By K. Topork. Sul Ross State University.

Outcomes are separate from but related (Hampton purchase suhagra 100mg mastercard erectile dysfunction causes anxiety, 1994; Sowell & Fuszard suhagra 100mg cheap erectile dysfunction vitamin d, 1989; Sowell & to performance criteria for evaluation of nursing Lowenstein, 1994). In this sense, they system provides structure for a continuous quality- are relating to the interpersonal systems in the improvement program (King, 1994). This is done within a variety of social action Process Model in my Theory of Goal systems in the community. Although the focus is Attainment gives a process that leads to goal attain- groups, nurses work with individuals for whom ment that represents outcomes. An example was given to 16–1) shows the interactions of the three systems in document effectiveness of nursing care if one uses community health. The record system is an information system based on Use in Hospitals my Theory of Goal Attainment. The record system Two case studies were presented to demonstrate can be designed and adapted to most health-care nurses’ use of the transaction process and knowl- systems. For nurses, it was designed to gather data edge of the concepts of perception, communica- from assessments of the patient, make a nursing tion, interaction, and role (King, 1986b). King’s Theory of Goal Attainment 243 nursing care, and write mutually agreed-upon goals twentieth century to the science of nursing in the and means to attain them. Elements in the goal-oriented nursing record are: (1) data base, (2) goal list, (3) nursing orders, (4) flow sheets, (5) progress notes, and (6) discharge summary. My conceptual Several nurses have tested the theory in research on system and transaction process in the Theory aging, parenting, psychiatric-mental health, and of Goal Attainment provides one approach to ambulatory care (Alligood et al. For interaction between nurses and health- ducted studies in their cultures to test the Theory of care professionals and between health- Goal Attainment (Coker et al. For common discourse among health pro- and responses to professional nursing care that fessionals and between nurses and nursing resulted in an instrument that measures patient personnel. Direct measure of outcomes resulting in My vision for the future of nursing is that nursing quality care and cost-effective care; that is, will provide access to health care for all citizens. One valid and reliable assessment instru- are directed to the right place in the system for ment to assess activities of daily living as a nursing care, medical care, social services informa- basis for goal-setting. For continuity of care within and between tion process will be used by every practicing nurse health-care agencies. Theory of Goal Attainment, and Transaction Process Model will continue to serve a useful pur- When knowledge of the concepts and the pose in delivering professional nursing care. The transaction process has been used in hospi- ideas have been tested in research and in practice, tals, homes, nursing homes, and community and nurses in education and practice have used the health agencies, nurses have been motivated knowledge of the concepts. The relevance of to seek additional knowledge in formal edu- evidence theory–based practice, using my theory, cational programs. Publications, including Frey & Sieloff (1995), identified from a review of the literature, will be summarized and briefly discussed. Finally, of King’s recommendations will be made for future knowl- edge development in relation to King’s Interacting Systems Framework and midrange theory, par- Theory of Goal ticularly in relation to the importance of their application within an evidence-based practice environment. Attainment Christina Leibold Sieloff, Maureen Application of Interacting Frey, & Mary Killeen Systems Framework In conducting the literature review, the authors began with the broadest category of application— application within the Interacting Systems Frame- Application of Interacting Systems work to nursing care situations. Because a con- Framework In conducting the literature review, the Concept Development Within the authors began with the broadest category Framework of application—application within the Interacting Systems Framework to nursing Theory of Goal Attainment care situations. Recommendations for Knowledge Development Related to King’s ceptual framework is, by nature, very broad and Framework and Theory abstract, it can only serve to guide, rather than prescriptively direct, nursing practice. Summary King’s Interacting Systems Framework has been used to guide nursing practice in several References ways. Fawcett, Vaillancourt, and Watson (1995) used the frame- Since the first publication of Dr.

