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By U. Tangach. Jones International University.
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 order ibuprofen 400 mg with amex pain treatment for dogs with cancer. The practi- is “to keep together 600mg ibuprofen with visa west valley pain treatment center az,” 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. Support the integrated healing and optimal and ultimately fails for lack of fail-safe options— restoration of structure and function [by sup- either those that the patient possesses (e. Provide support for a failing autoregulatory between the external and the internal envi- portion of the integrated system (e. Provide supportive measures to assure comfort tant that we understand the changes that and promote human concern when therapeutic occur and how the person who adapted measures are not possible (e. Balance a toxic risk against the threat of disease order to maintain balance or integrity. With an improved repertoire of or- bolic imbalances and to stimulate physiological ganismic responses, we can test how to pre- processes (e. Reinforce or antagonize usual response to create said with the understanding that nurses rec- a therapeutic change (e. The theorist offers a fresh vision, famil- provide interventions for communities that iar concepts brought together in bold, new de- suffer from environmental disasters. Thetheorist and poet seek excitement sessment of the internal environment’s re- in the sudden insights that make ordinary ex- sponse to the challenge of the external perience extraordinary, but theory caught in environment (e. An assessment of the external environment will provide an understanding of the changes occurring due to the assault References on the internal environment and a more Alligood, M. Models and theories: Critical thinking detailed assessment of the perceptive, organ- structures. Nursing theory: Analysis, application, this approach to describing, defining, and evaluation (4th ed. Clinical nursing: Pathophysiological and psy- organismic challenges that may not be imme- chological implications (2nd ed. Skin care strategies in a agenda and perhaps design public policy skilled nursing home. Journal of Gerontological Nursing, that might improve interventions in the con- 20(11), 28–34.
He xi xii the editors taught in the forensic odontology course at the Armed Forces Institute of Pathology from 1968 until 1998 generic 400mg ibuprofen sacroiliac pain treatment uk. He was one of the founding fathers of the American Society of Forensic Odontology and has held every ofce in that organization in the earlier years of the society discount 600 mg ibuprofen midwest pain treatment center wausau. He has held every ofce in that organization and has served on various study groups and committees. He is a registered emeritus diplomate of the American Board of Oral and Maxillofacial Pathol- ogy and an active diplomate of the American Board of Forensic Odontology. Frost Division of Oral and Maxillofacial Chief Medical Examiner Pathology Bexar County Medical Examiner’s Ofce College of Dentistry San Antonio, Texas University of Tennessee Memphis, Tennessee Harrell Gill-King Center for Human Identifcation Robert E. Golden New Orleans Forensic Center Deputy Coroner Orleans Parish Coroner Chief Forensic Odontologist New Orleans, Louisiana County of San Bernardino San Bernardino, California Paula C. Harris University of Texas Health Science Center at Professor San Antonio Department of Orthodontics and San Antonio, Texas Department of Pediatric Dentistry College of Dentistry Bryan Chrz University of Tennessee Consultant to the Ofce of the Chief Memphis, Tennessee Medical Examiner State of Oklahoma John D. David Biological Sciences Forensic Odontology Consultant Director Oral Medicine and Forensic Sciences Georgia Bureau of Investigation University of Colorado School of Division of Forensic Sciences Dental Medicine Atlanta, Georgia Aurora, Colorado xiii xiv the Contributors Harry H. Souviron County Medical Examiner Chief Forensic Odontologist Memphis, Tennessee Miami-Dade Medical Examiner Department