V. Gorn. Coastal Carolina University.

Also included are various profes- in Table 4–1 dutas 0.5mg low cost, which provides links directly to sional services and discussion forums with lists of each theorist’s Web site buy dutas 0.5mg without a prescription. Comprehensive bibliographies: compiled within anthologies of nursing theories, such as in the one you are now reading. You enter a word search for nursing A Search Example theory and are dismayed to discover thousands of articles through which you would need to sift. You discover that nursing theory meta-sites provide links to the majority of • clarify and adjust your expectations, nursing theory home pages and begin your journey • clarify and adjust your needs, and through each home page. Although some sites are There is little to show for your efforts except ex- exciting to visit, the information is less substantive, perience and rapidly accumulating wisdom. You less scholarly, or less specific on some nursing decide that in addition to gaining more experience theorist Web sites than on others. Given the multi- in literature searches, you need a way to distinguish tude of Web sites, you wonder how you can distin- credible and authoritative resources and to flexibly guish which sites are the most valuable sources of evaluate nursing theory resources across several information in the electronic domain. Choose as an exemplar for evaluation a Web site from a theorist in one of the Evaluation of nursing theory resources is chapters of this book. Begin evaluating this nursing of major importance in laying groundwork theorist’s Web site and as you thoughtfully consider for consistent, credible, and authoritative each question, assess whether or not the informa- research findings. Yes/No Who are authoritative sources who speak, write about, and Nursing authorities contribute to content. Are they contributors to the content on Practitioners of nursing contribute to the content. Yes/No What are the professional qualifications of these contribu- Other organizations use, refer to, or maintain links to tors? Evaluation of Authority: What are other major resources on this theory that are au- Acceptable/Not Acceptable thoritative? Information covers theory, practice, research, and Do authoritative sources show their credentials on the Web administration. Yes/No Does the resource provide information in a logical and easily Bibliography included. Evaluation of Content: Does the resource provide comprehensive, substantiated in- formation? Acceptable/Not Acceptable Does the information cover nursing research, administration, and education? Are you able to The Web site/resource is easy to use and well or- contact the webmaster from an onsite address? Yes/No Are you informed when you are seamlessly transferred to an- The Web site/resource is satisfying to visit. Are there fees or membership required to access the infor- Yes/No mation you need? This nursing theory resource will ground my inquiry as a credible, authoritative, and accurate source of information. Yes/No Reservations: ____________________________________________________________________________________ questions may not apply to all Web sites and may be • How comprehensive do you intend your analy- modified by the purpose of the Web site. Following are key reflective preparations that will When you have answered as many questions as help focus your activities: you are able to, synthesize your findings. White paper: Criteria for assessing the accuracy, credibility, currency, and trust- quality of health information on the Internet (working draft). Nursing decision making and the science of the Bartlett Publishers and National League for Nursing. The Nightingales Florence Nightingale transformed a “calling from were on an extended European tour, begun in 1818 God” and an intense spirituality into a new social shortly after their marriage. A reflection on this statement A legacy of humanism, liberal thinking, and love appears in a well-known quote from Notes on of speculative thought was bequeathed to Nursing (1859/1992): “Nature [i. His views on the educa- tion of God] alone cures … what nursing has to tion of women were far ahead of his time. Florence and her sis- Although Nightingale never defined human care or ter studied music; grammar; composition; modern caring in Notes on Nursing, there is no doubt that languages; Ancient Greek and Latin; constitutional her life in nursing exemplified and personified an history and Roman, Italian, German, and Turkish ethos of caring. It is model is yet to truly come of age in nursing or the Parthenope, the older sister, who clutches her fa- health care system. Justice- making is understood as a manifestation of com- passion and caring,“for it is our actions that brings about justice” (p. This chapter reiterates Nightingale’s life from the years 1820 to 1860, delineating the formative influences on her thinking and providing historical context for her ideas about nursing as we recall them today. Part of what follows is a well-known tale; yet it remains a tale that is irresistible, casting an age-old spell on the reader, like the flickering shadow of Nightingale and her famous lamp in the dark and dreary halls of the Barrack Hospital, Scutari, on the outskirts of Constantinople, circa 1854 to 1856. Early Life and Education A profession, a trade, a necessary occupation, some- thing to fill and employ all my faculties, I have always felt essential to me, I have always longed for, con- sciouslyornot....

