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Infants who are only a year old prefer to look at faces that adults consider to be attractive than at unattractive faces (Langlois buy discount prochlorperazine on-line acute treatment, Ritter purchase generic prochlorperazine canada medications pregnancy, Roggman discount 5mg prochlorperazine with mastercard treatment irritable bowel syndrome, & Vaughn, [3] 1991). Evolutionary psychologists have argued that our belief that “what is beautiful is also good‖ may be because we use attractiveness as a cue for health; people whom we find more attractive may also, evolutionarily, have been healthier (Zebrowitz, Fellous, Mignault, & [4] Andreoletti, 2003). Leslie Zebrowitz and her colleagues (Zebrowitz, 1996; [5] Zebrowitz, Luevano, Bronstad, & Aharon, 2009) have extensively studied the tendency for both men and women to prefer people whose faces have characteristics similar to those of babies. These features include large, round, and widely spaced eyes, a small nose and chin, prominent cheekbones, and a large forehead. People who have baby faces (both men and women) are seen as more attractive than people who are not baby-faced. People are more attracted to faces that are more symmetrical than they are to those that are less symmetrical, and this may be due in part to the [6] perception that symmetrical faces are perceived as healthier (Rhodes et al. Although you might think that we would prefer faces that are unusual or unique, in fact the [7] opposite is true. The researchers found that the more faces that were averaged into the stimulus, the more attractive it was judged. Although preferences for youthful, symmetrical, and average faces have been observed cross- culturally, and thus appear to be common human preferences, different cultures may also have unique beliefs about what is attractive. In modern Western cultures, “thin is in,‖ and people [8] prefer those who have little excess fat (Crandall, Merman, & Hebl, 2009). The need to be thin to be attractive is particularly strong for women in contemporary society, and the desire to maintain a low body weight can lead to low self-esteem, eating disorders, and other unhealthy Attributed to Charles Stangor Saylor. However, the norm of thinness has not always been in place; the preference for women with slender, masculine, and athletic looks has become stronger over the past 50 years. In contrast to the relatively universal preferences for youth, symmetry, and averageness, other [9] cultures do not show such a strong propensity for thinness (Sugiyama, 2005). Forming Judgments on the Basis of Appearance: Stereotyping, Prejudice, and Discrimination We frequently use people‘s appearances to form our judgments about them and to determine our responses to them. The tendency to attribute personality characteristics to people on the basis of their external appearance or their social group memberships is known as stereotyping. Our stereotypes about physically attractive people lead us to see them as more dominant, sexually warm, mentally healthy, intelligent, and socially skilled than we perceive physically unattractive [10] people (Langlois et al. And our stereotypes lead us to treat people differently—the physically attractive are given better grades on essay exams, are more successful on job interviews, and receive lighter sentences in court judgments than their less attractive counterparts [11] (Hosoda, Stone-Romero, & Coats, 2003; Zebrowitz & McDonald, 1991). In addition to stereotypes about physical attractiveness, we also regularly stereotype people on the basis of their sex, race, age, religion, and many other characteristics, and these stereotypes [12] are frequently negative (Schneider, 2004). Stereotyping is unfair to the people we judge because stereotypes are based on our preconceptions and negative emotions about the members of the group. Stereotyping is closely related to prejudice, the tendency to dislike people because of their appearance or group memberships, and discrimination, negative behaviors toward others based on prejudice. We may not vote for a gay person for public office because of our negative stereotypes about gays, and we may avoid people from other religions or those with mental illness because of our prejudices. Research has found, for instance, that attractive people are actually more sociable, more popular, and less lonely than less attractive individuals Attributed to Charles Stangor Saylor. And, consistent with the stereotype that women are “emotional,‖ women are, on average, more empathic and attuned to the emotions of others than are