CJL 305 Research Methods

Assignment 1: Topic and literature review

This will be the first of three papers that you construct for this class. The assignment is a 3-5-page paper written over a topic that you will pursue for the rest of the semester in subsequent assignments. This topic is your choice, but something related to criminal justice, criminology, and/or deviance. Follow these steps to complete your assignment.

1 Choose a topic that you are interested in and of which has a sufficient amount of  has academic research published on it. Avoid current event issues (ongoing trials, murder sprees, etc.) as these may not have sufficient amounts of research on the subjects published in peer-reviewed journals.

2 Go to the RU library’s website and use the following three search engines to find your articles: Criminal Justice Abstracts, Sociological Abstracts, or Proquest. Write down your keywords for your search that results in the most articles. Download at least 10 of those articles.

3 Build a reference page using APA citation style (a .pdf of APA lite is in your course documents). As you read through your articles, write a brief summary/annotation (what, who, how, and why of each article) after each reference in the bibliography. This is called an annotated bibliography. It will inform the remainder of your assignments for the rest of the semester concerning your chosen topic.

4 Construct (assignment 1) 3-5 pages about your topic. In short, this is the what, who, why, and how of your topic. This first paper explores what the topic is, who has researched the topic, how they went about researching the topic and why it is an important topic to criminal justice. This is called a literature review.

Complete steps one through three, first. Use the annotated bibliography to then write a literature review step four, last. 

Papers should be 12-point font, double-spaced, with one inch margins. Literature reviews should be structured like essays, complete with an introduction, a body, and a conclusion. Put together a title page with a working title—this will change and evolve but offers an opportunity be creative. Every paper needs a reference section to cite who and where you found your information. 

There is an old proverb that says, “if you are going to eat an elephant, you have to do it one bite at a time.” This is certainly true for research. Take your time, pick a topic that you are passionate about, then sit down and spend the time. We will work through it. Eat that elephant.

      

Abstract 

Background: Hypertension is the most common non-communicable   disease and the leading cause of cardiovascular disease in the world. Current   management of hypertension stressed the importance of salt and diet   modifications. Unfortunately, many hypertensive patients do not have proper   knowledge of this, which results to inadequate practice. Therefore, there is   need to develop strategies that will help to improve knowledge and practice   of salt and diet modifications among hypertensive. 

Objective: To determine the effect of nursing intervention on knowledge and   practice of salt and diet modifications among hypertensive patients.  

Materials and Methods: A quasi experimental design was   conducted using purposive sampling to select the sample size of 38   participants. A researcher-developed questionnaire derived from the   literature review and Hypertension Self-Care Activity Level Effects (H-SCALE)   adapted from Warren-Find low and Seymour (2011) was used to measure knowledge   and practice of salt and diet modification among the participants. Data   gathered from participants were expressed using tables and percentages while   research questions were answered with descriptive statistics of mean and   standard deviation through statistical package for the social science   software version 21. 

Results: the study revealed that   higher percentage of the participants (81.6%) had poor of knowledge of salt   and diet modification pre-intervention, also 92.1% of the participants   reported poor practice before intervention. Intervention was given to the   participants and results showed a positive change in knowledge and practice   of salt and diet practice post-intervention. 

Conclusion: regular training should   be given to hypertensive patients by nurses to improve their knowledge and   practice of salt and diet modification for effective blood pressure control. 

Keywords: Hypertension, Knowledge,   Practice, Salt and Diet modification, Nigeria 

 

  

Introduction 

The burden of hypertension and other noncommunicable diseases is rapidly increasing and this poses a serious threat to the economic development of many nations. Hypertension is a global public health challenge due to its high prevalence and the associated risk of stroke and cardiovascular diseases in adults. 

Globally, hypertension is implicated to be responsible for 7.1 million deaths and about 12.8% of the total annual deaths (World Health 

Organization (WHO), 2018). Africa, among other WHO regions was rated highest with increased prevalence of high blood pressure, estimated at 46% from age 25 years and above in which Nigeria contributes significantly to this increase (Okwuonu, Emmanuel, & Ojimadu 2014; Ekwunife, Udeogaranya, & Nwatu, 2018; WHO, 2018). This is so in spite of the availability to safe and potent drugs for hypertension and existence of clear treatment guidelines, hypertension is still grossly not controlled in a large proportion of patients worldwide. 

