By V. Tippler. Kenyon College.
Chapter 9 examines screening as a health behaviour and assesses the psychological factors that relate to whether or not someone attends for a health check and the psychological consequences of screening programmes discount januvia 100 mg online diabetes symptoms high blood sugar. Health psychology also focuses on the direct pathway between psychology and health and this is the focus for the second half of the book quality januvia 100 mg blood glucose 70. Chapter 10 examines research on stress in terms of its deﬁnition and measurement and Chapter 11 assesses the links between stress and illness via changes in both physiology and behaviour and the role of moderating variables discount januvia 100mg free shipping blood glucose 82. Chapter 12 focuses on pain and evaluates the psycho- logical factors in exacerbating pain perception and explores how psychological interven- tions can be used to reduce pain and encourage pain acceptance order januvia 100mg with amex diabetex international corp. Chapter 13 speciﬁcally examines the interrelationships between beliefs, behaviour and health using the example of placebo eﬀects. Chapter 16 explores the problems with measuring health status and the issues surrounding the measurement of quality of life. Finally, Chapter 17 examines some of the assumptions within health psychology that are described throughout the book. My thanks again go to my psychology and medical students and to my colleagues over the years for their comments and feedback. For this edition I am particularly grateful to Derek Johnston and Amanda Williams for pointing me in the right direction, to David Armstrong for conversation and cooking, to Cecilia Clementi for help with all the new references and for Harry and Ellie for being wonderful and for going to bed on time. Take advantage of the study tools oﬀered to reinforce the material you have read in the text, and to develop your knowledge of Health Psychology in a fun and eﬀective way. Study Skills Open University Press publishes guides to study, research and exam skills, to help under- graduate and postgraduate students through their university studies. Get a £2 discount oﬀ these titles by entering the promotional code app when ordering online at www. The chapter highlights differences between health psychology and the biomedical model and examines the kinds of questions asked by health psychologists. Then the possible future of health psychology in terms of both clinical health psychology and becoming a professional health psychologist is discussed. Finally, this chapter outlines the aims of the textbook and describes how the book is structured. This chapter covers: ➧ The background to health psychology ➧ What is the biomedical model? Darwin’s thesis, The Origin of Species, was published in 1856 and described the theory of evolution. This revolutionary theory identiﬁed a place for Man within Nature and suggested that we were part of nature, that we developed from nature and that we were biological beings. This was in accord with the biomedical model of medicine, which studied Man in the same way that other members of the natural world had been studied in earlier years. This model described human beings as having a biological identity in common with all other biological beings. The biomedical model of medicine can be understood in terms of its answers to the following questions: s What causes illness? According to the biomedical model of medicine, diseases either come from outside the body, invade the body and cause physical changes within the body, or originate as internal involuntary physical changes. Such diseases may be caused by several factors such as chemical imbalances, bacteria, viruses and genetic predisposition. Because illness is seen as arising from biological changes beyond their control, individuals are not seen as responsible for their illness. The biomedical model regards treatment in terms of vaccination, surgery, chemotherapy and radiotherapy, all of which aim to change the physical state of the body. Within the biomedical model, health and illness are seen as qualitatively diﬀerent – you are either healthy or ill, there is no continuum between the two. According to the biomedical model of medicine, the mind and body function independently of each other. From this perspective, the mind is incapable of inﬂuencing physical matter and the mind and body are deﬁned as separate entities. The mind is seen as abstract and relating to feelings and thoughts, and the body is seen in terms of physical matter such as skin, muscles, bones, brain and organs. Changes in the physical matter are regarded as independent of changes in state of mind. Within traditional biomedicine, illness may have psychological consequences, but not psychological causes. These developments have included the emergence of psychosomatic medicine, behavioural health, behavioural medicine and, most