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In many trusted tolterodine 2 mg medications safe while breastfeeding, if not most cases order tolterodine 2 mg free shipping medications with acetaminophen, our emotions and motivations operate out of our conscious Attributed to Charles Stangor Saylor discount tolterodine 4 mg without a prescription symptoms jaundice. We begin this chapter by considering the role of affect on behavior, discussing the most important psychological theories of emotions. We will discuss how the experience of long-term stress causes illness, and then turn to research onpositive thinking and what has been learned about the beneficial health effects of more positive emotions. Finally, we will review some of the most important human motivations, including the behaviors of eating and sex. The importance of this chapter is not only in helping you gain an understanding the principles of affect but also in helping you discover the important roles that affect plays in our everyday lives, and particularly in our mental and physical health. The study of the interface between affect and physical health—that principle that “everything that is physiological is also psychological‖—is a key focus of the branch of psychology known as health psychology. The importance of this topic has made health psychology one of the fastest growing fields in psychology. Velocity toward goal attainment in immediate experience as a determinant of affect. The unconscious regulation of emotion: Nonconscious reappraisal goals modulate emotional reactivity. The most fundamental emotions, known as the basic emotions, are those ofanger, disgust, fear, happiness, sadness, and surprise. The basic emotions have a long history in human evolution, and they have developed in large part to help us make rapid judgments about stimuli and to [1] quickly guide appropriate behavior (LeDoux, 2000). The basic emotions are determined in large part by one of the oldest parts of our brain, the limbic system, including the amygdala, the hypothalamus, and the thalamus. Because they are primarily evolutionarily determined, the basic emotions are experienced and displayed in much the same way across cultures (Ekman, 1992; [2] Elfenbein & Ambady, 2002, 2003; Fridland, Ekman, & Oster, 1987), and people are quite accurate at judging the facial expressions of people from different cultures. Video Clip: The Basic Emotions Not all of our emotions come from the old parts of our brain; we also interpret our experiences to create a more complex array of emotional experiences. For instance, the amygdala may sense fear when it senses that the body is falling, but that fear may be interpreted completely differently (perhaps even as “excitement‖) when we are falling on a roller-coaster ride than when we are falling from the sky in an airplane that has lost power. The cognitive interpretations that accompany emotions—known as cognitive appraisal—allow us to experience a much larger and more complex set of secondary emotions, as shown in Figure 10. Although they are in large part cognitive, our experiences of the secondary emotions are determined in part by arousal (on the vertical axis of Figure 10. They are determined by both their level of arousal (low to high) and their valence (pleasant to unpleasant). When you succeed in reaching an important goal, you might spend some time enjoying your secondary emotions, perhaps the experience of joy, satisfaction, and contentment. But when your close friend wins a prize that you thought you had deserved, you might also experience a variety of secondary emotions (in this case, the negative ones)—for instance, feeling angry, sad, resentful, and ashamed. You might mull over the event for weeks or even months, experiencing [3] these negative emotions each time you think about it (Martin & Tesser, 2006). Our response to the basic emotion of fear, for instance, is primarily determined by the fast pathway through the limbic system. When a car pulls out in front of us on the highway, the thalamus activates and sends an immediate message to the amygdala. Secondary emotions are more determined by the slow pathway through the frontal lobes in the cortex. When we stew in jealousy over the loss of a partner to a rival or recollect on our win in the big tennis match, the process is more complex. Information moves from the thalamus to the frontal lobes for cognitive analysis and integration, and then from there to the amygdala. We experience the arousal of emotion, but it is accompanied by a more complex cognitive appraisal, producing more refined emotions and behavioral responses. Although emotions might seem to you to be more frivolous or less important in comparison to our more rational cognitive processes, both emotions and cognitions can help us make effective decisions. In some cases we take action after rationally processing the costs and benefits of different choices, but in other cases we rely on our emotions. Emotions become particularly important in guiding decisions when the alternatives between many complex and conflicting alternatives present us with a high degree of uncertainty and ambiguity, making a complete cognitive analysis difficult. In these cases we often rely on our emotions to make decisions, and these decisions may in many cases be more accurate than those produced by cognitive processing (Damasio, 1994; Dijksterhuis, Bos, Nordgren, & van Baaren, 2006; Nordgren & Dijksterhuis, [5] 2009; Wilson & Schooler, 1991). The Cannon-Bard and James-Lange Theories of Emotion Recall for a moment a situation in which you have experienced an intense emotional response. Perhaps you woke up in the middle of the night in a panic because you heard a noise that made you think that someone had broken into your house or apartment. Or maybe you were calmly cruising down a street in your neighborhood when another car suddenly pulled out in front of you, forcing you to slam on your brakes to avoid an accident. I‘m sure that you remember that your emotional reaction was in large part physical.

