HISTORY ESSAY

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HISTORY ESSAY

Consider the fact that the light bulb and the telephone were invented only three years apart. Although it took many more years for such devices to find their way into common household use, they eventually wrought major changes in a relatively brief period of time. What effects did these inventions have on the lives of those who used them? Are there contemporary analogies in your lifetime of significant changes due to inventions or technological innovations?

your answer should be unique and in your own voice

A proper essay should contain an introduction with a thesis statement, several supporting body paragraphs, and a concluding paragraph with reliable sources (WITH MAX 2 RESEARCH WITH CITATION)

Breast cancer

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Copyright B 2016 Wolters Kluwer Health, Inc. All rights reserved.

K E Y W O R D S

Breast cancer

Grounded theory

Initial chemotherapy

Psychological process

Yen-Chieh Chen, MSN

Hui-Man Huang, PhD

Chia-Chan Kao, PhD

Cheuk-Kwan Sun, MD

Chun-Ying Chiang, PhD

Fan-Ko Sun, PhD

The Psychological Process of Breast Cancer Patients Receiving Initial Chemotherapy Rising From the Ashes

Background: In Taiwan, breast cancer is the most common cancer in women.

Most breast cancer patients are willing to receive chemotherapy and experience

adverse effects and suffering during the process of chemotherapy. Objectives: The

aim of this study was to explore patients’ psychological process when receiving

initial chemotherapy for breast cancer. Methods: A qualitative grounded theory

approach was used. Data were collected through semistructured interviews of

20 patients who were from 1 district teaching hospital during 2012 to 2013.

Results: A substantive theory was generated to describe the psychological process

experienced by breast cancer patients in their initial treatment. The core category

was ‘‘rising from the ashes.’’ Four categories emerged and represented 4 stages

of the psychological process experienced by breast cancer patients. They were

(1) fear stage: patients are frightened about permanent separation from family,

chemotherapy, and the disease getting worse; (2) hardship stage: patients

experience physical suffering and mental torment; (3) adjustment stage: patients fight

against the disease, find methods for adjustment, and get assistance from supporting

systems; (4) relaxation stage: patients were released from both the physical and

mental sufferings, and patients accepted the disease-related change in their lives.

Conclusion: Each stage is closely related to the other stages, and each is likely to

occur repeatedly. It is important to help patients achieve the relaxation stage.

Author Affiliations: Department of Nursing, National Cheng Kung University The authors have no funding or conflicts of interest to disclose. Hospital (Ms Chen); and Department of Nursing, Chang Jung Christian Uni- Correspondence: Fan-Ko Sun, PhD, Department of Nursing, I-Shou versity, Tainan (Dr Huang); and Department of Healthcare Administration University, No. 8, Yida Rd, Jiaosu Village, Yanchao District, Kaohsiung City (Dr Kao), Department of Emergency Medicine, E-Da Hospital (MD Sun), 82445, Taiwan, Republic of China (sunfanko@isu.edu.tw). and Department of Nursing, I-Shou University, Kaohsiung (Drs Chiang and Accepted for publication October 13, 2015. Sun), Taiwan, Republic of China. DOI: 10.1097/NCC.0000000000000331

E36 n Cancer NursingTM , Vol. 39, No. 6, 2016 Chen et al

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Implications for Practice: The results of this study may enhance nurses’

understanding of the psychological process of patients receiving initial chemotherapy

for breast cancer, thereby helping nurses to provide appropriate assistance to improve

the quality of patient care.

G lobally, cancer ranks first among the top 10 causes of death. Breast cancer is one of the most prevalent forms of cancer affecting women. In 2008, an estimated

1 380 000 women in the world had suffered from breast cancer, of which 460 000 women died of the disease.

1 In 2010,

an estimated 20 000 (n = 202 675) new breast cancer cases were diagnosed in the United States, contributing to 18% of all cancers diagnosed in the United States that year.

2 In the latest

statistical data in Taiwan, female breast cancer had the highest incidence in 2012 (n = 10 525), with the median age of pa- tients being 53 years.

3 The incidence of breast cancer in Taiwan

has increased 3-fold in the last 15 years, increasing from 3640 cases in 1997 to 10 525 cases in 2012.

3,4

A benefit arising from the recent increase of cancer screening and advancement in medical technology is that cancer survival rates have gradually risen. In particular, the survival rate of stage 0 breast cancer patients can now exceed 97%. Similarly, stage 1 survival rates can now surpass 95%, and stage 2 survival rates 89%. Stages 3 and 4 survival rates can be maintained at 70% and 25%,

5

respectively. Therefore, early diagnosis and treatment of breast cancer in women are very important for survival.

Aside from patients with stage 0 cancer, most breast cancer patients require chemotherapy.

6 There are 2 types of chemo-

therapy: adjuvant chemotherapy after a surgical operation and neoadjuvant chemotherapy before surgical operation. Adjuvant chemotherapy is aimed at reducing the chance of relapse and relocation following surgical operation. At present, the chemo- therapeutic drugs more commonly used include CEF (cyclo- phosphamide, epirubicin, 5-fluorouracil), AC (adriamycin, cyclophosphamide), and EC (epirubicin, cyclophosphamide). CEF is the most commonly used drug in adjuvant chemother- apy following surgery and in neoadjuvant chemotherapy before surgery. A course of chemotherapy requires an injection around once every 21 days for a total of 3 to 6 injections, which depend on participants’ pathology report. Therefore, a course of chemo- therapy is slow and requires approximately 4 to 5 months

7,8

The long duration of the chemotherapy process can entail multiple symptoms including (1) fatigueVapproximately 99% of breast cancer patients receiving chemotherapy report fatigue, and greater than 60% of chemotherapy patients experience mild to severe fatigue; the duration of fatigue can be several months to years, influencing patient capabilities and standard of living

9Y11 ;

(2) insomniaVapproximately 65% of patients experience a reduced quality of sleep after receiving chemotherapy; the quality of sleep is particularly worse on the first night of the chemotherapy

12 ;

(3) nausea, vomiting, and loss of appetiteVapproximately 6% to 74% of these women experience loss of appetite

