Discussion Theories In Nursing

Week 3 Discussion

A phenomenon is the term used to describe a perception or responses to an event. Examples of phenomena in nursing include caring and responses to stress. Assumptions are the ideas that we take for granted. They explain the nature of the concepts in the theory, giving it structure.

Choose a middle-range theory or grand theory that, in your opinion, can be applied to research.

  • What is the phenomenon of concern in this theory?
  • What are the assumptions underpinning this theory?

How do perceptions and beliefs of others influence awareness of our “lenses?”

Reflection #3

Movie: When the Levees Broke: A Requiem in Four Acts

Pages: 3 to 4

 

Objective

To relate the material in Chapter Four, “Perceiving and Believing” to the assigned film. Your paper (3-4 pages) will consist of three sections as follows.

 

Introduction Paragraph (2 pts.)

Briefly summarize the film in five sentences or less.

 

Thinking (6 pts.)

What was the event that inspired the film

What caused the event

What was the response

How did different points of view include factual reports, inductive inferences, evaluative judgements

How do perceptions and beliefs of others influence awareness of our “lenses?”

 

Conclusion Paragraph (2 pts.)

Briefly explain how the text relates to the text in Chapter Four, “Perceiving and Believing.”

 

 

 

 

 

Chapter 4

 

Things aren’t always what they seem! This “Mae West Room” in the Salvador Dali museum illustrates the complex and surprising nature of the process of perceiving and making sense of our world. How do we develop clear and accurate perceptions of the world that are not biased or slanted toward one perspective?

 

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david pearson/Alamy Stock Photo

Perceiving is the act of actively selecting, organizing, and interpreting sensations: selecting sensations to pay attention to, organizing sensations into a design or pattern, interpreting what this pattern or event means. Experiences shape our perceptions. We view the world through our own unique, lenses, which shape and influence our perceptions. We construct beliefs based on our perceptions. We construct knowledge based on our beliefs. Thinking critically involves understanding how, lenses, influence perceptions, beliefs, and knowledge.

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© 2019 Cengage

Thinking is how you make sense of the world. By thinking in an active, purposeful, and organized way, you are able to solve problems, work toward your goals, analyze issues, and make decisions. Your experience of the world comes to you by means of your senses: sight, hearing, smell, touch, and taste. These senses are your bridges to the world, making you aware of what occurs outside you; the process of becoming aware of your world through your senses is known as perceiving.

In this chapter, you will explore the way your perceiving process operates, how your perceptions lead to the construction of your beliefs about the world, and how both your perceptions and your beliefs relate to your ability to think effectively. In particular, you will discover the way you shape your personal experience by actively selecting, organizing, and interpreting the sensations provided by the senses. In a way, each of us views the world through a pair of individual “eyeglasses” or “lenses” that reflect our past experiences and unique personalities. As a critical thinker, you want to become aware of the nature of your own lenses to help eliminate any bias or distortion they may be causing. You also want to become aware of the lenses of others so that you can better understand why they view things the way they do.

At almost every waking moment of your life, your senses are being bombarded by a tremendous number of stimuli: images to see, noises to hear, odors to smell, textures to feel, and flavors to taste. The experience of all these sensations at once creates what the nineteenth-century American philosopher William James called “a bloomin’ buzzin’ confusion.” Yet to us, the world usually seems much more orderly and understandable. Why is this so?

In the first place, your sense equipment can receive sensations only within certain limited ranges. For example, animals can detect many sounds and smells that you cannot because their sense organs have broader ranges than yours do.

A second reason you can handle this sensory bombardment is that from the stimulation available, you select only a small amount on which to focus your attention. To demonstrate this, try the following exercise. Concentrate on what you can see, ignoring your other senses for the moment. Focus on sensations that you were not previously aware of and then answer the first question. Concentrate on each of your other senses in turn, following the same procedure.

1. What can you see? (e.g., the shape of the letters on the page, the design of the clothing on your arm)

2. What can you hear? (e.g., the hum of the air conditioner, the rustling of a page)

3. What can you feel? (e.g., the pressure of the clothes against your skin, the texture of the page, the keyboard against your fingers)

4. What can you smell? (e.g., the perfume or cologne someone is wearing, the odor of stale cigarette smoke)

5. What can you taste? (e.g., the aftereffects of your last meal)

Compare your responses with those of the other students in the class. Do your classmates perceive sensations that differ from the ones you perceived? If so, how do you explain these differences?

As you perform this simple exercise, it should become clear that for every sensation you focus your attention on, countless other sensations are simply ignored. If you were aware of everything that is happening at every moment, you would be completely overwhelmed. By selecting certain sensations, you are able to make sense of your world in a relatively orderly way. The activity of using your senses to experience and make sense of your world is known as  perceiving .

Actively Selecting, Organizing, and Interpreting Sensations

It is tempting to think that your senses simply record what is happening out in the world, as if you were a human camera or tape recorder. You are not, however, a passive receiver of information, a “container” into which sense experience is poured. Instead, you are an active participant who is always trying to understand the sensations you are encountering. As you perceive your world, your experience is the result of combining the sensations you are having with the way you understand these sensations. For example, examine the following collection of markings. What do you see?

FIG 04.02

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© 2019 Cengage

If all you see is a collection of black spots, try looking at the group sideways. After a while, you will probably perceive a familiar animal.

From this example, you can see that when you perceive the world, you do more than simply record what your senses experience. You are also actively making sense of these sensations. That is why this collection of black spots suddenly became the figure of an animal—you were able to actively organize these spots into a pattern you recognized.

