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However cheap colospa 135 mg visa muscle relaxant tl 177, in the Colbert order colospa without a prescription spasms of the esophagus, & Thomasma buy biaxin online pills, 1989; Halloran, 1983; health-care marketplace, consumers did not seek Minyard, Wall, & Turner, 1986). These studies an alternative as the price of hospital-based care showed that nursing units staffed with more regis- continued to rise (DiVestea, 1985). This imbalance tered nurses had decreased costs per nursing diag- of the supply-and-demand curve occurred because nosis, increased patient satisfaction, and decreased consumers paid little out-of-pocket expense for length of stay. Government expenditure for the cost- Helt and Jelinek (1988) examined registered based reimbursement system was predicted to nurse staffing in five different hospitals over two bankrupt Social Security by 1985 unless changes years. It was shown that, al- Economic Implications though the acuity of hospitalized patients in- of Bureaucratic Caring creased, the average length of stay dropped from 9. Nursing produc- Theory: Research in tivity improved and quality of care scores increased Current Atmosphere with the increased registered nurse staffing. The of Health-Care Reform higher costs of employing registered nurses was off- set by the productivity gains, and the hospitals net- Investigation of the economic dimension of bu- ted an average of 55 percent productivity savings reaucratic caring is being explicated in part in nurs- (Helt & Jelinek, 1988). Findings from these research Hospital administrators had made budgeting studies have been valuable when linking the con- and operating decisions based on the undocu- cepts of politics, economics, caring, cost, and qual- mented belief that nursing care accounted for 30 ity in the new paradigm of health-care delivery. However, Although caring and economics may seem para- documented nursing research showed this assump- doxical, contemporary health-care concerns em- tion to be in error. A study conducted at Stanford phasize the importance of understanding the cost University Hospital found that actual nursing costs of caring in relation to quality. Similarly, the Ray (1981, 1987, 1989), Ray and Turkel (2000, Medicus Corporation funded a study in which data 2001, 2003), Turkel (1997, 2001), and Valentine were collected from 22 hospitals and 80,000 patient (1989, 1991, 1993) have examined the paradox be- records. Direct nursing care costs represented, tween the concepts of human caring and econom- on average, only 17. However, any bursement and operating room nursing costs, efforts to reshape the health-care system in our nursing represented only 11 percent of the total country must take into account the value of caring. Nyberg’s (1990) research findings indicated that By the time nursing researchers had demon- nurses were extremely frustrated over the economic strated the difficulty of costing out caring activities pressures of the past five years but that human care with patient classification systems and the effective- was present in nurses’ day-to-day practice. With the nurses see human care as their responsibility and introduction of managed care and increased corpo- goal. One ment was changing faster than nurse researchers nurse administrator proposed “caring as the mis- could document the impact of these changes on sion of the hospital with economic and manage- clinical practice. Although there were organiza- industry is now faced with a shortage of registered tional differences, results showed a high correlation nurses. According to statistics provided by the of caring attributes among the various settings. Department of Interviews conducted with nurses indicated a con- Health and Human Services (2000), over the next cern that their “ability to be caring was in jeopardy.

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King’s Theory of Goal Attainment 237 interaction in those works influenced my ideas rel- framework”) safe 135mg colospa muscle spasms xanax withdrawal, and the result was the publication of ative to organizing a conceptual frame of reference a book entitled Toward a Theory of Nursing (King buy colospa 135mg with amex muscle relaxant withdrawal symptoms, for nursing generic 180 mg diltiazem free shipping, as shown in Figure 16–1. From being, commonly referred to as an “individual” or a my initial set of ideas in 1968 and 1971, my con- “person. For example, the concept of ings (ontology) and to the nature of knowledge perception has been studied in psychology for (epistemology). The literature indicated that most of the early studies dealt with sensory perception. From this research literature, I in systems research, I was introduced to a philoso- identified the characteristics of perception and de- phy of science called General System Theory (Von fined the concept for my framework. This philosophy of science searching literature for knowledge of each of the gained momentum in the 1950s, although its roots concepts in my framework. Von Bertalanffy, credited “Searching for scientific knowledge in nursing is an with originating the idea of General System ongoing dynamic process of continuous identifica- Theory, defined this philosophy of science move- tion, development, and validation of relevant con- ment as a “general science of wholeness: systems of cepts” (King, 1975). A concept is elements in mutual interaction” (Von Bertalanffy, an organization of reference points. This philosophy different types according to the different sources of gave me the impetus to focus on knowledge their meaning.... A concept is a term to which development as an information-processing, goal- meaning has been assigned. System Theory provides a holistic approach to The concept development and validation study nursing phenomena as an open system and process is as follows: frees one’s thinking from the parts-versus-whole dilemma. Review, analyze, and synthesize research litera- ing, the central ideas revolve around the nature of ture related to the concept. From the characteristics, write a conceptual However, because a manuscript was due in the definition. Review literature to select an instrument or ceptual system (formerly called a “conceptual develop an instrument. Decisions are made on selection of the popula- cently, several dissertations by Frey (1995), Sieloff tion to be sampled. Generally speaking, nursing care’s goal is to help in- dividuals maintain health or regain health (King, Concepts that represent phenomena in nursing 1990). Twelve concepts—self, body image, role, percep- tion, communication, interaction, transaction, Concepts of self, perception, communica- growth and development, power, authority, organi- tion, interaction, transaction, role, and zation, and decision making—were identified from decision making were selected. The concepts that provided substantive knowledge The concepts of self, perception, communication, about human beings were placed within the per- interaction, transaction, role, and decision making sonal system, those related to groups were placed were selected. Self is an individual whose percep- within the interpersonal system, and those related tion and role influence that person’s communica- to large groups that make up a society were placed tion, interaction, and decision making in small and within the social system. So, what is the health-care system all of the concepts is used in nurses’ interactions within which nurses function?

