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By X. Finley. Nicholls State University.

Regulating the interpersonal self: Strategic self-regulation for coping with rejection sensitivity order generic proscar on line prostate cancer 9 value. Predicting cognitive control from preschool to late adolescence and young adulthood buy proscar 5mg free shipping mens health youtube. Willpower in a cognitive-affective processing system: The dynamics of delay of gratification buy generic proscar 5mg line prostate cancer gleason scale. Explain how very high and very low intelligence is defined and what it means to have them cheap 5mg proscar with mastercard mens health 100. Define stereotype threat and explain how it might influence scores on intelligence tests. Most people in Western cultures tend to agree with the idea that intelligence is an important personality variable that should be admired in those who have it. But people from Eastern cultures tend to place less emphasis on individual intelligence and are more likely to view intelligence as reflecting wisdom and the desire to improve the society as a whole rather than only themselves (Baral & Das, 2004; Sternberg, [1] 2007). And in some cultures, such as the United States, it is seen as unfair and prejudicial to argue, even at a scholarly conference, that men and women might have different abilities in domains such as math and science and that these differences might be caused by genetics (even though, as we have seen, a great deal of intelligence is determined by genetics). In short, although psychological tests accurately measure intelligence, it is cultures that interpret the meanings of those tests and determine how people with differing levels of intelligence are treated. In a normal distribution, the bulk of the scores fall toward the middle, with many fewer scores falling at the extremes. These sex differences mean that about 20% more men than women fall in the extreme (very smart or very dull) ends of the distribution (Johnson, [2] Carothers, & Deary, 2009). Boys are about five times more likely to be diagnosed with the [3] reading disability dyslexia than are girls (Halpern, 1992), and are also more likely to be classified as mentally retarded. About 1% of the United States population, most of them males, fulfill the criteria for mental retardation, but some children who are diagnosed as mentally retarded lose the classification as they get older and better learn to function in society. Mental retardation is divided into four categories: mild, moderate, severe, and profound. One cause of mental retardation is Down syndrome, a chromosomal disorder leading to mental retardation caused by the presence of all or part of an extra 21st chromosome. The incidence of Down syndrome is estimated at 1 per 800 to 1,000 births, although its prevalence rises sharply in those born to older mothers. People with Down syndrome typically exhibit a distinctive pattern of physical features, including a flat nose, upwardly slanted eyes, a protruding tongue, and a short neck. Societal attitudes toward individuals with mental retardation have changed over the past decades. We no longer use terms such as “moron,‖ “idiot,‖ or “imbecile‖ to describe these people, although these were the official psychological terms used to describe degrees of retardation in the past. Supreme Court ruled that the execution of people with mental retardation is “cruel and unusual [6] punishment,‖ thereby ending this practice (Atkins v. It is often assumed that schoolchildren who are labeled as “gifted‖ may have adjustment problems that make it more difficult for them to create social relationships. This study found, first, that these students were not unhealthy or poorly adjusted but rather were above average in physical health and were taller and heavier than individuals in Attributed to Charles Stangor Saylor. The students also had above average social relationships—for instance, [8] being less likely to divorce than the average person (Seagoe, 1975). Terman‘s study also found that many of these students went on to achieve high levels of education and entered prestigious professions, including medicine, law, and science. Of the sample, 7% earned doctoral degrees, 4% earned medical degrees, and 6% earned law degrees. These numbers are all considerably higher than what would have been expected from a more general population. As you might expect based on our discussion of intelligence, kids who are gifted have higher scores on general intelligence (g). Some children are particularly good at math or science, some at automobile repair or carpentry, some at music or art, some at sports or leadership, and so on. There is a lively debate among scholars about whether it is appropriate or beneficial to label some children as “gifted and talented‖ in school and to provide them with accelerated special classes and other programs that are not available to [10] everyone. Although doing so may help the gifted kids (Colangelo & Assouline, 2009), it also may isolate them from their peers and make such provisions unavailable to those who are not classified as “gifted. The fact that women earn many fewer degrees in Attributed to Charles Stangor Saylor. On the other hand, it is possible that the differences are due to variability in intelligence, because more men than women have very high (as well as very low) intelligence. Women tend to do better than men on some verbal tasks, including spelling, writing, and pronouncing words [12] (Halpern et al. On average, men do better than women on tasks requiring spatial ability, such as the mental [14] rotation tasks shown in Figure 9. Boys tend to do better [15] than girls on both geography and geometry tasks (Vogel, 1996). Although these differences are real, and can be important, keep in mind that like virtually all sex group differences, the average difference between men and women is small compared to the average differences within each sex. There are many women who are better than the average man on spatial tasks, and many men who score higher than the average women in terms of emotional intelligence. Sex differences in intelligence allow us to make statements only about average differences and do not say much about any individual person. Although society may not want to hear it, differences between men and women may be in part genetically determined, perhaps by differences in brain lateralization or by hormones (Kimura & [17] Hampson, 1994; Voyer, Voyer, & Bryden, 1995). As infants, boys and girls show no or few differences in spatial or counting abilities, suggesting that the differences occur at least in part as a result of Attributed to Charles Stangor Saylor. Furthermore, the number of women entering the hard sciences has been increasing steadily over the past years, again suggesting that some of the differences may have been due to gender discrimination and societal expectations about the appropriate roles and skills of women. The bell curves for some groups (Jews and East Asians) are centered somewhat higher than for Whites in general (Lynn, 1996; [20] Neisser et al. Other groups, including Blacks and