By S. Lisk. Meredith College. 2019.
Consequently cheap 100mg nemasole overnight delivery, newer cost systems order nemasole 100mg on-line, such work and charitable religious organizations as managed care purchase nemasole 100 mg with amex, do not look at human caring (Dolan generic nemasole 100 mg fast delivery, 1985). Prior to the establishment of or the nurse-patient relationship when allocating Medicare and Medicaid in 1965, the health-care resource dollars for reimbursement. Nursing Historically, nursing care delivery has not been students subsidized hospitals, and hospital-based ﬁnanced or costed out in terms of reimbursement nursing care was not considered a reimbursable as a single entity. As nursing education As a result of the prospective payment system, moved away from the hospital setting to universi- hospital administrators were pressured to increase ties in the late 1950s and as the role of the student efficiency, reduce costs, and maintain quality. Research was con- the retrospective reimbursement of Medicare ducted in order to examine the costs associated and Medicaid in 1965 allowed for hospital prof- with nursing (Bargagliotti & Smith, 1985; Curtin, itability and the issue of nursing care costs was not 1983; McCormick, 1986; Walker, 1983). Hospital administrators were under process did not include the humanistic, caring considerable pressure to control costs. It Foshay (1988) investigated 20 registered nurses’ was assumed that the rising costs of health care perceptions of caring activities and the ability of were due to nurses’ salaries and the number of reg- patient classiﬁcation systems to measure these car- istered nurses (Walker, 1983). Findings from this study revealed that a percent of hospital charges could not be identi- patient classiﬁcation systems could not address the ﬁed, because historically they had been tied to the emotional needs of patients, the needs of the eld- room rate. Speciﬁc car- care costs continued to rise and did not follow ing behaviors that could not be measured included traditional economic patterns. Cost-based reim- giving a reassuring presence, attentive listening, and bursement altered the forces of supply and de- providing information. In the traditional economic marketplace, Other research of this time period focused on when the price of a product or service goes up, the the cost and outcomes of all registered nurse demand decreases and consumers seek alternatives stafﬁng patterns (Dahlen & Gregor, 1985; Glandon, at lower prices (Mansﬁeld, 1991). However, in the Colbert, & Thomasma, 1989; Halloran, 1983; health-care marketplace, consumers did not seek Minyard, Wall, & Turner, 1986). These studies an alternative as the price of hospital-based care showed that nursing units staffed with more regis- continued to rise (DiVestea, 1985). This imbalance tered nurses had decreased costs per nursing diag- of the supply-and-demand curve occurred because nosis, increased patient satisfaction, and decreased consumers paid little out-of-pocket expense for length of stay. Government expenditure for the cost- Helt and Jelinek (1988) examined registered based reimbursement system was predicted to nurse stafﬁng in ﬁve different hospitals over two bankrupt Social Security by 1985 unless changes years. It was shown that, al- Economic Implications though the acuity of hospitalized patients in- of Bureaucratic Caring creased, the average length of stay dropped from 9. Nursing produc- Theory: Research in tivity improved and quality of care scores increased Current Atmosphere with the increased registered nurse stafﬁng. The of Health-Care Reform higher costs of employing registered nurses was off- set by the productivity gains, and the hospitals net- Investigation of the economic dimension of bu- ted an average of 55 percent productivity savings reaucratic caring is being explicated in part in nurs- (Helt & Jelinek, 1988). Findings from these research Hospital administrators had made budgeting studies have been valuable when linking the con- and operating decisions based on the undocu- cepts of politics, economics, caring, cost, and qual- mented belief that nursing care accounted for 30 ity in the new paradigm of health-care delivery. However, Although caring and economics may seem para- documented nursing research showed this assump- doxical, contemporary health-care concerns em- tion to be in error. A study conducted at Stanford phasize the importance of understanding the cost University Hospital found that actual nursing costs of caring in relation to quality. Similarly, the Ray (1981, 1987, 1989), Ray and Turkel (2000, Medicus Corporation funded a study in which data 2001, 2003), Turkel (1997, 2001), and Valentine were collected from 22 hospitals and 80,000 patient (1989, 1991, 1993) have examined the paradox be- records. Direct nursing care costs represented, tween the concepts of human caring and econom- on average, only 17. However, any bursement and operating room nursing costs, efforts to reshape the health-care system in our nursing represented only 11 percent of the total country must take into account the value of caring. Nyberg’s (1990) research ﬁndings indicated that By the time nursing researchers had demon- nurses were extremely frustrated over the economic strated the difﬁculty of costing out caring activities pressures of the past ﬁve years but that human care with patient classiﬁcation systems and the effective- was present in nurses’ day-to-day practice. With the nurses see human care as their responsibility and introduction of managed care and increased corpo- goal. One ment was changing faster than nurse researchers nurse administrator proposed “caring as the mis- could document the impact of these changes on sion of the