By Z. Kirk. University of California, Berkeley.

Refer to written materials furnished by health-care providers for safe self-administration cheap 50 mg dramamine visa treatment of hyperkalemia. To develop a basic trust in (Birth–18 mistrust the mothering figure and months) be able to generalize it to others Early Autonomy vs dramamine 50 mg low price medications identification. To gain some self-control childhood shame and and independence within (18 months– doubt the environment 3 years) Late Initiative vs. To achieve a sense of self- (6–12 years) inferiority confidence by learning, competing, performing successfully, and receiv- ing recognition from significant others, peers, and acquaintances Adolescence Identity vs. To integrate the tasks (12–20 years) role mastered in the previous confusion stages into a secure sense of self Young adult- Intimacy vs. To form an intense, lasting hood isolation relationship or a commit- (20–30 years) ment to another person, a cause, an institution, or a creative effort Adulthood Generativity To achieve the life goals while vs. Differentiation Commencement of a primary recogni- tion of separateness from the mothering figure 10–16 b. Practicing Increased independ- months ence through loco- motor functioning; increased sense of separateness of self 16–24 c. Rapprochement Acute awareness of months separateness of self; learning to seek “emotional refueling” from mothering figure to maintain feeling of security 24–36 months d. Consolidation Sense of separate- ness established; on the way to object constancy (i. Punishment and Behavior is moti- (common from obedience vated by fear of ages 4 to orientation punishment 10 years) 2. Interpersonal Behavior is (common from concordance motivated by ages 10 to 13 orientation the expecta- years and into tions of others; adulthood) strong desire for approval and acceptance 4. Social contract Behavior is moti- tional (can legalistic vated by respect occur from orientation for universal adolescence on) laws and moral principles and guided by an internal set of values 6. Psychiatric/mental health nursing: Concepts of care in evidence-based practice (6th ed. She acknowl- alcohol Preventing attended edge the every day unaccept- nursing existence and cannot able or school to of a real stop fails to undesirable please her situation or acknowl- thoughts or parents. Identifica- A teen- Repression: An accident tion: ager who Involuntar- victim can An attempt required ily blocking remember to increase lengthy unpleasant nothing self-worth rehabilita- feelings and about his by acquir- tion after experiences accident. Intellectuali- S’s husband Sublimation: A mother zation: is being Rechan- whose son An attempt transferred neling of was killed to avoid with his job drives or by a drunk expressing to a city far impulses driver actual emo- away from that are chan- tions asso- her parents. Introjection: Children Suppression: Scarlett Integrating integrate The O’Hara the beliefs their par- voluntary says, “I and values ents’ value blocking of don’t want of another system unpleasant to think individual into the feelings and about that into one’s process of experiences now. On his feeling tone and raped, experience way home or emotion without that one he stops associated showing finds intol- and buys with it. Projection Sue feels a Attributing strong sexual feelings or attraction impulses to her track unacceptable coach and to one’s self tells her to another friend, “He’s person. Psychiatric/mental health nursing: Concepts of care in evidence-based practice (6th ed. This is congruent with Peplau’s (1962) identification of counseling as the major subrole of nurs- ing in psychiatry. If Sullivan’s (1953) belief is true, that is, that all emotional problems stem from difficulties with interpersonal relationships, then this role of the nurse in psychiatry becomes especially meaningful and purposeful. The therapeutic interpersonal relationship is the means by which the nursing process is implemented. Tasks of the relationship have been categorized into four phases: the preinteraction phase, the orientation (introductory) phase, the working phase, and the termination phase.

This relationship between love and caring ing processes and relationships—they affect the connotes inner healing for self and others order 50 mg dramamine mastercard medicine lyrics, extend- one caring and the one being cared for discount 50mg dramamine amex medications with pseudoephedrine. Further, the ing to nature and the larger universe, unfolding and basic core was grounded in what I referred to as evolving within a cosmology that is both meta- the philosophy, science, and even art of caring. This emerging model of nursing that goes beyond the “trim” of changing transpersonal caring moves from carative to caritas. Although the “trim” is important and not static models of nursing while simultaneously expendable, the point is that nursing cannot be de- evoking both the past and the future. For example, fined around its trim and what it does in a given the future of nursing is tied to Nightingale’s sense setting and at a given point in time. Nor can nurs- of “calling,” guided by a deep sense of commitment ing’s trim define and clarify its larger professional and a covenantal ethic of human service, cherishing ethic and mission to society—its raison d’être for our phenomena, our subject matter, and those we the public. That is where nursing theory comes into play, and transpersonal caring theory offers another It is when we include caring and love way that both differs from and complements that in our work and in our life that we which has come to be known as “modern” nursing discover and affirm that nursing, like and conventional medical-nursing frameworks. Formation of a humanistic-altruistic system of work and in our life that we discover and affirm values. Development of a helping-trusting, human require transforming self and those we serve, in- caring relationship. Promotion and acceptance of the expression of we more publicly and professionally assert these positive and negative feelings. Provision for a supportive, protective, and/ process; to engage in artistry of caring-healing or corrective mental, physical, societal, and practices. Allowance for existential-phenomenological- learning experience that attends to unity of spiritual forces. Provision for a supportive, protective, and/or carative factors still hold, and indeed are used as the corrective mental, physical, societal, and spir- basis for some theory-guided practice models and itual environment becomes creating a healing research, what I am proposing here, as part of my environment at all levels (a physical and non- evolution and the evolution of these ideas and the physical, subtle environment of energy and theory itself, is to transpose the carative factors into consciousness, whereby wholeness, beauty, “clinical caritas processes. Assistance with gratification of human needs and emerging transpersonal caring theory. Allowance for existential-phenomenological- suggesting more open ways in which they can be spiritual forces becomes opening and attending considered. For example: to spiritual-mysterious and existential dimen- sions of one’s own life-death; soul care for self 1. Instillation of faith-hope becomes being au- evocation of love and caring are merged for a new thentically present and enabling and sustaining paradigm for this millennium. Such a perspective the deep belief system and subjective life world ironically places nursing within its most mature of self and one being cared for. Cultivation of sensitivity to one’s self and to model of nursing—yet to be actualized but await- others becomes cultivation of one’s own spir- ing its evolution within a caring-healing theory. Development of a helping-trusting, human Thus, I consider my work more a philosophical, caring relationship becomes developing and ethical, intellectual blueprint for nursing’s evolving sustaining a helping-trusting, authentic caring disciplinary/professional matrix, rather than a spe- relationship. Promotion and acceptance of the expression of with the original work at levels of concreteness or positive and negative feelings becomes being abstractness. The caring theory has been, and is still present to, and supportive of, the expression of being, used as a guide for educational curricula, positive and negative feelings as a connection clinical practice models, methods for research and with deeper spirit of self and the one being inquiry, and administrative directions for nursing cared for. It is also a critical start- to ontological development of the nurse’s human ing point for nursing’s existence, broad societal competencies and ways of being and becoming. Nevertheless, its use and critical in this model as “technological curing com- evolution is dependent upon “critical, reflective petencies” were in the conventional modern, practices that must be continuously questioned and Western nursing-medicine model, which is now critiqued in order to remain dynamic, flexible, and coming to an end. Transpersonal Caring Relationship The nurse attempts to enter into and stay within the The terms transpersonal and a transpersonal caring other’s frame of reference for connecting with the relationship are foundational to the work. But transpersonal also goes beyond the ate comfort measures, pain control, a sense of well- ego self and beyond the given moment, reaching to being, wholeness, or even a spiritual transcendence the deeper connections to spirit and with the of suffering. Thus, a transpersonal caring rela- complete, regardless of illness or disease (Watson, tionship moves beyond ego self and radiates to 1996, p.

