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S. Porgan. University of Central Florida.

Such persons may believe that compliance will result in early release and that the risks entailed in providing a false confession may seem worthwhile in the presence of an overwhelming desire to re-establish access to their supply of drugs (75) 10 mg metoclopramide mastercard erosive gastritis definition. When faced with a suspect suffering from severe withdrawal discount metoclopramide 10 mg overnight delivery gastritis y probioticos, the doctor should consider advising that the interview be deferred until such time as the withdrawal has subsided or been adequately treated. If the doctor decides to treat the withdrawal state, consideration should be given to the risk that the therapeutic intervention, which may in itself have a bearing on fitness to inter- view. Arranging for therapy that the suspect has been receiving in the commu- nity to be continued in police custody is unlikely to influence fitness for interview (76,77). However, when substitution therapy is initiated in custody or when symptomatic treatment alone is provided, the doctor may well need to assess the effect of the treatment before an interview occurs. The Impact of Psychiatric Illnesses There has been a considerable amount of research on the manner in which certain functional psychiatric illnesses can affect the reliability of testimony (78,79). Thus, anxiety increases a suspect’s suggestibility and depression can lead to feelings of guilt and poor self-esteem that render a suspect vulnerable to providing a false confession (52). Psychiatric illness may also render a per- son unfit for interview by virtue of its effect on cognitive processes or because of associated thought disorder (80,81). However, careful questioning that avoids the use of leading questions and coercive pressures can often elicit reliable testimony. That a suspect suffers from an illness, such as schizophrenia, does not necessarily mean that he or she is unfit for interview (82); such an opinion would depend on the likely demand characteristics of the interview and the functional assessment by the doctor. Learning Difficulties The police rarely have difficulty recognizing moderate or severe learn- ing difficulties, but borderline or low-to-normal intelligence may not be obvi- ous even to trained observers (83–85). It is important to identify people with learning difficulties—questions regarding reading and writing ability and the need for special help with education can be useful—because they will be par- ticularly vulnerable in police custody. Such individuals may have difficulties in understanding their legal rights and in communicating with police officers. The Effect of Physical Illnesses on Fitness for Interview The presence of any physical illness renders an individual more vulner- able when faced with a stressful situation, such as a custodial interrogation. Features, such as anxiety or depression, affect a person’s ability to function during the police interview, and physical illness—especially if severe—is as likely to cause anxiety and depression as any other form of stress (87). The severity of the emotional response will depend on the nature of the illness itself, the personality of the individual, and social circumstances. Suspects who are already coping with physical illness are more likely to focus on the short-term consequences of their behavior than the long-term outcomes, thus increasing the risk that they might provide a false confession (52). Because the effect of physical illness on a person’s coping strategy is not disease-specific, depending more on the actual or perceived severity of the ill- ness rather than the nature of the illness itself, the actual diagnosis is unimpor- tant. By contrast, there are many physical illnesses in which characteristic disturbances in cognitive functioning have been recognized (88). With these illnesses, the nature and degree of the mental disturbance produced depends entirely on the diagnosis of the underlying condition. The more common of the conditions encountered in custody are discussed in the following subheadings. Epilepsy It is now clear, after long historical dispute, that a predisposition to epileptic fits does not mean per se that there will be associated intellectual impairment, personality disorder, or mental illness. Most patients with epi- lepsy remain mentally normal, although this does depend on the presence, site, and extent of any brain damage underlying the epilepsy (89). However, those patients with epilepsy without significant brain damage do, nonetheless, remain prone to cognitive impairment, particularly memory impairment, as a result of their epilepsy and its treatment. The potential impact of this cognitive impairment must be considered when assessing a patient with epilepsy’s fitness for interview. For example, problems with concentration, memory, and intellectual func- tioning can be seen when anticonvulsant drugs are administered in toxic doses or unsuitable combinations (90). Suspicion should be raised when a suspect complains of mental lethargy or appears to be performing below expected levels, symptoms particularly associated with toxicity. Further problems with the reliability of testimony from epileptics may be related to their personality. Patients with epilepsy are often overprotected in childhood by concerned parents and, later in life, can be exposed to pro- 226 Norfolk and Stark found social and occupational discrimination (91). All these factors can lead to personality problems, which include feelings of insecurity, low self-esteem, and dependency.

