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By K. Grompel. Barrington University. 2018.

Examples of behavioural strategies include talking to friends about a problem cheap dapoxetine 30mg on line, turning to drink or smoking more or getting distracted by shopping or watching a film generic dapoxetine 30mg free shipping. Examples of cognitive strategies include denying the importance of the problem and trying to think about the problem in a positive way dapoxetine 60 mg mastercard. Several factors have been shown to influence which coping strategy is used: Type of problem: Work problems seem to evoke more problem focused coping whereas health and relationship problems tend to evoke emotion focused coping (Vitaliano et al generic dapoxetine 60 mg free shipping. Age: Children tend to use more problem focused coping strategies whereas emotion focused strategies seems to develop in adolescence (Compas et al buy dapoxetine 90 mg with visa. Gender: It is generally believed that women use more emotion focused coping and that men are more problem focused. For example, Stone and Neale (1984) considered coping with daily events and reported that men were more likely to direct action than women. However, Folkman and Lazarus (1980) and Hamilton and Fagot (1988) found no gender differences. In contrast they use more emotion focused coping if the problem is perceived as being out of their control (Lazarus and Folkman 1987). Available resources: Coping is influenced by external resources such as time, money, education, children, family and education (Terry 1994). Poor resources may make people feel that the stressor is less controllable by them resulting in a tendency not to use problem focused coping. Measuring coping The different styles of coping have been operationalized in several measures which have described a range of specific coping strategies. The most commonly used measures are the Ways of Coping checklist (Folkman and Lazarus 1988) and Cope (Carver et al. The coping strategies described by these measures include the following: s Active coping (e. Some of these strategies are clearly problem focused coping such as active coping and planning. For example, positive reframing involves thinking about the problem in a different way as a means to alter the emotional response to it. Some strategies can also be considered approach coping such as using emotional support and planning whereas others reflect a more avoidance coping style such as denial and substance use. Therefore effective coping can be classified as that which reduces the stressor and minimizes the negative outcomes. In addition, recent research has shifted the emphasis away from just the absence of illness towards positive outcomes. Much research has addressed the impact of coping on the physiological and self-report dimensions of the stress response. Coping and the stress illness link: Some research indicates that coping styles may moderate the association between stress and illness. For some studies the outcome vari- able has been more psychological in its emphasis and has taken the form of well-being, psychological distress or adjustment. For example, Kneebone and Martin (2003) critic- ally reviewed the research exploring coping in carers of persons with dementia. They examined both cross-sectional and longitudinal studies and concluded that problem- solving and acceptance styles of coping seemed to be more effective at reducing stress and distress. In a similar vein, research exploring coping with rheumatoid arthritis sug- gests that active and problem-solving coping are associated with better outcomes whereas passive avoidant coping is associated with poorer outcomes (Manne and Zautra 1992; Young 1992; Newman et al. Similarly, research exploring stress and psoriasis shows that avoidant coping is least useful (e. For example, Holahan and Moos (1986) examined the relationship between the use of avoidance coping, stress and symptoms such as stomach-ache and headaches. The results after one year showed that of those who had experienced stress, those who used avoidance coping had more symptoms than those who use more approach coping strategies. Coping and positive outcomes: Over recent years there has been an increasing recognition that stressful events such as life events and illness may not only result in negative outcomes but may also lead to some positive changes in people lives. This phenomenon has been given a range of names including stress related growth (Park et al. This finds reflection in Taylor’s cognitive adaptation theory (Taylor 1983) and is in line with a new movement called ‘positive psychology’ (Seligman and Csikszentmihalyi 2000). Although a new field of study, research indicates that coping processes which involve finding meaning in the stressful event, positive reappraisal and problem focused coping are more associated with positive outcomes (Folkman and Moskowitz 2000). Coping is considered to moderate the stress/illness link and to impact upon the extent of the stressor. Much research has involved the description of the kinds of coping styles and strategies used by people and some studies suggest that some styles might be more effective than others.

