Best Counseling and Psychotherapy Clinical component 5 pages

Best Counseling and Psychotherapy Clinical component 5 pages

Week 6 clinical 300w. 3 references. Due 2.15.24 NU672 Counseling and Psychotherapy Clinical component.

Course Description

This course examines the guiding principles and ethics of counseling and the therapeutic environment for mental health patients across the lifespan. Techniques of counseling are introduced and correlated with relationships. Students will demonstrate techniques in the clinical setting in therapeutic milieus.

1. Clinical Highlights

a. Were there any patient management plans developed by your preceptor that surprised you?

b. Were you able to “teach” your preceptor anything this week?

2. What clinical goal would you like to tackle next week?

Course Learning Objectives

By the end of this course, you will be able to:

· Demonstrate an understanding of various psychotherapy theoretical concepts, frameworks, and modalities for the treatment and management of individuals, groups, and families across the lifespan with acute, complex, and chronic psychiatric mental health disorders including a focus on vulnerable populations at risk for mental health issues, and considerations of cultural, socio-economic, legal and ethical factors affect those seeking treatment.

· Exhibit knowledge of acute, complex, and chronic psychiatric mental health disorders related to criteria of the current edition of the Diagnostic and Statistical Manual for Mental Disorders to diagnose and manage individuals, groups, and families across the life span and the formation of a differential diagnosis to establish treatment planning for care with special emphasis on matching specific psychotherapy modalities that correlate to specific psychiatric mental health diagnosis for best outcomes based on evidence- based research data and findings.

Counseling and Psychotherapy Clinical component

Counseling and Psychotherapy Clinical component

· Analyze evidence-based therapeutic models of interview techniques to obtain a full history and assessment for use in developing a differential diagnosis and to develop a therapeutic relationship with patient-centered care for individuals, groups, and families across the life span with acute, complex, and chronic psychiatric mental health disorders.

· Evaluate the PMHNP role in screening, assessment, diagnosis, and treatment with psychotherapy modalities in psychiatric mental health care across the lifespan while including health promotion, advocacy, healthcare policy, and placement within the continuum of care.

· Identify core professional values and ethical/legal standards into the practice of the Psychiatric Mental Health Nurse Practitioner role with relation to patient safety, quality indicators, and outcome improvement in the delivery of quality psychiatric mental health care to patients.


American Psychiatric Association. (2013).  Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing, Inc.

Corey, G. (2016).  Theory and practice of counseling and psychotherapy (10th ed.). Boston, MA: Cengage. ISBN: 9781305263727

Carlat, D. (2023) The Psychiatric Interview, 5th Edition. Recommended

Bickley, L. (2016).  Bates’ Guide to Physical Examination and History-Taking [VitalSouce bookshelf version]. Eleventh, North American Edition; Lippincott Williams & Wilkins: ISBN 1609137620

Heldt, J. P., MD. (2017).  Memorable psychopharmacology. Create Space Independent Publishing Platform. ISBN-13: 978-1-535-28034-1

Stahl, S. M. (2013).  Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). Cambridge University Press. ISBN 978-1-107-68646-5

Stahl, S. M. (2020).  Prescriber’s guide: Stahl’s essential psychopharmacology (7th ed.). Cambridge University Press. ISBN 978-1108926010

Best psychiatric assessment interview with 4 references

Best psychiatric assessment interview with 4 references

Unit 6—Child/Adolescent Psychiatric Initial Interview/Assessment. Due 2-15-24. NU672 Counseling and Psychotherapy


In this assignment, you will complete a comprehensive psychiatric assessment interview of an adolescent/child less than 18yrs. You can use a patient you’ve seen in clinical or someone in your personal life. Your assessment should be comprehensive, and you should refer to course texts to inform items for inclusion in your assessment. Keep in mind that you will be responsible for covering those areas addressed in the reading assignments up to this point. 

Students always ask for a template.  Below is one that can be used to guide you in not forgetting any crucial information. There are further pieces of this assessment to include in the first column of this template. Make sure all points are addressed in each section. 

At a minimum, 4 scholarly references should be included and cited in APA 7th Edition formatting. The references page should be set up similar to papers that are in full APA 7th edition formatting.

Initial Psychiatric assessment Interview/SOAP Note Template

psychiatric assessment interview

There are different ways in which to complete a Psychiatric SOAP (Subjective, Objective, Assessment, and Plan) Note. This is a template that is meant to guide you as you continue to develop your style of SOAP in the psychiatric practice setting.