Many forms of psychotherapy are magnetically positive discount 100mg suhagra otc erectile dysfunction gel treatment, the other electromagneti- designed to help the client know and understand cally negative—helps release the blocked energy purchase 100mg suhagra with visa erectile dysfunction age 40, what is in their unconscious. Very few are designed and that release in turn promotes better physical, to actually change what is in the unconscious. The American Polar- ever, if the material in the unconscious is not ity Therapy Association was established in 1984. The used as a therapeutic topical application to relieve unconscious is primarily a record of the past and a pain and promote circulation. These tensions can be triggered by present events prakruti The human constitution consisting of so that they are felt in the present. In fact, because one or more of the primary body/personality their origin is from the unconscious, and we are types—vata, pitta, and kapha, according to thus unaware of their actual source, these power- Ayurvedic medicine. Studies have been conducted in which one therapy: “Primal integration is a form of therapy group of ill individuals has been prayed for and brought over to Britain by Bill Swartley, one of its another group has not been prayed for; the group main originators, although it was also pioneered of people who were prayed for had a better and here by Frank Lake. It is not to be confused with faster recovery rate, indicating that prayer, particu- Primal Therapy, coming from Arthur Janov; it is a larly when it is done by large groups of people, has parallel development occurring at about the same beneficial effects. This often involves technique geared toward releasing old and intense a cathartic experience called a ‘primal. According to a winter-spring guage, and instead call what they do regression- 128 psychic surgery integration therapy. Other initiatives such as our web- about this, and his holotropic therapy is close to site, world-wide contact list, therapist referral list, what we call primal integration. Because of the annual conventions, and regional retreats are emphasis of primal integration on early trauma, intended to bring more primal people closer people sometimes think it is going to put all neuro- together, and make primal life more available to sis down to one trauma, happening just once in those in need. The commonest causes of neurosis are simply the common experiences of childhood— psychic surgery An alternative, highly contro- all the ways in which our child needs are unmet or versial therapy that originated in the Philippine frustrated. Psychic surgeons (shamans) who practice in the sense of a one-off event—that is much too there may be located through local hotels. Rather would we say with Balint surgery is performed through the mind and spirit of that the trauma may come from a situation of some the healer, who through a vision has proclaimed to duration, where the same painful lack of ‘fit’ have been given the gift of healing and psychic between needs and supplies is continued. While in a semitrance or Rowan added that the goal of primal integra- meditative state, the healer’ hands, guided by the tion is straightforward: to contact and release the spirit, “detect” parts of the body that are diseased real self. Practition- “enormously useful work can be done in enabling ers and individuals who have undergone this expe- the person to work through the implications of rience say blood, tissue, pus, cartilage, bone, that, and to support the person through any life worms, stones, or other substances may materialize changes that may result. At times, it is also claimed, been contacted, the process of working to release the spirit causes the healer’s hands to enter the it will continue. Obviously the main technique is body and extract diseased tissue without leaving a regression—that is taking the person back to the wound or scar. Pri- “opens” body tissue and is considered similar to a mal integration agrees with this, and finds that scalpel by enthusiasts of this procedure: energy recession and regression go very well together. It is a gestalt which keeps on reappearing organs remain, but free of disease, or “cleansed,” in the person’s life. The relaxation response (Acupuncture & ElectroTherapeutics Research 1997; of the patient carries the quick, painless process; no 22:17–33), Y. Omura writes: “Most patients recovery period is necessary, and enthusiasts say received injections of a dark-brown solution, there are no complications or risks involved. How- which, some of the visiting doctors speculated, may ever, the psychic surgeon’s hands, acting as a be an iodine solution mixed with either alcohol or scalpel, are reported to create to observers a a local anesthetic. In many patients, he injected straight line perforating the skin over the diseased this solution near the pathological area or at an or injured area that causes little or no bleeding. Minor surgery Psychic surgical procedures of approximately 15 was performed in about 1⁄5 of the patients with to 30 minutes may include spinal adjustment, whom the author observed.