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Descartes postulated a radical mind-body been a powerful influence on succeeding generations of dualism buy nicotinell 17.5mg online quit smoking quit key, claiming that the universe consisted of two ut- philosophers and psychologists nicotinell 52.5 mg fast delivery quit smoking now for free. New Studies in the Philosophy of workings of matter and material things, including the Descartes. Some philosophers have advanced the argument Developed by Joseph Wolpe in the 1950s, desensiti- that human behavior is deterministic, although most have zation is a treatment method which weakens the learned resisted the idea that human beings merely react to exter- association between anxiety and feared objects or situa- nal events and do not voluntarily select behaviors. Relaxation There is a clear dilemma in explaining human be- responses are strengthened through progressive relax- havior through psychological principles. On the one ation training, first developed by Edmund Jacobson in the hand, if psychology is a science of behavior, then there 1930s. Clients first tighten and then relax 16 different should be laws allowing the prediction of behavior, just muscle groups in various parts of the body, releasing the as there are gravitational laws to predict the behavior of tension and focusing on the resulting feelings of relax- a falling object. Once people learn how their muscles feel when raised by individuals who believe that humans control they are truly relaxed, they develop the ability to repro- their own behaviors and possess free will. In this view, the mind may not be Next, the client outlines an “anxiety hierarchy,” a subject to the same laws as the body. Wilhelm Wundt list of situations or stimuli arranged in order from least (1832-1920) attempted to make the distinction between to most anxiety-provoking. For a person who is afraid of determinism and indeterminism by suggesting that psy- flying, such a list might begin with seeing a picture of an chological processes could be creative and free, whereas airplane, eventually progress to driving to the airport, the physiological processes in the brain were determin- and end with taking an actual plane flight. This argument does not solve the problem for psy- of the therapist, the client then works through the list, ei- chology, however, because psychologists consider men- ther imagining or actually experiencing each situation tal processes appropriate for study within a scientific while in a state of relaxation. As clients face progressively more threatening situa- Other psychologists like William James,who was tions, relaxation rather than fear becomes associated interested in religion and believed in free will, recog- with the source of their anxiety, and they become gradu- nized this conflict but was reluctant to abandon the con- ally desensitized to it. At one point, he sug- imagery does produce desensitization, actual real-life gested that mind and body operated in tandem, whereas exposure to the feared stimulus whenever possible is on another occasion he concluded that they interacted. Clearly, James struggled with the issue and, like others, was unable to resolve it. The behaviorists were the most Further Reading obvious proponents of determinism, dating back to John Craighead, W. He adopted a stance occur in completely predictable ways as a result of called radical behaviorism, which disregarded free will natural and physical laws. All behavior, Skinner maintained, was determined through reinforcement Since ancient times, the origins of human behavior contingencies, that is, the pattern of reinforcements and have been attributed to hidden or mystical forces. For of age and walk by the middle of the second year, any example, if people were not responsible for negative be- child who was more than five or six months delayed in haviors, they should not be punished, for they had no attaining those two milestones would probably be classi- control over their behaviors. Instead, the environment fied as developmentally delayed and the parents should that reinforced the unwanted behaviors should be consult the pediatrician. There- the unconscious and contended that behavior is caused fore, any child who is not speaking words or sentences by internal, mental mechanisms. In some ways, Freud by the third birthday would be considered developmen- was more extreme than Skinner, who acknowledged that tally delayed and, as in motor development delay, the some behaviors are not predictable. Thus, Thus, the small group of children with autism do not even though Freudians and Skinnerians differ on almost show normal social development but these children are every conceivable dimension, they have at least one usually called disabled or autistic rather than develop- commonality in their reliance on determinism. Similarly, most children are able to Those scientists who believe that behaviors are de- read single words by the second grade of elementary termined have recognized the difficulty in making ex- school. Thus, they have developed the concept dyslexic or learning disabled, or in some cases academi- of statistical determinism. Possible problems are indi- of them unknown, affect actions, which result in general- cated by muscles that are either too limp or too tight. The recently developed theory of or uncertain movements are another cause for concern, as chaos relates to making predictions about complex are abnormalities in reflexes. This theory suggests that in a ment may indicate the presence of a neurological condi- cause-effect situation, small differences in initial condi- tion such as mild cerebral palsy or Tourette’s syndrome. This theory Neurological problems may also be present when a child’s supports the notion that behaviors may not be complete- head circumference is increasing either too fast or too ly predictable even though they may be dictated by fixed slowly. Further Reading Important cognitive attainments that physicians look Doob, Leonard William. Inevitability: Determinism, Fatalism, for in infants in the first 18 months include object perma- and Destiny. Cognitive delays can signal a wide variety of problems, including fetal alco- hol syndrome and brain dysfunction. Developmental Developmental delay milestones achieved and then lost should also be investi- gated, as the loss of function could be sign of a degener- Any delay in a child’s physical, cognitive, behav- ative neurological condition.

