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Were there special circumstances (for example buy kamagra oral jelly 100 mg with mastercard, illness discount kamagra oral jelly 100 mg with visa, death 100 mg kamagra oral jelly with mastercard, divorce buy kamagra oral jelly 100 mg on-line, military service buy kamagra oral jelly 100mg fast delivery, etc. Does anything else important about her come to mind, whether positive or negative? Were there special circumstances (for example, illness, death, divorce, military service, etc. To the outside world, we seemed like a pretty typical family with no particular problems. Does anything else important about him come to mind, whether positive or negative? When he tried to teach me to do things, he’d explode if I didn’t get the hang of it right away. I looked up to my older sister, but she didn’t want anything to do with me after she went to junior high school. I realize now that I didn’t know how to handle my emotions very well — when I didn’t know what else to do, I’d just withdraw. I worked just hard enough to get Bs, but I know I could have done much better in school. It sort of makes sense that I shut down whenever I face possible rejection, criticism, or when someone gets angry with me. After completing the Emotional Origins form, Tyler has a better understanding of why he copes with stress the way he does. He sees that there’s a reason he shuts down when facing certain types of situations. The exercise isn’t about blame and faultfinding; rather, it helps Tyler forgive himself for being the way he is. If you happen to be receiving counseling or psychotherapy, your therapist will no doubt find this information useful and informative. You may jump-start your memory by talking with rela- tives or by looking through old photo albums. Then move on to answer the questions about your parents or caregivers as well as the questions about your childhood and adolescence. Memories aren’t always completely accurate, but, in a powerful way, they impact the way you feel today. Please realize that the intent of this exercise is not to place blame on your parents or other important people in your life. These people indeed may have made significant contributions to your problems, and that’s useful to know. Part I: Analyzing Angst and Preparing a Plan 24 Worksheet 2-2 My Emotional Origins Questions About Mother (or other caregiver) 1. Were there special circumstances (for example, illness, death, divorce, military service, etc. Does anything else important about her come to mind, whether positive or negative? Were there special circumstances (for example, illness, death, divorce, military service, etc. Does anything else important about him come to mind, whether positive or negative? From daily traffic hassles to major losses, stressful events deplete your coping resources and even harm your health. Complete The Current Culprits Survey in Worksheet 2-3 to uncover the sources of your stress. You can’t make your world less stressful unless you first identify the stress-causing culprits. In the past year or so, have I lost anyone I care about through death, divorce, or prolonged separation? Are there problems at work such as new responsibilities, longer hours, or poor management?

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The formants told the researcher about themselves and sunrise enabler (see Part 1 of this chapter by Dr discount kamagra oral jelly 100mg with mastercard. Key informants were care- care modes later in this part of the chapter) assists fully and purposefully selected quality kamagra oral jelly 100mg, often by the people and guides the researcher to tease out culture care themselves (e purchase 100 mg kamagra oral jelly overnight delivery. These informants were most knowledgeable about The observation participation reflection enabler the domain of inquiry and could give details to the guides the nurse researcher to be an active observer nurse researcher kamagra oral jelly 100mg line. General informants usually are and listener before being a participant in any re- not as fully knowledgeable about the domain of in- search context purchase kamagra oral jelly 100mg line. They have general helpful to observe informants and their environ- ideas about the domain, however, and can offer mental contexts before and after the researcher be- data from their emic and etic views. This is quite different general informants can reflect on how similar from the traditional participant observation and/or different their ideas are from those of the method used in anthropology, because the process is key informants when asked by the researcher. The stranger to trusted friend enabler is ex- Enablers tremely helpful when a researcher enters and re- In order to discover the peoples’ or insiders’ (in- mains in a strange and unfamiliar environment. Being a trusted friend leads to inform- out ideas from informants in meaningful and nat- ants sharing their cultural secrets and their insights ural ways. For instance, the author used the point that enablers are different from tools, scales, stranger friend enabler to assess her relationship or measurement instruments used in quantita- with elderly residents and the staff in a study of cul- tive studies, which tend to cut off natural flow ture care in a retirement home. Some of the enablers that abler to enter the informant’s world and get close to serve as important guides to obtain data naturalis- the people who were being studied (McFarland, tically and holistically are: Leininger’s observation 1997). Initially the researcher worked with a staff participation reflection enabler (Table 20–1); the nurse while observing and interviewing the in- stranger to trusted friend enabler (Table 20–2); formants for the first few weeks she was at the in- Leininger’s acculturation enabler (Leininger, stitution. 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. Overview and reflection of the Theory of Culture Care and the Ethnonursing Research Method. 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.

