The issues that you would need to be sensitive to when interacting with the patient

Discussion 2: Diversity and Health Assessments

In May 2012, Alice Randall wrote an article for The New York Times on the cultural factors that encouraged black women to maintain a weight above what is considered healthy. Randall explained—from her observations and her personal experience as a black woman—that many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, “Many black women are fat because we want to be” (Randall, 2012).

Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the health care field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and health care professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity.

In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds.

Case 1

Subjective Data

CC: “I came for my annual physical exam, but do not want to be a burden to my daughter.”

History of Present Illness (HPI): At-risk 86-year-old Asian male – who is physically and financially dependent on his daughter, a single mother who has little time or money for her father’s health needs.

PMH: hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency and chronic prostatitis

PSH: S/P cholecystectomy

Drug Hx:

Current Meds: Lisinopril 10mg daily, Prilosec 20mg daily, B12 injections monthly, and cipro 100mg daily.

Review of Systems (ROS)

General: + weight loss of 25 lbs over the past year; no recent fatigue, fever or chills.

Head, eyes, ears, nose & throat (HEENT): no changes in vision or hearing, no difficulty chewing or swallowing.

Neck: no pain or injury

Respiratory:

CV:

GI:

GU: no urinary hesitancy or change in urine stream

Integument: multiple bruises on his upper arms and back.

MS/Neuro: + falls x 2 within the last 6 months; no syncopal episodes or dizziness

Psych:

Objective Data

PE: B/P 188/96; Pulse 89; RR 16; Temp 99.0; Ht 5,6; wt 110; BMI 17.8

HEENT: Atraumatic, normocephalic, PERRLA, EOMI, arcus senilus bilaterally, conjunctiva and sclera clear, nares patent, ornasopharynx clear, edentulous.

Lungs: CTA AP&L

Cor: S1S2 without rub or gallop

Abd: benign, normoactive bowel sounds x 4

Ext: no cyanosis, clubbing or edema

Integument: multiple bruises in different stages of healing – on his upper arms and back.

Neuro: No obvious deformities, CN grossly intact II-XII

Case 2

Subjective Data

CC: “I am here for my annual physical exam and have been having vaginal discharge.”

History of Present Illness (HPI): 32-year-old pregnant lesbian – her pregnancy has been without complication thus far. She has been receiving prenatal care from an obstetrician. She received sperm from a local sperm bank.

Drug Hx:

Current Medications: prenatal vitamins and takes Tylenol over the counter for aches and pains on occasion

Family Hx: She a strong family history of diabetes. Gravida 1; Para 0; Abortions 0.

Review of Systems (ROS)

General: no fatigue, fever or chills.

Head, eyes, ears, nose & throat (HEENT):

Neck: no pain or injury

Respiratory:

CV:

GI:

GU:

Integument: multiple piercings, and tattoos. Old scars related to “cutting”.

Neuro: no syncopal episodes or dizziness, no change in memory or thinking patterns; no twitches or abnormal movements

Objective Data

PE: B/P 128/76; Pulse 83; RR 16; Temp 99.0; Ht 5,6; wt 128; BMI 20.98

HEENT: Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, ornasopharynx clear, good dentition. Piercing in her right nostril and lower lip.

Lungs: CTA AP&L

Cor: S1S2 without rub or gallop

Abd: benign, normoactive bowel sounds x 4

GU: external genitalia intact, no lesions or masses. White copious discharge with an amine odor; no cervical motion tenderness; adenxa intact.

Ext: no cyanosis, clubbing or edema

Integument: intact without lesions masses or rashes.

Neuro: No obvious deficits and CN grossly intact II-XII

Case 3

Subjective Data

CC: “Annual physical exam”

History of Present Illness (HPI): 23-year-old Native American male comes in to see you because he has been having anxiety and wants something to help him. He has been smoking “pot” and says he drinks to help him too. He tells you he is afraid that he will not get into Heaven if he continues in this lifestyle.

Drug Hx:

Current medication – denied

Allergies: no allergies to food or medications.

Family history: is very positive for diabetes, hypertension, and alcoholism.

Review of Systems (ROS)

General: no recent weight gains of losses, fatigue, fever or chills. Head, eyes, ears, nose & throat (HEENT):

Neck:

Respiratory:

CV: no chest discomfort or palpitations

GI:

GU:

Integument: history of eczema – not active

MS/Neuro: no syncopal episodes or dizziness, no change in memory or thinking patterns; no twitches or abnormal movements

Psych:

Objective Data

PE: B/P 158/90; Pulse 88; RR 18; Temp 99.2; Ht 5,7; wt 208; BMI 32.6

General: 23 year old male appears well developed and well nourished. He is anxious – pacing in the room and fidgeting, but in no acute distress.

HEENT: Atraumatic, normocephalic, PERRLA, EOMI, sclera with mild icterus, nares patent, ornasopharynx clear, poor dentition – multiple carries.

Lungs: CTA AP&L

Cor: S1S2, +II/VI holosystolic murmur; without rub or gallop

Abd: benign, normoactive bowel sounds x 4; Hepatomegaly 2cm below the costal margin.

Ext: no cyanosis, clubbing or edema

Integument: intact without lesions masses or rashes.

Neuro: No obvious deficits and CN grossly intact II-XII

To prepare:

  • Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.
  • Select one of the three case studies. Reflect on the provided patient information.
  • Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient you selected.
  • Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
  • Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?

By Day 3

Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you selected. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

Psychological Testing and Assessment

Psychological Testing and Assessment

According to Cohen and Swerdlik (2018), Reliability means to be consistent. In psychometric terms, the meaning of reliability is based on when something is said to be consistent. The book defines “a reliability coefficient is an index of reliability, a proportion that indicates the ratio between the true score variance on a test and the total variance” (Cohen & Swerdlik, 2018, p. 141). Moreover, in testing and assessment there exist three sources of error variance such as test construction, test administration, and test scoring and interpretation. The text state that a measurement error is everything that is associated with the process of the variable being measured instead of the variable being measured (Cohen & Swerdlik, 2018)Psychological Testing and Assessment.

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Internal consistency reliability coefficient = .92

According to Cohen and Swerdlik (2018), states that internal consistency reliability is when a one can obtain an estimation of a test being reliable without creating a different form of the test nor administering the same test twice to the same individual (Cohen & Swerdlik, 2018). Furthermore, a test that has an Internal consistency reliability coefficient = .92 means that the item on the test must relate to one another and it also means that there exists a strong relationship between the content of the test. As I mentioned at the beginning of the post reliability means to be consistent. The higher the coefficient, the more reliable the test is. A .92 means that the test has excellent reliability and it is acceptable.

Alternate forms reliability coefficient = .82

According to Cohen and Swerdlik (2018), states that alternate forms are different types of test that are built to be parallel. Hence, the reliability of the alternate forms refers to “an estimate of the extent to which these different forms of the same test have been affected by item sampling error, or other error” (Cohen & Swerdlik, 2018, p. 149). An example we can use is when a person is given two different versions of the same test at a different time.

Test-retest reliability coefficient = .50

According to Cohen and Swerdlick (2018), A test-retest reliability is when a test is administered twice at two different points of time. Moreover, one we have to evaluate the reliability of a test-retest that purport to measure is fairly stable over time (Cohen & Swerdlik, 2018)Psychological Testing and Assessment.