When you actively perceive the sensations you are experiencing, you are engaged in three distinct activities:

1. Selecting certain sensations to pay attention to

2. Organizing these sensations into a design or pattern

3. Interpreting what this design or pattern means to you

In the case of the  figure  , you were able to perceive an animal because you selected certain of the markings to concentrate on, organized these markings into a pattern, and interpreted this pattern as representing a familiar animal.

Of course, when you perceive, these three operations of selecting, organizing, and interpreting are usually performed quickly, automatically, and often simultaneously. Also, you are normally unaware that you are performing these operations because they are so rapid and automatic. This chapter is designed to help you slow down this normally automatic process of perceiving so that you can understand how the process works.

Let’s explore more examples that illustrate how you actively select, organize, and interpret your perceptions of the world. Carefully examine the following figure.

 

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Mary Evans Picture Library

Do you see both the young woman and the old woman? If you do, try switching back and forth between the two images. As you switch back and forth, notice how, for each image, you

· Select certain lines, shapes, and shadings on which to focus your attention

· Organize these lines, shapes, and shadings into different patterns

· Interpret these patterns as representing things that you are able to recognize—a hat, a nose, a chin

Another way to become aware of your active participation in perceiving your world is to consider how you see objects. Examine the illustration that follows. Do you perceive different-sized people or the same-sized people at different distances?

The same man seems to get smaller the further he stands.

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© 2019 Cengage

When you see someone who is far away, you usually do not perceive a tiny person. Instead, you perceive a normal-sized person who is far away from you. Your experience in the world has enabled you to discover that the farther the things are from you, the smaller they look. The moon in the night sky appears about the size of a quarter, yet you perceive it as being considerably larger. As you look down a long stretch of railroad tracks or gaze up at a tall building, the boundary lines seem to come together. Even though these images are what your eyes “see,” however, you do not usually perceive the tracks as meeting or the building as coming to a point. Instead, your mind actively organizes and interprets a world comprising constant shapes and sizes, even though the images you actually see usually vary, depending on how far you are from them and the angle from which you are looking at them.

In short, your mind actively participates in the way you perceive the world. By combining the sensations you receive with the way your mind selects, organizes, and interprets these sensations, you perceive a world of things that is stable and familiar, a world that usually makes sense to you.

The process of perceiving takes place at a variety of different levels. At the most basic level, the concept of “perceiving” refers to the selection, organization, and interpretation of sensations—for example, being able to perceive the various objects in your experience, such as a basketball. However, you also perceive larger patterns of meaning at more complex levels, as when you are watching the actions of a group of people engaged in a basketball game. Although these are very different contexts, both engage you in the process of actively selecting, organizing, and interpreting what is experienced by your senses—in other words, “perceiving.”

People’s Perceptions Differ

Your active participation in perceiving your world is something you are not usually aware of. You normally assume that what you are perceiving is what is actually taking place. Only when your perception of an event seems to differ from others’ perceptions of the same event are you forced to examine the manner in which you are selecting, organizing, and interpreting the events in your world.

In most cases, people in a group will have a variety of perceptions about what is taking place in the picture in Thinking Activity 4.1. Some may see the couple having a serious conversation, perhaps relating to the baby behind them. Others may view them as being in the middle of an angry argument. Still others may see them as dealing with some very bad news they have just received. In each case, the perception depends on how the person is actively using his or her mind to organize and interpret what is taking place. Because the situation pictured is by its nature somewhat puzzling, different people perceive it in different ways.

Thinking Activity 4.1

Analyzing Perceptions

1. Carefully examine this picture of a couple sitting on a bed with a baby. What do you think is happening in this picture?

 

Viewing the World through “Lenses”

To understand how various people can be exposed to the same stimuli or events and yet have different perceptions, it helps to imagine that each of us views the world through our own pair of “lenses.” Of course, we are not usually aware of the lenses we are wearing. Instead, our lenses act as filters that select and shape what we perceive without our realizing it.

Thinking Critically About Visuals

The Investigation

Explain why each witness describes the suspect differently. Have you ever been involved in a situation in which people described an individual or event in contrasting or conflicting ways? What is the artist saying about people’s perceptions?

 

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John Jonik/The New Yorker Collection/The Cartoon Bank

To understand the way people perceive the world, you have to understand their individual lenses, which influence how they actively select, organize, and interpret the events in their experience. A diagram of the process might look like this:

Persons Ay and person B participate in an event. They select, organize and interpret the information. Person Ay has perception Ay, and person B has perception B of the same event.

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© 2019 Cengage

Consider the following pairs of statements. In each of these cases, both people are being exposed to the same basic stimulus or event, yet each has a totally different perception of the experience. Explain how you think the various perceptions might have developed.

1.

1. That chili was much too spicy to eat.

Explanation:

2. That chili needed more hot peppers and chili powder to spice it up a little.

Explanation:

2.

1. People who wear lots of makeup and jewelry are very sophisticated.

Explanation:

2. People who wear lots of makeup and jewelry are overdressed.

Explanation:

3.

1. The music that young people enjoy listening to is a very creative cultural expression.

Explanation:

2. The music that young people enjoy listening to is obnoxious noise.

Explanation:

To become an effective critical thinker, you have to become aware of the lenses that you—and others—are wearing. These lenses aid you in actively selecting, organizing, and interpreting the sensations in your experience. If you are unaware of the nature of your own lenses, you can often mistake your own perceptions for objective truth without bothering to examine either the facts or others’ perceptions on a given issue.

What Factors Shape Perceptions?

Your perceptions of the world are dramatically influenced by your past experiences: the way you were brought up, the relationships you have had, and your training and education. Every dimension of “who” you are is reflected in your perceiving lenses. It takes critical reflection to become aware of these powerful influences on our perceptions of the world and the beliefs we construct based on them.

