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To prevent gradual weight gain over time buy isoniazid 300mg without a prescription, make small de- creases in food and beverage calories and increase physi- cal activity effective 300 mg isoniazid. Engage in regular physical activity and reduce sedentary activities to promote health, psychological well-being, and a healthy body weight. To reduce the risk of chronic disease in adulthood, en- gage in at least 30 minutes of moderate-intensity physical activity, above usual activity, at work or home on most days of the week. To help manage body weight and prevent gradual, unhealthy body weight gain in adulthood, engage in approximately 60 minutes of moderate- to vigorous-intensity activity on most days of the week while not exceeding caloric intake requirements. To sustain weight loss in adulthood, participate in at least 60 to 90 minutes of daily moderate-intensity physical activity while not exceeding caloric intake requirements. Achieve physical fitness by including cardiovascular con- ditioning, stretching exercises for flexibility, and resis- tance exercises or calisthenics for muscle strength and endurance. To help meet calcium needs, non-dairy calcium-containing alterna- tives may be selected by individuals with lactose intoler- ance or those who choose to avoid all milk products (e. Keep total fat intake between 20% and 35% of calo- ries, with most fats coming from sources of polyunsatu- rated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils. Consume less than 10% of calories from saturated fatty acids and less than 300 mg/day of cholesterol, and keep trans–fatty acid consumption as low as possible. Carbohydrate intake should comprise 45% to 64% of total calories, with the majority coming from fiber-rich foods. Important sources of nutrients from carbohydrates include fruits, vegetables, whole grains, and milk. Individuals who choose to drink al- coholic beverages should do so sensibly and in moderation— defined as the consumption of up to one drink per day for women and up to two drinks per day for men. One drink should count as: Complementary Therapies ● 385 • 12 ounces of regular beer (150 calories) • 5 ounces of wine (100 calories) • 1. Chiropractic Medicine Chiropractic medicine is probably the most widely used form of alternative healing in the United States. Palmer’s objective was to find a cure for disease and illness that did not use drugs but instead relied on more natu- ral methods of healing (Trivieri & Anderson, 2002). Palmer’s theory of chiropractic medicine was that energy flows from the brain to all parts of the body through the spinal cord and spinal nerves. When vertebrae of the spinal column become displaced, they may press on a nerve and interfere with the normal nerve transmission. Palmer named the displacement of these verte- brae subluxation, and he alleged that the way to restore normal function was to manipulate the vertebrae back into their normal positions. Adjustments are usually performed by hand, although some chiropractors have special treatment tables equipped to facilitate these manipulations. Other processes used to facilitate the out- come of the spinal adjustment by providing muscle relaxation in- clude massage tables, application of heat or cold, and ultrasound treatments. The chiropractor takes a medical history and performs a clini- cal examination, which usually includes x-ray films of the spine. Today’s chiropractors may practice “straight” therapy—that is, the only therapy provided is that of subluxation adjustments. Mixer is a term applied to a chiropractor who combines adjustments with adjunct therapies, such as exercise, heat treatments, or massage. Individuals seek treatment from chiropractors for many types of ailments and illnesses; the most common is back pain. In ad- dition, chiropractors treat clients with headaches, neck injuries, scoliosis, carpal tunnel syndrome, respiratory and gastrointes- tinal disorders, menstrual difficulties, allergies, sinusitis, and certain sports injuries (Trivieri & Anderson, 2002). Some chi- ropractors are employed by professional sports teams as their team physicians. They treat more than 20 million people in the United States annually (Sadock & Sadock, 2007). Therapeutic Touch and Massage Therapeutic Touch The technique of therapeutic touch was developed in the 1970s by Dolores Krieger, a nurse associated with the New York University School of Nursing. This therapy is based on the philosophy that the human body projects a field of energy around it. Practitioners of therapeutic touch use this technique to correct the blockages, thereby relieving the discomfort and improving health. Based on the premise that the energy field extends beyond the surface of the body, the practitioner need not actually touch the client’s skin.