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Lactulose decreases the serum ammonia level and is useful in liver diseases such as cirrhosis purchase dutas 0.5mg without a prescription. Glycerin acts like lactulose by increasing water in the feces in the large intestine 0.5mg dutas. The bulk that results from the increased water in the feces stimulates peristalsis and defecation. Patients who have diabetes mellitus should avoid lactulose because it contains glucose and fructose. Hypermagnesemia can result from continuous use of magnesium salts, causing symptoms such as drowsiness, weakness, paralysis, complete heart block, hypotension, flushing, and respiratory depression. Side effects from excess use are flatulence, diarrhea, abdominal cramps, nausea, and vomiting. Stimulants (contact or irritants) Stimulant laxatives increase peristalsis by irritating sensory nerve endings in the intestinal mucosa. Bisacodyl and phenolphthalein are two of the most frequently used and abused laxatives because they can be purchased over- the-counter. However, a small amount of bisacodyl absorption excreted in the urine changes the color to reddish-brown. With excessive use, fluid and electrolyte imbalances can occur (especially potassium and calcium). Caster oil is a harsh laxative (purgative) that acts on the small bowel and produces a watery stool within 2 to 6 hours. Caster oil is used mainly for bowel preparation and seldom used to correct constipation. Caster oil should not be used in early pregnancy because it stimulates uterine contractions and spontaneous abortion can occur. Prolonged use of Caster oil can damage nerves resulting in loss of intestinal muscular tone. Bulk-forming Bulk-forming laxatives are natural fibrous substances that promote large, soft stools by absorbing water into the intestines and increasing fecal bulk and peri- stalsis. Defecation usually occurs within 8 to 24 hours but can take up to 3 days after the start of therapy for the stool to become soft and formed. Powdered bulk-forming laxatives come in flavored and sugar-free prepara- tions and should be mixed in a glass of water or juice, stirred. The patient should drink it immediately, followed by a half to a full glass of water. Bulk-forming laxatives do not cause dependence and may be used by patients with diverticulosis, irritable bowel syndrome, ileostomy and colostomy. Calcium polycarbophil (FiberCon), methylcellulose (Citrucel), fiber granules (Perdiem), and psyllium hydrophilic mucilloid (Metamucil) are examples of bulk-forming laxatives. Patients with hypercalcemia should avoid calcium poly- carbophil because of the calcium in the drug. Metamucil is a nondigestible and nonabsorbent substance that when mixed with water, becomes a viscous solu- tion. Emollients are frequently prescribed for patients after a myocardial infarction (heart attack) or surgery and are also given prior to administration of other laxa- tives in treating fecal impaction. Docusate calcium (Surfak), docusate potassium (Dialose), docusate sodium (Colace), and docusate sodium with casanthranol (Peri-Colace) are examples of stool softeners. They are not indicated for children, the elderly, or patients with debilitating conditions because they can aspirate the mineral oil, resulting in lipid pneumonia. Duodenal ulcers (the first part of the small intestine) are more common than other types of peptic ulcers. Most ulcers are caused by an infection with the bac- terium Helicobacter pylori—not spicy food, acid, or stress—and can be cured with antibiotics in about two weeks. The most common ulcer symptom is burn- ing pain in the stomach: 1/2–11/2 hours after eating with gastric ulcers; 2–3 hours for a duodenal ulcer. The two sphincter muscles— cardiac and pyloric—act as barriers to prevent reflux of acid into the esophagus and the duodenum. Esophageal ulcers result from reflux of acidic gastric secretion into the esophagus as a result of a defective or incompetent cardiac sphincter. Duodenal ulcers are caused by hypersecretion of acid from the stomach that passes to the duodenum because of • insufficient buffers to neutralize the gastric acid in the stomach. Treatment of peptic ulcers is given in two-drug, three-drug, and four-drug regimens, or a combination medication consisting of multiple drugs combined into one package. However, the American College of Gastroenterology no longer recommends two-drug regimens since they are not as effective as other treatment regimens. These are: Tranquilizers Tranquilizers have minimal effect preventing and treating ulcers. Librax is a combination of the anxiolytic chlor- diazepoxide (Librium) and the anticholineratic clidinium (Quarzan) and is used in the treatment of ulcers. Anticholinergics delay gastric emptying time and are used frequently to treat duodenal ulcers.

