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Anxiety Research has also indicated that exercise may be linked to a reduction in anxiety clomiphene 25 mg. Again order generic clomiphene canada, there are problems with determining the direction of causality in this relationship buy generic clomiphene 100mg on line, but it has been suggested that exercise may decrease anxiety by diverting the individual’s attention away from the source of anxiety purchase clomiphene amex. Response to stress Exercise has been presented as a mediating factor for the stress response (see Chapters 10 and 11). Exercise may influence stress either by changing an individual’s appraisal of a potentially stressful event by distraction or diversion (e. Self-esteem and self-confidence It has also been suggested that exercise may enhance an individual’s psychological well- being by improving self-esteem and self-confidence. In addition, exercise may result in an improved sense of achievement and self-efficacy. Many theories have been developed to explain the factors that mediate the link between exercise and psychological state. These reflect both the physiological and psychological approaches to the study of exercise. For example, it has been argued that exercise results in the release of endorphins, the brain’s natural opioids (Steinberg and Sykes 1985), and increases in the levels of brain norepinephrine, which have been hypothesized to be a cause of depression. It has also been suggested that improved psychological state is related to the social activity often associated with exercise and the resulting increased confidence and self-esteem. Any reduction in levels of depression may be related to greater social contact, improved social support and increased self- efficacy. Because of the experimental design, the results allow some conclusions to be made about the direction of causality. However, as with many health- related behaviours, adherence to health promotion recommendations may be more motivated by short-term immediate effects (e. Therefore, understanding the immediate effects of exercise on mood has obvious implications for encouraging individuals to take regular exercise. Methodology Subjects The subjects were 36 male amateur athletes who were regularly involved in a variety of sports and exercised for more than 30 minutes at least three times per week, and 36 inactive men who exercised for less than 30 minutes per week. Design All subjects took part in two exercise sessions and completed measures of mood before and after each exercise session. Procedure At session one, all subjects completed a set of profile questionnaires (back- ground physical and psychological measures) and took part in a maximal exercise session on a cycle ergonometer. At session two, subjects were randomly allocated to 20 minutes of either maximal, moderate or minimal exercise. All subjects completed ratings of mood before exercise, 2 minutes after exercise and after 30 minutes of recovery. Measures The subjects rated items relating to tension/anxiety, mental vigour, depression/dejection, exhilaration and perceived exertion before and after each exercise session. In addition, all subjects completed measures of (1) personality and (2) trait anxiety once only at the beginning of the first session. Results The results were analysed to examine the effect of the differing degrees of exercise on changes in mood in the sportsmen and the inactive men. However, all subjects reported increased exhilaration and increased mental vigour two minutes after both the maximal and moderate exercise compared with the minimal condition, and in addition, the increase in exhilaration was maintained after the 30 minutes of recovery. Conclusion The authors conclude that both maximal and moderate exercise results in beneficial changes in both mental vigour and exhilaration in both sportsmen and inactive men and suggest that ‘exercise leads to positive mood changes even among people who are unaccustomed to physical exertion’. They also suggest that greater attention to the immediate effects of exercise may improve adherence to exercise programmes. Because of the potential benefits of exercise, research has evaluated which factors are related to exercise behaviour. The determinants of exercise can be categorized as either social/political or individual. Social/political predictors of exercise An increased reliance on technology and reduced daily activity in paid and domestic work may have resulted in an increase in the number of people having relatively seden- tary lifestyles. In addition, a shift towards a belief that exercise is good for an individual’s well-being and is relevant for everyone has set the scene for social and political changes in terms of emphasizing exercise. Therefore, since the late 1960s many government initiatives have aimed to promote sport and exercise. Factors such as the availability of facilities and cultural attitudes towards exercise may be related to individual participa- tion. Consequently, the Sports Council launched an official campaign in 1972 in an attempt to create a suitable climate for increasing exercise behaviour. Initiatives such as ‘Sport for All’, ‘Fun Runs’ and targets for council facilities, such as swimming pools and sports centres, were part of this initiative. In collaboration with the Sports Council, McIntosh and Charlton (1985) reported that the provision of council services had exceeded the Sports Council’s targets by 100 per cent. This evaluation concluded that: s Central government funding for sport and specific local authority allocations have helped participation in sport. This could take the form of vouchers for free access to the local leisure centre, an exercise routine with a health and fitness advisor at the leisure centre, or recommendations from the health and fitness advisor to follow a home-based exercise programme, such as walking. An alternative and more simple approach involves the promotion of stair rather than escalator or lift use. In addition, they can target the most sedentary members of the population who are least likely to adopt more structured forms of exercise. This is in line with calls to promote changes in exercise behaviour which can be incorporated into everyday life (Dunn et al. Research also indicates that stair climbing can lead to weight loss, improved fitness and energy expenditure and reduced risk of osteoporosis in women (e. For example, some research has explored the impact of motivational posters between stairs and escalators or lifts and has shown that such a simple intervention can increase stair walking (e. The results showed that larger posters were more effective at promoting stair use, that effectiveness was not related overall to whether the message emphasized time and health (i. Therefore, these initiatives have aimed to develop a suitable climate for promoting exercise. In addition, as a result of government emphasis on exercise, specific exercise programmes have been established in an attempt to assess the best means of encouraging participation. In particular it is possible to differentiate between individual and supervised exercise programmes. Using random telephone numbers they identified 357 adults, aged 50–65, who led relatively sedentary lifestyles. These subjects were then randomly allocated to one of four groups: s Group 1: the subjects were encouraged to attend a one-hour vigorous exercise session at a local community centre at least three times a week. The results showed greater adherence in the unsupervised home-based programmes, than in the supervised programme. However, all subjects who had been instructed to do some exercise showed an increase in cardiovascular fitness compared with the control group. The authors suggested that the results from this study provide insights into the development of successful national campaigns to promote exercise behaviour that involve a minimal and cheap intervention and argued for an emphasis on unsupervised individual exercising. Other factors that appear to play a role in developing successful exercise programmes are the use of behavioural contracts, whereby the individual signs a contract with an instructor agreeing to participate in a programme for a set period of time (e. Oldridge and Jones 1983) and the use of instructor praise and feedback and flexible goal-setting by the subject (e. These factors involve supervised exercise and suggest that individualized exercise programmes may not be the only form of intervention. The social/political climate therefore has implications for predicting and promoting exercise. However, even if councils provide the facilities and government programmes are established, individuals have to make decisions about whether or not to par- ticipate. Research has, therefore, also examined the individual predictors of exercise behaviour. Individual predictors of exercise Dishman and colleagues (Dishman 1982; Dishman and Gettman 1980) carried out a series of studies to examine the best individual predictors of exercise and suggested that these factors can be defined as either non-modifiable or modifiable. Non-modifiable predictors of exercise Dishman (1982) reported that non-modifiable factors such as age, education, smoking, ease of access to facilities, body fat/weight and self-motivation were good predictors of exercise. The results of a prospective study indicated that the best predictors of exercise behaviour were low body fat, low weight and high self-motivation (Dishman and Gettman 1980).

Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care discount clomiphene 100mg overnight delivery, 7th Edition buy generic clomiphene 25mg. Think about your responsibilities when ered by the pharmacy is labeled with the correct administering medication and then describe drug and dose order cheap clomiphene on line, but with another patient’s how you would respond in the following name generic clomiphene 50 mg on line. The nurse checks the patient identifica- situations: tion band, and notes that it does not match a. How might the nurse use blended nursing leaves, you read the order and don’t under- skills to respond to this medication error. Because you are legally responsible for medications admin- istered, what would you do? Interview several nurses about their experiences with errors and what contributes to them. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Lemke, age 42, is scheduled for elective Circle the letter that corresponds to the best hernia surgery. Lemke be administered by injecting a local anesthetic predisposed because of his use of antibiotics? When preparing a patient who has diabetes mellitus for surgery, the nurse should be 2. When obtaining a consent form from a aware of which of the following potential patient scheduled to undergo surgery, the surgical risks associated with this disease? The responsibility for securing informed cal risks related to obesity should be considered consent from the patient lies with the when performing an assessment for this nurse. When preparing this patient for infection surgery, the nurse should consider which of b. Alterations in fluid and electrolyte balance the following surgical risks associated with c. Place the patient in a flat position with legs pain control, the nurse should consider elevated 45 degrees. Place the patient in the Trendelenburg or patient should ask for the medication “shock” position. The nurse is responsible for ordering and physical preparation for a patient undergoing administering pain medications. To prevent postoperative complications, which of the following measures should be 13. The patient should be instructed to avoid pulmonary and oral secretions and prevent coughing if possible to minimize damage laryngospasm? The patient should not be turned in bed used in minimally invasive surgery of the until the incision is no longer painful. Keep him cool and uncovered to prevent Which of the following conditions would elevated temperature. Thrombophlebitis Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. The underlying disease process and its nat- ural course Multiple Response Questions d. Explanation of the risks involved and how Circle the letters that correspond to the best often they occur answers for each question. Which of the following actions would be per- binding and cannot be withdrawn formed in the postoperative phase of the peri- f. Which of the following examples of surgery necessitating careful monitoring of fluid would be classified as surgical procedures and electrolyte status and input and based on purpose? Older adults have an increased gastric pH and require monitoring of nutritional b. Which of the following statements accurately through which of the following methods? Endocrine diseases increase the risk for must be provided to a patient to obtain hyperglycemia after surgery. The name and qualifications of the nurse hemorrhage and hypovolemic shock after providing perioperative care surgery. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Encourage the patient to use incentive describe the effects the patient’s medications spirometry 10 times each waking hour for may have on surgical risk? Diuretics may cause respiratory depression patient deep breathing in the order in which from anesthesia. Ask the patient to exhale gently and may cause cardiovascular collapse in long- completely. Which of the following are significant abnor- mal findings related to presurgical screening e. Ask the patient to exhale as completely as possible through the mouth with lips b. Increased hyperkalemia or hypokalemia, 3 to 5 seconds and mentally count “one, indicating possible renal failure one thousand, two, one thousand, etc. Elevated blood urea nitrogen or creatinine levels, indicating an increased risk for cardiac problems e. Increased hemoglobin level, indicating patient effective coughing in the order in infection which they would be performed: a. Place the patient in a semi-Fowler’s position, leaning forward and provide a pillow or b. Place the patient in a semi-Fowler’s position to perform deep-breathing exercises every 1 e. Ask the patient to take a quick breath with to 2 hours for the first 24 to 48 hours after mouth open. Encourage the patient to lie still in bed and slowly through the nose three times. Teach the patient the appropriate leg exer- cises to increase venous blood return from the legs. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Assesses the patient on admission to the operating room and collaborates in safely 1. Surgical procedures are usually classified and research into care of the surgical patient according to , , and. Assists with monitoring the patient during surgery, provides additional supplies, and 3. Surgery that is planned and based on the maintains environmental safety patient’s choice is classified as. A patient who is scheduled for a colonoscopy would most likely receive what type of c. Give a brief description of the following types after receiving the appropriate information of surgery. Based on degree of risk: Match the type of nurse listed in Part A with the role he/she performs listed in Part B. Maintenance: surgical asepsis while draping and handling instruments and supplies 2. Emergence: exposure, hemostasis, and wound closure Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Hygiene and skin preparation: places the patient at greater risk for postoper- ative complications. Give three examples of expected outcomes for a patient during the intraoperative phase. Explain how you would help your patient overcome the following fears experienced in b. Prepare a teaching plan for a postoperative ing tests for the preoperative patient. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition.

