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Banks and Dabbs (1996) found that juvenile delinquents and prisoners who had [3] high levels of testosterone also acted more violently buy kamagra soft 100mg with mastercard, and Tremblay et al purchase 100mg kamagra soft with mastercard. Although testosterone levels are higher in men than in women buy 100mg kamagra soft with visa, the relationship between testosterone and aggression is not limited to males. Studies have also shown a positive relationship between testosterone and aggression and related behaviors (such as competitiveness) in women (Cashdan, [4] 2003). It must be kept in mind that the observed relationships between testosterone levels and aggressive behavior that have been found in these studies do not prove that testosterone causes aggression—the relationships are only correlational. In fact, there is evidence that the relationship between violence and testosterone also goes in the other direction: Playing an aggressive game, such as tennis or even chess, increases the testosterone levels of the winners Attributed to Charles Stangor Saylor. Recent research has also begun to document the role that female sex hormones may play in reactions to others. A study about hormonal influences on social-cognitive functioning (Macrae, [6] Alnwick, Milne, & Schloerscheidt, 2002) found that women were more easily able to perceive and categorize male faces during the more fertile phases of their menstrual cycles. Although researchers did not directly measure the presence of hormones, it is likely that phase-specific hormonal differences influenced the women’s perceptions. At this point you can begin to see the important role the hormones play in behavior. But the hormones we have reviewed in this section represent only a subset of the many influences that hormones have on our behaviors. In the chapters to come we will consider the important roles that hormones play in many other behaviors, including sleeping, sexual activity, and helping and harming others. What physiological reactions did you experience in the situation, and what aspects of the endocrine system do you think created those reactions? Testosterone, physical aggression, dominance, and physical development in early adolescence. Person perception across the menstrual cycle: Hormonal influences on social-cognitive functioning. Neurons are composed of a soma that contains the nucleus of the cell; a dendrite that collects information from other cells and sends the information to the soma; and a long segmented fiber, known as the axon, which transmits information away from the cell body toward other neurons and to the muscles and glands. An electrical charge moves through the neuron itself, and chemicals are used to transmit information between neurons. Within the neuron, the electrical charge occurs in the form of an action potential. Neurotransmitters travel across the synaptic space between the terminal button of one neuron and the dendrites of other neurons, where they bind to the dendrites in the neighboring neurons. More than 100 chemical substances produced in the body have been identified as neurotransmitters, and these substances have a wide and profound effect on emotion, cognition, and behavior. Drugs that we may ingest may either mimic (agonists) or block (antagonists) the operations of neurotransmitters. The brains of all animals are layered, and generally quite similar in overall form. It controls the most basic functions of life, including breathing, attention, and motor responses. Above the brain stem are other parts of the old brain involved in the processing of behavior and emotions, including the thalamus, the cerebellum, and the limbic system. The cerebral cortex contains about 20 billion nerve cells and 300 trillion synaptic connections, and it’s supported by billions more glial cells that surround and link to the neurons. The frontal lobe is primarily responsible for thinking, planning, memory, and judgment. The occipital lobe processes visual information, and the temporal lobe is responsible for hearing and language. The cortex also includes the motor cortex, the somatosensory cortex, the visual cortex, the auditory cortex, and the association areas. The brain can develop new neurons, a process known as neurogenesis, as well as new routes for neural communications (neuroplasticity). Sensory (afferent) neurons carry information from the sensory receptors, whereas motor (efferent) neurons transmit information to the muscles and glands. Glands in the endocrine system include the pituitary gland, the pancreas, the adrenal glands, and the male and female sex glands. The male sex hormone testosterone and the female sex Attributed to Charles Stangor Saylor. Many roads in the area were closed for security reasons, and police presence was high. As a prank, eight members of the Australian television satire The Chaser’s War on Everything assembled a false motorcade