Tag: Clinical-Nursing

  • nursing associations and the numerous current issues

    Reflect on the purpose of nursing associations and the numerous current issues with which they are faced. How do nursing associations work to promote policies that are patient-centered and lead the profession forward? Provide at least 2 specific examples of policies from one specific association.

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  • First Lieutenant Jimmy Cross carried letters from a girl named Martha, a junior at Mount Sebastian College in New Jersey. They were not love letters, but Lieutenant Cross was hoping, so he kept them folded in plastic at the bottom of his rucksack. In the late afternoon, after a day’s march, he would dig his foxhole, wash his hands under a canteen, unwrap the letters, hold them with the tips of his fingers, and spend the last hour of light pretending. He would imagine romantic camping trips into the White Mountains in New Hampshire. He would sometimes taste the envelope flaps, knowing her tongue had been there. More than anything, he wanted Martha to love him as he loved her, but the letters were mostly chatty, elusive on the matter of love. She was a virgin, he was almost sure. She was an English major at Mount Sebastian, and she wrote beautifully about her professors and roommates and midterm exams, about her respect for Chaucer and her great affection for Virginia Woolf. She often quoted lines of poetry; she never mentioned the war, except to say, Jimmy, take care of yourself. The letters weighed 10 ounces. They were signed Love, Martha, but Lieutenant Cross understood that Love was only a way of signing and did not mean what he sometimes pretended it meant. At dusk, he would carefully return the letters to his rucksack. Slowly, a bit distracted, he would get up and move among his men, checking the perimeter; then at full dark he would return to his hole and watch the night and wonder if Martha was a virgin.

    The things they carried were largely determined by necessity. Among the necessities or near-necessities were P-38 can openers, pocket knives, heat tabs, wristwatches, dog tags, mosquito repellent, chewing gum, candy, cigarettes, salt tablets, packets of Kool-Aid, lighters, matches, sewing kits, Military Payment Certificates, C rations, and two or three canteens of water. Together, these items weighed between 15 and 20 pounds, depending upon a man’s habits or rate of metabolism. Henry Dobbins, who was a big man, carried extra rations; he was especially fond of canned peaches in heavy syrup over pound cake. Dave Jensen, who practiced field hygiene, carried a toothbrush, dental floss, and several hotel-sized bars of soap he’d stolen on R&R° in Sydney, Australia. Ted Lavender, who was scared, carried tranquilizers until he was shot in the head outside the village of Than Khe in mid-April. By necessity, and because it was SOP,° they all carried steel helmets that weighed 5 pounds including the liner and camouflage cover. They carried the standard fatigue jackets and trousers. Very few carried underwear. On their feet they carried jungle boots—2.1 pounds—and Dave Jensen carried three pairs of socks and a can of Dr. Scholl’s foot powder as a precaution against trench foot. Until he was shot, Ted Lavender carried six or seven ounces of premium dope, which for him was a necessity. Mitchell Sanders, the RTO,° carried condoms. Norman Bowker carried a diary. Rat Kiley carried comic books. Kiowa, a devout Baptist, carried an illustrated New Testament that had been presented to him by his father, who taught Sunday school in Oklahoma City, Oklahoma. As a hedge against bad times, however, Kiowa also carried his grandmother’s distrust of the white man, his grandfather’s old hunting hatchet. Necessity dictated. Because the land was mined and booby-trapped, it was SOP for each man to carry a steel-centered, nylon-covered flak jacket, which weighed 6.7 pounds, but which on hot days seemed much heavier. Because you could die so quickly, each man carried at least one large compress bandage, usually in the helmet band for easy access. Because the nights were cold, and because the monsoons were wet, each carried a green plastic poncho that could be used as a raincoat or groundsheet or makeshift tent. With its quilted liner, the poncho weighed almost two pounds, but it was worth every ounce. In April, for instance, when Ted Lavender was shot, they used his poncho to wrap him up, then to carry him across the paddy, then to lift him into the chopper that took him away.

    They were called legs or grunts.

    To carry something was to hump it, as when Lieutenant Jimmy Cross humped his love for Martha up the hills and through the swamps. In its intransitive form, to hump meant to walk, or to march, but it implied burdens far beyond the intransitive.

    Almost everyone humped photographs. In his wallet, Lieutenant Cross carried two photographs of Martha. The first was a Kodacolor snapshot signed Love, though he knew better. She stood against a brick wall. Her eyes were gray and neutral, her lips slightly open as she stared straight-on at the camera. At night, sometimes, Lieutenant Cross wondered who had taken the picture, because he knew she had boyfriends, because he loved her so much, and because he could see the shadow of the picture-taker spreading out against the brick wall. The second photograph had been clipped from the 1968 Mount Sebastian yearbook. It was an action shot—women’s volleyball—and Martha was bent horizontal to the floor, reaching, the palms of her hands in sharp focus, the tongue taut, the expression frank and competitive. There was no visible sweat. She wore white gym shorts. Her legs, he thought, were almost certainly the legs of a virgin, dry and without hair, the left knee cocked and carrying her entire weight, which was just over one hundred pounds. Lieutenant Cross remembered touching that left knee. A dark theater, he remembered, and the movie was 
    Bonnie and Clyde,
     and Martha wore a tweed skirt, and during the final scene, when he touched her knee, she turned and looked at him in a sad, sober way that made him pull his hand back, but he would always remember the feel of the tweed skirt and the knee beneath it and the sound of the gunfire that killed Bonnie and Clyde, how embarrassing it was, how slow and oppressive. He remembered kissing her good night at the dorm door. Right then, he thought, he should’ve done something brave. He should’ve carried her up the stairs to her room and tied her to the bed and touched that left knee all night long. He should’ve risked it. Whenever he looked at the photographs, he thought of new things he should’ve done.          5

    What they carried was partly a function of rank, partly of field specialty.

    As a first lieutenant and platoon leader, Jimmy Cross carried a compass, maps, code books, binoculars, and a .45-caliber pistol that weighed 2.9 pounds fully loaded. He carried a strobe light and the responsibility for the lives of his men.

    As an RTO, Mitchell Sanders carried the PRC-25 radio, a killer, 26 pounds with its battery.

    As a medic, Rat Kiley carried a canvas satchel filled with morphine and plasma and malaria tablets and surgical tape and comic books and all the things a medic must carry, including M&M’s for especially bad wounds, for a total weight of nearly 20 pounds.

    As a big man, therefore a machine gunner, Henry Dobbins carried the M-60, which weighed 23 pounds unloaded, but which was almost always loaded. In addition, Dobbins carried between 10 and 15 pounds of ammunition draped in belts across his chest and shoulders.          10

    As PFCs or Spec 4s, most of them were common grunts and carried the standard M-16 gas-operated assault rifle. The weapon weighed 7.5 pounds unloaded, 8.2 pounds with its full 20-round magazine. Depending on numerous factors, such as topography and psychology, the riflemen carried anywhere from 12 to 20 magazines, usually in cloth bandoliers, adding on another 8.4 pounds at minimum, 14 pounds at maximum. When it was available, they also carried M-16 maintenance gear—rods and steel brushes and swabs and tubes of LSA oil—all of which weighed about a pound. Among the grunts, some carried the M-79 grenade launcher, 5.9 pounds unloaded, a reasonably light weapon except for the ammunition, which was heavy. A single round weighed 10 ounces. The typical load was 25 rounds. But Ted Lavender, who was scared, carried 34 rounds when he was shot and killed outside Than Khe, and he went down under an exceptional burden, more than 20 pounds of ammunition, plus the flak jacket and helmet and rations and water and toilet paper and tranquilizers and all the rest, plus the unweighed fear. He was dead weight. There was no twitching or flopping. Kiowa, who saw it happen, said it was like watching a rock fall, or a big sandbag or something—just boom, then down—not like the movies where the dead guy rolls around and does fancy spins and goes ass over teakettle—not like that, Kiowa said, the poor bastard just flat-fuck fell. Boom. Down. Nothing else. It was a bright morning in mid-April. Lieutenant Cross felt the pain. He blamed himself. They stripped off Lavender’s canteens and ammo, all the heavy things, and Rat Kiley said the obvious, the guy’s dead, and Mitchell Sanders used his radio to report one U.S. KIA° and to request a chopper. Then they wrapped Lavender in his poncho. They carried him out to a dry paddy, established security, and sat smoking the dead man’s dope until the chopper came. Lieutenant Cross kept to himself. He pictured Martha’s smooth young face, thinking he loved her more than anything, more than his men, and now Ted Lavender was dead because he loved her so much and could not stop thinking about her. When the dustoff arrived, they carried Lavender aboard. Afterward they burned Than Khe. They marched until dusk, then dug their holes, and that night Kiowa kept explaining how you had to be there, how fast it was, how the poor guy just dropped like so much concrete. Boom-down, he said. Like cement.