recently, health psychology. These diﬀerent areas of study illustrate an increasing role for psychology in health and a changing model of the relationship between the mind and body. Psychosomatic medicine The earliest challenge to the biomedical model was psychosomatic medicine. This was developed at the beginning of the twentieth century in response to Freud’s analysis of the relationship between the mind and physical illness. At the turn of the century, Freud described a condition called ‘hysterical paralysis’, whereby patients presented with paralysed limbs with no obvious physical cause and in a pattern that did not reﬂect the organization of nerves. Freud argued that this condition was an indication of the individual’s state of mind and that repressed experiences and feelings were expressed in terms of a physical problem. This explanation indicated an interaction between mind and body and suggested that psychological factors may not only be consequences of illness but may contribute to its cause. Behavioural health Behavioural health again challenged the biomedical assumptions of a separation of mind and body. Behavioural health was described as being concerned with the main- tenance of health and prevention of illness in currently healthy individuals through the use of educational inputs to change behaviour and lifestyle. The role of behaviour in determining the individual’s health status indicates an integration of the mind and body. Behavioural medicine A further discipline that challenged the biomedical model of health was behavioural medicine, which has been described by Schwartz and Weiss (1977) as being an amalgam of elements from the behavioural science disciplines (psychology, sociology, health edu- cation) and which focuses on health care, treatment and illness prevention. Behavioural medicine was also described by Pomerleau and Brady (1979) as consisting of methods derived from the experimental analysis of behaviour, such as behaviour therapy and behaviour modiﬁcation, and involved in the evaluation, treatment and prevention of physical disease or physiological dysfunction (e. Behavioural medicine therefore included psychology in the study of health and departed from traditional biomedical views of health by not only focusing on treatment, but also focusing on prevention and intervention. In addition, behavioural medicine challenged the traditional separation of the mind and the body. Health psychology Health psychology is probably the most recent development in this process of including psychology into an understanding of health. It was described by Matarazzo as the aggregate of the speciﬁc educational, scientiﬁc and professional contribution of the discipline of psychology to the promotion and maintenance of health, the promotion and treatment of illness and related dysfunction. Health psychology can be understood in terms of the same questions that were asked of the biomedical model: s What causes illness? Health psychology suggests that human beings should be seen as complex systems and that illness is caused by a multitude of factors and not by a single causal factor. Health psychology therefore attempts to move away from a simple linear model of health and claims that illness can be caused by a combination of biological (e. This approach reﬂects the biopsychosocial model of health and illness, which was developed by Engel (1977, 1980) and is illustrated in Figure 1. The biopsychosocial model represented an attempt to integrate the psychological (the ‘psycho’) and the environmental (the ‘social’) into the traditional biomedical (the ‘bio’) model of health as follows: (1) The bio contributing factors included genetics, viruses, bacteria and structural defects. Because illness is regarded as a result of a combination of factors, the individual is no longer simply seen as a passive victim. For example, the recognition of a role for behaviour in the cause of illness means that the individual may be held responsible for their health and illness. According to health psychology, the whole person should be treated, not just the physical changes that have taken place.
It is now known that a good part of our moral reasoning abilities are located in the frontal lobe discount 100 mg januvia with amex diabetes mellitus type 2 medscape, and at least some of this understanding comes from lesion studies buy 100 mg januvia otc blood glucose determination. For instance purchase 100 mg januvia overnight delivery type 2 diabetes questions to ask your doctor, consider the well-known case of Phineas Gage buy discount januvia 100mg on-line diabetes type 1 death, a 25-year-old railroad worker who, as a result of an explosion, had an iron rod driven into his cheek and out through the top of his skull, causing major damage  to his frontal lobe (Macmillan, 2000). Although remarkably Gage was able to return to work after the wounds healed, he no longer seemed to be the