hospital with economic and manage- clinical practice. Although there were organiza- industry is now faced with a shortage of registered tional differences, results showed a high correlation nurses. According to statistics provided by the of caring attributes among the various settings. Department of Interviews conducted with nurses indicated a con- Health and Human Services (2000), over the next cern that their “ability to be caring was in jeopardy. These nurses felt that the practice these studies did not merge economic concepts into of caring was being seriously threatened by the nursing research or theory. As the nursing practice economic pressure associated with health-care environment has continued to change, new re- changes. Foa (1971), an ex- Narrative examples of the attribute, exchanging change theorist, designed an economic theory that commodity values, were “making caring tangible” and “patient care is a commodity (economic good could bridge the gap between economic and or value). In this model, noneco- gotiating the politics were “the nurse administrator nomic resources (love, status, and information) is a system coordinator, nurses are the system and were correlated with economic resources (money, know what impinges on them,” and “nurses are po- goods, and services). The philosophical framework of quality care is located in the reciprocal actions of the economic dimension of bureaucratic caring has the interpersonal nurse-patient relationship served in part as the basis for this type of needed (Hoggard-Green, 1995). Turkel (1997) interviewed nurses, ethnographic approach to study nurse-patient in- patients, and administrators from the for-proﬁt teractions in the critical care environment. The sector to examine the process involved in the devel- subsequent theme generated among all categories opment of the nurse-patient relationship as an of interaction was the nurse-patient relationship. This research was conducted a qualitative study, Price (1993) examined the as managed care penetration was having an enor- meaning of quality nursing care from the perspec- mous impact on the current health-care delivery tive of parents of hospitalized children. The basic ing as a result of health-care reform and managed care, nurses are ﬁnding themselves in a period of transition, moving from traditional in-patient hos- The basic social process of the nurse- pital practice to community-based practice. In a re- patient relationship as an economic re- search study conducted by Turkel, Tappen, and Hall source was struggling to ﬁnd a balance, (1999), the development of a positive nurse-patient which referred to sustaining the caring relationship was shown to be seen as a reward for ideal in a new reality controlled by costs. The research’s long-term goal qualitative interviews were accomplished in not- is to establish caring as an economic interpersonal for-proﬁt and military sectors of the health-care resource. The purpose of this research was to through empirical nursing research, that hospitals continue the study of the nurse-patient relation- with a higher organizational caring score have in- ship as an economic interpersonal resource. Findings from this study identiﬁed that the nurse- patient relationship was both outcome and process. Categories, which emerged during data analysis, Economic/Political Implications included relationships, caring, and costs. The formal nomic dimension of bureaucratic caring can be theory of relational caring complexity illustrated used to guide administrative practice within that the caring relationship between the nurse, the health-care organizations. As a dimension of her patient, and the administrator is complex and research, Turkel (1997) interviewed eight top-level cocreative, is both process and outcome, and is hospital and corporate-level administrators to gain a function of a set of economic variables and a an understanding of how they viewed the experi- set of nurse-patient relational caring variables. Economic variables are depicted as time, technical, Administrators were chosen to be interviewed be- and organizational resources. Nurse-patient rela- cause they make the ultimate decision on how to al- tional caring variables are caring, relationships, and locate scarce human and economic resources education (Turkel & Ray, 2000). One administrator (1999) developed and tested a professional and shared the following with the researcher: patient questionnaire designed to measure organi- zational caring. The Organizational Caring ques- Lying in a bed like that, people feel vulnerable and are vulnerable, and they want to know that someone is tionnaire is a 26-item professional and an 18-item there for them and will share with them what’s going patient questionnaire designed from qualitative on. I hear [patients research (Ray & Turkel, 1995, 1997, 1999) and vali- say] that my nurse cared, she listened, and she kept dated and established as reliable through quantita- me informed. The three positive comments I receive from patients have to do subscales are caring, trust, and economics. What comes back to me questionnaire has been distributed in ﬁve different is they cared about me, they took time to talk to me, hospitals to over 500 participants. Given this, professional nursing practice remains in the forefront of organizational proﬁt- must embrace and illuminate the caring philosophy. The issue of time constraints Staff nurses describe the essence of nursing as and inadequate stafﬁng has been identiﬁed as prob- the caring relationship between nurse and patient lematic. However, nurses are practicing hindrance to forming a caring nurse-patient rela- in an environment where the economics and costs tionship. This points out the need for administra- of