The primary source of patient data is the that can be seen purchase 1mg tolterodine visa medications kidney infection, heard order 2 mg tolterodine overnight delivery treatment non hodgkins lymphoma, or felt by some- patient discount 2 mg tolterodine fast delivery medicine 770, but two other sources of patient data one other than the person experiencing are and. The conscious and deliberate use of the performed during the nurse’s initial contact five physical senses to gather information with the patient and involves collecting data 3. Clearly identifies patient strengths and about all aspects of the patient’s health is weaknesses, health risks, and potential called the. A planned communication to obtain lected upon assessment to keep it free of error, patient data bias, or misinterpretation, he/she is performing the act of. When a nurse asks a patient how having a patient’s condition and help the nurse newborn at home will affect her lifestyle, she in planning care is asking a(n) type of a question. A nurse who gathers data about a newly diag- nosed case of hypertension in a 52-year-old 7. Compares a patient’s current status to African American patient is performing a(n) baseline data obtained earlier type of assessment. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. An 85-year-old African American man is ended questions, and reflective questions that admitted to the coronary care unit after could be used to elicit information from your experiencing a possible stroke. A teenage boy is admitted to the hospital children who has recently been diagnosed with severe stomach pains and a possible with diabetes; she is admitted to the hospital ruptured appendix. Closed questions: questions (closed, open-ended, reflective, direct) resulted in the best interviews. Recall the last time you went to a doctor’s office for a checkup or medical problem. What would assessment priorities when collecting patient you do to incorporate this learning into your data. Patient’s developmental stage: Use the following expanded scenario from Chapter 12 in your textbook to answer the questions below. Patient’s need for nursing: Scenario: Susan Morgan is a 34-year-old woman newly diagnosed with multiple sclero- sis. Explain when the immediate communication year and planned to do lots of hiking and of data is indicated. It’s not fair for him to be tied down to me if I can’t be the wife and partner that he thought he married. A 50-year-old woman with diabetes and diabetic foot ulcers is admitted to the emer- gency room for observation after she expe- rienced a blackout. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. What resources might be helpful for and/or ethical/legal competencies are most Ms. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Which of the following nursing diagnoses Circle the letter that corresponds to the best would be written when the nurse suspects that answer for each question. Nursing diagnoses are written to describe clearly the responsibility of the nurse? Tailoring treatment and medication potential health problem that can be regimens for each individual prevented or resolved by an independent d. Which of the following statements describe ate nursing diagnosis for a toddler who has the purpose of diagnosing? To identify a disease in an individual, negligence in providing a safe environment? To identify how an individual, group, or parents community responds to actual or potential b. High Risk for Injury related to impaired health and life processes home management c. Make sure the patient problem and etiology performed by the nursing staff are linked by the phrase “related to. Make sure defining characteristics follow vidual, group, or community can draw on the etiology and are linked by the phrase to prevent or resolve problems “as manifested by” or “as evidenced by. Write nursing diagnoses in legally advisable ing interventions to achieve outcomes for terms. A possible diagnosis is a clinical judgment about an individual, group, or community d. When a nurse writes a patient outcome that describing a suspected problem for which requires pain medication for goal achievement, additional data are needed. Patient complaints of chills and nausea are cluster of actual or risk nursing diagnoses considered significant data or. Which of the following nursing diagnoses are which the data can be compared are termed written correctly? When a nurse groups patient cues that point fluid loss to the existence of a patient health problem, b.

