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By T. Giacomo. Palmer College of Chiropractic.

There is an ever nursing order colchicine 0.5mg online, searching for meaning in life buy generic colchicine 0.5 mg on-line, and finding greater concentration of economic and political new meaning in the complexities of work itself. Identifying professional nurse caring work as woven into the social and economic fabric of na- having value and an expression of one’s soul or tions. As organizations were affected by issues one’s creative self at work replaces the notion of of cost and profit, health-care systems underwent nursing as performing machinelike tasks. Leadership models, which ings and symbols of organizations (Ray, 1981, are fundamentally hierarchical because of the need 1989). Weber (1999) actually predicted that the fu- for order, continue to head the short-lived partici- ture belonged to the bureaucracy and not to the pative movement toward decentralization. Weber, who saw bureaucracy as an still in the hands of a few as global economics and efficient and superior form of organizational the market rule (Korten, 1995). As a result, the con- arrangement, predicted that bureaucratization of cept of bureaucracy does not seem as bad as was enterprise would dominate the world (Bell, 1974; once thought. This, of course, is witnessed by the radical than the business paradigm that focuses on current globalization of commerce. Recent acquisi- competition and response to market forces, subse- tions and mergers of industrial firms and even quently eradicating standards of fairness for health-care systems, especially in the United States, human beings in the workplace. As such, caring is considered by of organization, Britain and Cohen (1980) stated many nurse scholars to be the essence of nursing that, “Like it or not, humankind is being driven to (Boykin & Schoenhofer, 2001; Leininger, 1981, a bureaucratized world whose forms and functions, 1991, 1997; Morse, Solberg, Neander, Bottorff, & whose authority and power must be understood if Johnson, 1990; Ray, 1989, 1994a, 1994b; Swanson, they are ever to be even partially controlled”(p. Although not uni- The characteristics of bureaucracies are as formly accepted, Newman, Sime, and Corcoran- follows: Perry (1991; Newman, 1992) characterized the social mandate of the discipline of nursing as • A division of labor caring in the human health experience. Caring thus • A hierarchy of offices is an influential concept, and the expression “car- • A set of general rules that govern performances ing”in the human health experience emphasizes the • A separation of the personal from the official social mandate to which nursing has responded • A selection of personnel on the basis of techni- throughout its history and encompasses the scope cal qualifications of the discipline (Roach, 2002). Caring, however, is • Equal treatment of all employees or standards of manifested in different and complex ways in the fairness nursing discipline and profession (Morse et al. Various paradigms that en- • Protection of dismissal by tenure (Eisenberg & fold the care and caring ideal exist in nursing. In the past two decades, there has been a call person, society, environment, and health character- for decentralization and the “flattening” of organi- ize the nature of nursing. The simultaneity para- zational structures—to become less bureaucratic digm illuminates the human-environment integral and more participative or heterarchical (O’Grady & nature of nursing. Many firms have begun to hold to paradigm states that what constitutes nursing’s new principles that honor creativity and imagina- reality is the view that the human being is unitary tion (Morgan, 1997). Even nursing has advanced in and evolving as a self-organizing field embedded in a more collaborative or decentralized manner by its a larger self-organizing field identified by pattern focus on patient-centered nursing and more decen- and interaction with the larger whole. Health is tralized control from administration (Long, 2003; considered expanded consciousness, and caring in Nyberg, 1998). Technological/ Although the model demonstrates that the di- Political Physiological mensions are equal, the research revealed that the economic, political, technical, and legal dimensions Legal were dominant in relation to the social and ethi- cal/spiritual dimensions. Interactions and symbolic systems of meaning are formed and reproduced from the constructions or dominant values held within discipline (Newman, 1986, 1992; Newman, Sime, & the organization. Many caring theories corre- ganization,” which is analogous to Wittgenstein’s spond to one or all of these paradigms (Morse et al. The Theory of Bureaucratic Caring has its The theory has been embraced by educators, re- roots in all these paradigms by its synthesis of car- searchers, nursing administrators, and clinicians ing and the organizational context (see Figure who, after witnessing changes in health-care policy 23–1). In the qualitative study of as a foundation for additional research studies of caring in the institutional context, the research the nurse-patient relationship (Ray, 1987; Turkel, revealed that nurses and other professionals strug- 1997; Turkel & Ray, 2000, 2001). The discovery of bureaucratic car- Practice Theory Reviewed: ing resulted in both substantive and formal theories (Ray, 1981, 1984, 1989). The substantive theory Evolution of Theory emerged as differential caring and showed that Development caring in the complex organization of the hospital was complicated and differentiated itself in terms Facing the challenge of the crisis in health care and of meaning by its context—dominant caring di- nursing, disillusionment of registered nurses about mensions related to areas of practice or units the disregard for their caring services, and the con- wherein professionals worked and clients resided. The laws of haunted by bureaucracies, some functional, many the dialectic—codetermination of polar opposites, problematic. What, then, is