Your special interests and areas of expertise also affect how you see the world. Consider the case of two people who are watching a football game. One person, who has very little understanding of football, sees merely a bunch of grown men hitting each other for no apparent reason. The other person, who loves football, sees complex play patterns, daring coaching strategies, effective blocking and tackling techniques, and zone defenses with “seams” that the receivers are trying to “split.” Both have their eyes focused on the same event, but they are perceiving two entirely different situations. Their perceptions differ because each person is actively selecting, organizing, and interpreting the available stimuli in different ways. The same is true of any situation in which you are perceiving something about which you have special knowledge or expertise. The following are examples:

· A builder examining the construction of a new house

· A music lover attending a concert

· A cook tasting a dish just prepared

· A lawyer examining a contract

· An art lover visiting a museum

Think about a special area of interest or expertise that you have and how your perceptions of that area differ from those of people who don’t share your knowledge. Ask other class members about their areas of expertise. Notice how their perceptions of that area differ from your own because of their greater knowledge and experience.

In all these cases, the perceptions of the knowledgeable person differ substantially from the perceptions of the person who lacks knowledge of that area. Of course, you do not have to be an expert to have more fully developed perceptions. It is a matter of degree.

Thinking Activity 4.2

Thinking Critically About My Perceiving Lenses

1. This is an opportunity for you to think about the unique “prescription” of your perceiving lenses. Reflect on the elements in yourself and your personal history that you believe exert the strongest influence on the way that you view the world. These factors will likely include the following categories:

· Demographics (age, gender, race/ethnicity, religion, geographical location)

· Tastes in fashion, music, leisure activities

· Special knowledge, talents, expertise

· Significant experiences in your life, either positive or negative

· Values, goals, aspirations

2. Create a visual representation of the prescription for your perceiving lenses, highlighting the unique factors that have contributed to your distinctive perspective on the world. Then, compare your prescription with those of other students in your class, and discuss the ways in which your lenses result in perceptions and beliefs that are different from those produced by other prescriptions.

Thinking Activity 4.3

Analyzing Different Accounts of the Assassination of Malcolm X

1. Let’s examine a situation in which a number of different people had somewhat different perceptions about an event they were describing—in this case, the assassination of Malcolm X as he was speaking at a meeting in Harlem. The following are five different accounts of what took place that day. As you read through the various accounts, pay particular attention to the different perceptions of this event each one presents. After you finish reading the accounts, analyze some of the differences in these perceptions by answering the questions that follow.

Five Accounts of the Assassination of Malcolm X

 

 

The New York Times, February 22, 1965

Malcolm X, the 39-year-old leader of a militant Black Nationalist movement, was shot to death yesterday afternoon at a rally of his followers in a ballroom in Washington Heights. The bearded Negro extremist had said only a few words of greeting when a fusillade rang out. The bullets knocked him over backwards.

A 22-year-old Negro, Thomas Hagan, was charged with the killing. The police rescued him from the ballroom crowd after he had been shot and beaten. Pandemonium broke out among the 400 Negroes in the Audubon Ballroom at 160th Street and Broadway. As men, women and children ducked under tables and flattened themselves on the floor, more shots were fired. The police said seven bullets struck Malcolm. Three other Negroes were shot. Witnesses reported that as many as 30 shots had been fired. About two hours later the police said the shooting had apparently been a result of a feud between followers of Malcolm and members of the extremist group he broke with last year, the Black Muslims.

Life, March 5, 1965

His life oozing out through a half dozen or more gunshot wounds in his chest, Malcolm X, once the shrillest voice of black supremacy, lay dying on the stage of a Manhattan auditorium. Moments before, he had stepped up to the lectern and 400 of the faithful had settled down expectantly to hear the sort of speech for which he was famous—flaying the hated white man. Then a scuffle broke out in the hall and Malcolm’s bodyguards bolted from his side to break it up—only to discover that they had been faked out. At least two men with pistols rose from the audience and pumped bullets into the speaker, while a third cut loose at close range with both barrels of a sawed-off shotgun. In the confusion the pistol man got away. The shotgunner lunged through the crowd and out the door, but not before the guards came to their wits and shot him in the leg. Outside he was swiftly overtaken by other supporters of Malcolm and very likely would have been stomped to death if the police hadn’t saved him. Most shocking of all to the residents of Harlem was the fact that Malcolm had been killed not by “whitey” but by members of his own race.

New York Post, February 22, 1965

They came early to the Audubon Ballroom, perhaps drawn by the expectation that Malcolm X would name the men who firebombed his home last Sunday. . . . I sat at the left in the 12th row and, as we waited, the man next to me spoke of Malcolm and his followers: “Malcolm is our only hope. You can depend on him to tell it like it is and to give Whitey hell.”

. . .

There was a prolonged ovation as Malcolm walked to the rostrum. Malcolm looked up and said, “A salaam aleikum (Peace be unto you),” and the audience replied, “We aleikum salaam (And unto you, peace).”

Bespectacled and dapper in a dark suit, sandy hair glinting in the light, Malcolm said: “Brothers and sisters. . . .” He was interrupted by two men in the center of the ballroom, who rose and, arguing with each other, moved forward. Then there was a scuffle at the back of the room. I heard Malcolm X say his last words: “Now, brothers, break it up,” he said softly. “Be cool, be calm.”

Then all hell broke loose. There was a muffled sound of shots and Malcolm, blood on his face and chest, fell limply back over the chairs behind him. The two men who had approached him ran to the exit on my side of the room, shooting wildly behind them as they ran. I heard people screaming, “Don’t let them kill him.” “Kill those bastards.” At an exit I saw some of Malcolm’s men beating with all their strength on two men. I saw a half dozen of Malcolm’s followers bending over his inert body on the stage. Their clothes were stained with their leader’s blood.

