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By A. Grim. Judson College, Elgin IL.
Nevertheless discount prometrium 100mg fast delivery medications adhd, a thorough description of students at Teachers College (Columbia University) the recovery process of women with depression was were asked to make carbon copies of their interac- not reflected in the literature. Peplau studied these and no- a clinical phenomenon and a review of available in- ticed that the students could not talk in a friendly formation related to that phenomenon were the way until the patients had said “I need you” or “I first steps in Peplau’s process. Seven quently to nursing interventions to decrease women who were recovering from depression anxiety (O’Toole & Welt, 1989). Peplau assisted in the design of the semistructured interview guide (personal commu- nication, December 14, 1990). The process of recovering was initiated by a crisis or “turning point” experience. It continued with pro- Applications fessional support and the support of friends and family. Recovering, according to the participants, Peplau’s work has had remarkable influence on required determination, work over time, and a nursing practice and education as we know it today series of successes that enhanced self-esteem and and on development of later nursing theories. The process was dynamic, oc- One of her major contributions to nursing was curring in a nonserial order, with back-and-forth reinforcing nurses’ awareness of the knowledge- movement among the categories and phases. This study raised many ques- chapter reviews in depth Peplau’s practice-based tions and provided further direction for study. It then discusses future applications of shared strategies or techniques that facilitated re- Peplau’s work. Peplau’s process of practice-based theory develop- Follow-up Study ment has directed a program of research in the area of depression in women (Peden, 1998). Beginning Continuing in step two of the process, a follow-up with the identification of a clinical phenomenon— study (Peden, 1996) was conducted a year later to women recovering from depression—and culmi- further describe the recovery process of women nating in the testing of an intervention to reduce who had been depressed. Peplau’s Process of Practice-based Theory Development and Its Applications 63 covering process were identified. Interventions that negative thoughts focused primarily on self, being assisted patients in recovering instilled hope were different, disappointing self and others, not being psychoeducational in nature, included cognitive in- perfect, and always failing. The women described terventions that change thinking styles, and pro- their self-talk as constant, negative, and demeaning. They identified various means of managing the Peden’s study (1996) concluded with the realiza- negative thoughts. Once again, the use of affirma- tion that more information was needed on the tions, positive self-talk, and learning to change symptom of negative thinking. To understand a thinking were identified as reducing negative think- phenomenon, one must analyze its etiology, its ing. Steps one and two of the process of practice- cause, its meaning, and any clues to successful in- based theory development had provided direction tervention (Peplau, 1989c). At the suggestion of for moving into the third step, design of an inter- Peplau (personal communication, January 16, vention. A six-week group intervention was designed specif- ically to incorporate cognitive-behavioral tech- Negative Thinking niques to assist in reducing negative thinking in A qualitative study (Peden, 2000) was designed to depressed women. As described earlier, thought describe the nature or inherent quality of negative stopping and positive self-talk (or affirmations) thoughts, their content or subject matter, and the were identified as key strategies in reducing nega- origins of the negative thoughts experienced by tive thoughts. The participants specific content from Gordon and Tobin’s (1991) also shared strategies they used to manage the neg- Insight program, Copeland’s (1992) The Depression ative thoughts. The sample consisted of six women Workbook, and the investigator’s own clinical expe- with a diagnosis of major depression who were ex- riences with depressed women. Affirmations, direct periencing or had experienced negative thoughts actions, thought stopping, and information on dis- and were willing to talk about the experiences. The torted thinking styles were introduced to the group women participated in a series of six group inter- members. Guided by Peplau’s (1952) theory of in- views, the purpose of which was to elicit negative terpersonal nursing, the introduction of cognitive- views/thoughts held by the group participants. The behavioral techniques did not occur until the group interviews focused on the women’s life expe- second group session. The focus of the first week riences, views of self and significant others, was on enhancing the development of the nurse- lifestyles, and past experiences. Codes were derived from available literature and To pilot-test the intervention, 13 women with were based on recommendations from Peplau (per- a diagnosis of major depression were randomly sonal communication, January 16, 1993) and other assigned either to a control or to an experimental codes that emerged from the initial review of the group. Codes included negative thinking related to an outpatient clinic and receiving antidepressant self, negative thinking related to significant others, medication.
