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An inter- nuncial neuron (or association neuron) in the spinal cord passes along the signal to a motor neuron (or efferent fiber) that stimulates a muscle order baclofen 25 mg online spasms of the larynx, which immediately pulls the burning body part away from heat (see Figure 15-5) baclofen 10mg otc spasms perineum. Part V: Mission Control: All Systems Go 252 Musculocutaneous Cervical nerves nerve (8 pairs) Phrenic nerve Thoracic nerves (12 pairs) Radial nerve Median nerve Lumbar nerves (5 pairs) Ulnar nerve Femoral nerve Sacral nerves (5 pairs) Sciatic nerve Internal saphenous nerve Figure 15-4: Anterior tibial nerve The spinal nerves plus Musculocutaneous nerve branching plexus nerves purchase betapace online pills. Wolters Kluwer Health — Lippincott Williams &Wilkins Receptors in skin Pin Sensory neuron Muscle (effector) Figure 15-5: Motor neuron A reflex Cell body Internuncial neuron arc — Dorsal root ganglion Cell body of motor neuron responding Gray matter to pain. Wolters Kluwer Health — Lippincott Williams &Wilkins After a spinal nerve leaves the spinal column, it divides into two small branches. The posterior, or dorsal ramus, goes along the back of the body to supply a specific seg- ment of the skin, bones, joints, and longitudinal muscles of the back. The ventral, or anterior ramus, is larger than the dorsal ramus and supplies the anterior and lateral regions of the trunk and limbs. Chapter 15: Feeling Jumpy: The Nervous System 253 Groups of spinal nerves interconnect to form an extensive network called a plexus (Latin for “braid”), each of which connects through the anterior ramus, including the cervical plexus of the neck, brachial plexus of the arms, and lumbosacral plexus of the lower back (including the body’s largest nerve, the sciatic nerve). Instead, the anterior ramus directly supplies the inter- costal muscles (literally “between the ribs”) and the skin of the region. Thoracic Keep Breathing: The Autonomic Nervous System Just as the name implies, the autonomic nervous system functions automatically. Divided into the sympathetic and parasympathetic systems, it activates the involuntary smooth and cardiac muscles and glands to serve such vital systems that function auto- matically as the digestive tract, circulatory system, respiratory, urinary, and endocrine systems. Autonomic functions are under the control of the hypothalamus, cerebral cortex, and medulla oblongata. The sympathetic system, which is responsible for the body’s involuntary fight-or-flight response to stress, is defined by the autonomic fibers that exit the thoracic and lumbar segments of the spinal cord. The parasympathetic system is defined by the autonomic fibers that either exit the brainstem via the cranial nerves or exit the sacral segments of the spinal cord. The sympathetic and parasympathetic systems oppose each other in function, helping to maintain homeostasis, or balanced activity in the body systems. The sympathetic system dilates the eye’s pupil, but the parasympathetic system contracts it again. The sympathetic system quickens and strengthens the heart while the parasympathetic slows the heart’s action. The sympathetic system contracts blood vessels in the skin so more blood goes to muscles for a fight-or-flight reaction to stress, and the parasympathetic system dilates the blood vessels when the stress concludes. Part V: Mission Control: All Systems Go 254 As shown in Figure 15-6, a pair of sympathetic trunks lies to the right and left of the spinal cord and is composed of a series of ganglia that form nodular cords extending from the base of the skull to the front of the coccyx (tailbone). Sympathetic nerves origi- nate as a short preganglionic neuron with its cell body inside the lateral horn of the gray matter of the spinal cord from the first thoracic to the third lumbar. Axons of these nerves then pass through the ventral root of the spinal nerve, leaving it through a branch of the spinal nerve called the white rami (named for their white myelin sheaths), which connect to one of the two chains of ganglia in the trunks. Parasympathetic nerves consist of long preganglionic fibers that synapse in a terminal ganglion near or within the organ or tissue that’s being innervated.

A nurse enters clinical situa- observations in nursing situations” (Peplau buy 25 mg baclofen free shipping spasms right arm, 1989a buy baclofen 10 mg without prescription spasms back muscles, tions with “theoretical understanding order sumycin 250 mg on-line, personal p. Peplau asserted that nursing was an applied bias, and previously acquired nursing knowledge” science and that nurses used established knowledge (Reed, 1996, p. Decoding, subdividing data, categorizing data, identifying layers of meaning at different levels of abstraction, and applying a conceptual framework Peplau urged nurses to use nursing situa- to explain the phenomenon may occur as a means tions as a source of observations from of interpreting observations (Peplau, 1989b). At which unique nursing concepts could be that time, a structure for obtaining more informa- derived. Further ob- servation or interviewing leads to a clearer, more Peplau urged nurses to use nursing situations as a explicit description of the phenomenon or concept. To the collection of information about patterns or direct nurses in the development of practice-based processes that accompany the phenomenon. The nurse, as the interviewer, assists the patient in providing a thorough description of the Theory development begins with observations concept or process. In the first step, the nurse ob- view techniques that encouraged description; for serves a phenomenon, which is then named, cate- example: “Describe one time that you were... Only by thor- ing on existing literature to assist in naming the ough description of the concept or process can the concept, further information about the concept is nurse assure that all of the behaviors associated gained. Peplau viewed nursing depression—and culminating in the testing interventions as those that “assisted patients in of an intervention to reduce negative gaining interpersonal and intellectual competencies thinking in depressed women, Peplau’s evolved through the nurse-patient relationship” process of practice-based theory develop- (O’Toole & Welt, 1989, p. Useful interventions ment has provided direction and structure are derived and tested (Peplau, 1989c). Both she and her students collected verbatim recordings of interactions with patients. Nevertheless, 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. 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. 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.

