Rumi was a 13th century Sufi, a member of an ecstatic, whirling-dervish sect of Islam that engages in trance-worship and poetry as a path to God. Sufism tries to blur th

/in /by


Rumi was a 13th century Sufi, a member of an ecstatic, whirling-dervish sect of Islam that engages in trance-worship and poetry as a path to God. Sufism tries to blur the line between love of God and love of human, though this can be seen as blasphemous and sacrilegious by some—why so? How does Rumi manage to respect his God and respect his mortal lovers in a single breath? Why might this effort seem suspicious to some?

Aimee Bender’s “Fruit and Words” is an odd short story about actual words taking on the appearance of what they “refer” to, as if the word “thorn” were sharp and the word “poison” was toxic to consume. What sort of moral effect does the author seem to be aiming for here? What is the danger in thinking that our words are the same as the objects they point toward? What is the opposing danger of thinking that our words aren’t “actual” things in the “real” world?


hawkessays.com Plagiarism Free Papers

Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we\’ll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.

Why Hire hawkessays.com writers to do your paper?

Quality- We are experienced and have access to ample research materials.

We write plagiarism Free Content

Confidential- We never share or sell your personal information to third parties.

Support-Chat with us today! We are always waiting to answer all your questions.




Source link

Needs help with similar assignment?

We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paper

Get Answer Over WhatsApp Order Paper Now

Sometimes it’s hard to relate math to real life situations and that can make math seem intimidating in a classroom setting. However we use math in daily life more than w

/in /by


Sometimes it’s hard to relate math to real life situations and that can make math seem intimidating in a classroom setting. However we use math in daily life more than we probably realize. This video that I watched talks about using math (polynomials) to loose weight.  It talks about how: net calorie=calories from eating and drinking- calories burned from your body, so positive net calories=weight gain, negative net calories= weight loss. So basically this video talks about how to write in math form a weightloss plan and to see if these specific examples are going to make someone gain weight//loose weight//or stay the same. 

so if you use the example of Net calorie=calorie intake-(BMR x Activity level) 

if for example Joe has a low activity level of 1.2, but eats 3600 calories per day and based off weight his BMR is 1973 then the equation would look like:

Net Calories=3600-(1973 x 1.2)

=1232.4 calories 

So for this particular person they would have weight gain. This video was easy to understand and explained how to use polynomials in real life situations. 


hawkessays.com Plagiarism Free Papers

Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we\’ll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.

Why Hire hawkessays.com writers to do your paper?

Quality- We are experienced and have access to ample research materials.

We write plagiarism Free Content

Confidential- We never share or sell your personal information to third parties.

Support-Chat with us today! We are always waiting to answer all your questions.




Source link

Needs help with similar assignment?

We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paper

Get Answer Over WhatsApp Order Paper Now

This is the 2nd week of the going project that will continue for the next 16 weeks. During the weeks, you will use the ATTACHED DNP project to answer some of the questio

/in /by


This is the 2nd week of the going project that will continue for the next 16 weeks. During the weeks, you will use the ATTACHED DNP project to answer some of the questions below. There will be 2 assignments each week in one submission, with a total of 12 pages, each assignment to be 6 pages.

Please see the project info, including title in the ATTACHED DNP Project.

EXTENSION COURSE

This is the 2nd week of the going project that will continue for the next 16 weeks. During the weeks, you will use the ATTACHED DNP project paper to answer some of the questions below. There will be 2 papers each week, and each will be 6 pages.

WEEK 2

Identifying Population Gaps Paper

A Full and Complete 6-Page

For week 2, you will develop a full 6-page APA paper identifying gaps in care for individuals, communities, and populations related to your topic and community. Determine and discuss additional programs needed for promotion/disease prevention interventions that support your project and population.

Use five to six scholarly, academic references to support your paper that are less than 5 years old.

Identification of New Literature Paper

A Full and Complete 6-Page

For week 2, you will develop a full 6-page APA paper discussing at least 8 new research studies (literature not used in your current manuscript) that support your project. Provide an overview and synopsis of each article. Compare and contrast each of the eight research studies, identify which best supports and aligns with your project and explain why.

Use eight scholarly, empirical research studies that are less than 2 years old for this paper.

,

10

Effectiveness of Aerobic Exercise on Ambulatory Blood Pressure in Hypertensive Patients

Submitted by

Chinyere Christiana Pamugo

A Direct Practice Improvement Project Presented in Partial Fulfillment

of the Requirements for the Degree

Doctor of Nursing Practice

Grand Canyon University

Phoenix, Arizona

January 11, 2023

© by Chinyere Christiana Pamugo, 2023

All rights reserved.

GRAND CANYON UNIVERSITY

Effectiveness of Aerobic Exercise on Ambulatory Blood Pressure in Hypertensive Patients

Chinyere Christiana Pamugo

has been approved

January 11, 2023

APPROVED:

Dawn Robinson DNP, MSN, RN, LNHA, DPI Project Chairperson

Khoa Don Nguyen, MD., DPI Project Mentor

ACCEPTED AND SIGNED:

________________________________________

Lisa Smith, Ph.D., RN, CNE

Dean and Professor, College of Nursing and Health Care Professions

_________________________________________

Date

Abstract

Physical exercise may improve hypertension and minimize cardiac complications. At the project site there were no standardized guidelines for hypertensive patients utilizing aerobic exercise as a blood pressure (BP) management mechanism, so an evidence based solution was sought. The purpose of this quantitative, quasi-experimental quality improvement project was to determine if the translation of Saco-Ledo et al.’s research on aerobic exercise would impact systolic and diastolic blood pressures when compared to current practice among adult hypertensive patients in a primary care clinic in southwest Texas over four weeks. Dorothy Orem’s self-care deficit theory and Kurt Lewin’s change model provided the scientific underpinnings for the project. Data were retrieved from the clinic’s electronic medical records on adult hypertensive patients ( N=10) and compared at baseline and four weeks post implementation. A paired-sample t-test showed a statistically and clinically significant improvement in systolic BP from baseline ( M = 152.60, SD = 14.42) to four weeks post implementation ( M = 126.10, SD = 19.93), t (9) = 6.35, p = .001. A paired-sample t-test also showed a statistically and clinically significant decrease in the mean diastolic BP level from baseline ( M = 87.30, SD = 11.19) to four weeks post implementation ( M = 78.10, SD = 8.45) , t (9) = 2.56, p = .031. Based on the results, the translation of Saco-Ledo et al.’s research on aerobic exercise may impact blood pressures in this population. Recommendations include sustaining the project and disseminating the results.

Keywords: aerobic exercise, ambulatory blood pressure, Saco-Ledo et al.’s research on aerobic exercise, Dorothy Orem’s self-care deficit theory, hypertension, hypertension-related conditions, Kurt Lewin’s change model, evidence based practice.

Dedication

I dedicate this project to God, my life’s author and finisher. Irrespective of the unsurmountable challenges and moments of despair, your mercy, grace, and love lead me through. Without your divine wisdom, Almighty father, I would not have been here this day. To my beloved families here and abroad, my mum, siblings, cousins, and spouse Engr. G. O. Pamugo, I achieved this goal because of your fervent prayers, support, and encouragement that fortified my strength, endurance, perseverance, and resilience not to quit to frustrations and fears. Even with my poor health, I struggled and still made it to this day because you all held my weak parts as I journeyed and ran the race to success. Thank you for believing in me and investing in my success. God bless you all. To my dad-late Chief M.E. Chukwu, I did accomplish your dreams on me, and I know wherever your soul is at this time, it is full of joy; rest in peace, daddy, until we meet again.