the deeper reality of negation of each of the separate codetermining op- nursing practice? The following is a presentation of posites, and synthesis of conceptualizations toward theoretical views that relate to bureaucratic caring transformation and change—demonstrated that theory, culminating in a vision for understanding the understanding of institutional caring as a the deeper significance of nursing life. Substantive and formal theories emerge from in-depth qualitative studies of social cultural Middle-range theory deals with a relatively broad processes—action and interaction associated with scope of phenomena but does not cover the full the social world. The researcher considers evidence range of phenomena of a discipline, as do grand about how one event affects another and explains theories that encompass the fullest range or the the things observed and recorded by developing most global phenomena in the discipline (Chinn & theoretical relationships about the data. As such, middle-range theories are sampling (Glaser, 1978) refines, elaborates, and ex- generally considered narrower in scope than grand hausts conceptual categories so that an actual inte- theories, and to some extent narrower than formal gration of descriptors and categories can facilitate theory within the grounded theory tradition. The formal theory is generated by some intellectuals in the discipline as hav- from both the inductive process, based on substan- ing a narrow scope or a foundation for a middle- tive knowledge/theory, and deductive approaches, range theory. However, others who have adopted which draw upon cumulative knowledge from the Newman’s (1992) paradigmatic view regarding social world to examine the initial propositions ad- the focus of the discipline of nursing as caring vanced. A formal theory reflects the structure of in the human health experience or who have seri- both processes. Middle- institutional culture of a hospital, which resulted range theories are abstract enough to extend in a substantive theory of differential caring.

However generic colchicine 0.5mg free shipping, ionized cal- cium (iC) levels are sometimes reported separately (4–5 mg/dL) purchase colchicine 0.5 mg mastercard. Eggs, green leafy vegetables, broccoli, legumes, nuts, and whole grains provide smaller amounts. Absorption is influenced by the amount of vitamin D available and the levels of calcium already present in the body. Hypercalcemia Hypercalcemia is a condition when the serum calcium level is higher than 10. The calcium level may need to be lowered quickly because severe hypercalcemia can be life threatening. Administer furosemide (Lasix) or ethcrynic acid (Edecrin) loop diuret- ° ics after adequate fluid intake is established. Hemodialysis is the most effective method to lower calcium levels in severe cases when kidney function is not normal. Too little calcium intake causes cal- cium to leave the bone to maintain a normal calcium level. Fractures (broken bones) may occur if a calcium deficit persists because of calcium loss from the bones (demineralization). Patients who experience hypocalcemia may have the following symptoms: • Depression. Patient education should include information about dietary sources of cal- cium, the need to maintain physical activity to avoid bone loss, avoid overuse of antacids, and chronic use of laxatives. Patients should be taught to use fruits and fiber for improving bowel elimination. Mag- nesium is the coenzyme that metabolizes carbohydrates and proteins and is involved in metabolizing nucleic acids within the cell. Hypermagnesemia Hypermagnesemia is a condition experienced by a patient whose serum magne- sium level is greater than 2. The major cause of hypermagnesia is an excessive intake of magnesium salts in laxatives such as magnesium sulfate, milk of magnesia, and magnesium citrate. Patients who take lithium (anti- psychotic medication) are also at risk for hypermagnesemia. Hypomagnesemia Hypomagnesemia happens when the serum magnesium level is less than 1. This can be caused by long-term administration of saline infusions which can result in the loss of magnesium and calcium. Diuretics, certain antibiotics, laxatives, and steroids are drug groups that promote magnesium loss. Hypomagnesemia also enhances the action of digitalis and can cause dig- italis toxicity. Patients who have hypomagnesemia may exhibit no signs and symptoms until the serum level approaches 1. Signs of severe hypomagnesemia include tetany-like symptoms caused by hyperexcitability (tremors, twitching of the face), ventricular tachycardia that leads to ventricular fibrillation, and hypertension. Treatment for hypomagnesemia includes: • Administering intravenous magnesium sulfate in solution slowly. Use an infusion pump to prevent rapid infusion that might result in cardiac arrest. Keep calcium gluconate available for emergency reversal of hypermagne- semia as a result of overcorrecting hypomagnesemia. Phosphorus Phosphate is the primary anion inside the cell and plays a key role in the func- tion of red blood cells, muscles, and the nervous system. Phosphate is also involved the acid–base buffering and is involved with metabolizing carbohy- drates, proteins, and fats. As the serum calcium concentration increases, the concentration of serum phosphorus decreases and conversely as serum phosphorus increases, serum calcium decreases. Abnormally high levels of serum phosphate are usually caused by kidney malfunction. Hyperphosphatemia Hyperphosphatemia is the condition exhibited by a patient whose serum phos- phate is greater than 4. Unlike hyperkalemia and hypermagnesemia, acute hyperphosphatemia causes few sudden problems. The major effect is to cause hypocalcemia and tetany if serum phosphate rises too rapidly. The treatment for acute hyperphosphatemia is administration of phosphate binding salts, calcium, magnesium, and aluminum although aluminum is avoided in renal failure. Treatment for hyperphosphatemia can include: • Restricting foods and drinks (carbonated soda) high in phosphate.

