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However cheap 150 mg bupropion, in the Colbert generic 150mg bupropion with amex, & Thomasma cheap 150 mg bupropion with visa, 1989; Halloran 150mg bupropion sale, 1983; health-care marketplace discount 150 mg bupropion, consumers did not seek Minyard, Wall, & Turner, 1986). These studies an alternative as the price of hospital-based care showed that nursing units staffed with more regis- continued to rise (DiVestea, 1985). This imbalance tered nurses had decreased costs per nursing diag- of the supply-and-demand curve occurred because nosis, increased patient satisfaction, and decreased consumers paid little out-of-pocket expense for length of stay. Government expenditure for the cost- Helt and Jelinek (1988) examined registered based reimbursement system was predicted to nurse staffing in five different hospitals over two bankrupt Social Security by 1985 unless changes years. It was shown that, al- Economic Implications though the acuity of hospitalized patients in- of Bureaucratic Caring creased, the average length of stay dropped from 9. Nursing produc- Theory: Research in tivity improved and quality of care scores increased Current Atmosphere with the increased registered nurse staffing. The of Health-Care Reform higher costs of employing registered nurses was off- set by the productivity gains, and the hospitals net- Investigation of the economic dimension of bu- ted an average of 55 percent productivity savings reaucratic caring is being explicated in part in nurs- (Helt & Jelinek, 1988). Findings from these research Hospital administrators had made budgeting studies have been valuable when linking the con- and operating decisions based on the undocu- cepts of politics, economics, caring, cost, and qual- mented belief that nursing care accounted for 30 ity in the new paradigm of health-care delivery. However, Although caring and economics may seem para- documented nursing research showed this assump- doxical, contemporary health-care concerns em- tion to be in error. A study conducted at Stanford phasize the importance of understanding the cost University Hospital found that actual nursing costs of caring in relation to quality. Similarly, the Ray (1981, 1987, 1989), Ray and Turkel (2000, Medicus Corporation funded a study in which data 2001, 2003), Turkel (1997, 2001), and Valentine were collected from 22 hospitals and 80,000 patient (1989, 1991, 1993) have examined the paradox be- records. Direct nursing care costs represented, tween the concepts of human caring and econom- on average, only 17. However, any bursement and operating room nursing costs, efforts to reshape the health-care system in our nursing represented only 11 percent of the total country must take into account the value of caring. Nyberg’s (1990) research findings indicated that By the time nursing researchers had demon- nurses were extremely frustrated over the economic strated the difficulty of costing out caring activities pressures of the past five years but that human care with patient classification systems and the effective- was present in nurses’ day-to-day practice. With the nurses see human care as their responsibility and introduction of managed care and increased corpo- goal. One ment was changing faster than nurse researchers nurse administrator proposed “caring as the mis- could document the impact of these changes on sion of the hospital with economic and manage- clinical practice. Although there were organiza- industry is now faced with a shortage of registered tional differences, results showed a high correlation nurses. According to statistics provided by the of caring attributes among the various settings. Department of Interviews conducted with nurses indicated a con- Health and Human Services (2000), over the next cern that their “ability to be caring was in jeopardy. These nurses felt that the practice these studies did not merge economic concepts into of caring was being seriously threatened by the nursing research or theory. As the nursing practice economic pressure associated with health-care environment has continued to change, new re- changes. Foa (1971), an ex- Narrative examples of the attribute, exchanging change theorist, designed an economic theory that commodity values, were “making caring tangible” and “patient care is a commodity (economic good could bridge the gap between economic and or value). In this model, noneco- gotiating the politics were “the nurse administrator nomic resources (love, status, and information) is a system coordinator, nurses are the system and were correlated with economic resources (money, know what impinges on them,” and “nurses are po- goods, and services). The philosophical framework of quality care is located in the reciprocal actions of the economic dimension of bureaucratic caring has the interpersonal nurse-patient relationship served in part as the basis for this type of needed (Hoggard-Green, 1995). Turkel (1997) interviewed nurses, ethnographic approach to study nurse-patient in- patients, and administrators from the for-profit teractions in the critical care environment. The sector to examine the process involved in the devel- subsequent theme generated among all categories opment of the nurse-patient relationship as an of interaction was the nurse-patient relationship. This research was conducted a qualitative study, Price (1993) examined the as managed care penetration was having an enor- meaning of quality nursing care from the perspec- mous impact on the current health-care delivery tive of parents of hospitalized children. The basic ing as a result of health-care reform and managed care, nurses are finding themselves in a period of transition, moving from traditional in-patient hos- The basic social process of the nurse- pital practice to community-based practice. In a re- patient relationship as an economic re- search study conducted by Turkel, Tappen, and Hall source was struggling to find a balance, (1999), the development of a positive nurse-patient which referred to sustaining the caring relationship was shown to be seen as a reward for ideal in a new reality controlled by costs. The research’s long-term goal qualitative interviews were accomplished in not- is to establish caring as an economic interpersonal for-profit and military sectors of the health-care resource.

