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By F. Cobryn. Sierra Nevada College.

Aloe vera juice from the succulent plant gunas are part of the Samkhya philosophy of cre- is a natural oxygenator buy 25 mg unisom with visa equate 50 mg sleep aid, antiseptic cheap unisom 25 mg with mastercard sleep aids over the counter, astringent, and ation, which includes the beliefs that sound is the topical treatment for burns, ulcerations, and skin guna of ether, touch is the guna of air, sight is the disorders. Green and other grasses contain large guna of fire, taste is the guna of water, and smell is gunas 51 the guna of earth. Ether, air, fire, water, and earth male and female, slow and fast, and dull and sharp. The When one understands the universe in these practice of Ayurveda, also called the science of daily terms, he or she can recognize characteristics of living, is rooted in the ancient Indian system of both health and illness. The Ayurvedic physician Charak estab- in Ayurveda are based on the action and reaction of lished the idea that there are 20 fundamental the 20 gunas. The German physi- oped his method and remedies and published more cian (1753–1843) who developed the theory and of his findings in Dr. Hufeland’s German pharma- practice of modern homeopathy, an alternative cology review, Journal of Practical Pharmacology medical discipline based on the concept Similia sim- and Surgery, under the title “Essay on a New Prin- ilibus curantur—”Like cures like. Born Friedrich the single dry dose and the wait-and-watch Christian Samuel in Meissen, Germany, Hahne- philosophies characteristic of homeopathy, carried mann studied medicine in Leipzig. He married into the 20th century by the prominent home- Henriette Kuchler (1764–1830), the adopted opath James Tyler Kent. Some of Hahnemann’s daughter of the owners of the Mohren-Apotheke teachings have been lost, including his views on in Dessau, and they had 11 children. Five years Hippocratic temperaments, symptomatology, after Henriette died, he married again. He is thetic constitutions, and case management buried in Père Lachaise cemetery in France. Four bronze panels on the wall por- ful and spiritual awareness of his or her own emo- tray Hahnemann in his days as a medical student, tions, issues, insights, and coping mechanisms. Developed by Ron Kurtz, author of Body- opathy” in 1808, Hahnemann also published his Centered Psychotherapy: The Hakomi Method theories in the works “Essay on a New Principle” (Mendocino, Calif. The Hellerwork program consists of eleven 90-minute sessions, each of which focuses Hay, Louise American metaphysical teacher and on a combination of physical movement and author of 18 books, including You Can Heal Your Life manipulation to reduce stress and foster energy and (Carson, Calif. Hellerwork is not rec- The Mental Causes for Physical Illness and the Meta- ommended for individuals with cancer, rheumatoid physical Ways to Overcome Them (Hay House, 1994). Herbs Hellerwork Named for the aerospace engineer have always been recognized for their various Joseph Heller, this is a type of bodywork similar to effects on health. Mint, for example, is perhaps the Rolfing involving deep tissue massage and “move- most common remedy for digestive problems and ment reeducation,” geared toward relieving muscu- is often an ingredient in preparations for indiges- lar tension; stress, back, neck, and shoulder pain; tion and other gastrointestinal disturbances, and sports injuries; and respiratory ailments. Heller was echinacea is known to have potent immune-stim- born in Poland in 1940, was educated in Europe, ulating properties. Although herbal medicine lost and immigrated to Los Angeles, California, at age 16. Eventually he left engineering and turned to it is a thriving business today, with hundreds of the field of structural bodywork and bioenergetics, herbal preparations available over the counter in which led him to serve as director of Kairos, the Los health food stores, pharmacies, and supermarkets. Angeles Center for Human Development, and as the Although the federal Food and Drug Administra- first president of the Rolf Institute. He felt that chronic ten- what herbal-preparation manufacturers can claim sion in the muscles caused the body to fall out of about their products’ scope and efficacy. Herbalism holistic medicine 55 is a major component of traditional Chinese (and estly, assist nature, work for the good of the other Asian) medicine and Ayurveda, traditional patient, treat the whole person and not simply the Hindu and Indian medicine. In Hippocrates’ writings, he described the symp- herbal wraps Cloth or another substance such as toms of many illnesses and embraced the idea that seaweed saturated with herbal preparations and certain foods could cause what has now long been applied to the body for therapeutic and cosmetic established as allergic reaction. Herbal wraps may be used to counteract Hippocrates, the son of a physician, traveled and excess body fluid or fat (e. The collection consists of sources spelled Herring), one of the founders of the anatomy, physiology, medical ethics, general American homeopathic movement, that “the cura- pathology and descriptions of clinical subjects, tive process moves from within outward, from the gynecology and obstetrics, diseases of children, more important to the less important organs, in the mental illness, prognosis, treatment by diet and reverse order of the onset of the symptoms, and drugs, and surgery. Physi- Ptolemies to be the site of the entire scope of cians of the old school like to call asthma ‘eczema human knowledge. As we get stronger, we tend to push essarily his exact concept, is an ethical code and a the disorder out toward the surface. This is the pledge taken by nurses, physicians, and other opposite of suppression. We express the disor- health professionals at graduation, marking the der the way dirty water is expressed from a sponge.