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Freud argued that this condition was an indication of the individual’s state of mind and that repressed experiences and feelings were expressed in terms of a physical problem buy dutas 0.5 mg low price. This explanation indicated an interaction between mind and body and suggested that psychological factors may not only be consequences of illness but may contribute to its cause cheap dutas 0.5 mg line. Behavioural health Behavioural health again challenged the biomedical assumptions of a separation of mind and body. Behavioural health was described as being concerned with the main- tenance of health and prevention of illness in currently healthy individuals through the use of educational inputs to change behaviour and lifestyle. The role of behaviour in determining the individual’s health status indicates an integration of the mind and body. Behavioural medicine A further discipline that challenged the biomedical model of health was behavioural medicine, which has been described by Schwartz and Weiss (1977) as being an amalgam of elements from the behavioural science disciplines (psychology, sociology, health edu- cation) and which focuses on health care, treatment and illness prevention. Behavioural medicine was also described by Pomerleau and Brady (1979) as consisting of methods derived from the experimental analysis of behaviour, such as behaviour therapy and behaviour modification, and involved in the evaluation, treatment and prevention of physical disease or physiological dysfunction (e. Behavioural medicine therefore included psychology in the study of health and departed from traditional biomedical views of health by not only focusing on treatment, but also focusing on prevention and intervention. In addition, behavioural medicine challenged the traditional separation of the mind and the body. Health psychology Health psychology is probably the most recent development in this process of including psychology into an understanding of health. It was described by Matarazzo as the aggregate of the specific educational, scientific and professional contribution of the discipline of psychology to the promotion and maintenance of health, the promotion and treatment of illness and related dysfunction. Health psychology can be understood in terms of the same questions that were asked of the biomedical model: s What causes illness? Health psychology suggests that human beings should be seen as complex systems and that illness is caused by a multitude of factors and not by a single causal factor. Health psychology therefore attempts to move away from a simple linear model of health and claims that illness can be caused by a combination of biological (e. This approach reflects the biopsychosocial model of health and illness, which was developed by Engel (1977, 1980) and is illustrated in Figure 1. The biopsychosocial model represented an attempt to integrate the psychological (the ‘psycho’) and the environmental (the ‘social’) into the traditional biomedical (the ‘bio’) model of health as follows: (1) The bio contributing factors included genetics, viruses, bacteria and structural defects. Because illness is regarded as a result of a combination of factors, the individual is no longer simply seen as a passive victim. For example, the recognition of a role for behaviour in the cause of illness means that the individual may be held responsible for their health and illness. According to health psychology, the whole person should be treated, not just the physical changes that have taken place. This can take the form of behaviour change, encouraging changes in beliefs and coping strategies and compliance with medical recommendations. Because the whole person is treated, not just their physical illness, the patient is therefore in part responsible for their treatment. This may take the form of responsibility to take medication, responsibility to change beliefs and behaviour. From this perspective, health and illness are not qualitatively different, but exist on a continuum. Rather than being either healthy or ill, individuals progress along this continuum from healthiness to illness and back again. The twentieth century has seen a challenge to the traditional separation of mind and body suggested by a dualistic model of health and illness, with an increasing focus on an interaction between the mind and the body. This shift in perspective is reflected in the development of a holistic or a whole person approach to health. However, although this represents a departure from the traditional medical perspective, in that these two entities are seen as influencing each other, they are still categorized as separate – the existence of two different terms (the mind/the body) suggests a degree of separation and ‘interaction’ can only occur between distinct structures. Health psychology regards psycho- logical factors not only as possible consequences of illness but as contributing to its aetiology. Health Psychologists considers both a direct and indirect association between psychology and health. The direct pathway is reflected in the physiological literature and is illustrated by research exploring the impact of stress on illnesses such as coronary heart disease and cancer. From this perspective the way a person experiences their life (‘I am feeling stressed’) has a direct impact upon their body which can change their health status. The indirect pathway is reflected more in the behavioural literature and is illustrated by research exploring smoking, diet, exercise and sexual behaviour. From this perspective, the ways a person thinks (‘I am feeling stressed’) influences their behaviour (‘I will have a cigarette’) which in turn can impact upon their health. Health psychology emphasizes the role of psychological factors in the cause, progression and consequences of health and illness. The aims of health psychology can be divided into (1) understanding, explaining, developing and testing theory and (2) putting this theory into practice.

