Sample-Research Critique

Research Critique


The purpose of this research critique is to show how a quantitative study is effectively critiqued. The critiqued study follows the increased use of catheter in health care organizations and the resulting infections. In US for instance, CAUTIs account for around 34% of all health care associated infections. These infections are associated with high health care costs and excess morbidity. Even though there are CAUTI prevention practices in place, adherence to them has not been successful. This essay will explain the protection of human participants, data collection, data management and analysis, findings or interpretation of findings including implications for practice and future research, and conclusion.

Protection of Human Participants

As noted by Emanuel (2008), research studies that involve human participants are required to adhere to some norms to make them ethical and legal. The major expected aspects are obtaining consent, having voluntary participation, and institutional review board approval before the sample is selected. In this case, the researchers adhered to this and had several benefits. To start with, by obtaining informed consent, it was ensured that the participants knew what they were engaging into. The study participants did not agree to a study they did not understand; they understood the process and the part they were to play. This way, the researchers had willing participants. Further, by ensuring anonymity of the participants with the research being conducted on nurses, the researchers were able to get more detailed and honest responses. The participants also enjoyed voluntary participation and this encouraged their responding. Lastly, the Colorado Multiple Institutional Review Board gave approval to the researchers by exempting the study from human subjects’ research oversight (Fink et al, 2012).      

Data Collection

The dependent and independent variables in the study are very clear. The researchers wanted to determine the care practices in place for CAUTI prevention. As a result, the dependent variable was the CAUTI prevention. The independent variables were the care practices in three areas namely equipment and alternatives and insertion and maintenance techniques; personnel, policies, training, and education; and documentation, surveillance, and removal reminders. Data was collected through electronic surveying of NICHE hospital nurse coordinators on issues regarding IUC practices. Data was collected in December 2009 with 20 NICHE member hospital coordinators invited to complete the survey with 233 more invited to complete the survey in June 2010. The respondents had to gather the information required in completing the surveys from various sources including nurses from the units focusing on NICHE activities, purchasing staff, infection preventionists, local educators, and clinical informatics staff. The researchers used the Survey Monkey methodology to collect data. This was agreed to because it was considered the most appropriate in the current study and had been used in previous studies satisfactorily. The data was collected from December 2009 to June 2010. The respondents started by filling the survey forms after gathering adequate and relevant data from the identified personnel. The survey was completed in ten minutes. The coordinators were also to send copies of their hospital’s IUC placement, management, and CAUTI prevention procedure and policy (Fink et al, 2012).    

Data Management and Analysis

After the data was collected, it was managed and analyzed using SPSS version 19. The demographic data and survey items were summarized using tests of difference and association with a set at 0.05 and descriptive statistics. The authors in this case describe maintaining a paper trail of critical decisions that were made during the analysis of the data (Abbott, 2014). Further, they used statistical software to ensure accuracy of the analysis. The researchers had also measures in place to prevent research bias. They analyzed the data independently and later compared their analysis. They also had the help of experts in data analysis. 

Findings / Interpretation of Findings: Implications for Practice and Future Research

From the analyzed data, it was found out that even though there are CAUTI prevention practices in place in the NICHE hospitals examined with most of the practices aligning with evidence-based guidelines, there is considerable heterogeneity of practices and this called for improvement and standardization. Even though silver-coated catheter house-wide is noted to have equivocal evidence support, it is used by fewer hospitals because of the excess costs involved. Other used prevention practices are use of removal triggers such as reminders and stop orders and nursing-driven catheter removal protocols. Even though these practices had beneficial results, they were not used by all hospitals. Since the current findings agreed with earlier studies, it can be argued that they are valid and accurate. The implication of the study was therefore to have implemented local procedures and policies that incorporate evidence-based guidelines. The designed and implemented procedures and policies should achieve regulatory compliance and also standardize practice for providers. One of the major limitations of the study was that it focused on the nursing practice with physician practice out of the study’s scope. Future research should thus not overlook physician training and education since they are also involved in catheter placement. Further, the study used NICHE hospitals, which are not for profit hospitals and thus are not a representative of the general hospital population. The study also relied on self-reports from NICHE hospital coordinators who might have lacked perfect knowledge on CAUTI prevention (Fink et al, 2012).   


Even with increased catheter infections, there are prevention measures that can reduce the frequency is well adhered to. The preventive mechanisms should be standardized and aligned to the hospitals policy and procedures so that all physicians are encouraged to adhere to them. This study shows how CAUTI can be prevented if corrective measures are taken. There should be policies in place and the medical practitioners should be educated and trained on the same.




Abbott, H. (2014). Foundations for operating department practice: Essential theory for practice. London: Open University Press.

Emanuel, E. J. (2008). The Oxford textbook of clinical research ethics. Oxford: Oxford University Press.

Fink, R., Gilmartin, H., Richard, A., Capezuti, E., Boltz, M., & Wald, H. (2012). Indwelling urinary catheter management and catheter-associated urinary tract infection prevention practices in Nurses Improving Care for Health system Elders hospitals. American Journal of Infection Control, 1-6. Retrieved from

Sample-Journal entry- Frederick Douglass

Journal entry- Frederick Douglass


Frederick Douglass was a slave staying at one of the whites’ houses, Hugh Auld’s, in which learning was not allowed as it was seen as a way to empower the blacks and make them turn against their owners. However, he went against all odds to ensure that he acquired education through risks which would have cost his life. One of the ways was using the local boys to learn how to read by giving them small gifts. During that era, it was likely that these whites would report him to their parents which would take stern action against him (Richardson, Morgan & Fleener, 2012). However, he risked this and held writing competitions with the boys thus enabled him to learn how to write alphabets.

It can be noted that while in jail, he used a dictionary to list all the letters in the alphabet as well as words which he would later learn their meanings. Under normal circumstances, it is really heard to learn in a school setting yet he taught himself and was able to learn to write and read too (Richardson, Morgan & Fleener, 2012). Further, it has been seen that he used Auld’s old papers and scripts to scribble some writings. He also wrote on barks of trees, leaves and any other odd stuff that he could lay his hands on to necessitate his learning experience.

His boldness enabled him to achieve more than people in a formal setting are able to do. His determination has inspired many young people who feel that they should be pushed in order to learn. His ability to go against the slave owners and meet his goals has taught many lessons that people should remain resilient as long as they don’t infringe other peoples’ rights (Richardson, Morgan & Fleener, 2012). It is important to understand the reasons for carrying certain duties so that these remain the driving force that keep him focused.




Richardson, J. S., Morgan, R. F., & Fleener, C. E. (2012). Reading to learn in the content areas. Belmont, CA: Wadsworth.

sample-Group Dynamics

Group Dynamics


Whenever people meet in various groups, there are dynamics that can pose a great risk to the proceedings of the meeting if not well addressed. A professional is expected to understand that people react differently to information presented to them depending on how it is communicated (Curry et al., 2012). Due to this, there is a need to understand the people he is dealing with so as to reduce conflicts and consequently enhance unity. It is common knowledge that people prefer to avoid conflicts and situations that are potentially stressful other than facing them head on. They find it easier to avoid communication on subjects that appear controversial and let the discussions fester to maintain peace.

There are several ways in which to maintain healthy discussions among peers and other professionals. One is having planned conversations in which the content to be talked about is prior thought of and the place, time and other circumstances are planned for due to various reasons. Through this, the people involved can avoid direct attacks that would affect their counterparts while at the same time ensuring that their points are understood (Hackman & Katz, 2010). Taking time to plan what to say and how to say it may ease the reactions that one is likely to encounter from the listener. On the other hand, unplanned conversations occur without prior plans and they are often due to a certain surge of emotion which can be triggered by a certain circumstance.

In both cases, the repercussions associated with the conversations have either positive or negative effects which should be handled by the parties involved to avoid further conflicts. Dealing with conflict and difficult situations when collaborating with parents, families, and professionals in the education sector demand that the individual tries to reduce dire consequences that might aggravate the situation. A professional should handle difficult situations with tact, discretion, empathy, and clarity (Hoffman et al., 2014). In as much as people would try to avoid conflicting ideas, it is advisable that they air their views as they might be the right thing to do irrespective of the results. For instance, a manager may choose not to disclose a bad character of a student to the parents as he thinks that their health would be jeopardized.