This journal remains a principal reference for other since 1985 has drastically reduced the risk of transfu- professionals in the field purchase 30 mg dapoxetine overnight delivery. Children may be infected in utero or is considered perhaps the finest facility for family psy- by exposure to blood and vaginal secretions during chology in the world discount 30mg dapoxetine with amex. The child of an infected mother has a 25 to 35 percent chance of acquiring the virus purchase dapoxetine 30 mg otc. Within three to six weeks after infection they may tion of Psychoanalytic Medicine dapoxetine 30mg fast delivery, as well as a member of exhibit flu-like symptoms that last up to three weeks and the Academy of Child Psychiatry generic 90mg dapoxetine with amex, the American Psy- resolve spontaneously. New York: Avon Books, illness is challenging for friends, family, and others 1994. Originally thought of as a “gay men’s dis- as a wave of changing electrical charge. If the test is posi- During an action potential, there is a change in voltage tive, a more specific test, the Western blot assay, is ad- across the nerve cell membrane of about 120 millivolts, ministered. This is followed by progression of the disease, particularly the suppression the movement of potassium ions, which also carry a pos- of the immune system. New York: Mc- nence (especially among young people) and the use of Graw-Hill, 1993. Adaptation is crucial to the trol disorders, such as overeating, constitute a specific process of natural selection. Ethologists, scientists who type of compulsive behavior that provides short-term study the behavior of animals in their natural habitats gratification but is harmful in the long run. In contrast to from an evolutionary perspective, have documented two these various types of potentially addictive behavior, main types of adaptive behavior. Some behaviors, known physical addiction involves dependence on a habit-form- as “closed programs,” transmit from one generation to the ing substance characterized by tolerance and well-de- next relatively unchanged. In spite of the variety of activities that can be con- Adaptation occurs in individual organisms as well as sidered addictive, people who engage in them tend to in species. Sensory adaptation consists of physical have certain attitudes and types of behavior in common. Examples include the adjustment eyes ety or blocking out other types of uncomfortable feel- make when going from broad daylight into a darkened ings. To a greater or lesser extent, people engaged in ad- room and the way bodies adjust to the temperature of dictive behavior tend to plan their lives around it; in ex- cold water after an initial plunge. Once a steady level of treme cases they will do almost anything to obtain the stimulation (such as light, sound, or odor) is established, substance or engage in the behavior. When confronted, dangers called the “fight or flight” syndrome (including they generally deny that they have a problem, although rapid breathing, increased heart rate, and sweating) can privately they regret their addictive behavior, which in also be considered a form of adaptation. The psychologi- many cases they have tried without success to discontin- cal responses involved in classical and operant condi- ue. They tend to rationalize engaging in the behavior and tioning, which involve learned behaviors motivated by tell themselves they can stop whenever they want. They either positive reinforcement or fear of punishment, may also blame others for their addiction and often expe- can also be considered adaptation. Substance abuse and dependence (substance-related Further Reading disorders) are among the psychological disorders in the Bateson, P. Perspectives in Ethology: Behavior and Evolu- list of major clinical syndromes (Axis I) found in the tion. The Beak of the Finch: A Story of Evolution is classified as a depressant, is probably the most fre- in Our Time. Alcohol abuse and dependence affects over 20 million Americans— about 13 percent of the adult population. An alcoholic has been defined as a person whose drinking impairs his or her life adjustment, affecting health, personal relation- Addiction/Addictive ships, and/or work. Alcohol dependence, sometimes personality called alcoholism, is about five times more common in men than women, although alcohol abuse by women and A wide spectrum of complex behaviors that ranges from patterns of behavior to physical addiction. In addition to familiar addictions, rational processes are impaired, as well as motor coordi- such as alcohol dependence, drug dependence, and nation, speech, and vision. Alcohol abuse typically pro- smoking, addictive behavior has also been associated gresses through a series of stages from social drinking to with food, exercise, work, and even relationships with chronic alcoholism. Some experts describe the spec- ble onset of a drinking problem include the frequent de- trum of behaviors designated as addictive in terms of five sire to drink, increased alcohol consumption, memory interrelated concepts: patterns, habits, compulsions, im- lapses (“blanks”), and morning drinking. While drug abuse and de- pendence can occur at any age, they are most frequent in adolescence and early adulthood. Some people are at high risk for dependence due to genetic or physiological factors.