men (Hall [14] & Schmid Mast, 2008). Group differences in personality traits may occur in part because people act toward others on the basis of their stereotypes, creating a self-fulfilling prophecy. A self-fulfilling prophecyoccurs when our expectations about the personality characteristics of others lead us to behave toward those others in ways that make those beliefs come true. If I have a stereotype that attractive people are friendly, then I may act in a friendly way toward people who are attractive. This friendly behavior may be reciprocated by the attractive person, and if many other people also engage in the same positive behaviors with the person, in the long run he or she may actually become friendlier. But even if attractive people are on average friendlier than unattractive people, not all attractive people are friendlier than all unattractive people. And even if women are, on average, more emotional than men, not all men are less emotional than all women. Social psychologists believe that it is better to treat people as individuals rather than rely on our stereotypes and prejudices, because stereotyping and prejudice are always unfair and often inaccurate (Fiske, 1989; Stangor, [15] 1995). Furthermore, many of our stereotypes and prejudices occur out of our awareness, such that we do not even know that we are using them. Implicit Association Test You might want to test your own stereotypes and prejudices by completing the Implicit Association Test, a measure of unconscious stereotyping. Because our primitive ancestors needed to accurately separate members of their own kin group from those of others, categorizing people into “us‖ (the ingroup) and “them‖ (the outgroup) was useful and even necessary (Neuberg, [16] Kenrick, & Schaller, 2010). And the positive emotions that we experience as a result of our Attributed to Charles Stangor Saylor. We may gain social identity as members of our university, our sports teams, our religious and racial groups, and many other groups. But the fact that we may use our stereotypes does not mean that we should use them. Stereotypes, prejudice, and discrimination, whether they are consciously or unconsciously applied, make it difficult for some people to effectively contribute to society and may create both [18] mental and physical health problems for them (Swim & Stangor, 1998). In some cases getting beyond our prejudices is required by law, as detailed in the U. Civil Rights Act of 1964, the Equal Opportunity Employment Act of 1972, and the Fair Housing Act of 1978. There are individual differences in prejudice, such that some people are more likely to try to control and confront their stereotypes and prejudices whereas others apply them more freely [19] (Czopp, Monteith, & Mark, 2006; Plant & Devine, 1998). For instance, some people believe in group hierarchies—that some groups are naturally better than others—whereas other people are more egalitarian and hold fewer prejudices (Sidanius & Pratto, 1999; Stangor & Leary, [20] 2006). The tendency to hold stereotypes and prejudices and to act on them can be reduced, for instance, through positive interactions and friendships with members of other groups, through practice in avoiding using [21] them, and through education (Hewstone, 1996). Research Focus: Forming Judgments of People in Seconds Research has demonstrated that people can draw very accurate conclusions about others on the basis of very [22] limited data. Ambady and Rosenthal (1993) made videotapes of six female and seven male graduate students while they were teaching an undergraduate course. The courses covered diverse areas of the college curriculum, including humanities, social sciences, and natural sciences. For each teacher, three 10-second video clips were taken: 10 seconds from the first 10 minutes of the class, 10 seconds from the middle of the class, and 10 seconds from the last 10 minutes of the class. Ambady and her colleagues then compared the ratings of the participants who had seen the teacher for only 30 seconds with the ratings of the same instructors that had been made by students who had spent a whole semester with the teacher, and who had rated her at the end of the semester on scales such as ―Rate the quality of the section overall‖ and ―Rate section leader‘s performance overall. You can see that the correlations are all positive, and that many of them are quite large. The conclusion is that people are sometimes able to draw accurate impressions about other people very quickly. Half a minute: Predicting teacher evaluations from thin slices of nonverbal behavior and physical attractiveness.