13 ; and (4)

hair lossVhair loss begins 2 to 4 weeks following chemotherapy. Common psychological symptoms reported by women in

treatment with breast cancer include (1) worryVpatients were

faced with uncertainty regarding treatment results, relapse, and future living arrangements since the beginning of the disease. All breast cancer patients gave worry-related responses; of these, 28% were mildly worried, 50% moderately worried, and 22% indicated severe anxiety

14,15 ; (2) anxietyVpatients experienced

moderate to severe anxiety at the beginning of the diagnosis. Their anxiety levels were relatively lowered after their diagnosis was confirmed and decreased gradually after the first treatment

16 ;

(3) depressionVstudies have revealed that approximately 16% of breast cancer patients are mildly depressed, 11% moderately depressed, and 3% severely depressed. Those with severe de- pression reported suicidal ideations or attempts. Some patients developed severe levels of depression within the first month of diagnosis

13 ; (4) sadnessVcommonly associated with a perceived

loss such as losing their hair. 17

Much of the current breast cancerYrelated research focuses on patient fatigue after chemotherapy,

10,11,18 the adverse

effects of chemotherapy, 19,20

and quality of life during chemo- therapy.

21,22 However, studies in relation to the psychological

aspects of chemotherapy patients are rare. Therefore, in the current study, the psychological experience of breast cancer pa- tients during their first chemotherapy was explored to help generate new understanding of this experience for first-time chemotherapy breast cancer patients.

n Methods

Grounded theory (GT) focuses on describing theory or ex- plaining the stages of experience.

23 Because the current study

aimed at generating a theory to describe the psychological stages of breast cancer patients during their first chemotherapy, GT using the approach of Glaser

24 was the most suitable for this study.

Sample Breast cancer patients were recruited from a teaching hospital in southern Taiwan. The criteria for participant sampling included (1) intravenous chemotherapy patients; (2) any breast cancer stage but patients would need to have finished the first course of chemotherapy (a course has 3Y6 injections); the interview was to take place within 6 months of finishing the first course of chemo- therapy; (3) female breast cancer patients; (4) 20 years or older; (5) speaker of Mandarin or Taiwanese language; and (6) signed the agreement to participate in this study. Patients excluded from this study included those (1) experiencing a recurrence and (2) who were weak and unable to talk during the interview.

Twenty breast cancer patients were invited to participate in the study, and no one refused. Their age range was 39 to 62 years (mean, 49.8 years). Seventeen participants were married;

Psychological Process of Breast Cancer Patients Cancer NursingTM , Vol. 39, No. 6, 2016 n E37

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

 

 

20 participants were religious. The religions were mostly folk religion, Taoism, and Buddhism. Eighteen participants were em- ployed, and the remaining 2 were housewives. Nine participants had stage 2 breast cancer, 7 had stage 3, 2 stage 4, and 2 had stage 1 breast cancer. Six participants received adjuvant CEF combined chemotherapy injections 3 times, 4 participants received adjuvant CEF combined chemotherapy injections 6 times, 3 participants received adjuvant CEF combined chemotherapy injections 4 times, 4 participants received AC combined chemotherapy injections 4 times, 2 participants received neoadjuvant CEF combined che- motherapy injections 4 times, and 1 participant received neo- adjuvant CEF combined chemotherapy injections 3 times (Table).

Data Collection This study primarily used semistructured interviews to collect data during 2012 to 2013. The actual answers provided by the participants during the interviews were used to guide the in- terview into a deeper exploration of the psychological processes of breast cancer patients during their first chemotherapy. The interviewer had worked as a specialized nurse in a surgical ward for 7 years and had extensive knowledge regarding breast cancer chemotherapy. Interviews were conducted in an interview room in the hospital, which provided a comfortable, quiet, and un- disturbed environment. Each participant was interviewed once, and each interview lasted 30 to 60 minutes.

Three breast cancer patients who had undergone their first chemotherapy with at least 3 injections were selected to partic- ipate in a pilot study that was aimed at learning of problems that could arise during the interviewing process and details that required attending to and if interview guidelines needed to be

Table & Demographic Details of the Sample

refined based on the interviewee’s answers. After the pilot study, the open-ended grand tour interview questions became as follows: (1) What was on your mind before receiving chemo- therapy? How were your mood and feelings? (2) During chemo- therapy, what was on your mind? How were your mood and feelings? (3) After chemotherapy, what was on your mind? How were your mood and feelings? (4) How did the chemotherapy affect your life? (5) During chemotherapy, did you encounter any problems or difficulties? How did you adjust? Guided by participants’ interview content, the researcher would ask ques- tions linking to emergent concepts, subcategories, or categories in order to contribute to theoretical sampling and to reach the- oretical saturation. For example, the participant would be asked a question concerning physical suffering experienced as a result of receiving chemotherapy.

Ethical Considerations This study was approved by the institutional review board in a hospital (EMRP-101-030). Prior to participant enrollment, the interviewer explained in detail to the participants the aim of the study, the methods to be used, and the rights that the partic- ipants had. An agreement to participate in the study was signed only if the participant wished to join the study following the detailed disclosure about the study. Even after the agreement was signed, participants could request to opt out of the study at any time without providing reasons. During the interviews, in- terviewees had the right to decide on the details of the infor- mation shared. After the interviews were conducted, interviewees still could ask to delete any information provided. All interview data were processed based on anonymity; thus, privacy of the

Patient Age, y Marital Status Religion Occupation Breast Cancer Staging Chemotherapy