    In addition to the three standard weapons—the M-60, M-16, and M-79—they carried whatever presented itself, or whatever seemed appropriate as a means of killing or staying alive. They carried catch-as-catch-can. At various times, in various situations, they carried M-14s and CAR-15s and Swedish Ks and grease guns and captured AK-47s and Chi-Coms and RPGs and Simonov carbines and black market Uzis and .38-caliber Smith & Wesson handguns and 66 mm LAWs and shotguns and silencers and blackjacks and bayonets and C-4 plastic explosives. Lee Strunk carried a slingshot; a weapon of last resort, he called it. Mitchell Sanders carried brass knuckles. Kiowa carried his grandfather’s feathered hatchet. Every third or fourth man carried a Claymore antipersonnel mine—3.5 pounds with its firing device. They all carried fragmentation grenades—14 ounces each. They all carried at least one M-18 colored smoke grenade—24 ounces. Some carried CS or tear gas grenades. Some carried white phosphorus grenades. They carried all they could bear, and then some, including a silent awe for the terrible power of the things they carried.

    In the first week of April, before Lavender died, Lieutenant Jimmy Cross received a good-luck charm from Martha. It was a simple pebble, an ounce at most. Smooth to the touch, it was a milky white color with flecks of orange and violet, oval-shaped, like a miniature egg. In the accompanying letter, Martha wrote that she had found the pebble on the Jersey shoreline, precisely where the land touched water at high tide, where things came together but also separated. It was this separate-but-together quality, she wrote, that had inspired her to pick up the pebble and to carry it in her breast pocket for several days, where it seemed weightless, and then to send it through the mail, by air, as a token of her truest feelings for him. Lieutenant Cross found this romantic. But he wondered what her truest feelings were, exactly, and what she meant by separate-but-together. He wondered how the tides and waves had come into play on that afternoon along the Jersey shoreline when Martha saw the pebble and bent down to rescue it from geology. He imagined bare feet. Martha was a poet, with the poet’s sensibilities, and her feet would be brown and bare, the toenails unpainted, the eyes chilly and somber like the ocean in March, and though it was painful, he wondered who had been with her that afternoon. He imagined a pair of shadows moving along the strip of sand where things came together but also separated. It was phantom jealousy, he knew, but he couldn’t help himself. He loved her so much. On the march, through the hot days of early April, he carried the pebble in his mouth, turning it with his tongue, tasting sea salt and moisture. His mind wandered. He had difficulty keeping his attention on the war. On occasion he would yell at his men to spread out the column, to keep their eyes open, but then he would slip away into daydreams, just pretending, walking barefoot along the Jersey shore, with Martha, carrying nothing. He would feel himself rising. Sun and waves and gentle winds, all love and lightness.

    What they carried varied by mission.

    When a mission took them to the mountains, they carried mosquito netting, machetes, canvas tarps, and extra bug juice.          15

    If a mission seemed especially hazardous, or if it involved a place they knew to be bad, they carried everything they could. In certain heavily mined AOs,° where the land was dense with Toe Poppers and Bouncing Betties, they took turns humping a 28-pound mine detector. With its headphones and big sensing plate, the equipment was a stress on the lower back and shoulders, awkward to handle, often useless because of the shrapnel in the earth, but they carried it anyway, partly for safety, partly for the illusion of safety.

    On ambush, or other night missions, they carried peculiar little odds and ends. Kiowa always took along his New Testament and a pair of moccasins for silence. Dave Jensen carried night-sight vitamins high in carotene. Lee Strunk carried his slingshot; ammo, he claimed, would never be a problem. Rat Kiley carried brandy and M&M’s candy. Until he was shot, Ted Lavender carried the starlight scope, which weighed 6.3 pounds with its aluminum carrying case. Henry Dobbins carried his girlfriend’s pantyhose wrapped around his neck as a comforter. They all carried ghosts. When dark came, they would move out single file across the meadows and paddies to their ambush coordinates, where they would quietly set up the Claymores and lie down and spend the night waiting.

    Other missions were more complicated and required special equipment. In mid-April, it was their mission to search out and destroy the elaborate tunnel complexes in the Than Khe area south of Chu Lai. To blow the tunnels, they carried one-pound blocks of pentrite high explosives, four blocks to a man, 68 pounds in all. They carried wiring, detonators, and battery-powered clackers. Dave Jensen carried earplugs. Most often, before blowing the tunnels, they were ordered by higher command to search them, which was considered bad news, but by and large they just shrugged and carried out orders. Because he was a big man, Henry Dobbins was excused from tunnel duty. The others would draw numbers. Before Lavender died there were 17 men in the platoon, and whoever drew the number 17 would strip off his gear and crawl in headfirst with a flashlight and Lieutenant Cross’s .45-caliber pistol. The rest of them would fan out as security. They would sit down or kneel, not facing the hole, listening to the ground beneath them, imagining cobwebs and ghosts, whatever was down there—the tunnel walls squeezing in—how the flashlight seemed impossibly heavy in the hand and how it was tunnel vision in the very strictest sense, compression in all ways, even time, and how you had to wiggle in—ass and elbows—a swallowed-up feeling—and how you found yourself worrying about odd things: Will your flashlight go dead? Do rats carry rabies? If you screamed, how far would the sound carry? Would your buddies hear it? Would they have the courage to drag you out? In some respects, though not many, the waiting was worse than the tunnel itself. Imagination was a killer.

    On April 16, when Lee Strunk drew the number 17, he laughed and muttered something and went down quickly. The morning was hot and very still. Not good, Kiowa said. He looked at the tunnel opening, then out across a dry paddy toward the village of Than Khe. Nothing moved. No clouds or birds or people. As they waited, the men smoked and drank Kool-Aid, not talking much, feeling sympathy for Lee Strunk but also feeling the luck of the draw. You win some, you lose some, said Mitchell Sanders, and sometimes you settle for a rain check. It was a tired line and no one laughed.

    Henry Dobbins ate a tropical chocolate bar. Ted Lavender popped a tranquilizer and went off to pee.          20

    After five minutes, Lieutenant Jimmy Cross moved to the tunnel, leaned down, and examined the darkness. Trouble, he thought—a cave-in maybe. And then suddenly, without willing it, he was thinking about Martha. The stresses and fractures, the quick collapse, the two of them buried alive under all that weight. Dense, crushing love. Kneeling, watching the hole, he tried to concentrate on Lee Strunk and the war, all the dangers, but his love was too much for him, he felt paralyzed, he wanted to sleep inside her lungs and breathe her blood and be smothered. He wanted her to be a virgin and not a virgin, all at once. He wanted to know her. Intimate secrets: Why poetry? Why so sad? Why that grayness in her eyes? Why so alone? Not lonely, just alone—riding her bike across campus or sitting off by herself in the cafeteria—even dancing, she danced alone—and it was the aloneness that filled him with love. He remembered telling her that one evening. How she nodded and looked away. And how, later, when he kissed her, she received the kiss without returning it, her eyes wide open, not afraid, not a virgin’s eyes, just flat and uninvolved.