To my elder brother in the Lord, Rev. Fr. C. Iwuagwu, words cannot express the magnitude of gratitude I owe you for your fatherly and brotherly love, belief in my abilities, countless hours of encouragement, enormous -uplifts, and renewed determination. You are a blessing and gift to our family; remain blessed.

Acknowledgments

The fruitful journey of the Doctor of Nursing program (DNP) was made possible by the unconditional support of extraordinary and cherished individuals, such as Dr. Khoa and Don Nguyen, MD, for serving as my preceptor/mentor throughout the stages of my direct immersion project. I want to thank Dr. Dawn Robinson (Faculty /Chair), for her unshaken patience, quick feedback, and radiant positive energy, together with Dr. Sandi McDermott and faculty in course level review, reading countless revisions and providing knowledgeably expert guidance to the end of this course.

To my colleagues, Jeffrey Souza, Tresa Antony, Mercy Daniel, Lisa Johnson, Marissa Rafael, and Skyler Meyer, thank you for your unfading support. Countless times, I felt like the world has collapsed upon me, desperately seeking the way out in the darkness; lo and behold, your torchlights point through the doors of escape. I recognized each day we journeyed that the race was worth it because you all were there pointing your lights to the proper outlet.

To my supportive friends, Sr. Onyinyechukwu Uba, Ms. Euphemia, Ms. Amaka, Dr. Bashiru, Calista, Sylvia, Vincent, and Ogunbayode. Thank you for your support, encouragement, love, and understanding, especially in moments of desolation, sequestration, and poor communication from me due to loads of assignments on my table.

To my preceptees, Vivian, Michael, Adaeze, Jane, Kate, Esther, Marybeth, Florence, Ubong, Nkele, and others, your understanding when I transferred my frustrations to you humbled me most in my relationship with you as a preceptor. Looking upon the “role model thing” was the driving force that propelled me to this finishing point. You are more than welcome anytime for more guidance in the future in your further studies.

During this program, I also worked on my post-graduate certification program in the psychiatric mental health nurse practitioner program, and this is where I thank Dr. Ghislaine Mogo, my preceptor, for her tremendous patience and support. To my spiritual family, the Daughters of Charity of the Most Precious Blood, God gave me the best opportunity to be among you. Mother Ofelia Marzocca, see what I have become this day because of your decisions in the most challenging moments of my life and humble expression of an arduous journey that would benefit all. Thank you all, and may God reward us according to our deeds.

Table of Contents Chapter 1: Introduction to the Project 1 Background of the Project 2 Problem Statement 3 Purpose of the Project 4 Clinical Question 7 Advancing Scientific Knowledge 7 Significance of the Project 10 Rationale for the Methodology 11 Nature of the Project Design 12 Definition of Terms 13 Assumptions, Limitations, Delimitations 15 Summary and Organization of the Remainder of the Project 17 Chapter 2: Literature Review 19 Theoretical Foundations 22 Review of the Literature 25 Prevalence of Hypertension 26 Aerobic Exercise Health Intervention 31 Effect of Exercise on Blood Pressure 34 Summary 39 Chapter 3: Methodology 41 Statement of the Problem 42 Clinical Question 43 Project Methodology 44 Project Design 45 Population and Sample Selection 47 Instrumentation and Sources of Data 48 Validity 49 Reliability 50 Data Collection Procedures 50 Data Analysis Procedures 52 Potential Bias and Mitigation 53 Ethical Considerations 54 Limitations 55 Summary 55 Chapter 4: Data Analysis and Results 58 Descriptive Data 59 Data Analysis Procedures 60 Results 61 Summary 63 Chapter 5: Summary, Conclusions, and Recommendations 65 Summary of Findings and Conclusion 68 Implications 70 Theoretical Implications 70 Practical Implications 72 Future Implications 73 Recommendations 73 Recommendations for Future Projects 74 Recommendations for Practice 75 References 77 Appendix A 93 Grand Canyon University Institutional Review Board Outcome Letter 93 Appendix B 94 Saco-Ledo et al.’s Research Article 94 Appendix C 95 Permission to Use Saco-Ledo et al.’s Research Article 95

List of Tables

Table 1. Descriptive Data for Age 5 9

Table 2. Descriptive Data for Gender and Race 60

Table 3. Paired t – Test results for Systolic Blood Pressure Levels 6 2

Table 4. Paired t – Test results for Diastolic Blood Pressure Levels 6 2

Hypertension (HTN) is a medical condition associated with higher blood pressure, whereby the arteries that transport blood become damaged. Despite the availability of treatment strategies, less than one in five individuals have their blood pressure under control (Ghatage et al., 2021). Currently, in the United States (U.S.), the disease poses a significant problem that affects over half of the adult population (37 million individuals) (Centers for Disease Control and Prevention [CDC], 2021; Krist et al., 2021). Complications of the condition include myocardial infarction, heart failure, chronic renal disease, and stroke (Ghatage et al., 2021).

The increase in the cases of hypertension prompted the American Heart Association Task Force (AHA, 2022) to publish new guidelines to help manage the rise in hypertension among American adults (Wang et al., 2019). One critical change within the AHA guideline is the improvised reference and definition of hypertension values. The American College of Cardiology and the American Heart Association guidelines for hypertension management and definition of HTN defines it as having blood pressure at or above 130/80 mmHg (The American College of Cardiology (2022); American Heart Association, 2022). At the same time, stage 2 HTN is blood pressure at or above 140/90mmHg (CDC., 2021). Improved blood pressure (BP) among hypertensive patients has been associated with positive health outcomes (Severin et al., 2020), and early detection and control of BP have significantly impacted morbidity and mortality rates in the healthcare delivery system (CDC, 2021; Severin et al., 2020).

At the project site, the project manager collaborated with the Medical Director and clinical manager regarding the increasing ambulatory blood pressures seen within the past three months. Although the site provided patients with medication management for their disease, it was suggested that another strategy be employed to help reduce blood pressure. The conversation concluded with the project manager translating and implementing Saco-Ledo et al.’s (2020) research on aerobic exercise to impact the blood pressure of hypertensive patients.

The project was worth conducting because it helped to increase HTN patients’ knowledge levels and assist in helping them change their behaviors to combat this “silent killer” (Centers for Disease Control and Prevention [CDC], 2019). Unfortunately, many individuals are unaware of the symptoms, which makes the situation dire. This project promoted decreasing the fifth leading cause of death (CDC, 2019). Other areas the project impacted were improving their quality of life, reducing their chances of stroke, protecting their kidneys, and decreasing healthcare costs (CDC, 2019).

Chapter 1 introduced the topic of hypertension and the use of daily physical activity to combat the disease. Other sections of the chapter included the problem statement, purpose statement, and clinical question. Other chapter areas encompassed advancing scientific knowledge related to the theoretical underpinnings, quantitative methodology, and quasi-experimental design. The chapter’s last segments comprised the definition of terms, assumptions, limitations, and delimitations with a preview of Chapter 2.