However, this probably would be helpful to the student if they take up the action and take him to a rehabilitation center. It is due to this that managers are expected to communicate difficult information on several levels, to staff who are under-performing or if redundancies are necessary (Hoffman et al., 2014). Further, they are expected to report good or bad news to board members or directors so that the progress of an institution is understood and necessary action taken. It should be noted that different people react to change differently thus the approach that is used to address an issue is paramount.

As has already been mentioned, there are people who respond to a change in a positive way while others feel threatened and see a difficulty at first. All these should be put into consideration in order for one to function in a certain group setting (Curry et al., 2012). This helps in reducing anxiety and stress that would otherwise be encountered if they do not embrace the change and the benefits that would be associated with the change.




Curry, L. A., O’Cathain, A., Clark, V. L. P., Aroni, R., Fetters, M., & Berg, D. (2012). The role   of group dynamics in mixed methods health sciences research teams. Journal of mixed        methods research, 6(1), 5-20.

Hackman, J. R., & Katz, N. (2010). Group behavior and performance. Handbook of social            psychology.

Hoffman, D. M., Blasi, B., Ćulum, B., Dragšić, Ž., Ewen, A., Horta, H., … & Rios-Aguilar, C.     (2014). The methodological illumination of a blind spot: information and communication         technology and international research team dynamics in a higher education research           program. Higher Education, 67(4), 473-495.

sample-Article Review: Behavioral Skills Training for Staff Training

Article Review

Behavioral Skills Training for Staff Training

In the current global world, organizations rely on highly qualified staff with up to date skills to help beat competition. It is notable that even after hiring top talents, an organization has to continuously train its staff to prevent them from becoming obsolete. It is also notable that organizations need to choose the most appropriate training approaches that would ensure that what is learned during the training sessions is translated into the job. Organizations should also use approaches that would ensure continuous application of the newly acquired skills rather than having the learned skills ignored few months after the training. One of the best evidence training methods is behavioral skills training.

According to this approach, Gianoumis and Sturmey (2012) argue that training is done through a combination of behavioral techniques namely instructions, feedback, modeling, and rehearsal. The aim of the approach is to promote skill proficiency making it applicable for different people including teachers, children, and parents. Through the used techniques, Homlitas, Rosales and Candel,  (2014) assert that behavioral skills training, usually abbreviated as BST is very effective in training staff and having them transfer the learned knowledge to resolve any relevant challenges. For instance, when used on children with mental disorders, this approach helps with coping mechanisms thus making their lives bearable (Seiverling, Williams, Sturmey & Hart, 2012). This makes the BST approach an important topic to cover because of its effectiveness in extending the learned skills to real life. 

This paper will therefore not only discuss how BST helps in training but also address a number of questions. The first question is; how does BST approach ensure that the learned is transferred to the workplace? Secondly, how does the approach ensure that learners learn only what is relevant to their work and what effect does this have on long-term training benefits?

Article Analysis

The study by Parsons and Rollyson (2013) is a single subject design explaining the different between training without and with BST approach. The selected 10 practitioners were trained in a human service training using their traditional training approaches and later using the BST and results from the two programs compared. Based on the collected and analyzed data, the researchers concluded that all participants demonstrated better training results after using the BST approach. It was also reported that the trained practitioners took the learned skills to their workplace since they demonstrated better application of BST when training other staff members in the regular work setting. Since the study compared training assessment before and after implementation of the BST approach, I feel that the study was done well. In addition, the trained practitioners were followed to their places of work where they were seen training other staff using the same approach. This supports the conclusion that BST is an effective training program with long-lasting benefits.  

In their study, LaBrot, Radley, Dart, Moore and Cavell (2017) also conducted a single subject design as they carried out their study in phases. The study had two experiments. In the first experiment, eight parents were assigned randomly to one of the behavioral skills training sequences with each sequence being different in manner in which components of the training was introduced. From this experiment, it was concluded that feedback was very important in improving training benefits. In the second experiment, which was to determine the importance of feedback, the feedback was introduced only after other components of the BST approach were implemented. From this experiment, it was reported that integrity was high with introduction of feedback. The overall conclusion was that feedback is very important in the BST approach. Since the study was done in phases, I think that it was done well. It is also arguable that since the two experiments showed the same findings, the conclusion is justifiable.

Gunn, Sellers and Lignugaris (2017) also carried out a single subject design as they examined the difference in functioning by the study participant after using BST approach. The study used a young adult who was diagnosed with autism spectrum disorder who was enrolled in the early childhood special education program. Since this disorder impairs executive functioning and social pragmatics, the aim was to help the student address his deficits. By using immediate feedback, it was reported that the subject improved in all dependent variables (visual scanning, engagement with preschool age children, and verbal interactions). The researchers concluded that immediate feedback is very important in helping psychologically impaired children to identify their weaknesses and address them. Since the study included only one subject, I do not think that it was conducted well. Similarly, the findings might only have been reported because of other external factors since only one student was studied. 

The single subject design study by Galindo, Candeias, Pires, Gracio and Stuck (2018) was also conducted on children in schools in Portugal with failure difficulties. The study was in form of two empirical studies. The first study was to come up with behavioral diagnostic as well as training approached that would help in teaching lacking skills. The main instrument involved training programs applied in three areas namely basic behavior, social behavior, and academic behavior. Through pre-test and post-test training, it was reported that there was improved in all tested behaviors. To ensure efficacy of the findings in the first study, the second study was conducted in form of a quasi-experimental design in which it was revealed that there was few performance changes before the training but increased positive behavior change after BST. The researchers therefore concluded that BST helps in dealing with learning difficulties for students thus showing its effectiveness in improving academic performance. Since the study was done in two phases and compared results before and after BST, I think that it was done well. The findings also support the conclusion as the researchers went ahead to prove the efficacy of findings from the first study by conducting a second study.  

The single subject study design by Parsons and Rollyson (2012) was aimed at determining the effectiveness of BST in teaching staff in a human service setting. With six teachers and one assistant teacher, the researchers found out the trainers used the learned skills in their routine job duties and this helped in ensuring competent performance. This proved that BST helps in ensuring effectiveness of the training program. Since this study was conducted and later participants allowed to try the learned knowledge in their routine jobs, I feel that it was conducted well. In addition, the findings support the conclusion since date was collected and analyzed before, during, and after the training.      


From the reviewed articles, one of the most important things is that feedback is very crucial in improving training programs. It was revealed that feedback helps in identifying one’s weaknesses and thus improving them and being better in actual life (Gunn, Sellers & Lignugaris, 2017). This ensures that learners are informed of their mistakes during the training so that they are better when they get back to the practice field. Secondly, BST is proved to be an effective way of training. This is because from all the studies, it was reported that all the participants improved in the trained parameters. When trained to perform better as a trainer, the followed practitioners were proved as effective in training others (Parsons & Rollyson, 2013). Lastly, it was revealed that BST is an evidence-based training approach because of its long-lasting benefits. People who are trained using this approach were reported to implement the learned knowledge in the routine jobs and this proved that the training program was successful (Parsons & Rollyson, 2012).

Based on findings from the reviewed articles, it is a recommendation that the training program is relevant to one’s assignments so that it the trained person applies the learned knowledge in his field of work (Galindo, et al., 2018). It is also recommended that practitioners conduct long studies by comparing results before and after the training and if possible following trainees to their places of work. This would help in determining whether the training program was effective in that it helps the trainee when carrying out his routine tasks. Practitioners should also clearly identify the aspects that they need trainees to improve on (Gunn, Sellers & Lignugaris, 2017). This is because having so many expectations from the trainees might result to arguments that the program was a failure while in reality it was not.

Even though the analyzed studies showed that BST is an evidence-based and effective training approach, a further study should be conducted with many participants so that it is possible to generalize the results. This is based on the limitation on the study by Galindo, et al., (2018) in which only a single participant was involved. In addition, a randomized controlled trial should be conducted to compare BST with other training programs in order to guide practitioners better. Nevertheless, the studies agreed that BST is effective in improving training outcomes.          




Galindo, E., Candeias, A. A., Pires, H. S., Gracio, L., & Stuck, M. (2018). Behavioral skills training in Portuguese children with school failure problems. Frontiers in Psychology, 2(9), 23-27.

Gianoumis, S., & Sturmey P. (2012). Generalization procedures in training interventionists for individuals with developmental disabilities. Behavior Modification, 36(5), 619-629. 