Insult buy generic bupropion 150mg on-line, aggression buy bupropion 150 mg mastercard, and the southern culture of honor: An “experimental ethnography purchase 150mg bupropion. Field experiments examining the culture of honor: The role of institutions in perpetuating norms about violence purchase bupropion 150mg free shipping. A focus theory of normative conduct: Recycling the concept of norms to reduce littering in public places order bupropion 150 mg mastercard. Self-monitoring without awareness: Using mimicry as a nonconscious affiliation strategy. Strength of identification and intergroup differentiation: The influence of group norms. Summarize the advantages and disadvantages of working together in groups to perform tasks and make decisions. Just as our primitive ancestors lived together in small social groups, including families, tribes, and clans, people today still spend a great deal of time in groups. We study together in study groups, we work together on production lines, and we decide the fates of others in courtroom juries. A rock band that is writing a new song or a surgical team in the middle of a complex operation may coordinate their efforts so well that it is clear that the same outcome could never have occurred if the individuals had worked alone. But group performance will only be better than individual performance to the extent that the group members are motivated to meet the group goals, effectively share information, and efficiently coordinate their efforts. Because these things do not always happen, group performance is almost never as good as we would expect, given the number of individuals in the group, and may even in some cases be inferior to that which could have been made by one or more members of the group working alone. Working in Front of Others: Social Facilitation and Social Inhibition [1] In an early social psychological study, Norman Triplett (1898) found that bicycle racers who were competing with other bicyclers on the same track rode significantly faster than bicyclers who were racing alone, against the clock. This led Triplett to hypothesize that people perform tasks better when there are other people present than they do when they are alone. Subsequent findings validated Triplett‘s results, and experiments have shown that the presence of others can Attributed to Charles Stangor Saylor. The tendency to perform tasks better or faster in the presence of others is known as social facilitation. However, although people sometimes perform better when they are in groups than they do alone, the situation is not that simple. Perhaps you remember an experience when you performed a task (playing the piano, shooting basketball free throws, giving a public presentation) very well alone but poorly with, or in front of, others. Thus it seems that the conclusion that being with others increases performance cannot be entirely true. The tendency to perform tasks more poorly or more slowly in the presence of others is known as social inhibition. According to Zajonc, when we are with others we experience more arousal than we do when we are alone, and this arousal increases the likelihood that we will perform thedominant response, the action that we are most likely to emit in any given situation (Figure 14. Zajonc argued that when the task to be performed was relatively easy, or if the individual had learned to perform the task very well (a task such as pedaling a bicycle), the dominant response was likely to be the correct response, and the increase in arousal caused by the presence of others would create social facilitation. On the other hand, when the task was difficult or not well learned (a task such as Attributed to Charles Stangor Saylor. A meta-analysis by [4] Bond and Titus (1983), which looked at the results of over 200 studies using over 20,000 research participants, found that the presence of others significantly increased the rate of performing on simple tasks, and also decreased both rate and quality of performance on complex tasks. Although the arousal model proposed by Zajonc is perhaps the most elegant, other explanations have also been proposed to account for social facilitation and social inhibition. One modification argues that we are particularly influenced by others when we perceive that the others are [5] evaluating us or competing with us (Baron, 1986). In one study supporting this idea, Strube, [6] Miles, and Finch (1981) found that the presence of spectators increased joggers‘ speed only when the spectators were facing the joggers, so that the spectators could see the joggers and assess their performance. The presence of others did not influence joggers‘ performance when the joggers were facing in the other direction and thus could not see them. Working Together in Groups The ability of a group to perform well is determined by the characteristics of the group members (e. When the outcome of group performance is better than we would expect given the individuals who form the group, we call the outcome a group process gain, and when the group outcome is worse than we would have expected given the individuals who form the group, we call the outcome a group process loss. One group process loss that may occur in groups is that the group members may engage in social loafing, a group process loss that occurs when people do not work as hard in a group Attributed to Charles Stangor Saylor. In one of the earliest social psychology experiments, [7] Ringelmann (1913; reported in Kravitz & Martin, 1986) had individual men, as well as groups of various numbers of men, pull as hard as they could on ropes while he measured the maximum amount that they were able to pull. In fact, the loss was so large that groups of three men pulled at only 85% of their expected capability, whereas groups of eight pulled at only 37% of their expected capability.

