What is a partnership? What is prima facie evidence of a partnership’s existence? TQ 6.2: In OCA v. Hodges, why did the court conclude that the arrangement between the parties was invalid


TQ 6.1: What is a partnership? What is prima facie evidence of a partnership’s existence?

TQ 6.2: In OCA v. Hodges, why did the court conclude that the arrangement between the parties was invalid and unenforceable?
TQ 6.3: What are the core fiduciary duties that partners owe to each other? Explain what conduct was a potential violation of those duties in the cases of Meinhard v. Salmon, Page v. Page, and Shiraman v. Patel.
TQ 6.4: Briefly describe what the Uniform Partnership Act says with regard to defining what property is property of the partnership. Explain briefly the source of revenue from each of the contracts at issue in Sriraman v. Patel and explain why the revenue was or was not partnership property.


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Pathophysiology and Nursing Management of Client’s Health

The clinical manifestations for Mrs. J

Mrs. J manifests clinical signs and symptoms that show that she is suffering from acute decompensated heart failure as well as acute exacerbation of COPD. The symptoms that demonstrate the presence of acute decompensated heart include elevated jugular venous pressure. According to Ritchie et al. (2021) patients with acute decompensated heart failure show abnormal right heart dynamics as a result of jugular venous pressure. Another symptom that Mrs. J manifests is dyspnea present with pulmonary rales as well as orthopnea. Due to accumulation of fluid in the lungs Mrs J present with coughing up frothy blood tinged sputum, crackles, and decreased breath sounds.

Mrs J also displays symptoms of cardiac gallops which measure S3 and hepatomegaly which is below the costal margin of 4 centimeters. According to Vu et al. (2020), the right costal margin should be below 3.5 cm for one to confirm hepatomegaly. Mrs. J also manifests symptoms that are indicative of acute exacerbation of COPD. Some of the symptoms include strained physical activities and inability to conduct activities of daily living like eating, drinking, walking and always asking for support. The patient also experiences constant fatigue and shortness of breath due to compromised lung function. According to Ritchie et al. (2021), patients suffering from reduced lung function may regularly experience shortness of breath which affects their quality of life. The patient also manifests exhaustion and anxiety which according to Ritchie et al. (2021), patients suffering from hypoxia suffer increased ventricular drive. Mrs. J also presents a Spo2 of 82% which can be attributed to insufficient oxygen rich blood from the lungs. Additionally, the patient has decreased blood pressure which may occur when the cardiac function is restricted. She also manifests jugular vein distention with a heart rate of 132, which according to Vu et al. (2020), may be due to backing up of fluid in the lungs. This may result from backing up of fluid in the vein resulting in atrial fibrillation. Moreover, Mrs. J presents third heart sound (S3) is due to mitral valve regurgitation, low ejection fraction as well as restrictive diastolic filling. According to (Halpin et al., 2021), the third heart sound is actually produced by the large amount of blood striking a very compliant left ventricle.

Nursing Interventions

The nursing interventions offered to Mrs. J during her admission were suitable since the medications were intended to alleviate the symptoms. For instance, the nurse administered intravenous Furosemide in order to manage heart failure symptoms. According to Ritchie et al. (2021), furosemide targets the Na+ and K+ channels in order to reduce fluids caused by heart failure. The same author reveals that heart failure causes accumulation of fluids due to poor pumping of blood. As a result, administration of furosemide to Mrs. J was appropriate as it helped in management of heart failure through removal of excess fluids.

Secondly, the nurse administered enalapril to manage Mrs. J’s blood pressure to act as an ACE inhibitor which blocks angiotensin II formation (Halpin et al., 2021). According to Vu et al. (2020), angiotensin II results in clogging of blood arteries which results in hypertension.  Administration of Metoprolol was suitable as it managed rapid heart rate as it helps to relax the blood arteries. Additionally, administration of morphine was appropriate to calm the patient and helps in pain reduction by binding to pain receptors. The Administration of ProAir HFA also addressed the issue of shortness of breath. According to Ritchie et al. (2021), the drug acts on the lung muscles by enabling lung muscle relaxation which unblocks the airways. Flovent HFA was also appropriate as it addressed the issue of recurrent shortness of breath through treatment of inflammation on the lung muscles hence, easing breathing. Additionally, immediate administration of oxygen at a delivery rate of 2L/ NC was appropriate as it addressed breathlessness through a constant supply of oxygen.

Cardiovascular Conditions

There are several cardiovascular conditions, which may cause heart failure. Examples of such conditions include coronary artery disease, cardiomyopathy, hypertension as well as myocarditis. According to Ritchie et al. (2021), nursing interventions are necessary in the mentioned cardiovascular conditions in order to prevent heart failure. In case of coronary artery disease, the medical interventions include statins which function to reduce the fatty deposits from the walls of the coronary arteries. An additional intervention includes beta blockers which reduce the heart rate, thus lowering oxygen demand. Calcium channel blockers may also be administered as they help the beta blockers in lowering the heart, which in turn reduces the risk of heart failure (Halpin et al., 2021).

In case of cardiomyopathy, the nursing interventions include administration of vasotec which prevents clogging of blood arteries. Additionally, the nurse may also administer IV furosemide to prevent buildup of fluids and metoprolol which acts to maintain a regular heart rate. In case of hypertension, the nursing interventions include administration of diuretics to help in elimination of water and sodium from the body. Other interventions include calcium channel blockers and ACE inhibitors which act to prevent heart failure. In case of myocarditis, the nurse may administer beta blockers, ACE inhibitors like Lisinopril and diuretics like furosemide (Halpin et al., 2021).

Prevention of Multiple Drug Interactions

There are various nursing interventions that can be implemented to prevent drug interactions in elderly patients. For instance, nurses may encourage the elderly patients to maintain records of all their medication. Nurses may achieve this by educating the elderly patients on the importance of keeping such records. In turn, this enables the nurses to identify the medicines that may cause interactions to the patients (Halpin et al., 2021). Secondly, the nurses may recommend use of medication organizers by the elderly patients. This ensures that the elderly patients adhere to the right dosage and frequency which avoids multiple drug interactions.

Another intervention involves advocating for the elderly patient to have a single primary care giver in order to prevent confusion that might lead to multiple drug interactions. The fourth intervention involves helping the elderly patients to track all the medicines used since the onset of the disease including herbal medicine. According to Ritchie et al. (2021), herbal medicine may also result in drug interactions which affects the patient outcomes.

Health Promotion Teaching Plan

The teaching plan would entail convincing Mrs. J to adopt a different approach in order to manage her condition and attain independence. The approach involves resource allocation towards acquisition of the support systems that may promote and restore her health. The health promotion plan would include modifications such as home medical equipment and multidisciplinary resources such as nutritionist, a home care nurse as well as physiotherapist. For instance, the home medical equipment will enhance her independence as it will comprise of the oxygen support system to alleviate the shortness of breath issue. Additionally, the home care nurse will offer the intravenous drug injections as well as appropriate prescriptions.

