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By S. Kadok. Langston University.

Verbalization of feelings in a nonthreatening environment may help client come to terms with unresolved issues buy lamisil 250 mg with visa. Assist client to discharge pent-up anger through participation in large motor activities (e cheap 250 mg lamisil visa. Physical exercise provides a safe and effective method for discharging pent-up tension. Help client to understand that feelings such as guilt and anger toward the lost entity are appropriate and accept- able during the grief process. Knowledge of acceptability of the feelings associated with normal grieving may help to relieve some of the guilt that these responses generate. With support and sensitivity, point out reality of the situa- tion in areas where misrepresentations are expressed. Client must give up an idealized perception and be able to accept both positive and negative aspects about the lost entity be- fore the grief process is complete. Knowledge of cultural influences specific to the client is important before using this technique. Assist client in problem solving as he or she attempts to deter- mine methods for more adaptive coping with the experienced loss. Positive feedback increases self-esteem and encourages repetition of desirable behaviors. Encourage client to reach out for spiritual support during this time in whatever form is desirable to him or her. Assess spiri- tual needs of client and assist as necessary in the fulfillment of those needs. Client is able to verbalize normal stages of the grief process and behaviors associated with each stage. Client is able to identify own position within the grief pro- cess and express honest feelings related to the lost entity. Within reasonable time period, client will verbalize things he or she likes about self. By time of discharge from treatment, client will exhibit increased feelings of self-worth as evidenced by verbal expression of positive aspects of self, past accomplishments, and future prospects. By time of discharge from treatment, client will exhibit increased feelings of self-worth by setting realistic goals and trying to reach them, thereby demonstrating a decrease in fear of failure. Spend time with client to convey acceptance and contribute toward feelings of self-worth. Encourage participation in group activities from which client may receive positive feedback and support from peers. Help client identify areas he or she would like to change about self, and assist with problem solving toward this effort. Low self-worth may interfere with client’s percep- tion of own problem-solving ability. Ensure that client is not becoming increasingly dependent and that he or she is accepting responsibility for own behav- iors. Client must be able to function independently if he or she is to be successful within the less-structured community environment. Teach assertiveness techniques: the ability to recognize the differences among passive, assertive, and aggressive behaviors, and the importance of respecting the human rights of others while protecting one’s own basic human rights. Self-esteem is enhanced by the ability to interact with others in an assertive manner. Example: “I feel angry when you criticize me in front of other people, and I would prefer that you stop doing that. Positive feedback enhances self-esteem and encourages rep- etition of desirable behaviors. Client sets realistic goals for self and demonstrates willing attempt to reach them. Client will voluntarily spend time with other clients and nurse or therapist in group activities by time of discharge from treatment. Client will refrain from using egocentric behaviors that offend others and discourage relationships by time of discharge from treatment. Your presence may help improve client’s percep- tion of self as a worthwhile person. Develop a therapeutic nurse-client relationship through frequent, brief contacts and an accepting attitude. Your presence, acceptance, and conveyance of positive regard enhance the client’s feelings of self-worth.

A nursing administration perspective on use • What nursing and related technologies are re- of Orem’s self-care nursing theory discount 250 mg lamisil amex. Parker Introduction Why Evaluate Resources for Nursing Inquiry and Research Theory as a Guiding Framework for Evaluation How Do You Know What You Know? And if one begins discount lamisil 250mg visa, can the information that is often “here today and Never in human history have such vast quantities of gone tomorrow” be relied upon as accurate and information been so easily available. How can the information be evalu- brief space of a few decades, the acquisition, stor- ated? Given the complexity of data now available, age, and retrieval of information has been trans- can nursing theory resources even be evaluated formed from the realm of a labor-intensive manual across various types of media? Will the process be process to that of a digital, multidimensional vir- congruent with the theory and the values of the re- tual medium. The guide for evaluation of theory Nursing exists on the cusp of continual change, resources presented within this chapter moves to- with interfacing technological revolutions taking ward a realistic appraisal by the researcher of the place in nursing education, practice, and research. The rapid advance and integration of technology has not only affected practice (Sparks, 1999), but has also affected ways in which nurses investigate, eval- Theory as a Guiding Framework uate, think, and speak about practice (Turley, 1996). The framework for practice also becomes nursing knowledge is enhanced by the quality of a framework for education, research, and adminis- the resources used. A call for books, journals, and media recordings, 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.

