Free Essay

Health Patterns: the Taylor Family

In: Science

Submitted By ayancoskie
Words 1670
Pages 7
Health Patterns: The Taylor Family
Amber D. Yancoskie
Grand Canyon University: NRS-429 Family Centered Health Promotion
December 9, 2012

Gordon’s Functional Health Patterns is a system that was created by Marjorie Gordon in 1987. This system served as a guide to establishing a broader nursing database. Gordon’s 11 functional health patterns consist of values/health perception, nutrition, sleep/rest, elimination, activity/exercise, cognitive, self perception, role relationship, sexuality, and coping. Assessment is the first tool in the nursing process in formulating health care plans for the individual as well as the family. A thorough assessment lays groundwork to promote family health (Edelman & Mandle, 2010). The patterns of functional health can be used to determine how a family interacts with one another and deals with their everyday life. According to Catherine Ross, a professor at the University of Illinois; “It is in the family that the macro-level social and economic order affects individual physical and emotional well-being” (Mirowsky, Goldsteen & Ross, 1990 para.1). This essay will describe the health patterns of the Taylor family by using specific questions personalized to each of the 11 functional health patterns. The Taylor family is comprised of Judy, 52 years old and David, 53 years old. The two have been separated for more than fifteen years and have three adult children and five grandchildren. Joshua, the eldest is 28 years old and engaged to his fiancé. They have two young sons. Amanda, the oldest daughter is 26 years old, single with two small boys. Ashley, the youngest is 25, and a single parent of one son, Brennen who is ten years old. The separation of parents was result of “intense physical, mental, and emotional abuse endured by all of us”, stated Amanda. Amanda described in vivid detail the abuse she and her siblings suffered on a daily basis while their mother was away at work. “He would slam our heads into the closet doors and pull me by hair down the hall ways” described Ashley. David was a heavy alcoholic and declined treatment to keep the family as one unit. As a result, Judy chose to leave with the children. For many years, David remained a functional alcoholic but was not active in his children’s life. It was until March 2010, after being diagnosed with end stage liver disease and given the prognosis his death was imminent that he “got it together”. After a long recovery, David is now an active participant in all his children and grand children’s lives. David expressed his sorrows of missing out on important milestones in each of his children’s lives. He said, “I regret not being there for the kids when they needed me the most growing up”. They children smiled and hugged their dad, saying “Well, you’re here now dad and we love you for that!” The Taylor family had health perceptions that focused on maintaining their wellbeing of their health while preventing further destruction to health from long years of “bad habits”. David is a recovering alcoholic and has been sober for over two years. Now sober, he is seeing the multiple negative effects alcohol had on his body. His goal and focus today is to manage his deficits and promote ongoing healing and prevention of co-morbidities. Judy has had long standing medical issues comprised of hypothyroidism, coronary artery disease, peripheral vascular disease, and long years of smoking habits. She struggles to maintain her prescribed medication regimen due to financial strains but her view is consistent with the rest of the family in that health promotion is the key to a happy fulfilling life. The three children are relatively healthy share the same views as mentioned above. After the separation of their parents; Amanda, Josh, and Ashley drowned their frustrations, anger, and sadness into alcohol and multiple illegal drugs. Their polysubstance abuse lasted approx 3-4 years and each child was able to kick their habits and seek help in healthier ways such as therapy and better friend choices. Today, all three children deny use of any illegal substance, including alcohol abuse. Meal time can promote family bonding. Growing up, the family did not eat together. Judy worked nights and David more often than not drunk and passes out on the couch. Therefore the children ate together. With the exception of Josh and his fiancé, all members in the Taylor family eat at different intervals and often, not together. Judy, Ashley, and Brennen live together and Ashley is typically the one who prepares food on a regular basis. She tends to cook things from scratch and