1 48 Married Folk religion a

Businesswoman T2 N3 M0 IIIC CEF � 6 2 57 Married Folk religion

a Service industry T1 N1 M0 IIA AC � 4

3 50 Married Taoism Construction worker T1c N1 M1 IIA AC � 4 4 45 Married Taoism Labor T2 N2 M0 IIIA CEF � 3 5 49 Married Folk religion

a Labor T1c N0 M0 I CEF � 6

6 41 Married Folk religion a

Labor T2 N2 M0 IIIA CEF � 4 7 47 Married Taoism Labor T1c N0 M0 I CEF

b � 3 8 62 Widow Buddhism Farmer T4 N3 M1 IV CEF � 3 9 51 Married Folk religion

a Self employed T1c N1 M0 IIA AC � 4

10 59 Married Other Insurance Saleswoman T2 N2 M0 IIIA CEF � 3 11 43 Divorce Buddhism Businesswoman T2 N0 M0 IIA CEF � 6 12 52 Married Taoism Labor T2 N3 M0 IIIC CEF

b � 4 13 50 Divorce Taoism Construction worker T2 N0 M0 IIA CEF � 6 14 39 Married Buddhism Service industry T3 N1 M0 IIIA CEF � 3 15 47 Married Catholicism Government employee T1b N1 M0 IIA CEF � 4 16 59 Married Other Government employee T1c N2 M0 IIIA CEF � 3 17 45 Married Buddhism Service industry T2 N1 M0 IIB CEF � 3 18 46 Married Folk religion

a Labor T2 N1 M0 IIB AC � 4

19 56 Married Taoism Housewife T4 N2 M1 IV CEF b � 4

20 50 Married Folk religion a

Housewife T1c N1 M0 IIA CEF � 4

Abbreviations: AC, adriamycin (doxorubicin), Cytoxan (cyclophosphamide); CEF, Adjuvant chemotherapy, Cytoxan (cyclophosphamide), Ellence (epirubicin), 5-FU (5-fluorouracil). a A mix of Taoism and Buddhism

b CEF, neoadjuvant chemotherapy, Cytoxan (cyclophosphamide), Ellence (epirubicin), 5-FU (5-fluorouracil).

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participants was protected. Participants who exhibited intense emo- tional reactions during the interviews were comforted by the inter- viewer. In this study, only 1 participant required comfort from the interviewer, but no participant required a referral to a psychiatrist.

Data Analysis Data analysis involved open and theoretical coding processes to achieve data conceptualization. Coding involves analyzing every word and sentence in the text data and identifying important, outstanding, and repetitive messages during data analysis.

25 Each

interview was recorded using audio tape, and the interview verbatim was prepared within 3 days. Every word and sentence was then analyzed immediately to seek out important and re- petitive message code to form concepts. Similar concepts were then grouped into subcategories using the constant comparative method. Similar subcategories were grouped into categories. Software package NVivo 10 (QSR International Pty Ltd, Australia) was used to assist in the grouping of concepts, subcategories, and categories.

26,27 A purposive sampling was used initially for emerg-

ing concepts, and then theoretical sampling was used to select additional participants until categories were saturated.

28 For

example, when the category of ‘‘relaxation stage’’ began to emerge from the data, an additional 3 breast cancer patients were selected to elicit more data about relevant properties (subcategories) and to reach saturation of this category. Analysis became saturated with concepts after the number of participants reached 20. At this point, no new concepts were discovered, and consequently, participant

recruitment was terminated. At the end of the analysis, 4 categories and 10 subcategories and a core category were derived from the data; the process of ‘‘coding family’’ was used to link each category with the core category,

24 which led to the theory

generation of describing the psychological process of breast cancer patients in their initial treatment (Figure).

Rigor Five methods were used to enhance the credibility of the current study.

29 They were (1) prolonged engagementVthe researcher

would participate in the care of the participants during their hospitalization and the continuing care of the patients during their follow-up visits to establish a good therapeutic relationship; (2) persistent observationVthe researcher continued to observe the verbal and nonverbal expressions of participants during their follow-up visits to understand their actual situation; (3) peer briefingV3 breast cancer psychological experts with experience in qualitative research were invited to collaborate in reviewing and discussing the categories, subcategories, and concepts obtained from the analysis. This was to ensure that the results would be consistent; (4) member checkV2 participants were invited to check the categories, subcategories, and concepts obtained by the researcher in order to determine if the results represented their actual situation; (5) use of a reflective journalVthe researcher used the reflective journal to help with self-awareness for cor- recting interview techniques. This enabled more detail and actual research data to be obtained.

Figure n A theory to describe the psychological process of breast cancer patients in their initial treatment.

Psychological Process of Breast Cancer Patients Cancer NursingTM , Vol. 39, No. 6, 2016 n E39

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n Results

Four categories and a core category resulted. Using these 4 cate- gories, ‘‘the psychological process of breast cancer patients re- ceiving initial chemotherapy’’ was concluded. Four psychological processes were identified: the fear stage, hardship stage, adjust- ment stage, and relaxation stage. The core category was ‘‘rising from the ashes’’ (Figure). The 4 stages are described in the following sections, followed by a description of the GT con- structed around the core category.

Stage 1: Fear Stage In the first stage, breast cancer chemotherapy patients experienced the fear stage. The participants worried that the disease would be incurable and that they could no longer live with their family. They expressed fear at the thought of suffering adverse effects from the chemotherapy, cancer cell metastasis, and disease dete- rioration. Therefore, this category was classified into 3 subcategories.

FEAR OF PERMANENT SEPARATION FROM FAMILY

Many participants expressed fear about any possible, unfortu- nate event that could happen because of their breast cancer because their children were still minors or still required parental support. They also feared that their own parents would be worried when they were eventually informed about the cancer. Furthermore, the participants feared that their parents would think they were ill fated and worry that they would have to experience their child’s death before their own. Two participants had this to say:

I would think that if I really passed away, how would my child cope? I was the one who managed everything at home such as the child’s education. If I really passed away, my child and husband do not have a close relationship compared to me. I fear my child would not have anyone to talk to anymore. (Participant 1)

Since I am the only daughter at home, my father favors me the most. Therefore, I know he would be the one feeling hurt the most because of my cancer. I dare not to tell him about my cancer. I fear he would worry. (Participant 6)

FEAR OF CHEMOTHERAPY

Many participants knew there might be multiple adverse effects associated with the chemotherapy that could cause discomfort. Therefore, they were fearful of chemotherapy and wanted to look for alternative therapy. They also feared that chemotherapy would affect their body, and they would be unable to work. Three participants expressed their experiences as follows:

I am afraid when I hear about chemotherapy! This is my first time, I have heard from others that I may vomit. (Participant 18)

Before receiving chemotherapy, my husband suggested that I take herbal medicine to treat the breast cancer. (Participant 7)

Before receiving chemotherapy, I was very worried because I really wanted that job and would like to have

kept working. I worried that my body would become weak and be unable to work. I still need to earn money to support my family. (Participant 11)

FEAR OF THE DISEASE GETTING WORSE

Many participants received chemotherapy to kill off the cancer cells because they wanted to be completely cured from breast cancer, but they also feared that if the chemotherapy was un- successful, the cancer cells could spread, their lives could be cut short, and the disease could become incurable. Therefore, they were very worried about a possible relapse and their cancer metastasizing:

I fear of the possibility of cancer metastasis. I have heard others say that even if it is confirmed you have breast cancer, other cancers such as lung adenocarcinoma can arise. I am worried. (Participant 11)

During the chemotherapy treatment period, if I do not have to work and am lying on bed the whole day, I would think about anything, and they would usually be the negative side of things. I would worry about having a relapse or something similar. (Participant 18)

Stage 2: Hardship Stage After the participants began to receive chemotherapy, adverse effects began, and their bodies started to feel the strain. Their capability of performing daily chores was affected; they would start to feel the psychological strain as well. When both types of hardship combined, it became hard for the participants to withstand the suffering. This category was classified into 2 subcategories.

PHYSICAL SUFFERING

All participants complained about the various adverse effects of the chemotherapy, including hair loss and the worry that others would perceive them differently. Many participants expressed that after the chemotherapy they had symptoms such as nausea, vomiting, loss of appetite, insomnia, and inactivity due to fatigue. Some reported numbness in their limbs, a higher rate of infection due to weaker immunity, and poor memory. The following 5 par- ticipants shared their experiences:

After the chemotherapy, all my hair had fallen out; I locked myself at home because I was afraid of going out. This included when I needed to get some food for lunch, my husband had to manage that for me. When my husband was really tired, I would wear a wig out. I would consistently stare at people to see if anyone noticed that I was wearing a wig! (Participant 14)

After the chemotherapy, it made me lazy, and I did not want to move because I was so tired. Then, I had no appetite because my sense of taste changed. It was so different that I couldn’t taste the food. Everything was different in my body. (Participant 15)

I can usually fall asleep very easily, as in whenever I want to sleep, I can just go to bed and sleep. During chemotherapy, I felt very uncomfortable, tired, and sleepy, but I couldn’t fall asleep no matter what! (Participant 17)

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Because of the adverse effects of chemotherapy, my fingertips felt very numb. I went to do electrotherapy rehabilitation for a couple of weeks. My skin became red and itchy, and this led to infection. Because of this, I needed to get my own electrotherapy stickers. (Participant 12)

During the chemotherapy period, my memory wasn’t as good, and I often forgot things. I often forgot I had already gotten the things I wanted. (Participant 17)

MENTAL TORMENT

Many participants described feeling depressed when it was close to the next chemotherapy injection session because they did not want to suffer the adverse effects from chemotherapy. They felt that it was too hard to live and contemplated suicide. Some participants even blamed themselves for having done something wrong that caused the cancer. Two participants expressed:

I didn’t feel much from the first injection. In the second one, I felt very depressed. The discomfort could last for 4 to 5 days. I was thinking that if I had to suffer this much, I would rather not have had the chemotherapy. But my husband told me to be patient for a bit. In my third injection, I got even more depressed and uncomfortable. I was thinking that if I had to suffer this much to live, I would rather not live! (Participant 9)

My daughter had just given birth, so I made sesame oil chicken and fish soup for her. But she didn’t eat much, so I helped her eat it. I suspect that I ate too much and that it made me ill. My whole armpit was swollen, so I went to see the doctor. (Participant 12)

Stage 3: Adjustment Stage The psychological process of breast cancer patients during che- motherapy entailed both physical and mental suffering. They needed to adjust their mindset toward cancer using different positive coping methods such as exercise to surpass the suffering caused by chemotherapy. They also required help from friends, medical professionals, and religion to adjust themselves to with- stand the cancer treatment. This category was classified into 3 subcategories:

FIGHT AGAINST THE DISEASE

Most of the participants expressed that they had to live for their families and thus had to be brave in facing their disease. They had to adhere to the medical professionals’ instructions on how to treat their disease. Moreover, they had to fight for their lives by forcing themselves to eat, even when they were unable to eat. They had a desire to surpass their disease so that they could continue living. Two participants had this to say:

During chemotherapy, I felt that I had to fight this disease. I thought that I might as well try to fight it to see if I could live for a few more years! Besides taking the advice from doctors, I needed to depend on my own mental strength. After that, I tried to do as much exercise as possible and eat normally to help my body heal. (Participant 8)

After having chemotherapy, I couldn’t eat when I got home. But, I would think of some ways to eat something more nutritious. For example, when I cooked fish, I would add an egg in it. I would try to eat as much as I could. But if I couldn’t eat, I would make some fruit juice to drink. I don’t want to leave my child and his father behind! I will be brave and keep on living! (Participant 2)

 

List and explain areas/events what kind of data you need for online shopping sites like h&m and asos for decision making.

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List and explain areas/events what kind of data you need for online shopping sites like h&m and asos for decision making.

Explain the 7 types of decision making for your data such as:

1. Association Analysis: Identify how or what data would you need to provide SUPPORT

and CONFIDENCE for your rule. Explain, how you will calculate SUPPORT, CONFIDENCE

and LIFT. What DECISION would you take based on the values related to SUPPORT,

CONFIDENCE and LIFT

2. CLUSTER ANALYSIS: Identify if there is a possibility of creating a group/cluster in your

project  What criteria/data elements would you use to create clusters. How would you

create clusters (concepts only). How will clustering help you in your project? Explain in

terms of the concept of Heterogenous and Homogenous groups and effective use of the

clusters.