same person to those who knew him. The amiable, soft-spoken Gage had become irritable, rude, irresponsible, and dishonest. Although  there are questions about the interpretation of this case study (Kotowicz, 2007), it did provide  early evidence that the frontal lobe is involved in emotion and morality (Damasio et al. More recent and more controlled research has also used patients with lesions to investigate the  source of moral reasoning. In one of the scenarios the participants were asked if they would be willing to kill one person in order to prevent five other people from being killed. Persons with lesions in the frontal lobe were more likely to be willing to harm one person in order to save the lives of five others than were control participants or those with lesions in other parts of the brain. Recording Electrical Activity in the Brain In addition to lesion approaches, it is also possible to learn about the brain by studying the electrical activity created by the firing of its neurons. Research using these techniques has found, for instance, that there are specific neurons, known as feature detectors, in  the visual cortex that detect movement, lines and edges, and even faces (Kanwisher, 2000). Furthermore, by following electrical impulses across the surface of the brain, researchers can observe changes over very fast time periods. The patient lies on a bed within a large cylindrical structure containing a very strong magnet. Neurons that are firing use more oxygen, and the need for oxygen increases blood flow to the area. Often, the images take the form of cross-sectional “slices‖ that are obtained as the magnetic field is passed across the brain. The images of these slices are taken repeatedly and are superimposed on images of the brain structure itself to show how activity changes in different brain structures over time. When the research participant is asked to engage in tasks while in the scanner (e. There is still one more approach that is being more frequently implemented to understand brain function, and although it is new, it may turn out to be the most useful of all. Then the electrical stimulation is provided to the brain before or while the participant is working on a cognitive task, and the effects of the stimulation on performance are assessed. If the participant‘s ability to perform the task is influenced by the presence of the stimulation, then the researchers can conclude that this particular area of the brain is important to carrying out the task. Research Focus: Cyberostracism Neuroimaging techniques have important implications for understanding our behavior, including our responses to  those around us. Naomi Eisenberger and her colleagues (2003) tested the hypothesis that people who were excluded by others would report emotional distress and that images of their brains would show that they experienced pain in the same part of the brain where physical pain is normally experienced. In the first part of the experiment, the participants were told that as a result of technical difficulties, the link to the other two scanners could not yet be made, and thus at first they could not engage in, but only watch, the game play. Then, during a second inclusion scan, the participants played the game, supposedly with the two other players. In the third, exclusion, scan, however, the participants initially received seven throws from the other two players but were then excluded from the game because the two players stopped throwing the ball to the participants for the remainder of the scan (45 throws). The results of the analyses showed that activity in two areas of the frontal lobe was significantly greater during the exclusion scan than during the inclusion scan. Because these brain regions are known from prior research to be active for individuals who are experiencing physical pain, the authors concluded that these results show that the physiological brain responses associated with being socially excluded by others are similar to brain responses experienced upon physical injury. People who feel that they are excluded, or even those who observe other people being excluded, not only experience Attributed to Charles Stangor Saylor. Consider the different ways that psychologists study the brain, and think of a psychological characteristic or behavior that could be studied using each of the different techniques. The return of Phineas Gage: Clues about the brain from the skull of a famous patient. Cortex: A Journal Devoted to the Study of the Nervous System and Behavior, 46(6), 769– 780; Van den Eynde, F. Repetitive transcranial magnetic stimulation reduces cue-induced food craving in bulimic disorders. Disruption of the right temporoparietal junction with transcranial magnetic stimulation reduces the role of beliefs in moral judgments. When hurt will not heal: Exploring the capacity to relive social and physical pain. Explain how the electrical components