Hispanics, have averages somewhat lower than those of Whites. The observed average differences in intelligence between groups has at times led to malicious and misguided attempts to try to correct for them through discriminatory treatment of people [22] from different races, ethnicities, and nationalities (Lewontin, Rose, & Kamin, 1984). One of the most egregious was the spread of eugenics, the proposal that one could improve the human species by encouraging or permitting reproduction of only those people with genetic characteristics judged desirable. Eugenics became immensely popular in the United States in the early 20th century and was supported by many prominent psychologists, including Sir Francis Galton. Dozens of universities, including those in the Ivy League, offered courses in eugenics, and the topic was [23] presented in most high school and college biology texts (Selden, 1999). Congress to pass laws designed to restrict immigration from other countries supposedly marked by low intelligence, particularly those in eastern and southern Europe. Fortunately, the practice of sterilization was Attributed to Charles Stangor Saylor. By bias, what psychologists mean is that a test predicts outcomes—such as grades or occupational success—better for one group than it does for another. Another way that tests might be biased is if questions are framed such that they are easier for people from one culture to understand than for people from other cultures. For example, even a very smart person will not do well on a test if he or she is not fluent in the language in which the test is administered, or does not understand the meaning of the questions being asked. But modern intelligence tests are designed to be culturally neutral, and group differences are found even on tests that only ask about spatial intelligence. Although some researchers still are concerned about the possibility that intelligence tests are culturally biased, it is probably not the case that the tests are creating all of the observed group differences (Suzuki & Valencia, [25] 1997). Research Focus: Stereotype Threat Although intelligence tests may not be culturally biased, the situation in which one takes a test may be. One environmental factor that may affect how individuals perform and achieve is their expectations about their ability at a task. In some cases these beliefs may be positive, and they have the effect of making us feel more confident and thus better able to perform tasks. For instance, research has found that because Asian students are aware of the cultural stereotype that ―Asians are good at math,‖ reminding them of this fact before they take a difficult math test can [26] improve their performance on the test (Walton & Cohen, 2003). On the other hand, sometimes these beliefs are Attributed to Charles Stangor Saylor. Because Black students are aware of the stereotype that Blacks are intellectually inferior to Whites, this stereotype might create a negative expectation, which might interfere with their performance on intellectual tests through fear of confirming that stereotype. In support of this hypothesis, the experiments revealed that Black college students performed worse (in comparison to their prior test scores) on standardized test questions when this task was described to them as being diagnostic of their verbal ability (and thus when the stereotype was relevant), but that their performance was not influenced when the same questions were described as an exercise in problem solving. And in another study, the researchers found that when Black students were asked to indicate their race before they took a math test (again activating the stereotype), they performed more poorly than they had on prior exams, whereas White students were not affected by first indicating their race. Steele and Aronson argued that thinking about negative stereotypes that are relevant to a task that one is performing createsstereotype threat—performance decrements that are caused by the knowledge of cultural stereotypes. That is, they argued that the negative impact of race on standardized tests may be caused, at least in part, by the performance situation itself. Because the threat is ―in the air,‖ Black students may be negatively influenced by it. Research has found that stereotype threat effects can help explain a wide variety of performance decrements among those who are targeted by negative stereotypes. For instance, when a math task is described as diagnostic of intelligence, Latinos and Latinas perform more poorly than do Whites (Gonzales, Blanton, & Williams, [28] 2002). Similarly, when stereotypes are activated, children with low socioeconomic status perform more poorly in math than do those with high socioeconomic status, and psychology students perform more poorly than do natural [29] science students (Brown, Croizet, Bohner, Fournet, & Payne, 2003; Croizet & Claire, 1998). Even groups who typically enjoy advantaged social status can be made to experience stereotype threat. White men perform more poorly on a math test when they are told that their performance will be compared with that of Asian men (Aronson, Lustina, [30] Good, Keough, & Steele, 1999), and Whites perform more poorly than Blacks on a sport-related task when it is Attributed to Charles Stangor Saylor.

Dosage: 400–600 mg of a prod- uct that contains 40–60 percent boswellic acid three times daily discount 5mg proscar free shipping prostate lymph nodes. Enzymes: Bromelain purchase discount proscar line prostate irritation, chymotrypsin proscar 5 mg with mastercard mens health 9 rules, papain proscar 5 mg low price androgen hormone function, and trypsin have been shown in some studies to help reduce inflammation and pain caused by trauma, surgery, sports injuries, and arthri- tis. Most studies B have focused on its effects on hip and knee osteoarthritis, but it may offer benefits for the back as well. The active component is salicin, which is similar to aspirin, only it is better tolerated. To prevent injuries, exercise to increase strength and flexibility, use proper lifting techniques, and use proper form for sitting and standing. While it can be embarrassing and annoying, bad breath is not just a cosmetic problem—it can signify an underlying health problem. Approximately 90 percent of cases of bad breath originate from problems in the mouth. Poor oral hygiene (not brushing or flossing regularly or properly) allows bac- B teria to grow and feed on food particles in the mouth. Bacteria emit sulphur gases, which not only cause bad breath, but also damage the tissues in the mouth, leading to inflammation of the gums (periodontitis). If left untreated, the bacteria continue to grow and cause gum recession, tooth decay, and even worse-smelling breath. The ancient Greeks chewed tree resin and the Mayans chewed chicle (sap from sapo- dilla tree) to keep their breath fresh. Curtis made and sold the first commercial chewing gum called the State of Maine Pure Spruce Gum. When brushing, don’t forget to brush your tongue as it can trap large amounts of bacteria. If the cause of bad breath is a lung, throat, or mouth infection, an