The prevalence of hypertension among the adult population in the United States (U.S.) increased rapidly between 1988 to 2010, accounting for half of all fatalities from stroke and end-stage renal disease (ESRD) (Million Hearts, 2021). According to Muntner et al. (2020) trend analysis, the estimated proportion of the U.S. adult population suffering from hypertension between 1999 and 2000 was 31.8 %. The adult population affected by hypertension increased from 31.8 % in 1999-2000 to 48.5 % in 2007 and 2008 (Muntner et al., 2020). The number of affected U.S. adults has been on the rise ever since, and between 2013 and 2014, which was 53.8 % (Muntner et al., 2020). The percentage dropped slightly from 53.8% to 43.7% between 2017 and 2018, but the value is still relatively high (Muntner et al., 2020). This data imply that the American population is considerably affected by hypertension at an alarming rate.

The current hypertensive population impacted by increased ambulatory blood pressure is 43.7%, according to a recent study by Adams and Wright (2020). Currently, there are no standardized guidelines for educating hypertensive patients regarding incorporating exercise (daily physical activity) as a blood pressure management mechanism at the project site. The standard treatments include medications such as diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and calcium channel blockers (Mayo Clinic, 2021). After collaborating with the medical director and nursing staff, the decision was to implement Saco-Ledo et al.’s (2020) research on aerobic exercise to help lower systolic and diastolic blood pressures among this clinic’s adult hypertensive population.

It was not known if or to what degree the translation of Saco-Ledo et al.’s (2020) research on aerobic exercise would impact systolic and diastolic blood pressures when compared to current practice among adult hypertensive patients. At the clinical site, there were no standardized guidelines for clinicians to educate hypertensive patients regarding implementing daily physical activity as a blood pressure management mechanism. Collaboration with the medical director and some nursing staff showed an increase of 37.1% in diagnosed HTN patients within the past six months. The clinic’s findings corresponded with the health statistics from the Texas Health and Human Services Commission (2022), as the county ranks 22 in the States with diagnosed hypertensive patients. The data, in combination with current literature by the Centers for Disease Prevention and Control [CDC] (2021), emphasizes that hypertension affects approximately 45% of American adults.

The project contributes to the current body of literature, such as Aung and Htay (2021), Krist et al. (2021), and Saco-Ledo et al. (2020), regarding aerobic exercise being included in hypertension management. The CDC (2020) states that regular physical activity is essential for general wellness, weight loss, and well-being. Other areas impacted are the reduced symptoms of depression and anxiety (CDC, 2020). The project validated that using aerobic exercise, as stated by Saco-Ledo et al. (2020), decreased one’s systolic blood pressure by approximately 2 to 4 mm Hg in normotensive and 5 to 8 mm Hg in hypertension adult patients.

The purpose of this quantitative, quasi-experimental quality improvement project was to determine if the translation of Saco-Ledo et al.’s research on aerobic exercise would impact systolic and diastolic blood pressures when compared to current practice among adult hypertensive patients in a primary care clinic in southwest Texas over four weeks. The independent variable for the project was the translation of Saco-Ledo et al.’s (2020) research on aerobic exercise, and the dependent variable was blood pressure measurements. Convenience sampling was used to choose the patients during office visits. The project was conducted within four weeks using a quasi-experimental design and quantitative methodology. Six healthcare providers were educated to offer aerobic exercise using a translation of Saco-Ledo et al.’s research on aerobic exercise. The impact was measured using an Oscar 2 blood pressure monitoring device for HTN patients. The primary investigation carried out the implementation and comparison of data during the project using ambulatory blood pressure collected baseline and postimplementation. Patient blood pressures measured by the Oscar-2 were automatically imported into the patient’s medical record. Data were retrieved from the clinic’s electronic medical record and inputted into a Microsoft Excel spreadsheet. A statistician not associated with the primary investigator or project analyzed the data. A paired sample t-test was used to analyze the statistical significance of the variables using the Statistical Package for the Social Sciences (SPSS-28).

The inclusion criteria for the patients were 18 and older, diagnosed with HTN, current clinic patients, and able to participate in aerobic activity. The exclusion criteria are patients with musculoskeletal disabilities, mental disorders, and individuals with comorbidities that could bias the project findings. The patients engaged in aerobic exercise for 30 minutes in 24 hours, three days a week, for the four weeks of the project duration. The postimplementation outcome was a reduction in ambulatory blood pressure reading of the recommended BP below 140/80mmHg. The average decrease in SBP with aerobic exercise is approximately 2 to 4 mm Hg in normotensive patients and 5 to 8 mm Hg in adult hypertension patients (Saco-Ledo et al., 2020).

The individuals who implemented the intervention were one physician, two nurse practitioners, two registered nurses, and one medical assistant. All healthcare providers were educated to include aerobic exercise within office visits with HTN patients. Aerobic exercise was offered as translated from Saco-Ledo et al.’s (2020) research on aerobic exercise. The use of Oscar 2 Device for measuring ambulatory blood pressure. The clinicians demonstrated understanding via the teach-back method to the project manager to safeguard all the patients were taught the same way. They currently work full-time at the clinic for over one year and have access to the documentation software.

The project site’s geographic location is in southwest Texas, the most populous county and the third most populous county in the United States (U.S. Census Bureau, 2020). The affected population was patients diagnosed with HTN. The demographics show a diverse population of White (28.9 %), White-Hispanic (36.72%), Blacks (18.5%), Asians (6.9 %), and Latinos (8.98. %) (U.S. Census Bureau, 2020). Many residents over the age of 60 have chronic diseases such as (chronic obstructive pulmonary disease, heart disease, and diabetes) (UT Health Science Center at Houston, 2020). The age groups in the county 18 to 34 (20,586), 35 to 54 (46,513), and 55 to 64 reflect the patients in the project.

The project contributed to the nursing field by offering an evidence-based strategy and evaluating how aerobic exercises such as walking improve ambulatory blood pressure. The project provided vital information that could be shared with other nursing staff or healthcare providers at other primary care clinics, minority communities, or populations in similar diverse populations. The project also preferred an avenue for helping individuals and families to understand the relationship between the disease process and its management.

Saco-Ledo et al. (2020) conducted a systematic review and meta-analysis. The authors claimed that ambulatory blood pressure (ABP) better predicts cardiovascular disease and mortality in adult hypertensive populations. Aerobic exercise played a significant role in lowering blood pressure and was beneficial in lowering ambulatory blood pressure in HTN patients. The following clinical question guided this quantitative project: To what degree does the translation of Saco-Ledo et al.’s (2020) research on aerobic exercise impact systolic and diastolic blood pressures compared to curren


hawkessays.com Plagiarism Free Papers

Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we\’ll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.

Why Hire hawkessays.com writers to do your paper?

Quality- We are experienced and have access to ample research materials.

We write plagiarism Free Content

Confidential- We never share or sell your personal information to third parties.

Support-Chat with us today! We are always waiting to answer all your questions.




Source link

Needs help with similar assignment?