Moreover, the nutritionists will prescribe proper diet in order to ensure health promotion and independence of the patient. For instance, the nutritionist may recommend no more than 1500mg of sodium in her diet. According to Halpin et al. (2021), intake of high levels of sodium ions may cause fluid accumulation in her tissues which may in turn exacerbate edema. The physiotherapist will enhance her movement by encouraging her to exercise safely. This might require a cardiac rehabilitation program to assist with safe body exercise. According to Ritchie et al. (2021), effective exercise enhances cardiac function as it allows for smooth blood flow to the heart and other body parts. The same author reveals that proper exercise helps the patient to transition to independence as they can eventually walk without assistance. However, since Mrs. J has difficulties walking, she should be encouraged to use a walker and cane until the patient is able to walk on her own, thus achieving independence (Halpin et al., 2021).

Mrs. J has a weight of 95.5kgs and a height of 175cm. Upon calculation of body mass index (BMI), Mrs J is considered overweight. Therefore, she should be encouraged to enroll in a weight management program.  Vu et al. (2020) confirm that being overweight subjects a patient to impaired cardiac function due to accumulation of cholesterol in the coronary arteries. Additionally, Mrs. J should be subjected to a skill training facility to build her strength as she cannot walk on her own. According to Ritchie et al. (2021), strength-building activities such as knee extension exercise add strength to the quadriceps and hamstrings. As a result, Mrs. J should take advantage of such activities to regain independence. Mrs. J is strongly advised to undergo smoking cessation since smoking is associated with COPD and cardiovascular diseases.    Smoking cessation will lead to better cardiovascular and pulmonary outcomes.

Method for Patient Education

The best teaching strategy for Mrs. J’s medication maintenance includes a face to face session between the patient and the clinicians.  The face to face session would enable the nurses to educate Mrs. J on how best to store the medicine, how to organize the drugs in terms of dosage and frequency. According to Vu et al. (2020), patients may adopt color-coded tins to organize their drugs in terms of frequency and dosage to avoid confusion. The same author reveals that confusing medicines uptake may increase the rate of hospital readmissions. Notably, the face to face sessions will allow Mrs. J to ask questions and receive immediate feedback from the clinicians. The clinicians may also demonstrate to Mrs. J on the best way to store the drugs.

COPD Triggers

There are several triggers for chronic obstructive pulmonary disease that might result in recurrent hospital visits as well as exacerbation. In the case of Mrs. J, smoking cigarettes may exacerbate her condition resulting in hospital visits. According to Vu et al. (2020), cigarette smoke accounts for approximately 90% of all chronic obstructive pulmonary disease cases. Therefore, if the patient goes back to smoking, her condition may worsen and become hospitalized.

The second COPD trigger includes cold weather which is a common agent for COPD exacerbation. A study by Ritchie et al. (2021) revealed that most COPD patients who are subjected to weather extremities suffer exacerbation which results to hospital revisits. Another trigger includes dust and fumes which irritate the respiratory tract and may worsen Mrs. J’s condition. The smoking cessation options for Mrs. J would include non-nicotine drugs like varenicline and bupropion. According to Ritchie et al. (2021), these options have proven to be effective for long term smokers.

 

 

 

 

 

References

Halpin, D. M., Criner, G. J., Papi, A., Singh, D., Anzueto, A., Martinez, F. J., & Vogelmeier, C. F. (2021). Global initiative for the diagnosis, management, and prevention of chronic obstructive lung disease. The 2020 GOLD science committee report on COVID-19 and chronic obstructive pulmonary disease. American journal of respiratory and critical care medicine, 203(1), 24-36.

Ritchie, A. I., Baker, J. R., Parekh, T. M., Allinson, J. P., Bhatt, S. P., Donnelly, L. E., & Donaldson, G. C. (2021). Update in chronic obstructive pulmonary disease 2020. American Journal of Respiratory and Critical Care Medicine, 204(1), 14-22.

Vu, G. V., Ha, G. H., Nguyen, C. T., Vu, G. T., Pham, H. Q., Latkin, C. A., & Ho, C. S. (2020). Interventions to improve the quality of life of patients with chronic obstructive pulmonary disease: A global mapping during 1990–2018. International journal of environmental research and public health, 17(9), 3089.

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Explore the Beauty in Nature


11540Instructions

Let’s take some time to contemplate the beauty of nature. Many of you have seen the planet earth videos that show the incredible uniqueness, diversity, and beauty of biology. Please take some time to view the following videos:

In this video, Frank Wilczek, a theoretical physicist, unpacks the concept of beauty found in science: The Science of Why Nature is Beautiful to Us.
This clip illustrates the beauty of nature:

Post your thoughts to the following questions:

The physicist Nima Arkani-Hamed quoted in Scientific American states that “Despite all this, I don’t want scientists to abandon their talk of beauty. Anything that inspires scientific thinking is valuable…” Let’s take part in some of that valuable thinking. Do some research and discuss one aspect of nature that you find beautiful. How is the science in this enhance its beauty?
Take a moment today to look outside and notice the nature that is around you. Find one aspect that is beautiful and inspires awe. In what ways are science and the art of nature compatible? What thoughts do you have as you take notice of nature’s beauty around you?
Does the beauty of nature motivate a desire to conserve its biodiversity? What are some other reasons we should seek to steward the vast variety we see on planet earth?


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SOAP NOTE – College Pal


39161To prepare: 

Review the Focused Note Checklist provided in this week’s Learning Resources and consider how you will develop your Focused Note for this week’s Assignment.
Use the Focused SOAP Note Template and the example found in the Learning Resources for this week to complete this Assignment.
Select an adolescent patient that you examined during the last 3 weeks. With this patient in mind, address the following in a Focused Note. 
Assignment

Subjective: What details did the patient or parent provide regarding the personal and medical history? Include any discrepancies between the details provided by the child and details provided by the parent as well as possible reasons for these discrepancies.
Objective: What observations did you make during the physical assessment? Include pertinent positive and negative physical exam findings. Describe whether the patient presented with any growth and development or psychosocial issues.
Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority and include their ICD-10 code for the diagnosis. What was your primary diagnosis and why?
Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management? Include pharmacologic and non-pharmacologic treatments, alternative therapies, and follow-up parameters as well as a rationale for this treatment and management plan.
Reflection notes: What was your “aha” moment? What would you do differently in a similar patient evaluation?