CriteriaClinical Notes
Informed ConsentInformed consent given to patient about psychiatric interview process and psychiatric/psychotherapy treatment. Verbal and Written consent obtained. Patient has the ability/capacity to respond and appears to understand the risk, benefits, and (Will review additional consent during treatment plan discussion)
SubjectiveVerify PatientName:DOB:Minor:Accompanied by:Demographic:Gender Identifier Note:CC:HPI:Pertinent history in record and from patient: XDuring assessment: Patient describes their mood as X and indicated it has gotten worse in TIME.Patient self-esteem appears fair, no reported feelings of excessive guilt,no reported anhedonia, does not report sleep disturbance, does not report change in appetite, does not report libido disturbances, does not report change in energy,no reported changes in concentration or memory.Patient does not report increased activity, agitation, risk-taking behaviors, pressured speech, or euphoria. Patient does not report excessive fears, worries or panic attacks.Patient does not report hallucinations, delusions, obsessions or compulsions. Patient’s activity level, attention and concentration were observed to be within normal limits. Patient does not report symptoms of eating disorder. There is no recent weight loss or gain. Patient does not report symptoms of a characterological nature.SI/ HI/ AV: Patient currently denies suicidal ideation, denies SIBx, denies homicidal ideation, denies violent behavior, denies inappropriate/illegal behaviors.Allergies: NKDFA.(medication & food)Past Medical Hx:Medical history: Denies cardiac, respiratory, endocrine and neurological issues, including history head injury.Patient denies history of chronic infection, including MRSA, TB, HIV and Hep C.Surgical history no surgical history reportedPast Psychiatric Hx:Previous psychiatric diagnoses: none reported.Describes stable course of illness.Previous medication trials: none reported.Safety concerns:History of Violence to Self: none reportedHistory of Violence t o Others: none reportedAuditory Hallucinations:Visual Hallucinations:Mental health treatment history discussed:History of outpatient treatment: not reportedPrevious psychiatric hospitalizations: not reportedPrior substance abuse treatment: not reportedTrauma history: Client does not report history of trauma including abuse, domestic violence, witnessing disturbing events.Substance Use: Client denies use or dependence on nicotine/tobacco products.Client does not report abuse of or dependence on ETOH, and other illicit drugs.Current Medications: No current medications.(Contraceptives):Supplements:Past Psych Med Trials:Family Medical Hx:Family Psychiatric Hx:Substance useSuicidesPsychiatric diagnoses/hospitalizationDevelopmental diagnosesSocial History:Occupational History: currently unemployed. Denies previous occupational hxMilitary service History: Denies previous military hx.Education history: completed HS and vocational certificateDevelopmental History: no significant details reported.(Childhood History include in utero if available)Legal History: no reported/known legal issues, no reported/known conservator or guardian.Spiritual/Cultural Considerations: none reported.ROS:Constitutional: No report of fever or weight loss.Eyes: No report of acute vision changes or eye pain.ENT: No report of hearing changes or difficulty swallowing.Cardiac: No report of chest pain, edema or orthopnea.Respiratory: Denies dyspnea, cough or wheeze.GI: No report of abdominal pain.GU: No report of dysuria or hematuria.Musculoskeletal: No report of joint pain or swelling.Skin: No report of rash, lesion, abrasions.Neurologic: No report of seizures, blackout, numbness or focal weakness. Endocrine: No report of polyuria or polydipsia.Hematologic: No report of blood clots or easy bleeding.Allergy: No report of hives or allergic reaction.Reproductive: No report of significant issues. (females: GYN hx; abortions, miscarriages, pregnancies, hysterectomy, PCOS, etc…)
Verify Patient: Name, Assigned  identification number (e.g., medical record number), Date of birth, Phone number, Social security number, Address, Photo.Include demographics, chief complaint, subjective information from the patient, names and relations of others present in the interview.HPI:, Past Medical and Psychiatric History,Current Medications, Previous Psych Med trials,Allergies.Social History, Family History.Review of Systems (ROS) – if ROS is negative, “ROS noncontributory,” or “ROS negative with the exception of…”
ObjectiveVital Signs: StableTemp:BP:HR:R:O2:Pain:Ht:Wt:BMI:BMI Range:LABS:Lab findings WNLTox screen: NegativeAlcohol: NegativeHCG: N/APhysical Exam:MSE:Patient is cooperative and conversant, appears without acute distress, and fully oriented x 4. Patient is dressed appropriately for age and season. Psychomotor activity appears within normal.Presents with appropriate eye contact, euthymic affect – full, even, congruent with reported mood of “x”. Speech: spontaneous, normal rate, appropriate volume/tone with no problems expressing self.TC: no abnormal content elicited, denies suicidal ideation and denies homicidal ideation. Process appears linear, coherent, goal-directed.Cognition appears grossly intact with appropriate attention span & concentration and average fund of knowledge.Judgment appears fair . Insight appears fairThe patient is able to articulate needs, is motivated for compliance and adherence to medication regimen. Patient is willing and able to participate with treatment, disposition, and discharge planning.
This is where the “facts” are located.Vitals,**Physical Exam (if performed, will not be performed every visit in every setting)Include relevant labs, test results, and Include MSE, risk assessment here, and psychiatric screening measure results.
AssessmentDSM5 Diagnosis: with ICD-10 codesDx: -Dx: -Dx: -Patient has the ability/capacity appears to respond to psychiatric medications/psychotherapy and appears to understand the need for medications/psychotherapy and is willing to maintain adherent.Reviewed potential risks & benefits, Black Box warnings, and alternatives including declining treatment.
Include your findings, diagnosis and differentials (DSM-5 and any other medical diagnosis) along with ICD-10 codes, treatment options, and patient input regarding treatment options (if possible), including obstacles to treatment.Informed Consent Ability
Plan(Note some items may only be applicable in the inpatient environment)Inpatient:Psychiatric. Admits to X as per HPI.Estimated stay 3-5 daysSafety Risk/Plan: Patient is found to be stable and has control of behavior. Patient likely poses a minimal risk to self and a minimal risk to others at this time.Patient denies abnormal perceptions and does not appear to be responding to internal stimuli.Pharmacologic interventions: including dosage, route, and frequency and non-pharmacologic:· No changes to current medication, as listed in chart, at this time· or…Zoloft is an excellent option for many women who experience any menstrual cycle complaints. I usually start at 50 mg and move to 100 week 6-8. f/u within 2 weeks initially then every 6-8 weeks.· Psychotherapy referral for CBTEducation, including health promotion, maintenance, and psychosocial needs· Importance of medication· Discussed current tobacco use. NRT not indicated.· Safety planning· Discuss worsening sx and when to contact office or report to EDReferrals: endocrinologist for diabetesFollow-up, including return to clinic (RTC) with time frame and reason and any labs that are needed for next visit 2 weeks☒ > 50% time spent counseling/coordination of care.Time spent in Psychotherapy 18 minutesVisit lasted 55 minutesBilling Codes for visit:XXXXXX____________________________________________NAME, TITLEDate: Click here to enter a date. Time: X

5 new concept model

5 new concept model

Complete the assigned reading of chapter 21 and discuss how does the concept model transition to the research proposal? 