make home-style meals. Amanda prepares food for her children about once a week. “I can’t cook like I want to because I am always on the go”. Her children eat fast food about three times per week. Everyone in Taylor family has different schedules and no two are alike. Judy gets minimal sleep; approx. five hours per night. Her reasoning is “My work schedule is so inconsistent and my hours are often stacked”. Amanda and Ashley work nights and they sleep during the days. David is the only adult in the family who takes naps daily. Judy and Ashley suffer from stress urinary incontinence which developed after childbirth. It hasn't affected their activities of daily living at this point. Judy suffers from constipation secondary to her hypothyroidism but states, “it is managed well with adding fiber in my diet”. Physical exercise has been more prevalent in recent years with the Taylors. Josh stated, “Anytime you have two young one running around, you stay active!” The three children discussed how times have changed with the younger generations compared to when they were young. They described their childhood memories, most being outside in the backyard, woods, etc. Ashley stated, “We were always outside; from sun up to sun down when mom used to call us in for dinner”. Amanda expressed her concern of children today, “It seems like all the kids do today is eat, sleep, and play video games!”. Ashley, Amanda, and Josh make their children spend at least 6 hours outside each week, weather permitting of course. Their rationale is “they kids will explore what our world has to offer, they get exercise, and fresh air.” Watching television and playing video games is limited to 3-4 hours per week. Educational screen-viewing toys like Leap frog, V-tech are encouraged and practiced often with the kids to promote learning as well as bonding; Amanda said, “I always buy educational toys to help them learn”. The Taylor family does not have very cost-efficient medical insurance. Unfortunately they do not seek medical attention unit their “home remedies” have not worked or their symptoms become unbearable. This of course leads to longer recovery, more medicine, and more money in the long run. When asked how they seek medical care, Ashley stated, “Well I don’t have a primary doctor so I usually go to patient first or if I really don’t feel well, I will go to the emergency room. Amanda and Josh also confessed they do not have primary care doctors that. All of the grandchildren have Medicaid insurance and do get regular checkups and dental care via primary doctors. Judy and David also see a primary care physician, but often miss appointments due to lack of financial resources. Amanda, Josh, and Ashley have an angry tone towards David for the many years they endured his abuse and lack of fatherly support. Amanda and Ashley are close and rely on one another for support in raising their children. Amanda made the comment, “Ashley is all I have to help me, she is like the kids dad!”. Josh and his fiancé don’t interact too often with his siblings unless, “someone in the family is sick or the holiday is near”, according to Ashley. All of the children express their wishes of family could conjoin more frequently for get together. In as an adult, Ashley feels more like the parent of Judy. She stated sarcastically, “I cook for her, clean the house regularly, and pay most of the bills in the house”. Ashley came out and declared her preferred sexual orientation as a lesbian few years ago. She said, “It caused tension within my family, particularly between mom (who was against it) and the rest of the family a short while, but resolved after a few months”. The Taylor family copes with stressful life events by “coming together and being in each other’s presence”, said Josh. Over the years, each person has become more spiritual. Two wellness Nursing diagnosis’s that pertain to the assessment of the Taylor family include: Effective Therapeutic Regimen Management r/t alcohol abuse aeb understanding of the implications of not following the prescribed treatment plan and modifying personal habits by eliminating alcohol in diet. The Taylor family certainly doesn’t mirror the traditional family seen on TV shows such as The Brady bunch, or 7th-Heaven. While the adult children have endured a challenging and abusive childhood, they have triumphed to become well-adjusted adults with families of their own. and Readiness for Enhanced relationship and interaction r/t emotions from enduring physical abuse aeb family members attempts to describe growth impact of crisis, moves in direction of enriching lifestyle and health promotion, and individual chooses experiences that optimize wellness.