made up of two black four-wheel-drive vehicles, a black sedan, two motorcycles, body guards, and chauffeurs (see the video below). Group member Chas Licciardello was in one of the cars disguised as Osama bin Laden. The motorcade drove through Sydney‘s central business district and entered the security zone of the meeting. The motorcade was waved on by police, through two checkpoints, until the Chaser group decided it had taken the gag far enough and stopped outside the InterContinental Hotel where former President Bush was staying. Only at this time did the police belatedly check the identity of the group members, finally arresting them. Afterward, the group testified that it had made little effort to disguise its attempt as anything more than a prank. The group‘s only realistic attempt to fool police was its Canadian-flag marked vehicles. The ability to detect and interpret the events that are occurring around us allows us to respond to [1] these stimuli appropriately (Gibson & Pick, 2000). In most cases the system is successful, but as you can see from the above example, it is not perfect. In this chapter we will discuss the strengths and limitations of these capacities, focusing on both sensation—awareness resulting from the stimulation of a sense organ, and perception—the organization and interpretation of sensations. Sensation and perception work seamlessly together to allow us to experience the world through our eyes, ears, nose, tongue, and skin, but also to combine what we are currently learning from the environment with what we already know about it to make judgments and to choose appropriate behaviors. The study of sensation and perception is exceedingly important for our everyday lives because the knowledge generated by psychologists is used in so many ways to help so many people. Psychologists work closely with mechanical and electrical engineers, with experts in defense and military contractors, and with clinical, health, and sports psychologists to help them apply this knowledge to their everyday practices. The research is used to help us understand and better prepare people to cope with such diverse events as driving cars, flying planes, creating robots, [2] and managing pain (Fajen & Warren, 2003). We will begin the chapter with a focus on the six senses of seeing, hearing, smelling, touching, tasting, and monitoring the body’s positions (proprioception). We will see that sensation is sometimes relatively direct, in the sense that the wide variety of stimuli around us inform and guide our behaviors quickly and accurately, but nevertheless is always the result of at least some interpretation. We do not directly experience stimuli, but rather we experience those stimuli as they are created by our senses.

Initially order kamagra soft 100 mg, developmental psychology fo- order with each dependent on the previous ones (sensori- cused on childhood but was subsequently expanded to motor kamagra soft 100mg amex, preoperational buy kamagra soft 100 mg overnight delivery, concrete operational, and formal cover changes that occur over the entire life span, from operational). Subsequent research has challenged some the intrauterine environment through childhood, adoles- of his assumptions, finding in some cases that children cence, middle age, and maturity. Three processes that are capable of advanced thinking at younger ages than play a central role in development are growth, matura- those posited by Piaget. Growth refers to physical changes led to the conclusion that cognitive development is more that are quantitative, such as increases in height or uneven and less systematic than previously thought, and weight. Maturation involves anatomical, neurophysio- that children’s reasoning abilities in a specific situation logical, and chemical transformations that change the may depend on variables—familiarity with certain ob- way a person functions (such as a woman’s passage into jects, language comprehension, and prior experiences— or out of childbearing age). One recent model long-term changes in behavior or performance acquired advances the notion of cognitive development in “pock- through observation, experience, or training. Anoth- er alternative that has been suggested is an information One of the oldest questions in developmental psy- processing model focusing on gradual quantitative ad- chology involves the nature-nurture controversy, vances in memory and other learning abilities rather which asks how and to what degree nature (inherited or than qualitative progress through a series of stages. This issue has been debated for centuries by the entire life span from infancy through old age, in- philosophers, who often argued strenuously for the pre- spired an interest in the continuation of development past dominance of one influence over the other (a famous ex- childhood. Erikson’s work also popularized the concept ample is the British philosopher John Locke’s concept of of the