We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paper

Get Answer Over WhatsApp Order Paper Now

What are the three most important things you learned this week? What questions remain uppermost in your mind? Is there anything you did not understand?521BipolarDisorder

/in /by


DSM

The depressive side of bipolar disorder is characterized by a major depressive episode resulting in depressed mood or loss of interest or pleasure in life. The DSM-5 states that a person must experience five or more of the following symptoms in two weeks to be diagnosed with a major depressive episode:

Depressed mood most of the day, nearly every day

Loss of interest or pleasure in all, or almost all, activities

Significant weight loss or decrease or increase in appetite

Engaging in purposeless movements, such as pacing the room

Fatigue or loss of energy

Feelings of worthlessness or guilt

Diminished ability to think or concentrate, or indecisiveness

Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt



Source link

Needs help with similar assignment?

We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paper

Get Answer Over WhatsApp Order Paper Now

Your initial post should be at least 500 words,?formatted and cited in current APA style with support from at least 2 academic sources.?Your initial post is worth 8 poin

/in /by


 

  • Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
  • You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 
  • All replies must be constructive and use literature where possible.


hawkessays.com Plagiarism Free Papers

Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we\’ll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.

Why Hire hawkessays.com writers to do your paper?

Quality- We are experienced and have access to ample research materials.

We write plagiarism Free Content

Confidential- We never share or sell your personal information to third parties.

Support-Chat with us today! We are always waiting to answer all your questions.




Source link

Needs help with similar assignment?

We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paper

Get Answer Over WhatsApp Order Paper Now

Annotated bibliography;? Each annotation should summarize , synthesize and analyze the content of each article. APA format for annotation is required.? Each annotation m

/in /by


Annotated bibliography; 

Each annotation should summarize , synthesize and analyze the content of each article. APA format for annotation is required. 

Each annotation must be 250 words or more and include the following content:

  • 1. Theoretical foundation/framework for the evidence-based practice(s) described in article
  • 2. Strengths and weaknesses of evidence-based practice(s) described in article
  • 3. Research design, including research methods implemented in the study
  • 4. How can the information presented in the article be applied to action research related to your topic?

Using these sources 

1. https://academic.oup.com/epirev/article/40/1/157/4951841 

Skarupski, K. A., Gross, A., Schrack, J. A., Deal, J. A., & Eber, G. B. (2018). The health of America’s aging prison population. Epidemiologic Reviews, 40(1), 157-165. 

2. https://academic.oup.com/psychsocgerontology/article/75/5/970/5096750

Alexandra D Crosswell, PhD, Madhuvanthi Suresh, BA, Eli Puterman, PhD, Tara L Gruenewald, PhD, Jinkook Lee, PhD, Elissa S Epel, PhD, Advancing Research on Psychosocial Stress and Aging with the Health and Retirement Study: Looking Back to Launch the Field Forward, The Journals of Gerontology: Series B, Volume 75, Issue 5, June 2020, Pages 970–980, https://doi.org/10.1093/geronb/gby106

Using APA format

250 words for both articles. 500 words in total. 



Source link

Needs help with similar assignment?

We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paper

Get Answer Over WhatsApp Order Paper Now

Your staff development PPT presentation will include the information from your written ?in 10-12 slides (including a title and reference slide in APA format). Make sure

/in /by


Your staff development PPT presentation will include the information from your written  in 10-12 slides (including a title and reference slide in APA format). Make sure to include speaker notes at the bottom of your slide to explain the content of your slide.

2

Falls among older adults in acute care hospitals are a major cause of morbidity and mortality, leading to serious injury, increased healthcare costs, and reduced quality of life. For this reason, it is important to investigate the effectiveness of different interventions in reducing the risk of falls. The PICOT question I have chosen to investigate is: In adults aged 65 and over (P) in acute care hospitals, how does the implementation of a multidisciplinary team-based approach (I) compared to the standard of care (C) affect the rate of falls (O) within a six-month period (T)?

The proposed intervention, a multidisciplinary team-based approach, may reduce the risk of falls in acute care hospitals through improved risk assessment, patient education, and targeted interventions. The comparison intervention is the standard of care that is typically provided in acute care hospitals and may include patient education, environmental assessment, and other interventions. The outcome of interest is the rate of falls within a six-month period.

The evidence I found indicates that the implementation of a multidisciplinary team-based approach is effective in reducing the rate of falls in acute care hospitals. A systematic review by Choi et al. (2023) found that the implementation of a multidisciplinary team-based approach was associated with a 25% reduction in the rate of falls in older adults in acute care hospitals. The review also found that the implementation of a multidisciplinary team-based approach was associated with a reduction in the risks of fall-related injuries.

To evaluate the effectiveness of the implementation of a multidisciplinary team-based approach in reducing the rate of falls in older adults in acute care hospitals, I would use a before-and-after study design. In this study design, the rate of falls would be measured before and after the implementation of the intervention (Siddique et al., 2021). This would allow us to compare the rate of falls before and after the implementation of the intervention and to determine if there was a significant reduction in the rate of falls after the implementation of the intervention.

In addition, I would also use a randomized controlled trial (RCT) to evaluate the effectiveness of the intervention. In this study design, participants would be randomly assigned to either the intervention or the control group. The intervention group would receive the multidisciplinary team-based approach, while the control group would receive the standard of care (Goldberg et al., 2019). The rate of falls in each group would then be measured at the end of the study period. This would allow us to compare the rate of falls between the two groups and to determine if the intervention was effective in reducing the rate of falls (Goldberg et al., 2019). By comparing the rate of falls between the intervention and control groups, it would be possible to identify any factors that may have contributed to the success or failure of the intervention, such as the age of the participants or the length of the intervention.

I would also use qualitative methods to evaluate the effectiveness of the intervention. Qualitative methods such as interviews and focus groups can provide valuable insight into the experiences of patients and healthcare providers with the intervention (Ibrahim et al., 2022). These methods can help to identify potential barriers and facilitators to the implementation of the intervention and can provide valuable information on how to improve the effectiveness of the intervention (Morris et al., 2022). Qualitative methods can also be used to identify areas of improvement in the design and delivery of the intervention. Qualitative methods can help to uncover any unintended consequences of the intervention so that they can be addressed.

In conclusion, the implementation of a multidisciplinary team-based approach in acute care hospitals may be effective in reducing the rate of falls in older adults. The proposed evaluation methods, including before-and-after studies, randomized controlled trials, and qualitative methods, can provide valuable information on the effectiveness of the intervention and can help to identify potential barriers and facilitators to implementation.

References

Choi, J.-Y., Rajaguru, V., Shin, J., & Kim, K. (2023). Comprehensive geriatric assessment and multidisciplinary team interventions for hospitalized older adults: A scoping review. Archives of Gerontology and Geriatrics, 104, 104831. https://doi.org/10.1016/j.archger.2022.104831

Goldberg, E. M., Marks, S. J., Ilegbusi, A., Resnik, L., Strauss, D. H., & Merchant, R. C. (2019). GAPcare: The Geriatric Acute and Post‐Acute Fall Prevention Intervention in the Emergency Department: Preliminary Data. Journal of the American Geriatrics Society, 68(1), 198–206. https://doi.org/10.1111/jgs.16210

Ibrahim, H., Harhara, T., Athar, S., Nair, S. C., & Kamour, A. M. (2022). Multi-Disciplinary Discharge Coordination Team to Overcome Discharge Barriers and Address the Risk of Delayed Discharges. Risk Management and Healthcare Policy, Volume 15(15), 141–149. https://doi.org/10.2147/rmhp.s347693

Morris, M. E., Webster, K., Jones, C., Hill, A.-M., Haines, T., McPhail, S., Kiegaldie, D., Slade, S., Jazayeri, D., Heng, H., Shorr, R., Carey, L., Barker, A., & Cameron, I. (2022). Interventions to reduce falls in hospitals: a systematic review and meta-analysis. Age and Ageing, 51(5). https://doi.org/10.1093/ageing/afac077

Siddique, S. M., Tipton, K., Leas, B., Greysen, S. R., Mull, N. K., Lane-Fall, M., McShea, K., & Tsou, A. Y. (2021). Interventions to Reduce Hospital Length of Stay in High-risk Populations: A Systematic Review. JAMA Network Open, 4(9), e2125846–e2125846. https://doi.org/10.1001/jamanetworkopen.2021.25846


hawkessays.com Plagiarism Free Papers

Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we\’ll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.

