By R. Jaroll. Capitol College.

The result of study to a group of neonatologists purchase 20mg torsemide otc hypertension treatment in pregnancy, I received a very this phenomenological inquiry was that the caring interesting comment cheap 20 mg torsemide free shipping blood pressure medication rash. One young physician told me categories were further refined and a definition of that it was the caring and attaching parts of his vo- caring was finally derived. Such a schism in his role-performance expectations and evaluations had forced him to hold the caring I define caring as a “nurturing way and attaching parts of doing his job inside. His remarks left me to wonder if the true ori- ‘other’ toward whom one feels a personal sense of gin of burnout is the failure of professions and care commitment and responsibility” (Swanson, 1991, delivery systems to adequately value, monitor, and p. It includes being there, conveying availability, and sharing feelings while not burden- While I was still a postdoctoral scholar, Dr. They became quite excited and claimed that doing for include anticipating needs, comforting, the model captured what it had been like for them performing competently and skillfully, and protect- to care for a group of socially at-risk new mothers. As it turned out, about four years prior to my meet- “Enabling” means facilitating the other’s passage ing them, these five advanced practice nurses had through life transitions and unfamiliar events. Specifically, it was “maintaining belief,” which means sustaining faith proposed that if women were guided through in- in the other’s capacity to get through an event or depth discussion of their experience and felt un- transition and face a future with meaning. This derstood, informed, provided for, validated, and means believing in the other and holding him or believed in, they would be better prepared to inte- her in esteem, maintaining a hope-filled attitude, grate miscarrying into their lives. Content for the offering realistic optimism, helping find meaning, three counseling sessions was derived from the mis- and going the distance or standing by the one cared carriage model—a phenomenologically derived for, no matter how his or her situation may unfold model that summarized the common human re- (Swanson, 1991, 1993, 1999a, 1999b). Women were randomly assigned to two levels of The Miscarriage Caring Project treatment (caring-based counseling and controls) and two levels of measurement (“early”—comple- As my postdoctoral studies were coming to an end, tion of outcome measures immediately, six weeks, Dr. Barnard challenged me and claimed, “I think four months, and one year postloss; or “delayed”— you’ve described caring long enough. It’s time you completion of outcome measures at four months did something with it! Counseling took place at one, gathering interviews were so often perceived by five, and eleven weeks postloss. Outcome measures in- that, at the very least, open-ended interviews in- cluded self-esteem (Rosenberg, 1965); overall emo- volved aspects of knowing, being with, and main- tional disturbance, anger, depression, anxiety, and taining belief. We suspected that if doing-for and confusion (McNair, Lorr, & Droppleman, 1981); enabling interventions specifically focused on com- and overall miscarriage impact, personal signifi- mon human responses to health conditions were cance, devastating event, lost baby, and feeling added, it would be possible to transform the tech- of isolation (investigator-developed Impact of niques of phenomenological data gathering into a Miscarriage Scale). That conversation ultimately A more detailed report of these findings is pub- led to my design of a caring-based counseling lished elsewhere (Swanson, 1999a). The next thing I knew, I was writing a proposal Participants were within five weeks of loss at en- for a Solomon four-group randomized experimen- rollment; 89 percent were partnered, 77 percent tal design (Swanson, 1999a, 1999b). The primary purpose of the study tional disturbance, anger, and depression; and (2) was to examine the effects of three one-hour-long, with the passage of time, women attributed less caring-based counseling sessions on the integration personal significance to miscarrying and realized of loss (miscarriage impact) and women’s emo- increased self-esteem and decreased anxiety, de- tional well-being (moods and self-esteem) in the pression, anger, and confusion. Additional aims of the In summary, the Miscarriage Caring Project study were to (1) examine the effects of early versus provided evidence that, although time had a heal- delayed measurement and the passage of time on ing effect on women after miscarrying, caring did women’s healing in the first year after loss, and (2) make a difference in the amount of anger, depres- develop strategies to monitor caring as the inter- sion, and overall disturbed moods that women ex- vention/process variable. This study was unique An assumption of the caring theory was that in that it employed a clinical research model to the recipient’s well-being should be enhanced by determine whether or not caring made a difference. Swanson: A Program of Research on Caring 357 I believe that its greatest strength lies in the fact that presession moods (thus