The frequency and function of passive voice use in nurses' notes

Health care providers of all professions depend on written information to communicate with those not co-present during various phases of patient care, thus making communications about patients of key importance to understanding what sorts of discourses are prevalent and valued in hospitals. While physicians’ written discourse has enjoyed some attention, there has been very little research done on written nursing discourse, a critical component of patient care, from the perspective of organizational communication. For this pilot study of nurses’ written communications, I examined 34 nurses' patient progress notes from computer-based in-patient records obtained from a local regional medical center. Because extensive use of the passive voice is a defining characteristic of medical discourse, I chose to focus my discourse analysis of nurses’ notes on the frequency and function of its use. Furthermore, an analysis of passive voice use is salient because the passive voice has for so long been an object of hotly contested debate in the fields of English composition and technical and organizational communications. Of 335 transitive verb phrases, with human agents, in the notes, I found that 48.96% were in the passive voice. Of the passive verbs, 85.98% of them refer to actions performed by the nurse writing the note, only 2.74% of them refer to patients’ actions, and 10.37% of them refer to actions performed by other hospital personnel. The passive voice appears to serve the rhetorical function of deferring attention away from the agent, the nurse, and towards the patient or the materials being used to treat the patient, much as it is used in scientific writing. However, I also found that the passive voice is sometimes used inconsistently, and its use varies from nurse to nurse, even within the same unit. It is my hope that this pilot study, having revealed the inconsistency and complexity of passive voice use in nurses’ notes, will lead to more, comprehensive studies of writing in the nursing discourse community

The effects of high stakes testing on the teaching practices of National Board Certified Teachers

This study was conducted to determine if the state mandated multiple-choice end-ofcourse assessments for North Carolina affect the teaching practices of National Board certified teachers. In addition, discrepancies between the teaching methods utilized by National Board certified teachers in their EOC and non-EOC courses were explored. Four National Board Certified teachers who taught high school classes with and without North Carolina End-of- Course tests (EOCs) participated in this study. Information was collected from participants using pre-interview questionnaires, face-to-face interviews, and written follow-up reflection questions, revealing six themes. The dichotomy present between the standards supported by the National Board for Professional Teaching Standards and the teaching practices used to teach test-taking strategies and increase standardized test scores was not only apparent in the literature, but also in the data collected for this study. This study revealed that mandated standardized assessments do affect the teaching practices of National Board Certified teachers. Implications for these findings are discussed

Perceptions and concerns of healthy eating in low-income African American mothers of preschoolers

Health disparities are prevalent in the U.S, with low-income African American children suffering from higher rates of obesity and chronic diseases compared to White children. Currently, little is known about parental perceptions of healthy eating, and concerns related to child health and weight in this at-risk population. The main purpose of this study was to examine perceptions, motivating factors and barriers to healthier eating in a sample of low-income African American parents of 3-5 year old children. The second purpose was to assess parental concerns about health and/or weight and to examine the accuracy of parental perceptions of child weight status. Participants were recruited from Head Start Programs in North Carolina. The Social Cognitive Theory constructs guided focus groups and a survey administered to the participants. Content analysis of 8 focus groups generated the following themes: 1) lack of nutrition knowledge and misconceptions; 2) healthy meals are home-cooked, include meat and starch; 3) family members, lack of maternal modeling, and child pickiness are main barriers to healthier eating; 4) strong awareness of family history of chronic disease, including obesity; 5) lack of concern about child's current weight. Over 25% of mothers underestimated their child's weight status. Our findings highlight important maternal perspectives influencing children's diet quality and long-term health outcomes among low-income at-risk preschoolers. Nutrition educators should be aware that low-income African American mothers may be aware of chronic disease risks, but do not perceive food choices in early childhood as having strong impact on the child's future health

An interpretative essay concerning twelve paintings

The purpose of this essay is to interpret the author's thesis paintings which, exist as a manifestation of his reality from reality. The objective has been to carry each observer into his own soul in order to conjure a realm of existence in which one may stretch each sense to its point of transcendence. Here, where the absence of reason is the fuel for flight, the only means of mental conveyance to the sublime, human knowledge and experience cease; and one is able to realize his God-reflected self and grasp a bit of the infinite. There is a mood which captivates and frees the human mind from the directness of reality—and seems as important. Given complete freedom, it is capable of becoming reality; controlled, it refreshes and relaxes. This mood is fantasy—the fantasy found in a Perrault fairy tale, where no moral is sought or lesson prescribed. It is the recognition of a naive freshness embodied in the imagination of a child, apparently free from the sophisticated conflicts within adults

Dystopian dilemma

This thesis consists of a text and a series of five oil paintings that explores the psychological complexities and relationships that exist within the 21st Century post-modern American society

Development of a self-instructional program on the sewing machine

Modern science and technology have resulted in a tremendous increase in knowledge which has made it difficult for students and teachers to keep up with changes. These changes make education more essential to our progress. Students find themselves in overcrowded classrooms and teachers find themselves trying to meet the needs of each individual student. Such dilemma results in frustration for both. Steps have been taken to improve these conditions. Psychologists have advanced during the last decade a revolutionary new method of teaching and learning which may help to solve the problems of the increase in knowledge and overcrowding in the classroom. This method is popularly called automated or programed instruction. Briefly programed instruction takes the place of a tutor as it leads the student through a set of materials designed and sequenced to teach him to behave in a certain way

