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Understanding Independent Samples t-Test

Statistical Technique in Review

The independent samples t-test is a parametric statistical technique used to determine significant differences between the scores obtained from two samples or groups. Since the t-test is considered fairly easy to calculate, researchers often use it in determining differences between two groups. The t-test examines the differences between the means of the two groups in a study and adjusts that difference for the variability (computed by the standard error) among the data. When interpreting the results of t-tests, the larger the calculated t ratio, in absolute value, the greater the difference between the two groups. The significance of a t ratio can be determined by comparison with the critical values in a statistical table for the t distribution using the degrees of freedom (df) for the study (see Appendix A Critical Values for Student’s t Distribution at the back of this text). The formula for df for an independent t-test is as follows:

df=(numberofsubjectsinsample1+numberofsubjectsinsample2)−2

Exampledf=(65insample1+67insample2)−2=132−2=130

The t-test should be conducted only once to examine differences between two groups in a study, because conducting multiple t-tests on study data can result in an inflated Type 1 error rate. A Type I error occurs when the researcher rejects the null hypothesis when it is in actuality true. Researchers need to consider other statistical analysis options for their study data rather than conducting multiple t-tests. However, if multiple t-tests are conducted, researchers can perform a Bonferroni procedure or more conservative post hoc tests like Tukey’s honestly significant difference (HSD), Student-Newman-Keuls, or Scheffé test to reduce the risk of a Type I error. Only the Bonferroni procedure is covered in this text; details about the other, more stringent post hoc tests can be found in Plichta and Kelvin (2013) and Zar (2010).

The Bonferroni procedure is a simple calculation in which the alpha is divided by the number of t-tests conducted on different aspects of the study data. The resulting number is used as the alpha or level of significance for each of the t-tests conducted. The Bonferroni procedure formula is as follows: alpha (α) ÷ number of t-tests performed on study data = more stringent study α to determine the significance of study results. For example, if a study’s α was set at 0.05 and the researcher planned on conducting five t-tests on the study data, the α would be divided by the five t-tests (0.05 ÷ 5 = 0.01), with a resulting α of 0.01 to be used to determine significant differences in the study.

The t-test for independent samples or groups includes the following assumptions:

1. The raw scores in the population are normally distributed.

2. The dependent variable(s) is(are) measured at the interval or ratio levels.

162

3. The two groups examined for differences have equal variance, which is best achieved by a random sample and random assignment to groups.

4. All scores or observations collected within each group are independent or not related to other study scores or observations.

The t-test is robust, meaning the results are reliable even if one of the assumptions has been violated. However, the t-test is not robust regarding between-samples or within-samples independence assumptions or with respect to extreme violation of the assumption of normality. Groups do not need to be of equal sizes but rather of equal variance. Groups are independent if the two sets of data were not taken from the same subjects and if the scores are not related (Grove, Burns, & Gray, 2013; Plichta & Kelvin, 2013). This exercise focuses on interpreting and critically appraising the t-tests results presented in research reports. Exercise 31 provides a step-by-step process for calculating the independent samples t-test.

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Copyright © 2017, Elsevier Inc. All rights reserved. 67 EXERCISE 6 Questions to Be Graded Follow your instructor ’ s directions to submit your answers to the following questions for grading. Your instructor may ask you to write your answers below and submit them as a hard copy for grading. Alternatively, your instructor may ask you to use the space below for notes and submit your answers online at http://evolve.elsevier.com/Grove/statistics/ under “Questions to Be Graded.”

Name: _______________________________________________________

Class: _____________________

Date: ___________________________________________________________________________________ 68EXERCISE 6 •

1. What are the frequency and percentage of the COPD patients in the severe airfl ow limitation group who are employed in the Eckerblad et al. (2014) study?

2. What percentage of the total sample is retired? What percentage of the total sample is on sick leave?

3. What is the total sample size of this study? What frequency and percentage of the total sample were still employed? Show your calculations and round your answer to the nearest whole percent.

4. What is the total percentage of the sample with a smoking history—either still smoking or former smokers? Is the smoking history for study participants clinically important? Provide a rationale for your answer.

5. What are pack years of smoking? Is there a signifi cant difference between the moderate and severe airfl ow limitation groups regarding pack years of smoking? Provide a rationale for your answer.

6. What were the four most common psychological symptoms reported by this sample of patients with COPD? What percentage of these subjects experienced these symptoms? Was there a sig-nifi cant difference between the moderate and severe airfl ow limitation groups for psychological symptoms?

7. What frequency and percentage of the total sample used short-acting β 2 -agonists? Show your calculations and round to the nearest whole percent.

8. Is there a signifi cant difference between the moderate and severe airfl ow limitation groups regarding the use of short-acting β 2 -agonists? Provide a rationale for your answer.

9. Was the percentage of COPD patients with moderate and severe airfl ow limitation using short-acting β 2 -agonists what you expected? Provide a rationale with documentation for your answer.

