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The approach to ethical decision making can follow the steps of the nursing process erectile dysfunction vacuum pumps australia order viagra master card. Although the steps of the nursing process have been stated in various ways by different writers impotence world association cheap 25 mg viagra free shipping, the common components cited are assessment erectile dysfunction treatment natural way cheap viagra 75 mg with amex, diagnosis impotence biking discount viagra express, planning, implementation, and evaluation. For the purposes of this text, the nursing process will be based on the traditional five steps and will delineate two components in the diagnosis step: nursing diagnoses and collaborative problems. After the diagnoses or problems have been determined, the desired outcomes are often evident. For those who wish to emphasize its importance, analysis may be identified as a separate step of the nursing process. Nursing diagnoses: Actual or potential health problems that can be managed by independent nursing interventions b. Collaborative problems: "Certain physiologic complications that nurses monitor to detect onset or changes in status. Nurses manage collaborative problems using physician-prescribed and nursing-prescribed interventions to minimize the complications of the events" (Carpenito, 1999, p. Planning: Development of goals and outcomes, as well as a plan of care designed to assist the patient in resolving the diagnosed problems and achieving the identified goals and desired outcomes. Dividing the process into separate steps is, however, artificial: the process functions as an integrated whole, with the steps being interrelated, interdependent, and recurrent. Chart 3-6 presents an overview of the nursing activities involved in applying the nursing process. In addition, ongoing monitoring is crucial to remain aware of patient needs and the effectiveness of the nursing care that the patient receives. Compare alternatives with applicable ethical principles and professional code of ethics. Utilitarian approach: Predict the consequences of the alternatives; assign a positive or negative value to each consequence; choose the consequence that predicts the highest positive value or "the greatest good for the greatest number. Deontological approach: Identify the relevant moral principles; compare alternatives with moral principles; appeal to the "higher-level" moral principle if there is a conflict. These guidelines reflect an active process in decision making, similar to the nursing process detailed in this chapter. This step entails recognition of the ethical, legal, and professional dimensions involved. Does the situation entail substantive moral problems (conflicts among ethical principles or professional obligations)? Include the following information: the medical facts, treatment options, nursing diagnoses, legal data, and the values, beliefs, and religious components. Chapter 3 Outcome(s) Critical Thinking, Ethical Decision Making, and the Nursing Process 35 Chart 3-6 Steps of the Nursing Process en Docum tation rs n of nu ing care Pla achieved or re vise mes tco d iv Ou laborat e activities Col ected outcomes Exp orative problem llab s Co alth history He als and priorities Go diagnos rsing es Nu Assessment 1. Identify potential problems or complications that require collaborative interventions. Include nursing diagnoses, goals, nursing interventions, expected outcomes, and critical times. Involve the patient, family or significant others, nursing team members, and other health team members in all aspects of planning. Coordinate the activities of the patient, family or significant others, nursing team members, and other health team members. Include the patient, family or significant others, nursing team members, and other health care team members in the evaluation. Identify alterations that need to be made in the nursing diagnoses, collaborative problems, goals, nursing interventions, and expected outcomes. Continue all steps of the nursing process: assessment, diagnosis, planning, implementation, and evaluation. Starting from the innermost circle, nursing assessment, the process moves outward through the formulation of nursing diagnoses and collaborative problems; planning, with setting of goals and priorities in the nursing plan of care; implementation and documentation; and, finally, the ongoing process of evaluation and outcomes. The interview is a personal dialogue between the patient and the nurse that is conducted in order to obtain information. Achieving a relationship of mutual trust and respect requires the ability to communicate a sincere interest in the patient. Examples of effective therapeutic communication techniques that can be used to achieve this goal are found in Table 3-1.
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To them erectile dysfunction heart attack proven 50 mg viagra, potentially stressful situations are interesting and meaningful; change and new situations are viewed as challenging opportunities for growth erectile dysfunction nervous generic 75mg viagra fast delivery. Some positive support has been found for hardiness as a significant variable that positively influences rehabilitation and overall improvement after an onset of an acute or chronic illness (Felton erectile dysfunction doctor in pune cheap 100 mg viagra, 2000; Williams impotence zinc purchase viagra 100mg mastercard, 2000). During this stage, adaptation to the noxious stressor occurs, and cortisol activity is still increased. If exposure to the stressor is prolonged, exhaustion sets in and endocrine activity increases. This produces deleterious effects on the body systems (especially the circulatory, digestive, and immune systems) that can lead to death. Stages one and two of this syndrome are repeated, in different degrees, throughout life as the person encounters stressors. During childhood, there are too few encounters with stress to promote the development of adaptive functioning, and the child is vulnerable. This syndrome includes the inflammatory response and repair processes that occur at the local site of tissue injury. The local adaptation syndrome occurs in small, topical injuries, such as contact dermatitis. If the local injury is severe enough, the general adaptation syndrome is activated as well. Selye emphasized that stress is the nonspecific response common to all stressors, regardless of whether they are physiologic, psychological, or social. Conditioning factors also account for differences in the tolerance of different people for stress: some people may develop diseases of adaptation, such as hypertension and migraine headaches, while others are unaffected. The stress response is a "cascade of neural and hormonal events that have short- and long-lasting consequences for both brain and body. Interpretation of Stressful Stimuli by the Brain Physiologic responses to stress are mediated by the brain through a complex network of chemical and electrical messages. The neural and hormonal actions that maintain homeostatic balance are integrated by the hypothalamus, which is located in the center of the brain, surrounded by the limbic system and the cerebral hemispheres. The hypothalamus integrates autonomic nervous system mechanisms that maintain the chemical constancy of the internal environment of the body. Together with the limbic system, it also regulates emotions and many visceral behaviors necessary for survival (eg, eating, drinking, temperature control, reproduction, defense, aggression). The hypothalamus is made up of a number of nuclei; the limbic system contains the amygdala, hippocampus, and septal nuclei, along with other structures. Literature supports the concept that each of these structures responds differently to stimuli, and each has its own characteristic response (Watkins, 1997). The cerebral hemispheres are concerned with cognitive functions: thought processes, learning, and memory. The limbic system has connections with both the cerebral hemispheres and the brain stem. In addition, the reticular activating system, which is a network of cells that forms a two-way communication system, extends from the brain stem into the midbrain and limbic system. In the stress response, afferent impulses are carried from sensory organs (eye, ear, nose, skin) and internal sensors (baroreceptors, chemoreceptors) to nerve centers in the brain. The response to the perception of stress is integrated in the hypothalamus, the General Adaptation Syndrome Hans Selye developed a theory of adaptation that profoundly influenced the scientific study of stress. In 1936, Selye, experimenting with animals, first described a syndrome consisting of enlargement of the adrenal cortex; shrinkage of the thymus, spleen, lymph nodes, and other lymphatic structures; and the appearance of deep, bleeding ulcers in the stomach and duodenum. From this beginning, he developed a theory of adaptation to biologic stress that he named the general adaptation syndrome. Because living in a continuous state of alarm would result in death, the person moves Chapter 6 which coordinates the adjustments necessary to return to homeostatic balance. The degree and duration of the response varies; major stress evokes both sympathetic and pituitary adrenal responses. Neural and neuroendocrine pathways under the control of the hypothalamus are also activated in the stress response. First, there is a sympathetic nervous system discharge, followed by a sympathetic-adrenal-medullary discharge.
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