Gunn, S. L., Sellers, T. P., & Lignugaris, B. (2017). Application of coaching and behavioral skills training during a preschool practicum with a college student with autism spectrum disorder. Quarterly Journal of Experimental Psychology, 16(4), 11-19.

Homlitas, C., Rosales, R., & Candel, L. (2014). A further evaluation of behavior skills training for implementation of the picture exchange communication system. Journal of Applied Behavior Analysis, 47(1), 1-6.

LaBrot, Z. C., Radley, K. C., Dart, E., Moore, J., & Cavell, H. J. (2017). A component analysis of behavioral skills training for effective instruction delivery. Journal of Family Psychotherapy, 2(3), 1-20.

Parsons, M. B., & Rollyson, J. H. (2012). Evidence-based staff training: A guide for practitioners. Behavioral Analysis Practice, 5(2), 2-11.

Parsons, M. B., & Rollyson, J. H. (2013). Teaching practitioners to conduct behavioral skills training: A pyramidal approach for training multiple human service staff. Behavioral Analysis Practice, 6(2), 4-16.

Seiverling, L., Williams, K., Sturmey, P., & Hart, S., (2012) Effects of behavioral skills training on parental treatment of children’s food selectivity. Journal of Applied Behavior Analysis, 45(1), 197-203.

sample-Counseling Theories/Approaches






Counseling Theories/Approaches




Psychotherapy theories and approaches have been effective in efforts to transform social work and counseling services based on specific client needs and preferences. Such theories include the feminist therapy model, narrative theory/therapy, constructive theory, as well as, solution-based therapy. The models/theories promote individualized approaches in therapy in efforts to understand how personal values, beliefs, perceptions, and experiences affect their lives. The models/theories named above are applicable in my counseling practice because they promote client-focused care, communication, and the development of interpersonal relations. Concepts promoted by the theories include rewriting stories in a culturally dominant society, proper communication, developing client-therapist relationships, and client participation in problem-solving.




Feminist Therapy

Feminist therapy is an approach used in psychotherapy; it focuses on women mental health by highlighting stressors and challenges that women face due to discrimination, oppression, bias, and stereotyping. The approach seeks to establish a therapeutic relationship between the client and therapist in efforts to empower the patients into understanding health issues and their relation to various social factors (Draganović, 2012). From a personal standpoint, the therapy model is relevant and useful in empowering women who intend to overcome the mental and emotional challenges of discrimination. Creating a relationship with the client enables the therapist to understand the client’s background, which works to suit effective communication (Draganović, 2012). It is notable that therapists rely on client response to therapy procedures and techniques. Feminist therapy entails eliminating the sense of worthlessness and victimization by encouraging individuals to develop courage. It can be used to empower individuals from marginalized groups such as immigrants, refugees, people of color, or the gay community.

The concepts of communication and development of counselor-client relationships are applicable in my practice. Proper communication facilitates interpersonal understanding in which the therapist understands the client’s values, beliefs, and preferences regarding healthcare. In this regard, I intend to ensure effective communication in the care setting with patients to support the development of therapist-client relationships. In so doing, clients will feel empowered, which, in turn, will help in lifting the mental barriers that affect their psychological well-being (Draganović, 2012). My goal as a counselor is to comfort clients while engaging them in an integrative therapeutic process to find their strengths and identity. The concept of creating relations with clients in feminist therapy is useful because it involves sharing stories and empowering clients to believe in overcoming any adversity.

Solution-Focused Therapy

Solution-focused therapy, also known as, solution-focused brief therapy (SFBT) centers on finding solutions in the present time. The approach is effective because it supports focusing on a specific goal or objective towards achieving a quicker resolution of the problem at hand. It can be used to treat children and adults with behavioral problems, involved in child or domestic abuse, fighting addiction, and facing relationship issues (Lloyd, Macdonald & Wilson, 2016). The approach uses the goal-setting technique in which client plan to change is identified and necessary therapeutic solutions integrated. It also relies on the concept of proper communication; the counselor has to understand the client’s plans and perception of the issue at hand. Clients answer questions based on their issue and in doing so, provide therapists with a plan to devise life-changing solutions. It is important to note that SFBT is based on the assumption that individuals are willing and hopeful to find a solution to their problems.

The techniques, procedures, and concepts of the therapy approach are applicable in my therapy practice. For instance, the underlying assumption that people are willing to find a solution to their problems can be used to guide communication and interactions. Interactions in the care setting provide varying hints on how an individual’s problem can be solved. The concept of setting goals is applicable in my practice. This is because it supports identifying a specific aspect of the issue or problem and accomplishing the possible (Lloyd, Macdonald & Wilson, 2016). The trust that comes with working on goals discussed by the therapist and client facilitates continuous work to find long-term solutions. Communication between involved parties supports the development of confidence, which enables clients to share details about their personal life for better and timely outcomes.

Narrative Therapy

The approach is based on the theoretical understanding that individuals experience problems when societal discourses and expectations outdo their abilities. Socio-cultural practices, societal expectations, and assumptions tend to highlight the acceptable way of life, which can be depressing for some people. The therapy model is founded on the concept of separating the client from the problem created by dominant social discourses or expectations (Chang & Nylund, 2013). The therapist assumes the role of a problem-solver by examining how the client perceives or evaluates him/herself. The psychological technique that ‘problems are imposed on people, as opposed to people having problems’ helps in evaluating the quality of life based on personal knowledge. On this subject, the approach aids in identifying alternative ways of viewing life regardless of societal pressure. Similar to SFBT, narrative therapy grounds on the assumption that individuals have strengths, which could be optimized to overcome mental, social, and cultural issues.

The model is applicable in my counseling practice because it supports the concept of living beyond society’s expectations and pressure. Clients need to be empowered into realizing the influence of understanding self-worth and love. Narrative therapy seeks to promote individuality when making decisions that determine happiness and satisfaction from life (Chang & Nylund, 2013). For instance, an individual should not feel pressured to marry just because society expects people of a certain age to be married. The model can be useful in examining the likely effects of continuing to live according to society’s expectations. It can help clients to develop suitable filters through which to see the world in efforts to avoid the negative effects of social pressure (Chang & Nylund, 2013). Stories told based on expectations drawn from a dominant social culture affect people way of thinking. In this regard, I will use the model to help clients in rewriting stories to suit their life towards triggering more positive feelings and values.

Constructive Therapy and Theory

Constructive therapy is based on constructivism theory; it grounds on the concept that one’s life experiences shape his/her understanding of life and sense of reality. The model seeks to examine the meaning people assign to various life experiences (Sharf, 2015). In so doing, it is easier and more convenient to become an active participating in achieving set goals and change. The concept of how people relate to the world is helpful in determining suitable ways through which individuals can view life experiences uniquely. The idea that reality it constructed indicates the people problems vary and thus, should be perceived and treated independently (Sharf, 2015). Applying the model in therapy requires the client to participate actively in finding a solution to their problem by identifying the likely causal factors. The model supports an open-minded and continuous learning strategy in which personal experiences and interactions with others aid in making better choices to benefit self.

Constructive theory and therapy can be applied in my practice; for instance, a client struggling with self-esteem issues can benefit from creating own meaning to life based on personal experience. The solution can be acknowledging that bullies are existent and the only issue is how one reacts to being bullied. The concept of individuals assigning meaning to life based on experiences can be useful in counseling because it guides on the relationship between thoughts and feelings (Sharf, 2015). The expectations that people place on others based on behavior or actions can be altered, which indicates that clients can attempt new behaviors without necessarily having to be accepted widely.


It is evident that psychotherapy models and theories can be effective in advancing patient-based care, especially on issues concerning mental health. The models and theories discussed above highlight the need to understand underlying factors when solving a problem. For instance, feminist therapy model encourages therapists to consider the factors that affect women’s mental health in efforts to achieve desired change in perception and behavior. The SFBT focuses on solving issues through client-therapist communication to identify underlying aspects of the problem at hand. The narrative theory, which focuses on changing the story to suit personal life experiences, can be useful in counseling. Constructivism or constructive therapy focuses on constructing individual experiences to suit better emotions and feelings, which improve the quality of life.




Chang, J., & Nylund, D. (2013). Narrative and solution-focused therapies: A twenty-year retrospective. Journal of Systemic Therapies32(2), 72-88.

