learning resources: Watch VOPP: Brief Motivational Interviewing: https://kumc.hosted.panopto.com/Panopto/Pages/Viewer.aspx?id=b52f41fa-939f-4331-a98c-ac3001428219 Here is the link to the youtube video in the presentation.. learning resources: Watch VOPP: Brief Motivational Interviewing: https://kumc.hosted.panopto.com/Panopto/Pages/Viewer.aspx?id=b52f41fa-939f-4331-a98c-ac3001428219 Here is the link to the youtube video in the presentation..
Watch VOPP: Brief Motivational Interviewing: https://kumc.hosted.panopto.com/Panopto/Pages/Viewer.aspx?id=b52f41fa-939f-4331-a98c-ac3001428219
Here is the link to the youtube video in the presentation. https://www.youtube.com/watch?v=URiKA7CKtfc
Perinatal Services BC. (n.d). Introduction to brief motivational interviewing. http://www.perinatalservicesbc.ca/Documents/Resources/HealthPromotion/Weight/MotivationalInterviewing.pdf
Souders, B. (2021, January 21). 17 motivational interviewing questions and skills. PositivePsychology.com.
You are a nurse in the emergency department at the local hospital. One of your patients today is a 17 year old female named Ali who came in with a forehead laceration. The laceration occurred when the patient hit her head on the steering wheel as her car rear-ended the vehicle in front of her. The patient states “I was texting my friend that I was running late. When I looked up, the vehicle in front of me had stopped and I barely had time to hit the brakes on my car.”
The driver from the vehicle Ali hit is also in the emergency department due to neck and back pain following being rear-ended. You are concerned about Ali’s safety and the safety of other drivers in regard to her texting while driving. When you ask Ali about how she feels about texting and driving after the accident, she states, “I didn’t ever think something like this would happen to me. I wonder if the other driver is alright. Last I saw, he was being taken somewhere in the ambulance.”
What stage of change do you think Ali is in?
What will you say to Ali to help her think about moving to the next stage of change?
What professional communication techniques can you use in your conversation with Ali?
Write out at least three different statements you would use in your conversation with Ali? (Hint: think about open-ended questions and active listening)
Be sure to use and properly cite at least one supporting source in your responses to these questions. You may write out the answers, create a Panopto, VOPP, or PowerPoint presentation.
The Two Case Studies are attached as well that you will need
The Two Case Studies are attached as well that you will need to write this assignment.
THINK: Pick TWO case studies of revolution and compare and contrast their ORIGINS or causes. For example, you may compare the origins or causes of the Mexican and Russian Revolutions. Be sure to compare and contrast both underlying and precipitating causes. You will also need to think of both similarities and differences. I suggest making a list of similarities and a list of differences as part of your preparation. You should identify multiple points of comparison and these should include underlying and precipitating causes and similarities and differences.
WRITE: Write a short essay that compares and contrasts the origins of at least TWO of the revolutions studied in this course. Be sure to include a thesis and introduction, body and conclusion. The minimum structural length of the essay is three paragraphs. The minimum word count is 500 words. (A strong essay will most likely be more than the minimum word count.) The essay should be double spaced. It must also include examples as well as citations. Points will be deducted if you are missing examples and citations, or if the essay is not double spaced. You must use the sources assigned for the course, rather than outside sources you find on the internet.[supanova_question]
The two responses that are required for this assignment are also attached!
learning resources: Watch VOPP: Brief Motivational Interviewing: https://kumc.hosted.panopto.com/Panopto/Pages/Viewer.aspx?id=b52f41fa-939f-4331-a98c-ac3001428219 Here is the link to the youtube video in the presentation. The two responses that are required for this assignment are also attached! Thanks!
THINK: Pick two different case studies of revolution and compare their OUTCOMES or results. You MAY NOT use the same case studies that you used for the first essay. Thus, if you compared the origins of the Mexican and Russian Revolutions you may not use either one of these case studies when discussing the outcomes. Just like with the first essay, you should make a list of similarities and differences before writing the essay. Some possible themes to compare include political changes, agrarian reform, industrial policy, state repression, women’s rights etc. You will also need to discuss both similarities and differences as you did in the first essay. I suggest making a list of similarities and a list of differences as part of your preparation. You must have multiple points of comparison that you incorporate into the argumentative thesis.
WRITE: Write a second short essay that compares and contrasts the OUTCOMES of at least two of the revolutions studied in this course. Remember: you must choose two different revolutions than you used for the first essay. Be sure to include a thesis and introduction, body and conclusion. The minimum structural length of the essay is three paragraphs. The minimum word count is once again 500 words. The essay should be double spaced. It must also include examples as well as citations. Points will be deducted if you are missing examples and citations, or if the essay is not double spaced. You must use the sources assigned for the course, rather than outside sources you find on the internet. Please see the rubric in the assignment folder.[supanova_question]
ADVERTISEMENT ANALYSIS #2 – COMPARISON ANALYSIS For this assignment, choose a product
ADVERTISEMENT ANALYSIS #2 – COMPARISON ANALYSIS
For this assignment, choose a product category that is being promoted (such as cosmetics, coffee, hotel, cars, computer etc.- in addition to a physical product, a product in marketing terms can also a service, organization, idea or a person!)
Select two advertisements or commercials (you can also compare entire promotional campaigns –e.g. Dove’s Real Beauty is an example of a promotional campaign) promoting your chosen product. These two advertisements should be by different companies/brands (e.g. Starbucks vs. Coffee Bean, Apple vs. Microsoft).
Task: Write a brief paper (max. 1000 words) comparing the two advertisements. The following questions can be used as guidelines for what to focus on your paper. You don’t need to follow them in the order given in your paper.
Describe the product being advertised. In what stage of the PLC (product life cycle) is this product in the marketplace? In what ways does this impact how advertisers generally promote this product?
What is the purpose /objective of each advertisement? In what ways do the advertisements/commercials you have chosen reflect the different strategies/positions of the two companies/brands in the marketplace?
Who are the advertisements targeted to? Are the advertisements targeting the same or a different target segment?
Which advertisement is more effective according to the AIDA model? (ATTENTION – INTEREST – DESIRE – ACTION)? Which advertisement, in your opinion, is more effective in reaching and resonating with its target audience?
What is the “big idea” behind each advertisement? In case of a TV commercial, what is the technique used (drama, parody, slice-of-life etc.…)?
In what ways does each commercial connect emotionally with its target consumer?
Which advertisement/commercial is better at capturing current marketplace trends?
Upon further research on promotional campaigns in this product category, do you notice similarities how products in this particular category are usually promoted? In what ways could advertisers “cut through the clutter” when promoting their products in this category?
You can also discuss additional thoughts and observations! Please make sure to include a picture (or provide a link) of your advertisement in your paper! You can either answer the questions directly or format your analysis like an essay. The (approximate) word limit is 1,000 words.[supanova_question]
PSY 215 Abnormal Psychology Diagnostic Exercise Case Vignette: Geoffrey “Porky” Schumacher Geoffrey
PSY 215 Abnormal Psychology Diagnostic Exercise
Case Vignette: Geoffrey “Porky” Schumacher
Geoffrey Schumacher referred to, as Porky is a male born on January 15, 1988 to Rowan and Vivian Schumacher. The family is of Irish decent and they live in Connecticut. From a very young age, Porky had disciplinary problems in school and a possible learning disability. After extensive testing and meeting with school counselors, he was deemed to be suffering from Attention-Deficit Hyperactivity Disorder.
It was very obvious that Porky had a strong family history of multiple psychiatric disorders. His father was diagnosed with depression in the late 90’s. He was on medication and would see a therapist regularly. In addition, his father had antisocial personality disorder and panic disorder without agoraphobia. His father was involved in organized crime, which caused strains on his parents’ relationship. Due to these marital issues between his parents, Porky would often act out during their period of separation and possible divorce. As Porky got older, his father insisted on him becoming more responsible and not a failure in life. As a way to make Porky more productive, his father got him a job at a construction site. Porky started the job and was doing well. He met a Canadian girl named Olivia at the construction site and they started dating.
The two became really close, and Porky eventually proposed to Olivia. After some reconsideration, she decided that Porky was not right for her and broke up with him. This is when he became depressed. Porky continued to work at the construction site for some time, but the site of Olivia talking to other men became too much for him, so he eventually quit. Just as things seemed like they would never improve, Porky met some childhood friends whose fathers were also in the gang with his father.