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Nevertheless buy cheap tolterodine 1mg on-line treatment 3 nail fungus, a thorough description of students at Teachers College (Columbia University) the recovery process of women with depression was were asked to make carbon copies of their interac- not reflected in the literature cheap 2mg tolterodine overnight delivery treatment yeast in urine. Peplau studied these and no- a clinical phenomenon and a review of available in- ticed that the students could not talk in a friendly formation related to that phenomenon were the way until the patients had said “I need you” or “I first steps in Peplau’s process buy tolterodine 2 mg with mastercard medicine cabinets with lights. Seven quently to nursing interventions to decrease women who were recovering from depression anxiety (O’Toole & Welt, 1989). Peplau assisted in the design of the semistructured interview guide (personal commu- nication, December 14, 1990). The process of recovering was initiated by a crisis or “turning point” experience. It continued with pro- Applications fessional support and the support of friends and family. Recovering, according to the participants, Peplau’s work has had remarkable influence on required determination, work over time, and a nursing practice and education as we know it today series of successes that enhanced self-esteem and and on development of later nursing theories. The process was dynamic, oc- One of her major contributions to nursing was curring in a nonserial order, with back-and-forth reinforcing nurses’ awareness of the knowledge- movement among the categories and phases. This study raised many ques- chapter reviews in depth Peplau’s practice-based tions and provided further direction for study. It then discusses future applications of shared strategies or techniques that facilitated re- Peplau’s work. Peplau’s process of practice-based theory develop- Follow-up Study ment has directed a program of research in the area of depression in women (Peden, 1998). Beginning Continuing in step two of the process, a follow-up with the identification of a clinical phenomenon— study (Peden, 1996) was conducted a year later to women recovering from depression—and culmi- further describe the recovery process of women nating in the testing of an intervention to reduce who had been depressed. Peplau’s Process of Practice-based Theory Development and Its Applications 63 covering process were identified. Interventions that negative thoughts focused primarily on self, being assisted patients in recovering instilled hope were different, disappointing self and others, not being psychoeducational in nature, included cognitive in- perfect, and always failing. The women described terventions that change thinking styles, and pro- their self-talk as constant, negative, and demeaning. They identified various means of managing the Peden’s study (1996) concluded with the realiza- negative thoughts. Once again, the use of affirma- tion that more information was needed on the tions, positive self-talk, and learning to change symptom of negative thinking. To understand a thinking were identified as reducing negative think- phenomenon, one must analyze its etiology, its ing. Steps one and two of the process of practice- cause, its meaning, and any clues to successful in- based theory development had provided direction tervention (Peplau, 1989c). At the suggestion of for moving into the third step, design of an inter- Peplau (personal communication, January 16, vention. A six-week group intervention was designed specif- ically to incorporate cognitive-behavioral tech- Negative Thinking niques to assist in reducing negative thinking in A qualitative study (Peden, 2000) was designed to depressed women. As described earlier, thought describe the nature or inherent quality of negative stopping and positive self-talk (or affirmations) thoughts, their content or subject matter, and the were identified as key strategies in reducing nega- origins of the negative thoughts experienced by tive thoughts. The participants specific content from Gordon and Tobin’s (1991) also shared strategies they used to manage the neg- Insight program, Copeland’s (1992) The Depression ative thoughts. The sample consisted of six women Workbook, and the investigator’s own clinical expe- with a diagnosis of major depression who were ex- riences with depressed women. Affirmations, direct periencing or had experienced negative thoughts actions, thought stopping, and information on dis- and were willing to talk about the experiences. The torted thinking styles were introduced to the group women participated in a series of six group inter- members. Guided by Peplau’s (1952) theory of in- views, the purpose of which was to elicit negative terpersonal nursing, the introduction of cognitive- views/thoughts held by the group participants. The behavioral techniques did not occur until the group interviews focused on the women’s life expe- second group session. The focus of the first week riences, views of self and significant others, was on enhancing the development of the nurse- lifestyles, and past experiences. Codes were derived from available literature and To pilot-test the intervention, 13 women with were based on recommendations from Peplau (per- a diagnosis of major depression were randomly sonal communication, January 16, 1993) and other assigned either to a control or to an experimental codes that emerged from the initial review of the group. Codes included negative thinking related to an outpatient clinic and receiving antidepressant self, negative thinking related to significant others, medication. The experimental group participated interactions with significant others, and developing in the six-week cognitive-behavioral group inter- view of self. For the six women who participated in the study, Pre- and post-test measures were collected on the negative thoughts had their origins in child- depression using the Beck Depression Inventory hood. There were the trend is to return to practice for knowledge de- more significant decreases from pretest to post-test velopment. Peplau used clinical situations to derive in the experimental group in negative thoughts and theories inductively and then tested them in clini- depressive symptoms and an increase in self-esteem cal practice. Although the sample size theories to nursing phenomena, combining induc- was small, the intervention had a significant posi- tion (observation and classification) with deduc- tive effect on depression.

