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By J. Riordian. Avila College.

King’s framework and theory for transcultural Applications of the framework and related theories nursing penegra 100 mg with visa. Spratlen (1976) drew heavily from King’s have been documented in the following countries framework and theory to integrate ethnic cultural beyond the United States: Canada (Coker et al 100 mg penegra with visa. Key Sugimori, 1992), Portugal (Moreira & Arajo, 2002; elements derived from King’s work were the focus Viera & Rossi, 2000), and Sweden (Rooke, 1995a, on perceptions and communication patterns that 1995b). In Japan, a culture very different from the motivate action, reaction, interaction, and transac- United States with regard to communication style, tion. Rooda (1992) derived propositions from the Kameoka (1995) used the classification system of midrange Theory of Goal Attainment as the frame- nurse-patient interactions identified within the work for a conceptual model for multicultural Theory of Goal Attainment (King, 1981) to analyze nursing. In addition to research Cultural relevance has also been demonstrated and publications regarding the application of in reviews by Frey, Rooke, Sieloff, Messmer, and King’s work to nursing practice internationally, Kameoka (1995) and Husting (1997). King have been Husting identified that cultural issues were implicit translated into other languages, including Japanese variables throughout King’s framework, particular (King, 1976, 1985; Kobayashi, 1970). Therefore, attention was given to the concept of health, which, perception and the influence of culture on percep- according to King (1990), acquires meaning from tion were identified as strengths of King’s theory. Table 16–10 lists applications of King’s work in Undoubtedly, the strongest evidence for the countries outside the United States. The theory and conceptual model also can apply in various situations relevant to nursing work and Work Settings administration. An additional source of division within the nursing profession is the work sites where nursing is prac- Nursing Specialties ticed and care is delivered. As the delivery of health care moves from the more traditional site of the A topic that frequently divides nurses is their area acute care hospital to community-based agencies of specialty. However, by using a consistent frame- and clients’ homes, it is important to highlight work across specialties, nurses would be able to commonalities across these settings, and it is im- focus more clearly on their commonalities, rather portant to identify that King’s framework and than highlighting their differences. A review of the midrange Theory of Goal Attainment continue to literature clearly demonstrates that Dr. King’s framework and related theories have application within a variety of nursing specialties (see Table Although many applications tend to be 16–11). This application is evident whether one is with nurses and clients in traditional reviewing a “traditional” specialty, such as medical- settings, successful applications have surgical nursing (Gill et al. Two specific ex- be with nurses and clients in traditional settings, amples of this include the application of King’s successful applications have been shown across work to case management (Hampton, 1994; Sowell other, including newer and nontraditional, settings. Both case management and & Rasi, 1990; Lockhart, 2000) to nursing homes managed care incorporate multiple disciplines as (Zurakowski, 2000), King’s framework and related they work to improve the overall quality and cost theories provide a foundation on which nurses can efficiency of the health care provided. Table 16–12 lists cations also address the continuum of care, a prior- applications within a variety of nursing work ity in today’s health-care environment. This use of knowledge across disciplines occurs frequently and can be very ap- Obviously, new nursing knowledge has resulted propriate if both disciplines’ perspectives are simi- from applications of King’s framework and theory. Second, the nursing rules of What is evidence-based practice and how will evidence must include heavier weight for research evidence-based nursing practice evolve? Titler been assimilated and accepted as core beliefs of the (1998), a nurse, defines evidence-based practice as discipline. In addition, King’s concept of perception (1981) Research conducted with a King theoretical base lends itself well to the definition of client out- is well positioned for application by nurse care- comes. Johnson and Maas (1997) define a nursing- givers, nurse administrators (Sieloff, 2003), and sensitive client outcome as “a measurable client or client-consumers (Killeen, 1996) as part of an family caregiver state, behavior, or perception that evolving definition of evidence-based nursing is conceptualized as a variable and is largely influ- practice. For example, King (1971) addressed client enced and sensitive to nursing interventions” preference, a possible part of an evidence-based (p. In an update nursing knowledge requires the use of client out- of the concept of satisfaction, King submits that come measurement. The use of standardized client satisfaction is a subset of her central concept of outcomes as study variables increases the ease with perceptions (Killeen, 1996). The evaluation component of the nursing process con- Both managed care and increasing use of technol- sistently refers back to the original goal state- ogy have challenged existing conceptual frame- ment(s). Standardized terms for diagnoses, inter- that King’s concepts have evolved within this ventions, and outcomes potentially improve com- changing health-care climate. Biegen and Tripp-Reimer (1997) sug- King (1981) has always promoted cooperation and gested middle-range theories be constructed from collaboration among disciplines. Alternatively, King’s terpersonal, and social systems need to include an framework and theory may be used as a theoretical expanded conceptualization of King’s concept of basis for these phenomena and may assist in knowl- goal-setting. Personal and professional goal-setting, edge development in nursing in the future. In addition, the variety of practice ap- able goals; solicit input for client care planning; re- plications evident in the literature clearly vise client care plan, as necessary; discuss progress attest to the complexity of King’s work. As re- toward goals; and provide data to facilitate evalua- searchers continue to integrate King’s theory tion of client care plan” (p. Specifically, she recom- References mends using her concepts of self, role, power, au- thority, decisions, time, space, communication, and Alligood, M. King’s evaluate the use of King’s concepts, and possibly, interacting systems and empathy.

