By E. Gonzales. Johnson and Wales University. 2018.

Chronic conditions 120mg silvitra mastercard impotence with beta blockers, such as organic mental disorder or mental retardation discount 120mg silvitra with visa erectile dysfunction yoga, are thought to impair the ability of an individual to adapt to stress, causing increased vulnerability to adjustment disorder. Sadock and Sadock (2007) suggest that genetic factors also may influence individual risks for maladaptive response to stress. Some proponents of psychoana- lytical theory view adjustment disorder as a maladaptive response to stress that is caused by early childhood trau- ma, increased dependency, and retarded ego development. Other psychoanalysts put considerable weight on the con- stitutional factor, or birth characteristics that contribute to the manner in which individuals respond to stress. In many instances, adjustment disorder is precipitated by a specific meaningful stressor having found a point of vulnerability in an individual of otherwise adequate ego strength. Some studies relate a predispo- sition to adjustment disorder to factors such as develop- mental stage, timing of the stressor, and available support systems. When a stressor occurs, and the individual does not have the developmental maturity, available support systems, or adequate coping strategies to adapt, normal functioning is disrupted, resulting in psychological or somatic symptoms. The individual may remain in the denial or anger stage, with inadequate de- fense mechanisms to complete the grieving process. This model considers the type of stressor the individual experiences, the situational con- text in which it occurs, and intrapersonal factors in the predisposition to adjustment disorder. It has been found that continuous stressors (those to which an individual is exposed over an extended period of time) are more com- monly cited than sudden-shock stressors (those that occur without warning) as precipitants to maladaptive function- ing. Intrapersonal factors that have been implicated in the predisposition to adjustment disorder include birth temperament, learned social skills and cop- ing strategies, the presence of psychiatric illness, degree of flexibility, and level of intelligence. Violation of societal norms and rules, such as truancy, van- dalism, reckless driving, fighting 12. Physical complaints, such as headache, backache, other aches and pains, fatigue Common Nursing Diagnoses and Interventions (Interventions are applicable to various health-care settings, such as inpatient and partial hospitalization, community outpatient clinic, home health, and private practice. Related/Risk Factors (“related to”) [Fixation in earlier level of development] [Negative role modeling] Adjustment Disorder ● 239 [Dysfunctional family system] [Low self-esteem] [Unresolved grief] [Psychic overload] [Extended exposure to stressful situation] [Lack of support systems] [Biological factors, such as organic changes in the brain] Body language (e. Client will verbalize adaptive coping strategies for use when hostile or suicidal feelings occur. Client will demonstrate adaptive coping strategies for use when hostile or suicidal feelings occur. Do this through rou- tine activities and interactions; avoid appearing watchful and suspicious. Close observation is required so that intervention can occur if required to ensure client’s (and others’) safety. Observe for suicidal behaviors: verbal statements, such as “I’m going to kill myself” and “Very soon my mother won’t have to worry herself about me any longer,” and nonverbal behaviors, such as giving away cherished items and mood swings. Clients who are contemplating suicide often give clues regarding their potential behavior. Obtain verbal or written contract from client agreeing not to harm self and to seek out staff in the event that suicidal ideation occurs. Discussion of suicidal feelings with a trusted individual provides some relief to the client. A contract gets the subject out in the open and places some of the responsibil- ity for his or her safety with the client. Help client recognize when anger occurs and to accept those feelings as his or her own. Have client keep an “anger notebook,” in which feelings of anger experienced during a 24-hour period are recorded. Information regarding source of anger, behavioral response, and client’s perception of the situation should also be noted. Discuss entries with client and suggest alternative behavioral responses for those iden- tified as maladaptive. Act as a role model for appropriate expression of angry feel- ings and give positive reinforcement to client for attempting to conform. It is vital that the client express angry feelings, because suicide and other self-destructive behaviors are often viewed as the result of anger turned inward on the self. Try to redirect violent behavior by means of physical outlets for the client’s anxiety (e.

