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The staff nurse was friendly and acted as 1991b); and specific enablers developed by the re- a guide but also watched the researcher and searcher to tap into ideas of informants related to planned her day in a general way order indinavir 400mg mastercard. Overview and reflection of the Theory of Culture Care and the Ethnonursing Research Method generic 400mg indinavir visa. Examples of special enablers can be found to a trusted friend; the informant revealed mean- in the studies previously mentioned and in other ingful and sensitive information to her, and the in- ethnonursing research studies listed in the refer- formant felt safe and trusted the researcher. This ences at the end of this chapter and in the Journal of enabler is invaluable to gauge one’s relationship Transcultural Nursing (1989 to 1999). This enabler is useful with all informants, but espe- Qualitative Criteria to cially with immigrant groups undergoing rapid Evaluate Ethnonursing Studies cultural changes. The Sunrise Enabler was also de- veloped to help researchers discover multiple and Leininger (1991b, 1995) has developed specific cri- diverse holistic lifeways related to culture care ex- teria to evaluate qualitative research, including periences and practices. Because qualitative studies holistic yet specific factors influencing care in cul- have very different meanings and purposes, goals, tures under study within ethnohistorical, language, and outcomes from quantitative studies, the nurse social structure, and environmental contexts researcher is required to use qualitative criteria to (Leininger, 1991b, 1995, 1997). Credibility: Refers to direct evidence from the must be clearly stated to provide guidance to assist people and the environmental context as truths nurses in providing culturally congruent and rele- to the people. Themes are the dominant finding from evidence from the people who can firmly and the analysis, and thematic statements require much knowingly confirm the data or findings. Meaning-in-context: Refers to meaningful or un- the emic and etic raw data and holistic findings. Recurrent patterning: Refers to documented evi- The general research process of conducting an dence of repeated patterns, themes, and acts ethnonursing study is presented as a guide. The over time, reflecting consistency in lifeways or process may be modified to fit with the research patterned behaviors. Saturation: Refers to in-depth evidence of taking flexible so the researcher can move with the people in all that can be known or understood about and be open to make allowances or change plans in phenomena or a domain of inquiry under study accord with naturalistic developments. Transferability: Refers to whether the findings and processing research data, modifications in the from the study will have similar (not identical) research plan often become necessary. The phases meanings and relevance in a similar situation or of the ethnonursing research method developed by context (Leininger, 1997, p. Identify the general intent or purpose(s) of your fully and explicitly in a systematic and continuous study with a focus on the domain(s) of inquiry process while obtaining data or observing inform- phenomenon under study, area of inquiry, or re- ants over periods of time. Identify the potential significance of the study to Four Phases of Ethnonursing advance nursing knowledge and practice. Review available literature on the domain or Leininger (2002) has developed the phases of phenomena being studied. The four phases provide for systematic on- ning to the end with the following general going data analysis, which occurs from the begin- phases or sequence of factors in mind: ning of data collection until completion of the final a. Consider the research site, community, and analysis and written report of the research findings. Explore and gradually gain entry (with essen- gram or similar ones can be used to assist the re- tial permissions and/or informed consent) to searcher with large-volume data analysis. The first the community, hospital, or country where two phases of data analysis are focused on obtain- the study is being done. The third phase of data related to gatekeepers’ expectations, language, analysis requires that the researcher identify recur- political leaders, location, and other factors. Select and appropriately use the ethnonurs- ing and synthesizing major themes derived from ing enablers with the research process; for ex- the previous sequential three phases. A research ample, Leininger’s stranger to trusted friend mentor skilled in the ethnonursing method can guide, observation participation