10. Are these fi ndings ready for use in practice? Provide a rationale for your answer.

Understanding Frequencies and Percentages STATISTICAL TECHNIQUE IN REVIEW Frequency is the number of times a score or value for a variable occurs in a set of data. Frequency distribution is a statistical procedure that involves listing all the possible values or scores for a variable in a study. Frequency distributions are used to organize study data for a detailed examination to help determine the presence of errors in coding or computer programming ( Grove, Burns, & Gray, 2013 ). In addition, frequencies and percentages are used to describe demographic and study variables measured at the nominal or ordinal levels. Percentage can be defi ned as a portion or part of the whole or a named amount in every hundred measures. For example, a sample of 100 subjects might include 40 females and 60 males. In this example, the whole is the sample of 100 subjects, and gender is described as including two parts, 40 females and 60 males. A percentage is calculated by dividing the smaller number, which would be a part of the whole, by the larger number, which represents the whole. The result of this calculation is then multiplied by 100%. For example, if 14 nurses out of a total of 62 are working on a given day, you can divide 14 by 62 and multiply by 100% to calculate the percentage of nurses working that day. Calculations: (14 ÷ 62) × 100% = 0.2258 × 100% = 22.58% = 22.6%. The answer also might be expressed as a whole percentage, which would be 23% in this example. A cumulative percentage distribution involves the summing of percentages from the top of a table to the bottom. Therefore the bottom category has a cumulative percentage of 100% (Grove, Gray, & Burns, 2015). Cumulative percentages can also be used to deter-mine percentile ranks, especially when discussing standardized scores. For example, if 75% of a group scored equal to or lower than a particular examinee ’ s score, then that examinee ’ s rank is at the 75 th percentile. When reported as a percentile rank, the percentage is often rounded to the nearest whole number. Percentile ranks can be used to analyze ordinal data that can be assigned to categories that can be ranked. Percentile ranks and cumulative percentages might also be used in any frequency distribution where subjects have only one value for a variable. For example, demographic characteristics are usually reported with the frequency ( f ) or number ( n ) of subjects and percentage (%) of subjects for each level of a demographic variable. Income level is presented as an example for 200 subjects: Income Level Frequency ( f ) Percentage (%) Cumulative % 1. < $40,000 2010%10% 2. $40,000–$59,999 5025%35% 3. $60,000–$79,999 8040%75% 4. $80,000–$100,000 4020%95% 5. > $100,000 105%100% EXERCISE 6 60EXERCISE 6 • Understanding Frequencies and PercentagesCopyright © 2017, Elsevier Inc. All rights reserved. In data analysis, percentage distributions can be used to compare fi ndings from different studies that have different sample sizes, and these distributions are usually arranged in tables in order either from greatest to least or least to greatest percentages ( Plichta & Kelvin, 2013 ). RESEARCH ARTICLE Source Eckerblad, J., Tödt, K., Jakobsson, P., Unosson, M., Skargren, E., Kentsson, M., & Thean-der, K. (2014). Symptom burden in stable COPD patients with moderate to severe airfl ow limitation. Heart & Lung, 43 (4), 351–357. Introduction Eckerblad and colleagues (2014 , p. 351) conducted a comparative descriptive study to examine the symptoms of “patients with stable chronic obstructive pulmonary disease (COPD) and determine whether symptom experience differed between patients with mod-erate or severe airfl ow limitations.” The Memorial Symptom Assessment Scale (MSAS) was used to measure the symptoms of 42 outpatients with moderate airfl ow limitations and 49 patients with severe airfl ow limitations. The results indicated that the mean number of symptoms was 7.9 ( ± 4.3) for both groups combined, with no signifi cant dif-ferences found in symptoms between the patients with moderate and severe airfl ow limi-tations. For patients with the highest MSAS symptom burden scores in both the moderate and the severe limitations groups, the symptoms most frequently experienced included shortness of breath, dry mouth, cough, sleep problems, and lack of energy. The research-ers concluded that patients with moderate or severe airfl ow limitations experienced mul-tiple severe symptoms that caused high levels of distress. Quality assessment of COPD patients ’ physical and psychological symptoms