Current national recommendations for the prevention and treatment of high blood pressure emphasized non-pharmacological therapy, also termed “lifestyle modification” which includes salt and diet modification. However, there is a dearth of information on the knowledge and practice of salt and diet modification among hypertensive patients attending Nigeria’s health institutions (Abubakar et. al, 2017). Hence, poor knowledge of salt and diet modifications, and inability to practice these were one of the identified patient- related barriers to hypertension control (Tesema et.al, 2016). This gap may also be attributed to the type of information or training programmes given to patients on salt and diet modification. 

Therefore, this study might help to improve the knowledge of hypertensive patients on salt and diet modification which in turn may affect its practice thus reducing the death burden, complications and economic cost of poorly controlled hypertension among patients and in the society. 

Objective 

The aim of the study was to determine the effect of nursing intervention on knowledge and practice of lifestyle modification among hypertensive patients. The following research questions were expected to be answered: 

1. What is the pre-intervention knowledge and practice of salt and diet modification among hypertensive patients? 

2. What is the post-intervention knowledge and practice of salt and diet modification among hypertensive patients? 

Methods 

It is a quasi-experimental study, which adopted one pre-test-post-test design, conducted between February and September 2019, at a secondary health facility (General Hospital), South-west, Nigeria. The study was carried out among hypertensive patients attending medical outpatients department (MOPD) in the general hospital. The hospital was purposively selected being the only secondary health facility located in one of the densely populated communities in a major commercial city of South-west, Nigeria. 

Sample size and sampling procedure: Sample size was calculated using Taro Yamane method of sample size determination, n = calculated sample size, Population size (N) = 42 based on daily clinic attendance of hypertensive patients, and margin of error = 0.05 with a confidence level of 95% given a sample size of 38 participants. Inclusion criteria were male and female patients who were ≥18 years of age, diagnosed to be hypertensive and attending medical out-patients department (MOPD), available and willing to participate in the study, who could communicate either in English or Pidgin English. Exclusion criteria were other patients at MOPD who were not diagnosed to be hypertensive, or with any co-morbidity that could interfere with participation in the training, and have attended previous educational programme on salt and diet modification. Participants were selected based on the inclusion criteria using purposive sampling. 

Data collection tools and procedures: Data were gathered using researcher-developed questionnaire derived from the literature review with the opinions of experts in the field to assess participants’ knowledge of salt and diet practice and modified Hypertension Self-Care Activity Level Effects (H-SCALE) developed by WarrenFindlow and Seymour (2011) to assess practice of salt and diet modification among the participants.The questionnaire consists of three parts. The first part includes the demographic characteristics of the participants with eight (8) items; the second part assessed the participants’ knowledge of salt and diet modification. The knowledge of salt and diet modification questions includes twelve (12) items with maximum and minimum scores of 12 and 0 respectively. Participants’ knowledge scores of 9-12 points indicate high knowledge, 6-8 points indicate moderate knowledge and scores <6 points indicate poor knowledge. The third part assessed the practice of salt and diet modification among the participants with seven items which were used to assess practices related to eating a healthy diet, avoiding salt while cooking and eating, and avoiding foods high in salt content. Responses were coded ranged from never (1) to always (3). Responses were summed up creating a range of scores from three (3) to twenty one (21). Scores of eleven (11) and above indicates that participants followed the low-salt diet and was considered as having good low salt diet practice while score <11 indicate poor salt diet practice. The psychometric properties of the instrument was checked by experts in the field using face and content validity criteria, the reliability of the instrument was determined using split-half method and the Cronbach’s alpha reliability coefficient on knowledge of salt and diet modification was 0.78, while salt and diet practice was 0.72 which showed high reliability of the instrument. The method of data collection involved three phases: 

Phase 1: this involved meeting with the consultant and nurses in charge of MOPD of the General Hospital to explain the purpose of the study and its benefits, and to seek their cooperation for the success of the study. This took place during the first week of the study. In the second week of the study, the researcher with two research assistants visited the MOPD to listen to health talk given to the patients by the nurses and other health personnel, gaps were identified which was used to modify the training modules. The participants were met to discuss the purpose, course and potential benefits of the study. Interested participants were enrolled for the study after obtaining their consent. Further selection of the participants continued in the third and fourth week. A pre-test instrument (questionnaire) was given to the selected participants to complete during the selection. No external interference was allowed during data collection, researcher and research assistants stayed with the participants throughout the period of completing the questionnaire after which they were thoroughly checked for completeness before retrieval from the participants.The results from this phase were also used to modify the training module for better intervention. Reminder for the training programme was given through phone calls, text messages and visits on the clinic- days prior to the training. 