of the nervous system and the chemical components of the endocrine system work together to influence behavior. Now that we have considered how individual neurons operate and the roles of the different brain areas, it is time to ask how the body manages to “put it all together. In this section we will see that the complexities of human behavior are accomplished through the joint actions of electrical and chemical processes in the nervous system and the endocrine system. Electrical Control of Behavior: The Nervous System The nervous system (see Figure 3. Everything that we see, hear, smell, touch, and taste is conveyed to us from our sensory organs as neural impulses, and each of the commands that the brain sends to the body, both consciously and unconsciously, travels through this system as well. A sensory (or afferent) neuron carries information from the sensory receptors, whereas a motor (or efferent) neuron transmits information to the muscles and glands. Interneurons allow the brain to combine the multiple sources of available information to create a coherent picture of the sensory information being conveyed. The spinal cord is the long, thin, tubular bundle of nerves and supporting cells that extends down from the brain. Within the spinal cord, ascending tracts of sensory neurons relay sensory information from the sense organs to the brain Attributed to Charles Stangor Saylor. When a quicker-than-usual response is required, the spinal cord can do its own processing, bypassing the brain altogether. A reflex is an involuntary and nearly instantaneous movement in response to a stimulus. Reflexes are triggered when sensory information is powerful enough to reach a given threshold and the interneurons in the spinal cord act to send a message back through the motor neurons without relaying the information to the brain (see Figure 3. When you touch a hot stove and immediately pull your hand back, or when you fumble your cell phone and instinctively reach to catch it before it falls, reflexes in your spinal cord order the appropriate responses before your brain even knows what is happening. These quick responses, known as reflexes, can reduce the damage that we might experience as a result of, for instance, touching a hot stove. The somatic nervous system consists primarily of motor nerves responsible for sending brain signals for muscle contraction. The autonomic nervous system itself can be further subdivided into thesympathetic and parasympathetic systems (see Figure 3. The sympathetic and the parasympathetic divisions normally function in opposition to each other, such that the sympathetic division acts a bit like the accelerator pedal on a car and the parasympathetic division acts like the brake. Our everyday activities are controlled by the interaction between the sympathetic and parasympathetic nervous systems. For example, when we get out of bed in the morning, we would experience a sharp drop in blood pressure if it were not for the action of the sympathetic system, which automatically increases blood flow through the body. Similarly, after we eat a big meal, the parasympathetic system automatically sends more blood to the stomach and intestines, allowing us to efficiently digest the food. And perhaps you’ve had the experience of not being at Attributed to Charles Stangor Saylor. The two systems work together to maintain vital bodily functions, resulting in homeostasis, the natural balance in the body’s systems. The Body’s Chemicals Help Control Behavior: The Endocrine System The nervous system is designed to protect us from danger through its interpretation of and reactions to stimuli.
Fetal Circulatory System 289 1 Internal jugular vein and right common carotid artery 2 Right and left brachiocephalic vein 3 Aortic arch 4 Superior vena cava 5 Foramen ovale 6 Inferior vena cava 7 Ductus venosus 8 Liver 9 Umbilical vein 10 Small intestine 11 Umbilical artery 12 Urachus 13 Trachea and left internal jugular vein 14 Left pulmonary artery 15 Ductus arteriosus (Botalli) 16 Right ventricle 17 Hepatic arteries (red) and portal vein (blue) 18 Stomach 19 Urinary bladder 20 Portal vein 21 Pulmonary veins 22 Descending aorta 23 Placenta Thoracic and abdominal organs in the newborn (anterior aspect) buy discount januvia 100mg blood sugar not going down. The greater omentum partly fixed to the transverse colon covers the small intestine cheap januvia 100mg on-line diabetic ulcer of foot icd 9. The liver buy cheap januvia 100mg on line diabetes mellitus type zwei, stomach 100 mg januvia free shipping diabetes insipidus koira, and superior part of 1 the duodenum are connected to the lesser omentum covering the omental bursa, the entrance of which is the epiploic foramen. The hepatoduodenal ligament contains 2 the portal vein, the common bile duct, and the hepatic arteries. The heart is in contact with the diaphragm (from Lütjen-Drecoll, Rohen, Innenansichten des menschlichen