adolescent “identity crisis” (a term he coined). Yet the newborn human being as a blank slate, or tabula another type of development that has gained increased rasa, to be formed by experience). Pioneered by the interest in recent years is moral development, which American psychologist Arnold Gesell, the concept of has been most extensively investigated by Lawrence maturation, which is central to developmental psycholo- Kohlberg. Also, not all individuals reach the final stage, at which following rules and obeying the so- ”Autonomy versus shame” from one-and-a-half to cial order is superseded by the imperative of the individ- three years ual conscience to obey ethical principles that may tran- ”Initiative versus guilt” from three to six years scend the law. The universality of some of Kohlberg’s findings has been challenged in terms of applicability to ”Industry versus inferiority” from six to 12 years. When Carol Gilligan questioned sub- ”Sensorimotor stage” from birth to two years jects about moral conflicts, the reactions of male and fe- male respondents differed significantly, and Gilligan ”Preoperational stage” from two to seven years drew up her own model for women. The Stages of Life: A Groundbreaking Dis- ”Preconventional stage,” where moral decisions covery: the Steps to Psychological Maturity. New York: are based on how they themselves are affected Atlantic Monthly Press, 1995. The Developing Person Through the ”Conventional stage,” where moral judgments are Life Span. Developmental stages, theories of famous theories of developmental psychology was put forth by the psychological theorist Erik Erikson in The various stages developmental psychologists theorize people go through as they develop from 1963 in his important work Childhood and Society. The first of grown adult, focusing mainly on the factors that con- Erikson’s stages is “trust versus mistrust” and occurs tribute to intelligence, personality, morality, and from birth to 1 years. Of special interest are the effects certain stimuli ing or mistrusting relationship to the world around it, have on the development of humans. These genetics pre-program a person to be introverted, or is needs, at this young age, generally have to do with satis- that personality trait the result of specific life events that faction of physical cravings (food, sleep, and comfort) caused him or her to retreat inward? Here, young children learn to Over the past hundred years or so, several promi- be independent and autonomous on the condition that nent psychologists and psychiatrists have devised vari- they are adequately encouraged to explore their world ous theories seeking to quantify the developmental and given the freedom to do so. On the other hand, chil- stages humans pass through, and in doing so, have dren with overly restrictive or anxious parents who wield sought to map out this difficult process. According to Piaget, and to many who Between the ages of three and six, children pass believe in his framework, not everyone reaches this stage through the stage Erikson refers to as “initiative versus of cognitive development. The guilt comes about when there are unexpected culture-based phenomena and that in less technological consequences involved in these initiations. The final societies, almost no one reaches the stage—mainly be- stage of childhood development is called “industry ver- cause such thinking is not valued or even necessary. Here, children seek to become industrious in all areas of life, A final theory dealing with developmental psychol- from school to interpersonal relations. Mastery of these ogy was devised by Lawrence Kohlberg and presented skills, with adequate support at home and in school, in his 1981 book The Philosophy of Moral Development: brings about a sense of overall competence, whereas fail- Moral Stages and the Idea of Justice. He called the earli- Another prominent theorist in developmental psy- est stage the “preconventional. He theorized that people pass Something is “right,” in other words, if they are not like- from one stage to another not just as a matter of course, ly to be punished for doing it. The next level is the “con- but only when they are confronted with the correct type ventional” stage. Piaget believed that in moral judgments on the conventions of society (or of the absence of the correct kinds of stimulation, children family or religion or some other social order). Many people do children are in the “sensorimotor” stage of cognitive de- not pass beyond the conventional level of moral reason- velopment. They also have little or no ability for “post-conventional level,” where moral judgments are what is called symbolic representation, that is, the ability based on personal beliefs. People in this stage of moral to conceive of things existing outside of their immediate development will do what they consider is “right” even vicinity. In this stage, children begin to use lan- guage and other representational