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By S. Kaffu. University of Hawai`i, Manoa. 2018.

She completed a PhD in provide a basis for understanding and explicating educational foundations and administration at the meaning of nursing cheap crestor 20mg cholesterol test no food, listed as follows and de- Kansas State University in 1983. In 1990, Schoen- tailed here: hofer cofounded Nightingale Songs, an early venue for communicating the beauty of nursing in poetry • Persons are caring by virtue of their humanness. In addition to her work on caring, in- • Persons are whole and complete in the moment. Model for Transforming Practice, she has written on • Personhood is a way of living grounded in nursing values, primary care, nursing education, caring. Caring is not the unique allowing for reflection and creativity in advancing province of nursing. The full meaning of caring Personhood is understood to mean living grounded cannot be restricted to a definition but is illumi- in caring. From the perspective of the theory of nated in the experience of caring and in the reflec- nursing as caring, personhood is the universal tion on that experience. A profound understanding of person- hood communicates the paradox of person-as- Focus and Intention of Nursing person and person-in-communion all at once. Disciplines as identifiable entities or “branches of Call for Nursing knowledge” grow from the holistic “tree of knowl- edge” as need and purpose develop. A discipline is a “A call for nursing is a call for acknowledgment and community of scholars (King & Brownell, 1976) affirmation of the person living caring in specific with a particular perspective on the world and what ways in the immediate situation” (Boykin & it means to be in the world. Calls for nursing are calls munity represents a value system that is expressed for nurturance through personal expressions of in its unique focus on knowledge and practice. Calls for nursing originate within persons as they live out caring uniquely, expressing personally meaningful dreams and aspirations for growing in The focus of nursing, from the perspec- caring. Calls for nursing are individually relevant tive of the theory of nursing as caring, is ways of saying, “Know me as caring person in the person as living in caring and growing in moment and be with me as I try to live fully who I caring. Because calls for nursing are unique theory of nursing as caring, is person as living in situated personal expressions, they cannot be pre- caring and growing in caring. Nursing Situation Nursing Response The practice of nursing, and thus the practical knowledge of nursing, lives in the context of As an expression of nursing, “caring is the inten- person-with-person caring. The nursing situation tional and authentic presence of the nurse with an- involves particular values, intentions, and actions other who is recognized as living caring and of two or more persons choosing to live a nursing growing in caring” (Boykin & Schoenhofer, 1993, relationship. The nurse enters the nursing situation with mean the shared lived experience in which caring the intentional commitment of knowing the other between nurse and nursed enhances personhood. All knowl- edging, affirming, and celebrating the person as edge of nursing is created and understood within caring. Any single nursing situation sion of caring nurturance to sustain and enhance has the potential to illuminate the depth and com- the “other” as he or she lives caring and grows in plexity of nursing knowledge. Nursing re- are best communicated through aesthetic media to sponses to calls for caring evolve as nurses clarify preserve the lived meaning of the situation and the their understandings of calls through presence and openness of the situation as text. Sensitivity and skill in creating unique and effective ways of communicating caring are devel- His eyes meet mine, oped through intention, experience, study, and Unable to speak, reflection in a broad range of human situations. It is the loving relation into which nurse Our bond is made, Unspoken thoughts, But understood, The caring between is the source and I care for him! Collins (1993) and nursed enter and cocreate by living the inten- Each encounter—each nursing experience— tion to care. In Collins’s reflections, ing between, unidirectional activity or reciprocal he shares a story of practice that illuminates the exchange can occur, but nursing in its fullest sense opportunity to live and grow in caring. It is in the context of the caring be- In the nursing situation that inspired this poem, tween that personhood is enhanced, each express- the nurse and nursed live caring uniquely. This al- particular experience of nursing and linked to a lows him to see past the “anger-filled” room and to general conception of nursing. By living caring moment to moment, hope emerges and fear My hands are moist, subsides. Through this experience, both nurse and My heart is quick, nursed live and grow in their understanding and My nerves are taut, expressions of caring.