D. Kimberley Molina Miami, Florida Deputy Chief Medical Examiner Bexar County Medical Examiner’s Ofce Paul G. Pitluck University of Texas Dental Branch Circuit Court Judge, Retired Houston, Texas 19th Judicial Circuit and State of Illinois Forensic Dental Consultant, Chief Crystal Lake, Illinois Odontologist Harris County Medical Examiner Christopher J. Plourd Houston, Texas Certifed Criminal Law Specialist Forensic Evidence Consultant David Sweet O. Schrader Professor Forensic Odontology Consultant Faculty of Dentistry Travis County Medical Examiner University of British Columbia Austin, Texas Vancouver, British Columbia, Canada and Bexar County Medical Examiner’s Ofce Michael P. Tabor San Antonio, Texas Chief Forensic Odontologist and Davidson County Clinical Instructor-Fellowship in Forensic State of Tennessee Odontology Nashville, Tennessee University of Texas Health Science Center at San Antonio Aaron J. Senn Latent Print Support Unit Director Federal Bureau of Investigation Laboratory Center for Education and Research in Quantico, Virginia Forensics University of Texas Health Science Center at Richard A. Weems San Antonio University of Alabama School of Dentistry San Antonio, Texas Forensic Odontologist Consultant and Alabama Department of Forensic Sciences Chief Forensic Odontologist and Bexar County Medical Examiner’s Ofce Jeferson County Chief Medical Examiner San Antonio, Texas Birmingham, Alabama the Contributors xv Franklin D. Wright Forensic Odontology Consultant Hamilton County Coroner’s Ofce Cincinnati, Ohio Science, the Law, and Forensic 1 Identifcation Christopher J. However, it is also mis- understood due to Hollywood’s resolve to complete every case within the context of a one-hour, commercials included, pseudo-real-life crime drama. When the actual real-life judicial system needs science to resolve a question, the person who is called upon to bring science into the courtroom is ofen a forensic scientist. Science is an empirical method of learning, anchored to the principles of observation and discovery as to how the natural world works. Scientifc knowledge increases human understanding by developing experiments that provide the scientist with an objective answer to the question presented. Trough the scientifc method of study, a scientist systematically observes physical evidence and methodically records the data that support the scientifc process. Te law, on the other hand, starts out with at least two competing parties with markedly diferent views who use the courthouse as a battleground to resolve factual issues within the context of constitutional, statutory, and decisional law. Science meets the law only to the extent that the legal system must look to science to help resolve a legal dispute. Scientists in today’s world no longer maintain the fction that all science is equal. Te fundamental paradigm of the judicial system in America is that science is an open process, collegial in nature, unlike the legal system, which is adversarial in nature and legal strategies are developed in secret. With a scientist, the objective of the scientifc endeavor is to reach a correct result that will withstand scrutiny from fellow scientists who can review the methodology and examine the data. Science is premised upon observable phenomena, logical deductions, and inferences that are transparent and open to scrutiny. Te inherently conficting underpinnings between science and the law frequently make forensic science controversial and the courthouse an open arena in which forensic scientists are used as pawns in the resolution of legal disputes. To complicate the legal process, each of the nonscientist par- ties has an interest in the outcome, be it signifcant sums of money, personal freedom, or even life itself in cases involving the death penalty. At the center of legal cases there sits a person who wears a long black robe to whom we refer as a judge. Te judge’s job, usually with the help of a jury, is to keep the adversarial parties at bay long enough to accomplish the orderly resolution of the factual questions raised by the warring litigants using applicable law.