Why Hire hawkessays.com writers to do your paper?

Quality- We are experienced and have access to ample research materials.

We write plagiarism Free Content

Confidential- We never share or sell your personal information to third parties.

Support-Chat with us today! We are always waiting to answer all your questions.




Source link

Needs help with similar assignment?

We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paper

Get Answer Over WhatsApp Order Paper Now

Post a brief summary of the results of your self-assessment and the implications of these results in terms of your cultural awareness and competence. Describe your react

/in /by


Post a brief summary of the results of your self-assessment and the implications of these results in terms of your cultural awareness and competence. Describe your reaction to these results and explain how you plan to use this information to further develop your cultural competence and accomplish your professional goals. 300 word minimum.

Be sure to support your postings and responses with specific references to the Learning Resources. 

Assessment:

https://cdn-media.waldenu.edu/2dett4d/Walden/PUBH/8410/CP/index.html

https://www.apa.org/pi/oema/resources/policy/provider-guidelines

The Place of Culture in Forensic Psychiatry

Laurence J. Kirmayer, MD, Cécile Rousseau, MD, MSc, and Myrna Lashley, PhD

Members of a multicultural society must all be subject to the same equitable system of justice. However, culture exerts profound influences on human behavior, and cultural considerations have a place in determinations of capacity and in appropriate sentencing. Cultural psychiatry can contribute to forensic psychiatry by helping to contextualize individuals’ actions and experiences. This contextualizing can be done through cultural consultations that employ interpreters and culture brokers to identify the role of culture in individuals’ psychopathology. Clarifying how cultural background has affected individuals’ capacity to form a criminal intent or control their behavior may allow a better determination of level of culpability and guide appropriate sentencing. However, framing behavior as culturally influenced may also stereotype and stigmatize specific groups. To avoid this, culture must be understood in terms of power relationships between minority groups and the dominant society. Cultural factors are not only relevant to the experience of specific groups but pervade the entire judicial system shaping the process of moral and legal reasoning.

J Am Acad Psychiatry Law 35:98–102, 2007

Recent years have witnessed a growing debate on the place of culture in the legal system. Legal practitio- ners and theorists have argued the pros and cons of using culture as a defense in criminal cases.1,2 The value of attending to culture includes having a better understanding of the origins of behavior and the level of volition and intent in the accused individual’s be- havior. At a wider societal level, acknowledging cul- tural differences in law can contribute to building a pluralistic society that can accommodate some dif- ferences in values that are important to cultural com- munities.3 This is evident, for example, in efforts to develop customary law and sentencing circles among indigenous peoples that respect traditional values of harmony and connectedness.4,5

Those supporting the use of culture as a defense argue that is it intrinsically unfair to judge someone exclusively by the rules and values of a society that he or she does not know. Moreover, since culture shapes personal identity, emotional responses, and patterns of reasoning, it can be expected to influence motiva-

tion and intent in situations involving criminal ac- tions. Following this line of argument, in regard to considerations of individual volition and intent be- ing important for determining legal culpability, cul- tural considerations become pertinent in an equita- ble justice system.

Against this pluralistic view, critics argue that al- lowing culture as a defense is dangerous. It will un- dermine the fairness of the justice system by allowing inconsistent or arbitrary standards to be applied; crimes that are consistent with local cultural conven- tions will go unpunished; and, ultimately, whole groups will be stigmatized because they are not being held to the same moral and juridical standards as the rest of society. Advocates of universal human rights note the importance of clearly articulated standards to which every individual must adhere and by which everyone is judged.6,7

This ongoing legal debate in multicultural societ- ies is reflected in the field of forensic psychiatry, where consultants may be asked to supplement their usual psychiatric assessment with attention to social and cultural factors that can explain or contextualize the behavior of individuals accused of crimes. Boe- hnlein and colleagues8 noted the complexities of this area and suggested that applying cultural consider- ations to the process of sentencing may be less con- tentious than introducing culture as a defense against

Dr. Kirmayer is James McGill Professor and Director, and Dr. Rous- seau is Associate Professor, Division of Social and Transcultural Psy- chiatry, McGill University, Montreal, Quebec, Canada. Dr. Lashley is Professor, Department of Psychology, John Abbott College, Montreal, Quebec, Canada. Work on this article was supported by a Senior Investigator Award to Dr. Kirmayer from the Canadian Institutes of Health Research (MSS-55123). Address correspondence to: Laurence J. Kirmayer, MD, Jewish General Hospital, 4333 Cote Ste. Catherine Road, Montreal QC H3T 1E4, Canada. E-mail: [email protected] mcgill.ca

98 The Journal of the American Academy of Psychiatry and the Law

A N A L Y S I S A N D C O M M E N T A R Y

a crime. The determination of whether someone com- mitted the crime is then separated from questions of their level of intent and the appropriate punishment. Recognition of the contribution of culture also may help in the determination of what interventions should be employed to bring about rehabilitation.

The assessment of cultural factors affecting behav- ior can be conducted by a psychiatrist or psychologist who is familiar with the language and cultural back- ground of the patient or who has access to interpret- ers and culture brokers.9,10 The cultural formulation in Appendix I of DSM-IV11 provides a framework for organizing cultural information relevant to psy- chiatric assessment and, although it was not designed for this setting, can be applied in forensic con- texts.12,13 In support of this use of the cultural for- mulation, Boehnlein and colleagues presented the case of a refugee from Cambodia who was facing the death penalty and for whom many developmental insults and traumatic experiences evidently contrib- uted to criminal actions. The crucial factors in that case relevant to sentencing were linked to the impact of perinatal trauma (brain anoxia and subsequent damage resulting in poor school performance and impulsivity) and organized violence (which acts in many ways: directly, as a cause of physical and psy- chological trauma; developmentally, through im- paired parenting; and socially, through subsequent experiences of dislocation).

There is a long history of jurisprudence that rec- ognizes decreased culpability in people with evident cognitive impairments and that modifies sentencing on this basis.14 Recent decisions in the United States that prohibit the death penalty for individuals with intellectual disabilities reflect this basic principle of justice.15 As Boehnlein and colleagues8 pointed out in discussing their case, cultural issues arise mainly regarding the appropriate use of culturally fair and meaningful methods of neuropsychological testing or clinical assessment and the use of interpreters. These are important matters given that, for people from many backgrounds, culturally adapted and val- idated testing instruments do not exist, and most clinicians have little training or experience in work- ing with interpreters and culture brokers. However, these technical problems have obvious solutions, in- cluding changes to training programs and profes- sional accreditation.