is needed to improve the management of their symptoms. Relevant Study Results Eckerblad et al. (2014 , p. 353) noted in their research report that “In total, 91 patients assessed with MSAS met the criteria for moderate ( n = 42) or severe airfl ow limitations ( n = 49). Of those 91 patients, 47% were men, and 53% were women, with a mean age of 68 ( ± 7) years for men and 67 ( ± 8) years for women. The majority (70%) of patients were married or cohabitating. In addition, 61% were retired, and 15% were on sick leave. Twenty-eight percent of the patients still smoked, and 69% had stopped smoking. The mean BMI (kg/m 2 ) was 26.8 ( ± 5.7). There were no signifi cant differences in demographic characteristics, smoking history, or BMI between patients with moderate and severe airfl ow limitations ( Table 1 ). A lower proportion of patients with moderate airfl ow limitation used inhalation treatment with glucocorticosteroids, long-acting β 2 -agonists and short-acting β 2 -agonists, but a higher proportion used analgesics compared with patients with severe airfl ow limitation. Symptom prevalence and symptom experience The patients reported multiple symptoms with a mean number of 7.9 ( ± 4.3) symptoms (median = 7, range 0–32) for the total sample, 8.1 ( ± 4.4) for moderate airfl ow limitation and 7.7 ( ± 4.3) for severe airfl ow limitation ( p = 0.36) . . . . Highly prevalent physical symp-toms ( ≥ 50% of the total sample) were shortness of breath (90%), cough (65%), dry mouth (65%), and lack of energy (55%). Five additional physical symptoms, feeling drowsy Understanding Frequencies and Percentages • EXERCISE 6Copyright © 2017, Elsevier Inc. All rights reserved. TABLE 1 BACKGROUND CHARACTERISTICS AND USE OF MEDICATION FOR PATIENTS WITH STABLE CHRONIC OBSTRUCTIVE LUNG DISEASE CLASSIFIED IN PATIENTS WITH MODERATE AND SEVERE AIRFLOW LIMITATION Moderate n = 42 Severe n = 49 p Value Sex, n (%)0.607 Women19 (45)29 (59) Men23 (55)20 (41)Age (yrs), mean ( SD )66.5 (8.6)67.9 (6.8)0.396Married/cohabitant n (%)29 (69)34 (71)0.854Employed, n (%)7 (17)7 (14)0.754Smoking, n %0.789 Smoking13 (31)12 (24) Former smokers28 (67)35 (71) Never smokers1 (2)2 (4)Pack years smoking, mean ( SD )29.1 (13.5)34.0 (19.5)0.177BMI (kg/m 2 ), mean ( SD )27.2 (5.2)26.5 (6.1)0.555FEV 1 % of predicted, mean ( SD )61.6 (8.4)42.2 (5.8) < 0.001SpO 2 % mean ( SD )95.8 (2.4)94.5 (3.0)0.009Physical health, mean ( SD )3.2 (0.8)3.0 (0.8)0.120Mental health, mean ( SD )3.7 (0.9)3.6 (1.0)0.628Exacerbation previous 6 months, n (%)14 (33)15 (31)0.781Admitted to hospital previous year, n (%)10 (24)14 (29)0.607Medication use, n (%) Inhaled glucocorticosteroids30 (71)44 (90)0.025 Systemic glucocorticosteroids3 (6.3)0 (0)0.094 Anticholinergic32 (76)42 (86)0.245 Long-acting β 2 -agonists30 (71)45 (92)0.011 Short-acting β 2 -agonists13 (31)32 (65)0.001 Analgesics11 (26)5 (10)0.046 Statins8 (19)11 (23)0.691 Eckerblad, J., Tödt, K., Jakobsson, P., Unosson, M., Skargren, E., Kentsson, M., & Theander, K. (2014). Symptom burden in stable COPD patients with moderate to severe airfl ow limitation. Heart & Lung, 43 (4), p. 353. numbness/tingling in hands/feet, feeling irritable, and dizziness, were reported by between 25% and 50% of the patients. The most commonly reported psychological symptom was diffi culty sleeping (52%), followed by worrying (33%), feeling irritable (28%) and feeling sad (22%). There were no signifi cant differences in the occurrence of physical and psy-chological symptoms between patients with moderate and severe airfl ow limitations” ( Eckerblad et al., 2014 , p. 353). 62EXERCISE 6 • Understanding Frequencies and PercentagesCopyright © 2017, Elsevier Inc. All rights reserved. STUDY QUESTIONS 1. What are the frequency and percentage of women in the moderate airfl ow limitation group? 2. What were the frequencies and percentages of the moderate and the severe airfl ow limitation groups who experienced an exacerbation in the previous 6 months? 3. What is the total sample size of COPD patients included in this study? What number or fre-quency of the subjects is married/cohabitating? What percentage of the total sample is married or cohabitating? 4. Were the moderate and severe airfl ow limitation groups signifi cantly different regarding married/cohabitating status? Provide a rationale for your answer. 5. List at least three other relevant demographic variables the researchers might have gathered data on to describe this study sample. 6. For the total sample, what physical symptoms were experienced by ≥ 50% of the subjects? Identify the physical symptoms and the percentages of the total sample experiencing each symptom.