Symptoms include nausea order ibuprofen 600mg on line pain treatment center richmond ky, diarrhoea order ibuprofen 400 mg line pain treatment center dover de, vomiting, stomach cramps, burning of the throat, headaches and dizziness. Other adverse reactions, in more severe cases, include hallucinations, loss of sensation, paralysis, fever, jaundice, dilated pupils and hypothermia. The toxicities of samandarin include muscle convulsions, raised blood pressure and hyperventilation. Betaine itself is used to treat high homocysteine levels, and sometimes as a mood enhancer. It causes profound activation of the peripheral parasympathetic nervous system, which may result in convulsions and death. Muscarine mimics the action of the neurotransmitter acetylcholine at the muscarinic acetylcholine receptors. Macrocyclic alkaloids This group of alkaloids possess a macrocycle, and in most cases nitrogen is a part of the ring system. Acanthaceae, Scrophulariaceae, Leguminosae, Ephedraceae and possess various biological properties, for example budmunchiamines L4 and L5, two antimalarial spermine alkaloids isolated from Albizia adinoce- phala (Leguminosae). In this test the alkaloids are mixed with a tiny amount of potassium chlorate and a drop of hydrochloric acid and evaporated to dryness, and the resulting residue is exposed to ammonia vapour. Eating a high carbohydrate diet will ensure maintenance of muscle and liver glyco- gen (storage forms of carbohydrate), improve performance and delay fatigue. Thus, carbohy- drates are a group of polyhydroxy aldehydes, ketones or acids or their derivatives, together with linear and cyclic polyols. Most of these com- pounds are in the form CnH2nOn or Cn(H2O)n, for example glucose, C6H12O6 or C6(H2O)6. Monosaccharides These carbohydrates, commonly referred to as ‘sugars’, contain from three to nine carbon atoms. Most common mono- saccharides in nature possess five (pentose,C 5H10O5) or six (hexose, C6H12O6) carbon atoms. For example, glucose, a six-carbon-containing sugar, is the most common monosaccharide that is metabolized in our body to provide energy, and fructose is also a hexose found in many fruits. Di-, tri- and tetrasaccharides These carbohydrates are dimers, trimers and tetramers of monosaccharides, and are formed from two, three or four monosaccharide molecules, with the elimination of one, two or three molecules of water. For example, sucrose is a disaccharide composed of two monosaccharides, glucose and fructose. Oligosaccharides The name ‘oligosaccharide’ refers to saccharides con- taining two to 10 monosaccharides. Polysaccharides Polysaccharides are composed of a huge number of monosaccharide units, and the number forming the molecule is often approximately known. For example, cellulose and starch are polysacchar- ides composed of hundreds of glucose units. Classification of monosaccharides according to functional groups and carbon numbers The two most common functional groups found in monosaccharides (in open chain form) are aldehyde and ketone. Sometimes, monosaccharides are classified more precisely to denote the functional group as well as the number of carbon atoms. For example, glucose can be classified as an aldohexose, as it contains six carbon atoms as well as an aldehyde group. If any monosaccharide lacks the usual numbers of hydroxyl groups, it is often called a deoxy sugar. For example, 2-amino-2- deoxy-D-glucose, also known as glucosamine, is an amino sugar, and glucuronic acid is a sugar acid. It can be noted that D- and L-notations have no relation to the direction in which a given sugar rotates the plane-polarized light i. In Fischer projections, most natural sugars have the hydroxyl group at the highest numbered chiral carbon pointing to the right. In Fischer projections, L-sugars have the hydroxyl group at the highest numbered chiral carbon pointing to the left. When a sample of either pure anomer is dissolved in water, its optical rotation slowly changes and ultimately reaches a constant value of þ 52. Both anomers, in solution, reach an equilibrium with fixed amounts of a (35 per cent), b (64 per cent) and open chain ($1 per cent) forms. For example, the anomeric carbon (C-1) in glucose is a hemiacetal, and that in fructose is a hemiketal. Only hemi-acetals and hemiketals can exist in equilibrium with an open chain form.