Phase 2: A developed intervention package was implemented based on feedback obtained from pre-intervention knowledge and practice score with learning modules which was used for the educational training of hypertensive patients on salt and diet modification. The intervention package had two modules of learning which was delivered for two hours weekly for two weeks. Different instructional methods were utilized to deliver the programme including lectures, group discussion, questions and answers, chats/pictures and educational hand out. Follow-up through phone calls and text messages was done every week after intervention to ensure adequate practice before the post-intervention test. 

Phase 3: A post-test was given one month postintervention with the same instruments used during the pre-test. Data collected were coded and processed using statistical package for social science (SPSS), version 21. Frequency table was constructed and data were expressed on it. The research questions were answered using descriptive statistics of mean and standard deviation. 

Ethical Consideration: The ethics committee of the researcher’s institution approved the study with approval reference BUHREC102/19 dated 27th February, 2019 and written permission of the State Health Service Commission was also obtained to conduct the study. Participants were informed about the purpose of the study and their consents both verbal and written were taken before the study commences. Participation was voluntary and participants have the right to withdraw at any stage of the study. 

Results 

The socio-demographic data reveals that greater number of the participants was females (68.4%) possibly, because females tend to pay more attention to their health and engaged more in physical and emotion stress than their male counterparts. Majority, (44.7%) participants were between the ages of 46 to 60 years, also many of the participants (28.9%) have primary education and 42.1% were self-employed. This could also be related to the fact that the study was carried out in one of the largest commercial city in South-west Nigeria and research facility was located in one of the densely populated communities in the state which often require constant subsidized health care services (Table 2) 

Connection to Disciplines: Students will be able to identify and evaluate insights from multiple disciplines.

Insert  your Draft Interdisciplinary Research Paper from PRST 4995 that  demonstrates your achievement of this learning outcome, and answer the  reflection prompts below for the Interdisciplinary Research Paper (see  pages 332-330 in your textbook).

• How has researching and writing about this topic from an  interdisciplinary perspective challenged your bias and initial  understanding of the problem?
• How has an interdisciplinary approach enlarged your understanding of  the problem as a whole? What did you learn that surprised you?
• How is an interdisciplinary approach applicable beyond the classroom?

You may insert your Research Proposal and Literature Review from PRST  4995 OR another example of your work that demonstrates your achievement  of this learning outcome, and answer the reflection prompts below for  the work you insert.

• Description: In this space write a reflection that includes a brief  overview of the assignment.  How does this artifact relate to the  learning outcome that students will be able to locate, evaluate, and  synthesize sources?
• Transfer: Discuss what specific skills, knowledge, or abilities were  gained or necessary for the completion of this work. How might having  this skill, knowledge, or ability affect you or be useful to you in your  personal or professional life?
• Integration: How does this experience relate to other experiences  you have had in other classes in your major? In other classes in  general? To other experiences you have had outside the classroom?
• Importance: Why is what you learned or demonstrated in this  assignment important to you? How does this learning contribute to your  educational and career goals?

POST 1

Jacqueline

The impact of working night shifts on nurses’ daily lives

should be understood and considered by healthcare systems. As we know, working the night shift has always been accepted as a part of working in the healthcare profession; twenty-four-hour- 7 days a week coverage is required. However, very few studies focus on the impact of night shift work on the daily life and overall health of nurses working it. 

Research Question: What are the impacts on life outside of work and the

the overall health of nurses who work night shifts in health care?

Methodology:

            Multiple methodologies can be used in this study.

However, the phenomenology method is the best fit in this researcher’s opinion. 

Researchers suggest that “a qualitative exploratory design allows the researcher to explore a topic with limited coverage within the literature and allows the participants of the study to contribute to the development of new knowledge in that area (Reid-Searl & Happell, 2012)

Sampling

The stratified purposive sampling is appropriate for this study. This study allows the researcher to ensure that participants have various work backgrounds, ages, ethnicities, and marital statuses, which will increase the sample representativeness (Gray et al., 2017,

p.345). Furthermore, Stebbins (2001) suggested that the sampling method is used to maximize the representativeness of a population and recognized that this might be achieved through purposeful or snowball procedures.

