By W. Ugo. Cleveland Institute of Art. 2018.

In a recent study She would lead us in challenging the status involving 506 hospitals in 10 states generic nizagara 50 mg free shipping, Kovner and quo and speak of the necessity for nursing Gergen (1998) reported that patients who have sur- leaders to have a clear vision of nursing prac- gery done in hospitals with fewer registered nurses tice and a willingness to advocate for nursing per patient run a higher risk of developing avoid- regardless of external forces seeking to un- able complications following their operation generic nizagara 25 mg line. Patients dresses outcomes of care and validates the in hospitals with fewer full-time registered nurses impact of professional nursing order 25 mg nizagara free shipping, particularly per in-patient day had a greater incidence of uri- in long-term care settings. She would agree nary tract infections, pneumonia, thrombosis, that the improvement of care to elders in pulmonary congestion, and other lung-related nursing homes is a significant ethical issue problems following major surgery. The authors for society and that nurses, the largest group suggested that these complications can be pre- of care providers to elders in nursing homes, vented by hands-on nursing practices and that this play a vital role in the improvement of care. Clinical outcomes for nurse-led in-patient this population consists only of bed and body care. The effectiveness of bly envision it as a means for highly educated “nursing beds”: A review of the literature. Journal of Advanced nurses to use their expertise more effectively Nursing, 27, 1184–1192. She would encourage advanced prac- dress before a meeting of the Department of Baccalaureate and Higher Degree Programs of the New Jersey League for tice nurses to continue to develop knowledge Nursing, February 7, 1955, at Seton Hall University, Newark, related to the nursing discipline and the New Jersey. Montefiore Medical Center Archives, Bronx, New unique contribution of nursing to the health York. Montefiore nity nursing organizations as an opportunity Medical Center Archives, Bronx, New York. Summary of project report: Loeb for nurses to coordinate and deliver continu- Center for Nursing and Rehabilitation. Summary of project report: Loeb Center Finally, she would urge nurses to recapture for Nursing and Rehabilitation. The Loeb Center for Nursing and Rehabilita- tion, Montefiore Hospital and Medical Center, Bronx, New York. Image: Journal of Nursing Scholarship, 30, Nursing Clinics of North America, 6, 273–280. Record Hearings before the Special Subcommittee on Intermediate Care of the Committee on Veterans’ Affairs. Josephine Paterson is originally from the East were the positions they held when I met them as a Coast where she attended a diploma school of graduate student in psychiatric mental health nurs- nursing in New York City. Paterson agreed to work with me as my her bachelor’s degree in nursing education from St. In her graduate work at Johns The following two years brought me a world of Hopkins University, she focused on public health enrichment. Zderad, those nursing and then earned her doctor of nursing sci- years culminated in their retirement and relocation ence degree from Boston University. She later spired me to carry on their work, using it in my earned her bachelor’s degree in nursing education nursing situations, whether in clinical, administra- from Loyola University of Chicago. In her graduate tive, or most recently, with nursing students, and to work she majored in psychiatric nursing at the share what I have come to know. She subsequently The Humanistic Nursing Theory was originally earned her doctor of philosophy from Georgetown formulated as a way for nurses to define nursing. That is, a way to illuminate the values and mean- Josephine Paterson and Loretta Zderad met in ings central to nursing experiences. Zderad were nursing visionaries who emphasized Their joint project was to create a new program synthesis and wholeness rather than reduction and that would encompass the community health com- logical/mathematical analysis. They challenged the ponent and the psychiatric component of the notion that the reductionistic approach is the graduate program. This started a collaboration, di- touchstone of explanatory power, and they postu- alogue, and friendship that has lasted for over 45 lated an “all-at-once” character of existence in years. They shared and developed their concepts, nurses’ experiences of being in the world. They led approaches, and experiences of “existential phe- the way to many of the contemporary nursing the- nomenology,”which evolved into the formal Theory ories that emphasize the caring aspects of nursing of Humanistic Nursing. It speaks to the essences of nursing and embraces They were hired as “nursologists” by a forward- the dynamics of being, becoming, and change.