This becomes important once the patient is discharged and takes medication at home cheap prochlorperazine 5 mg online symptoms 8dpiui. Caution should be used when administering intravenous medications because the body quickly absorbs these drugs discount 5 mg prochlorperazine free shipping medicine 5513. Therefore buy prochlorperazine with a mastercard treatment 1 degree av block, healthcare providers need to know expected side effects, effects that occur when the drug is first given, effects the drug has dur- ing its therapeutic peak, and duration of the drug’s action. This method is also used in some acute and long- term care institutional settings. In these settings the nurse gives the patient a packet of medications with instructions that are kept at the bedside. The patient takes the medication according to the instructions and advises the nurse when he or she has done so. This practice help patients learn how to manage the medications and prepares them for discharge and use of these medications in the home. Patients should be advised of the consequences of the refusal to take the medication such as a worsening of the condition. As a general rule, every effort is made to encourage the patient to take the medica- tion. Healthcare providers should avoid speaking in medical terminology and, instead, use common words and expressions that are familiar to the patient—and always in the language that the patient speaks. The patient provides feedback that he or she understands everything about the medication. It is common for the healthcare provider to ask the patient to tell in his or her own words what was told to them about the medication. The list should have the name of the medication, dose, time the medication is to be taken and the name and phone number of the prescriber who ordered the medication. Summary Pharmacology is the study of drug effects on living tissue and how drugs cure, prevent, or manage diseases. Drugs are derived from plants, animals, miner- als, and are synthesized in the laboratory. These are the chemical name, the generic name that is considered the official name for the drug, and the brand name, which is used by the manufacturer to market the drug. There are two general classifications of drugs: prescription and over-the- counter drugs. Prescription drugs are also known as legend drugs and must be prescribed by an authorized healthcare provider. Drugs have three effects: these are the therapeutic effect to fight or prevent a disease; a side effect that isn’t harmful; and an adverse effect that is harmful to a varying degree. Healthcare providers must know about these effects before administering the med- ication to the patient. Clinical studies determine the therapeutic effect, adverse effect, and side effects the drug has on humans. A drug is prescribed to a patient by writing a drug order or medical prescrip- tion. A drug order specifies, among other things, the name of the drug, the dose, route of administration, and frequency. These are to give the right patient the right drug, in the right dose, at the right time, by the right route. Patients also have the right to refuse medication and the right to education about the medication. With this overview of pharmacology under your belt, let’s take a closer look at how drugs work by exploring the principles of drug action and drug inter- actions in the next chapter. A brand name of a drug is (a) the non-trademarked name given by the original drug manufacturer. A drug order that requires the drug to be given immediately is called a (a) one-time order. The number of times a drug is given to a patient can be determined by the half-life of the drug. You might have even reached the point when you’d welcome an injection of a miracle drug if it would get you back on your feet quickly. Drugs aren’t miracles and have nothing to do with magic although you might think differently when your nose is running, eyes watering, and you feel rotten all over. In this chapter, you’ll be introduced to the scientific principles that describe how drugs interact with cells in your body to bring about a pharmaceutical response that either directly attacks the pathogen that is causing your sniffles or stimulates your body’s own defense mechanism to stamp them out. This occurs when an antihypertensive (high blood pressure) drug interferes with the process that constricts blood vessels and may cause blood pressure to rise. A drug action begins when the drug enters the body and is absorbed into the bloodstream where the drug is transported to receptor sites throughout the body (see Pharmacokinetics, in this chapter). Once the drug hooks onto a receptor site, the drug’s pharmacological response initiates. The pharmacological response is the therapeutic effect that makes the patient well. The desirable effect is what makes the patient well or prevents the disease or disorder. Some side effects are desirable and others are undesirable (see Side Effects, in this chapter). The strength of a drug action is determined by how much of the drug is given, (the dose) and how often the drug is given (the frequency). For example, a patient who has a sore throat can be given a large dose of an antibiotic—a loading dose— on the first day of treatment and a normal or maintenance dose for the next five days. These are: • Pharmaceutic Phase: This phase occurs after the drug is given and involves disintegration and dissolution of the dosage form. The inactive ingredient, called excipient, is the substance that has no pharmaceutical response but helps in the delivery of the drug. The coating around tiny particles of a capsule that causes a timed-release action of the drug is an inactive ingredient. The time necessary for the drug to disintegrate and dissolve so it can be absorbed is called the rate limiting time. A drug has a higher rate limiting time (Table 2-1) if it is absorbed in acidic fluids rather than alkaline fluids. Some drugs are more effective if absorbed in the small intestine rather than the stomach. Therefore, pharmaceutical manufacturers place an enteric coating around the drug that resists disintegration in the stomach. Enteric coating is also used to delay the onset of the pharmaceutical response and to prevent food in the stomach from interfering with the dissolution and absorption of the drug. Tip: Never crush a capsule that contains enteric release beads or is coated for timed-release. Drug molecules move to the intended site of action in the plasma but sometimes this journey can be limited because they have to get into the interior of a cell or body compartment through cell membranes.