systems to conceive of, Further Reading and even discuss, things or people who are not physically Marse, Michele Black. That is, preoperational children can conceive of things that are not present, but they can not conceive of others perceiving what they can not. The classic example of this kind of thinking is the young child John Dewey who in order to hide simply covers his eyes, thinking that since he can no longer see, no one else can either. Dur- dently before entering the graduate program in philosophy ing the formal operational stage, from age 12 to adult- at Johns Hopkins University. In contrast, functionalism sought to consider the total organism as it functioned in the environment—an active perceiver rather than a passive receiver of stimuli. Dewey was also an educational reformer and a pio- neer in the field of educational psychology. Paralleling his philosophical and psychological theories, his concept of instrumentalism in education stressed learning by doing, as opposed to authoritarian teaching methods and rote learning. Dewey’s ideas have remained at the center of much educational philosophy in the United States. While at the University of Chicago, Dewey founded an experimental school to develop and study new educa- tional methods, a project that won him both fame and controversy. He experimented with educational curricula and methods, successfully combining theory and prac- tice, and also pioneered in advocating parental participa- tion in the educational process. His first influential book on education, The School and Society (1899), was adapt- ed from a series of lectures to parents of the pupils in his school at the University of Chicago. During his time at Columbia, he continued working on the applications of psychology to problems in education, and his work in- fluenced educational ideas and practices throughout the world. Dewey served as president of the American Psy- writings on educational theory and practice were widely chological Association from 1899 to 1900 and was the read and accepted. He held that the disciplines of philoso- first president of the American Association of University phy, pedagogy, and psychology should be understood as Professors in 1915. In the following years, mentalist” theory of knowledge, in which ideas are seen to Dewey surveyed educational practices in several foreign exist primarily as instruments for the solution of problems countries, including Turkey, Mexico, and the Soviet encountered in the environment. After his retirement in 1930, Dewey continued Dewey’s work at the University of Chicago between his writing and his advocacy of political and educational 1894 and 1904—together with that of his colleague, causes, including the advancement of adult education. Rowland Angell (1869-1949)—made that institution a Among Dewey’s large body of writings are: Applied world-renowned center of the functionalist movement in Psychology: An Introduction to the Principles and Prac- psychology.

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Table 16–4 provides a However purchase kamagra soft 100mg with mastercard, instruments developed for a research listing of applications of King’s work in relation to study rarely undergo the rigor of research the nursing process and to nursing languages cheap kamagra soft 100mg. King (1988a) developed the Health Development of middle-range theories is a natural Goal Attainment instrument 100 mg kamagra soft visa, designed to detail the extension of a conceptual framework. Middle- level of attainment of health goals by individual range theories, clearly developed from within a clients. The Family Needs Assessment Tool was de- conceptual framework, accomplish two goals: (1) veloped by Rawlins, Rawlins, and Horner (1990). Such theories can be directly applied to nursing sit- Table 16–6 provides a listing of instruments devel- uations, whereas a conceptual framework is usually oped in relation to King’s work. Additional evidence of the scope and usefulness of In addition to the midrange Theory of Goal King’s framework and theory is its use with clients Attainment (King, 1981), several other midrange across the life span. Several applications have tar- theories have been developed from within King’s geted high-risk infants (Frey & Norris, 1997; Norris Interacting Systems framework. Hanna (1993) investigated the effect of systems (the nursing staff and hospital environ- nurse-client interactions on oral-contraceptive ad- ment). Interestingly, these theory is their utility in encompassing complex set- studies considered personal systems (infants), in- tings and situations. Kenny (1990) also studied the 1988), and renal procedures (Hanucharurnkui role of the elderly in their care. Gender-specific work in- ied the “impact of information on the health be- cluded Sharts-Hopko’s (1995) use of concepts haviors of older adults” (p. Clearly, focus of care (client system) and/or focus of health these applications, and