Mark Corson

By N. Hamlar. Benedictine College. 2018.

Whatever the reason the responders come purchase dipyridamole 25mg without a prescription, the people to whom the services are being rendered should be cheap 25 mg dipyridamole with mastercard, and most ofen are dipyridamole 100mg free shipping, aware of the great sacrifces these responders are making. Te forces of nature are very powerful and can easily destroy man-made objects and take human lives. Transportation of large numbers of people presents the possibility for large-scale injuries and death if an accident occurs. Most of nature’s disasters come very quickly and surprise the unsuspecting population. Weather and seismic predictors have been employed and improved as early warning systems that have the potential to save countless lives. Other than warning and evacuation to safer areas, there are no dependable ways and means to prevent natural disasters. One of the services deemed most needed for the families is a Family Assistance Center to provide the family members with things necessary for their comfort and well-being. Many times transportation accidents involve fuels, toxic container rupture, or other complications creating extreme hazards for the responders. A safety and dental identifcation in multiple Fatality incidents 249 hazmat team is used to maximize responders’ safety and protect the health of the public. Te most common form of terrorism seen in current times involves some sort of explosive device used to kill and maim large numbers of people. Control of the scene and maintaining appropriate chain of evidence is of utmost importance. Tere should be an assigned position for scene security to ensure the integrity of the investigation. In other mass disaster scenarios law enforcement ofcers may be utilized to fll the position due to the nature of their formal training. Each team member should be instructed on the importance of following the instructions of the site security ofcer. Whether it involves a single building or half a city, the barriers controlling the perimeter should be well defned and visible to workers and the public. Experience has shown that it is easier to decrease the area of control than to increase it, making it wise to establish a generous perimeter in the opening phases of the operation. In the past it was found that simple grid sys- tems worked well with fat scenes, similar to an airplane crash on land. It has been found in recent incidents that when dealing with collapsed buildings and water settings, simple grids fail to give adequate information about elevation and return points of reference. A control system needs to be established early in the incident to allow access to the crime scene to only authorized personnel. Badge systems, periodic changes of codes, and photo identifcation have all been used to prevent unauthorized access. A security ofcer and an established security protocol should be the focus areas for all security-related questions. Te protocol should be required reading for all workers, who should avow that they have read and understood the policies in a signed document as a part of their indoctrination into the operation of the incident. Safety should be among the most important aspects in the management of a mass disaster site. Tere may be a large number of injured and dead individuals as a result of the disaster. Tere is no justifcation for adding to those numbers with responders who do not follow safe practices. A safety ofce should be created, and as in the security section, there should be a safety protocol developed, understood, and adhered to by the workers to prevent more injuries and loss of life. Te debris feld of an airplane crash or the resulting devastation of a detonation of a bomb in an urban setting yields situations and materials that are physically dangerous and potentially contaminated with dangerous substances. Te safety ofcer and the person responsible for hazardous materials (hazmat) should coordinate and estab- lish the safety of the site before responders enter the area. Te safety ofce dental identifcation in multiple Fatality incidents 251 should address the problem of proper decontamination of materials being sent to the morgue area. Tere are, in most cases, emergency plans of action in place by the local emergency response ofce to activate police, fre protection, and medical services. Tese local agencies should be in close communication and would be best organized if one person is assigned to supervise the operation. Tere should also be con- tingency plans for contacting outside resources for assistance if the situation becomes too complex for the local responders to handle. In times of natural disaster the state agencies work with their state governor to seek this aid through a presidential declaration. In the early and middle 1990s several complaints were lodged by family members of victims killed in airplane crashes. Te complaints revolved around poor treatment and lack of communication with the families. Congress felt strong enough about these complaints that they enacted the Family Assistance Act of 1996. Most of these units act as a resource for each country but work together in an inter- national response when needed. Trough training and establishment of response manuals this person is usu- ally defned for most local jurisdictions. Te problem arises when many state and federal agencies come together in a response role and then try to work as independent agencies. Any assignments within the command framework not delegated to others revert to the incident commander. In more complicated situations with many agencies involved, a modifed system can be implemented with a unifed command replacing a single incident commander.