The idea is that therapy works cheap tolterodine 1 mg fast delivery symptoms melanoma, in the sense that it is better than doing nothing discount tolterodine 1mg visa symptoms yeast infection women, but that all therapies are pretty much equal in what they are able to accomplish cheap tolterodine 4mg on line medicine dosage chart. Finally, placebo effects are improvements that occur as a result of the expectation that one will get better rather than from the actual effects of a treatment. Effectiveness of Psychological Therapy Thousands of studies have been conducted to test the effectiveness of psychotherapy, and by and large they find evidence that it works. Some outcome studies compare a group that gets treatment with another (control) group that gets no treatment. For instance, Ruwaard, Broeksteeg, [2] Schrieken, Emmelkamp, and Lange (2010) found that patients who interacted with a therapist over a website showed more reduction in symptoms of panic disorder than did a similar group of patients who were on a waiting list but did not get therapy. Although studies such as this one control for the possibility of natural improvement (the treatment group improved more than the control group, which would not have happened if both groups had only been improving naturally over time), they do not control for either nonspecific treatment effects or for placebo effects. The people in the treatment group might have improved simply by being in the therapy (nonspecific effects), or they may have improved because they expected the treatment to help them (placebo effects). An alternative is to compare a group that gets “real‖ therapy with a group that gets only a [3] placebo. However, one-half of the patients were randomly assigned to actually receive the antianxiety drug Paxil, while the other half received a placebo drug that did not have any medical properties. The researchers ruled out the possibility that only placebo effects were occurring because they found that both groups improved over the 8 weeks, but the group that received Paxil improved significantly more than the placebo group did. If the researchers believe that their treatment is going to work, why would they deprive some of their participants, who are in need of help, of the possibility for improvement by putting them in a control group? Social skills training augments the effectiveness of cognitive behavioral group therapy for social anxiety disorder. These studies are advantageous because they compare the specific effects of one type of treatment with another, while allowing all patients to get treatment. Research Focus: Meta-Analyzing Clinical Outcomes Because there are thousands of studies testing the effectiveness of psychotherapy, and the independent and dependent variables in the studies vary widely, the results are often combined using a meta-analysis. A meta- analysis is a statistical technique that uses the results of existing studies to integrate and draw conclusions about those studies. In one important meta-analysis analyzing the effect of psychotherapy, Smith, Glass, and Miller [7] (1980) summarized studies that compared different types of therapy or that compared the effectiveness of therapy against a control group. To find the studies, the researchers systematically searched computer databases and the reference sections of previous research reports to locate every study that met the inclusion criteria. Over 475 studies were located, and these studies used over 10,000 research participants. The results of each of these studies were systematically coded, and a measure of the effectiveness of treatment known as the effect size was created for each study. Smith and her colleagues found that the average effect size for the influence of therapy was 0. What this means is that, overall, receiving psychotherapy for behavioral problems is substantially better for the individual than not receiving therapy (Figure 13. Although they did not measure it, psychotherapy presumably has large societal benefits as well—the cost of the therapy is likely more than made up for by the increased productivity of those who receive it. On the basis of these and other meta-analyses, a list ofempirically supported therapies—that is, therapies that are known to be effective—has been [11] developed (Chambless & Hollon, 1998; Hollon, Stewart, & Strunk (2006). What this means is that a good part of the effect of therapy is nonspecific, in the sense that simply coming to any type of therapy is helpful in comparison to not coming. This is true partly because there are fewer distinctions among the ways that different therapies are practiced than the theoretical differences among them would suggest. What a good therapist practicing psychodynamic approaches does in therapy is often not much different from what a humanist or a cognitive- behavioral therapist does, and so no one approach is really likely to be better than the other. This is why many self-help groups are also likely to be effective and perhaps why having a