The gluteus maximus muscle and the long head of biceps femoris muscle have been divided and displaced order penegra 50mg online. Flexor muscles of right leg (posterior Flexor muscles of right leg (posterior aspect) generic penegra 50 mg on line. Arteries 467 1 Femoral artery 2 Profunda femoris artery 3 Ascending branch of lateral circumflex femoral artery 4 Descending branch of lateral circumflex femoral artery 5 Lateral superior genicular artery 6 Popliteal artery 7 Lateral inferior genicular artery 8 Anterior tibial artery 9 Peroneal artery 10 Lateral plantar artery 11 Arcuate artery with dorsal metatarsal arteries 12 Plantar arch with plantar metatarsal arteries 13 Medial circumflex femoral artery 14 Profunda femoris artery with perforating arteries 15 Descending genicular artery 16 Medial superior genicular artery 17 Middle genicular artery 18 Medial inferior genicular artery 19 Posterior tibial artery 20 Dorsalis pedis artery 21 Medial plantar artery 22 Superficial and deep circumflex iliac arteries 23 Femoral nerve 24 Lateral circumflex femoral artery 25 Sartorius muscle (cut and reflected) 26 Rectus femoris muscle 27 Vastus medialis muscle 28 Inguinal ligament 29 Femoral vein (cut) 30 External pudendal artery and vein 31 Adductor longus muscle 32 Great saphenous vein 33 Obturator artery and nerve 34 Gracilis muscle 35 Saphenous nerve 36 Tendinous wall of adductor canal 37 Anterior cutaneous branch of femoral nerve 38 Infrapatellar branch of saphenous nerve 39 Popliteal vein 40 Tibial nerve 41 Medial head of gastrocnemius muscle 42 Biceps femoris muscle 43 Common peroneal nerve 44 Lateral head of gastrocnemius muscle 45 Plantaris muscle 46 Soleus muscle 47 Flexor hallucis longus muscle 48 Spermatic cord Arteries of the right leg (posterior aspect). Dissection of tibial nerve, posterior tibial vessels, and great saphenous vein (veins injected with blue resin). Veins 469 30 7 7 30 11 4 27 15 4 21 15 22 7 7 27 26 15 22 Superficial veins of leg (posterior Superficial veins of leg. Anastomoses between superficial and deep veins of the leg (schematic drawing, after Aigner). Pelvic organs with peritoneum and part of the levator ani muscle have been removed. Anterior portion of thoracic vertebrae removed, dural sheath opened, and spinal cord slightly reflected to the right to display the dorsal and ventral roots. Surface Anatomy of the Lower Limb: Anterior Aspect 477 1 Iliac crest 2 Anterior superior iliac spine 3 Tensor fasciae latae muscle 1 4 Quadriceps femoris muscle 2 5 Iliotibial tract 6 Tendon of biceps femoris muscle 3 7 Patella 8 Patellar ligament 9 Tibia 10 Tendon of tibialis anterior muscle 11 Lateral malleolus 12 Venous network of dorsum of foot 4 13 Iliohypogastric nerve 14 Lateral femoral cutaneous nerve 15 Femoral nerve 16 Common peroneal nerve 5 17 Superficial peroneal nerve 18 Ilio-inguinal nerve 19 Obturator nerve 20 Saphenous nerve 21 Deep peroneal nerve 6 7 8 9 10 11 Cutaneous nerves of the lower limb (anterior aspect). The Inguinal nodes with lymphatic vessels fascia lata and fasciae of the thigh muscles have been removed. The fascia lata has been removed, and the sartorius muscle has been slightly has been removed, and the sartorius muscle has been divided. Sartorius muscle, The sartorius, pectineus, adductor longus, and rectus pectineus muscle, and femoral artery have been cut to femoris muscles have been divided and reflected. The greater part of the femoral artery has been The rectus