By I. Ramon. University of Nebraska, Omaha.

It has a quick onset of action (one to two weeks) and is not associated with any side effects or drug interactions buy etoricoxib 90mg visa. Dosage: 600 mg once daily of a product standardized to provide 95 percent diosmin and 5 percent hesperidin etoricoxib 60 mg on line. Over 30 clinical studies have found diosmin safe and effective for improving vein disor- ders etoricoxib 60 mg sale, including chronic venous insufficiency and varicose veins. C Horse chestnut seed extract: Promotes circulation, improves vein wall tone, and relieves swelling. It may cause nausea and upset stomach and can enhance the effect of blood-thinning medications. Pine bark extract: A flavonoid that offers antioxidant activity, strengthens capillaries, improves circulation, and supports vein health. In addition to diosmin and pine bark, other antioxidants to consider include vitamins C and E, bilberry, and grape seed extract. Butcher’s broom: Improves the strength and tone of the veins, acts as a mild diuretic, and has mild anti-inflammatory effects. Gotu kola: Is a plant extract shown in preliminary research to reduce swelling, pain, fatigue, sensation of heaviness, and fluid leakage from the veins. Boost intake of fibre and antioxidant-rich foods; reduce your intake of saturated fats, processed foods, and sodium. Exercise regularly, elevate your feet when resting, and avoid standing or sitting in the same spot. Most people contract cold sores during childhood, although some people get them C later in life. After infection with the virus, it can remain dormant for long periods of time and then periodically cause outbreaks, particularly when the immune system is weakened. An outbreak of cold sores causes: • Clusters of tiny, red, fluid-filled blisters • Crusting once they burst • Pain Cold sores typically last for seven to 10 days. Contact your doctor if: the sores do not heal within two weeks; the symptoms are severe; you get frequent recurrences; you C experience pain or irritation in your eyes. Prescription antiviral drugs such as Valtrex and Zovirax may shorten the dura- tion and severity of the infection, but are not approved for prevention. These drugs are expensive, associated with side effects (nausea, vomiting, and headache), and are not recommended for children, pregnant women, or those with impaired kidney or liver function. Over-the-counter products that may be recommended include: Aspirin, acetaminophen (Tylenol) or ibuprofen: Oral medications that help re- duce pain. Dietary Recommendations Foods to include: • Foods high in the amino acid lysine (legumes, fish, meat, and dairy) may help to reduce levels of arginine. Foods to avoid: • Foods that contain high amounts of arginine (chocolate, nuts, whole grains, and gelatin) allow the cold sore virus to thrive. Lifestyle Suggestions To avoid contracting or spreading the virus, don’t share personal items such as drinking glasses, toothbrushes, razors, lipstick, or towels. It provides thermal therapy to enhance the immune system re- sponse and stop the virus. Clinical studies have shown that it can prevent outbreaks when used during the prodromal phase. There are no side effects; it can be used by children over six years and pregnant women; available without a prescription in most pharmacies. Once the blisters have appeared, try the following: C • Apply an ice pack, wrapped in a washcloth, for five minutes several times a day to ease pain and help dry out the sores. Top Recommended Supplements Lemon balm: An herb, also known as Melissa officinalis, lemon balm has antiviral proper- ties that can help speed healing and shorten the duration of an outbreak. Lysine: An amino acid that inhibits growth of the cold sore virus and may reduce recur- rence; take at the first sign of a cold sore. Complementary Supplement Antioxidants: The antioxidants vitamins C and E may help to promote healing and strength- en the immune system’s response to the virus. To cut your risk of an outbreak, get adequate rest, reduce stress, avoid sharing utensils or personal items, and wear sunscreen and lip balm. Use a cold pack and witch hazel to relieve pain and prevent spreading, and a cream with lemon balm to promote healing. Children are most susceptible to contracting the virus and may experience as many as 10 colds a year. As we get older, we develop immunity to many viruses and are less likely to get colds. For example, if you are beside someone who has the virus and coughs or sneezes and you inhale those virus droplets, then you can catch a cold. It can also be spread by hand-to-hand contact or by touching an object that has been contaminated with the virus and then rubbing your eyes, nose, or mouth.