psychiatric service dog may also make us feel better. Effectiveness of Biomedical Therapies Although there are fewer of them because fewer studies have been conducted, meta-analyses also support the effectiveness of drug therapies for psychological disorder. People who take antidepressants for mood disorders or antianxiety medications for anxiety disorders almost always report feeling better, although drugs are less helpful for phobic disorder and obsessive-compulsive disorder. Some of these improvements are almost certainly the result [16] of placebo effects (Cardeña & Kirsch, 2000), but the medications do work, at least in the short term. One problem with drug therapies is that although they provide temporary relief, they don‘t treat the underlying cause of the disorder. In addition many drugs have negative side effects, and some also have the potential for addiction and abuse. Different people have different reactions, and all drugs carry Attributed to Charles Stangor Saylor. As a result, although these drugs are frequently prescribed, doctors attempt to prescribe the lowest doses possible for the shortest possible periods of time.

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The proposed advantage of these tests is that they are more indirect—they allow the respondent to freely express whatever comes to mind purchase tolterodine 4 mg on-line medicine names, including perhaps the contents of their unconscious experiences 2mg tolterodine fast delivery treatment quality assurance unit. One commonly used projective test is the Rorschach Inkblot Test buy discount tolterodine 4mg on line symptoms of strep, developed by the Swiss psychiatrist Hermann Rorschach (1884–1922). TheRorschach Inkblot Test is a projective measure of personality in which the respondent indicates his or her thoughts about a series of 10 symmetrical inkblots (Figure 11. The participants are asked to respond to the inkblots, and their responses are systematically scored in terms of what, where, and why they saw what they saw. For example, people who focus on the details of the inkblots may have obsessive-compulsive tendencies, whereas those who talk about sex or aggression may have sexual or aggressive problems. The sketches are shown to individuals, who are asked to tell a story about what is happening in the picture. Trained coders read the stories and use them to develop a personality profile of the respondent. Other popular projective tests include those that ask the respondent to draw pictures, such as the [30] Draw-A-Person test (Machover, 1949), and free association tests in which the respondent quickly responds with the first word that comes to mind when the examiner says a test word. Another approach is the use of “anatomically correct‖ dolls that feature representations of the male and female genitals. Investigators allow children to play with the dolls and then try to determine on the basis of the play if the children may have been sexually abused. The advantage of projective tests is that they are less direct, allowing people to avoid using their defense mechanisms and therefore show their “true‖ personality. The idea is that when people view ambiguous stimuli they will describe them according to the aspects of personality that are most important to them, and therefore bypass some of the limitations of more conscious responding. Despite their widespread use, however, the empirical evidence supporting the use of projective [31] tests is mixed (Karon, 2000; Wood, Nezworski, Lilienfeld, & Garb, 2003). The reliability of the measures is low because people often produce very different responses on different occasions. The projective tests often fail to distinguish between people with psychological disorders and those without or to correlate with other measures of personality or with behavior. Psychology in Everyday Life: Leaders and Leadership One trait that has been studied in thousands of studies is leadership, the ability to direct or inspire others to achieve goals. Trait theories of leadership are theories based on the idea that some people are simply ―natural leaders‖ [32] because they possess personality characteristics that make them effective (Zaccaro, 2007). Consider Bill Gates, the founder of the Microsoft Corporation, shown in Figure 11. What characteristics do you think he possessed that allowed him to create such a strong company, even though many similar companies failed? Research has found that being intelligent is an important characteristic of leaders, as long as the leader communicates [33] to others in a way that is easily understood by his or her followers (Simonton, 1994, 1995). Other research has found that people with good social skills, such as the ability to accurately perceive the needs and goals of the group [34] members and to communicate with others, also tend to make good leaders (Kenny & Zaccaro, 1983). Because so many characteristics seem to be related to leader skills, some researchers have attempted to account for leadership not in terms