The recency effect refers to the tendency to better remember stimuli that are presented later in a list safe 100mg dipyridamole. There are a number of explanations for primacy and recency effects generic dipyridamole 25mg free shipping, but one of them is in terms of the effects of rehearsal on short-term and long-term memory (Baddeley buy dipyridamole 100mg cheap, Eysenck, & [11] Anderson, 2009). Because we can keep the last words that we learned in the presented list in short-term memory by rehearsing them before the memory test begins, they are relatively easily remembered. So the recency effect can be explained in terms of maintenance rehearsal in short- term memory. And the primacy effect may also be due to rehearsal—when we hear the first word in the list we start to rehearse it, making it more likely that it will be moved from short-term to long-term memory. Retroactive interferenceoccurs when learning something new impairs our ability to retrieve information that was learned earlier. For example, if you have learned to program in one computer language, and then you learn to program in another similar one, you may start to make mistakes programming the first language that you never would have Attributed to Charles Stangor Saylor. In this case the new memories work backward (retroactively) to influence retrieval from memory that is already in place. In contrast to retroactive interference, proactive interference works in a forward direction. Proactive interference occurs when earlier learning impairs our ability to encode information that we try to learn later. For example, if we have learned French as a second language, this knowledge may make it more difficult, at least in some respects, to learn a third language (say Spanish), which involves similar but not identical vocabulary. Forming categories, and using categories to guide behavior, is a fundamental part of human nature. Associated concepts within a category are connected through spreading activation, which occurs when activating one element of a category activates other associated elements. For instance, because tools are associated in a category, reminding people of the word “screwdriver‖ will help them remember the word “wrench. If they have just remembered the word “wrench,‖ they are more likely to remember the word “screwdriver‖ next than they are to remember the word “dahlia,‖ because the words are organized in memory by category and because dahlia‖ is activated by spreading [12] activation from“wrench‖ (Srull & Wyer, 1989). Some categories have defining features that must be true of all members of the category. For instance, all members of the category “triangles‖ have three sides, and all members of the category “birds‖ lay eggs. But most categories are not so well-defined; the members of the category share some common features, but it is impossible to define which are or are not members of the category. Members of categories (even those with defining features) can be compared to the category prototype, which is the member of the category that is most average or typical of the category. Some category members are more prototypical of, or similar to, the category than others. For instance, some category members (robins and sparrows) are highly prototypical of the category “birds,‖ whereas other category members (penguins and ostriches) are less prototypical. We retrieve information that is prototypical of a category faster than we retrieve information that [13] is less prototypical (Rosch, 1975). Mental categories are sometimes referred to as schemas—patterns of knowledge in long-term memory that help us organize information. We have schemas about objects (that a triangle has three sides and may take on different angles), about people (that Sam is friendly, likes to golf, and always wears sandals), about events (the particular steps involved in ordering a meal at a restaurant), and about social groups (we call these group schemas stereotypes). Read the following paragraph (Bransford & Johnson, [14] 1972) and then try to write down everything you can remember. If you have to go somewhere else due to lack of facilities, that is the next step; otherwise you are pretty well set. It is difficult to foresee any end to the necessity for this task in the immediate future, but then one never can tell. After the procedure is completed, one arranges the materials into different groups again. Eventually they will be used once more and the whole cycle will then have to be repeated. It turns out that people‘s memory for this information is quite poor, unless they have been told ahead of time that the information describes “doing the laundry,‖ in which case their memory for the material is much better. This demonstration of the role of schemas in memory shows how our existing knowledge can help us organize new information, and how this organization can improve encoding, storage, and