RUBRIC:
PRAC_6541_Week3_Assignment2_Rubric
PRAC_6541_Week3_Assignment2_Rubric
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeOrganization of Write-up
30 to >26.0 pts
Excellent
All information organized in logical sequence; follows acceptable format
26 to >23.0 pts
Good
Information generally organized in logical sequence; follows acceptable format
23 to >20.0 pts
Fair
Errors in format; information intermittently organized
20 to >0 pts
Poor
Errors in format; information disorganized
30 pts
This criterion is linked to a Learning OutcomeThoroughness of History
20 to >17.0 pts
Excellent
Thoroughly documents all pertinent history components for type of note; includes critical as well as supportive information
17 to >15.0 pts
Good
Documents most pertinent history components; includes critical information
15 to >13.0 pts
Fair
Fails to document most pertinent history components; Lacks some critical information or rambling in history
13 to >0 pts
Poor
Minimal history; critical information missing
20 pts
This criterion is linked to a Learning OutcomeThoroughness of Physical Exam
10 to >8.0 pts
Excellent
Thoroughly documents all pertinent examination components for type of note
8 to >7.0 pts
Good
Documents most pertinent examination components
7 to >6.0 pts
Fair
Documents some pertinent examination components
6 to >0 pts
Poor
Physical examination cursory; misses several pertinent components
10 pts
This criterion is linked to a Learning OutcomeDiagnostic Reasoning
10 to >8.0 pts
Excellent
Assessment consistent with prior documentation. Clear justification for diagnosis. Notes all secondary problems. Cost effective when ordering diagnostic tests
8 to >7.0 pts
Good
Assessment consistent with prior documentation. Clear justification for diagnosis. Notes most secondary problems.
7 to >6.0 pts
Fair
Assessment mostly consistent with prior documentation. Fails to clearly justify diagnosis or note secondary problems or orders inappropriate diagnostic tests
6 to >0 pts
Poor
Assessment not consistent with prior documentation. Fails to clearly justify diagnosis or note secondary problems or orders inappropriate diagnostic tests
10 pts
This criterion is linked to a Learning OutcomeTreatment Plan/Patient Education
10 to >8.0 pts
Excellent
Treatment plan and patient education addresses all issues raised by diagnoses, excellent insight into patient’s needs. Evidence based decisions. Cost effective treatment. Reflection is thoughtful and in depth.
8 to >7.0 pts
Good
Treatment plan and patient education addresses most issues raised by diagnoses. Reflection is thoughtful and in depth.
7 to >6.0 pts
Fair
Treatment plan and patient education fail to address most issues raised by diagnoses. … Reflection is brief, vague. and does not discuss anything that would have been done in addition to or differently.
6 to >0 pts
Poor
Minimal treatment plan and/or patient education addressed … Reflection is absent.
10 pts
This criterion is linked to a Learning OutcomeWritten Expression and FormattingEnglish writing standards: Correct grammar, mechanics, and proper punctuation.
10 to >8.0 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.
8 to >7.0 pts
Good
Contains a few (1-2) grammar, spelling, and punctuation errors.
7 to >6.0 pts
Fair
Contains several (3-4) grammar, spelling, and punctuation errors.
6 to >0 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
10 pts
This criterion is linked to a Learning OutcomeWritten Expression and FormattingThe assignment follows parenthetical/in-text citations, and at least 3 evidenced based references are listed.
10 to >8.0 pts
Excellent
Contains parenthetical/in-text citations and at least 3 evidenced based references are listed.
8 to >7.0 pts
Good
Contains parenthetical/in-text citations and at least 2 evidenced based references are listed
7 to >6.0 pts
Fair
Contains parenthetical/in-text citations and at least 1 evidenced based reference is listed
6 to >0 pts
Poor
Contains no parenthetical/in-text citations and 0 evidenced based references listed.
10 pts
Total Points: 100


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PICOT QUESTION – hawk essays


PICOT question

In severe sepsis patients (P), how does an education program for nurses (I) compared to no intervention (C) improve continuation of fluid bolus administration, repeat lactic acid collection and antibiotic administration (O) within 6 months? (T)

PICOT problem

The problem addressed in the PICOT question involves risk reporting on severe sepsis. The needs assessment at Adams Memorial hospital revealed increased concerns for severe sepsis specifically on risk reporting from the emergency department to the medical surgical department. According to Chen et al. (2022), sepsis bundle compliance is critical in the management of severe sepsis as it improves patient outcomes. The needs assessment at Adams Memorial hospital revealed a concern on the sepsis bundle strategy in that continuation of the fluid bolus administration, repeat lactic acid collection, and antibiotic administration is either not properly documented or continuity is not properly maintained.             The clinical issues that may arise from reduced compliance to the sepsis bundle strategy includes increased mortality rate, high rates of readmission and reduced recovery rate for severe sepsis patients. According to Abe et al. (2018), failure to comply with the sepsis bundle or failure to practice proper risk reporting between departments may affect the patient outcomes as well as the quality of health care delivery. The evidence-based solution for severe sepsis management involves sepsis bundle compliance which incorporates the aspect of proper risk reporting between the nursing departments. Therefore, the role of nurses is critical in ensuring that severe sepsis patients receive patent care both within and without the hospital settings through health care agency.

Nursing intervention

The proposed solution for the problem of risk reporting on severe sepsis at Adams Memorial hospital implementing an education program to sensitize the nurses on the importance of adhering to the sepsis bundle. The program will highlight the need for nurses to make use of checklists when risk reporting on sepsis. Additionally, the program will reiterate the need to adhere to the fluid bolus, lactic acid and antibiotic administration in terms of amount given and the frequency of administration (Kempker et al., 2019).

The comparison group will involve the severe sepsis patients before the implementation of the education program on the nurses. It is expected that the patient population will report improved outcomes after the nurses have received training on proper risk reporting and compliance to the sepsis bundle. The expected time frame will be six months which will be sufficient to determine the outcome of the intervention. According to Chabrera et al. (2021), education programs that take at least six months produce satisfactory results for the nursing practice. Therefore, the choice of the six months’ time frame is expected to provide valid and reliable outcome for the severe sepsis patients.

Summary of the clinical problem and patient outcome

The clinical problem which involves risk reporting on severe sepsis by nursing professionals will form the basis of the capstone project. The concerns related to the management of severe sepsis at Adams Memorial hospital revolves around fluid bolus administration, repeat lactic acid collection, antibiotic administration and the use of checklists.

The patient outcome associated with the clinical problem involve proper risk reporting regarding fluid bolus administration, repeat lactic acid collection and antibiotic administration which in turn reduces mortality rate, rehospitalization rates and reduces the length of hospital stay. Therefore, the successful implementation of the education intervention program will positively affect the nursing practice through improved health care service delivery, patient outcomes and health collaboration among the health care professionals (Nunnally & Patel, 2019).

References

Abe, T., Ogura, H., Shiraishi, A., Kushimoto, S., Saitoh, D., Fujishima, S. & Gando, S. (2018). Characteristics, management, and in-hospital mortality among patients with severe sepsis in intensive care units in Japan: the FORECAST study. Critical Care22(1), 1-12. https://doi.org/10.1186/s13054-018-2186-7

Chabrera, C., Dobrowolska, B., Jackson, C., Kane, R., Kasimovskaya, N., Kennedy, S., & Cabrera, E. (2021). Simulation in nursing education programs: findings from an international exploratory study. Clinical Simulation in Nursing59, 23-31. https://doi.org/10.1016/j.ecns.2021.05.004

Chen, A. X., Simpson, S. Q., & Pallin, D. J. (2019). Sepsis guidelines. N Engl J Med380(14), 1369-1371. https://doi.org/10.1056/nejmclde1815472

Kempker, J. A., Kramer, M. R., Waller, L. A., Wang, H. E., & Martin, G. S. (2019). State-level hospital compliance with and performance in the Centers for Medicaid & Medicare Services’ early management severe sepsis and septic shock bundle. Critical Care23(1), 1-4. https://doi.org/10.1186/s13054-019-2382-0

Nunnally, M. E., & Patel, A. (2019). Sepsis-What’s new in 2019? Current Opinion in Anesthesiology32(2), 163-168. https://doi.org/10.1097/aco.0000000000000707