Interpreting Line Graphs EXERCISE 7

69 Interpreting Line Graphs STATISTICAL TECHNIQUE IN REVIEW Tables and fi gures are commonly used to present fi ndings from studies or to provide a way for researchers to become familiar with research data. Using fi gures, researchers are able to illustrate the results from descriptive data analyses, assist in identifying patterns in data, identify changes over time, and interpret exploratory fi ndings. A line graph is a fi gure that is developed by joining a series of plotted points with a line to illustrate how a variable changes over time. A line graph fi gure includes a horizontal scale, or x -axis, and a vertical scale, or y -axis. The x -axis is used to document time, and the y -axis is used to document the mean scores or values for a variable ( Grove, Burns, & Gray, 2013 ; Plichta & Kelvin, 2013 ). Researchers might include a line graph to compare the values for three or four variables in a study or to identify the changes in groups for a selected variable over time. For example, Figure 7-1 presents a line graph that documents time in weeks on the x -axis and mean weight loss in pounds on the y -axis for an experimental group consuming a low carbohydrate diet and a control group consuming a standard diet. This line graph illustrates the trend of a strong, steady increase in the mean weight lost by the experimental or intervention group and minimal mean weight loss by the control group. EXERCISE 7 FIGURE 7-1 ■ LINE GRAPH COMPARING EXPERIMENTAL AND CONTROL GROUPS FOR WEIGHT LOSS OVER FOUR WEEKS. Weight loss (lbs)Weeksy-axisx-axisControlExperimental10864201234 70EXERCISE 7 • Interpreting Line GraphsCopyright © 2017, Elsevier Inc. All rights reserved. RESEARCH ARTICLE Source Azzolin, K., Mussi, C. M., Ruschel, K. B., de Souza, E. N., Lucena, A. D., & Rabelo-Silva, E. R. (2013). Effectiveness of nursing interventions in heart failure patients in home care using NANDA-I, NIC, and NOC. Applied Nursing Research, 26 (4), 239–244. Introduction Azzolin and colleagues (2013) analyzed data from a larger randomized clinical trial to determine the effectiveness of 11 nursing interventions (NIC) on selected nursing out-comes (NOC) in a sample of patients with heart failure (HF) receiving home care. A total of 23 patients with HF were followed for 6 months after hospital discharge and provided four home visits and four telephone calls. The home visits and phone calls were organized using the nursing diagnoses from the North American Nursing Diagnosis Association International (NANDA-I) classifi cation list. The researchers found that eight nursing interven tions signifi cantly improved the nursing outcomes for these HF patients. Those interventions included “health education, self-modifi cation assistance, behavior modifi -cation, telephone consultation, nutritional counselling, teaching: prescribed medications, teaching: disease process, and energy management” ( Azzolin et al., 2013 , p. 243). The researchers concluded that the NANDA-I, NIC, and NOC linkages were useful in manag-ing patients with HF in their home. Relevant Study Results Azzolin and colleagues (2013) presented their results in a line graph format to display the nursing outcome changes over the 6 months of the home visits and phone calls. The nursing outcomes were measured with a fi ve-point Likert scale with 1 = worst and 5 = best. “Of the eight outcomes selected and measured during the visits, four belonged to the health & knowledge behavior domain (50%), as follows: knowledge: treatment regimen; compliance behavior; knowledge: medication; and symptom control. Signifi cant increases were observed in this domain for all outcomes when comparing mean scores obtained at visits no. 1 and 4 ( Figure 1 ; p < 0.001 for all comparisons). The other four outcomes assessed belong to three different NOC domains, namely, functional health (activity tolerance and energy conservation), physiologic health (fl uid balance), and family health (family participation in professional care). The scores obtained for activity tolerance and energy conservation increased signifi cantly from visit no. 1 to visit no. 4 ( p = 0.004 and p < 0.001, respectively). Fluid balance and family participation in professional care did not show statistically signifi cant differences ( p = 0.848 and p = 0.101, respectively) ( Figure 2 )” ( Azzolin et al., 2013 , p. 241). The signifi cance level or alpha ( α ) was set at 0.05 for this study. Interpreting Line Graphs • EXERCISE 7Copyright © 2017, Elsevier Inc. All rights reserved. FIGURE 2 ■ NURSING OUTCOMES MEASURED OVER 6 MONTHS (OTHER DOMAINS): Activity tolerance (95% CI − 1.38 to − 0.18, p = 0.004); energy conservation (95% CI − 0.62 to − 0.19, p < 0.001); fl uid balance (95% CI − 0.25 to 0.07, p = .848); family participation in professional care (95% CI − 2.31 to − 0.11, p = 0.101). HV = home visit. CI = confi dence interval. Azzolin, K., Mussi, C. M., Ruschel, K. B., de Souza, E. N., Lucena, A. D., & Rabelo-Silva, E. R. (2013). Effectiveness of nursing interventions in heart failure patients in home care using NANDA-I, NIC, and NOC. Applied Nursing Research, 26 (4), p. 242. 5.04.54.03.53.02.52.01.51.00.50MeanHV1HV2HV3HV4Fluid balanceFamily participationin professional careActivity toleranceEnergy conservation FIGURE 1 ■ NURSING OUTCOMES MEASURED OVER 6 MONTHS (HEALTH & KNOWLEDGE BEHAVIOR DOMAIN): Knowledge: medication (95% CI − 1.66 to − 0.87, p < 0.001); knowledge: treatment regimen (95% CI − 1.53 to − 0.98, p < 0.001); symptom control (95% CI − 1.93 to − 0.95, p < 0.001); and compliance behavior (95% CI − 1.24 to − 0.56, p < 0.001). HV = home visit. CI = confi dence interval. 5.04.54.03.53.02.52.01.51.00.50MeanHV1HV2HV3HV4Compliance behaviorSymptom controlKnowledge: medicationKnowledge: treatment reg 72EXERCISE 7 • Interpreting Line GraphsCopyright © 2017, Elsevier Inc. All rights reserved. STUDY QUESTIONS 1. What is the purpose of a line graph? What elements are included in a line graph? 2. Review Figure 1 and identify the focus of the x -axis and the y -axis. What is the time frame for the x -axis? What variables are presented on this line graph? 3. In Figure 1 , did the nursing outcome compliance behavior change over the 6 months of home visits? Provide a rationale for your answer. 4. State the null hypothesis for the nursing outcome compliance behavior. 5. Was there a signifi cant difference in compliance behavior from the fi rst home visit (HV1) to the fourth home visit (HV4)? Was the null hypothesis accepted or rejected? Provide a rationale for your answer. 6. In Figure 1 , what outcome had the lowest mean at HV1? Did this outcome improve over the four home visits? Provide a rationale for your answer.