Data Collection

  This study will include either a questionnaire survey or semi-structured interviews recorded and transcribed to collect data concerning the experienced effects of shift work on life outside work and night shift work on their health by each participant.  

Challenges

           Challenges are common in most research studies; however, I would not anticipate many challenges. Although usually a severe concern to most studies, funding should not be a significant issue because of the type of study. However, participant representation can become an issue; it is essential to represent the participants honestly and transparently. Lastly, there may be some challenges with participant transparency and with translating data into useful information.

           Ethical practices are a priority for any good researcher in having a valid study. Some concerns to address will be to ensure that participants had the freedom to speak candidly and that their voices are heard. Additionally, ensuring that the participants’ perceptions are accurately represented. Moreover, the researcher should reflect on any bias to ensure an ethical study.  

STRENGTH AND WEAKNESSES

OF PHENOMENOLOGY METHODOLOGY

           There are several strengths of phenomenological research. Firstly, the phenomenology method provides a vibrant and detailed description of the human experience. It allows for a unique approach to understanding the phenomena. 

            As great as this method is, there are also some

weaknesses. It is challenging to present the findings from this research type; the results can prove to be highly qualitative, which makes it hard to present in a way that would be useful.

Alternative Methods

            Although the phenomenology method is used here, this

author believes that the narrative approach would be just as practical.

Narrative inquiry is a form of qualitative research in which the stories

themselves become the raw data. This

approach has been used in many disciplines to learn more about the narrator’s culture, historical experiences, identity, and lifestyle (Lieblich et al.,1998).

In conclusion, there are many components to consider when conducting a research study; being well informed and prepared will allow researchers to continue implementing evidence-based practice and improving healthcare outcomes. 

Reference:

Gray, J., Grove, S.K., & Sutherland S.(2017). The Practice of Nursing Research: Appraisal, Synthesis, 

and Generation of Excellence. St. Louis, MO: Elsevier.

Lieblich, A., Tuval-Mashiach, R., & Zilber, T. (1998). Narrative research: Reading analysis and interpretation. Thousand Oaks, CA: Sage.

Searl, R., & Happell, B. (2012). Supervising nursing students administering medication: a perspective from registered nurses. Journal of Clinical Nursing 21(13), pp. 1998-2005.

Stebbins, R.A. (2001). Exploratory research in the social sciences. London: Sage Publications

POST 2 

Jackson

Emerging from depression: The experiential process of Healing Touch explored through grounded theory and case study

Do individuals perceive less depression or anxiety after receiving Healing Touch? Do persons experience an increase in spiritual development after receiving Healing Touch?   These are a few of the qualitative research questions that could be presented as a qualitative research question to aid in identifying the objectives of this study. When attempting to obtain a subjective response than using a grounded theory approach, might be suitable.

In using a constructivist grounded theory approach (Charmaz, 2017)   I would focus on providing participants subjective experiences with suggestive or tentative conclusions (Creswell & Poth, 2018). This pragmatic perspective might be difficult to execute because of the ethical issues related to this vulnerable population; however, it is possible. Once approval has been attained from the institution responsible for endorsing the study, I would then seek to confirm each participant’s awareness of this study is completely voluntary and that they may recuse themselves at any time. Participants are then informed of the objective of the study, the risks, and the benefits of their participation. Ample time would be provided for participants to ask questions and ponder their decision before providing written informed consent. I would then remind them that the data obtained were kept securely stored and descriptors are used throughout the paper to maintain the anonymity of the participants.

If the grounded theory approach presents as cumbersome then the phenomenology theory might be a viable option (. Phenomenology is nearly purely subjective data-driven to obtain the participants’ perception interactions from their experience within the study’s environment.  The strength of this approach through phenomenological research can be robust in identifying the presence of factors, however, one must be cautious in suggesting the relevance to the population from which the participants or cases were drawn. In such a case, it is possible to have research that demonstrates quantitative significance but fails to demonstrate statistical significance.  Bracketing is difficult to fully extrapolate from any research project, even more so in such a subjective-based method as phenomenology.