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A 50-year-old man comes to your office for a routine physical examination. He is a new patient to your practice. He states his father died at the age of 73 of a heart attac


Case 1

A 50-year-old man comes to your office for a routine physical examination. He is a new patient to your practice. He states his father died at the age of 73 of a heart attack. His mother is alive at the age of 80. He has hypertension, which he takes chlorthalidone 25 mg PO daily. Takes Tylenol as needed for pain. Denies seasonal or drug allergies. He has two younger siblings with no known chronic medical conditions. Last eye and dental exam two years ago. He is married in a monogamous relationship without children. Has a high school diploma. Works full-time for local landscaping business. He does not smoke, drink alcohol, use any recreational drugs and does not exercise. He denies fever, chills, weight loss or weight gain. He denies hearing changes, headaches or dizziness. He reports some visual changes when reading close-up. He denies shortness of breath, dyspnea on exertion, swelling or chest pain. He reports increase urination and thirst. Denies abdominal pain, nausea, vomiting or changes in appetite. He reports daily BM. Denies rashes or bug bites. Uses sunscreen daily due to working outside.

Denies anxiety or depression. On examination his blood pressure is 126/82, pulse is 80 beats/min, respiratory rate is 18. Height is 67 inches and weight is 190lbs. Does not appear in acute distress, responses are appropriate and appears reliable source. Alert, oriented to person, place, time and situation. Well-nourished, skin warm, dry and intact. Normocephalic. Pupils size 3 mm, equal and reactive to light. Extraocular eye movements intact to six directions.

Tympanic membranes gray with adequate cone of light bilaterally. Mucous membranes pink and moist. No palpable masses, thyromegaly, lymphadenopathy or JVD. Regular heart rate and rhythm, S1 and S2. No bruits auscultated. Capillary refill less than 3 seconds. Breath sounds clear bilaterally to auscultation. No use of accessory muscles or purse lip-breathing. Soft, non- tender, non-distended, normoactive bowel sound. No organomegaly or guarding. Denies numbness or tingling. He reports he has not had HIV or PSA screenings.

Case 2

A 40-year-old woman presents with 10 episodes of watery, non-bloody diarrhea that started last night. She vomited twice last night but has been able to tolerate liquids today. She is complaining of intermittent abdominal cramping, rating pain 4 out of 10. She also reports having muscle aches, weakness, headache, and low-grade fever of 99.7 at home. She states her son has had the same symptoms that started this morning. She has no significant medical history, denies surgeries, and does not take any prescribed medications. Last wellness examination was 2 years ago when cervical screening was completed. She does not smoke, use alcohol, or illicit drugs. She does report that her and her family returned home yesterday after spending a week in Cancun. On examination she is not in acute distress, blood pressure is 110/60, pulse 98, respiratory rate is 16, and temperature is 99.1. Bowel sounds are hyperactive, and her abdomen is mildly tender throughout but there is no rebound tenderness and no guarding. Her mucous membranes are dry. A rectal examination is normal, and stool is guaiac negative. Reports trying Pepto-Bismol this morning without relief. Denies food, seasonal or drug allergies. Last menses 3 weeks ago, currently single and not sexually active. Heart rate regular rate and rhythm with S1 and S2. Breath sounds clear to auscultation bilaterally with symmetrical chest expansion. Alert and oriented, does not appear acutely ill. Needs a work excuse, works part-time at community college.

Case 3

A 40-year-old single male presents to your office complaining of left knee pain that has started last night. He says that the pain started suddenly and was severe within about 3 hours’ time. He denies injury, fever, systemic symptoms, or prior episodes. He has a history of hypertension and does take hydrochlorothiazide 12.5 mg PO daily to control it. He admits to consuming a large amount of wine with dinner last night. He currently is not working. Has allergy to Percocet which he reports reaction is urticaria. Upon examination his temperature is 98, pulse is 90, respirations are 22 and blood pressure is 129/88. Heart and lung examinations are unremarkable. The patient is reluctant to flex the left knee and does wince with pain at touch. He has passive range of motion. The knee is edematous, hot to touch, and has erythema of the overlying skin. No crepitation or deformity is apparent. No other joints are involved. Inguinal lymph notes are not enlarged. He denies trauma or previous injury to his left knee. He denies weight loss or weight gain. He reports in the past having swelling to his big toe that went away on its own. He tried ibuprofen without relief of the pain this morning. Rates the pain about six out of ten that is constant. Denies any family history of joint or musculoskeletal issues. He denies smoking or illicit drug use. Was recently seen in the office 6 months ago for wellness exam with normal blood pressure reading and A1c. He is alert and oriented to self, place, time and situation. Well-nourished on exam reports eating keto diet. Thoughts are coherent, mood and affect appropriate.



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GROUP VERSUS FAMILY ASSESSMENT – College Pal


11541Submit a 2-page paper on the Family Therapy video:

Evaluate the family dynamics from a systems perspective as seen in the video.
Explain how principles of group dynamics would apply to this family vignette.
Compare the process of assessing dynamics in a family with assessing dynamics in a group. Draw on your Discussion response this week to highlight the similarities and differences.
Use the Learning Resources to support your Assignment. Make sure to provide APA citations and a reference list


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PICOT – hawk essays


PICOT question

In severe sepsis patients (P), how does an education program for nurses (I) compared to no intervention (C) improve continuation of fluid bolus administration, repeat lactic acid collection and antibiotic administration (O) within 6 months? (T)

PICOT problem

The problem addressed in the PICOT question involves risk reporting on severe sepsis. The needs assessment at Adams Memorial hospital revealed increased concerns for severe sepsis specifically on risk reporting from the emergency department to the medical surgical department. According to Chen et al. (2022), sepsis bundle compliance is critical in the management of severe sepsis as it improves patient outcomes. The needs assessment at Adams Memorial hospital revealed a concern on the sepsis bundle strategy in that continuation of the fluid bolus administration, repeat lactic acid collection, and antibiotic administration is either not properly documented or continuity is not properly maintained.             The clinical issues that may arise from reduced compliance to the sepsis bundle strategy includes increased mortality rate, high rates of readmission and reduced recovery rate for severe sepsis patients. According to Abe et al. (2018), failure to comply with the sepsis bundle or failure to practice proper risk reporting between departments may affect the patient outcomes as well as the quality of health care delivery. The evidence-based solution for severe sepsis management involves sepsis bundle compliance which incorporates the aspect of proper risk reporting between the nursing departments. Therefore, the role of nurses is critical in ensuring that severe sepsis patients receive patent care both within and without the hospital settings through health care agency.

Nursing intervention

The proposed solution for the problem of risk reporting on severe sepsis at Adams Memorial hospital implementing an education program to sensitize the nurses on the importance of adhering to the sepsis bundle. The program will highlight the need for nurses to make use of checklists when risk reporting on sepsis. Additionally, the program will reiterate the need to adhere to the fluid bolus, lactic acid and antibiotic administration in terms of amount given and the frequency of administration (Kempker et al., 2019).