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It is tic child will develop normally for the first year or two of also thought that they may be projecting their own weak- life order 50 mg nizagara mastercard. However nizagara 50mg on-line, a break usually occurs before the age of nesses and fears onto the groups they denigrate as inferi- two and a half purchase nizagara 25mg fast delivery, when speech development (if it has or. Other traits associated with this personality type in- begun) stops and social responses fail to develop. As infants, they may refuse Further Reading to cuddle and may react to physical contact by stiffening Eiser, J. There is also a lack of interest in or a failure to form peer relationships, and the ordinary desire to share experiences and interests with others tends to be lacking. Autistic children lack in- Autism terest and skill in games and other typical kinds of recip- rocal child’s play, including imitative play. Standard A severe psychological disorder that first appears in nonverbal behaviors that support social interactions— early childhood and is characterized by impaired eye contact, facial expressions, and body language—are social interaction and language development, and other behavioral problems. Leo Kanner in 1943, autism is most often leads parents to seek diagnosis and help for a severe psychological disorder that affects an estimat- autistic children. Autism manifests itself in either delayed or totally absent in children with autism. The autistic child is impaired socially, Those who can speak still have trouble listening to oth- in language development, and exhibits other behavioral ers and initiating or carrying on a conversation. This disorder is also known as infantile or speech of autistic persons often lacks normal grammati- childhood autism and Kanner’s autism. Besides social and language impairments, the other Further Information major symptom of autism is the presence of repetitive, Autism Society of America (formerly National Society for ritualized patterns of behavior. Autistic behavior may also take such forms as arranging objects in specific patterns or quantities, mimicking a particular action, or performing a routine activity exactly the same way every day. Other behavioral characteristics associated with autism are a Autoeroticism preoccupation with a single interest (often one for which Manual stimulation (usually self-stimulation) of the a large number of facts may be collected); resistance to genital organs with the intention, typically, of pro- trivial changes in routine; fascination with a moving ob- ducing sexual arousal and orgasm. Autoeroticism is the scientific term used to describe Persons with autism may exhibit oversensitivity to certain masturbation, the stimulation of the genital organs to stimuli (such as light or touch), unusual pickiness in eat- achieve orgasm. Although masturbation was widely con- ing, inappropriate fear and/or fearlessness, and self-injur- demned in most premodern societies, and has been the ing behavior, such as head banging. As many as 25 per- subject of remarkable and persistent superstitions and ex- cent of autistic children develop epileptic seizures later in treme taboos, there is evidence that contemporary atti- life, often in adolescence, although this particular symp- tudes toward masturbation are becoming increasingly tol- tom appears only in those who are mentally retarded. Howev- adult males and about 80 percent of adolescent and adult er, many demonstrate skill in music, mathematics, long- females have engaged in masturbation. While masturba- term memorization of trivial data, and specialized tasks tion is usually a private, solitary activity, it is often ac- such as assembling jigsaw puzzles. Relatively few individuals consistently pre- for living and working independently as adults, although fer masturbation to sexual activity that involves another only one in six children with autism becomes a well-ad- person. It has been shown that masturbation is not physi- justed adult, with another one out of six achieving a fair cally harmful, and the psychological significance of mas- degree of adjustment. Even those autistic adults who turbation depends on how it is regarded by the individual. New York: International dictors of future adjustment for autistic children are their Universities Press, 1975. While psychotherapy has not been of value in treating persons with autism, behavior modification, medica- Autonomic nervous system tion, and dietary recommendations have been proven ef- fective in controlling specific symptoms. Special educa- The nervous system responsible for regulating auto- tion programs are able to improve the social interaction matic bodily processes, such as breathing and heart rate. The autonomic system also involves the of autistic children and enhance their academic skills. Further Reading The nervous system consists of two main struc- Autism: Nature, Diagnosis, and Treatment.