femoris muscle has been slightly reflected. Sciatic nerve Inferior gluteal artery, vein, and nerve Posterior femoral cutaneous nerve Internal pudendal artery and vein Pudendal nerve C Lesser sciatic foramen Pudendal nerve Internal pudendal artery and vein Red lines 1 Spine-tuber line: the infrapiriform foramen is situated in the middle of this line 2 Spine-trochanter line: the suprapiriform foramen is located in the upper third 3 Tuber-trochanter line: the ischiadic nerve can be found between the middle and posterior third Other structures 4 Posterior superior iliac spine 5 Iliac crest 6 Greater trochanter Gluteal region, right side (postero-lateral aspect). Location of 7 Ischial tuberosity sciatic foramina in relation to the bones (schematic drawing). Notice the position of the foramina above and below the piriformis muscle and the lesser sciatic foramen. Thigh: Posterior Region 485 Gluteal region and posterior region of right thigh (posterior Gluteal region and posterior region of right thigh (posterior aspect). Knee and Popliteal Fossa 487 Right leg, popliteal fossa, middle layer (posterior aspect). Tibial nerve and popliteal vein have been partly removed and a portion of the soleus muscle was cut away to display the anterior tibial artery. Crural Region 491 1 Semimembranosus muscle 2 Semitendinosus muscle 3 Popliteal vein 4 Popliteal artery 5 Tibial nerve 6 Small saphenous vein (cut) 7 Muscular branch of tibial nerve 8 Medial head of gastrocnemius muscle 9 Tendon of plantaris muscle 10 Posterior tibial artery 11 Medial malleolus 12 Biceps femoris muscle 13 Common peroneal nerve 14 Sural arteries 15 Plantaris muscle 16 Lateral head of gastrocnemius muscle 17 Soleus muscle 18 Calcaneal tendon 19 Lateral malleolus 20 Calcaneal tuberosity 21 Sartorius muscle 22 Popliteal artery 23 Tendinous arch of soleus muscle 24 Flexor digitorum longus muscle 25 Flexor retinaculum 26 Peroneal artery 27 Soleus muscle 28 Flexor hallucis longus muscle 29 Anterior tibial artery 30 Muscular branches of tibial nerve 31 Tibialis posterior muscle 32 Communicating branch of peroneal artery 33 Tendon of tibialis anterior muscle 34 Tibia 35 Tendon of extensor hallucis longus muscle 36 Tendons of extensor digitorum longus muscle 37 Anterior tibialis artery 38 Fibula 39 Tendons of peroneus longus and brevis muscles Right leg, posterior crural region, deepest layer (posterior Cross section of the leg, superior to the malleoli aspect). The common peroneal nerve has been elevated to show its course around the head of fibula. Cross section of the right foot at the level of the The extensor digitorum and hallucis brevis muscles have metatarsal bones (posterior aspect). Foot: Anterior Region 501 1 Proper plantar digital nerves 2 Common plantar digital nerves 3 Plantar aponeurosis 4 Superficial branch of lateral plantar nerve 5 Superficial branch of lateral plantar artery 6 Abductor digiti minimi 7 Proper plantar digital arteries 8 Common plantar digital arteries 9 Digital branch of medial plantar nerve to great toe 10 Medial calcaneal branches 11 Tendons of flexor digitorum brevis muscle 12 Flexor digitorum brevis muscle 13 Superficial branch of lateral plantar nerve 14 Lateral plantar artery 15 Plantar aponeurosis (remnant) 16 Digital synovial sheath 17 Lumbrical muscles 18 Tendon of flexor hallucis longus muscle 19 Flexor hallucis brevis muscle 20 Medial plantar artery 21 Medial plantar nerve 22 Abductor hallucis muscle 23 Calcaneal tuberosity 