CHAPTER 21 Reconceptualizing Normal: From Concept

Building to Proposal Development

Shelley J. Greif

The idea of studying and understanding challenges faced by parents caring for a child after traumatic brain injury (TBI) grew directly out of my work provid- ing care coordination, education, and support caring for children and families who had recently sustained TBI. This practice was within a state program for children with special healthcare needs as well as brain and spinal cord injury. I worked for many years with the broad population of children with special healthcare needs and families. However, I found when working with TBI sur- vivors and families there was a unique depth of parental involvement and commitment that was different from previous experience. I wanted to better understand the experience of those parents in order to inform and improve practice in the fi eld. The structure and process that was used in the develop- ment of this concept is described in detail in Reconceptualizing Normal (Greif, 2014). This chapter briefl y summarizes the concept development and then describes the process used in moving from concept building to proposal devel- opment for my doctoral dissertation.


The concept reconceptualizing normal was derived from practice. The prac- tice story situation was about Maria, who sustained a severe TBI at the age of 16, when she was struck and dragged by a truck while riding a bicycle. The story describes the experience of Maria and her mother as they moved through trauma care, inpatient rehabilitation, and outpatient services, including inte- gration into educational and community settings.

concept model

concept model


The Theory of Uncertainty in Illness (Mishel & Clayton, 2008) was used as a lens to shape reconceptualizing normal. This theory describes uncertainty in

Copyright Springer Publishing Company. All Rights Reserved. From: Middle Range Theory for Nursing, Fourth Edition DOI: 10.1891/9780826159922.0021


situations where the impact of illness is unpredictable or there is insuffi cient information to determine the meaning of the event. In a study on adjustment of families with members who had heart transplants, Mishel and Murdaugh (1987) found that adjustments were continually being made and belief of return to normal was gradually eroded. They described the process of adjust- ment as one which includes an awareness of the need to redefi ne what is normal.


TBI is frequently referred to as the “silent epidemic” because the complications from TBI, such as changes affecting thinking, sensation, language, or emo- tions, may not be readily apparent. Each year, TBIs contribute to a substantial number of deaths and cases of permanent disability. Recent data show that, on average, approximately 1.7 million people sustain a TBI annually (Faul, Xu, Wald, & Coronado, 2010). Children from birth to 4 years of age, teenagers 15 to 19, and adults over the age of 65 are most likely to sustain a TBI. Furthermore, almost half a million emergency department visits are made annually by chil- dren from birth to 14 years.

Consistent throughout the literature is the importance of family functioning. Review of qualitative research suggests that what is central to successful adap- tation and community reintegration is the family’s ability to reconceptualize what is normal to change expectations about how they and their child will live and experience daily activities (Duff, 2002, 2006; Kao & Stuifbergen, 2004; Mishel & Murdaugh, 1987; Roscigno, 2008; Wongvatunyu & Porter, 2008a, 2008b).


There is persistent uncertainty associated with how a child will recover from brain injury. Families develop basic competencies and patterns that foster growth, protect their child, and enable recovery. In coping with uncertainty, they demonstrate fl exibility and draw on unconditional love that enables them to get to know their child again and to develop new approaches for everyday living. Willing openness to know anew (Roscigno, 2008; Wongvatunyu & Porter, 2008b), intentional fl exibility (Duff, 2002, 2006; Kao & Stuifbergen, 2004), and unconditional love (Kao & Stuifbergen, 2004; Wongvatunyu & Porter, 2008b) are the core qualities of reconceptualizing normal. Reconceptualizing normal is willing openness to know anew through intentional fl exibility and uncondi- tional love (Greif, 2014).

Figure 21.1 illustrates the process of reconceptualizing normal after TBI.


Unconditional love

Intentional flexibility

W illing openness

Know anew

FIGURE 21.1 Model of Reconceptualizing Normal.


In continuing to develop and refi ne the concept of reconceptualizing normal, Story Theory provided an approach that intuitively resonated with exploring and understanding the phenomenon. Story Theory was developed by Smith and Liehr to provide a story-centered structure for guiding nursing practice and research (Smith & Liehr, 2014). The theory recognizes that listening to per- sons’ stories about their health experience is a fundamental nursing process that allows people to express what matters to them. Smith and Liehr (2014) describe story as the “narrative happening of connecting with self-in-relation through intentional dialogue to create ease.” In this description story incorpo- rates narration of events as remembered and infuses unique personal perspec- tives that shape meaning and guide choices in the moment.


The purpose of this study is to understand how parents manage the care and community reintegration of their child who has experienced a TBI over time. This study uses a mixed-method approach, exploring critical turning points for parents as they move from “normalcy” prior to and then an altered health tra- jectory following their child’s TBI. Health challenges that parents experience and their approaches for resolving health challenges are also explored.

The population of interest is parent caregivers of children who had a mod- erate or severe TBI (at least 2 years ago) when they were between the ages of 12 and 18 years. This population is selected for several reasons. It is the age group most at risk and is the largest percentage of children referred for TBI. Adolescents and young adults, who have already begun the developmen- tal processes of independence, are beginning to gain the skills for transition to adulthood. The signifi cant change in their needs following TBI, including dependence and behavioral and cognitive needs, puts them and their families at high risk for dysfunction, stress, and depression.


The research questions for the qualitative component are:

• What are the dimensions of the health challenge of caring for a child who has had a moderate-to-severe TBI?

• What are the turning points that mark change over time for parents of children who have experienced a TBI?

• How have parents managed the challenges they face?

The research questions for the quantitative component are:

• How do parents assess the quality of life for their child who has experienced a TBI?

• How do parents self-appraise management of everyday living following their child’s TBI?