Körpers, 2010). Transverse section through the abdominal cavity at the level of the second lumbar vertebra (from below). Anterior Abdominal Wall 293 1 Left ventricle with pericardium 2 Diaphragm 3 Remnant of liver 4 Ligamentum teres (free margin of falciform ligament) 5 Site of umbilicus 6 Medial umbilical fold (containing the obliterated umbilical artery) 7 Lateral umbilical fold (containing inferior epigastric artery and vein) 8 Median umbilical fold (containing remnant of urachus) 9 Head of femur and pelvic bone 10 Urinary bladder 11 Root of penis 12 Falciform ligament of liver 13 Rib (divided) 14 Iliac crest (divided) 15 Site of deep inguinal ring and lateral inguinal fossa 16 Iliopsoas muscle (divided) 17 Medial inguinal fossa 18 Supravesical fossa 19 Posterior layer of rectus sheath 20 Transversus abdominis muscle 21 Umbilicus and arcuate line 22 Inferior epigastric artery 23 Femoral nerve 24 Iliopsoas muscle 25 Remnant of umbilical artery 26 Femoral artery and vein 27 Tendinous intersection of rectus abdominis Anterior abdominal wall with pelvic cavity and thigh (frontal section, male) muscle (internal aspect). The peritoneum and parts of the posterior layer of rectus sheath have been removed. Parasagittal section through upper 30 Intervertebral disc part of left abdominal cavity 3. Stomach 295 1 2 9 10 4 9 11 1 2 3 5 12 10 4 6 6 11 8 7 13 8 14 Muscular coat of stomach, outer layer (ventral aspect). Stomach and transverse colon have been removed, liver elevated; superior mesenteric vein is slightly enlarged. Parasagittal section through the left side of the abdomen 2 cm lateral to median plane. Liver 299 1 Fundus of gallbladder 2 Peritoneum (cut edges) 3 Cystic artery 4 Cystic duct 5 Right lobe of liver 6 Inferior vena cava 7 Bare area of liver 8 Notch for ligamentum teres and falciform ligament 9 Ligamentum teres 10 Falciform ligament of liver 11 Quadrate lobe of liver 12 Common hepatic duct 13 Left lobe of liver 14 Hepatic artery proper 15 Common bile duct Portal triad 16 Portal vein 17 Caudate lobe of liver 18 Ligamentum venosum 19 Ligament of inferior vena cava 20 Appendix fibrosa (left triangular ligament) 21 Coronary ligament of liver 22 Hepatic veins Liver (inferior aspect). It should be noted that the anatom- ical left and right lobes of the liver do not reflect the internal distribution of the hepatic artery, portal vein, and biliary ducts. With these structures, used as criteria, the left lobe includes both the caudate and quadrate lobes, and thus the line dividing the liver into left and right functional lobes passes through the gallbladder and inferior vena cava. The three main hepatic veins drain segments of the liver that have no visible external Liver (ventral aspect) (transparent drawing illustrating margins of peritoneal folds). In this case the accessory pancreatic duct represents the main excretory duct of the pancreas. Vessels of the Abdominal Organs: Portal Circulation 303 1 2 3 7 8 9 4 5 10 11 6 Tributaries of portal vein (blue) and branches of superior mesenteric artery (red) (anterior aspect). Stomach and transverse 33 Superior rectal artery colon have been removed and the liver elevated. Vessels of the Abdominal Organs: Inferior Mesenteric Artery 305 Vessels of the retroperitoneal organs. Direction of the inferior mesenteric artery and its anastomosis with the middle colic artery (arrow = Riolan’s anastomosis). Greater omentum and transverse colon have been reflected, the intestine partly removed. The normally retrocecally located vermiform appendix has been replaced anteriorly. Dissection of the Abdominal Organs 307 1 Diaphragm 2 Costal margin 3 Transverse colon 4 Ascending colon with haustra 5 Free taenia of cecum 6 Ileum 7 Cecum 8 Falciform ligament of liver 9 Liver 10 Stomach 11 Gastrocolic ligament 12 Jejunum 13 Sigmoid colon 14 Vermiform appendix 15 Terminal ileum 16 Meso-appendix 17 Mesentery Abdominal organs in situ. Ascending colon, cecum, and vermiform Variations in the position of the vermiform appendix. The transverse colon with mesocolon has been raised and the small intestine reflected. Dissection of the Abdominal Organs: Upper Abdominal Organs 311 Upper abdominal organs (anterior aspect). Thorax and anterior part of diaphragm have been removed and the liver raised to display the lesser omentum. Red arrows: 26 Pancreas routes of the arterial branches of celiac trunk to liver, stomach, 27 Lesser sac (omental bursa) duodenum, and pancreas (posterior aspect). The gastrocolic ligament has been divided and the whole stomach raised to display the posterior wall of the lesser sac. The lesser omentum has been removed and the lesser curvature of the stomach reflected to display the branches of the celiac trunk. Dissection of the Abdominal Organs: Upper Abdominal Organs 315 Arteries of upper abdominal organs (anterior aspect). The stomach, superior part of duodenum, and celiac ganglion have been removed to reveal the