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Paratyphoid fever is milder than typhoid fever Complications: Intestinal perforation Lower gastrointestinal bleeding Dissenmination to different body organs including meninges and brain Mortality rate Untreated cases: 10-15% Treated cases: < 1% 2 buy 120mg etoricoxib otc. Gram reaction: Gram-negative rods Culture: Bacteriologic methods for salmonella isolation 1 cheap 120 mg etoricoxib with visa. Inhibit replication of normal intestinsl flora and permit replication of salmonella Egs buy 60mg etoricoxib mastercard. Selenite F broth Tetrathionate broth Non-lactose fermenting , H2S producing colonies in Mac conkey agar. Tube dilution agglutination test Used to determine antibody titers in patients with unknown illness 240 Method: • Serial dilutions of unknown serum are tested against antigens from representative salmonella species. Slide agglutination test/ Kauffman-White system Used to identify unknown cultures with known sera 241 Required: Salmoella O and H polyvalent antiserum Method:. Pathogenesis and Clinical features: Route of infection is fecal-oral route Inoculum dose: 103 organisms Pathogenicity determinant: Toxins: Endotoxin: irritate the bowel wall Exotoxin: Enterotoxin and neurotoxin S. Complication: Dehydration Electrolyte and acid-base disturbance High prevalence: Poor sanitation Poor personal hygiene Polluted water supply Young children are frequently affected. Laboratory diagnosis: Specimen: Stool,serum Gram reaction: Gram-negative non-motile rods. Laboratory diagnosis: Specimen: Urine, pus, blood, ear discharge Smear: Gram-negative rods Culture: Produce characteristic swarming growth over the surface of blood agar. Indole negative Serology: Cross react with Weil-fellix test Treatment: Based on sensitivity testing. Bubonic plague: Fever, vomiting, painful lymphadenitis(buboes) in the groin or axillae 2. Pneumonic plague: Ip is 1-3 days Profuse mucoid or bloody expectoration with signs of pneumonia 3. Septicemic plague Fever, vomiting, diarrhea, hypotension, altered mentation, renal and heart failure, intra vascular coagulopathy Lab. Formalin-killed vaccine for travellers to hyperendemic areas and high risk persons Yersinia enterocolitica and Yersinia pseudotuberculosis Non-lactose fermenting gram negative rods Urease positive Oxidase negative Y. Human infection occurs by contaminated food and drinks from domestic animals or rodents Y. Human infection results from ingestion of food and drinks contaminated by animalfeces Antigenic structure. Diagnosis: Specimen: Stool, blood, rectal swab Culture: Grow in routine enteric media Biochemical tests for species identification Treatment: Fluid replacement for enterocolitis (Antibiotics not required) rd Cephalosporin (3 generation) + Aminoglycosides for sepsis/ meningitis Prevention and control: Conventional sanitary precautions 2. Found in human and animal intestine, water, soil and moist environment in hospitals. Invasive and toxigenic, produces infections in patients with abnormal host defenses Antigenic characteristic:. Exotoxin A: Cytotoxic by blocking protein synthesis Clinical features: Pathogenic only when introduced into areas devoid of normal defenses eg. Urinary tract infection- chronic, complicated Urinary tract infection and associated with indwelling catheter. Otitis externa- Malignant external ear infection in poorly treated diabetic patients. Laboratory diagnosis: Specimen: pus, urine, sputum, blood, eye swabs, surface swabs Smear: Gram-negative rods Culture:. Obligate aerobe, grows readily on all routine media over O wide range of temperature(5-42 C). Bluish-green pigmented large colonies with characteristic “fruity” odor on culture media. Species of medical importance: Vibrio cholerae-01 Vibrio cholerae Characteristics:. Readily killed by heat and drying; dies in polluted water but may survive in clean stagnant water, esp. All strains possess a distinctive O antigen and belong to subgroup I with subdivision into three serotypes; Ogawa, Inaba, Hikojima. ElTor biotype is more resistant to adverse conditions than Classical diotype of V. Little value in identification Clinical features: Route of infection is fecal-oral route. Laboratory diagnosis: Specimen: Stool flecks Smear: Gram-negative motile curved rods Motility of vibrios is best seen using dark-field microscopy. Presumptive diagnosis: Inactivation of vibrios in a wet preparation after adding vibrio antiserum.