References

Charmaz, K. (2017). The power of constructivist grounded theory for critical inquiry. Qualitative Inquiry, 23 (1), 34-45. Doi: 10.1177/1077800416657105

Creswell, J., &Creswell, J. (2018). Qualitative inquiry & research design: Choosing among five approaches (4th ed.). Thousand Oaks, CA: Sage.

Gray, J.R., Grove, S.K., & Sutherland, S. (2017). Burns and Grove’s the Practice of Nursing       Research: Appraisal, Synthe

POST 3

Lolade

The selected personal health record for appraisal is followmyhealth.com. Followmyhealth is a personal health records platform that allows patients and healthcare providers to interact on health-related issues. Patients develop a profile that they use to link with their healthcare providers. The platform allows for the digital delivery of healthcare services through methods such as e-health and telehealth. Patients can also perform other roles such as managing prescriptions and confirming appointments (Roehrs et al., 2017). Therefore, the personal health records profile is highly effective in managing care.

 Personal health records have improved health care delivery and clinical practice. The technology has improved the efficiency in the delivery of health care services. The technology has also strengthened continuity in care alongside patient-centeredness. The increased utilization of the personal health records have led to enhanced operations management alongside patient and provider interaction (Dameff et al., 2019). Personal health records should be mandated for use in health. Personal health records improve the cost-efficiency, patient-centeredness, satisfaction, and continuity of care. Personal health records also facilitate the use of healthcare technologies to achieve goals of Meaningful Use. It ensures the delivery of value-based care to patient populations. The features that might motivate individuals to use the personal health records include ease of use, interconnectedness to other healthcare providers, continuity in case, easy accessibility, and elimination of barriers to care. Issues such as the lack of trust on the safety of patient data with the use of the personalized health records may however deter individuals from using this service (Roehrs et al., 2017). Therefore, I have concerns related to the mechanisms and laws that regulate the protection of the patient data in the use of the system. Despite the concerns, PHRs will influence my professional practice by reducing the cost of care, promoting continuity in care, patient satisfaction and empowerment of patients to take responsibility for their health. 

References

Dameff, C., Clay, B., & Longhurst, C. A. (2019). Personal Health Records: More Promising in the Smartphone Era? JAMA, 321(4), 339–340. https://doi.org/10.1001/jama.2018.20434

Roehrs, A., Costa, C. A. da, Righi, R. da R., & Oliveira, K. S. F. de. (2017). Personal Health Records: A Systematic Literature Review. Journal of Medical Internet Research, 19(1), e13. https://doi.org/10.2196/jmir.5876

POST 4

Victoria

Personal Health Records

Personal health records (PHRs) are software applications that patients can use to communicate with their clinician, to enter their own health data, and to access information from their medical record and other sources. PHR  is an aggregation of a patient’s health information over the course of the patient’s life. The contents of a patients PHR varies and includes personal information, insurance information, physician’s information, prescribed medications, and history of payments, insurance claims and health expenses. Software’s that are used to gather data for PHR can also use that information to provide a customized information about the diagnosis, medications and preventive treatments. PHRs benefit more if they are integrated with an electronic health record (EHR). PHR is an important tool for patient-centered care (Reti et al., 2010). PHR are controlled by their patient, information contained in the PHR  are not available to the physician unless the patient makes it available  to the doctor by giving them access to the information. An integrated health record combines the EHR and the PHR and It originates from the health care provider so that clinicians and patients both have access but the information provided by the clinician is view-only by the patient and may not be changed or edited except to enter information from other care providers. PHRs can potentially maximize access and coordination of health information and improve patient/clinician collaboration, patient self-management, and health outcomes (Wagner et al., 2010).

Appraisal of Selected Personal Health Patient Portal

 Follow My Health is a free, secure, online medical records patient portal that helps patients manage their personal health care on a computer, tablet, or smartphone. Patients with access to Follow My Health have direct access to request appointments, communicate with their physician, view lab results, and manage their demographic information anytime. The portal is organized into three sections, the first section is for patients, where they can connect with their doctor. The second is the engagement platform and the last is the employee wellness (Follow my health FMH,2020).

The Influence of PHRs on Health Care Delivery and Clinical Practice.