24 Tendons of flexor digitorum longus muscle 25 Quadratus plantae muscle 26 Lateral plantar nerve 27 Flexor digitorum brevis muscle (cut) 28 Synovial sheaths 29 Plantar arch Sole of the right foot, middle layer (from below). The flexor digitorum brevis muscle, the quadratus plantae muscle with the tendons of the flexor digitorum longus muscle, and some branches of the medial plantar nerve have been removed. The flexor hallucis brevis and adductor hallucis muscles have been cut and portions removed to show the somewhat atypical course of the medial plantar artery and deep muscles of the foot. Ring, inguinal Aqueduct Adduction of fingers 395 – tympanic, of newborn 33 – cerebral 65, 73 ff, 86, 90, 94, 99, 112, 116, Adductor hiatus 453 Anus 350 ff, 354, 361 ff, 366 121 Adhesion, interthalamic 86, 107 Aorta 16 f – of cochlea 129 Adnexa of uterus 359 ff – abdominal 16, 210, 245, 256, 278, 292, 296, – of vestibule 27, 129 Air cells 300, 302, 329 ff, 348, 359 f Arachnoid mater 84 f, 89, 92, 100, 118 – ethmoidal 28, 36, 38, 41 f, 44 f, 48, 53, 135 – – subtraktion angiography 328 – spinal 230, 232, 474 – – openings 144 – ascending 243, 245, 252 ff, 260, 266, 272, Arbor vitae of cerebellum 94, 116 – mastoid 70, 125 ff 284, 396 Arch Ala s. Arch – – common 83, 95, 97, 152, 157, 163, 165, ––––anterior 254 f, 263 – zygomatic 20, 33, 52, 54, 60 f, 79 168 ff, 252 f, 255, 266, 281, 396, 414 –––septal branch 254 – – coronal section 62 –––offetus 288 – – right 243, 253 ff, 257 f, 263, 270, 287 – – of newborn 33 – – external 63, 67, 69, 79, 97, 152, 163, 164, –––posterior interventricular branch 262 Arcus costalis (s. Artery(-ies) – – orifices of pulmonary veins 285 – extrahepatic 296 f, 301, 316 – suprascapular – nasal 144 Bladder, urinary s. Urinary bladder – – anastomosis with circumflex scapular artery – right, of heart 244 f, 252 f, 255 ff, 259, 261 ff, Blindness 139 404 270 f, 273, 283 f Body – supratrochlear 93, 134, 168 – – of fetus 288 – amygdaloid 107, 110 f, 114 ff – sural 487, 491 Auditory apparatus 122 ff, 129 – of axis 200 – tarsal, lateral 499 Auditory pathway 131 – carotid 164 f – temporal Auricle 122 ff – cavernous s. Joint – first 50 – cuboid 443, 449, 495 Atlas 53, 159, 165, 188 ff, 192 ff, 200 ff, 240, – second 50 – cuneiform 369 f Bifurcation – – intermediate 442, 449, 495 – articulation with dens of axis 200 – of atrioventricular bundle 261 – – lateral 443 Atrium – of trachea 18, 246, 274 ff, 281 – – medial 495 – left, of heart 245, 252 ff, 256 ff, 273, 281, 285 Bile duct(s) 296 f – ethmoidal 20 ff, 23, 34, 37 f, 40 ff, 44 f, 47 – – midsagittal section 322 – common 292, 296 f, 299 f, 317 – – of newborn 35 Index 507 Page numbers in bold indicate main discussions. Spinal cord – sphenoidal 25 – inferior of midbrain 67, 103, 111, 114 ff, 131 – umbilical 233, 359 – supraventricular 271 – of midbrain 67, 86, 90 f, 99, 107 – urachus 219 – transverse 123 – seminal 338 f, 344 f Cornea 132 f, 135 f – urethral 338 – superior of midbrain 114 ff Cornu s. Vertebral column – – fiber system 104 – lateral, of superficial inguinal ring 217, 362 Commissure – – median section 90 f, 233 – long, of incus 126, 128 – anterior 86, 90 f, 94, 99, 107, 110, 116, 137 – – in neonate 233 – medial, of superficial inguinal ring 362 – of fornix 104 – cavernosum – penis 337, 339, 342, 345, 352 – habenular 107 – – of clitoris 356, 360 – posterior, of stapes 128 – labial, posterior 361 – – of penis 336 ff, 339 f, 341 f, 347 – right of lumbar