Four policemen took the stretcher and carried Malcolm through the crowd and some of the women came out of their shock and one said: “I hope he doesn’t die, but I don’t think he’s going to make it.”

Associated Press, February 22, 1965

A week after being bombed out of his Queens home, Black Nationalist leader Malcolm X was shot to death shortly after 3 [p.m.] yesterday at a Washington Heights rally of 400 of his devoted followers. Early today, police brass ordered a homicide charge placed against a 22-year-old man they rescued from a savage beating by Malcolm X supporters after the shooting. The suspect, Thomas Hagan, had been shot in the left leg by one of Malcolm’s bodyguards as, police said, Hagan and another assassin fled when pandemonium erupted. Two other men were wounded in the wild burst of firing from at least three weapons. The firearms were a .38, a .45 automatic and a sawed-off shotgun. Hagan allegedly shot Malcolm X with the shotgun, a double-barreled sawed-off weapon on which the stock also had been shortened, possibly to facilitate concealment. Cops charged Reuben Frances, of 871 E. 179th St., Bronx, with felonious assault in the shooting of Hagan, and with Sullivan Law violation—possession of the .45. Police recovered the shotgun and the .45.

Amsterdam News, February 27, 1965

“We interrupt this program to bring you a special newscast . . .,” the announcer said as the Sunday afternoon movie on the TV set was halted temporarily. “Malcolm X was shot four times while addressing a crowd at the Audubon Ballroom on 166th Street.” “Oh no!” That was my first reaction to the shocking event that followed one week after the slender, articulate leader of the Afro-American Unity was routed from his East Elmhurst home by a bomb explosion. Minutes later, we alighted from a cab at the corner of Broadway and 166th St. just a short 15 blocks from where I live on Broadway. About 200 men and women, neatly dressed, were milling around, some with expressions of awe and disbelief. Others were in small clusters talking loudly and with deep emotion in their voices. Mostly they were screaming for vengeance. One woman, small, dressed in a light gray coat and her eyes flaming with indignation, argued with a cop at the St. Nicholas corner of the block. “This is not the end of it. What they were going to do to the Statue of Liberty will be small in comparison. We black people are tired of being shoved around.” Standing across the street near the memorial park one of Malcolm’s close associates commented: “It’s a shame.” Later he added that “if it’s war they want, they’ll get it.” He would not say whether Elijah Muhammad’s followers had anything to do with the assassination. About 3:30 p.m. Malcolm X’s wife, Betty, was escorted by three men and a woman from the Columbia Presbyterian Hospital. Tears streamed down her face. She was screaming, “They killed him!” Malcolm X had no last words. . . . The bombing and burning of the No. 7 Mosque early Tuesday morning was the first blow by those who are seeking revenge for the cold-blooded murder of a man who at 39 might have grown to the stature of respectable leadership.

Source: (1) From The New York Times, February 22, 1965. © 1965 The New York Times. All rights reserved. Used by permission and protected by the Copyright Laws of the United States. The printing, copying, redistribution, or retransmission of this Content without express written permission is prohibited. (2) “On Death and Transfiguration,” Life magazine, March 5, 1965. Copyright Time Inc. Reprinted/translated by permission. Time is a registered trademark of Time Inc. All rights reserved. (3) Excerpt from the New York Post, February 22, 1965. Reprinted by permission. (4) Associated Press. (5) The Amsterdam News, February 27, 1965. Reprinted by permission of N.Y. Amsterdam News.

Questions for Analysis

1. What details of the events has each writer selected to focus on?

2. How has each writer organized the details that have been selected? Bear in mind that most news organizations present what they consider the most important information first and the least important information last.

3. How does each writer interpret Malcolm X, his followers, the gunmen, and the significance of the assassination?

4. How has each writer used language to express his or her perspective and to influence the thinking of the reader? Which language styles do you find most effective?

Thinking Critically About Visuals

Witnessing a Martyrdom

Have you ever been a witness to an event that other people present described in contrasting or conflicting ways? Why do you think this happens? What are the responsibilities of bearing witness?

 

Thinking Passage: Experiences Shape Your Perceptions

Your ways of viewing the world are developed over a long period of time through the experiences you have and your thinking about these experiences. As you think critically about your perceptions, you learn more from your experiences and about how you make sense of the world. Your perceptions may be strengthened by this understanding, or they may be changed by it. For example, read the following student passage and consider the way the writer’s experiences—and his reflection on these experiences—contributed to shaping his perspective on the world.

by Luis Feliz

I shuffle through a pile of photos on my desk and draw out one of my father. In this picture, he looks like Tito Rojas—thick mustachio, not one hair out of place, boyish and expectant eyes with wrinkles sprouting from the sides, gentle smile with big, square Chiclet white teeth overwhelming the brown earth of his face. He wears a yellow, black, and red striped turtleneck with long sleeves. The zipper of his black jeans has faded slightly. He is putting all his body weight on his left leg. He doesn’t look much different in this photograph than he does today.

Sun up, he sleeps. Sun down, he works. He is a taxi-driver. He fades into the shadows. He becomes shadowy, no mark left behind, itinerant. The residue that remains is his absence. I recall the award ceremony he didn’t attend because he was sleeping, the Christmas party cut short because he had to work. The fast stream of the highway allows two modes of existence: forward and backward. His foot is always pressed against the gas pedal. The taxi-cab roves. Forward. Reverse. Life rushes forward and recedes simultaneously. It’s not that the driver doesn’t pull to a curb to rest or park the car and get out to stretch or talk with friends. He claws out of the cab with a limp spine, but his mind remains belted in the seat his body occupied. He walks into relationships mentally immobilized. When I see my father, I see a man trapped behind a steering wheel.