3. Decision Tree: Decision tree is used to show the effect of categorical input on

categorical output (mostly dichotomous/binary). What could be the categorical input

and output in your project? How would you measure the effectiveness of effect of the

input on output? Concept of Chi test and p-value  How would you measure the

reliability of this model in decision making? Does Decision Tree help you with decision

making?

4. Logistic Regression: Used when we need to show the effect of an input in

dichotomous/binary output  Identify the reason of using odds ratio. How would this be

different to what decision tree provides? Compare between logistic and decision tree,

which one would you prefer.

5. Neural Network: Used for any type of input or output. Specify the significance of its

ability to use multiple models in single model. How can Neural Network help with better

decision making for your online shopping site?

6. Text Mining: How do you collect unstructured data in your project? How would you

utilize text mining to better understand the data you may have for your project? How

important is it, in your project, to perform text mining and how would you explain its

importance? You need to explain with examples on why and how text analysis is helpful

in decision making.

7. Social Network Analysis: How would you use the concept of degree, betweenness and

closeness centrality to promote your online shopping? Does SNA have significance in

terms of decision making?

Pick what you think helps you most with decision making Of the 7 models/methods. Which

one(s) do you think will help you with decision making? List the models and if it hasn’t been

explained earlier, explain the reason for choosing them.

Research Paper Questions

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Research Paper Questions

TO:  All Students

Following are three alternate Research Paper questions.  You may write your paper on any one of the three.

0. Should “water boarding” be used as an interrogation technique? – The concern is effectiveness, limits, morality, etc.  Do not discuss current law on legality. 

1. Should the U.S. military be used for border security to help prevent illegal immigration?

2. Should martial law be declared in border towns (e.g., Laredo, Texas) where Mexican drug cartels pose a danger to U.S. citizens?

3. Did the DOJ and FBI abuse the FISA warrant process in the 2016 election cycle?

As applicable, your paper should include a review of state and federal law, the U.N. Charter and pronouncements, relevant Geneva Conventions, and other related international law and treaties.  You may use any other relevant sources, so long as the sources are academic in nature.  Wikipedia is not a valid primary academic source.  News media should be used sparingly.  Do not forget the ultimate question for this course, is what you propose legal?

Take a position, set it forth in your thesis, and support it with the sources you have found in your research.  Note that it matters not whether the Instructor may or may not agree with your position – do not presume what you think the instructor’s position might be – what matters is whether you have adequately supported it in a logical, rational manner with adequate research.  In other words, convince your Instructor that your position is correct.

If you would like to write a paper on a different topic, you most submit a written request to the Instructor.  If the Instructor preapproves your topic, you may submit a paper on that topic.  Requests must be submitted on the “Messages” link.   Such request should be submitted in the first week of this course.  

A few additional issues to remember:

· First, do not appeal to emotion.  This is not a sociology, philosophy, or religion course.  This is a law course.

· Second, follow the instructions provided on how to prepare and submit your paper.

· Third, while the primary concern is the subject matter addressed in your paper, be aware that spelling, punctuation, grammar, etc. are considered in grading.

Once more, review the instructions on the Research Paper which were previously provided.

If you are having any problems, please contact me.

Pete Kleff

Pierre A. Kleff, Jr., JD, MA

· Research Paper Instructions

TO:  All Students

It is important that you think of the Research Paper as an example of your ability to research a subject and not a test of how much you know about a subject.  In every case, a paper that ignores the wider narrative in favor of an in-depth study of an issue within the wider narrative is preferred.

To this end, you should include primary source material in your paper.  There is a significant amount of primary source material available to you through the Central Texas College library site.  The Internet provides a plethora of research material.

Your Research Paper should be not less than five (5) pages in length, spacing 1.5, and use Arial font 11.   Insert page numbers and center at bottom.   It is preferable to use footnotes, as opposed to endnotes.   It is not necessary to include a bibliography.   Sources referenced should be included in either the body or footnotes. Note: Wikipedia is not a valid primary or end source.

A sample research paper is attached.   See site menu at the left of your screen.   It is an example for you to emulate or follow.   Do not fret, it is a graduate level course paper.   Note: the Instructor will provide you the question. The thesis and content are your responsibility.  Follow the format in the sample paper.

There is no preference as to the writing style you use. Here are the three major academic writing styles:

· American Psychological Association (APA) Style: It is quite difficult to meet all the requirements.  Most Instructors do not particularly care for APA.  If you use it, however, be sure to follow the instructions above regarding footnotes, which is contrary to APA.

· Modern Language Association (MLA) Style: This style is not so strict comparing to APA or other styles. MLA is the most used style for academic writing.  It has its own citation and reference rules but in general you have a wide discretion.  Here you are to pay attention to spacing and formatting requirements.  In-text citations of this style are simple.  If you use this style, again follow the instructions above for footnotes.

· The Chicago Style: Another format style used mostly for topics on humanitarian sciences.  Here, unlike APA style, you use footnotes at the bottom of appropriate page.  In this course, no bibliographical page is required. Chicago style is preferred.

With regard to proper citations, here are some examples:

Miscamble, Wilson D., From Roosevelt to Truman: Potsdam, Hiroshima, and the Cold War (New York, NY: Cambridge University Press, 2007), 51.

Churchill, Winston, “The Sinews of Peace”, Winston S. Churchill: His Complete Speeches 1897-1963 Volume VII: 1943-1949, ed. Rhodes James (New York: Chelsea House Publishers, 1974), 7285-7293.

Quoted by Kreinin, Mordechai E., “The ‘Outer-Seven’ and European Integration,” American Economic Review 50 (June 1960), 371.

www.historiasiglo20.org/europetraroma.htm

Kreinin, op. cit., 370.

Citations for court cases are critical and must be correct. Here are some examples from your course:

Berlin Democratic Club v. Rumsfeld, 410 F.Supp.144 (1976)

Zweibon v. Mitchell, 720 F.2d 162 (1983)

Brown v. United States, 484 F.2d 418 (1973), cert. den. 415 U.S. 960 (1974)

Butenko v. United States, 392 U.S. 923 (1968)

As an aside, using the Instructor as a source, reference, or authority, while perhaps flattering to the Instructor, is discouraged. 