part of diaphragm 282 f, 335 Concha – spongiosum of penis 336 f, 339 ff – short, of incus 126, 128 – of auricle 122, 124 – sterni 194 Culmen of vermis 102 – nasal Cortex Cuneus 137 – – inferior 20, 22 f, 36 f, 42, 44, 46, 48, 53, 86, – cerebral 85, 92, 118 ff Cupula 125, 129 90, 142, 143 ff, 147 f – insular 113 Curvature – – – inferior border 48 – of kidney 326 – cervical 193 – – middle 22 f, 33, 36 f, 38, 40, 44 f, 48, 86, – limbic 99 – greater, of stomach 294 f, 311 f, 316 143 ff – striate 121 – lesser, of stomach 294 f, 311 f – – superior 36 f, 48, 86, 145 – of suprarenal gland 326 – – longitudinal muscle layer 295 Condyle – of temporal lobe 116 – lumbar 193 – lateral – visual 121, 138 – thoracic 193 – – of femur 9, 439, 441, 447 Costae fluctuantes 194 Cusp 261 – – of tibia 440, 446 f Cowper’s gland 336 f, 339, 342, 344 – anterior, of tricuspid valve 258 – medial Crest – semilunar – – of femur 9, 439, 447 – conchal 40, 42, 44 – – anterior, of pulmonary valve 259 – – of tibia 440 – frontal 28, 30 ––left – occipital 21, 25, 27, 33, 36, 46, 62, 202 – of greater tubercle of humerus –––ofaortic valve 259 Cone, medullary, of spinal cord 472 f 373 –––ofpulmonary valve 259 Confluence of sinuses 75, 85, 87 f, 241 – iliac 3, 189, 330, 433, 435, 482 f – – posterior, of aortic valve 259 Conjugate – – surface anatomy 476 f – – right – diagonal 434, 438 – infratemporal 52 –––ofaortic valve 259 – true 434, 438 – – of sphenoid 21, 25 f, 38 –––ofpulmonary valve 259 Conjunctiva – intertrochanteric 438 f – septal, of tricuspid valve 259, 261 – of eyeball 133 – lacrimal Cuspid (canine) 50 f – palpebral, of lower lid 142 – – anterior 41 – permanent 51 Connection, intertendinous 392 – – posterior 22 Conus – of lesser tubercle of humerus 373 – arteriosus 256, 258 – nasal 40, 42, 44 f – – horizontal section 286 – of nasal septum 146 510 Index Page numbers in bold indicate main discussions. D – – of newborn 35 – collateral 107 Douglas’pouch 354, 357 ff, 366 f – frontal 35 Declive of vermis 102 Duct 128 ff, 219 – iliopubic 433, 435, 438 Decussation – cystic 296 f, 299 f, 317 – intercondylar 440 f – of pyramidal tracts 109, 114 – ejaculatory 336 ff, 344 – parietal 29, 35 – of superior cerebellar peduncle 103 – endolymphatic 128 f Epicardium 273 Demifacet – epididymal 343 Epicondyle – inferior, for head of rib 191, 197 – hepatic 296 f – lateral – superior, for head of rib 191, 197 – – common 297, 299, 317 – – of femur 439, 441, 446 Dens of axis 53, 86, 89 f, 165, 191, 195, 200 f, – lymphatic, right 332 – – of humerus 373, 379, 391 f 203 – nasofrontal 145 – medial – articulation with atlas 200 – nasolacrimal 135, 142, 145 – – of femur 439 Dentition 50 – – opening 145 – – of humerus 373, 379, 387 f, 415 Desmocranium 22 – pancreatic 296 f, 300 f, 317 Epididymis 218, 330, 336 f, 339, 341, 343 Diameter – – accessory 297, 301, 317 – longitudinal section 343 – largest, of pelvis 438 – parotid 54, 58, 61, 77, 82, 151, 153, 168 Epiglottis 86, 89 f, 146, 155, 158, 161, 163 – oblique 434 – perilymphatic 129 Epiphysis 114 – transverse 434 – semicircular Epithelium Diaphragm 3, 16, 206, 244, 255, 264 ff, 269 ff, – – anterior 122, 127 f – conjunctival 133 273, 276, 279 f, 281 ff, 284 f, 292 f, 307, 320 – – lateral 122, 127 f – corneal 133 – central tendon 278, 283, 298, 329 – – posterior 122, 127 f – pigmented, retinal 133 – changes of position during respiration 282 – submandibular 152 f Equator of lens 133 – costal part 278, 282 f – thoracic 17, 