Self-reports Self-report scales of pain rely on the individuals’ own subjective view of their pain level buy 600mg ibuprofen with amex pain medication for dogs after acl surgery. Describe your pain: no pain proven ibuprofen 400 mg knee pain treatment ligament, mild pain, moderate pain, severe pain, worst pain) and descriptive questionnaires (e. Some self-report measures also attempt to access the impact that the pain is having upon the individuals’ level of functioning and ask whether the pain influences the individuals’ ability to do daily tasks such as walking, sitting and climbing stairs. Observational assessment Observational assessments attempt to make a more objective assessment of pain and are used when the patients’ own self-reports are considered unreliable or when they are unable to provide them. For example, observational measures would be used for children, some stroke sufferers and some terminally ill patients. Observational measures include an assessment of the pain relief requested and used, pain behaviours (such as limping, grimacing and muscle tension) and time spent sleeping and/or resting. Physiological measures Both self-report measures and observational measures are sometimes regarded as unreliable if a supposedly ‘objective’ measure of pain is required. In particular, self- report measures are open to the bias of the individual in pain and observational measures are open to errors made by the observer. Such measures include an assess- ment of inflammation and measures of sweating, heart rate and skin temperature. However, the relationship between physiological measures and both observational and self-report measures is often contradictory, raising the question ‘Are the indi- vidual and the rater mistaken or are the physiological measurements not measuring pain? However, the gate control theory, developed in the 1960s and 1970s by Melzack and Wall, included psychological factors. As a result, pain was no longer understood as a sensation but as an active perception. Due to this inclusion of psychological factors into pain perception, research has examined the role of factors such as learning, anxiety, fear, catastrophizing, meaning, attention and pain behaviour in either decreasing or exacerbating pain. As psychological factors appeared to have a role to play in eliciting pain perception, multi- disciplinary pain clinics have been set up to use psychological factors in its treatment. Recently, researchers have suggested a role for pain acceptance as a useful outcome measure and some research indicates that acceptance, rather than coping might be a better predictor of adjustment to pain and changes following treatment. Early models of pain regarded the physical aspects of pain as ‘real’ and categorized pain as either ‘organic’ or ‘psychogenic’. Such models con- ceptualized the mind and body as separate and conform to a dualistic model of individuals. Recent models of pain have attempted to integrate the mind and the body by examining pain as a perception that is influenced by a multitude of different factors. However, even within these models the mind and the body are still regarded as separate. It is often assumed that changes in theoretical perspective over time represents improvement with the recent theories reflecting a better approximation to the truth of ‘what pain really is’. However, perhaps these different theories can also be used themselves as data to show how psychologists have thought in the past and how they now think about individuals. For example, in the past pain was seen as a passive response to external stimuli; therefore, individuals were seen as passive responders. However, today pain is increasingly seen as a response to the individual’s self-control – pain is a sign of either successful or failed self-control. Therefore, contemporary individuals are seen as having self-control, self-management and self-mastery. Perhaps the different theories over time reflect different (not necessarily better) versions of individuality. This book provides a comprehensive and critical overview of the complex area of pain assessment. This edited collection provides a detailed account of contemporary approaches to treating pain. This edited collection provides an excellent overview of how pain can be measured and the problems inherent within pain assessment. This paper examines how theories of pain perception can be used to reduce the pain experience. This chapter examines problems with defining placebos and then assesses the different theories concerning how they work, highlighting the central role for patient expectations. It then outlines the implications of placebos for the different areas of health psychology discussed in the rest of this book, such as health beliefs and illness cognitions, health behaviours, stress, pain and illness and places this within a discussion of the relationship between the mind and body and the interrelationship between beliefs, behaviour and health and illness.