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On the secondary survey effective nicotinell 17.5 mg quit smoking 80524 zip code, you note motor weakness of his left lower extremity and the loss of pain sensation in the right lower extremity purchase nicotinell 17.5 mg without a prescription quit smoking oils. A bystander tells paramedics that the patient was punched and kicked multiple times and sustained multiple blows to his head with a stool. He states he was wearing his seat belt in the driver’s seat when a car hit him from behind. He thinks his chest hit the steering wheel and now complains of pain with breathing. The stab wound is located between the angle of the mandible and the cricoid cartilage and violates the platysma. Radiographs of the cer- vical spine reveal bilateral fractures of the C2 vertebra. A 71-year-old man is found lying on the ground one story below the balcony of his apartment. On examination, you note clear fluid dripping from his left ear canal and an area of ecchymosis around the mastoid bone. He has obvi- ous head trauma with a scalp laceration overlying a skull fracture on his occiput. He does not speak when asked his name, his respirations are poor and you hear gurgling with each attempted breath. His pelvis is unstable with movement laterally to medially and you note blood at the urethral meatus. His right leg is grossly deformed at the knee and there is an obvious fracture of his left arm. Create two Burr holes into the cranial vault to treat a potential epidural hematoma. Immediately reduce the extremity injuries and place in a splint until the patient is stabilized. Plan for endotracheal intubation of the airway with in-line stabilization of the cervical spine. A 20-year-old man was found on the ground next to his car after it hit a tree on the side of the road. Bystanders state that the man got out of his car after the collision but collapsed within a few minutes. She cannot wiggle her toes, has 1/5 motor function of her quadriceps, and only patchy lower extremity sensation. Which of the fol- lowing statements is most appropriate regarding management of a hypotensive trauma patient who fails to respond to initial volume resuscitation? Secondary survey reveals an unstable pelvis upon movement with lateral to medial force. Which of the following is the most appropri- ate immediate next step in management? The lifeguard on duty accompanies the patient and states that he dove head first into the shallow end of the pool and did not resurface. On examination, the patient is speaking but cannot move his arms or legs and cannot feel pain below his clavicle. When examining his cervical spine, he denies tenderness to palpation and you do not feel any bony deformities. Cerebral atrophy in the elderly population provides protection against subdural hematomas. Increased elasticity of their lungs, allows elderly patients to recover from tho- racic trauma more quickly than younger patients. The most common cervical spine fracture in this age group is a wedge fracture of the sixth cervical vertebra. Despite lack of cervical spine tenderness, imaging of his cervical spine is warranted. His breath sounds are equal bilaterally and chest wall is without contusion or bony crepitus.

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A fundamental role of a nurse generic 17.5 mg nicotinell amex quit smoking zap, therefore cheap nicotinell 35 mg with amex quit smoking gift ideas, is to be with and for the patient; this is compatible with the advocacy role promoted by A Strategy for Nursing (DoH 1989). This role is facilitated by making patients the focus in the organisation of care (such as through primary/named nursing). This constant presence of a specific nurse at the patient’s bedside should allow more holistic, patient-centred care. Intensive care nursing 6 Relatives Relatives, together with friends and significant others, form an important part of each person’s life, and they too are similarly distressed by the patient’s illness. The psychological crises experienced by relatives necessitate skilful psychological care, such as the provision of information to allay anxiety and make decisions, and facilities to meet their physical needs (Curry 1995). Relatives should be offered the opportunity to be actively involved in the patient’s care (Hammond 1995) without being made to feel guilty or becoming physically exhausted, rather than left sitting silently at the bedside, afraid to touch their loved ones in case they interfere with some machine. Having recognised the primacy of the patient, nurses can then develop their valuable technological skills, together with other resources, in order to fulfil their unique role in the multidisciplinary team for the benefit of patients. The beliefs, attitudes and philosophical values of nurses will ultimately determine nursing’s economic value. This chapter is placed Nursing perspectives 7 first in order to establish fundamental nursing values, prior to considering individual pathologies and treatments; nursing values can (and should) then be applied to all aspects of holistic patient care. Henderson, famous for her earlier definition of the unique role of the nurse, wrote a classic article about nursing in a technological age (Henderson 1980). Over the years, many accounts of patients’ experiences have been written; Watt (1996) and Sawyer (1997) are recent, easily accessible and vivid articles, while Dyer (1995) offers further challenging perspectives. Examine the potential conflicts between these strategies and the more technical, physiologically necessary interventions. What do they contribute to actual patient care, and how is their effectiveness evaluated? Chapter 2 Humanism Introduction Philosophical beliefs affect our values, and so influence our approaches to care. This chapter describes and contrasts two influential philosophies to supply a context for developing individual beliefs and values. As this is not a book about philosophy, descriptions of these movements are brief and simplified, and readers are encouraged to pursue their ideas through further reading. The label ‘humanism’ has been variously used throughout human history, probably because its connotations