Pharma Purdue and the Opioid Crisis

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The first step of our decision making model is to determine all the facts in the case being studied and judged. This paper will dive into the issue currently at hand with Purdue Pharma, a privately held drug company and their lawsuit with the state of Oklahoma, which was taken to court in March of this year, among many others. Purdue Pharma is known for their most famous product, OxyContin, which is a prescription painkiller. Purdue Pharma was founded in 1892 by doctors John Purdue Gray and and George Frederick Bingham. It was in 1952 that the company was sold to brothers Raymond and Mortimer Sackler, whose descendants are owners of said company to this day (Wikipedia). Purdue Pharma is renowned as being the pioneer in developing medication to reduce pain, something we know today to be simple painkillers we can pick up at a convenience. In 1995, Purdue Pharma’s most popular and groundbreaking drug OxyContin was released to the world. With this came a push for the company to have doctors aggressively praise the pill as being a safe choice to take on a 12 hour cycle. This marketing tactic worked as the people were convinced the drug was safe to consume frequently and allowed this to become one of Purdue Pharma’s biggest products. Unfortunately, the business’ choice to aggressively market the product as safe would hurt the general public due to a highly addictive and dangerous ingredient: oxycodone.

OxyContin contains oxycodone as its only active ingredient. When released in 1995, it was lauded as being a “breakthrough, long lasting narcotic” that would help patients dealing with an intense pain (Keefe). The drug was a huge market success for the company making well over thirty five billion dollars in revenue. However, oxycodone is a dangerous additive to be using as it is similar in chemical structure to “heroin, which is up to twice as powerful as morphine” (Keefe). Many doctors are averse to prescribing opioids likes these as they are highly addictive. To counter this precedent, Purdue Pharma hired out doctors and paid for research in an attempt to convince the public that the opioid crisis was no more than a myth and that their drug would be able to treat them for many conditions. With this marketing pushed on the public, millions of people to date have purchased OxyContin believing it to be a safe choice to treat their conditions.

See also:

Challenges and Developments of the Opiod Epidemic

From 1999 onwards, there have been over 200,000 deaths attributed to overdoses involving OxyContin. In fact, in 2017 there were 74,000 deaths caused by drug overdose with 40,000 of them being caused by opioids. It should also be noted that those who get hooked to opioids are likely to find themselves taking solace in other drugs including heroin. Today, multiple states have taken action against Purdue Pharma for their false marketing and downplaying of the addictive nature of OxyContin. Nearly 1,600 lawsuits have been filed against the company and Oklahoma is one of the first to be taken to court in March of 2019. Attorney General Mike Hunter filed in June of 2017 alleging that Purdue helped to ignite the opioid crisis (Bebinger). He sought 20 billion dollars in damages to the state. Although this case ended with Purdue Pharma paying 270 million to the state for funds of research and treatment in the state, they are still selling the harmful drug.

The second step of the decision making model is to determine the dimensions of right and wrong concerning those involved. First, we should ask whether it was right or wrong for Purdue Pharma to market their product as being a safe and non addictive product when they clearly knew it wasn’t. We have to decide whether this was an immoral action or not. Another dimension we should delve into is if it was justifiable for Mike Hunter to claim Purdue Pharma was at an entire fault for the opioid crisis within Oklahoma. We should consider that there may be factors outside of just this drug that caused it. Finally, we should consider the ethics of the doctors who were paid off by Purdue Pharma and if it was moral for them to take pay in exchange for not considering their patients’ health. We must look at what may be right or wrong within cases in order to assess biases properly.

For the third step of the decision making model, we must assess every stakeholder.


Stakeholder


Their Stake in the Case

General Attorney Mike Hunter

They would like to see justice brought to the people of Oklahoma. With reparations from the company, they could work on rebuilding and nursing the people affected by this crisis.

Purdue Pharma

They would like to continue marketing and selling OxyContin. Without this drug, their company would assuredly go under with all the bad press and their other products might fail to come off shelves.

Consumers/Patients

They are now aware of the harm being brought by these drugs and would like to see alternatives. It isn’t right for them to not have known what was going on with their drugs being given to them.

Workers of Purdue Pharma

They would like to continue working. They have their own lives to attend to and need a salary to fund it.

Opioid Addicts

They are the ones hurt the most by this crisis. The reparations that would be paid out should go to these people as they try to build their lives once more and research will let them know action is being taken to prevent and treat this awful addiction.

Family of Opioid Addicts (alive or deceased)

They would like to see justice brought for their family members who have fallen victim to addiction. For those deceased, they should receive some compensation in some form and want to see the crisis being handled to prevent others from hurting in the same way.

Doctors

They want to supply their patients with the best medication for their health and having not to sell OxyContin would of course aid in this. It would alleviate the guilt of selling a harmful product in some sense as well.

In this step, it is important to also assess my own bias. I have not been affected by the opioid crisis in anyway as my family nor I have been addicted to any kind of painkiller or drug.

In the fourth step of our decision making model, we must delineate and create alternative courses of action. These solutions should be feasible ways to solve our case. The first possible solution/outcome is that Purdue Pharma chooses not to comply in any way and continues the same practices with OxyContin. This would mean they continue to pay off doctors and push their marketing scheme. Another possible solution/outcome is that Purdue Pharma is forced to openly admit on their products that it can be addictive and that consumers should be cautious. This means each product will be labeled accordingly to their level of potential danger. Finally, Purdue Pharma could continue to sell their product but not be allowed to persuade doctors with monetary gain to promote the product. This means doctors will no longer be forced to tell customers that the product is safe when they are aware it isn’t.

In the fifth step of our decision making model, we must assess how the stakeholders would respond to each alternative presented.


Stakeholder


Responses

General Attorney Mike Hunter

Act 1: Without any action taken, the crisis will simply worsen overtime and Hunter will not be able to combat for the sake of Oklahoma.

Act 2: They will be okay with this situation as now the public will likely take note of their products and Hunter can focus on helping those already affected instead of prevention.

Act 3: Same as Act 2 as doctors now prevent people from getting a hold of the drugs and misusing it. Hunter will be able to take funds and funnel it into research to aiding patients who have already succumb to addiction.

Purdue Pharma

Act 1: They continue to sell their products without interference. They are able to have doctors vouch for their product as they pay them off.

Act 2: They are forced to label their products. Most likely their products will take a dip in purchase as people are put off from purchasing it, meaning their revenue falls.

Act 3: Without doctor push, people are less likely than before to use OxyContin for pain relief meaning again their revenue would drop.

Consumers/Patients

Act 1: They would still be receiving products that are harmful to them and addictive. This would be good in the short term for pain but long term leads to a longer opioid crisis.

Act 2: With labeled products, consumers are able to make an educated decision on whether or not they’d like to purchase this supposedly addictive product. Informed consumer is best!

Act 3: Patients will no longer be persuaded by doctors to consume this product. Less people will fall victim to the facade and be able to avoid becoming addicted.

Workers of Purdue Pharma

Act 1: They will continue to work in the same way as the revenue of the company is not hurt so they can continue to fund workers.

Act 2 and 3: These outcomes are roughly the same. With a decrease in revenue for the company, it is likely they will need to lay off workers to circumvent the loss.

Opioid Addicts

Act 1: They can continue to consume the opioids without warning or awareness from others. This will prolong the crisis.

Act 2: With warning labels, people are more likely to become educated on their addiction and attempt to seek help.