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Actual or potential health problems that can be prevented or resolved by independent Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins 5mg prochlorperazine for sale medications on carry on luggage. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care cheap 5 mg prochlorperazine mastercard medications similar to adderall, 7th Edition buy prochlorperazine online from canada 7mm kidney stone treatment. What questions would you ask a patient to appetite validate the following nursing diagnoses? No problem: Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Possible problem: from degenerative joint disease and has talked for years about having “just a touch of arthritis,” this never kept him from c. Recently, however, he spends all day sitting in a chair and seems to have no desire to engage in self-care d. He tells the visiting nurse that he diagnosis: doesn’t get washed up anymore because he’s “too stiff” in the morning to bathe and “I just don’t seem to have the energy. Give three examples of how standards may be visiting nurse notices that his hair is matted used to identify significant cues. List five questions a nurse should consider when using critical thinking in diagnostic reasoning. In her book on the nursing process, Alfaro- bed—this while she was in a private room. At approach focuses on early evidence-based present, she cannot move either her left intervention to prevent and manage problems arm or leg. Describe Nursing Diagnosis: the three activities nurses need to perform to follow this approach in daily nursing care. In each and that he was selected because he resem- one, underline the cues that form a data clus- bled Ted. Rosemary became pregnant after ter indicating a nursing diagnosis, and write the second in-vitro fertilization attempt and the appropriate nursing diagnosis as a three- delivered a healthy baby girl named Sarah. Klinetob, age 86, has been seriously Rosemary have learned from blood tests depressed since the death 6 months ago of that their fertility specialist is the biologic his wife of 52 years. Although he suffers Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Interview members of your family or several to some couples about using sperm from close friends. Use the following expanded scenario from Rosemary tells the nurse in her pediatri- Chapter 13 in your textbook to answer the cian’s office that she is concerned about questions below. Questioning reveals that problems with constipation and I’ve seen Rosemary has found herself yelling at Sarah some blood when I wipe myself after a bowel for minor disobedience and spanking her, movement. Prescott’s about Sarah’s striking physical resemblance father and an uncle both died in their early to the fertility specialist but attributed this 50s from colon cancer. What nursing diagnosis would be appropriate I see her now, I can’t help but see Dr. Rosemary express great remorse that Sarah, who is innocent, is bearing the brunt of something that is in no way her fault. With a partner or several classmates, write and/or ethical/legal competencies are most appropriate nursing diagnoses for the likely to bring about the desired outcome? She is overwrought and says she feels God is punishing her for an abortion she had when she was in college. She and her husband have been trying to have children for years and were counting on this pregnancy to come to term. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Identification of factors causing undesirable success or failure response and preventing desired change d. Which of the following is a correctly written desired change goal for a patient who is scheduled to ambulate d. Over the next 24-hour period, the patient 50-year-old executive, is being discharged will walk the length of the hallway assisted from the hospital after undergoing coronary by the nurse. The nurse will help the patient ambulate strates an affective goal for this patient? Patient will become mobile within a demonstrate breathing techniques to 24-hour period. Which of the following patient sufficiently to reduce the cholesterol in his goals for Mr. Nursing interventions are a separate entity carry out necessary self-care behaviors at from the original goal/outcome. According to Maslow, which of the following ten and when the plan of care is reviewed. At least one of the outcomes should show a Multiple Response Questions direct resolution of the problem statement in the nursing diagnosis. The patient and family need not value the outcomes as long as they support the plan 1. Which of the following actions occur during strate injecting himself with insulin. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Conditions a restaurant for lunch, how to help a young cancer patient accept the loss of a limb, e. Which of the following goals are written planning that are critical to comprehensive correctly? The patient will know how to dress her “Pain related to delayed healing of surgical wound after receiving a demonstration. After attending an infant care class, the patient will correctly demonstrate the pro- cedure for bathing her newborn. By 4/5/12, the patient will demonstrate Outcomes Project, presents the first compre- how to care for a colostomy. When a nurse writes a statement regarding a two coping measures to deal with stress. Which of the following accurately describe the supporting the statement, he/she is writing purposes of a plan of nursing care? It represents an effective philosophy of on clinical judgment and knowledge that a nursing and is intended to advance only nurse performs to enhance patient outcomes. When a nurse supplies education to an obese patient best and is recorded on the day the teenager regarding the fat content in food and patient presents for treatment and care, helps him choose a nutritious diet, he/she is according to agency policy. When a nurse administers physician- always a response to the individual charac- prescribed pain medication to a patient teristics and needs of the patient. A(n) is a set of steps (typically responsibilities for fulfilling the medical and embedded in a branching flowchart) that interdisciplinary plan of care. It is separate from the discharge plan and clinician and is used to make a decision.