Research suggests influence of basic conditioning factors on the self- that this relationship is particularly salient in prac- care agency of persons enrolled in a weight-loss tice situations in which persons are experiencing program buy generic clomiphene 100mg on line. The work of selected in- of family variables and caregiver variables on the vestigators is presented here to exemplify this line of self-care abilities of the spouses of patients with a inquiry buy generic clomiphene 50mg online. Baker (1991) explored the predic- the self-care abilities of persons with coronary tive effect of basic conditioning factors on the self- artery disease has been studied with both American care agency and self-care in adolescents with cystic and Dutch adult patient populations (Isenberg buy cheap clomiphene 100mg, fibrosis trusted 50 mg clomiphene. Across these ence of basic conditioning factors on the self-care studies, changes in health state were found to be capabilities of unmarried women at risk for sexu- critical determinants of the quality of the self-care ally transmitted disease. As the health tualized personality as a basic conditioning factor state of patients improved, so did their capabili- and tested the model with a healthy population and ties for self-care. Conversely, self-care capabilities a comparative clinical population with chronic tended to decline as patients experienced recur- renal disease. The findings re- ence of basic conditioning factors on the self-care vealed a positive relationship between health state abilities of a healthy and clinical adult population and self-care agency in patients with cardiac disease. In addition to the study of variation in health Baiardi (1997) explored the influence of health state due to pathophysiology, the conditioning in- state and caregiving factors on the self-care agency fluence of health state on self-care agency has also of the caregivers of cognitively impaired elders. West ined the influence of personal and environmental (1993) investigated the influence of clinical varia- factors on the self-care behaviors among patients tions in the level of depression, conceptualized as a with congestive heart failure. In a study with Dutch psychiatric patients, Deficit Nursing Theory have been greatly enhanced Brouns (1991) also reported that variations in men- by the measurement work with self-care concepts tal health state significantly influenced patients’ that has transpired over the past 20 years. In both studies a positive rela- portant to note that the theory-testing studies cited tionship between health state and self-care agency above were made possible by the development and was revealed. Higher levels of mental health were psychometric testing of instruments to measure the correlated with higher self-care agency scores. Instruments are currently These findings verified the conditioning influence available to measure the self-care agency of adoles- of health state on the self-care agency of patients’ cent populations (Denyes, 1982), adult populations experience variations in physical and mental health. The availability The conditioning influence of other basic fac- of valid and reliable measures of self-care agency tors on the self-care abilities of clinical and non- has been vital to the advancement of the theoretical clinical populations has been the focus of inquiry component of self-care nursing science. Intervention studies therapeutic self-care demand, self-care agency, and designed to enhance self-care performance are also the self-care actions of individuals with chronic ob- under way. Health state was found to gram of research focused on the self-care of cancer offer significant explanation of variations in the patients who were receiving chemotherapy or radi- self-care actions of this population. Her early descriptive studies clarified universal, developmental, and health deviation self- the health-deviation self-care requisites of this pop- care requisites, Riley (1996) developed a tool to ulation and documented the therapeutic self-care measure the performance and frequency of the self- demand (Dodd, 1982, 1984). More recent work de- care actions of patients with chronic obstructive scribed specific self-care behaviors initiated by pa- lung disease. This tool has the potential to be useful tients receiving these therapies and led to the as an outcome measure in future intervention stud- identification of a patient profile of self-care that ies designed to enhance the self-care abilities of this can be used in practice to target specific patient population. Dodd’s intervention studies Nursing Theory as the basis for her program of re- demonstrated that with targeted information, search with children. She has developed the Child patients can learn more about their treatment and and Adolescent Self-Care Practice questionnaire, can perform more effective self-care behaviors which can be used to assess the self-care perfor- (Dodd, 1997). Children with higher Through her 20-year program of descriptive, pre- self-concept scores were found to perform more dictive, and intervention studies based on self-care self-care activities than children with low self- theory, Dodd’s research has demonstrated how to concept scores (Mosher & Moore, 1998). Investigators have used Orem’s theory to iden- The utility of the Self-Care Deficit Nursing Theory tify the self-care requisites and self-care capabilities beyond our national borders can be explained in of patients across a broad range of health devia- tions. Based on the theory, Utz and Ramos (1993) The utility of the Self-Care Deficit Nursing have conducted a sequence of studies to explore Theory beyond our national borders can and describe the self-care needs of people with be explained in part by the fact that symptomatic mitral valve prolapse. The self-care Orem’s intention was to develop a general capabilities and the self-care needs (requisites) of theory of nursing that would be useful in persons with rheumatoid arthritis have also been describing and explaining universal nursing described. Duration of illness velop a general theory of nursing that would be (health state) and educational level were found to useful in describing and explaining universal nurs- be related to self-care agency (Ailinger & Dear, ing