Service dogs are constant buy colchicine 0.5mg mastercard, loving companions who provide emotional support and companionship to their embattled colchicine 0.5mg amex, often isolated owners (Shim, 2008; Lorber, 2010; Alaimo, 2010; Schwartz, [1] 2008). Despite the reports of success from many users, it is important to keep in mind that the utility of psychiatric service dogs has not yet been tested, and thus would never be offered as a therapy by a trained clinician or paid for by an insurance company. Psychological disorders create a tremendous individual, social, and economic drain on society. Disorders make it difficult for people to engage in productive lives and effectively contribute to their family and to society. Disorders lead to disability and absenteeism in the workplace, as well as physical problems, premature death, and suicide. It has been estimated that the annual financial burden of each case of anxiety disorder is over $3,000 per year, meaning that the annual cost of anxiety disorders alone in the United States runs into the trillions of dollars (Konnopka, Leichsenring, Leibing, & König, 2009; Smit et al. The goal of this chapter is to review the techniques that are used to treat psychological disorder. Just as psychologists consider the causes of disorder in terms of the bio-psycho-social model of illness, treatment is also based on psychological, biological, and social approaches. The social approach to reducing disorder focuses on changing the social environment in which individuals live to reduce the underlying causes of disorder. These approaches include group, couples, and family therapy, as well as community outreach programs. The community approach is likely to be the most effective of the three approaches because it focuses not only on treatment, [4] but also on prevention of disorders (World Health Organization, 2004). A clinician may focus on any or all of the three approaches to treatment, but in making a decision about which to use, he or she will always rely on his or her knowledge about existing empirical tests of the effectiveness of different treatments. These tests, known as outcome studies, carefully compare people who receive a given treatment with people who do not receive a treatment, or with people who receive a different type of treatment. Taken together, these studies have confirmed that many types of therapies are effective in treating disorder. Cost-of-illness studies and cost-effectiveness analyses in anxiety disorders: A systematic review. Costs of nine common mental disorders: Implications for curative and preventive psychiatry. Prevention of mental disorders: Effective interventions and policy options: Summary report. Outline and differentiate the psychodynamic, humanistic, behavioral, and cognitive approaches to psychotherapy. Treatment for psychological disorder begins when the individual who is experiencing distress visits a counselor or therapist, perhaps in a church, a community center, a hospital, or a private practice. The therapist will begin by systematically learning about the patient‘s needs through a formalpsychological assessment, which is an evaluation of the patient’s psychological and mental health. In some cases of psychological disorder—and particularly for sexual problems—medical treatment is the preferred course of action. For instance, men who are experiencing erectile dysfunction disorder may need surgery to increase blood flow or local injections of muscle relaxants. Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level:  Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities  Often has trouble keeping attention on tasks or play activities  Often does not seem to listen when spoken to directly  Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)  Often has trouble organizing activities  Often avoids, dislikes, or doesn‘t want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework)  Often loses things needed for tasks and activities (e. Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:  Often fidgets with hands or feet or squirms in seat Attributed to Charles Stangor Saylor. One approach to treatment is psychotherapy, the professional treatment for psychological disorder through techniques designed to encourage communication of conflicts and insight. The fundamental aspect of psychotherapy is that the patient directly confronts the disorder and works with the therapist to help reduce it. Therapy includes assessing the patient‘s issues and problems, planning a course of treatment, setting goals for change, the treatment itself, and an evaluation of the patient‘s progress. Therapy is practiced by thousands of psychologists and other trained practitioners in the United States and around the world, and is responsible for billions of dollars of the health budget. To many people therapy involves a patient lying on a couch with a therapist sitting behind and nodding sagely as the patient speaks. Though this approach to therapy (known as psychoanalysis) is still practiced, it is in the minority. It is estimated that there are over 400 different kinds of therapy practiced by people in many fields, and the most important of these are shown in Figure 13. The therapists who provide these treatments include psychiatrists (who have a medical degree and can prescribe drugs) and clinical psychologists, as well as social workers, psychiatric nurses, and couples, marriage, and family therapists. Psychologists conducting psychotherapy in 2001: A study of the Division 29 membership. Psychology in Everyday Life: Seeking Treatment for Psychological Difficulties Many people who would benefit from psychotherapy do not get it, either because they do not know how to find it or because they feel that they will be stigmatized and embarrassed if they seek help. The decision to not seek help is a very poor choice because the effectiveness of mental health treatments is well documented and, no matter where a [2] person lives, there are treatments available (U.