The higher the coefficient, the more reliable the test is. .92 means that the test has excellent reliability and it is acceptable the higher, the greater. An Alternate forms reliability coefficient = .82 is still high reliability, and it is also acceptable. A test-retest is a correlation of the same test over two administrator which relates to stability that involves scores. The book states that the more extended time has, the higher the chances that the reliability coefficient will be lower. Therefore, the passage of time may be an error of variance (Cohen & Swerdlik, 2018). Thus, depending on what the individual has been through some traumatic event it may also create an error variance which will impact their score variance and which will change, and the reliability will be lower than if that individual did not have any traumatic event. Therefore, if it is below .50 is not considered to be a reliable test nor acceptable. The book also states that “If we are to come to proper conclusions about the reliability of the measuring instrument, evaluation of a test-retest reliability estimate must extend to a consideration of possible intervening factors between test administrations” (Cohen & Swerdlik, 2018, p. 146)Psychological Testing and Assessment.

Reference

Cohen, R. J., Swerdlik, M. (2018). Psychological Testing and Assessment. [Capella]. Retrieved from https://capella.vitalsource.com/#/books/1260303195/

Emotional and Social Development in Middle Adulthood

Emotional and Social Development in Middle Adulthood

Midlife is a time of increased generativity—giving to and guiding younger generations. Charles Callis, director of New Zealand’s Olympic Museum, shows visiting schoolchildren how to throw a discus. His enthusiastic demonstration conveys the deep sense of satisfaction he derives from generative activities.

chapter outline

·   Erikson’s Theory: Generativity versus Stagnation

· ■  SOCIAL ISSUES: HEALTH  Generative Adults Tell Their Life Stories

Other Theories of Psychosocial Development in Midlife  

·   Levinson’s Seasons of Life

·   Vaillant’s Adaptation to Life

·   Is There a Midlife Crisis? Emotional and Social Development in Middle Adulthood

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·   Stage or Life Events Approach

Stability and Change in Self-Concept and Personality

·   Possible Selves

·   Self-Acceptance, Autonomy, and Environmental Mastery

·   Coping with Daily Stressors

·   Gender Identity

·   Individual Differences in Personality Traits

· ■  BIOLOGY AND ENVIRONMENT  What Factors Promote Psychological Well-Being in Midlife?

Relationships at Midlife

·   Marriage and Divorce

·   Changing Parent–Child Relationships

·   Grandparenthood

·   Middle-Aged Children and Their Aging Parents

·   Siblings

·   Friendships

· ■  SOCIAL ISSUES: HEALTH  Grandparents Rearing Grandchildren: The Skipped-Generation Family

·   Vocational Life

·   Job Satisfaction

·   Career Development

·   Career Change at Midlife

·   Unemployment

·   Planning for Retirement

 

One weekend when Devin, Trisha, and their 24-year-old son, Mark, were vacationing together, the two middle-aged parents knocked on Mark’s hotel room door. “Your dad and I are going off to see a crafts exhibit,” Trisha explained. “Feel free to stay behind,” she offered, recalling Mark’s antipathy toward attending such events as an adolescent. “We’ll be back around noon for lunch.”

“That exhibit sounds great!” Mark replied. “I’ll meet you in the lobby.”

“Sometimes I forget he’s an adult!” exclaimed Trisha as she and Devin returned to their room to grab their coats. “It’s been great to have Mark with us—like spending time with a good friend.” Emotional and Social Development in Middle Adulthood

In their forties and fifties, Trisha and Devin built on earlier strengths and intensified their commitment to leaving a legacy for those who would come after them. When Mark faced a difficult job market after graduating from college, he returned home to live with Trisha and Devin and remained there for several years. With their support, he took graduate courses while working part-time, found steady employment in his late twenties, fell in love, and married in his mid-thirties. With each milestone, Trisha and Devin felt a sense of pride at having escorted a member of the next generation into responsible adult roles. Family activities, which had declined during Mark’s adolescent and college years, increased as Trisha and Devin related to their son as an enjoyable adult companion. Challenging careers and more time for community involvement, leisure pursuits, and each other contributed to a richly diverse and gratifying time of life.

 

The midlife years were not as smooth for two of Trisha and Devin’s friends. Fearing that she might grow old alone, Jewel frantically pursued her quest for an intimate partner. She attended singles events, registered with dating services, and traveled in hopes of meeting a like-minded companion. “I can’t stand the thought of turning 50,” she lamented in a letter to Trisha. Jewel also had compensating satisfactions—friendships that had grown more meaningful, a warm relationship with a nephew and niece, and a successful consulting business.

Tim, Devin’s best friend from graduate school, had been divorced for over five years. Recently, he had met Elena and had come to love her deeply. But Elena was in the midst of major life changes. In addition to her own divorce, she was dealing with a troubled daughter, a career change, and a move away from the city that served as a constant reminder of her unhappy past. Whereas Tim had reached the peak of his career and was ready to enjoy life, Elena wanted to recapture much of what she had missed in earlier decades, including opportunities to realize her talents. “I don’t know where I fit into Elena’s plans,” Tim wondered aloud on the phone with Trisha.

With the arrival of middle adulthood, half or more of the lifespan is over. Increasing awareness of limited time ahead prompts adults to reevaluate the meaning of their lives, refine and strengthen their identities, and reach out to future generations. Most middle-aged people make modest adjustments in their outlook, goals, and daily lives. But a few experience profound inner turbulence and initiate major changes, often in an effort to make up for lost time. Together with advancing years, family and work transitions contribute greatly to emotional and social development Emotional and Social Development in Middle Adulthood.

More midlifers are addressing these tasks than ever before, now that the baby boomers have reached their forties, fifties, and sixties (see  page 12  in  Chapter 1  to review how baby boomers have reshaped the life course). Indeed, 45- to 54-year-olds are currently the largest age sector of the U.S. population, and they are healthier, better educated, and—despite the late-2000s recession—more financially secure than any previous midlife cohort (U.S. Census Bureau,  2012b ; Whitbourne & Willis,  2006 ). As our discussion will reveal, they have brought increased self-confidence, social consciousness, and vitality—along with great developmental diversity—to this period of the lifespan.

A monumental survey called Midlife Development in the United States (MIDUS), conducted in the mid-1990s, has contributed enormously to our understanding of midlife emotional and social development. Conceived by a team of researchers spanning diverse fields, including psychology, sociology, anthropology, and medicine, the aim of MIDUS was to generate new knowledge on the challenges faced by middle-aged adults. Its nationally representative sample included over 7,000 U.S. 25- to 75-year-olds, enabling those in the middle years to be compared with younger and older individuals. Through telephone interviews and self-administered questionnaires, participants responded to over 1,100 items addressing wide-ranging psychological, health, and background factors, yielding unprecedented breadth of information in a single study (Brim, Ryff, & Kessler,  2005 ). The research endeavor also included “satellite” studies, in which subsamples of respondents were questioned in greater depth on key topics. And it has been extended longitudinally, with 75 percent of the sample recontacted at first follow-up, in the mid-2000s (Radler & Ryff,  2010 )Emotional and Social Development in Middle Adulthood.