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However patient discomfort from ventilation (coughing discount nizagara 50mg with visa, gagging—often from oral tracheal tubes cheap 25 mg nizagara mastercard, including biting on tubes) may cause problems buy nizagara 100 mg without prescription. Nurses should monitor effects of ventilation, providing comfort where possible (e. When physical restraint cannot be avoided, it is best limited to manual restraint, using the minimum force necessary, which should be released as soon as possible. Tidal volume Tidal volume affects gas exchange, but can also cause shearing damage to lungs; settings should therefore balance immediate needs of oxygenation and carbon dioxide removal against potential lung damage/healing. While not too dissimilar to peak flow volumes, normal respiration preferentially distributes air to dependent lung bases (especially when standing) (Ryan 1998), matching maximal ventilation with optimum perfusion; lying down reduces the functional residual capacity by about one-third, thus artificial ventilation distributes gas unevenly, overdistending upper lung zones (Ryan 1998). Patients at greatest risk from alveolar trauma usually have poor compliance, low functional lung volumes and hypoxia, creating dilemmas between adequate oxygenation and risks of lung damage. When patient-initiated negative pressure exceeds the set trigger level, patients can ‘breath through’ the ventilator. With most ventilatory modes, triggered breaths are in addition to preset volumes, but included in measured expired minute volume. Incorporating triggering/sensitivity into ventilators aids weaning and facilitates patient comfort by overcoming the problems of ‘fighting’. At rest, self-ventilation negative pressure is approximately −3 mmHg (Adam &; Osborne 1997); trigger levels below this can cause discomfort (fighting). Early methods of immersing expiratory port tubing into water (hence measurement in cmH2O) have been replaced by resistance valves (usually incorporated into ventilators). However, frequent small tidal volumes may achieve minute volume limits without clearing airway dead space. Once a breath is triggered, pressure support delivers gas until the preset peak airway pressure is reached. Thus pressure support encourages patients to initiate breaths, but replaces shortfall in volume from weak respiratory muscles. However tidal volumes are sufficiently consistent; alveolar ventilation is optimised (Bohm & Lachmann 1996) with minimal barotrauma. Flow-by Triggering (and pressure support) require sufficient negative pressure to open a closed valve, causing a delay in ventilation, increasing work of breathing and causing possible distress to patients. Flow-by provides a continuous flow of gas (5–20 litres per minute) through ventilator circuits (Kalia &: Webster 1997) to prevent these problems occurring. Inspiratory:expiratory ratio A breath has three potential parts: ■ inspiration ■ pause/plateau ■ expiration Oxygen transfer occurs primarily during inspiration and plateau; incomplete expiration (e. Changing inspiration to expiration (I:E) ratio therefore manipulates alveolar gas exchange. Some ventilators determine breath pattern by adjusting two of the parts as percentages of the whole breath; other ventilators set an I:E (inspiratory to expiratory) ratio, with separate control for pause/plateau time. Sigh Normal respiration includes a physiological sigh every 5 to 10 minutes (Hough 1996). Ratios between intra-alveolar pressure and volume differ between inspiration and expiration (hysteresis); lung expansion during inspiration increases alveolar surface area, facilitating adsorption of new surfactant adsorbed onto alveolar surfaces; this reduces surface tension during deflation by up to one-fifth (Drummond 1996). Occasional hyperinflation (sigh) prevents atelectasis during shallow respirations (Hough 1996), increases compliance, and so prevents infection. Since physiological sighs are lost with unconsciousness (Hough 1996), mechanical sighs were incorporated into ventilator technology, often delivering double tidal volumes. Bersten and Oh (1997) suggest that with use of smaller tidal volumes, sigh use requires reassessment. Independent lung ventilation With single-lung pathology, patients may benefit from different modes of ventilation being used to each lung. Independent lung ventilation requires double lumen endotracheal Artificial ventilation 33 tubes, one lumen entering each bronchus. Independent ventilators, each using any available mode, may then be used for each lung. Independent lung ventilation may be impractical due to: ■ insufficient ventilators available ■ increased costs and workload (e. However, as air leaks are invariably present and the airway is unprotected, with no access for suction (Elliott et al. Noninvasive ventilation is not intended for prolonged use, although it may facilitate weaning (Wedzicha 1992).