If you are having any problems, please contact me.

Pete Kleff

Pierre A. Kleff, Jr., JD, MA

Three Branches of Government/Separation of Powers 2023

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Three Branches of Government/Separation of Powers 2023

 

Course Learning Objective: Summarize the roles, powers, and operation of the three main branches of the U.S. federal government.

Overview: In this paper you will: (1) explain our three branches of government with a focus on the separation of powers and checks and balances; and (2) you will illustrate our three branches of government/separation of powers/checks and balances by providing examples for each of the three branches per the prompt below.
Detailed Instructions:
In the instructions below the (%) indicates percentage of your paper/score that should be spent on that part of the prompt.
In your paper –
1. (5%) Introduction – Your paper should provide a summary of your entire paper. I suggest that you draft this section after you have completed your paper.
2. (10 %) Summarize the roles, powers, and operation of the three main branches of government as well as the concepts of (a) separation powers and (b) checks and balances.
3. (about 78% ) (Spend the most time/effort/paper space on this part.)
(26%) Legislative Branch
What can you tell me about the legislative branch with respect to separation of powers and checks and balances? (The videos we watched in class regarding the Constitutional Convention and the Yosemite school might be useful here and for other parts of this paper).
Please include in your discussion:
Differences between House and Senate
An example of a veto override
An example of a fillibuster
An example of Senate approval of a treaty
An example of Senate approval of a presidential appointee
(26%) Executive Branch
What can you tell me about the executive branch with respect to separation of powers and checks and balances?
Please include in your discussion:
The presidency:
An example of the president urging Congress to pass a certain law
An example of a presidential veto (it can be the same veto as in the override example, above)
An example of an executive order
The bureaucracy – (You can use information you used for your “Rooting for You” assignment when we studied the bureaucracy here).
Describe how the executive department/agency you selected carries out laws
Tell me again about the regulation you selected for your assigment and the reason for the regulation.
(26%) Judicial Branch
What can you tell me about the judicial branch with respect to separation of powers and checks and balances?
Please include in your discussion:
Why is the judicial branch considered the “least dangerous branch”?
Is an impartial judiciary important to democracy?
Refer back to your “classroom discussion” in our judicial branch module – named very creatively as “Paper #2 Focus: The Judicial Branch.”
Give an overview of the U.S. Supreme Court decision you selected for that assignment and how the U.S. Supreme Court resolved the conflict.
How does the judicial branch’s role with this law/case reflect what we have learned regarding separation of powers/checks and balances?
4. (About 2 % of your paper) Looking at what you have discussed in your paper – How effective are the three branches of government set up by the Constitution in dealing with contemporary problems? For example, what are some ways that our system of government is effective in addressing these issues? What are some ways that our system of government is not effective in addressing these issues? Can you suggest a better way?
5. (About 5%) Conclusion – summarize and conclude your paper.
6. Additional Details:
Your task is to write a concise, thoughtful paper that critically analyzes the above questions/points. (You must answer all questions/address all points.)
The focus of this paper will be on the depth of your analysis and the application of the concepts we are learning in this class to this assignment. Please provide substantive analysis and give examples to support your claims. You may use the above headings (or similar) in your final draft of your paper, if desired.
Please be sure to review the paper rubric on the online assignment page.
You must use the course materials in your analysis. Your paper should contain at least three quotes to our textbook and/or class materials (PowerPoints/lectures/online module pages).
You should use Chicago Style, MLA, or APA source citations. Please see this link for more information: https://libguides.mjc.edu/citeyoursourcesLinks to an external site.
Again: Wikipedia and Ballotpedia may be a resource, but they should not be cited as sources in your paper. Always find and cite the actual source, instead. Use of Wikipedia or Ballotpedia as a cited source will result in a 10 point deduction in your grade.
**THE TEXTBOOK WE ARE USING IN THIS CLASS IS: KEEPING THE REPUBLIC, POWER AND CITIZENSHIP IN AMERICAN POLITICS, NINTH BRIEF EDITION

Evidenced-based Patient-centered Concept Map and Narrative

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Evidenced-based Patient-centered Concept Map and Narrative