antibiotic may B be prescribed. If it is due to constipation and poor digestion, which can lead to the release of toxins into the breath, a laxative and/or fibre supplement may be recom- mended. Foods to avoid: • Foods that move slowly through your digestive tract are more likely to cause constipation and bad breath, such as red meat, fried foods, and processed foods. Odours are transferred to the lungs and expelled by our breath and continue until the food is eliminated. Lifestyle Suggestions • Brush your teeth after meals to remove food particles, especially after drinking coffee or eating sulphur-containing foods such as milk products, fish, eggs, and meat. Look for products that con- tain zinc (reduces sulphur compounds in the mouth), or tea tree or eucalyptus oil, which have antibacterial and antiseptic properties. Top Recommended Supplements Chlorophyll: A component of green plants, chlorophyll helps neutralize odour. Coenzyme Q10: A deficiency of coenzyme Q10, an antioxidant that is important for gum health, has been linked to gum disease, and studies have found that it can help promote healing of the gums. Probiotics: Friendly bacteria that help to reduce formation of bad bacteria that cause bad breath. Complementary Supplement Vitamin C: Essential for healthy gums and teeth; levels may be deficient in those with gum disease and in smokers. Chew gum with xylitol and/or peppermint and take supplements of chlorophyll, coenzyme Q10, and probiotics for gum health. Normally the urine is sterile and does not contain any bacteria, viruses, or fungi. However, an infection can develop when these bugs en- ter the urethra (the tube that carries urine out of the body) and travel up into the bladder. This leads to inflammation of the bladder (cystitis) and unpleasant urinary B symptoms. If a bladder infection is not treated properly, it can spread to the kidneys and become very serious. This is often due to a structural abnormality in the urethra or bladder affecting the flow of urine. Infections of the bladder are the second most common infection in women and the most common complication of pregnancy. When urine is left to stagnate in the bladder, the risk of developing infec- tion increases. While necessary, there are various drawbacks to the use of antibiotics, including side effects such as diarrhea, stomach upset, and yeast overgrowth. Overuse of anti- biotics causes resistance—the bugs become stronger than the drugs, leaving people vulnerable to attack by bacteria. To relieve the pain and burning, a drug called phenazopyridine (Pyridium) may be prescribed. This is given for two to three days; it contains a dye and will cause discolouration of the urine and feces. Dietary Recommendations Foods to include: • Drink eight or more glasses of water daily to help flush bacteria out of your bladder. You can sweeten it with stevia, which is a natural, low-calorie plant-based sweetener. Juice cocktails are an alternative that offer better taste and toler- ability, but contain less juice and have added sugar; drink three 16 oz. Foods to avoid: • Caffeine has diuretic properties, which promote fluid loss, making the urine more concen- trated. Wear cotton un- derwear, which allows the skin to breathe; change clothing promptly after swimming. Top Recommended Supplements Cran-Max: Studies show that it prevents bladder infections and may also be effective in treating early bladder infections if taken at the first sign of symptoms. Vitamin C: Acidifies urine, making it more difficult for bacteria to grow; inhibits the growth of E. Complementary Supplements Oil of oregano: Has antibacterial properties, and is available in capsules or liquid. Probiotics: Support immune function, help fight off infections, and are essential for those on antibiotics because they restore the friendly bacteria destroyed by antibiotics. Acute bronchitis most commonly occurs follow- ing a respiratory infection, such as a cold or flu. It can also develop due to exposure to cigarette smoke or pollution, or in those who have gastroesophageal reflux disease due to backflow of acids into the lungs. Acute bronchitis caused by a viral infection B often clears up on its own in a week or two without lasting effects. Long-term exposure to lung irritants (particularly cigarette smoke) can lead to continual inflammation and thickening of the lining of your bronchial tubes, which is called chronic bronchitis. People with chronic bronchitis have a persistent productive cough and shortness of breath. If you have a cold or flu and symptoms persist beyond a few weeks, consult with your doctor. Those with chronic bronchitis who smoke are at increased risk of lung cancer above and beyond the normal risk that a smoker faces. Since most cases of acute bronchitis are caused by a viral infection, antibiotics offer little benefit unless your doctor suspects a bacte- rial infection or you are at risk of this. Taking an antibiotic when not necessary can lead to resistance and secondary infections, such as thrush, yeast, and urinary tract B infections, so it is important to ask your doctor if antibiotics are necessary if one is prescribed. Cough suppressants are not recommended because coughing helps the lungs remove irritants. However, if your cough disrupts your sleep, then you may want to take a cough medicine at bedtime. For severe cases of bronchitis, your doctor may prescribe an inhaler to reduce inflammation and help you breathe. Herbal teas, such as Throat Coat, which contains marshmallow and licorice, can help relieve sore throat. Studies have shown that increasing fruit and vegetable consumption may reduce the risk of developing bronchitis. Researchers at Harvard did a study of 2,112 teenagers and found an association between good lung function and levels of dietary intake of fruit and fish rich in omega-3 fatty acids. Teens who ate less of these foods (two servings of fruit per week and less than 22 mg of omega-3 fatty acids per day) had higher rates of asthma, wheezing, and symptoms of chronic bronchitis such as cough and phlegm (Chest, 2007: 132; 238–245). Some practitioners feel that dairy products can increase mucus formation, and that people with bronchitis should minimize these foods. Avoid adding sugar to foods and minimize high- sugar foods (candy, soft drinks, and sweets). Tobacco is damaging to the lungs and increases your risk of chronic bronchitis and emphysema. Air purifiers remove bacteria, viruses, and dust from the air, cleaning the air you breathe. A humidifier adds moisture to the air, and warm, moist air helps relieve coughs and loosens mucus in your airways. But be sure to clean the humidifier according to the manufacturer’s recommendations to avoid the growth of bacteria and fungi in the water container. Top Recommended Supplements Echinacea: Helps support immune function and studies show that it can reduce the sever- ity and frequency of cold symptoms. Dosage: 300–600 mg capsules twice daily or 2–4 mL tincture four to six times daily at the first sign of a cold for seven to 10 days. Some products combine echinacea with astragalus, which also has antiviral and antibacterial properties.