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Serologic tests are confirmatory buy prochlorperazine 5 mg otc treatment 4 burns, but treatment with doxycycline or chloramphenicol should be started prior to confirmation cheap prochlorperazine generic treatment plant. These patients may progress to a necrotizing fasciitis or myositis discount 5 mg prochlorperazine with mastercard medications requiring prior authorization, requiring surgical intervention. Fever, headache, arthralgias, altered mental status, and abnor- mal vitals may also be found, along with neck stiffness. For patients overall, S aureus is the leading cause of osteomyelitis, followed by Streptococcus species. Pain, swelling, fever, redness, and drainage may all occur, but pain is the presenting complaint in most cases. Definitive diagnosis is made by bone scan which will demonstrate osteomyelitis within 72 hours of symptom onset. Radiographs may be normal early on, but will demon- strate periosteal elevation within 10 days. Blood cultures, which are positive in 50% of cases, should be used to guide antibiotic treatment. First, patients receiving implanted prosthetic devices during orthopedic surgery are at higher risk for osteomyelitis from Pseudomonas. Puncture wounds to the foot also increase the risk of osteomyelitis from Pseudomonas. Pseudomonas does not appear to grow on puncture objects, but rather appears to grow on the footwear and may be inoculated into the wound. In neonates, group B Streptococcus is a common infecting bacterium of bone and joint infections, and group A Streptococcus may be seen in children 3 months to 14 years of age. This patient’s condition is most consistent with severe sepsis, which is defined as sepsis with acute organ dysfunction. Some examples of end-organ dysfunction include acute lung injury, encephalopathy, confusion, progressive coagulopathy caused by inability to synthesize clotting factors, elevated unconjugated serum biliru- bin, oliguria, anuria, and systolic and diastolic heart failure. Septic shock (e) is defined as sepsis with persistent hypotension despite fluid resuscitation and resulting tissue hypoperfusion. Typically, it is a polymicrobial infection involving aerobic and anaerobic bacteria of the mouth. The most commonly isolated organisms include streptococci, staphylococci, and bacteroides species. A tense edema and brawny induration of the neck above the hyoid may be present and is described as a “bull neck. Trismus and fever are often present, but usually no palpable fluctuance or cervical lymphadenopathy. Signs of impending airway compromise include stridor, tachypnea, dyspnea, drooling, and agitation. The upper airway may be distorted making endotracheal intubation difficult or impossible. Cricothy- rotomy may also be difficult and increases the risk of spreading infection into the mediastinum. Soft-tissue radiographs of the neck may confirm the diagnosis by demonstrating edema of the affected area, airway narrowing, and gas collections. However, radiographs should not delay treatment or place the patient in an area where emergent airway management is difficult. Today, surgery is used only for those patients who fail to respond to antibiotic therapy or those with purulent collections. Appropriate regimens include high-dose penicillin with metronidazole, or cefoxitin used alone. Clin- damycin, ticarcillin-clavulanate, piperacillin-tazobactam, or ampicillin sul- bactam may also be used. It is characterized by a sharply demarcated border surrounding skin that is raised, deeply erythematous, indurated, and painful, and is associated with nephrotic syndrome, postoperative wounds, and small breaks in the skin. Erysipelas is more superficial than cellulitis and is more likely to occur in the young and in the elderly, but the distinction between the two is often subtle and therapeutically irrelevant. Treatment of erysipelas and facial cellulitis requires hospital admission and parenteral antibiotics. Treatment is aimed at the predominant organism, group A Streptococcus, but Staphylococcus and other Streptococcus species are also found. An immediate ophthalmologic consult should be obtained if there is any orbital or periorbital involvement. A Tzanck smear is a test that is done to diagnose infections caused by herpesviruses. When Fever Answers 199 unilateral, they must be distinguished from early herpes zoster infection, especially if vesicles are present. Women of childbearing age comprise 90% of affected individuals, and clinical presentation generally includes multisystem involvement. The Centor criteria, seen below, is used for predicting streptococcal pharyngitis and whether or not to treat the patient with antibiotics. Centor Criteria Points Presence of tonsillar exudates +1 Tender anterior cervical adenopathy +1 Fever by history +1 Absence of cough +1 Age <15 years +1 Age >45 years −1 Centor criteria 4 points 2–3 points 0–1 point Treat with Rapid antigen No further tests antibiotics test + No further Treat with Throat No antibiotics testing antibiotic culture 200 Emergency Medicine Since his rapid antigen test was negative, the patient should receive a throat culture and be treated only if the results are positive. In addition, he should be treated symptomatically with