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Choose as an exemplar for evaluation a Web site from a theorist in one of the Evaluation of nursing theory resources is chapters of this book order 60mg etoricoxib amex. Begin evaluating this nursing of major importance in laying groundwork theorist’s Web site and as you thoughtfully consider for consistent purchase 90mg etoricoxib free shipping, credible etoricoxib 120mg with amex, and authoritative each question, assess whether or not the informa- research findings. Yes/No Who are authoritative sources who speak, write about, and Nursing authorities contribute to content. Are they contributors to the content on Practitioners of nursing contribute to the content. Yes/No What are the professional qualifications of these contribu- Other organizations use, refer to, or maintain links to tors? Evaluation of Authority: What are other major resources on this theory that are au- Acceptable/Not Acceptable thoritative? Information covers theory, practice, research, and Do authoritative sources show their credentials on the Web administration. Yes/No Does the resource provide information in a logical and easily Bibliography included. Evaluation of Content: Does the resource provide comprehensive, substantiated in- formation? Acceptable/Not Acceptable Does the information cover nursing research, administration, and education? Are you able to The Web site/resource is easy to use and well or- contact the webmaster from an onsite address? Yes/No Are you informed when you are seamlessly transferred to an- The Web site/resource is satisfying to visit. Are there fees or membership required to access the infor- Yes/No mation you need? This nursing theory resource will ground my inquiry as a credible, authoritative, and accurate source of information. Yes/No Reservations: ____________________________________________________________________________________ questions may not apply to all Web sites and may be • How comprehensive do you intend your analy- modified by the purpose of the Web site. Following are key reflective preparations that will When you have answered as many questions as help focus your activities: you are able to, synthesize your findings. White paper: Criteria for assessing the accuracy, credibility, currency, and trust- quality of health information on the Internet (working draft). Nursing decision making and the science of the Bartlett Publishers and National League for Nursing. The Nightingales Florence Nightingale transformed a “calling from were on an extended European tour, begun in 1818 God” and an intense spirituality into a new social shortly after their marriage. A reflection on this statement A legacy of humanism, liberal thinking, and love appears in a well-known quote from Notes on of speculative thought was bequeathed to Nursing (1859/1992): “Nature [i. His views on the educa- tion of God] alone cures … what nursing has to tion of women were far ahead of his time. Florence and her sis- Although Nightingale never defined human care or ter studied music; grammar; composition; modern caring in Notes on Nursing, there is no doubt that languages; Ancient Greek and Latin; constitutional her life in nursing exemplified and personified an history and Roman, Italian, German, and Turkish ethos of caring. It is model is yet to truly come of age in nursing or the Parthenope, the older sister, who clutches her fa- health care system. Justice- making is understood as a manifestation of com- passion and caring,“for it is our actions that brings about justice” (p. This chapter reiterates Nightingale’s life from the years 1820 to 1860, delineating the formative influences on her thinking and providing historical context for her ideas about nursing as we recall them today. Part of what follows is a well-known tale; yet it remains a tale that is irresistible, casting an age-old spell on the reader, like the flickering shadow of Nightingale and her famous lamp in the dark and dreary halls of the Barrack Hospital, Scutari, on the outskirts of Constantinople, circa 1854 to 1856. Early Life and Education A profession, a trade, a necessary occupation, some- thing to fill and employ all my faculties, I have always felt essential to me, I have always longed for, con- sciouslyornot.... Nightingales and both daughters made an extended —Florence Nightingale, private note, 1850, cited tour of France, Italy, and Switzerland between the in Woodham-Smith (1983, p. From there, Nightingale vis- By all accounts, Nightingale was an intense and ited Germany, making her first acquaintance with serious child, always concerned with the poor and Kaiserswerth, a Protestant religious community the ill, mature far beyond her years. A few months that contained the Institution for the Training of before her seventeenth birthday, Nightingale Deaconesses, with a hospital school, penitentiary, recorded in a personal note dated February 7, 1837, and orphanage. What that Fleidner, and his young wife had established this service was to be was unknown at that point in community in 1836, in part to provide training for time. This was to be the first of four such experi- women deaconesses (Protestant “nuns”) who ences that Nightingale documented. Nightingale was to return there in The fundamental nature of her religious convic- 1851 against much family opposition to stay from tions made her service to God, through service to July through October, participating in a period of “nurses training” (Cook, Vol. What the make it without”(Nightingale, private note, cited in Kaiserswerth training lacked in expertise it made Woodham-Smith, 1983).