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Discussion Topic/ Principalism

PHI-413V Lecture 3

Biomedical Ethics in The Christian Narrative

Introduction

The reality of religious pluralism (the view that there are many different religions with different teachings) does not logically imply any sort of religious relativism (the view that there is no such thing as truth, or that everything is a matter of opinion). There are genuine distinctions between religions and worldviews. Given this fact, it is imperative that one be tolerant of differences and engage civilly with those of different religions or worldviews. It might be tempting to think that one is being tolerant or civil by simply rolling all religions into one sort of generic “spirituality” and to claim that all religions are essentially the same. But this is simply false. Once again, there are genuine and important differences among religions; these differences are meaningful to the followers of a particular faith. To simply talk of some sort of a generic “spirituality,” while maybe properly descriptive of some, does not accurately describe most of the religious people in the world. Furthermore, this terminology often reduces religion to a mere personal or cultural preference, and it ignores the distinctions and particularity of each. The point is that such a reductionism is not respectful of patients. It should also be noted that atheism or secularism are not simply default or perfectly objective (or supposedly scientific) starting positions, while religious perspectives are somehow hopelessly biased. Every religion or worldview brings with it a set of assumptions about the nature of reality; whether or not a particular view should be favored depends upon whether or not it is considered true and explains well one’s experience of reality.

Biomedical Ethics

Bioethics is a subfield of ethics that concerns the ethics of medicine and ethical issues in the life sciences raised by the advance of technology. The issues dealt with tend to be complex and controversial (i.e., abortion, stem cell research, euthanasia, etc.). In addition, bioethics usually also involves questions of public policy and social justice. As such, the complexities of bioethical discussion in a pluralistic society are compounded. There have been several different approaches to bioethical questions put forth that have to do with the theory behind ethical decision making. Three positions have been prominent in the discussion principalism (also known as the four-principle approach), virtue ethics, and casuistry.  For this lecture, it will be useful to outline principalism and to describe the general contours of a Christian approach to bioethical issues.

Principalism is often referred to as the “four-principle approach” because of its view that there are four ethical principles that are the frame work of bioethics. These four principles are the following, as spelled out by Tom L. Beauchamp and David DeGrazia (2004):

1.      Respect for autonomy − A principle that requires respect for the decision-making capacities of autonomous persons.

2.      Nonmaleficence − A principle requiring that people not cause harm to others.

3.      Beneficence − A group of principles requiring that people prevent harm, provide benefits, and balance benefits against risks and costs.

4.      Justice − A group of principles requiring fair distribution of benefits, risks and costs.

(p. 57)

For every bioethical question, one must seek to act according to these principles. For each case there will be details, circumstances, and factors that must be considered. The process of applying these principles to each unique case is referred to as specification and balancing. That is, these principles in and of themselves are abstract with no content or concrete application. One must specify the context and details of a case or dilemma to concretely apply these principles and arrive at concrete action guiding results (i.e., individuals need to know how to apply these principles to specific cases and circumstances). But secondly, the task of balancing involves figuring out how each of the four principles ought to be weighted in a case. One needs to determine which of the four principles deserves the most priority in any given case, especially in cases in which there are conflicts between the principles.

Though there is disagreement and diversity about whether or not principalism is the best theory and method of addressing bioethical questions, these four principles and this methodology have become foundational for bioethical reflection. One common misunderstanding about these principles, and most other bioethical methodologies or theories, is that they can stand on their own and comprise a neutral or secular system of solving ethical issues. However, this is a serious misunderstanding. Though these principles describe well much of the current cultural consciousness about right and wrong (and so describe what Beauchamp and Childress call the “common morality” that all human beings ought to hold to), they do not have enough moral or concrete content on their own apart from prior assumptions and worldview considerations.

Thus, one might come at the four principles from a Buddhist perspective, or an Islamic perspective, or an atheistic perspective and achieve vastly different results. The moral content and concrete application of the four principles would not simply depend on the particular details of a case, but also on the worldview from which one is approaching the moral question to begin with. The same is true of causitry as well. The point is that when one utilizes the principalist approach to bioethical dilemmas, it will always also incorporate broader worldview considerations and never be purely neutral or unbiased.

The Christian Narrative

While it is not possible to survey every possible religion, the description below will at least attempt to do justice to the biblical narrative and Judeo-Christian tradition.

The Bible is a collection of 66 books written over thousands of years in several different languages and in different genres (e.g., historical narrative, poetry, letters, prophecy), yet there is an overarching story, or big picture, which is referred to as the Christian biblical narrative. The Christian biblical narrative is often summarized as the story of the creation, fall, redemption, and restoration of human beings (and more accurately this includes the entire created order). Concepts such as sin, righteousness, and shalom provide a framework by which the Christian worldview understands the concepts of health and disease.

Briefly, consider the following summary of each of the four parts of the grand Christian story:

Creation

According to Christianity, the Christian God is the creator of everything that exists (Gen 1-2). There is nothing that exists that does not have God as its creator. In Christianity, there is a clear distinction between God and the creation. Creation includes anything that is not God–the universe and everything in it, including human beings. Thus, the universe itself and all human beings were created. The act of creating by God was intentional. In this original act of creation, everything exists on purpose, not accidentally or purely randomly, and it is good. When God describes his act or creating, and the creation itself as good, among other things, it not only means that it is valuable and that God cares for it, but that everything is the way it is supposed to be. There is an order to creation, so to speak, and everything is how it ought to be. This state of order and peace is described by the term “Shalom.” Yale theologian Nicholas Wolterstorff (1994) describes Shalom as, “the human being dwelling at peace in all his or her relationships: With God, with self, with fellows, with nature” (p. 251).