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This is analogous to physicians in their practice learning is true no matter how much human-use data is about a therapy and discount crestor 20mg otc high cholesterol fat foods, as they come to know more available. For example, PhisoHex (hexachloro- about the use of the treatment and their practice phene) gained broad usage as a skin wash and dynamics change, modifying the use of that ther- scrub to combat the spread of infection. The overall process Notwithstanding all this, it became a safety and skill is an important part of the training within issue. This advanced, more and more premature babies were effort may include the issues of quality-of-life able to survive. There was therefore a new poten- industry for pioneering work on subjects as diverse tially ‘at-risk’ group. Hexachlorophene toxicity in as prostaglandins, anti-infectives, and pharmaco- humans was considered to have resulted, and this logical receptors such as the histamine and the led to the product being modified or removed in b-adrenergic receptor. In a relatively recent history the opportunity to carry out seminal work with of healthcare, there have been several such issues, entirely unique concepts, even if many of them for example Zomax, Oraflex, Tylenol tampering, do not become therapies for humans. Human is toxic shock syndrome, Reye’s syndrome, the a unique animal which can, and does, exhibit Dalcon shield, contaminated blood supply, silicon unique responses to a new chemical entity. No implants and the so-called ‘generic drug scandal’, pre-clinical work can be entirely predictive of a to mention but a few. Some is part of the role of a pharmaceutical physician products fail because of safety problems specific to recognize new opportunities and to be alert for to humans, and some because the early promise of any emerging evidence of potential added benefits efficacy in model systems is not realized in and/or new safety issues, as products and those of humans. They lap perhaps seemed to be with clinical pharmacol- are responsible for the products of the pharmaceu- ogy. Indeed, clinical pharmacologists have a real tical industry that are in use today. As such, they are interest in the R&D of the pharmaceutical industry influencing the health of far more people globally and their training is good for entry into the industry. Indeed, Any discussion of the discipline of pharmaceu- some pharmaceutical physicians will work in even tical medicine today would be incomplete without more basic and theoretical science settings, whilst a comment on the impact of biotechnology and the others will work in more commercial settings. This is a course, many within the speciality can and do focus revolution that is driven in a very different way on the development of disease models and the than that in which the pharmaceutical industry has evaluation of new chemical entities in these dis- classically been run. The most modern methods in such areas are tude of small venture capital companies which are vital to the successful development of new drugs, espousing the very cutting edges of research in and the continued and continuous interaction biologics, genetics and technology. They are lar- between the industry and academia is absolutely gely managed by a combination of bioscientists necessary. In this context, the role of pharma- Indeed, the distinction between academia and ceutical medicine takes on its most extreme var- pharmaceutical medicine is becoming blurred. At one end are physician/scientists, who are pharmaceutical industry R&D effort is now lead- the research brain of the venture, and at the other 2. In either of more, there is a growing understanding within these settings, pharmaceutical medicine is needed academia that in the past someone else was capi- and the specialist will apply all of the training talizing on their intellectual endeavours, so we are components that, as already indicated, compose seeing more medical and bioscience academics this new discipline. The biotechnology industry is carrying forward As this progress continues, the two disciplines of some of the best and brightest projects of the research and business are coming to realize that world’s leading academic institutions. Pharmaceutical pure research concepts through applied research medicine is the natural common pathway and the into development and finally to the production of integrating speciality which will fill this need and remarkable new therapeutic products. If try has already created two or three new companies this is so, then pharmaceutical medicine will of substance, with sales of over $1 billion per year become a leadership medical function in the and a capitalization measured in billions. The speciality lies at the con- than these obvious and huge successes, the industry junction of changing societal needs for healthcare, has spawned literally thousands of venture capital the burgeoning biosciences and the understandings efforts and new companies developing drugs, of how to provide improved quality of life and devices, diagnostics and all manner of medical cost–utility for patients today. Amazingly, this is an industry contains and provides includes basic sciences, which has come into being in the last decade or such as chemistry and mathematics, applied two. Already, companies are finding paediatrics to geriatrics and from family medicine that the major transition points in the therapeutic to the individual subspecialities. As such, pharma- product development process, from molecular to ceutical medicine is one of the most challenging, biochemical system, to cellular system, to organ exciting and rewarding areas of medicine. It is a model, to intact organism, to mammalian model, to career for those who wish to be in the vanguard of humans, are all real watersheds.