R H H H R C+ > R C+ > R C+ > H C+ R R H H 3ocarbocation 2ocarbocation 1ocarbocation Methyl cation The relative stabilities of radicals follow the same trend as for carboca- tions discount proscar line prostate cancer 80 year old. Like carbocations purchase proscar with visa prostate 90 foundation, radicals are electron deficient purchase proscar 5 mg free shipping prostate cancer 9 gleason, and are stabilized by hyperconjugation purchase proscar 5mg on line man health hu. For example, a 3 alkyl radical is more stable than a 2 alkyl radical, which in turn is more stable than a 1 alkyl radical. Allyl and benzyl radicals are more stable than alkyl radicals, because their unpaired electrons are delocalized. Therefore, a hydrogen atom, bonded to either an allylic carbon or a benzylic carbon, is substituted more selectively in the halogenation reaction. The percentage substitution at allylic and benzylic carbons is greater in the case of bromination than in the case of chlorination, because a bromine radical is more selective. N Br N + Br O O The bromine radical abstracts an allylic hydrogen atom of the cyclohex- ene, and forms a resonance stabilized allylic radical and hydrogen bromide. Addition reactions are of two types: electrophilic addition to alkenes and alkynes, and nucleophilic addition to aldehydes and ketones. In an addition reaction, the product contains all of the elements of the two reacting species. The p bonds of alkenes and alkynes are involved in the reaction, and reagents are added to the double or triple bonds. In the case of alkynes, two molecules of reagent are needed for each triple bond for the total addition. A vinyl cation is less able to accommodate a positive charge, as the hyperconjugation is less effective in stabilizing the positive charge on a vinyl cation than on an alkyl cation. The vinyl cation is more stable with positive charge on the more substituted carbon. Electrophilic addition reactions allow the conversion of alkenes and alkynes into a variety of other functional groups. Fast C C C C + E Nu E Nu:− Product Addition of hydrogen atoms to alkenes and alkynes: catalytic hydrogenation Preparation of alkanes Addition of hydrogen atoms in the presence of a metal catalyst to double or triple bonds is known as hydrogenation or catalytic hydrogenation. Alkenes and alkynes are reduced to alkanes by the treatment with H2 over a finely divided metal catalyst such as platinum (PtÀÀC), palladium (PdÀÀC) or Raney nickel (Ni). The platinum catalyst is also frequently used in the form of PtO2, which is known as Adams’s catalyst. In the catalytic hydrogenation, two new CÀÀH s bonds are formed simultaneously from H atoms absorbed into the metal surface. Thus, catalytic hydrogenation is stereospecific, giving only the syn addition product. If the atoms are added on the same side of the molecule, the addition is known as syn addition. If the atoms are added on opposite sides of the molecule, the addition is called an anti addition. For example, 2-butene reacts with H2 in the presence of a metal catalyst to give n-butane. For example, acetylene reacts with hydrogen in the presence of a metal catalyst to give ethane. This reaction proceeds through a cis- alkene intermediate, but cannot be stopped at this stage except with the use of a special catalyst. Selective hydrogenation of alkynes Preparation of cis-alkenes Lindlar’s catalyst, which is also known as poisoned catalyst, consists of barium sulphate, palladium and quinoline, and is used in selective and partial hydrogenation of alkynes to produce cis-alkenes. Hydrogen atoms are delivered simultaneously to the same side of the alkyne, resulting in syn addition (cis-alkenes). Thus, the syn addition of alkyne follows same procedure as the catalytic hydrogena- tion of alkyne. Unsymmetrical means different substituents are at each end of the double or triple bond. Electrophilic addition of unsym- metrical reagents to unsymmetrical double or triple bonds follows Markovnikov’s rule. The reaction is not stereoselective since it proceeds via a planar carbocation intermediate. However, when reaction proceeds via a cyclic carbocation intermediate, it produces regiospecific and stereospecific product (see below). A regioselective reaction is a reaction that can potentially yield two or more constitutional isomers, but actually produces only one isomer. A reaction in which one stereoisomer is formed predominantly is called a stereoselective reaction. Thus, Markovnikov addition to unsymme- trical p bonds produces regioselective product. The reaction is regioselective, and occurs via the most stable carbocation intermediate. Hydrogen halides can be added to alkynes just like alkenes, to form first the vinyl halide, and then the geminal alkyl dihalide. The vinyl cation is more stable with positive charge on the more substituted carbon, because a secondary vinylic cation is more stable than a primary vinylic cation. When the internal alkyne has identical groups attached to the sp carbons, only one geminal-dihalide is produced. The free radical initiators change the mechanism of addition from an electrophilic addition to a free radical addition. The reversal of regiochemistry through the use of peroxides is called the peroxide effect. This is called acid-catalysed hydration of alkenes, which is the reverse of the acid-catalysed dehydration of an alcohol. The reaction proceeds via protonation to give the more stable tertiary carbocation intermediate. Addition of water by oxymercura- tion–reduction or hydroboration–oxidation has two advantages over the acid-catalysed addition of water. These procedures do not require acidic condition, and carbocation rearrangements never occur. Oxymercuration–reduction of alkenes: preparation of alcohols Addition of water to alkenes by oxymercuration–reduction produces alcohols via Markovnikov addition. The electrophilic mercury of mercuric acetate adds to the double bond, and forms a cyclic mercurinium ion intermediate rather than a planer carbocation. In the next step, water attacks the most substituted carbon of the mercurinium ion to yield the addition product. In the addition reaction, borane bonds to the less substituted carbon, and hydrogen to the more substituted carbon of the double bond. When the internal alkyne has identical groups attached to the sp carbons, only one ketone is obtained. For example, 2-butyne reacts with water in the presence of acid catalyst to yield 2-butanone. For example, 2-pentyne reacts with water in the presence of acid catalyst to yield 3-pentanone and 2-pentanone. Addition of water to acetylene gives acetaldehyde, and all other terminal alkynes give ketones. Oxygen loses a proton to form a mercuric enol, which under work-up produces enol (vinyl alcohol). Terminal alkynes are converted to aldehydes, and all other alkynes are converted to ketones. A sterically hindered dialkylborane must be used to prevent the addition of two borane molecules. A vinyl borane is produced with anti-Markovnikov orientation, which is oxidized by basic hydrogen peroxide to an enol. The addition of alcohols in the presence of an acid catalyst, most commonly aqueous 5. The reaction proceeds via protonation to give the more stable carbocation intermediate. The reaction mechanism is exactly the same as the oxymercuration–reduction of alkenes. This reaction is used as a test for unsaturation (p bonds), because the red colour of the bromine reagent disappears when an alkene or alkyne is present. The negative part of bromine is the nucleophile, which attacks the less substituted carbon to open up the cyclic bromonium ion and forms 1,2-dibromoethane (vicinal-dihalide). A reaction is stereospecific when a particular stereoisomeric form of the starting material gives a specific stereoisomeric form of the product. For example, the halogenation of cis- and trans-2-butene produces a racemic mixture of 2,3-dibromo- butane and meso-2,3-dibromobutane, respectively. Addition of Br2 to cycloalkenes gives a cyclic bromonium ion intermediate instead of the planar carbocation. When one mole of halogen is added, a dihaloalkene is produced, and a mixture of syn and anti addition is observed. In the first stage of the reaction, acetylene is converted to an alkene, 1,2-dibromoethene. In the final stage, another molecule of bromine is added to the p bond of this alkene, and produces 1,1,2,2-tetrabromoethane. The halide adds to the less substituted carbon atom via a bridged halonium ion intermediate, and the hydroxyl adds to the more substituted carbon atom. The reaction mechanism is similar to the halogenation of alkenes, except that instead of the halide nucleophile, the water attacks as a nucleophile. Methylene can be prepared by heat or light initiated decomposition of diazomethane (explosive and toxic gas).