knowledge. Aish (1993) tested the effect of an Orem- Western civilizations may be further explained by based nursing intervention on the nutritional the inclusion of culture as a primary influence on self-care of myocardial infarction patients. Professor and the activities of self-care are learned according Georges Evers at the Catholic University of Leuven to the beliefs and practices that characterize the in Belgium has developed an extensive program of cultural way of life of the group to which the indi- research based on the theory. The individual first descriptive and explanatory studies of the self-care learns about cultural standards within the family. The theory provides a means to study the types of Orem’s theory is also being applied by Jaarsma self-care needs identified by specific cultural groups and colleagues as a basis for an ongoing program of and the acceptable cultural self-care practices to research with cardiac patients in the Netherlands. With a population of patients promotion self-care within Orem’s Self-Care with advanced heart failure, Jaarsma, Halfens, Deficit Nursing Theory and went on to explore Senten, Saad, and Dracup (1998) identified the through a descriptive study the self-care actions therapeutic self-care demand of this population performed by healthy middle-aged women to pro- and then developed a supportive-educative pro- mote well-being. The women studied were able to gram designed to enhance their self-care abilities. The jority of which were related to the universal self- book Nursing: Concepts of Practice (Orem, 1985) care requisites (Hartweg, 1993). The interview has been translated into Dutch, French, German, guide used with this American population has Italian, Spanish, and Japanese. Whetstone (1987) the Self-Care Deficit Nursing Theory in nursing sit- and Whetstone and Hansson (1989) also con- uations in Australia, Belgium, Denmark, Finland, ducted cross-cultural comparative studies using Germany, the Netherlands, Norway, Portugal, self-care concepts. They compared the meanings Sweden, Switzerland, the United Kingdom, Hong of self-care among Americans, German, and Kong, Taiwan, Thailand, Turkey, Canada, Mexico, Swedish populations. In addition to the cross-cultural comparative re- Moreover, over the past 15 years, the author has search, the Self-Care Deficit Nursing Theory is been privileged to be a part of an international net- being applied in studies with specific cultural work of nurse scholars and scientists focused on the groups. In an ethnographic study based on con- development of disciplinary knowledge derived cepts within Orem’s theory, Villarruel (1995) ex- from the Self-Care Deficit Nursing Theory. Our plored the cultural meanings, expressions, self-care, collaborative work began in 1983 when the author and dependent care actions related to pain with a was invited as a consultant to the faculty of health Mexican American population and commented on sciences at the University of Maastricht in the the theory’s use with this population. Dashiff Netherlands to assist faculty and students in devel- (1992) applied Orem’s theory in her description of oping programs of nursing theory–based research. In 1986, we extended the are currently using the Self-Care Deficit Nursing seminars to include nurses from all parts of Europe. The participants studied the Self- research work cited above was funded in part by Care Deficit Nursing Theory, research methodol- a variety of agencies: the Netherlands Heart ogy, and the interrelatedness of theory and Foundation, the Swiss National Fund, Fulbright research. Each participant developed a self-care Scholarship, Finnish Academy of Science, and the theory-based research project that could be imple- Kellogg Foundation. To date, specific knowledge and, by means of transnational compar- propositions of the theory have been tested in nine isons, identify culture-specific knowledge. Through this theory testing program of current shared programs of research focus on: research, data are being accrued that will provide (1) influences of aging on the self-care abilities answers to the question,“To what extent is the Self- of Americans (Jirovec & Kasno, 1990), Canadians Care Deficit Nursing Theory relevant to the global (Ward-Griffin & Bramwell, 1990), Danes (Loren- community? In 1991, the International Orem Society for lems, such as coronary artery disease, on the self- Nursing Science and Scholarship was founded. The care abilities of Americans (Isenberg, 1987, 1993), society’s mission is to advance nursing science and Canadians (Aish & Isenberg, 1996), and Dutch scholarship through the use of Dorothea E. Orem’s clients (Isenberg, 1993; Isenberg, Evers, & Brouns, nursing conceptualizations in nursing education, 1987; Senten, Evers, Isenberg, & Philipsen, 1991). The results of her study indicated Practice that health state was the predominant predictor of women’s self-care agency and self-care perfor- In this section, we focus on the ways in which the mance (Gallegos, 1997). The level of poverty Self-Care Deficit Nursing Theory is guiding nurs- experienced by the Mexican women also had a sig- ing research because the theory’s utility to nursing nificant influence on their self-care performance. Since the pioneering efforts of Crews (1972) and Backscheider (1974) in the use of the Ailinger, R. Arthritis Care and Research, 6(3), theory in structuring and organizing nursing care 134–140. An examination of the self- have been proclaiming the usefulness of the theory care needs of clients with rheumatoid arthritis... Rehabilitation Nursing, 22(3), guide practice across a wide range of nursing situa- 135–140. An investigation of a nursing system to support tions in all types of care settings, ranging from nutritional self-care in post myocardial infarction patients. Effects of Orem-based to the care of patients in intensive care units nursing intervention on nutritional self-care of myocardial infarction patients. Self-care requirements, self-care capa- ages with all kinds of health-deviation self-care req- bilities and nursing systems in the diabetic nurse manage- uisites and developmental requisites. The influence of health status, burden, and degree of cognitive impairment on the self-care agency and of ambulatory adolescent transplant recipients.

