By S. Roy. Saint Olaf College.

Marital com- mitment is defined here as the degree to which a person intends to remain in the marital relationship 1 mg finasteride free shipping. Commitment Is Different from Attachment Attachment has been described as involving the symbolic bonds that emerge between two persons because of shared beliefs finasteride 1 mg online, values order 5 mg finasteride, meaning discount finasteride 5 mg, and identity (Eckstein trusted finasteride 5mg, Leventhal, Bentley, & Kelley, 1999). One can be strongly attached to being married and to the maintenance of the status quo without being emotionally and faithfully 32 LIFE CYCLE STAGES committed to one’s spouse and sharing in a reciprocal and mutually fulfill- ing relationship. Examples may be found in marriages in which a man is bound to marriage by the security and social status of having a wife and children while maintaining a mistress on the side with whom he shares an emotionally meaningful relationship. Commitment Is Different from Marital Satisfaction Jones, Adams, and Berry (1995) pointed out that commitment and marital satisfaction are conceptu- ally different phenomena when they developed and tested marital satisfac- tion and commitment scales. Satisfaction was defined as the degree to which one expresses happiness and satisfaction with the marital dyad or with the partner. Commitment Has Multiple Features Johnson, Caughlin, and Huston (1999) have described marital commitment as providing personal, moral, and structural reasons for staying married. Commitment Is Central to Marital Stability and Success Clinical observation and study of experiences with hundreds of couples highlight the impor- tance of commitment in the formation and stability of a workable and satis- fying marriage (Nichols, 1988; Nichols & Everett, 1986). Among the elements that seem to influence fear of marriage and/or certain avoidant patterns associated with marital commitment are fear about loss of iden- tity, fear of loss of control, financial fears, and fears about accepting adult responsibility (Curtis, 1994). Hence, we need to know what the issues are for couples attempting to make a strong commitment and to form a serious relationship. What factors miti- gate against getting off on the right foot in entering into the marriage or coupling? REVIEW OF EXISTING THEORETICAL AND EMPIRICAL INFORMATION We need to understand as best we can, and to help clients understand and accept, the factors and expectations that affect their desires and behaviors during the period of their early relationship and commitment. CHOICE OF MATE Mate selection in American society, as noted, is a relatively open process in which two young persons decide whom they will wed. Unlike some soci- eties in which there is little or no choice, American marriages typically are not arranged by the families of the bride and groom. Contextual factors such as race, religion, education, propinquity, and socioeconomic status The First Years of Marital Commitment 33 tend to influence heavily the field of eligibles (Hollingshead, 1950) among whom one fishes for a mate in this voluntary quest, but in the final analysis one selects a partner on essentially psychological grounds (Nichols, 1978). Murstein, 1976) pro- vide the final, major push behind selecting a mate in our voluntary selec- tion process. Within the realm of psychological and emotional choice of a mate, two different patterns have been posited: need complementarity, which stems from the work of Sigmund Freud (Bowen, 1966; Dicks, 1967; Kubie, 1956; Sager, 1976; Winch, 1958), and need similarity (B. Framo (1980) sought to reconcile these conflicting opinions, indicating that both ideas may be accurate, depending on the depth and length of in- ference one makes regarding mate selection. Object relations play a major role in selecting a mate and engaging in family and marital interaction (Dicks, 1967; Fairbairn, 1952; Framo, 1970; Nichols, 1988, 1996; Nichols & Everett, 1986; Scharff & Scharff, 1991). Space limitations prevent a description and discussion of object relations and the important ob- ject relations processes that affect mate selection and marital interaction, specifically splitting, projective identification, introjection, projection, and collusion. We internalize a model of each parent, a model of the affective interaction between spouses, and a model of our parents as a system (Davis, 1983; Skynner, 1976). These models contain more than "simply images of what marriage looks like; they also contain a strong emo- tional feeling about what marriage is supposed to be" (Nichols, 1988, p. These models exist partly in our conscious awareness and partly outside awareness. Differential Background Experiences for the Genders John Gottman (1994) con- tends that our "upbringing couldn’t be a worse training ground for a suc- cessful marriage" (p. Usu- ally, boys care most about the game, while girls care most about the relation- ships between the players" (p. These cycles, includ- ing their specific tasks, are discussed in detail in Nichols (1996) and in The Handbook of Family Development and Intervention (Nichols, Pace-Nichols, Becvar, & Napier, 2000). There are at least two basic approaches to the use of developmental stages in viewing family pathology. One is that family pathology comes from a com- bination of life-stage events plus external circumstances (Duvall, 1957, 1977; Haley, 1973). Another, based more explicitly on clinical work, "suggests that pathology emerges as a function of the continuation of the family system it- self, and that the developmental stage simply colors its expression or defines the nature of its symptoms" (p.