He started hanging out with them and seemed to be improving. He improved to the point that he even began to take some college courses. However, these new friends turned out to be a bad influence. They were running some illegal gambling on campus and would use violence to collect money. Porky did not seem to be affected by this, but when they badly beat up an Jewish student, this sent Porky spiraling down once again.
After the breakup with Olivia, Porky started sleeping all the time and would not come out of his room. He had a decreased appetite and anhedonia. He seemed to lack energy for quite some time. There were no suicidal ideations initially. After the Jewish student incident, he again confined himself to his room and developed similar symptoms to what he was displaying after his break up with Olivia. It progressed to the point that he attempted to kill himself by tying a plastic bag around his face, wrapping a cinder block around his leg, and jumping in the pool while his parents were out of the house. Luckily, his father came home and saved him prior to there being any significant damage.[supanova_question]
Case Study – First American Bank Read the Case Study located on
Case Study – First American Bank
Read the Case Study located on pg. 269 of the text and answer the following:
1. How do the service characteristics of intangibility, perishability, inseparability, and variability fit into this discussion of marketing a bank?
Intangibility fits perfectly into the discussion of marketing by a bank through dealing with the services. Inside a bank you have the Loan department that can be considered highly intangible. This can be further detailed by office itself with the desks, printers, books, etc. Per our chapter studies items like this are services with the actual outcome of the service is not seen until the service is performed. Perishability can be equated with marketing of a bank by comparing the products of which are being marketed to the consumers. You have the different checking, savings, and credit cards being offered. In my perception you can also add in the bank location itself. If the volume of consumers is strictly doing online banking and only need ATM’s for other services. That can place the actually bank location in jeopardy and could close due to the overhead cost exceeding. Inseparability can fit into this discussion by the minimization of the customer to employee interaction. More now than before automation has become a major leading factor with banking today. You can see the difference within certain generations. The older generation still wants the personal interaction with bank tellers. The younger generation is more acceptable with using online resources and minimized personal interactions. They will use the ATM as their primary choice before thinking to go into a bank for assistance. Variability fits into this discussion by the characteristics of services and standardization of processes and services provided by the bank. Many banks may have the same products offered for consumers, but it falls on how each bank handles each individual interaction performed. Not every transaction so to say will be the same. The concept may be the same, but the process could vary from customer to customer based on their individual needs or wants.
2. Using all of the information presented in this case, what theme would you suggest for marketing of the First American Bank to the under-30 consumer? Why?
Based off the information I would suggest them to market more online resources. As stated in the chapter reading. The younger generation has decreased the need of having to personally go into a bank for assistance. One thing that can be marketed is faster services by doing self-serve such as depositing checks, bill pay, and transfer of funds all online. Another item the chapter reading discussed about the under 30 consumers is Trust. They can build trust simply by marketing via emails, commercials, and the marketing on ATMs.
3. Can you target new customers and use the same set of ads to encourage current customers to stay with the bank? Why or why not?
I would not use the same set of ads for future customers that you have for the existing customers. The reason behind this is because the current ads cater to what your current consumer is needing. That same ad may not relate to the current customer. Whether is age, gender, and/ or race you have to keep the marketing materials fresh and updated to reach and connect with different consumers. It is possible use the same set of ads for current customers as new customers. In the case, Lascu and Clow (2018) stated, ”For those satisfied, the primary reasons for leaving were because of perceived better prices or a better value package from a competitor” (Lascu & Clow, 2018, p. 271). Focusing an ad campaign on this topic would also draw new people to the bank.
4. If trust is an important value to bank customers, how can that message be conveyed to customers who bank primarily using the ATM, drive-up, or online banking?
As for any business they should want to reclaim any customers that they are losing. Retention is a major part of any business unit. One thing they can complete is a survey to research client’s reason for leaving or reasons that could possible retain them. From that point a business should be able to address the issues and see what they can do to minimize clients leaving. This could be as simple as updated technology, personal interaction with employees, user friendly website or processes, etc. I believe it would be beneficial to poll he customers that are being lost to competitors and see the reasons they are choosing to bank through someone else, this can offer some answers as far as what needs to be addressed. Once the issues are identified, the marketers can then adjust their recruiting strategies to highlight their services and customer service representatives can make adjustments to how they interact with clients. To address the concept of trust in an ATM and drive up setting, the bank can make a point to interacting with the customers while they’re waiting in line for the drive thru and while they wait for the ATM. They can also build trust through the consistent use of technology with payment receipts, fraudulent charge inquiries and increased online security for mobile banking users (Build Trust, n.d.)
Chow, K. E., & Lascu, D.-N. (2018). Marketing Essentials 6e. Saint Paul: Textbook Media Press.
Build Trust In Your Bank Through Technology. (n.d.).\ https://arca.com/resources/blog/build-trust-in-your-bank-through-technology[supanova_question]
You are working in a family medicine clinic with Dr. Hill. She
You are working in a family medicine clinic with Dr. Hill. She asks you to see Mr. Fitzgerald, a 68-year-old male who has been her patient for several years.
Dr. Hill tells you, “I spoke with Mr. Fitzgerald’s daughter at church yesterday. She is a nurse and is very concerned about her father’s skin condition, along with his other medical problems. He was not particularly interested in coming to see me, but his daughter encouraged him to do so.”
She continues, “Before we go in and see Mr. Fitzgerald together, let’s briefly talk about the way to describe skin conditions. The terminology used to describe primary and secondary skin lesions is the basic language of dermatology, the means by which you can accurately describe the lesion to a colleague.”
You examine the lesion on Mr. Fitzgerald’s arm.
You and Dr. Hill enter the exam room. After introducing you to Mr. Fitzgerald, Dr. Hill receives permission from him to let you interview him and then steps out.
You sit down across from Mr. Fitzgerald and ask a few questions:
“Well, I have had this red spot on my left arm for a while and it is slightly itchy and my daughter urged me to come and see Dr. Hill.”
You look at Mr. Fitzgerald’s left forearm to see the lesion he shows you.
Right away you note that the lesion is erythematous. Remembering what Dr. Hill just taught you about dermatology terminology, you run your finger over the lesion. Since the skin over the lesion does not feel raised to you, you decide you would call it either a macule (if it is smaller than one centimeter), or a patch (if it is larger than one centimeter). You estimate it is larger than one centimeter, and determine it is a “patch.”
“How long have you had this spot?”
“I am not really sure, but it has been there a few years, maybe three or four years, and it seems to be growing a little bit recently.”
“Have you hurt your arm at all where the spot is?”
You continue taking Mr. Fitzgerald’s history.
You decide to gather information about the rest of his history.
Past medical history: Seizure disorder diagnosed about 20 years ago. Takes carbamazepine.
Surgical history: Splenectomy done about 15 years ago because he fell from a ladder and injured his spleen.
Family history: He reports no family history of skin cancers.
Social history: He is divorced and lives by himself, but is thinking about dating someone. He states that he does not smoke and stopped drinking alcohol about 10 years ago. He says that he used to be a heavy drinker. He retired from work as a bricklayer for more than 30 years. He used to bike about 50 to 60 miles a week until his hip bothered him too much. He babysits for his daughter’s kids on the weekend, and he walks once daily.
Review of systems: Decreased stream and dribbling of urine for the past four to five months, but reports no chest pain, shortness of breath, or headaches. Slight right hip pain.
You thank Mr. Fitzgerald for the opportunity to interview him and inform him that you will step out of the room to discuss your findings with Dr. Hill. In the meantime, you instruct Mr. Fitzgerald to change into a gown.
You step out of the exam room and fill Dr. Hill in on what you have discovered so far, including that Mr. Fitzgerald has a 35 x 25 mm oval erythematous patch on his left forearm.
Dr. Hill suggests, “Before we go back to see Mr. Fitzgerald together, let’s talk a little bit more about what else to look for on a skin exam.”
You and Dr. Hill enter the room and perform the physical exam:
Temperature is 36.8 °C (98.2 °F)
Pulse is 64 beats/minute
Respiratory rate is 18 breaths/minute
Blood pressure is 124/76 mmHg
Head, eyes, ears, nose, and throat (HEENT): Unremarkable.
Cardiovascular: Regular heart rhythm without a murmur.
Respiratory: Lungs clear to auscultation and percussion.
Abdominal: Well-healed linear scar on his left upper quadrant.