fluids, topical anesthetics, and acetaminophen or ibuprofen. Signs and symptoms include a sore throat, muffled voice, trismus, fluctuant mass, deviation of the uvula, odynophagia, and drooling. Airway patency must be assessed because of the obstructing potential of an abscess. Treatment includes either needle aspi- ration or incision and drainage of the abscess, in addition to antibiotic treatment. Some studies demonstrate the safety and cost-effectiveness of needle aspiration over incision and drainage. It is a progressive cellulitis of the floor of the mouth and neck that begins in the submandibular space. Physical findings include bilateral sub- mandibular swelling, tongue swelling, and protrusion. A tense edema and induration of the neck may occur that is described as a “bull neck. There is debate on whether these patients should be managed surgically with incision and drainage or medically with antibiotics. Conventional radiography on the day of injury is insensitive to the detection of osteomyelitis; even 1 week after the injury x-ray diagno- sis is limited. How- ever, Pseudomonas is responsible for bone and joint infections in three settings. Pseudomonas does not grow on the puncture object, but rather is associated with the shoe itself and may be inoculated into the bone as the sharp object passes through the col- onized shoe into the wound. Treatment is aggressive fluid resuscitation, surgical debridement, broad-spectrum antibiotics, and possibly hyperbaric oxygen therapy.

Inherent in this the practice of assigning patients to lesser trained theory is a strong statement: What transpires be- workers on the basis of complexity level order 5mg prochlorperazine amex medications help dog sleep night. For tween the patient and the nurse is of the highest Henderson cheap prochlorperazine 5 mg on-line administering medications 7th edition ebook,“all ‘nursing care’ prochlorperazine 5mg online medicine januvia. The true worth of her nursing theory is that plex because it involves constant adaptation of pro- it clearly states what nursing is or should be today. It is the nurse’s fits that modern technology and modern health role, according to Henderson, “to ‘get inside the care bring—and there are many—we need to pause patient’s skin’ and supplement his strength, will or and ask the question “What is at risk in health care knowledge according to his needs” (Harmer & today”? Conceptualizing the nurse reconsideration of the value of Orlando’s theory as a substitute for the patient’s lack of necessary as perhaps the critical link for enhancing relation- will, strength, or knowledge to attain good health ships between nursing and patient today (Rittman, and to complete or make the patient whole, high- 2001). Despite pendently initiates and controls activities related to Henderson’s belief that it was difficult to promote a basic nursing care. Relating the conceptualization universal definition of nursing, Basic Principles of of basic care components with the unique func- Nursing Care (Henderson, 1960) became an inter- tions of nursing provided the initial groundwork national sensation. To date, it has been published for introducing the concept of independent nurs- in 29 languages and is referred to as the twentieth- ing practice. In her 1966 publication, The Nature of century equivalent of Florence Nightingale’s Notes Nursing, Henderson stated: “It is my contention on Nursing. After visiting countries worldwide, she that the nurse is, and should be legally, an inde- concluded that nursing varied from country to pendent practitioner and able to make independent country and that rigorous attempts to define it have judgments as long as he, or she, is not diagnosing, been unsuccessful, leaving the “nature of nursing” prescribing treatment for disease, or making a largely an unanswered question (Henderson, 1991). She was one of the first nurses to and responded to the question “What is nurs- articulate that nursing had a unique function yield- ing? In writing reflections on the nature of person, not object, and that the relationship nursing, Henderson (1966) states that her concept of nurse and patient is valuable to all. The effects varied nursing approaches Henderson has been heralded as the greatest advo- have on patients’ complaints of pain. The effect of an automatic and deliber- completion of her revised text in 1955, Henderson ative process of nursing activity on the relief of patients’ pain: moved to Yale University. The effects of nursing ap- 1950s there was an increasing interest on the part of proaches during admission. Parker, Nursing theories and active in the work of classifying nursing literature. Textbook of the principles electronic networking system would have to ad- and practice of nursing. Geneva: vance the work of staff nurses by providing them International Council of Nurses. The dynamic nurse-patient relation- nurse-patient interactions using nursing ship: Function, process and principles. The discipline and teaching of nursing orists defined the ways nursing is thought process: An evaluative study. Family centered maternity nursing Paper presented to the Connecticut State Council on Civil (2nd ed. Functions of the professional nurse and A history of the Nursing Information Bureau. Family nurse