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True presence is lived metaphors buy 90 mg dapoxetine otc, poetry buy 90mg dapoxetine free shipping, rhythmical movements discount dapoxetine 60 mg with visa, and through the human becoming dimensions and other expressions (Parse purchase 90 mg dapoxetine visa, 1998a order dapoxetine 30mg free shipping, p. The nurse with individuals or groups is truly present with the The Human Becoming School of Thought is a unfolding meanings as persons explicate, dwell with, guide for research, practice, education, and admin- and move on with changing patterns of diversity. Scholars Living true presence is unique to the art of from five continents have embraced the belief human becoming. It is sometimes misinterpreted system and live Human Becoming in a variety of as simply asking persons what they want and re- venues, including health-care centers and univer- specting their desires. R hy thm icity um an beco in g isco creatin g creatin g rhy thm ical pattern s Sy n chr n izin g rhy thm shappen s eo le live en ia liies wih a ct ua liies a ll- a t rhy thm ical pattern s frel atin g frel atin g isl ivin g the para- in dwel l in g with the pitch, y aw, n ce; he a p a r en sie fwha t is in in pen in terchan ge with the do x ical un ity freveal in g- an d r fthe in terhum an he f r e fex er ien ce is a lwa ys a lso r es- un iverse. T ran scen den ce um an beco in g istran scen din g tran scen din g with the po ssi- bil izin g tran scen den ce hap- eo le live wih cha n ge in cho sen wa ys ha t m ul tidim en sio n al l y with the bl esispo werin g rigin atin g in pen sin vin g bey o n d the evo lve in a t er n s flivin g ha t a lso un f l din g po ssibl es the pr cess ftran sf r in g. There is a Parse home page on the Toronto, Canada, is in the process of conducting an World Wide Web that is updated regularly. Each 18-month study (Bournes & Ferguson-Paré, 2004) year, most of the 100 or more members of the to evaluate implementation of human becoming as International Consortium of Parse Scholars meet a guide to nursing practice on a unit where they are in Canada for a weekend immersion in human be- also evaluating the implementation of a staffing coming research and practice. Members of the con- model in which registered nurses are spending 80 sortium have prepared a set of teaching modules percent of their time in direct patient care and 20 (Pilkington & Jonas-Simpson, 1996) and a video percent of their time on professional development recording (International Consortium of Parse (80/20 model). It is believed that learning to use the Scholars, 1996) of Parse nurses in true presence human becoming theory in practice will enhance with persons in different settings. Parse scholars nurses’ satisfaction and be responsive to health-care present lectures and symposia regularly at interna- recipients’ call for patient-centered care (Bournes, tional forums. The addition of the 80/20 nurse staffing model is to address issues raised in the nurse reten- The Institute of Human Becoming tion literature indicating that nurses want profes- sional development opportunities, time to be The Institute of Human Becoming, founded in involved in developing professional practice and re- 1992, was created to offer interested nurses and search initiatives, demonstrated commitment and others the opportunity to study, with the au- support from nurse leaders, and reductions in thor, the ontological, epistemological, and workload. There are other health centers through- methodological aspects of the human becom- out the world that have Human Becoming as a ing school of thought. Toward that goal, the in- guide to health care (see, for example, the “Scholarly stitute offers regular sessions devoted to the Dialogue” column in Nursing Science Quarterly, study of the ontology and the research and volume 17, numbers 3 and 4). There are also sessions In South Dakota, a parish nursing model was on teaching-learning, leading-following, com- built on the principles of human becoming to guide munity, and family. All of the sessions have as nursing practice at the First Presbyterian Church in their goal the understanding of the meaning of Sioux Falls (Bunkers, Michaels, & Ethridge, 1997; the human-universe-health process from a Bunkers & Putnam, 1995). Nursing of South Dakota has adopted a decisioning model based on the human becoming school of thought (Damgaard & Bunkers, 1998). Augustana College (in Sioux Falls) has human becoming as one central focus of the curricula for the baccalau- reate and master’s programs. It is the basis of Through the efforts of Parse scholars, the Augustana’s Health Action Model for Partnership Human Becoming School of Thought will in Community (Bunkers, Nelson, Leuning, Crane, continue to emerge as a major force in the & Josephson, 1999). Knowledge gained from the basic re- hope was conducted using the Parse method, with search studies will continue to be synthesized participants from Australia, Canada, Finland, Italy, to further explicate the meaning of lived ex- Japan, Sweden, Taiwan, the United Kingdom, and periences. These syntheses will guide deci- of various choices, and select ways to move on amid sions for continually creating the vision for