By V. Bengerd. Towson University.

The first part will include an overview of ing research method cheap naprosyn 500mg visa, it is important to understand the ethnonursing research method cheap 250 mg naprosyn overnight delivery, which was de- the major philosophical differences between the signed to study the Theory of Culture Care qualitative and quantitative paradigms. The second part will has described qualitative paradigmatic research as present a discussion of the implications of the cul- “characterized by naturalistic and open inquiry ture care theory and related ethnonursing research methods and techniques focused on systematically findings for clinical nursing practice. Many nursing documenting, analyzing, and interpreting attri- theories are rather abstract and do not focus on butes, patterns, characteristics, and meanings of how practicing nurses might use the research find- specific domains and gestaltic (or holistic) features ings related to a theory. However, with the Culture of phenomena under study within designated Care Theory, along with the ethnonursing method, environmental or living contexts” (Leininger, 1997, there is a purposeful built-in means to discover and p. She has described quantitative research as confirm data with informants in order to make “characterized by a focus on an empirical and ob- nursing actions and decisions meaningful and jective analysis of discrete and preselected variables culturally congruent (Leininger, 2002). In viewpoints of human care, well-being, health, and qualitative research there is no control of inform- environmental contexts. The terms emic and etic ant’s ideas or manipulation of data or variables by were important concepts chosen for foci with the the researcher; open inquiry prevails to obtain data ethnonursing method. Ethnonursing focuses directly and naturally from informants in their own largely on the importance of emic (insiders’ or local homes, communities, or other natural environ- peoples’) views but does not neglect etic (the non- mental contexts. In contrast, in quantitative re- local or outsiders’) views to obtain a holistic view. Leininger has stated that the quantitative on their ideas and experiences with care but also and qualitative paradigms should not be mixed, as gathered etic data focused on the professional per- they violate the philosophy, purposes, and integrity spectives of the nursing staff (McFarland, 1997). The ethnonursing method is a The culture care theory has been developed to be unique and essential qualitative method to study congruent with the ethnonursing method and re- caring and healing practices, beliefs, and values in quires the researcher to move into familiar and nat- diverse cultural and environmental contexts and is uralistic people settings to discover human care and a major holistic method specifically designed to fit the related nursing phenomena of health (well- the culture care theory. Purpose and Philosophical Features Domain of Inquiry Leininger developed the ethnonursing research method from a nursing and cultural care perspec- A domain of inquiry is the major focus of the ethno- tive to discover largely unknown phenomena held nursing researcher’s interests. With the ethnonursing understanding and meaning of the people’s daily method, problem statements are not used because a life experiences related to human care, health, and researcher does not know whether there is a people well-being in different or similar environmental problem or more of a researcher’s problem of se- contexts” (Leininger, 1991b, p. The central pur- lected (and possibly biased) views of the people pose of the ethnonursing research method is “to es- (Leininger, 1997). For example, some domains of tablish a naturalistic and largely emic open inquiry inquiry in ethnonursing studies using the culture method to explicate and study nursing phenomena care theory have been: the care meanings and expe- especially related to the Theory of Cultural Care riences of Lebanese Muslims living in the United Diversity and Universality” (Leininger, 1991b, p. The term ethnonursing was purposefully coined the cultural care of elderly Anglo and African for this method. The prefix ethno comes from the American residents within the environmental con- Greek word ethos and refers “to the people,” while text of a long-term care institution (McFarland, the suffix nursing is essential to focus the research 1997); and the care of Mexican American women on the phenomena of nursing, particularly human during pregnancy (Berry, 1999). The ethnonursing research method has philo- Key and general informants are important in the sophical and research features that fit well with the ethnonursing research method. Philosophically, the ethnonurs- this method does not have subjects but works with ing method has been grounded with the people informants. In an ethnonursing study of the culture (Leininger, 1991b) and has supported the discovery care of Anglo and African American elderly resi- of people truths in human living contexts dents of a retirement home, the researcher worked (Leininger, 1988). The formants told the researcher about themselves and sunrise enabler (see Part 1 of this chapter by Dr. Key informants were care- care modes later in this part of the chapter) assists fully and purposefully selected, often by the people and guides the researcher to tease out culture care themselves (e. These informants were most knowledgeable about The observation participation reflection enabler the domain of inquiry and could give details to the guides the nurse researcher to be an active observer nurse researcher. General informants usually are and listener before being a participant in any re- not as fully knowledgeable about the domain of in- search context. They have general helpful to observe informants and their environ- ideas about the domain, however, and can offer mental contexts before and after the researcher be- data from their emic and etic views. This is quite different general informants can reflect on how similar from the traditional participant observation and/or different their ideas are from those of the method used in anthropology, because the process is key informants when asked by the researcher. The stranger to trusted friend enabler is ex- Enablers tremely helpful when a researcher enters and re- In order to discover the peoples’ or insiders’ (in- mains in a strange and unfamiliar environment. Being a trusted friend leads to inform- out ideas from informants in meaningful and nat- ants sharing their cultural secrets and their insights ural ways. For instance, the author used the point that enablers are different from tools, scales, stranger friend enabler to assess her relationship or measurement instruments used in quantita- with elderly residents and the staff in a study of cul- tive studies, which tend to cut off natural flow ture care in a retirement home. Some of the enablers that abler to enter the informant’s world and get close to serve as important guides to obtain data naturalis- the people who were being studied (McFarland, tically and holistically are: Leininger’s observation 1997). Initially the researcher worked with a staff participation reflection enabler (Table 20–1); the nurse while observing and interviewing the in- stranger to trusted friend enabler (Table 20–2); formants for the first few weeks she was at the in- Leininger’s acculturation enabler (Leininger, stitution. The staff nurse was friendly and acted as 1991b); and specific enablers developed by the re- a guide but also watched the researcher and searcher to tap into ideas of informants related to planned her day in a general way. Overview and reflection of the Theory of Culture Care and the Ethnonursing Research Method.