Science is an empirical method of learning generic ibuprofen 400mg without a prescription shoulder pain treatment guidelines, anchored to the principles of observation and discovery as to how the natural world works purchase ibuprofen 400 mg on line innovative pain treatment surgery center of temecula. Scientifc knowledge increases human understanding by developing experiments that provide the scientist with an objective answer to the question presented. Trough the scientifc method of study, a scientist systematically observes physical evidence and methodically records the data that support the scientifc process. Te law, on the other hand, starts out with at least two competing parties with markedly diferent views who use the courthouse as a battleground to resolve factual issues within the context of constitutional, statutory, and decisional law. Science meets the law only to the extent that the legal system must look to science to help resolve a legal dispute. Scientists in today’s world no longer maintain the fction that all science is equal. Te fundamental paradigm of the judicial system in America is that science is an open process, collegial in nature, unlike the legal system, which is adversarial in nature and legal strategies are developed in secret. With a scientist, the objective of the scientifc endeavor is to reach a correct result that will withstand scrutiny from fellow scientists who can review the methodology and examine the data. Science is premised upon observable phenomena, logical deductions, and inferences that are transparent and open to scrutiny. Te inherently conficting underpinnings between science and the law frequently make forensic science controversial and the courthouse an open arena in which forensic scientists are used as pawns in the resolution of legal disputes. To complicate the legal process, each of the nonscientist par- ties has an interest in the outcome, be it signifcant sums of money, personal freedom, or even life itself in cases involving the death penalty. At the center of legal cases there sits a person who wears a long black robe to whom we refer as a judge. Te judge’s job, usually with the help of a jury, is to keep the adversarial parties at bay long enough to accomplish the orderly resolution of the factual questions raised by the warring litigants using applicable law. Te logic of the legal system is further complicated for the forensic scientist because ofen conficting forensic scientifc evidence that is generated by the opposing parties is ultimately submitted to the review and decision of twelve citizens, known as a trial jury. Te most common question asked by the legal system of a forensic sci- entist is a request to provide proof of identity of an item or person, which is a component of criminalistics. Tis area of forensic science involves the asso- ciation of an evidentiary item that is typically related to a crime. A forensic identifcation has two essential steps: Te frst step is a comparison between an unknown evidentiary item and a known item and having the forensic scientist render a judgment as to whether there is a sufcient concordance to say there is a “match. Te second part to the identifcation analysis should give some meaning to the concordance (match) by provid- ing a scientifc statement that would allow the trier of fact, a judge or jury, to weigh the signifcance of the matching association and answer a simple ques- tion for the beneft of the trier of fact: What does “match” mean? A forensic investigation requires a skillful blend of science using both proven techniques and common sense. Te ultimate efectiveness of the scien- tifc investigation depends upon the ability of the forensic scientist to apply the scientifc method to reach a valid, reliable, and supportable conclusion about a question in controversy. Overall, science and the law must coexist within the framework of our judicial system, although each discipline may and ofen does have conficting and competing interests. Any expert who is interested in the practice of a forensic science specialty must have a clear understanding not only of the fundamental principles of science, and presumably his or her chosen feld, but also of the applicable legal standards relating to that area of forensic science; they must know quite a lot about that area of the law. Every forensic scientist who is called into court to give the results of his or her study must frst be qualifed as an expert witness. A witness qualifes as an expert by reason of “knowledge, skill, experience, training, or education. Before a judge can make that determination, the profered scientifc evidence must frst pass a simple test of relevancy. Relevant evidence is defned by the Federal Rules of Evidence and most state court jurisdictions as “evidence having any tendency to make the existence of any fact that is of consequence to the determination of the action more probable or less probable than it would be without the e v i d e n c e. United States7 held that, to be admissible, scientifc evidence must be “sufciently established to have gained general 4 Forensic dentistry acceptance in the particular feld in which it belongs. Courts ofen struggled with the Frye standard because the inquiry did not focus on the reliability of the particular scientifc evidence; instead, the Frye test focused upon the general reliability of the scientifc testing as a whole and its acceptance by others in the feld. Another problem was that it was dif- fcult to identify the appropriate expert community to answer the question of general acceptance. Some courts became concerned with the correctness of the Frye standard because the standard unfairly discredited new tests and accepted scientifc principles. In 1993, the Supreme Court developed a new standard for scientifc evidence in Daubert v.
