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By L. Basir. Kennesaw State University.

The events included employment buy 25 mg atomoxetine with mastercard, financial atomoxetine 18mg line, housing order 18 mg atomoxetine free shipping, health, and relationship stressors. The dependent measure in the study was the level of depression reported by the participant, as [18] assessed using a structured interview test (Robins, Cottler, Bucholtz, & Compton, 1995). But for the participants who did not have a short allele, increasing stress did not increase depression (bottom panel). Furthermore, for the participants who experienced 4 stressors over the past 5 years, 33% of the participants who carried the short version of the gene became depressed, whereas only 17% of participants who did not have the short version did. This important study provides an excellent example of how genes and environment work together: An individual‘s response to environmental stress was influenced by his or her genetic makeup. But psychological and social determinants are also important in creating mood disorders and depression. In terms of psychological characteristics, mood states are influenced in large part by our cognitions. Negative thoughts about ourselves and our relationships to others create negative moods, and a goal of cognitive therapy for mood disorders is to attempt to change people‘s Attributed to Charles Stangor Saylor. Negative moods also create negative behaviors toward others, such as acting sad, slouching, and avoiding others, which may lead those others to respond negatively to the person, for instance by isolating that person, which then creates even more depression (Figure 12. You can see how it might become difficult for people to break out of this “cycle of depression. These differences seem to be due to discrepancies between individual feelings and cultural expectations about what one should feel. People from European and American cultures report that it is important to experience emotions such as happiness and excitement, whereas the Chinese report that it is more important to be stable and calm. If the depression continues and becomes even more severe, the diagnosis may become that of major depressive disorder. Give a specific example of the negative cognitions, behaviors, and responses of others that might contribute to a cycle of depression like that shown inFigure 12. Given the discussion about the causes of negative moods and depression, what might people do to try to feel better on days that they are experiencing negative moods? Aspinall, Apsychology of human strengths: Fundamental questions and future directions for a positive psychology (pp. Hedonic tone and activation level in the mood-creativity link: Toward a dual pathway to creativity model. Hippocampal neurogenesis: Opposing effects of stress and antidepressant treatment. Identify the biological and social factors that increase the likelihood that a person will develop schizophrenia. The term schizophrenia, which in Greek means “split mind,‖ was first used to describe a psychological disorder by Eugen Bleuler (1857–1939), a Swiss psychiatrist who was studying patients who had very severe thought disorders. Schizophrenia is a serious psychological disorder marked by delusions, hallucinations, loss of contact with reality, inappropriate affect, disorganized speech, social withdrawal, and deterioration of adaptive behavior. Schizophrenia is the most chronic and debilitating of all psychological disorders. It affects men and women equally, occurs in similar rates across ethnicities and across cultures, and affects at any one time approximately 3 million people in the United States (National Institute of Mental [1] Health, 2010). Onset of schizophrenia is usually between the ages of 16 and 30 and rarely Attributed to Charles Stangor Saylor. Symptoms of Schizophrenia Schizophrenia is accompanied by a variety of symptoms, but not all patients have all of them (Lindenmayer & Khan, 2006). Finally, cognitive symptoms are the changes in cognitive processes that accompany schizophrenia (Skrabalo, 2000). Auditory hallucinations are the most common and are reported by approximately three quarters [6] of patients (Nicolson, Mayberg, Pennell, & Nemeroff, 2006). Schizophrenic patients frequently report hearing imaginary voices that curse them, comment on their behavior, order them to do [7] things, or warn them of danger (National Institute of Mental Health, 2009). Visual hallucinations are less common and frequently involve seeing God or the devil (De Sousa, [8] 2007). Schizophrenic people also commonly experience delusions, which are false beliefs not commonly shared by others within one’s culture, and maintained even though they are obviously out of touch with reality. People with delusions of grandeur believe that they are important, famous, or powerful. They often become convinced that they are someone else, such as the president or God, or that they have some special talent or ability. Some claim to have been assigned to a [9] special covert mission (Buchanan & Carpenter, 2005). People with delusions of persecution believe that a person or group seeks to harm them.