of individual traits, but rather in terms of a package of traits that successful leaders seem to have. Some have considered this in terms of charisma (Sternberg & Lubart, 1995; Sternberg, [35] 2002). Charismatic leadersare leaders who are enthusiastic, committed, and self-confident; who tend to talk about the importance of group goals at a broad level; and who make personal sacrifices for the group. Charismatic leaders express views that support and validate existing group norms but that also contain a vision of what the group could or should be. Charismatic leaders use their referent power to motivate, uplift, and inspire others. And research has found a positive relationship between a leader‘s charisma and effective leadership performance (Simonton, [36] 1988). Another trait-based approach to leadership is based on the idea that leaders take either transactional or transformational leadership styles with their subordinates (Bass, 1999; Pieterse, Van [37] Knippenberg, Schippers, & Stam, 2010). Transactional leaders are the more regular leaders, who work with their subordinates to help them understand what is required of them and to get the job done. Despite the fact that there appear to be at least some personality traits that relate to leadership ability, the most important approaches to understanding leadership take into consideration both the personality characteristics of the leader as well as the situation in which the leader is operating. Bush‘s ratings as a leader increased dramatically after the September 11, 2001, terrorist attacks on the World Trade Center. This is a classic example of how a situation can influence the perceptions of a leader‘s skill. In still other cases, different types of leaders may perform differently in different situations.

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Qualitative data turbances were present and nutrition was helps to explain the quantitative data and provides compromised generic tolterodine 4 mg amex treatment notes, there were no significant rela- a more holistic perspective regarding the data expe- tionships with fatigue order tolterodine 4mg amex 7 medications that cause incontinence. Schaefer’s (1991b; Schaefer & Shober-Potylycki 4mg tolterodine otc medications held before dialysis, Several investigators have contributed signifi- 1993) research supports the finding that the ex- cant research to the support and expansion of the perience of fatigue in congestive heart failure is Conservation Model as a model for nursing prac- an experience that affects one’s whole sense of tice. Following is a summary of promotion for preterm infants derived from several of the conclusions of research using the Levine’s Conservation Model. Although the proposed models as, and resulted in less perineal damage than, were not supported, findings revealed that an in- sustained breath holding during the second crease in the level of consistency of nursing care- stage of labor (Yeates & Roberts, 1984). There giving decreased the age at which health was were no differences in the mean duration of the achieved, and an increase in the level of consis- second stage of labor between the two groups. Patients moved more slowly and deliber- great deal of her professional career on preparing ately than did the healthy subjects. Consistent with advanced practice nurses as clinical nurse special- Levine’s (1973, p. Levine’s Conservation Model and the theories to that which is absolutely necessary,” patients seem developed from the model provide a basis for the to reduce activity on their own to promote healing. The model includes Levine (1989) later stated that: a method for assessment; identification of prob- lems; development of a hypothesis about the prob- The conservation of energy is clearly evident in the lem; the identification, selection, and application of very sick, whose lethargy, withdrawal, and self- concern are manifested while, in its wisdom, the body an intervention; and an evaluation of the response. Health is a goal for individuals, families, studies or are the beginnings of research program communities, and populations at large. There is no replication and little con- global perspective, “health for all” is an appropriate sistency in how the variables are measured. Patients inherently conserve their own The model includes three major concepts energy when confronted with environmental chal- that are critical to understanding the lenges. The second important finding is that atten- health-care delivery systems of the future: tion to the conservation principles explains the adaptation, wholism (health), and conser- organismic response of confusion (delirium) better vation (balance of energy supply and de- than does any single principle alone. This supports mand within the capabilities of the patient the assumption that using the conservation princi- [organization, community, and universe]). Investigators are encouraged to continue their The Conservation Model provides the concep- excellent work with Levine’s