Skin: Entire skin examined from head to toe, including his scalp, soles, and palms. Left forearm oval erythematous patch measures 35 X 25 mm.
Dr. Hill instructs Mr. Fitzgerald to get dressed while you both step out of the room, promising to return in a moment.
You discuss Mr. Fitzgerald’s diagnosis with Dr. Hill.
As you reflect on your differential diagnoses, you tell Dr. Hill that even though you are leaning toward the diagnosis of skin cancer (either squamous cell carcinoma, basal cell carcinoma, or melanoma), you have not completely ruled out the possibility that this is either eczema or a fungal skin infection.
“Okay,” Dr. Hill summarizes, “so do you think we should treat his skin lesion with an antifungal cream or a corticosteroid cream?”
After you think about this for a moment, you reply, “I’m not really sure. I don’t think we can decide how to treat the lesion until we know the diagnosis.”
You tell Dr. Hill that you think the best option for Mr. Fitzgerald is a punch biopsy. She smiles at you and replies, “Excellent. That was a bit of a trick question. In some cases, if there’s not a good diagnostic procedure, or if there is not huge risks associated with a condition, it is appropriate to treat empirically. But, in this situation, we have a good diagnostic test and the risks associated with skin cancer are too great to treat empirically or observe. I agree with you that a punch biopsy is the most suitable course of action for Mr. Fitzgerald at this point in time. Of course, we’ll have to obtain his consent first.”
She picks up a sheet of paper and shows you the consent form (PDF).
Mr. Fitzgerald is reluctant to do the procedure.
You and Dr. Hill return to the room to speak with Mr. Fitzgerald. Dr. Hill says, “The skin lesion on your left forearm seems to be a patch of long duration. As you were exposed to the sun during your working years and even now through biking, there is a possibility that this lesion could be either a condition that leads to skin cancer or an early stage of skin cancer. We would like to take a small piece of tissue out of the lesion and take a look at it under a microscope. Then we can tell you exactly what the diagnosis is. We call this procedure a biopsy. There are different ways of doing biopsies, but the best way for your case is to use a cylindrical punch to take the tissue out under local anesthesia.”
Mr. Fitzgerald says, “What if I don’t want to do the procedure?”
“Well, if that is the case,” Dr. Hill answers, “we would not know the exact diagnosis and do not know how to treat your skin condition. And if it is truly a skin cancer, it could get worse and may proceed to an advanced stage, which is difficult to treat.”
“Well then I guess it is better for me to do it,” sighs Mr. Fitzgerald.
“I agree.” Dr. Hill tells him. “Here is the form for you to sign. The risk with this procedure is that obviously you will have a scar after the procedure. There is also a small chance of bleeding and infection, even though we do our best to prevent these things. Do you have any questions?”
Mr. Fitzgerald does not have further questions and signs his name on the form. Dr. Hill also signs her name on the form and asks the medical assistant to sign their name as a witness. Then, Mr. Fitzgerald is escorted to the procedure room and the area of skin lesion is cleansed with povidone solution.
Dr. Hill performs a punch biopsy on the skin lesion.
You and Dr. Hill enter the procedure room. She washes her hands and wears a disposable sterile gown and gloves with the help of a medical assistant. You watch as she verifies that the area is disinfected with povidone solution and infiltrates the area of biopsy with 1% lidocaine solution using a 25 gauge needle.
After properly draping the area, she uses a 3 mm disposable punch and performs the punch biopsy at the periphery of the lesion. After taking out a small portion of the lesion and putting it in a formalin jar, Dr. Hill places a Steri-Strip to approximate the edge of the skin of the biopsy site.
She then applies compressive dressing and tells Mr. Fitzgerald to keep the wound dry for the next three days, and after that, to air dry the area. She mentions that the Steri-Strip may fall off after a few days. She instructs Mr. Fitzgerald that if he sees that the wound is red about six to seven days after the procedure, or sees pus coming out, he should contact Dr. Hill without delay. She finally mentions how to manage possible bleeding.
The specimen is being sent to the pathology lab and Dr. Hill asks Mr. Fitzgerald to come back to the office in about seven to ten days for follow-up.
A week has passed, and you see that Mr. Fitzgerald is on the schedule for his follow-up appointment.
You look up Mr. Fitzgerald’s electronic medical record (EMR) and find:
Pathology report of the punch biopsy: Squamous-cell carcinoma in-situ (Bowen disease).
You do some research on the office computer to figure out what the treatment options are. You discover that one factor to consider when determining which treatment to prescribe is the risk of recurrence and metastasis.
Treatment options are presented to Mr. Fitzgerald.
After you have discussed treatment options with Dr. Hill and agree that wide excision is the best treatment for Mr. Fitzgerald, you and Dr. Hill go together to see him.
You find him seated in the exam room next to a young woman whom he introduces as his daughter Sarah, who is a nurse.
Dr. Hill begins, “We’ve received the results from your biopsy and you have what is called cutaneous squamous cell carcinoma in situ.”
“Just what we were afraid of, cancer,” sighs Sarah.
“I know that sounds scary, but these skin cancers are usually treatable. In fact, you have a particularly slow-growing form of squamous cell carcinoma called Bowen Disease. This has a very good prognosis. How are you feeling Mr. Fitzgerald?” Dr. Hill asks, looking him in the eyes.
Mr. Fitzgerald says, “I thought that something was wrong and that was why I did not want to come to see you, but am I going to be okay?”
Dr. Hill puts her hand on his arm and continues. “As I said, it is very likely treatable without any harm. There are a few treatment options for this. I recommend what we call a wide excision. This can be done right here in the office under local anesthesia. We simply cut out the spot and a margin of normal tissue around it. I send in the margin of normal tissue for histological testing to make sure that we’ve gotten all the cancer. This procedure has a 95% cure rate.”
“I can also refer you to a surgeon who can take the spot off via Mohs micrographic surgery. The surgeon can confirm complete excision by immediately reviewing pathology, and then removing more tissue if necessary. I don’t think this is necessary in your case since I can see the edges of the spot on your forearm very clearly, so I should be able to get all of the cancer on the first attempt. Furthermore, this is on your arm, not near any important structures like your eyes or nose; so we can make sure to remove enough area to get the cancer, and we won’t need to worry about plastic surgery.”
“Are there options other than surgery?” Mr. Fitzgerald wants to know.
“Because this lesion could spread if untreated, surgical removal is the best approach. This allows me or the surgeon to confirm that the surgical margins are free of disease. But if you feel you really don’t want surgery, we can offer you alternative treatments that destroy cells such as topical 5-florouracil (5-FU), or cryotherapy.”
“Sounds like I’d better have the surgery done that you said you can do here,” Mr. Fitzgerald decides.
After obtaining the consent form, the excision of the lesion is done successfully by Dr. Hill and the specimen is sent to pathology. After the procedure, Dr. Hill gives Mr. Fitzgerald detailed postoperative wound care instructions and asks him to return for follow-up in ten days.
Ten days later, Mr. Fitzgerald returns for follow-up. After examining his skin, Dr. Hill says, “There is no drainage from the wound and the margins are well-approximated. The wound is well-healed.” She then takes out stitches and continues, “Make sure that you wear a wide-brimmed hat when you go out in the sun and do not expose yourself to the sun unnecessarily. Do you have any questions?”
“Doctor, my daughter, Sarah, is very worried about me, and she’s asking me to get some information about what to look for on my skin.”
Dr. Hill advises Mr. Fitzgerald on what to look for.
Mr. Fitzgerald thanks you both for the information regarding the care of his skin. Then he says, “Doctor, I have another question about something totally different. I have to get up during the night several times, maybe two or three times, to go to the bathroom. It takes a long time to start urination. Do I have a prostate condition?”
Dr. Hill asks you what could be your differential diagnoses in this case.
You say, “Considering the age and symptoms, BPH may be one of my top differential diagnoses, but I also think that we need to rule out acute or chronic prostatitis, and prostate cancer could be a very remote possibility.”
Dr. Hills says, “You are right in your differential diagnoses.”
Dr. Hill says to Mr. Fitzgerald, “It is quite likely that you may have a condition called benign prostatic hyperplasia. Why don’t you make an appointment with me in a week or two so that we can look into this more? In the meantime, I’d like you to have a few tests done so we can have the information we need on hand the next time you come in. Also, please complete this questionnaire which will help us to better understand your condition.”
As Dr. Hill speaks with Mr. Fitzgerald, you think about how to assess Mr. Fitzgerald’s condition.