life’s unfolding consequences. The nurse guided by sciencing and living the art of the Human the human becoming perspective lives a commit- Becoming School of Thought for the better- ment to honor persons as they disclose their reali- ment of humankind. The nurse who embraces these particular values and beliefs expresses them with others who recognize the presence of human be- Becoming coming nursing. As Rosemarie Rizzo Parse (1998) has shown ear- lier in the chapter, the Theory of Human Becoming School of has given rise to a school of thought. The theory’s assumptions and principles comprise the school of thought’s ontology, which describes the person as Thought freely choosing meaning in situation, coexisting and interrelating multidimensionally with the uni- Gail J. Mitchell, Sandra Schmidt verse, and continuously cotranscending with the possibles in uniquely personal ways. Freely choos- Bunkers, & Debra Bournes ing meaning is cocreating reality through one’s imaginings and self-expressions while living cher- ished values. Coexisting and interrelating with oth- ers generates rhythmical patterns and paradoxes Applications that disclose the ups and downs of living. One con- tinuously transcends with the possibles through References shifting perspectives of unfolding events and com- mitting to one course of action over another while never fully knowing the outcomes. The human becoming practice methodology Applications flows from these beliefs and delineates a way of au- This section of the chapter describes the applica- thentically living these beliefs. The essence of the tion of Parse’s Theory of Human Becoming in methodology is structured in the written dimen- practice, research, administration, education, and sions and processes published by Parse in 1987; but regulation. Feeling confident is feeling important and worthwhile, encourag- Cherished triumphs emerge with gratitude in the ing others, getting psyched up, accomplishing something of in- wavering buoyancy of pursuing sustaining- terest, and staying mostly confident, except when intimidated daunting engagements.

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The quality and integrity of any swab or con- tainer used to obtain a forensic sample must be ensured buy discount dapoxetine 60 mg on line. The provision of sealed generic 90mg dapoxetine with visa, standardized clinical forensic examination kits or modules ensures that these requirements can be guaranteed (8 generic dapoxetine 90mg without prescription,9) cheap 60 mg dapoxetine fast delivery. Blood and urine samples for drug and alcohol analysis should be placed in containers with a preservative that prevents decomposition and fermentation (e cheap dapoxetine 30 mg overnight delivery. Because many of the samples are subsequently frozen, all the containers should be shatterproof. However, if storage space is restricted, then any used proctoscopes or specula may be swabbed and only the swabs retained for later forensic sampling. Sterile water may be used to moisten the proctoscope/speculum to facili- tate its insertion into a body orifice. Other lubricants should not be used when body fluid analysis or lubricant identification may be pertinent to the case (see Heading 11 on Lubricants). Controls An unopened swab from each batch should be retained and sent with the samples as a control for that batch of swabs. If any water is used in the sampling process, the remaining water in the ampule or an unused swab moistened with some of the water should be retained as a control sample for the water. Packaging and Continuity Any retrieved items must be packaged quickly and efficiently to prevent accidental loss of material and minimize decomposition of the sample. The use of bags with integral tamper-evident seals is recommended to prove that the sample has not been contaminated with exogenous substances since it was sealed. The exhibit should be labeled with the site of the sample, the date and time (24-h clock) it was obtained, and the name of the examinee. Again, the use of bags with integral labels will prevent accidental detachment of this vital information (see Fig. Each exhibit is also labeled with an exhibit identification code, usually formed by the forensic practitioner’s initials and a number reflecting the order in which the samples were obtained. The latter is particularly important when more than one sample has been obtained from the same site (7). Every exhibit should be signed by the person who first handled Sexual Assualt Examination 67 Fig. It is good practice for others who subsequently handle the exhibit to sign the label also, so that, if necessary, they can be called to court to explain their part in collection, transport, and storage (10). Clothing should be placed in bags made of material, such as paper, that prevents the accumu- lation of condensation, which could accelerate decomposition of body flu- ids. When the clothing is overtly wet or possibly contaminated with accelerants, the forensic science laboratory should be asked for advice on packaging and storage. The following additional information should then be recorded on the appropriate label: • Which items were worn during the offense. The forensic scientist must be provided with