    Lieutenant Cross gazed at the tunnel. But he was not there. He was buried with Martha under the white sand at the Jersey shore. They were pressed together, and the pebble in his mouth was her tongue. He was smiling. Vaguely, he was aware of how quiet the day was, the sullen paddies, yet he could not bring himself to worry about matters of security. He was beyond that. He was just a kid at war, in love. He was twenty-four years old. He couldn’t help it.

    A few moments later Lee Strunk crawled out of the tunnel. He came up grinning, filthy but alive. Lieutenant Cross nodded and closed his eyes while the others clapped Strunk on the back and made jokes about rising from the dead.

    Worms, Rat Kiley said. Right out of the grave. Fuckin’ zombie.

    The men laughed. They all felt great relief.          25

    Spook city, said Mitchell Sanders.

    Lee Strunk made a funny ghost sound, a kind of moaning, yet very happy, and right then, when Strunk made that high happy moaning sound, when he went 
    Ahhooooo,
     right then Ted Lavender was shot in the head on his way back from peeing. He lay with his mouth open. The teeth were broken. There was a swollen black bruise under his left eye. The cheekbone was gone. Oh shit, Rat Kiley said, the guy’s dead. The guy’s dead, he kept saying, which seemed profound—the guy’s dead. I mean really.

    The things they carried were determined to some extent by superstition. Lieutenant Cross carried his good-luck pebble. Dave Jensen carried a rabbit’s foot. Norman Bowker, otherwise a very gentle person, carried a thumb that had been presented to him as a gift by Mitchell Sanders. The thumb was dark brown, rubbery to the touch, and weighed four ounces at most. It had been cut from a VC corpse, a boy of fifteen or sixteen. They’d found him at the bottom of an irrigation ditch, badly burned, flies in his mouth and eyes. The boy wore black shorts and sandals. At the time of his death he had been carrying a pouch of rice, a rifle, and three magazines of ammunition.

    You want my opinion, Mitchell Sanders said, there’s a definite moral here.

    He put his hand on the dead boy’s wrist. He was quiet for a time, as if counting a pulse, then he patted the stomach, almost affectionately, and used Kiowa’s hunting hatchet to remove the thumb.          30

    Henry Dobbins asked what the moral was.

    Moral?

    You know. 
    Moral.

    Sanders wrapped the thumb in toilet paper and handed it across to Norman Bowker. There was no blood. Smiling, he kicked the boy’s head, watched the flies scatter, and said, It’s like with that old TV show—Paladin. Have gun, will travel.

    Henry Dobbins thought about it.          35

    Yeah, well, he finally said. I don’t see no moral.

    There it is, man.

    Fuck off.

    They carried USO stationery and pencils and pens. They carried Sterno, safety pins, trip flares, signal flares, spools of wire, razor blades, chewing tobacco, liberated joss sticks and statuettes of the smiling Buddha, candles, grease pencils, 
    The Stars and Stripes,
     fingernail clippers, Psy Ops leaflets, bush hats, bolos, and much more. Twice a week, when the resupply choppers came in, they carried hot chow in green mermite cans and large canvas bags filled with iced beer and soda pop. They carried plastic water containers, each with a two-gallon capacity. Mitchell Sanders carried a set of starched tiger fatigues for special occasions. Henry Dobbins carried Black Flag insecticide. Dave Jensen carried empty sandbags that could be filled at night for added protection. Lee Strunk carried tanning lotion. Some things they carried in common. Taking turns, they carried the big PRC-77 scrambler radio, which weighed 30 pounds with its battery. They shared the weight of memory. They took up what others could no longer bear. Often, they carried each other, the wounded or weak. They carried infections. They carried chess sets, basketballs, Vietnamese-English dictionaries, insignia of rank, Bronze Stars and Purple Hearts, plastic cards imprinted with the Code of Conduct. They carried diseases, among them malaria and dysentery. They carried lice and ringworm and leeches and paddy algae and various rots and molds. They carried the land itself—Vietnam, the place, the soil—a powdery orange-red dust that covered their boots and fatigues and faces. They carried the sky. The whole atmosphere, they carried it, the humidity, the monsoons, the stink of fungus and decay, all of it, they carried gravity. They moved like mules. By daylight they took sniper fire, at night they were mortared, but it was not battle, it was just the endless march, village to village, without purpose, nothing won or lost. They marched for the sake of the march. They plodded along slowly, dumbly, leaning forward against the heat, unthinking, all blood and bone, simple grunts, soldiering with their legs, toiling up the hills and down into the paddies and across the rivers and up again and down, just humping, one step and then the next and then another, but no volition, no will, because it was automatic, it was anatomy, and the war was entirely a matter of posture and carriage, the hump was everything, a kind of inertia, a kind of emptiness, a dullness of desire and intellect and conscience and hope and human sensibility. Their principles were in their feet. Their calculations were biological. They had no sense of strategy or mission. They searched the villages without knowing what to look for, not caring, kicking over jars of rice, frisking children and old men, blowing tunnels, sometimes setting fires and sometimes not, then forming up and moving on to the next village, then other villages, where it would always be the same. They carried their own lives. The pressures were enormous. In the heat of early afternoon, they would remove their helmets and flak jackets, walking bare, which was dangerous but which helped ease the strain. They would often discard things along the route of march. Purely for comfort, they would throw away rations, blow their Claymores and grenades, no matter, because by nightfall the resupply choppers would arrive with more of the same, then a day or two later still more, fresh watermelons and crates of ammunition and sunglasses and woolen sweaters—the resources were stunning—sparklers for the Fourth of July, colored eggs for Easter—it was the great American war chest—the fruits of science, the smokestacks, the canneries, the arsenals at Hartford, the Minnesota forests, the machine shops, the vast fields of corn and wheat—they carried like freight trains; they carried it on their backs and shoulders—and for all the ambiguities of Vietnam, all the mysteries and unknowns, there was at least the single abiding certainty that they would never be at a loss for things to carry.

  • necessity

    First Lieutenant Jimmy Cross carried letters from a girl named Martha, a junior at Mount Sebastian College in New Jersey. They were not love letters, but Lieutenant Cross was hoping, so he kept them folded in plastic at the bottom of his rucksack. In the late afternoon, after a day’s march, he would dig his foxhole, wash his hands under a canteen, unwrap the letters, hold them with the tips of his fingers, and spend the last hour of light pretending. He would imagine romantic camping trips into the White Mountains in New Hampshire. He would sometimes taste the envelope flaps, knowing her tongue had been there. More than anything, he wanted Martha to love him as he loved her, but the letters were mostly chatty, elusive on the matter of love. She was a virgin, he was almost sure. She was an English major at Mount Sebastian, and she wrote beautifully about her professors and roommates and midterm exams, about her respect for Chaucer and her great affection for Virginia Woolf. She often quoted lines of poetry; she never mentioned the war, except to say, Jimmy, take care of yourself. The letters weighed 10 ounces. They were signed Love, Martha, but Lieutenant Cross understood that Love was only a way of signing and did not mean what he sometimes pretended it meant. At dusk, he would carefully return the letters to his rucksack. Slowly, a bit distracted, he would get up and move among his men, checking the perimeter; then at full dark he would return to his hole and watch the night and wonder if Martha was a virgin.