Taking cancer as an exam- difference is significant and can be reproducibly ple buy ibuprofen 600 mg overnight delivery pain treatment center johns hopkins, malignant cells often contain over-expressed ibuprofen 400 mg sale texas pain treatment center frisco tx, observed in the laboratory, it can be exploited for mutated or absent ‘oncogenes’ (i. In other diseases, the cell which is code for particular proteins or receptors in normal identified can be normal but activated to a destruc- cells, but are mutated, and thus cause pathological tive state by stimulation with disease pathogens. In overactivity or underactivity of those gene pro- rheumatoid arthritis, for example, the normal T- ducts in tumor cells). An enzyme that is changes to alterations in the cellular architecture essential to life is a ‘no-hoper’ from the point of required for mitosis (cytoskeleton and cell moti- view of the drug developer. Nonsteroidal anti-inflammatory drugs such a research program might have found reports and methotrexate are examples of each of these in the literature of transgenic mice which, when in patients with rheumatoid arthritis. But the antibodies are also concerning cellular infiltrates in joint effusions, unattractive drugs. They are not orally available, with monocytes and T-lymphocytes being the and they elicit of immune responses after several most prevalent. Such antibodies will be compet- tion by phosphorylation or proteolysis, and to ing products for a long time in the future, given that examine the sorts of compound that may be cap- it is difficult to obtain regulatory approval for able of this. Gene expression profiling is useful not A key decision in each lab is when to incur the only in target identification as described here but expense, and time to clone the molecular target and also in finding significant use in later stages of drug set up the robotized in vitro assays which can development such as toxicology, surrogate marker screen compounds with a high rate of throughput. Cata- logues exist where the researcher can simply look The Human Genome Project has had a significant up which genes a particular antisense sequence will effect on target identification. One by-product was map to, and the use of fluorescent tags can then be that gene expression profiling technologies were used to probe the location of disease-producing invented which allowed for direct comparisons of mutants. But the pharmaceutical researcher should not ‘gene microarrays’ or ‘gene chips’; Cunningham, rely entirely on gene expression profiling for target 2000; Clarke et al. Technologies such as identification, even though the technology is very these allow the pharmaceutical researcher to com- powerful. Gene expression does not automatically pare the expression levels of nearly all the genes in lead to predictable protein synthesis. Proteins hugely outnumber only a few trial peptides need then be synthesized, genes in all mammals. In been coined to describe the analogous study of turn, this allows rapid identification and cloning of proteins within particular cells or tissues (Figeys, new targets for assay development. Thus, the application of proteomics also extends far beyond the target Pharmacologists are often able to develop tissue identification stage in drug development. In Further exploitation of this genomic and protei- some instances, studies on isolated tissues, such nomic can be obtained by making comparisons of as blood vessels, heart muscle or brain slices, will these data with epidemiological observations in allow a tissue- or organ-specific understanding of human populations. This is Electric stimulation can induce contraction of the known as ‘Linkage Analysis’, and, ultimately, the vascular smooth muscle, and the effects of hyper- precise chromosomal location, relative to the loca- tensive drugs on vascular contraction can then be tion of other known genes, can be found using a measured. Because ple of new target identification using these methods these methods are much less direct than molecular was the identification of ApoE as a causative factor screening, they are now relegated to secondary or in Alzheimer’s disease (Pericak-Vance, 1991). Whole animal models tional cloning can help identify disease-causative are often seen as critical decision-making points for genes and their proteins in animals which have a newly discovered drug. Thus, it is often neces- is the ob/ob genetic mouse, which is obese and has sary to induce a pathological state by introduction mutations in a gene for a peptide hormoneknown as of a pathogen or stimulant directly into a healthy leptin. Of course, human disease is rarely as Why are in vivo (whole animal) studies still simple as a single genetic defect, so these models important to drug discovery? All the new technol- must be used with some caution when testing drugs ogy, as well as mathematical modeling using com- or when identifying the causative genes. Pathophy- puters, has reduced but not eliminated the need for siological studies of organisms that have been animal experimentation. Computer models still engineered to contain (transgenic ‘splice in’), or cannot accurately predict the effects of chemical to be free from (‘knock out’) the identified gene is compounds on the cell, let alone in systems with an extension of this concept (see also below). In vivo cells operate in a dynamic and drugs bring with them specific, regulatory, clinical communicative environment, where an effect of a trials and manufacturing difficulties. Gene therapy, drug in one place may well lead to corresponding or in particular, carries human safety risks that do not compensatory changes elsewhere. The summation apply to other classes of therapy, for example the of these innumerable responses often defeats the infective nature of some types of vector that are predictions of high-throughput screens and three- employed, and the potential for incorporation of dimensional drug-receptor ‘design the key for the the test genetic material into the genome in lock’ calculations.