practitioner for maternal Wiedenbach, Tape 1, October 20, 1980; Tape 2, February 2, and child care. Her model was the first to provide both a guide to understanding and Dorothy Johnson’s earliest publications pertained a guide to action. These two ideas—understanding to what knowledge base nurses needed for nursing seen first as a holistic, behavioral system process care (Johnson, 1959, 1961). Throughout her career, mediated by a complex framework and second as Johnson stressed that nursing had a unique, inde- an active process of encounter and response—are pendent contribution to health care that was dis- central to the work of other theorists who followed tinct from “delegated medical care. She received her associate of support the validity of a behavioral system model arts degree from Armstrong Junior College in (Ainsworth, 1964; Crandal, 1963; Gerwitz, 1972; Savannah, Georgia, in 1938 and her bachelor of sci- Kagan, 1964; and Sears, Maccoby, & Levin, 1954). The combination of nursing, her academic career at Vanderbilt University School development, and general systems introduces into of Nursing. During her academic career, Dorothy Johnson Johnson’s model incorporates five core principles addressed issues related to nursing practice, nurs- of system thinking: wholeness and order, stabiliza- ing education, and nursing science. While she was a tion, reorganization, hierarchic interaction, and pediatric nursing advisor at the Christian Medical College School of Nursing in Vellare, South India, Johnson’s model incorporates five core she wrote a series of clinical articles for the Nursing principles of system thinking: wholeness Journal of India (Johnson, 1956, 1957). She worked and order, stabilization, reorganization, with the California Nurses’ Association, the hierarchic interaction, and dialectical National League for Nursing, and the American contradiction. Nurses’ Association to examine the role of the clin- ical nurse specialist, the scope of nursing practice, and the need for nursing research. Each of these general pleted a Public Health Service–funded research systems principles has analogs in developmental project (“Crying as a Physiologic State in the theories that Johnson used to verify the validity of Newborn Infant”) in 1963 (Johnson & Smith, her model (Johnson, 1980, 1990). The foundations of her model and her be- order provide the basis for continuity and identity, liefs about nursing are clearly evident in these early stabilization for development, reorganization for publications. Johnson conceptualized a person as an Introducing the Theory open system with organized, interrelated, and in- terdependent subsystems. Wholes and their parts cal background, and many years of thought, discus- create a system with dual constraints: Neither has sions, and writing (Johnson, 1968). From Florence The overall representation of the model can also Nightingale came the belief that nursing’s concern be viewed as a behavioral system within an envi- is a focus on the person rather than the disease. The behavioral system and the environ- Systems theorists (Buckley, 1968; Chin, 1961; ment are linked by interactions and transactions. Parsons & Shils, 1951; Rapoport, 1968; and Von We define the person (behavioral system) as being Bertalanffy, 1968) were all sources for her model. In homeorrhesis, the system stabi- the sustenal imperatives (Grubbs, 1980; Holaday, lizes around a trajectory rather than a set point. A toddler placed in a body cast may show motor lags when the cast is removed but soon shows age- Wholeness and Order appropriate motor skills. An adult newly diagnosed The developmental analogy of wholeness and order with asthma who does not receive proper education is continuity and identity. Given the behavioral sys- until a year after diagnosis can successfully incor- tem’s potential for plasticity, a basic feature of the porate the material into her daily activities. These system is that both continuity and change can exist are examples of homeorhetic processes or self- across the life span. Instead, the issue should be cast in with illness, he or she is subject to biopsychosocial terms of determining patterns of interactions perturbations. The nurse, according to Johnson among levels of the behavioral system that may (1980, 1990), acts as the external regulator and promote continuity for a particular subsystem at a monitors patient response, looking for successful given point in time. If behavioral system balance tinuity is in the relationship of the parts rather than returns, there is no need for intervention. Johnson (1990) noted that at nurse intervenes to help the patient restore behav- the psychological level, attachment (affiliative) and ioral system balance. It is hoped that the patient dependency are examples of important specific be- matures and with additional hospitalizations the haviors that change over time while the representa- previous patterns of response have been assimilated tion (meaning) may remain the same. Adaptation is defined as balance, this pattern of dependence to independ- change that permits the behavioral system to main- ence may be repeated as the behavioral system en- tain its set points best in new situations.

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