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However order etoricoxib 90mg on line, one-half of the patients were randomly assigned to actually receive the antianxiety drug Paxil generic 90mg etoricoxib fast delivery, while the other half received a placebo drug that did not have any medical properties buy etoricoxib 90mg on line. The researchers ruled out the possibility that only placebo effects were occurring because they found that both groups improved over the 8 weeks, but the group that received Paxil improved significantly more than the placebo group did. If the researchers believe that their treatment is going to work, why would they deprive some of their participants, who are in need of help, of the possibility for improvement by putting them in a control group? Social skills training augments the effectiveness of cognitive behavioral group therapy for social anxiety disorder. These studies are advantageous because they compare the specific effects of one type of treatment with another, while allowing all patients to get treatment. Research Focus: Meta-Analyzing Clinical Outcomes Because there are thousands of studies testing the effectiveness of psychotherapy, and the independent and dependent variables in the studies vary widely, the results are often combined using a meta-analysis. A meta- analysis is a statistical technique that uses the results of existing studies to integrate and draw conclusions about those studies. In one important meta-analysis analyzing the effect of psychotherapy, Smith, Glass, and Miller [7] (1980) summarized studies that compared different types of therapy or that compared the effectiveness of therapy against a control group. To find the studies, the researchers systematically searched computer databases and the reference sections of previous research reports to locate every study that met the inclusion criteria. Over 475 studies were located, and these studies used over 10,000 research participants. The results of each of these studies were systematically coded, and a measure of the effectiveness of treatment known as the effect size was created for each study. Smith and her colleagues found that the average effect size for the influence of therapy was 0. What this means is that, overall, receiving psychotherapy for behavioral problems is substantially better for the individual than not receiving therapy (Figure 13. Although they did not measure it, psychotherapy presumably has large societal benefits as well—the cost of the therapy is likely more than made up for by the increased productivity of those who receive it. On the basis of these and other meta-analyses, a list ofempirically supported therapies—that is, therapies that are known to be effective—has been [11] developed (Chambless & Hollon, 1998; Hollon, Stewart, & Strunk (2006). What this means is that a good part of the effect of therapy is nonspecific, in the sense that simply coming to any type of therapy is helpful in comparison to not coming. This is true partly because there are fewer distinctions among the ways that different therapies are practiced than the theoretical differences among them would suggest. What a good therapist practicing psychodynamic approaches does in therapy is often not much different from what a humanist or a cognitive- behavioral therapist does, and so no one approach is really likely to be better than the other. This is why many self-help groups are also likely to be effective and perhaps why having a psychiatric service dog may also make us feel better. Effectiveness of Biomedical Therapies Although there are fewer of them because fewer studies have been conducted, meta-analyses also support the effectiveness of drug therapies for psychological disorder. People who take antidepressants for mood disorders or antianxiety medications for anxiety disorders almost always report feeling better, although drugs are less helpful for phobic disorder and obsessive-compulsive disorder. Some of these improvements are almost certainly the result [16] of placebo effects (Cardeña & Kirsch, 2000), but the medications do work, at least in the short term. One problem with drug therapies is that although they provide temporary relief, they don‘t treat the underlying cause of the disorder. In addition many drugs have negative side effects, and some also have the potential for addiction and abuse. Different people have different reactions, and all drugs carry Attributed to Charles Stangor Saylor. As a result, although these drugs are frequently prescribed, doctors attempt to prescribe the lowest doses possible for the shortest possible periods of time. Older patients face special difficulties when they take medications for mental illness. Older people are more sensitive to drugs, and drug interactions are more likely because older patients tend to take a variety of different drugs every day. They are more likely to forget to take their pills, to take too many or too few, or to mix them up due to poor eyesight or faulty memory. Like all types of drugs, medications used in the treatment of mental illnesses can carry risks to an unborn infant. Tranquilizers should not be taken by women who are pregnant or expecting to become pregnant, because they may cause birth defects or other infant problems, especially if taken during the first trimester. Food and [18] [19] Drug Administration, 2004), as do antipsychotics (Diav-Citrin et al. Decisions on medication should be carefully weighed and based on each person‘s needs and circumstances. Medications should be selected based on available scientific research, and they should be prescribed at the lowest possible dose. Effectiveness of Social-Community Approaches Measuring the effectiveness of community action approaches to mental health is difficult because they occur in community settings and impact a wide variety of people, and it is difficult to find and assess valid outcome measures. Nevertheless, research has found that a variety of community interventions can be effective in preventing a variety of psychological disorders [20] (Price, Cowen, Lorion, & Ramos-McKay,1988). And the average blood- lead levels among children have fallen approximately 80% since the late 1970s as a result of federal legislation designed to remove lead paint from housing (Centers for Disease Control and [22] Prevention, 2000).

