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By U. Gembak. Franciscan University of Steubenville. 2018.

Conservation Adolescents can think systematically order desyrel 100mg without a prescription, can reason about Formal 11 years to abstract concepts desyrel 100 mg free shipping, and can understand ethics and scientific operational adulthood reasoning desyrel 100 mg with visa. Abstract logic The first developmental stage for Piaget was the sensorimotor stage, the cognitive stage that begins at birth and lasts until around the age of 2. It is defined by the direct physical interactions that babies have with the objects around them. During this stage, babies form their first schemas by using their primary senses—they stare at, listen to, reach for, hold, shake, and taste the things in their environments. Piaget found, for instance, that if he first interested babies in a toy and then covered the toy with a blanket, children who were younger than 6 months of age would act as if the toy had disappeared completely—they never tried to find it under the blanket but would nevertheless smile and reach for it when the blanket was removed. Piaget found that it was not until about 8 months that the children realized that the object was merely covered and not gone. Piaget used the term object permanence to refer to the child’s ability to know that an object exists even when the object cannot be perceived. Video Clip: Object Permanence Children younger than about 8 months of age do not understand object permanence. At about 2 years of age, and until about 7 years of age, children move into thepreoperational stage. During this stage, children begin to use language and to think more abstractly about objects, but their understanding is more intuitive and without much ability to deduce or reason. The thinking is preoperational, meaning that the child lacks the ability to operate on or transform objects mentally. In one study that showed the extent of this inability, [10] Judy DeLoache (1987) showed children a room within a small dollhouse. The researchers took the children to another lab room, which was an exact replica of the dollhouse room, but full-sized. Three-year-old children, on the other hand, immediately looked for the toy behind the couch, demonstrating that they were improving their operational skills. The inability of young children to view transitions also leads them to be egocentric—unable to readily see and understand other people‘s viewpoints. Developmental psychologists define the theory of mind as the ability to take another person’s viewpoint, and the ability to do so Attributed to Charles Stangor Saylor. In one demonstration of the development of theory of mind, a researcher shows a child a video of another child (let‘s call her Anna) putting a ball in a red box. Then Anna leaves the room, and the video shows that while she is gone, a researcher moves the ball from the red box into a blue box. The child is then asked to point to the box where Anna will probably look to find her ball. Children who are younger than 4 years of age typically are unable to understand that Anna does not know that the ball has been moved, and they predict that she will look for it in the blue box. After 4 years of age, however, children have developed a theory of mind—they realize that different people can have different viewpoints, and that (although she will be wrong) Anna will nevertheless think that the ball is still in the red box. After about 7 years of age, the child moves into the concrete operational stage, which is marked by more frequent and more accurate use of transitions, operations, and abstract concepts, including those of time, space, and numbers. An important milestone during the concrete operational stage is the development of conservation—the understanding that changes in the form of an object do not necessarily mean changes in the quantity of the object. Children younger than 7 years generally think that a glass of milk that is tall holds more milk than a glass of milk that is shorter and wider, and they continue to believe this even when they see the same milk poured back and forth between the glasses. It appears that these children focus only on one dimension (in this case, the height of the glass) and ignore the other dimension (width). However, when children reach the concrete operational stage, their abilities to understand such transformations make them aware that, although the milk looks different in the different glasses, the amount must be the same. Video Clip: Conservation Children younger than about 7 years of age do not understand the principles of conservation.