New scientific views state that phenomena authority discount 5mg proscar prostate cancer gleason score 8, technology and the law order 5 mg proscar mastercard prostate disease, and the psycho- that are antithetical actually coexist—determinism dynamics of caring in human experience discount 5mg proscar free shipping prostate enlarged symptoms. Middle- with uncertainty and reversibility with irreversibil- range theory embodies the perspective that these ity (Nicolis & Prigogine buy proscar on line prostate cancer 7 on gleason score, 1989). Thus, both linear theories fall between the concrete world of practice and nonlinear and simple (e. One of the tools in the studies of complexity reflects the concrete world of practice and responds is chaos theory. Chaos deals with life at the edge, or to the caring ideal that is unique to nursing. The holographic paradigm in science recognizes Certain nursing theorists have embraced the notion that the ontology or “what is” of the universe or of nursing as complexity in which consciousness, creation is the interconnectedness of all things, that caring, and choice making are central to nursing the epistemology or knowledge that exists is in the (Davidson & Ray, 1991; Newman, 1986, 1992; relationship rather than in the objective world or Ray, 1994, 1998). Holography means that the implicit order from the decisions that were made about the struc- ture of organization (consciousness), the caring Holography means that the implicit order transactions that were engaged in (caring), and the (the whole) and explicit order (the part) effective negotiations or ability to make choices and are interconnected, that everything is a reconcile the system demands with the humanistic holon in the sense that everything is a client care needs (choice making). The theoretical whole in one context and a part in an- processes of awareness of viewing truth or seeing other—each part being in the whole the good of things (caring), and communication, and the whole being in the part. The dialectic of caring (the implicit order) in relation to the various struc- (the whole) and explicit order (the part) are inter- tures (the explicit order) illustrates that there is connected, that everything is a holon in the sense room to consider the theory as holographic. It is the relational aspect of informa- connected—humanistic and spiritual tion that makes it a holistic rather than a mecha- caring and the organizational system— nistic construct. Nursing is being shaped by the that everything is interconnected—humanistic and historical revolution going on in science, social spiritual caring and the organizational system—the sciences, and theology (Harmon, 1998; Newman, whole is in the part and the part is in the whole, a 1992; Ray, 1998; Reed, 1997; Watson, 1997; holon. In these new approaches, con- How can knowledge of caring interconnected- structs of consciousness and choice are central and ness motivate nursing to continue to embrace the demonstrate that phenomena of the universe, in- human dimension within the current economic cluding society, arise from the choices that are or are and technologic environment of health care? Can not made (Freeman cited in Appell & Triloki, 1988; higher ground be reclaimed for the twenty-first Harmon, 1998). Higher ground requires that we make task is to comprehend the relationship between excellent choices. It is therefore imperative that what is given in culture (the jural order) and what is spiritual and ethical caring thrive in complex sys- chosen (the moral and spiritual) between destiny tems. In nursing, the unitary-transforma- Bureaucratic Caring, illustrates that through spir- tive paradigm and the various theories of Newman, itual/ethical caring as the choice point for commu- Leininger, Parse, Rogers, and the holographic nication in relation to the complexity of the Theory of Bureaucratic Caring are challenging sociocultural system, nursing can reclaim higher nursing to comprehend a similar relationship. As noted, a re- Ray, 1991; Ray, 1994a, 1998; Reed, 1997; Vicenzi, vision toward this end is taking place in science White, & Begun, 1997). Nursing has the capacity to make creative and Through “authentic conscience” (Harmon, 1998) moral choices for a preferred future. Spiritual/ethical caring is both a part and a whole, and every part secures its Social- purpose and meaning from each of the parts that Physical Cultural can also be considered wholes. It brings with it a spirit of repentance, hended within as intimacy and spirit (Harmon, seeing in a new way, a change of heart. Because of the crisis of our rela- As the twenty-first century is evolving, nurs- tionship to work, we are challenged to reinvent it. As the Theory of Bureaucratic Caring in touch with others, not only in terms of personal has demonstrated, caring is the primordial gain, but also at the level of service to humanity or construct and consciousness of nursing. Reenvisioning the theory as holographic Work must be spiritual, with recognition of the shows that through creativity and imagina- creative spirit at work in us. Thus, nurses must be tion, nursing can build the profession it the “custodians of the human spirit” (Secretan, wants. The ethical imperatives of caring that join with The new scientific and spiritual approach the spiritual relate to questions or issues about our to nursing theory as holographic will have moral obligations to others. The union of science, ethics, edifying the good through communication and in- and spirit will engender a new sense of teraction involve never treating people simply as a hope for transformation in the work world. Ethical content—as principles of doing good, Nurses can reintroduce the spiritual and eth- doing no harm, allowing choice, being fair, and ical dimensions of caring. The deep values promise-keeping—functions as the compass in our that underlie choice to do good for the many decisions to sustain humanity in the context of po- will be felt both inside and outside organiza- litical, economic, and technological situations tions. Roach (2002) pointed out act on this awareness and no longer surren- that ethical caring is operative at the level of dis- der to injustices and oppressiveness of sys- cernment of principles, in the commitment needed tems that focus primarily on the good of a to carry them out, and in the decisions or choices to few. The holographic Theory of health is a community responsibility, an idea that is Bureaucratic Caring—idealistic, yet practical; rooted in ancient Hebrew ethics. The expression of visionary, yet real—can give direction and human caring as an ethical act is inspired by spir- impetus to lead the way. Spiritual/ ethical caring for nursing does not question whether or not to care in complex systems but inti- mates how sincere deliberations and ultimately the facilitation of choices for the good of others can or This transformation toward relational should be accomplished. Nurses can reintroduce the spiri- The recognition that we need to change the way we tual and ethical dimensions of caring. However, nurse researchers, nurse admin- istrators, and nurses in practice can use the politi- cal and/or