The comparison group will involve the severe sepsis patients before the implementation of the education program on the nurses. It is expected that the patient population will report improved outcomes after the nurses have received training on proper risk reporting and compliance to the sepsis bundle. The expected time frame will be six months which will be sufficient to determine the outcome of the intervention. According to Chabrera et al. (2021), education programs that take at least six months produce satisfactory results for the nursing practice. Therefore, the choice of the six months’ time frame is expected to provide valid and reliable outcome for the severe sepsis patients.

Summary of the clinical problem and patient outcome

The clinical problem which involves risk reporting on severe sepsis by nursing professionals will form the basis of the capstone project. The concerns related to the management of severe sepsis at Adams Memorial hospital revolves around fluid bolus administration, repeat lactic acid collection, antibiotic administration and the use of checklists.

The patient outcome associated with the clinical problem involve proper risk reporting regarding fluid bolus administration, repeat lactic acid collection and antibiotic administration which in turn reduces mortality rate, rehospitalization rates and reduces the length of hospital stay. Therefore, the successful implementation of the education intervention program will positively affect the nursing practice through improved health care service delivery, patient outcomes and health collaboration among the health care professionals (Nunnally & Patel, 2019).

References

Abe, T., Ogura, H., Shiraishi, A., Kushimoto, S., Saitoh, D., Fujishima, S. & Gando, S. (2018). Characteristics, management, and in-hospital mortality among patients with severe sepsis in intensive care units in Japan: the FORECAST study. Critical Care22(1), 1-12. https://doi.org/10.1186/s13054-018-2186-7

Chabrera, C., Dobrowolska, B., Jackson, C., Kane, R., Kasimovskaya, N., Kennedy, S., & Cabrera, E. (2021). Simulation in nursing education programs: findings from an international exploratory study. Clinical Simulation in Nursing59, 23-31. https://doi.org/10.1016/j.ecns.2021.05.004

Chen, A. X., Simpson, S. Q., & Pallin, D. J. (2019). Sepsis guidelines. N Engl J Med380(14), 1369-1371. https://doi.org/10.1056/nejmclde1815472

Kempker, J. A., Kramer, M. R., Waller, L. A., Wang, H. E., & Martin, G. S. (2019). State-level hospital compliance with and performance in the Centers for Medicaid & Medicare Services’ early management severe sepsis and septic shock bundle. Critical Care23(1), 1-4. https://doi.org/10.1186/s13054-019-2382-0

Nunnally, M. E., & Patel, A. (2019). Sepsis-What’s new in 2019? Current Opinion in Anesthesiology32(2), 163-168. https://doi.org/10.1097/aco.0000000000000707



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After reading the chapter, identify 3 artifacts in the form of lyrics, poems, pictures, etc. that embody and/or represent your own definition of postmodernism and its influ


After completing the weekly readings, provide a thorough response in your own words to the weekly questions posted below. Please make sure you submit a one-word document with all your answers. A minimum of 550 words and a maximum of 700 words (font size 12, single-spaced) are required for each complete assignment. Please follow APA format in your work. Please remember to include one or two sentences identifying the habits of mind Links to an external site.you have used to promote the reflection of the readings.

From Aronowitz and Giroux Chapter 3:

After reading the chapter, identify 3 artifacts in the form of lyrics, poems, pictures, etc. that embody and/or represent your own definition of postmodernism and its influence (Make sure you provide an explanation of why you chose each artifacts), and (2) Reflect and evaluate the three postmodern problematics discussed in the chapter (do you see any of those problematics in today’ school system?)

From Aronowitz and Giroux Chapter 5:
How is border pedagogy related to postmodernism?, and (2) evaluate how border pedagogy can help teachers to become agents of difference (provide specific examples).

From Tyack and Cuban Chapter 2:
Explain and evaluate the relationship between policy cycles and institutional trends described by the authors.
 

  • Tyack & Cuban: Tinkering Toward Utopia,

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24. Juno Jordan, ()n C.111/: 1101/t/, u/ I NN,1y, (llmli111 ‘” ,1111, I lttl It I 1f1 I, 111 2~. The no~ion. of litorac~ n~ , form of rnll 111 ,1I polllli – 1111,1 , 111111 .. 11, 1 p,lll lt 111,11 11.,ct

gog,cal practice Is most evident in the works o f f’,Hdo 11 11111, ,.,., 1111 , •~~lllfilo, l’,ill ln re1r:, Pedagogy of the Oppressed, trans. Myra Uorgman 11,111 11,~ (Nnw Ymk : ~IH•i>III ) ress, _1968); Paulo Fre,re and Donaldo Macedo, Literacy: Rc11tllnH !ho l\nd and r/11,

orld LSouth Hadley, Mass.: Bergin & Garvey, 1987). 26. Jordan, On Cati, 29.

27. Martha Nus.sba~m’s comment on the narrowness of Bloom’s reading of the fruit~ f Western c1vrl1zatton Is worth repeating:

His special love for these books fthe old Great Books of the ancient philosophers] has certainly prevented him from attending to works of literature and phi losophy that lie outside the tradition they began. for he makes the remarkable claim that “onlv in the Western nations i e th · fl , , .•, ose in uence~ by Greek philosophy, is there some w ill ingness to doubt the 1den1_1f1cat1on of the good with one’s own way.” This statement shows a startling ignorance of the critical and rational ist tradition in classical Indian tho.ugh!, of the arguments of classical Chinese thinkers, and beyond this, of countless examples of philosophical and nonphilosophical self-criticism from many parts of the world. (Nussbaum, “Undemocratic Vistas,” 22)

a F P W

o CHAPTER 3

POSTMODERNISM AND THE DISCOURSE OF

EDUCATIONAL CRITICISM

Genealogical practice transforms history from a judgment on the past in the name ofa present truth to a “counter-memory” that combats our current modes of truth and jus­ tice, helping us to understand and change the present byplacing it in a n ew relation to the past. Jonathan Arac, Postmodernism and Politics

The Crisis of Modernism in the Postmodern Age

Educational theory and practice have always been strongly wedded to the language and assumptions of modernism. Educato rs as d iverse as John Dewey (1916), Ralph Tyler (1950), Herb Gintis (Bowles and Gintis, 1976), John Goodlad (1984), and Martin Carnoy (Carnoy and Levin, 1985) have shared a faith in those modernist ideals that stress the ca­ pacity of individuals to think critically, to exercise social responsibility, and to remake the world in the interest of the Enlightenment dream of reason and freedom. Central to th is view of education and modernity has been an abiding faith in the ability of individuals to situate them­ selves as self-motivating subjects within the wider discourse of pub lic life. For many educators, modernism is synonymous w ith ”the contin­ ual progress o f the sciences and of techn iques, the rational division of industrial work, and the intensification of human labor and of human domination over nature” (Baudri l lard, 1987, 65-66). A faith in rational-

57

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ity, science, and technology bull1 t•<1-.1,., tlw 11111,h 1111 1111 th f 111 I”‘””• nent change, and in the continual ,md fHOK1,,1111 lv1 1111f11ldl t1H 111 hl11 l111y Similarly, education p rovides the soclaliz lng J>1111 ‘ “””‘” ,111cl l0Hllli1h1ll1111 codes by which the grand narrative of progrcs:-i and 111111111n dt•v11lnp ment can be passed on to future generations.