Sleep and work triumph over family. When I was 7-years-old, I was reunited with my father after five years of separation. It was difficult to overcome the awkwardness of being separated for so long. So whenever I found him sleeping, I edged into the room and peered down at his toes. He lay wrapped up in blankets as if he were in a sack and his curled toes jutted out through a small tear.

Then, at 6 p.m., when he awoke, we sat down to eat. I never met his gaze at the dinner table. My eyes scoured the words on the magnets on the refrigerator door. I shuffled my feet. My moist hands clutched the toy in my pocket. I wanted to bolt out of there. Instead, I curled my toes into hooks and firmly latched myself to the floor. When the food was brought, I sucked my stomach in. I hated the food, and I would drop the fork to delay eating. The brown beans smelled like rotten eggs. The yellow rice filled with meat looked like gnarled flesh. I pleaded with my eyes. O, Papi por favor. Dinner was the hardest part of living with strange people. I couldn’t venture into their intimacy.

My step-mother approached. I bent down and snuck under the table. I prayed. Overhead, the conversation abruptly ended. My father yelled. I rose. I leaned over the table and looked at my father. He terrified me when he looked me in the eye. Without me realizing it, he had shamed me into eating; he began to tell of the hardships of his yola trip from the Dominican Republic to Puerto Rico.

In front of me I have a picture of him and Mami dancing at a family party after they got back together. He wears a white shirt with light gray stripes, top button undone, and those pointy white shoes that Mami always gives him hell about. The ring on his right hand gleams as light strikes it’s [sic] fake diamonds. He raises the Corona bottle to his lips before he gets up to dance. His hair is jet black and gelled up. He is well-groomed, unlike me. He wears blue H&M pants.

I recall how after they finish dancing he withdraws into his inner-cellar and the boyish dark almond eyes dim. A man’s eyes hold not only the mountains he has climbed, but also the ditches into which he has fallen. My father’s aspirations sag—the unfinished house in the Dominican Republic, the denied loan for a house here in New York, the incessant calls from bill collectors—his dreams wilt.

I remember his story of leaving for Puerto Rico on a yola again: “The morning before I leave I get a bill from the doctor. I owe 3,000 pesos. My son’s health doesn’t improve. I can’t afford the bills anymore. The night before I depart a gentle breeze scatters some leaves into my room. I bend down and throw them out. I kiss my wife on the forehead. She moves, but doesn’t rise. No one knows that I am leaving. In the center of town, I get into a van and then a man puts me into a boat. I lean over the wooden side of the turquoise blue boat and look up at the sky. I see so many stars. Below the water stirs. The boat sways from side to side. The men to my side are young like me. They are scared too. A woman wrinkles her forehead as the boat pulls away from the shore. She doesn’t want to cry in the company of men. Shortly after, the men fall asleep. Just the woman and me remain awake. The silence of the sea terrifies me. I am alone, and although I don’t know it yet, I will never be the same person, and I will never accept it; today I have scraped off the rust marks of security.”

My father’s words bind us to each other. He drenches me in the music of his voice. The bare language allows me a glimpse of his pain: “We had nothing to eat for weeks and weeks.” I gazed at my father as he retold his hardships, and I loved him. I wanted to reach with outstretched arms and embrace him. An onrush of guilt propelled me forward. I attempted to rise from the chair, yet I slipped back. I guess that is the intent. Immigrant parents propagate the lie that the world is ours for the taking, and sometimes, the children believe it. I am here at Amherst College because I believed that lie. Graduating from high school at nineteen didn’t stop me from pursuing my dreams. Having an accent does not prevent me from shouting my opinions in a crowded room.

I am here at Amherst College because my imperfect father taught me through his struggle to pursue my crooked path. The obstacles he braved for me to sit here and share his story and mine jolt me forward and sustain my hopes in days when I fear that I might tumble down and break a few bones.

I didn’t want to understand my father’s optimism because I saw him as a failure; someone to set up as a foil to a “successful” person. I grasped the lesson from the stories about his hardships. Through the concept of nosostros, we, I started to see my father. Like Richard Rodriguez, I see nosostros as the horizontal and the communal vantage point. My father fell, got up, and shook it off, because it was never about him. He subsumed the individual into the collective. It was always about us, his family. If the bedrock of his dreams was solely his own progress, he would have quit the struggle long ago. Then, a naive child, I overlooked the power of my father’s story, his effort to spin struggle into wisdom, his desire to share his most profound perceptions. I knew that my father had struggled, but it wasn’t until later that I realized that he was the bearer of all his family’s dreams. Once I realized this, I began to plumb the depths of his sorrow. I started to really understand the nature of his pain and struggle. Just as my father’s dreams were fueled by love for us, so too I am fueled by the love I have for the people in my community. I meet a new daybreak with the voices and stories of a multitude. I am because of we.

Source: Reprinted with permission of Luis Feliz.

Thinking Critically About Visuals

The Roots of Violence

If our experiences shape our perceptions, is it possible that our experiences can influence our actions as well? In the wake of increased numbers of mass shootings in the past decade, including the horrific massacre of nine people at Emmanuel AME Church in Charleston, South Carolina, in 2015, there have been renewed efforts to understand the roots of gun violence so that we can better limit or even eradicate it from our lives. Although research studies have not yet established a definitive link between violent movies and video games on the one hand, and gun violence on the other. Many people believe that these graphically violent experiences do in fact contribute to creating a culture of violence. Examine carefully these two photographs depicting images from violent video games. Do you find any of the elements disturbing? Do you think that repeated exposure to games like these, particularly in young children, contributes to “numbing” them to violence, or helps make violence more socially acceptable? Or do you believe that these sorts of games provide harmless entertainment that in no way contributes to making people more violent? Do you still hold this opinion when it comes to fully immersive, virtual reality games? Dylann Roof, the Charleston murderer, spent untold hours playing violent video games. Does this fact influence your opinion regarding the potential threat of violent video games? Why or why not? If you were in a position to dictate public policy on video games for children, what policies would you recommend? For example, like movie ratings, do you think the ratings given to video games prevent young children from playing the most graphically violent ones? Why or why not? What experiences and beliefs do you have that led you to this conclusion?