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A general slowdown of motor activity commonly accompa- nies depression (called psychomotor retardation) generic desyrel 100 mg overnight delivery. Energy level is depleted discount 100mg desyrel free shipping, movements are lethargic generic desyrel 100 mg on line, and performance of daily activities is extremely difficult. Regression is common, evidenced by withdrawal into the self and retreat to the fetal position. Severely depressed persons may manifest psycho- motor activity through symptoms of agitation. These are constant, rapid, purposeless movements, out of touch with the environment. When depressed persons do speak, the content may be either ruminations regarding their own life regrets or, in psychotic clients, a reflection of their delusional thinking. The depressed client has an inclination toward egocentrism and narcissism—an intense focus on the self. This discourages others from Mood Disorders: Depression ● 129 pursuing a relationship with the individual, which increases his or her feelings of worthlessness and penchant for isolation. Common Nursing Diagnoses and Interventions for Depression (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”) [Depressed mood] Grief; hopelessness; social isolation History of prior suicide attempt [Has a suicide plan and means to carry it out] Widowed or divorced Chronic or terminal illness Psychiatric illness or substance abuse States desire to die Threats of killing self Goals/Objectives Short-term Goals 1. Client will make short-term verbal (or written) contract with nurse not to harm self. Remove all poten- tially harmful objects from client’s access (sharp objects, straps, belts, ties, glass items). Formulate a short-term verbal or written contract with the client that he or she will not harm self during specific time period. Discussion of suicidal feelings with a trusted indi- vidual provides some relief to the client. A contract gets the subject out in the open and places some of the respon- sibility for the client’s safety with the client. Secure promise from client that he or she will seek out a staff member or support person if thoughts of suicide emerge. Discussion of feelings with a trusted indi- vidual may provide assistance before the client experiences a crisis situation. Depending on level of suicide precaution, provide one-to-one contact, constant visual observation, or every-15-minute checks. Close observation is necessary to ensure that client does not harm self in any way. Being alert for suicidal and escape attempts facilitates being able to prevent or inter- rupt harmful behavior. Make rounds at frequent, irregular intervals (especially at night, toward early morning, at change of shift, or other predictably busy times for staff). To be aware of client’s location is important, especially when staff is busy, unavailable, or less observable. Through exploration and discussion, help client to identify symbols of hope in his or her life. Help client to identify true source of anger and to work on adaptive coping skills for use outside the treatment setting. Depression and suicidal behaviors may be viewed as anger turned inward on the self. If this anger can be verbalized in a nonthreatening environment, the client may be able to eventually resolve these feelings. Identify community resources that client may use as sup- port system and from whom he or she may request help Mood Disorders: Depression ● 131 if feeling suicidal. Having a concrete plan for seeking assistance during a crisis may discourage or prevent self- destructive behaviors. Take care not to belittle client’s fears or indicate disapproval of verbal expressions. This provides a feeling of safety and security, while also conveying the mes- sage, “I want to spend time with you because I think you are a worthwhile person.

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Although the focus is on the child buy desyrel 100mg line, the parents must never forget about each other best 100 mg desyrel. Parenting is time consuming and emotionally taxing buy 100 mg desyrel with amex, and the parents must work together to create a relationship in which both mother and father contribute to the household tasks and support each other. It is also important for the parents to invest time in their own intimacy, as happy parents are more likely to stay together, and divorce has a profoundly negative impact on children, particularly during and immediately after the divorce (Burt, Barnes, McGue, & Iaconon, 2008; Ge, Natsuaki, [9] & Conger, 2006). Physical and Cognitive Changes in Early and Middle Adulthood Compared with the other stages, the physical and cognitive changes that occur in the stages of early and middle adulthood are less dramatic. As individuals pass into their 30s and 40s, their Attributed to Charles Stangor Saylor. Visual acuity diminishes somewhat, and many people in their late 30s and early 40s begin to notice that their eyes are changing and they need eyeglasses. Adults in their 30s and 40s may also begin to suffer some hearing loss because of damage to the hair cells (cilia) [11] in the inner ear (Lacher-Fougëre & Demany, 2005). And it is during middle adulthood that many people first begin to suffer from ailments such as high cholesterol and high blood pressure [12] as well as low bone density (Shelton, 2006). Corresponding to changes in our physical abilities, our cognitive and sensory abilities also seem to show some, but not dramatic, decline during this stage. Menopause The stages of both early and middle adulthood bring about a gradual decline in fertility, particularly for women. Eventually, women experience menopause,the cessation of the menstrual cycle, which usually occurs at around age 50. Menopause occurs because of the gradual decrease in the production of the female sex hormones estrogen and progesterone, which slows the production and release of eggs into the uterus. Women whose menstrual cycles have stopped for 12 consecutive months are considered to have entered menopause (Minkin & Wright, [13] 2004). Researchers have found that women‘s responses to menopause are both social as well as physical, and that they vary substantially across both individuals and cultures. Within individuals, some women may react more negatively to menopause, worrying that they have lost their femininity and that their final chance to bear children is over, whereas other women may regard menopause more positively, focusing on the new freedom from menstrual discomfort and unwanted pregnancy. In Western cultures such as in the United States, women are likely to see menopause as a challenging and potentially negative event, whereas in India, where older Attributed to Charles Stangor Saylor. Infants have better chances of survival when their mothers are younger and have more energy to care for them, and the presence of older women who do not have children of their own to care for (but who can help out with raising grandchildren) can be beneficial to the family group. Also consistent with the idea of an evolutionary benefit of menopause is that the decline in fertility occurs primarily for women, who do most of the child care and who need the energy of youth to accomplish it. If older women were able to have children they might not be as able to effectively care for them. Most men never completely lose their fertility, but they do experience a gradual decrease in testosterone levels, sperm count, and speed of erection and ejaculation. Social Changes in Early and Middle Adulthood Perhaps the major marker of adulthood is the ability to create an effective and independent life. Whereas children and adolescents are generally supported by parents, adults must make their own living and must start their own families. Although the timing of the major life events that occur in early and middle adulthood vary substantially across individuals, they nevertheless tend to follow a general sequence, known as a social clock. The social clock refers tothe culturally preferred “right time‖ for major life events, such as moving out of the childhood house, getting married, and having children. Marriage is beneficial to the partners, both in terms of mental health and physical health. People who are married report greater life satisfaction than those who are not married and also suffer fewer health problems (Gallagher & Waite, 2001; Liu & Umberson, [16] 2008). In 2003 almost half of marriages in the [17] United States ended in divorce (Bureau of the Census, 2007), although about three quarters of people who divorce will remarry. Most divorces occur for couples in their 20s, because younger people are frequently not mature enough to make good marriage choices or to make marriages last. Marriages are more successful for older adults and for those with more education (Goodwin, [18] Mosher, & Chandra, 2010).