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In some cases 100mg kamagra oral jelly sale, antibiotics are prescribed if the condition is severe or long lasting and an infection is suspected purchase kamagra oral jelly 100 mg overnight delivery. Pharyngitis is caused by a virus (viral pharyngitis) or by bacteria (bacteria pharyngitis) such as the beta-hemolytic streptococci generic 100 mg kamagra oral jelly amex. Sometimes patients experience acute pharyngitis along with other upper respiratory tract disease such as a cold order kamagra oral jelly 100 mg visa, rhinitis buy 100 mg kamagra oral jelly fast delivery, or acute sinusitis. Patients who have a viral pharyngitis are given medications that treat the symptoms rather than attacking the underlying virus. Acetaminophen or ibupro- fen is given to reduce the patient’s temperature and discomfort. Saline gargles, lozenges, and increased fluid are usually helpful to soothe the sore throat. Patients who have bacterial pharyngitis are given antibiotics to destroy the beta-hemolytic streptococci bacteria. However, antibiotics are only prescribed if the result of the throat culture is positive for bacteria. Patients are also given the same treatments for viral pharyngitis to address the symptoms of pharyngitis. Patients who come down with acute tonsillitis experi- ence a sore throat, chills, fever, aching muscles, and pain when they swallow. A throat culture is taken to determine the cause of the infection before an appropriate antibiotic is prescribed to the patient. The patient is also given acet- aminophen or ibuprofen to reduce the fever and the aches and pains associated with acute tonsillitis. The patient is also encouraged to use saline gargles, lozenges, and increased fluid to soothe the soreness brought on by infected ton- sils. Other times it is caused by stress or overuse of the vocal cords—a common occurrence for fans whose team wins the Super Bowl. Refraining from speaking and avoiding exposure to substances that can irritate the vocal cords, such as smoking, is the preferred treatment for acute laryngitis. The result is an impairment of oxygen reach- ing lung tissues that can in some cases irreversibly damage lung tissues. The airway obstruction occurs when the bronchioles constrict (bronchospasm) and mucous secretions increase causing the patient to experience difficulty breathing (dyspnea). Symptoms include fever, chills, cough, rapid breathing, wheezing and/or grunting respirations, labored breathing, vomiting, chest pain, abdominal pain, loss of appetite, decreased activity, and, in extreme cases, signs of hypoxia (low oxygen levels) or cyanosis such as a bluish tint around the mouth or fingernails. That is, bronchodilators, antipyretics (fever reducing), analgesics such as ibuprofen, cough medications that include expectorants, mucolytics, as well as suppressants to help the patient sleep. Bacterial and fungal pneumonia are treated with antimicrobials as well as the above treatment for viral pneumonia. The antimicrobial is chosen based on the specific microorganism causing the pneumonia. Pneumonia is contagious and is spread from person to person via droplets in the air from coughing and sneezing. It can also be attributed to the increasingly crowded living conditions in urban areas. Tuberculosis is transmitted from one person to another by droplets dispersed in the air through coughing and sneezing. The tubercle bacilli can spread from the lungs to other organs of the body via the blood and lymphatic system. If the body’s immune system is strong or intact, the phagocytes stop the multiplication of the tubercle bacilli. When the immune system is compromised, the tubercle bacilli spread in the lungs and to other organs. Dissemination of tuberculosis bacilli can be found in the liver, kidneys, spleen, and other organs. Patients who develop chronic bronchitis have excess mucous production that irritates the bronchial causing the patient to have a persistent productive cough. Patients exhibit a gurgling lung sound (rhonchi) both on inspiration and expi- ration. The excess mucus blocks the airway causing a build up of carbon diox- ide in the blood (hypercapnia) and a decrease in oxygen (hypoxemia) which leads to respiratory acidosis.

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