Fall

Sometime after the creation, there occurred an event in human history in which this created order was broken. In Genesis 3, the Bible describes this event as a fundamental act of disobedience to God. The disobedience of Adam and Eve is referred to as the Fall, because, among other things, it was their rejection of God’s rule over them and it resulted in a break in Shalom. According to the Bible, the Fall had universal implications. Sin entered into the world through the Fall, and with it, spiritual and physical death. This break in Shalom has affected the creation ever since; death, disease, suffering, and, most fundamentally, estrangement from God, has been characteristic of human existence.

Redemption

The rest of the story in the Bible after Genesis 3 is a record of humanity’s continual struggle and corruption after the Fall, and God’s plan for its redemption. This plan of redemption spans the Old and New Testaments in the Bible and culminates in the life, death, and resurrection of Jesus Christ. The climax of the Christian biblical narrative is the atoning sacrificial death of Jesus Christ, by which God makes available forgiveness and salvation by grace alone, through faith alone. The death of Christ is the means by which this estrangement caused by sin and corruption is made right. Thus, two parties, which were previously estranged, are brought into unity (i.e., “at-one-ment”). For the Christian, salvation fundamentally means the restoration of a right and proper relationship with God, which not only has consequences in the afterlife, but here and now.

Restoration

The final chapter of this narrative is yet to fully be realized. While God has made available a way to salvation, ultimately the end goal is the restoration of all creation to a state of Shalom. The return of Jesus, the final judgment of all people, and the restoration of all creation will inaugurate final restoration.

The Christian Ethical Approach − An Outline

While the principalist approach may be used by the Christian as a general methodological tool for bioethical reflection, the general contours of a Christian approach to ethics (not only bioethics) may be described as a mix of deontoogy and virtue ethics (Rae, 2009, p. 24). Given the reality that there is a God who exists and has created the world with a moral structure and and purpose, what is truly right and good is a reflection of the character and nature of the God of the Bible. The ethic that follows from the holy and loving nature of God is deontological because it will include principles and rules regarding right and wrong.

These principles can be known in two main ways: in the form of divine commands, as recorded in the Bible (take for example the 10 commandments), and in the structure of the world, from which a natural law (about right and wrong, not legal matters) can be detected. The biblical ethic will also involve elements of virtue ethics. The perfect man and moral exemplar (though much more than only a man and an exemplar) in the Christian tradition is Jesus Christ himself. The Christian is to not only obey God’s commands, but to be transformed into his image. Jesus Christ is the perfect representation of such a life; Christian’s thus ought to embody the virtues and character of Jesus himself. The attaining of these virtues will not only be a matter of intellectual knowledge of right and wrong, but an active surrender and transformation by means of God’s own Holy Spirit. Furthermore, the wisdom to navigate all the complexities of ethical dillemas and apply biblical and natural law principles appropriately will be a consequence of a person’s character and the active guidance of the Holy Spirit.

Worldview and the Christian Narrative

The way in which Christianity will answer the seven basic worldview questions will be in the context of the above narrative. In the same vein, a Christian view of health and health care will stem from the above narrative and God’s purposes. Of course, the pinnacle of this framework is the person of Jesus Christ. Thus, for Christianity, medicine is called to serve God’s call and purposes, and everything is done in remembrance of, and in light of, Jesus’ ultimate authority and kingship.

Reference

Beauchamp, T. L., and DeGrazia, D. (2004). “Principles and principalism” in Philosophy and medicine vol. 78. Handbook of bioethics: Taking stock of the field from a philosophical perspective. Dordrecht: Kluwer Academic Publishers.

Rae, Scott B. Moral (2009). Moral choices: An introduction to ethics. (3rd ed.). Grand Rapids, MI: Zondervan.

Wolterstorff, N. (1994). “For justice in Shalom.” In W. G. Boulton, T. D. Kennedy, & A. Verhey (eds.), From Christ to the world: Introductory readings in Christian ethics. Grand Rapids, MI: Wm. B. Eerdmans Publishing Company

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Assessment

is based in Ocala Florida/Marion County, the slides should be based on the spirit of the community, social interactions, common goals and interests, barriers, and challenges, including any identified social determinate of health.

every slide with pictures and speaker notes and references

Shouldbe 3or 4slides

This assignment consists of both an interview and a PowerPoint (PPT) presentation.

Assessment/Interview

Select a community of interest. It is important that the community selected be one in which a CLC group member currently resides. Students residing in the chosen community should be assigned to perform the physical assessment of the community.

Perform a direct assessment of a community of interest using the “Functional Health Patterns Community Assessment Guide.”
Interview a community health and public health provider regarding that person’s role and experiences within the community.
Interview Guidelines

Interviews can take place in-person, by phone, or by Skype. Complete the “Provider Interview Acknowledgement Form” and submit with the group presentation.

Develop one set of interview questions to gather information about the role of the provider in the community and the health issues faced by the chosen community.

Compile key findings from the interview, including the interview questions used, and submit with the group presentation.

PowerPoint Presentation

Within your group, create a PowerPoint presentation of 15-20 slides (slide count does not include title and reference slide) describing the chosen community interest.