The moral, politica l, and social technologies that structure and drlVt the imperatives of publ ic school ing are drawn from the modernist vlnw of the individual student and educator as the guarantor of the dolk ,111′ balance between private and public life, as the safeguard who t ·,111 guarantee that the economy and the democratic state w ill functio n i11 ,, mutually determining manner. Within the discourse of modernism, knowledge draws its boundaries almost exclusively from a Europc,111 model of cultu re and civilization. Civilization in this script is an extc 11 sion of what Jean-Frarn;ois Lyotard (1984) calls the “great story” of tht• Enlightenment. ln addition, modernism has been largely drawn front cultural scripts written by wh ite males whose work is often privileged as a model of high cu lture informed by an elite sensibility that sets it off from what is often dismissed as popular or mass culture. While it is not the purpose of this chapter to w rite either the story of modernism1 or its specific expressions in the history of educational theory and prac­ tice, it is important to note that modernism in both its progressive and reactionary forms has provided the central categories that have given rise to various versions of educational theory and practice. To question the most basic principles of modernity redefines the meaning of schooling, and also calls into q uestion the very basis of our history, our cu ltural critic ism, and our manifestations and expressions of public life. In effect, to challenge modernism is to redraw and remap the very nature of our social, political, and cu ltural geography. It is for this rea­ son alone that the challenge currently being posed by various post­ modernist discourses needs to be taken up and examined critically by educators.

In th is chapter, we want to argue that the challenge of postmodern­ ism is important for educators because it raises crucial questions re­ garding certain hegemonic aspects of modernism and, by implication, how t hese have affected the meaning and dynamics of present-day schooling. Postmodern criticism is also important because it offers the promise of deterritorializing modernism and redrawing its political, so­ cial, and cultural boundaries, wh ile simultaneously affirming a politics of racial, gender, and ethnic difference. Moreover, postmodern criti­ cism does not merely challenge dominant Western cultural models with their attendant notion of universally valid knowledge; it also re­ situates us w ithin a world that bears little resemblance to the one that

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t 1011,K l11lhw111 c• of 1111 ulnc 1t o 11 k mass media and information tech­ n11l11H), 1111• c ll11t1Klt1g 11,111111• of dass and social format ions in post in-

111 11 l,dl11•d 1,1pl t,1l lsI socl<•1’ics, and the growing transgression of 1111111,d,11 !11~ l>c•lwoon li fe and art, high and popular culture, and image

11d 11111l l ty. w,, wlll , 11 guc in this essay that postmodern criticism offers a com­

ltl11 ,1ll1111 o f roaclionary and progressive possibilities, and that its vari­ ” ‘ ‘ ” cll~c·ourscs have to be examined with great care if we are to benefit 111 1ll! li ,,lly and pedagogically from its assumptions and analyses. We ~ 111 1111>0 ,lrgue that a crit ical pedagogy is not to be developed on the 111111111 of a cho ice between modernism and postmodernism. As Ernesto I , 11 l,111 ( 1988) aptly states, “Postmodern ism cannot be a simple rejec­ llc lll o( modernity; rather, it involves a different modulation of its th11111cs and categories” (65}.2 Moreover, both discourses as forms of , 11llural criticism are flawed; they need to be examined for the ways in wll lC”h each cancels out the worst dimensions of the other. They each 111nlain elements of strength, and educators have an opportunity to l,1’lh lon a critical pedagogy that draws on the best insights of each.

. Most important, we will argue that those ideals of the project of mo­ d1•rnity that link memory, agency, and reason to the construction of a 1h•mocratic public sphere need to be defended as part of a discourse of 1 l’lt lcal pedagogy with in (rather than in opposition to} the existing con­ ditions of a postmodern world. At issue here is the task of delineating tho broader cultural complexities that inform what we shall call a post­ modern sensibility and criticism. Such a delineation needs to take place within t he boundaries of a pedagogy and politics that recl~i’:11.s ,md reinvigorates, rather than denies o r is indifferent to, the poss1b1lt­ tlcs of a radical democracy (Giroux, 1991}.

The argument that is developed here unfolds as follows: first, we will provide some theoretical groundwork for developing a broad map of what constitutes the meaning of postmodernism, and what can be called the postmodern condition. Briefly put, the postmodern condi­ tion refers to the various discursive and structural transformations that characterize w hat can be called a postmodern cult ure in the era of late capitalism. Second, we w ill articu late some of the central and most crit­ ical themes that have emerged from the various discourses on post­ modern theory. In this section we will examine the conservative and radical implications of these positions. Third, we will argue that in or­ der to develop a more adequate theory of schooling as a form of cul­ tural politics it is important that contemporary educators integrate the

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central theoretical fealurcs of u post111odc-111l.,111 111 ” 111 111111 wllli 1111• more radical elements of modernist dist 0 111 s1•.

The Meaning of Postmodernism

Though postmodernisrn has influenced a wide variety of fields that in­ clu~e music, fiction’. film, drama, architecture, criticism, anthropology, sociology, and the visual arts, there is no agreed-upon meaning for the term.3 In keeping w ith the multiplicity of difference that it celebrates, postmodernism is not only subject to different ideological appropria­ tions, it is also marked by a wide variety of interpretations. This can be illustrated by briefly looking at the different views of postmodernism articulated by two of its leading theorists, Jean-Fran~ois Lyotard (1984} and Fredric Jameson (1984).

Lyotard has described postmodernism as a rejection of grand narra­ tives, metaphysical philosophies, and any other form of totalizing thought. In his view, the meaning of postmodernism is inextricably re­ lated to the changing conditions of knowledge and technology that are producing forms of social organization that are undermining the old habits, bonds, and social practices of modernity. For Lyotard, the post­ modern is defined th rough the diffusion throughout Western societies of computers, scientific knowledge, advanced technology, and elec­ tronic texts, each of wh ich accents and privileges diversity, locality, specificity, and the contingent against the totalitizing narratives of the previous age. According to Lyotard, technical, scientific, and artistic in­ novations are creating a world where individuals must make their own way w ithout the benefit of fixed referents or traditional philosophical moorings. Total mastery and liberation are dismissed as the discourses of terror and forced consensus. In its place postmodernism appears as an ideological and political marker for referencing a world without sta­ bility, a world where knowledge is constantly changing and where meaning can no longer be anchored in a teleological view of history.