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Thinking Activity 4.4

Describing a Shaping Experience

1. Think of an experience that has shaped your life. Write an essay describing the experience and the ways it changed your life and how you perceive the world. (The essay by Luis Feliz that starts in Thinking Passage: Experiences Shape Your Perceptions is an example of a response to this activity.) After writing, analyze your experience by answering the following questions:

1. What were your initial perceptions of the situation? As you began the experience, you brought into the situation certain perceptions about the experience and the people involved.

2. What previous experiences had you undergone? Identify some of the influences that helped to shape these perceptions. Describe the actions that you either took or thought about taking.

3. As you became involved in the situation, what experiences influenced you to question or doubt your initial perceptions?

4. In what new ways did you view the situation that would better explain what was taking place? Identify the revised perceptions that you began to form about the experience.

 

Perceiving and Believing

As should be clear by now, perceiving is an essential part of the thinking process and of your efforts to make sense of the world. However, your perceptions, by themselves, do not provide a reliable foundation for your understanding of the world. Your perceptions are often incomplete, distorted, and inaccurate. They are shaped and influenced by your perceiving “lenses,” which reflect your own individual personality, experiences, biases, assumptions, and perspective. To clarify and validate your perceptions, you must critically examine and evaluate them.

Thinking critically about your perceptions results in the formation of your beliefs and ultimately in the construction of your knowledge about the world. For example, consider the following statements and answer yes, no, or not sure to each.

1. Humans need to eat to stay alive.

2. Smoking marijuana is a harmless good time.

3. Every human life is valuable.

4. Developing your mind is as important as taking care of your body.

5. People should care about other people, not just about themselves.

Your responses to these statements reflect certain beliefs you have, and these beliefs help you explain why the world is the way it is and how you ought to behave. In fact, beliefs are the main tools you use to make sense of the world and guide your actions. The total collection of your beliefs represents your view of the world, your philosophy of life.

What exactly are “beliefs”?  Beliefs  represent interpretations, evaluations, conclusions, or predictions about the nature of the world. For example, this statement—“I believe that the whale in the book Moby Dick by Herman Melville symbolizes a primal, natural force that men are trying to destroy”—represents an interpretation of that novel. To say, “I believe that watching ‘reality shows’ is unhealthy because they focus almost exclusively on the least attractive qualities of people” is to express an evaluation of reality shows. The statement “I believe that one of the main reasons two out of three people in the world go to bed hungry each night is that industrially advanced nations have not done a satisfactory job of sharing their knowledge” expresses a conclusion about the problem of world hunger. To say, “If drastic environmental measures are not undertaken to slow the global warming trend, I believe that the polar ice caps will melt and the earth will be flooded” is to make a prediction about events that will occur in the future.

In addition to expressing an interpretation, evaluation, conclusion, or prediction about the world, beliefs also express an endorsement of the accuracy of the beliefs by the speaker or author. In the preceding statements, the speakers are not simply expressing interpretations, evaluations, conclusions, and predictions; they are also indicating that they believe these views are true. In other words, the speakers are saying that they have adopted these beliefs as their own because they are convinced that they represent accurate viewpoints based on some sort of evidence. This “endorsement” by the speaker is a necessary dimension of a belief, and we assume it to be the case even if the speaker doesn’t directly say, “I believe.” For example, the statement “Astrological predictions are meaningless because there is no persuasive reason to believe that the position of the stars and planets has any effect on human affairs” expresses a belief, even though it doesn’t specifically include the words “I believe.”

Describe beliefs you have that fall into each of these categories (interpretation, evaluation, conclusion, prediction) and then explain the reason(s) you have for endorsing the beliefs.

1. Interpretation (an explanation or analysis of the meaning or significance of something)

· My interpretation is that . . .

· Supporting reason(s):

2. Evaluation (a judgment of the value or quality of something, based on certain standards)

· My evaluation is that . . .

· Supporting reason(s):

3. Conclusion (a decision made or an opinion formed after consideration of the relevant facts or evidence)

· My conclusion is that . . .

· Supporting reason(s):

4. Prediction (a statement about what will happen in the future)

· My prediction is that . . .

· Supporting reason(s):

Main content

4-3Believing and Perceiving

The relationship between the activities of believing and perceiving is complex and interactive. On the one hand, your perceptions form the foundation of many of your beliefs about the world. On the other hand, your beliefs about the world shape and influence your perceptions of it. Let’s explore this interactive relationship by examining a variety of beliefs:

1. Interpretations (“Poetry enables humans to communicate deep, complex emotions and ideas that resist simple expression.”)

2. Evaluations (“Children today spend too much time on the Internet and too little time reading books.”)

Assignment 2: Focused SOAP Note and Patient Case Presentation

Assignment 2: Focused SOAP Note and Patient Case Presentation

Photo Credit: Pexels

Psychiatric notes are a way to reflect on your practicum experiences and connect them to the didactic learning you gain from your NRNP courses. Focused SOAP notes, such as the ones required in this practicum course, are often used in clinical settings to document patient care.

For this Assignment, you will document information about a patient that you examined during the last three weeks, using the Focused SOAP Note Template provided. You will then use this note to develop and record a case presentation for this patient.