170, 172 f, 184 f, 276, 279, 332 Esophagus 86, 154 f, 157, 244 f, 273 ff, 279, 291 – lumbar part 282, 315, 327 Ductus 338 – abdominal part 278, 282 – – right crus 282 f – arteriosus Botalli 263, 288 f – Head’s area 205 – midsagittal section 322 – – remnant 253, 256 – horizontal section 286 – oral 150 – deferens 218 f, 330, 336 ff, 341 ff, 344 – relation to bronchial tree 275 – pelvic – venosus 288 f – thoracic part 278, 281 – – in the female 362 f Duodenum 291 f, 296, 300, 302, 316 Eustachian valve (Valve of inferior vena cava) – – in the male 350 ff – descending part 297, 311 f 288 – sternal part 278, 283 – Head’s area 205 Exostosis 380 – superior aspect 283 – horizontal part 309, 317 Extremity s. Foramen(-ina) – ovalis 258, 283 – submandibular 81, 151 – supra-orbital 42, 44 f – popliteal 457, 468, 484, 487, 489 – sympathetic 279 f, 327, 335 – suprapiriform 482 f – – coronal section 486 – trigeminal 31, 68 f, 72 ff, 140, 146 – transversarium 157, 191 – – surface anatomy 476 Genital organs – – of atlas 200 – pterygopalatine 31, 37, 46, 72 f – female 354 ff – – of axis 200 – radial, of humerus 373, 379 – – external 361 ff – vertebral 191 – retromandibular 168 – – – cavernous tissue 362 – zygomaticofacial 28 – rhomboid 67, 69, 71, 115 f, 163 – – internal 358 ff, 366 f Forceps – scaphoid 124 – – arteries 360 – major of corpus callosum 104 – sublingual 52 – – lymph vessels 360 – minor of corpus callosum 104 – submandibular 52 – – position 354 Forearm 368 – supraspinous 371 – male 336 ff – anterior region 423 – supravesical 293 – – arteriography 341 – arteries 397, 421 – temporal 20, 52 – – external 340 ff – axial section 419, 431 – triangular 124 – – internal 343 f – blood vessels 419, 421 – trochlear 28 – – nerves 349 – bones 374 f Fovea – – vessels 340, 346 f, 351 – muscles 388 ff, 419 – centralis 134 – position 323 – – extensor 392 f – of head of femur 439, 445 Genu s. Knee joint – inguinal 217 ff – permanent 51 – metacarpophalangeal 10 f, 368, 375, 381, Hiatus Incisura 394, 425 – adductor 453 – angularis 294 f – – of thumb 425 – aortic 282, 453 – tentorii 75 – metatarsophalangeal 432, 443, 449 – esophageal 282, 298 Incisure – – of great toe 495 – maxillary 36 f, 42, 46, 48, 144 – of pancreas 297 – midcarpal 368, 375 – sacral 434, 437 – of tympanic ring 125 – monaxial 11 – semilunar 53, 145 Inclination, pelvic 438 – multiaxial 11 Hilum of spleen 300 Incus 20, 122 f, 126, 128 f – radio-ulnar 10 Hindbrain 91 Indusium griseum 104 – – distal 375, 381, 425 Hindgut 291 Infundibulum – – proximal 374 f, 379 Hinge joint 10, 11, 432 – of hypophysis 65, 74 f, 93 f, 99, 114, 116, 148 – sacro-iliac 432, 434 f, 437 Hip bone 188 f, 432 – of right ventricle 256 – of shoulder 378 Hip joint 432 – of uterine tube 354, 356 f, 361, 366 – sternoclavicular 177, 368 f, 406 – axial section 496 Insula 94, 116, 119 f – subtalar 443, 449, 451 – bones 438 Intersections, tendinous, of rectus abdominis – synovial 12 – coronal section 444 muscle 211, 213, 293 – talocalcaneonavicular 432, 443, 449, 451, 495 – ligaments 444 Intestine, small s. Cavity, articular 112 f, 120 J Juga Humerus 7, 10, 15, 368, 372 ff, 378, 430 – alveolaria 41, 45 – antero-lateral surface 373 Jejunum 292, 302 ff, 306 – cerebralia 28 – antero-medial surface 373 Joint Junction – of newborn 9 – acromioclavicular 368 ff, 372, 378 – costochondral 196 – posterior surface 373 – of ankle 432, 443, 449 ff, 495 – ileocecal 310 Hymen 354, 356, 361 – atlanto-axial 200 f Hyoid s.