PHRs can help make patients aware of their health conditions, which could initiate changes in their healthcare plan. Tethered PHRs are connected with EHRs, which means that patients can see data that providers have placed into the PHR. Utilization of PHRs can be beneficial because it allows for the correction of errors in medical records and gives patients access to the information to share with other providers (Lester et al., 2016).

                                                             My Stance on PHRs                                                             

Even if the debate on PHRs are over, I think PHR should stay because it has a lot of potential benefits, one of the most important is the patient access to a wide array of credible health information, data, and knowledge. Patients can leverage that access to improve their health and manage their diseases.

Capabilities and Features that Might Motivate Individuals to Maintain PHRs

The features of PHR that might motivate patients to maintain a PHR are that PHRs captures a patient’s health information so that they are all available in one place, with all the health data in one place, patients can easily identify inconsistencies, track and update their health data, and it decreases the time spent with physicians (Lester et al., 2016).

Factors That May Deter Individuals from Signing Up For PHR

Some factors that may deter patients from signing up for PHR are that the data management can be overwhelming and time consuming.

Lack of awareness because many people are not aware that they have access to their PHR.

Privacy and security concerns of the system being hacked, and their health information compromised.

Lack of interoperability as most physicians are not able to transfer information generated in their system to another provider system and when te patient moves to another system they will be required to start all over to enter detailed information about their diagnoses and treatment all over again which patients found to be time consuming (Ball et al., 2011).

Concerns About a PHR’s Capability to Securely Maintain Personal Information?

From my point of view, there is actually less concerns about the capability of a PHR maintaining personal information as most PHRs provide patients with the capability to control who can access the health information. 

Influence of PHR On My Professional Practice and On Patients’ Health Outcomes. Positively 

The integrated PHR and EHR is the best solution since it allows for the flow of information between the patient and the clinician. The patient can check on the accuracy of the information in the medical record and use it to become better informed about his or her own health. By viewing the patient-entered information, the clinician obtains a more complete record, which can enable better care (Reti et al., 2010).

References

Ball, M. J., Douglas, J. V., Hinton Walker, P., DuLong, D., Gugerty, B., Hannah, K. J., . . . Troseth, M. R. (Eds.) (2011). Nursing informatics: Where technology and caring meet (4th ed.). London, England: Springer-Verlag.

Follow My Health. (2020). Patient engagement platform. https://about.followmyhealth.com/

Lester, M., Boateng, S., Studeny, J., & Coustasse, A. (2016). Personal Health Records: Beneficial or Burdensome for Patients and Healthcare Providers?. Perspectives in health information management, 13(Spring), 1h.

Reti, S. R., Feldman, H. J., Ross, S. E., & Safran, C. (2010). Improving personal health records for patient-centered care. Journal of the American Medical Informatics Association, 17(2), 192–195. https://doi-org.ezp.waldenulibrary.org/10.1136/jamia.2009.000927

Wagner, P. J., Howard, S. M., Bentley, D. R., Seol, Y. H., & Sodomka, P. (2010). Incorporating patient perspectives into the personal health record: implications for care and caring. Perspectives in health information management, 7(Fall), 1e. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2966356//

 

• Think of a problem from your degree major that interests you. You will use this problem throughout the entire course, so choose carefully. There is an Application Index starting on page XIX of the textbook that might prove to be helpful. You might also look at the datasets in Statdisk for ideas, but don’t use any of them.
• Create a scenario for your problem and gather or make up data to include one qualitative and two quantitative variables relating to your scenario and 15 data values. Be sure to include the units of measurement for the variables. 
• Review the rubric that will be used for grading, linked in the Submission and Grading area below.

Example: I am a nurse interested in the relationship between gender, weight, and systolic blood pressure. My data is as follows: (click to expand/reduce)

With these thoughts in mind:

By Day 1

By the end of Day 1, you can post your scenario and data for your Instructor to review.  If you do not submit this by the end of Day 1, you will need to proceed to submit the entire Discussion on Day 3.

 

Post a 2- to 3-paragraph response that includes the following information:

• Describe your scenario and the variables that you are using. 
• Post your dataset in your Discussion.
• Fill in the following table for your variables and explain why you made the choices you did. 

VariableQualitative/QuantitativeContinuous/DiscreteLevel of Measurement            

• After you have completed the scenario with the dataset and table with the information on your variables, discuss any problems you have had this week in learning the terminology and vocabulary. Also, include what you did to overcome this problem.