Act 3: Doctors will likely take more action to recognize those who abused opioids and give them alternatives and the aid they need to get over it rather than allow them to have it.

Family of Opioid Addicts (alive or deceased)

Act 1: No justice is served to their family member was a victim of the crisis.

Act 2 and 3: Justice is brought for the family as they see other people are kept from falling victim to the crisis as a result of labeling and doctors no longer vouching for the drug.

Doctors

Act 1: They continue their practice of accepting pay from Purdue Pharma and push the harmful drug on people.

Act 2: They are unaffected by this mostly as people on their own become aware of the harm of the drugs.

Act 3: They no longer receive pay but are able to instruct people on the dangers of the drug. Removes guilt and allows them to put the life of the patient as the main priority.

The sixth step of the decision making model is to seek guidance. In doing so, we are able to assess our solutions and possibly create more for our case. In this case, we have a company choosing to hide the addictive nature of a product from their consumers through heavy marketing. I would first inquire researchers of the active drug, oxycodone. I would like to see them publicly explain, to myself as well, how harmful this makes OxyContin to consume on a regular day to day basis. They can confirm public destress over the product and show how Purdue Pharma has had a large hand in the opioid crisis plaguing states all over the country, namely Oklahoma. I would also ask doctors who have treated opioid addicts and ask them how effective labeling of products is in preventing abuse further was. I would like to see how much of an impact treatment can make for victims as well as how labels caution people from using the drugs. This will allow me to confirm my decision in this case and decide whether or not Purdue Pharma should follow through.

The final step in the decision making model is to make a decision and then ultimately decide whether the accused have been ethical. In this case, I have found Purdue Pharma to be truly unethical in their choice to market the product OxyContin as a nonaddictive drug. Their immoral decision has lead to a large opioid crisis in the state of Oklahoma as well as plenty of others and has cost many their lives. I would like to see alternatives 2 and 3 brought to fruition where Purdue Pharma can no longer pay off doctors to promote their product and they must label their products as containing highly addictive ingredients. With this choice of using both solutions, we should be able to prevent the continuation of the opioid crisis with and funnel more care into researching ways to help those already affected. The consumer has a right to be informed of the harm in what they are consuming and that is what this mix of solutions strives for. With this, Purdue Pharma will be doing what they should have done from the start which was ensuring the safety of any and all customers.


Works Cited

  • Bebinger, Martha. “Purdue Pharma Agrees To $270 Million Opioid Settlement With Oklahoma.”

    NPR

    , NPR, 26 Mar. 2019, www.npr.org/sections/health-shots/2019/03/26/706848006/purdue-pharma-agrees-to-270-million-opioid-settlement-with-oklahoma.
  • Bernstein, Lenny. “Oklahoma Judge Refuses to Delay First Trial of Responsibility for Opioid Crisis.”

    The Washington Post

    , WP Company, 8 Mar. 2019, www.washingtonpost.com/national/health-science/oklahoma-judge-refuses-to-delay-first-trial-of-responsibility-for-opioid-crisis/2019/03/08/0fa2de04-41e4-11e9-a0d3-1210e58a94cf_story.html?utm_term=.26c71f3e571f.
  • Keefe, Patrick Radden. “The Family That Built an Empire of Pain.”

    The New Yorker

    , The New Yorker, 28 Feb. 2019, www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain.
  • “Purdue Pharma.”

    Wikipedia

    , Wikimedia Foundation, 22 May 2019, en.wikipedia.org/wiki/Purdue_Pharma.
  • Scholl, Lawrence. “Drug and Opioid-Involved Overdose Deaths – United States, 2013–2017 | MMWR.”

    Centers for Disease Control and Prevention

    , Centers for Disease Control and Prevention, 4 Jan. 2019, www.cdc.gov/mmwr/volumes/67/wr/mm675152e1.htm.

The Need And Importance Of Utilizing Nursing Research Finding Nursing Essay

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Introduction

Every year, researches are conducted in institutions and the findings are then disseminated through various publications. However, such information is often not utilized, and instead ends up being stored in the journals, drawers or even in the books found in the library, thus not accomplishing the main purpose for which the research was intended. Cavanagh & Tross (2006) indicated that research utilization encourages activities from being innovative to being practical. It is considered important in promoting education, in that, those in educational practices can grow in complexity while their educators become accountable for the learning process.

Cavanagh & Tross (2006) have suggested that, while nursing as a profession is concerned with applying knowledge to serve people, the challenge faced by the nursing students is using the research methods and knowledge effectively, i.e. in a meaningful way. Utilization of research findings in nursing is successful when the students are in a position to modify their practice in response to the new knowledge impacted on them. According to Parahoo & Mc Caughan (2001), utilization of nursing research findings enables the teacher or the one mentoring the students be in able to prepare and mentor their students effectively.

It also aids the nursing students to be in a position to share their experiences with others who have undergone the same encounters therefore getting a practical solution to their questions. Nursing research findings helps the nursing students in getting help where they feel that the management has neglected them, in not providing them with adequate information. Cavanagh & Tross (2006) stressed that most nursing students undergo hard times while in the trainings, but they fear expressing themselves for fear of being secluded as being lazy or not ready to train; therefore students using research findings (even if done by others) are able to learn by themselves.

Cavanagh & Tross (2006) supports the notion that the research utilization enables the educators to be in a better position to offer quality services to the patients under their care. Utilization enables them to effectively put nursing research findings into practice and therefore, use the knowledge and innovations realized while in the study to handle the patients. Parahoo & Mc Caughan (2001) also indicated that the utilizations reassure the researchers that they are not the only ones to encounter the complexity of conducting researches. They are therefore in a position to use what others have already done on the topic and advance on the findings to arrive at a more practical solution that is beneficial to both nursing student and the patients.

According to Parahoo & Mc Caughan (2001), the health ministries, are aiming to transform findings into a form that is practical to the environment. By doing this, they are likely to build up mechanisms that will evaluate, analyze and make sure that research findings and products are practically utilized. Dissemination of the research findings are usually aimed at three categories, which includes the public health workers and those in the management, policy or decision makers and lastly those working in the clinic (clinic staff). Utilization of research findings is enhanced when those meant to use those findings are in a position to consider which findings are to be disseminated, when and how. Such users should consider the characteristics, interest and enough knowledge for which the research targeted and lastly be in a position to use sound and sustainable findings that will ensure incorporation into practice.

Parahoo & Mc Caughan (2001) insisted that application of research findings should be taken seriously, just like conducting the research itself. He explained that research is incomplete unless the findings are synthesized and applied into practical situations. He further argued that medical research councils, WHO, national center for expertise and professional bodies should work together to enhance the attainment of the goal intended by the research itself. They should ensure that all the researches that are carried out, are analyzed, synthesized and effectively applied in the health ministries and clinics.

According to Parahoo (2000), the spread of scientific knowledge is influenced by socioeconomic, environmental, educational, political and cultural differences amongst those conducting the research. He discovered that application of research work is determined by the attitude of health programmers towards the utilization of research findings and research based knowledge. He suggested that the health practitioners may not be in a position to apply research findings because of reasons such as; they do not understand them, they do not know much about them, they do not know how to apply them, they are not allowed to use them or they do not believe in them (p.95).

Barriers to utilizing research findings have been intensively studied by many researchers and the possible measures to enhance application proposed. Some of the barriers to utilizing research findings discovered included;

Lack of skills and awareness or isolation from knowledgeable individuals with whom to share and discuss the ideas.