MIDUS has greatly expanded our knowledge of the multidimensional and multidirectional nature of midlife change, and it promises to be a rich source of information about middle adulthood and beyond for many years to come. Hence, our discussion repeatedly draws on MIDUS, at times delving into its findings, at other times citing them alongside those of other investigations. Let’s turn now to Erikson’s theory and related research, to which MIDUS has contributed.

Erikson’s Theory: Generativity versus Stagnation

 

Through his work with severely malnourished children in Niger, this nurse, affiliated with the Nobel Prize–winning organization Doctors Without Borders, integrates personal goals with a broader concern for society.

Erikson’s psychological conflict of midlife is called  generativity versus stagnation.  Generativity involves reaching out to others in ways that give to and guide the next generation. Recall from  Chapter 14  that generativity is under way in early adulthood through work, community service, and childbearing and child rearing. Generativity expands greatly in midlife, when adults focus more intently on extending commitments beyond oneself (identity) and one’s life partner (intimacy) to a larger group—family, community, or society. The generative adult combines the need for self-expression with the need for communion, integrating personal goals with the welfare of the larger social world (McAdams & Logan,  2004 ). The resulting strength is the capacity to care for others in a broader way than previously.

Erikson ( 1950 ) selected the term generativity to encompass everything generated that can outlive the self and ensure society’s continuity and improvement: children, ideas, products, works of art. Although parenting is a major means of realizing generativity, it is not the only means: Adults can be generative in other family relationships (as Jewel was with her nephew and niece), as mentors in the workplace, in volunteer endeavors, and through many forms of productivity and creativity.

Notice, from what we have said so far, that generativity brings together personal desires and cultural demands. On the personal side, middle-aged adults feel a need to be needed—to attain symbolic immortality by making a contribution that will survive their death (Kotre,  1999 ; McAdams, Hart, & Maruna,  1998 )Emotional and Social Development in Middle Adulthood. This desire may stem from a deep-seated evolutionary urge to protect and advance the next generation. On the cultural side, society imposes a social clock for generativity in midlife, requiring adults to take responsibility for the next generation through their roles as parents, teachers, mentors, leaders, and coordinators (McAdams & Logan,  2004 ). And according to Erikson, a culture’s “belief in the species”—the conviction that life is good and worthwhile, even in the face of human destructiveness and deprivation—is a major motivator of generative action. Without this optimistic worldview, people would have no hope of improving humanity.

The negative outcome of this stage is stagnation: Once people attain certain life goals, such as marriage, children, and career success, they may become self-centered and self-indulgent. Adults with a sense of stagnation express their self-absorption in many ways—through lack of interest in young people (including their own children), through a focus on what they can get from others rather than what they can give, and through taking little interest in being productive at work, developing their talents, or bettering the world in other ways.

Some researchers study generativity by asking people to rate themselves on generative characteristics, such as feelings of duty to help others in need or obligation to be an involved citizen. Others ask open-ended questions about life goals, major high points, and most satisfying activities, rating people’s responses for generative references. And still others look for generative themes in people’s narrative descriptions of themselves (Keyes & Ryff,  1998a ,  1998b ; McAdams,  2006 ,  2011 ; Newton & Stewart,  2010 ; Rossi,  2001 ,  2004 ). Whichever method is used, generativity tends to increase in midlife. For example, in longitudinal and cross-sectional studies of college-educated women, and in an investigation of middle-aged adults diverse in SES, self-rated generativity rose throughout middle adulthood (see  Figure 16.1 ). At the same time, participants expressed greater concern about aging, increased security with their identities, and a stronger sense of competence (Miner-Rubino, Winter, & Stewart,  2004 ; Stewart, Ostrove, & Helson,  2001 ; Zucker, Ostrove, & Stewart,  2002 ). As the Social Issues: Health box on  page 534  illustrates, generativity is also a major unifying theme in middle-aged adults’ life stories.

 

FIGURE 16.1 Age-related changes in self-rated generativity, concern about aging, identity security, and sense of competence.

In a longitudinal study of over 300 college-educated women, self-rated generativity increased from the thirties to the fifties, as did concern about aging. The rise in generativity was accompanied by other indicators of psychological health—greater security with one’s identity and sense of competence.

(Adapted from Stewart, Ostrove, & Helson, 2001.)

Just as Erikson’s theory suggests, highly generative people appear especially well-adjusted—low in anxiety and depression; high in autonomy, self-acceptance, and life satisfaction; and more likely to have successful marriages and close friends (Ackerman, Zuroff, & Moskowitz,  2000 ; An & Cooney,  2006 ; Grossbaum & Bates,  2002 ; Westermeyer,  2004 ). They are also more open to differing viewpoints, possess leadership qualities, desire more from work than financial rewards, and care greatly about the welfare of their children, their partner, their aging parents, and the wider society (Peterson,  2002 ; Peterson, Smirles, & Wentworth,  1997 ). Furthermore, generativity is associated with more effective child rearing—higher valuing of trust, open communication, transmission of generative values to children, and an authoritative style (Peterson,  2006 ; Peterson & Duncan,  2007 ; Pratt et al.,  2008 ). Generative midlifers are also more involved in political activities, including voting, campaigning, and contacting public officials (Cole & Stewart,  1996 )Emotional and Social Development in Middle Adulthood.

Although these findings characterize adults of all backgrounds, individual differences in contexts for generativity exist. Having children seems to foster generative development in both men and women. In several studies, including the MIDUS survey, fathers scored higher in generativity than childless men (Marks, Bumpass, & Jun,  2004 ; McAdams & de St. Aubin,  1992 ; Snarey et al.,  1987 ). Similarly, in an investigation of well-educated women from ages 43 to 63, those with family commitments (with or without a career) expressed greater generative concerns than childless women who were solely focused on their careers (Newton & Stewart,  2010 ). Parenting seems to spur especially tender, caring attitudes toward succeeding generations.

For low-SES men with troubled pasts as sons, students, workers, and intimate partners, fatherhood can provide a context for highly generative, positive life change (Roy & Lucas,  2006 ). At times, these fathers express this generativity as a refusal to pass on their own history of suffering. As one former gang member, who earned an associate’s degree and struggled to keep his teenage sons off the streets, explained, “I came through the depths of hell to try to be a father. I let my sons know, ‘You’re never without a daddy, don’t you let anybody tell you that.’ I tell them that if me and your mother separate, I make sure that wherever I go, I build something for you to come to” ( p. 153 )Emotional and Social Development in Middle Adulthood

Social Issues: Health Generative Adults Tell Their Life Stories

In research aimed at understanding how highly generative adults make sense of their lives, Dan McAdams and his colleagues interviewed two groups of midlifers: those who often behave generatively and those who seldom do. Participants were asked to relate their life stories, including a high point, a low point, a turning point, and important scenes from childhood, adolescence, and adulthood (McAdams,  2006 ,  2011 ; McAdams et al.,  2001 ). Analyses of story lines and themes revealed that adults high and low in generativity reconstruct their past and anticipate their future in strikingly different ways.