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Then the participants were asked again silvitra 120 mg with mastercard impotence journal, either 1 discount 120mg silvitra otc erectile dysfunction hernia, 6, or 32 weeks later, to recall their memories. The participants became less accurate in their recollections of both the emotional event and the everyday events over time. But the participants‘ confidence in the accuracy of their memory of learning about the attacks did not decline over time. After 32 weeks the participants were overconfident; they were much more certain about the accuracy of their flashbulb memories than [22] they should have been. Schmolck, Buffalo, and Squire (2000) found similar distortions in memories of news about the verdict in the O. Heuristic Processing: Availability and Representativeness Another way that our information processing may be biased occurs when we use heuristics, which are information-processing strategies that are useful in many cases but may lead to errors when misapplied. Let‘s consider two of the most frequently applied (and misapplied) heuristics: the representativeness heuristic and the availability heuristic. In many cases we base our judgments on information that seems to represent, or match, what we expect will happen, while ignoring other potentially more relevant statistical information. Boy Using the representativeness heuristic may lead us to incorrectly believe that some patterns of observed events are more likely to have occurred than others. In this case, list B seems more random, and thus is judged as more likely to have occurred, but statistically both lists are equally likely. Most people think that list B is more likely, probably because list B looks more random, and thus matches (is “representative of‖) our ideas about randomness. But statisticians know that any pattern of four girls and four boys is mathematically equally likely. The problem is that we have a schema of what randomness should be like, which doesn‘t always match what is mathematically the case. Similarly, people who see a flipped coin come up “heads‖ five times in a row will frequently predict, and perhaps even wager money, that “tails‖ will be next. But mathematically, the gambler‘s fallacy is an error: The likelihood of any single coin flip being “tails‖ is always 50%, regardless of how many times it has come up “heads‖ in the past. The tendency to make judgments of the frequency or likelihood that an event occurs on the basis of the ease with Attributed to Charles Stangor Saylor. Imagine, for instance, that I asked you to indicate whether there are more words in the English language that begin with the letter “R‖ or that have the letter “R‖ as the third letter. You would probably answer this question by trying to think of words that have each of the characteristics, thinking of all the words you know that begin with “R‖ and all that have “R‖ in the third position. Because it is much easier to retrieve words by their first letter than by their third, we may incorrectly guess that there are more words that begin with “R,‖ even though there are in fact more words that have “R‖ as the third letter. We may think that our friends are nice people, because we see and remember them primarily when they are around us (their friends, who they are, of course, nice to). And the traffic might seem worse in our own neighborhood than we think it is in other places, in part because nearby traffic jams are more easily retrieved than are traffic jams that occur somewhere else. Salience and Cognitive Accessibility Still another potential for bias in memory occurs because we are more likely to attend to, and thus make use of and remember, some information more than other information. For one, we tend to attend to and remember things that are highly salient, meaning that they attract our attention. Things that are unique, colorful, bright, moving, and unexpected are more salient [24] (McArthur & Post, 1977; Taylor & Fiske, 1978). In one relevant study, Loftus, Loftus, and [25] Messo (1987) showed people images of a customer walking up to a bank teller and pulling out either a pistol or a checkbook. By tracking eye movements, the researchers determined that people were more likely to look at the gun than at the checkbook, and that this reduced their ability to accurately identify the criminal in a lineup that was given later. The salience of the gun drew people‘s attention away from the face of the criminal. The salience of the stimuli in our social worlds has a big influence on our judgment, and in some cases may lead us to behave in ways that we might better not have. You checked Consumer Reports online and found that, although the players differed on many dimensions, including price, battery life, ability to share music, and so forth, the Zune was nevertheless rated significantly higher by owners than was the iPod.