The next week, Mr. Fitzgerald returns to the office for evaluation of his prostate problem. You look up the laboratory results.
PSA: 1.6 ng/ml.
You also review the results of his AUA BPH Symptom Index questionnaire.
You and Dr. Hill visit Mr. Fitzgerald together. With his permission, Dr. Hill performs a digital rectal exam and tells you, “Mr. Fitzgerald’s prostate is slightly enlarged, but I could not appreciate any nodule from each lobe of the prostate. He does not have any prostate tenderness either.”
Dr. Hill explains age-related prostate symptoms.
You and Dr. Hill step out of the room to allow Mr. Fitzgerald to change back into his clothes.
When you return, Dr. Hill begins, “Mr. Fitzgerald, as we suspected, you have what is called ‘benign prostatic hyperplasia’ or BPH. This refers to the increase in size of the prostate that often occurs in middle-aged and older adult males. As you see in this picture, this enlargement of the prostate can compress the urethral canal to cause partial obstruction of the urethra, which interferes with the normal flow of urine; causing the urinary symptoms you have described.”
Mr. Fitzgerald wants to know,
“Does this mean I’m going to have prostate cancer?”
“No. BPH is not considered a condition that leads to cancer. On your rectal exam, I found your prostate symmetrically firm and enlarged, which indicates BPH. If your prostate had felt harder or irregular on its surface or not-symmetric I would be concerned that you could have prostate cancer. We can follow your BPH in six months with a repeat PSA.”
You explain to Mr. Fitzgerald what he can do to improve his symptoms.
Mr. Fitzgerald indicates that he doesn’t have any other questions. He thanks you and Dr. Hill for your time and prepares to leave.
As he was leaving Mr. Fitzgerald says, “Oh, I almost forgot to mention this, but I have one unrelated question. I’ve been having some trouble with my feet lately. Can we address that now as well?”
“Sure!” Dr. Hill smiles and agrees to hear about Mr. Fitzgerald’s concern, although you know she has patients waiting to be seen.
“It is a relatively minor matter,” he claims, “but I have been noticing this burning sensation for the last week after I stepped in a mud puddle as I changed my bike route. I rode the bike continually in a damp right shoe and sock as I did not bring spare socks with me. Do you want to take a look at them?”
Dr. Hill nods and proceeds to examine Mr. Fitzgerald’s feet. After removing his shoes and socks, the patient points to his toes, drawing your attention to the redness present in the interdigital spaces. “Do you have any fever, swelling, or other problems associated with this?” you inquire.
“No, just the burning and this redness,” the patient says.
Dr. Hill steps aside to allow you to inspect Mr. Fitzgerald’s feet. You check between each toe looking for broken skin and find dry, red skin with occasional cracks in each web space. There is also redness proximal to the toes on the dorsum of the foot with the same dry appearance. You feel no warmth and Mr. Fitzgerald reports no pain to palpation. You further inspect finding no swelling and noting equal pulses in each of the feet.
Dr. Hill asks you,
“What condition may be causing Mr. Fitzgerald’s dry, cracking, erythematous skin between toes?”
You respond that you think Mr. Fitgerald may have tinea pedis. Dr. Hill congratulates you on your diagnostic accuracy. She explains to you and Mr. Fitzgerald that he has “a classic case of tinea pedis-or in lay terms ‘athlete’s foot.”
This is a ubiquitous dermatophyte infection and the most common of the superficial fungal infections.
Local friction and warmth between the toes, in combination with the patient’s wearing and frequency of changing of socks and shoes as well as wearing of wet shoes for a prolonged period of time, and the accumulation of moisture in his feet, particularly between the toes represent common contributory factors.
Other factors could be diabetes, immune compromising states such as chronic steroid therapy, and chemotherapy. HIV/AIDS can also lead to tinea pedis and onychomycosis.
The diagnosis is often made clinically but can also be aided with microscopy, where scrapings from the affected area are examined under microscopy, after treatment with potassium hydroxide.
You suggest a one-week course of terbinafine 1% cream. Dr. Hill concurs and provides Mr. Fitzgerald with a prescription and instructions.?
Mr. Fitzgerald thanks you and Dr. Hill for your help and heads out the door.[supanova_question]
You are working with Dr. Nayar at an inner-city office adjacent to
You are working with Dr. Nayar at an inner-city office adjacent to a small hospital. He has asked you to see Andrew, a 17-year-old male with right scrotal pain, who was brought in by his mother.
Dr. Nayar tells you, “Andrew is the third child of Ms. Deborah Hailey, a single mother who works as a home attendant and is also a patient of mine. Before you go in the room, let’s look at the chart to review his history. I have known him since his birth and have been seeing him regularly for health care maintenance. His last visit was more than a year ago for a sports preparticipation physical. He has been a good student, but had behavioral issues during his early teenage years. His mother really struggled with this as Andrew is quite different from her other two children. I provided some counseling to the family to help them adjust to and manage Andrew’s issues.”
You take a look at the problem list in Andrew’s medical chart.
Viral gastroenteritis at age 1 year
Upper respiratory infection at age 5 years
Appendectomy at age 12 years
Behavior problems at age 14 years
When you have finished looking at the chart, you and Dr. Nayar discuss some issues that might come up during an interview with family members present.
You find Andrew in distress on the exam table.
You enter the exam room and find Andrew lying down in an uncomfortable position on the exam table. His mother, Ms. Hailey, is sitting next to her son visibly worried and anxious.
You introduce yourself and explain, “I understand you are not feeling well. Would it be okay if I get some information about how you’re feeling? First, I would like to talk with you and your mom; then I would like to talk to you by yourself for a bit.”
“Can you tell me more about your pain?”
Andrew is having a hard time talking, but he states, “I have really bad pain in the right side of my groin. I was all right in the morning. It started suddenly about four hours ago while I was playing football. The pain started in my groin and at first, it was off and on, but now it’s moved to the right side of my scrotum and it’s been sharp and constant for the last couple of hours.” He adds,” I don’t think I did anything unusual in the football practice.”
You note that Andrew has already told you the location, quality, character, onset, and duration of his pain. You still have a few more questions to ask:
“Do you have other concerns, like nausea, sweating, chills, vomiting, or fever?”
“I feel very nauseated but I don’t have any fever or vomiting.”
You interview Andrew and complete the history.
You have a few more questions:
“How bad is the pain? On a scale from 1-10, with 1 being the slightest pain and 10 being the worst pain you have ever felt?”
Andrew grunts, “It is the worst pain I have ever had. I would give a score of 10.”
“Does anything make it worse? What happens if you . . .?”
Andrew getting annoyed with these multiple questions and interrupts “It is already worse.”
You reply, “I am very sorry for bothering you with all these questions. I need this information to find out what is going on with you.
“Has anything made it better?”
“Nothing is relieving the pain.”
Ms. Hailey interjects, “He had similar pain few months ago and it was relieved without any treatment.” She looks worried, “I hope he didn’t hurt himself while playing.”
You complete the history. Andrew denies any increased urinary frequency, dysuria, urethral discharge, abdominal pain, or vomiting.
Ms. Hailey wants to know, “Could you tell me what is going on with Andrew?”
You respond, “Well, I have to ask Andrew a few more questions and then examine him before I could tell you anything. Can you please excuse us for now and I will call you back as soon as we are done.”
After obtaining information about his pain you want to inquire about his sexual history.
You ask Andrew if he is in a sexual relationship.
Before Mrs. Hailey leaves the room, you reassure Andrew by saying, “What you and I talk about is confidential, which means that I am not going to tell your mother anything we talk about unless I am worried that you are hurting yourself, hurting someone else, or someone is hurting you.”
Mrs. Hailey leaves the room, and you begin your conversation:
“You must be in eleventh grade. How is school going?”
Andrew responds, “My schoolwork is going pretty well. I am getting As and Bs. Next month I am going to take the SAT.”
“Do you have a romantic or sexual relationship with anyone?”
Andrew reports that he has been sexually active with a single female partner for the past year and uses condoms sometimes for protection.
“Have you ever been pressured to do something sexually that you didn’t want to do?”
Andrew denies being subjected to any kind of pressure.
On further questioning, he denies past history of sexually transmitted diseases, urological/surgical procedures (aside from the appendectomy), or congenital anomalies.