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Cross-sectional research This type of research indicates a role for the following beliefs and attitudes: s Perceived social benefits of exercise buy discount isoniazid 300 mg on-line. Research examining the predictors of exercise behaviour consistently suggests that the main factors motivating exercise are the beliefs that it is enjoyable and provides social contact order 300 mg isoniazid visa. In a cross-sectional study examining the differences in attitude between joggers and non-joggers, the non- joggers reported beliefs that exercise required too much discipline, too much time, they did not believe in the positive effects of jogging and reported a lower belief that significant others valued regular jogging (Riddle 1980). In support of this, the non- joggers in the study by Riddle (1980) also reported a lower value on good health than the joggers. Exercisers have also been shown to differ from non-exercisers in their beliefs about the benefits of exercise. For example, a study of older women (aged 60–89 years) indicated that exercisers reported a higher rating for the health value of exercise, reported greater enjoyment of exercise, rated their discomfort from exer- cise as lower and perceived exercise programmes to be more easily available than non-exercisers (Paxton et al. They developed a questionnaire entitled the ‘Temptation to not exercise scale’ which measured two forms of barriers ‘affect’ and ‘competing demands’. The answers include ‘when I am angry’ and ‘when I am satisfied’ to reflect ‘affect’ and ‘when I feel lazy’ and ‘when I am busy’ to reflect competing interests. The authors argue that such temptations are central to understanding exercise uptake and should be used alongside the stages of change model. Prospective research This has examined which factors predict the uptake of exercise. It has often been carried out in the context of the development of exercise programmes and studies of adherence to these programmes. The results indicated that exercise self-efficacy, attitudes to exercise and health knowledge were the best pre- dictors. They concluded that having realistic aims and an understanding of the possible outcomes of a brief exercise programme were predictive of adherence to the programme. To further understand the predictors of exercise adherence, social cognition models have been used. Riddle (1980) examined predictors of exercise using the theory of reasoned action (Fishbein and Ajzen 1975; see Chapter 2) and reported that attitudes to exercise and the normative components of the model predicted intentions to exercise and that these intentions were related to self-reports of behaviour. Research has also used the health belief model (Sonstroem 1988) and models emphasizing exercise self-efficacy (e. Research has also applied the stages of change model to exercise behaviour (see Chapters 2 and 5). This model describes behaviour change in five stages: precontem- plation, contemplation, preparation, action and maintenance (e. DiClemente and Prochaska 1982) and suggests that transitions between changes is facilitated by a cost benefit analysis and by different cognitions. This suggests that encouraging individuals to focus on the pros of exercise may increase the transition from thinking about exercising to actually doing it. The study included a large sample of adults who completed measures by telephone at baseline and then recorded their exercise stage by mail after one year. The results showed that baseline attitude, intention and subjective norm predicted the transition from precontemplation to contemplation, that progression from contemplation to preparation was predicted by intention, perceived behavioural control, attitudes and social support, that progression from preparation to action was predicted by intention and attitude and that transition from action to maintenance was predicted by intention, attitude and social support. This study was an attempt to test directly the role of two social cognition models in predicting exercise behaviour. Background Social cognition models such as the theory of reasoned action and the health belief model have been used to predict and examine health behaviours such as smoking (see Chapter 5), screening (see Chapter 9) and contraception use (see Chapter 8). Norman and Smith (1995) used the theory of planned behaviour (Ajzen 1988) to predict exercise behaviour over a six-month period. Methodology Subjects Eighteen people were asked to complete open-ended questions in order to identify beliefs about exercise that could then be incorporated into a questionnaire. The questionnaire was distributed to 250 subjects and returned by 182 (a response rate of 72. Because the study used a prospective design, a second questionnaire was sent out after six months; 83 individuals returned it completed. Design The study involved a repeated-measures design with questionnaires completed at baseline (time 1) and after six months (time 2). Measures The questionnaire at time 1 asked for the subject’s age and sex and con- tained questions about the following aspects of the theory of planned behaviour, which were rated on a seven-point Likert scale. At time 2, the subjects were asked about their frequency of exercising (as in prior behaviour).

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It is impor- tant for the nurse to be present when the client awakens order isoniazid 300mg with visa, to alleviate the fears that accompany this loss of memory purchase 300mg isoniazid with visa. The major cause is cardiovascular complications, such as acute myocardial infarction or cardiac arrest. However, some clients have reported retrograde amnesia extending back to months before treatment. Although the potential for these effects appears to be mini- mal, the client must be made aware of the risks involved before consenting to treatment. Risk for aspiration related to altered level of consciousness immediately following treatment. Disturbed thought processes related to side effects of tempo- rary memory loss and confusion. Ensure that physician has obtained informed consent and that a signed permission form is on the chart. Prior to the treatment, client should void, dress in night clothes (or other loose clothing), and remove dentures and eyeglasses or contact lenses. Assist physician and/or anesthesiologist as necessary in the administration of intravenous medications. A short-acting anesthetic, such as methohexital sodium (Brevital sodium), is given along with the muscle relaxant succinylcholine chloride (Anectine). After the procedure, take vital signs and blood pressure every 15 minutes for the first hour. Highest level of education achieved Occupation Presenting Problem Has this problem ever occurred before? Describe the family living arrangements Who is the major decision maker in the family? Describe client’s/family members’ roles within the family Describe religious beliefs and practices Are there any religious requirements or restrictions that place limitations on the client’s care? Describe client’s usual emotional/behavioral response to: Anxiety Anger Loss/change/failure Pain Fear Describe any topics that are particularly sensitive or that the client is unwilling to discuss (because of cultural taboos) Describe any activities in which the client is unwilling to par- ticipate (because of cultural customs or taboos) What are the client’s personal feelings regarding touch? Examples include: problems related to primary support group, social environment, education, occupation, housing, economics, access to health care services, interaction with the legal system or crime, and other types of psychosocial and environmental problems. This scale represents in global terms a single measure of the individual’s psychological, social, and occupational function- ing. Source: From the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, 2000. Example of a psychiatric diagnosis using the Multiaxial Evaluation System: Axis I 300. Do not include impairment in functioning due to physical (or environ- mental) limitations. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. The mental status examination is a description of all the areas of the client’s mental functioning. The following are the compo- nents that are considered critical in the assessment of a client’s mental status. The outward emotional expression is what would be expected in a certain situation (e. Verbalizations are lengthy and tedious, and because of numerous details, are delayed reaching the intended point 4. The individual is making up nonsensical-sounding words, which only have meaning to him or her 6. Speaking in puns or rhymes; using words that sound alike but have different meanings 8. Reference: An idea that whatever is happening in the en- vironment is about him or her (e. Control or influence: A belief that his or her behavior and thoughts are being controlled by external forces (e. Nihilistic: A belief that he or she, or a part of the body, or even the world does not exist or has been destroyed (e.