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The finding of enduring interest was that no matter what change was introduced to working conditions buy nizagara 100 mg mastercard, the result was increased productivity purchase nizagara 100mg with visa. For example discount nizagara 25mg amex, improving or reducing the lighting in the production areas under test produced similar effects. Subsequently the definition has been broadened; in clinical research it refers to treatment response; see also bias, labelling phenomenon, placebo effect, white-coat hypertension. This includes spending by both public and private sources (including households) on medical services and goods, public health and prevention programmes and administration. Excluded are health-related expenditure such as training, research and environmental health. The two major components of total current health expenditure are: expenditure on personal health care and expenditure on collective services. Heaton–Ward effect Subjective assessments can be severely biased by viola- tion of blinding or the expectation of the observer: in a supposed cross-over trial the observer is likely to report a deterioration after cross-over if he initially assumed an improvement and an improvement in those he first imagined had not occurred; see also bias, blinding, design. Certain exudates that have not been subjected to a specific treatment are also considered to be herbal substances. Hochberg correction In order to avoid errors by repeated significance testing the signi fi cance level is divided by the number of comparisons; see also bonferroni correction. An illness is treated with a medicine which could produce similar symptoms in a healthy person. The active ingredients are given in highly diluted form to avoid toxicity”; homeopathic remedies are virtually 100 % safe; see also allopathy. Hygiene program Procedures relating to health, hygiene and clothing of personnel during manufacturing; see good manufacturing practice, loi huriet. Secreted antibodies bind to antigens on the surfaces of invading microbes (such as viruses or bacte- ria), which flags them for destruction. Many are cell growth factors that accelerate the production of specific cells that are important in mounting an immune response in the body. It was originally proposed 50 years ago as a measure of the impact that individual articles have on the research community, but it is now more commonly used across all articles pub- lished by a journal to provide a measure of a journal’s impact on the research community rather than the impact of an individual article. The journal impact factor is thus calculated as the number of citations a journal has received in the last complete year for articles published in the two preceding years, divided by the total number of articles the journal published in the two preceding years. So it gives an average number of citations of published articles, without giving any unfair advantage to the larger or more frequently published journals. Such jour- nal citation reports are used widely as the basis for assessing research output. They are used by funding bodies to gauge the quality of publications, by 120 researchers to assess which journals they choose to submit manuscripts to, and I as a basis for journals to attract new subscriptions and advertising. Conditions, practices or processes that adversely affect the rights, safety or well being of the subjects and/or the quality and integrity of data, or that poses a risk to public health or that represents a serious violation of applicable legislation and guidelines. Conditions, practices or processes that would not be expected to adversely affect the rights, safety or well being of the subjects and/or the quality and integrity of data; see also audit, inspection. I intensive monitoring System of record collation in designed areas such as hos- pitals or physicians in community practice (Vol. Germany), familiar with the back- ground of the drug and the requirements of the study, reputated to have high 131 ethical standards and professional integrity; the legal status of persons autho- rised to act as investigators differs between states; coordinating i. Karch and Lasagna classification see causality; see also standardised assessment of causality. Karnofsky performance status scale which was devised for use in trials of chemotherapeutic agents for carcinoma; 100 % = normal, no complaints, no evidence of disease; 90 % = able to carry on normal activity, minor signs or symptoms of disease; 80 %=normal activity with effort, some signs or symptoms of disease; 70 % = cares for self, unable to carry on normal activ- ity or to do active work; 60 % = requires occasional assistance but is able to care for most of his needs; 50 % = requires considerable assistance and fre- quent medical care; 40 %=disabled, requires special care and assistance; 30 %=severely disabled, hospitalisation is indicated although death is not imminent; 20 %=very sick, hospitalisation necessary, active supportive treatment necessary; 10 % = moribund, fatal processes progressing rapidly; 0 %=dead; this scale however has never been validated; see also perfor- mance status. Korotkoff sound first sound during auscultatory blood pressure measurement: first appearance of faint clear tapping sounds which gradually increase in inten- sity (the systolic pressure is heard for two consecutive beats and this correlates well with intra-arterial pressures; also the pressure at which pulse of arteria radialis/brachialis reappears); fourth sound: point of muffling of sounds, i. Lasagna’s law The incidence of patient availability sharply decreases when a study begins and returns to its original level as soon as a study is completed (because most trialists overestimate the number of eligible patients); similar to muench’s law, murphy’s law, Pareto’s principle. Latin square Cross-over design, where each of n patients (or of n groups of subjects) receives n treatments in a randomised order (represented by n× n squares); e. The customer/doctor is encouraged to use the product (important: scientific and medical evidence); use expansion s. Broadening indications, providing evidence for safe use in other patient groups/higher dosages, line extension a.

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