Draganović, S. (2012). Approaches to feminist therapy: a case study illustration. Epiphany4(1).

Lloyd, H. F., Macdonald, A., & Wilson, L. (2016). Solution-focused brief therapy. In Psychological therapies and people who have intellectual disabilities. The British Psychological Society.

Sharf, R. S. (2015). Theories of psychotherapy & counseling: Concepts and cases. Cengage Learning.

sample-Movie review Remember the Titans

Movie review Remember the Titans


“ Remember the Titans” is a film  based on real events in 1971, where T.C. Williams High School, a now newly integrated school, becomes a beacon of unification through their mixed race football team. The film is a parable about racial harmony crafted to the formula of a sports movie based on the true story of a high school in Virginia that is integrated with white and black students, white and black teachers, and white and black athletic coaches. It is arguable that in Virginia high school football is a way of life with each game celebrated more lavishly than the Christmas holiday and with each playoff distinguished more grandly than any national holiday (Howard, 2000). It should be noted that with such recognition, comes powerful emotions. In 1971 high school football was everything to the people of Alexandria. But when the local school board was forced to integrate an all black school with an all-white school, the very foundation of football’s great tradition was put to the test.

              After the school is integrated the board brings in Coach Boone (Denzel Washington) as the new head coach, replacing Coach Yoast (Will Patton), who is expected to become his assistant Coach. Yoast understandably does not want to be demoted in the name of affirmative action and Coach Boone does not like it, either mainly because he lost his own job in North Carolina and he does not fancy costing Coach Patton his job. However, Alexandria’s black residents gather on Boone’s lawn to cheer for the first black coach at the newly integrated high school and Boone realizes that he has a responsibility and so does Yoast (Yoast & Sullivan, 2005). His white players have pledged to boycott the team if he does not participate but he doesn’t want them to lose college scholarships, so he swallows his pride and agrees to be Boone’s assistant, leading the whites back to practice and takes up the position of defensive coordinator under Boone.

           Oscar winner Denzel Washington (Coach Boone) gives yet another one of his finest performances as the new head coach of the high school football team, and Will Patton (Coach Yoast) is equally good and together they try to get their players of both races to get along and put on a winning team as well as establishing harmony among the two races, the whites, and the blacks. This is evidenced by the fact that victories over racism and victories over opposing teams alternate quickly that sometimes the distinction between cheering for tolerance or touchdowns is unidentifiable. In addition to Washington and Patton, there are some other terrific performances by the young actors who portray the football players. As it is told in the film, the Titans did have what became known as the perfect season, whilst the bond formed between the black and white members most definitely existed (Howard, 2000). That said, the film soars high as an inspirational piece for the mixed race community coming together and existing harmoniously.

For Boone however, his career takes a dip soon after returning from football camp and he is told by a member of the school board that if he loses even a single game, he will be dismissed. Luckily, the Titans go through the season undefeated while battling racial prejudice, before slowly gaining support from the host community (Yoast & Sullivan, 2005). Discipline and mutual respect is of great importance as seen when Gerry has his best friend Ray removed from the team because of his racism following an incident where he intentionally missed a block which consequently led to an horrific injury of starting quarterback Jerry “Rev” Harris.

It is admirable the way the screenplay, by Gregory Allen Howard does not make Boone noble and Yoast a racist, but shows them both as ambitious and skilled professionals. There are times when Boone treats his players more like Marines than high school kids. This is evidenced by an office scene where Coach Yoast mentioned to Coach Boone, “You may be a little too hard on the boys.” This is after Coach Boone employs the use of forceful coaching tactics and rigorous athletic training which clearly Coach Yoast does not approve and he does not hesitate to protest. Coach Boone however is not moved by Yoast’s concerns about the boys as he is seen asking “Which boys are you talking about?” He actually believes that Coach Yoast is being overprotective of the blacks whom he has scolded harshly whenever Yoast tries to comfort them and Boone maintains that he would never cosset his fellow whites (Howard, 2000).

            Captain Bertier was initially inclined to the idea of having a black coach as well as having black teammates but as the film progresses he is forced to make amends and as a result of his new outlook of the team, he becomes more disciplined in his training strategies and attempts to enforce this same discipline towards his other teammates (Yoast & Sullivan, 2005). He even develops a close friendship with Julius, a Black player on the team and this is evidenced by a hospital scene where he stated to Julius “I was afraid of you”. This act proved that the prejudice attitudes he once held were completely erased.

It was Coach Boone speech that got Gerry Bertier to think about the bigger picture, involving the true meaning of teamwork to accomplish a goal, and as captain of the team, the responsibility he has to ensure that all his fellow teammates are respecting one another even if they don’t like each other. This would be the turning point as he would ensure that there is team spirit and hard work towards a common goal (Yoast & Sullivan, 2005). This is replicated by the team’s success at the championship and infact it got Coach Yoast stating that, “I know football, but what you did with those boys…you were the right man at the right time”. It is apparent that whether the Titans win or lose has nothing to do with the season they have played and what they were trying to prove but the fact that the crowd would cheer the closing touchdown as if it is a victory over racism.             

                    In conclusion, the film serves as a reminder of how much goodness there is inside people, just waiting for the right person to bring it out. It depicts the nature of racism within people’s lives very well and shows how common love for different things can pull people together so that simple and wrong beliefs are forgotten. Talent wins games, but teamwork and intelligence wins championships (Howard, 2000).




Howard, G. A. (2000). Remember the Titans: Based on a true story. Santa Monica, CA: Jerry      Bruckheimer Films.

Yoast, B. R., & Sullivan, S. D. (2005). Remember this Titan: The Bill Yoast story: lessons            learned from a celebrated coach’s journey. New York: Taylor Trade Publishing

sample-Use of SAT Scores and ACT Scores


Use of SAT Scores and ACT Scores

SAT and ACT are considered a rite of passage in the American education system. They are used to determine the readiness for college for a student thus making them a critical gateway to higher learning. While there are efforts to equalize learning and academic opportunity, these types of scopes have led to large gender and racial gaps. The SAT is used to measure academic inequality after completing secondary schooling. From the study conducted by Hoover and Supiano (2010), it was concluded that these types of scores increase racial gaps because students from racial minority groups end up not getting the aspired opportunities. This conclusion was based on the findings that while the mean score for math section for all assessed students was 511 out of 800, Blacks scored an average of 428, Latinos scored 457, Whites scored 534 and Asians scored 598. From these results, it is notable that both Whites and Asian scored above average thus having Blacks and Latinos clustered at the bottom of the distribution, Whites relatively normally distributed, and Asians clustered at the top.  

A similar study conducted by Klopfenstein and Thomas (2011) on Princeton University showed the same distribution of results with Asians scoring 140 points more than Whites, 270 higher than Hispanics, and 450 higher than Blacks. From the two studies, it is evident that Hispanics and Blacks are more likely to miss chances in university and college admissions. With these tests administered in schools, different universities (such as Harvard and Yale) have had lawsuits urging for investigation of the admission practices because of having Hispanic student population remain roughly at 13-16% for 20 years while than of Asians has doubled. Due to the harm of using standardized tests, Hoover (2012) reported that by 2010, over 830 4-year colleges did not use SAT or ACT. In addition, it was revealed that colleges that reported to attach considerable importance to standardized scores had increased from 46% in 1993 to 60% in 2006. From the findings, it is notable that the use of SAT scores and ACT scores solely to determine college acceptance hinders minorities acceptance rates because the standardized test typically hurt minority groups and as a result, colleges should look to do away with that requirement.   

Opposing Arguments

            While SAT and ACT scores are considered disadvantageous to minority populations (people of minority races, females, and those coming from poor socioeconomic backgrounds), Atkinson and Geiser (2009) note that they are fair and should be utilized in determining college applicants’ acceptance. As explained by Keller and Hoover (2011), while standardized tests are considered bias, this aspect has been removed by the test bias has been addressed by current admission tests that have extensive researched and developed question items. This means that the asked questions have been reviewed to cater for individual differences of the catered students. This way, it is ensured that only students who fit admissions for higher learning are enrolled. Klopfenstein and Thomas (2011) note that if SAT and ACT tests were dropped, most students who are academically fit for higher learning opportunities would be denied the chance and given to other less deserving students. It is also notable that since students are subjected to both types of tests, they are given a chance of performing better in one of them. Since the two tests do not test the same types of skills, the scores would be used to determine the types of students.