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Occupational health nurses must Continuous quality improvement in nursing and understand the political system discount 120mg silvitra fast delivery smoking erectile dysfunction statistics, the economic sys- health care is a reality cheap silvitra 120 mg line erectile dysfunction treatment pills. Structure provides an overall organi- health programs as they interact and set goals with zation of the program. Process relates to nursing interdisciplinary teams to manage health care activities. Outcomes are separate from but related (Hampton, 1994; Sowell & Fuszard, 1989; Sowell & to performance criteria for evaluation of nursing Lowenstein, 1994). In this sense, they system provides structure for a continuous quality- are relating to the interpersonal systems in the improvement program (King, 1994). This is done within a variety of social action Process Model in my Theory of Goal systems in the community. Although the focus is Attainment gives a process that leads to goal attain- groups, nurses work with individuals for whom ment that represents outcomes. An example was given to 16–1) shows the interactions of the three systems in document effectiveness of nursing care if one uses community health. The record system is an information system based on Use in Hospitals my Theory of Goal Attainment. The record system Two case studies were presented to demonstrate can be designed and adapted to most health-care nurses’ use of the transaction process and knowl- systems. For nurses, it was designed to gather data edge of the concepts of perception, communica- from assessments of the patient, make a nursing tion, interaction, and role (King, 1986b). King’s Theory of Goal Attainment 243 nursing care, and write mutually agreed-upon goals twentieth century to the science of nursing in the and means to attain them. Elements in the goal-oriented nursing record are: (1) data base, (2) goal list, (3) nursing orders, (4) flow sheets, (5) progress notes, and (6) discharge summary. My conceptual Several nurses have tested the theory in research on system and transaction process in the Theory aging, parenting, psychiatric-mental health, and of Goal Attainment provides one approach to ambulatory care (Alligood et al. For interaction between nurses and health- ducted studies in their cultures to test the Theory of care professionals and between health- Goal Attainment (Coker et al. For common discourse among health pro- and responses to professional nursing care that fessionals and between nurses and nursing resulted in an instrument that measures patient personnel. Direct measure of outcomes resulting in My vision for the future of nursing is that nursing quality care and cost-effective care; that is, will provide access to health care for all citizens. One valid and reliable assessment instru- are directed to the right place in the system for ment to assess activities of daily living as a nursing care, medical care, social services informa- basis for goal-setting. For continuity of care within and between tion process will be used by every practicing nurse health-care agencies. Theory of Goal Attainment, and Transaction Process Model will continue to serve a useful pur- When knowledge of the concepts and the pose in delivering professional nursing care. The transaction process has been used in hospi- ideas have been tested in research and in practice, tals, homes, nursing homes, and community and nurses in education and practice have used the health agencies, nurses have been motivated knowledge of the concepts. The relevance of to seek additional knowledge in formal edu- evidence theory–based practice, using my theory, cational programs. Publications, including Frey & Sieloff (1995), identified from a review of the literature, will be summarized and briefly discussed. Finally, of King’s recommendations will be made for future knowl- edge development in relation to King’s Interacting Systems Framework and midrange theory, par- Theory of Goal ticularly in relation to the importance of their application within an evidence-based practice environment. Attainment Christina Leibold Sieloff, Maureen Application of Interacting Frey, & Mary Killeen Systems Framework In conducting the literature review, the authors began with the broadest category of application— application within the Interacting Systems Frame- Application of Interacting Systems work to nursing care situations. Because a con- Framework In conducting the literature review, the Concept Development Within the authors began with the broadest category Framework of application—application within the Interacting Systems Framework to nursing Theory of Goal Attainment care situations. Recommendations for Knowledge Development Related to King’s ceptual framework is, by nature, very broad and Framework and Theory abstract, it can only serve to guide, rather than prescriptively direct, nursing practice. Summary King’s Interacting Systems Framework has been used to guide nursing practice in several References ways.