health care permeate discussions and clinical de- tors to restructure the organization so that the cisions. The focus on costs is not a transient re- maximum of nursing time is focused on direct sponse to shrinking reimbursement; instead, it has nurse-patient interactions. Hospital administrators become the catalyst for change within corporate desire high levels of quality care and see ﬁnancial health-care organizations. With a system goal of decreasing administrators must maintain adequate stafﬁng ra- length of stay and increasing stafﬁng ratios, nurses tios in order to allow time for nurses to be with need to establish trust and initiate a relationship their patients. As this In the research conducted by Turkel and Ray relationship is being established, nurses need to (2000, 2001, 2003), administrator participants con- focus on being, knowing, and doing all at once ﬁrmed the above but also discussed the concomi- (Turkel, 1997) and being there from a patient per- tant need for maintaining care and quality. For the nurses, this means completing a challenge facing administrators in a managed care task while simultaneously engaging with a patient.
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These are problems developed a fear of hospitals order 100 mg nemasole with amex, blood buy generic nemasole 100mg on-line, and even the scent that might take more than the usual eight to ten sessions a of ether buy nemasole 100 mg online, which made him feel as if he would faint order 100mg nemasole with visa. Even- relatively simple case of depression would take to re- tually, he overcame those fears rationally. Beck insists that his cognitive approach can be to be concerned about the faint feeling, but just to keep used to treat psychotic disorders,even those as serious active,” he later recounted. A prolific writer, Beck has authored several books and articles both on his own as well as under collaboration. His books include Prisoners of Hate (1999), Depression: Clinical, Experimental, and Theoretical (1980), Cognitive Therapy and the Emotion- al Disorders (1979), and Depression: Causes and Treat- ment (1972). The Beck Depression Inventory and Scale for Suicide Ideation are among two of the widely used tools that he developed for use by therapists. After the publication of this work, and with the general support of the medical community, Beers became a leading fig- Clifford Beers ure in the movement to reform the treatment of, and at- 1876-1943 titudes toward, mental illness. In the same year his American reformer and founder of the mental hy- book was published, Beers founded the Connecticut giene movement. Society for Mental Hygiene (a name suggested by the psychologist Adolf Meyer, another supporter of Clifford Whittingham Beers was born in New Beers’s efforts). This organization lobbied for im- Haven, Connecticut, studied at Yale University, and proved treatment of mental patients and heightened began a professional career in the insurance industry. In 1909, Beers or- 1900 he was institutionalized for a mental breakdown ganized the National Committee for Mental Hygiene after a suicide attempt and diagnosed as manic-depres- and served as its secretary until 1939. Confined to both public and private institutions establish the American Foundation for Mental Hygiene over a three-year period, Beers found the treatment of in 1928. When his ef- Beers’s influence eventually spread beyond the forts to complain directly to hospital administrators United States. Hincks were ignored, Beers smuggled letters out to state offi- found a mental hygiene society in Canada, the Canadian cials, and his efforts met with some success. Beers was ac- Beers was able to return to his career, but continued to tive in organizing the International Congress on Mental work on behalf of reforming the treatment of the men- Health in 1930, and three years later received an award tally ill. Beers’s autobiogra- a popular autobiographical study of his confinement phy remained popular and influential, having gone into and recovery, which was praised by the prominent psy- 26 printings by the time of his death in 1943. A treatment approach, based on the principles of operant conditioning, that replaces undesirable be- haviors with more desirable ones through positive This famous urban legend was perpetuated by a or negative reinforcement. The box was, in fact, a cli- Behavior modification is based on the principles of mate-controlled, baby-sized room that Skinner built, operant conditioning, which were developed by Ameri- called the “aircrib. In his research, sorbing wood, had a humidifier, an air filter, and was he put a rat in a cage later known as the Skinner Box, in temperature-controlled by a thermostat. Dissatisfied which the rat could receive a food pellet by pressing on a with traditional cribs, Skinner built the box to keep his bar. The food reward acted as a reinforcement by new daughter warm, safe, and quiet without having to strengthening the rat’s bar-pressing behavior. Skinner was quoted in studied how the rat’s behavior changed in response to dif- New Yorker magazine as saying his daughter “…spent fering patterns of reinforcement. By studying the way the most of the next two years and several months there, rats “operated on” their environment, Skinner formulat- naked and happy. The Skinner considered his discovery applicable to a wide box-like structure and people’s misunderstandings about range of both human and animal behaviors and intro- behavioral psychology contributed to the misconception duced operant conditioning to the general public in his that Skinner was experimenting on his daughter and also 1938 book, The Behavior of Organisms. People got the impression that Skinner was raising his