Narratives of highly generative people usually contained an orderly sequence of events that the researchers called a commitment story, in which adults give to others as a means of giving back to family, community, and society (McAdams,  2006 )Emotional and Social Development in Middle Adulthood. The generative storyteller typically describes an early special advantage (such as a good family or a talent), along with early awareness of the suffering of others. This clash between blessing and suffering motivates the person to view the self as “called,” or committed, to being good to others. In commitment stories, the theme of redemption is prominent. Highly generative adults frequently describe scenes in which extremely negative life events, involving frustration, failure, loss, or death, are redeemed, or made better, by good outcomes—personal renewal, improvement, and enlightenment.

Consider a story related by Diana, a 49-year-old fourth-grade teacher. Born in a small town to a minister and his wife, Diana was a favorite among the parishioners, who showered her with attention and love. When she was 8, however, her life hit its lowest point: As she looked on in horror, her younger brother ran into the street and was hit by a car; he died later that day. Afterward, Diana, sensing her father’s anguish, tried—unsuccessfully—to be the “son” he had lost. But the scene ends on an upbeat note, with Diana marrying a man who forged a warm bond with her father and who became accepted “as his own son.” One of Diana’s life goals was to improve her teaching, because “I’d like to give something back … to grow and help others grow” (McAdams et al.,  1997 , p. 689). Her interview overflowed with expressions of generative commitment.

Whereas highly generative adults tell stories in which bad scenes turn good, less generative adults relate stories with themes of contamination, in which good scenes turn bad. For example, a good first year of college turns sour when a professor grades unfairly. A young woman loses weight and looks good but can’t overcome her low self-esteem.

Why is generativity connected to life-story redemption events? First, some adults may view their generative activities as a way to redeem negative aspects of their lives. In a study of the life stories of ex-convicts who turned away from crime, many spoke of a strong desire to do good works as penance for their transgressions (Maruna,  2001 ; Maruna, LeBel, & Lanier,  2004 ). Second, generativity seems to entail the conviction that the imperfections of today can be transformed into a better tomorrow. Through guiding and giving to the next generation, mature adults increase the chances that the mistakes of the past will not happen again. Finally, interpreting one’s own life in terms of redemption offers hope that hard work will lead to future benefits—an expectation that may sustain generative efforts of all kinds, from rearing children to advancing communities and societies Emotional and Social Development in Middle Adulthood.

Life stories offer insight into how people imbue their lives with meaning and purpose. Adults high and low in generativity do not differ in the number of positive and negative events included in their narratives. Rather, they interpret those events differently. Commitment stories, filled with redemption, involve a way of thinking about the self that fosters a caring, compassionate approach to others (McAdams & Logan,  2004 ). Such stories help people realize that although their own personal story will someday end, other stories will follow, due in part to their own generative efforts.

The more redemptive events adults include in their life stories, the higher their self-esteem, life satisfaction, and certainty that the challenges of life are meaningful, manageable, and rewarding (Lilgendahl & McAdams,  2011 ; McAdams,  2001 ). Researchers still have much to learn about factors that lead people to view good as emerging from adversity Emotional and Social Development in Middle Adulthood.

 

Carlos Arredondo, who lost his older son in the Iraq War and his younger son to suicide, now travels the country, telling the story of how he overcame despair and committed himself to campaigning for peace in his sons’ memory. After the Boston Marathon bombings in April 2013, Arredondo, a spectator, leapt into action and rescued this gravely injured bystander.

Finally, compared with Caucasians, African Americans more often engage in certain types of generativity. They are more involved in religious groups and activities, offer more social support to members of their community, and are more likely to view themselves as role models and sources of wisdom for their children (Hart et al.,  2001 ). A life history of strong support from church and extended family may strengthen these generative values and actions. Among Caucasian Americans, religiosity and spirituality are also linked to greater generative activity (Dillon & Wink,  2004 ; Son & Wilson,  2011 ; Wink & Dillon,  2008 ). Highly generative middle-aged adults often indicate that as children and adolescents, they internalized moral values rooted in a religious tradition and sustained their commitment to those values, which provided lifelong encouragement for generative action (McAdams,  2006 )Emotional and Social Development in Middle Adulthood. Especially in individualistic societies, belonging to a religious community or believing in a higher being may help preserve generative commitments.

Other Theories of Psychosocial Development in Midlife

Erikson’s broad sketch of psychosocial change in midlife has been extended by Levinson and Vaillant. Let’s revisit their theories, which were introduced in  Chapter 14 .

Levinson’s Seasons of Life

Return to  page 470  to review Levinson’s eras (seasons of life). His interviews with adults revealed that middle adulthood begins with a transition, during which people evaluate their success in meeting early adulthood goals. Realizing that from now on, more time will lie behind than ahead, they regard the remaining years as increasingly precious. Consequently, some make drastic revisions in their life structure: divorcing, remarrying, changing careers, or displaying enhanced creativity. Others make smaller changes in the context of marital and occupational stability.

· Whether these years bring a gust of wind or a storm, most people turn inward for a time, focusing on personally meaningful living (Neugarten,  1968b ). According to Levinson, to reassess and rebuild their life structure, middle-aged adults must confront four developmental tasks. Each requires the individual to reconcile two opposing tendencies within the self, attaining greater internal harmony.

· ● Young–old: The middle-age person must seek new ways of being both young and old. This means giving up certain youthful qualities, transforming others, and finding positive meaning in being older. Perhaps because of the double standard of aging (see  pages 516 – 517  in  Chapter 15 ), most middle-aged women express concern about appearing less attractive as they grow older (Rossi,  2005 )Emotional and Social Development in Middle Adulthood. But middle-aged men—particularly non-college-educated men, who often hold blue-collar jobs requiring physical strength and stamina—are also highly sensitive to physical aging. In one study, they were more concerned about physical changes than both college- and non-college-educated women, who exceeded college-educated men (Miner-Rubino, Winter, & Stewart,  2004 ).

Compared with previous midlife cohorts, U.S. baby boomers are especially interested in controlling physical changes—a desire that has helped energize a huge industry of anti-aging cosmetic products and medical procedures (Jones, Whitbourne, & Skultety,  2006 ; Lachman,  2004 ). And sustaining a youthful subjective age (feeling younger than one’s actual age) is more strongly related to self-esteem and psychological well-being among American than Western-European middle-aged and older adults (Westerhof & Barrett,  2005 ; Westerhof, Whitbourne, & Freeman,  2012 ). In the more individualistic U.S. context, a youthful self-image seems more important for viewing oneself as self-reliant and capable of planning for an active, fulfilling late adulthood Emotional and Social Development in Middle Adulthood.

Leadership and the Graduate Nursing Role

Assignment 2: Leadership and the Graduate Nursing Role

In Week 5, the Final Project will synthesize what you have discovered about the different advanced practice roles and scope of practice found in the master of nursing curriculum. Family Nurse Pactitioner You will review all roles and then examine the specialty for which you were admitted, focusing on the scope of practice, core competencies, certification requirements, and legal aspects of practice for that specific role. This week you will focus on Leadership and the Graduate Nurse Role.

The graduate nurse evidences leadership as seen in the four domains: the profession of nursing, clinical practice arena, health policy arena, and systems level. In order to complete this assignment, complete the short eighteen-question quiz (this takes approximately five minutes) about your leadership style at

Cherry, K. (2016). What’s Your Leadership Style? Learn more about your        strengths and weaknesses as a leader. Retrieved from        https://www.verywell.com/whats-your-leadership-style-3866929

In a 3- to 5-page paper (excluding the title page, references and appendices), you will address the following criteria:

  • Report your findings from the quiz:
    • What kind of leader were you?
    • How does this fit into your beliefs about your leadership style?
  • Examine the attributes of leadership that may be needed for graduate level nurses.
  • Analyze your personal leadership attributes you feel you have that will help you in your graduate nursing role. Also discuss those attributes that you feel you may need to develop in your graduate nursing role.