Lack of skills to evaluate research quality,

Unwillingness to try out new ideas

Secondly, it was found out that some administrative issues arose when trying to implement new ideas and bringing about changes in the methods related to research findings. According to Kajermo et al (2008), insufficient authority, insufficient time allocated to analyzing and synthesizing research findings, inadequate support facilities to support this, absence of opportunities to conduct discussions pertaining to research findings and lack of support from professionals working in the health organizations were also identified to be factors resulting to infrequent application to research findings. Parahoo (2000) also noted further that low qualities of research methods also hindered the application of research. This was observed in the methodological inadequacies, conflicting readings and translation of research literatures, differences in results justification and poorly drawn conclusions from the study conducted.

As noted by Kajermo et al (2008), many early studies indicated that the initial nursing trainings did not focus on clinical problems and this made the application of knowledge to patients hard for the nurses. To overcome this barrier, many researchers focused on ways that could be used to improve the quality and quantity of clinical research studies by first improving on the results obtained and making the findings more applicable in practice. Another barrier that existed in the profession was that, most of the nursing studies had not been replicated. This is where two or more studies focused on the same problem but there was no sound research finding that could be used in the various research settings. This problem meant that the studies needed to be replicated in different settings so that it would fit with any target population.

According to Funk et al (2005), many measures have today been undertaken by those in the management positions at healthcare ministries to ensure that the application of research findings is effectively carried out by the nurses. One of the measures included replicating more of the research studies by presenting the researches at research conferences and publishing the researches in journals and other clinical books in time, to avoid delays in publication. This measure was supported by the national institute of nursing research (NINR), which started and still funds the replication research projects.

Another measure which was taken was to break the communication barrier that existed between the students and their educators. Application of research results became difficult because the researchers communicated their findings using words that were so difficult for the nursing students to understand and apply in their course work (Kajermo et al 2008). Some of the reports written by the researchers did not indicate how the findings from the studies were useful to the nursing practice and application by the student nurses. Kajermo et al (2008) reports that, to overcome the communication barrier between the students and the researchers, special clinical journals have been published for nurses in practice. Such journals were developed to bring the major points in a manner that could be easily understood by the nursing students in practice. The researchers were also advised to work hand in hand with the decision makers so that a link could be established which absorbs their requirements while analyzing the results.

Kajermo et al (2008) recommended that, countries should be in a position to establish advisory committees which will focus on putting research results into practice. They noted that the decision makers were too busy to get involved in the research planning process, and so most of them overlooked the need of considering research findings in their decision making process. Other measures included conducing high quality proposals, maintaining support through the research process, developing specific funding criteria to be used when conducting a research and putting more emphasis on the aspect of application in the nursing practice, using easy and understandable research designs and avoiding the use of complicated research statistical techniques, and lastly empowering the staff on the need to prioritize research work. It is therefore conclusively the responsibility of the health managers to ensure that their nursing students get an easy way to use and apply their research findings well.

A potential entrepreneur is trying to decide whether to open a new health spa.she presently makes $3 Show more.

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A potential entrepreneur is trying to decide whether to open a new health spa.she presently makes $3 Show more.

A potential entrepreneur is trying to decide whether to open a new health spa.she presently makes $35000 per year as an aerobics instructor and will have to give up this job if she opens the new health spa.if she chooses to open the spait will cost her $200000 per year in rent and other operating expenses. a. what are her accounting cost? b. what are her opportunity costs? c. how much would she need to make in revenues to earn positive accounting profits? positive economic profits? Show less

GROUPS DYNAMICS IN HEALTHCARE

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GROUPS DYNAMICS IN HEALTHCARE

The dynamic and increasingly complex world of health care often requires nurses to work collaboratively on interprofessional teams. In the group environment, individuals with unique skills and expertise come together to focus on a common goal; however, groups must become cohesive before they can become effective.

Your experiences working with groups—whether you perceive them as positive, negative, or neutral—can be used to facilitate insight and development. Health care, with its focus on interprofessional teamwork and collaboration, offers ample opportunities and an imperative for continuous learning.

For this Discussion, you focus on strategies for facilitating the group process.

To prepare:
•Review the information in this week’s Learning Resources regarding the stages of group formation, problematic roles individuals play in groups, and strategies for facilitating and maintaining positive group collaboration. In particular, review Learning Exercise 19.12 on page 464 of the course text.
•Reflect on various groups with which you have been or are currently involved. Select one specific group to analyze for the purposes of this Discussion. Identify the purpose or task that the group is or was meant to perform.
•Consider the four stages of group formation (forming, storming, norming, and performing). How would you describe the progression between stages? Is there a stage in which you believe your group is or was “stuck”?
•Consider the task or group-building role you normally play in a group setting. How could you apply the information from the Learning Resources to improve your group participation and facilitation, as well as the functioning of the group as a whole?
•In addition, think about which individuals within your group (including yourself) may fall into problematic roles such as the Dominator, the Aggressor, or the Blocker. How have you and your group members addressed the enactment of these roles and its impact on interactions? With information from the Learning Resources in mind, what strategies would you apply now or going forward?

On the Week 5 Discussion Board, post on or before Day 3 a description of a group with which you have been or are currently involved. Assess where the group is in terms of the four stages of group formation. If you are reflecting on a past experience, explain if your group moved through all four stages. Describe the task or group-building role you typically play, or played, in this group. Then, explain what strategies you, as a leader, can apply to better facilitate the group process and address any problematic individual roles in the group.

Required Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Readings
•Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins. ◦Chapter 19 “Organizational, Interpersonal, and Group Communication”

Chapter 19 covers many aspects of the communication process, including group communication. As you read this chapter, focus on the stages of group development (forming, storming, norming, performing) and group dynamics (group task roles, group building and maintenance roles, problematic roles). Consider how you can apply these concepts as you engage in group work.

•Adams, S. L., & Anantatmula, V. (2010). Social and behavioral influences on team process. Project Management Journal, 41(4), 89–98.
Retrieved from the Walden Library databases.

In this article, the authors report on the effects of individual behaviors on project teams and provide a model that identifies the progress of social and behavioral development. For each stage, the authors provide recommendations for managing team members.
•Chun, J. S., & Choi, J. N. (2014). Members’ needs, intragroup conflict, and group performance. The Journal Of Applied Psychology, 99(3), 437-450. doi:10.1037/a0036363

This study theorizes and empirically investigates the relationships among the psychological needs of group members, intragroup conflict, and group performance.
•Haynes, J., & Strickler, J. (2014). TeamSTEPPS makes strides for better communication. Nursing, 44(1), 62-63. doi:10.1097/01.NURSE.0000438725.66087.89

Teamwork and communication are the focus of this article and include the use of the TeamStepps model for Quality Improvement.
•Hogg, M. A., Van Knippenberg, D., & Rast, D. E., III. (2012). Intergroup leadership in organizations: Leading across group and organizational boundaries. Academy of Management Review, 37(2), 232–255.
Retrieved from the Walden Library databases.

The authors of this article introduce a theory on intergroup leadership that is based on social theory and intergroup relations. This theory purports that intergroup performance relies on a leader’s capacity to create intergroup relational identities.
•Kaufman, B. (2012). Anatomy of dysfunctional working relationships. Business Strategy Series, 13(2), 102–106.
Retrieved from the Walden Library databases.