Edelman, C., & Mandle, C. (2010). Health promotion throughout the life span. (7 ed., p. 175). St. Louis, Missouri: Elsevier. Retrieved from

Mirowsky, J., Goldsteen, K., & Ross, C. (1990). The impact of the family on health: The decade in review. Journal of marriage and family, 52(4), 1059-1078. Retrieved from olog y/Reading Lists/Mental Health Readings/Ross-MarriageandFamily- 1990.pdf

Weber, J.R. (2005) Nurses’ Handbook of Health Assessment, 5th Edition. Philadelphia: Lippincott Williams & Wilkins. Retrieved on December 7, 2012, from oses%20grouped%20by%20functional%20health%20patterns.pdf

Similar Documents

Premium Essay

Family Health Assessment

...A health assessment is an important tool in formulating a health care plan for an individual or family. Nurses therefore have an important role in health promotion and by using the principles of Gordon’s functional health pattern it can assist in developing a diagnosis and nursing care plan. The functional health patterns serve as a framework that is adaptable to all models of care that can be used as a tool for nursing diagnosis for individuals or communities. It is based on the assumption that health and wellbeing is the result of harmony between the body and the environment (Crisp & Taylor 2009, p. 257). The eleven functional health patterns, was used by the nursing student as the basis for an interview conducted with Daphne Trigg. The aim was to identify the functional and dysfunctional patterns in her everyday life. Daphne Trigg is a sixty seven year old woman who lives in the northern rural area of Adelaide. Collection of basic information and sequences of behaviour were captured and these patterns are also used by health professionals to form client data bases, structure assessments and make diagnoses (Gordon 1994, p. 69). This essay will incorporate discussion of relevant literature and aims to gather ‘objective’ and ‘subjective’ (Crisp & Taylor 2009, p. 260) data as this provides an informative awareness of the interviewee’s overall health. Topics covered are the eleven functional health patterns. They consist of Health Perception–health management......

Words: 552 - Pages: 3

Free Essay

Nursing Study Case Case Study Of A Functional Health Pattern Assessment Nursing Essay The following Functional Health Pattern assessment is based on a 65 year old Scottish woman who lives independently with her husband in their home at Happy Valley. The purpose of the interview was explained in addition to an outline of the types of questions which would be asked during the interview. A copy of the interview questions were provided prior to the interview (Appendix 1) so the questions would be familiar, and to minimise any embarrassment. The importance of maintaining her privacy and the necessity of choosing a pseudonym was discussed which she perceived as great fun. She chose ‘Patricia’ as she thought it was rather a ‘posh’ sounding name and one which she had always liked. At the beginning of the interview the confidentiality aspects were reiterated to which Patricia indicated verbal permission for her information to be disclosed as applicable and appropriate with due regard to her ethical and legal rights (ANMC 2008, p.4). Patricia was advised any questions which she did not feel happy answering could be skipped in order for her to feel comfortable within the interview environment. That said however, Patricia stated she was happy to discuss anything and was keen to progress the interview. Health perception/health management pattern An outline of the client’s perceived pattern of health and......

Words: 3352 - Pages: 14

Premium Essay

What Is Sociology of Health and Illness

...This brief abstract is a concept note on the subject of sociology of health and illness. It is going to give a brief sketch background of medical sociology, highlight various definitions of what is health, illness and how the production, distribution and patterns of diseases are influenced by the context in which they occur. The biomedical understanding of health and illness was entirely in the context of bacteriology and immunology dominated the subject of heath care systems for centuries. The history of medical sociology began in the 1800 with extensive contributions of Virchow to social medicine (Virchow, 1864). The resurgence of medical sociology and its institutionalization emerged in the 1960s and 1970s following the deficiencies of biomedicine to account various diseases which came about on the eve of industrialization and urbanization. Some diseases have their roots in the economic, social, cultural, political and environmental context. It is in these backdrops among other reasons that the sociology of health and illness gained recognition and institutionalization. Medical sociology did not discredit biomedical explanations and practice but have attributed that production, patterns, distribution and reproduction of health and illness is socially constructed (Waitzkin et al., 2001; Foucault, 1977; White, 2006). Sociology of health and Illness uses sociological perspectives such as the Sick role (Parsons, 1951), historical materialist approaches (Engels, 1844/1973),......

Words: 841 - Pages: 4

Premium Essay

Food Security in North Carolina for the households. The situation leads to a person or household having to eat less than what they would prefer to consume (Taylor and Francis, 2015). The qualitative aspect of food security entails access to food of preferred nutritional value depending on the age or health requirements. The Psychological domain of food security denotes the anxiety and worry that people tend to exhibit when the food situation in the country is unpredictable. Its other facet is the concern over the absence of the preferred quality of food (Edward et al., 2013). The social aspect entails the socially approved ways people use to access for their consumption. These could include buying on credit, borrowing or even some socially unacceptable means such as stealing. Several types of researches done on the issue of food security consider it from the mothers’ perspectives. It is in conformity with their traditional roles of engaging in acquisition and management of household food reserves. The tool used in the determination of food security is the U.S Household Food Security Survey Module, HFSSM. The toll was devised in 1997. The model investigates both children and adults with fifteen being the lower age limit and no upper age limit. The model focuses mainly on the quantitative and qualitative aspects, with a small focus on psychological aspects of food security (Taylor and Francis, 2015). It pays no attention to the social domain of food security. A common perception is that parents......