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Having recognised the primacy of the patient discount 100 mg desyrel otc, nurses can then develop their valuable technological skills order 100 mg desyrel mastercard, together with other resources generic 100 mg desyrel overnight delivery, in order to fulfil their unique role in the multidisciplinary team for the benefit of patients. The beliefs, attitudes and philosophical values of nurses will ultimately determine nursing’s economic value. This chapter is placed Nursing perspectives 7 first in order to establish fundamental nursing values, prior to considering individual pathologies and treatments; nursing values can (and should) then be applied to all aspects of holistic patient care. Henderson, famous for her earlier definition of the unique role of the nurse, wrote a classic article about nursing in a technological age (Henderson 1980). Over the years, many accounts of patients’ experiences have been written; Watt (1996) and Sawyer (1997) are recent, easily accessible and vivid articles, while Dyer (1995) offers further challenging perspectives. Examine the potential conflicts between these strategies and the more technical, physiologically necessary interventions. What do they contribute to actual patient care, and how is their effectiveness evaluated? Chapter 2 Humanism Introduction Philosophical beliefs affect our values, and so influence our approaches to care. This chapter describes and contrasts two influential philosophies to supply a context for developing individual beliefs and values. As this is not a book about philosophy, descriptions of these movements are brief and simplified, and readers are encouraged to pursue their ideas through further reading. The label ‘humanism’ has been variously used throughout human history, probably because its connotations of human welfare and dignity sound attractive. The Renaissance ‘humanistic’ movement included such influential philosophers as Erasmus and Sir Thomas More. In this text, however, ‘humanism’ is a specifically twentieth-century movement in philosophy led primarily by Abraham Maslow and Carl Rogers. The humanist movement, sometimes called the ‘third force’ (the first being psychoanalysis, the second behaviourism), was a reaction to behaviourism. Playle (1995) suggests that the art-versus-science debate within nursing is an extension of the humanistic-versus- mechanistic (i. Behaviourism The behaviourist theory was largely developed by John Broadus Watson (1878–1958) who, drawing on Pavlov’s famous animal experiments, stated that if each stimulus eliciting a specific response could be replaced by another (associated) stimulus, the desired response (behaviour) could still be achieved (‘conditioning’) (1998 [1924]). The behaviourist theory enabled social control and so became influential when society valued a single socially desirable behaviour. Thus behaviourism focuses on outward, Humanism 9 observable behaviours and for behaviourists, learning is a change in behaviour (Reilly 1980). Holloway and Penson (1987) have suggested that nurse education contains a ‘hidden curriculum’ controlling the behaviour of students and their socialisation into nursing culture. Through Gagne’s (1975, 1985) influence, many nurses have accepted and been acclimatised into a behaviouristic culture without always being made aware of its philosophical framework. Hendricks-Thomas and Patterson (1995) suggest that this behaviouristic philosophy has often been covert, masked under the guise of humanism. Thus using aspects from humanism, such as Maslow’s hierarchy of needs in Roper et al. Behaviourist theory draws largely on animal experiments; but humans do not always function like animals, especially where cognitive skills are concerned. Thus if internal values remain unaltered, desired behaviour exists only as long as external motivators remain (see Chapter 48). Options: explanation (cognitive) accepting extubation analgesia and sedation (control) restraint (e. Nevertheless, description remains deliberately behaviouristic, seeing the problem as behaviour (extubation). While extubation causes justifiable concern, behaviour is a symptom of more complex psychology.

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