retrieval. When pathways in these neural networks are frequently and repeatedly fired, the synapses become more efficient in communicating with each other, and these changes create memory. Memory is not confined to the cortex; it occurs through sophisticated interactions between new and old brain structures (Figure 8. One of the most important brain regions in explicit memory is the hippocampus, which serves as a preprocessor and elaborator of information (Squire, [17] 1992). The hippocampus helps us encode information about spatial relationships, the context in which events were experienced, and the associations among memories (Eichenbaum, [18] 1999). The hippocampus also serves in part as a switching point that holds the memory for a short time and then directs the information to other parts of the brain, such as the cortex, to actually do the rehearsing, elaboration, and long-term storage (Jonides, Lacey, & Nee, [19] 2005). Without the hippocampus, which might be described as the brain‘s “librarian,‖ our explicit memories would be inefficient and disorganized. The hippocampus is particularly important in explicit memories, the cerebellum is particularly important in implicit memories, and the amygdala is particularly important in emotional memories. While the hippocampus is handling explicit memory, the cerebellum and the amygdala are concentrating on implicit and emotional memories, respectively. Research shows that the cerebellum is more active when we are learning associations and in priming tasks, and animals and humans with damage to the cerebellum have more difficulty in classical conditioning studies (Krupa, Thompson, & Thompson, 1993; Woodruff-Pak, Goldenberg, Downey-Lamb, Boyko, & [20] Lemieux, 2000). The storage of many of our most important emotional memories, and particularly those related to fear, is initiated and controlled by the amygdala (Sigurdsson, [21] Doyère, Cain, & LeDoux, 2007). As with memory interference effects, amnesia can work in either a forward or a backward direction, affecting retrieval or encoding.

Regardless buy generic dipyridamole 100mg online, the idea of knowing persons guiding a process that ultimately regards human beings as nursing practice is novel in the sense that there is “stuff” to care about cheap dipyridamole 25 mg mastercard, rather than as knowledgeable no prescription or direction that is the ideal; rather participants of their care order 100mg dipyridamole visa. Participating in his or her there is the wholesome appreciation of an in- care frees the person from having to be “assigned” a formed practice that allows the use of multiple care that he or she may not want or need. This re- ways of knowing such as described by Phenix lationship signifies responsiveness (Hudson, 1988). These ways Continuous knowing results from the contention of knowing involve the empirical, ethical, personal, that findings or information appreciated through and aesthetic. Aesthetic expressions document, consequent knowing further informs the desire to communicate, and perpetuate the appreciation of know “who is” and “what is” the person. Continuous knowing overpowers the mo- poetry, visual expressions as in drawings, illustra- tivation to prescribe and direct the person’s life. Encountering aes- her hopes, dreams, and aspirations as a participat- thetic expressions again allows the nurse and the ing human being. Calls for nursing sional practice grounded in a legitimate theoretical are individual expressions by persons who seek perspective of nursing. The nurse appreciates the uniqueness of to the contemporary demands for nursing actions persons in his or her nursing. There is no let- sustains and enhances the wholeness of the human ting up, because advancing technology currently being, while facilitating the realization of the per- encompasses the bulk of functional activities that sons’ completeness through “acting for or with” the nurses are expected to perform, particularly when person. These calls are specific mechanisms that persons use while allowing the nurse to respond with authentic intentions to know them fully as persons in the moment. Calls for nursing may be The purpose of this chapter is to describe and expressed in various ways, oftentimes as hopes and explain “knowing persons as whole,” a frame- dreams, such as hoping to be with friends while re- work of nursing guiding a practice grounded cuperating in the hospital, or desiring to play the in the theoretical construct of technological piano when his or her fingers are well enough to competency as caring in nursing (Locsin, function effectively, or simply the ultimate desire to 2004). As uniquely nates the harmonious relationship between as these calls for nursing are expressed, the nurse technology competency and caring in nurs- knows the person continuously moment to mo- ing. Assump- saving medications, institute transfer plans, or