reflection help the researcher reflect on the major phases and guide, and others. Maintain trusting and favorable relationships made it imperative that nurses understand different with the people conferring with ethnonursing cultures to work and care for people who have di- research experts to prevent unfavorable devel- verse and similar values, beliefs, and ideas about opments. This is a continuous process from the goal of the Theory of Culture Care Diversity and beginning to the end and requires the use of Universality is to improve or maintain health and qualitative research criteria to confirm find- well-being by providing culturally congruent care ings and credibility factors. Maintain continuous data processing on the of the client, family, or cultural group. The sunrise computer and with field journals, depicting enabler serves as a cognitive map depicting the active analysis and reflections and discussions seven culture and social structure dimensions that with research mentor(s). Computer-assisted influence care, which in turn influence the health data analysis with large volumes of qualitative and/or illness of clients. Frequently present and reconfirm findings or folk care and professional care, and provides a with the people studied to check credibility focus on both types of care for the provision of cul- and confirmability of findings. Do final analysis and writing of research find- clashes, cultural illnesses, and other unfavorable ings soon after completing the study. Prepare published findings in appropriate general ideas are kept in mind as one uses findings journals. To provide a different focus from traditional nurs- Again, flexibility exists with the ethnonurs- ing, Leininger developed the unique three modes of ing data processing, but the above steps help to care to incorporate theory findings (refer to sunrise conceptualize the process and thus promote the re- enabler, Figure 20–1). The three modes are: culture searcher’s ability to perform a systematic investiga- care preservation or maintenance; culture care ac- tion that has credibility and meets other qualitative commodation or negotiation; and culture care evaluation criteria. The theorist has pre- dicted that the researcher can use ethnoresearch Culture Care Theory findings to guide nursing judgments, decisions, and actions related to providing culturally congruent and Nursing Practice care (Leininger, 2002). Leininger prefers not to use Over the past five decades, the culture care theory, along with the ethnonursing method, have been Leininger prefers not to use the phrase used by nurse researchers to discover knowledge nursing intervention because this term that can be and has been used in nursing practice.

Journal of Alternative Therapies cheap 400 mg indinavir, 9(3) generic 400mg indinavir amex, nursing models: Education, research, practice, & administration A65–79. For complete publication citations of Watson and related publications and clinical-educational initiatives and contact informa- tion on Watson’s caring human theory, please go to www. Reconnecting with spirit: Caring and healing To obtain: e-mail University of Colorado Health Sciences our living and dying. Leininger Introducing the Theorist Introducing the Theory The Sunrise Enabler: A Conceptual Guide to Knowledge Discovery Current Status of the Theory References Introducing the Theorist Colorado. Scholastic College in Atchison, Kansas, and her Madeleine Leininger is the founder and leader of master’s degree was earned at the Catholic the field of transcultural nursing, focusing on com- University of America in Washington, D. She parative human care theory and research, and she is completed her PhD in social and cultural anthro- founder of the worldwide Transcultural Nursing pology at the University of Washington. Leininger’s initial nursing education Leininger was dean and professor of nursing at the was at St. Her persistent lead- of master degree programs in nursing at American ership has made transcultural nursing and human and overseas institutions. Leininger is a fellow care central to nursing and respected as formal and distinguished living legend of the American areas of study and practice. She is professor emeritus of “Margaret Mead of the health field” and the “New the College of Nursing at Wayne State University Nightingale” by colleagues and students. Some of her well- known books include Basic Psychiatric Concepts in One of the most significant and unique contribu- Nursing (Leininger & Hofling, 1960); Caring: An tions of Dr. Leininger was the development of her Essential Human Need (1981); Care: The Essence of Culture Care Diversity and Universality