Answer In a chronic asthmatic patient who is receiving high-dose inhaled steroids (and may have received oral glucocortico- steroids periodically) cheap etoricoxib 120 mg free shipping, any severe stress (e discount etoricoxib 90mg online. In this case buy discount etoricoxib 60mg on line, the development of refractory hypotension in a patient who is on antibiotics and pressors, and the subse- quent hypoglycaemia, should alert one to the probability of adrenal insufficiency. This possibility is further supported by the low sodium, slightly increased potassium and elevated urea levels. The treatment consists of immediate administration of intravenous hydrocortisone and intravenous glucose. Hydro- cortisone should then be given eight hourly for 24–48 hours, together with intravenous 0. With improvement, the patient could then be given twice his nor- mal dose of prednisolone or its parenteral equivalent for five to seven days. This unfortunate clinical scenario could have been avoided if parenteral hydrocortisone was given preop- eratively and every eight hours for the first 24 hours post- operatively. Glucocorticosteroids should be continued at approximately twice their normal dose for the next two to three days post-operatively, before reverting to his usual dose (clinical state permitting). Oestrogens influ- • treatment of certain neoplastic diseases; ence the development of secondary sexual characteristics, • treatment of hereditary haemorrhagic telangiectasia including breast development and the female distribution of (Osler–Weber–Rendu syndrome); fat, as well as ovulation during the reproductive years. From the start of menses until the menopause, the primary oestrogen is oestradiol-17β, whereas in post-menopausal women Ethinylestradiol, a synthetic oestrogen, is an alternative for oestrone predominates. The newer progestogens, Pharmacokinetics desogestrel, gestodene and norgestimate produce good Oestrogens are absorbed by mouth and via the skin and mucous cycle control and have a less marked adverse effect on membranes. The most potent natural oestrogen is oestradiol-17β plasma lipids; however, studies have shown that oral which is largely oxidized to oestrone and then hydrated to pro- contraceptives containing desogestrel and gestodene are duce oestriol. All three oestrogens are metabolized in the liver associated with an increase of around two-fold in the risk and excreted as glucuronide and sulphate conjugates in the bile of venous thromboembolism compared to those and urine. Estimation of urinary oestrogen excretion provides a containing other progestogens and should be avoided in measure of ovarian function. Ethinylestradiol has a prolonged women with risk factors for thromboembolic disease. Progesterone is the precursor of 17-hydroxyprogesterone progestogen norelgestromin is combined with which is converted to androstenedione which subsequently is ethinylestradiol in a transdermal contraceptive patch. Progesterone is produced in the adrenal glands, by the corpus luteum, the Mechanism of action brain and by the placenta. Progestogens act on intracellular cytoplasmic receptors and Progestogens act on tissues primed by oestrogens whose initiate new protein formation. There are two main groups of progesto- is via an action on cervical mucus which renders it impene- gens, namely the naturally occurring hormone progesterone trable to sperm. Nortestosterone derivatives are partially and its analogues, and the testosterone analogues, such as metabolized oestrogenic metabolites which may account for norethisterone and norgestrel. Apseudodecidual change oestrogenic and anti-gonadotrophic properties, and differ in in the endometrium further discourages implantation of the their potency and their side effects. Uses of progesterone Pharmacokinetics The uses of progesterone are: Progesterone is subject to presystemic hepatic metabolism and • to control anovulatory bleeding; is most effective when injected intramuscularly or adminis- • to prepare the uterine lining in infertility therapy and tered sublingually. It is excreted in the urine as pregnanediol to support early pregnancy; and pregnanelone. It has prolonged absorption and an elimi- • for recurrent pregnancy loss due to inadequate nation half-life of 25–50 hours. It is the most consistently effective contraceptive • as an anti-androgen in androgen-sensitive tumours, method and allows sexual relations to proceed without inter- such as prostate cancer, e. The most an intact uterus to counteract the effects of unopposed commonly used oestrogen is ethinylestradiol. Jaundice similar to that of preg- Progestogens currently used in combined oral contracep- nancy cholestasis can occur, usually in the first few