According to Alon and Tienda (2007), the major reason for reviewing standardized test scores during the acceptance review is to ensure the candidate is able to perform at the college level and succeed. This is based on evaluation studied predicting success in colleges since they highlight factors  most linked to college GPA and class rank at the end of the first year. It also helps in predicting the probability of graduating as well as the likely cumulative GPA at graduation. This is because the major purpose of SAT is to measure the potential of a student for academic success in the university while ACT is closely linked to mastery of high school curriculum. This way, the test scores serve as a benchmark that all incoming college students have been properly prepared (educated) to be successful. As explained by Hoover (2012), use of both ACT and SAT predicts how well students would perform in their initial college years indicating that they are a way to evaluate student preparedness that is fair for applicants. Keller and Hoover (2011) also note that they help in determining the type of students thus coming up with the best teaching approach to support his success.

Even though SAT and ACT tests are supported by many as the best approach of determining student’s preparedness for college education and predicting student success as well as probability of graduating, they have been noted by Atkinson and Geiser (2009) to be used to deny chances to deserving students leading to racial and gender gaps. From personal experience, I do not support either of the tests because if not used, students who could have performed very poorly in them would be enrolled in universities and succeed academically. I was denied acceptance into FSU because my math test score was to low even though I had a 4.0 GPA. While taking AP courses, hours of community service, was a varsity cheerleader. I applied to UWF and was granted provisional acceptance because of my math test scores all because I am not a strong standardized test taker. I also have a friend who was denied scholarship and thus the only chance she would advance her education because of her performance on these standardized tests. While she was the second best in her high school class of 310 students, with an exceptional high school grade, and with a goal of being the only one in the family to attend a university to study molecular engineering, these dreams were shattered when she scored 1000 in SAT out of 1600.  

In order to address the challenges posed by SAT and ACT scores, Hoover and Supiano (2010) propose a holistic approach that would test different skills for students.  Since different students are gifted differently and thus able to perform better in some subjects over others, it is advisable that a different testing approach is used. Using a holistic approach is supported by Alon and Tienda (2007) to help in testing different skills that are not only required in enrolling students to universities but also help in identifying the best course/ career each student should follow. A holistic approach would also include the GPA score in high school. The average GPA of each student is the best determinant of one’s academic performance since it tests different skills. While a student might be poor in math, for instance, he might be talented in critical thinking and this helps in catering for the low math score thus scoring an overall high score (McDermott, 2008).

The major benefit of using a holistic approach in student admission to colleges is enhancing diversity. This would help deal with the earlier noted issue in that Hispanics and Blacks are less likely to win college admissions if subjected to SAT and ACT tests. Even though they are good academically with a good GPA, the tested skills in SAT make them lose chances in advancing their education (Shanley, 2007). In addition, a holistic approach would help in increasing college chances for female students as well as those coming up poor socioeconomic backgrounds. This would ensure that dreams of those who perform well and score high GPAs would have a chance of advancing their dream careers. It is also notable that since SAT and ACT predicts the student’s performance in initial years in college, it does not necessarily mean that the student would perform better academically for the remaining years. As a result, using a holistic approach would help admit the best performers in colleges (Atkinson & Geiser, 2009).       


While SAT and ACT scores are highly supported since they are linked to a high probability of graduating and performing well academically in colleges, they have led to racial and gender bias. They are also disadvantageous to students from poor socioeconomic backgrounds. They have denied many deserving students with top GPA scores college admission and scholarship thus shattering the dream of many. Replacing them with a holistic approach would help in enhancing diversity in colleges. It would also ensure that students who are great academic performers but lack the skills tested in SAT and ACT get their chances in colleges.




Alon, S., & Tienda, M. (2007). Diversity, opportunity, and the shifting meritocracy in higher education. American Sociological Review, 72(4), 487-511.

Atkinson, R. C., & Geiser, S. (2009). Reflections on a century of college admission tests. Educational Researcher, 38(9), 665-676.

Hoover, E. (2012). What admissions officials think. The Chronicle of Higher Education, 54(34), 3-7.

Hoover, E., & Supiano, B. (2010). Wake Forest U. joins ranks of test-optional colleges. The Chronicle of Higher Education, 54(39), 21-36.

Keller, J., & Hoover, E. (2011). U. of California adopts sweeping changes in admissions policy. The Chronicle of Higher Education, 55(23), 33-37.

Klopfenstein, K., & Thomas, M. K. (2009). The link between advanced placement experience and early college success. Southern Economic Journal, 75(3), 873-891.

McDermott, A. B. (2008. Surviving without the SAT. Commentary, The Chronicle of Higher Education, 55(7), 41-44.

Shanley, B. J. (2007). Test-optional admission at a liberal arts college: A founding mission affirmed. Harvard Educational Review, 77(4), 429-435.



sample-Thesis: Cardiac Death Vs Brain Death

Thesis: Cardiac Death Vs Brain Death


Thesis statement

It can be argued that in cases of brain death, the body or organism remains alive, but the person, as distinct from the organism, has died due to irreversible unconsciousness. Some scholars argue that the terms alive and dead in this context are covertly normative, or moral terms, functioning similarly as person does in the abortion debates, and signal a moral evaluation of the permissibility of organ procurement (Flowers et al., 2000). On this view, to say that brain-dead patients are dead means that they lack moral status as members of the human community, and that removal of organs is permissible, though, again, the body remains biologically alive. This essay supports the argument that cardiac death rather than brain death should be the standard understanding to pronouncing an individual deceased and not declared dead prematurely.

Another type of view holds that whether such patients are alive or dead is in some sense a social choice, or a social construction, and that there are good social, legal and moral reasons to draw the, somewhat arbitrary, dividing line between life and death in such a way that brain dead patients are on the dead side of the line. However, each of the above views approaches the question of brain death from a largely non-biological perspective. However, the most influential views, at least in terms of law and policy, have treated death in biological terms. The President’s Council on Bioethics in 2008 reiterated this stance, “I reject the idea that death should be treated merely as a legal construct or as a matter of social agreement. Instead, I respect the biological reality of death” (Bacqué et al., 2018).

Exposition: background information and definitions

Cardiac death can be defined a condition in which the heart suddenly and unexpectedly stops beating. If this happens, blood stops flowing to the brain and other vital organs. Brain death, on the other hand, is defined as the irreversible loss of all functions of the brain, including the brainstem (Doig & Burgess, 2003). The three essential findings in brain death are coma, absence of brainstem reflexes. The established view regarding ‘brain death’ in medicine and medical ethics is that patients determined to be dead by neurological criteria are dead in terms of a biological conception of death, not a philosophical conception of personhood, a social construction or a legal fiction. Although such individuals show apparent signs of being alive, in reality they are (biologically) dead, though this reality is masked by the intervention of medical technology. In this article, we argue that an appeal to the distinction between appearance and reality fails in defending the view that the brain dead are actually dead. Specifically, this view relies on an inaccurate and overly simplistic account of the role of medical technology in the physiology of a ‘brain dead’ patient. We conclude by offering an explanation of why the conventional view on ‘brain death’, though mistaken, continues to be endorsed in light of its connection to organ transplantation and the dead donor rule.

Humanity has thoughtfully struggled with the concept and criteria for death for millennia and the line between life and death continues to be debated. The profound changes brought about by organ failure support, organ replacement technology and transplantation continue to challenge people’s notions of life and death (Flowers et al., 2000). While the discussions at this forum were about the determination of death, this focus was based on a desire to maintain a reverence for life and to further inform when life ends in view of the ongoing advances in biological insight and technology. Human death is defined based on measurable biomedical standards. Participants supported a movement away from anatomically-based terms such as brain death or cardiac death that erroneously imply the death of that organ. Emphasis was placed on the cessation of neurological or circulatory function and the predominance of brain function for determination of death.