    The things they carried were largely determined by necessity. Among the necessities or near-necessities were P-38 can openers, pocket knives, heat tabs, wristwatches, dog tags, mosquito repellent, chewing gum, candy, cigarettes, salt tablets, packets of Kool-Aid, lighters, matches, sewing kits, Military Payment Certificates, C rations, and two or three canteens of water. Together, these items weighed between 15 and 20 pounds, depending upon a man’s habits or rate of metabolism. Henry Dobbins, who was a big man, carried extra rations; he was especially fond of canned peaches in heavy syrup over pound cake. Dave Jensen, who practiced field hygiene, carried a toothbrush, dental floss, and several hotel-sized bars of soap he’d stolen on R&R° in Sydney, Australia. Ted Lavender, who was scared, carried tranquilizers until he was shot in the head outside the village of Than Khe in mid-April. By necessity, and because it was SOP,° they all carried steel helmets that weighed 5 pounds including the liner and camouflage cover. They carried the standard fatigue jackets and trousers. Very few carried underwear. On their feet they carried jungle boots—2.1 pounds—and Dave Jensen carried three pairs of socks and a can of Dr. Scholl’s foot powder as a precaution against trench foot. Until he was shot, Ted Lavender carried six or seven ounces of premium dope, which for him was a necessity. Mitchell Sanders, the RTO,° carried condoms. Norman Bowker carried a diary. Rat Kiley carried comic books. Kiowa, a devout Baptist, carried an illustrated New Testament that had been presented to him by his father, who taught Sunday school in Oklahoma City, Oklahoma. As a hedge against bad times, however, Kiowa also carried his grandmother’s distrust of the white man, his grandfather’s old hunting hatchet. Necessity dictated. Because the land was mined and booby-trapped, it was SOP for each man to carry a steel-centered, nylon-covered flak jacket, which weighed 6.7 pounds, but which on hot days seemed much heavier. Because you could die so quickly, each man carried at least one large compress bandage, usually in the helmet band for easy access. Because the nights were cold, and because the monsoons were wet, each carried a green plastic poncho that could be used as a raincoat or groundsheet or makeshift tent. With its quilted liner, the poncho weighed almost two pounds, but it was worth every ounce. In April, for instance, when Ted Lavender was shot, they used his poncho to wrap him up, then to carry him across the paddy, then to lift him into the chopper that took him away.

    They were called legs or grunts.

    To carry something was to hump it, as when Lieutenant Jimmy Cross humped his love for Martha up the hills and through the swamps. In its intransitive form, to hump meant to walk, or to march, but it implied burdens far beyond the intransitive.

    Almost everyone humped photographs. In his wallet, Lieutenant Cross carried two photographs of Martha. The first was a Kodacolor snapshot signed Love, though he knew better. She stood against a brick wall. Her eyes were gray and neutral, her lips slightly open as she stared straight-on at the camera. At night, sometimes, Lieutenant Cross wondered who had taken the picture, because he knew she had boyfriends, because he loved her so much, and because he could see the shadow of the picture-taker spreading out against the brick wall. The second photograph had been clipped from the 1968 Mount Sebastian yearbook. It was an action shot—women’s volleyball—and Martha was bent horizontal to the floor, reaching, the palms of her hands in sharp focus, the tongue taut, the expression frank and competitive. There was no visible sweat. She wore white gym shorts. Her legs, he thought, were almost certainly the legs of a virgin, dry and without hair, the left knee cocked and carrying her entire weight, which was just over one hundred pounds. Lieutenant Cross remembered touching that left knee. A dark theater, he remembered, and the movie was 
    Bonnie and Clyde,
     and Martha wore a tweed skirt, and during the final scene, when he touched her knee, she turned and looked at him in a sad, sober way that made him pull his hand back, but he would always remember the feel of the tweed skirt and the knee beneath it and the sound of the gunfire that killed Bonnie and Clyde, how embarrassing it was, how slow and oppressive. He remembered kissing her good night at the dorm door. Right then, he thought, he should’ve done something brave. He should’ve carried her up the stairs to her room and tied her to the bed and touched that left knee all night long. He should’ve risked it. Whenever he looked at the photographs, he thought of new things he should’ve done.          5

    What they carried was partly a function of rank, partly of field specialty.

    As a first lieutenant and platoon leader, Jimmy Cross carried a compass, maps, code books, binoculars, and a .45-caliber pistol that weighed 2.9 pounds fully loaded. He carried a strobe light and the responsibility for the lives of his men.

    As an RTO, Mitchell Sanders carried the PRC-25 radio, a killer, 26 pounds with its battery.

    As a medic, Rat Kiley carried a canvas satchel filled with morphine and plasma and malaria tablets and surgical tape and comic books and all the things a medic must carry, including M&M’s for especially bad wounds, for a total weight of nearly 20 pounds.

    As a big man, therefore a machine gunner, Henry Dobbins carried the M-60, which weighed 23 pounds unloaded, but which was almost always loaded. In addition, Dobbins carried between 10 and 15 pounds of ammunition draped in belts across his chest and shoulders.          10

    As PFCs or Spec 4s, most of them were common grunts and carried the standard M-16 gas-operated assault rifle. The weapon weighed 7.5 pounds unloaded, 8.2 pounds with its full 20-round magazine. Depending on numerous factors, such as topography and psychology, the riflemen carried anywhere from 12 to 20 magazines, usually in cloth bandoliers, adding on another 8.4 pounds at minimum, 14 pounds at maximum. When it was available, they also carried M-16 maintenance gear—rods and steel brushes and swabs and tubes of LSA oil—all of which weighed about a pound. Among the grunts, some carried the M-79 grenade launcher, 5.9 pounds unloaded, a reasonably light weapon except for the ammunition, which was heavy. A single round weighed 10 ounces. The typical load was 25 rounds. But Ted Lavender, who was scared, carried 34 rounds when he was shot and killed outside Than Khe, and he went down under an exceptional burden, more than 20 pounds of ammunition, plus the flak jacket and helmet and rations and water and toilet paper and tranquilizers and all the rest, plus the unweighed fear. He was dead weight. There was no twitching or flopping. Kiowa, who saw it happen, said it was like watching a rock fall, or a big sandbag or something—just boom, then down—not like the movies where the dead guy rolls around and does fancy spins and goes ass over teakettle—not like that, Kiowa said, the poor bastard just flat-fuck fell. Boom. Down. Nothing else. It was a bright morning in mid-April. Lieutenant Cross felt the pain. He blamed himself. They stripped off Lavender’s canteens and ammo, all the heavy things, and Rat Kiley said the obvious, the guy’s dead, and Mitchell Sanders used his radio to report one U.S. KIA° and to request a chopper. Then they wrapped Lavender in his poncho. They carried him out to a dry paddy, established security, and sat smoking the dead man’s dope until the chopper came. Lieutenant Cross kept to himself. He pictured Martha’s smooth young face, thinking he loved her more than anything, more than his men, and now Ted Lavender was dead because he loved her so much and could not stop thinking about her. When the dustoff arrived, they carried Lavender aboard. Afterward they burned Than Khe. They marched until dusk, then dug their holes, and that night Kiowa kept explaining how you had to be there, how fast it was, how the poor guy just dropped like so much concrete. Boom-down, he said. Like cement.

    In addition to the three standard weapons—the M-60, M-16, and M-79—they carried whatever presented itself, or whatever seemed appropriate as a means of killing or staying alive. They carried catch-as-catch-can. At various times, in various situations, they carried M-14s and CAR-15s and Swedish Ks and grease guns and captured AK-47s and Chi-Coms and RPGs and Simonov carbines and black market Uzis and .38-caliber Smith & Wesson handguns and 66 mm LAWs and shotguns and silencers and blackjacks and bayonets and C-4 plastic explosives. Lee Strunk carried a slingshot; a weapon of last resort, he called it. Mitchell Sanders carried brass knuckles. Kiowa carried his grandfather’s feathered hatchet. Every third or fourth man carried a Claymore antipersonnel mine—3.5 pounds with its firing device. They all carried fragmentation grenades—14 ounces each. They all carried at least one M-18 colored smoke grenade—24 ounces. Some carried CS or tear gas grenades. Some carried white phosphorus grenades. They carried all they could bear, and then some, including a silent awe for the terrible power of the things they carried.