cycles. There is a small increased risk of liver can- binding globulin, ceruloplasmin, transferrin, coagulation cer. There is a decreased incidence of benign breast lesions and factors and renin substrate, while increased fibrinogen functional ovarian cysts. Progestogen-only pills may be appropriate • increased incidence of gallstones; in women at higher risk of thrombotic disease. The data preparations that contain third-generation progestogens, such with regard to breast cancer suggest that there may be a small as desogestrel and gestodene, reporting incidences of about 25 increased risk, but this is reduced to zero ten years after stop- per 100000 women per year of use. With regards to cervical cancer, there is a small risk is still very small and well below the risk associated with increase after five years and a two-fold increase after ten pregnancy, provided that women are well informed about the years of treatment. Increased blood pressure is common with the pill, and is clin- Key point ically significant in about 5% of patients.

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The biological componentof the bio-psycho-social model refers to the Attributed to Charles Stangor Saylor 120 mg etoricoxib with mastercard. Particularly important are genetic characteristics that make some people more vulnerable to a disorder than others and the influence of neurotransmitters etoricoxib 120mg low price. The psychological component of the bio-psycho- social model refers to the influences that come from the individual buy 120mg etoricoxib, such as patterns of negative thinking and stress responses. Thesocial component of the bio-psycho-social model refers to the influences on disorder due to social and cultural factors such as socioeconomic status, homelessness, abuse, and discrimination. To consider one example, the psychological disorder of schizophrenia has a biological cause because it is known that there are patterns of genes that make a person vulnerable to the disorder [4] (Gejman, Sanders, & Duan, 2010). But whether or not the person with a biological vulnerability experiences the disorder depends in large part on psychological factors such as how the individual responds to the stress he experiences, as well as social factors such as whether or not he is exposed to stressful environments in adolescence and whether or not he has support from people who care about him (Sawa & Snyder, 2002; Walker, Kestler, Bollini, & Hochman, [5] 2004). Similarly, mood and anxiety disorders are caused in part by genetic factors such as hormones and neurotransmitters, in part by the individual‘s particular thought patterns, and in part by the ways that other people in the social environment treat the person with the disorder. We will use the bio-psycho-social model as a framework for considering the causes and treatments of disorder. Although they share many characteristics with them, psychological disorders are nevertheless different from medical conditions in important ways. Current research is beginning to provide more evidence about the role of brain structures in psychological disorder, but for now the brains of people with severe mental disturbances often look identical to those of people without such disturbances. Because there are no clear biological diagnoses, psychological disorders are instead diagnosed on the basis of clinical observations of the behaviors that the individual engages in. These observations find that emotional states and behaviors operate on a continuum, ranging from more “normal‖ and “accepted‖ to more “deviant,‖ “abnormal,‖ and “unaccepted. It is not unusual to worry about and try to improve one‘s body image, but Robert‘s struggle with his personal appearance, as discussed at the beginning of this chapter, was clearly unusual, unhealthy, and distressing to him. Whether a given behavior is considered a psychological disorder is determined not only by whether a behavior is unusual (e. An intense fear of spiders, for example, would not be considered a psychological disorder unless it has a significant negative impact on the sufferer‘s life, for instance by causing him or her to be unable to step outside the house. The focus on distress and dysfunction means that behaviors that are simply unusual (such as some political, religious, or sexual practices) are not classified as disorders. Put your psychology hat on for a moment and consider the behaviors of the people listed in Table 12. For each, indicate whether you think the behavior is or is not a psychological disorder. If you‘re not sure, what other information would you need to know to be more certain of your diagnosis? Charlie believes that the noises made by cars and planes going by outside his