This perspective emphasizes the physical and biological changes that happen as a result of intentional movements purchase generic clomiphene from india. This distinction illustrates a shift in emphasis from intensive exercise resulting in cardiovascular fitness to moderate exercise resulting in mild changes in health status generic clomiphene 25mg. It also illustrates a shift towards using a definition of health that includes both biological and psychological changes discount clomiphene 100mg without a prescription. For example purchase 25 mg clomiphene overnight delivery, Paffenbarger and Hale (1975) differentiated between occupational activity, which was performed as part of an individual’s daily work, and leisure activity, which was carried out in the individual’s leisure time. These definitions are not mutually exclusive and illustrate the different ways exercise has been conceptualized. The results of a survey, in which men and women were asked about their exercise behaviour, are shown in Figure 7. They suggest that the four most common forms of exercise are walking, swimming, snooker/pool/billiards and keep fit/yoga. Research has examined the possible physical and psychological benefits of exercise. They reported the results from a longitudinal study which suggested that individuals with a weekly energy expenditure of more than 2000 kcals on exercise reported as walking, stair climbing and sports, lived for two-and-a-half years longer on average than those with an energy expenditure of less than 500 kcal per week on these activities. The possible reasons for the effects of exercise on longevity are as follows: 1 Reduction in blood pressure: physical activity has an inverse relationship to both diastolic and systolic blood pressure. This effect is particularly apparent in those who have mild or moderately raised blood pressure. Exercise may help promote weight loss/maintenance (see Chapter 15 for details of exercise and obesity). Coronary heart disease The effects of exercise on coronary heart disease have been examined by assessing the consequences of both occupational activity and leisure activity. Regarding occupational activity, Paffenbarger and Hale (1975) followed up 3975 longshoremen for 22 years. The results showed that at the end of this period, 11 per cent had died from coronary heart disease and that those longshoremen who expended more than 8500 kcal per week had a significantly lower risk of coronary heart disease than those in jobs requiring less energy. This difference remained when other risk factors such as smoking and blood pressure were controlled. This relationship between occupational activity and coronary heart disease has also been shown in samples of both men and women (Salonen et al. Research has also evaluated the relationship between leisure-time activity and coronary heart disease. The results showed that those who attempted to keep fit showed less than half the incidence of coronary heart disease at follow-up compared with the other subjects. Exercise may influence coronary heart disease in the following ways: 1 Increased muscular activity may protect the cardiovascular system by stimulating the muscles that support the heart. The physical benefits of exercise have been summarized by Smith and Jacobson (1989) as: (1) improved cardiovascular function; (2) increased muscle size and strength and ligament strength for maintaining posture, preventing joint instability and decreasing back pain; (3) improved work effort; and (4) changing body composition. The psychological benefits of exercise Research also indicates that exercise may improve psychological well-being. These effects are outlined below: Depression Research using correlational designs suggests an association between the amount of exercise carried out by an individual and their level of depression. Much of the reviews into this association have stressed the correlational nature of the research and the inherent problems in determining causality (e. However, McDonald and Hodgdon (1991) carried out a meta-analysis of both the correlational and experimental research into the association between depression and exercise. They concluded that aerobic exercise was related to a decrease in depression and that this effect was greatest in those with higher levels of initial depressive symptoms. In an attempt to clarify the problem of causality, McCann and Holmes (1984) carried out an experimental study to evaluate the effect of manipulating exercise levels on depression. After five weeks, the results showed a significant reduction in depressive symptomatology in the exercise group compared with the other two subject groups supporting the relationship between exercise and depression and suggesting a causal link between these two variables; that is, increased exercise resulted in a reduction in depression. The results showed improvements in affect from baseline to follow up which supports previous research suggesting that exercise is beneficial. The authors suggest that although prolonged exercise may improve mood this dip in mood may explain why people fail to adhere to exercise programmes. Anxiety Research has also indicated that exercise may be linked to a reduction in anxiety. Again, there are problems with determining the direction of causality in this relationship, but it has been suggested that exercise may decrease anxiety by diverting the individual’s attention away from the source of anxiety. Response to stress Exercise has been presented as a mediating factor for the stress response (see Chapters 10 and 11). Exercise may influence stress either by changing an individual’s appraisal of a potentially stressful event by distraction or diversion (e. Self-esteem and self-confidence It has also been suggested that exercise may enhance an individual’s psychological well- being by improving self-esteem and self-confidence. In addition, exercise may result in an improved sense of achievement and self-efficacy. Many theories have been developed to explain the factors that mediate the link between exercise and psychological state. These reflect both the physiological and psychological approaches to the study of exercise. For example, it has been argued that exercise results in the release of endorphins, the brain’s natural opioids (Steinberg and Sykes 1985), and increases in the levels of brain norepinephrine, which have been hypothesized to be a cause of depression. It has also been suggested that improved psychological state is related to the social activity often associated with exercise and the resulting increased confidence and self-esteem. Any reduction in levels of depression may be related to greater social contact, improved social support and increased self- efficacy. Because of the experimental design, the results allow some conclusions to be made about the direction of causality. However, as with many health- related behaviours, adherence to health promotion recommendations may be more motivated by short-term immediate effects (e. Therefore, understanding the immediate effects of exercise on mood has obvious implications for encouraging individuals to take regular exercise. Methodology Subjects The subjects were 36 male amateur athletes who were regularly involved in a variety of sports and exercised for more than 30 minutes at least three times per week, and 36 inactive men who exercised for less than 30 minutes per week. Design All subjects took part in two exercise sessions and completed measures of mood before and after each exercise session. Procedure At session one, all subjects completed a set of profile questionnaires (back- ground physical and psychological measures) and took part in a maximal exercise session on a cycle ergonometer. At session two, subjects were randomly allocated to 20 minutes of either maximal, moderate or minimal exercise. All subjects completed ratings of mood before exercise, 2 minutes after exercise and after 30 minutes of recovery. Measures The subjects rated items relating to tension/anxiety, mental vigour, depression/dejection, exhilaration and perceived exertion before and after each exercise session. In addition, all subjects completed measures of (1) personality and (2) trait anxiety once only at the beginning of the first session. Results The results were analysed to examine the effect of the differing degrees of exercise on changes in mood in the sportsmen and the inactive men. However, all subjects reported increased exhilaration and increased mental vigour two minutes after both the maximal and moderate exercise compared with the minimal condition, and in addition, the increase in exhilaration was maintained after the 30 minutes of recovery. Conclusion The authors conclude that both maximal and moderate exercise results in beneficial changes in both mental vigour and exhilaration in both sportsmen and inactive men and suggest that ‘exercise leads to positive mood changes even among people who are unaccustomed to physical exertion’. They also suggest that greater attention to the immediate effects of exercise may improve adherence to exercise programmes. Because of the potential benefits of exercise, research has evaluated which factors are related to exercise behaviour. The determinants of exercise can be categorized as either social/political or individual. Social/political predictors of exercise An increased reliance on technology and reduced daily activity in paid and domestic work may have resulted in an increase in the number of people having relatively seden- tary lifestyles. In addition, a shift towards a belief that exercise is good for an individual’s well-being and is relevant for everyone has set the scene for social and political changes in terms of emphasizing exercise.