others, show how the problem (phenomenon of concern). The focus of complexity of King’s framework and midrange the- care, or interest, can be an individual (personal sys- ory increases its usefulness for nursing (refer to tem) or group (interpersonal or social system). Thus, application of King’s work, across client sys- tems, would be divided into the three systems iden- Client Systems tified within King’s Interacting Systems Framework A major strength of King’s work is that it can (1981): personal (the individual), interpersonal be used with virtually all client populations. Frey addition, applications proposed the Theory of and Norris (1997) used both the Interacting Sys- Goal Attainment as the practice model for case tems Framework and Theory of Goal Attain- management (Hampton, 1994; Tritsch, 1996). The earliest 1995a) and revised into a Theory of Group Power applications involved the use of the framework and within Organizations (2003). Educational settings, theory to guide continuing education (Brown & also considered as social systems, have also been Lee, 1980) and nursing curricula (Daubenmire, the focus of application of King’s work (Bello, 1989; Gulitz & King, 1988). Table 16–9 sum- marizes applications related to clients’ phenomena Phenomena of Concern to Clients of concern; the table also groups these applications, Within King’s work, it is critically important for the primarily identified by disease or medical diagno- nurse to focus on, and address, the phenomenon of sis, as illness management. Without this emphasis on the Health is one area that certainly binds clients client’s perspective, mutual goal-setting cannot and nurses. Hence, a client’s phenomena of concern was end point, or outcome, of nursing care and selected as neutral terminology that clearly demon- something to which clients aspire. In addition, Frey applications, tends to support the goal of improved (1996) expanded her research to include risky health directly and/or indirectly, as the result of the behaviors. Health status is explic- As stated previously, diseases or diagnoses are itly the outcome of concern in practice applica- often identified as the focus for the application of tions by Smith (1988). For example, Kohler (1988) conducted research with patients with broncho- focused on increased morale and satisfaction, and pneumonia, while patients with end-stage renal DeHowitt (1992) studied well-being. In Health promotion has also been an emphasis for addition, clients with chronic inflammatory bowel the application of King’s ideas. The experience of parenting was studied by concerns have also been the focus of work, using Norris and Hoyer (1993), and health behaviors King’s conceptualizations (Murray & Baier, 1996; were Hanna’s (1995) focus of study. Clients’ concerns ranged from King (1981) stated that individuals act to main- psychotic symptoms (Kemppainen, 1990) to fami- tain their own health. Although not explicitly lies experiencing chronic mental illness (Doornbos, stated, the converse is probably true as well: 2002) to clients in short-term group psychotherapy Individuals often do things that are not good for (Laben, Sneed, & Seidel, 1995). Accordingly, it is not surprising that eates applications related to clients’ phenomena the Interacting Systems Framework and related of concern. Frey (1997), Frey and Denyes (1989), and Frey and Fox Multicultural applications of King’s Interact- (1990) looked at both health behaviors and illness ing Systems Framework and related theories are management behaviors in several groups of chil- many. King’s framework and theory for transcultural Applications of the framework and related theories nursing. Spratlen (1976) drew heavily from King’s have been documented in the following countries framework and theory to integrate ethnic cultural beyond the United States: Canada (Coker et al. Key Sugimori, 1992), Portugal (Moreira & Arajo, 2002; elements derived from King’s work were the focus Viera & Rossi, 2000), and Sweden (Rooke, 1995a, on perceptions and communication patterns that 1995b). In Japan, a culture very different from the motivate action, reaction, interaction, and transac- United States with regard to communication style, tion. Rooda (1992) derived propositions from the Kameoka (1995) used the classification system of midrange Theory of Goal Attainment as the frame- nurse-patient interactions identified within the work for a conceptual model for multicultural Theory of Goal Attainment (King, 1981) to analyze nursing. In addition to research Cultural relevance has also been demonstrated and publications regarding the application of in reviews by Frey, Rooke, Sieloff, Messmer, and King’s work to nursing practice internationally, Kameoka (1995) and Husting (1997). King have been Husting identified that cultural issues were implicit translated into other languages, including Japanese variables throughout King’s framework, particular (King, 1976, 