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High cortisol levels caused by stress can negatively impact these hormones as well buy 10 mg metoclopramide with mastercard gastritis diet education. The severity and duration of symptoms experienced vary due to genetics generic 10mg metoclopramide with amex gastritis diet , ethnicity, cultural factors, and even attitude. High estrogen levels, as is common in perimenopause or among those with estrogen 324 dominance (low progesterone levels), can impair thyroid function, which may lead to weight gain because the thyroid gland is involved in regulating metabolic rate. Weight gain around the waist could be associated with stress, which elevates cortisol levels and causes fat to accumulate around the midsection. One study also found that estrogen caused cognitive decline and dementia in older women. When it is necessary, it should be used at the lowest dose for the shortest periods of time (less than five years). Bioidentical hormones are becoming more widely used as a safer alternative to synthetic hormones, while still providing symptom relief. Bioidentical means that the hormones are exactly the same as the ones your body produces. Compounding pharmacists can make customized hormones in various dosages and forms (creams, suppositories, and capsules) to suit your individual needs. Bioidentical hormones are available in compounding pharmacies, by a doctor’s prescription. Women who experience serious emotional symptoms are sometimes prescribed antidepressants and tranquilizers. However, there are many side effects with these drugs, and it is best to try natural methods first. Bone-building drugs such as bisphosphonates (Didrocal, Fosamax, and Actonel) or selective estrogen receptor modulators (Evista) are often given to women with osteoporosis or those at great risk. It is still important that women taking these drugs get adequate calcium intake and weight-bearing exercise for optimal bone health. Most blood tests measure hor- mones that are bound to protein, not that which is available to the tissues. Saliva tests M measure the amount of hormone that has made it into tissue because hormones pass through the salivary gland tissue before getting into saliva. Dietary Recommendations Foods to include: • Vegetables, fruit, whole grains, and legumes provide essential vitamins, minerals, anti- oxidants, fibre, and compounds that can reduce the risk of cancer and heart disease and improve overall health. In particular, load up on broccoli, Brussels sprouts, cauliflower, and cabbage, as these vegetables contain compounds that help the liver process hormones while reducing the risk of breast cancer. It also contains lignans (another form of phytoestrogen), which may help balance estrogens and reduce menopausal symptoms. Stress can make menopausal symptoms more pronounced and af- fect your adrenal gland function, reducing hormone production. Massage and acupuncture promote relax- ation and studies have shown that acupuncture can reduce hot flashes. Studies have shown that regular exercise reduces the frequency and severity of hot flashes. It also improves mood and sleep, protects against heart disease, and weight-bearing activities strengthen the bones. Smoking can worsen hot flashes and symptoms of anxiety, irritability, and depression. Watch funny movies, go to comedy shows, and spend time M with people who make you happy and laugh. Top Recommended Supplements Black cohosh: An herb that has been found in many studies to reduce hot flashes, night sweats, insomnia, nervousness, and irritability. Calcium and magnesium: Important minerals for bone health; women over 50 years should have 1,200 mg of calcium and 320 mg of magnesium daily, or more if they have osteopo- rosis. It is difficult to get this amount from diet alone, so supplements are often necessary.

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Nursing’s practical experience evidence required to demonstrate the impact of and knowledge have been shared buy cheap metoclopramide 10 mg online gastritis chest pain, transformed into nursing practice trusted 10mg metoclopramide gastritis symptoms and treatment mayo clinic. It is only by being Values and Beliefs thoroughly grounded in the discipline’s concepts, substance, and modes of inquiry that the bound- Nursing has distinctive views of persons and strong aries of the discipline, however tentative, can be un- commitments to compassionate and knowledge- derstood and possibilities for creativity across able care of persons through nursing. Nurses often interdisciplinary borders can be created and ex- express their love and passion for nursing. The state- concepts, language, and forms of data that reflect ments of values and beliefs are expressed in the new ways of thinking and knowing in nursing. The philosophies of nursing that are essential under- complex concepts used in nursing scholarship and pinnings of theoretical developments in the disci- practice require language that can be used and un- pline. The language of nursing theory facilitates Systems of Education communication among members of the discipline. Expert knowledge of the discipline is often required Nursing holds the stature and place of a discipline for full understanding of the meaning of special of knowledge and professional practice within in- terms. A distinguishing mark of any disci- This attribute calls attention to the array of books, pline is the education of future and current mem- periodicals, artifacts, and aesthetic expressions, as bers of the community. These indicators in- Closely aligned with attributes of nursing as a dis- clude procedures, tools, and instruments to cipline previously described is consideration of determine the impact of nursing practice and are nursing as a professional practice. Professional essential to research and management of outcomes practice includes clinical scholarship and processes of practice (Jennings & Staggers, 1998). Resulting of nursing persons, groups, and populations who data form the basis for improving quality of nurs- need the special human service that is nursing. Theory-based research is needed in ery and interdisciplinary work demands practice order to explain and predict nursing outcomes es- from a theoretical perspective. Nursing’s discipli- sential to the delivery of nursing care that is both nary focus is essential within an interdisciplinary humane and cost-effective (Gioiella, 1996). Because environment (Allison & McLaughlin-Renpenning, nursing theory exists to improve practice, the test of 1999). Nursing actions reflect nursing concepts and nursing theory is a test of its usefulness in profes- thought. Careful, reflective, and critical thinking is sional practice (Fitzpatrick, 1997; Colley, 2003). Chapters in and use of nursing theory offer opportunity for the remaining sections of this book highlight use of successful collaboration with related disciplines nursing theories in nursing practice. From the viewpoint of practice, know what they are doing, why they are doing what Gray and Forsstrom (1991) suggest that through they are doing, what may be the range of outcomes use of theory, nurses find different ways of looking of nursing, and indicators for measuring nursing’s at and assessing phenomena, have rationale for impact. These nursing theoretical frameworks serve their practice, and have criteria for evaluating out- in powerful ways as guides for articulating, report- comes. Recent studies reported in the literature af- ing, and recording nursing thought and action. Further, these tion and refinement through research, must be re- studies illustrate that nursing theory can stimulate turned to practice (Dickoff, James, & Wiedenbach, creative thinking, facilitate communication, and 1968). Within nursing as a practice discipline, nurs- clarify purposes and relationships of practice. The ing theory is stimulated by questions and curiosi- practicing nurse has an ethical responsibility to use ties arising from nursing practice. Development of the discipline’s theoretical knowledge base, just as it nursing knowledge is a result of theory-based nurs- is the nurse scholar’s ethical responsibility to de- ing inquiry. The circle continues as data, conclu- velop the knowledge base specific to nursing prac- sions, and recommendations of nursing research tice (Cody, 1997, 2003). Can nursing theories in- form us how to stand with and learn from peoples Nursing Theory and the Future of the world? Can we learn from nursing theory how to come to know those we nurse, how to be Nursing theory in the future will be more fully in- with them, to truly listen and hear? Can these ques- tegrated with all domains of the discipline and tions be recognized as appropriate for scholarly practice of nursing.