enabling examination of the intervention was based both on an empirically the association between counselor presession derived understanding of what it is like to miscarry mood and self or client postsession ratings of and on a conscientious attempt to enact caring in caring). Of course, to complete the Caring Professional Scale (investi- the greatest limitation of that study is that I derived gator-developed). Women, having been left alone the caring theory (developed from the interven- to complete the measure, were asked to place the tion) and conducted most of the counseling ses- evaluations in a sealed envelope. Hence, it is unknown whether similar results in another room, the counselor wrote out her would be derived under different circumstances. I am currently making consisted of 18 items on a five-point Likert-type a concerted effort to rectify this situation and to ex- scale. It was developed through the Miscarriage amine what it is like for diverse groups of women to Caring Project and was completed by participants experience both miscarriage and caring. The items document that, as claimed, caring had indeed oc- included: “Was the health-care provider that just curred. First, approximately 10 percent of the inter- took care of you understanding, informative, aware vention sessions were transcribed. The items were derived from the car- study, found she could not approach analysis of the ing theory. Three negatively worded items (abrupt, transcripts naively—that is, with no preconceived emotionally distant, and insulting) were dropped notions, as would be expected in the conduct of due to minimal variability across all of the data sets. Hence, she employed For the counselors at one, five, and eleven weeks both deductive and inductive content analytic tech- postloss, Chronbach alphas were.

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The person may have intermittent craving for a few months cheap torsemide 20 mg without a prescription prehypertension dizziness, which is best treated by exercise discount 20mg torsemide otc heart attack zip. These drugs alter the mind and change a person’s perception of time, reality, and the environment. Hallucinogens disrupt the normal activity of serotonin, which is a neurotransmitter that sends signals throughout the brain. Hallucinogens cause abnormal activation of serotonin in the part of the brain responsible for coordinating and processing hearing and sight. The result is that people taking hallucinogens hear voices and see images that don’t exist. Researchers are unsure if hallucinogens permanently alter the brain’s chem- istry, however, some patient’s who have taken hallucinogens experience chronic mental disorders. This results in a stage of exhaustion and feeling of emptiness where the person is unable to coordinate thoughts. If this approach fails, drug therapy is employed using a benzodiazepine such as diazepam (Valium). These can exacerbate the patient’s panic reaction and cause postural hypotension (low blood pressure when standing). Also avoid large doses of tranquilizers, using restraints, and isolating the patient because these interventions are more traumatic than therapeutic. Mescaline Mescaline is an alkaloid that is extracted from the flowering heads (mescal but- tons) of the peyote cactus. The extract is a soluble crystalline power that can be dissolved into tea or placed in capsules for ingestion. This drug takes effect almost immediately and lasts about six hours before it reaches its half-life and is excreted into the urine. People taking mescaline expe- rience anxiety, hyperreflexia, static tremors, and psychic disturbances with vivid visual hallucinations. It produces a subjective hal- lucinogenic effect that is similar to mescaline, but of shorter duration. Psilocybin takes effect in a half hour to an hour after the drug is administered and its effect can last up to six hours. People who take this drug experience a pleasant mood although some users become apprehensive. Some exhibit hyperkinetic (compulsive movements) behavior and inappropriate laughter. They have nystagmus (rapid eye movements), diplopia (double vision), and pto- sis (drooping eyelids). They also exhibit the effects of alcohol intoxication with ataxia (staggering gait) and generalized numbness of the extremities. This follows with the second stage when the patient’s hearing and vision become distorted. The third stage occurs when the patient feels apathy, estrangement, and alienation. Attention span is impaired as is motor skills and overall sense of body boundaries. The drug’s hallucinatory effects can occur long after the patient’s acute symptoms are gone. The patient can experience psychotic disturbances which are exhibited by paranoid behavior, self-destructive actions, random eye movement, and excita- tion. These are combined with physiological changes such as tachycardia, hyper- tension, respiratory depression, muscle rigidity, increased reflexes, seizures, and an unconscious state with open eyes. The only treatment is to keep the patient quiet, in a dark room, away from sensory stimuli, and protected from self-inflicted injury. Don’t attempt to talk the patient down as the patient can per- ceive any interaction as a personal attack and may become very violent.