model. New investiga- tual basis for the development of three theories: the tors are encouraged to consider the Conservation theory of conservation, the theory of redun- Model as a basis for study and to test the proposi- dancy, and the theory of therapeutic intention. Nursing theory should define the boundaries of Alligood (1997) first made the Theory of nursing. It is the researcher who should challenge the Conservation is natural law that is fundamental to cherished ideas and find the data that will sup- many basic sciences. The practi- is “to keep together,” which means “to maintain a tioner must provide the ultimate test of proper balance between active nursing interven- relevance to the theorist’s work. Unless the the- tions coupled with patient participation on the one ory can be interpreted by the nurse who reaches hand and the safe limits of the patients’ abilities to the patient wherever nursing is practiced, theory participate on the other” (Levine, 1973, p. It is essential that concepts that are shared from Conservation assures wholeness, integrity, and other disciplines are accurately reproduced unity. The sharing of The conservation principles form the major concepts from other disciplines has enhanced propositions (Levine, 1973, pp. The individual is always within an environment the knowledge and skills to provide holistic milieu, and the consequences of his awareness of care. The individual protects and defends himself excite what Brunner (1985) called the effective within his environment by gaining all the infor- surprise, where the combination of recognition mation he can about it. Even in the presence of disease, the organism re- can—nor should—survive, but ‘serious intel- sponds wholly to the environment interaction in lectual inquiry’ will create new theories, and which it is involved, and a considerable element nursing can only prosper when it does” (1995, of nursing care is devoted to restoring the sym- p. The biological re- one global theory of nursing that will fit all alities faced by nurses include areas of concern that situations, and should be refined and further devel- focus on living organisms; their structure, form, oped by new researchers. She noted that some the- function, behavior, growth, and development; and ories might be time limited and new theories would relationships to their environment and organisms be developed. We realities of health, illness, and disease, nurses are or- learn and grow as we continue to review and rein- ganizing interventions across the life span, in a va- terpret her work in preparation for the future of riety of settings, and based on the principles drawn nursing. Therefore, the guiding assump- The theory of redundancy is grounded in the tions for this theory are: concept of adaptation. Change associated with therapeutic intervention there are fail-safe options available in the physio- results in adaptation. The proper application of conservation (conser- of individuals who are employed in the develop- vation principles) results in the restoration of ment of patient care. Activities directed toward the preservation of volves a series of adaptive responses (cascade of health include health promotion, surveillance, integrated responses—simultaneous, not separate) illness prevention, and follow-up activities. The selection of an op- the following goals of the theory of therapeutic in- tion rests with the knowledge of the health-care tention: provider in consultation with the patient.

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Upon leaving the Army in Born in London on February 26 generic tolterodine 2 mg with mastercard medications you can take while pregnant, 1907 order tolterodine 2 mg on-line symptoms gluten intolerance, Edward John 1946 cheap tolterodine 2 mg on-line symptoms vertigo, he accepted a fellowship at the Menninger Foun- Mostyn Bowlby was the son of Major Sir Anthony Bowl- dation in Topeka, Kansas, where he studied psycho- by and the former May Mostyn. When John, that, despite Freud’s success, his methods fell short in one of six children, was born, his father was 52 and his one important regard: recognizing the family as a unit mother was 40. His childhood was typical of many mid- with its own emotional needs and behaviors. Whereas dle- and upper-class children in Britain; early years spent Freud focused on the self, Bowen saw the family as a with a nanny or governess, then boarding school. As one of five siblings, and as a husband Bowlby attended the Royal Naval College and Cam- and father of four children, he no doubt observed much bridge, where he prepared for medical school. Two Bowen moved to the National Institute of Mental children in particular intrigued Bowlby: an adolescent Health in 1954, and then to Georgetown University Med- loner who had been expelled from school for stealing, ical Center in 1959, where he remained for the rest of his and a nervous seven-year-old who was called Bowlby’s career. In the late 1950s he further developed what he shadow because