Kaufman examines the impact of dysfunctional working relationships in an organization. She provides managers with tips that will allow them to identify early warning signs of dysfunctional behavior and to minimize its effects in the workplace.
•Mind Tools. (2012). Forming, storming, norming and performing: Helping new teams perform effectively, quickly. Retrieved from https://www.mindtools.com/pages/article/newLDR_86.htm

This web article discusses stages of team development and provides strategies for moving through the early stages effectively.
•Mind Tools. (2009). Team charters. Retrieved fromhttps://www.mindtools.com/pages/article/newTMM_95.htm

This web page features helpful information about team charters. Before you begin work on the Week 7 Assignment, you may find it helpful to create a charter that can guide your group’s work together.
•Ortega, A., Sánchez-Manzanares, M., Gil, F., & Rico, R. (2013). Enhancing team learning in nursing teams through beliefs about interpersonal context. Journal Of Advanced Nursing, 69(1), 102-111. doi:10.1111/j.1365-2648.2012.05996.x

This article examines the relationship between team-level learning and performance in nursing teams, and the role of beliefs about the interpersonal context in this relationship.

•Table Group. (n.d.). Retrieved July 24, 2012, from https://www.tablegroup.com/

Patrick Lencioni is recognized worldwide for his work on teams. Under the Patrick Lencioni link, download and read articles related to addressing team dysfunctions.

Role of therapeutic relationship within mental health nursing

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Research is a significant component of the educational process and is essential for current and future professional nursing practice (Tingen, 2009). To describe what nursing research is, Tingen (2009) uses a definition by Polit and Beck (2006, p4) who describe it as a:

‘Systematic inquiry designed to develop knowledge about issues of importance to nurses, including nursing practice, nursing education and nursing administration.’

Without research, nurses would not be able to practice evidence based care, the importance of which is stated within the Code of Conduct (Nursing and Midwifery Council 2008). According to Haynes and Haines (1998) evidence based practice aims to integrate current best evidence from research with clinical policy and practice.

It is important to critically evaluate any research study to establish the significance and worth of each individual publication (Hek, 1996). For the purpose of this assignment I will use a universal critical appraisal tool that can be used to evaluate any type of research, which can be located in Appendix 1. It has been adapted and devised using appraisal tools from Hawker et al (2002) and the Critical Appraisal Skills Programme (CASP) (Public Health Resource Unit, 2007).

Background

I have chosen to review the topic of therapeutic relationships within the field of mental health nursing. I feel this is a vital component in the nursing role, and something every mental health nurse should be skilled in. Literature states that the therapeutic relationship is a central element of care through which many aspects of mental health nursing is carried out (Priebe and McCabe, 2006).

Search strategy

My question is ‘what role does the therapeutic relationship have within mental health nursing?’ I carried out my literature search using the Cinahl database. Although there are a variety of database choices, Cinahl produced ample results so other database searches were not required. Table 1 summarises my literature search results.

Table 1: literature search strategy

database name

key words/phrases used

database headings used

search limits (inclusions/exclusions)

no. results

Cinahl

(Search was conducted on 1st April 2011)

‘therapeutic relationship’ and ‘mental health’

None

Primary research

English language

Peer reviewed

64

‘Therapeutic relationship’ and ‘psychiatric’

None

Primary research

English language

Peer reviewed

68

I searched the terms ‘mental health’ and ‘psychiatric’ separately but in conjunction with the words ‘therapeutic relationship’ to ensure a more in-depth search as both terms are used interchangeably within literature. The three papers I have selected to review are Johansson and Eklund (2003), Scanlon (2006) and Forchuk et al. (2005). They were chosen so that both qualitative and quantitative research is included and that differing perspectives on the therapeutic relationship were researched. A summary of the relevant information from each article can be found in a critical appraisal grid in Appendix 2. Elements of the summary will be referred to in the following discussion.

Critical Review:

Research aims

Any research paper should make clear the purpose of the study being reported so that the reader can establish whether or not it is relevant to them (Couchman and Dawson, 1990). It is suggested that an abstract or summary is a good way to give a brief overview of the content of the paper (Couchman and Dawson, 1990). Greenhalgh (2010) recommends that the introductory sentence of a research paper should state the background to the research. All three highlighted papers clearly set out their aims and give background information as to the importance of their study and why it has been chosen. The Forchuk et al. (2005) study aims to replicate a successful pilot study conducted several years earlier, but seemingly on a larger scale.

Research approach/design

When assessing the methodological quality and approach of a paper Greenhalgh (2010) proposes five key questions. They are; was the study original, whom was it about, was it well designed, was systematic bias avoided and was it large enough and continued for long enough to make the results credible (Greenhalgh, 2010). Johansson and Eklund (2003) give good rationale for the research design using literature as evidence. Both authors are experienced in the field of psychiatry, but the first author conducted all interviews, which helped to maintain consistency and credibility.

Scanlon (2006) appears to have spent time designing her study, using established literature as well as her own experience to develop an interview guide which was piloted to ensure its suitability. The Forchuk et al. (2005) study describes a clear and concise research design using cluster randomisation. The study had a control group to compare to a group receiving the model used in the aforementioned pilot study.

Ethical issues

Any research involving human participants and animal materials or specimens is subject to ethical review, whether it is clinical, biomedical or social research, including the secondary use (Sheffield Hallam University, 2011). Literature regarding ethical considerations varies in the areas they discuss but in general, there are four main areas of ethical concern where the rights and dignity of the participant must be preserved, namely ensuring consent; prevention of harm; protecting confidentiality (Behi and Nolan, 1995; Marion, 2004); and that the research process provides more benefit than harm (Behi and Nolan, 1995).

The study by Johansson and Eklund (2003) was initiated by the ethics committee of the county council, so it is assumed they were recruited to complete the study, although no information is given other than the authors had no collaboration with either of the two settings used to recruit participants. Although written consent was sought it is not stated as to whether the participants understood the aims of the study. Both Scanlon (2006) and Forchuk et al. (2005) provide little information other than ethical principles being followed.

Sampling

For any study to take place, the subjects must be selected, and this is called sampling. The process used to select a group of people, events, behaviours or situations must ensure that the subjects are representative of the population being studied (Burns and Grove, 2007), or the research will not be credible. The population being studied will guide what process will be used to complete the sampling process (Burns and Grove, 2007). Johansson and Eklund (2003) give in-depth and referenced reasoning for their chosen sampling process. However their attempts at ensuring ‘maximum variation’ can be argued to have failed with only 9 participants recruited.

In contrast, little information is given by Scanlon (2006) as to her sampling process, but there is a clear inclusion criterion for the sample of six participants. The sampling process used by Forchuk et al. (2005) appears to be in-depth with attempts to reduce any potential limitations or barriers. A large sample size of 390 participants partook in the study, which was a year long. A dropout rate of 36% resulted in 249 completing the study.

Data collection

Burns and Grove (2007) define data collection as ‘the precise, systematic gathering of information relevant to the research purpose or the specific objectives, questions, or hypotheses of a study.’ The choice of data collecting technique used will be determined by the type and purpose of the study being conducted (Burns and Grove, 2007). The data collection method utilised in the Johansson and Eklund (2003) study was an open-ended in-depth interview with a clear focus. The interview was hand written during discussion with no other recording equipment used. They themselves admit that this can introduce bias and the potential for data to be missed using this process. To maintain consistency the interviewer was the same person for all interviews, but the person transcribing is not stated.

Other than developing a piloted interview guide, Scanlon (2006) does not give detail about the data collection technique, other than semi-structured interviews being conducted. The interview guide is attached as an appendix. Data collection methods in the Forchuk et al. (2005) study would appear to be very thorough involving 5 tools, 3 of which were designed solely for this research.