The first domain in- bined caring (one nurse counseling plus three cludes descriptions of the capacities or characteris- videotapes and journals) order unisom 25 mg without prescription sleep aid restless leg syndrome, and no intervention tics of caring persons purchase unisom 25 mg with visa insomnia upenn. These are the values nurses hold that lead partners (husbands or male mates) in the first year them to practice in a caring manner. All intervention materials have scribes the conditions (nurse, patient, and organi- been developed based on the Miscarriage Model zational factors) that enhance or diminish the and the Caring Theory. Nursing as informed caring for the well- long way to go to make a case for the educa- being of others. What’s known about caring in nursing importance of nurses practicing in a caring science: A literary meta-analysis. The effects of caring, measurement, ing in terms of time, money, and personal en- and time on miscarriage impact and women’s well-being in ergy expended. Research-based practice with women under the framework of caring in order to tie who miscarry. The unborn one: The human (nurses and clients), to the cultural contexts experience of miscarriage (Doctoral dissertation, University of Colorado Health Sciences Center, 1983). Miscarriage: A new under- and communities experience when living standing of the mother’s experience. Her current research, McMaster University in Hamilton, Canada, and which uses both qualitative and quantitative re- a doctorate from the University of Utah in search methods, relates to the study of the complex Transcultural Nursing. She retired as a colonel in nurse-patient relational caring process and its im- 1999 after 30 years of service with the U. Revolutionary approaches to scientific theory de- velopment, such as the quantum theory, the science of wholeness, holographic and chaos theories, and Introducing the Theory fractals or the idea of self-similarity within the sci- ences of complexity (Bassingthwaighte, Liebovitch, This chapter will present a discussion of contempo- & West, 1994; Battista, 1982; Briggs & Peat, 1984; rary nursing culture, share theoretical views related Davidson & Ray, 1991; Harmon, 1998; Peat, 2003; to the author’s developmental theoretical vision of Ray, 1998; Wheatley, 1999; Wilbur, 1982) illuminate nursing, and discuss the Theory of Bureaucratic the nature and creativity of science itself. After revisiting the ception of the multiple interconnectedness and re- theory in the contemporary age, the author will lational reality of all things, the interdependence of elucidate bureaucratic caring theory as a holo- all human phenomena, and the discovery of order graphic theory to further the vision of nursing and in a chaotic world demonstrate the pioneering organizations as relational, integrated, and com- story of twentieth-century science and how the in- plex. Theory is the intellectual life of nursing sightful idea of relationality (a powerful nursing (Levine, 1995). Van Manen (1982) refers position that nurses do need nursing theory to to theory as “wakefulness of mind” or the pure stimulate thinking and critique as they function in viewing of truth. Truth in the Greek sense is not the the complex world of nursing science, research, ed- property of consensus among theorists but the dis- ucation, and practice. Theories, as the integration closure of the essential nature or the good of things. The Theory assumptions of nursing as serving the good, the locus of the discipline centers on caring for others, The Theory of Bureaucratic Caring illu- caring in the human health experience (Newman, minated in this chapter is a theory with 1992; Newman, Sime, & Corcoran-Perry, 1991). A a practical purpose that emerged from theory of nursing actually must direct or enlighten the worldviews of health professionals the good. Grounded or middle-range theories, how- the significance of spiritual and ethical caring in re- ever, focus on particular aspects of nursing practice lation to the structural dimensions of complex or- and are commonly generated from nursing prac- ganizational cultures, such as political, economic, tice. As such, some intellectuals view middle-range technological, and legal, bureaucratic caring theory theories as more relevant and useful to nursing invites us to view how a new model may facilitate than the application of grand theories (Cody, understanding of how nursing can be practiced in 1996). Confidence in major health-care institutions and The practice of nursing occurs in organizations their leaders fell so low as to put the legitimacy of that are generally bureaucratic or systematic in na- executives at risk. Although there has been much discussion ment to employees, investment in the worker, fair- about the end of bureaucracy to better cope with ness in pay, and the need to provide good benefits twenty-first-century innovation and worklife were in jeopardy. Health-care systems fell victim to (Pinchot & Pinchot, 1994), bureaucracy remains a the corporatization of the human enterprise. Informal organization or the 2001), currently is being evaluated in terms of is- integration of codes of conduct encompassing sues of patient safety (Page, 2004). Nursing educa- commitment, identity, character, coherence, and a tion is highlighted as a bridge to quality (Long, sense of community was considered essential to the 2003). Since the Institute of Medicine report (Page, successful functioning or the administering of 2004), a resurgence of interest is taking place in the power and authority in the formal organization. What distin- work (Cuilla, 2000; Ray, Turkel, & Marino, 2002) is guishes organizations as culture from other para- replacing the language of downsizing, restructur- digms, such as organizations as machines, brains, ing, mergers, and acquisitions.