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Pen- nate muscles do not move their tendons as far as parallel muscles do be- cause the fibers pull on the tendon at an angle less than 90° purchase finasteride 1mg without prescription. On the other hand buy 1mg finasteride, pennate muscle contains more muscle fibers than a parallel mus- cle of the same size purchase 1 mg finasteride overnight delivery. Depending on the pennate angle buy discount finasteride 1mg line, a pennate muscle has the potential of generating larger levels of tension than a parallel mus- cle of the same size purchase 5 mg finasteride with amex. If all the muscle cells in a pennate muscle are found on the same side of the tendon, the muscle is called unipennate. If the tendon branches within the pennate muscle, then the muscle is said to be multipennate. In a convergent muscle, muscle fibers are based over a broad area, but all the fibers come together at the common insertion site (Fig. In this muscle the direction of the pull can be changed by activating one group of muscle cells at any one time. When all the cells in this muscle group are activated at once, they generate less force than a parallel mus- cle of the same size. Human Body Structure (a) (b) parallel unipennate bipennate (c) (d) circular convergent FIGURE 1. In pen- nate muscles, the tendon and the muscle fibers are oriented at an oblique angle (b). In convergent muscle, muscle fiber direction varies within the muscle but all the fibers converge at a point (c). Circular muscles contract to control the size of an orifice of the human body (d). A prime mover (agonist) is a muscle whose contraction is chiefly responsible for producing a particular movement. For example, the biceps is made up of two muscles on the front part of the upper arm that are re- sponsible for flexing the forearm upward toward the shoulder. A syner- gist muscle contracts to help the prime mover in performing the move- ment of a bone. Antagonists are muscles whose action opposes that of the agonist; that is, if the agonist produces flexion, the antagonist will produce extension. When an agonist contracts to produce a particular movement, the corresponding antago- nist will be stretched. The tension in the antagonist is adjusted by the ner- vous system to control the speed of the movement and ensure the smooth- ness of the motion. Muscles visible at the body surface are often called externus and superficialis, and they typically serve important functions to stabilize a joint or cause movement. With the naked eye it is often possible to identify the muscle group responsi- ble for a certain action. Belonging to the group of axial musculature are the muscles of the head and neck that move the face, tongue, and larynx. The muscles of the spine include flexor and ex- tensor muscles of the head, neck, and spinal column. In the chest area these muscles are partitioned by the ribs, but over the abdominal surface, they form broad muscular sheets. Trunk muscles keep the internal organs of the body intact, and in that function, they are similar to the corset that nineteenth-century women were obliged to wear in the Western world. The muscles that stabilize the shoulder, hip, and the limbs are called the appendicular musculature. The appendicular musculature is divided into two groups: (1) the muscles of the shoulders and upper extremities (arm, forearm, hand) and (2) muscles of the pelvic girdle (hip joint) and lower extremities (thigh, leg, foot). Gluteus maximus, the ma- jor muscle group of the buttocks, is a monoarticular muscle; it only acts on the hip joint. For exam- ple, the hamstring muscle, the semitendinosus and biceps femoris, tra- verses two joints and acts both on the hip and the knee. The quad mus- cle, rectus femoris, and the calf muscle, gastrocnemius, also act on two joints and as such are called biarticular muscles. A plausible answer to this question may be that biarticular muscle, by affecting two joints at 22 1. Human Body Structure (a) shoulder (deltoids) front of arm (biceps) chest (pectorals) sides (obliques ) stomach (abdominals ) back of thigh (hamstrings) inner thigh calf (adductors) (gastrocnemius ) FIGURE 1. The rate of rotation of a joint has to be zero at the instant the joint is fully extended. It has been suggested that biarticular muscles prevent the rotational energy of segments from reaching levels that could lead to injury to the ligaments and tendons.