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Sex was seen as a biological drive that needed to be expressed but which should be expressed within the limitations of its function discount torsemide 10mg with visa prehypertension blood pressure, reproduction cheap torsemide 10mg line arrhythmia update 2015. Sex as biological, for pleasure From the beginning of the twentieth century, there was a shift in perspective. Although sex was still seen as biological, the emphasis was now on sexual behaviour rather than on outcome (reproduction). It resulted in a burgeoning literature on sex therapy and manuals on how to develop a good sex life. This emphasis is illustrated by the classic survey carried out by Kinsey in the 1940s and 1950s, the research programmes developed by Masters and Johnson in the 1960s and the Hite reports on sexuality in the 1970s and 1980s. The Kinsey Report Kinsey interviewed and analysed data from 12,000 white Americans and his attempts to challenge some of the contemporary concerns with deviance were credited with causing ‘a wave of sexual hysteria’ (e. He developed his analysis of sexual behaviour within models of biological reductionism and argued that sex was natural and therefore healthy. Kinsey argued that the sexual drive was a biological force and the expression of this drive to attain pleasure was not only acceptable but desirable. He challenged some of the contemporary concerns with premarital sex and argued that as animals do not get married, there could be no difference between marital and premarital sex. He emphasized similarities between the sexual behaviour of men and women and argued that if scientific study could promote healthy sex lives then this could improve the quality of marriages and reduce the divorce rates. His research suggested that a variety of sexual outlets were acceptable and emphasized the role of sexual pleasure involving both sexual intercourse and masturbation for men and women. Masters and Johnson used a variety of experimental laboratory techniques to examine over 10,000 male and female orgasms in 694 white middle-class heterosexuals (e. They recorded bodily contractions, secretions, pulse rates and tissue colour changes and described the sexual response cycle in terms of the following phases: (1) excitement; (2) plateau; (3) orgasm; and (4) reso- lution. They emphasized similarities between men and women (although it has been argued that their data suggests more difference than they acknowledged; Segal 1994) and emphasized that stable marriages depended on satisfactory sex. According to Masters and Johnson, sexual pleasure could be improved by education and sex therapy and again their research suggested that masturbation was an essential component of sexuality – sex was for pleasure, not for reproduction. The Hite Reports Shere Hite (1976, 1981, 1987) published the results from her 20 years of research in her reports on female and male sexuality. Her research also illustrates the shift from the outcome of sex to sex as an activity. Hite’s main claim is that ‘most women (70 per cent) do not orgasm as a result of intercourse’ but she suggests that they can learn to increase clitoral stimulation during intercourse to improve their sexual enjoyment. She describes her data in terms of women’s dislike of penetrative sex (‘Perhaps it could be said that many women might be rather indifferent to intercourse if it were not for feelings towards a particular man’) and discusses sex within the context of pleasure, not reproduction. Segal (1994) has criticized Hite’s interpretation of the data and argues that the women in Hite’s studies appear to enjoy penetration (with or without orgasm). Although this is in contradiction to Hite’s own conclusion, the emphasis is still on sex as an activity. In summary From the start of the twentieth century, therefore, sex was no longer described as a biological means to an end (reproduction) but as an activity in itself. Discussions of ‘good sex’, orgasms and sexual pleasure emphasized sex as action, however, even as an activity sex remained predominantly biological. Kinsey regarded sex as a drive that was natural and healthy, Masters and Johnson developed means to measure and improve the sexual experience by examining physiological changes and Hite explained pleasure with descriptions of physical stimulation. Sex as a risk to health Recently, there has been an additional shift in the literature on sex. Although research still emphasizes sex as an activity, this activity has been viewed as increasingly risky and dangerous. However, studying sexual behaviour is not straightforward from a psychological perspective as it presents a problem for psychologists – a problem of interaction. Sex as interaction Social psychologists have spent decades emphasizing the context within which behaviour occurs. This is reflected in the extensive literature on areas such as con- formity to majority and minority influence, group behaviour and decision making, and obedience to authority.

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