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The process happens so quickly that it may feel to us as if emotion is simultaneous with our physical arousal cheap 120 mg silvitra with amex drugs for erectile dysfunction ppt. On the other hand buy 120 mg silvitra amex erectile dysfunction 18-25, and as predicted by the James-Lange theory, our experiences of emotion are weaker without arousal. Patients who have spinal injuries that reduce their experience of arousal [8] also report decreases in emotional responses (Hohmann, 1966). There is also at least some support for the idea that different emotions are produced by different patterns of arousal. The Two-Factor Theory of Emotion Whereas the James-Lange theory proposes that each emotion has a different pattern of arousal, the two-factor theory of emotion takes the opposite approach, arguing that the arousal that we experience is basically the same in every emotion, and that all emotions (including the basic emotions) are differentiated only by our cognitive appraisal of the source of the arousal. The two-factor theory of emotion asserts that the experience of emotion is determined by the intensity of the arousal we are experiencing, but that the cognitive appraisal of the situation determines what the emotion will be. Because both arousal and appraisal are necessary, we can say that emotions have two factors: an arousal factor and a cognitive factor (Schachter & Singer, [12] 1962): emotion = arousal + cognition In some cases it may be difficult for a person who is experiencing a high level of arousal to accurately determine which emotion she is experiencing. That is, she may be certain that she is feeling arousal, but the meaning of the arousal (the cognitive factor) may be less clear. Some romantic relationships, for instance, have a very high level of arousal, and the partners alternatively experience extreme highs and lows in the relationship. One day they are madly in love with each other and the next they are in a huge fight. In situations that are accompanied by high arousal, people may be unsure what emotion they are experiencing. In the high arousal relationship, for instance, the partners may be uncertain whether the emotion they are feeling is love, hate, or both at the same time (sound familiar? When he had finished, she wrote her name and phone number on a piece of paper, and invited him to call if he wanted to hear more about the project. More than half of the men who had been interviewed on the bridge later called the woman. In contrast, men approached by the same woman on a low solid bridge, or who were interviewed on the suspension bridge by men, called significantly less frequently. The idea of misattribution of arousal can explain this result—the men were feeling arousal from the height of the bridge, but they misattributed it as romantic or sexual attraction to the woman, making them more likely to call her. Research Focus: Misattributing Arousal If you think a bit about your own experiences of different emotions, and if you consider the equation that suggests that emotions are represented by both arousal and cognition, you might start to wonder how much was determined by each. That is, do we know what emotion we are experiencing by monitoring our feelings (arousal) or by monitoring our thoughts (cognition)? The bridge study you just read about might begin to provide you an answer: The men seemed to be more influenced by their perceptions of how they should be feeling (their cognition) rather than by how they actually were feeling (their arousal). Schachter and Singer believed that the cognitive part of the emotion was critical—in fact, they believed that the arousal that we are experiencing could be interpreted as any emotion, provided we had the right label for it. Thus they hypothesized that if an individual is experiencing arousal for which he has no immediate explanation, he will ―label‖ this state in terms of the cognitions that are created in his environment. On the other hand, they argued that people who already have a clear label for their arousal would have no need to search for a relevant label, and therefore should not experience an emotion. On the basis of this cover story, the men were injected with a shot of the neurotransmitter epinephrine, a drug that normally creates feelings of tremors, flushing, and accelerated breathing in people. Then, according to random assignment to conditions, the men were told that the drug would make them feel certain ways. The men in theepinephrine informed condition were told the truth about the effects of the drug—they were told that they would likely experience tremors, their hands would start to shake, their hearts would start to pound, and their faces might get warm and flushed. The participants in the epinephrine-uninformed condition, however, were told something untrue—that their feet would feel numb, that they would have an itching sensation over parts of their body, and that they might get a slight headache. The idea was to make some of the men think that the arousal they were experiencing was caused by the drug (the informed condition), whereas others would be unsure where the arousal came from (the uninformed condition). Then the men were left alone with a confederate who they thought had received the same injection. While they were waiting for the experiment (which was supposedly about vision) to begin, the confederate behaved in a wild and crazy (Schachter and Singer called it ―euphoric‖) manner. Then right before the vision experiment was to begin, the participants were asked to indicate their current emotional states on a number of scales. If you are following the story, you will realize what was expected: The men who had a label for their arousal (the informed group) would not be experiencing much emotion because they already had a label available for their arousal.