Data analysis

After the data is collated, the research will be of no use to anyone if it is not analysed as it will have no meaning or explanation (McMichael, 2007). Analysis transforms the data collected into new knowledge (Thorne, 2000) and with its primary purpose being to impose some order to data so that conclusions can be made and communicated (Massey, 1995). The analysis process in the Johansson and Eklund (2003) study would appear to be very thorough. However the interviewer was one of the researchers categorising, so the transcripts were known and analysis may have been affected. Scanlon’s (2006) research provides a good example of thorough data analysis, using a recognised coding procedure comprising of three sets of coding. In contrast Forchuk et al. (2005) give little information regarding their data analysis providing only one small paragraph explaining how t-tests were used to test hypothesis.

Findings

The findings or results of any study should be presented in a way that advises the reader of any significant outcomes (Burns and Grove, 2007). It is suggested that tables and discussion are separate to as to avoid confusion (Couchman and Dawson, 1990). Johansson and Eklund (2003) give a good example of separating the ways in which the data is presented, with an in-depth discussion about each category. Sub categories were created to provide further clarity and quotes from interview are used to emphasise points. However the table gives little information other than the headings for each category and brings little value to the report.

Scanlon (2006) uses an in-depth discussion to relay her findings, with quotes from participants supporting literature on the topic area. The study’s aims have clearly been achieved. Considering the extent of data collected, the findings are surprisingly sparse in the Forchuk et al. (2005) paper. Baseline data is presented in a table, but little information is available as the findings did not support the hypothesis.

Generalisability/transferability

Generalisability refers to the extent to which research findings are valid and relevant to other settings (Pibouleau, 2009) and how useful they are (Altman and Bland, 1998). Pibouleau (2009) explains how poor reporting of generalisability can be a barrier to research findings being introduced to clinical practice. If findings are not generalisable then they will not be suitable to be implemented into clinical practice. The small scale of the study by Johansson and Eklund (2003) indicates that it is weak and that its generalisability is limited. They attempt to argue that due to having no contrasting findings that it gives rise to a certain degree of representativeness, but their conclusion contradicts this by stating there was some variation, the culprit being a patient with psychosis. Scanlon (2006) reports her study to not be generalisable due to its small scale. However, it does discuss how therapeutic relationships fit in with the role of psychiatric nursing, so the study can be argued to be transferable to the wider population. The Forchuk et al. (2005) study failed to meet its aims, so is not generalisable in any way. This is despite it being based on a successful pilot study conducted some years previously.

Implications for practice

The research by Johansson and Eklund (2003) offers very little implication for practice other than to offer issues that should be addressed in future similar studies. The study is flawed, and has limitations and contradictions within the discussion. Both authors have previous experience in research in the topic area which is evident in the referencing of their own work, so it raises concerns that these issues have not been addressed in previous work. In contrast Scanlon (2006) recognises all flaws in her study, and gives several recommendations for future research. The fact that the interview guide is included and the findings discussed in such depth allows the study to be replicated. Very little can be gained from the Forchuk et al. (2005) research with regards to enhancing practice, but recommendations are made for future study, almost as a token gesture. However, the paper does highlight factors to consider when planning the discharge process to ensure success, so cannot be completely dismissed.

Discussion

Considering the significance of therapeutic relationships within the field of mental health and the importance it plays within the role of the nurse, the analysis of the highlighted papers is disappointing. The Johansson and Eklund (2003) paper is flawed offering nothing significant for clinical practice. The Forchuk et al. (2005) study failed to meet its aims and as a result provided very little information other than the importance of providing support in the transition from hospital to community. Although very valid, this is does not compensate for the complete failure of the research which was based on a successful pilot. It can be argued that the only paper critiqued that can offer anything to clinical practice is that published by Scanlon (2006), but then her conclusions infer the opposite. Despite the fact that her study can easily be replicated and recommendations for future research are offered, she casts doubt by having a negative focus on her findings.

Conclusion

This critical review has little to offer to address my question, but the background research and literature reviews within the reviewed papers does offer a rich source of secondary information. Despite that none of the studies have generalisability; they do highlight issues that future researchers should be aware of. From this review it seems that a qualitative approach is best suited to a study in this topic area. It is recommended that the flaws and limitations highlighted in the above research designs are used to establish an effective method for evaluating the role of the therapeutic relationship in mental health nursing.

References

ALTMAN, D.G. and BLAND, J.M. (1998). Generalisation and extrapolation. [online]. British Medical Journal, 317 (7155), 409-410. Article from British Medical Journal last accessed 1 April 2011 at: http://www.bmj.com.lcproxy.shu.ac.uk/content/317/7155/409.full.pdf

BEHI, R. and NOLAN, M. (1995). Ethical issues in research. British Journal of Nursing, 4 (12), 712-716.

BURNS, N. and GROVE, S.K. (2007). Understanding Nursing Research: Building an evidence-based practice. 4th ed., China, Saunders Elsevier.

COUCHMAN, W. and DAWSON, J. (1990). Nursing and health-care research. London, Scutari Press.

FORCHUK, C. et al. (2005). Therapeutic relationships: from psychiatric hospital to community. [online]. Journal of Psychiatric and Mental Health Nursing, 12 (5), 556-564. Article from Ebscohost last accessed 1 April 2011 at: http://web.ebscohost.com.lcproxy.shu.ac.uk/ehost/pdfviewer/pdfviewer?sid=f3dd7acd-4bbe-4931-88aa-e5fbf505b948%40sessionmgr14&vid=2&hid=10

GREENHALGH, T. (2010). How to read a paper: The basics of evidence-based medicine. 4th ed., West Sussex, Wiley-Blackwell.

HAWKER, S. et al. (2002). Appraising the Evidence: Reviewing Disparate Data Systematically. [online]. Qualitative Health Research, 12 (9), 1284-1299. Article from Sage last accessed 1 April 2011 at: http://qhr.sagepub.com.lcproxy.shu.ac.uk/content/12/9/1284.full.pdf+html

HAYNES, B. and HAINES, A. (1998). Barriers and bridges to evidence based clinical practice. British Medical Journal, 317 (7153), 273-276.

HEK, G. (1996). Guidelines of conducting critical research evaluation. Nursing Standard, 11 (6), 40-43.

JOHANSSON, H. and EKLUND, M. (2003). Patients’ opinion on what constitutes good psychiatric care. [online]. Scandinavian Journal of Caring Sciences, 17 (4), 339-346. Article from Ebscohost last accessed 1 April 2011 at: http://web.ebscohost.com.lcproxy.shu.ac.uk/ehost/pdfviewer/pdfviewer?sid=c7e46787-eb49-4138-85ac-a8a551792d91%40sessionmgr11&vid=2&hid=10

MARION, R. (2004). Ethics in research. [online] Last accessed 1 April

2011 at: http://www.sahs.utmb.edu/pellinore/intro_to_research/wad/ethics.htm

MASSEY, V.H. (1995). Nursing research. Pennsylvania, Springhouse Corporation.