Brain death generally is caused by blunt head trauma from accidents, falls, or crush injuries, thrombotic or hemorrhagic stroke, especially when the infarct causes brain herniation, or an anoxic injury that causes the death of brain cells that do not regenerate (Essien et al., 2017). Any injury that causes brain death injures the entire brain and its function. As with this case study, sometimes brain injury is seen in combination with cardiac arrest, which may be the underlying cause of brain death. Brain death is often confused with a coma or a persistent vegetative state, but they differ greatly. Patients in a coma or persistent vegetative state may have limited brain function, but some areas of the brain still remain intact. These patients often have intact reflexes, take spontaneous breaths, and may respond to stimuli even when higher cognitive functioning is absent. In brain death, there’s no function in the brain at all thus patients have no respiratory function, no spontaneous movements, and all reflexes are absent. Since the heart is not controlled by the brain, a patient receiving artificial ventilation may continue to have a heartbeat.

An EEG is almost always performed when there’s a suspicion of brain death. It’s used to monitor brain wave activity via electrodes on the scalp to detect electrical patterns in the brain. On the monitor screen, these patterns appear similar to chaotic ECG tracings. Brain wave patterns vary throughout the day and appear different when a person is asleep. However, in brain death, there will be no electrical activity and the wave pattern will appear flat. When an EEG is performed as a confirmation of death, the patient should be free from sedation and warmed to a normal body temperature. A negative EEG will have flat waves, showing no brain activity. When making a determination about brain death, two EEGs are conducted at least 12 hours apart. After being declared brain-dead by doctors, while a brain-dead person is not legally alive, the respiratory card, renal system gastrointestinal systems keeps on working with the help of technology (Essien et al., 2017). Without the help of technology the body dies immediately the support is withdrawn.

Cardiac death/body death/physical death is characterized by the heart’s intrinsic electrical system that can keep the organ beating for a short time after a person becomes brain-dead, this the body is still alive hence the individual is still alive. Cardiac, or circulatory death, is what most lay people think of when they think about the definition of death (Bacqué et al., 2018). It is typically seen when the heart has stopped beating or is beating too irregularly to sustain life. The heart’s main function is to pump blood through the lungs for oxygenation and then out to the rest of the body. When the heart stops contracting, tissues are deprived of oxygen and become ischemic. Cardiac arrest causes a generalized lack of perfusion to all organs, anaerobic metabolism, and global cellular death.

Signs and symptoms of acute cardiac arrest (cardiac death) include the absence of all peripheral pulses, cyanosis, and possibly apnea. Patients who are not apneic may present with shallow, irregular, gasping breathing known as agonal respirations. The rhythms that coincide with cardiac arrest are asystole, ventricular tachycardia, and ventricular fibrillation, which may be seen on the ECG (Nowak et al., 2014). However, a patient may appear to have normal electrical activity but have no pulses. This is called pulseless electrical activity and it may look like a sinus rhythm or sinus bradycardia on the monitor, but no peripheral pulses will be present. Although cardiac arrest may be reversed with the rapid initiation of CPR and ACLS, most instances are not reversible. If a perfusable rhythm is not restored quickly, the risk of permanent damage increases. The sooner circulation is restored, the better the patient outcome. After 3 to 5 minutes, brain cells start to die and this damage is irreversible. With a ventilator, some biological processes including kidney and gastric functions, can continue for about a week but without the brain, the body does not secrete important hormones that is needed to keep the biological processes alive/going.

Studies have proved that cardiac death should be declared the ultimate death. This is due to the fact that at first, there is the brain death, then organ failure follows as brain is not supporting vital functions to continue life (Doig & Burgess, 2003). Once cardiac death/organ failure occurs, all life has ceased, thus individual should be declared deceased/dead. Death has always been a difficult topic, but technology has caused people to redefine what it really means. Although most patients experience cardiac death, brain death is an important consideration. There have been several sensational cases that have continued to blur the lines, but life legally ends when the heart stops beating or there is no brain function. Recognizing both forms of death and their signs will help a doctor educate and guide families through an already difficult time. Family and doctors can keep someone on a machine to prevent cardiac death as long as the family accepts the situation because there is no specific time line. Humane timeline outlines the major events in the development of the human.

Objection 1

If appropriate, it is advisable that the hospital’s pastoral care or the patient’s own religious figure is involved to help the family process the patient’s death. Everyone deals with death and dying differently. Brain death cases usually require additional compassion and support. Although it may be difficult for the family to process, the doctor should not give the impression that the patient will improve. All team members must be clear about the patient’s death so that the family can grieve properly. Family members may not understand brain death. They will have questions about why their family member’s heart is still beating and why he or she is not being fed. It is due to this that the doctor need to be prepared to answer difficult questions with both fact and compassion. Until life support is withdrawn, it is important to continue to provide support and education when appropriate. There are also religious aspects that should be put into consideration. Although transplant services have become more common, there are still some religions that don’t endorse organ donation (Hassan et al., 2011). For instance, certain Jewish denominations are less likely to donate their organs post brain death.

Objection 2

Medical team caring for the patient are not often directly involved in the organ donation process, but in most states are encouraged to contact the organ bank if brain death is suspected. A medical coordinator will often review the patient’s chart to see if the patient is an appropriate candidate. Age, infection, and cancer are common reasons that a patient is not a donation candidate (Iserson, 1999). Another consideration in patients with suspected brain death, especially in a younger person, is the possibility of organ donation. Although bone and corneas can be harvested after cardiac death, most major organs need to be harvested while there is still circulation. Brain death allows for this unique opportunity, but causes added stress for the family members making the decision. Due to the delicate nature and legality of organ donation, there is usually a dedicated team that approaches the family about organ donation.


Although many people feel that an individual can only be declared dead when his brain stops functioning, the medical world terms cardiac death as the legal death. A GCS score of less than 6 should trigger a call to the local organ bank (Hassan et al., 2011). This should however be preceded by authorization from the family who would ascertain that they are comfortable with the idea of having their loved ones organs donated to the bank. In addition, as has been mentioned, pastoral care should be consulted for any patient with a risk of imminent death. All members of the healthcare team need to be supportive but not provide the family with false hope of recovery. They should advised on the reasons for withdrawing a life support among other issues. It has been outlined that the subject of organ donation should be addressed with the family by the organ donation team. Further, basic nursing care and practices that include turning the patient, bathing, oral care among others, should continue until life support is withdrawn.




Bacqué MC, ME Barone, A Yankowski, A Antik, L Trunzo, S Fioretti & P Penone (2018).”Neurocritical Patient Characteristics Related to Brain Death”. Transplantation Proceedings. 50 (2): 397-399.

Doig, C. J., & Burgess, E. (2003). Brain death: Resolving inconsistencies in the ethical declaration of death. Canadian Journal of Anesthesia, 50(7), 725-31.doi:

Essien EO, Fioretti, K Scalea, TM & Stein DM. (2017). “Physiologic Features of Brain Death”. The American Surgeon. 83 (8): 850-854.

Flowers Jr., W. Mel., Bharti R. P., W M Flowers Jr, & B R Patel. (2000) “Accuracy of Clinical Evaluation in the Determination of Brain Death.” Southern Medical Journal 93 (2): 203–6. (accessed November 26, 2018).

Zaki-Udin, H., Sloan, P., Lustbader, D. & Mosenthal, A. (2011) “Current Innovations in the Diagnosis and Management of Brain Death and Donation After Cardiac Death (426) (Advanced)”. Journal of Pain & Symptom Management. 41 (1). (accessed November 26, 2018).

Iserson, Kenneth V. Grave Words: Notifying Survivors about Sudden, Unexpected Deaths.           Tucson, AZ: Galen Press, 1999.

Machado, C., J. Korein, Y. Ferrer, L. Portela, M. de la C. Garcia, M. Chinchilla, Y. Machado, and J. M. Manero. (2007). The declaration of Sydney on human death. Journal of medical ethics 33, (12) (12): 699, (Accessed November 26, 2018).

Nowak E, R Pfitzner, P Koźlik, A Kozynacka, L Durajski, G Wasilewski, & P Przybyłowski. (2014). “Brain death versus irreversible cardiac arrest–the background and consequences of young people’s opinions on stating death in Polish transplantology”. Transplantation Proceedings. 46 (8): 2530-4. (Accessed November 26, 2018).

Pallis, Christopher. 1983. “THE DECLARATION OF DEATH“. British Medical Journal (Clinical Research Edition). 286 (6358). (Accessed November 26, 2018).

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Salladay, S. A. 2004. Defining death. Nursing 34, (8) (08): 10,  (Accessed November 26, 2018).