The women described terventions that change thinking styles cheap 50 mg dramamine with mastercard treatment pink eye, and pro- their self-talk as constant buy 50mg dramamine free shipping medicine 5443, negative, and demeaning. They identified various means of managing the Peden’s study (1996) concluded with the realiza- negative thoughts. Once again, the use of affirma- tion that more information was needed on the tions, positive self-talk, and learning to change symptom of negative thinking. To understand a thinking were identified as reducing negative think- phenomenon, one must analyze its etiology, its ing. Steps one and two of the process of practice- cause, its meaning, and any clues to successful in- based theory development had provided direction tervention (Peplau, 1989c). At the suggestion of for moving into the third step, design of an inter- Peplau (personal communication, January 16, vention. A six-week group intervention was designed specif- ically to incorporate cognitive-behavioral tech- Negative Thinking niques to assist in reducing negative thinking in A qualitative study (Peden, 2000) was designed to depressed women. As described earlier, thought describe the nature or inherent quality of negative stopping and positive self-talk (or affirmations) thoughts, their content or subject matter, and the were identified as key strategies in reducing nega- origins of the negative thoughts experienced by tive thoughts. The participants specific content from Gordon and Tobin’s (1991) also shared strategies they used to manage the neg- Insight program, Copeland’s (1992) The Depression ative thoughts. The sample consisted of six women Workbook, and the investigator’s own clinical expe- with a diagnosis of major depression who were ex- riences with depressed women. Affirmations, direct periencing or had experienced negative thoughts actions, thought stopping, and information on dis- and were willing to talk about the experiences. The torted thinking styles were introduced to the group women participated in a series of six group inter- members. Guided by Peplau’s (1952) theory of in- views, the purpose of which was to elicit negative terpersonal nursing, the introduction of cognitive- views/thoughts held by the group participants. The behavioral techniques did not occur until the group interviews focused on the women’s life expe- second group session. The focus of the first week riences, views of self and significant others, was on enhancing the development of the nurse- lifestyles, and past experiences. Codes were derived from available literature and To pilot-test the intervention, 13 women with were based on recommendations from Peplau (per- a diagnosis of major depression were randomly sonal communication, January 16, 1993) and other assigned either to a control or to an experimental codes that emerged from the initial review of the group. Codes included negative thinking related to an outpatient clinic and receiving antidepressant self, negative thinking related to significant others, medication. The experimental group participated interactions with significant others, and developing in the six-week cognitive-behavioral group inter- view of self. For the six women who participated in the study, Pre- and post-test measures were collected on the negative thoughts had their origins in child- depression using the Beck Depression Inventory hood. There were the trend is to return to practice for knowledge de- more significant decreases from pretest to post-test velopment. Peplau used clinical situations to derive in the experimental group in negative thoughts and theories inductively and then tested them in clini- depressive symptoms and an increase in self-esteem cal practice. Although the sample size theories to nursing phenomena, combining induc- was small, the intervention had a significant posi- tion (observation and classification) with deduc- tive effect on depression. This provided a creative, nonlin- Testing the Intervention with ear approach to the formation of ideas. At-Risk Women She also proposed the linkage of qualitative and Upon recommendation of Peplau (personal com- quantitative methods. Using her methodology, the munication, January 16, 1993), the intervention nurse would begin with an in-depth look at a phe- was tested on at-risk college women to determine nomenon, which would evolve into a quantitative if it had preventive effects (Peden, Hall, Rayens, study testing an intervention directed at the phe- & Beebe, 2000a, 2000b). These ideas, proposed during the posi- prevention trial was conducted to test the efficacy tivist period of nursing, were highly revolutionary.