You ask him about his diet and he tells you that he maintains a healthy diet and feels satisfied with his current weight and shape. He adds, “I have never experimented with dietary supplements or steroids, although I know of some kids on the football team that have tried them.”
During the conversation, Andrew notes, “Several of my friends have begun to smoke cigarettes, but I don’t like the taste of them.”
You then excuse yourself while Andrew undresses for the physical exam. You ask him if he would like to have his mother in the room while he is being examined.
While waiting for Andrew to undress, you quickly go to Dr. Nayar to update him on the case so far.
After you have discussed the differential diagnosis, Dr. Nayar tells you, “Before we go back in to see Andrew, let’s review the basics of the scrotal exam. This exam will help us narrow the differential.”
You and Dr. Nayar begin the physical exam.
You knock on the door to ensure Andrew is ready, then enter the room to perform the physical examination. Andrew’s mother is seated in the corner because he has requested her presence.
Dr. Nayar greets Andrew and his mother, and expresses concern about Andrew’s pain, then proceeds to perform a physical exam with you.
Temperature: 98.7 Fahrenheit
Heart rate: 90 beats/minute
Respiratory rate: 14 breaths/minute
Blood pressure: 130/82 mmHg
Weight: 145 lbs
Height: 5′ 9″
Body Mass Index: 21 kg/m2
Pain score: 10/10
General: Well-built male in moderate to severe discomfort.
Head, eyes, ears, nose and throat (HEENT): No conjunctival icterus or pallor.
Cardiac: Regular, Normal S1 and S2. No pleural rubs, murmurs, or gallops.
Lungs: Clear to auscultation bilaterally.
Abdomen: No distension. Active bowel sounds; No abdominal bruits. There is no guarding or rebound tenderness. No rigidity. No palpable masses or hepatosplenomegaly.
Back: No costovertebral angle or spine tenderness.
Extremities: Femoral and pedal pulses are strong and equal.
Genitourinary: Inspection of his genitals reveals a swollen and erythematous right scrotum. His right testicle is exquisitely tender, swollen and has no palpable masses. Elevation of the testis results in no reduction in pain (negative Prehn sign). The left scrotum and the testicle are normal. Epididymis and other scrotal contents were within normal limits. The scrotum does not transilluminate. Cremasteric reflex is present on the left side but absent on the right. There is no penile discharge, inguinal lymphadenopathy, or hernias.
Rectal: Nontender. Stool medium brown, heme negative. Prostate gland normal size, smooth and nontender.
After completing the examination, you and Dr. Nayar excuse yourselves from the room in order to give Andrew a chance to put his clothes back on.
Dr. Nayar asks you to summarize the case.
Dr. Nayar asks you to consider the differential diagnosis of unilateral scrotal pain in this patient.
Trauma, testicular torsion, epididymitis, and torsion of the testicular appendages are the four most likely diagnoses at this point.
Dr. Nayar tells Andrew and his mother about his condition.
You and Dr. Nayar return together to the exam room.
He sits down in a chair and explains, “Andrew has a condition called testicular torsion.”
Ms. Hailey asks,
“What do you mean by testicular torsion?”
Dr. Nayar takes a paper and pen and draws a diagram of a normal testicle and its blood supply and explains, “Here is a picture of the blood supply to the testicle. In testicular torsion, a testicle gets twisted and the blood supply to the stalk is blocked.”
“How did Andrew get this?”
“The cause of testicular torsion usually is not clear.”
“How can you tell that I have testicular torsion?”
“You have severe pain in your scrotum. Your right testicle is swollen and is higher in the scrotum than the other testicle. Infection, cancer, or an injury also can cause pain in the scrotum. However based on your history and physical findings we strongly suspect testicular torsion,” Dr. Nayar answers.
Dr. Nayar continues, “I know this is a lot to process, but it can be treated. You will need immediate surgery to untwist the testicle. I will call the urologist who will be performing the surgery and they will make sure the testicle does not twist again. They also will make sure the other testicle doesn’t twist.”
Dr. Nayar hurriedly says, “Now if you don’t have any further questions I need to send you to the emergency room for further testing and to prepare Andrew for surgery.”
He reassures them that he will come to the emergency room to follow up on the tests and to further explain the management plan.
You accompany Andrew to the emergency department. The attending, Dr. D’Souza, quickly places him in one of the adolescent rooms and begins to evaluate him. Intravenous access is established. She sends blood and urine samples for further testing, and pages the urologist.
By now, Andrew’s pain has become much more intense and he asks for pain medication. Dr. D’Souza gives him 2 milligrams of intravenous morphine, which provides some relief. You wait patiently for the results to come back, while at the same time, you are trying to reassure Ms. Hailey.
The urologist, Dr. Greenburg, arrives quickly, examines Andrew, and confirms the diagnosis of testicular torsion based on a history and physical findings. He then discusses the results of the tests and a management plan with Andrew and Ms. Hailey.
“Andrew, your complete blood count (CBC) is normal. Your urine analysis is also normal. However, we ordered urine tests for infection that will not be back for a couple of days. At this point, we do not suspect an infection as a cause for your symptoms.” Dr. Greenberg explains the risks and benefits of surgical intervention and general anesthesia, obtains informed consent from Ms. Hailey and prepares for immediate surgical exploration.
You also give Mrs. Hailey patient information on testicular torsion to help her to understand better about the condition.
After Dr. Greenburg has finished his preparations, while he awaits the anesthesiologist, he reviews the procedure with you.
Andrew has returned for his follow-up visit. You review his inpatient records including the operative and post operative course using his electronic medical record (EMR).
EMR review reveals that Andrew had surgical exploration of the scrotum through the midline scrotal raphe. The ipsilateral scrotal compartment was entered and the testes was untwisted. The testes was found to be viable (Signs of a viable testes after detorsion include, a return of color, return of Doppler flow, and arterial bleeding after incision of tunica albuginea). To prevent subsequent torsion, the gonads were fixed to the scrotal wall with nonabsorbable sutures. The contra lateral testes was explored and anchored through the same incision. The post-operative period was uneventful. Andrew was discharged from the hospital 48 hours after the surgery. He also had a follow-up visit with Dr. Greenburg a week later.
You and Dr. Nayar visit with Ms. Hailey and Andrew. You discover that Andrew is doing well[supanova_question]
Travis Kalanick was the founding CEO of the ride-sharing giant Uber. Under
Travis Kalanick was the founding CEO of the ride-sharing giant Uber. Under his leadership, Uber has become a globally successful firm with a valuation of over $60 billion. Kalanick is in his early forties, but Uber is the third firm that he started. Earlier in his career, he founded the file-sharing company Scour which ended up going bankrupt due to lawsuits. He had more success with another file-sharing company called Red Swoosh, which he later sold for $19 million.
In spite of all of his accomplishments and success, he has always been a controversial CEO. Recently he was caught on video berating an Uber driver, a video that went viral. He has also faced allegations of fostering a toxic corporate culture. After facing a continuing wave of negative publicity, Kalanick had to step aside as CEO but remains as a powerful member of Uber’s Board of Directors. He is also still one of their major shareholders, so even though another CEO will be managing the day-to-day, affairs he is likely to remain as a major leader within Uber.
For this paper, you should first thoroughly review the background readings and make sure you are clear on the distinction between charismatic, transformational, and transactional leadership. Then do some research on Travis Kalanick’s leadership style. There is no shortage of articles about Travis Kalanick and Uber. But harder to find are articles on what kind of leader he is and how he leads his employees. Here are a few articles to get you started, but if you can find articles that are more recent or have more information about his leadership style, feel free to use them in your paper instead:
Chafkin, M. (2015). Travis Kalanick, the fall and spectacular rise of the man behind Uber. Retrieved from http://www.scmp.com/magazines/post-magazine/article/1860723/travis-kalanick-fall-and-spectacular-rise-man-behind-uber
Somerville, H. (2017). Uber CEO’s iron grip poses challenge in COO search. Retrieved from https://www.reuters.com/article/us-uber-governance/uber-ceos-iron-grip-poses-challenge-in-coo-search-idUSKBN17F1CO?il=0[supanova_question]
Making sure to use each of the 7 components listed in the
Making sure to use each of the 7 components listed in the Powerpoint provided, brief the State v. Ramer case. This case must be submitted on Canvas by no later than August 4th, at 11:59pm. To receive credit for your assignment, it must be submitted by this time. You can also find this case online at: https://caselaw.findlaw.com/wa-supreme-court/1039973.html (Links to an external site.)