    In the first week of April, before Lavender died, Lieutenant Jimmy Cross received a good-luck charm from Martha. It was a simple pebble, an ounce at most. Smooth to the touch, it was a milky white color with flecks of orange and violet, oval-shaped, like a miniature egg. In the accompanying letter, Martha wrote that she had found the pebble on the Jersey shoreline, precisely where the land touched water at high tide, where things came together but also separated. It was this separate-but-together quality, she wrote, that had inspired her to pick up the pebble and to carry it in her breast pocket for several days, where it seemed weightless, and then to send it through the mail, by air, as a token of her truest feelings for him. Lieutenant Cross found this romantic. But he wondered what her truest feelings were, exactly, and what she meant by separate-but-together. He wondered how the tides and waves had come into play on that afternoon along the Jersey shoreline when Martha saw the pebble and bent down to rescue it from geology. He imagined bare feet. Martha was a poet, with the poet’s sensibilities, and her feet would be brown and bare, the toenails unpainted, the eyes chilly and somber like the ocean in March, and though it was painful, he wondered who had been with her that afternoon. He imagined a pair of shadows moving along the strip of sand where things came together but also separated. It was phantom jealousy, he knew, but he couldn’t help himself. He loved her so much. On the march, through the hot days of early April, he carried the pebble in his mouth, turning it with his tongue, tasting sea salt and moisture. His mind wandered. He had difficulty keeping his attention on the war. On occasion he would yell at his men to spread out the column, to keep their eyes open, but then he would slip away into daydreams, just pretending, walking barefoot along the Jersey shore, with Martha, carrying nothing. He would feel himself rising. Sun and waves and gentle winds, all love and lightness.

    What they carried varied by mission.

    When a mission took them to the mountains, they carried mosquito netting, machetes, canvas tarps, and extra bug juice.          15

    If a mission seemed especially hazardous, or if it involved a place they knew to be bad, they carried everything they could. In certain heavily mined AOs,° where the land was dense with Toe Poppers and Bouncing Betties, they took turns humping a 28-pound mine detector. With its headphones and big sensing plate, the equipment was a stress on the lower back and shoulders, awkward to handle, often useless because of the shrapnel in the earth, but they carried it anyway, partly for safety, partly for the illusion of safety.

    On ambush, or other night missions, they carried peculiar little odds and ends. Kiowa always took along his New Testament and a pair of moccasins for silence. Dave Jensen carried night-sight vitamins high in carotene. Lee Strunk carried his slingshot; ammo, he claimed, would never be a problem. Rat Kiley carried brandy and M&M’s candy. Until he was shot, Ted Lavender carried the starlight scope, which weighed 6.3 pounds with its aluminum carrying case. Henry Dobbins carried his girlfriend’s pantyhose wrapped around his neck as a comforter. They all carried ghosts. When dark came, they would move out single file across the meadows and paddies to their ambush coordinates, where they would quietly set up the Claymores and lie down and spend the night waiting.

    Other missions were more complicated and required special equipment. In mid-April, it was their mission to search out and destroy the elaborate tunnel complexes in the Than Khe area south of Chu Lai. To blow the tunnels, they carried one-pound blocks of pentrite high explosives, four blocks to a man, 68 pounds in all. They carried wiring, detonators, and battery-powered clackers. Dave Jensen carried earplugs. Most often, before blowing the tunnels, they were ordered by higher command to search them, which was considered bad news, but by and large they just shrugged and carried out orders. Because he was a big man, Henry Dobbins was excused from tunnel duty. The others would draw numbers. Before Lavender died there were 17 men in the platoon, and whoever drew the number 17 would strip off his gear and crawl in headfirst with a flashlight and Lieutenant Cross’s .45-caliber pistol. The rest of them would fan out as security. They would sit down or kneel, not facing the hole, listening to the ground beneath them, imagining cobwebs and ghosts, whatever was down there—the tunnel walls squeezing in—how the flashlight seemed impossibly heavy in the hand and how it was tunnel vision in the very strictest sense, compression in all ways, even time, and how you had to wiggle in—ass and elbows—a swallowed-up feeling—and how you found yourself worrying about odd things: Will your flashlight go dead? Do rats carry rabies? If you screamed, how far would the sound carry? Would your buddies hear it? Would they have the courage to drag you out? In some respects, though not many, the waiting was worse than the tunnel itself. Imagination was a killer.

    On April 16, when Lee Strunk drew the number 17, he laughed and muttered something and went down quickly. The morning was hot and very still. Not good, Kiowa said. He looked at the tunnel opening, then out across a dry paddy toward the village of Than Khe. Nothing moved. No clouds or birds or people. As they waited, the men smoked and drank Kool-Aid, not talking much, feeling sympathy for Lee Strunk but also feeling the luck of the draw. You win some, you lose some, said Mitchell Sanders, and sometimes you settle for a rain check. It was a tired line and no one laughed.

    Henry Dobbins ate a tropical chocolate bar. Ted Lavender popped a tranquilizer and went off to pee.          20

    After five minutes, Lieutenant Jimmy Cross moved to the tunnel, leaned down, and examined the darkness. Trouble, he thought—a cave-in maybe. And then suddenly, without willing it, he was thinking about Martha. The stresses and fractures, the quick collapse, the two of them buried alive under all that weight. Dense, crushing love. Kneeling, watching the hole, he tried to concentrate on Lee Strunk and the war, all the dangers, but his love was too much for him, he felt paralyzed, he wanted to sleep inside her lungs and breathe her blood and be smothered. He wanted her to be a virgin and not a virgin, all at once. He wanted to know her. Intimate secrets: Why poetry? Why so sad? Why that grayness in her eyes? Why so alone? Not lonely, just alone—riding her bike across campus or sitting off by herself in the cafeteria—even dancing, she danced alone—and it was the aloneness that filled him with love. He remembered telling her that one evening. How she nodded and looked away. And how, later, when he kissed her, she received the kiss without returning it, her eyes wide open, not afraid, not a virgin’s eyes, just flat and uninvolved.

    Lieutenant Cross gazed at the tunnel. But he was not there. He was buried with Martha under the white sand at the Jersey shore. They were pressed together, and the pebble in his mouth was her tongue. He was smiling. Vaguely, he was aware of how quiet the day was, the sullen paddies, yet he could not bring himself to worry about matters of security. He was beyond that. He was just a kid at war, in love. He was twenty-four years old. He couldn’t help it.

    A few moments later Lee Strunk crawled out of the tunnel. He came up grinning, filthy but alive. Lieutenant Cross nodded and closed his eyes while the others clapped Strunk on the back and made jokes about rising from the dead.

    Worms, Rat Kiley said. Right out of the grave. Fuckin’ zombie.

    The men laughed. They all felt great relief.          25

    Spook city, said Mitchell Sanders.

    Lee Strunk made a funny ghost sound, a kind of moaning, yet very happy, and right then, when Strunk made that high happy moaning sound, when he went 
    Ahhooooo,
     right then Ted Lavender was shot in the head on his way back from peeing. He lay with his mouth open. The teeth were broken. There was a swollen black bruise under his left eye. The cheekbone was gone. Oh shit, Rat Kiley said, the guy’s dead. The guy’s dead, he kept saying, which seemed profound—the guy’s dead. I mean really.

    The things they carried were determined to some extent by superstition. Lieutenant Cross carried his good-luck pebble. Dave Jensen carried a rabbit’s foot. Norman Bowker, otherwise a very gentle person, carried a thumb that had been presented to him as a gift by Mitchell Sanders. The thumb was dark brown, rubbery to the touch, and weighed four ounces at most. It had been cut from a VC corpse, a boy of fifteen or sixteen. They’d found him at the bottom of an irrigation ditch, badly burned, flies in his mouth and eyes. The boy wore black shorts and sandals. At the time of his death he had been carrying a pouch of rice, a rifle, and three magazines of ammunition.

    You want my opinion, Mitchell Sanders said, there’s a definite moral here.