Studies of children’s cognitive and functional recovery following TBI identify factors that infl uence outcomes, including pretrauma profi le, family character- istics, and severity of injury. None of these factors or variables exists in isola- tion. Lack of recognition of need by parents or caregivers has been identifi ed as one barrier to improved outcomes, with the recommendation that primary care providers be alert to unrecognized need and provide appropriate referrals (Slomine et al., 2006). Children with preexisting psychosocial conditions such as learning disabilities, behavior disorders, and/or low socioeconomic status are more likely to report unmet needs. It has been suggested that intensive nurse visiting to assess needs and provide support for cognitive and social interventions may improve outcomes for both the family and the child (Keenan, Runyan, & Nocera, 2006). Findings from quantitative research on children’s TBI suggest the importance of inquiring into the care and experience of chil- dren who have had TBIs. In addition, the experience of families is warranted, given the role that families play in their child’s outcomes.

This research is an attempt to understand and appreciate the impact of pedi- atric TBI through the lens of Story Theory, using a mixed-method design for data collection and analysis. It is expected that this research will: (a) inform nursing practice with respect to understanding the experience for families in managing the care and community reintegration of their child; and (b) high- light opportunities to support family management and strengthening.


Story Theory was developed to provide a story-centered structure for guid- ing nursing practice and research, recognizing that stories are a fundamental


dimension of the human experience. Smith and Liehr (2014) identifi ed three interrelated concepts of the theory: intentional dialogue, connecting with self- in-relation, and creating ease. Intentional dialogue is “purposeful engage- ment with another to summon the story of a complicating health challenge” (p. 230). It is the nurse’s intentional presence as a way of coming to know the other person. Connecting with self-in-relation is “the active process of recog- nizing self as related with others in a story plot” (p. 231), and in Story Theory, connecting with self-in-relation incorporates personal history and refl ective awareness. Creating ease is a “release experienced as the story comes together in a movement toward resolving” (p. 232). These three concepts interrelate with each other in a dynamic way to describe story as “a narrative happen- ing of connecting with self-in-relation through intentional dialogue to cre- ate ease” (p. 234). The theory proposes concept-related processes named as components of the theory method: intentional dialogue about a complicat- ing health challenge, connecting with self-in-relation through developing story plot (high points, low points, turning points), and creating ease through movement toward resolving the complicating health challenge. The gathering of stories is relevant to both nursing practice and research. The development of Story Theory and method offers an opportunity to embrace story-gathering as an intentional intervention as well as a tool for research expanding nursing knowledge and wisdom.



This study utilizes a mixed-method approach. In the qualitative component, the following experiences were explored: (a) dimensions of the health chal- lenges faced by parents caring for a child after a TBI; (b) critical turning points for parents as they face the health challenges; and (c) approaches for move- ment toward resolving health challenges. In the quantitative component, par- ents’ perceptions of their child’s quality of life and their own ability to manage their child’s health challenge are also explored. Mixed methods refers to the combination of qualitative and quantitative research, and is used when the two approaches complement one another and lead to a more comprehensive understanding of the phenomenon than one or the other could do alone.

Story inquiry method is used to gather and analyze data about health chal- lenges, approaches for resolving health challenges, and turning points as parents move along to reconceptualize normal. These qualitative data are enhanced with a quantitative study component. The Pediatric Quality of Life Inventory (PedsQL) Measurement Model is used to assess the child’s quality of life and the Family Management Measure (FaMM) is used to assess parents’ ability to manage their child’s health challenge.


Qualitative Approach

According to Creswell (2007), “narrative research is best for capturing the detailed stories or life experiences of a single life or the lives of a small num- ber of individuals” (p. 55). Narrative research draws from the humanities, including anthropology, literature, psychology, sociology, and history, and is well suited for telling the stories of individual experiences. The procedures for conducting narrative research include collecting information about the con- text of the stories, which are situated within the participants’ personal experi- ences, their culture, and their historical contexts; analyzing the participants’ stories; and then “restorying” them into an organized framework. It also calls for collaborating with participants by actively involving them in the research. Creswell noted that in narrative research, there is a relationship between the researcher and the researched in which both parties learn and change in the encounter. This relationship allows the parties to negotiate the meaning of the stories, adding a validation check to the analysis (Creswell, 2007).

Story narrative encourages and allows the participant to articulate expe- riences that are meaningful, offering the researcher an opportunity to fully understand. In this case, how families moved through the experience of having a child with a TBI is the focus of inquiry. This approach is particularly valuable in uncovering the life-changing dimensions of being thrust unexpectedly into an intensive and complex system of health and related care needs. Engaging in dialogue and eliciting stories that are meaningful to participants allows for the expression of whatever is most important and vital for the care of their child, and allows for consideration of ways to incorporate care into their daily lives.


Story inquiry method is used to gather and analyze data about health chal- lenges, turning points, and movement toward resolving health challenges. Story inquiry method derives from Story Theory and is an approach for sys- tematically gathering and analyzing stories with the intention of informing nursing knowledge development (Liehr & Smith, 2007). Liehr and Smith (2007) proposed fi ve inquiry processes: (a) gathering stories about a complicat- ing health challenge, (b) deciphering dimensions of the complicating health challenge, (c) describing the developing story plot (turning points), (d) identi- fying movement toward resolving, and (e) synthesizing fi ndings to address the research question. Each phase of the story inquiry method is used in this study.

Quantitative Approach

Several existing tools were examined to determine feasibility of use with this population. The challenge was to identify tools that adequately measure fam- ily management and how it infl uences outcomes in quality of life for children with TBI.



The FaMM was created to assess families’ strategies for managing caring for children with chronic illness and the extent to which they incorporate condi- tion management into everyday life (Knafl et al., 2011). The eight dimensions of the Family Management Style Framework (FMSF; Child Identity, Illness View, Management Mindset, Parental Mutuality, Parenting Philosophy, Management Approach, Family Focus, and Future Expectations) were used to generate the initial set of items for the FaMM (Knafl et al., 2011). The current version of the FaMM has 65 items with 7 to 9 items/subscale. The fi nal set of items of the measure comprises the Parent Mutuality subscale for partnered parents only. Alpha reliability for mothers/fathers for each of the subscales were accept- able: Child’s Daily Life (.76/.79), Condition Management Ability (.72/.73), Condition Management Effort (.74/.78), Family Life Diffi culty (.90/.91), View of Condition Impact (.73/.77), and Parental Mutuality (.79/.75); test–test reli- ability for the subscales ranged from .71 to .94 (Knafl et al., 2011). Knafl et al. (2011) also reported construct validity testing that indicated consistency with established measures.