salient information regard- ing the incident and subsequent actions of the complainant in order to deter- mine the type of forensic analysis required. Their abundance and hypervariability make them ideal markers for the identification of an indi- vidual. As yet, it is unclear how useful this tool will be in the forensic setting (see Subheadings 5. The technique is best suited to discrete samples, such as hairs without roots and fecal material, and is not ideal for mixtures of body fluids, particularly when the complainant’s body fluid is likely to be present in larger quantities than that of the assailant (Tully, G. Therefore, in sexual offenses, the selection of material to be analyzed by this technique is limited and its use needs careful consideration. The forensic science laboratory must be notified when it is alleged that people who are closely related have been involved in a sexual offense, because their profiles will have greater similarity than profiles from individuals picked at random, and further differentiating tests may need to be performed. Method of Sampling All areas of unwashed skin that have been licked, kissed, sucked, bitten, or ejaculated on by either the assailant or the complainant must be sampled. There- fore, when dealing with an assault conducted by an unknown assailant, con- sideration should be given to sampling marks or injuries on the skin that the complainant attributes to direct contact by the offender. However, the prob- lem with this type of sampling is there is considerable lack of understanding about issues of transfer and persistence (24).

Activity and muscle tone: Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins dapoxetine 90mg on-line. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care dapoxetine 60mg low price, 7th Edition buy discount dapoxetine 90mg on-line. Develop a list of preferred foods to ensure healthy bowel elimination for the following patients generic dapoxetine 90mg overnight delivery. Describe the following exercises designed for his job complains of frequent diarrhea dapoxetine 60mg mastercard. Abdominal settings: What other factors are likely to promote healthy bowel elimination in these patients? Perform a physical assessment and write a nursing diagnosis for a patient who has just had a colostomy performed. List four reasons for prescribing cleansing will this patient face in his life, and what can enemas. Ileostomy: Use the following expanded scenario from Chapter 38 in your textbook to answer the questions below. Colostomy: Scenario: Leroy Cobbs, age 56, was recently diagnosed with prostate cancer. Describe how the following factors help pro- acetaminophen (Tylenol) with codeine for mote healthy bowel habits in patients. Cobbs reports that he had regular, pain-free bowel movements, once daily, before taking the pain c. He appears frustrated and says, “I’ll take my chances with the cancer pain in the future rather than take more pain d. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Reluctant to suggest substituting another medication too quickly, she asks more questions and Ms. What would be a successful outcome for in the morning and maybe a glass of wine at Mr. What intellectual, technical, interpersonal, is a workaholic computer programmer and and/or ethical/legal competencies are most spends what little spare time she has watching likely to bring about the desired outcome? She reports tiring after walking one flight of stairs and says she avoids all forms of vigor- ous exercise. Identify pertinent patient data by placing a single underline beneath the objective data in the case study and a double underline beneath 4. Complete the Nursing Process Worksheet on page 261 to develop a three-part diagnostic statement and related plan of care for this patient. Read the following patient care study and use your nursing process skills to answer the Patient strengths: questions below. Elgaresta, age 54, a single Hispanic woman, is being followed by a cardi- ologist who monitors her arrhythmia. At this visit, she says to the nurse practi- tioner who works with the cardiologist: “Right after I started taking that medication, I got 4. Pretend that you are performing a nursing terribly constipated, and nothing seems to assessment of this patient after the plan of help. The nurse practitioner realizes that Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. For the purposes of this exercise, develop the one patient goal that demonstrates a direct resolution of the patient problem identified in the nursing diagnosis. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Dullness bronchioles that are the sites of gas exchange are known as which of the following? A patient who has difficulty breathing, increased respiratory and pulse rates, and d. A nurse suctioning a patient through a is generally preferred, despite its addictive tracheostomy tube should be careful not to quality? Cough syrup with codeine catheter because it would cause which of the following to occur? Suctioning of carbon dioxide ing should be placed in which of the follow- ing positions? The patient has no impairment of speaking lobes of the lungs, the nurse should place the function.

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