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The exact amount of sleep needed varies among individuals generic crestor 5mg online cholesterol medication take at night, but is thought to be between seven and nine hours. An occasional sleepless night is not a concern, but persistent difficulty in falling asleep, waking up too early, awakening frequently during the night, or waking up feeling tired and not refreshed could indicate insomnia. Lack of sleep, particularly deep (delta) sleep, not only makes us feel tired, but it has serious consequences such as memory loss, poor concentration, depression, headache, irritability, increased 48 | Chapter 6 response to stress, high blood pressure, depressed immune function, and low libido. More recently sleep deprivation has been linked to obesity due to hormonal changes that reduce metabolism and increase appetite. Animal studies have also shown that sleep deprivation can lead to death within two to three weeks—a similar time frame for death due to starvation. Causes of Insomnia There are many factors that can affect the quality of sleep such as stress, medical problems (depression, anxiety), medications, alcohol, poor nutrition, noise/light, the need to go to the bathroom during the night, and poor sleep hygiene (going to bed at different times). Insomnia and its causes and treatments are covered in greater detail in Section 3 of this book. Tips for a Better Night’s Rest For a good night’s sleep, consider the following: • Establish a regular bedtime and wake time. We don’t have enough time, take on too much, worry about health and wealth, and feel overwhelmed and stressed out on a regular basis. According to recent reports, 43 per- cent of all adults suffer the adverse health effects of stress, and stress-related ailments account for 75–90 percent of all visits to physicians. Understanding Stress Stress, as defined by Hans Selye, an Austrian-born Canadian physician who studied the physiological and biochemical results of stress and anxiety, is “the non-specific re- sponse of the body to any demand placed upon it. In other words, stress is not an external force but rather how we react to external stimuli—how we feel and respond to traffic, deadlines at work, or any event that we perceive as stressful. Stress and Disease In response to stress, the body releases stress hormones—adrenaline, noradrena- line, and cortisol—to prepare the body to fight, hence this is known as the fight or flight response. Heart rate, blood pressure, and lung tone increase to enhance the function of the heart and lungs. This innate reaction served us well many centuries ago when we had to fight off wild animals and protect our villages. It is chronic, pervasive, and insidious because it stems primarily from psychological rather than physical threats and has far-reaching effects on our health. Numerous studies have linked stress to heart disease, cancer, diabetes, high cholesterol and blood pressure, anxiety, depression, memory loss, insomnia, muscle tension, obesity, fatigue, low libido, erectile dysfunction, menstrual cycle disturbances, and many more problems. Stress Management Stress can certainly take a toll on your body and mind, so it is absolutely crucial to find ways to cope effectively. Start by identifying your stressors and then look for ways to change your reaction to those situations. It may be a matter of analyzing and rethinking your natural reaction, avoiding certain situations, or utilizing one of the following stress-reducing strategies. Seeking help from a counsellor or psychologist can be very helpful to learn coping techniques and strategies. Meditation Meditation is the practice of focusing the mind and consciously relaxing the body for a sustained period. This is common among Eastern cultures and is gaining popular- ity in North America. Focusing on a single object or your breath or a sound occupies your mind and diverts it from the problems that are causing you stress. You can do this when feeling stressed, or make a habit of meditating once or twice a day for better health and relaxation. Breathing Techniques Taking slow, controlled breaths is a great way to promote calming when feeling stressed or anxious. Place the tip of your tongue against the roof of your mouth just behind your front teeth. Begin by exhaling through your mouth around your tongue, then close your mouth and inhale deeply through your nose for four seconds. Hold your breath for five seconds and then 50 | Chapter 6 completely exhale through your mouth, making a whoosh sound. Exercise Getting regular exercise is a great way to reduce stress, promote calming, and im- prove both physical and emotional well-being.

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If Sullivan’s (1953) belief is true order crestor 5mg visa cholesterol medication liver, that is, that all emotional problems stem from difficulties with interpersonal relationships, then this role of the nurse in psychiatry becomes especially meaningful and purposeful. The therapeutic interpersonal relationship is the means by which the nursing process is implemented. Tasks of the relationship have been categorized into four phases: the preinteraction phase, the orientation (introductory) phase, the working phase, and the termination phase. Although each phase is presented as specific and distinct from the others, there may be some overlapping of tasks, particularly when the interaction is limited. The Preinteraction Phase The preinteraction phase involves preparation for the first encounter with the client. Obtaining available information about the client from the chart, significant others, or other health-team members. Examining one’s feelings, fears, and anxieties about work- ing with a particular client. For example, the nurse may have been reared in an alcoholic family and have ambivalent feel- ings about caring for a client who is alcohol dependent. All individuals bring attitudes and feelings from prior experi- ences to the clinical setting. The nurse needs to be aware of how these preconceptions may affect his or her ability to care for individual clients. The Orientation (Introductory) Phase During the orientation phase, the nurse and client become acquainted. Establishing a contract for intervention that details the expectations and responsibilities of both the nurse and client 3. Developing a plan of action that is realistic for meeting the established goals 8. Exploring feelings of both the client and the nurse in terms of the introductory phase. Introductions are often uncom- fortable, and the participants may experience some anxiety until a degree of rapport has been established. Several interactions may be required to fulfill the tasks associated with this phase. The Working Phase The therapeutic work of the relationship is accomplished during this phase. Maintaining the trust and rapport that was established dur- ing the orientation phase 2. Overcoming resistance behaviors on the part of the client as the level of anxiety rises in response to discussion of painful issues 5. A plan for continuing care or for assistance during stress- ful life experiences is mutually established by the nurse and client. Through these interactions, the client learns that it is acceptable to un- dergo these feelings at a time of separation. Through this knowledge, the client experiences growth during the pro- cess of termination. Note: When the client feels sadness and loss, behaviors to delay termination may become evident. If the nurse experi- ences the same feelings, he or she may allow the client’s behaviors to delay termination. For therapeutic closure, the nurse must establish the reality of the separation and resist being manipulated into repeated delays by the client. Giving Allows the client to “What would you like to broad take the initiative talk about today? Placing the Clarifies the relation- “What seemed to lead event in ship of events in up to...? Helps the “What was your client recognize life response the last experiences that tend time this situation to recur as well as occurred? Perhaps you especially well with and I can discuss it a client who is mov- together. This technique is not therapeutic, how- ever, with the client who is very anxious. Exploring Delving further into a “Please explain that subject, idea, experi- situation in more ence, or relation- detail.






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