The PedsQL (Varni, Seid, & Kurtin, 1999) is a 23-item self-report instrument for children and proxy report for parents that includes physical functioning (8 items), emotional functioning (5 items), social functioning (5 items), and school functioning (5 items). The measure includes developmentally appropri- ate report forms for different age ranges, as well as condition-specifi c modules to complement the generic scales. It is designed to be used for healthy popula- tions as well as children with acute and chronic health conditions. The tool has been used in numerous studies of health-related quality of life for both typi- cally developing children and children with special healthcare needs. Internal consistency reliability for the full 23-item scale approaches .90 for both reports. Validity has been demonstrated through correlation with other measures of disease burden. In this study, the PedsQL Measurement Model proxy report for parents will be used to enhance understanding about how parents assess the quality of life for their child who has had a TBI.


The sample for this study is a purposive sample of parents who have cared for a child after a TBI. Participants will be identifi ed from a population of indi- viduals who had been referred to the Florida Department of Health—Brain and Spinal Cord Injury Program. Florida statute requires trauma centers to report all moderate-to-severe traumatic brain and spinal cord injuries through a central registry. Individuals identifi ed through the registry are referred to


local case managers in their community or region to contact for education, resources, and assistance with coordination of inpatient and/or rehabilitation discharge plans with the goal of community reintegration. Participation in the program is voluntary.


Invitations to participate will be sent by the Regional Children’s Medical Services Nursing Director to all families who meet the inclusion criteria, with request to contact the researcher if they are interested in and willing to partici- pate. While it is hypothesized that there may be similarities and differences in culture care beliefs and how families reconceptualize normal and manage care of a child who has had a TBI, families who do not speak or read English will be excluded due to the diffi culties of translating and effectively understanding the nuances of language in their stories.

Sample Size Consideration

Stories will be collected from 10 to 15 parent caregivers of a child who has sus- tained a TBI. The maximum of 15 participants was chosen with the expectation that it will be a suffi cient number to reach saturation. Saturation in qualitative research occurs when there is no longer additional information that adds to the understanding of the area of study. In this mixed-method approach the quali- tative dimension of the study is guiding sample size determination. Creswell (2007) suggests that in narrative research, as few as one or two individuals can be sampled unless a larger pool is used to develop a collective story. In this pro- posed research, a larger pool is indicated to understand the collective story of parenting a child with TBI. In phenomenology, recommendations are to study 3 to 10 subjects, and for Grounded Theory, 20 to 30 individuals (Creswell, 2007). Analysis of the quantitative data is conceptualized as descriptive, and is intended to enhance understanding of the qualitative data.

Stories will be audiotaped and transcribed for analysis. Stories will be ana- lyzed to identify the dimensions of what matters most about the complicat- ing health challenge for the parent caregiver. Descriptive statements will be grouped and labeled with the themes that refl ect the complex dimensions of the health challenge. Stories will be examined to identify the turning points that contribute to management of the care of their child with TBI. An additional step in the inquiry process will be to identify approaches used by parents to move toward resolving the health challenge of parenting a child with TBI.

Story-gathering will begin by asking the participant to share their “Story of Parenting a Child Who Has Had a Traumatic Brain Injury.” The participant will be provided with a piece of paper with the title and a horizontal line drawn on it. They will be asked to identify the date of the circumstance that resulted in the TBI and it will be noted near the left end of the line. Then the date that


the story is being gathered will be noted on the line. Story-gathering will fol- low a story path approach (Smith & Liehr, 2014). The researcher will begin the dialogue in the present. Participants will be asked to describe challenges that they are facing in the present and how they are managing those challenges. Then, participants will be asked to think about the time before the TBI and tell the researcher what they remember about what life was like for them and their child. They will then be asked to think about and describe the time between the injury and now, and how they got from the time of the injury to the pres- ent point in time. Finally, the last inquiry will ask participants to describe their hopes and dreams for the future.

Analysis Plan


Deciphering the dimensions of the complicating health challenge involves engaging with the stories to fi gure out “what matters most.” Dimensions are unique descriptions shared by the storyteller about his or her personal expe- rience of the complicating health challenge (Liehr & Smith, 2011). Multiple themes will refl ect the different and complex dimensions of the health chal- lenge. An inductive approach will be used. Stories will be read and reread to ascertain meaning. Passages related to the health challenge description will be identifi ed. Like passages will be grouped and themes that address the dimen- sions of the health challenge will be named.


Movement toward resolving refers to action taken to resolve the health chal- lenge. Stories will be examined to evaluate movement toward resolving the health challenge of caring for a child who has suffered a TBI. It is expected that there will be stories along the continuum from nearly complete resolution to little or no resolution. Once again, an inductive approach will be used as previously described. At the completion of this process, there will be a set of health challenge themes, and a second set of themes descriptive of approaches used to resolve the health challenge of parenting a child who has experienced a TBI.


Finally, stories will be analyzed to identify the turning points that are integral to the health challenge. Turning points are defi ned as issues that have impor- tance for moving through the health challenge being faced, in this case car- ing for a child who has had a TBI. Turning points are important decisions or shifts in the story of the unfolding health challenge, and may interplay with movement toward resolving. An inductive approach will, once again, be used,


grouping similar descriptions of transition shared by parents. Themes will be identifi ed for each set of turning point descriptions.