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After you identify your life-lenses bupropion 150mg amex, it’s a good idea to consider more examples of how the lenses lead to problematic thoughts and feelings cheap 150 mg bupropion with visa. Notice how the life-lenses are a broad theme and the thoughts are specific to a given event cheap bupropion 150mg visa. See how life-lenses influence how the fathers inter- pret this identical event and respond to their daughters cheap 150mg bupropion free shipping. Chapter 7: Correcting Your Life-Lenses: A New Vision 103 Jim has a guilty and blameworthy life-lens purchase 150mg bupropion free shipping. He feels like he’s done something wrong, even when it’s not his fault (see Worksheet 7-3). Worksheet 7-3 Jim’s Influence of Life-Lenses Event: My daughter is 30 minutes late getting home. Life-Lens & Definition Thoughts Feelings Guilty and blameworthy: I worry I must be a terrible father; Sad and about whether I’ve done the otherwise, my daughter depressed wrong thing. He likes to be in charge and feels uncomfortable when others challenge his authority (see Worksheet 7-4). Worksheet 7-4 Paul’s Influence of Life-Lenses Event: My daughter is 30 minutes late getting home. Life-Lens & Definition Thoughts Feelings Over-control: I like to be in How dare she be late? He worries that the people he cares about will leave him and needs frequent reassurance that he’s loved (see Worksheet 7-5). Worksheet 7-5 Wayne’s Influence of Life-Lenses Event: My daughter is 30 minutes late getting home. Life-Lens & Definition Thoughts Feelings Abandonment-fearful: I worry Oh no, she’s probability Fear and about losing people I care had an accident. These three examples show you how life-lenses affect people’s thoughts and feelings. It’s your turn to complete an Influence of Life-Lenses worksheet (see Worksheet 7-6). Filling out these exercises works a whole lot better than just reading about them, so don’t forget to do the work. The event can be something happening in your world or something that runs through your mind. In the middle column, write down the thoughts or interpretations you have about the event. If you have difficulty with this step, flip to Chapter 6 for more information about events and thoughts. Check out the Daily Unpleasant Emotions Checklist in Chapter 4 for a list of feelings. Review the Problematic Life-Lenses Questionnaire in Worksheet 7-1 (you did do it, didn’t you? Think about which life-lens fits your thoughts and feelings best and write that in the left-hand column. Also, include a brief definition of the life-lens based on the reflections you recorded in Worksheet 7-2. In Worksheet 7-7, reflect on what this exercise tells you about your problematic emotions and where they come from. Worksheet 7-6 The Influence of My Life-Lenses Event: ____________________________________________________________________________ Life-Lens & Definition Thoughts Feelings Event: ____________________________________________________________________________ Life-Lens & Definition Thoughts Feelings Event: ____________________________________________________________________________ Life-Lens & Definition Thoughts Feelings For more copies of this form, visit www. The more forms you fill out, the more you’ll understand how life-lenses impact your life. Chapter 7: Correcting Your Life-Lenses: A New Vision 105 Worksheet 7-7 My Reflections The origins of life-lenses Usually, the prescription for your life-lenses is established in your childhood. People don’t come into the world seeing themselves as inadequate, undeserving, entitled, or perfectionis- tic. Life-lenses emerge from abuse, abandonment, betrayal, criticism, natural disasters, loss, rejection, and other emo- tionally powerful events. Some life-lenses even develop from well-meaning parents who unwittingly go overboard (probably because of their own life-lenses).