Include the following in your presentation:

Description of community and community boundaries: the people and the geographic, geopolitical, financial, educational level, ethnic, and phenomenological features of the community as well as types of social interactions, common goals and interests, barriers, and challenges, including any identified social determinates of health.
Summary of community assessment: (a) funding sources and (b) partnerships.
Summary of interview with community health/public health provider.
Identification of an issue that is lacking or an opportunity for health promotion. The issue identified can be used for the Community Teaching Plan: Community Teaching Work Plan Proposal assignment.
A conclusion summarizing your key findings and a discussion of your impressions of the general health of the community.
In addition to submitting this assignment in the LoudCloud dropbox, email a copy of your submission to RNBSNclientcare@gcu.edu.

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.

You are not required to submit this assignment to Turnitin.

When submitting this assignment, include the interview questions, the interview findings, completed “Provider Interview Acknowledgement Form,” and the community assessment PPT presentation.

NRS-427V.R.ProviderInterviewAcknowledgementForm_10-14-13.doc NRS427V.R.FunctionalHealthPatternsCommAssessment_Student_10-14-13.doc

Healthcare Progrma/Policy Evaluation

To Prepare: Review the Healthcare Program/Policy Evaluation Analysis Template provided in the Resources. Select an existing healthcare program or policy evaluation or choose one of interest to you and get approval to use it from your Instructor. Review the healthcare program or policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described. The Assignment: (2–3 pages) Based on the program or policy evaluation you selected, complete the Healthcare Program/Policy Evaluation Analysis Template. Be sure to address the following: Describe the healthcare program or policy outcomes. How was the success of the program or policy measured? How many people were reached by the program or policy selected? How much of an impact was realized with the program or policy selected? At what point in program implementation was the program or policy evaluation conducted? What data was used to conduct the program or policy evaluation? What specific information on unintended consequences was identified? What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples. Did the program or policy meet the original intent and objectives? Why or why not? Would you recommend implementing this program or policy in your place of work? Why or why not? Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after 1 year of implementation.

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Assessing A Healthcare Program/Policy Evaluation

Program/policy evaluation is a valuable tool that can help strengthen the quality of programs/policies and improve outcomes for the populations they serve. Program/policy evaluation answers basic questions about program/policy effectiveness. It involves collecting and analyzing information about program/policy activities, characteristics, and outcomes. This information can be used to ultimately improve program services or policy initiatives.

Nurses can play a very important role assessing program/policy evaluation for the same reasons that they can be so important to program/policy design. Nurses bring expertise and patient advocacy that can add significant insight and impact. In this Assignment, you will practice applying this expertise and insight by selecting an existing healthcare program or policy evaluation and reflecting on the criteria used to measure the effectiveness of the program/policy.

To Prepare:

• Review the Healthcare Program/Policy Evaluation Analysis Template provided in the Resources.
• Select an existing healthcare program or policy evaluation or choose one of interest to you and get approval to use it from your Instructor.
• Review the healthcare program or policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described.

The Assignment: (2–3 pages)

Based on the program or policy evaluation you selected, complete the Healthcare Program/Policy Evaluation Analysis Template. Be sure to address the following:

• Describe the healthcare program or policy outcomes.
• How was the success of the program or policy measured?
• How many people were reached by the program or policy selected?
• How much of an impact was realized with the program or policy selected?
• At what point in program implementation was the program or policy evaluation conducted?
• What data was used to conduct the program or policy evaluation?
• What specific information on unintended consequences was identified?
• What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples.
• Did the program or policy meet the original intent and objectives? Why or why not?
• Would you recommend implementing this program or policy in your place of work? Why or why not?
• Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after 1 year of implementation.

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Case Study

Required Resources
Read/review the following resources for this activity:

• Textbook: Chapter 28, 29, 30
• Lesson
• Minimum of 1 primary source
• Minimum of 4 scholarly sources (in addition to the textbook)

Optional Resources to Explore
Feel free to review the library guide for scholarly sources and videos at the following link:

• Link (website): History Library Guide (Links to an external site.)

Introduction
The purposes of each case study assignment include the following:

• To hone your abilities to research using scholarly sources
• To advance critical thinking and writing skills
• To compile a response to the prompts provided
• To explore a historical topic and make connections to change over time

Instructions
Pick one (1) of the following topics. Then, address the corresponding questions/prompts for your selected topic. Use at least one (1) documented example of the corresponding primary source in your writing.

Option 1: McCarthyism and Anti-Communist Campaigns
The Cold War brought about an irrational fear of communism and communist activities in the United States. As we are learning this week, one of the most vocal instigators of this paranoia was Senator Joseph McCarthy. McCarthy delivered a speech about the imminent threat of communism on February 9, 1950. Perform a search on the internet and locate and read Joseph McCarthy’s speech given in Wheeling, West Virginia on February 9, 1950. Copy and paste the following keywords into your Google search bar: “Joseph McCarthy, Wheeling, West Virginia.” The speech is also referred to as “Enemies from Within.”

Construct the case study by responding to the following prompts:

• Explain how Senator Joseph McCarthy defined communist nations within the speech. What specific threats did these nations pose?
• Assess if Senator Joseph McCarthy charges were accurate.
• Analyze anti-communist sentiments during the Cold War era, were these sentiments valid. If so, how? If not, why not?
• Explain if there are other examples of events similar to the Red Scare that have occurred throughout history and modern day.
• Examine what happened to people who invoked the Fifth Amendment, refused to appear or were found in violation of the law as defined by the Congressional Committee.

Option 2: The Civil Rights Movement
Using the Internet, locate and read Martin Luther King Jr’s “I Have a Dream” speech given in Washington D.C., August 1963. Copy and paste the following keywords into your Google search bar: “I Have a Dream by Martin Luther King, Jr.” Feel free also to locate and incorporate additional scholarly sources to respond to this case study, including information on the Civil Rights Movement.