Once they have been toasted they are trans- ferred to a large generic 25mg atomoxetine visa, tall mortar and pulverised with a pestle buy cheap atomoxetine 40mg online. The resultant ash is mixed with the pulverised coca to form mambe (Antonio Kiriyati-ki: Muina (Uitoto) discount 25mg atomoxetine with mastercard, Cacique of Peñas Negras (Resguardo) Localisation: between: resguardo los Monos and above Resguardo of Puerto Sábalo; right hand side of the Ríver Caquetá). The yarumo is found in various locations in the Amazon forest and is an invasive, colonising plant. Yajé cielo (Banesteriopsis caapi) Sabedor Rene Moreno Vaneo told the authors in an interview (interview 1 in the addendum):12 Yajé is a plant which is fundamental to the ancestral knowledge for us in the Trapecio (Amazonas, Colombia). In other parts of Colombia such as the Páez and Inga pueblos, and other ethnic groups in the Putumayo area, the plant is known as yajé. Resguardo Peñas Caquéta medio, Amazonas, Negras, Caquéta medio, Amazonas, Colombia, Colombia, 10 January 1992. The variety of yajé shown in the photograph is cielo (sky) ayahuasca or cielo yajé. It is called this because when the ritual is carried out with this variety of yajé it is possible to travel to infinity. Uses Yajé and other entheogenic plants are used in the realisation of powerful and dangerous shamanic journeys of recognition. In the state of trance when people move from normal conscience to altered conscience by means of taking, inhaling or bathing in entheogenic substances, or using other methods under the effect of entheogens, especially yajé or ayahuasca, conscience and sensations are activated, including: intuition, visionary capacity and amplified sensorial perception, among others; spiritual forms are ‘seen’ and ‘felt’ and strange odours and surroundings are experienced. During these journeys the shaman is exposed to a struggle between good and evil which he must overcome using his skills and wisdom. The indi- vidual’s fears are brought to the surface in such a way that, on returning from the entheogenic trance to the normal state of conscience, the memory of the trance remains. For Uitoto and Muinane ethnic groups the use of yaje is used only as a last resource for the solution of problems or illnesses that cannot be resolved using other more commonly used ritual plants such as coca or tobacco or minerals. They have their own methods of identification, which they describe as identifying the energy of the plant – its power to heal. The location, identification and collection of the plants require great concentration. An infinite number of curative plants can be collected from the forest, but the most commonly used are planted very near to the houses to be avail- able for frequent use; others are planted together with the ritual and edible plants in the chagras. The time of collection of medicinal plants is considered to be important and depends on when the plants are sensed to be more powerful or have positive energy to heal. In general the ethnic groups in Amazonia use their medicinal plants fresh because they consider them to have more healing power than when dried. When available the indigenous groups will use western medicine to treat fractures. However, due to the remote location of many of the communities, the sabedores use the bark of certain trees as a splint which they say heals the bone as well as acting as an analgesic. Examples of traditional curative plant medicines Among the enormous number of plants, below are included a few of those used by sabedores from different tribes in the Amazon forest. Amori (Uitoto language) Preparation The Amori tree, which has not been botanically identified, is found in primary forest. The sabedores record it as having hallucinogenic effects and it is also known as ambil de monte. It is cura- Araracuara, Caquéta medio, Amazonas, tive for nervous conditions, high Colombia, 26 June 1991. In the Caquetá Media geographical area Albahaca is known in the Uitoto language as Jaibikie. According to Sabedor Oscar Román, the plant is used to bathe children to improve their mood and to lower fevers caused by influenza and cough. To treat diarrhoea the plant is prepared in hot water with cinnamon and lemon (see interview 3 in the addendum). As a comparison, we include an example of use of the same plant, Alba- haca (Ocimum micranthum), used by the Quichua ethnic group, Amazon forest, Ecuador. In this case, Sabedor Gabriel Tapuy explains that the plant can be used to treat ‘mal aire’. The plant is collected and passed over the person repeatedly in the form of a cross in order to extract negative energies or ‘clean’ them. According to Sabedor Gabriel, the