In the typical twin study 100mg penegra overnight delivery, all three sources of influence are operating simultaneously purchase 50 mg penegra free shipping, and it is possible to determine the relative importance of each type. An adoption study compares biologically related people, including twins, who have been reared either separately or apart. Evidence for genetic influence on a trait is found when children who have been adopted show traits that are more similar to those of their biological parents than to those of their adoptive parents. Evidence for environmental influence is found when the adoptee is more like his or her adoptive parents than the biological parents. The results of family, twin, and adoption studies are combined to get a better idea of the influence of genetics and environment on traits of interest. Genetic and environmental effects on same-sex sexual behavior: A population study of twins in Sweden. Nature, nurture, and cognitive development from 1 to 16 years: A parent-offspring adoption study. This column represents the pure effects of genetics, in the sense that environmental differences have been controlled to be a small as possible. You can also see from the table that, overall, there is more influence of nature than of parents. Identical twins, even when they are raised in separate households by different parents (column 4), turn out to be quite similar in personality, and are more similar than fraternal twins who are raised in separate households (column 5). These results show that genetics has a strong influence on personality, and helps explain why Elyse and Paula were so similar when they finally met. For instance, for sexual orientation the estimates of heritability vary from 18% to 39% of the total across studies, suggesting that 61% to 82% of the total influence is due to environment. You might at first think that parents would have a strong influence on the personalities of their children, but this would be incorrect. Shared environment does influence the personality and behavior of young children, but this influence decreases rapidly as the child grows older. By the time we reach adulthood, the impact of shared environment on our [6] personalities is weak at best (Roberts & DelVecchio, 2000). What this means is that, although parents must provide a nourishing and stimulating environment for children, no matter how hard they try they are not likely to be able to turn their children into geniuses or into professional athletes, nor will they be able to turn them into criminals. If parents are not providing the environmental influences on the child, then what is? You can see that these factors—the largely unknown things that happen to us that make us different from other people—often have the largest influence on personality. Studying Personality Using Molecular Genetics In addition to the use of behavioral genetics, our understanding of the role of biology in personality recently has been dramatically increased through the use of molecular genetics, which is the study of which genes are associated with which personality traits (Goldsmith et al. Molecular genetics researchers have also developed new techniques that allow them to find the locations of genes within chromosomes and to identify the effects those genes have when activated or deactivated. In this approach the researchers use specialized techniques to remove or modify the influence of a [9] gene in a line of “knockout‖ mice (Crusio, Goldowitz, Holmes, & Wolfer, 2009). When these animals are born, they are studied to see whether their behavior differs from a control group of normal animals. Research has found that removing or changing genes in mice can affect their anxiety, aggression, learning, and socialization patterns. Research using molecular genetics has found genes associated with a variety of personality traits including novelty-seeking (Ekelund, Lichtermann, Järvelin, & Peltonen, [10] [11] 1999), attention-deficit/hyperactivity disorder (Waldman & Gizer, 2006), and smoking [12] behavior (Thorgeirsson et al. Over the past two decades scientists have made substantial progress in understanding the important role of genetics in behavior. Behavioral genetics studies have found that, for most Attributed to Charles Stangor Saylor. And molecular genetics studies have begun to pinpoint the particular genes that are causing these differences. The results of these studies might lead you to believe that your destiny is determined by your genes, but this would be a mistaken assumption. Over time we will learn even more about the role of genetics, and our conclusions about its influence will likely change. Current research in the area of behavioral genetics is often criticized for making assumptions about how researchers categorize identical and fraternal twins, about whether twins are in fact treated in the same way by their parents, about whether twins are representative of children more generally, and about many other issues. Although these critiques may not change the overall conclusions, it must be kept in mind that these findings are relatively new and will certainly be [13] updated with time (Plomin, 2000). Furthermore, it is important to reiterate that although genetics is important, and although we are learning more every day about its role in many personality variables, genetics does not determine everything. In fact, the major influence on personality is nonshared environmental influences, which include all the things that occur to us that make us unique individuals. These differences include variability in brain structure, nutrition, education, upbringing, and even interactions among the genes themselves. The genetic differences that exist at birth may be either amplified or diminished over time through environmental factors. The brains and bodies of identical twins are not exactly the same, and they become even more different as they grow up. As a result, even genetically identical twins have distinct personalities, resulting in large part from environmental effects.