Just short of proclaiming the burial a much more recent one purchase 0.5mg colchicine free shipping, he was reminded of an almost identical experience described by William Bass discount colchicine 0.5mg free shipping, who in the 1970s encountered similar fndings in a Civil War era burial. When the anthropologist is asked to examine remains at the end of this process with little or no reliable information about context or procedure, it is prudent to refrain from any except the most general estimate of postmortem interval. While recognizing that there are far more causes of death that will not be 150 Forensic dentistry reported by the hard tissues, those that do afect the skeleton or dentition rep- resent the most enduring kind of evidence. Hard tissue injuries are designated as antemortem, perimortem, or postmortem according to time of occurrence. Te classic examples are oral or orthopedic pathologies and their respective treatments, prostheses, etc. Some chronic antemortem conditions may extend to the end of life, and on a few occasions, may even contribute to death. Obviously, such fndings assume added importance when a clear cause of death can- not be shown. A skeleton with a pacemaker beneath the disarticulated bones of the thorax was recently encountered by the author. Subsequent tracking of the serial number identifed an elderly decedent with a long history of cardiovascular disease. Tough not as diagnostic as an atheromatous set of coronary arteries in the hands of a pathologist the day afer death, the fnd- ing suggests, at least, a contributing cause. Te most frequently encountered fatal perimortem defects are induced by gunshot, blade, or a blunt object forcibly applied. As a two-phase material (calcium hydroxyapatite and collagen), bone withstands compression and stretch. Under slow loading of force, the struck surface compresses while the opposite side stretches. Because bone is weaker under tensile forces, the stretched side fails frst, ofen producing concentric cracking (as in the fat bones of the skull) or concoidal (wedge-shaped) fracture lines emanating from the point of failure. Under rapid loading (as in a bullet strike), the bone responds as a brittle material. In the latter instance one may see radiating cracks across the bone surface, or none at all. In most instances, given an adequate sample of remains, one should be able to determine (1) entry and exit sites, (2) the approximate angle Forensic anthropology 151 of entry of a projectile, (3) the order of entry defects if in the same surface, and (4) an approximation of caliber, or at least the elimina- tion of certain calibers. Because the sof tissue has disappeared, and because garments may not be available for inspection, determin- ing range of fre is ofen not possible. Except when a projectile has struck an intermediate target, the entry defect should provide, at least in one dimension, the approximate diameter (caliber) of the round. Variations in the shape of an entry from circular to elliptical report the approximate angle of entry. Usually, the exit defect will be irregular and somewhat larger than the entry because of deformation of the round during its transit through the target. Both entry and exit bevels will have edges that slope approximately 45° from the incident angle. Tis feature owes to the manner in which fracture lines propa- gate through the hydroxyapatite crystal. Notable exceptions to this rule include the keyhole defect produced by a low-angle strike tangent to the skull. Although the round may not enter the skull, a bevel is produced on both the outer and inner surfaces. Detailed descriptions of the interaction of projectiles and bone may be found in several sources65 (DiMaio 2003, 175–83). If garments accompany the remains, they should be examined for defects over- laying any ballistic injuries for possible indications of range of fre, such as soot or scorching. Ballistic metal usually transfers some of its substance to the bone through which it passes. Rounds entering the body and skull are ofen fragmented as they strike bone tissue. For this reason, remains believed to contain ballistic materials should be radiographed before an examination begins. When this is the case, following x-ray, the skull should be opened and examined to determine the path of the round and to retrieve it for ballistic examination. Blade injury: When death appears to be the result of sharp force injury, a close examination of all bone surfaces is imperative. Imagine the torso from chin to the pubic bones (the vital area), then picture the subtending bones (vertebrae, sternum, ribs, clavicles, scapulae) painted upon this surface. When the torso is morphed into a round target, and the underlying bones into a bull’s-eye, the latter com- prises about 65 to 75% of the target. In theory, in a fatal blade injury one would expect bone to be marked 152 Forensic dentistry in the majority of such cases.