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Push with arms and let legs hang over side of the bed until feet are flat on floor 1mg finasteride with mastercard. The helper can bring legs down and place hand under the shoul- der to help person lift up from the trunk order finasteride 1 mg overnight delivery. Grasp snap hook bar in one hand purchase 5mg finasteride, and reaching under patient’s leg generic 5 mg finasteride free shipping, grasp D ring in other and pull until front edge of sling is just behind knees purchase finasteride 1 mg on line. Bring lifter behind patient and support 189 APPENDIX C • Transfers and Mobility patient’s head and neck on pillow placed over litter base. Rosner LJ, Ross S (1992) Multiple Sclerosis: New Hope and Practical Guidelines for People with MS and Their Families. ELECTRONIC INFORMATION SOURCES Some of the best sources of information about MS available on the Internet are: • National Multiple Sclerosis Society: www. Thomas Health Administration Press, Chicago AUPHA Press, Arlington, VA AUPHA HAP Your board, staff, or clients may also benefit from this book’s insight. For more information on quantity discounts, contact the Health Administration Press Marketing Manager at (312) 424-9470. This publication is intended to provide accurate and authoritative infor- mation in regard to the subject matter covered. It is sold, or otherwise pro- vided, with the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought. The statements and opinions contained in this book are strictly those of the author and do not represent the official positions of the American College of Healthcare Executives, of the Foundation of the American College of Healthcare Executives, or of the Association of University Programs in Health Administration. Copyright © 2005 by the Foundation of the American College of Healthcare Executives. This book or parts thereof may not be reproduced in any form without written permission of the publisher. Williams; Cover designer: Trisha Lartz Health Administration Press Association of University Programs A division of the Foundation in Health Administration of the American College of 2000 N. The first conference on health- M care marketing was sponsored by the American Hospital Association, and the first book on the topic was published in 1977. While formal mar- keting activities became common early on among retail-oriented healthcare organizations like health insurance, pharmaceuticals, and medical supplies, health services providers had long resisted the incorporation of formal mar- keting activities into their operations. Of course, hospitals and other health- care organizations had been doing "marketing" under the guise of public relations, physician relationship development, community services, and other activities, but few health professionals equated these with marketing. To many, marketing meant advertising, and, until the 1970s, advertising on the part of health services providers was considered inappropriate. The formal recognition in the 1980s of marketing as an appropriate activity for health services providers represented an important milestone for healthcare. The acceptance of marketing by health professionals opened the door for a variety of new activities on the part of healthcare organiza- tions. This development led to the establishment of marketing budgets and the creation of numerous new positions within the organizations, culmi- nating with the establishment of the position of vice president for market- ing in many organizations. This development opened healthcare up to an influx of concepts and methods from other industries and helped to intro- duce modern business practices into the healthcare arena. While most would agree that, after years of grudging acceptance, mar- keting has become reasonably well established as a legitimate healthcare func- tion, the process has not been without its fits and starts. Healthcare has demonstrated surges of interest in marketing, followed by periods of retrench- ment when marketing, and marketers, were considered unnecessary and/or inappropriate. Periods of prosperity for marketing have alternated with peri- ods of neglect over the past 25 years. There have been periods of exuberant, almost reckless, marketing frenzy and periods of retrenchment. There has xi xii Introduction been ongoing tension between those who eagerly accepted marketing as a function of the healthcare organization and those who doggedly resisted its intrusion into their realm. With each revival of marketing in healthcare, new wrinkles have been added that made the "new" marketing, if not better, at least different from previous approaches.