child in a box similar to the kind he used to of problems in both adults and children. One behavior modification technique that is widely Behavior therapy used is positive reinforcement, which encourages certain behaviors through a system of rewards. In behavior ther- A goal-oriented, therapeutic approach that treats emotional and behavioral disorders as maladaptive apy, it is common for the therapist to draw up a contract learned responses that can be replaced by healthier with the client setting out the terms of the reward system. In addition to rewarding desirable behavior, behav- ior modification can also discourage unwanted behavior, In contrast to the psychoanalytic method of Sig- through either negative reinforcement, or punishment. The removal of reinforcement altogether is called havior therapy focuses on observable behavior and its extinction. This technique re- work, including the classical conditioning principles of moves the expected reward of parental attention. Behavior Modification: What It Is and How to concept of operant conditioning, in which behavior is Do It. By the Further Information 1970s, behavior therapy enjoyed widespread popularity Association for the Advancement of Behavior Therapy. Handbook of As an initial step in many types of behavioral thera- Behavior Therapy with Children and Adults: A Develop- py, the client monitors his or her own behavior carefully, mental and Longitudinal Perspective. The therapist’s role is often similar to An Empirical Approach to Mental Health Problems. Behavior Therapy: work assignments” and provides advice and encourage- Application and Outcome. A number of specific techniques are commonly used Further Information in behavioral therapy. Human behavior is routinely moti- Association for the Advancement of Behavior Therapy. Rules are established that specify particular behaviors that are to be reinforced, and a reward system is set up. With children, this sometimes takes the form of Behaviorism tokens that may be accumulated and later exchanged for A theory of human development initiated by Amer- certain privileges. Just as providing reinforcement ican educational psychologist Edward Thorndike, strengthens behaviors, withholding it weakens them. For example, a child who ha- Behaviorism is a psychological theory of human de- bitually shouts to attract attention may be ignored unless velopment that posits that humans can be trained, or con- he or she speaks in a conversational tone. The client is exposed to an that humans and animals acquire behaviors through the unpleasant stimulus while engaged in or thinking about association of stimuli and responses. Eventually the behavior itself laws of learning to explain why behaviors occur the way becomes associated with unpleasant rather than pleasant they do: The Law of Effect specifies that any time a be- feelings. One treatment method used with alcoholics is havior is followed by a pleasant outcome, that behavior the administration of a nausea-inducing drug together is likely to recur. The Law of Exercise states that the with an alcoholic beverage to produce an aversion to the more a stimulus is connected with a response, the taste and smell of alcohol by having it become associat- stronger the link between the two. In counterconditioning,amaladaptive 1936) groundbreaking work on classical conditioning response is weakened by the strengthening of a response also provided an observable way to study behavior. A well-known type of coun- though most psychologists agree that neither Thorndike terconditioning is systematic desensitization, which nor Pavlov were strict behaviorists, their work paved the counteracts the anxiety connected with a particular be- way for the emergence of behaviorism. This method is often used in the treatment of The birth of modern behaviorism was championed people who are afraid of flying. Modeling, another treat- early in the 20th century by a psychologist at Johns Hop- ment method, is based on the human tendency to learn kins University named John Watson. A desired behavior is Behaviorism, Watson made the notorious claim that, performed by another person while the client watches. Freudian psychoanalytical theories of development, which many people found threatening. Watson’s scheme rejected all the hidden, unconscious, and suppressed longings that Freudians attributed to behaviors and posit- Bender-Gestalt Test ed that humans respond to punishments and rewards. Be- havior that elicits positive responses is reinforced and Diagnostic assessment test to identify learning dis- ability, neurological disorders, and developmental continued, while behavior that elicits negative responses delay. The complete name of this test is Bender Visual Skinner (1904-1990) who deduced the evolution of Motor Gestalt Test. It is a test used with all age groups to human behavior by observing the behavior of rats in a help identify possible learning disabilities, neurological maze. Skinner even wrote a novel, Walden Two, about a disorders, mental retardation, or developmental delay. Utopian society where human behavior is governed to- Test results also provide information about specific abili- tally by self-interested decisions based on increasing ties, including motor coordination, memory, and organi- pleasure. The test-taker is given a series of nine designs, many to believe that behaviorism could indeed produce each on a separate card, and asked to reproduce them on such a society. The test is In the 1950s, however, the popularity of behaviorism scored by professionals who consider a variety of fac- began to decline. The first sustained attack on its tenets tors, including form, shape, pattern, and orientation on was made by Noam Chomsky (1928-), a renowned lin- the page.