Finish with a quotation from a library article related to leadership in an advanced nursing role. Look in some of the known leadership journals like The Journal of Nursing Scholarship or Nursing Leadership Forum or the American Journal of Nursing, Journal of Nursing Administration, Nursing Administration Quarterly, Nursing Management or Health Care Management Review

Prevention for diabetes and cardiovascular disease

hidden 

group

Please see attachment with case study, use APA and .edu references. Thank you.

Actions for Discussion 3: Healthcare Disparities

Your text, Chapter 7, provides compelling discussion on the sociocultural ecologies of disease and illness. With focus on the text’s Case Study: Impacts of a Cultural Ecology: Historical Trauma, American Indians/Alaska Natives, and Health (p. 92-97), discuss this case by sharing perspective on the questions below.

This obviously takes some referencing (minimum of one reference beyond text is required) and expect a good 175-200 words as a guide.

Can you think of any other internal cultural patterns that cause vulnerabilities to disease?

What could the hypothetical Chalmy people do to reduce their malnutrition levels despite the constraints they face?

Edberg (2013) describes the political-economic system is how resources and social benefits are distributed in a society, and more. What are some political-economic circumstances that could impede people from engaging in wellness activities, such as exercise as prevention for diabetes and cardiovascular disease?

What could be done to reduce the health consequences of historical trauma?

Parenting Styles Worksheet

Parenting Styles Worksheet

Directions: For this assignment, you will complete the table about parenting styles by filling in the reactions of each parenting style to the behavior, by explaining the child’s perception, and by explaining possible outcomes. See the example below to assist you.

Example:

Age: 5 years old

Behavior: Call from teacher stating the 5-year-old has been aggressive toward another student at school.
Authoritarian Parent: Verbally scolds child who “knows better” and spanks the child, who is not given dessert after dinner.

Child’s perceptions: The child feels she is bad and that her parents are scary.

Possible outcomes: The child will lack problem-solving skills, parents are intimidating, unsafe. Parenting Styles Worksheet

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Authoritative Parent: Expresses disappointment and concern for feelings of the other child. Explores context of incident and reminds child of more appropriate alternatives.

Child’s perceptions: The child feels remorse, his feelings/frustration are validated by parents who do not condone nor judge.

Possible outcomes: The child learns empathy, feels unconditional positive regard from parents, and learns problem solving.

Permissive Parent: Explores context of situation and suggests child refrain from hitting.

Child’s perceptions: The child feels parents will find out what she does at school, but will not follow up.

Possible outcomes: May encourage deception.

Dismissive Parent: Did you go to school today?

Child’s perceptions: Believes parents do not care what the child does. The child feels insignificant.

Possible outcomes: The child may be subject to risky behaviors, negative peer influence, and have low motivation to succeed.

 

Now, fill in the reactions of each parenting style to the behavior by explaining the child’s perception, and by explaining possible outcomes. Cite two to three scholarly sources to support your explanations.

Age: 5 years old
Behavior: Johnny cries and holds on to his mother’s legs when she takes him to kindergarten. His teacher reports that he usually settles down within 5 minutes and is well-liked by other children.
Authoritarian Parent:

Child’s perceptions:

Possible outcomes:

Authoritative Parent:

Child’s perceptions:

Possible outcomes:

Permissive Parent:

Child’s perceptions:

Possible outcomes:

Dismissive Parent:

Child’s perceptions:

Possible outcomes: Parenting Styles Worksheet

Age: 6 years old
Behavior: Teacher reports how the child struggles to complete tasks and often seems to be daydreaming. She spends a lot of time sharpening her pencil and asking to use the restroom. At times, she pretends not to hear the teacher’s instructions, although there is no hearing impairment.
Authoritarian Parent:

Child’s perceptions:

Possible outcomes:

Authoritative Parent:

Child’s perceptions:

Possible outcomes:

Permissive Parent:

Child’s perceptions:

Possible outcomes:

Dismissive Parent:

Child’s perceptions:

Possible outcomes:

Age: 7 years old
Behavior: Bobby loves collecting rocks, which he keeps meticulously organized. While he was at school, his little sister got into his room and knocked over the box of his recent treasures. When Bobby discovered the damage, he slapped her hand angrily, leaving a red mark, which she showed her parents. When confronted, Bobby denied hitting her and blamed his mother for leaving his bedroom door open.
Authoritarian Parent:

Child’s perceptions:

Possible outcomes:

Authoritative Parent:

Child’s perceptions:

Possible outcomes:

Permissive Parent:

Child’s perceptions:

Possible outcomes:

Dismissive Parent:

Child’s perceptions:

Possible outcomes:

Age: 8 years old
Behavior: The daughter started a new school and has met new friends. Suddenly, she will not eat meat, not even chicken nuggets, which are her favorite. She claims that none of her friends eat meat, and that people who do are “gross and disgusting.” Parenting Styles Worksheet
Authoritarian Parent:

Child’s perceptions:

Possible outcomes:

Authoritative Parent:

Child’s perceptions:

Possible outcomes:

Permissive Parent:

Child’s perceptions:

Possible outcomes:

Dismissive Parent:

Child’s perceptions:

Possible outcomes:

Age: 9 years old
Behavior: The child plays competitive soccer. At a recent tournament, the hotel the team was staying in had a series of fire drills waking the team up several times. The team arrived completely exhausted the next morning for the championship game, which they lost 6-3. Naturally, they were upset by the loss, but they were positively enraged but the lack of fairness.
Authoritarian Parent:

Child’s perceptions:

Possible outcomes:

Authoritative Parent:

Child’s perceptions:

Possible outcomes:

Permissive Parent:

Child’s perceptions:

Possible outcomes:

Dismissive Parent:

Child’s perceptions:

Possible outcomes:

Age: 10 years old
Behavior: The son earns an allowance and had saved up for a new video game he had been longing for. He has been sullen lately, so his parents decide to cheer him up by offering to supplement the balance and surprise him with it today. Instead of excitement, he says he has changed his mind. When his parents question him further, he tells them he lost his money, then bursts in to tears. His parents learn that he had been getting bullied at school and had to ‘pay’ the bully to leave him alone. Parenting Styles Worksheet

Discussion Cognitive psychology

Discussion Cognitive psychology

Write a 1,050- to 1,200-word instruction paper on the processes involved with attaining expertise, reference the chapter in your text titled, “Expertise”. Anderson, J.R. (2009). Cognitive psychology and its implications (7th Ed.). New York, NY: Worth Publishers

Include the following salient points in your work:

1. Outline the stages in the development of expertise.

2. Outline the dimensions involved in the development of expertise.

3. Discuss how obtaining skills makes changes to the brain Discussion Cognitive psychology

4. EXAMPLE OF PAPER BELOW DO NOT COPY Plag FREE COPY ONLY

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The Nature of Expertise

So far in this chapter, we have considered some of the phenomena associated

with skill acquisition. An understanding of the mechanisms behind these phenomena

has come from examining the nature of expertise in various fields of

endeavor. Since the mid-1970s, there has been a great deal of research looking

at expertise in such domains as mathematics, chess, computer programming,

and physics. This research compares people at various levels of development of

their expertise. Sometimes this research is truly longitudinal and follows students

from their introduction to a field to their development of some expertise.