Words: 1380 - Pages: 6

Premium Essay

Childhood Obesity

...epidemic affecting millions of the world population. Childhood obesity is especially worrisome as it is linked to higher incidence of health issues in adulthood (Lakshman, Elks, & Ong, 2012). There are many factors to look at when assessing the prevalence of childhood obesity, including culture, socio-economic status, food availability, activity, and genetics. To better understand this problem, it is essential to understand the factors that lead to obesity, how obesity is studied, and what are ways to help reduce the occurrence of obesity. Through epidemiology, this health concern can be better understood and provide the information needed to generate a plan of action to help reduce the risk factors that lead to childhood obesity. Epidemiology is “the study of the occurrence and distribution of health–related states or events and specified populations, including the study of the determinants influencing such states, and the application of this knowledge to control the health problems” (Stanhope & Lancaster, 2012, pg 255). Through epidemiology the questions of who, what, where, when, how, and why can be investigated to offer information about the dissemination or patterns of health measures. The Epidemiological Triangle allows epidemiologists to understand the relationships between agent, host, and the environment when looking at a specific health concern. When considering childhood obesity, the agent could be viewed as an energy imbalance, where the energy expended is......

Words: 2108 - Pages: 9

Premium Essay

Acute Nursing

...that the work presented follows the guidelines set out in the Programme Handbook and is my own original work. We reserve the right to withhold marks or request further information if we are not satisfied that the work presented is the student’s own, or has been referenced appropriately. Introduction A nurse has a crucial responsibility to make accurate and appropriate clinical decisions in an acute setting working in partnership with health consumers across varies lifespan (Crisp, Taylor, Douglas, Rebeiro, 2013). The assignment aims to help develop the clinical skills of a nurse by demonstrating key aspects of client-centered nursing care in an acute setting during the placement. This assignment is based on a health consumer; that was encountered during clinical placement who is of non-Pacific identity as permission was sought from the tutors before the start of the assignment. To begin with, the assignment will introduce the health consumer and incorporate his relevant present and past medical information with known cause, family details, education, employment, and relationship. All information used from the client will maintain client autonomy and confidentiality by...

Words: 4540 - Pages: 19

Premium Essay

Orem Theory

...nursing. Examples are provided of how the Self- Care Deficit Theory views education from this perspective. The Self-Care Deficit Theory was chosen because it good framework for nursing school curriculum and helps to guide the author’s present nursing practice. Theory as a Microscope of Nursing Nursing theories contain concepts that take a closer look at the features of nursing related to nurses and clients. The relationships between and among the concepts form the structure of the theory. Theories are formed after concepts are named and validation occurs. Theory takes a closer look at the features of situations in nursing practice and the relationships between them that are common to all occurrences in nursing (Orem and Taylor, 2011). Orem and Taylor (2011) stated that the formation of theories starts with a search of the dominant features of nursing practice situations. Then they are isolated and a search is started to understand their meaning. Finally the concepts are...

Words: 2933 - Pages: 12

Premium Essay

Obesity Patients and the Role of the Professional Nurse

...doubled (CDC, 2014). Clinically defined, children who are determined to be overweight are those who have excess body weight for their height and it is attributed to fat, muscle, bone, water, or a combination of (Stats, 2014). Children who are determined to be obese are those who have an excess amount of body fat and it is not attributed to physical characteristics (Krebs et al, 2007). For nurses who work with this population of patients, special care will need to be taken to address the host of physical and emotional issues that will be a part of this population’s treatment and care. Nursing staff must be prepared to appropriately diagnose obesity related health problems and provide effective intervention and treatment recommendations. Nurses who develop insightful treatment planning will be cognizant of the variety of health complications that may affect the patient in their care and can plan accordingly (Felix et al, 2013). As such, nurses also need to be more knowledgeable about how genetic susceptibility may also be a contributing factor to a child’s obesity (Seal, 2011). This will enable the treatment planning to incorporate genetic testing and environmental strategies in the overall intervention and treatment planning. All of this is critical in better understanding the negative impact that childhood obesity can have an on individual’s growth and functioning. The rise in obesity rates have been accompanied by an increase in preventable diseases, such as type 2......

