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Broad Application for Advanced Practice Nursing: Summary Nursing as caring provides a theoretical perspective with an organizing framework that guides practice and al- lows for the generation of new knowledge order zudena 100mg online. In addition discount 100mg zudena, it lends a methodological process to define proven zudena 100 mg, explain buy discount zudena 100mg on-line, and verify this knowledge. Nursing as caring guides the use of nursing knowledge and information from other disciplines in ways appropriate to nursing. Through the application of this theory, I have come to know new possibilities for nursing practice. I believe now more than ever that, with the advancing roles of nurses, we need to be clear on what it is that we do that is different from other practitioners. As nurse practitioners continue to be lumped into categories with other midlevel practitioners, we need to demonstrate to our patients that our profession was born of a need from society, a need that only nurses can fill. If there is no call to nursing, our profession will dissolve into the sea of midlevel practitioners. To ensure that our prac- tice maintains its identity, the practice must be built upon research-based nursing theory. Nursing Administration Quarterly, 25(1), nursing practice, ontology, epistemology. Cleveland: William Collings & World pinnings of an emergent methodology for nursing as caring Publishing Co. Krieger Giving of oneself on another’s behalf: The phenomenology of Publishing Co. New of nursing in high-technology environments: Outcomes re- York: National League for Nursing Press. Rethinking primary care: Connec- College of Nursing, Florida Atlantic University, 777 Glades tions to nursing. So, hand in glove, the have situated myself as a nurse and as a woman so research has constantly gone back and forth be- that the context of my scholarship, particularly as it tween “what’s wrong and what can be done about pertains to caring, may be understood. I consider it,” “what’s right and how can it be strengthened,” myself to be a second-generation nursing scholar. I and “what’s real to women (and most recently their was taught by first-generation nurse scientists (that mates) who miscarry and how might care be cus- is, nurses who received their doctoral education in tomized to that reality. My struggles for identity of this line of inquiry has resulted in insights about as a woman and as an academician were, like many the nature of miscarrying and caring that might women of my era (the baby boomers), a somewhat otherwise have remained elusive. Third- Predoctoral Experiences generation nursing scholars (those taught by nurses whose doctoral preparation is in nursing) may find My preparation for studying caring-based thera- my “yearning” somewhat odd. To those who might peutics from a psychosocial perspective began, offer critique about the egocentricity of my pon- ironically, in a cardiac critical care unit. Have we a unique sue a job at the brand-new University of Massachu- body of knowledge? I was drawn to that institution be- preciate that questions of uniqueness and entitle- cause of the nursing administration’s clear articula- ment have not completely disappeared. It was so have faded as a backdrop to the weightier concerns exciting to be there from day one. We were all part of making a significant contribution to the health of shaping the institutional vision for practice. It of all, working collaboratively with consumers and was phenomenal witnessing myself and my friends other scientists and practitioners, embracing plu- (nurses, physicians, respiratory therapists, and ralism, and acknowledging the socially constructed housekeepers) make a profound difference in the power differentials associated with gender, race, lives of those we served. I realized that there was a pow- Turning Point erful force that people could call upon to get them- selves through incredibly difficult times. Watching In September 1982 I had no intention of studying patients move into a space of total dependency and caring; my goal was to study what it was like for come out the other side restored was like witness- women to miscarry. Jean Watson, who guided me toward the need waiting room while they entrusted the heart (and to examine caring in the context of miscarriage. I lives) of their partner to the surgical team was awe- am forever grateful for her foresight and wisdom. It was encouraging to observe the inner reserves family members could call upon in order I believe that the key to my program of to hand over that which they could not control. I research is that I have studied human felt so privileged, humbled, and grateful to be in- responses to a specific health problem vited into the spaces that patients and families cre- (miscarriage) in a framework (caring) ated in order to endure their transitions through that assumed from the start that a illness, recovery, and, in some instances, death. Swanson: A Program of Research on Caring 353 all of these emotional insights had to do with nurs- such concepts as loss, stress, coping, caring, trans- ing. Four weeks into the same semester in completing my baccalaureate degree, I enrolled in which I was required to complete that exercise, my the Adult Health and Illness Nursing program at first son was born. It so happened that an obstetri- as such, was invited to attend a two-day retreat to cian had been invited to speak to the group about revise the master’s program. Jacqueline Fawcett and being found his lecture informative with regard to the amazed at hearing her talk about health, environ- incidence, diagnosis, prognosis, and medical man- ments, persons, and nursing and claiming that agement of spontaneous abortion.