of human welfare and dignity sound attractive. The Renaissance ‘humanistic’ movement included such influential philosophers as Erasmus and Sir Thomas More. In this text, however, ‘humanism’ is a specifically twentieth-century movement in philosophy led primarily by Abraham Maslow and Carl Rogers. The humanist movement, sometimes called the ‘third force’ (the first being psychoanalysis, the second behaviourism), was a reaction to behaviourism. Playle (1995) suggests that the art-versus-science debate within nursing is an extension of the humanistic-versus- mechanistic (i. Behaviourism The behaviourist theory was largely developed by John Broadus Watson (1878–1958) who, drawing on Pavlov’s famous animal experiments, stated that if each stimulus eliciting a specific response could be replaced by another (associated) stimulus, the desired response (behaviour) could still be achieved (‘conditioning’) (1998 [1924]). The behaviourist theory enabled social control and so became influential when society valued a single socially desirable behaviour. Thus behaviourism focuses on outward, Humanism 9 observable behaviours and for behaviourists, learning is a change in behaviour (Reilly 1980). Holloway and Penson (1987) have suggested that nurse education contains a ‘hidden curriculum’ controlling the behaviour of students and their socialisation into nursing culture. Through Gagne’s (1975, 1985) influence, many nurses have accepted and been acclimatised into a behaviouristic culture without always being made aware of its philosophical framework. Hendricks-Thomas and Patterson (1995) suggest that this behaviouristic philosophy has often been covert, masked under the guise of humanism. Thus using aspects from humanism, such as Maslow’s hierarchy of needs in Roper et al.

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The acute stress paradigm has enabled researchers to study gender differences in stress reactivity nicotinell 35mg low cost quit smoking 3 months ago women, the interrelationship between acute and chronic stress buy discount nicotinell 35 mg quit smoking online support, the role of personality in the stress response and the impact of exercise on mediating stress related changes (e. Naturalistic setting Some researchers study stress in a more naturalistic environment. Naturalistic research also examines the impact of ongoing stressors such as work-related stress, normal ‘daily hassles’, poverty or marriage conflicts. These types of studies have provided important information on how people react to both acute and chronic stress in their everyday lives. Costs and benefits of different settings Both laboratory and naturalistic settings have their costs and benefits: 1. The degree of stressor delivered in the laboratory setting can be controlled so that differences in stress response can be attributed to aspects of the individual rather than to the stressor itself. Researchers can artificially manipulate aspects of the stressor in the laboratory to examine corresponding changes in physiological and psychological measures. Laboratory researchers can artificially manipulate mediating variables such as control and the presence or absence of social support to assess their impact on the stress response. The laboratory is an artificial environment which may produce a stress response which does not reflect that triggered by a more natural environment. Naturalistic settings allow researchers to study real stress and how people really cope with it. However, there are many other uncontrolled variables which the researcher needs to measure in order to control for it in the analysis. Physiological measures Physiological measures are mostly used in the laboratory as they involve participants being attached to monitors or having fluid samples taken. However, some ambulatory machines have been developed which can be attached to people as they carry on with their normal activities. They can also take blood, urine or saliva samples to test for changes in catecholamine and cortisol production. Self-report measures Researchers use a range of self-report measures to assess both chronic and acute stress. Self- report measures have been used to describe the impact of environmental factors on stress whereby stress is seen as the outcome variable (i. They have also been used to explore the impact of stress on the individual’s health status whereby stress in seen as the input variable (i. Costs and benefits of different measures Physiological and self-report measures of stress are used in the main to complement each other. The former reflects a more physiological emphasis and the latter a more psycho- logical perspective. A researcher who has a greater interest in physiology might argue that physiological measures are more central to stress research, whilst another researcher who believes that experience is more important might favour self-report. Most stress researchers measure both physiological and psychological aspects of stress and study how these two components interact. However, in general the different types of measures have the following costs and benefits: 1. Physiological measures are more objective and less effected by the participant’s wish to give a desirable response or the researcher’s wish to see a particular result. Self-report measures reflect the individual’s experience of stress rather than just what their body is doing. Self-report measures can be influenced by problems with recall, social desirability, different participants’ interpreting the questions in different ways. Self-report measures are based upon the life events or hassles that have been chosen by the author of the questionnaire. One person’s hassle such as ‘trouble- some neighbours’ which appears on the hassles scale may not be a hassle for another whereas worries about a child’s school might be which doesn’t appear on this scale. Associations between research in different settings using different measures Given that stress research takes place in both the laboratory and in more naturalistic setting and uses both physiological and self-report measures it is important to know how these different studies relate to each other.

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