There is no page length required for this assignment. However, make sure that you thoroughly address each of the components.
Your brief MUST be in your own words — not using a summary found online (like oyez or Wikipedia). I realize you will have to use the case a great deal to word your brief, and that is okay, as long as it is also in your own words.
Using material from the case itself is NOT plagiarism (for this assignment only), but it is important to show that you are comprehending the material. This is done so by interpreting what you have read, and putting it into your own words. (I.e., paraphrasing!)
Finally, the case you are briefing is, legally speaking, very technical. You will probably want to look up words like “Habeas Corpus,” etc., to understand exactly what the Court is saying. I have provided a link above to Black’s Law Dictionary for you to be able to easily access any definitions to legal terms.
FORMAT FOR WRITTEN CASE ANALYSIS Required Sections Guidelines I. Executive Summary One
FORMAT FOR WRITTEN CASE ANALYSIS
I. Executive Summary
One to two paragraphs in length
On cover page of the report
Briefly identify the major problems facing the manager/key person
Summarize the recommended plan of action and include a brief justification of the recommended plan
II. Statement of the Problem
State the problems facing the manager/key person
Identify and link the symptoms and root causes of the problems
Differentiate short term from long term problems
Conclude with the decision facing the manager/key person
III. Causes of the Problem
Provide a detailed analysis of the problems identified in the Statement of the Problem
In the analysis, apply theories and models from the text and/or readings
Support conclusions and /or assumptions with specific references to the case and/or the readings
IV. Decision Criteria and Alternative Solutions
Identify criteria against which you evaluate alternative solutions (i.e. time for implementation, tangible costs, acceptability to management)
Include two or three possible alternative solutions
Evaluate the pros and cons of each alternative against the criteria listed
Suggest additional pros/cons if appropriate
V. Recommended Solution, Implementation and Justification
Identify who, what, when, and how in your recommended plan of action
Solution and implementation should address the problems and causes identified in the previous section
The recommended plan should include a contingency plan(s) to back up the ‘ideal’ course of action
Using models and theories, identify why you chose the recommended plan of action – why it’s the best and why it would work
VI. External Sourcing
External sources (in addition to your textbook) should be referenced to back up your recommendations or to identify issues. This information would be ideally sourced in current journals, magazines and newspapers and should reflect current management thought or practice with respect to the issues identified.
VII. Spelling Grammar and Presentation
Your case analysis should :
Include the 5 sections listed in the outline
Be double spaced and the pages should be numbered
Have 1inch margins – top bottom left and right
Use 12 point font size
Be free of spelling errors
Use an established referencing system
Present the executive summary on the first page of the assignment along with your name (s), student number(s), course section and due date[supanova_question]
Case Study Personal Information Name: Mr. Christopher Franklin Age: 60 years old
Name: Mr. Christopher Franklin
Age: 60 years old
Mr. Franklin is a 60-year-old patient with a history of a thrombotic cerebrovascular accident two years ago. After the stroke he started with seizure attacks. He has been suffering from hypertension for the last ten years and ulcerative colitis since last year. He currently takes lisinopril, hydrochlorothiazide, aspirin, carbamazepine, and a low dose of prednisone.
Mr. Franklin has been suffering from epigastric pain, sensation of fullness, and occasional nausea for the last six months. This time, he was brought to the ER because, while he was talking to his son, he had a dizzy spell and fell to the floor. He is conscious and is complaining of severe epigastric pain. He began with mild abdominal pain two days after he started taking a new cycle of prednisone for his colitis, around seven days ago. The pain increases when he eats or drinks something. He is also complaining of suffering from pyrosis, malaise, and dizziness, and he has noticed that his feces are dark.
The patient was a heavy alcohol drinker until he had the stroke. He is a cigarette smoker since he was 20 years old. His mother suffered from Alzheimer’s disease and died of colon cancer, and his father died of cirrhosis of the liver.
On physical examination we found:
Remarkable Signs on Physical Exam by Regions
Abdomen: Pain on palpation on epigastric region
SOMA: Right hemiplegia and hyperreflexia
Remarkable Signs on Physical Exam by Systems
Integumentary system: Pallor, diaphoresis, coldness
Cardiovascular system: Tachycardia. Blood pressure 70/50 mmHg. Radial pulse 110.
Digestive system: Tenderness of epigastric region. Rectal exam showed melena.
Neurologic system: The patient is conscious and well oriented to time, place, and person. Right hemiplegia and hyperreflexia.
Complete blood count (CBC)
Abdominal CT scan
Upper digestive bleeding due to drug-induced gastritis
Stabilized thrombotic cerebrovascular accident
Mr. Franklin’s diagnoses of multiple digestive disorders has severely and acutely impacted his quality of life. If you’ve ever had a stomach ache, or even just mild bloating, you can appreciate how important a healthy digestive system is to your health and happiness. Similarly, living with neurological disorders can be confounding and scary to patients. In this module, you will explore disorders related to these two systems and take a deeper look at Mr. Franklin’s conditions.
In at least 750 words, or 3 double-spaced pages, prepare a case report that addresses the following:
Based on the case study provided, respond to the following questions:
Identify and differentiate the symptoms from the signs in this patient.
Did you find any remarkable detail in the personal and social history of our patient that can help to make the diagnosis?
What results do you expect to find in the tests ordered?
What are some future complications the patient is at risk of developing?
What organs are included in the upper digestive system? Mention and explain at least three other conditions of the upper digestive system that may be a cause of digestive bleeding.
What specific sign on the physical exam is characteristic of upper digestive system bleeding?
What organs are included in the lower digestive system? What are some causes of lower digestive system hemorrhages, and how do you differentiate them from upper digestive system hemorrhages?
According to the patient’s previous medical history, it is possible that he has cirrhosis of the liver? Why? Can cirrhosis of the liver be a cause of upper digestive bleeding? What is the prognosis? Explain.
Are there any specific risk factors of diseases of the gallbladder or pancreas? If so, why, and what is the prognosis?
Please use references and intext citation[supanova_question]
Class Activity CASE STUDY – Changes at Honey Grove High Case Narrative
CASE STUDY – Changes at Honey Grove High
Founded in 1860, the city of Honey Grove has prided itself on maintaining its rural appeal despite the fact that its population is rapidly growing on an everyday basis. While the majority of its residents are of working-class origin, there are a handful of individuals—mostly teachers and young professionals who have received a college education, and have subsequently returned to their “hometown” for employment purposes. Indeed, Honey Grove is a hometown in the truest sense of the word. In fact, the annual Barn-Warming Festivities, Christmas Pageant, and Easter Ham Suppers, are just a few of the activities that define the essence of the Honey Grove community.
The vast majority of students in the Honey Grove School District attend one of three public schools (one elementary, one middle, one high school). The district covers approximately 225 square miles and serves three different counties (Hickory, Oak, and Sassafras). In most cases, children in the district have attended—or will attend—the same schools their parents, and perhaps grandparents, attended when they were young. In fact, the connection to the schools is so strong, that generations of alumni attend the Honey Grove homecoming festivities every year. Approximately four years ago, the Honey Grove Chamber of Commerce managed to attract Farmlake Industries—one of the leading poultry processing and distribution operations in the US—to establish a processing plant near the city of Honey Grove. Although local residents were hesitant to accept this proposal, the mayor and the city council insisted it was a good idea to have a nationally-recognized company in their midst. After all, Farmlake would create immediate job openings that would translate into higher buying power and boost the entire economy of the city.
However, when Farmlake opened its doors, local residents found there were few lucrative job openings at the plant. Instead, the majority of the “new” jobs were concentrated in the lower ranks, paying slightly above minimum wage for labor that was less than appealing. Faced with a shortage of employees, Farmlake began to aggressively recruit Latina/o1 workers from a Farmlake plant in a neighboring state, offering them a moving bonus to relocate to the newly opened plant. Many Latinas/os immediately accepted Farmlake’s offer. These initial recruits, seeing there were plenty of job openings in the area, encouraged other relatives, friends, and extended kin to relocate as well. This created a sudden influx of Latina/o workers that impacted the Honey Grove community in many ways.