Strength of identification and intergroup differentiation: The influence of group norms discount 100 mg zudena. Summarize the advantages and disadvantages of working together in groups to perform tasks and make decisions purchase 100 mg zudena otc. Just as our primitive ancestors lived together in small social groups purchase zudena 100mg online, including families buy 100mg zudena with visa, tribes, and clans, people today still spend a great deal of time in groups. We study together in study groups, we work together on production lines, and we decide the fates of others in courtroom juries. A rock band that is writing a new song or a surgical team in the middle of a complex operation may coordinate their efforts so well that it is clear that the same outcome could never have occurred if the individuals had worked alone. But group performance will only be better than individual performance to the extent that the group members are motivated to meet the group goals, effectively share information, and efficiently coordinate their efforts. Because these things do not always happen, group performance is almost never as good as we would expect, given the number of individuals in the group, and may even in some cases be inferior to that which could have been made by one or more members of the group working alone. Working in Front of Others: Social Facilitation and Social Inhibition [1] In an early social psychological study, Norman Triplett (1898) found that bicycle racers who were competing with other bicyclers on the same track rode significantly faster than bicyclers who were racing alone, against the clock. This led Triplett to hypothesize that people perform tasks better when there are other people present than they do when they are alone. Subsequent findings validated Triplett‘s results, and experiments have shown that the presence of others can Attributed to Charles Stangor Saylor. The tendency to perform tasks better or faster in the presence of others is known as social facilitation. However, although people sometimes perform better when they are in groups than they do alone, the situation is not that simple. Perhaps you remember an experience when you performed a task (playing the piano, shooting basketball free throws, giving a public presentation) very well alone but poorly with, or in front of, others. Thus it seems that the conclusion that being with others increases performance cannot be entirely true. The tendency to perform tasks more poorly or more slowly in the presence of others is known as social inhibition. According to Zajonc, when we are with others we experience more arousal than we do when we are alone, and this arousal increases the likelihood that we will perform thedominant response, the action that we are most likely to emit in any given situation (Figure 14. Zajonc argued that when the task to be performed was relatively easy, or if the individual had learned to perform the task very well (a task such as pedaling a bicycle), the dominant response was likely to be the correct response, and the increase in arousal caused by the presence of others would create social facilitation. On the other hand, when the task was difficult or not well learned (a task such as Attributed to Charles Stangor Saylor. A meta-analysis by [4] Bond and Titus (1983), which looked at the results of over 200 studies using over 20,000 research participants, found that the presence of others significantly increased the rate of performing on simple tasks, and also decreased both rate and quality of performance on complex tasks. Although the arousal model proposed by Zajonc is perhaps the most elegant, other explanations have also been proposed to account for social facilitation and social inhibition. One modification argues that we are particularly influenced by others when we perceive that the others are [5] evaluating us or competing with us (Baron, 1986). In one study supporting this idea, Strube, [6] Miles, and Finch (1981) found that the presence of spectators increased joggers‘ speed only when the spectators were facing the joggers, so that the spectators could see the joggers and assess their performance. The presence of others did not influence joggers‘ performance when the joggers were facing in the other direction and thus could not see them. Working Together in Groups The ability of a group to perform well is determined by the characteristics of the group members (e. When the outcome of group performance is better than we would expect given the individuals who form the group, we call the outcome a group process gain, and when the group outcome is worse than we would have expected given the individuals who form the group, we call the outcome a group process loss. One group process loss that may occur in groups is that the group members may engage in social loafing, a group process loss that occurs when people do not work as hard in a group Attributed to Charles Stangor Saylor. In one of the earliest social psychology experiments, [7] Ringelmann (1913; reported in Kravitz & Martin, 1986) had individual men, as well as groups of various numbers of men, pull as hard as they could on ropes while he measured the maximum amount that they were able to pull. In fact, the loss was so large that groups of three men pulled at only 85% of their expected capability, whereas groups of eight pulled at only 37% of their expected capability. This type of process loss, in which group productivity decreases as the size of the group increases, has been found to occur on a wide variety of tasks. Group process losses can also occur when group members conform to each other rather than expressing their own divergent ideas. Groupthink is a phenomenon that occurs when a group made up of members who may be very competent and thus quite capable of making excellent decisions nevertheless ends up, as a result of a flawed group process and strong conformity Attributed to Charles Stangor Saylor. Groupthink is more likely to occur in groups whose members feel a strong group identity, when there is a strong and directive leader, and when the group needs to make an important decision quickly. The problem is that groups suffering from groupthink become unwilling to seek out or discuss discrepant or unsettling information about the topic at hand, and the group members do not express contradictory opinions. Because the group members are afraid to express opinions that contradict those of the leader, or to bring in outsiders who have other information, the group is prevented from making a fully informed decision.