Words: 2474 - Pages: 10

Premium Essay

Healthcare and Immigration healthcare? Healthcare is a service that is supposed to be provided to a country’s citizens that the U.S., for some reason, cannot get right (shocker!). Meanwhile, Canada has no problem handing medical care to its citizens for free, that’s right free. Why can’t the U.S. be as caring as Canada? On a side note I hope they take Bieber back. The people (the ones that aren’t fanatically crazy for him because of raging teenage hormones) of the U.S. do not want his presence here and no longer will we the people suffer from headaches due to his annoyance. No longer will important political or non-political events that are being streamed by news media (by which news stations consider “breaking news”) be interrupted. At this very moment my family and I have no medical insurance, thus resulting in $3000 of medical bills that I am not paying simply put “because I don’t feel like paying 3 grand for a f**king checkup that tells me my spouse has depression problems once every so often, it’s a given.” What I do know for sure is my son is eligible for Nevada Checkup; however, seeing that the online healthcare system that was supposed to make applying for medical insurance so easy for all of its U.S. citizens just happened to be in a few nice words “a piece of s**t!” My son (who is turning one this 24th of February) still has no insurance. I have been paying out of pocket costs for routine checkups and medications hoping that I won’t ever have to return to doctors unless otherwise......

Words: 1318 - Pages: 6

Premium Essay

Obesity in Children

...Alice Livingston Family Development Research/ Appropriate Use of Technology Nutrition through the Life Cycle Obesity in children Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems. Physicians and researchers did numerous studies on children’s habits and lifestyles as an important part of society. Nowadays, children face big problems with obesity. As a result, researchers have learned that healthy habits could have a profound impact on the future of every child and get a better understanding of how children perceive healthy eating. Researchers have proved and would like to emphasize that obesity has tripled in Canadian children in recent decades. For this reason, researchers have identified that healthy behaviors have numerous benefits. By making healthy food choices and explaining the nutritional value of various foods to children will improve the lifestyle of every child and make children’s health better. After a large quantity of interviews that were used to collect data on what food children prefer to eat and why it was discovered that they have bad eating habits and lifestyle. Researchers have found that only 75% of children understood healthy eating by identifying what is healthy food and what is junk food. Almost all children have mentioned eating fruits and vegetables. Findings suggested that children had previously......

Words: 3486 - Pages: 14

Premium Essay

Client Careplan

...Nursing Program CLIENT INFORMATION FORM Student's Name Date of Care: Client Initials Room Number Sex: Age : Admission Date: Admitting Diagnosis: Rt. Lobe infiltrate, Breast & Bone Cancer Secondary Diagnosis if any): Respiratory Distress Surgery Type/Date (if any): Lumpectomy on Rt. Foot at 2002 Working Medical Diagnosis/Etiology (describe definition, pathophysiology, and sign/symptoms) Metastatic Breast Cancer Metastatic breast cancer is the term used to describe cancer that has spread from the original site in the breast to other organs or tissues in the body. Cancer cells can break away from the original cancer in the breast and the cancer cells that break away can spread to other parts of the body via blood vessels or lymphatic vessels. The original site where the cancer cells came from is called the primary cancer. When cancer cell travels from the breast around the body they can lodge themselves in various body organs or tissues. These cells can begin to form breast cancer in new place and this new cancer is called secondary or a metastasis. Breast cancer most commonly spreads to one or more sites: bone, liver, brain and lungs. The sign or symptoms that may experience will depend on where the cancer is in the body and the extent of the cancer. If its spread to the: Bone- pain is fairly constant, aching pain. It may...

Words: 5102 - Pages: 21

Premium Essay

Mr Tony Gao

...Perspectives of Human Resource Management LO 2 Understand the ways of developing flexibility in the workplace. LO 3 Understand the impact of equal opportunities in the workplace LO4 Understand approaches to human resources practice in organisations Case Study – Mercer Mercer is a medium sized, family run UK manufacturer, located in the Midlands. The company was established in 1980 and focus predominantly on the UK market. The company originally employed 25 staff, most of which were family members. Over the last 30 years the organisation has grown significantly and the company is looking to expand its operations outside of the UK, particularly in Europe. Mercer currently employ 125 workers, 100 of which work on the factory floor including line managers and the reminder accounted for several administrative post including marketing and sales. Traditionally, employee issues such as recruitment and the management of employee disputes were dealt with by on an ad hoc basis by a senior manager. The system has placed signification strain and stress on both the employees and management. The growth of Mercer has led to changes the business structure and the work patterns of the company. In addition, a steady increase in staff numbers and changes in UK regulations has recently led Mercer to establishing a Human Resource Department to deal with the management of its employees. The HR department will deal with issues such recruitment, remuneration, employee......