Bringing awareness of cultural concerns to the at- tention of judges and jurors can play an important

role in improving the functioning of the justice sys- tem. It is worth asking, however, whether some social and cultural circumstances are so familiar or taken for granted that they are not recognized or given weight as explanations for criminal actions. Would a young African American growing up in an urban ghetto exposed to repeated traumas and violence re- ceive a milder sentence if a cultural psychiatrist or psychologist provides an empirically based account of the ways in which his actions were influenced by his upbringing and current surroundings?

A cultural psychiatrist could certainly argue the case that persons exposed to such systematic inequal- ities, who suffer cognitive impairment as a result, should receive some mitigation of their sentence. In these circumstances, however, the consultant might encounter considerable resistance from those who take for granted the culturally constructed inequali- ties of U.S. society (which emerged from the history of racism and slavery) or, indeed, blame these endur- ing inequalities on the victims of the legacy of histor- ical injustices.16 This discrepancy between the re- sponse to the compelling story of someone from far away exposed to genocidal violence and the familiar story of yet another victim of the unjust social system close to home, points to the danger of focusing on “culture” as a construct that elides the social, politi- cal, and economic factors that create structural violence.

Cultural psychiatry must attend to the culture of the familiar and especially to the interactions be- tween the values of the dominant society and those of local communities and individuals who are system- atically disadvantaged by the dominant ideologies and institutions. The focus of the cultural formula- tion on the culture of the “other” should be supple- mented with frameworks for assessment that cover matters related to the social predicament of specific groups, their histories of migration, and in particular their position vis-à-vis the dominant cultural ideolo- gies and practices of U.S. society. In the case of the United States, this must include the widespread im- pact of racism and its legacy on the well-being of individuals and on the functioning of the criminal justice system itself.

Although most discussion of cultural factors in forensic psychiatry focuses on the dilemmas of eth- noracial groups, the criminal justice system itself is a cultural institution based on specific concepts, per- spectives, and values that may not be in complete

Kirmayer, Rousseau, and Lashley

99Volume 35, Number 1, 2007

accord with other cultural traditions. This disparity is transparently the case with regard to the use of capital punishment—a practice in which the U.S. is unique among the countries of the West. Specific U.S. cultural values and attitudes must be invoked to account for the persistence and acceptance of the death penalty, where so many other countries have come to find it morally beyond the pale.

Culture and Context

Consideration of the relevance of cultural back- ground and experience to the process of sentencing raises several complex theoretical and practical ques- tions. In what sense can a cultural explanation justify a claim of (1) diminished capacity to make a moral distinction between legally right and wrong behav- ior, (2) lack of criminal intent or volition, or (3) other mitigating circumstances that should influence sen- tencing? The answer to each of these questions is somewhat different.

The capacity to make moral judgments depends not only on intact cognitive-emotional functioning but also on having acquired the implicit rules and hierarchy of values that govern local morality. In noncapital cases, it is easy to recognize cultural diver- gences in these values. For example, exposure to vio- lence may change the capacity for thinking through the consequences of one’s actions by causing a nar- rowing of attention or intense emotion that inter- feres with thinking about the consequences of one’s actions.

Volitional behavior emerges from a complex ma- trix of social, psychological, and biological processes, each of which can link past experience to current behavior. Cultural variations in childrearing and cul- tural concepts of the person may lead to differences in emotional experience, self-control, and explana- tions of action.17 Hence, any comprehensive ac- count of the origins of behavior must include cultural dimensions. This necessity is especially true of moti- vation, volition, intent, and control that are crucial in determining the degree of culpability for harmful actions and the appropriate social response. Both so- cial and psychological considerations suggest that there are many gradations of volition and control in behavior and that these may be crucial to deciding the level of intent.18 We need a detailed understand- ing of the role of culture in ordinary cognitive func- tioning and in psychopathology to understand when and where individuals may be partially exculpated

because their cultural background has affected their capacity to form a criminal intent or to control their behavior.

In many cases, it is not whether the act was com- mitted that is in question, or the level of intent or control, but what its meaning and significance is to the defendant. Culture frames problems and presents us with the categories and concepts through which we organize and understand our own actions. For example, the Japanese mother who tries to kill her child and herself may be following the cultural tem- plate of otaku—joint suicide—in which, because of cultural values, the lives of mother and child are linked.19 The intent then is not murder as a separate act but the completion of a suicide in which the child is included as an extension of the self. Understanding this has implications for judgments of culpability and the extent to which a person may commit other acts of violence in the future.

Supplying the cultural context of behavior changes its meaning and renders the individual’s rea- soning more transparent. In effect, it allows the judge to reconstruct imaginatively the affective logic of the defendant’s cultural world.20,21 The increased empa- thy that results may allow a better sense of the ratio- nale for the person’s behavior; such understanding could increase or decrease the assessment of his or her culpability. What weight should be given to personal and social suffering in assessing the level of responsi- bility of a given person? Here, there is a wide range of positions. Some argue that people who have been victimized themselves cannot be held entirely re- sponsible for their subsequent actions. To the extent that we recognize victimization as modifying the per- son’s capacity for insight, intent, and voluntary con- trol of behavior, we might want to mitigate the sen- tence. However, exposure to a traumatizing or disadvantaged social environment or developmental history per se cannot be sufficient reason for altering a sentence. There must be evidence that these hard- ships have directly affected the individual’s ability to form and express criminal intent and control and to act.

Cultural Understanding or Racial Stereotyping?

Since we are fundamentally cultural beings, cul- tural concerns are ubiquitous and are not the sole province of people identified as ethnically different. A social and cultural account can be given for the

Culture in Forensic Psychiatry

100 The Journal of the American Academy of Psychiatry and the Law

origins of any behavior, action, or episode. Why then should cultural explanations be offered just in some cases? Surely this has to do with the assumption that the law is already based on a fund of tacit cultural knowledge shared by all participants from a similar background. This cultural background knowledge is part of everyday moral thinking as well as the formal deliberations of the law—both of which use reason- ing based on narrative models or templates.22 These narratives tend to present the values and perspectives of the dominant culture as simply common sense and so obscure the cultural context of moral and legal reasoning.23 The recognition of culture also reflects the politics of identity and exclusion. Certain indi- viduals or groups are recognized as different accord- ing to the history, norms, and values of the dominant society and its institutions. Their behavior therefore requires explication in terms of culture.

Framing behavior as culturally influenced or de- termined thus serves not only to explain some of their historical and contextual origins, but also to separate and divide groups. By its very nature, cultural expla- nations invoke collective values and experiences to explain individual actions. Although aiming to rec- ognize the collective roots of an individual’s identity, experience, and behavior, the use of a cultural de- fense may contribute to stereotyping and stigmatiz- ing whole groups or communities.16

For example, in 1988 a judge in Quebec, Monique Dubreuil, sentenced two men convicted of the gang rape of a young woman to 100 hours of community work and 18 months of house arrest.24 The prosecu- tor had asked for four to five years of incarceration. The judge’s rationale for this lenient sentence was “cultural sensitivity.” The young woman and the perpetrators were all Haitian immigrants to Canada, and the judge opined, “The absence of regret of the two accused seems to me to be related more to a cultural context, particularly with regard to relations to women, than to a truly sexual problem” (Ref. 24, author’s translation). Women’s rights groups as well as many within the Haitian community in Montreal were outraged. In effect, in the name of cultural sen- sitivity, a whole group was stereotyped and stigmatized.