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At this stage cheap 100mg zudena free shipping, chil- ents can enhance their children’s intellectual develop- dren can sort items into categories zudena 100 mg low cost, reverse the direction ment through environmental factors order zudena 100 mg on-line. Other funda- mature discount 100 mg zudena amex, parents can both challenge and support the mental aspects of cognition are reasoning, the process by child’s talents. Although a supportive environment in which people formulate arguments and arrive at conclu- early childhood provides a clear advantage for a child, it sions, and problem solving—devising a useful represen- is possible to make up for early losses in cognitive devel- tation of a problem and planning, executing, and evaluat- opment if a supportive environment is provided at some ing a solution. Studies in Cognitive Growth: A Collabora- term memory provides the basis for one’s working tion at the Center for Cognitive Studies. The cognitive function that most distinctively sets Piaget, Jean, and Barbel Inhelder. The Growth of Logical humans apart from other animals is the ability to com- Thinking from Childhood to Adolescence. Of historical interest is the work of Benjamin Whorf (1897-1941), the proponent of the idea that the language people use determines the way in which they view the world. As of the late 1990s, most Cognition psychologists view the Whorfian hypothesis with skepti- A general term for the higher mental processes by cism, believing that language and perception interact to which people acquire knowledge, solve problems, influence one another. Language acquisition is another topic of debate, Cognition depends on the ability to imagine or rep- with some—including psycholinguist Noam Chomsky resent objects and events that are not physically present —arguing that all humans have innate language abilities, at a given moment. Cognitive functions include atten- while behaviorists stress the role of conditioning and so- tion, perception, thinking, judging, decision making, cial learning theorists stress the importance of imitation problem solving, memory, and linguistic ability. One of the most basic cognitive functions is the abil- Since the 1950s, cognitive psychology, which fo- ity to conceptualize, or group individual items together cuses on the relationship between cognitive processes as instances of a single concept or category, such as and behavior, has occupied a central place in psychologi- “apple” or “chair. The cognitive psychologist studies human framework for thought, allowing people to relate most perceptions and the ways in which cognitive processes objects and events they encounter to preexisting cate- operate on them to produce responses. People learn concepts by building prototypes to most cognitive psychologists is Jerome Bruner, who which variations are added and by forming and testing has done important work on the ways in which needs, hypotheses about which items belong to a particular cat- motivations, and expectations (or “mental sets”) affect egory. In the area of linguistics, the forced to deal with the opposing thoughts “I smoke” and work of Noam Chomsky has rekindled the age-old de- “smoking is dangerous” are likely to alter one of them bate over whether language exists in the mind before ex- by deciding to quit smoking. Other well-known work in cognitive psycholo- fuse dissonance by reducing its importance (discounting gy includes that of D. Berlyne on curiosity and infor- the evidence against smoking or adopting the view that mation seeking; George Kelly’s theory of personal con- smoking will not harm you personally); adding new in- structs; and investigations by Herman Witkin, Riley formation that gives more weight to one of the dissonant Gardner, and George Klein on individual perceptual and beliefs or appears to reconcile them (deciding that smok- cognitive styles. The development of the modern computer has influ- In a classic study of cognitive dissonance, subjects enced current ways of thinking about cognition through were asked to perform a dull task and then to persuade computer simulation of cognitive processes for research others that this task was interesting and enjoyable. Some purposes and through the creation of information-pro- were paid one dollar to do this, while others were paid cessing models. These models portray cognition as a sys- $20, and all of their attitudes toward the task were mea- tem that receives information, represents it with sym- sured at the conclusion of the experiment. The subjects bols, and then manipulates the representations in various who had been paid one dollar showed a marked improve- ways. The senses transmit information from outside ment in their attitude toward the task, while the more stimuli to the brain, which applies perceptual processes highly paid subjects did not. The designers of the experi- to interpret it and then decides how to respond to it. Cog- information may simply be stored in the memory or it nitive dissonance was created in all of the subjects by the may be acted on. Acting on it usually affects a person’s conflicting facts that the task had been boring and that environment in some way, providing more feedback for they were saying it was interesting—their statements and the system to process. Broadbent’s infor- $20 had been given a justification for lying: they could mation theory of attention, learning, and memory; and tell themselves that their actions made some kind of Miller, Galanter, and Pribram’s analysis of planning and sense. Thus they acted to re- ment duce the dissonance by changing their original belief. Children have shown similar responses to experi- Further Reading mental situations involving cognitive dissonance. New Those children who had accommodated the polite request York: Oxford University Press, 1987. However, the children who were threatened felt no pressure to change their opinions about the toy since they had a logical reason for giving it up. In post-decision dissonance, a person must de- cide between two choices, each of which has both posi- An influential concept in the study of the relation- tive and negative components (in other contexts, this type ship between attitudes and behavior. Forced compliance dissonance occurs when people First proposed by Leon Festinger in 1957, the theo- are forced to act in ways that conflict with their beliefs ry of cognitive dissonance is based on the principle that and can not find any way to justify their actions to them- people prefer their cognitions, or beliefs, to be consistent selves. Dissonance also occurs when people are exposed with each other and with their own behavior. Various group situations also generate cognitive makes people uneasy enough to alter these ideas so that dissonance. Cognitive processes (which may involve language, symbols, or imagery) include perceiv- ing, recognizing, remembering, imagining, conceptualiz- ing, judging, reasoning, and processing information for planning, problem-solving, and other applications.