Words: 1273 - Pages: 6

Free Essay

Health Psychology Committee Report

...HCA Health Psychology Committee Report Beth Lowery HCA 250 The Health Psychology Committee is committed to enhance the health of patients and to assist patients in obtaining the shortest hospital stay, while improving the hospital's performance with respect to following the appropriate protocols and regimens. To that end, the Committee has established a new Division of Psychiatry, which is staffed by five specialists who are responsible for addressing specific interests of a wide-ranging population and assisting the hospital in treating the "whole" patient. The committee has sought to address a key issue facing individuals who are facing a hospital stay – that is, an overriding fear of hospitals. According to the Child Development Institute (2008), one of the major fears faced by adults and children is that of hospitals. This fear often manifests itself in stress, which can make the illnesses or ailments of the patient worse. Stress impacts the response of the immune system to the physical systems of the body, and psychological interventions can assist the patient in developing coping methods to address these stressors (Sarafino, 2006). The committee's hope is that integration of psychology and health care will reduce the stresses on the patient, enhance their health, increase compliance by the patient with treatment programs, and shorten their hospital stays. Additionally, the patient will be provided with coping skills that will help them deal with their......

Words: 2048 - Pages: 9

Premium Essay

Marijuana vs Alcohol

...and marijuana. According to Substance Abuse and Mental Health Services Administrations (SAMHSA) alcohol is the number one legal drug used in the United States, which marijuana being the most-illegal drug used. Even though alcohol is legal and marijuana illegal, does not mean that either is good for you. Marijuana is a very controversial topic in the media right now, alongside with alcohol. The effects are very different; marijuana has immediate effect and can last for up to two hours after smoking. With alcohol, users feel slight effects after one drink. They can recover faster-depending how much they drank, how much they weigh, and if they ate before they drunk any alcohol. The immediate effects of alcohol use are slurred speech, poor judgment, and lack of motor skills. While the effects of marijuana are red eyes, dry mouth, increased appetite, paranoia, hallucinations, slowed reaction and memory loss. Drinking large amounts of alcohol can lead to coma, and even death, for a person to overdose on marijuana they would have to inhale about 40,000 times the amount of THC that took them to get high. To obtain the amount of THC to overdose a smoker would theoretically have to consume nearly 1,500 pounds of marijuana within about fifteen minutes to induce a lethal response. It is almost impossible to die from overdose of marijuana, but it all depends on the purity of the marijuana, other drugs in the marijuana, and your health conditions you have, just like with alcohol. ......

Words: 1547 - Pages: 7

Premium Essay

Nursing and Workplace Violence

...Some of the most dangerous aspects associated with healthcare do not come from blood borne pathogens, chemical exposures or falls, but comes directly from people as evident in workplace violence(Fernandes, Bouthillette, Raboud, Bullock, Moore, Rae, Ouellet, Gillrie & Way, 1999). The effects of workplace violence is far-reaching and costly(Hoag-Apel, 1998). In fact according to the international council of nurses “ health care workers are more likely to be attacked at work than prison guards and police officers”(ICN, 2009). The aim of this essay is to critically appraise a systematic review of the literature based on workplace violence in the emergency department and to identify characteristics of interventional studies to guide best practice. This review will discuss current practices in reference to NSW health policy and guidelines, critique the systematic review by (Taylor & Rew, 2010) in terms of discussing methodology and provided a comprehensive overview of (Taylor & Rew, 2010) article(Hoag-Apel, 1998) (NSW Health, 2005). Finally, this review will attempt to recommend a change in practice in terms of the research question of what are the suggested interventions for workplace violence in the ED conducted by studies from 2004 ? Based on best evidence based practice and research(Hoag-Apel, 1998) . Although healthcare professionals and exclusively nurses are at higher risk of workplace violence, NSW legislation doesn’t reflect the increase risk associated or current......

Words: 4091 - Pages: 17