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sample-Suicide in Adolescence

Suicide in Adolescence


Suicide can be considered as a silent and sometimes unpredictable leading cause of death among teenagers. Suicidal ideation among adolescents can be attributed to psychological, family, physical, emotional, and social factors. The need to fit in and the lack of social support can trigger depression from hopelessness, which contributes to suicidal ideation and execution. Adolescents are the most endangered group regarding exposure to suicide ideation triggers; in this regard, more suicide deaths are reported among adolescents (Kennebeck et al., 2017). The paper will address suicide risk factors, signs or characteristics, gender differences concerning non-suicidal self-injury (NSSI), and attention seeking behavior. The role of parents in adolescence suicide, prevention programs, reasons why teenagers commit suicide, as well as, suicidal thoughts will be addressed. Anxiety, stress, and depression are the main psychological factors associated with suicidal ideation, attempts, and deaths.  

Suicide Risk Factors Among Adolescents

Suicide is a broad health issue because it can be triggered by factors associated with social media use, family dispute, economic stressors, academic stress, bullying, or traumatic experiences. Most teens are likely to fall into the suicide ideation trap because changes in behavior are often overlooked (Kennebeck et al., 2017). During adolescence, changes in personality can be confused with the natural growth process in which teenagers’ psychical and psychological attributes change. Adolescents tend to commit suicide in response to challenges in life; for instance, a teenager who constantly disagrees with his/her parents is likely to feel neglected, which can trigger suicidal thoughts. According to Silva et al. (2014), teens respond to stress within the family or school differently; this can be confusing for parents and educators. Teens that tend to mask their emotions are likely to commit suicide or develop suicidal thoughts because depression and anxiety affect cognition and decision-making ability. It is undeniable that adolescence comes with naivety; heavy social media use to fit in or due to addiction is a suicide risk factor.

Teenagers seek for approval on social media platforms by posting pictures and expecting positive comments by other users. In most cases, social media use results in suicide after one lacks the social support he/she was expecting. Although it is unwise to align emotions with people’s opinions, teenagers tend to fall for the trap, which triggers depression and suicide thoughts, attempts or deaths. Strandheim et al. (2014), assert that teens can commit suicide due to bullying associated with body weight, height, or racial and ethnic discrimination. Economic stressors in adolescence suicide affect the teenager’s access to the life they would prefer, which causes dissatisfaction (Strandheim et al., 2014). The lack of motivation due to poor school performance, coupled with family financial struggles results in stress and depression. Teenagers tend to live on peer-pressure, which involves buying trending clothes, shoes, smartphones, or even traveling. Comparing one’s life with that of others creates mental pressure, this can trigger suicidal thoughts and attempts (Silva et al., 2014). Teenagers can also commit suicide due to bullying associated with sexuality; adolescents belonging to the gay community are at a higher risk.

Generic Signs and Characteristics

Although teens respond differently to stressors and changes in life during adolescence, suicide signs are noticeable with proper intervention and behavior analysis. One of the signs associated with suicide is ideation. Parents and educators can predict the likelihood of a teenager attempting or committing suicide based on weird conversations about death, suicide, or dying (Kennebeck et al., 2017). In the modern technology era, teenagers can look for ways to kill or harm oneself from the Internet. Another sign of suicide among adolescents is substance use. Increased alcohol use and smoking are associated with stress and anxiety, especially from traumatic or inconveniencing experiences (Kwon et al., 2016). In this regard, parents and educators can predict the risk of teenagers committing suicide based on their indulgence in drug use and unhealthy lifestyle. It is worth noting that drug use exposes one to social stigma, which can be stressing. It also contributes to the lack of purpose in life, as one struggles from day to day with mental health issues.

Hopelessness is another sign associated with suicide among adolescents; individuals tend to feel like they are trapped in an endless bad situation. In so doing, they lack the motivation to live on a daily basis, which triggers suicidal thoughts. According to Kwon et al. (2016), being hopeless affects one’s decision-making ability, thus, rendering them cognitively unaware of the possible remedies to problems in life. Hopeless teenagers tend to withdraw from family, society, and friends. Failure to intervene in examining the cause of stress and depression can trigger violent and reckless acts, which increase the likelihood of committing suicide. Withdrawal from friends is disastrous considering that depression and stress can only be minimized by sharing, but not isolation. Being alone increases agitation, changes in sleep pattern, worry, and fear, which, in turn, affect mental health resulting in suicidal attempts and deaths (Kwon et al., 2016). Loneliness and hopelessness are closely linked to hostile behaviors. Violence against family members, friends, or siblings should be discouraged in efforts to minimize the aspect of suffering in adolescents’ lives. All signs and behavioral characteristics of suicide discussed are linked to one’s psychological well-being, which indicates that minimizing stressors can help prevent adolescence suicides.

Non-Suicidal Self-Injury (NSSI) Prevalence Based on Gender

In a study by Yang & Feldman on gender differences in the prevalence of NSSI, it was concluded that specific gender differences exist in NSSI incidence among Chinese adolescents. In the study, NSSI prevalence among middle school students showed that girls are likely to inflict self-injury than boys. For college-going youths, it was established that males had a higher NSSI prevalence than females (Yang & Feldman, 2018). The authors acknowledged that NSSI behavior patterns in China were different compared to Western countries. Gender role socialization and differences in hormones make women more susceptible to NSSI behavior. Young girls, especially in modern society are likely to experience low self-esteem and body dissatisfaction considering that beauty is defined differently. Compared to boys, teenage girls are likely to struggle with sexuality and sexual orientation, which can trigger hopelessness and self-hate (Young et al., 2014). Boys are less likely to engage in NSSI behaviors compared to girls, which can be attributed to challenges presented by gender differences. On this subject, adolescents who identify as LGBT are more likely to engage in NSSI behaviors because of discrimination, which causes stress and depression.

Misconceptions about NSSI and Attention Seeking Behavior

One of the common misconceptions about NSSI is that people who self-injure only belong to the psychiatric population. This is because individuals with poor emotion regulation, anxiety, and depression caused by socio-economic factors also practice NSSI behaviors. Another common misconception is that NSSI cases are only prevalent in women. Research shows nearly equivalent rates in NSSI prevalence among adolescents (Klonsky, Victor & Saffer, 2014). NSSI behaviors are mistaken for attention seeking; this can be harmful to the teenagers involved considering that suicide attempts and deaths are associated with mental health. The truth is that NSSI behaviors are preceded by intense negative emotions, which trigger illogical and harmful thoughts. It is illogical to only attribute all NSSI behaviors to psychiatric populations considering that self-punishment, emotion regulation, and interpersonal influence such behaviors.

Suicidal teenagers use attention-seeking behaviors to gain the attention of their friends and family. In this regard, individuals should be supported in varying ways to ease the pressure that comes with depression and anxiety from bullying, family struggles, or economic stressors. Adolescents that portray attention-seeking behavior should not be discriminated because doing so would risk their mental health and future communication (Klonsky, Victor & Saffer, 2014). The need to inform one’s family, friends, or colleagues indirectly stems from the psychological impact of stress. On this note, it is important to follow-up on behaviors associated with self-harm so that individuals experiencing suicidal thoughts can feel supported in the mental health journey. It is important to acknowledge that teen suicide is caused by various reasons, which are linked to mental health.

Roles Parents Play in Adolescence Suicide

Parents have a significant role to play in the mental health of their children, especially during adolescence. One the important roles parents can play in their teenage daughter or son’s mental health is evaluating behaviors to note changes that indicate anxiety and depression. Parents need to be supportive of their teenage children because social support is crucial during the phase of emotional, psychological, and physical body changes (Klein, 2016). Teenagers need constant approval and guidance to make healthy decisions that would limit anxiety and stress. Parents have the mandate to restrict teenagers from smoking and alcohol use. This is because one’s overall health is crucial to their mental health, which, in turn, relates to decision-making ability. Parents can help teenagers with suicidal thoughts and ideation by intervening to take them to therapy programs to encourage behavior change (Klein, 2016). Counseling programs use client-focused therapy approaches to set behavior change goals and engage the client in achieving them. Parents are discouraged against overlooking the seriousness of suicidal ideation incidences by their teenage children. Doing so risks continued indulgence in unhealthy behaviors such as smoking and alcohol use, which then triggers the execution of suicide plans as earlier insinuated.