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Although a number of tests have been devised to measure practical intelligence (Sternberg generic silvitra 120mg otc erectile dysfunction surgery, Wagner 120 mg silvitra mastercard erectile dysfunction generic, & Okagaki, 1993; [15] Wagner & Sternberg, 1985), research has not found much evidence that practical intelligence is distinct from g or that it is predictive of success at any particular tasks (Gottfredson, [16] 2003). Practical intelligence may include, at least in part, certain abilities that help people perform well at specific jobs, and these abilities may not always be highly correlated with [17] general intelligence (Sternberg, Wagner, & Okagaki, 1993). On the other hand, these abilities or skills are very specific to particular occupations and thus do not seem to represent the broader idea of intelligence. Another champion of the idea of multiple intelligences is the psychologist Howard Gardner [18] (1983, 1999). Gardner argued that it would be evolutionarily functional for different people to have different talents and skills, and proposed that there are eight intelligences that can be differentiated from each other (Table 9. Gardner noted that some evidence for multiple intelligences comes from the abilities ofautistic savants, people who score low on intelligence tests overall but who nevertheless may have exceptional skills in a given domain, such as math, music, art, or in being able to recite statistics [19] in a given sport (Treffert & Wallace, 2004). The idea of multiple intelligences has been influential in the field of education, and teachers have used these ideas to try to teach differently to different students. For instance, to teach math problems to students who have particularly good kinesthetic intelligence, a teacher might encourage the students to move their bodies or hands according to the numbers. On the other hand, some have argued that these “intelligences‖ sometimes seem more like “abilities‖ or “talents‖ rather than real intelligence. Are sense of humor, artistic skills, dramatic skills, and so forth also separate intelligences? Furthermore, and again demonstrating the underlying power of a single intelligence, the many different intelligences are in fact correlated and thus represent, in part, g [20] (Brody, 2003). Measuring Intelligence: Standardization and the Intelligence Quotient The goal of most intelligence tests is to measure g, the general intelligence factor. Good intelligence tests are reliable, meaning that they are consistent over time, and also Attributed to Charles Stangor Saylor. Because intelligence is such an important individual difference dimension, psychologists have invested substantial effort in creating and improving measures of intelligence, and these tests are now the most accurate of all psychological tests. In fact, the ability to accurately assess intelligence is one of the most important contributions of psychology to everyday public life. A 3-year-old who could accurately multiply 183 by 39 would certainly be intelligent, but a 25-year-old who could not do so would be seen as unintelligent. Thus understanding intelligence requires that we know the norms or standards in a given population of people at a given age. Thestandardization of a test involves giving it to a large number of people at different ages and computing the average score on the test at each age level. It is important that intelligence tests be standardized on a regular basis, because the overall level of intelligence in a population may change over time. The Flynn effect refers to the observation that scores on intelligence tests worldwide have increased substantially over the past [21] decades (Flynn, 1999). There are many explanations for the Flynn effect, including better nutrition, increased access to information, and more familiarity with [22] multiple-choice tests (Neisser, 1998). But whether people are actually getting smarter is [23] debatable (Neisser, 1997). Once the standardization has been accomplished, we have a picture of the average abilities of people at different ages and can calculate a person‘smental age, which is the age at which a person is performing intellectually. Most modern intelligence tests are based the relative position of a person‘s score among people of the same age, rather than on the basis of this formula, but the idea of an intelligence “ratio‖ or “quotient‖ provides a good description of the score‘s meaning. It consists of 15 different tasks, each designed to assess intelligence, including working memory, arithmetic ability, spatial ability, and general knowledge about the world (see Figure 9. It also shows significant correlations with measures of everyday functioning among the mentally retarded. The intelligence tests that you may be most familiar with are aptitude tests, which are designed to measure one‘s ability to perform a given task, for instance, to do well in college or in postgraduate training. These tests are useful for selecting students because they predict success in the programs that they are designed for, particularly in the first year of the [25] program (Kuncel, Hezlett, & Ones, 2010). Intelligence tests are also used by industrial and organizational psychologists in the process of personnel selection.

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