A distinct feature is cross- ing from the interaction between a living organism and a drug tolerance lamisil 250 mg free shipping, where tolerance to one type of drug is associated characterized by behavioural and other responses that always with tolerance to other drugs generic lamisil 250 mg overnight delivery. Cross-tolerance, which can include a compulsion to take the drug on a continuous or encompass chemically distinct drugs, has been clearly demon- periodic basis in order to experience its psychic effects and strated for alcohol, benzodiazepines and other sedative drugs. In the above definitions, a distinction is made between • Continued drug use despite awareness of its harmful physical and psychological dependence. Factors that increase the likelihood of addiction include: after withdrawal of alcohol or benzodiazepines, or depression and lethargy seen after withdrawal of stimulants). Physical and • Genetic factors: Genetic factors can predispose to psychological dependence may be distinguished clinically. The major difference between drug abuse and drug behaviour is influenced by the example set by family or dependence is quantitative. This may explain why dependence on nicotine and alcohol is a Drugs Comment Diamorphinea Mainly obtained on the black market. It is of much greater public health problem than dependence on illegal drugs, because of their greater availability. It may be used dependence have a common biochemical pathway: they all increase dopamine in the nucleus accumbens, intravenously (mainlining), subcutaneously associated with mood elevation and euphoria. Dependence-potential of different drugs is related and inhaling the smoke) (t1/2 60–90min) to potency in releasing dopamine (cocaine is most potent). Methadone This is the mainstay of drug addiction clinics, The rate of dopamine release is also important, e. It is easily crushed up and Diconal®)a dissolved for intravenous use By the time an addict presents for assessment and treatment, Other opoids All opioids, including mixed he or she is likely to have diverse and major problems. Their financial and living circum- aDiamorphine, dipipanone and cocaine (not an opioid) can only be stances may have been adversely affected by their drug habit prescribed to addicts for treatment of their addiction by doctors with a special licence. It is often adulterated with other white powders, such as qui- Complete abstinence is emphasized for nicotine, alcohol or nine (which is bitter, like opiates), caffeine, lactose and even cocaine addiction, whereas for heroin addiction many patients chalks, starch and talc. In addition to the illegal supply of heroin from based on reduction in drug use and improvements in health Afghanistan and elsewhere, opioids are obtained from phar- and social functioning. A treatment programme should macy thefts and the legal prescription of drugs for treatment of include medical and psychiatric assessment and psychological the addiction. Addicts should be referred to specialist The pharmacological actions of opioids are described in services if these are available. Other services based in the vol- Chapter 25 and their effects on the central nervous system untary sector (e. The majority of these The pharmacological treatment of addictions, which includes relate to use of infected needles, the effects of contaminating treatment of intoxication, detoxification (removal of the drug substances used to cut supplies or the life-style of opioid from the body, including management of withdrawal symp- addicts. These are the principal reasons for the development toms) and treatment to prevent relapse, is discussed below. Over the next few hours the user may describe a warm Release of antidiuretic hormone sensation in the abdomen and chest. However, chronic users often state that the only effect they obtain is remission from abstinence symptoms. These signs can be reversed with Infection Endocarditis – bacterial, often tricuspid valve, naloxone. Severe overdose may cause immediate apnoea, circu- Abscesses latory collapse, convulsions and cardiopulmonary arrest. Alternatively, death may occur over a longer period of time, Tetanus usually due to hypoxia from direct respiratory centre depres- Septicaemia sion with mechanical asphyxia (tongue and/or vomit block- Hepatitis ing the airway). A common complication of opioid poisoning is non- Pulmonary Pneumonia – bacterial, fungal, aspiration cardiogenic pulmonary oedema. This is usually rapid in onset, Pulmonary oedema – ‘heroin lung’ but may be delayed. Therefore, any patient who is admitted Embolism following heroin overdose should usually be hospitalized for Atelectasis approximately 24 hours. Naloxone reverses opioid poisoning with a rapid increase in pupil diameter, respiratory rate and Fibrosis/granulomas depth of respiration. It may precipitate an acute abstinence syndrome in addicts and (very rarely) convulsions. This does Skin Injection scars not contraindicate its use in opioid overdoses in addicts. Abscesses Severe hypoxia causes mydriasis and some opioids (notably Cellulitis pethidine) have an anti-muscarinic atropine-like mydriatic Lymphangitis effect, so absence of small pupils should not preclude a trial of Phlebitis naloxone when the clinical situation suggests the possibility Gangrene of opioid overdose. Naloxone is eliminated more rapidly than morphine and may need to be administered repeatedly Neurological Cerebral oedema (Chapter 25).