economic dimensions of the Theory of Applications of Bureaucratic Caring as a framework to guide prac- tice and decision making. Use of these dimensions of the theory integrates the constructs of politics, Marilyn Ray’s economics, and caring within the health-care organization. The purpose of this chapter is to illuminate the Theory of notion of political/economic caring in the current health-care environment. Ray’s (1989) original Theory of Bureaucratic Caring included political Bureaucratic and economic entities as separate and distinct structural caring categories. The revised Theory of Bureaucratic Caring, however, is represented Caring as a complex holographic theory. Turkel dimensions of bureaucratic caring as portrayed in this chapter are illuminated as interrelated constructs. The political and economic dimensions of bu- Current Context of Health-Care reaucratic caring encompass not only health-care Organizations reform at the national level, but also refer to the po- litical and economic impact of these changes at the Review of the Literature: Political organizational level. Through sections on the cur- and Economic Constraints of rent context of health-care organizations, review of Nursing Practice the literature related to the political and economic constraints of nursing practice, economic caring Economic Implications of Bureau- research, political and economic implications of cratic Caring Theory: Research in bureaucratic caring, and visions for the future, we Current Atmosphere of Health-Care learn how the Theory of Bureaucratic Caring Reform applies. Economic/Political Implications Current Context of of Bureaucratic Caring Health-Care Organizations Summary In the wake of the controversial health-care reform References process that is currently being debated in the United States, the central thesis in today’s economic health-care milieu in both the for-profit and not- for-profit sectors is managed care (Williams & Ray (1989, p. Managed care is an economic con- tion of America and other health care systems to cept based on the premise that purchasers of care, corporate enterprises emphasizing competitive both public and private, are unwilling to tolerate management and economic gain seriously chal- the substantial growth of the last several years in lenges nursing’s humanistic philosophies and theo- health-care costs. Managed care involves managed ries, and nursing’s administrative and clinical competition and is based on the assumption that policies. Within traditional complex health-care or- nursing services to the bed rate for patients ganizations, community or public health agencies, (Shaffer, 1985). This new form of health-care fi- trators who must determine how these resource nancing, based on the ratio of benefits over costs or dollars will be allocated within their respective the “highest quality services at the lowest available institutions. When professional nursing salary outcomes are paramount to health-care organiza- dollars are viewed as an economic liability that tional survival and the economic viability of pro- limits the potential profit margins of organiza- fessional nursing practice. From an economic per- executives attribute these workforce reductions to spective, health-care organizations are a business. It is imperative to the future of is becoming stronger, cost controls are becoming professional nursing practice that the economic tighter, and reimbursement is declining. However, value of caring be studied and documented, so human caring is not subsumed by the economics of The human dimension of health care is health care. Review of the Literature: the human dimension of health care is missing from the economic discussion. Political and Economic In the economic debate, the belief in caring for Constraints of Nursing Practice the patients as the goal of health-care organizations has been lost. Ray (1989) questioned how eco- In order to use the economic dimension of the nomic caring decisions are made related to patient Theory of Bureaucratic Caring to guide research, care in order to enhance the human perspective nursing administration, and clinical practice, it is within a corporate culture. When patients are hos- necessary to understand both the way in which pitalized, it is the caring and compassion of the reg- health care has been financed and the current reim- istered nurse that the patients perceive as quality bursement system. Nurses, who understand the care and making a difference in their recovery economics of health-care organizations, will be (Turkel, 1997). The concerns of patients themselves able to synthesize this knowledge into a framework are not about costs or health-care finance. Yet, in a for practice that integrates the dimensions of climate increasingly focused on economics, it has economics and human caring. Consequently, newer cost systems, such work and charitable religious organizations as managed care, do not look at human caring (Dolan, 1985). Prior to the establishment of or the nurse-patient relationship when allocating Medicare and Medicaid in 1965, the health-care resource dollars for reimbursement. Nursing Historically, nursing care delivery has not been students subsidized hospitals, and hospital-based financed or costed out in terms of reimbursement nursing care was not considered a reimbursable as a single entity. As nursing education As a result of the prospective payment system, moved away from the hospital setting to universi- hospital administrators were pressured to increase ties in the late 1950s and as the role of the student efficiency, reduce costs, and maintain quality. Research was con- the retrospective reimbursement of Medicare ducted in order to examine the costs associated and Medicaid in 1965 allowed for hospital prof- with nursing (Bargagliotti & Smith, 1985; Curtin, itability and the issue of nursing care costs was not 1983; McCormick, 1986; Walker, 1983). Hospital administrators were under process did not include the humanistic, caring considerable pressure to control costs. It Foshay (1988) investigated 20 registered nurses’ was assumed that the rising costs of health care perceptions of caring activities and the ability of were due to nurses’ salaries and the number of reg- patient classification systems to measure these car- istered nurses (Walker, 1983). Findings from this study revealed that a percent of hospital charges could not be identi- patient classification systems could not address the fied, because historically they had been tied to the emotional needs of patients, the needs of the eld- room rate. Specific car- care costs continued to rise and did not follow ing behaviors that could not be measured included traditional economic patterns. Cost-based reim- giving a reassuring presence, attentive listening, and bursement altered the forces of supply and de- providing information. In the traditional economic marketplace, Other research of this time period focused on when the price of a product or service goes up, the the cost and outcomes of all registered nurse demand decreases and consumers seek alternatives staffing patterns (Dahlen & Gregor, 1985; Glandon, at lower prices (Mansfield, 1991).