The reabsorp- tion of acidic and basic drugs is reduced if the pH favours salt formation as charged molecules are not readily transported across membranes (see Appendi- ces 3 and 5) buy prometrium 100 mg cheap symptoms miscarriage. Elimination occurs in the liver by biliary clearance, very large molecules being metabolized to smaller compounds before being excreted. However, a fraction of some of the excreted drugs is reabsorbed through the enterohepatic cycle. This reabsorption can be reduced by the use of suitable substances in the dosage form, for example, the ion exchange resin cholestyramine is used to reduce cholesterol levels by preventing its reabsorption. Bioavailability is not constant but varies with the body’s physio- logical condition. It is now known that a drug is most effective when its shape and electron distribution, that is, its stereoelectronic structure, is complementary to the steroelectronic structure of the active site or receptor. The role of the medicinal chemist is to design and synthesize a drug structure that has the maximum beneficial effects with a minimum of toxic side effects. The stereo- chemistry of the drug is particularly important, as stereoisomers often have different biological effects, which range from inactive to highly toxic (see Table 2. At the begining of the 19th century it was largely carried out by individuals but it now requires teamwork, the members of the team being specialists in various fields, such as medicine, biochemistry, chemistry, computerized molecular modelling, pharma- ceutics, pharmacology, microbiology, toxicology, physiology and pathology. It also introduces the stereochemical and water solubility factors that should be taken into account when selecting a structure for a lead compound. These objectives will normally require a detailed assessment of the pathology of the disease and in some cases basic biochemical research will be necessary before initiating a drug design investigation (Figure 3. The information obtained is used by the team to decide what intervention would be most likely to bring about the desired result. Once the point of intervention has been selected, the team has to propose a structure for a lead compound that could possibly bring about the required change. This frequently requires an extensive literature and database search to identify compounds found in the organism (endogenous compounds) and compounds that are not found in the organism (exogenous compounds) that have some biological effect at the intervention site. Molecular modelling techniques (see Chapter 5) are sometimes used to help the team reach a decision. In many cases, a number of structures are found to be suitable, but the expense of producing drugs dictates that the team has to choose only one or two of these compounds to either act as the lead or to be the inspiration for the lead compound. Assessment of the biochemical and biological processes of the disease and/or its cause. This uses a simultaneous multiple synthesis technique to produce large numbers of potential leads. These potential leads are subjected to rapid high throughput biological screening to identify the most active lead compounds. Once the structure of the proposed lead has been agreed, it becomes the responsibility of the medicinal chemist to devise a synthetic route and prepare a sample of this compound for testing. Once synthesized, the compound undergoes initial pharmacological and toxicological testing. The results of these tests enable the team to decide whether it is profitable to continue development by preparing analogues (Figure 3. The usual scenario is to prepare a series of analogues, measure their activity and correlate the results to determine the structure with optimum activity. The selection of a lead compound and the development of a synthetic path- way for its preparation (see Chapters 10 and 11) is not the only consideration at the start of an investigation. Researchers must also devise suitable in vivo and in vitro tests to assess the activity and toxicity of the compounds produced. There is no point in carrying out an expensive synthetic procedure if at the end of the day it is impossible to test the product. Consequently, the overall shape of the structure of a molecule is an important consideration when designing an analogue. Some structural features impose a considerable degree of rigidity on a structure, whilst others make the structure more flexible. Other structures give rise to stereoisomers, which can exhibit different potencies, types of activity and unwanted side effects (see Table 2. This means that it is necessary to pharma- cologically evaluate individual stereoisomers and racemates. Consequently, one must take into account all these stereochemical features when proposing struc- tures for potential leads and analogues.