Results of the PedsQL and the FaMM will be analyzed using descriptive statistics (means and standard deviations) to address the quantitative research questions: (a) How do parents assess the quality of life for their child who has experienced a TBI? and (b) How do parents self-appraise management of everyday living following their child’s TBI? The small sample size prohibits inferential statistics but these descriptive data may shed light on the qualita- tive fi ndings by providing another perspective regarding how caregivers are managing their challenges in relation to the circumstance of having a child who suffered a TBI.

This parallel mixed-method design results in two sets of inferences, one qualitative and one quantitative, each developed from independent analysis (Chiang-Hanisko, Newman, Dyess, Piyakong, & Liehr, 2016). At the comple- tion of independent data analysis, the inferences will be examined together to identify areas of consistency and discrepancy, thereby enabling identifi cation of guidance for both practice and research.

Study Rigor

Sandelowski (1986) addresses the issue of rigor in qualitative research, noting that qualitative research emphasizes the meaningfulness of the research prod- uct rather than control of the process. Guba and Lincoln (1981) suggest that credibility of a qualitative study is the measure of its truth value, and is evident when the study presents such faithful descriptions of the experience that peo- ple immediately recognize it from description or interpretation as their own.

Tappen (2011) identifi es a number of ways to ensure trustworthiness of qual- itative research. Credibility is established through prolonged engagement and observation, member checking, peer debriefi ng, negative case analysis, and tri- angulation. Two of these approaches will be used: prolonged engagement and peer debriefi ng.

Prolonged engagement and persistent observation allow time and opportu- nity to test possible explanations and develop emerging explanations. Length of engagement is infl uenced by how well you already know the language and culture. This researcher has worked directly with children and families of chil- dren with TBIs for more than 5 years and is familiar with what families expe- rience. Story-gathering is intended to provide a structure and framework for enhancing understanding of the multiple dimensions of the health challenge. During the interview the researcher will ask participants to clarify informa- tion that has been shared as part of story-gathering, to be sure that an accurate refl ection of their intention has been heard.

Peer debriefi ng, seeking feedback from individuals with expertise on the subject and methodology, is another strategy for ensuring trustworthiness of qualitative research. The doctoral candidate’s dissertation committee chair will


serve as the expert, and will be asked to review 20% of the sample for assess- ment of analysis. Feedback will be elicited from other committee members who are subject matter experts.

Cases will be examined after the initial analysis is completed to see whether the dimensions of the health challenge, movement toward resolving, and turn- ing points are applicable to all cases. Negative cases (those that differ from the prevailing themes), if identifi ed, will also be included for analysis. It is important to consider divergent meaning and incorporate this consideration into conclusions.

The dependability of qualitative research is equivalent to reliability in quan- titative research. Lincoln and Guba address the importance of an audit trail, a careful compilation of material. The researcher will keep careful records of raw data (fi eld notes, audio recordings, documents), data analysis products (sum- maries or ideas that occur to the researcher during study), coding schemes, process notes (descriptions of how data were obtained and how analysis done), refl ections of the investigator (personal notes and refl ective journal), and surveys or questionnaire guides (forms used to collect information on par- ticipants, interview guides).

Ethics and Institutional Review Board

Because this is research involving human subjects, institutional review board approval will be necessary. Institutional review board approval will need to be obtained from the Florida Department of Health as well as Florida Atlantic University. Invitations will be sent by the Regional Nursing Director for Children’s Medical Services, in order to protect the confi dentiality of clients. Subjects who express interest in the study will be informed that their partici- pation is voluntary, and their decision about participation will not affect the services they receive through the Brain and Spinal Cord Injury Program. Also, refusal to participate will involve no penalty or loss of benefi ts, and they may stop participating at any time. The purpose of the research will be explained to participants both verbally and in writing, to ensure understanding of participation.

It is possible that in the process of sharing stories about managing care of their child with TBI, parents may identify unmet needs. They will be provided with contact information for the Brain Injury Association of Florida, which provides family support to survivors and caregivers of survivors of TBI, information, and educational resources. They will also be provided contact information as appro- priate for their local community health and/or community mental health center.

Data Collection Protocol

Parents who respond to the invitation to participate will be contacted by the researcher to further explain the study and to set up an appointment. The total


time allocated for the appointment will be 1.5 to 2 hours. The consent form will be introduced and explained. Time for story-gathering will be 45 minutes to 1 hour, with additional time for introduction, demographic and health data, and completion of quantitative measures.

Demographic and health data will be collected in an interview format, in order to establish rapport and get to know the participant. These data will include caregiver and child information. Caregiver information will include: age, gender, ethnic background, marital status, duration of marriage, educa- tion, occupation, and parent perception of severity of injury. Child informa- tion will include: age, gender, ethnic background, age at time of injury, and preexisting conditions (e.g., attention defi cit hyperactivity disorder [ADHD], behavioral or learning disabilities).

Stories will be collected as previously described using a story path approach (Smith & Liehr, 2014), beginning with the present experience, life before the TBI, time from the TBI to the present, and future hopes and dreams. Stories will be audiotaped for accuracy and to facilitate the analysis process.

Parents will be asked to complete the PedsQL and FaMM immediately after the story is completed. If they are unable to complete these due to time con- straints or other factors at that time, they will be offered the option to com- plete the measures within 48 hours and then mail back to the researcher. The researcher will telephone participants after 48 hours to see if there is anything they want to add to the story that might not have been included, and to remind them to mail back the measures.


The process of moving from concept development to the proposal and imple- mentation of research was guided by the concept of reconceptualizing normal after TBI. The foundational understanding of this idea emerging during con- cept building set in motion a proposal development process that integrated qualitative and quantitative approaches for data gathering and analysis.

This study used a parallel mixed-method approach to understand how fami- lies manage the care of a child with TBI. The qualitative inquiry was guided by Story Theory and story inquiry method. This narrative approach was selected because of its essential congruence with nursing practice and research and my understanding about the importance of knowing the stories of these families, based on years of nursing practice experience. Quantitative data was collected using the PedsQL and the FaMM to provide descriptive data with the potential to enhance understanding of the complexity of the health challenge of parent- ing a child who had suffered a TBI.