house have secret meanings. He is convinced that he was involved in the start of a nuclear war and that the only way for him to survive is to find the answer to a difficult riddle. She sometimes stays in her pajamas for the whole weekend, eating chocolate and Attributed to Charles Stangor Saylor. He worries about driving on the highway and about severe weather that may come through his neighborhood. But mostly he fears mice, checking under his bed frequently to see if any are present. A worshipper speaking in “tongues‖ at an Evangelical church views himself as “filled‖ with the Holy Spirit and is considered blessed with the gift to speak the “language of angels. Talking to ourselves out loud is unusual and can be a symptom of schizophrenia, but just because we do it once in a while does not mean that there is anything wrong with us. It is natural to be depressed, particularly in the long winter nights, but how severe should this depression be, and how long should it last? If the negative feelings last for an extended time and begin to lead the person to miss work or classes, then they may become symptoms of a mood disorder. It is normal to worry about things, but when does worry turn into a debilitating anxiety disorder? And what about thoughts that seem to be irrational, such as being able to “speak the language of angels‖? Are they indicators of a severe psychological disorder, or part of a normal religious experience? Again, the answer lies in the extent to which they are (or are not) interfering with the individual‘s functioning in society. Another difficulty in diagnosing psychological disorders is that they frequently occur together. For instance, people diagnosed with anxiety disorders also often have mood disorders (Hunt, [7] Slade, & Andrews, 2004), and people diagnosed with one personality disorder frequently suffer from other personality disorders as well. Comorbidity occurs when people who suffer from one disorder also suffer at the same time from other disorders. Because many psychological disorders are comorbid, most severe mental disorders are concentrated in a small group of people Attributed to Charles Stangor Saylor. Psychology in Everyday Life: Combating the Stigma of Abnormal Behavior Every culture and society has its own views on what constitutes abnormal behavior and what causes it (Brothwell, [9] 1981).

A call for books discount 120 mg etoricoxib free shipping, journals purchase etoricoxib 60mg on-line, and media recordings purchase 120 mg etoricoxib fast delivery, emphasis nursing is also a call for transforming knowledge rests upon evaluation of the author and contents of and information; therefore, the response from each resource. In the utilization of the Internet as a nursing should be with clarity, conviction, and resource for “discovery” (Boyer, 1996, p. In this way, nursing theory is inte- dimension requiring evaluation is realized: The grated, lived out in the personhood of the nurse host of the virtual environment, now ubiquitous and continues to shape, guide, and focus the nurse and often fleeting, also must be identified, exam- in all activities. Authorial responsibility and sources is therefore an extension and affirmation of veracity in books and journals that are closely scru- the values grounding the practice of nursing. Role-blurring between Web media routinely complement traditional textbooks site author and owner is subtle yet insistent. The with the virtual world of Internet Web sites that author of the Web pages, or the “webmaster,” is offer sensate immersion in motion, color, and most often another party hired to create and main- sound. Browsing on the Internet frequently results tain the look of the Web site environment and is in traveling through a succession of hyperlinks that therefore not responsible for the content. The thoughtful sible data has also created a paradox: The sheer vol- study of nursing theory, therefore, includes not ume of information has created a gap in the human only consideration of works contributed by the the- ability to process and evaluate it (Jenkins, 2001). To practitioners who are the sources of disseminated whom or what does one respond or carry concerns nursing knowledge. A framework of non-nursing tion resources are exactly alike, guidelines for eval- values is engineered and deeply embedded in elec- uation need to be flexible and adaptable. Conceptual frameworks The thoughtful nurse researcher should proceed in the nurse’s mind provide the means of interfac- flexibly in the research and evaluation process ing and transforming these values embedded in the using “alternating rhythms” (Mayeroff, 1971, p. The challenge for the nurse is to analyze, rower frameworks to comprehend how one