MCMICHAEL, C. (2007). Qualitative data analysis. [online]. Last accessed 2 April 2011 at: http://www.latrobe.edu.au/publichealth/Units/phe6/phe6hrb/Week%206%202007%20Analysis.pdf

NURSING and MIDWIFERY COUNCIL (2008). The Code in Full. [online]. Last accessed 1 April 2011 at: http://www.nmc-uk.org/Nurses-and-midwives/The-code/The-code-in-full/#standard

PIBOULEAU, L. (2009). Applicability and generalisability of published results of randomised controlled trials and non-randomised studies evaluating four orthopaedic procedures: methodological systematic review. [online]. British Medical Journal, 339 (b4538), 1-8. Article from British Medical Journal last accessed 1 April 2011 at: http://www.bmj.com/content/339/bmj.b4538.full

POLIT, D.F. and BECK, C.T. (2006). Essentials of nursing research: Methods, appraisal, and utilization. 6th ed., Philadelphia, Lippincott Williams and Wilkins.

PRIEBE, S. and MCCABE, R. (2006). The therapeutic relationship in psychiatric settings. [online]. Acta Psychiatrica Scandinavica, 113 (s429), 69-72. Article from Wiley last accessed 1 April 2011 at: http://onlinelibrary.wiley.com.lcproxy.shu.ac.uk/doi/10.1111/j.1600-0447.2005.00721.x/pdf

PUBLIC HEALTH RESOURCE UNIT (2007). Appraisal Tools. [Online]. Last accessed 1 April 2011 at: http://www.phru.nhs.uk/Pages/PHD/resources.htm

SCANLON, A. (2006). Psychiatric nurses perceptions of the constituents of the therapeutic relationship: a grounded theory study. [online]. Journal of Psychiatric and Mental Health Nursing, 13 (3), 319-329. Article from Ebscohost last accessed 1 April 2011 at: http://web.ebscohost.com.lcproxy.shu.ac.uk/ehost/pdfviewer/pdfviewer?sid=476f44a1-8cff-4a3c-a40f-c96bc336d3c3%40sessionmgr14&vid=2&hid=10

SHEFFIELD HALLAM UNIVERSITY (2011). Research ethics: 1. Research involving human participants. [online]. Last accessed 1 April 2011 at: http://students.shu.ac.uk/rightsrules/resethics1.html

THORNE, S. (2000). Data analysis in qualitative research. Evidence Based Nursing, 3 (3), 68-70.

TINGEN, M.S. et al. (2009). The importance of nursing research. Journal of Nursing Education, 48 (3) 167-170.

Appendix 1

A Universal Critical Appraisal Tool

Adapted from HAWKER, Sheila et al (2002) Appraising the Evidence: Reviewing Disparate Data Systematically. Qualitative Health Research, 12 (9), 1284-1299 and the Critical Appraisal Skills Programme (CASP) appraisal tools: http://www.phru.nhs.uk/Pages/PHD/CASP.htm

1: Research aims and research question: Is there a clear statement of aims and a research question?

Consider:

Is the goal of the research clearly stated?

Are reasons given for why the research is relevant or important?

2: Research approach/design: Is the approach appropriate and clearly explained?

Consider:

Is the research approach/design justified?

Is an explanation offered as to why it was chosen?

3: Ethics: have ethical issues been addressed and was necessary ethical approval obtained?

Consider:

Are issues of confidentiality, sensitivity and consent addressed?

Are research governance processes clearly described?

4: Sampling: Is the sampling strategy appropriate to address the research aims?

Consider:

Is how the participants were recruited, selected or allocated explained?

Are details provided (e.g. race, gender, age, context) of who was studied?

Is the sample size for the study justified?

5: Data collection: Are the methods of data collection appropriate and clearly explained?

Consider:

Is it clear how the data were collected and are the methods chosen justified?

6: Data analysis: Is the description of the data analysis sufficiently rigorous?

Consider:

Is there a clear description of how analysis was done –

Qualitative – Is there a description of how themes or concepts were derived?

Quantitative – Are reasons for the statistical tests selected described and statistical significance discussed?

7: Findings: Is there a clear description of the findings?

Consider:

Are findings explicit, easy to understand and in logical progression?

Are tables, if present, explained in the text?

Do results relate directly to the aims?

Are sufficient data presented to support the findings?

8: Transferability or generalisability: Are the findings of this study transferable, or generalisable to a wider population?

Consider:

Are the context and setting of the study described sufficiently to allow comparison with other contexts and settings?

Is there sufficient detail provided about the sample (as in section 4)?

9: Implications and usefulness: How important are these findings to policy and/or practice?

Consider:

Do the findings contribute something new and/or different in terms of understanding, insight or perspective?

Are ideas for further research suggested?

Are implications for policy and/or practice suggested?

The disruption(s) associated with the digital technologies what was the status quo for how that industry(or sub-topic) was organized as a business.

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The disruption(s) associated with the digital technologies what was the status quo for how that industry(or sub-topic) was organized as a business.

Subject Company Analysis

Topic you make choose

Type Essay

Level High School

Style APA

Sources 5

Language English(U.S.)

Description

You are to play the role of a business analyst and use the same industry that examined in your first assignment, “Through the lens”, for the project outlined below. You will conduct an analysis of that industry- or- a sub-industry/topic (for example, ‘digital currency’ can be considered a sub-topic of banking) which is focused on the technology disruptions in that industry and how that industry is adapting. You should endeavor to use the same firm as in your first assignment, however, if that is not possible then you should choose another- in some instances the firm you chose in the first assignment IS the disruptor. If you are unsure then please contact me for help.

Your analysis will address the following issues:

What is the subject (or sub-topic/industry);

Prior to the disruption(s) associated with the digital technolgies what was the status quo for how that industry(or sub-topic) was organized as a business;

What is the current state of that industry.

What are the disruptive technologies, why are they disruptive? –

how is that disruption measured?,

the impact(s) to existing businesses models and approaches to service or product delivery due to the disruptive technologies;

What has been impact on job growth/decline, profts, gross/net revenues, and whatever other metrics are necessary to understand and measure the impact;

Based-on all of the above:

What are the foreseable and likely medium and long-term impacts (2020-2025) to the industry; And finally,

Pick an existing firm that is negatively impacted by the disruption(s) you described. Briefly explain why that firm has been negatively impacted and what scale of that impact is. In other words “how bad/disruptive is it?”; finally,

Describe what would you advise the Board of Directors of that firm what to do in light of your analysis.

Regarding the technical matters of the paper itself

The analysis above should be no more than 1200 words.

Any footnotes or citations are not included as part of the word count.

Please don’t interpret this to mean that you are not required to include your in-text citations or properly identify your sources.

You must cite your evidence and therefore include a bilbliography. Unless you are a world-class expert in the subject matter you are analyzing then it is assumed that you did research- which must be cited appropriately, preferably APA.

It should be well-written and edited.

Please use the materials provided in the “Tips on Formal Writing” folder (in the Assignments area)

Use correct Template (hint its NOT template 1 or 3!)

Make sure you follow the best practices associated with the in-text citations and bibliography

In case it was not clear on the “Through the lens assignment” please note the following:

You may not use the “retail” industry to do your analysis

You may not use the “retail” industry to do your analysis

You may not use the “retail” industry to do your analysis

Spacing Double

Pages 3

Capsim simulation final company performance summary/ report

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I need help with Capsim Simulation Final Company Performance Summary/ Report

Prompt

Since you just finished the Capsim simulation, compiled your results, and are now looking to the future of your company, the first component of your capstone requires you to compose a company performance summary. Imagine that this summary is for new members of the topic of directors of your company. It is imperative that the topic understand your company, its value, and its development cycle over the last eight years. This is your opportunity to exhibit your knowledge of your organization, your products, and how your business functions.