Additional cognitions that predict smoking behaviour include associating smoking with fun and pleasure safe naprosyn 250mg, smoking as a means of calming nerves and smoking as being sociable and building confidence generic naprosyn 500 mg free shipping, all of which have been reported by young smokers (Charlton 1984; Charlton and Blair 1989; see also Chapter 11 for a discussion of smoking and stress reduction). Social predictors of smoking initiation and maintenance Much research focuses on the individual and takes the individual out of their social context. Individual cognitions may predict smoking behaviour but they are a product of the individual’s socialization. Interactions within the individual’s social world help to create and develop a child’s beliefs and behaviour. The main factor that predicts smoking is parental smoking, with reports that children are twice as likely to smoke if their parents smoke (Lader and Matheson 1991). In addition, parents’ attitudes to smoking also influence their offsprings’ behaviour. For example, if a child perceives the parents as being strongly against smoking, he or she is up to seven times less likely to be a smoker (Murray et al. The results showed that individuals who are identified by themselves and others as being problem-prone, doing poorly at school, rarely involved in school sports, high in risk-taking behaviour such as alcohol and drug use, and with low self-esteem were more likely to have smoked (Mosbach and Leventhal 1988; Sussman et al. On the other hand, research has also found that high rates of smoking can also be found in children who are seen as leaders of academic and social activities, have high self-esteem and are regarded as popular by their peers (Mosbach and Leventhal 1988). Another factor that influences whether children smoke is the attitude of their school to smoking behaviour. A Cancer Research Campaign study (1991) found that smoking prevalence was lower in schools that had a ‘no smoking’ policy, particularly if this policy included staff as well as students. In summary, social factors such as the behaviour and beliefs of parents, peers and schools influence the beliefs and behaviours of children. Using an entirely different methodology, Graham used interviews with low income women with pre-school children to explore the contextual factors which may maintain smoking behaviour. She argued that although smoking is seen by researchers as unhealthy and something to be prevented, the women in her study regarded smoking as central to their attempts to ‘reconcile health keeping and housekeeping when their reserves of emotional and physical energy may be seriously depleted’ (Graham 1987: 55). She stated that smoking works to promote these women’s sense of well-being and to help them cope with caring. She reports that smoking can be seen as ‘the only activity they do, just for themselves’. Smoking is therefore a product not only of beliefs but also an individual’s social world. Alcohol initiation and maintenance Most people try alcohol at some time in their lives. The most common reasons for never drinking alcohol were religion and not liking it. Therefore, rather than examining predictors of drinking ‘ever’ or ‘occasionally’, this section examines what factors predict developing a problem with drinking. Psychological predictors of alcohol initiation and maintenance The tension-reduction hypothesis (Cappell and Greeley 1987) suggests that individuals may develop a drink problem because alcohol reduces tension and anxiety. However, it has been suggested that it is not the actual effects of alcohol use that promote drinking but the expected effects (George and Marlatt 1983). Therefore, because a small amount of alcohol may have positive effects people assume that these positive effects will continue with increased use. This perspective is in line with the social learning model of addictive behaviours and emphasizes the role of reinforcement and cognitions. Social predictors of alcohol initiation and maintenance Many of the social factors that relate to smoking behaviour are also predictive of alcohol consumption. According to a disease model of addictions it could be argued that this reflects the genetic predisposition to develop an addictive behaviour. However, parental drinking may be influential through ‘social hereditary factors’, with children being exposed to drinking behaviour and learning this behaviour from their parents (Orford and Velleman 1991). In addition, peer group alcohol use and abuse also predicts drinking behaviour as does being someone who is sensation seeking, with a tendency to be aggressive and having a history of getting into trouble with authority. Johnston and White (2003) used the theory of planned behaviour (see Chapter 2) to predict binge drinking in students. However, given the social nature of binge drinking they focused on the role of norms. Using a longitudinal design, 289 undergraduate students completed a questionnaire concerning their beliefs with follow-up collected about reported binge drinking. The results showed an important role for norms particularly if the norms were of a behaviourally relevant reference group that the student reported a strong identification with. Cessation of an addictive behaviour can be examined in terms of the processes involved in cessation and the interventions designed to motivate individuals to quit their behaviour. The process of cessation Traditionally, smoking cessation was viewed as a dichotomy: an individual either smoked or did not. This perspective was in line with a biomedical model of addictions and emphasized the ‘all or nothing nature’ of smoking behaviour. However, early attempts at promoting total abstinence were relatively unsuccessful and research now often emphasizes cessation as a process.