I need this assignment revised based on the professor comments:
Criteria: Designs a patient-centered concept map, but the map is not well individualized to treat a specific patient’s health, economic, or cultural needs.
Faculty Comments:
You have a good start here but I don’t see all three areas (health, economic, and cultural needs) addressed. As you look at your diagnoses, consider how you can apply one to each of these areas. It may be helpful to put the area addressed in parentheses after each diagnosis to remind yourself to include assessment findings, interventions, and outcomes that relate to the area. Also, to be sure that your concept map is evidence-based, be sure to cite scholarly sources in your intervention areas.
CRITERION
Explain the value and relevance of the resources used as the basis for a patient-centered concept map.
Faculty Comments:
You have determined the relevance of the evidence as it is cited in your plan of care for Keith. To justify its value, you have to look at the evidence as it is categorized in the levels of evidence. Levels of evidence are ranked on a hierarchy and show that some evidence carries a higher value than others. This site may help.
https://libguides.winona.edu/ebptoolkit/Levels-Evidence
The easiest way to complete this area (and all of the other assessments with this criteria) is to create a table with 3 columns. In the first column, you will cite your source. In the second column, you will identify the level of evidence. In the third column, you will briefly discuss why this resource is relevant to your analysis and interventions.
To make the area distinguished, note how the evidence is specifically unique to this patient’s case and situation.
CRITERION
Apply strategies for communicating with the patient and their family in an ethical, culturally sensitive, and inclusive way.
Your result: Basic
Faculty Comments:
You have a good start to this area. You have identified the need to ensure that your communication is honest, open, and ethical (confidentiality). You have ensured that Keith is involved in the communication. How would you ensure that your communication is culturally sensitive, based on Keith’s culture?
To make the area distinguished, consider how you would help to make complex medical terms and concepts understandable to your patient and their family, regardless of language, abilities, or educational level.
Create a patient-centered concept map and write a 3-5 page narrative in which you explain the process and considerations that went into creating your concept map.
Introduction
Evidence-based practice is a key skill in the tool kit of the master’s-prepared nurse. Its goal is to ensure that health care practitioners are using the best available evidence to ensure that patients are receiving the best care possible (Godshall, 2020). In essence, evidence-based practice is all about ensuring quality care.
In this assessment, you will apply evidence-based practice and personalized care concepts to ensure quality care and improve the health of a single patient. The concept map that you will create is an example of a visual tool that you can use for patient and family education.
Reference
Godshall, M. (2020). Fast facts for evidence-based practice in nursing (3rd ed.). Springer Publishing Company.
Professional Context
Concept maps are widely used in nursing care. They can be effective tools for organizing workload, prioritizing patient care strategies, and developing personalized care approaches. In addition to organizing care, they can aid in ensuring that the patient’s care is individualized to not only their health conditions, but also their familial, cultural, and environmental situations.
Scenario
The purpose of a concept map is to visualize connections between ideas, connect new ideas to previous ideas, and to organize ideas logically. Concept maps can be an extremely useful tool to help organize and plan care decisions. By utilizing a concept map, a nurse can simplify the connection between disease pathways and emotional, cultural, socioeconomic, and personality considerations that impact a patient’s health.
—–////////
Original Instructions for the paper:
Develop a patient-centered concept map for a chosen condition. This could be a disease, or a disorder based upon the best available evidence that has been individualized to treat your patient’s health, economic, and cultural needs. Write a brief 3–5 page narrative that explains why the resources cited in the concept map and narrative are valuable and relevant. Describe how you incorporated the patient’s individual culture, identity, abilities, and beliefs into the plan of care. Also, be clear about your specific communication strategies for relating information to the patient and their family.
The bullet points below correspond to grading criteria in the scoring guide. Be sure that your map and narrative address all of the bullets below, at minimum.
Part 1: Concept Map
Visit Healthy People 2030’s Browse Objectives page and select a topic.
https://health.gov/healthypeople/objectives-and-data/browse-objectives
Design a patient-centered concept map based upon the best available evidence for treating a patient’s specific health, economic, and cultural needs.
Include objective and subjective assessment findings to support three nursing diagnoses.
Include interventions that will meet your patient’s individual needs.
Include measurable outcomes for each nursing diagnosis using SMART goals: (S)pecific, (M)easurable, (A)chievable, (R)elevant, and (T)ime-bound.
Part 2: Supporting the Concept Map
Analyze the needs of a patient, and those of their family, to ensure that the interventions in the concept map will be relevant and appropriate for their beliefs, values, and lifestyle.
Explain how you incorporated the patient’s individual culture, identity, abilities, and beliefs into the plan of care.
Consider how your patient’s economic situation and relevant environmental factors may have contributed to your patient’s current condition or could affect future health.
Consider how your patient’s culture or family should inform your concept map.
Apply strategies for communicating with the patient and their family in an ethical, culturally sensitive, and inclusive way.
Explain how you will communicate the proposed interventions and evaluation plan in an ethical, culturally sensitive, and inclusive way. Ensure that your strategies:
Promote honest communications.
Facilitate sharing only the information you are required and permitted to share.
Enable you to make complex medical terms and concepts understandable to your patient and their family regardless of language, abilities, or educational level.
Explain the value and relevance of the resources you used as the basis for your patient-centered concept map.
Explain why your evidence is valuable and relevant to your patient’s case.
Include a critique of the resources you used and specify the level of evidence.
Explain why each piece of evidence is appropriate for the health issue you are addressing and for the unique situation of your patient and the family.
Include how the evidence was used to plan your interventions.
Convey purpose of the assessment narrative in an appropriate tone and style, incorporating supporting evidence and adhering to organizational, professional, and scholarly communication standards.
Integrate relevant sources to support assertions, correctly formatting citations and references using APA style.
The suggested headings for your paper are:
Patient Needs Analysis.
Communication Strategies.
Value and Relevance of Resources.
Submission Requirements
Length of narrative: 3–5 double-spaced, typed pages. Your narrative should be succinct yet substantive.
Number of references: Cite a minimum of 3–5 sources of scholarly or professional evidence that support your evaluation, recommendations, and plans. Current source material is defined as no older than five years unless it is a seminal work. Be sure you are citing evidence in both parts.
APA formatting: Resources and citations are formatted according to current APA style.
Please submit both your concept map and your narrative as separate documents in the assessment submissions area.
You must submit both documents at the same time. Make sure both documents are attached before submitting your assessment.
BELOW ARE EXAMPLES OF WHAT THE CONCEPT MAP AND NARRATIVE SHOULD LOOK LIKE….

International trade evaluation

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International trade evaluation

Promoting international trade is not a zero-sum game. It is a win-win proposition; both parties gain from trade.

Consider the following:
Tariffs are paid by the citizens of the country imposing tariffs, not by the citizens of the country producing the products upon which the tariffs are levied.
The term “trade deficits” is a misnomer. Every country’s trade is always in balance.
Trade deficits do not mean the US no longer produces anything to export. The US is the world’s second largest manufacturer and the world’s second largest exporter of manufactured goods.
Trade deficits reflect a strong economy. Trade deficits rise during economic expansions and fall during economic contractions. Unemployment falls as trade deficits rise and rises as trade deficits fall.
Imports and exports are complements, not competitors. Both are necessary and both contribute to economic growth.
Roughly one-third of all US imports and exports is trade between US multinational companies and their overseas subsidiaries.
Foreign-owned companies operating in the US number in the thousands and provide directly or indirectly jobs for more than 13 million US workers (roughly, 10% of the US workforce).
US trade deficit in goods in 2018 (as a % of GDP) was the same as it was 5, 10 and 15 years earlier.
The rise in US goods trade deficit with China has not increased the US total goods trade deficit. It has been offset by reduced goods imports from other trading partners.
There is a strong correlation between the rise in world trade and:
The rise in world GDP
The dramatic fall in the world’s extreme poverty rate
The rise in world life expectancy
For every US manufacturing job lost to trade between 2000 and 2010, seven US jobs were lost to domestic productivity improvements. Those seven jobs cannot be brought back from overseas because they never left the US.
Write a 700- to 1,050-word evaluation of credible economists’ unbiased opinions on the benefits, costs, and results of current US trade and tariff policies. Complete the following in your evaluation:
Evaluate how US trade policy changes in the last 2 years affect global trade activities by multinational corporations.
Discuss credible economists’ opinions on the long-term effects of trade and tariff policies changes in the last 2 years.
Explain the effect recent changes to trade and tariff policies have had on your employer, you, or someone you know.