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Likewise purchase colospa overnight spasms after bowel movement, stress may cause physiological changes such as raised blood pressure but this is often most apparent in those that also exhibit particularly unhealthy behaviours (Johnston 1989) buy generic colospa from india spasms groin area. Therefore discount lotrisone online visa, in reality, stress is linked to illness via a complex interaction between behavioural and physiological factors. Further, Johnston (1989) argued that these factors are multi- plicative, indicating that the more factors that are changed by stress the greater the chance that stress will lead to illness. To some extent this is due to the role of variables such as coping, control, personality and social support which are described in detail later on. However, research indicates that this variability is also due to individual differences in stress reactivity, stress recovery, the allostatic load and stress resistance. Stress reactivity Some individuals show a stronger physiological response to stress than others which is known as their level of ‘cardiovascular reactivity’ or ‘stress reactivity’. This means that when given the same level of stressor and regardless of their self perceived stress some people show greater sympathetic activation than others (e. Research suggests that greater stress reactivity may make people more susceptible to stress-related illnesses. For example, individuals with both hypertension and heart disease have higher levels of stress reactivity (e. However, these studies used a cross sectional design which raises the problem of causality. The results showed that stress and illness were not linked in the children with low reactivity but that those with higher reactivity showed more illness if they had experienced more stress. Everson and col- leagues (1997) also assessed baseline stress reactivity and explored cardiac health using echo cardiography at follow-up. The results showed that higher stress reactivity at base- line was predictive of arteriol deterioration after four years. In addition, stress reactivity has been suggested as the physiological mechanism behind the impact of coronary prone behaviours on the heart (Harbin 1989; Suarez et al. This doesn’t mean that individuals who show greater responses to stress are more likely to become ill. However, some people recover more quickly than others and some research indicates that this rate of recovery may relate to a susceptibility to stress-related illness. This is reflected in Seyle’s (1956) notion of ‘exhaustion’ and the general wear and tear caused by stress. Some research has focused particularly on changes in cortisol production suggesting that slower recovery from raised cortisol levels could be related to immune function and a susceptibility to infection and illness (e. Allostatic load McEwan and Stellar (1993) described the concept ‘allostatic load’ to reflect the wear and tear on the body which accumulates over time after exposure to repeated or chronic stress. They argued that the body’s physiological systems constantly fluctuate as the individual responds and recovers from stress, a state of allostasis, and that as time progresses recovery is less and less complete and the body is left increasingly depleted. Therefore if exposed to a new stressor the person is more likely to become ill if their allostatic load is quite high.

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These observations find that emotional states and behaviors operate on a continuum cheap colospa on line muscle relaxant use in elderly, ranging from more “normal‖ and “accepted‖ to more “deviant colospa 135mg with visa muscle relaxer 86 67,‖ “abnormal 150 mg effexor xr with mastercard,‖ and “unaccepted. It is not unusual to worry about and try to improve one‘s body image, but Robert‘s struggle with his personal appearance, as discussed at the beginning of this chapter, was clearly unusual, unhealthy, and distressing to him. Whether a given behavior is considered a psychological disorder is determined not only by whether a behavior is unusual (e. An intense fear of spiders, for example, would not be considered a psychological disorder unless it has a significant negative impact on the sufferer‘s life, for instance by causing him or her to be unable to step outside the house. The focus on distress and dysfunction means that behaviors that are simply unusual (such as some political, religious, or sexual practices) are not classified as disorders. Put your psychology hat on for a moment and consider the behaviors of the people listed in Table 12. For each, indicate whether you think the behavior is or is not a psychological disorder. If you‘re not sure, what other information would you need to know to be more certain of your diagnosis? Charlie believes that the noises made by cars and planes going by outside his house have secret meanings. He is convinced that he was involved in the start of a nuclear war and that the only way for him to survive is to find the answer to a difficult riddle. She sometimes stays in her pajamas for the whole weekend, eating chocolate and Attributed to Charles Stangor Saylor. He worries about driving on the highway and about severe weather that may come through his neighborhood. But mostly he fears mice, checking under his bed frequently to see if any are present. A worshipper speaking in “tongues‖ at an Evangelical church views himself as “filled‖ with the Holy Spirit and is considered blessed with the gift to speak the “language of angels. Talking to ourselves out loud is unusual and can be a symptom of schizophrenia, but just because we do it once in a while does not mean that there is anything wrong with us. It is natural to be depressed, particularly in the long winter nights, but how severe should this depression be, and how long should it last? If the negative feelings last for an extended time and begin to lead the person to miss work or classes, then they may become symptoms of a mood disorder. It is normal to worry about things, but when does worry turn into a debilitating anxiety disorder? And what about thoughts that seem to be irrational, such as being able to “speak the language of angels‖? Are they indicators of a severe psychological disorder, or part of a normal religious experience? Again, the answer lies in the extent to which they are (or are not) interfering with the individual‘s functioning in society.