Defending the Thought Prosecuting the Thought My son is doing horrible in He had one bad report card buy cheap proscar 5 mg androgen hormone and not enough estrogen hormone. If I were a good mother order proscar without a prescription androgen hormone acne, I I wonder why the teacher didn’t contact me would have known that he before report card time discount proscar 5mg without prescription prostate zonal anatomy. I haven’t gone on a field trip Out of 30 kids generic proscar 5mg amex wikibooks prostate radiation oncology, only a few parents were able to with my son’s class because drive on field trips. Other mothers even I wish I could spend more time with my son, but volunteer in the classroom. I have been putting my job That’s not really true; when my kids really need ahead of my children. Chapter 6: Indicting and Rehabilitating Thoughts 87 Defending the Thought Prosecuting the Thought I don’t know what to do to I guess I’ll do what the teacher suggests and help him. Thought Court is one of the most effective tools for combating anxiety, depression, and other unpleasant emotions. If you have trouble with the exercise, spend more time going over the Prosecutor’s Investigative Questions in Worksheet 6-3. It also doesn’t hurt to review Chapter 5 and re-read the examples in this chapter. If you still struggle, we recom- mend you consult a mental health professional who’s proficient in cognitive therapy. After the Verdict: Replacing and Rehabilitating Your Thoughts Hopefully, the prosecution presents a convincing case against a variety of your malicious thoughts, and you begin to see that many of your thoughts are guilty of scrambling reality and causing excessive emotional distress. When criminals are convicted, society usually tries to rehabilitate them and give them a second chance. In this section, we show you how to rehabilitate your guilty thoughts, one at a time. Rehabilitating your thoughts decreases feelings of depression and anxiety because rehabili- tated thoughts are less distorted, judgmental, and critical. We call rehabilitated thoughts replacement thoughts because they replace your old malicious thoughts. The reason for forming a single replacement thought is that you can use that new thought repeatedly when- ever the old, malicious thoughts start rumbling through your mind. The new thought is a quick and easy comeback to negative, distorted, reality-scrambled thinking. You can use a number of different techniques to develop effective replacement thoughts. The strategies outlined in the following sections help you discard distortions and straighten out your thinking. With these strategies, you discover how to replace your twisted thoughts with more helpful, realistic replacement thoughts. You start by imagining that a good friend of yours is going through the same kind of problem as you are. We don’t want you to simply try to make your friend feel better by sugarcoating the issue; rather, tell your friend about a reasonable way to think about the problem. The essence of this powerful, yet surprisingly simple, technique is that the advice you would give a friend is advice you can give to yourself. The following example shows you how to use Getting Help from a Friend to your advantage. Emma (see “Emma: Filled with anxiety” earlier in this chapter) has taken her most malicious thought to Thought Court and found it guilty. She imagines Louise coming to her with the same problem and concerns about her son. In other words, Louise is thinking Emma’s most malicious thought and seeking advice (see Worksheet 6-11). Emma’s/Louise’s most malicious thought: I’m a complete failure as a mother; my son is falling apart. Worksheet 6-11 Emma’s Getting Help from a Friend (Louise) Well, Louise, I know you feel like a failure, but your son only came home with two C’s and three B’s. Sure, you haven’t spent as much time with him lately, but you’ve been pretty tied up at work. Besides, your son is 16 now; don’t you think he has something to do with his own success and failure? She sees that her perspective changes when she gives Louise advice rather than listen to the negative automatic dialogue in her own head. Next, she distills this perspective into a single replacement thought (see Worksheet 6-12). Worksheet 6-12 Emma’s Replacement Thought My son isn’t falling apart and I’m not a failure. Chapter 6: Indicting and Rehabilitating Thoughts 89 Take one of your most malicious thoughts and use the Getting Help from a Friend strategy to devise an effective response to that thought. Of course, it helps to take the malicious thought to Thought Court first, which you’ve done — right? Write down one of your most malicious thoughts from your Thought Tracker (see Worksheet 6-6). Imagine that the friend has a problem very similar to your own and has similar thoughts about the problem. Imagine you’re talking with your friend about a better way to think about and deal with the problem. Look over that advice and try to rehabilitate your most malicious thought into a more balanced, summary replacement thought in Worksheet 6-14. My most malicious thought: __________________________________________________________________________________ Worksheet 6-13 My Getting Help from a Friend Worksheet 6-14 My Replacement Thought Traveling to the future The events that disrupt your life today rarely have the same meaning after a few days, weeks, or months. If you think back on these events after some time has passed, however, rarely can you muster up the same intensity of emotion. That’s because most upsetting events truly aren’t all that important if you look at them in the context of your entire life. Check out the following example of the Traveling to the Future technique in action. He’d like to sell the property, but he knows it’s worth far more if it can be zoned for commercial purposes first. In order to do that, Joel must present his case in front of the Zoning Commission. He expects some opposition and criticism from homeowners in the area, and he’s been putting this task off for months because of the intense anxiety it arouses in him. He fills out a Thought Tracker (see “From Arraignment to Conviction: Thought Court” ear- lier in this chapter) and identifies his most malicious thought: “I’ll make a fool out of myself. He rates the emotional upset and effect on his life that he feels right now, and then he re-rates the impact on his life at the conclusion of the exercise. Worksheet 6-15 Joel’s Traveling to the Future If I do indeed make a fool out of myself, I’ll probably feel pretty bad and the impact on my life will feel like 30 or even 40 on a 100-point scale. I suspect that images of the incident will go through my mind fairly often, but six months from now, I doubt I’ll think about the inci- dent much at all. So I guess the overall effect on my life will likely be about a 1 on a 100-point scale. After pondering what his malicious thought will seem like in the future, Joel feels ready to develop a more realistic replacement thought (see Worksheet 6-16). Chapter 6: Indicting and Rehabilitating Thoughts 91 Worksheet 6-16 Joel’s Replacement Thought Even if I should happen to make a fool out of myself, it’s hardly going to be a life-changing event. The Traveling to the Future technique won’t apply to all your thoughts and problems, but it works wonders with quite a few. In Joel’s case, he could have analyzed his malicious thought for obvious distortions such as labeling and enlarging. In other words, be sure to try out a variety of strate- gies for rehabilitating your thoughts in order to find the one that works best for you and for a particular thought or thoughts. Take one of your most malicious thoughts and use the Traveling to the Future strategy to devise an effective response to that thought. Write down one of your most malicious thoughts from your Thought Tracker (see Worksheet 6-6). In Worksheet 6-17, rate the overall amount of upset and impact you feel at the moment (on a scale of 1 to 100, with 100 representing the highest imaginable impact). In Worksheet 6-18, write down a balanced, summary replacement thought based on any new perspective you obtain with this strategy. People worry about things yet to happen to them, such as facing a plane crash, catching germs, encountering heights, and experiencing embarrassment. They predict that whatever they undertake will result in horror, misery, or unhappiness. In other words, people tend to overestimate the risks of negative outcomes, and they do so more often when they’re in emotional distress. When you predict negative outcomes, you have malicious thoughts that paralyze you from taking action. In order to develop replacement thoughts for your malicious ones, you first need to rethink your negative predictions. After you analyze your predictions, you’ll be able to rehabilitate your malicious thoughts. Melinda takes on Allison’s responsibilities in her absence and assumes the extra work without thinking about it. She predicts that she won’t be able to handle the job, and she can’t see herself as a boss. Her most malicious thoughts are, “I’m not cut out to handle supervising others — I’m a fol- lower, not a leader.