Theory. Nursing and Health (1984); Care: Discovery and She introduced this theory in the early 1960s to Uses in Clinical and Community Nursing (1988); provide culturally congruent and competent care Care: Ethical and Moral Dimensions of Care (Leininger, 1991a, 1995). She believed that tran- (1990d); and Culture Care Diversity and Universal- scultural nursing care could provide meaningful ity: A Theory of Nursing (1991). Nursing and Anthropology: Two Worlds to cultural nursing concepts, principles, theories, and Blend (1970) was the first book to bring together research-based knowledge to guide, challenge, and nursing and anthropology. This was a significant Concepts, Theories, and Practices (1978) was the first and new contribution to nursing and has been an book on transcultural nursing. The Qualitative important means to open the door to advance new Research Methods in Nursing (1985) was the first scientific and humanistic dimensions of caring for qualitative research methods book in nursing. The use of Her published books and articles cover five this culture care theory has greatly expanded nurs- decades of cumulative transcultural nursing and ings’ knowledge base about people of diverse human care with many cultures throughout the cultures in the world. Leininger initiated the Journal of The Theory of Culture Care Diversity and Transcultural Nursing, which was the first transcul- Universality was developed in order to establish tural nursing journal in the world. Leininger conducted the first field study of in discovery and use of the knowledge in transcul- the Gadsup of the Eastern Highlands of New tural nursing practices. Leininger envisioned that nurses would need ied approximately 25 Western and non-Western transcultural knowledge and practices to func- cultures. Leininger led nurses to use qualitative tion with people of diverse cultures worldwide ethnonursing research methods and developed the (Leininger, 1970, 1978). In 1987, she initiated the idea of worldwide certification of nurses prepared in transcultural nursing in order to Caring for people of many different protect and respect the cultural needs and lifeways cultures was a critical and esssential of people of diverse cultures. Leininger’s Theory of Culture Care Diversity and Universality 311 that caring for people of many different cultures edge and experiences were woefully inadequate. Instead, nursing and covered a wealth of potentially valuable knowledge medicine were focused on using new medical tech- that would be helpful within a nursing perspective. They were focused To care for children of diverse cultures and link on studying biomedical diseases and symptoms. It was This part of the chapter presents an overview knowledge that went beyond the traditional physi- of the Theory of Culture Care Diversity and cal and emotional needs of clients. Leininger was Universality, along with its purpose, goals, assump- concerned whether it would be possible to incorpo- tions, theoretical tenets, predicted hunches, and re- rate such new knowledge, given the traditional lated general features of the theory. The next part of norms of nursing and its orientation toward the chapter discusses applications of the knowledge medical knowledge. For more in- At that time, she had questioned what made depth reading of the theorist’s perspectives, readers nursing a distinct and legitimate profession. She de- should consult primary literature on the theory clared in the mid-1950s that care is (or should be) (Leininger, 1970, 1981, 1989a, 1989b, 1990a, 1990b, 1991, 1995, 1997, 1998, 2002, and 2004). The idea to develop never explain nursing and be accepted by medicine the Culture Care Theory came to her while she was (Leininger, 1970, 1977, 1981, 1984). Nonetheless, functioning as a clinical child nurse specialist in a Leininger firmly held to the claim and began to child guidance home in a large Midwestern city teach, study, and write about care as the essence of (Leininger, 1970, 1991, 1995). From her focused nursing as its unique and dominant attribute observations and daily nursing experiences with (Leininger, 1970, 1981, 1988, 1991). From both an- the children, she became aware that the children in thropological and nursing perspectives, she held the guidance home were from many different cul- that care and caring were basic and essential human tures. Children were different in their behaviors, needs for human growth, development, and sur- needs, responses, and care expectations. She argued that what home were children who were Anglo-Caucasian, humans need is human caring to survive from birth African American, Jewish American, Appalachian, to old age, when ill or well.