1985; Kobayashi, 1970). Therefore, attention was given to the concept of health, which, perception and the influence of culture on percep- according to King (1990), acquires meaning from tion were identified as strengths of King’s theory. Table 16–10 lists applications of King’s work in Undoubtedly, the strongest evidence for the countries outside the United States. The theory and conceptual model also can apply in various situations relevant to nursing work and Work Settings administration. An additional source of division within the nursing profession is the work sites where nursing is prac- Nursing Specialties ticed and care is delivered. As the delivery of health care moves from the more traditional site of the A topic that frequently divides nurses is their area acute care hospital to community-based agencies of specialty. However, by using a consistent frame- and clients’ homes, it is important to highlight work across specialties, nurses would be able to commonalities across these settings, and it is im- focus more clearly on their commonalities, rather portant to identify that King’s framework and than highlighting their differences. A review of the midrange Theory of Goal Attainment continue to literature clearly demonstrates that Dr. King’s framework and related theories have application within a variety of nursing specialties (see Table Although many applications tend to be 16–11). This application is evident whether one is with nurses and clients in traditional reviewing a “traditional” specialty, such as medical- settings, successful applications have surgical nursing (Gill et al. Two specific ex- be with nurses and clients in traditional settings, amples of this include the application of King’s successful applications have been shown across work to case management (Hampton, 1994; Sowell other, including newer and nontraditional, settings. Both case management and & Rasi, 1990; Lockhart, 2000) to nursing homes managed care incorporate multiple disciplines as (Zurakowski, 2000), King’s framework and related they work to improve the overall quality and cost theories provide a foundation on which nurses can efficiency of the health care provided. Table 16–12 lists cations also address the continuum of care, a prior- applications within a variety of nursing work ity in today’s health-care environment. This use of knowledge across disciplines occurs frequently and can be very ap- Obviously, new nursing knowledge has resulted propriate if both disciplines’ perspectives are simi- from applications of King’s framework and theory.

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Encourage client to talk about feelings he or she was having just prior to this behavior buy 100mg kamagra soft with mastercard. To problem-solve the situation with the client buy cheap kamagra soft 100 mg on line, knowledge of the precipitating factors is important 100mg kamagra soft visa. Act as a role model for appropriate expression of angry feel- ings and give positive reinforcement to the client when at- tempts to conform are made. It is vital that the client express angry feelings, because suicide and other self-destructive behaviors are often viewed as a result of anger turned inward on the self. Try to redirect violent behavior with physical outlets for the client’s anxiety (e. Have sufficient staff available to indicate a show of strength to the client if necessary. This conveys to the client evidence of control over the situation and provides some physical security for staff. Administer tranquilizing medications as ordered by physi- cian or obtain an order if necessary. Monitor the client for effectiveness of the medication and for the appearance of adverse side effects. Tranquilizing medications such as anxiolytics or antipsychotics may have a calming effect on the client and may prevent aggressive behaviors. Use of mechanical restraints or isolation room may be required if less restrictive interventions are unsuccessful. Follow policy and procedure prescribed by the institu- tion in executing this intervention. The physician must reevaluate and issue a new order for restraints every 4 hours for adults and every 1 to 2 hours for children and adolescents. Observe the client in restraints every 15 minutes (or according to institutional policy). Ensure that circulation to extremities is not compromised (check temperature, color, pulses). Position the client so that com- fort is facilitated and aspiration can be prevented. May need to assign staff on a one-to-one basis if warranted by acuity of the situation. Clients with borderline personal- ity disorder have extreme fear of abandonment; leaving them alone at such a time may cause an acute rise in level of anxiety and agitation. Client verbalizes community support systems from which as- sistance may be requested when personal coping strategies are unsuccessful. It is an alerting signal that warns of impending danger and enables the individual to take