anterior aspect of the posterior wall of the lesser sac (omental bursa) and the vessels and ducts of the hepatoduodenal ligament. The gastrocolic ligament has been divided, the transverse colon and the stomach replaced to display the pancreas and superior mesenteric vessels. The stomach has been removed, the liver raised, and the duodenum anteriorly opened. Posterior Abdominal Wall: Root of the Mesentery and Peritoneal Recesses 319 Peritoneal recesses on the posterior abdominal wall. The 1 1 great center of the autonomic nervous system, the solar plexus (celiac ganglion, etc. In the male, the testis has moved out of the abdominal cavity and penetrated the 3 inguinal canal to be finally located within the extragenital organs. View of the female pelvis showing uterus with uterine ligaments, ovary, and urinary bladder (from Lütjen-Drecoll, Rohen, Innenansichten des 5 6 menschlichen Körpers, 2010). Retroperitoneal tissue, position of the right kidney Notice that the upper part of the kidney reaches the level of the (schematic drawing). Sections through the Retroperitoneal Region 325 1 Scalenus anterior, medius, and posterior muscles 2 Left subclavian artery 3 Left subclavian vein 4 Pulmonic valve 5 Arterial cone 6 Right ventricle of heart 7 Liver 8 Stomach 9 Transverse colon 10 Small intestine 11 Left lung 12 Left main bronchus 13 Branches of pulmonary vein 14 Left ventricle of heart 15 Spleen 16 Splenic artery and vein and pancreas 17 Left kidney 18 Psoas major muscle 19 Inferior vena cava 20 Renal vein 21 Body of twelfth thoracic vertebra and vertebral canal 22 Right kidney 23 Superior mesenteric artery 24 Superior mesenteric vein 25 Pancreas 26 Abdominal aorta 27 Left psoas major and quadratus lumborum muscles 28 Anterior layer of renal fascia of Gerota 29 Posterior layer of renal fascia 30 Perirenal fatty tissue 31 Abdominal cavity 32 Descending and sigmoid colon Parasagittal section through the thoracic and abdominal cavities at the level of the left kidney (5. The renal pelvis has been opened and the fatty tissue removed to display the renal vessels. Each kidney can be divided into five segments supplied by individual interlobar arteries known as end arteries. The anterior kidney surface reveals four segments; the posterior, only three (Nos. Kidney 327 1 Hepatic vein 22 2 Anterior and posterior vagal trunk 3 Inferior vena cava 4 Lumbar part of diaphragm 23 5 Right greater and lesser splanchnic nerves 6 Celiac trunk 16 7 Celiac ganglion and plexus 8 Superior mesenteric artery 9 Left renal vein 23 10 Right sympathetic trunk and ganglion 11 Abdominal aorta 12 Left sympathetic trunk 13 Esophagus (cut), left greater splanchnic nerve 14 Left suprarenal gland 15 Left renal artery 16 Renal pelvis 17 Renal papilla with minor calyx 18 Left testicular vein 19 Ureter 19 20 Psoas major muscle 21 Quadratus lumborum muscle 22 Lumbar vertebra (L2) 23 Renal calyx 24 Catheter 24 Renal pelvis with calices and ureter (X-ray, retrograde injection; by courtesy of Prof. Scanning electron micrograph showing glomeruli Architecture of vascular system of kidney and associated arteries. Part of the left psoas major muscle has been removed to display the lumbar plexus. Retroperitoneal Region: Autonomic Nervous System 335 56 Ganglia and plexus of the autonomic nervous system within the retroperitoneal space (anterior aspect). The penis includes the urethra and thus serves for both ejaculation and micturition. The internal (involun- 29 tary) and external (voluntary) urethral sphincters are widely 32 separated. The ureter, having crossed the ductus deferens, 33 enters the urinary bladder at its base. The peritoneum is 34 reflected off of the posterior surface of the bladder and Male urogenital system (schematic drawing). Male Genital Organs (isolated) 337 10 11 2 Male genital organs, isolated (right lateral aspect). Posterior half of male urethra and prostate in continuity with neck of bladder (anterior aspect).
As a consultant at McLean Hospital in Johns Hopkins School of Nursing in 1925 (Nickel buy 100mg januvia free shipping diabetes mellitus y embarazo, Belmont discount januvia 100 mg fast delivery diabete ostrich multiplication unit, Massachusetts januvia 100mg fast delivery diabetes test in jaipur, Orlando continued to Gesse buy cheap januvia 100mg online diabetes mellitus zielwerte, & MacLaren, 1992. After completing a study nursing practice and developed a training master of arts at Columbia Univeristy in 1934, she program and nursing service department based on became a professional writer for the American her theory. With two opment of prescriptive theory (Dickoff, James & of her brothers serving in the armed forces during Wiedenbach, 1968). Even after her retirement in World War I and in anticipation of a critical short- 1966, she and her lifelong friend Caroline Falls of- age of nurses, Virginia Henderson entered the Army fered informal seminars in Miami, always remind- School of