The problem centers on how culture and commu- nity can be thought about in ways that acknowledge distinctiveness without stereotyping or essentializ- ing—that is, reducing the complexity of a group or individual to a single essential characteristic.25 Such a

simplification can only be achieved through a de- tailed account that shows the links between past and present social contexts and behavior. In her discus- sion of the culture defense, Anne Renteln2 employs the UNESCO view of culture as “traditional culture” shared by a group, but in the contemporary world, most people are between cultures, forming their own distinctive hybrid identities in which their relation- ship to community and tradition is shifting, ambig- uous, and often contentious.26 Moreover, culture it- self cannot be understood without looking at the power relationships between minority groups and the dominant society. Approaching culture from the point of view of the dynamics of power and hybridity works against the tendencies to essentialize and ste- reotype the “other” and underscores the ways in which culture exerts its effects, not only through re- modeling the individual’s brain,27 but even more forcefully through constructing and justifying social institutions and practices.28

Conclusions

As our countries become more diverse, we must make certain that efforts to respect cultural difference and diversity do not lead us to essentialize and exoti- cize the “other.” Misguided beneficence may inad- vertently make people second-class citizens and im- pede their integration into the community. Being part of a multicultural society means being subject to the same judicial rules as the rest of the community. However, as with the provision of mental health ser- vices, true equity does not mean that everyone re- ceives precisely the same treatment regardless of their ability to understand and respond. Taking culture into account means that the purposes of the criminal justice system—which include prevention and reha- bilitation—can be achieved more effectively. Cul- tural awareness must be coupled with an equally as- tute political awareness that traces the consequences of clinical or forensic consultations out into the larger society. Ultimately, culture is not something that be- longs just to the person in an identified minority group; it pervades the whole judicial system.

References 1. Golding MP: The cultural defense. Ratio Juris 15:146–58, 2002 2. Renteln AD: The Cultural Defense. New York: Oxford Univer-

sity Press, 2004 3. Kymlicka W: Multicultural Citizenship. Oxford, UK: Oxford

University Press, 1995

Kirmayer, Rousseau, and Lashley

101Volume 35, Number 1, 2007

4. Ross R: Returning to the Teachings: Exploring Aboriginal Justice. Toronto: Penguin Books, 1996

5. Drummond SG: Incorporating the Familiar: An Investigation Into Legal Sensibilities in Nunavik. Montreal, Buffalo: McGill- Queen’s University Press, 1997

6. Finkielkraut A: In the Name of Humanity: Reflections on the Twentieth Century. New York: Columbia University Press, 2000

7. Ignatieff M: The Rights Revolution. Toronto: House of Anansi Press, 2000

8. Boehnlein JK, Schaefer MN, Bloom JD: Cultural considerations in the criminal law: the sentencing process. J Am Acad Psychiatry Law 33:335–41, 2005

9. Kirmayer LJ, Groleau D, Guzder J, et al: Cultural consultation: a model of mental health service for multicultural societies. Can J Psychiatry 48:145–53, 2003

10. Kirmayer LJ, Rousseau C, Jarvis GE, et al: The cultural context of clinical assessment, in Psychiatry (ed 2). Edited by Tasman A, Lieberman J, Kay J. New York: John Wiley & Sons, 2003, pp 19–29

11. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR (ed 4). Washington, DC: American Psychiatric Association, 2000

12. Group for the Advancement of Psychiatry: Cultural Assessment in Clinical Psychiatry. Washington, DC: American Psychiatric Press, 2002

13. Lewis-Fernandez R, Diaz N: The cultural formulation: a method for assessing cultural factors affecting the clinical encounter. Psy- chiatr Q 73:271–95, 2002

14. Verdun-Jones SN: Forensic psychiatry, ethics and protective sen- tencing: what are the limits of psychiatric participation in the criminal justice process? Acta Psychiatr Scand 399:77–82, 2000

15. Bonnie RJ: The American Psychiatric Association’s resource doc- ument on mental retardation and capital sentencing: implement-

ing Atkins v. Virginia. J Am Acad Psychiatry Law 32:304–8, 2004

16. Hicks JW: Ethnicity, race, and forensic psychiatry: are we color- blind? J Am Acad Psychiatry Law 32:21–33, 2004

17. Markus HR, Kitayama S: Models of agency: sociocultural diversity in the construction of action. Nebr Symp Motiv 49:1–57, 2003

18. Bennett MR, Hacker PMS: Philosophical Foundations of Neuro- science. Malden, MA: Blackwell Publishers, 2003

19. Takahashi Y, Hirasawa H, Koyama K, et al: Suicide in Japan: present state and future directions for prevention. Transcultur Psychiatry 35:271–89, 1998

20. Kirmayer LJ: Failures of imagination: the refugee’s narrative in psychiatry. Anthropol Med 10:167–85, 2001

21. Kirmayer LJ: Empathy and alterity in cultural psychiatry. Ethos, in press

22. Bruner J: Making Stories: Law, Literature, Life. New York: Farrar, Straus and Giroux, 2002

23. Geertz C: Local Knowledge. New York: Basic Books, 1983 24. Bilge S: La ‘différence culturelle’ et le traitement au pénal de la

violence à l’endroit des femmes minoritaires: quelques exemples canadiens. Int J Victimol 3, 2005. Available at http://www.jidv. com/BILGE-S-JIDV2005_10.htm. Accessed January 2, 2007

25. Appiah A: The Ethics of Identity. Princeton, NJ: Princeton Uni- versity Press, 2005

26. Eriksen TH: Between universalism and relativism: a critique of the UNESCO concept of culture, in Culture and Rights: Anthro- pological Perspectives. Edited by Cowan JK, Dembour M-B, Wil- son RA. Cambridge, UK: Cambridge University Press, 2001, pp 127–48

27. Wexler BE: Brain and Culture: Neurobiology, Ideology, and So- cial Change. Cambridge, MA: MIT Press, 2006

28. Kirmayer LJ: Beyond the ‘new cross-cultural psychiatry’: cultural biology, discursive psychology and the ironies of globalization. Transcult Psychiatry 43:126–44, 2006

Culture in Forensic Psychiatry

102 The Journal of the American Academy of Psychiatry and the Law

,

FOCUS ON ETHICS

Jeffrey E. Barnett, Editor

Ethics and Multiculturalism: Advancing Cultural and Clinical Responsiveness

Miguel E. Gallardo Pepperdine University

Josephine Johnson Livonia, Michigan

Thomas A. Parham University of California, Irvine

Jean A. Carter Washington, D.C.

The provision of ethical and responsive treatment to clients of diverse cultural backgrounds is expected of all practicing psychologists. While this is mandated by the American Psychological Association’s ethics code and is widely agreed upon as a laudable goal, achieving this mandate is often more challenging than it may seem. Integrating culturally responsive practices with more traditional models of psychotherapy into every practitioner’s repertoire is of paramount importance when considering the rapidly diversifying population we serve. Psychologists are challenged to reconsider their conceptualizations of culture and of culturally responsive practice, to grapple with inherent conflicts in traditional training models that may promote treatments that are not culturally responsive, and to consider the ethical implications of their current practices. Invited expert commentaries address how conflicts may arise between efforts to meet ethical standards and being culturally responsive, how the application of outdated theoretical constructs may result in harm to diverse clients, and how we must develop more culturally responsive views of client needs, of boundaries and multiple relationships, and of treatment interventions. This article provides addi- tional considerations for practicing psychologists as they attempt to navigate dimensions of culture and culturally responsive practice in psychology, while negotiating the ethical challenges presented in practice.