Fr~d ~i_c Ja,:nes~n’.s _(1984, 1988) writings on postmodern ism challenge the nihilism 1mphc1t In many such theories. Jameson defines postmod­ ernism as the “cultural logic” that represents the third great stage of late capitalism, as well as the new cultural dominant of the times in W~stern societies. For Jameson (1984), postmodernism is an epochal shift that alerts us to the present remapping ofsocial space and the crea­ tion of new social formations. If postmodern ism represents new forms of fragmentation, the creation of new constellation s of forms, and the emergence of new technological and artistic developments in capitalist

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••II«’ I >oui;l,,s Kellner (1988) is right in arguing that Jameson’s view of post-

11111dc11•11lsm is quite different from that of Lyotard and a number of nll11•r prominent theorists of the postmodern. Kellner wri tes:

In any case, one sees how, against Lyotard, Jameson employs Ihc form of a grand narrative, of a totalizing theory of society ,ind history that makes specific claims about featu res of postmodernism–which interprets as “the cultural log_ic of_ capital” rather than as a code word for a new (post)h1stoncal condition – as do Lyotard and Baudrillard (however much they reject totalizing thought). Obviously, Jameson wishes to preserve Marxism as the Master Narrative and to relat ivize all competing theories as sectorial or regional theories to be subsumed in their proper place within the Marxian Master Narrative. (262}

Postmodernism’s refusal of grand narratives, its rejection of univer­ s.al reason as a foundation for human affairs, its decentering of the hu­ manist subject, its radical problematization of representation, and its celebration of plurality and the politics of racial, gender, and ethnic dif­ ference have sparked a major debate among conservatives, liberals, and radicals in an increasingly diverse number of fields. For example, conservative cu ltural critics such as Allan Bloom (1987) argue that post­ modernism represents “the last, predictable stage in the suppression of reason and the denial o f the possibility of truth” (379). In a similar fashion, conservatives such as Daniel Bell (1976) claim that postmod­ ernism extends the adversarial and hedonistic tendencies of modern­ ism to destructive extremes. For a host of other conservatives, post­ modernism as it is expressed in the arts, music, film , and fiction is pejoratively dismissed as ” a reflection of .. . the present wave of (destructive] political reaction sweeping the Western world” (Gott, 1986, 10).

Liberals such as Jurgen Habermas and Richard Rorty take opposing positions on the relevance of postmodernism. Habermas (1983) sees it as a threat to the foundations of democratic public life, while Rorty (1985) appropriates its central assumptions as part of the defense of lib­ eral capitalist society. Among left-wing radicals, postmodernism runs a theoretical gamut that ranges from adulation to condemnation to a

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cautious skepticism. R..idlc;.11 nllll’s MH 11 ,,~ h•11 y I AHie 11111 11’1111, ), I11 111 y Anderson (1984), and Barbara ChrlstiJ11 ( 11/11/ ) 111•1 1111,.1111111l11111l’i111 ,111

either a threat to or a flight fro m the rea l world ot pulll It ” ,11 ic I 11111tl-(l{l1• Hal Foster (1983), Andreas Huyssen (1986), Stua, I I l,1II (1 11 Cros~htllK, (1986), and a number of feminist critics such as ll! l'(‘~il de La u1·1•ll’I (1987), Meaghan Morris (1988), and Nancy Fraser and Linda Nicho lson (1990), approach the discourse of postmodernism cautiously by int(•I rogating critically its claims and absences. Radical avant-garde theorisl~ such as Jean Baudrillard (1988) and Jean-Fran~ois Lyotard (1984) utili.t.t ‘ postmodern discourses as a theoretical weapon to articulate either th(• nihilism of capitalist society and its alleged collapse of meaning or thl’ tyranny implicit in the totalizing narratives characteristic of modernity.

While it would be easy to dismiss postmodernism as simply a code word for a new theoretical fashion, the term is important because it di• rects our attention to a number of changes and challenges that are a part of the contemporary age. For some social theorists, postmodern­ ism may be on the verge of becoming an empty signifier, while others credit it with a theoretical and heuristic relevance deriving from its ca­ pacity to provide a focus for a number of historically significant de­ bates. As Dick Hebdige (1986) points out, there can be little doubt that the term “postmodern” appears to “have occupied a semantic ground in which something precious and important was felt to be embedded” (79). The discourse of postmodernism is worth struggling over, and not merely as a semantic category that needs to be subjected to ever more precise definitional rigor. Rather, it is important to mine its contradic­ tory and oppositional insights for possible use in the service of a radi­ cal cultural politics and a critical theory of pedagogy. At the same time, to provide a basis for understanding its cultural and political insights, we want to argue that postmodernism in the broadest sense refers to an intellectual position, a form of cultural critici sm, as well as to an emerging set of social, cultural, and economic conditions that have come to characterize the age of global capitalism and industrialism. In the first instance, postmodernism represents a form of cultural criti­ c ism that radically questions the logic of foundations that has become the epistemological cornerstone of modernism. In the second in­ stance, postmodernism refers to an increasingly radical change in the relations of production, the nature of the nation-state, the develop­ ment of new technologies that have redefined the fields of telecom­ munications and information processing, and the forces at work in the growing globalization and interdependence of the economic, political, and cultural spheres. All of these issues will be taken up below in more specific detail.

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11, ,11111• 1•11111111 1111111H wlr ,, w 1· thl11!- ,111 1 tlw l><tsl< assumptions that 1h11 v,11 I111I., d h , 11111 1o , .., 111 I11 ,-.1i11111h•1 nlsm have in common, we want to 1t,1i,lly 11l,1llllt ,1tn 1111 “”‘”‘ ‘ o l th<• conditio ns that have come to charac- 11111, , 1 wh,,t c,111 lw 1 ,1llod ,1 postmodern age. We don’t believe that 1111•, t111o d11rnlsm represents a drastic break or ru_pture fr?’:11 modernity ,,11 111u r h ns it signals a shift toward a set of social cond1t1ons that are 11 11 onstlluting the social, cultural, and geopolitical map of the world, wllll t’ simultaneously producing new forms of cultural criticism. Such a ,.1,1(1 represents a break away from certain definitive features of mod- 1•m ism, ” with the emphasis firmly on the sense of the relational move ,1wny” (Featherstone, 1988, 197). At the same t ime, we believe that_the v.irious discourses o·f postmodernism have underplayed the continu­ it ies t hat mark the transition from one age to another w ithin the cur­ rPnt capital ist countries. Modernism is far from dead – its central cate­ KOries are simply being written within a plurality of narratives that ar~ ,11empting to address the new set of social, political, technical, and s~1- t1ntific configurations that constitute the current age. Stuart Hall (1n Grossberg, 1986) captures the complexity of the relationship between modernity and postmodernism in the following comment:

But I don’t know that w ith “postmodernism” we are dealing with something totally and fundamentally different from that break at the turn of the century. I don’t mean to deny that we’ve gone through profound qualitative changes between . then and now. There are, therefore, now some very perplexing features to contemporary culture that certainly tend to outrun the critical and theoretical concepts generated in the early modernist period. We have, in that sense, to constantly update our theories and to be dealing with new experiences. I also accept that these changes may constitute new subject-positions and social identities for people. But I don’t think there is any such absolutely novel and unified thing as the postmodern condition. It’s another vers ion of that historical amnesia characteristic of American cultu re- the tyranny of the New. (47)

In what follows we will discuss some of the major features of the post modern condition. In doing so, we will draw on a vari~ty of differ­ ent theoretical perspectives regarding the nature and meaning of these conditions.