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Chapter 11 distinguishes between public relations buy 1mg finasteride, advertising purchase 5 mg finasteride fast delivery, and other traditional marketing activities 5mg finasteride overnight delivery. Chapter 12 presents contemporary marketing techniques generic 5 mg finasteride with mastercard, often adopted from other industries purchase finasteride 5mg mastercard, and their potential contribution to health- care marketing. Part IV presents a practical guide to managing and supporting the marketing process in healthcare. Just as the concept of marketing is rela- tively new in healthcare, so is the notion of "managing" the process. Chapter 13 provides an overview of the marketing process, tying together various components discussed earlier in the text. It provides an overview of the issues involved in managing and evaluating marketing initiatives. Part IV also describes the various functions that are necessary to support the mar- keting effort, from the initial market research to technology-based approaches to managing the customer base. Chapter 14 presents an overview of the marketing research process, describing the uses of research by marketers and reviewing basic research techniques with application of healthcare. Notwithstanding its late introduction in the book, marketing planning should be an early and constant consideration in the marketing process. Chapter 16 examines the categories of data that are used for marketing research and planning, indicating the manner in which these data are generated and the sources from which they can be obtained. Part V includes a single chapter—Chapter 17—on the future of healthcare marketing. The current status of the field is summarized and prospects for the future are considered. The factors that are likely to influ- ence the future course of marketing are considered, and speculation on the future characteristics of healthcare marketing, and marketers, is offered. PART I HEALTHCARE MARKETING: HISTORY AND CONCEPTS art I describes the overall context necessary for an understanding of the field of marketing and its applications to healthcare. One can- P not understand where the field is going unless one knows where it has been, so the evolution of the field requires review. Ultimately, this sec- tion places healthcare marketing solidly within the frameworks of both the healthcare industry and the marketing profession and provides insights into what had been tried in the past. Chapter 1 presents an overview of the history of marketing, ulti- mately focusing on its more recent history in the healthcare arena. It describes the factors that led to a shift from a production orientation to a service orientation in healthcare, with the concomitant growing awareness of market demands. The stages in the development of healthcare market- ing are outlined, and the changes that occurred in the field are noted at each stage. The factors that have contributed to successive periods of health- care marketing successes and setbacks during the past quarter of a century are reviewed. Chapter 2 addresses marketing within a context that was initially resistant to any type of business principles in general and "formal" mar- keting in particular. The chapter describes the ways in which healthcare is different from other industries and in which healthcare marketing is dif- ferent from other types of marketing. The factors that have contributed to the acceptance of marketing in healthcare are identified, along with the contribution that marketing can make to the industry. Chapter 3 reviews the developments that have occurred in health- care in recent years and describes their implications for marketing. The importance of the transformation experience by healthcare in the 1980s for the emergence of marketing as a function within healthcare organiza- tions is noted. The halting evolution of marketing as a legitimate health- care endeavor is outlined. Key terms and concepts are defined, and the special treatment of these notions in healthcare is reviewed. The challenge of adopting marketing con- cepts and techniques from other industries to healthcare is explored. Chapter 5 examines the current status of marketing in healthcare, identifying the types of organizations that are most actively involved in promotional activities. The regard with which marketing is held in health- care today is noted, and current trends in the application of marketing tech- niques in healthcare are reviewed. CHAPTER 1 THE HISTORY OF MARKETING IN HEALTHCARE espite its short history, healthcare marketing has experienced many twists and turns. Since the notion of marketing was introduced to D healthcare providers during the 1970s, the field has gone through var- ious periods of growth, decline, retrenchment, and renewed growth. It is a uniquely American concept, and the English word "marketing" has been adopted by other languages that lack a word for this concept.

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