he followed him around. At the Institute he was supervised by the innovative cal Practice, in 1978, and he was a founder and first child psychoanalyst Melanie Klein. Although Bowlby president of the American Family Therapy Association did not agree with many of Klein’s theories, her guid- from 1978 to 1982. His first empirical study, in fact, tracked 44 children whose be- havior patterns included anxiety and petty crime. He dis- covered a common thread among these children: they had been deprived of their mothers at some point during their childhood. John Bowlby During the Second World War, Bowlby moved away 1907-1990 from child research and conducted studies on officer se- British psychiatrist who discovered insights into the lection criteria for the military. In 1946 he joined the staff of the John Bowlby’s pioneering work on the relationship Tavistock Clinic in London, where he spent the remain- between mothers and children was instrumental in shap- der of his career. During his years at Tavistock, Bowlby ing child psychology in the twentieth century. These types of mother), and his belief that early experience influenced disorders that could be termed disorders of the brain in a later behavior grew stronger. From 1950 to 1952, Bowl- broad sense include depression, schizophrenia, and by served as a consultant for the World Health Organiza- bipolar disorder. Beyond these, however, are several tion, in which he worked with orphaned and institution- other types of disorders of the brain, including stroke, alized children who had been separated by their mothers. The term; when physicians speak of strokes, they are refer- books included Attachment (1969), Separation (1973), ring to thromboses, hemorrhages, or embolisms. Initially, his theories were attacked by ly, the term stroke refers to the loss of blood to a part of traditional psychoanalysts (including Anna Freud) who the brain and the resulting tissue damage. But as variables involved, strokes are often not correctly diag- psychologists and psychiatrists revised Freud’s theories, nosed. Often, especially with very mild events, a patient they realized that Bowlby’s theories were both innova- will attribute odd sensations to something else. He continued his speaking, if tissue damage occurred in the right brain association with Tavistock, but he also spent more time hemisphere, the victim may experience some degree of at his vacation home on the Isle of Skye, off the Scottish paralysis on the left side of the body, a distortion of vi- coast, with his family. If the tissue affected is on of Charles Darwin,was published in 1990, only months the left side of the brain, patients may experience some before his death of a stroke on September 2 on Skye. Milite Other common brain disorders include the array of conditions caused by head trauma. Injuries to the head can, obviously, vary tremendously, but such injuries all Further Reading result in biochemical abnormalities in the brain. New York, the head has been injured in some way, a tremendous Basic Books, 1969, 1973, 1980. Lon- often have detrimental effects on brain cells, including don, Routledge, 1993. Recent medical advances have uncovered some drugs and treat- ments that can offset this after-effect of trauma, and physicians now know that brain cells can be replaced in Brain disorders adults, a procedure that was thought impossible only a decade ago. Doctors now have the ability to procure ac- Any of the various disorders associated with the curate images of the brain from magnetic resonance human brain, including stroke, trauma, and tu- mors. It has recently been reported that neurology, the The incidence of brain tumors has increased in re- study of the brain, is the fastest growing specialty in the cent years, although it is not certain if this trend is sim- life sciences. Nonetheless, treatments devised thus far have of the more prevalent brain disorders. Researchers have found varieties of brain disorders that affect humans, including that certain genes inside tumors are capable of creating Alzheimer’s disease, Parkinson’s disease, epilepsy, resistance to drugs being used to destroy the tumor. The four principal Developmental neurologic disorders of the brain in- sections of the human brain are the brain stem, the dien- clude well-known brain diseases such as Alzheimer’s, cephalon, the cerebrum, and the cerebellum. Most of these disorders are now known to be inheritable, passed from one generation to another genetically. Re- The brain stem cent research has isolated the gene that causes strains of The brain stem connects the brain with the spinal Alzheimer’s, Huntington’s disease, and several other cord. Cerebral palsy, a devastating devel- brain and spinal cord pass through the medulla—a part opmental neurologic disorder involving severe muscle of the brain stem—via fibers. The fibers on the right side and coordination deterioration, has been attributed to of the medulla cross to the left and those on the left cross stroke in newborn infants.