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This This effect follows months or years of antipsychotic appears to underlie the tardive dyskinesias that are caused by treatment; prolonged use of the conventional antipsychotic drugs buy discount indinavir 400mg. Emotional These include the following: flattening is common order indinavir 400 mg on-line, but it may be difficult to 1. Jaundice occurs in 2–4% of patients taking delirium; chlorpromazine, usually during the second to fourth 3. Substitution of another phenothiazine may opioids while reducing nausea and vomiting; not reactivate the jaundice. About 5% of patients develop urticarial, maculopapular Adverse effects or petechial rashes. The most common adverse effects are dose-dependent the drug and may not recur if the drug is reinstated. Abnormal melanin pigmentation may and receptor occupancy of, D2 receptors) – parkinsonism develop in the skin. Sedation Extrapyramidal Hypotension The incidence of agranulocytosis is approximately 1 in symptoms 10000 patients receiving chlorpromazine. Cardiac dysrhythmia, including torsades de pointes Chlorpromazine (see Chapter 32) and arrest. Its clinical features are rigidity, hyperpyrexia, Butyrophenones stupor or coma, and autonomic disorder. It responds to Haloperidol treatment with dantrolene (a ryanodine receptor Thioxanthines antagonist that blocks intracellular Ca2 mobilization). A 50-year-old woman whose schizophrenia is treated with oral haloperidol is admitted to the Accident and The most common serious reactions were fits, coma, severe Emergency Department with a high fever, fluctuating level hypotension, leukopenia, thrombocytopenia and cardiac of consciousness, muscular rigidity, pallor, tachycardia, arrest. Contraindications and cautions Question 2 These include the following: How should this patient be managed? Answer 1 • coma due to cerebral depressants, bone marrow Neuroleptic malignant syndrome. The pharmacokinetics of conventional antipsychotic drugs ‘Newer’ or ‘second-generation’ antipsychotics are synonymous have been little studied. In comparison to the conventional antipsychotics their large apparent volumes of distribution (V ) (e. Efficacy against negative symptoms, as well as less extrapyra- midal side effects, are characteristic. These may be the result of Drug interactions the transient (‘hit and run’) binding to D2 receptors. These include the following: Clozapine is the original ‘atypical’ antipsychotic and is described below. A variety of other atypical anti- • hypotensive drugs and anaesthetics – enhanced psychotic drugs are available. Many newer alternatives, but none with the unique properties • Brain:plasma concentration is 5:1. The control of hypomanic and manic episodes with diagnosed schizophrenic patients and in those who have chlorpromazine is often dramatic. It is available as an intramuscular injection Patients with organic disorders may experience fluctuating for acute control of agitation and disturbed behaviour. It is not associated with Case history 2 extrapyramidal effects, prolactin secretion or weight gain. A 60-year-old man with schizophrenia who has been treated for 30 years with chlorpromazine develops involun- tary (choreo-athetoid) movements of the face and tongue. Key points Question 1 Pharmacological treatment What drug-induced movement disorder has developed? Question 2 • Receptor blockade: Will an anticholinergic drug improve the symptoms? Question 3 • Although there may be a rapid behavioural benefit, a Name three other drug-induced movement disorders delay (usually of the order of weeks) in reduction of associated with antipsychotic drugs. Key points Adverse effects of antipsychotic drugs • Extrapyramidal motor disturbances, related to dopamine blockade. Haloperidol can rapidly terminate violent and psychotic • Impaired temperature homeostasis. When treating violent patients, large doses of anti- psychotics may be sometimes needed. The combination of lorazepam and haloperidol has Acute attacks are managed with antipsychotics, but lithium been successful in treating otherwise resistant delirious is a common and well-established long-term prophylactic behaviour. Drugs and in alcohol withdrawal states, in alcoholics or in those depend- Therapeutics Bulletin 2004; 42: 57–60.