Commercial fish oils are generally derived from appropriate uncontaminated fish stocks 100 mg clomiphene mastercard, but attention to the label is important to assure this clomiphene 50mg on-line. They may also suffer from contamination generic clomiphene 25 mg on line, especially if animal byproducts are used for food purchase clomiphene 50 mg amex. Thus, despite the increased risk of contamination, “wild” fish are preferable until fish farm inspection reports are included on fish labels. Regular canned salmon, with skin and bones, has about 10 to 14 grams of total fat per four ounces (about ½ cup), which provides about 2,000 milligrams of omega-3s. Skinless, boneless, “premium” canned salmon has much less total fat (about three to four g per four ounces), and thus only about 650 milligrams of omega-3s. Greater dosages have been associated with nosebleeds or blood in the urine and call for closer monitoring to avoid serious complications such as stroke or high blood sugar. Gastrointestinal upset is common with the use of fish oil supplements, as is diarrhea, with potentially severe diarrhea at very high doses. The Natural Standard also documents reports of fishy aftertaste, increased burping, acid reflux/heartburn/indigestion, abdominal bloating, and abdominal pain. The Natural Standard recommends that gastrointestinal side effects be minimized by taking fish oil with meals and starting with low dosages. The World Health Organization and governmental health agencies in “several countries” recommend consuming 0. Claims about “molecular distillation” and other special purification processes are unverified. Still, recent tests of dozens of brands found that nearly all supplements contained the amount of omega-3 fats listed on the labels—with no significant contamination. The oil usually contains very high levels of A, which may weaken bones and cause birth defects. Since it is made from livers, which filter out toxins, there is also greater concern about contaminants, even though the oil is supposed to be purified. But fish also contains vitamins, minerals, other fats, and other substances that may work with the omega-3s to protect the heart and overall health. Moreover, fish, which is rich in protein and low in saturated fat, can replace less-healthful foods such as red meat. As emphasized by Berkeley Wellness, the benefits of fish far outweigh the potential risks from contaminants, especially if you eat it in moderation (two servings a week, about 8 to 12 ounces total) and vary the types of fish. A large study in the journal Circulation: Heart Failure found that eating fried fish at least once a week was associated with a 48 percent 58 higher risk of heart failure, so other cooking methods are preferred. Atlantic salmon is almost 2%, but most fish are under 1%, meaning 100grams of fish for each gram of omega-3s. At that rate, a therapeutic dose of 6-9 grams would take a lot of fish: up to two pounds a day, so supplementation is essential. Psychiatry 72(8):1054–1062 (2010) 24 Natural Standard Herb and Supplement Guide: An Evidence-based Reference, op. However, a 2013 update from Berkeley Wellness examines the recent evidence: “In 2012, two large analyses pooled data from well-designed clinical trials involving people with pre-existing heart disease or multiple risk factors. One was published in the Archives of Internal Medicine, the other in the Journal of the American Medical Association. They concluded that overall the evidence does not support claims that omega-3 supplements help prevent cardiovascular events. It found that the 26 observational studies suggested that higher fish intake was associated with moderately reduced stroke risk, but that the 12 clinical trials (considered the gold standard in medical research) concluded that the supplements offered no benefit. In a large trial in the New England Journal of Medicine in 2012, people with diabetes or prediabetes, who are at elevated risk for cardiovascular disease, took 1,000 milligrams of omega-3 supplements a day or a placebo. After an average of six years, the supplement takers were no less likely to have a heart attack or stroke or to die. A British study in the American Journal of Clinical Nutrition in 2011 found that various doses of omega-3s did not help keep arteries flexible in healthy people (ages 45 to 70). Another British study, in the journal Atherosclerosis, similarly found no vascular benefit in people with peripheral artery disease. However, a 2012 analysis in the same journal concluded that omega-3s can improve arterial functioning. In the newest study, published in the New England Journal of Medicine in May, more than 6,000 Italians at high risk for cardiovascular disease took 1,000 milligrams of omega-3 supplements a day. After five years, they did no better than a placebo group in terms of heart attacks, strokes and death rates. This was true even of people with low baseline dietary intakes of omega-3s and those not taking statins. Others have criticized how the studies included in the meta-analyses were selected. Had certain other studies been included, the critics say, the overall results would have been more positive. Bottom line: The proposed cardiovascular benefits of fish oil supplements now seem uncertain. In any case, your best bet is to get your omega-3s from two or three servings of fatty fish a week. That’s still good advice if you don’t eat fish, especially since some of the other proposed benefits of omega-3s may still pan out. The supplements have few, if any, serious adverse effects—unless, that is, they lead you to think you can eat an unhealthy diet or can avoid taking the statins or other drugs you may need. The most salient point may be that in the studies from recent years, far more participants at elevated cardiovascular risk were taking “state-of-the-art” medication, such as statins and blood pressure drugs, compared to early studies. Even if omega-3s provide benefits, these would be hard to detect against the backdrop of the much larger benefits of these drugs. Rhodiola’s efficacy in treating mental health conditions isn’t well-known in America because the earliest studies suffered from poor controls and generalized claims and were not done in the United States or Western Europe. However, those studies and the traditional practices that spawned them have caused people to use rhodiola to treat a wide range of conditions, such as stress, fatigue, anxiety, depression, and cognitive impairment, primarily in Eastern Europe and Asia, but increasingly in the United States and around the world. Rhodiola can be used to reduce stress, combat fatigue, increase mental performance and improve physical and mental fitness and resilience. The Natural Standard mildly but decisively dissents, finding these claims unsubstantiated. Bipolar Disorder Two sources warn against rhodiola use in persons with bipolar disorder. This requires working closely with a physician if there is any chance of bipolar “cycling. Brown and Gerbarg note that rhodiola has been used in small doses for children as young as 10 years of age without adverse effects but emphasize that dosages for children (8-12 years old) must be small and carefully titrated to avoid overstimulation. The risk of drug interactions and side effects is minimal, but consumers using antianxiety, antibiotic, or antidepressant medications, birth