Nursing at Walter Reed Army Hospital. It ing students and faculty of the need for clarity of was there that she began to question the regimen- purpose, based on reality. She even continued to talization of patient care and the concept of nurs- use her gift for writing to transcribe books for the ing as ancillary to medicine (Henderson, 1991). Her pioneer work in the area of “series of almost unrelated procedures, beginning identifying and structuring nursing knowledge has with an unoccupied bed and progressing to aspira- provided the foundation for nursing scholarship tion of body cavities” (Henderson, 1991, p. Henderson admired Goodrich’s intel- Introducing the Theories lectual abilities and stated: “Whenever she visited our unit, she lifted our sights above techniques Virginia Henderson, sometimes known as the and routine” (Henderson, 1991, p. Henderson modern day Florence Nightingale, developed the credited Goodrich with inspiring her with the deﬁnition of nursing that is most well known inter- “ethical signiﬁcance of nursing” (Henderson, 1991, nationally. Ida Jean Orlando was perhaps the ence forever inﬂuenced her ethical understanding ﬁrst nurse to use qualitative research methods and of nursing and her appreciation of the importance was the ﬁrst to articulate nursing concepts based on and complexity of the nurse-patient relationship. Each of these She continued to explore the nature of nursing nurses helped us focus on the patient, instead of on as her student experiences exposed her to different the tasks to be done, and to plan care to meet needs ways of being in relationship with patients and of the person. For instance, a pediatric experience caring based on the perspective of the individual as a student at Boston Floating Hospital introduced being cared for—through observing, communicat- Henderson to patient-centered care in which ing, designing, and reporting. Each was concerned nurses were assigned to patients instead of tasks, with the unique aspects of nursing practice and and warm nurse-patient relationships were encour- scholoarship and with the essential question of, aged (Henderson, 1991). She enjoyed the less formal vis- Initial work on Wiedenbach’s prescriptive theory is iting nurse approach to patient care and became presented in her article in the American Journal skeptical of the ability of hospital regimes to alter of Nursing (1963) and her book, Meeting the patients’ unhealthy ways of living upon returning Realities in Clinical Teaching (1969). She entered Teachers tion of prescriptive theory is that:“Account must be College at Columbia University, earning her bac- calaureate degree in 1932 and her master’s degree “Account must be taken of the motivating in 1934. She continued at Teachers College as an in- factors that inﬂuence the nurse not only in structor and associate professor of nursing for the doing what she does but also in doing it next 20 years. Henderson wrote about nursing the way she lived it: focusing on what taken of the motivating factors that inﬂuence the nurses do, how nurses function, and on nursing’s nurse not only in doing what she does but also in unique role in health care. Her works are beauti- doing it the way she does it with the realities that fully written in jargon-free, everyday language. The nurse’s central purpose in nursing is the • The Recipient, or the patient receiving this nurse’s professional commitment. For Wiedenbach, action or on whose behalf the action is the central purpose in nursing is to motivate the taken; individual and/or facilitate his efforts to over- • The Framework, comprised of situational fac- come the obstacles that may interfere with his tors that affect the nurse’s ability to achieve ability to respond capably to the demands made nursing results; of him by the realities in his situation • The Goal, or the end to be attained through (Wiedenbach, 1970, p. She emphasized that nursing activity on behalf of the patient; the nurse’s goals are grounded in the nurse’s • The Means, the actions and devices through philosophy, that “those beliefs and values that which the nurse is enabled to reach the shape her attitude toward life, toward fellow goal. She rec- in whatever setting they are found for the purpose of ognized that nurses have different values and avoiding, relieving, diminishing or curing the indi- various commitments to nursing and that to vidual’s sense of helplessness. Following is an overview of the major nurse to undergo this experience and be “willing components of Orlando’s work. The nursing process includes identifying needs nursing for examination and discussion when of patients, responses of the nurse, and nursing appropriate” (Wiedenbach, 1970, p. The prescription indicates the broad general ac- practiced by Orlando, is not the linear model tion that the nurse deems appropriate to fulﬁll- often taught today, but is more reﬂexive and ment of her central purpose. The nurse