Her goals cease being tied up with She saw this being accomplished by the “where can I throw my nursing stuff around discount 50 mg penegra with mastercard,”or “how special and unique way nurses work with can I explain my nursing stuff to get the patient to do patients in a close interpersonal process what we want him to do purchase penegra 50mg visa,” or “how can I understand with the goal of fostering learning, growth, my patient so that I can handle him better. In She saw this being accomplished by the special and this way, the nurse recognizes that the power to heal unique way nurses work with patients in a close in- lies in the patient and not in the nurse unless she is terpersonal process with the goal of fostering learn- healing herself. At the Loeb Center, ability to help the patient tap this source of power in nursing was the chief therapy, with medicine and his continuous growth and development. A new comes comfortable working cooperatively and con- model of organization of nursing services was im- sistently with members of other professions, as she plemented and studied at the center. Hall stated: meshes her contributions with theirs in a concerted program of care and rehabilitation. She will facilitates the interpersonal process and invited the be involved not only in direct bedside care but she will patient to learn to reach the core of his difficulties also be the instrument to bring the rehabilitation while seeing him through the cure that is possible. Specialists in re- Through the professional nursing process, the pa- lated therapies will be available on staff as resource tient has the opportunity of making the illness a persons and as consultants. The 80-bed unit The Loeb Center for Nursing was staffed with 44 professional nurses employed and Rehabilitation around the clock. Professional nurses gave direct patient care and teaching and were responsible for Lydia Hall was able to actualize her vision of nurs- eight patients and their families. Senior staff nurses ing through the creation of the Loeb Center for were available on each ward as resources and men- Nursing and Rehabilitation at Montefiore Medical tors for staff nurses. The center’s major orientation was rehabil- nurses there was one nonprofessional worker called itation and subsequent discharge to home or to a a “messenger-attendant. Doctors referred patients to the center, and Instead, they performed such tasks as getting linen a professional nurse made admission decisions. Morning and evening shifts were the teachings of Harry Stack Sullivan, Carl Rogers, staffed at the same ratio. Nurses were taught to less; however, Hall (1965) noted that there were use a nondirective counseling approach that em- “enough nurses at night to make rounds every hour phasized the use of a reflective process. Within this and to nurse those patients who are awake around process, it was important for nurses to learn to the concerns that may be keeping them awake” know and care for self so that they could use the self (p. In most institutions of that time, the number therapeutically in relationship with the patient of nurses was decreased during the evening and (Hall, 1965, 1969). Hall reflected: night shifts because it was felt that larger numbers If the nurse is a teacher, she will concern herself with of nurses were needed during the day to get the the facilitation of the patient’s verbal expressions and work done. Hall took exception to the idea that will reflect these so that the patient can hear what he nursing service was organized around work to be says. Through this process, he will come to grips with done rather than the needs of the patients. Lydia Hall directed the Loeb Center from 1963 Rather than strict adherence to institutional rou- until her death in 1969. Genrose Alfano succeeded tines and schedules, patients at the Loeb Center her in the position of director until 1984. At this were encouraged to maintain their own usual pat- time, the Loeb Center became licensed to operate as terns of daily activities, thus promoting independ- a nursing home, providing both subacute and long- ence and an easier transition to home. Additionally, Center, its daily operations, and the nursing work there were no doctor’s progress notes or nursing that was done from 1963 to 1984 (Alfano, 1964, notes. Instead, all charting was done on a form en- 1969, 1982; Bowar, 1971; Bowar-Ferres, 1975; titled “Patient’s Progress Notes. Hall believed that what was important to record was the patient’s progress, Implications for not the duties of the nurse or the progress of the Nursing Practice physician. Patients were also encouraged to keep their own notes to share with their caregivers. The stories and case studies written by nurses who Referring back to Hall’s care, core, and cure worked at Loeb provide the best testimony of the model, the care circle enlarges at Loeb. The cure cir- implications for nursing practice at the time cle becomes smaller, and the core circle becomes (Alfano, 1971; Bowar, 1971; Bowar-Ferres, 1975; very large. Griffiths and Wilson-Barnett (1998) the patient’s person through the closeness of inti- noted: “The series of case studies from staff at the mate bodily care and comfort. The interpersonal Loeb illustrate their understanding of this practice process established by the professional nurse dur- and describe a shift in the culture of care both be- ing the provision of care was the basis for rehabili- tween nurses and patient and within the nursing tation and learning on the part of the patient. Before hiring, the phi- tors included economic incentives that favored losophy of nursing and the concept of professional keeping the patient in an acute care bed, and the practice were discussed with the applicant. Alfano difficulties encountered in maintaining a popula- stated: “If she agrees to try the nondirective ap- tion of short-term rehabilitation patients in the ex- proach and the reflective method of communica- tended care unit. Pearson (1984) suggested that the tion, and if she’s willing to exercise all her nursing philosophy of the center may have been “threaten- skills and to reach for a high level of clinical prac- ing to established hierarchies and power relation- tice, then we’re ready to join forces” (1964, p. Administration its time” and that dissatisfaction with nursing worked with nurses in the same manner in which homes, the nation’s excess hospital bed capacities, they expected nurses to work with patients, empha- and an increasing emphasis on rehabilitation might sizing growth of self. Bowar (1971) described the contribute to replication of the Loeb model in the role of senior resource nurse as enabling growth future. Two Staff conferences were held at least twice weekly British nurses, Peter Griffiths and Alan Pearson, as forums to discuss concerns, problems, or ques- both traveled to the Loeb Center in preparation for tions. In a comprehensive review of the published by nurses who worked at Loeb describe literature, Griffiths and Wilson-Barnett (1998) nursing situations that demonstrate the effect of identify several nursing-led in-patient units, in- professional nursing on patient outcomes.

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