An Exploratory Assessment of Codependency in Student-Athletes

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An Exploratory Assessment of Codependency in Student-Athletes

An Exploratory Assessment of Codependency in-1-1.pdf

Two page summary
1.5 Space
Cover sheet and APA Version 7 Citation Required
Introduction – Brief statement about the purpose and significance
Content- nuts and bolts… what the video/article is about
Understanding…. your comprehension of the content
Reflection… your thoughts and views
Consider:
Quantitative or Qualitative
Purpose
Significance
Methods

mapping of the Five Process Groups

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Mapping of the Five Process Groups

Purpose

Module 4 offers students; 1) an introduction to the “Standard for Project Management”; 2) a reintroduction of “the Fundamentals”; and 3) a mapping of the Project Management Process Groups (and Process) vis-à-vis the Knowledge Areas. With an appraisal of the “Standard”; the “Fundamentals”; the process Groups; and the Knowledge Areas, the purpose of Module 4 discussion is to reinforce project management knowledge, and connect the foundational components of project management. From this discussion, students should be able to survey the “panoramic view”; the mapping and integration of the Process Groups (and Process) vis-à-vis the Knowledge Areas. A more intricate examination of the Process Groups (and Process) vis-à-vis the Knowledge Areas ensues subsequently in Modules 5, 6, and 7.
The assigned readings for Module 4 are PMBOK Part 2 (Section I: Standard for Project Management Introduction pp 422-434). Pay special attention to Table 1-1, pp. 432. There is also one assigned video, and supplemental videos
Instructions
After mapping out the Process Groups vis-a-vis the management Knowledge Areas, the subsequent modules, Modules 5-7, examine the integration between EACH Process Group (and Process) and the management Knowledge Areas.
PMBOK Part II 422-434, the assigned, and supplementary videos will be used to guide Module 4 Discussion
Task(s)
In three paragraphs this discussion will be presented following these tasks:
Task One (Chapter Summary)
Present a summary including the general key points of the assigned video………………
Task Two (“Key Points to Remember”)
Select, and further examine ONE “Key takeaway” of the assigned video. Your discussion must interrogate, and expand on the selected “key take away”. Referencing the supplementary videos is required. Referencing other external sources/research to help bolster your understanding of the “key takeaway” is highly encouraged.
Task Three (PMBOK Cross-Referencing)
Cross reference your selected “Key takeaway” to the corresponding PMBOK chapter. A) How does PMBOK Part 2 help bolster your understanding of the Process Groups and the management Knowledge Areas. B) Specifically, which components of PMBOK Part II do you find most helpful, and why?

Applied Ethics Mini Case Study: Corporate Social Responsibility Assignment

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Applied Ethics Mini Case Study: Corporate Social Responsibility Assignment

Write your mini case studies in APA format with a title page and a reference list page. Include APA citations in the text and a reference list at the end as appropriate. Each paper should cite at least three references from the textbook readings, article(s), and/or video presentations. Other references may be researched and utilized also, and they would be in addition to the minimum of

three references from the assigned readings.Write your mini case studies in APA format with a title page and a reference list page. Include APA citations in the text and a reference list at the end as appropriate. Each paper should cite at least three references from the textbook readings, article(s), and/or video presentations. Other references may be researched and utilized also, and they would be in addition to the minimum of three references from the assigned readings.Write your mini case studies in APA format with a title page and a reference list page. Include APA citations in the text and a reference list at the end as appropriate. Each paper should cite at least three references from the textbook readings, article(s), and/or video presentations. Other references may be researched and utilized also, and they would be in addition to the minimum of three references from the assigned readings.Write your mini case studies in APA format with a title page and a reference list page. Include APA citations in the text and a reference list at the end as appropriate. Each paper should cite at least three references from the textbook readings, article(s), and/or video presentations. Other references may be researched and utilized also, and they would be in addition to the minimum of three references from the assigned readings.
***Theme: Corporate Social Responsibility in Aviation
For this mini case study, refer to the textbook readings and the articles:
     Dallas Willard: The Business of Business: https://dwillard.org/articles/business-of-business-thehttps://dwillard.org/articles/business-of-business-the
     Milton Friedman: Cultural Social Responsibility; A Friedman doctrine–: The Social Responsibility Of Business Is to Increase Its Profits
     Ferrara: Friedman’s Take on Corporate Social Responsibility is Brilliant and Elegant—But Obsolete: https://merionwest.com/2018/06/30/friedmans-take-on-corporate-social-responsibility-is-brilliant-and-elegant-but-obsolete/https://merionwest.com/2018/06/30/friedmans-take-on-corporate-social-responsibility-is-brilliant-and-elegant-but-obsolete/
     Stanford and Homan: A Model of Applied Ethics in Aviation Safety: The Aviation Safety Reporting System.: https://commons.erau.edu/jaaer/vol9/iss1/1/https://commons.erau.edu/jaaer/vol9/iss1/1/
     Also read 1 Kings 12:1-24, the story of King Rehoboam and Baugus: Entrepreneurship in
the Bible (https://tifwe.org/entrepreneurship-in-the-bible/).
Case situation: The aviation safety reporting system as a model of applied ethics.
Using the Cultural Relativism Ethics System and/or the Ethical Egoism Ethics System as
framework(s), provide 1) your critical analysis and thoughts on what motivates leaders of
corporations to do what they do, and 2) your critical analysis and thoughts on the ethics of not
reporting mistakes in a work profession. Derive practical lessons from your case study analysis***