will have circular and occurs during encounters with thought through the kind of results to be sought patients. Understanding the meaning of patient behavior accepting accountability for what she does and is influenced by the nurse’s perceptions, for the outcomes of her action. It may be validated then, is deliberate action that is mutually under- through communication between nurse and pa- stood and agreed upon and that is both patient- tient. Patients experience distress when they directed and nurse-directed (Wiedenbach, cannot cope with unmet needs. The realities are the aspects of the immediate nurs- ior to discover distress and meaning. Nurse-patient interactions are unique, complex, achieves through what she does (Wiedenbach, and dynamic processes. Professional nurses function in an independent • The Agent, who is the nurse supplying the role from physicians and other health-care nursing action; providers. Keep the body clean and well groomed and protect the integument While working on the 1955 revision of the Textbook 9. Avoid dangers in the environment and avoid of the Principles and Practice of Nursing, Henderson injuring others focused on the need to be clear about the function 10. She opened chapter one with the fol- tions, needs, fears, or opinions lowing question: What is nursing and what is the 11. Henderson believed this question was complishment fundamental to anyone choosing to pursue the 13. Learn, discover, or satisfy the curiosity that leads to normal development and health and Her often-quoted deﬁnition of nursing ﬁrst ap- use the available health facilities. It is likewise the Applications unique contribution of nursing to help people be in- dependent of such assistance as soon as possible. She believed the deﬁnitions of the day were too general and failed to “The practice of clinical nursing is goal differentiate nurses from other members of the directed, deliberately carried out and health team, which led to the following questions: patient centered. Based on Henderson’s deﬁnition, and after coin- This model and detailed charts were later edited ing the term “basic nursing care,” Henderson iden- and published in Clinical Nursing: A Helping Art tiﬁed 14 components of basic nursing care that (Wiedenbach, 1964). Eat and drink adequately may be envisioned as a set of concentric circles, with the experiencing individual in the circle at its core. Move and maintain desirable postures tion of the individual’s experienced need for help, 5. Select suitable clothes—dress and undress help provided fulﬁlled its purpose, ﬁlls the circle adja- 7. The next circle holds the essential range by adjusting clothing and modifying the concomitants of direct service: coordination, i. Her sister, she added, had hemorrhaged and almost lost her life the day after she had her baby two years ago. The nurse expressed her understanding of the mother’s fear, but then encouraged her to compare her current experi- ence with that of her sister. She believed that this was necessary to understand the theory that underlies the “nurse’s way of nursing. Reprinted with permission from the Wiedenbach Reading what context she did what she did” (Wiedenbach, Room (1962),Yale University School of Nursing. Realizing her early efforts to link theory, practice, and merit, and to include these consultation, i. The nonprofessional groups concerned with the individ- opportunity you have to do this is exciting! The content of the fourth circle repre- is rewarding, for, by helping nurses to uncover the sents activities which are essential to the ultimate theory that underlies their practice, you are paving well-being of the experiencing individual, but only the way for them to render a ﬁner quality of service to indirectly related to him: nursing education, nursing the patient, and to gain a deepened sense of fulﬁll- administration and nursing organizations. This has been known as the ﬁrst theory of The focus of Practice is the experiencing individual, nursing process and has been widely used in nurs- i. For example, a mother had a red vaginal dis- work to be a theoretical framework for the practice charge on her ﬁrst postpartum day. The doctor had of professional nursing, emphasizing the essential- recognized it as lochi, a normal concomitant of the ity of the nurse-patient relationship. Orlando’s the- phenomenon of involution, and had left an order for oretical work reveals and bears witness to the her to be up and move about. During the Furthermore, Henderson believed that func- 1960s, several studies were published that explored tions pertaining to patient care could be catego- nursing practice issues. She believed that tients’ complaints of pain (Barron, 1966; Bochnak, limiting nursing activities to “nursing care” was a 1963), incidence of post-operative vomiting useful method of conserving professional nurse (Dumas & Leonard, 1963), patient admission power (Harmer & Henderson, 1955).