By M. Angir. Columbia Union College.

Behaviourial approaches can be useful buy flagyl 400 mg cheap virus replication cycle, but they can also be harmful by dehumanising others to a list of task-orientated responses cheap 200 mg flagyl free shipping antibiotic vancomycin. Smith (1991) found that preregistration courses still emphasised task-orientated, rather than holistic, nursing. Nurses should analyse their values and beliefs, understanding the implications they have for practice, and selecting appropriate approaches to each context; this is, after all, an extension of individualising care. Humanism The humanist movement was concerned that behaviourism overemphasised animal instincts (and relied too heavily on animal experiments) in an attempt to control outward behaviour. Hence humanism emphasises inner values that distinguish people from animals and is a ‘person-centred’ philosophy; rather than emphasising society’s needs, humanism emphasises the needs of the individual self. Maslow’s Motivation and Personality (1987 [1954]) popularised the concept of ‘holism’ (the whole person). Humanists believe that people have a psychological need to (attempt to) achieve and to realise their maximum potential. Maslow (1987[1954]) described a hierarchy of needs, self-actualization being the highest of these; Roper et al. However, adopting primacy of the individual, inherent in humanism, conflicts with the objective decontextualisation of traditional scientific methodologies (Playle 1995), raising difficulties when undertaking humanist research, as exemplified by debate surrounding qualitative and quantitive nursing research. Emphasis on inner values led humanist educationalists to concentrate on developing and/or attempting to change inner values: values that are internalised will continue to influence actions after external motivators are removed. Thus, changes in nursing practice made in order to conform with the desires of another may not continue after that person has left, or even when absent (e. Concern for inner values and holistic approaches to care makes humanism compatible with many aspects of healthcare and nursing, although over-familiarity with terms can reduce them to clichés. Humanism has much to offer nurses in the process of analysing their philosophies of care and practice, but ideas should not be accepted uncritically. Lifelong learning Where the aim of behaviourist education was to achieve conformity, humanist education sought to promote individuality, and these differences are reflected in the training-versus- education debate. Training seeks to equip learners with a repertoire of responses to specific stimuli, and is, by implication, time-limited. In animals, stimulus-response reactions are often simple (as with Pavlov’s dogs); in humans, more complex responses Humanism 11 may be learned. Such subconscious (conditioned) responses can be valuable: a cardiac arrest requires rapid action and follows protocols shared by other team members. However, for many nursing interventions, ‘training’ fails to provide the higher skills to work constructively through actual and potential problems. Training equips the learner to be reactive to problems (stimuli) rather than proactive (to prevent potential problems occurring). For humanist education, facts and ideas are quickly outdated (Rogers 1983) and so are less valued by humanists than the development of skills to enable personal growth (Maslow 1971) and learning (Rogers 1983). Humanism seeks to develop higher cognitive and affective skills in order to analyse issues according to individual needs—most valuable human interactions occur above the stimulus-response levels. For healthcare, humanism promotes a person-centred philosophy that enables learning to continue beyond designated courses; each clinical area becomes a place for learning, and nurses should be extending and developing their skills through practice. The current trend away from the teaching of factual information to the emphasis on individualised learning (e.

Likely (but unproven) physiological benefits include improved lymphatic drainage discount 400mg flagyl free shipping does oral antibiotics for acne work, returning plasma proteins to the circulation generic flagyl 400 mg with amex infection vs inflammation. Reflexology Although there are ancient precedents, modern Western reflexology derives from the work of William Fitzgerald, a nineteenth-century doctor who accidentally found that the Intensive care nursing 442 use of pressure could replace anaesthesia during minor operations (Griffiths 1995). Fitzgerald believed that organ malfunction resulted in tiny crystalline deposits of calcium and uric acid on the nerve endings of the feet, and that breaking down these deposits with massage would heal the organ (Griffiths 1995). Fitzgerald identified ten energy zones of life-force running longitudinally through the body (not too dissimilar to the twelve meridians of Ki), reflecting the organs in specific parts of the feet (and hands). Reflexologists can therefore treat any part of the body using specialised foot massage that breaks down the crystalline deposits. If reflexology’s assumptions are correct, it is possible that nurses manipulating feet and hands (e. Griffiths (1995) warns that reflexology initiates a ‘healing crisis’ which can last up to 24 hours, although this is less likely to occur with the gentler Western approaches than the more vigorous approaches used in the East. The absence of any reported complications suggests this may not be an actual problem, but it leaves a (currently) unanswered question. Shiatsu Although derived from the Japanese for ‘finger pressure’, Shiatsu practice has gained wider connotations; it usually treats the whole meridian system (of vital energy/life force) in order to harmonise Ki (Stevensen 1995). Like other variants of massage, shiatsu is best left to those with specialist knowledge. Aromatherapy Aromatherapy implies the use of essential oils with direct chemical effects, not just burning something which emits pleasant smells (although boundaries between pleasure and therapy can become blurred when evaluating psychological benefit): burning neroli (see Massage above) can reduce anxiety. As active chemicals, essential oils can be considered to be drugs, albeit not restricted by regulations governing traditional medicines. Because of the nature of this therapy, the effects of aromatherapy may affect anyone (staff, other patients) in the immediate environment, so although relaxation may help some patients, it could be harmful to others, while possibly reducing staff efficiency. Complementary therapies 443 Placebo effect Throughout history significant minorities of people have benefited from inactive medicines (placebos); Hippocrates was familiar with the problems of patients who had been given unhelpful (and often harmful) treatments. Complex interactions between human physiology and psychology can make it difficult to ascribe a particular effect to a particular cause. When evaluating any treatment (complementary or orthodox), placebo, rather than active components, can benefit 35–52 per cent of patients (French 1989). Double-blind trials are designed to identify the extent of placebo effects, thus measuring whether any significant further benefit is gained from active ingredients. However, the value of quantitative research methodology for qualitative interventions is questionable. With their focus on the health of the whole person, rather than dysfunction of single organs, complementary therapist-client time typically exceeds the amount of time doctors can afford to spend with the majority of their patients. Thus, the benefits claimed for complementary therapies may result from prolonged human interaction rather than from active treatment. If nursing and touch are in themselves therapeutic, then benefits from many complementary therapies may be largely or solely due to nursing touch, rather than specific interventions. If the desired end effect of nursing is the comfort (in its widest sense) of patients and relatives, then utilitarian ethics can justify whatever means are used to gain that end. However, deliberate misinformation (such as injecting water instead of analgesia) breaks duty-based codes, and is (at best) ethically dubious.