Four main questions have been developed and re- • What is the range of nursing situations in fined to facilitate study of nursing theories for use which the theory is useful? What major resources are authoritative • How can interactions of the nurse and the sources on the theory? What are major theoretical influences on this • Is the theory used to guide programs of nurs- theory? What were major external influences on devel- • Has nursing research led to further theory opment of the theory? What are projected influences of the theory on 3 Who are authoritative sources for infor- nursing’s future? Who are nursing authorities who speak about discount ibuprofen 600mg line chronic pain treatment guidelines, • In what ways has nursing as a professional write about generic ibuprofen 400 mg on-line pain treatment center northside hospital, and use the theory? Nurses in group practice may seek to use a nursing theory that will not only guide their practice, but also pro- vide visions for the organization and administra- This chapter has presented a guide designed tion of their practice. A shared understanding of for nurses to study nursing theory for use in the focus of nursing can facilitate goal-setting and practice. The guide is intended to accompany achievement as well as day-to-day communication more general formats of analysis and evalua- among nurses in practice and administration. This guide provides Allison and McLaughlin-Renpenning (1999) de- additional evaluative components for nurses scribe the need for a vision of nursing shared by all who are focusing on nursing practice. These questions are in- strate that a theory of nursing can guide practice as tended to further guide the study of nursing well as the organization and administration. The following questions are derived from components of a nursing administration model References (Allison & McLaughlin-Renpenning, 1999). Nursing questions are intended to guide descriptions of the administration in the 21st century: A self-care theory approach. New • How can the range of nursing situations be de- York: National League for Nursing. A nursing administration perspective on use • What nursing and related technologies are re- of Orem’s self-care nursing theory. Parker Introduction Why Evaluate Resources for Nursing Inquiry and Research Theory as a Guiding Framework for Evaluation How Do You Know What You Know? And if one begins, can the information that is often “here today and Never in human history have such vast quantities of gone tomorrow” be relied upon as accurate and information been so easily available. How can the information be evalu- brief space of a few decades, the acquisition, stor- ated? Given the complexity of data now available, age, and retrieval of information has been trans- can nursing theory resources even be evaluated formed from the realm of a labor-intensive manual across various types of media? Will the process be process to that of a digital, multidimensional vir- congruent with the theory and the values of the re- tual medium. The guide for evaluation of theory Nursing exists on the cusp of continual change, resources presented within this chapter moves to- with interfacing technological revolutions taking ward a realistic appraisal by the researcher of the place in nursing education, practice, and research. The rapid advance and integration of technology has not only affected practice (Sparks, 1999), but has also affected ways in which nurses investigate, eval- Theory as a Guiding Framework uate, think, and speak about practice (Turley, 1996). The framework for practice also becomes nursing knowledge is enhanced by the quality of a framework for education, research, and adminis- the resources used. A call for books, journals, and media recordings, emphasis nursing is also a call for transforming knowledge rests upon evaluation of the author and contents of and information; therefore, the response from each resource. In the utilization of the Internet as a nursing should be with clarity, conviction, and resource for “discovery” (Boyer, 1996, p. In this way, nursing theory is inte- dimension requiring evaluation is realized: The grated, lived out in the personhood of the nurse host of the virtual environment, now ubiquitous and continues to shape, guide, and focus the nurse and often fleeting, also must be identified, exam- in all activities. Authorial responsibility and sources is therefore an extension and affirmation of veracity in books and journals that are closely scru- the values grounding the practice of nursing. Role-blurring between Web media routinely complement traditional textbooks site author and owner is subtle yet insistent. The with the virtual world of Internet Web sites that author of the Web pages, or the “webmaster,” is offer sensate immersion in motion, color, and most often another party hired to create and main- sound. Browsing on the Internet frequently results tain the look of the Web site environment and is in traveling through a succession of hyperlinks that therefore not responsible for the content. The thoughtful sible data has also created a paradox: The sheer vol- study of nursing theory, therefore, includes not ume of information has created a gap in the human only consideration of works contributed by the the- ability to process and evaluate it (Jenkins, 2001). To practitioners who are the sources of disseminated whom or what does one respond or carry concerns nursing knowledge.
