USW1/201850_03/BS_HLST/HLTH_3115_WC/artifacts/USW1_HLTH_3115_Week2-CDC_social_determinants_of_health_workbook.pdf.

ADDITIONAL RESOURCES

 

UNICEF http://www.unicef.org 

AMFAR http://amfar.org/ 

WHO http://www.who.int/en/ 

Pan American Health Organization (PAHO) http://new.paho.org

International Federation of Red Cross and Red Crescent Societies http://www.ifrc.org/ 

HHS Global Health http://www.globalhealth.gov/ 

CARE http://www.care.org 

Doctors Without Borders/Médecins Sans Frontières (MSF) http://www.doctorswithoutborders.org/

Ford Foundation http://www.fordfoundation.org/ 

Rockefeller Foundation http://www.rockefellerfoundation.org/ 

Save the Children http://www.savethechildren.org/site/c.8rKLIXMGIpI4E/b.6115947/k.8D6E/Official_Site.htm 

World Bank http://www.worldbank.org 

Student ADA Version ofthe Arterial Blood Gas Interpretation Pre-Assessment Anatomy

Question

Student ADA Version

ofthe Arterial Blood Gas Interpretation Pre-Assessment

Anatomy

1. Backward effects of left-sided heart failure include:

A. Pulmonary congestion

B. Jugular vein distention

C. Dependent edema in the legs

D. Bounding pulses

Anatomy

2. In performing a physical assessment, the nurse notes the patient has a “barrel” configuration to the chest. This is a consequence of:

A. Reduced intrapleural pressures

B. Bronchial airway expansion

C. Increased vital capacity

D. Increased residual lung volume

Anatomy

3. Ausculation of the chest reveals bilateral fine crackles in the bases bilaterally, indicating:

A. Right-sided heart failure

B. Left-sided heart failure

C. Pneumonia

D. Acute respiratory distress syndrome

Biology
4. The signs and symptoms of anemia are all related to what common pathophysiologic feature of the condition?

A. Increased oxygen consumption by tissues

B. Decreased blood oxygen content

C. Vasodilation

D. A shift in the oxyhemoglobin dissociation curve

Biology
5. In addition to hypertension, preeclampsia is characterized by:

A. Nausea and vomiting

B. Fatigue and lower back pain

C. Protein in the urine and edema

D. Retinal changes and rates in the lungs

Biology
6. Common manifestations of bacterial pneumonia include all of the following except:

A. Fever

B. Productive Cough

C. Tachypnea

D. Hyperinflation

Biology
7. Closed drainage systems work to re-expand a lung after pneumothorax by:

A. Re-establishing the normal negative intrapleural pressure.

B. Creating a positive pressure in the pleural space

C. Removing excess fluid from the pleural space so that there is room for lung expansion.

D. Pulling oxygen into distal air sacs to re-expand lung tissue

Biology
8. Patients with chronic renal failure usually exhibit:

A. Bradycardia

B. Hypokalemia

C. Hypocalcemia

D. Hematomas

Biology
9. The diet of a patient in end-stage kidney disease is restricted in all of the following except:

A. Fluid

B. Potassium

C. Protein

D. Calories

Anatomy

10. Which of the following is true of the biological functions of progesterone?

A. Progesterone is the most important hormone associated with pregnancy.

B. Progesterone directs male sexual characteristics.

C. Levels of progesterone increases if the egg is not fertilized.

D. Levels of progesterone remain stable if the egg is not fertilized.

Anatomy

11. Which of the following is true of the biological functions of testosterone?

A. Testosterone is not secreted by the ovaries.

B. Testosterone is needed for development of female secondary sexual characteristics.

C. Testosterone stimulates ovulation.

D. Testosterone is needed for development of male secondary sexual characteristics.

Anatomy