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    In 1993 the Department of Health instructed that incidence of pressure sores in hospitals must be reduced by 5 per cent each year discount 25mg strattera with visa. Assessment Although there is no nationally recognised classification of pressure sores (Waterlow 1996) generic 25mg strattera fast delivery, a 1992 consensus conference produced the ‘Stirling’ scale (Reid & Morison 1994a) (see Table 12 order strattera 18mg with visa. Whichever classification system is used, all staff on the unit should be familiar with it (a wall poster is often helpful). However, classification only describes current problems; risk assessment and prevention requires an additional risk assessment tool. Tools relying on colour codes can also be difficult to use if black and white photocopies are made (copyright status should be checked before making photocopies). A handful of assessment tools have been designed specifically for use in intensive care. Birtwistle’s study (1994) found it easy to use and appropriate for critically ill patients; while visually clear and simple, the absence of a score necessitates incorporating the whole tool with Intensive care nursing 106 each record in nursing documentation, and the tool does not appear to have been widely adopted. Stage Partial-thickness skin loss or damage involving epidermis 2 and/or dermis 2. Stage Full-thickness skin loss involving damage or necrosis of 3 subcutaneous tissue but not extending to underlying bone, tendon or joint capsule 3. Until debrided it is not possible to observe whether damage extends into muscle or involves damage to bone or supporting structures. Stage Full thickness skin loss with extensive destruction and 4 tissue necrosis extending to underlying bone, tendon or joint capsule 4. Like Waterlow’s scale, Cubbin and Jackson’s scale is an aid, not a substitute, for more detailed assessment. Lowery (1995) reports successfully adapting Cubbin and Jackson’s scale (the ‘Sunderland’ scale); Sollars’ (1998) single- patient study supports this adaptation. A revised version of Cubbin and Jackson’s scale was published in 1999 (Jackson 1999). This was also published following a pilot study, although the sample size was 51 patients. While based on substantial research, its presentation appears (rather than is) unnecessarily complicated; the proposed ‘next stage’ for the scoring system does not appear to have been published yet, and the system has not been widely adopted. Units dissatisfied with their current system should pilot other tools and consider adapting them through action research. For all patients, pressure on skin can be decreased either by changing position or increasing the surface area over which pressure is spread. Two-hourly pressure area care owes more to ritual than logic; prevention strategies need to be individually planned following individual assessment of risk factors. Intensive care nursing 108 Many aids have been marketed; bedding includes: ■ mattress overlays ■ alternating pressure mattresses ■ tilting beds ■ fluidised beds Booth (1993) lists many available mattresses, although others have been marketed since his article. In addition, the lack of airflow from prolonged immobility allows the accumulation of perspiration. Alternating pressure mattresses assist healing provided the capillary occlusion pressure remains below the minimum mattress inflation pressure. Some alternating pressure mattresses have static head areas to prevent seasickness; this exposes cranial skin to constant high pressures, and so checking for back-of-head sores should not be neglected. Various tilting and turning beds have been developed for spinal injury units (Waterlow 1995). Kinetic therapy can assist ventilation (see Chapter 27), and also prevent pressure sores; it enables rotation through 124°, but hard mattresses and pressure from straps can often cause, rather than heal, sores (Dobson et al.