I really wanted to make it home when I got near the end of my journey; I would have been extremely disappointed if the car broke down only a few miles from my home metoclopramide 10 mg with amex gastritis symptoms in morning. Perhaps you have noticed that once you get close to finishing something metoclopramide 10 mg with visa chronic gastritis omeprazole, you feel like you really need to get it done. Jurors who were asked to award monetary damages to others who had been in an accident offered them substantially more in compensation if they barely avoided injury than they offered if the accident seemed inevitable (Miller, Turnbull, & McFarland, [29] 1988). Psychology in Everyday Life: Cognitive Biases in the Real World Perhaps you are thinking that the kinds of errors that we have been talking about don‘t seem that important. After all, who really cares if we think there are more words that begin with the letter ―R‖ than there actually are, or if bronze medal winners are happier than the silver medalists? But it turns out that what seem to be relatively small cognitive biases on the surface can have profound consequences for people. Why would so many people continue to purchase lottery tickets, buy risky investments in the stock market, or gamble their money in casinos when the likelihood of them ever winning is so low? One possibility is that they are victims of salience; they focus their attention on the salient likelihood of a big win, forgetting that the base rate of the event occurring is very low. The belief in astrology, which all scientific evidence suggests is not accurate, is probably driven in part by the salience of the occasions when the predictions are correct. People may also take more care to prepare for unlikely events than for more likely ones, because the unlikely ones are more salient. For instance, people may think that they are more likely to die from a terrorist attack or a homicide than they are from diabetes, stroke, or tuberculosis. And people are frequently more afraid of flying than driving, although the likelihood of dying in a car crash is hundreds of times greater than dying in a plane crash (more than 50,000 people are killed on U. Because people don‘t accurately calibrate their behaviors to match the true potential risks (e. Salience and accessibility also color how we perceive our social worlds, which may have a big influence on our behavior. For instance, people who watch a lot of violent television shows also view the world as more dangerous [31] (Doob & Macdonald, 1979), probably because violence becomes more cognitively accessible for them. We also [32] unfairly overestimate our contribution to joint projects (Ross & Sicoly, 1979), perhaps in part because our own contributions are highly accessible, whereas the contributions of others are much less so. Even people who should know better, and who need to know better, are subject to cognitive biases. Economists, stock traders, managers, lawyers, and even doctors make the same kinds of mistakes in their professional activities that [33] people make in their everyday lives (Gilovich, Griffin, & Kahneman, 2002). Just like us, these people are victims of overconfidence, heuristics, and other biases. Furthermore, every year thousands of individuals, such as Ronald Cotton, are charged with and often convicted of crimes based largely on eyewitness evidence. When eyewitnesses testify in courtrooms regarding their memories of a crime, they often are completely sure that they are identifying the right person. But the most common cause of [34] innocent people being falsely convicted is erroneous eyewitness testimony (Wells, Wright, & Bradfield, 1999). Although cognitive biases are common, they are not impossible to control, and psychologists and other scientists are working to help people make better decisions. One possibility is to provide people with better feedback about their Attributed to Charles Stangor Saylor. Weather forecasters, for instance, learn to be quite accurate in their judgments because they have clear feedback about the accuracy of their predictions. Other research has found that accessibility biases can be reduced by leading people to consider multiple alternatives rather than focus only on the most obvious ones, and particularly by leading people to think about opposite possible outcomes than the ones they are expecting (Lilienfeld, Ammirtai, & [36] Landfield, 2009). Forensic psychologists are also working to reduce the incidence of false identification by helping police develop better procedures for interviewing both suspects and eyewitnesses (Steblay, Dysart, Fulero, & Lindsay, [37] 2001). Schemas help us remember new information but may also lead us to falsely remember things that never happened to us and to distort or misremember things that did. Consider a time when you were uncertain if you really experienced an event or only imagined it. How do these knowledge structures bias your information processing and behavior, and how might you prevent them from doing so? Imagine that you were involved in a legal case in which an eyewitness claimed that he had seen a person commit a crime.