The impacts included the obvious linguistic and cultural differences of this population. Because the new residents spoke very little English, and because their cultural background was unfamiliar to local residents, many Honey Grove natives perceived the new arrivals as “outsiders” who were taking over their community. Unfortunately, the living conditions under which many Latinas/os lived, e.g., travel trailers, dilapidated homes, and overcrowded living arrangement, only served to heighten and reinforce stereotypes of a Latina/o underclass. Moreover, schools were impacted by this demographic shift, as increasing numbers of Latina/o children began to enroll at Honey Grove public schools.
General Description of Honey Grove: Four Communities
The City of Honey Grove, while largely homogenous on the surface, was really comprised of four distinct communities: (a) the larger “community” of Honey Grove, (b) the Honey Grove Public School community, (c) the American Indian2 community, and (d) the emerging Latina/o community. While the stakeholders of these communities overlap, the voices become distinct to each community and yield a portrait of a rich and complex landscape within which the school system and its personnel operate.
The Honey Grove Community
Because of its central location, low cost of living, exceptional schools, low crime rate, and convenient access to the State Fairgrounds, the City of Honey Grove has consistently been ranked as “one of the best places to raise a child” by a popular civic organization in the state. Despite the steady increase in population in recent years, Honey Grove manages to maintain its Rural appeal and its characteristic charm. This is primarily due to the fact that Honey Grove is Organized around three distinct “neighborhoods,” each with a particular flavor that enhances the Overall feeling of a close-knit community. In fact, much of the families in the city have lived there for generations. The spirit and lifeblood of Honey Grove are defined by these families and characterized by their participation in events such as the annual High School Invocation, the FFA-sponsored Barn-Warming Dance, and the annual “Little Miss Honey Grove” Beauty Competition.
The 2000 United States Census data indicate that the population of Honey Grove is 1,246. However, Census data suggests the distribution of the population has dramatically diversified in the last few years, with Latinas/os growing at much faster rate. The distribution of the population, by ethnicity, is as follows: Caucasian (87%), African-American (0.8%), American Indian (6%), and Latina/o (6%). These changes have certainly influenced the overall “flavor” of the Honey Grove community, as it struggles with the difficulty of this transition.
Honey Grove Public Schools
Honey Grove Public Schools holds a prominent place in the community. In fact, the main street through the center of Honey Grove—officially named Broad Street—is often called “School Street” by many, and the superintendent has commented that “the community is always at the heart of its school.” The water tower that dominates the landscape proudly displays the high school name and mascot for all to see. The school system has a rich tradition, particularly in the area of athletics. There is a fervent sense of support for the athletic teams, and much of the social life of the community revolves around school functions, especially athletic events. The school district athletic banquet at the end of the school year is a major event for both the school district and the community. Letters are given to students for athletic achievements, and they wear them with much pride.
The traditions associated with Honey Grove Public Schools lie within several areas, most notably, athletic events, participation in the Coalition of Christian Athletes, and the overriding sense of stability that has been part of the school and the broader community. The superintendent spoke of these traditions in a recent School Board meeting at which improvements in the high school field house were being discussed:
We have invested in, and have, a great tradition in athletics and sports—and I believe for all the right reasons. It’s community driven and the community expects it. The community knows and understands the leadership qualities that can come out of asking youngsters to work hard, under discipline, to face adversity, to reach a little deeper, to expect a little more of themselves. So, all these things that we profess about athletic programs have manifested themselves over the years here in Honey Grove, and therefore, we have invested in a nice track and lights for the football field—items which might appear frivolous if we look at why we didn’t have computers and other niceties. But, given the value system and what the community is shooting for, it makes logical sense.
A corollary to the sense of tradition within Honey Grove Public Schools is the stability that has, until recently, undergirded the school community. Many of the personnel of the school system, including administrators, teachers, and support personnel, are graduates of the system. Five of seven administrators (including the superintendent), 25% of the teachers and 40% of support personnel graduated from Honey Grove High. Moreover, members of the school board have been even more stable than school personnel. Over half of them are graduates of the system, and several of the same individuals have held office for many years. Even when a change in board membership occurs, it appears that the same stakeholder groups, interests, and values are still being represented.
The tradition and stability of the school district are often related to the sense of pride expressed by members of the school board and the broader community. As one board member noted, “There is always community pride among people who are close together. They not only work together but also play together.” Parents also recognize the tradition of the schools and have been appreciative of the stability the district has enjoyed. Parents consistently speak of the importance of rigorous training in the basics, a sentiment echoed by school board members and in public pronouncements of administrators and teachers. Another source of pride is the district’s dropout rate that is lower than the state’s average of 20%. Additionally, it has been a common belief that teachers and school administrators are above reproach, serving as role models for the students and the rest of the community.
The High School, a two-story building built in 1922, houses the senior high students in grades 9-12. A middle school (grades 6-8) was built in the late 1980s and is located at the edge of Honey Grove. An elementary school, Lamb Elementary (K-5), is on the campus of the High School where the district offices are also located. Lamb Elementary was named after the first superintendent of the district—an Army training officer during World War I who went on to earn his doctorate at a normal school before coming to Honey Grove to head the newly formed school district. As stated above, the district serves three different counties. To cover the six daily bus routes that serve the students, Honey Grove maintains a fleet of 9 buses.
In 1997 there were 381 students enrolled in Honey Grove Public Schools. As of 2000, the enrollment jumped to 602 students. Of these, 85% are Caucasian, 6% are American Indian, and 9% are Latina/o. School district staff are comprised of seven administrators (a superintendent, a director of special education and five principals), 38 teachers, and 22 support staff. In recent years, however, the district has had to hire several additional teachers—many who are unfamiliar with the traditions of Honey Grove Public Schools.
The American Indian Community
This community is rarely mentioned in school board meetings or by school personnel in their discussions of school problems and issues. In addition, given the small percentage of students who are American Indian, when distributed across the four schools, these students often times find themselves as the lone representatives of their community in many individual classes. Leaders of the American Indian community consistently note that they feel disenfranchised from school decisions, highlighting that the dropout rate among their children is higher than for other students, and that the culture of American Indians is poorly understood by school personnel and rarely dealt with in the curriculum. Moreover, they contend that when American Indian issues are addressed in schools, they are often misinterpreted through majority perspectives.
The Latina/o Community
The Latina/o community has experienced tremendous growth the past three years as members of this community have been attracted to employment offered by Farmlake Industries. The growth in the size of this community is posing a challenge for the schools, since many parents and children in the Latina/o community cannot speak English. In addition, about 50% of the community is highly transient, leaving for better employment in another locale after spending less than a year in Honey Grove. From the Latina/o community’s point of view, the school is not dealing well with either the language issue or in being sensitive to community norms and values. In addition, leaders of the Latina/o community are concerned that the schools themselves are one of the reasons their members are so transient. They believe those who leave are not only looking for better employment, but also better schools and communities for their children.
A Threat to Stability and Tradition
Honey Grove had been steeped in tradition that had been relatively stable for many years. But increasingly, change has begun to intrude. First, was the growth in the Latina/o community, which is posing challenges to the school district and its personnel. Second, the growth in neighboring Oakville (located in Oak County) has resulted in district student population growth owing to the presence of Douglas State University, which is located there. This growth in student population not only has put strains on Honey Grove School’s facilities, but also has required the hiring of additional teaching staff.
Moreover, drug and gang problems are being increasingly noticed; the community and school personnel attribute these problems to the influx of students from Oak County. The make-up of the teaching staff is also rapidly changing. Just a few years ago, only 25% of the teaching staff came from neighboring Oakville. Now, that percentage has risen to 55%. The Oakville teachers, like the Oakville students, are “different” according to Honey Grove residents. They believe the newcomers don’t understand the values and traditions of the community and have little knowledge of how the school system traditionally operates. Finally, due to growth in the Oak County, a new school board member has recently been elected—a member who, for the first time in residents’ recent memories, represents constituent groups and interests different from those represented in the past.
Problems at Honey Grove High School
Many of the tensions related to change have begun to manifest themselves at Honey Grove High School and have particularly troubled its principal, Walter Reid. This is Walter’s first year as the principal of Honey Grove—having only two years of administrative experience under his belt. Before his current role, Walter was an assistant principal at a high school at a neighboring school district. Before becoming an administrator, Walter was an English teacher for seven years. He completed his undergraduate, graduate, and specialist degrees at Douglas State University, and recently celebrated his 33rd birthday.