Construct the case study by responding to the following prompts:

• Explain if the Civil Rights Movement of the 1960s effectively changed the nation.
• What effect would the Civil Rights Acts have across the continent on minority groups?
• Do you think that the tactics and strategies that civil rights activists used in the 1960s would apply to today’s racial and ethnic conflicts? Why or why not?
• Do the ideas of the 1960s still have relevance today? If so how? If not, why not?
• Analyze how the Civil Rights Movement would impact diversity in America today.

Option 3: American Domestic and Foreign Policies (1953-1991)
Complete a search either in the Chamberlain Library or internet for domestic and foreign polices of four (4) of the following Presidents. Please incorporate at least one primary source of either a policy or act that you have chosen to write about.

• Eisenhower
• Kennedy
• Johnson
• Nixon
• Ford
• Carter
• Reagan

Then, compare domestic and foreign polices of your four (4) presidents by answering the following prompts:

• Explain how your selected presidents worked to improve the United States economically and socially. Give at least one example of each president.
• Assess if the policies of your choice of presidents strengthen or weaken the United States.
• Explain how you see your choice of presidents served the public interest and further the cause of democracy.
• Determine if it is constitutional for the United States to fight preemptive wars.
• Determine if human rights and morality should be the cornerstones of United State foreign policy.

Writing Requirements (APA format)

• Length: 4-5 pages (not including title page and references page)
• 1-inch margins
• Double spaced
• 12-point Times New Roman font
• Title page
• References page
• In-text citations that correspond with your end reference

references: .S. history. OpenStax CNX. Retrieved from /orders/cnx.org/contents/p7ovuIkl@6.18:gMXC1GEM@7/IntroductionLinks to an external site.

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Risk Management Program Analysis

The purpose of this assignment is to analyze a health care risk management program.

Conduct research on approaches to risk management processes, policies, and concerns in your current or anticipated professional arena to find an example of a risk management plan. Look for a plan with sufficient content to be able to complete this assignment successfully. In a 1,000‐1,250-word paper, provide an analysis of the risk management plan that includes the following:

1. Summary of the type of risk management plan you selected (new employee, specific audience, community‐focused, etc.) and your rationale for selecting that example. Describe the health care organization to which the plan applies and the role risk management plays in that setting.
2. Description of the standard administrative steps and processes in a typical health care organization’s risk management program compared to the administrative steps and processes you identify in your selected example plan. (Note: For standard risk management policies and procedures, look up the MIPPA-approved accrediting body that regulates the risk management standards in your chosen health care sector, and consider federal, state, and local statutes as well.)
3. Analysis of the key agencies and organizations that regulate the administration of safe health care in your area of concentration and an evaluation of the roles each one plays in the risk management oversight process.
4. Evaluation of your selected risk management plan’s compliance with the standards of its corresponding MIPPA-approved accrediting body relevant to privacy, health care worker safety, and patient safety.
5. Proposed recommendations or changes you would implement in your risk management program example to enhance, improve, or secure the aforementioned compliance standards.

In addition to your textbook, you are required to support your analysis with a minimum of three peer‐reviewed references.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Benchmark Information

This benchmark assignment assesses the following programmatic competency:

BS Health Sciences

3.2 Discuss compliance with risk management protocol.

Theory Week 13

Copyright © 2015. F.A. Davis Company

References

Ritzer, G., (1992 Metatheorizing: Newbury park, CA:sage.)

Thoma, H. (2003). Holistic science: All at the same time. Resurgence, 1(216), 15–17.

Turkel, M. (1997). Struggling to find a balance: A grounded theory study of the nurse-patient relationship in the changing health care environment. Unpublished doctoral dissertation, University of Miami, Florida. Microfilm #9805958.

Turkel, M. (2001). Struggling to find a balance: The paradox between caring and economics. Nursing

Administration Quarterly, 26(1), 67–82.

Turkel, M., & Ray, M. (2000). Relational complexity: A theory of the nurse-patient relationship within an

economic context. Nursing Science Quarterly, 13(4), 307–313.

Watson, J. (2005). Caring science as sacred science. Philadelphia: F. A. Davis.

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Nursing Question Reflection

Purpose

The self-assessment is completed using the TIGER-based  Assessment of Nursing Informatics Competencies  (TANIC) tool. TIGER refers to the Technology Informatics Guiding Education Reform Initiative which identified a list of the minimum informatics competencies for all nurses and students graduating from pre- and post-licensure programs.  The graded self-evaluation of your informatics competencies is required in order to increase one’s own understanding  of competencies in nursing informatics which will enable  the planning of strategies to  enhance knowledge and skills.

Reflect upon your current or most recent clinical practice as an ICU bedside nurse and answer the following:

1. How is informatics used?
2. Regarding the Pre-TANIC Self-Assessment for this week, how did your perceived competency level prior to the self-assessment compare to after the self-assessment? Explain in detail.
3. What TWO competencies do you use in your current clinical role? Provide examples.
4. Identify TWO resources to develop a strategic plan to enhance your competency skills.
5. Which resources are suited to your needs and why?
6. How do you intend to enact this improvement plan?

Please follow the rubric when answering each question, APA format, references within the last 5 years

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