Research buy flagyl 500mg without a prescription antibiotics for sinus infection how long, education buy flagyl 200 mg on-line virus zapping robot, and due diligence are required if forensic odontology is to progress and, in the process, minimize the prob- ability of the occurrence of future problem cases. Te manual then describes a bitemark as “a circular or oval patterned injury consisting of two opposing symmet- rical, U-shaped arches separated at their bases by open spaces. Following the periphery of the arches are a series of individual abrasions, contusions, and/or lacerations refecting the size, shape, arrangement, and distribution of the class characteristics of the contacting surfaces of the human dentition”35 (Figures 14. Tere has been much discussion about whether bitemark should be written as one word or two (bite mark) or hyphenated (bite-mark), for any of the forms the meaning is understandable and gram- matically correct. Te authors contend that this is a pointless argument and choose to use the single word form except in quoted material that uses other forms. Tis may occur when skin or other objects contact the teeth instead of a biter intentionally closing his jaws, and hence his teeth, into skin or an object. A fst striking the teeth in an afray is a common and dangerous example ofen referred to as a clenched fst injury or “fght bite. Teeth marks are passive, as they involve no active, intentional or refexive jaw movement, whereas in bitemarks the jaw muscles are active, causing the jaws and thence the teeth to move into the bitten substrate. Teeth mark examples include marks lef by teeth on steering wheels, dashboards, or other objects during motor vehicle accidents. If struck in the mouth, the teeth of the victim may leave imprints 334 Forensic dentistry on the fst or other object. Teeth marks may be found on the inner aspect of a victim’s upper and lower lips afer an attack. Pressure applied to the lips, which are consequently pressed against the teeth, leaves the teeth marks, patterned injuries that may indicate asphyxiation by force. Teeth mark inju- ries have not been widely discussed in the literature separate from bitemarks. Te teeth marks lef in diferent locations during motor vehicular accidents may be used to help distinguish passengers from drivers. Teeth marks have been found on exterior parts of vehicles during hit-and-run accidents. Teeth marks lef on fsts or hands as when striking a victim in the mouth can be crucial evidence placing a subject at a scene and showing that there was a violent interaction. Tese may be particularly helpful when a victim’s body may have been severely afected by trauma or fre. Teeth marks on the hand or arm of a police ofcer or other law enforcement ofcial may be used to support or disprove conficting testimony in a police custody scenario, for example, a policeman’s claim that the detainee bit him versus the prisoner stating, “He had me in a strangle hold and his forearm was forced into my mouth. Tus, a bitemark class characteristic identifes the group from which it originates: human, animal, fsh, or other species. Confrming the pres- ence of class characteristics should be the frst step in evaluating a bitemark. If unable to distinguish upper from lower arches, the evidence should not be considered to be of sufcient quality for comparison analysis. Misinterpretations of injuries that look similar to dental arches have led to errors in evaluation. It must be emphasized that, if unable to distinguish between upper and lower dental arches in a patterned injury, or to be able to identify which marks were made by specifc individual teeth, forensic dentists should not attempt to compare the injury to suspect information unless that pattern contains one or more unique individual characteristics that may also be seen in a suspect biter’s tooth or teeth. In some cases it may be possible to exclude individuals based on lower quality bite pattern information (Figures 14. An example would be a contusion pattern that exhibited a gap or gaps and a suspect that Bitemarks 335 Figure 14. Tis information would come, not from comparison, but from the profle generated from the analysis of the mark. Arch charac- teristics that qualify as individual distinguish one person’s arch from another’s and may include “a combination of rotated teeth, [teeth in] buccal or lingual version, mesio-distal [sic, mesial or distal] drifing [of teeth], and [variations in] horizontal alignment [of teeth that] contribute to diferentiation between individuals.