Keywords: ethics, multicultural, psychotherapy, culture, cultural competency

MIGUEL E. GALLARDO received his PsyD in clinical psychology from the California School of Professional Psychology, Los Angeles. He is associate professor of psychology at Pepperdine University Graduate School of Education and Psychology and maintains a part-time independent and consultation practice. His areas of research and practice include culturally responsive practices with Latinos and multicultural and social justice issues. He co-edited the book Intersections of Multiple Identities: A Case- book of Evidence-Based Practice with Diverse Populations in 2009. JOSEPHINE JOHNSON received her PhD in clinical psychology from the University of Detroit. She has a full-time independent practice in Livonia, Michigan; is a consultant to community mental health and residential treatment facilities; and provides clinical supervision. Her professional interests include cultural competency and business-of-practice issues. She chaired the American Psychological Association Task Force on the Imple- mentation of the Multicultural Guidelines. THOMAS A. PARHAM received his PhD in counseling psychology at South- ern Illinois University at Carbondale. He is Assistant Vice Chancellor for

Counseling and Health Services, as well as an adjunct faculty member, at the University of California, Irvine. His areas of research and practice include psychological nigrescence and racial identity development. He has been the author or co-author of four books on African-centered psychol- ogy. His most recent book, entitled Counseling Persons of African Descent, was published in 2002. JEAN A. CARTER received her PhD in counseling psychology from the University of Maryland. She maintains a full-time independent practice in Washington, D.C., serves as adjunct faculty at the University of Maryland, College Park, and is a 2009 –2011 member of the American Psychological Association Board of Directors. Her interests include professional practice issues, professional development, and ethical di- lemmas. CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Miguel E. Gallardo, Pepperdine University, Graduate School of Psy- chology, 18111 Von Karman Avenue, Suite 209, Irvine, CA 92612. E-mail: [email protected]

Professional Psychology: Research and Practice, 2009, Vol. 40, No. 5, 425–435 © 2009 American Psychological Association 0735-7028/09/$12.00 DOI: 10.1037/a0016871

425

Th is

d oc

um en

t i s c

op yr

ig ht

ed b

y th

e A

m er

ic an

P sy

ch ol

og ic

al A

ss oc

ia tio

n or

o ne

o f i

ts a

lli ed

p ub

lis he

rs .

Th is

a rti

cl e

is in

te nd

ed so

le ly

fo r t

he p

er so

na l u

se o

f t he

in di

vi du

al u

se r a

nd is

n ot

to b

e di

ss em

in at

ed b

ro ad

ly .

Ethics and Multiculturalism: Where the Rubber Hits the Road

By Miguel E. Gallardo

The first step in the evolution of ethics is a sense of solidarity with other human beings.—Albert Schweitzer

The delivery of ethical and culturally consistent therapeutic approaches has continued to challenge practitioners today because of demographic changes throughout the country, professional man- dates, and the complex manner in which culture is understood and manifested therapeutically. In addition, applied psychology is still challenged in adequately translating our theories and discourse around multicultural issues into practice. Another systematic chal- lenge in the profession is the lack of ethnic and racial students in the pipeline and psychologists in the field. There remains a


hawkessays.com Plagiarism Free Papers

Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we\’ll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.

Why Hire hawkessays.com writers to do your paper?

Quality- We are experienced and have access to ample research materials.

We write plagiarism Free Content

Confidential- We never share or sell your personal information to third parties.

Support-Chat with us today! We are always waiting to answer all your questions.




Source link

Needs help with similar assignment?

We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paper

Get Answer Over WhatsApp Order Paper Now

Respond to at least two of your peers by commenting on similarities and differences between your research experiences or by offering an answer to their questions or conc

/in /by


Respond to at least two of your peers by commenting on similarities and differences between your research experiences or by offering an answer to their questions or concerns

Respond to at least two of your peers by commenting on similarities and differences between your research experiences or by offering an answer to their questions or concerns.

ASHANTI

Research Topic

The topic I am choosing to research is homelessness. However, I have not yet narrowed down what the focus area will be when researching. As of now, I have been currently focusing on homelessness and mental health. I am leaning towards mental health the most as a focus, however upon doing research on this population, I am learning mental health issues are just one of this population’s concerns and that there are many more issues that they are facing. Yet as of now, I am researching homelessness and mental health.

What Went Well

My library search went well. The population of those struggling with homelessness has increased over the last few years so there is more and more research available. However, the difficult part is the fact there is so much more research so it makes it difficult to pick a specific area to focus on. For example, there is so much research on homelessness and the impacts of covid. Though my main focus has been homelessness and mental health, the mental health piece has a lot of research collaborating with covid and how it affected this particular population. Overall, when it came to finding information from the library search, I was able to find a plethora of research, the challenging part was narrowing down all the research that was provided to be able to have a clear direction for my own research.

Research Strategy

The research strategy I used was learned from my last quarter’s classes. Using Walden’s Library was strongly emphasized when doing research, and if it was not used as a main tool it should definitely be where we start. So since learning that, I have always started at the Walden Library to do research. Learning to use this tool has truly been a go-to for me, it helps me formulate an idea of what I want to focus on. One of my favorite aspects of this tool is having the ability to use more than one keyword during a search. Now one may say, that is your favorite part?, but let me explain. When beginning research it can be difficult to figure out what I need to look up, but if I know what my topic is, homelessness, then coming up with one keyword to get my library search started can make all the difference. For example, when I do not have the words to formulate “The impacts on homelessness from Covid-19”, I can type homelessness in one search box and type covid in the next box, or mental health or any word that I feel can help start my research with this specific population. This may be something so minuscule to someone else, but it is the simple things that can take us a long way.


hawkessays.com Plagiarism Free Papers

Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we\’ll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.

Why Hire hawkessays.com writers to do your paper?

Quality- We are experienced and have access to ample research materials.

We write plagiarism Free Content

Confidential- We never share or sell your personal information to third parties.

Support-Chat with us today! We are always waiting to answer all your questions.




Source link

Needs help with similar assignment?

We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paper

Get Answer Over WhatsApp Order Paper Now

Personal Narrative? on? Jazlyn Gonzalez? South Florida Native 12 grade wants to persue anesthetic career? Loves fashion working out and traveling current in a relationsh

/in /by


400-500 work Personal Narrative 

on 

Jazlyn Gonzalez 

South Florida Native 12 grade wants to persue anesthetic career 

Loves fashion working out and traveling current in a relationship 

Would love to build a career in anesthetic to help people feel good about themselves 


hawkessays.com Plagiarism Free Papers

Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we\’ll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.

Why Hire hawkessays.com writers to do your paper?

Quality- We are experienced and have access to ample research materials.

We write plagiarism Free Content

Confidential- We never share or sell your personal information to third parties.

Support-Chat with us today! We are always waiting to answer all your questions.




Source link

Needs help with similar assignment?

We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paper

Get Answer Over WhatsApp Order Paper Now