person who carries out the treatment will feel the arm become heavy if he or she is successful at extracting the ‘mal aire’ (see interview 4 in the addendum). Traditional medicine used in the Colombian Amazon forest | 77 Badea (Passiflora quadrangularis) Sabedor Hilario Rivero Yukuna, originally from Mirití said in an interview in, Leticia, Amazonas, Colombia (see interview 5 in the addendum): Seven leaves of Badea are collected and cooked in water. The plant is used to clean the stomach when suffering painful cramps and diarrhoea. Members of other ethnic groups or pueblos such as Muinas (Uitotos), Muinanes, Andokes, Yukunas and others use the young Badea leaves to cure hepatitis A and B in the early stages: on the first day of treatment, the juice of one leaf is taken, and each following day the juice of another leaf is added until nine leaves are being used; the plant is then suspended for 3 days. On resuming the treatment, the number of leaves taken is reduced by one leaf each day until returning to one leaf (see interview 6 in the addendum).

The terms nursing cheap 10 mg atomoxetine overnight delivery, envi- ronment buy generic atomoxetine 25 mg on line, and interpersonal relations did not differ nursing situations where life and health goals significantly buy atomoxetine 10 mg on line, which indicated a few commonalities are influenced by a severe illness, nurses give in those three programs. My statements of philosophy imply differences in cur- systems framework has described a holistic view of ricula, which in turn provide different kinds of the complexity in nursing within various groups, education for different kinds of nursing practice. This This study, done over 15 years ago, raised the ques- framework differs from other conceptual schema tions, What is the philosophy of nursing education? They determined The use of my conceptual system and Theory of that nurses could identify the published nursing di- Goal Attainment in family health was suggested agnoses in 1990 with the concepts in the frame- (King, 1983). Nurses in Canada, in social environment in which individuals grow and which two hospitals were involved at a distance develop and learn through interactions to set from each other, used the conceptual framework to goals. Nurses work with families and with individ- design a system for delivery of nursing care ual family members. The of nursing research and education in a large mu- family is also viewed as an interpersonal system. Congruence in ment used my framework and Theory of Goal perceptions of nurse and family members helps in Attainment (Benedict & Frey, 1995). The Theory of assessing a situation to identify concerns and/or Goal Attainment was used in adult orthopedic problems in the interpersonal system. Two cases were presented and the use Sneed (1991) stated that my interactive systems ap- of the Theory of Goal Attainment was described in proach of goal attainment is an ideal basis for each situation. This group used Community Health my theory with inpatient juvenile sexual offenders, offenders in maximum security, and community Community health nursing involves a variety of parolees. For example, school nurses must understand the edu- Continuous Quality Improvement cation system. Occupational health nurses must Continuous quality improvement in nursing and understand the political system, the economic sys- health care is a reality. Structure provides an overall organi- health programs as they interact and set goals with zation of the program. Process relates to nursing interdisciplinary teams to manage health care activities. Outcomes are separate from but related (Hampton, 1994; Sowell & Fuszard, 1989; Sowell & to performance criteria for evaluation of nursing Lowenstein, 1994). In this sense, they system provides structure for a continuous quality- are relating to the interpersonal systems in the improvement program (King, 1994). This is done within a variety of social action Process Model in my Theory of Goal systems in the community. Although the focus is Attainment gives a process that leads to goal attain- groups, nurses work with individuals for whom ment that represents outcomes. An example was given to 16–1) shows the interactions of the three systems in document effectiveness of nursing care if one uses community health. The record system is an information system based on Use in Hospitals my Theory of Goal Attainment. The record system Two case studies were presented to demonstrate can be designed and adapted to most health-care nurses’ use of the transaction process and knowl- systems. For nurses, it was designed to gather data edge of the concepts of perception, communica- from assessments