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Te majority of biological infrared images are formed from details not on the outside of the subject… order naprosyn 250mg with mastercard. Tis feature accounts for the misty appearance of many infra- red refection records generic naprosyn 500 mg line. Rather, it may just mean that the injuries are not such that the incident wavelength of nonvisible light doesn’t “see” the injuries based on the components in the injured skin. It must also be pointed out that even if the techniques work and images are captured, the resultant images may not add to the evidentiary value (Figures 11. The use of multiple photo- graphic modalities failed to increase the forensic/evidentiary value. Sometimes, nonvisible light photography can be used to help determine if the injuries represent human bitemarks or come from another source. In such cases, the use of digital full-spectrum photography benefts the investigator since the resultant images are instantly available for review (Figures 11. Tis chapter has dealt with the photographic techniques that apply to collecting evidence of patterned injuries in skin, primarily human bitemarks. It should be mentioned that these techniques work for other types of injuries in human skin. While this chapter’s authors are forensic odontologists whose area of expertise is bitemark analysis, full-spectrum photographic documen- tation of injuries in skin not made by teeth can also be important and should be pursued by other criminal investigators (Figures 11. The appearance of a bitemark on the back of the left hand of a homicide victim (Figures 11. Te appropriate protocols for evidence management are fully discussed in Chapter 17. Te protocols require accountability as to who had possession of the evidence from the time it was collected until it is marked and introduced into the legal system. It is important to maintain the integrity of the evidence in terms of its original form and reproducibility. Photography is one of the most important tools used in the practice of forensic dentistry. Te demands on the photographer can be great, especially in situations where an injury is the only evidence tying a suspect to the crime. Time, patience, and preparation in forensic photography are requirements for successful pattern injury documentation. Injury to this breast was thought to have been the result of an avulsive bite when viewed in the color photograph (Figure 11. The images show details indicating that a rope had been used to tie the neck of the bound victim to the headrest of an automobile. The details of the rope seen in the photographs indicated that the ligature marks on the neck were not caused by the border of the seat belt, as the defendant had claimed. Developing the skills necessary to competently document these injuries with visible and nonvis- ible light is one of the great challenges in forensic dentistry. Infrared photography, medical and scien- tifc photography: An online resource for doctors, scientists, and students. Tesis for doctor of philosophy, University of London, Oral Pathology, London Hospital Medical College. A theoretical and experimental study of light absorption and scattering by in vivo skin. Recapturing a fve month old bite mark by means of refective ultraviolet photography. Te World Trade Center attack, the Pentagon attack, and the Pennsylvania crash all related to the 9/11 terrorist’s attacks lef the United 245 246 Forensic dentistry States in shock. Te world watched in astonishment as the tsunami of December 26, 2004, wiped out entire cites and islands around the Indian Ocean. Te identifcation process is very important to the family members of the deceased for legal and psychological reasons. Every phase of the identifca- tion process should lead toward an accurate and scientifcally based iden- tifcation. Tose who read this chapter should have the ability to defne a multiple fatality incident and know the types and causes of those incidents. He or she should understand the principles of site management, relationships with other agencies, and the role of the forensic odontologist in the response, including the latest technological advances in imaging and forensic dental identifcation sofware. For instance, a transportation accident in the New York City area with one to two hundred fatalities could be well within the abilities of the local emergency manage- ment system, fre and police departments, and medical examiner. Conversely, in a juris- dictional area in the Midwest with sparse population and limited resources, a multicar accident with twenty fatalities could create a situation that would be beyond the capabilities of the existing system. Tis situation could be termed a mass disaster, and some sort of outside aid would be needed to assist the local responders. Of course, the survivors of a mass disaster are the initial concern of the responders. Once this priority is accomplished, the eforts intensify to locate, identify, and return to their families those victims who did not survive.