How- bladder purchase dutas 0.5mg mastercard, an irritable bladder buy generic dutas 0.5mg line, and inflammation or ever, saunas should not be taken by individuals infection of the prostate or enhance preparation for who have acute rheumatoid arthritis, acute infec- pregnancy. Do not use warm or rising-temperature tion, active tuberculosis, sexually transmitted dis- sitz baths for hemorrhoids. To prevent ill effects of excessive should be in a relaxed position while a linen cloth heat, wipe your face often with a cold cloth and stay moistened with cold water (warm water for respi- in the sauna no longer than 15 to 20 minutes. The moist linen cloth hyperthermia Various types of heat treatment is in turn wrapped with a dry cotton or linen cloth. If the wrap does not feel warm after 15 min- types of heat treatments are superficial and deep. Superficial heat treatments involve applying heat If the patient feels ill or uncomfortable, the wrap topically—to the outside of the body. Various wraps treatments through ultrasound or electric current include neck (for sore throat), chest (for neuralgia direct heat toward specific inner tissues and struc- and upper respiratory disease), body from the tures. Heat treatments are beneficial before exer- costal arch to the pubic bone (for inflammatory dis- cise, when warming the soft tissues makes muscles eases, ulcers, fever, cramps), trunk (for high fever), more flexible and prevents the possibility of injury hip (for prostatitis, vaginitis, hemorrhoids, anal to “cold” muscles. Different ways to convey heat eczema, inflammation in the pelvic cavity), calf (for include conduction—the transfer of heat from one lymphostasis, edema, withdrawal of heat in fever object to another, with objects in direct contact and phlebitis; in varicose veins the effect can some- with each other; conversion—turning another times be amplified by applying earth or loam poul- form of energy into heat; radiation—the transmis- stices), and joint wrap (for rheumatoid arthritis and sion and absorption of electromagnetic waves to arthrosis). Alternatively, the wrap may receive heat packs are readily available in hospitals, walk-in a coating of hot mud mustard flour, or fango. As a medical care centers, physical therapy centers, further alternative, hayseed may be placed in a sports training facilities, and elsewhere. This wrap may aid the treatment apeutic temperature not exceeding 131°F (55°C), of painful chronic diseases such as arthrosis, renal the hot pack is placed over several layers of towels disease, or cystitis and may stimulate blood flow. For a cool commercially prepared hot packs may be warmed wrap, cooled cataplasm is spread onto the wrap- in a microwave before being applied to the patient. Hot-water bottles have long provided superficial Crushed ice in a plastic bag may also be repeatedly heat treatment. When using protective cloth or pad, the hot-water bottle is ice packs, place a thin cloth between the pack and placed on the treatment area until the water has the skin to prevent frostbite. Electric heating pads may also be used, cation of cold is not indicated for individuals who although safety issues are to be considered. Melted paraffin wax containing mineral oil con- General hydration of the entire body—a ducts superficial heat and is often the topical heat response to thirst and loss of water through elimi- treatment of choice for uneven surfaces such as the nation and perspiration—is extremely important. Paraffin placed in a small bath unit solidifies Experts suggest drinking eight glasses of water per at room temperature and is used as a liquid heat day. In what is commonly known as the “dip and wax 62 hypnotherapy method,” the patient dips a hand or other body area. The drum has a wire coil surrounded by dead part eight to 12 times into the paraffin. The hand is space and other insulators such as a plastic hous- then covered with a plastic bag and a towel for ing. Several layers of towels are placed between the insulation for approximately 20 minutes. This device works on the Hydrotherapy, a heat treatment involving sub- premise of a magnetic field’s effect on connective mersion in water, is prescribed for many muscu- tissues. Hydrotherapy tanks and pools other heat treatments is that although fat resists an are generally set at warm temperatures up to 150°F electrical field, it does not resist a magnetic field. Because the patient may perform resis- Diathermy is reported to be helpful to individuals tance exercises while in the water, higher temper- with chronic low back pain and muscle spasms. Because of this, many assessed to prevent burns and other injury, and the hydrotherapy baths are now being set at 95–110°F skin over the affected area should be clean. There are also units available with heat treatment, symptoms of dizziness and nausea, movable turbine jets, which provide a light mas- local irritation, or discoloration should be charted. Some people find that a brief dip in a hot tub Treatments should be administered at least one or spa before exercise is beneficial as a warmup. Any heat Fluidotherapy was developed in the 1970s as a treatment may cause damage if there are excessive dry-heat modality consisting of cellulose particles temperatures or improper insulation or treatment suspended in air. Overexposure to heat may cause redness, ent sizes, and some are restricted to treating only a blisters, burns, or reduced blood circulation, and in hand or foot. The turbulence of the gas-solid mix- ultrasound therapy, excessive heat over bony areas ture provides heat to objects immersed in the with little soft tissue (such as hands, feet, and medium. Temperatures of this treatment range elbows) may cause pain and possible tissue dam- from 110°F to 123°F (43. Exposure to the electrode drum during ing and increasing the flow of blood to the limb, diathermy may produce hot spots.

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