Prior to Matriculation, Student Registered Nurse Anesthetist Stress Mitigation by Participation in an On-Boarding Student Led Session

Background: Each year thousands of students across the country apply to nurse anesthesia programs. Due to the rigorous nature of the nurse anesthesia concentration, only a select few are accepted to each program. Nurse anesthesia school is highly stressful, and it is important to identify and decrease these stressors to ensure successful completion of the program. Purpose: The aim of this project was to evaluate whether providing an onboarding simulation day to first-year registered nurse anesthetist students prior to matriculation would decrease their stress levels. Methods: A quantitative design was used for this study. Participants for the intervention group were incoming first-year registered nurse anesthetist students. The control group consisted of current first-year registered nurse anesthetist students. Both groups attend the nurse anesthesia concentration at the University of North Carolina-Greensboro. Students participated in the same pre- and post-intervention survey that evaluated school-related, personal-related, and other stressors on a 5-point Likert scale. Results: A single ANOVA, f-tests, and t-tests were conducted, and 13 questions were analyzed. The overall stress score did not show a significance between the pre-intervention (M=3.00, SD=0.78) and post-intervention groups (M=2.86, SD=0.87); however, there was a statically significant improvement between the control (M=3.56, SD=0.75) and post-intervention groups (M=2.86, SD=0.87). Conclusion: My study suggests that providing first-year registered nurse anesthesia students an onboarding experience could be an effective way to decrease overall student stress scores

The possibility of critical realist randomised controlled trials.

BACKGROUND: Some realists have criticised randomised controlled trials for their inability to explain the causal relations that they identify; to take into account the influence of the social context of the interventions they evaluate; and to account for individual difference. However, among realists, there is controversy over whether it is possible to improve trials by making them realist, or whether realism and the philosophical assumptions underlying trials are incompatible. This paper contributes to the debate in Trials on this issue. The debate thus far has concentrated on the possibility of combining trial methodology with that of realist evaluation. MAIN BODY: We concur with the contention that it is not feasible to combine randomised controlled trial design with the realist evaluation approach. However, we argue that a different variant of realism, critical realism, provides a more appropriate theoretical grounding for realist trials. In contrast to realist evaluation, which regards social mechanisms as an amalgam of social resources and people's reasoning, critical realism insists on their distinction. It does so on the basis of its assertion of the need to distinguish between social structures (in which resources lie) and human agency (which is at least partly guided by reasoning). From this perspective, conceiving of social mechanisms as external to participants can be seen as a valid methodological strategy for supplementing the exclusive concentration of trials on outcomes. While accepting realist evaluation's insistence that causality in open systems involves a configuration of multiple generative mechanisms, we adopt the critical realist interpretation of the experimental method, which sees it as creating artificial closure in order to identify the effects of specific causal mechanisms. If randomised controlled trials can be regarded as epidemiological proxies that substitute probabilistic controls over extraneous factors for closed experiments, their examination of the powers of discrete mechanisms through observation of the variation of outcomes is appropriate. CONCLUSION: While there are still issues to be resolved, critical realist randomised controlled trials are possible and have the potential to overcome some of the difficulties faced by traditional trial designs in accounting for the influence of social context and individual interpretation

Case-Control Study of Fetal Microchimerism and Breast Cancer

Prior pregnancy is known to protect against development of breast cancer. Recent studies have demonstrated that pregnancy has the capacity to establish small numbers of immunologically active fetal-derived cells in the mother, a phenomenon known as fetal microchimerism (FMc). We asked whether presence of FMc, routinely acquired during pregnancy, is a protective factor for breast cancer.DNA extracts from peripheral blood specimens were obtained from a population-based case-control study of risk factors for breast cancer in women 21 to 45 years old. Specimens were tested with quantitative PCR for presence and concentrations of male DNA presumed to derive from prior pregnancies with a male fetus. Odds ratios (OR) and 95% confidence intervals (CI) were estimated with consideration of multiple established reproductive and environmental risk factors for breast cancer. FMc results were generated on 99 parous women, 54 with primary invasive breast cancer and 45 general population controls. FMc prevalence was 56% (25/45) and 26% (14/54) in controls and cases, respectively. Women harboring FMc were less likely to have had breast cancer (OR = 0.29, 95% CI 0.11-0.83; p = 0.02, adjusting for age, number of children, birth of a son, history of miscarriage, and total DNA tested). In addition, FMc concentrations were higher in controls versus cases (p = 0.01). Median concentrations were 2 (0-78) and 0 (0-374) fetal genomes/10(6) maternal genomes in controls and cases, respectively.Results suggest that the enigma of why some parous women are not afforded protection from breast cancer by pregnancy might in part be explained by differences in FMc. Mechanistic studies of FMc-derived protection against breast cancer are warranted