An advantage of descriptive research is that it attempts to capture the complexity of everyday behavior order naprosyn 500 mg otc. Case studies provide detailed information about a single person or a small group of people generic naprosyn 250 mg with amex, surveys capture the thoughts or reported behaviors of a large population of people, and naturalistic observation objectively records the behavior of people or animals as it occurs naturally. Thus descriptive research is used to provide a relatively complete understanding of what is currently happening. Despite these advantages, descriptive research has a distinct disadvantage in that, although it allows us to get an idea of what is currently happening, it is usually limited to static pictures. Although descriptions of particular experiences may be interesting, they are not always transferable to other individuals in other situations, nor do they tell us exactly why specific behaviors or events occurred. For instance, descriptions of individuals who have suffered a stressful event, such as a war or an earthquake, can be used to understand the individuals’ reactions to the event but cannot tell us anything about the long-term effects of the stress. And because there is no comparison group that did not experience the stressful situation, we cannot know what these individuals would be like if they hadn’t had the stressful experience. Correlational Research: Seeking Relationships Among Variables In contrast to descriptive research, which is designed primarily to provide static pictures, correlational research involves the measurement of two or more relevant variables and an assessment of the relationship between or among those variables. For instance, the variables of height and weight are systematically related (correlated) because taller people generally weigh more than shorter people. In the same way, study time and memory errors are also related, because the more time a person is given to study a list of words, the fewer errors he or she will Attributed to Charles Stangor Saylor. When there are two variables in the research design, one of them is called the predictor variable and the other the outcome variable. The research design can be visualized like this, where the curved arrow represents the expected correlation between the two variables: Figure 2. A point is plotted for each individual at the intersection of his or her scores for the two variables. When the association between the variables on the scatter plot can be easily approximated with a straight line, as in parts (a) and (b) of Figure 2. When the straight line indicates that individuals who have above-average values for one variable also tend to have above-average values for the other variable, as in part (a), the relationship is said to be positive linear. Examples of positive linear relationships include those between height and weight, between education and income, and between age and mathematical abilities in children. In each case people who score higher on one of the variables also tend to score higher on the other variable. Negative linear relationships, in contrast, as shown in part (b), occur when above-average values for one variable tend to be associated with below-average values for the other variable. Examples of negative linear relationships include those between the age of a child and the number of diapers the child uses, and between practice on and errors made on a learning Attributed to Charles Stangor Saylor. In these cases people who score higher on one of the variables tend to score lower on the other variable. Relationships between variables that cannot be described with a straight line are known as nonlinear relationships. In this case there is no relationship at all between the two variables, and they are said to be independent. For instance, part (d) shows the type of relationship that frequently occurs between anxiety and performance. Increases in anxiety from low to moderate levels are associated with performance increases, whereas increases in anxiety from moderate to high levels are associated with decreases in performance. Relationships that change in direction and thus are not described by a single straight line are called curvilinear relationships. Note that the Pearson correlation coefficient (r) between variables that have curvilinear relationships will likely be close to zero. The most common statistical measure of the strength of linear relationships among variables is the Pearson correlation coefficient, which is symbolized by the letter r. The direction of the linear relationship is indicated by the sign of the correlation coefficient. The strength of the linear relationship is indexed by the distance of the correlation coefficient from zero (its absolute value). Because the Pearson correlation coefficient only measures linear relationships, variables that have curvilinear relationships are not well described by r, and the observed correlation will be close to zero. It is also possible to study relationships among more than two measures at the same time. A research design in which more than one predictor variable is used to predict a single outcome variable is analyzed through multiple regression(Aiken & West, [6] 1991). Multiple regression is a statistical technique, based on correlation coefficients among variables, that allows predicting a single outcome variable from more than one predictor variable. The use of multiple regression analysis shows an important advantage of correlational research designs—they can be used to make predictions about a person’s likely score on an outcome variable (e. An important limitation of correlational research designs is that they cannot be used to draw conclusions about the causal relationships among the measured variables. Consider, for instance, a researcher who has hypothesized that viewing violent behavior will cause increased aggressive play in children.

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