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Social psychologists believe that it is better to treat people as individuals rather than rely on our stereotypes and prejudices order indinavir 400mg on-line, because stereotyping and prejudice are always unfair and often inaccurate (Fiske buy discount indinavir 400mg on line, 1989; Stangor, [15] 1995). Furthermore, many of our stereotypes and prejudices occur out of our awareness, such that we do not even know that we are using them. Implicit Association Test You might want to test your own stereotypes and prejudices by completing the Implicit Association Test, a measure of unconscious stereotyping. Because our primitive ancestors needed to accurately separate members of their own kin group from those of others, categorizing people into “us‖ (the ingroup) and “them‖ (the outgroup) was useful and even necessary (Neuberg, [16] Kenrick, & Schaller, 2010). And the positive emotions that we experience as a result of our Attributed to Charles Stangor Saylor. We may gain social identity as members of our university, our sports teams, our religious and racial groups, and many other groups. But the fact that we may use our stereotypes does not mean that we should use them. Stereotypes, prejudice, and discrimination, whether they are consciously or unconsciously applied, make it difficult for some people to effectively contribute to society and may create both [18] mental and physical health problems for them (Swim & Stangor, 1998). In some cases getting beyond our prejudices is required by law, as detailed in the U. Civil Rights Act of 1964, the Equal Opportunity Employment Act of 1972, and the Fair Housing Act of 1978. There are individual differences in prejudice, such that some people are more likely to try to control and confront their stereotypes and prejudices whereas others apply them more freely [19] (Czopp, Monteith, & Mark, 2006; Plant & Devine, 1998). For instance, some people believe in group hierarchies—that some groups are naturally better than others—whereas other people are more egalitarian and hold fewer prejudices (Sidanius & Pratto, 1999; Stangor & Leary, [20] 2006). The tendency to hold stereotypes and prejudices and to act on them can be reduced, for instance, through positive interactions and friendships with members of other groups, through practice in avoiding using [21] them, and through education (Hewstone, 1996). Research Focus: Forming Judgments of People in Seconds Research has demonstrated that people can draw very accurate conclusions about others on the basis of very [22] limited data. Ambady and Rosenthal (1993) made videotapes of six female and seven male graduate students while they were teaching an undergraduate course. The courses covered diverse areas of the college curriculum, including humanities, social sciences, and natural sciences. For each teacher, three 10-second video clips were taken: 10 seconds from the first 10 minutes of the class, 10 seconds from the middle of the class, and 10 seconds from the last 10 minutes of the class. Ambady and her colleagues then compared the ratings of the participants who had seen the teacher for only 30 seconds with the ratings of the same instructors that had been made by students who had spent a whole semester with the teacher, and who had rated her at the end of the semester on scales such as ―Rate the quality of the section overall‖ and ―Rate section leader‘s performance overall. You can see that the correlations are all positive, and that many of them are quite large. The conclusion is that people are sometimes able to draw accurate impressions about other people very quickly. Half a minute: Predicting teacher evaluations from thin slices of nonverbal behavior and physical attractiveness. If the finding that judgments made about people in 30 seconds correlate highly with judgments made about the same people after a whole semester surprises you, then perhaps you may be even more surprised to hear that [23] we do not even need that much time. Indeed, Willis and Todorov (2006) found that even a tenth of a second was enough to make judgments that correlated highly with those same judgments made by other people who were given several minutes to make the judgments. Other research has found that we can make accurate [24] judgments, for instance, about our perceptions of salespersons (Ambady, Krabbenhoft, & Hogan, 2006) and [25] about the sexual orientation of other people (Ambady, Hallahan, & Conner, 1999), in just a few seconds. Taken together, this research shows that we are well able to form initial impressions of others quickly and often quite accurately. Close Relationships One of the most important tasks faced by humans is to develop successful relationships with others. These relationships include acquaintanceships and friendships but also the more important close relationships, which are the long-term intimate and romantic relationships that we develop with another person—for instance, in a marriage (Hendrick & Hendrick, [27] 2000). Because most of us will want to enter into a close relationship at some point, and because close relationships are evolutionarily important as they form the basis for effective child Attributed to Charles Stangor Saylor. A major interest of social psychologists is the study of interpersonal attraction, or what makes people like, and even love, each other. One important factor is a perceived similarity in values [28] and beliefs between the partners (Davis & Rusbult, 2001). Similarity is important for relationships both because it is more convenient (it‘s easier if both partners like to ski or go to the movies than if only one does), but also because similarity supports our values—I can feel better about myself and my choice of activities if I see that you also enjoy doing the same things that I do. Liking is also enhanced by self-disclosure, the tendency to communicate frequently, without fear of reprisal, and in an accepting and empathetic manner. Friends are friends because we can talk to them openly about our needs and goals, and because they listen to and respond to our needs [29] (Reis & Aron, 2008).

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