To Prepare
  • Review this week’s Learning Resources and consider the insights they provide. Also review the Kaltura Media Uploader resource in the left-hand navigation of the classroom for help creating your self-recorded Kaltura video.
  • Select a patient of any age (either a child or an adult) that you examined during the last 3 weeks.
  • Create a Focused SOAP Note on this patient using the template provided in the Learning Resources. There is also a completed Focused SOAP Note Exemplar provided to serve as a guide to assignment expectations.
    Please Note:

    • All SOAP notes must be signed, and each page must be initialed by your Preceptor. Note: Electronic signatures are not accepted.
    • When you submit your note, you should include the complete focused SOAP note as a Word document and PDF/images of each page that is initialed and signed by your Preceptor.
    • You must submit your SOAP note using SafeAssign. Note: If both files are not received by the due date, faculty will deduct points per the Walden Grading Policy.
  • Then, based on your SOAP note of this patient, develop a video case study presentation. Take time to practice your presentation before you record.
  • Include at least five scholarly resources to support your assessment, diagnosis, and treatment planning.
  • Ensure that you have the appropriate lighting and equipment to record the presentation.
The Assignment

Record yourself presenting the complex case study for your clinical patient. In your presentation:

  • Dress professionally with a lab coat and present yourself in a professional manner.
  • Display your photo ID at the start of the video when you introduce yourself.
  • Ensure that you do not include any information that violates the principles of HIPAA (i.e., don’t use the patient’s name or any other identifying information).
  • Present the full complex case study. Include chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; current psychiatric diagnosis including differentials that were ruled out; and plan for treatment and management.
  • Report normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value.
  • Be succinct in your presentation, and do not exceed 8 minutes. Specifically address the following for the patient, using your SOAP note as a guide:
    • Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
    • Objective: What observations did you make during the psychiatric assessment?
    • Assessment: Discuss their mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses and why you chose them. List them from highest priority to lowest priority. What was your primary diagnosis and why? Describe how your primary diagnosis aligns with DSM-5 diagnostic criteria and supported by the patient’s symptoms.
    • Plan: What was your plan for psychotherapy? What was your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan. Also be sure to include at least one health promotion activity and one patient education strategy.
    • Reflection notes: What would you do differently with this patient if you could conduct the session again? If you are able to follow up with your patient, explain whether these interventions were successful and why or why not. If you were not able to conduct a follow up, discuss what your next intervention would be.
By Day 7 of Week 3

Submit your Video and Focused SOAP Note Assignment. You must submit two files for the note, including a Word document and scanned pdf/images of each page that is initialed and signed by your Preceptor.

  • NRNP/PRAC 6665 & 6675 Focused SOAP Psychiatric Evaluation Exemplar

     

    INSTRUCTIONS ON HOW TO USE EXEMPLAR AND TEMPLATE—READ CAREFULLY

    If you are struggling with the format or remembering what to include, follow the Focused SOAP Note Evaluation Template AND the Rubric as your guide. It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. After reviewing full details of the rubric, you can use it as a guide.

    In the Subjective section, provide:

    · Chief complaint

    · History of present illness (HPI)

    · Past psychiatric history

    · Medication trials and current medications

    · Psychotherapy or previous psychiatric diagnosis

    · Pertinent substance use, family psychiatric/substance use, social, and medical history

    · Allergies

    · ROS

    Read rating descriptions to see the grading standards!

    In the Objective section, provide:

    · Physical exam documentation of systems pertinent to the chief complaint, HPI, and history

    · Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.

    Read rating descriptions to see the grading standards!

    In the Assessment section, provide:

    · Results of the mental status examination, presented in paragraph form.

    · At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case .

    · Read rating descriptions to see the grading standards!

    Reflect on this case. Include: Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations ( demonstrate critical thinking beyond confidentiality and consent for treatment !), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

    (The FOCUSED SOAP psychiatric evaluation is typically the follow-up visit patient note. You will practice writing this type of note in this course. You will be focusing more on the symptoms from your differential diagnosis from the comprehensive psychiatric evaluation narrowing to your diagnostic impression. You will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for illnesses which could be impacting your patient. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.)

    EXEMPLAR BEGINS HERE

    Subjective:

    CC (chief complaint): A brief statement identifying why the patient is here. This statement is verbatim of the patient’s own words about why presenting for assessment. For a patient with dementia or other cognitive deficits, this statement can be obtained from a family member.

    HPI: Begin this section with patient’s initials, age, race, gender, purpose of evaluation, current medication and referral reason. For example:

    N.M. is a 34-year-old Asian male presents for medication management follow up for anxiety. He was initiated sertraline last appt which he finds was effective for two weeks then symptoms began to return.

    Or

    P.H., a 16-year-old Hispanic female, presents for follow up to discuss previous psychiatric evaluation for concentration difficulty. She is not currently prescribed psychotropic medications as we deferred until further testing and screening was conducted.

    Then, this section continues with the symptom analysis for your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis.

    Paint a picture of what is wrong with the patient. First what is bringing the patient to your follow up evaluation? Document symptom onset, duration, frequency, severity, and impact. What has worsened or improved since last appointment? What stressors are they facing? Your description here will guide your differential diagnoses into your diagnostic impression. You are seeking symptoms that may align with many DSM-5 diagnoses, narrowing to what aligns with diagnostic criteria for mental health and substance use disorders.

    Substance Use History: This section contains any history or current use of caffeine, nicotine, illicit substance (including marijuana), and alcohol. Include the daily amount of use and last known use. Include type of use such as inhales, snorts, IV, etc. Include any histories of withdrawal complications from tremors, Delirium Tremens, or seizures.

    Current Medications: Include dosage, frequency, length of time used, and reason for use. Also include OTC or homeopathic products.

    Allergies: Include medication, food, and environmental allergies separately. Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction vs. intolerance.