aspect is connected with the whole. Evaluation may be un- derstood as alternating between two overlapping The challenge for the nurse is to analyze, phases: The first phase is one in which technical de- evaluate, and transform non-nursing values sign, organization, and aesthetic comportment of embedded in electronic media into a con- the Web site are considered in relation to the con- ceptual framework of human values that tent. The second phase comprises focused evalua- are realized in theory and actualized in tion on the reason for the Web site itself, that is, on practice. The response is evaluate, and transform non-nursing values em- clearly affirmative. Nurses know in many different bedded in electronic media into a conceptual ways, and when this knowing is recorded, shared, framework of human values that are realized in and confirmed, it becomes nursing knowledge. Understanding fundamental patterns of knowing The ubiquitous Web site—the most prolific and in nursing is a way to begin the process of illumi- transient of electronic data or resource locators to nating theory and research. As you proceed in your search, you will experience Criteria for evaluating Internet Web pages several different patterns of knowing (Carper, 1975; abound (Harris, 1997; Howe, 2001; Tillman, 2003; Mueller, 1953; Phenix, 1964). Methods and tools for evaluating describes different dimensions of the activity of and rating the quality of Web sites have been devel- knowing and, like “a range of colors” (Mueller, oped by a range of organizations (Rippen, 1999; 1953, p. These fundamental patterns of categories: codes of conduct, quality labels, user knowing are: personal, empiric, ethical, aesthetic guides, filters, and third party certification. While (Carper, 1978), symbolic, and integrative (or syn- these tools are generally applicable to health care optic) (Phenix, 1964). These patterns of knowing and commercial Web sites, they do not directly ad- are fluid, recursive, and without discrete bound- dress evaluation of the specialized content of nurs- aries. Personal knowing can when you evaluate the balance, organiza- broadly be described as subjective, concrete, direct, tion, and harmony of the resource content. Phenix (1964) asserts that it “signifies rela- resource, whether or not it is pleasing, de- tional insight or direct awareness” (p. You will experience visual appeal of the theory resource, whether or not personal knowing in conjunction with other pat- it is pleasing, denotes aesthetic appreciation of terns as you engage in your self-preparation and re- beauty and organization. Symbolic Knowing Empirical Knowing Symbolic knowing encompasses the realm of the Empirical knowing relates to the science of nursing. Phenix According to Carper (1975), this type of knowing is (1964) states that symbolic systems constitute the “factual, descriptive and ultimately aimed at devel- most fundamental of all realms in that they must be oping abstract and theoretical explanations. You will be engaging in empir- symbolic realms, as well as nondiscursive, symbolic ical knowing particularly when you recognize, forms used in all the arts and for the expression of assess, evaluate, and describe various aspects of the feelings, values, ideals, rituals, and commitments. Symbolic forms are also indicated in signals, man- ners, and gestures and encompass experience and Ethical Knowing history. Ethics is the moral pattern of knowing that focuses You will be experiencing symbolic knowing on the primary principle of obligation and what when you engage in self-examination and reflection. The goals and the meaning of theory, and searching virtual media actions of nursing, including your search, involve are also abstract ideas which you experientially normative judgments of moral value. This critical way of knowing en- Aesthetic knowing is a perception of unity and re- ables an individual to grow and change with the in- sists expression into the discursive. Aesthetic design is “controlled by lated nursing knowledge, intuition, and knowing perception of the balance, rhythm, proportion and derived from your search to arrive at a unique con- unity of what is done in relation to the dynamic in- clusion about the nursing theory resource. Therefore, as you begin your search, honor your You will be engaging in aesthetic knowing when unique and complex abilities and realize that you you evaluate the balance, organization, and har- are able to articulate more than you had ever real- mony of the resource content. Time spent browsing books and knowledge that can contribute to the knowledge journals because they are interesting, yet irrelevant base of nursing.

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