The postmodern condition has to be seen as part of an ongoing shift related to global structural changes as well as a radical change in the way in wh ich culture is produced, circulated, read, a_nd consumed. Such shifts cannot be seen as part of the old Marxist base/super-

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struct ure model. Instead, they have 10 bt• vl1•wc•cl ”” 111111 111 ,, ..,.,1,,1; of uneven developments that have emerged out of tfw, 1111fllt I l11•lwm•11 traditional economic models and new cultu ral fon1111tl011’I 1111cl 111od11’I of criticism, on the one hand, and related discourses th,1I 111,1rk out thu terrains of certain aspects of modernism and postmodernism on tlw other. On an ideological level, the deterritorialization and remappinf( characteristic of the postmodern condition can be seen in the effort by many theorists and critics to challenge and rewrite in oppositional terms the modernist idea ls of rationality, totality, certainty, and progress along with its “globalizing, integrative vision of the individu­ al’s place in h istory and society” (Richard , 1987/1988, 6). But the struggle against the ideals of modernity is not limited to the rewriting of its major texts and assumptions. For example, such a struggle cannot be seen exclusively as a matter of challenging a privileged modernist aesthetic, which calls into question the oppressive organization of space and experience that characterizes institutions such as schools, museums, and t he workplace ; nor can the struggle against modernity be read simply as a call to open up texts to the heterogeneity of mean­ ings t hey embody and mediate. These sites of struggle and contesta­ tion are important, but the postmodern condition is also rooted in those fundamental political and technological shifts that undermine the cent ral modernist notion that there exists “a legitimate center – a unique and superior position from which to establish control and to determine hierarch ies” (Richard, 1987/1988, 6). This center refers to the privileging of Western patriarchal culture, with its representations of dominat ion rooted in a Eurocentric conception of the world, and to the technological, political, economic, and m ilitary resources that once were almost exclusively dominated by the Western industrial coun­ tries . In effect, the basic e lements of the postmodern condition have been created by major changes in the global redistribution of political power and cultural legitimation, the deterritorialization and decenter­ ing of power in the West, the transformations in the nature of the forces of production, and the emergence of new forms of cultural crit­ icism. In what follows, we will spell these out in greater detail.

The economic and political cond itions that have come about in the Western nations since the Second World War have been extensively analyzed by theorists such as Stanley Aronowitz (1987/1988), Scott Lash and John Urry (1987), and Jean Baudrillard (1988). Although these theo­ rists hold differing positions on the importance of postmodern ism, each of them believes that postmodernism can only be understood in terms of its problell)atic relationship w ith central features of the mod­ ernist tradition. Each of their analyses is impo rtant. For Aronowitz

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11’111 /1’11111), 111111l1•1111ty II f,1lllt 1111111 1 , ..,1 11111 11t,11t· Ii-, rcc;cding o n a world­ wide lc•wl ”” th,• 1111, ‘ ‘” 111 p1 11drn 11011 thal drive tho global economy 14111 h11111,t’llllHIY dl11111 111111d through the multinatio nalism of corpo ra­ ‘” •11• u11cl tlw o irH rgP11< ‘<.l of economic powers outside of the Western 1111 l11 11 ttl,dl1od nations. M o reover, Aronowitz believes that the modern­ I t l1•Hlllrni1Iing narratives of public life no longer have the power of , , •11vl1 IIon o r the ideological cohesiveness they once had. Ideological •111ppoI t has given way to bad faith. This can be seen in the various ways 111 which sexual and power hierarchies, electoral politics, and faith in h11h1sl rlalism are now under attack from a wider variety of groups at 1h11 •,11mc time that they are more deeply entrenched in elite publ ic dis­ , 11111 sc and politics.

I or Lash and Urry (1987), capitalism has become increasingly disor- 11,111ILcd. They argue that this process, while not contributing directly lo the development of postmodernist culture, represents a powerful lw·c·c in the emergence of many elements making up the postmodern , ondition. The central changes that Lash and Urry point to include the d,•concentration of capital as national markets become less regulated l1y national corporations; the decline in the number of blue-collar workers as deindustrialization reconstructs the centers of production ,ind changes the makeup of the labor force; a dramatic expansion of Ilic white-collar workforce as well as a distinctive service class; an in­ <rcase in cultural pluralism and the development of new cu ltural/ 1 lhnidpolitical formations; and demographic changes involving the fi­ nancial collapse of inner cities and the growth in rural and suburban populations. And, finally, though they touch on a number of other con­ siderations, Lash and Urry emphasize the appearance of an ideological/ cultural apparatus in which the production of information and symbols not only becomes a central aspect of the making and remaking of ev­ eryday life, but contributes to the breakdown of the division between reality and image.

In Jean Baudrillard’s (1988) discourse, the postmodern condition represents more than a massive transgression of the boundaries that are essential to the logic of modernism; it represents a form of hyper­ reality, an infinite proliferation of meanings in which all boundaries collapse into models of simulation. In this perspective, there is no rele­ vance to an epistemology that searches out the higher elevations of truth, exercises a depth reading, or tries to penetrate reality in o rder to uncover the essence of meaning. Reality is on the surface. Ideology, alienation, and values are all jettisoned in this version of postmodern discourse, and are subsumed within the orbit of a society saturated w ith media messages that have no meaning or content in the rationalist

hl11 1 l’!l’tlM11lllllNl’,M ‘°INl>llllll !llt>N,I Ill I

sense. In this view, information as noli>l’ b p,1,,lvd ) , 1111 11111, d by the masses, whose brutish indifference obliterates 1h11 g1111111d ol nu•dl,1 tion, po litics, and resistance. In emphasizing the glitter ol tlw 1•vcryd,1y as spectacle, Baudrillard points to the new forms of techno logy and 111 formation that have become central to a reproductive order that blur, the lines between past and present, art and life, and commitment and experience.

But Baudrillard’s (1988) society of simulatio ns, a society in which “signs replace the logic of production and class conflict as key constitu• ents of contemporary capitalist societies” (Kellner, in press, 11), trans­ lates less into a provocative analysis of the changing contours and fea­ tures of the age than it does into a nihil ism that undermines its own radical intent. Fatalism replaces struggle, and irony resigns itself to a ” mediascape” that offers the opportunity for a form of refusal defined simply as play. Foundationalism is out, and language has become a sig­ nifier, floating anchorless in a terrain of images that refuse definition and spell the end of representation. In Baudrillard’s postmodern world, history is finished, subsumed in a vertigo of electronic fantasy­ images that privilege inertia as reality. For theorists like Baudrillard, the masses have become the b lack hole into which all meaning simply dis­ appears. Domination now takes place through the proliferation of signs, images, and signifiers that envelop us without a hint o f either where they come from or what they mean. The task is not to interpret but to consume-to revel in the plurality of uncertainties that claim no boundaries and seek no resolutions. This is the world of the spectacle and the simulacrum, a world in which the modernist notion of the “aura” of a work, personality, o r text no longer exists (Benjamin, 1969). Everything is a copy, everything and everyone is networked into a com­ munication system in which we are all electronically wired , pu lsating in response to the simulations that keep us watching and consuming. In Baudrillard’s world, the postmodern condition is science fict ion, mean­ ing is an affront to reality, and pedagogy vanishes except as form be­ cause there are no more experts.

In spite of the different politics and analyses presented by each of these positions, they all respectively conced e that we are living in a transitional era in w hich emerging social conditions call into question the ability of o ld orthodoxies to name and understand the changes that are ushering us into the twenty-first century. Whether these cha


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  1. Analyze your nursing leadership skills-discuss transformational style leadership 
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  3. Create an action plan to address self-assessment capitalizing on strengths and addressing opportunities for improvement in your hospital or healthcare workplace 


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