One of the qualities essential for both concept building and proposal devel- opment was adherence to a systematic scholarly process. The skills that were


developed during concept building, like thoughtful refl ection to synthesize ideas and determine next directions, were critical to proposal development. Each step from beginning with the practice story in concept building to prepa- ration of a three-chapter dissertation proposal was built upon the learning that has come before it. From my perspective, concept building and dissertation proposal development are parts of a whole for scholars on a path to complete dissertation research.


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Guidance for using mixed methods design in nursing practice research. Applied Nursing Research, 31, 1–5.

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injury: A grounded theory study. Axon, 24(2), 14–22.

Duff, D. (2006). Family impact and infl uence following severe traumatic brain injury.

Axon, 27(2), 9–23.

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3 pages worst Health care worker problems

3 pages worst Health care worker problems

Develop, in detail, a situation in which a health care worker might be confronted with ethical problems related to patients and prescription drug use OR patients in a state of poverty.

Health care worker

Health care worker
  • Your scenario must be original to you and this assignment. It cannot be from the discussion boards in this class or any other previous forum.
  • Articulate (and then assess) the ethical solutions that can found using “care” (care-based ethics) and “rights” ethics to those problems.
  • Assessment must ask if the solutions are flawed, practicable, persuasive, etc.
  • What health care technology is involved in the situation? What moral guidelines for using that kind of healthcare technology should be used there? Explore such guidelines also using utilitarianism, Kantian deontology, ethical egoism, or social contract ethics.
  • Say how social technologies such as blogs, crowdfunding, online encyclopedias can be used in either case. What moral guidelines for using that kind of healthcare technology should be used there? Develop such guidelines also using utilitarianism, Kantian deontology, ethical egoism, or social contract ethics.

You should not be using any text you used in a discussion board or assignment for this class or any previous class.

Cite the textbook and incorporate outside sources, including citations.


  • Length: 2-3 pages (not including title page or references page)
  • 1-inch margins
  • Double spaced
  • 12-point Times New Roman font
  • Title page
  • References page (minimum of 2 scholarly sources)

7 better ways to Conduct internal and external research

7 better ways to Conduct internal and external research

Assessment Description

The purpose of this assignment is to conduct internal and external research to determine viable solutions that could be implemented to solve an identified problem.

For this assignment, you will create an Excel spreadsheet that summarizes the data collection you have completed. The spreadsheet should indicate the date on which particular data were collected, the source of the data collected, the type of data (qualitative or quantitative), and a one- or two-sentence summary of the data findings. Name the Excel spreadsheet as follows: lastname.firstname.datacollection.xlsx.

Please note that as part of the research process, taking the initiative to speak with management and then requesting and reviewing business metrics and operations reports will allow you to find the data you need for the project while also showing your employer that you can be proactive and use critical thinking to solve problems within the organization.

Part 1:

The first step in data collection is to conduct research. You are looking for specific, measurable data (statistics and numbers) related to how the problem is affecting the organization. This information should be recorded in the form of a chart or graph that presents the data so key decision makers can see the “cost” of failing to address the problem. Use the study materials for assistance with creating Excel graphs and charts that can be used to illustrate your findings.

Part 2:

conduct internal and external research

conduct internal and external research

Next, conduct additional research to learn what has already been done to address this problem within the organization. Ask questions and interview individuals who assisted with the implementation of previous solutions used to address the problem.

Prior to meeting with individuals, develop a list of questions about previous solutions. Consider factors such as customer importance, efficiency, quality, employee satisfaction, and cost effectiveness. You will want to make sure you ask questions that allow you to gather measurable data and include information about how successful previous solution options were in addressing each of the problems. When you have completed your research, the findings should be summarized in an illustration using at least one chart or graph that represents the data you have collected. Use the study materials for assistance with creating Excel graphs and charts that can be used to illustrate your findings.

Part 3:

The last step in determining potential solutions is to conduct external research. Using Internet and industry resources, research ways other companies have addressed this issue or one very similar to it. Look for specific information related to the customer response, efficiency, quality, employee satisfaction, and cost effectiveness of solutions others have implemented.

Find at least five potential solutions you can consider for solving the problem you have identified. Your goal in conducting this research is to find practical examples and measurable data related to how other companies, and related industries, have resolved the same problem or one very similar to it. When you have completed your research, the findings should be summarized in an illustration using at least one chart or graph, representing the data you have collected. Use the study materials for assistance with creating Excel graphs and charts, as this will help illustrate your findings.

Submit the data collection Excel spreadsheet and the three data summary charts/graphs you have created from the research conducted to your instructor.

The three charts/graphs you create will be used again in your Business Proposal Presentation in Topic 7, as well as within the Final Business Proposal you will submit in Topic 8. Evidence of revision from instructor feedback will be assessed on the final business proposal.

General Requirements:

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

BS Applied Management

2.1 Analyze qualitative and quantitative methods of research.

2.2 Develop data collection plans for action research in organizations.  


Source of DateDate Data CollectedDescription of DataType of DataAnticipated Hypothesis Test

E-commerce Best 6 pages with 10 slides

E-commerce Best 6 pages with 10 slides

E-commerce Project

(Part A)


In this project, you are required to evaluate the website below. The evaluation will cover the different aspects of E-commerce such as business idea, website design, marketing, security … etc.



You will need to analyze the business and provide suggestions to improve the current business situation.

The following questions require critical thinking to be answered successfully. The answers to these questions will drive the ways of improvement of the current e-commerce business.

1.Know the business

1. What is the business?

(Introduce the e-commerce business you have chosen).

1. What is the idea?

(Provide an overview of the business idea & The visioning process).