On the other hand, parents play a role in triggering teens’ suicidal thoughts, ideation, and attempts. Conflicts within the family trigger stress among adolescents because they feel disengaged and neglected (Klein, 2016). Failure to communicate properly can create an awkward mood in which personal conversations are inconvenient or result in disagreements. Parents should help their teenage children in the growth and development process by downplaying the need to compare one’s life with others. Family financial struggles result in poor living standards and the lack of resources, which can trigger stress (Klein, 2016). Adolescents want to live based on trends and thus, lack of access to fancy clothes and technology devices can lead to depression and anxiety. The re-occurrence of suicidal thoughts among teenagers is common despite undergoing therapeutic counseling. Parents have the role to follow-up and communicate with teenagers to ensure suicide signs are addressed at the less serious level. Neglecting the parental role of leading by example can influence teenagers to act recklessly, which exposes them to mental health issues and suicide.

Suicidal Thoughts

Suicidal thoughts, also known as suicidal ideation, refers to the act of imagining, explaining, or enquiring to know more about killing oneself and self-harm. The only applicable way of controlling suicidal thoughts and attempts or deaths is by minimizing teenage exposure to stressors. It is worth noting that most teenagers have suicidal thoughts due to varying experiences in daily life; however, not all pursue them to illogical conclusions (Silva et al., 2014). The involvement of parents, peers, and educators can help in highlighting challenges in one’s life. Sharing personal problems is no common occurrence during the teenage years because individuals are only discovering more about life. In this regard, suicidal thoughts are common across the gender spectrum. The need to execute suicidal thoughts resulting in death is triggered by hopelessness and irrational decision-making ability (Silva et al., 2014). Suicidal thoughts should be discouraged to minimize chances of individuals planning or attempting suicide. Suicide notes and messages left by deceased teenagers show that ignorance by parents, close relatives, or even therapists play a crucial role in the conclusion of suicide thoughts.

Suicide Prevention and Awareness Programs for Adolescents

Suicide cases among adolescents can be prevented by creating awareness on behaviors and risk factors that lead to hopelessness and careless character. Prevention programs can be grouped into violence prevention, generic social and cognitive skills building, multi-component, multi-domain, and programs designed to change school ecology. Violence prevention programs create awareness of behaviors that can expose on to stressors to the extent of choosing to cause self-harm or hurting others (Greenberg, Domitrovich & Bumbarger, 1999). Teachers and behavior therapists can engage teenagers in devising ways to approach issues without resolving to violence. Impulse control, anger management, and empathy are essential aspects that should be taught in violence prevention programs. It is important to note that minimizing conflicts influences mental health by reducing stress, which improves one’s cognitive decision-making ability. Teaching teenagers how to respond through positive ways can result in the development of empathy and respect for others (Greenberg, Domitrovich & Bumbarger, 1999). This influences self-respect and love, which, in turn, prevents self-harm and execution of suicidal thoughts.

Programs such as the Social Decision-Making and Social Problem Solving (SDS-SPS) help student to balance social, educational emotional, and behavior aspects for better mental health and less stress. Students enrolled in the program can benefit from sharing personal issues, understanding normal body changes, and more knowledge on how the society works. Bullying based on individual differences in appearance, opinions/views/ or gender can be solved by engaging in SDM-SPS (Greenberg, Domitrovich & Bumbarger, 1999). Adolescence suicide thoughts, deaths, and injuries can also be prevented through awareness creation on drug use. Teenagers tend to resolve to drug use in efforts to comprehend changes in life and make peer friends. Drugs cause inconsistencies in behavior and communication, which affect interpersonal relations.


Suicide cases are common among adolescents; research indicates that the planning and conclusion of suicidal thoughts are linked to mental health. Undeniably, teenagers are likely to make naïve decisions, which expose them to unhealthy levels of stress and anxiety. The uncertainty that comes with personal growth and development, as well as, social pressure and expectations triggers stress among teens. Other predisposing factors include conflicts within the family, poor performance in school, bullying in social situations, and low self-esteem. Equipping children and youths with effective communication and interpersonal skills can prevent suicide deaths and injuries.




Greenberg, M. T., Domitrovich, C., & Bumbarger, B. (1999). Preventing mental disorders in school-age children: A review of the effectiveness of prevention programs. Prevention Research Center for the Promotion of Human Development, College of Health and Human Development, Pennsylvania State University.

Kennebeck, S., Bonin, L., Brent, D., Blake, D., & Solomon, D. (2017). Suicidal ideation and behavior in children and adolescents: evaluation and management.

Klein, K. T. (2016). The Effects of an Uncompleted Suicide Attempt: A Parent’s Perspective.

Klonsky, E. D., Victor, S. E., & Saffer, B. Y. (2014). Non-suicidal self-injury: What we know, and what we need to know. Can J Psychiatry, 59(11): 565–568. DOI: [10.1177/070674371405901101]

Kwon, A., Song, J., Yook, K. H., Jon, D. I., Jung, M. H., Hong, N., & Hong, H. J. (2016). Predictors of suicide attempts in clinically depressed Korean adolescents. Clinical Psychopharmacology and Neuroscience14(4), 383.

Silva, R. J. D. S., Santos, F. A. L. D., Soares, N. M. M., & Pardono, E. (2014). Suicidal ideation and associated factors among adolescents in Northeastern Brazil. The Scientific World Journal2014.

Strandheim, A., Bjerkeset, O., Gunnell, D., Bjørnelv, S., Holmen, T. L., & Bentzen, N. (2014). Risk factors for suicidal thoughts in adolescence-a prospective cohort study: the Young-HUNT study. BMJ Open4(8), e005867.

Yang, X., & Feldman, M. W. (2018). A reversed gender pattern? A meta-analysis of gender differences in the prevalence of non-suicidal self-injurious behavior among Chinese adolescents. BMC Public Health18(1), 66.

Young, R., Sproeber, N., Groschwitz, R. C., Preiss, M., & Plener, P. L. (2014). Why alternative teenagers self-harm: exploring the link between non-suicidal self-injury, attempted suicide and adolescent identity. BMC Psychiatry14(1), 137.

Sample-Kristen Swanson’s Theory of Caring

Kristen Swanson’s Theory of Caring


Kristen Swanson’s theory of caring aims at determining the effectiveness of a nurse’s caring relationship on the blood pressure and the quality of life of patients with hypertension. It states that caring revolves around five categories which when applied to nursing practice fuel the caregiver’s attitude and improve overall patient’s well-being (Cara, 2003). Nurses caring relationships with hypertensive patients can have a positive effect upon their blood pressure and may increase the quality of life and prolongation of life. Hypertension affects a large number of people. It is important that that affected receive, in addition to the best available medical treatment, nursing care that best meets their needs and adds to the quality of their lives. Watson’s Caring Model is one nursing approach consistent with the needs of persons with hypertension and was used in this study to guide both research and practice.

Jean Watson was Kristen Swanson’s dissertation chair and mentor and as a result, Watson’s Theory of Transpersonal Care had an impact on Swanson and the development of her Theory of Caring. Jean Watson’s Theory of Transpersonal Caring was developed in 1979 and has been revised over the years although, the basic concepts remain the same. The theory combines scientific knowledge with the elements of human caring and presence (Erci et al., 2003). It was designed to bring meaning and focus to nursing as a distinct health profession. Interactions or caring moments result when the nurse and patient make contact, the nurse enters the patient’s room, and when a feeling of expectation is created. These moments transform both the patient and nurse and link them together in a patient-centered relationship.

Nurses caring relationships with hypertensive patients can have a positive effect upon their blood pressure and may increase the quality of life and prolongation of life. Hypertension affects a large number of people. It is important that that affected receive, in addition to the best available medical treatment, nursing care that best meets their needs and adds to the quality of their lives (Cara, 2003). Watson’s Caring Model is one nursing approach consistent with the needs of persons with hypertension and was used in this study to guide both research and practice.




Cara, C. (2003). A pragmatic view of Jean Watson’s caring theory. International Journal for       Human Caring, 7(3), 51-61.

Erci, B., Sayan, A., Tortumluoǧlu, G., Kiliç, D., Şahin, O., & Güngörmüş, Z. (2003). The                         effectiveness of Watson’s Caring Model on the quality of life and blood pressure of           patients with hypertension. Journal of Advanced Nursing, 41(2), 130-139. 41. 130 – 139.            10.1046/j.1365-2648.2003.02515.x.