of the patient, make a nursing tion, interaction, and role (King, 1986b). King’s Theory of Goal Attainment 243 nursing care, and write mutually agreed-upon goals twentieth century to the science of nursing in the and means to attain them. Elements in the goal-oriented nursing record are: (1) data base, (2) goal list, (3) nursing orders, (4) flow sheets, (5) progress notes, and (6) discharge summary. My conceptual Several nurses have tested the theory in research on system and transaction process in the Theory aging, parenting, psychiatric-mental health, and of Goal Attainment provides one approach to ambulatory care (Alligood et al. For interaction between nurses and health- ducted studies in their cultures to test the Theory of care professionals and between health- Goal Attainment (Coker et al. For common discourse among health pro- and responses to professional nursing care that fessionals and between nurses and nursing resulted in an instrument that measures patient personnel. Direct measure of outcomes resulting in My vision for the future of nursing is that nursing quality care and cost-effective care; that is, will provide access to health care for all citizens. One valid and reliable assessment instru- are directed to the right place in the system for ment to assess activities of daily living as a nursing care, medical care, social services informa- basis for goal-setting. For continuity of care within and between tion process will be used by every practicing nurse health-care agencies. Theory of Goal Attainment, and Transaction Process Model will continue to serve a useful pur- When knowledge of the concepts and the pose in delivering professional nursing care. The transaction process has been used in hospi- ideas have been tested in research and in practice, tals, homes, nursing homes, and community and nurses in education and practice have used the health agencies, nurses have been motivated knowledge of the concepts. The relevance of to seek additional knowledge in formal edu- evidence theory–based practice, using my theory, cational programs. Publications, including Frey & Sieloff (1995), identified from a review of the literature, will be summarized and briefly discussed. Finally, of King’s recommendations will be made for future knowl- edge development in relation to King’s Interacting Systems Framework and midrange theory, par- Theory of Goal ticularly in relation to the importance of their application within an evidence-based practice environment.

Instrument development in nursing is needed in (1995) implemented nursing diagnoses within the order to measure relevant nursing concepts buy cheap atomoxetine 10mg. Table 16–4 provides a However discount atomoxetine 10 mg amex, instruments developed for a research listing of applications of King’s work in relation to study rarely undergo the rigor of research the nursing process and to nursing languages discount atomoxetine 25mg otc. King (1988a) developed the Health Development of middle-range theories is a natural Goal Attainment instrument, designed to detail the extension of a conceptual framework. Middle- level of attainment of health goals by individual range theories, clearly developed from within a clients. The Family Needs Assessment Tool was de- conceptual framework, accomplish two goals: (1) veloped by Rawlins, Rawlins, and Horner (1990). Such theories can be directly applied to nursing sit- Table 16–6 provides a listing of instruments devel- uations, whereas a conceptual framework is usually oped in relation to King’s work. Additional evidence of the scope and usefulness of In addition to the midrange Theory of Goal King’s framework and theory is its use with clients Attainment (King, 1981), several other midrange across the life span. Several applications have tar- theories have been developed from within King’s geted high-risk infants (Frey & Norris, 1997; Norris Interacting Systems framework. Hanna (1993) investigated the effect of systems (the nursing staff and hospital environ- nurse-client interactions on oral-contraceptive ad- ment). Interestingly, these theory is their utility in encompassing complex set- studies considered personal systems (infants), in- tings and situations. Kenny (1990) also studied the 1988), and renal procedures (Hanucharurnkui role of the elderly in their care. Gender-specific work in- ied the “impact of information on the health be- cluded Sharts-Hopko’s (1995) use of concepts haviors of older adults” (p. Clearly, focus of care (client system) and/or focus of health these applications, and others, show how the problem (phenomenon of concern). The focus of complexity of King’s framework and midrange the- care, or