More typically, such research samples people at different levels of expertise. For

instance, research on medical expertise might look at students just beginning

medical school, residents, and doctors with many years of medical practice.

This research has begun to identify some of the ways that problem solving

becomes more effective with experience. Let us consider some of these dimensions

of the development of expertise. Discussion Cognitive psychology

Tactical Learning

As students practice problems, they come to learn the sequences of actions

required to solve a problem or parts of the problem. Learning to execute such

sequences of actions is called tactical learning. A tactic refers to a method that

accomplishes a particular goal. For instance, Greeno (1974) found that it took

only about four repetitions of the hobbits and orcs problem (see discussion

surrounding Figure 8.7) before participants could solve the problem perfectly.

In this experiment, participants were learning the sequence of moves to get the

creatures across the river. Once they had learned the sequence, they could simply

recall it and did not have to figure it out. Discussion Cognitive psychology

Logan (1988) argued that a general mechanism of skill acquisition involves

learning to recall solutions to problems that formerly had to be figured out. A

nice illustration of this mechanism is from a domain called alpha-arithmetic. It

entails solving problems such as _ 3, in which the participant is supposed to

say the letter that is the number of letters forward in the alphabet—in this case,

_ 3 _ I. Logan and Klapp (1991) performed an

experiment in which they gave participants problems

that included addends from 2 (e.g., _ 2) through 5

(e.g., _ 5). Figure 9.9 shows the time taken by participants

to answer these problems initially and then

after 12 sessions of practice. Initially, participants

took 1.5 s longer on the 5-addend problems than on

the 2-addend problems, because it takes longer to

count five letters forward in the alphabet than two

letters forward. However, the problems were repeated

again and again across the sessions. With repeated,

continued practice, participants became faster on all

problems, reaching the point where they could solve

the 5-addend problems as quickly as the 2-addend

problems. They had memorized the answers to these

problems and were not going through the procedure

of solving the problems by counting.1 Discussion Cognitive psychology

There is evidence that, as people become more

practiced at a task and shift from computation to

retrieval, brain activation shifts from the prefrontal

cortex to more posterior areas of the cortex. For

instance, Jenkins, Brooks, Nixon, Frackowiak, and

Passingham (1994) looked at participants learning to key out various sequences

of finger presses such as “ring, index, middle, little, middle, index, ring, index.”

They compared participants initially learning these sequences with participants

practiced in these sequences. They used PET imaging studies and found that

there was more activation in frontal areas early in learning than late in learning.2

On the other hand, later in learning, there was more activation in the hippocampus,

which is a structure associated with memory. Such results indicate that, early

in a task, there is significant involvement of the anterior cingulate in organizing

the behavior but that, late in learning, participants are just recalling the answers

from memory. Thus, these neurophysiological data are consistent with Logan’s

proposal.

Tactical learning refers to a process by which people learn specific procedures

for solving specific problems.

Strategic Learning

The preceding subsection on tactical learning was concerned with how students

learn tactics by memorizing sequences of actions to solve problems. Many small

problems repeat so often that we can solve them this way. However, large and

complex problems do not repeat exactly, but they still have

similar structures, and one can learn how to organize one’s

solution to the overall problem. Learning how to organize

one’s problem solving to capitalize on the general structure of

a class of problems is referred to as strategic learning. The

contrast between strategic and tactical learning in skill acquisition

is analogous to the distinction between tactics and strategy

in the military. In the military, tactics refers to smaller-scale

battlefield maneuvers, whereas strategy refers to higher-level

organization of a military campaign. Similarly, tactical learning

involves learning new pieces of skill, whereas strategic learning

is concerned with putting them together. Discussion Cognitive psychology

One of the clearest demonstrations of such strategic changes is in the domain

of physics problem solving. Researchers have compared novice and expert solutions

to problems like the one depicted in Figure 9.10. A block is sliding down an

inclined plane of length l, and u is the angle between the plane and the horizontal.

The coefficient of friction is m. The participant’s task is to find the velocity of the

block when it reaches the bottom of the plane. The typical novices in these studies

are beginning college students and the typical experts are their teachers.

In one study comparing novices and experts, Larkin (1981) found a difference

in how they approached the problem.

The novice’s solution typifies the reasoning backward method, which starts with

the unknown—in this case, the velocity v. Then the novice finds an equation for

calculating v. However, to calculate by this equation, it is necessary to calculate a,

the acceleration. So the novice finds an equation for calculating a; and the novice

chains backward until a set of equations is found for solving the problem.

The expert, on the other hand, uses similar equations but in the completely

opposite order. The expert starts with quantities that can be directly computed,

such as gravitational force, and works toward the desired velocity. It is also apparent

that the expert is speaking a bit like the physics teacher that he is, leaving

the final substitutions for the student. Discussion Cognitive psychology

Another study by Priest and Lindsay (1992) failed to find a difference in

problem-solving direction between novices and experts. Their study included

British university students rather than American students, and they found that

both novices and experts predominantly reasoned forward. However, their

experts were much more successful in doing so. Priest and Lindsay suggest that

the experts have the necessary experience to know which forward inferences are

appropriate for a problem. It seems that novices have two choices—reason forward,

but fail (Priest & Lindsay’s students) or reason backward, which is hard

(Larkin’s students)

Reasoning backward is hard because it requires setting goals and subgoals

and keeping track of them. For instance, a student must remember that he

or she is calculating so that can be calculated and hence so that can be

calculated. Thus, reasoning backward puts a severe strain on working memory

and this can lead to errors. Reasoning forward eliminates the need to keep

track of subgoals.

 

However, to successfully reason forward, one must know

which of the many possible forward inferences are relevant to the final solution,

which is what an expert learns with experience. He or she learns to associate

various inferences with various patterns of features in the problems. The

novices in Larkin’s study seemed to prefer to struggle with backward reasoning,

whereas the novices in Priest and Lindsay’s study tried forward reasoning

without success. Discussion Cognitive psychology

Not all domains show this advantage for forward problem solving. A good counterexample is computer programming (Anderson, Farrell, & Sauers, 1984; Jeffries, Turner, Polson, & Atwood, 1981; Rist, 1989). Both novice and expert programmers develop programs in what is called a top-down manner; that is, they

work from the statement of the problem to sub problems to sub-sub problems, and so on, until they solve the problem. This top-down development is basically the same as what is called reasoning backward in the context of geometry or physics. There are differences between expert programmers and novice programmers, however. Experts tend to develop problem solutions breadth first, whereas novices develop their solutions depth first. Physics and geometry problems have a rich set of givens that are more predictive of solutions than is the goal. In contrast, nothing in the typical statement of a programming

problem would guide a working forward or bottom-up solution. The typical problem statement only describes the goal and often does so with information that will guide a top-down solution. Thus, we see that expertise in different domains requires the adoption of those approaches that will be successful for

those particular domains. In summary, the transition from novices to experts does not entail the same

changes in strategy in all domains. Different problem domains have different structures that make different strategies optimal. Physics experts learn to reason forward; programming experts learn breadth-first expansion. Strategic learning refers to a process by which people learn to organize their

problem solving.