The culture of each individual group order online proscar man health advisor, or sources discount 5mg proscar free shipping mens health 4 week diet plan, including people order discount proscar prostate anatomy diagram, literature cheap proscar 5mg visa prostate abscess, society documents, and findings. Basic research is designed to directly influ- descriptions of nursing theorists and their cen- ence or improve clinical practice. Hildegard Peplau: Nursing is a therapeutic, on the level of current knowledge about a interpersonal, and goal-oriented process. Data that researchers collect from subjects who requires help to reach independence. A hypothesis is based on the independent ill person in the healthcare setting; describes variables that the researcher finds. Martha Rogers: A focus on rehabilitation, conditions that are manipulated or identi- encompassing nursing’s autonomy in the fied to determine the effects of the depend- therapeutic use of cure and care. Instruments are the devices used to collect self-care deficits require nursing actions. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Systems are hierarchical in nature and are functions that bring about a desired goal composed of interrelated subsystems that 2. Systems are not separated from each other and construct our perceptions of life by boundaries. A system communicates with and reacts to the common purpose of contributing an its environment through input and output. The theory describes the process by which living matter adjusts to other living 7. Defines a continuously occurring process coercion, or to refuse to participate without that effects change and involves interac- jeopardizing the care he/she will receive. Outlines human growth as a predictable supported by reliable research-based evidence. Adaptation theory principles of the following theories that are basic to many nursing concepts. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Which nursing theorist(s) best defines your own personal beliefs about nursing practice, and why? Describe how three different theories of nursing would direct the nursing care (identification and management of health/nursing needs) of c. A teacher who reported the inci- dent is close to the girl and asks to speak to the 3. Cultural influences on nursing: a piece of paper, along with a brief description of their basic tenets (refer to Table 5-1 in the textbook). Interview your faculty, nurses you know, and classmates and have them rank the theories in order of importance based on their own system of beliefs. Educational influences on nursing: give you an example of their personal philoso- phy that they would like to incorporate into their nursing practice. Note which theory was most widely respected, and determine its value to your own practice. Improved communication in nursing: Scenario: Charlotte Horn, the daughter of a 57-year-old patient being discharged with an order for intermittent nasogastric tube feedings, is being taught how to perform the procedure. During one of the teaching sessions, Charlotte asks several questions: “How will I know the e. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. What intellectual, technical, interpersonal, concerns regarding the care of her mother? Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. An action is right or wrong depending on the process used to arrive at the action. The rightness or wrongness of an action is not dependent on the process used to arrive Circle the letter that corresponds to the best at the action. When a nurse is able to recognize that an ethi- oped by the American Hospital Association to cal moment has occurred with a patient, he/ enumerate the rights and responsibilities of she is experiencing which of the following patients while receiving hospital care? A nurse who is caring for a new mother realizes agency could be described as the cultivated that the woman is not prepared to go home dispositions that allow one to act as one with her newborn after a hospital stay of only believes one ought to act? Ethical dissatisfaction support that patients and their families need to make the decision that is right for them, 3. Which of the following principles applies to he/she is practicing which of the following utilitarian action guiding theory? A nurse becomes a mentor to a student well-being over the claims of the patient’s nurse working on her floor. A nurse respects the right of a Native Amer- ican to call in a shaman for a consultation. Which of the following statements reflect the the use of the professional value of human mode of value transmission known as laissez- dignity? Which of the following actions best describe represent the basic principles of ethics? A nurse stays later than his/her shift to or communal standards of right or wrong. A nurse reads the Patient Bill of Rights to a and vice, and of good and evil, as they visually impaired patient. A commitment to developing one’s ability team members to ensure the best possible to act ethically is known as one’s ethical treatment for his patient. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Personal or communal standards of right on his own with no guidance from his parents, and wrong the parents are using a(n) approach to value transmission. Parents who encourage their children to seek institutional constraints make it nearly more than one solution to a problem and impossible to pursue the right actions weigh the consequences of each are practicing the mode of value transmission. When a nurse analyzes her feelings regarding choices that need to be made when several 7. A systematic inquiry into the principles alternatives are presented and decides whether of right and wrong conduct, of virtue and these choices are rationally made, she is vice, and of good and evil, as they relate engaging in the practice of. The protection and support of another’s decision to further his education is involved in rights the step of the process of valuing. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. A child is encouraged to interact with people of various cultures to explore dif- a. Describe how you, as a nurse, would help the following patient to define her values and d. Justice: choose a plan of action using the steps listed in your text: A 36-year-old mother of a 10-year-old child with cystic fibrosis works during the day as a cashier and is going to school at night to study nursing. The child needs more attention than the mother has time to supply, and the mother feels guilty for spending time to better herself. Describe how a nurse might react in this situa- a full-time caretaker for her child. You are afraid to confront the nurse because she is your superior and has been known to punish coworkers who displease her c. Identify four ethical issues confronted by nurses in their daily nursing practice. Ethical character: Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Use the five-step model of ethical decision making listed in your text to resolve the following moral distress: You believe that a g. Transformative ethical leadership: homeless patient, diagnosed with high blood pressure, needs a psychological work-up. An infant born addicted to crack cocaine riors insist she be discharged without further whose mother wants to take him home: treatment, and you are told there is no room for her on the psychiatric ward. A 12-year-old girl who seeks a pregnancy test at a Planned Parenthood clinic without b. A 15-year-old girl who is anorexic and who refuses to eat anything during her hospital d. Give an example of an ethical problem that from an infected male partner, and who may occur between the following healthcare tells you that the other nurses have been personnel, patients, and institutions. Describe how you would respond in an ethical most important in developing your own manner to the requests of the following patients: personal code of ethics: a. A patient with end-stage pancreatic cancer confesses to you that the only relief he can get from his pain is from smoking marijuana. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. A recent policy and marks consistent with domestic abuse change stopped this practice approximately tells you that her husband pushed her 4 weeks ago. When her husband arrives, he he refuses to take the prescriptions, saying, hovers over her in an obsessive and overly “Why take that useless paper? A doctor asks you to falsify a report that he prescribed medicine contraindicated for a patient’s condition. Share your responses with a classmate and explore the difference in your responses.