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Or if crowds make you nervous — really nervous buy baclofen canada muscle relaxant metabolism, that is — you likely avoid the shopping mall during the holidays order baclofen 10 mg without a prescription spasms throughout body. When you make the decision to avoid something you fear cheap strattera 18mg free shipping, you instantly feel relief, and relief feels pretty good. People tend to do things more often when they’re rewarded; therefore, you’re more likely to avoid again. In fact, you’ll probably find yourself avoiding more frequently and in response to other, somewhat similar events. That avoid- ance feels pretty good until smaller crowds start making you nervous, too. So you avoid smaller and smaller crowds, and your avoidance continues to grow until you’re barely able to get yourself out of your house, lest you run into even a few people. In this chapter, we give you a list of common anxieties and fears that people commonly experience so that you can identify the ones that cause you the most distress and choose one to battle. We show you how to break your fear into manageable pieces, guiding you up the Staircase of Fear, one step at a time. Most people have at least a few minor worries or anxieties, and that’s no big deal. When the guy in the car in front of you slams on his brakes, the sudden anxiety you feel helps your body to respond quickly — and that’s a good thing. Go through our 50 Fears Checklist in Worksheet 9-1 and check off each item that causes you significant concern. If a few of your top fears don’t seriously interfere with your life, you may decide simply to live with them — and that’s okay! For example, Laura (co-author of this book) has no inten- tion of doing anything about her silly fear of bugs. It doesn’t prevent her from enjoying the outdoors or life in general, and she always has Charles (the other co-author) around to get rid of them if they appear. If all else fails, 15 tissues provide enough of a barrier between her and any bugs as to enable her to muster the courage to eliminate them. Well, maybe not any fear — it should be one that bothers you and that you’d like to do something about (it’s probably from your Top Five Fears list; see Worksheet 9-2). The exposure technique for facing and overcoming fear involves breaking your fear into manageable steps and gradually confronting each one. You don’t proceed to the next step until you’ve conquered the one you started with.

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The nurse who embraces these particular values and beliefs expresses them with others who recognize the presence of human be- Becoming coming nursing cheap generic baclofen canada spasms lower stomach. As Rosemarie Rizzo Parse (1998) has shown ear- lier in the chapter generic baclofen 25mg spasms and cramps, the Theory of Human Becoming School of has given rise to a school of thought purchase 50mg pletal with visa. 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. Nurses of multiple backgrounds, encouragement from available texts and other with different levels of preparation and in varied media (Fitne, 1997; International Consortium settings and countries, have found Parse’s perspec- of Parse Scholars, 1996), from the regular confer- tive to be closest to their own beliefs about nursing ences of the International Consortium of Parse and have therefore chosen to use the theory to Scholars and its regional chapters, from sessions guide their practice and research. Parse at the Human Becoming Institute in The broad appeal of the theory and its meaning- Pittsburgh, and from the annual conferences led by fulness in practice has been described in many Parse at Loyola University in Chicago. In several uni- though not impossible, to implement the theory in versity-affiliated settings in Canada, human be- practice without the support of others. The theory has guided different definitions of such key notions as health, practice in several community settings with various family, community, presence, person, freedom, groups, including persons who have no home change, and reality. Parse’s Theory of Human (Bunkers, Nelson, Leuning, Crane, & Josephson, Becoming is not a model for nursing practice that 1999; Williamson, 2000). The Parse Implementing the human becoming theory as nurse lives the values and beliefs manifest and the central guide to nursing practice is never easy structured linguistically in the theory. Adopting the can only become an actuality through individual Human Becoming Theory often means confronting study, reflection, choice, and action. Bunkers and Putnam (1995) are dedicated to cocreating quality of life from each state,“The nurse, in practicing from the human be- person’s own perspective. In this section of the coming perspective and emphasizing the teachings chapter, we present two detailed examples of prac- of the Beatitudes, believes in the endless possibili- tice guided by the Human Becoming Theory, illus- ties present for persons when there is openness, trating a parish nursing model and a community caring, and honoring of justice and human free- action model. Human Becoming as a Guide Human Becoming as a Guide for Parish Nursing for Nursing Education-Practice A Human Becoming parish nursing practice model The Health Action Model for Partnership in was developed at the First Presbyterian Church in Community is a nursing education-practice model Sioux Falls, South Dakota (Bunkers & Putnam, originating in the Department of Nursing at 1995). The central focus of this nursing theory– Augustana College in Sioux Falls, South Dakota, based health model is quality of life for the parish which addresses “the connections and disconnec- community (see Fig.