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Instead quality 3ml bimat medications made from animals, the issue should be cast in with illness purchase 3ml bimat free shipping top medicine, he or she is subject to biopsychosocial terms of determining patterns of interactions perturbations buy cheap bimat 3ml on-line medications removed by dialysis. The nurse, according to Johnson among levels of the behavioral system that may (1980, 1990), acts as the external regulator and promote continuity for a particular subsystem at a monitors patient response, looking for successful given point in time. If behavioral system balance tinuity is in the relationship of the parts rather than returns, there is no need for intervention. Johnson (1990) noted that at nurse intervenes to help the patient restore behav- the psychological level, attachment (affiliative) and ioral system balance. It is hoped that the patient dependency are examples of important specific be- matures and with additional hospitalizations the haviors that change over time while the representa- previous patterns of response have been assimilated tion (meaning) may remain the same. Adaptation is defined as balance, this pattern of dependence to independ- change that permits the behavioral system to main- ence may be repeated as the behavioral system en- tain its set points best in new situations. To the ex- gages in new situations during the course of a tent that the behavioral system cannot assimilate lifetime. The nurse acts to provide con- respond to contextual changes by either a homeo- ditions or resources essential to help the accommo- static or homeorhetic process. Systems have a set dation process, may impose regulatory or control point (like a thermostat) that they try to maintain mechanisms to stimulate or reinforce certain be- by altering internal conditions to compensate for haviors, or may attempt to repair structural com- changes in external conditions. A behavioral system is embedded in an tion of ability or effort are behavioral homeostatic environment, but it is capable of operating inde- processes we use to interpret activities so they are pendently of environmental constraints through the consistent with our mental organization. Hierarchic Interaction The combination of systems theory and develop- Each behavioral system exists in a context of hier- ment identifies “nursing’s unique social mission archical relationships and environmental relation- and our special realm of original responsibility in ships. Hierarchies, or a pattern of Next, we review the model as a behavioral system relying on particular subsystems, lead to a degree of within an environment. A disruption or failure will not destroy the Person whole system but leads instead to a decomposition to the next level of stability. Johnson conceptualized a nursing client as a behav- The judgment that a discontinuity has occurred ioral system. The behavioral system is orderly, is typically based on a lack of correlation between repetitive, and organized with interrelated and in- assessments at two points of time. For example, terdependent biological and behavioral subsys- one’s lifestyle prior to surgery is not a good fit post- tems. These discontinuities can provide op- subsystems that interrelate to form the behavioral portunities for reorganization and development. Dialectical Contradiction The client is seen as a collection of behav- ioral subsystems that interrelate to form The last core principle is the motivational force for the behavioral system.


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Leininger has Leininger has defined the ethnonursing re- Culture Care search method as “a qualitative research method using naturalistic purchase discount bimat online symptoms lyme disease, open discovery generic bimat 3 ml with amex treatment kidney cancer symptoms, and largely inductively derived emic modes Diversity and and processes with diverse strategies discount 3 ml bimat free shipping symptoms 0f low sodium, tech- niques, and enabling tools to document, describe, understand, and interpret the Universality people’s meanings, experience, symbols, and other related aspects bearing on Marilyn R. Qualitative Paradigm and Quantitative Paradigm The purpose of the second part of Chapter 20 is In order to understand the qualitative ethnonurs- twofold. The first part will include an overview of ing research method, it is important to understand the ethnonursing research method, which was de- the major philosophical differences between the signed to study the Theory of Culture Care qualitative and quantitative paradigms. The second part will has described qualitative paradigmatic research as present a discussion of the implications of the cul- “characterized by naturalistic and open inquiry ture care theory and related ethnonursing research methods and techniques focused on systematically findings for clinical nursing practice. Many nursing documenting, analyzing, and interpreting attri- theories are rather abstract and do not focus on butes, patterns, characteristics, and meanings of how practicing nurses might use the research find- specific domains and gestaltic (or holistic) features ings related to a theory. However, with the Culture of phenomena under study within designated Care Theory, along with the ethnonursing method, environmental or living contexts” (Leininger, 1997, there is a purposeful built-in means to discover and p. She has described quantitative research as confirm data with informants in order to make “characterized by a focus on an empirical and ob- nursing actions and decisions meaningful and jective analysis of discrete and preselected variables culturally congruent (Leininger, 2002). In viewpoints of human care, well-being, health, and qualitative research there is no control of inform- environmental contexts. The terms emic and etic ant’s ideas or manipulation of data or variables by were important concepts chosen for foci with the the researcher; open inquiry prevails to obtain data ethnonursing method. Ethnonursing focuses directly and naturally from informants in their own largely on the importance of emic (insiders’ or local homes, communities, or other natural environ- peoples’) views but does not neglect etic (the non- mental contexts. In contrast, in quantitative re- local or outsiders’) views to obtain a holistic view. Leininger has stated that the quantitative on their ideas and experiences with care but also and qualitative paradigms should not be mixed, as gathered etic data focused on the professional per- they violate the philosophy, purposes, and integrity spectives of the nursing staff (McFarland, 1997). The ethnonursing method is a The culture care theory has been developed to be unique and essential qualitative method to study congruent with the ethnonursing method and re- caring and healing practices, beliefs, and values in quires the researcher to move into familiar and nat- diverse cultural and environmental contexts and is uralistic people settings to discover human care and a major holistic method specifically designed to fit the related nursing phenomena of health (well- the culture care theory. Purpose and Philosophical Features Domain of Inquiry Leininger developed the ethnonursing research method from a nursing and cultural care perspec- A domain of inquiry is the major focus of the ethno- tive to discover largely unknown phenomena held nursing researcher’s interests. With the ethnonursing understanding and meaning of the people’s daily method, problem statements are not used because a life experiences related to human care, health, and researcher does not know whether there is a people well-being in different or similar environmental problem or more of a researcher’s problem of se- contexts” (Leininger, 1991b, p. The central pur- lected (and possibly biased) views of the people pose of the ethnonursing research method is “to es- (Leininger, 1997). For example, some domains of tablish a naturalistic and largely emic open inquiry inquiry in ethnonursing studies using the culture method to explicate and study nursing phenomena care theory have been: the care meanings and expe- especially related to the Theory of Cultural Care riences of Lebanese Muslims living in the United Diversity and Universality” (Leininger, 1991b, p. The term ethnonursing was purposefully coined the cultural care of elderly Anglo and African for this method. The prefix ethno comes from the American residents within the environmental con- Greek word ethos and refers “to the people,” while text of a long-term care institution (McFarland, the suffix nursing is essential to focus the research 1997); and the care of Mexican American women on the phenomena of nursing, particularly human during pregnancy (Berry, 1999). The ethnonursing research method has philo- Key and general informants are important in the sophical and research features that fit well with the ethnonursing research method. Philosophically, the ethnonurs- this method does not have subjects but works with ing method has been grounded with the people informants.

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