Problem Perception

As they acquire expertise problem solvers learn to perceive problems in ways

that enable more effective problem-solving procedures to apply. This dimension

can be nicely demonstrated in the domain of physics. Physics, being an intellectually

deep subject, has principles that are only implicit in the surface features

of a physics problem. Experts learn to see these implicit principles and represent

problems in terms of them. Discussion Cognitive psychology

Chi, Feltovich, and Glaser (1981) asked participants to classify a large set of

problems into similar categories. Figure 9.11 shows sets of problems that

novices thought were similar and the novices’ explanations for the similarity

groupings. As can be seen, the novices chose surface features, such as rotations

or inclined planes, as their bases for classification. Being a physics novice myself,

I have to admit that these seem very intuitive bases for similarity. Contrast

The Nature of Expertise | 255

Anderson7e_Chapter_09.qxd 8/20/09 9:49 AM Page 255

these classifications with the pairs of problems in Figure 9.12 that the expert

participants saw as similar. Problems that are completely different on the

surface were seen as similar because they both entailed conservation of energy

or they both used Newton’s second law. Thus, experts have the ability to map

surface features of a problem onto these deeper principles. This ability is very

useful because the deeper principles are more predictive of the method of

solution. This shift in classification from reliance on simple features to reliance

on more complex features has been found in a number of domains, including

mathematics (Silver, 1979; Schoenfeld & Herrmann, 1982), computer

programming (Weiser & Shertz, 1983), and medical diagnosis (Lesgold et al.,

1988)Discussion Cognitive psychology .

A good example of this shift in processing of perceptual features is the interpretation

of X rays. Figure 9.13 is a schematic of one of the X rays diagnosed by

participants in the research by Lesgold et al. The sail-like area in the right lung is a

shadow (shown on the left side of the X ray) caused by a collapsed lobe of the

lung that created a denser shadow in the X ray than did other parts of the lung.

Medical students interpreted this shadow as an indication of a tumor because tumors

are the most common cause of shadows on the lung. Radiological experts,

on the other hand, were able to correctly interpret the shadow as an indication of

a collapsed lung. They saw counterindicative features such as the size of the saillike

region. Thus, experts no longer have a simple association between shadows

on the lungs and tumors, but rather can see a richer set of features in X rays.

An important dimension of growing expertise is the ability to learn to perceive problems in ways that enable more effective problem-solving procedures to apply.

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Pattern Learning and Memory

A surprising discovery about expertise is that experts seem to display a special enhanced

memory for information about problems in their domains of expertise.

This enhanced memory was first discovered in the research of de Groot (1965,

1966), who was attempting to determine what separated master chess players from

weaker chess players. It turns out that chess masters are not particularly more

intelligent in domains other than chess. De Groot found hardly any differences between Discussion Cognitive psychology

expert players and weaker players—except, of course, that the expert players

chose much better moves. For instance, a chess master considers about the same

number of possible moves as does a weak chess player before selecting a move. In

fact, if anything, masters consider fewer moves than do chess duffers.

However, de Groot did find one intriguing difference between masters and weaker players.He presented chess masters with chess positions (i.e., chessboards with pieces in a configuration that occurred in a game) for just 5 s and then removed the chess pieces. The chess masters were able to reconstruct the positions of more than 20 pieces after just 5 s of study. In contrast, the chess duffers could

reconstruct only 4 or 5 pieces—an amount much more in line with the traditional capacity of working memory. Chess masters appear to have built up patterns of 4 or 5 pieces that correspond to common board configurations as a result of the massive amount of experience that they have had with chess.

Thus, they remember not individual pieces but these patterns. In line with this analysis, if the players are presented with random chessboard positions rather than ones that are actually encountered in games, no difference is demonstrated between masters and duffers—both reconstruct only a few chess positions. The masters also complain about being very uncomfortable and disturbed by such chaotic board positions.

In a systematic analysis, Chase and Simon (1973) compared novices, Class A players, and masters.

and to reproduce random positions such as those illustrated in Figure 9.14b. Figure 9.15 Discussion Cognitive psychology

shows the results. Memory was poorer for all groups for the random positions and, if anything, masters were worse at reproducing these positions. On the other hand, masters showed a considerable advantage for the actual board positions. This basic phenomenon of superior expert memory for meaningful problems has been demonstrated in a large number of domains, including the game of Go

(Reitman, 1976), electronic circuit diagrams (Egan & Schwartz, 1979), bridge hands (Engle

& Bukstel, 1978; Charness, 1979), and computer programming (McKeithen, Reitman,

Rueter, & Hirtle, 1981; Schneiderman, 1976).

Chase and Simon (1973) also used a

chessboard-reproduction task to examine the

nature of the patterns, or chunks, used by

chess masters. The participants’ task was simply to reproduce the positions of

pieces of a target chessboard on a test chessboard. In this task, participants

glanced at the target board, placed some pieces on the test board, glanced back

to the target board, placed some more pieces on the test board, and so on.

Chase and Simon defined a chunk to be a group of pieces that participants

moved after one glance. They found that these chunks tended to define

meaningful game relations among the pieces. For instance, more than half of

the masters’ chunks were pawn chains (configurations of pawns that occur

frequently in chess)Discussion Cognitive psychology .

Simon and Gilmartin (1973) estimated that chess masters have acquired

50,000 different chess patterns, that they can quickly recognize such patterns on

a chessboard, and that this ability is what underlies their superior memory performance

in chess. This 50,000 figure is not unreasonable when one considers

the years of dedicated study that becoming a chess master requires.What might

be the relation between memory for so many chess patterns and superior performance

in chess? Newell and Simon (1972) speculated that, in addition to

learning many patterns, masters have learned what to do in the presence of

such patterns. For instance, if the chunk pattern is symptomatic of a weak side,

the response might be to suggest an attack on the weak side. Thus, masters

effectively “see” possibilities for moves; they do not have to think them out,

which explains why chess masters do so well at lightning chess, in which they

have only a few seconds to move.

To summarize, chess experts have stored the solutions to many problems

that duffers must solve as novel problems. Duffers have to analyze different

configurations, try to figure out their consequences, and act accordingly.

Masters have all this information stored in memory, thereby claiming two

advantages. First, they do not risk making errors in solving these problems,

because they have stored the correct solution. Second, because they have stored

correct analyses of so many positions, they can focus their problem-solving efforts

on more sophisticated aspects and strategies of chess. Thus, the experts’

pattern learning and better memory for board positions is a part of the tactical

learning discussed earlier. The way humans become expert at chess reflects the

fact that we are very good at pattern recognition but relatively poor at things

like mentally searching through sequences of possible moves. As the Implications

box describes, human strengths and weaknesses lead to a very different

way of achieving expertise at chess than we see in computer programs for playing

chess Discussion Cognitive psychology .

260 | Expertise

chess in the 1960s, was beaten by the program of an

MIT undergraduate, Richard Greenblatt, in 1966 (Boden,

2006, discusses the intrigue surrounding

these events). However, Dreyfus was a

chess duffer and the programs of the

1960s and 1970s performed poorly

against chess masters. As computers

became more powerful and could search

larger spaces, they became increasingly

competitive, and finally in May 1997,

IBM’s Deep Blue program defeated the

reigning world champion, Gary Kasparov.