tions about human beings as persons, nurs- refer patients for services to other health-care ing as caring, and technological competency are presented as foundational to the process of knowing persons as whole in the mo- The entirety of nursing is to direct, focus, ment—a process of nursing grounded in the attain, sustain, and maintain the person. The entirety of nursing is to direct, The process of knowing persons as whole focus, attain, sustain, and maintain the person. In is explicated as technological efficiency in doing so, hearing calls for nursing is continuous nursing practice. The em- The process of knowing persons is continu- pirical, personal, ethical, and aesthetic ways of ous. In this process of nursing, with calls and knowing that are fundamental to understanding responses, the nurse and nursed come to persons as whole increase the likelihood of know- know each other more fully as persons in the ing persons in the moment. Grounding the process is the appre- ciation of persons as whole and complete in the moment, of human beings as unpre- As unpredictable and dynamic, human dictable, of technological competency as an beings are ever-changing moment to expression of caring in nursing, and of nurs- moment. This characteristic challenges the nurse References to know persons continuously as wholes, discour- Boykin, A. Nursing as caring: A model aging and ceasing the traditional conception of for transforming practice. New York: Jones and Bartlett, possibly knowing persons completely at once, in National League for Nursing Press. University, where she is founding director of the Workshops have been developed and conducted on Quantum Foundation Center for Innovation in critical thinking and competency skills for school School and Community Well-Being. Her writings include nursing values, is to enhance nursing practice and education inquiry groups for community assessments, and through nursing theory, using both innovative and cultural caring. Her current research includes traditional means to improve care and advance the the study of adiposity in children, health-care discipline. Parker received the President’s Leadership manuscript reviewer for the International Journal Award at Florida Atlantic University, recognizing of Human Caring. Parker’s active participation in nursing edu- she holds a bachelor’s degree in health administra- cation and health care in several countries led to tion, a master’s degree in nursing from Florida her 2001 Fulbright Scholar Award to Thailand. It is Atlantic University in Boca Raton, and a doctoral there that she continues to teach, consult, and par- degree from the University of Miami, Florida. She ticipate in research with Thai colleagues in devel- is nationally certified in school nursing. Her commitment to caring for underserved popu- Developing a Community lations and to health policy evaluation led to Nursing Practice Model: being named a National Public Health Leadership Institute Fellow and to being elected a distin- The Ideal and the Practical guished practitioner in the National Academies of Practice—Nursing. Parker is a fellow in the Developing the Community Nursing Practice American Academy of Nursing. Barry is an associate professor and to be a blend of, the ideal and the practical. The ideal associate director at the Quantum Foundation was the commitment of one of the authors to devel- Center for Innovation in School and Community oping and using nursing concepts to guide nursing Well-Being at the Florida Atlantic University practice, education, and scholarship, and of a desire Christine E. Barry to develop a nursing practice as an essential compo- serves on the Education Committee of the National nent of a nursing college. She has been active added commitment of the other author in bringing in the Florida Association of School Nurses since this model to life. The added efforts of faculty, staff 1996 and has served as president, treasurer, and and students contributed to the development model board member. Lynn College of Nursing multicultural communities and is accepted by local (Florida Atlantic University College of Nursing communities and providers as essential to the Philosophy and Mission, 1994/2003). In 2004, more than 10,000 per- The model’s initial conceptual framework also sons received primary health care and an additional grew out of the political reality that some concepts 12,000 participated in various health-promotion that were readily understood and valued by persons activities. This year also more than 100 undergrad- in the wider community must be used in order to uate, master’s, and doctoral students studied nurs- secure funding. The result was a proposal for a ing practice and research and eight nursing faculty demonstration project to develop a framework for practiced and conducted research guided by the nursing as primary health care and early interven- model.