measures to deal with threat. Possible Etiologies (“related to”) Threat to self-concept Unmet needs [Extreme fear of abandonment] Unconscious conflicts [associated with fixation in earlier level of development] Defining Characteristics (“evidenced by”) [Transient psychotic symptoms in response to severe stress, manifested by disorganized thinking, confusion, altered com- munication patterns, disorientation, misinterpretation of the environment] [Excessive use of projection (attributing own thoughts and feel- ings to others)] [Depersonalization (feelings of unreality)] [Derealization (a feeling that the environment is unreal)] [Acts of self-mutilation in an effort to find relief from feelings of unreality] Goals/Objectives Short-term Goal Client will demonstrate use of relaxation techniques to maintain anxiety at manageable level. Long-term Goal Client will be able to recognize events that precipitate anxiety and intervene to prevent disabling behaviors. Clients with borderline personality disorder often resort to cutting or other self-mutilating acts in an effort to relieve the anxiety. If injury occurs, care for the wounds in a matter-of-fact manner without providing reinforcement for this behavior. During periods of panic anxiety, stay with the client and provide reassurance of safety and security. Administer tranquilizing medications as ordered by physi- cian, or obtain order if necessary. Monitor client for effec- tiveness of the medication as well as for adverse side effects. Confronting misinterpretations honestly, with a car- ing and accepting attitude, provides a therapeutic orienta- tion to reality and preserves the client’s feelings of dignity and self-worth. Help him or her recognize ownership of these feelings rather than pro- jecting them onto others in the environment. Exploration of feelings with a trusted individual may help the client per- ceive the situation more realistically and come to terms with unresolved issues. Client may feel totally abandoned when nurse or therapist leaves at shift change or at end of therapy session. It is extremely important for more than one nurse to develop a therapeutic relationship with the borderline client. It is also necessary that staff maintain open communication and consistency in the provision of care for these individu- als. Individuals with borderline personality disorder have a tendency to cling to one staff member, if allowed, transfer- ring their maladaptive dependency to that individual. This dependency can be avoided if the client is able to establish therapeutic relationships with two or more staff members who encourage independent self-care activities. Client is able to verbalize events that precipitate anxiety and demonstrate techniques for its reduction. Possible Etiologies (“related to”) [Maternal deprivation during rapprochement phase of develop- ment (internalized as a loss, with fixation in the anger stage of the grieving process)] Defining Characteristics (“evidenced by”) Persistent emotional distress [Anger] [Internalized rage] Depression [Labile affect] [Extreme fear of being alone (fear of abandonment)] [Acting-out behaviors, such as sexual promiscuity, suicidal gestures, temper tantrums, substance abuse] [Difficulty expressing feelings] [Altered activities of daily living] [Reliving of past experiences with little or no reduction of intensity of the grief] [Feelings of inadequacy; dependency] Goals/Objectives Short-term Goal Client will discuss with nurse or therapist maladaptive patterns of expressing anger. Long-term Goal Client will be able to identify the true source of angry feelings, accept ownership of these feelings, and express them in a so- cially acceptable manner, in an effort to satisfactorily progress through the grieving process. Convey an accepting attitude—one that creates a nonthreat- ening environment for the client to express feelings. An accepting attitude conveys to the client that you believe he or she is a worthwhile person. Verbalization of feelings in a nonthreatening envi- ronment may help the client come to terms with unresolved issues. Encourage client to discharge pent-up anger through par- ticipation in large motor activities (e. Physical exercise provides a safe and effective method for discharging pent-up tension. This is pain- ful therapy that often leads to regression as the client deals with the feelings of early abandonment. It seems that some- times the client must “get worse before he or she can get bet- ter. As anger is displaced onto the nurse or therapist, caution must be taken to guard against the negative effects of coun- tertransference. These are very difficult clients who have the capacity for eliciting a whole array of negative feel- ings from the therapist. The existence of negative feel- ings by the nurse or therapist must be acknowledged, but they must not be allowed to interfere with the therapeutic process.

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