control pills, or diabetic and thyroid drugs should consult with the prescribing physician. Rhodiola is just becoming known in America, and is being popularized by experts like Brown, Gerbarg, Mischoulon, and Weil. Although much more study is needed, it appears to have a promising future in low-risk mental health treatment and self- care. Rhodiola rosea (hereinafter “rhodiola”) is widely distributed at high altitudes in the mountainous regions of Europe and Asia, where it is known as “golden root,” “arctic root,” “roseroot,” or “Aaron’s rod. The roots of the plant have been used for centuries in the traditional medicine of Asia, Scandinavia, and Eastern Europe as a health-enhancing supplement stimulating the nervous system, enhancing physical and mental performance, and alleviating fatigue, psychological stress, and depression. Its stimulating and adaptogenic properties are attributed to p-tyrosol, salidroside, rosavins, and additional phenolic compounds. Specific neurochemical mechanisms have been documented for some but not all of the bioactive compounds. Studies of uncertain methodological rigor found that rhodiola 2 “enhanced intellectual work capacity, abstract thinking, and reaction time. However, based on trials conducted in the former Soviet Union beginning in 1987 and their own clinical practice, they note that rhodiola also can be useful in the treatment of depression. A recent small open-label study showed promising results for the use of rhodiola for anxiety, but the size and open label study design preclude any conclusion at 4 this point except for the usual need for more study. The tests were performed before and after night duty during three two-week periods in a double-blind cross-over trial. A statistically significant improvement in fatigue and mental performance was observed in the treatment group during the first 2 weeks.

She characterized the perspectives about health as expanding conscious- overall pattern to be one of isolation and being ness discount clomiphene 25mg on-line. In discussing the implications her research closed in because participants isolated themselves holds for nursing practice buy generic clomiphene canada, Moch stressed that in- from situations they were unable to deal with and corporating a “health-within-illness experience” avoided any stimuli that could threaten their pul- view has the potential to drastically change the way monary status 25mg clomiphene. They found three common themes: the activity restrictions discount clomiphene 50 mg amex, and in their inability to pur- need to excel, the need to please others, and feelings of sue what they need and want” (p. These findings were consistent with the Rosenthal (1996) conducted a similar study in the literature on coronary artery disease and personal- United States and found a relationship between ity type. When applying Young’s (1976) theory to pattern recognition and evolving consciousness to the participants, they found that most participants be related to a sense of connectedness, with the par- were caught in a repetitive cycle characteristic of ticipants who manifested a sense of connectedness the centering stage. Blocks to movement along the being able to utilize pattern recognition to tran- spectrum were seen as being mirrored by the blocks scend their illness. If they had She (Yamashita, 1999) described a process whereby reached the limits of their resources, death was the caregivers moved through struggling alone and feel- ‘transformative door’ to higher consciousness” ing alienated from those around them as the schiz- (Moss, 1981, p. Newman and Moch stress ophrenia was first manifested, and feeling a lack of that nurses could help patients get in touch with connectedness, particularly with health-care profes- their pattern and express themselves more fully. Yamashita reported that in the process of Newman (1995) further demonstrated the im- pattern recognition, participants were able to rec- portance of nurses being fully present, seeking to ognize turning points in their lives and discover know about the most meaningful experiences in new rules as they started to move beyond the patients’ lives, mirroring the story so that insights binding stage in Young’s spectrum of conscious- can be gained into the evolving pattern, and being ness. Neill (2002b) concludes that pattern recogni- tic dialectic process with midlife women. Picard found congru- and the Nurse-Patient Partnership ence between the narratives and the expressions of creative movement. Picard reports that partici- (1993, 1997, 1999, 2004) has led the way in focus- pants expressed the awareness of the past within ing on the process of the nursing partnership with the present and experienced a deep sense of healing patients and families. Participants reported valuing: (1993) described health patterning as “a process of being known, feeling accepted, not being diag- nursing practice whereby, through dialogue, fami- nosed, and having enough time to tell their stories. Picard met with each partic- which there may be increased self-determination as ipant for two interview/dialogue sessions and then a feature of health” (p. In a presentation of this research, Picard did Through her research over several years with fami- a slide presentation of her study’s findings and then lies with complex health predicaments requiring performed a choreographed dance made up of the repeated hospitalizations, Litchfield (1993, 1999, combined movements of all of the parents in her 2004) found that she could not stand outside of the study (Jonsdottir, Litchfield, Pharris, & Picard, process of recognizing pattern to observe a fixed 2001). She sees the pattern as very deep level what the experience of being a par- continuously evolving dialectically in the dialogue ent of a person with bipolar disorder might be like. The findings are It was a different and deeper way of knowing the literally created in the participatory process of the experience from that gained by reading the com- partnership (Litchfield, 1999). As the fam- rheumatoid arthritis (2002a) and other chronic ill- ily reflects on the pattern, insight into action may nesses (2002b). Family health is she went back the second time with the diagram- seen as a function of the nurse-family relationship. Newman’s Theory of Health as Expanding Consciousness and Its Applications 229 service from traditional health-care services (1999, stands, and honors the undivided wholeness of the 2004). She found a pattern of ticipants differed in the pace of evolving movement living in uncertainty to exist for the families in the toward a turning point and in the characteristics of intense period of disruption and disorganization personal growth at the turning point. The charac- following the birth of their medically fragile child teristics of growth ranged from assertion of self, to through the first few years. Tommet fix clients’ problems from a medical diagnostic found that “families changed from being passive re- standpoint, but to provide individuals with an op- cipients to active participants in the care of their portunity to know themselves, to find meaning in children” (p. Tommet demonstrated insights gained in (2000) carried out a similar study with Japanese family pattern recognition and concluded that a families in which the wife-mother was hospitalized nurse-parent