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Foods rich in copper are shellfish (crabs and oysters) buy discount bupropion 150mg line, liver bupropion 150mg visa, nuts 150 mg bupropion free shipping, seeds (sunflower order bupropion 150 mg amex, sesame) buy cheap bupropion 150 mg on-line, legumes, and cocoa. A prolonged copper deficiency can result in anemia and cause changes in the skin and blood including a decrease in the white blood count, intolerance to glucose, decrease in skin and hair pigmen- tation, and mental retardation if the patient is young. High levels of copper in serum can be an indication of Wilson’s disease, which is an inborn error of metabolism that allows for large amounts of copper to accumulate in the liver, brain, cornea, or kidney. Zinc also inhibits tetra- cycline (antibiotic) absorption and therefore should not be taken with antibi- otics. Chromium Chromium is acquired from meats, whole-grain cereals, and brewer’s yeast and plays a role in controlling non-insulin-dependent diabetes by normalizing blood glucose thereby increasing the effects of the body’s insulin on cells. Chromium 50 to 200 µg/d is considered within the normal range for children older than 6 years old and adults. Selenium Selenium is a trace mineral that is a cofactor for antioxidant enzymes that pro- tect protein and nucleic acids from damage caused by oxidation. Contraindications Although contraindicated for diabetic patients blood sugar levels should be monitored closely. However, such a dose might cause weakness, loss of hair, dermatitis, nausea, diarrhea, and abdominal pain. Selenium Dose 40 to 75 µg (high doses for males and lower dose for females) Maintenance 40 to 75 µg (high doses for males and lower dose for females) Pregnancy category A Deficiency conditions Heart disease Side effects Causes a garlic-like odor from the skin and breath in large doses. Each day we need to eat a balanced diet that supplies us with the sufficient amount of vita- mins and minerals to remain healthy. Water-soluble vitamins are used immediately and then excreted from the body in urine. As part of the nursing process, assess the patient for vitamin deficiencies and determine what caused the deficiency. Some deficiencies are caused by changes in the body that affect absorption of vitamins. After administering prescribed vitamin therapy, the patient should be educated about the importance of eating well-balanced meals and taking vitamin supplements if necessary. Minerals are inorganic substances that the body uses for blood cells, tissues, and to stimulate enzymes to cause a catabolic reaction in the body. In the next chapter, we’ll examine the balancing act of fluids and electrolytes and how they maintain equilibrium. We’ll also see how to use fluid and elec- trolyte therapies to restore the equilibrium if they become imbalanced. What vitamin protects the heart and arteries and cellular components from being oxidized? Fat-soluble vitamins are immediately excreted in urine shortly after they are absorbed. What vitamin is given to help alleviate symptoms of neuritis caused by isoniazid therapy for tuberculosis? You would be unable to move, talk, and eventually your brain would be unable to function. In order for muscles to contract, your body needs the proper balance between fluids and electrolytes inside and outside of cells. Electrolytes are salts whose positive and negative charges generate the electrical impulse to contract muscles in your body. Diseases and treatment of disease can cause fluids and electrolytes to become imbalanced and require the patient to receive medication to restore the balance. In this chapter, you’ll learn how to recognize the signs and symptoms of fluid and electrolyte imbalance and learn about therapeutic treatment that brings them back into balance. However, water is 45% to 55% of an older adult’s body weight and as much as 70% to 80% of an infant’s weight is water. Lean adults have more water than heavy adults because adipose cells (cells containing fat) contain less water than other cells. Water is the solvent that contain salts, nutri- ents, and wastes that are solutes dissolved in the water and transported by the water throughout the body. The space is occupied by plasma and lymph, transcellular fluid, and fluid in the bone and connective tis- sues. About a third is plasma and two thirds of extracellular fluid is in the space between the cells.

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