interest, can be an individual (personal sys- ory increases its usefulness for nursing (refer to tem) or group (interpersonal or social system). Thus, application of King’s work, across client sys- tems, would be divided into the three systems iden- Client Systems tified within King’s Interacting Systems Framework A major strength of King’s work is that it can (1981): personal (the individual), interpersonal be used with virtually all client populations. Frey addition, applications proposed the Theory of and Norris (1997) used both the Interacting Sys- Goal Attainment as the practice model for case tems Framework and Theory of Goal Attain- management (Hampton, 1994; Tritsch, 1996). The earliest 1995a) and revised into a Theory of Group Power applications involved the use of the framework and within Organizations (2003). Educational settings, theory to guide continuing education (Brown & also considered as social systems, have also been Lee, 1980) and nursing curricula (Daubenmire, the focus of application of King’s work (Bello, 1989; Gulitz & King, 1988). Table 16–9 sum- marizes applications related to clients’ phenomena Phenomena of Concern to Clients of concern; the table also groups these applications, Within King’s work, it is critically important for the primarily identified by disease or medical diagno- nurse to focus on, and address, the phenomenon of sis, as illness management. Without this emphasis on the Health is one area that certainly binds clients client’s perspective, mutual goal-setting cannot and nurses. Hence, a client’s phenomena of concern was end point, or outcome, of nursing care and selected as neutral terminology that clearly demon- something to which clients aspire. In addition, Frey applications, tends to support the goal of improved (1996) expanded her research to include risky health directly and/or indirectly, as the result of the behaviors. Health status is explic- As stated previously, diseases or diagnoses are itly the outcome of concern in practice applica- often identified as the focus for the application of tions by Smith (1988). For example, Kohler (1988) conducted research with patients with broncho- focused on increased morale and satisfaction, and pneumonia, while patients with end-stage renal DeHowitt (1992) studied well-being. In Health promotion has also been an emphasis for addition, clients with chronic inflammatory bowel the application of King’s ideas. The experience of parenting was studied by concerns have also been the focus of work, using Norris and Hoyer (1993), and health behaviors King’s conceptualizations (Murray & Baier, 1996; were Hanna’s (1995) focus of study. Clients’ concerns ranged from King (1981) stated that individuals act to main- psychotic symptoms (Kemppainen, 1990) to fami- tain their own health. Although not explicitly lies experiencing chronic mental illness (Doornbos, stated, the converse is probably true as well: 2002) to clients in short-term group psychotherapy Individuals often do things that are not good for (Laben, Sneed, & Seidel, 1995). Accordingly, it is not surprising that eates applications related to clients’ phenomena the Interacting Systems Framework and related of concern. Frey (1997), Frey and Denyes (1989), and Frey and Fox Multicultural applications of King’s Interact- (1990) looked at both health behaviors and illness ing Systems Framework and related theories are management behaviors in several groups of chil- many. King’s framework and theory for transcultural Applications of the framework and related theories nursing. Spratlen (1976) drew heavily from King’s have been documented in the following countries framework and theory to integrate ethnic cultural beyond the United States: Canada (Coker et al. Key Sugimori, 1992), Portugal (Moreira & Arajo, 2002; elements derived from King’s work were the focus Viera & Rossi, 2000), and Sweden (Rooke, 1995a, on perceptions and communication patterns that 1995b). In Japan, a culture very different from the motivate action, reaction, interaction, and transac- United States with regard to communication style, tion. Rooda (1992) derived propositions from the Kameoka (1995) used the classification system of midrange Theory of Goal Attainment as the frame- nurse-patient interactions identified within the work for a conceptual model for multicultural Theory of Goal Attainment (King, 1981) to analyze nursing. In addition to research Cultural relevance has also been demonstrated and publications regarding the application of in reviews by Frey, Rooke, Sieloff, Messmer, and King’s work to nursing practice internationally, Kameoka (1995) and Husting (1997).

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