    He put his hand on the dead boy’s wrist. He was quiet for a time, as if counting a pulse, then he patted the stomach, almost affectionately, and used Kiowa’s hunting hatchet to remove the thumb.          30

    Henry Dobbins asked what the moral was.

    Moral?

    You know. 
    Moral.

    Sanders wrapped the thumb in toilet paper and handed it across to Norman Bowker. There was no blood. Smiling, he kicked the boy’s head, watched the flies scatter, and said, It’s like with that old TV show—Paladin. Have gun, will travel.

    Henry Dobbins thought about it.          35

    Yeah, well, he finally said. I don’t see no moral.

    There it is, man.

    Fuck off.

    They carried USO stationery and pencils and pens. They carried Sterno, safety pins, trip flares, signal flares, spools of wire, razor blades, chewing tobacco, liberated joss sticks and statuettes of the smiling Buddha, candles, grease pencils, 
    The Stars and Stripes,
     fingernail clippers, Psy Ops leaflets, bush hats, bolos, and much more. Twice a week, when the resupply choppers came in, they carried hot chow in green mermite cans and large canvas bags filled with iced beer and soda pop. They carried plastic water containers, each with a two-gallon capacity. Mitchell Sanders carried a set of starched tiger fatigues for special occasions. Henry Dobbins carried Black Flag insecticide. Dave Jensen carried empty sandbags that could be filled at night for added protection. Lee Strunk carried tanning lotion. Some things they carried in common. Taking turns, they carried the big PRC-77 scrambler radio, which weighed 30 pounds with its battery. They shared the weight of memory. They took up what others could no longer bear. Often, they carried each other, the wounded or weak. They carried infections. They carried chess sets, basketballs, Vietnamese-English dictionaries, insignia of rank, Bronze Stars and Purple Hearts, plastic cards imprinted with the Code of Conduct. They carried diseases, among them malaria and dysentery. They carried lice and ringworm and leeches and paddy algae and various rots and molds. They carried the land itself—Vietnam, the place, the soil—a powdery orange-red dust that covered their boots and fatigues and faces. They carried the sky. The whole atmosphere, they carried it, the humidity, the monsoons, the stink of fungus and decay, all of it, they carried gravity. They moved like mules. By daylight they took sniper fire, at night they were mortared, but it was not battle, it was just the endless march, village to village, without purpose, nothing won or lost. They marched for the sake of the march. They plodded along slowly, dumbly, leaning forward against the heat, unthinking, all blood and bone, simple grunts, soldiering with their legs, toiling up the hills and down into the paddies and across the rivers and up again and down, just humping, one step and then the next and then another, but no volition, no will, because it was automatic, it was anatomy, and the war was entirely a matter of posture and carriage, the hump was everything, a kind of inertia, a kind of emptiness, a dullness of desire and intellect and conscience and hope and human sensibility. Their principles were in their feet. Their calculations were biological. They had no sense of strategy or mission. They searched the villages without knowing what to look for, not caring, kicking over jars of rice, frisking children and old men, blowing tunnels, sometimes setting fires and sometimes not, then forming up and moving on to the next village, then other villages, where it would always be the same. They carried their own lives. The pressures were enormous. In the heat of early afternoon, they would remove their helmets and flak jackets, walking bare, which was dangerous but which helped ease the strain. They would often discard things along the route of march. Purely for comfort, they would throw away rations, blow their Claymores and grenades, no matter, because by nightfall the resupply choppers would arrive with more of the same, then a day or two later still more, fresh watermelons and crates of ammunition and sunglasses and woolen sweaters—the resources were stunning—sparklers for the Fourth of July, colored eggs for Easter—it was the great American war chest—the fruits of science, the smokestacks, the canneries, the arsenals at Hartford, the Minnesota forests, the machine shops, the vast fields of corn and wheat—they carried like freight trains; they carried it on their backs and shoulders—and for all the ambiguities of Vietnam, all the mysteries and unknowns, there was at least the single abiding certainty that they would never be at a loss for things to carry.

  • Soldiers on patrol during the Vietnam War.

    Soldiers on patrol during the Vietnam War.

  • The Evidence Based Practice (EBP) Project: Literature Review and Nursing Implications

    The Evidence Based Practice (EBP) Project: Literature Review and Nursing Implications

    Now that you’ve found your evidence, summarized the material, and completed your TOE, it’s time to do your critical literature review and nursing implications sections. Use the data from your TOE to help you.

    Submit to the Assignments section the following:

    The names of all group members.

    Restate your PICO question (in question format only).

    Complete the Literature Review section

    Include 5-10 paragraphs demonstrating that you have fully read and analyzed all of the evidence. You will likely need to use subheadings to organize your review. Consider questions such as:

    What were the common themes throughout the articles?

    Were the articles studying the same/different variables?

    Were the findings the same/different?

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    How do the main objectives/purposes of the researchers affect how the studies were designed/carried out?

    Discuss the levels of evidence and how that affects the credibility of the findings.

    How did the design of the studies affect the outcomes?

    Discuss reliability and validity of findings.
     (Focus heavily on this part. It doesn’t matter what the findings say if they aren’t reliable/valid, so fully evaluate them based on the criteria from the textbook. Discuss the different types of reliability/validity. Be very specific.)

    Is the evidence contradictory? If so, why might this be so? (i.e. One study is more reliable than the other.)

    Complete the Implications for Nursing Practice section

    Include 1-2 paragraphs of implications for nursing practice.

    Consider such questions as:

    How can/should nursing practice change based on these findings?

    How should nurses respond to these findings?

    Can current nursing practices be improved with these findings?

    Etc.

    Note: This is the crux of your entire paper, so make sure to focus on it. Nursing research is only important if you can use it to improve nursing practice. This section doesn’t have to be long, but make it count.

     

    Table 1: Group Table of Evidence (TOE) Part 4

     

    Citation

    (Write citation using APA format, just as you would in a reference list. Put articles in alphabetical order by the first author’s last name)

    Purpose Statement (quote directly from the study), Sample, and Setting

    Research Question or Hypothesis

    (If the study doesn’t list one, write what the implied RQ or Hypothesis is and label as “implied.”)

    Variables

    (State independent and dependent variables using bullet points.
    Note: Participants are not variables)

    Design

    (Include study design (i.e. meta-analysis, RCT), level of evidence (See the Evidence Hierarchy in Polit & Beck (2014)), other key design features such as use of placebo, blinding, etc.

    Outcomes (meaning what the researchers were trying to measure) with Measures and Time Administered (meaning how the data was collected/recorded)

    (Do not put the actual data here. That belongs in the Findings column.)

    Findings

    (Include quantitative data. What are the researchers’ final conclusions based on the outcomes?)

    Casiday, R. E., Wright, C. M., Panter-Brick, C., & Parkinson, K. N. (2004). Do early infant feeding patterns relate to breastfeeding continuation and weight gain? Data from a longitudinal cohort study.
    European Journal Of Clinical Nutrition, 58(9), 1290-1296
    .

     

    Purpose:

    To describe the first-week feeding patterns for breast- vs. bottle-fed babies, and their association with sustained breastfeeding and infant weight gain at 6 weeks.

     

    Sample:

    923 full-term mothers of infants that were born at the time of recruitment took part in the study. Out of 54% of the cohort study, the return of the usable diaries was 502.

    Setting:

    Urban, northeastern community in the United Kingdom

     

     

     

    Research Question/Hypothesis:

    Do early infant feeding patterns relate to breastfeeding continuation and weight gain?

    Independent variable(s):

    Early infant feeding patterns

    Dependent variable(s):

    Breastfeeding continuation and weight gain for infants at 6 weeks. The frequency of breastfeeding for both breastfed and bottle-fed infants was observed and recorded and also weight gain for both.