These are ways to clarify and verify views This can be a situation from your current practice about nursing and to seek and offer support for or may be from your nursing in years past buy generic prometrium 200 mg line medicine expiration dates. The previous reflective exercises offer guidance for • What nursing responses did I offer to the needs knowing about values and nursing practice. Using the Phenix (1964) model of types of mean- • What was the environment of the nursing situa- ing, Carper described personal, empirical, ethical, tion? Chinn • What about the environment was important to and Kramer (2004) apply Carper’s patterns of the needs for nursing and to my nursing re- knowing to develop a framework for nursing sponses? Consider Chapter 4 of this text employs patterns of knowing that values and beliefs are the basis for our nursing. Using this frequent in nursing situations in which even pattern of knowing in nursing, the client is not momentary connection and genuine presence seen as an object but as a person moving toward between the nursing and client is realized. The • Reflecting on the experience of nursing is nurse is also recognized as always learning and primary in understanding esthetic knowing. Reflecting on a person as a client and a per- that nursing practice has in fact been created, son as a nurse in the nursing situation can that each instance of nursing is unique, and that enhance understanding of nursing practice and outcomes of nursing cannot be precisely pre- the centrality of relationships in nursing. Nurses often express esthetic knowing insights are useful for choosing and studying through use of an art form, and thus recreate nursing theory. Empirical knowing concerns nursing theory that emphasizes presence and the science of nursing; the nurse uses empirical perhaps spirituality in the relationship of nurse knowing to access data from nursing, from re- and client. The amount and quality of em- selecting a nursing theory to study and consider for pirical knowing can guide selection of a nursing guiding practice. You will want to answer these theory as a way to frame and use empirics for questions: nursing purposes. According • What theories do I believe are consistent with to Carper (1978), ethics in nursing is the moral my personal values and society’s beliefs? Ethical knowing informs • Given my reflection on a nursing situation, do I us of what is right, what is our obligation, what want theory to support this description of my the nurse ought to do in this situation. These commitments of experience of practice for myself and for my pa- the nurse may be the focus of reflection and may tients? Search the Internet and use on- as highly valued as the science and ethics of line resources for information on nursing theories nursing. However, many nurses realize that es- and their use in practice, research, education, and thetic knowing subsumes all other patterns of administration. You and your tion, consider the level and scope of the theory, as colleagues may seek consultation for assistance discussed in the previous chapter. Is the theory a with analysis and evaluation of specific nursing grand nursing theory? Not all as- pects of theory described in an evaluation guide will be evident in all levels of theory. Whall (1996) recognizes this in offering guides for analysis and evaluation of nursing the- particular guides for analysis and evaluation that ory. Done individually or as a group, this is an ad- vary according to three types of nursing theory: ditional opportunity to learn and to share. This is models, middle-range theories, and practice theo- demanding work, but along with the challenge, this ries. It may be helpful to think of analysis of theory as neces- sary for adequate study of a nursing theory and evaluation of theory as the assessment of a theory’s Analysis and Evaluation utility for particular purposes. Guides for theory of Nursing Theory evaluation are intended as tools to inform us about theories and to encourage further development, re- It is important to understand definitions of nursing finement, and use of theory. There are no guides for theory (as described in Chapter 1) before moving theory analysis and evaluation that are adequate to theory analysis and evaluation. These have tions is adequate for study of any nursing theory, continued in use over time and offer direction for choose the definition that seems to best fit with guides in use today. For ex- ory should: ample, one of the definitions by Chinn and Jacobs (1987) or Chinn and Kramer (2004) may be chosen • define the congruence of nursing practice with for using theory in research. The definition by Silva societal expectations of nursing decisions and (1997) may be more appropriate for study of nurs- actions; ing theory for use in practice. Another way to think • clarify the social significance of nursing, or the about this is to consider whether the definition of impact of nursing on persons receiving nursing; nursing theory in use fits the theory being analyzed and and evaluated. Look carefully at the theory, read the • describe social utility, or usefulness of the theory theory as presented by the theorist, and read what in practice, research, and education. The whole The following are outlines of the most fre- quently used guides for analysis and evaluation.