Adoption of change Rogers and Shoemaker (1971) identify six groups that staff can fall into: innovators early adopters early majority later majority laggards rejectors Managing change 451 Innovators are change agents and allies (usually few in number) sharing enthusiasm for change; when planning change order 300 mg isoniazid free shipping, identify your allies generic isoniazid 300 mg without a prescription. As momentum gathers, early adopters show interest and can help pilot change, serving as role models for others. As change becomes accepted by most staff, the early majority establish it as the norm; further acceptance brings in the later majority. Laggards may be won over, albeit reluctantly, possibly attempting to undermine initiatives; superficial acceptance of change may be reversed at an early opportunity. Laggards may prove to be more problematic than the rejecters, who are usually open with their opposition and unlikely to be convinced. Active resistance is deliberate, but open; passive resistance is usually caused by apathy, with initiatives failing from lack of active support. Passive resistance can be difficult to overcome as it necessitates motivating others. Resistance is usually caused by how change is introduced rather than by the change itself (Closs 1996). Change, and the unknown, are threatening; people fearing they will not cope seek refuge in, and defend, the status quo. Motivation for resistance should therefore be acknowledged and respected; belittling resisters increases the threat, damages morale, and may cause them to leave. As their confidence develops, resisters may share ownership of change, gain a sense of achievement and join the (very) later majority. Change is not always beneficial; enthusiasm can blind change agents to any faults. Opposition can stimulate healthy debate, possibly even finding better ways forward. Change agents unwilling to consider that the change they have made might subsequently need changing become tyrants; resistance can usefully moderate misplaced enthusiasm (Wright 1998). If change proves beneficial, and becomes the norm, continuing resistance may prove destructive. Once other avenues are exhausted, persistent resisters may leave; their resignation may be the best compromise for everyone. Lewin’s strategy Lewin’s (1952) classic work on change management includes: ■ field theory ■ stages of change Lewin’s field theory suggests that opposing forces both drive and restrain change. Habit, often enshrined in rituals (Walsh & Ford 1989; Ford & Walsh 1994) is a major restraining force. More widely cited is Lewin’s three stages of change: Intensive care nursing 452 ■ unfreezing (destabilising) ■ moving (changing) ■ refreezing (re-establishing) Unfreezing, breaking habits and rituals, creates motivation for change. Wright (1998) suggests that unfreezing may occur when: ■ expectations have not been met ■ staff have uncomfortable feelings about something ■ obstacles to change are removed (‘psychological safety’) Moving occurs when change is planned and initiated. Stability may have been possible when Lewin published his ideas in 1952, but if change and instability are now the norm (Toffler 1970), unfreezing may be unnecessary and refreezing impossible; change agents may only have to plan the moving stage. Human needs Change causes stress for everyone, including (often especially) change agents. Failed initiatives can leave change agents physically and emotionally exhausted, while ‘shifting sand’ quickly buries their ideas. Familiarity breeds contempt (the ‘wallpaper effect’ (Wright 1998): we cease to notice familiar problems); change agents may become conservative, defending their own change against any subsequent developments. However, safety needs should be balanced against the benefits of taking risks; this does not mean turning off ventilators each shift to see whether patients can breathe on their own, but it does include taking calculated risks when the likely benefits appear to outweigh the possible dangers. Nursing has inherited a culture of negative criticism, which undermines the confidence of nurses who usually only receive feedback when they have done something wrong. Pressures should be recognised, and Managing change 453 planned for; actions should be specific and timetabled, with achievable targets for everyone to work towards. It is necessary therefore to plan: who will achieve something by what date how all staff will be made aware of changes how they will be achieved, and where specific events will occur Plans which remain flexible and adaptable are more likely to succeed (Wilkinson 1994); targets may need modification later. Evaluation However good ideas may sound, their effects in practice, together with their strengths and weaknesses, should be evaluated and, if necessary, the ideas should be modified, developed further, or even abandoned.

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