    Study design:

    A longitudinal cohort study

    Level of evidence:

    Level 2

    Key design features:

    Placebo-controlled study

    Outcomes:

    Interest was in breastfeeding continuation and weight gain for infants over a period of 6 weeks with regards to the frequency and patterns of breastfeeding. Mother’s midwives collected data through questionnaire dairies and collected it at routine screening visits made to the mothers each week for the 6 week period.

    Findings:

    The frequency of breastfed infants was higher at 2.71 h between feeds as compared to infants that were bottle-fed that was at 3.25 h between feeds and for infants that received both types of breastfeeding it was 3.14 h between feeds (P<0.001) within week 1 of life, but the feed duration was the same for all. For the first week, only maternal education (P=0.004) and breastfeeding (P<0.001) were exclusively related to breastfeeding continuation over the period of 6 weeks. Feeding frequency in the first week was greater which indicated a higher 6-week weight gain for breastfed infants, however for bottle-fed infants no analyzed factors led to the incr4ease in weight gain (Casiday et al., 2004, pp. 1292-1293). Conclusions: First-week feeding patterns of the longitudinal cohort study indicate the significance and infant weight gain and breastfeeding continuation complicated issues, and education accorded to mothers on the feeding implications. At 6 weeks, breastfeeding was discontinued for supplementary bottle feeds. For infants that breastfed, frequent feeding led to higher weight gain during that period. Ferguson, M., & Molfese, P. (2007). Breastfed infants process speech differently from bottle-fed infants: evidence from neuroelectrophysiology. Developmental Neuropsychology, 31(3), 337-347 Purpose: To evaluate whether breastfed infants, process speech differently from bottle-fed infants.   Sample: 12 infants at the age of 6 months were tested Setting: Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY 40292, USA Research Question/Hypothesis: Do infants that have been breast-fed process speech differently as compared to infants that have been bottle-fed. Independent variable(s): Breastfed infants and bottle-fed infants are the independent variables   Dependent variable(s): Speech processing ability is the dependent variable Study design: Retrospective cohort study design Level of evidence: Level 3   Key design features: Placebo-controlled study Outcomes: Interest was in Event-related potential (ERP) wavelength or speech processing measurement and recording of a range of behavioral measures. Data was collected through physical testing of the infants over a specified period.   Findings: The study sought to find out the breastfeeding differential impact against PUFA-enriched formula from a group of 12 infants aged 6 months that were well matched. Recording of data was done on ERP wavelengths and range of behavioral measures. Differences were identified in ERP wavelengths when the comparison was made between PUFA-fed infants and breastfed infants at the age of 6 months. Upon equating cognitive, biological, and perinatal factors, breastfed infants recorded ERPs were seen to change throughout the period of recording at 700 msec when the two groups were evaluated. Their ERPs also showed a difference in all speech sounds, and also recorded scalp recordings generated differences from all regions. Conclusions: In conclusion, differences observed in brain range responses possibly indicate an advantage in terms of later cognitive and linguistic development for infants that were breastfed as compared to infants that were bottle-fed. Kim, T., Lee, H., Park, J., Jang, S., and Kim, M. (2013). Effects of early breastfeeding education on maintenance of breastfeeding practice: A prospective observational study. Open Journal of Nursing , 3 , 209-213.           Purpose: To evaluate the effect of early breastfeeding and prenatal education of breastfeeding in the maintenance of breastfeeding practice after delivery. Sample: 82 pregnant women that were recruited experienced virginal delivery and took part in the study. Setting: Soonchunhyang University Hospital, Department of Obstetrics and Gynecology in Bucheon, South Korea.       Research Question/Hypothesis: Implied It is suggested that new-born infants’ early breastfeeding impacts the postpartum practice of breastfeeding and also related education effects on the practice of breastfeeding. Independent variable(s): Early breastfeeding education is the Independent variable. Dependent variable(s): Breastfeeding practice maintenance is the dependent variable Study design: Observational survey study design Level of evidence: Level 5   Key design features: Placebo-controlled study Outcomes: Interest was in education level and information provision effects on the types and maintenance of feeding. Data was collected through survey questionnaires that detailed information about mother and infant, breastfeeding patterns, and education level of the patient. After birth delivery in weeks 1 and 4, telephone survey interviews were conducted. Analysis of data was done using One-way ANOVA.   Findings: The 82 women sample size were separated into two groups with one having women that breastfed within 2 hours of delivery, and the second one breast-fed in between 2 hours and 24 hours after delivery. Women with degrees from college showed statistical significance in terms of maintaining a higher breastfeeding percentage even after discharge from hospital in the 4 th week (p=0.01). After provision of information, types of feeding (powder, breast milk) indicated differences that were statistically significant in the samples only before the discharge from hospital period by p=0.03. 1 st weeks p-value was 0.97 and 0.83 after the four week period. With this statistical data, it was clear there was no or little statistical significance in the relationship between breastfeeding of infants early and breastfeeding practice maintenance (Kim et al., 2013, pp.210-211) Conclusions: Education of post-partum and antenatal period with regards to breastfeeding is crucial for the maintenance of the breastfeeding practice. Recommended developing educational programs further studies. Singhal, A., Cole, T., Lucas, A., Singhal, A., Cole, T. J., & Lucas, A. (2001). Early nutrition in preterm infants and later blood pressure: two cohorts after randomized trials. Lancet, 357 North American Edition (9254), 413-419.   Purpose: To determine whether early nutrition in preterm infants results in later life lower blood pressure. Sample: 216 (23%) children out of 926 born prematurely and that took part in two randomized trials that were parallel took part in the study in five UK based neonatal units. Setting: Medical Research Council Childhood Nutrition Research Centre, Institute of Child Health, London, UK.   Research Question/Hypothesis: Hypothesis: It is suggested that early diet programmes blood pressure in later life in children randomly assigned different diets at birth. Independent variable(s): Early nutrition is the independent variable Operational definition: Early nutrition refers to early breastfeeding where preterm infants were given dietary interventions such as preterm formula vs. donated banked breast milk and preterm formula vs. standard term formula. Conceptual definition: Early nutrition refers to the process of nourishing or provision of food (in this case breast milk) to infants (preterm) for growth and health. Dependent variable(s): Lower blood pressure is the dependent variable. Operational definition: lower blood pressure in this context refers to the presumed effect brought about by early breastfeeding in infants born prematurely. Conceptual definition: Low blood pressure also referred to as hypotension is a medical condition where the pressure in the arteries is less than 90/60 mmHg which is the measurement used to gauge blood pressure in the arteries. Study design: Randomized controlled study design Level of evidence: Level 1 Key design features: Placebo-controlled design Outcomes:            Interest was in blood pressure measurement. Data was collected from the 216 children aged between 13-16 years that were born prematurely through physical tests by medical practitioners.   Findings: Those children that were followed up at ages between 13 and 16 showed similar characteristics of anthropometry and social class at birth when compared to those that were not followed up. At this age group, 66 children that were given banked breast milk (together with the milk from the mother or alone) showed a lower arterial blood pressure mean as compared to the 64 children that were given preterm formula (mean 81·9 [SD 7·8] versus 86·1 [6·5] mm Hg; 95% CI for difference −6·6 to −1·6; p=0·001). Analysis done in the non-randomized sample showed that the human milk enteral intake proportion in the period of neonatal was related inversely to the arterial pressure later mean (β=−0·3 mm Hg per 10% increase [95% CI −0·5 to −0·1]; p=0·006). No conclusive difference was noticed in comparison of term formula (n=44) and preterm formula (n=42) (Singhal et al., 2001, pp. 416-417). Conclusions: Breast milk consumption was seen to reduce blood pressure in prematurely born children. Data retrieved from the study provides for experimental programming evidence of a risk factor in the cardiovascular through early nutrition and long-term positive breast milk effects were further supported.

  • Academic Research Essay Outline

    Academic Research Essay Outline

    Topic: You may choose your topic so long as it specifically relates to law, society, &/or justice.  The only topics you may not write about are abortion, death penalty, or marijuana.