Serotonin transporter polymorphism and borderline or antisocial traits among low-income young adults buy colchicine 0.5mg otc. Reduced prefrontal gray matter volume and reduced autonomic activity in antisocial personality disorder colchicine 0.5mg with visa. This complexity of symptoms and classifications helps make it clear how difficult it is to accurately and consistently diagnose and treat psychological disorders. In this section we will review three other disorders that are of interest to psychologists and that affect millions of people:somatoform disorder, factitious disorder, and sexual disorder. Somatoform and Factitious Disorders Somatoform and factitious disorders both occur in cases where psychological disorders are related to the experience or expression of physical symptoms. The important difference between them is that in somatoform disorders the physical symptoms are real, whereas in factitious disorders they are not. One case in which psychological problems create real physical impairments is in the somatoform disorder known assomatization disorder (also called Briquet‘s syndrome or Brissaud- Marie syndrome). Somatization disorder is a psychological disorder in which a person experiences numerous long-lasting but seemingly unrelated physical ailments that have no identifiable physical cause. A person with somatization disorder might complain of joint aches, vomiting, nausea, muscle weakness, as well as sexual dysfunction. The symptoms that result from a somatoform disorder are real and cause distress to the individual, but they are due entirely to psychological factors. The somatoform disorder is more likely to occur when the person is under stress, and it may disappear naturally over time. Somatoform disorder is more common in women than in men, and usually first appears in adolescents or those in their early 20s. Another type of somatoform disorder is conversion disorder, a psychological disorder in which patients experience specific neurological symptoms such as numbness, blindness, or paralysis, Attributed to Charles Stangor Saylor. The difference between conversion and somatoform disorders is in terms of the location of the physical complaint. In somatoform disorder the malaise is general, whereas in conversion disorder there are one or several specific neurological symptoms. Conversion disorder gets its name from the idea that the existing psychological disorder is “converted‖ into the physical symptoms. It was the observation of conversion disorder (then known as “hysteria‖) that first led Sigmund Freud to become interested in the psychological aspects of illness in his work with Jean-Martin Charcot. Conversion disorder is not common (a prevalence of less than 1%), but it may in many cases be undiagnosed. We have seen an example of one of them, body dysmorphic disorder, in the Chapter 12 "Defining Psychological Disorders" opener. There are no sex differences in prevalence, but men are most often obsessed with their body build, their genitals, and hair loss, whereas women are more often obsessed with their breasts and body shape. Hypochondriasis (hypochondria) is another psychological disorder that is focused on preoccupation, accompanied by excessive worry about having a serious illness. The patient often misinterprets normal body symptoms such as coughing, perspiring, headaches, or a rapid heartbeat as signs of serious illness, and the patient‘s concerns remain even after he or she has been medically evaluated and assured that the health concerns are unfounded. Many people with hypochondriasis focus on a particular symptom such as stomach problems or heart palpitations. Two other psychological disorders relate to the experience of physical problems that are not real. Patients with factitious disorder fake physical symptoms in large part because they enjoy the attention and treatment that they receive in the hospital. In the more severe form of factitious disorder known asMünchausen syndrome, the patient has a lifelong pattern of a series of successive hospitalizations for faked symptoms. Factitious disorder is distinguished from another related disorder known asmalingering, which also involves fabricating the symptoms of mental or physical disorders, but where the motivation for doing so is to gain financial reward; to avoid school, work, or military service; to obtain drugs; or to avoid prosecution. The somatoform disorders are almost always comorbid with other psychological disorders, [2] including anxiety and depression and dissociative states (Smith et al. Somatoform and factitious disorders are problematic not only for the patient, but they also have societal costs. People with these disorders frequently follow through with potentially dangerous medical tests and are at risk for drug addiction from the drugs they are given and for injury from the complications of the operations they submit to (Bass, Peveler, & House, 2001; Looper & [3] Kirmayer, 2002). In addition, people with these disorders may take up hospital space that is needed for people who are really ill. To help combat these costs, emergency room and hospital workers use a variety of tests for detecting these disorders. Sexual Disorders Sexual disorders refer to a variety of problems revolving around performing or enjoying sex. These include disorders related to sexual function, gender identity, and sexual preference. Disorders of Sexual Function Sexual dysfunction is a psychological disorder that occurs when the physical sexual response cycle is inadequate for reproduction or for sexual enjoyment. Sexual disorders affect up to 43% of women and 31% of men (Laumann, Paik, & Rosen, [4] 1999).