High-level business executives are often short on time, so it is important that your summary is concisely written and rich in content. As has been emphasized in previous classes in the business core, effective business communication, peer-to-peer and peer-to-leader collaboration, and professional etiquette are mandatory skills to have when entering today’s business world. Because this is the last course in the business core, the second component of your capstone

requires you to reflect on your use of business communication skills, professional etiquette, and collaboration skills throughout the Capsim simulation, this course, and the previous courses you have taken in the business core.

Capstone Component 1: Executive Summary

For the first of two capstone components, you will develop a comprehensive, professional executive summary by analyzing quantitative and qualitative tools, analyzing strategic problem-solving skills, assessing any ethical, legal, or social challenges that may be encountered, analyzing global markets, and analyzing entrepreneurial approaches. This executive summary will be used to inform new members of the topic of directors who must become familiar with your company.

The following sections should be included:

I. Progress of the Company. You should briefly bring the new topic members up to speed about the progress of your company over the past eight years. While it is not important to describe every change, be sure to give an executive-level overview of the various products, strategies, and performances.

II. Current Situation. Here, discuss the current situation of your company by performing and analyzing a full SWOT analysis. a) Strengths: Identify the strengths of the organization.

b) Weaknesses: Identify the weaknesses of the organization.

c) Opportunities: Identify potential opportunities the organization should explore in order to expand.

d) Threats: Identify external factors that could negatively affect the organization.

III. Future of the Company. Consider the results of your SWOT analysis, and detail an approach you plan to take regarding your top priority at the company. Be sure to include any innovative or sustainable approaches in your plan.

IV. Ethical, Legal, and Social Challenges. Discuss any ethical, legal, or social challenges the company may have faced or could face in the future, and suggest strategies for how the company could overcome these challenges.

V. Global Considerations. In this section, discuss what necessary factors would need to be considered if the company were to expand into the global market. Consider the opportunities and threats outlined in the SWOT analysis previously in order to analyze the greatest advantages and disadvantages to expanding this company into the global market.

Capstone Component 2: Professional Reflection

For the second and final component of your capstone, you will compose a reflection in which you discuss the process and outcomes of this project, as well as how your coursework culminated in the capstone project. This may include discussions of unforeseen problems or obstacles, and any unexpected surprises. The reflection should also discuss your identified strengths and problems that you encountered while completing the capstone. Finally, the reflection will examine how the capstone project will be useful in the job market or in furthering your education.

You should envision this component as a personal reflection on the capstone and your experience in the business core program as a whole. For instance, relative to the capstone, you could discuss what you did (or intended to do), and then consider what worked well, what challenges you faced, and what you would change or do differently to make your experience better. In reflecting on your time in the business core program, you might discuss where you started, where you are, and where you see yourself going. Note that this component is not about evaluating the capstone itself but rather your experience within the capstone project.

Some of the issues that you could address in this final component of this capstone include the following:

• Overall, what was your capstone experience like?

• Reflect on your experience performing the Capsim simulation.

• Reflect on the significance of the capstone in relation to your own experience at SNHU.

• What connections do you see between your capstone and your academic program?

• How will you apply what you have learned to your future academic and/or professional life?

• How did you demonstrate effective business communication in both this capstone course and throughout the business core program?

• How will you utilize these business communication skills in your future classes here at SNHU and in the working world after graduation?

• Reflect on your experiences with peer-to-peer and peer-to-leader collaboration in this capstone course.

• How has peer-to-peer and peer-to-leader collaboration influenced your performance and decision making in this class?

• Reflect on establishing and maintaining a professional business etiquette in both this capstone course and throughout the business program.

Final Project Rubric

This rubric will be applied to both components as a whole, and no component will be assessed on its own.

The “Possible Indicators of Success” are examples for you and the instructor of the types of concepts to look for to demonstrate proficiency. They are neither exhaustive nor proscriptive and should be used as guides for illustrating how your capstone embodies the outcome. All outcomes are weighted equally.

Guidelines for Submission: The submitted executive summary should be comprehensive and adhere to best practices for business writing. Be sure that your writing is concise and appropriate for your target audience. Any quoted, paraphrased, or borrowed information should be cited according to the guidelines in the Publication Manual of the American Psychological Association (APA).

Annotated Bibliography: Effect of Social Media on Teen Mental Health

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Abstract

This annotated bibliography will introduce five scholarly articles regarding research on social evidence of the need of further research that needs to be done. In order to fill in the gaps additional research needs to be sufficiently demonstrated on how social media sites promotes or declines the mental health of teens. These articles will be examined and display evidence that is applicable and support the research proposal presented. Each article will display evidence that aids social media sites use for teenager’s mental health disputes social media sites usage for teenager’s mental health. Lastly, it will focus on how social media influences mental health for teenagers and whether if the outcome is positive or negative. All sources utilized will be displayed in the standard APA format as well as an examination and narrative of each article. In addition, the annotated bibliography will also provide the qualifying expertise of the author of the articles, one type of assessment that was used, and a concise explanation of purpose to the research topic.

References

1.) Barry, C. T., Sidoti, C. L., Briggs, S. M., Reiter, S. R., & Lindsey, R. A. (2017, December).

Adolescent social media use and mental health from adolescent and parent perspectives.

Journal of Adolescence

,

61

, 1-11.

Christopher T. Barry, who is the author has a doctoral degree in Clinical Psychology. He also is a professor at Washington State University in the department of Psychology.  The main research question for this study was: “Are parent-reported symptoms of inattention, hyperactivity/impulsivity, conduct problems, depression, and anxiety related to the reported number of adolescents’ social media accounts and the frequency with which adolescents’ report checking their social media accounts”?  (Barry et al., 2017, p. 3). Furthermore, the article provides a complete study of how parents and teenagers report of teenagers utilizing social media and how it relates to teenager’s mental health. Barry, Sidoti, Briggs, Reiter, and Lindsey utilized a sample of 226 participants consisting of 113 parent-teenager’s ratios. The teenagers ranged from the following ages 14 to 17 and does a good job utilizing this as good sample size. The subject matter examined the reports produce by teenagers and parents regarding social media usage in connection to parent who reported the following symptoms of depression, fear of missing out (FoMO), and anxiety.

Lastly the research demonstrates the number of teenagers who have social media accounts and how often they checked their social media accounts which were positive and corresponded with teenagers-reported loneliness and parent reported symptoms of depression and anxiety in their teenage children.

2.) Best, P., Manktelow, R., & Taylor, B. (2014). Online communication, social media,

and adolescent wellbeing: A systematic narrative review.

Children and Youth Services Review

,

41

, 27-36.

Paul Best, who is the author of this article has a doctoral degree of Philosophy from Queen’s University Belfast. This article’s purpose is to review current empirical research regarding social technologies and the mental well being of teens. The results were the authors discovered 43 research papers and learned that most of the studies showed blended or no effects of social media used and teens mental health. The study utilized a valued appraisal tool and narrative synthesis methodology to review the articles and examine results. The specific question of the study was: What are the beneficial and harmful effects of social media amongst young people (Best et al., 2014).

Furthermore, this research depicts the positive and negative effects on teens mental health from utilizing social media, this outcome assists me to conduct my research for social media and the effects on teen health. This article does not provide any use of psychometric results; however, the article analyzes different sources on the subject matter of social media sites and teen mental health. Although there are many sources being correlated and reviewed, there is also room for variation and different groups.

Best et al. (2014) demonstrates that there is evidence that upholds both positive and negative effects of social media on teens well-being, however it also implies there needs to be further research enhance support to social media and teens mental health with a more suitable constructed study.