partnership could have had a more because of a cancer diagnosis. Families found profound impact on these families, and hence the meaning in their patterns and reported increased services they used, during the first three years of understanding of their present situation. The goal of the pilot project, which The researchers concluded that pattern recognition built on Litchfield’s previous work (1993, 1999), as a nursing intervention was a “meaning-making was to explore a model of nurse case management transforming process in the family-nurse partner- incorporating the use of a family nurse trained in ship” (p. Family nurses shared their understanding the interrelatedness of time, move- stories of the families with the research group, who ment, space, and consciousness as manifestations reflected together on the families’ changing of health. These studies pointed to the need to look predicaments and the whole picture of family living at health as expanding consciousness using a re- in terms of how each family moved in time and search methodology that acknowledges, under- place. The research surgery experience could be put in proper context group found that families became more open and and appropriate care provided. Nursing presurgical spontaneous through the process of pattern recog- visits were emphasized. Flanagan reported that the nition, and their interactions evidenced more nursing staff was exuberant to be free to be a nurse focus, purposefulness, and cooperation. In analyz- once again, and patients frequently stopped by to ing costs of medical care for one participating fam- comment on their preoperative experience and ily, it was estimated that a 3 to 13 percent savings evolving life changes. Based on Litchfield’s practice and the sense of connectedness among work with families with complex health predica- staff, families, and residents—each became more ments, the government has funded a large demon- peaceful, relaxed, and loving. These nurses are free to focus on family community pattern of rising youth homicide rates health as defined and experienced by the families by conducting a study with incarcerated teens con- themselves. Endo and colleagues (Endo, Minegishi, & Kubo, When the experiences of meaningful events and 2004; Endo, Miyahara, Suzuki, & Ohmasa, 2004) in relationships were compared across participants, Japan have expanded their work to incorporate the pattern of disconnection with the community the pattern-recognition process at the hospital became evident and various aspects of the commu- nursing unit level. Insights transformed commu- journals and come together to reflect on the expe- nity responses to youths at risk for violent per- rience of expanding consciousness in their patients petration. Endo, Miyahara, Suzuki, and pattern-recognition process to be transformative, Ohmasa (2004) conclude: “Retrospectively it was and expanding consciousness was visible in changed found through dialogue in the research/project behaviors, increased connectedness, and more meetings that in the usual nurse-client relation- loving attention to meaningful relationships. Pharris (2004) and an amazing experience with clients’ transforma- colleagues are extending the community pattern- tions. The nurses’ transformation occurred con- recognition process in a partnership with a multi- comitantly, and they were free to follow the clients’ ethnic community interested in understanding paths and incorporate all realms of nursing inter- and transforming patterns of racism and health ventions in everyday practice into the unitary disparities. Newman’s Theory of Health as Expanding Consciousness and Its Applications 231 several weeks to gain insight into patterns of mean- of expanding consciousness for the young man. He ingful people and events in his life, the process reflected that he wished he had had a nurse to talk seemed to be blocked, with the pattern not emerg- with prior to “catching his case” (being arrested for ing and little insight being gained. He had been seen by a nurse in the juve- he felt he had lost himself several years back when nile detention center, who did a physical exam and he went from being a straight A student from a sta- gave him aspirin for a headache. A few days before ble family to stealing cars, drinking, getting into the murder, he saw a nurse practitioner in a clinic fights, and eventually murdering someone. One who wrote a prescription for antibiotics and talked week he walked into the room where the nurse was with him about safe sex. These interactions are waiting and his movements seemed more con- explicate patterns of the implicate order of the trolled and labored; he sat with his arms tightly U. He talked as usual in a very de- the physical realm, and nurses operating out of the tached manner, but his words came out in bursts. She re- insights arising in their dialogue shed light on an flected that he seemed to be exerting a great deal of expanded horizon of potential actions (Newman, energy holding back something that was erupting 1997a; Litchfield, 1999). With this insight, he was quiet for a few Another example, at the community level, arises minutes and tears began rolling down his cheeks. It became obvious that the participants to suffering and physical deterioration experience of covering up the abuse had been so and at the same time introduced greater sensitivity all-encompassing that it was suppressing his pat- and openness to themselves and to others. This young man had reached a choice point at on the work of cultural historian William Irwin which he realized his old ways of interacting with Thompson, systems theorist Will McWhinney, and others were no longer serving him, and he chose to musician David Dunn, Lamendola and Newman, interact with his environment in a different way. By state: the next meeting, his movements had become They [Thompson, McWhinney, and Dunn] see the smooth and sure, his complexion had cleared up, loss of membranal integrity as a signal of the loss of he was now able to reflect on his insights, and he no autopoetic unity analogous to the breaking down of longer was involved in the chaos and fighting in his boundaries at a global level between countries, ide- cellblock. In their subse- pathogen not as an object but as heralding the need for living together characterized by a symbiotic rela- quent work together, this young man and the nurse tionship. Since that time, the young community, and global level, Lamendola and man has been able to transcend previous limita- Newman quote Thompson (1989, p. She finding greater meaning in life, and of reach- found that the nursing partnership was very impor- ing new dimensions of connectedness with tant to the families as they struggled to make sense other people and the world” (1). The evolving pattern of these families included the social and political forces within the educational, disabilities support, and health care systems, as well as community patterns References of caring, prejudice, and racism (Falkenstern, 2003). Expanding the dialogue on praxis in nursing logue as these stories are shared and reflected upon. Pattern recognition as a nursing intervention ing communities in dialogue about what is mean- with Japanese women with ovarian cancer. Creating action re- on the task of engaging her or his country’s nurses search teams: A praxis model of care.