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A complete toxicologic evaluation should also be performed discount zudena 100mg mastercard, even if not related to cause of death buy zudena 100 mg lowest price. Te presence of certain medications or illicit chemi- cals may give information regarding lifestyle or possible medical facilities order zudena 100 mg with amex. For example purchase zudena 100 mg free shipping, if methadone is present, treatment facilities could be contacted for helpful information. Identifying characteris- tics, such as a broken bone resulting in a malunion or varus/valgus deformity of a long bone, can also be used (Figure 5. Radiographs may reveal the presence of foreign material, such as old bullets or shrapnel (Figures 5. Te presence or absence of growth plates or the extent of osteophyte formation (Figure 5. Te determination of stature is performed by measuring the long bones and utilizing multiple formulae developed for such a purpose. Pelvic morphology is the best indicator for determining sex, as a woman’s pelvis is wider and shallower with an obtuse subpubic angle and an oval inlet. Te cranium can also be used to attempt to determine sex, if the pelvis is not available. A male’s skull tends to have a receding forehead, prominent brow ridges and occipital protuberance, and a large mastoid process. If the skeleton is that of a younger person (less than thirty years), growth plates can help delineate age as the plates tend to close (fuse) at certain stages 74 Forensic dentistry of development. As the person becomes older, age-related changes can be seen, such as osteophyte formation, calcifcation of the cartilaginous margins of the ribs, and wearing changes of the symphysis pubis. Tese changes, along with fusion of the cranial sutures, can be used to approximate age. Ancestry becomes more and more complex as our society becomes more global and less isolated. Traditionally, anthropologists acknowledged three races: Caucasoid, Mongoloid, and Negroid. Ancestry determi- nations ofen combine the classic features of each race, and computer pro- grams are used to determine a likely lineage. Classically, Negroid crania show wide nasal orifces, round/oval orbits, and alveolar prognathism; Caucasoid crania have narrow nasal orifces, parabolic palates, and rectangular orbits; and Mongoloid crania ofen demonstrate elliptical palates, complex cranial sutures, and square orbits (see Chapter 8). When a cranium is present, facial reconstruction can be performed in addition to anthropologic analysis. Te forensic artist is given the anthro- pologic data of approximate age, sex, ancestry, and physical attributes (e. Te morphologic properties of the cranium are combined with the artist’s presumptive rendition of the sof tissue features, includ- ing eye color and hairstyle, to generate either a sketch or model of how the deceased looked in life (Figure 5. A photo of the resulting face can then be distributed to the media or local community in an attempt to fnd a witness who can identify the individual. Unfortunately, the resulting image does not always accurately approximate the deceased and may end up misdirecting the investigation. Forensic medicine and human identifcation 75 Anthropology and facial reconstruction are rarely used alone to estab- lish identity. Should no materials be present to allow for such a presumptive identifcation, several databases exist for comparison of unidentifed persons to missing per- sons. Te information is then cross-referenced against known missing persons to fnd similar, matching cases. If similar cases are found, the investigating agencies are able to contact each other to obtain the information required to establish a positive identifcation. Unfortunately, not all unidentifed persons or missing persons get placed into the system. Its purpose is to provide a “…role-based access to enter and search records of the unidentifed, while allowing the public access to information that may assist in the identifcation of these individuals. In 2007, the National Institute of Justice began funding the National Missing and Unidentifed Persons System (NamUs). Te database will be searchable by and accessible to medical examiners, forensic scientists, law enforcement, and the general public. Extensive photographs should be taken, including photos of all distinguishing characteristics—eyes, tattoos, scars, etc. In cases of deceased individuals, a full autopsy should be performed, thoroughly docu- menting all disease processes, presence and absence of organs or tissues, organ weights, and detailed and accurate descriptions of all pertinent positive and nega- tive fndings. One unidentifed person can require a great deal of organization and doc- umentation to establish identity; however, in cases of natural or man-made disasters, organization is a necessity. All bodies/body parts, including any and all corresponding property, must be kept separate and uniquely marked. Each body requires the same examination outlined above in an orderly and organized manner, yet it must be conducted as rapidly as possible. In addi- tion, mass disasters may include the need for decontamination of the bodies, a media contact person for the central dispersion of information, as well as a centralized record-keeping system.

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