Walter relocated to Honey Grove when the previous principal, Mr. Anderson, took an early retirement due to a heart complication. Stepping into Anderson’s shoes, however, was quite a task for Walter. Not only was Anderson the principal of the school for 23 years, but he was also cherished by everyone in the community for his leadership and vision. Moreover, Mr. Anderson not only hired the “winningest” coach in Honey Grove history, but he was also a key figure in the Honey Grove Spirit Campaign which helped renovate the football bleachers, provide separate weight training facilities for the football team, and repaint the high school mascot on the water tower. Indeed, Mr. Anderson was a local legend, and there were very few people in the community who had negative things to say about him.
Walter knew he had some big shoes to fill. Not only did he have to overcome the aura and legendary status of Mr. Anderson, but also had to make others understand and accept his unique style of leadership, which was more participatory and collaborative than the style of his predecessor. Another barrier he had to overcome was his relative youth and inexperience. He knew it would be difficult, particularly for the senior faculty, to take directives from a young administrator.
To help him secure a foundation in implementing his vision for the high school, Walter searched for faculty members whose values and beliefs were supportive of change, reform, and diversity. Many of these new hires were recent college graduates from Douglas State University. Although there was some resistance, primarily from the superintendent and board, in hiring these individuals, Walter believed they possessed the spirit of change and positive energy that could bring the community together in times of transition. “This is what the community needs right now” he told the superintendent. “We need people who are change agents, people with a vision, people who have a positive outlook about teaching, people who genuinely believe all children can succeed and welcome the challenge of teaching all learners.”
Veteran teachers not only resented these new hires, but also felt they were receiving preferential treatment because of their “liberal” beliefs. The new hires were not seen as equals, but were often referred to as “kids” or “still wet behind the ears.” In response, the new hires felt the veteran teachers ere too “old fashioned,” too “set in their ways,” and were not doing anything proactive to become full members of the school community. These contrasting belief systems served as the foundation for many tensions between the faculty.
Evidence of this tension came in several forms. Fred Barnhardt, head of the Science Department (which was still composed entirely of veteran faculty) had approached Walter on numerous occasions raising concerns about the school’s movement away from its traditional foundations. “Look Walter,” Fred stated, “I’ve got a lot of respect for you. I don’t like most of your cockamamie ideas, but I respect you as a person. And I feel I need to be honest with you. As the head of this department, and as a representative of this faculty, I think I have a duty to tell you that some of us aren’t happy with the direction in which you’re taking us.” Walter was a bit disturbed by this comment, but realized there was, indeed, increasing talk among the veteran teachers about “how it used to be” when Dr. Lamb and Mr. Anderson were still in charge. The tensions had also been manifested by Jane Mead, a newly hired teacher. She was a recent graduate of Douglas State’s English Education program. When hired, she decided to maintain her apartment in Oakville and commute daily to Honey Grove in a car pool of other Oakville residents who commuted to Honey Grove to teach. According to Ms. Mead, her efforts to “fit in” with the rest of the teachers had been difficult. In her rides to and from Honey Grove, commuting teachers would tell her one thing. When she was at the school, resident teachers would tell her another. It was if she were caught between the two groups. When she did anything that was contrary to either group, leaders of the particular group would remind her that what she had done was not consistent with the way things were done. She was confused and frustrated and had come to Walter for advice.
When Walter called a faculty meeting to address some of these tensions, veteran teachers sat where they always had—next to the coffeepot—and were less than cordial to new teachers when they got up to fill their cups. As Walter expected, neither group was willing to admit the tensions between the groups, nor were they willing to discuss them to any significant extent. It was as though no one wanted to discuss the source of these tensions, despite the fact that they were clearly affecting the overall climate of the school.
Instead of forcing teachers to talk about this issue, Walter began to discuss new business. An issue was raised by an outspoken social studies teacher (a new hire) about the school’s explicit emphasis on sports at the expense of academics. He suggested that the school should not only pay more attention to scholarship, but also recognize outstanding student scholars in the same way it recognizes outstanding student athletes. Another new teacher suggested the school should consider replacing the trophy cases at the front of the school with honor role lists and pictures of the school’s valedictorian and salutatorian. This proposal was well received by the newcomers, but angered the veteran teachers. Fred Barnhardt quipped, “I’m tired of all these touchy-feely, suggestions I’ve been hearing lately. Those trophy cases are our pride, our traditions, our life—something you all obviously don’t know anything about. I have a better suggestion: why don’t we just keep the trophy cases where they are and send you all back to Oakville where you came from.” The veteran teachers broke out in laughter while the newer teachers became visibly upset. As the meeting progressed, teachers began shouting and rudely interrupting each other as they expressed their opinions about the trophy cases. They were clearly passionate about this issue and Walter could not control the tone of the meeting. Rather than try to settle those differences on the spot, Walter suggested that teachers put their opinions in writing and submit them to him by lunch the following day. At 8:35 the next morning, Walter received an urgent phone call from the superintendent and the school board president.
The Urgent Phone Call
The purpose of the phone call was twofold. On the one hand, the superintendent and the school board president wanted to remind Walter that very influential people in the community (including the bank president and the local state representative) were former football players, and would not look favorably on the decision to relocate the trophy cases. “Look Walter,” said the school board president bluntly, “this isn’t about academics versus sports. It’s about what the community wants. It’s what the community expects. I know you’re still new to Honey Grove, so let me give you a piece of advice: things can get real sticky around here if you’re not careful. Remember, you’re still on a provisional contract. I wouldn’t upset the apple cart, if I were you.”
The superintendent reiterated the point: “One of the reasons we hired you, Walter, was because we knew you had a good head on your shoulders and would make the right decisions. I know you had all these dreams about doing things differently when you became principal. Heck, I had ‘em too when I started out. But you need to remember: there’s fantasy, and then there’s reality. I think it’s time you start getting in touch with reality, son.”
After discussing this first issue, the superintendent quickly moved to the second issue: “The second thing we wanted to talk to you about, was what you were doing about the growing drug and gang problem in the school.” “It’s getting way out of hand!” interrupted the school board president. Walter assured them that he would get a committee together as soon as possible and look into the issue. “Great,” said the superintendent. “I’m sure Sally Thompson and Bob Bailey would be glad to serve on the committee as well.”
Although Walter did not plan to put these individuals on the committee, he felt his hands were tied politically. The following day, Walter decided to appoint a committee to recommend how to deal with this growing problem. The committee was comprised of veteran and new teachers, the PTA president, and the two recommended individuals from the community. After examining mounds of data and reports on the subject, and after extensive review and discussion, the committee recommended the establishment of an in-school suspension program. Although Walter did not believe suspension was the answer to the problem, he accepted the committee’s recommendation and announced that it would be put into effect immediately. Announcements of the new policy were made at the next school board meeting, and flyers describing the policy were sent to all students and their parents.
The Suspension Program
Within two months, the suspension program was bulging at the seams. Parents complained that teachers were using the policy to get rid of students they did not want in their classes. Leaders of the American Indian and Latina/o communities believed the policy was resulting in discrimination, as American Indian and Latina/o students were over-represented in the program. In addition, a disproportionate number of special education students (especially those with behavior disorders) seemed to find their way into the program as well. To make matters worse, a local reporter from Oakville printed the following lead story in the Oakville Daily Banner: In-School Suspension at Honey Grove High School: A solution or part of the problem? Parents of students at Honey Grove High School in Honey Grove are up in arms over the continued use of an in-school suspension program instituted by Dr. Walter Reid, principal. While the argument for keeping the students in school appears sound, the program may be a smoke screen for discrimination. Officials in the Honey Grove district office said they are looking into the problem and did not want to comment at this time. Dr. Reid was unavailable for comment…
Using examples from this case, describe the relationship between organizational culture and organizational climate?
What strategies are used by veteran teachers to ensure the maintenance of present culture? How are new teachers impacting the culture and climate of the school?
What would you do if you were in Mr. Reid’s shoes? How would you manage the culture of the school to ensure the creation best possible learning environment for students?
Do educational leaders shape, or are they shaped by, their organization’s culture?[supanova_question]
learning resources: Watch VOPP: Brief Motivational Interviewing: https://kumc.hosted.panopto.com/Panopto/Pages/Viewer.aspx?id=b52f41fa-939f-4331-a98c-ac3001428219 Here is the link to the youtube video in the presentation.
learning resources: Watch VOPP: Brief Motivational Interviewing: https://kumc.hosted.panopto.com/Panopto/Pages/Viewer.aspx?id=b52f41fa-939f-4331-a98c-ac3001428219 Here is the link to the youtube video in the presentation.