1. What are the type of products and/or services provided?

(Explain the products and services does the online store provide such as customer service, exchange and return, delivery, and payment options).

1. Explain the business statement, business vision and business objective.

1. Where is the money?

(Explain the company’s business model and the revenue model. Give a general idea of how the business generates revenues)

1. Who and where is the target audience?

(Explain demographics, lifestyle, consumption patterns, etc.).

1. Characterize the marketplace

(Research the market and give an idea about the size, growth, demographics, structure, competition).

1. Describe the content of the business website

1. Conduct a SWOT analysis for the business

(Provide 3 points each)

1. Develop an e-commerce presence map.

(For example: website, email … etc. What activities does the company use these platforms for? (E.g., marketing, customer service, news…etc.).

2.Explain the design of the system

Explain in detail the design of the system (business objectives, system functionality, information provided)

Business ObjectiveSystem FunctionalityInformation provided
Ex: Display goodsDigital CatalogDynamic text and graphics catalog

What can be improved or added into the system design?

3.Explain the current business e-commerce features

What are the current website features? And what types of these features can be annoying to customers? Provide pictures.

(What can you do to improve the current features on the website?)

4.Explain the business e-commerce process

Explain in detail all the steps from the time user enters the website until the final user buys a product.

(What can be improved in the process?)

(Part B)


This is a continuous activity for part A, keep working on the same website in part A. In this part you are required to evaluate the website. The evaluation will cover the different aspects of E-Commerce such as business idea, website design, marketing, security … etc. You will need to analyze the business and provide suggestions to improve the current business situation. The following questions require critical thinking to be answered successfully. The answers to these questions will drive the ways of improvement of the current e-commerce business.

5.Site Design

Evaluate the website design focusing on the eight most important factors in successful ecommerce site design (ease of use, ease of purchase, simple graphics … etc.). You are required to evaluate each factor.

(Discuss possible suggestions to improve the site design).

6.Business software

The development of an e-commerce website requires more interactive functionalities, such as the ability to respond to user input (name and address forms), capturing customer orders for goods and services, clearing credit card transactions on the fly, consolidating price and product databases, and even adjusting advertising on the screen based on user characteristics.

(Explain the different types of software used on the website to perform the current functionalities). What can be done to improve the software?

7.Payment and Security

1. What are the methods of payment available in the online store?

(What other methods can be added? Explain why?)

1. What are the technologies used on the website to secure the online transactions?

(What other technologies can be added? Explain why?)

1. What is the current privacy policy of the online store? Outline how the information is collected and used? (What can be added to the privacy policy? Explain why?)

8.Categorize marketing and advertising strategy and method

Explain the current online, offline, and social media marketing strategies of the e-commerce business? (Provide photos or screenshots of your business marketing activities, What can be done to improve the marketing aspects of the business?)

9.Know your competitors

Choose a website of one competitor in the same industry (locally or globally) and compare it with your chosen company’s site. Indicate why the competitor’s website is better or worse than the chosen company’s website. (What can be done by learning from your competitor’s experience?)

10.Conclude your report

Summarize the above points and include your recommendation to improve the e-commerce business.

E-commerce Project



Upon completing the project – Parts A and B, you will be asked to create a powerpoint presentation of the same e-commerce business as in Part A and B. The presentation should cover all the elemnts that were discussed in the project as listed below:

Presentation must have the following format:

1. First slide: Cover Page

1. Business profile: Name of the business and what is your business, target market, marketplace, products and services provided.

1. Explain the business system design. (Business objectives, system functionality, information provided).

1. Explain the current business e-commerce features.

1. Explain the business e-commerce process.

1. Explain the business software

1. Explain the payment and security of the chosen website

1. What is the marketing and advertising strategy?

1. Competitor’s analysis

1. Conclusion

1. References

Guidelines for the Presentation:

1. There must be 10 slides in the presentation.

1. The slides should have a clear background design, readable font size and style with appropriate color.

1. The power-point presentation must answer all the above parts.

1. Make sure to include the cover page in the first slide.

1. Ensure that you follow the APA style in your references.

1. The minimum number of required references is 5 references using APA style

1. You must avoid plagiarism on this PowerPoint Presentation.

Guidelines for the project part A & B:

0. You must avoid plagiarism on this project.

0. Ensure that you follow the APA style in the project and references.

0. The minimum number of required references is 5 references using APA style.

0. The whole project report length should be between 1250 to 1600 words.

0. You must check the spelling and grammar for any mistakes.

1. You must check the spelling and grammar for any mistakes.

Embed course material concepts, principles, and theories (which require supporti

Embed course material concepts, principles, and theories (which require supporti

Embed course material concepts, principles, and theories (which require supporting citations) in your initial response along with at least one scholarly, peer-reviewed journal article. Keep in mind that these scholarly references can be found in the Saudi Digital Library by conducting an advanced search specific to scholarly references. Use Saudi Electronic University academic writing standards and APA style guidelines. 500 words 2 references

Use any Statistics Software except Excel and do the following work Download, cal

Use any Statistics Software except Excel and do the following work
Download, cal

Use any Statistics Software except Excel and do the following work
Download, calculate, and interpret the descriptive statistics of the quarterly effective Federal Funds rate (FEDFUNDS) from Fred : . Your answer should include the Code, output, graph, and analysis.

Instructions: Why is the existence of evil and suffering such a problem for the

Why is the existence of evil and suffering such a problem for the

Why is the existence of evil and suffering such a problem for the Christian worldview?
Does any other worldview beside Christian theism have an answer to pain and suffering? Discuss.
Summarize possible theistic responses to the problem of evil, including natural catastrophes.
Read and reflect on the assigned material carefully. In some cases there are no right or wrong answers to the questions; what I am looking for is thoughtful engagement with each question. Be sure to answer all parts of each question.
Make use of Gilson and Weitnauer, eds., True Reason, chap. 15