     

    Part 1: Outline the Following Preliminary Ideas for Your Essay:

     

    Thesis statement
    -A one-sentence, overall argument that you assert or your take-away message—a “should”-type statement.

     

    A topic sentence for your background information paragraph.  This sentence should convey the overall meaning of the paragraph.

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    III.
                A “reason” topic sentence.  A reason provides a “why” or “because” the thesis statement is true.  This sentence states the overall meaning or concept that will be covered in the paragraph.

     

    Another “reason” topic sentence.  A reason provides a “why” or “because” the thesis statement is true.  This sentence states the overall meaning or concept that will be covered in the paragraph.

     

    Another “reason” topic sentence.  A reason provides a “why” or “because” the thesis statement is true.  This sentence states the overall meaning or concept that will be covered in the paragraph.

  • Assessing critical business indicators

    Assessing critical business indicators

    For your Week 10 Discussion response, you are to be assigned one of the four problems (#9, #10, #11 or #12) on pages 414–415 of the text (eBook) Financial Management of Health Care Organizations: An Introduction to Fundamental Tools, Concepts, and Applications (3rd ed.). 
    Please just pick one of these questions for your Week 10 Discussion that makes sense for you. I will not be assigning it as it will be your choice.
    Thanks.

    Here is the text elink

    http://site.ebrary.com/lib/waldenu/docDetail.action?docID=10341702

    Zelman, W., McCue, M.,, & Glick, N. (2009).
    Financial management of health care organizations: An introduction to fundamental tools, concepts, and applications
    (3rd ed.).

  • Transforming Nursing and Healthcare through Technology Essay

    Transforming Nursing and Healthcare through Technology Essay

    Health Literacy

    In order to effectively manage their own health, individuals need to have competencies in two areas—basic literacy and basic health literacy. What is the difference? Basic literacy refers to the ability to read, even simple language. Health literacy is defined as, “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (National Coalition for Literacy, 2009). Unfortunately, according to a Department of Education report on health literacy, only 12% of adults aged 16 and older are considered to have a proficient level of health literacy (U.S. Department of Education, 2006). Acquiring health literacy skills has become more complicated with the explosion of online health information, some credible and some misleading.

    In this Discussion, you focus on how to help individuals find credible information on the Internet and develop strategies nurses can use to increase the health literacy of their patients.

    To prepare:

    · Think about the nurse’s role in improving the health literacy of patients.

    · Consider the many ways patients access health information, including blogs, social media, patient portals, websites, etc.

    · Reflect on experiences you have had with patients who self-diagnose using online medical sources.

    · Using the Internet, the Walden Library, or other trustworthy sources, identify a resource that you could introduce to patients to help them evaluate the credibility of health information found online.

    · What are some strategies you could employ to improve the health literacy of patients?

    Required Readings

    McGonigle, D., & Mastrian, K. G. (2015).
    Nursing informatics and the foundation of knowledge
    (3rd ed.). Burlington, MA: Jones and Bartlett Learning.

    Chapter      17, “Supporting Consumer Information and Education Needs”

    This chapter explores health literacy and e-health. The chapter examines a multitude of technology-based approaches to consumer health education.

    Chapter      18, “Using Informatics to Promote Community/Population Health”

    In this chapter, the authors supply an overview of community and population health informatics. The authors explore a variety of informatics tools used to promote community and population health.

    Chapter      16, “Informatics Tools to Promote Patient Safety and Clinical Outcomes”

    The authors of this chapter present strategies for developing a culture of safety using informatics tools. In addition, the chapter analyzes how human factors contribute to errors.

    Health literacy: How do your patients rate? (2011).
    Urology Times, 39
    (9), 32.

    The authors of this article define health literacy and emphasize its poor rates in the United States. Additionally, the authors recommend numerous websites that offer patient education materials.

    Huff, C. (2011). Does your patient really understand?
    H&HN, 85
    (10), 34.

    This article defines hospital literacy and highlights the barriers that prevent it from increasing. It also emphasizes the difficulties created by language and financial costs.

    The Harvard School of Public Health. (2010).
    Health literacy studies
    . Retrieved from http://www.hsph.harvard.edu/healthliteracy

    This website provides information and resources related to health literacy. The site details the field of health literacy and also includes research findings, policy reports and initiatives, and practice strategies and tools.

    Office of Disease Prevention and Health Promotion (n.d.).
    Health literacy online
    . Retrieved June 19, 2012, from http://www.health.gov/healthliteracyonline/

    This webpage supplies a guide to writing and designing health websites aimed at increasing health literacy. The guide presents six strategies that should be used when developing health websites.

    U.S. Department of Health and Human Services. (n.d.a).
    Quick guide to health literacy
    . Retrieved June 19, 2012, from http://www.health.gov/communication/literacy/quickguide/Quickguide.pdf

    This article contains an overview of key health literacy concepts and techniques for improving health literacy. The article also includes examples of health literacy best practices and suggestions for improving health literacy.

    Required Media

    Agency for Healthcare Research and Quality (Executive Producer). (2012a).
    Interview with Rachelle Toman, M.D. Ph.D.
    Rockville, MD: Author. Retrieved from http://www.ahrq.gov/patients-consumers/patient-involvement/ask-your-doctor/videos/clinician06/index.html

    In this interview, Dr. Toman discusses the importance of asking patients questions to ensure they have been able to sufficiently communicate their concerns.

    Agency for Healthcare Research and Quality (Executive Producer). (2012b).
    The waiting room video
    . Rockville, MD: Author. Retrieved from http://www.ahrq.gov/patients-consumers/patient-involvement/ask-your-doctor/videos/waitroom/index.html

    This video addresses the importance of communication in the patient-health care professional relationship. It highlights the need to ask meaningful questions to the patient to fully understand issues and concerns

  • Medicare, Medicaid and managed care

    Medicare, Medicaid and managed care

    MMA was signed by President Bush in 2003. The MMA brought about sweeping changes that increased enrollment and improved access to Medicare Plans. Similarly, the PPACA was signed into law by President Obama in 2010. The law is expected to significantly increase access to Medicaid for the uninsured, low-income families, and individuals. Medicaid managed care has been implemented by most states, mainly because of rising costs, plan quality, access to providers, and the decrease in state revenues and federal matching funding. Medicare has explored managed care for the same reasons: to reduce costs, improve quality and improve access to providers. Using the South University Online Library or the Internet, research the following two topics and write a paper evaluating the impact of these policies on Medicare and Medicaid managed care.

    You need to research on the following two topics:

    Medicare and managed care

    Medicaid and managed care

    Based on your research, answer the following questions:

    Write a summary for each topic tying together the information learned about that topic.

    Analyze the challenges Medicaid faces in terms of improving access to care, quality of care, and reducing the cost of care.

    Analyze the challenges Medicare faces in terms of improving access to care, quality of care, and reducing the cost of care.

    Draw conclusions about the future of managed care in each program—will it grow or decline? What will be the challenges for success?

    Select at least four reputable articles per topic that address the challenges facing Medicare and Medicaid managed care.

    Based on your research, summarize your findings on the selected topics and compile your observations in a 5 page Microsoft Word document.

    Support your responses with examples.

    Cite any sources in APA format

  • Personal Worldview Essay – Spirituality and pluralism, scientism, and postmodernism

    Personal Worldview Essay – Spirituality and pluralism, scientism, and postmodernism

    Write an 800-1,000 word essay on your personal worldview. Briefly discuss the various possible meanings of the term “spirituality,” and your understanding of the concepts of pluralism, scientism, and postmodernism. Primarily, address the following seven basic worldview questions:

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    What is prime reality?

    What is the nature of the world around you?

    What is a human being?

    What happens to a person at death?

    Why is it possible to know anything at all?

    How do people know what is right or wrong?

    What is the meaning of human history?

    Prepare this assignment according to the APA guidelines . An abstract is not required.