Beta-blockers can cause tiredness and slowness but not to the extent seen in this woman purchase 25 mg unisom with mastercard insomnia kevin gates. This woman has Parkinson’s disease presenting with the classic triad of tremor generic unisom 25 mg mastercard sleep aid headphones, rigidity and hypokinesia. There is difficulty starting to walk (freezing) and the patient uses small steps and has difficulty stopping (festination). The characteristic pathological abnormality is degeneration of dopamine-secreting neurones in the nigrostriatal pathway of the basal ganglia. Parkinsonian features (parkinsonism) may occur in a variety of diseases: • Parkinson’s disease • postencephalitic parkinsonism • neuroleptic drug-induced Parkinson’s disease • parkinsonism in association with Alzheimer’s/multi-infarct dementia. Classification of tremor • Rest tremor: the tremor is worse at rest and is typical of parkinsonism. Benign essential tremor is not present at rest, but appears on holding the arms outstretched but is not worse on movement (finger–nose testing). There is usually a family history of tremor and the tremor is helped by alcohol and beta-blockers. It is usually caused by brainstem or cerebellar disease caused by such diseases as multiple sclerosis, localized tumours or spinocerebellar degeneration. Selegiline, an inhibitor of monoamine oxidase B may delay the need to start levodopa and may slow the rate of progression of the disease, but has significant side-effects. Levodopa is usually used in combination with a selective dopa decarboxylase inhibitor which does not cross the blood–brain barrier and reduces peripheral adverse effects. The commonest side-effects are nausea, vomiting, dizziness, postural hypotension and neuropsychiatric problems. After many years of treatment the effects tend to diminish and the patient may develop rapid oscillations in control – the ‘on–off’ effect. When these develop, a sustained release for- mulation of levodopa or a dopamine agonist, e. Because of the loss of effect with time, treatment should not be started too early. She should be assessed by a physiotherapist and occupational therapist and provided with advice and aids. This has progressed so that she is now short of breath on walking up one flight of stairs and walks more slowly on the flat than other people her age. She has two children aged 8 and 10 years and they have a cat and a rabbit at home. In the respiratory system expansion of the lungs seems to be reduced but sym- metrical. It is often difficult to be sure of the exact length of history when a symptom such as breathlessness has an insidi- ous onset. There is a history of asthma but the absence of wheezing or obstruction on the respiratory function tests rule that out. An occupational history is always important in lung disease but probably not here. Occupational asthma can be associated with the printing trade but not a restrictive problem as shown here. The findings on examination fit with a restrictive problem with limited expansion and the crackles caused by re-opening of airways closing during expir- ation because of stiff lungs and low lung volumes. Further tests such as transfer factor would be expected to be reduced in the presence of pulmonary fibrosis. The chest X-ray shows small lung fields and nodular and reticular shadowing most marked in mid and lower zones. These changes are compatible with diffuse pulmonary fibrosis (fibro- sing alveolitis). In talking about fibrosis of the lungs it is important to differentiate diffuse fine pulmonary fibrosis, as in this case, and localized pulmonary fibrosis as a result of scarring after an acute inflammatory condition such as pneumonia.