    Reproductive Hx: Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse: oral, anal, vaginal, other, any sexual concerns

    ROS: Cover all body systems that may help you include or rule out a differential diagnosis. Please note: THIS IS DIFFERENT from a physical examination!

    You should list each system as follows: General: HeadEENT: etc. You should list these in bullet format and document the systems in order from head to toe.

    Example of Complete ROS:

    GENERAL: No weight loss, fever, chills, weakness, or fatigue.

    HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

    SKIN: No rash or itching.

    CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.

    RESPIRATORY: No shortness of breath, cough, or sputum.

    GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.

    GENITOURINARY: Burning on urination, urgency, hesitancy, odor, odd color

    NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.

    MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness.

    HEMATOLOGIC: No anemia, bleeding, or bruising.

    LYMPHATICS: No enlarged nodes. No history of splenectomy.

    ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.

    Objective:

    Diagnostic results: Include any labs, X-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines).

    Assessment:

    Mental Status Examination: For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patient’s appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudohallucinations, illusions, etc.)., cognition, insight, judgment, and SI/HI. See an example below. You will modify to include the specifics for your patient on the above elements—DO NOT just copy the example. You may use a preceptor’s way of organizing the information if the MSE is in paragraph form.

    He is an 8-year-old African American male who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical. There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinking.   He denies any current suicidal or homicidal ideation. Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good.

    Diagnostic Impression: You must begin to narrow your differential diagnosis to your diagnostic impression. You must explain how and why (your rationale) you ruled out any of your differential diagnoses. You must explain how and why (your rationale) you concluded to your diagnostic impression. You will use supporting evidence from the literature to support your rationale. Include pertinent positives and pertinent negatives for the specific patient case.

    Also included in this section is the reflection. Reflect on this case and discuss whether or not you agree with your preceptor’s assessment and diagnostic impression of the patient and why or why not. What did you learn from this case? What would you do differently?

    Also include in your reflection a discussion related to legal/ethical considerations (demonstrating critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

    Case Formulation and Treatment Plan

    Includes documentation of diagnostic studies that will be obtained, referrals to other health care providers, therapeutic interventions including psychotherapy and/or psychopharmacology, education, disposition of the patient, and any planned follow-up visits. Each diagnosis or condition documented in the assessment should be addressed in the plan. The details of the plan should follow an orderly manner. *See an example below. You will modify to your practice so there may be information excluded/included. If you are completing this for a practicum, what does your preceptor document?

    Risks and benefits of medications are discussed including non- treatment. Potential side effects of medications discussed (be detailed in what side effects discussed). Informed client not to stop medication abruptly without discussing with providers. Instructed to call and report any adverse reactions. Discussed risk of medication with pregnancy/fetus, encouraged birth control, discussed if does become pregnant to inform provider as soon as possible. Discussed how some medications might decreased birth control pill, would need back up method (exclude for males).

     

    Discussed risks of mixing medications with OTC drugs, herbal, alcohol/illegal drugs. Instructed to avoid this practice. Encouraged abstinence. Discussed how drugs/alcohol affect mental health, physical health, sleep architecture.

     

    Initiation of (list out any medication and why prescribed, any therapy services or referrals to specialist):

     

    Client was encouraged to continue with case management and/or therapy services (if not provided by you)

     

    Client has emergency numbers: Emergency Services 911, the Client’s Crisis Line 1-800-_______. Client instructed to go to nearest ER or call 911 if they become actively suicidal and/or homicidal. (only if you or preceptor provided them)

     

    Reviewed hospital records/therapist records for collaborative information; Reviewed PMP report (only if actually completed)

     

    Time allowed for questions and answers provided. Provided supportive listening. Client appeared to understand discussion. Client is amenable with this plan and agrees to follow treatment regimen as discussed. (this relates to informed consent; you will need to assess their understanding and agreement)

     

    Follow up with PCP as needed and/or for:

     

    Labs ordered and/or reviewed (write out what diagnostic test ordered, rationale for ordering, and if discussed fasting/non fasting or other patient education)

     

    Return to clinic:

    Continued treatment is medically necessary to address chronic symptoms, improve functioning, and prevent the need for a higher level of care.

     

    References (move to begin on next page)

    You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.

     

     

    © 2021 Walden University Page 1 of 3

What steps are required to get Jack’s therapeutic plan under control?

 

Jack is a 54-year-old patient who has difficulty coming in for primary care visits. He sees cardiology, pulmonary clinic, and endocrine clinic for his comorbid conditions of diabetes mellitus, post-coronary artery bypass grafting (CABG) 2 years ago, and mild chronic obstructive pulmonary disease issues from a 30-year pack history of smoking. His last visit with you was over a year ago. Today, your registered nurse brings you a telephone triage call requesting a refill of his Crestor prescription, which was ordered by cardiology soon after his CABG. Per the electronic links to the cardiology service within your facility, the medication was due to be renewed about 2 months ago. His last lipid labs were a year ago and his last complete metabolic panel (CMP) was done at the same time. He was recently at the pulmonary clinic and his last recorded HgA1C was 9.0 from a visit to endocrine 4 months ago.

Review of records include a prescription for his hypertension (Lisinopril 20 mg daily), metformin 1,000 mg twice a day for his diabetes and no known medications for his pulmonary issues. The Crestor prescription appears to have multiple dosing levels over the past few refills.

His last vital signs were blood pressure 170/110 mm Hg, pulse 88, and respirations 22. His body mass index is 30 and he indicates a pain level of 4 out of 5. His pulse oximetry was 92% on room air.

1. How do you respond to this telephonic request?

2. What steps are required to get Jack’s therapeutic plan under control?

3. What is the role of the primary care provider in this scenario?