3.) O’Reilly, M., Dogra, N., Hughes, J., Reilly, P., George, R., & Whiteman, N. (2018). Potential of social media in promoting mental health in adolescents.

Health Promotion International

, 1-11.

Michelle O’Reilly, who is the author is a lecturer at the University of Leicester and is also a consultant for research at Leicestershire Partnership NHS Trust.  This article was also managed buy the University of Leicester Research Ethics Committee. O’Reilly, Dogra, Hughes, Reilly, George, and Whiteman (2018) used focus groups supervised with teenagers, mental health professionals, and educational professionals.  A qualitative model was utilized, and participants were chosen from London and Leicester. Thematic analysis was utilized because of the data meaning-making focus (O’Reilly et al., 2018). The focus (research) question utilized was: “What are the perspectives of key stakeholders about the extent to which social media can play a role in mental health promotion?” (O’Reilly et al., 2018, p. 2).

The research describes how three main subjects were examined:  the role of how social media and mental health develop in teenagers with utilizing social media, and the positive benefits and negative challenges of social media and mental health. Furthermore, this helps to prove that social media can have an impact on teenager’s mental health in a positive and negative way. Lastly this study does a spectacular job with breaking down  the use of males and females as well as different age groups that provide a extensive range of opinions for results regarding social media and its possible effects  The focus group  was developed around conceptualizations of social media opinions, mental health and ideas on health and social media development.

In addition, O’Neill et al. (2018) suggested that social media can have an impact on mental health development, while also stating the need for further research need for expanded evidence base. This also assists me with my research regarding the need of research on social media and the possible effects on teenager’s mental health.

4.) O’Reilly, M., Dogra, N., Whiteman, N., Hughes, J., Eruyar, S., & Reilly, P. (2018, May). Is social media bad for mental health and wellbeing? Exploring the perspectives of adolescents.

Clinical Child Psychology and Psychiatry

, 1-13.

Michelle O’Reilly, who is the author is a lecturer at the University of Leicester and is also a consultant for research at Leicestershire Partnership NHS Trust. O’Reilly, Dogra, Whiteman, Hughes, Eruyar, and Reilly (2018) utilized a qualitative method, precisely a macrosocial constructionist view of six focus groups. The research question of the subject matter: “What do adolescents think of social media and its relevance to mental health and emotional wellbeing”?  (O’Reilly et al., 2018). The questions that were focused on in those focused groups were regarding the understand of mental health, the individuals personal experience from usage, and the usage of social media. In addition to examining plenty of data saturation between both focus groups and the individuals that participated. Furthermore, thematic analysis was utilized so that certain members of the team utilizes three levels of coding methods that confirmed inter coder accuracy (O’Reilly et al., 2018).

The outcomes of the research suggest that the participants perceived social media had a negative impact for teenager’s mental health overall.  This also proves the case that researcher is further needed, and to focus on ways is social media negative and how does the negativity of social media precisely do teenager’s mental health.

Lastly the article focuses on how some teenagers did understanding the meaning of mental health but nor did they comprehend what the meaning of positive mental health was, this subject matter could use further research on social media’s impact on teenager’s mental health.  And to also further research on how to effectively and appropriately educate teenagers on positive mental health.

5.) Seo, H., Houston, J. B., Knight, L. A. T., Kennedy, E. J., & Inglish, A. B. (2014). Teens’ social media use and collective action.

New Media & Society

,

16

(6), 883–902. https://doi.org/

10.1177/1461444813495162

Hyunjin Seo, who is the author of the article is an associate professor of strategic communication in the William Allen White School of Journalism and Mass Communications at the University of Kansas.  Hyunjin, Houston, Knight, Kennedy, and Inglish (2014) used a survey questionnaire specifically a macrosocial constructionist focus group with 18 teenagers which were obtained through a teen-orientated radio station. The Research Question that was posed was: How teens are using social media to facilitate planning and organizing

flash mobs

? (Hyunjin et al., 2014).  The questions focused on understanding how teenager’s social med usage and social psychological characteristics are related with the participants and their interested in flash mob. This research suggests that theoretical and operational evidence in the study conducted is useful for those who would be studying teenager’s behavior, group identity, and collective action. Furthermore, the findings determined that this research could help policymakers identify more effective ways to encourage teenagers in this duration of social media as well as online social networking (Hyunjin et al., 2014).

Advanced registered nursing graduates are entering the profession.Advanced registered nursing graduates are entering the profession at dynamic time when roles and scope of practice are shifting based on developments in legislation and policy in response to the evolving needs of the health care system.

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Advanced registered nursing graduates are entering the profession.Advanced registered nursing graduates are entering the profession at dynamic time when roles and scope of practice are shifting based on developments in legislation and policy in response to the evolving needs of the health care system.

Professional nursing organizations play an important role in making sure the perspectives of advanced registered nurses are heard, and in supporting nurse specialties in their efforts to expand their scope of practice and their full participation throughout the health care system.
For this assignment, you will conduct research on the current scope of practice for your specialty and efforts that are being made to expand that scope and the role of the advanced nurse in positively influencing the health care system. Write a 1,250-1,500-word paper that includes the following:
1. A discussion of the scope of your future role as an advanced registered nurse, including any regulatory, certification, or accreditation agencies that define that scope.
2. A discussion of three professional nursing organizations that you think are most influential in advancing the scope and influence of advanced nursing. Of these organizations, evaluate the one that you would most like to join. How do its goals and mission fit in with your worldview and philosophy of care? How might membership in this organization improve your practice?
3. A discussion of a controversial or evolving issue that is most likely to affect your scope of practice or role in the next few years. How do you think this issue could influence the profession and other stakeholders, and why does it matters to the advanced registered nurse?

Adolescence is a time of transition between childhood and adulthood

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Adolescence is a time of transition between childhood and adulthood.

We have learned that adolescence is a time of transition between childhood and adulthood. A critical milestone of this stage is the ability to successfully achieve a sense of identity. Around the world, there are different rites of passage to mark the transition to adulthood. In the United States, this might include obtaining a driver’s license, landing one’s first job, senior prom, or high school graduation. In this assignment, we will explore the role that family and society play in the development of the individual’s sense of self.

By Monday, December 19, 2016, create two documents for parents of minority teens 1) A 9–12-slide PowerPoint presentation (complete with speaker’s notes) and 2) an accompanying 1–2-page handout/flier in Word document or PDF format. Be sure that both illustrate the following:

1. Describe common rites of passage from two cultures around the world and compare them to a common American rite of passage. Possible resources might include National Geographic and the Argosy University Online Library.
2. Compare and contrast these rites to common US rites of passage. Do they coincide with the physical, cognitive, or socioemotional changes taking place at this age? Describe which specific changes (physical, cognitive, or socioemotional) they coincide with. Does this explain their importance in a particular culture?
3. How might such a social ritual, such as a rite of passage, influence the identity formation process of adolescents?
4. In light of Erikson and Marcia’s theories, discuss how the process of identity development is affected when the adolescent belongs to a minority group (racial, ethnic, sexual, or religious). Be sure to explain these theories and how they apply to identity development.
5. Summarize research from at least two peer-reviewed* studies on the effect of minority status on identity development, ensuring you describe the main findings of the study as well as the research methods used to study the topic.
6. Apply the information you gathered from the online notes, textbook, and research articles to provide at least three practical recommendations for what the family, school, and community can do to ease the process for adolescents.