Various methods of relaxation include the following: Deep-Breathing Exercises: Tension is released when the lungs are allowed to breathe in as much oxygen as pos- sible buy 100 mg dipyridamole free shipping. Deep-breathing exercises involve inhaling slowly and deeply through the nose purchase dipyridamole 25mg amex, holding the breath for a few seconds buy dipyridamole 25mg lowest price, then exhaling slowly through the mouth, pursing the lips as if trying to whistle. Progressive Relaxation: This method of deep-muscle re- laxation is based on the premise that the body responds to anxiety-provoking thoughts and events with muscle tension. Each muscle group is tensed for 5 to 7 seconds and then relaxed for 20 to 30 seconds, during which time the individual concentrates on the difference in sensa- tions between the two conditions. A modified version of this technique (called passive progressive relaxation) involves re- laxation of the muscles by concentrating on the feeling of relaxation within the muscle, rather than the actual tens- ing and relaxing of the muscle. It brings on a special state of consciousness as attention is concentrated solely on one thought or object. During meditation, as the individual becomes totally pre- occupied with the selected focus, the respiration rate, heart rate, and blood pressure decrease. The frame of reference is very personal, based on what each individual considers to be a relaxing environment. The relaxing sce- nario is most useful when taped and played back at a time when the individual wishes to achieve relaxation. Biofeedback: Biofeedback is the use of instrumentation to become aware of processes in the body that usually go un- noticed and to help bring them under voluntary control. Biological conditions, such as muscle tension, skin surface temperature, blood pressure, and heart rate, are monitored by the biofeedback equipment. With special training, the individual learns to use relaxation and voluntary control to modify the biological condition, in turn indicating a modification of the autonomic function it represents. Bio- feedback is often used together with other relaxation tech- niques such as deep breathing, progressive relaxation, and mental imagery. Assertive behavior increases self-esteem and the ability to develop satisfying interpersonal relationships. This is ac- complished through honesty, directness, appropriateness, and respecting one’s own rights, as well as the rights of others. Individuals develop patterns of responding in various ways, such as role modeling, by receiving positive or negative rein- forcement, or by conscious choice. These patterns can take the form of nonassertiveness, assertiveness, aggressiveness, or passive-aggressiveness. Nonassertive individuals seek to please others at the expense of denying their own basic human rights. Assertive individuals stand up for their own rights while protecting the rights of oth- ers. Those who respond aggressively defend their own rights by violating the basic rights of others. Individuals who respond in a passive-aggressive manner defend their own rights by expressing resistance to social and occupational demands. Some important behavioral considerations of assertive be- havior include eye contact, body posture, personal distance, physical contact, gestures, facial expression, voice, fluency, tim- ing, listening, thoughts, and content. Example: “I don’t want to go out with you tonight,” instead of “I can’t go out with you tonight. Example: Telephone salesperson: “I want to help you save money by changing long-distance services. Example: Male board member: “You made a real fool of yourself at the board meeting last night. Changing the focus of the communication from discussing the topic at hand to ana- lyzing what is actually going on in the interaction. Concurring with the critic’s argu- ment without becoming defensive and without agreeing to change. Putting off further discussion with an angry in- dividual until he or she is calmer. In cognitive therapy, the in- dividual is taught to control thought distortions that are consid- ered to be a factor in the development and maintenance of mood disorders. In the cognitive model, depression is characterized by a triad of negative distortions related to expectations of the environment, self, and future. The environment and activities within it are viewed as unsatisfying, the self is unrealistically devalued, and the future is perceived as hopeless. In the same model, mania is characterized by a positive cognitive triad—the self is seen as highly valued and powerful, experiences within the environment are viewed as overly positive, and the future is seen as one of unlimited opportunity. Therapy focuses on changing “automatic thoughts” that occur spontaneously and contribute to the distorted affect. Another technique involves evaluating what would most likely happen if the client’s automatic thoughts were true. He or she should be reassured that there are a number of techniques that may be used, and both therapist and client may explore these possibilities. Cognitive therapy has been shown to be an effective treatment for mood disor- ders, particularly in conjunction with psychopharmacological intervention. The current is sufficient to induce a grand mal seizure, from which the desired therapeutic effect is achieved. It is sometimes administered in conjunction with antidepressant medication, but most physicians prefer to perform this treat- ment only after an unsuccessful trial of drug therapy. There has been evidence, however, of its effectiveness in the treatment of acute schizophrenia, particularly if it is accompanied by cata- tonic or affective (depression or mania) symptomatology (Black & Andreasen, 2011). Other conditions, although not considered absolute contraindications, may render clients at high risk for the treatment. They are largely cardiovascular in nature and include myocardial infarction or cerebrovascular accident within the preceding 3 months, aortic or cerebral aneurysm, severe underlying hypertension, and congestive heart failure.