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    The middle portion (emotion) corre- ing treatment includes the use of corrective sponds to the circulation quality strattera 40 mg, and the lower portion orthopedic braces to be worn in the mouth purchase 40mg strattera fast delivery. Nose order strattera 10 mg without prescription, pulse, and hand maps are also used by practition- blood cleansing A one- to two-month diet plan ers to identify disorders. Among the various plans is one that advocates using fresh, organic produce whenever possible; body unit A system of measurement that corre- drinking pau d’arco and other teas, green drinks, sponds to the body’s acupuncture points. One unit and specially prepared juices made from aloe is equal to the width of the second joint of the vera, carrot, papaya, and other ingredients; doing thumb, and three body units is equal to the breadth weekly colonic irrigation; avoiding meat, dairy of the second, third, fourth, and fifth fingers held and fried foods, saturated fats, salt, sugars, sweet- together. Each major body segment has a certain eners, sodas, artificial drinks, and canned, frozen, number of body units. For example, five body units prepackaged, and refined foods; getting early may be measured from the navel to the pubic bone, morning sunlight every day; and taking brisk and 12 body units make up the area from the daily walks. These include also effective as energy-boosting, anti-infective the following: the Alexander Technique; blood cleansers. Feldenkrais Method; Trager Approach; Rolfing; myofascial release; Aston-Patterning; Hellerwork; body map A technique for the diagnosis of ill- Barral visceral manipulation; Bowen Therapy; acu- ness or dysfunction. A Chinese tongue map, for pressure; acupuncture; massage; (Oriental body- example, shows each region of the tongue in cor- work: shiatsu, jin shin jyutsu); reflexology; Bonnie relation with other organs and structures of the Prudden Myotherapy; bioenergetics; Therapeutic body. The area at the back of the tongue relates to Touch; Healing Touch; Reiki; polarity therapy; the uro-genital organs; the midsection relates to Reichian therapy; hakomi; the Rosen Method; and the liver, gallbladder, and other digestive organs; the Rubenfeld Synergy Method. Chinese doc- wraps, hydrotherapy, enemas, compresses, over- tors also observe the color and condition of the heating therapy, and any other form of a “laying on tongue, very often keys to diagnosing a problem. A of hands” that is meant to facilitate a transfer of dark coating on the tongue, for instance, indicates energy from one person to another for the purpose a toxicity in the body, and a dry, shiny tongue of healing. Schuessler’s system of homeopathic practice century American herbalist Samuel Thomson and the golden age of homeopathy in America. When 22-year-old Thomson’s young Medica with Repertory (Philadelphia: Boericke and daughter contracted scarlet fever in 1791, and the Runyon, 1927). In 1805, a yellow Therapeutic Astrology: Using the Birth Chart in Psy- fever (or some other deadly fever) epidemic broke chotherapy and Spiritual Counseling (Berkeley, Calif. By 1839, there were 100,000 Thom- sonian practitioners registered in America, and a Bohm, David Physicist and author of Wholeness decade later the Eclectic Medical Institute emerged and the Implicate Order (London: Ark Paperbacks, when physicians and herbalists decided to join 1983). Several schools operated in major cities throughout the country from the late 19th century Bond, Mary Author of Balancing Your Body: A Self- and into the 20th, but patent medicines rose as Help Approach to Rolfing Movement (Rochester, Vt. Bonnie Prudden Myotherapy A technique for the relief of pain based on the use of manual pres- Bott, Victor Physician and author of Anthropo- sure on areas of the body known as “trigger sophical Medicine (Rochester, Vt. Prudden’s work contributed to the establishment of the President’s Bowen Method A hands-on modality designed to Council on Physical Fitness and Sports during the balance and positively affect the autonomic ner- 1950s. Trigger points, or places on the body where vous system, developed in the 1950s by the Aus- painful muscle spasm occurs, may be the result of tralian lay healer Thomas Bowen. With the fully trauma or injury, repetitive motion, prenatal clothed patient lying prone on a padded table, injury, or child or sexual abuse and may be exacer- Bowen advocated a series of moves such as pulling bated by the presence of disease, substance abuse, the skin away from a muscle or tendon, then and the aging process. Although medication can applying gentle pressure, and eventually allowing break the spasm-pain-spasm cycle, Prudden’s the specific structure to spring back into its original method aims to eliminate the trigger points com- position. Bowen developed certain patterns for pletely by applying deep pressure on each point for three sets of moves to treat lower back, upper back, five to seven seconds. Other moves are also added to performing stretches and trigger-point sessions to accommodate the patient’s particular health prob- prevent recurrence of muscle spasm, strains, lem. Treatment sessions vary from 20 to 45 min- sprains, dislocations, tension headaches, migraines, utes. A variation of ney of Personal Healing (both published by Bantam Bowen’s therapy, known as the Neurostructural Books, New York, 1987 and 1993). Broths of onion, miso, garlic, scallion, apple, carrot, potato, and Bower, Peter A medical doctor practicing in other ingredients, are geared toward balancing Charlottesville, Virginia, where he and his associ- body pH and are alkalizing agents.

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    Values also frequently come into play in determining what research is appropriate or Attributed to Charles Stangor Saylor purchase strattera 40mg on line. There were more than 30 buy 25 mg strattera,000 deaths caused by handguns in the Handguns should be outlawed buy 18mg strattera with visa. More than 35% of college students indicate that blue is their Blue is my favorite color. Although scientists use research to help establish facts, the distinction between values and facts is not always clear-cut. Sometimes statements that scientists consider to be factual later, on the Attributed to Charles Stangor Saylor. Although scientific procedures do not necessarily guarantee that the answers to questions will be objective and unbiased, science is still the best method for drawing objective conclusions about the world around us. When old facts are discarded, they are replaced with new facts based on newer and more correct data. Although science is not perfect, the requirements of empiricism and objectivity result in a much greater chance of producing an accurate understanding of human behavior than is available through other approaches. Levels of Explanation in Psychology The study of psychology spans many different topics at many different levels of explanation, which are the perspectives that are used to understand behavior. Lower levels of explanation are more closely tied to biological influences, such as genes, neurons, neurotransmitters, and hormones, whereas the middle levels of explanation refer to the abilities and characteristics of individual people, and the highest levels of explanation relate to social groups, organizations, and [7] cultures (Cacioppo, Berntson, Sheridan, & McClintock, 2000). The same topic can be studied within psychology at different levels of explanation, as shown in Figure 1. For instance, the psychological disorder known as depression affects millions of people worldwide and is known to be caused by biological, social, and cultural factors. Studying and helping alleviate depression can be accomplished at low levels of explanation by investigating how chemicals in the brain influence the experience of depression. This approach has allowed psychologists to develop and prescribe drugs, such as Prozac, which may decrease depression in many individuals (Williams, Simpson, Simpson, & [8] Nahas, 2009). At the middle levels of explanation, psychological therapy is directed at helping individuals cope with negative life experiences that may cause depression. And at the highest level, psychologists study differences in the prevalence of depression between men and women and across cultures. The occurrence of psychological disorders, including depression, is substantially higher for women than for men, and it is also higher in Western cultures, such as in the United States, Canada, and Europe, than in Eastern cultures, such as in India, China, and Attributed to Charles Stangor Saylor. These sex and cultural differences provide insight into the factors that cause depression. The study of depression in psychology helps remind us that no one level of explanation can explain everything. All levels of explanation, from biological to personal to cultural, are essential for a better understanding of human behavior. The questions psychologists pose are as difficult as those posed by doctors, biologists, chemists, physicists, and [10] other scientists, if not more so (Wilson, 1998). Making predictions is difficult in part because people vary and respond differently in different situations. Individual differences are the variations among people on physical or psychological dimensions. For instance, although many people experience at least some symptoms of depression at some times in their lives, the experience varies dramatically among people. Some people experience major negative events, such as severe physical injuries or the loss of significant others, without experiencing much depression, whereas other people experience severe depression for no apparent reason. Other important individual differences that we will discuss in the chapters to come include differences in extraversion, intelligence, self-esteem, anxiety, aggression, and conformity.

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