Deep Blue evaluated 200 million imagined

chess positions per second. It also

had stored records of 4,000 opening

positions and 700,000 master games

(Hsu, 2002) and had many other optimizations

that took advantage of special computer hardware.

Today there are freely available chess programs

for your personal computer that can be downloaded

over the Web and will play highly competitive chess at

a master level. These developments have led to a profound

shift in the understanding of intelligence. It once

was thought that there was only one way to achieve

high levels of intelligent behavior, and that was the

human way. Nowadays it is increasingly being accepted

that intelligence can be achieved in different ways, and

the human way may not always be the best. Also, curiously,

as a consequence some researchers no longer

view the ability to play chess as a reflection of the

essence of human intelligence.

Implications

Computers achieve computer expertise differently than humans

In Chapter 8, we discussed how human problem solving

can be viewed as a search of a problem space, consisting

of various states. The initial situation

is the start state, the situations on the

way to the goal are the intermediate

states, and the solution is the goal state.

Chapter 8 also described how people

use certain methods, such as avoiding

backup, difference reduction, and meansends

analysis, to move through the

states. Often when humans search a

problem space, they are actually manipulating

the actual physical world, as in

the 8-puzzle (Figures 8.3 and 8.4).

However, sometimes they imagine states,

as when one plays chess and contemplates

how an opponent will react to

some move one is considering, how one might react to

the opponent’s move, and so on. Computers are very

effective at representing such hypothetical states and

searching through them for the optimal goal state.

Artificial intelligence algorithms have been developed

that are very successful at all sorts of problem-solving

applications, including playing chess. This has led to a

style of chess playing program that is very different from

human chess play, which relies much more on pattern

recognition. At first many people thought that, although

such computer programs could play competent and

modestly competitive chess games, they would be no

match for the best human players. The philosopher

Hubert Dreyfus, who was famously critical of computer

Anderson7e_Chapter_09.qxd 8/20/09 9:49 AM Page 260

Experts can recognize patterns of elements that repeat in many problems,

and know what to do in the presence of such patterns without having to

think them through.

Long-Term Memory and Expertise

One might think that the memory advantage shown by experts is just a workingmemory

advantage, but research has shown that their advantage extends to

long-term memory. Charness (1976) compared experts’ memory for chess positions

immediately after they had viewed the positions or after a 30-s delay filled

with an interfering task. Class A chess players showed no loss in recall over the

30-s interval, unlike weaker participants, who showed a great deal of forgetting.

Thus, expert chess players, unlike duffers, have an increased capacity to store

information about the domain. Interestingly, these participants showed the

same poor memory for three-letter trigrams as do ordinary participants. Thus,

their increased long-term memory is only for the domain of expertise.

There is reason to believe that the memory advantage goes beyond experts’

ability to encode a problem in terms of familiar patterns. Experts appear to be

able to remember more patterns as well as larger patterns. For instance, Chase

and Simon (1973) in their study (see Figures 9.14 and 9.15) tried to identify the

patterns that their participants used to recall the chessboards. They found that

participants would tend to recall a pattern, pause, recall another pattern, pause,

and so on. They found that they could use a 2-s pause to identify boundaries

between patterns.With this objective definition of what a pattern is, they could

then explore how many patterns were recalled and how large these patterns

were. In comparing a master chess player with a beginner, they found large

differences in both measures. First, the pattern size of the master averaged

3.8 pieces, whereas it was only 2.4 for the beginner. Second, the master also

recalled an average of 7.7 patterns per board, whereas the beginner recalled an average of only Discussion Cognitive psychology

How you will address this gaps in nursing practice with your preceptor

For the initial discussion post, review the article by Miller, Drummond and Carey:

  • Miller, J., Drummond Haye, D., & Carey, K. W. (2015). 20 QUESTIONS: Evidence-based practice or sacred cow? Nursing, 45(8), 46-55. doi:10.1097/01.NURSE.0000469234.84277.95

Scenario:

  • You begin your career in an acute care hospital as a newly licensed RN. During your orientation, you observe your preceptor checking gastric feeding tube placement by injecting air and auscultating the abdomen, stopping continuous enteral tube feedings before a patient is turned or repositioned, and routinely inserting rectal tubes for patients with diarrhea. You know that ALL three (3) of these practices are currently NOT supported by nursing evidence. When asked, your preceptor responds, “This is the way we have always cared for patients with tube feedings and diarrhea.” You prepare to talk to this peer about necessary changes in nursing practice.

Initial Discussion Post:

Address the following:

  • Choose ONE (1) of the practices described in the scenario.
  • Describe how you will address this gap in nursing practice with your preceptor. Write out exactly what you might say to this RN to professionally address the current evidence for the nursing care of patients.
  • Include when and where you would communicate this information
  • Consider any additional information you might provide to your preceptor to support changing nursing practice

Base your initial post on your readings and research of this topic. Your initial post must contain a minimum of 250 words. References, citations, and repeating the question do not count towards the 250 word minimum.

Diagnosis and Management of Genitourinary Disorders

Assignment on PEDIATRIC Patient (CHILD or ADOLESCENSE

Discussion: Diagnosis and Management of Genitourinary Disorders

Case Study :

Mark is a 15-year-old with complaint of acute left scrotal pain with nausea. The pain began approximately 6 hours ago as a dull ache and has gradually worsened to where he can no longer stand without doubling over. He is afebrile and in marked pain. Physical exam is negative except for elevation of the left testicle, diffuse scrotal edema, and the presence of a blue dot sign.

To prepare:

·         Review the above provided case studies

·         Analyze the patient information.

·         Post an explanation of the differential diagnosis for the patient in the case study you selected.

·         Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis.

·         Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments.

·         Finally, explain strategies for educating patients and families on the treatment and management of the genitourinary disorder.

NOTE: This paper is on a child; not an ADULT patient.

WRITE a 11/2 (one & half) PAGE PAPER.

–Due Saturday 5/1/17; before Midnight

Must have Nursing background to take this job.

–Deliver scholarly written material not high school stuff I saw.

APA format with at least 5-6 references on your topic of choice.

—All references cited on paper and must be within 5 years old.

— Must be original and FREE OF PLAGIARISM.

NOTE: Each paper is run through Turn-it- in

Promoting health literacy in a low-income urban area

  1. Read the scenario below.
  2. Respond to the questions in full sentences. Be sure to use standard English grammar and spelling
  1. Why is information on health literacy essential for this group?
  2. What is the initial step you would take before designing the program?
  3. What role/function would you play in the beginning of the assessment phase?
  4. What role/function would you play at the end of the program?
  5. What additional resources would be needed to implement this program?

Scenario:

As a Community Health Nurse, you are assigned to develop a health literacy program at the Yvonne Learning Center to promote health literacy in a low-income urban area. This program will focus on children ages 3-7 years old, 9-12 years old and 14 to 18 years old .

You will provide basic health information and services about health and teach the children about their bodies and how having a positive attitude and good behaviors influence their health in general.

The goal of information literacy is to promote self-learning and the ability to be self-sufficient.