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Influence of self-reported distress and empathy on egoistic versus altruistic motivation to help buy quibron-t 400 mg mastercard allergy symptoms cough dry. Sacrificing time and effort for the good of others: The Attributed to Charles Stangor Saylor generic 400mg quibron-t mastercard allergy medicine in pregnancy. The tendency to help others in need is in part a functional evolutionary adaptation purchase 400 mg quibron-t otc allergy symptoms vs asthma. Although helping others can be costly to us as individuals buy 400 mg quibron-t visa allergy testing levels, helping people who are related to us can perpetuate our own genes (Madsen et al. Burnstein, Crandall, and Kitayama (1994) found that students indicated they would be more likely to help a person who was closely related to them (e. People are more likely to donate kidneys to relatives than to strangers (Borgida,  Conner, & Manteufel, 1992), and even children indicate that they are more likely to help their  siblings than they are to help a friend (Tisak & Tisak, 1996). Although it makes evolutionary sense that we would help people who we are related to, why would we help people to whom we not related? One explanation for such behavior is based on the principle of reciprocal altruism (Krebs & Davies, 1987; Trivers,  1971). Reciprocal altruismis the principle that, if we help other people now, those others will return the favor should we need their help in the future. By helping others, we both increase our chances of survival and reproductive success and help others increase their survival too. Over the course of evolution, those who engage in reciprocal altruism should be able to reproduce more often than those who do not, thus enabling this kind of altruism to continue. Furthermore, the prevalence of altruism was particularly high in children‘s shows. For  instance, Anderson and Bushman (2001) found that playing violent video games led to a decrease in helping. We are more likely to help when we receive rewards for doing so and less likely to help when helping is costly. Parents praise their children who share their toys with others, and may reprimand children who are selfish. We are more likely to help when we have plenty of time than  when we are in a hurry (Darley and Batson 1973). When we act altruistically, we gain a reputation as a person with high status who is able and willing to help others, and this status makes us more desirable in the eyes  of others (Hardy & Van Vugt, 2006). The outcome of the reinforcement and modeling of altruism is the development of social norms about helping—standards of behavior that we see as appropriate and desirable regarding helping. The reciprocity norm reminds us that we should follow the principles of reciprocal altruism. If someone helps us, then we should help them in the future, and we should help people now with the expectation that they will help us later if we need it. The reciprocity norm is found in everyday adages such as “Scratch my back and I‘ll scratch yours‖ and in religious and philosophical teachings such as the “Golden Rule‖: “Do unto other as you would have them do unto you. We might hope that our children internalize another relevant social norm that seems more altruistic: the social responsibility norm. The social responsibility norm tells us that we should try to help others who need assistance, even without any expectation of future paybacks. The teachings of many religions are based on the social responsibility norm; that we should, as good human beings, reach out and help other people whenever we can. How the Presence of Others Can Reduce Helping Attributed to Charles Stangor Saylor. When the police interviewed Kitty‘s neighbors about the crime, they discovered that 38 of the neighbors indicated that they had seen or heard the fight occurring but not one of them had bothered to intervene, and only one person had called the police. Video Clip: The Case of Kitty Genovese Was Kitty Genovese murdered because there were too many people who heard her cries? Two social psychologists, Bibb Latané and John Darley, were interested in the factors that  influenced people to help (or to not help) in such situations (Latané & Darley, 1968). The model has been extensively tested in many studies, and there is substantial support for it. Social psychologists have discovered that it was the 38 people themselves that contributed to the tragedy, because people are less likely to notice, interpret, and respond to the needs of others when they are with others than they are when they are alone. Latané and Darley (1968) demonstrated the important role of the social situation in noticing by asking research participants to complete a questionnaire in a small room. Some of the participants completed the questionnaire alone, whereas others completed the questionnaire in small groups in which two other participants were also working on questionnaires. A few minutes after the participants had begun the questionnaires, the experimenters started to let some white smoke come into the room through a vent in the wall. The experimenters timed how long it took before the first person in the room looked up and noticed the smoke. The people who were working alone noticed the smoke in about 5 seconds, and within 4 minutes most of the participants who were working alone had taken some action. On the other hand, on average, the first person in the group conditions did not notice the smoke until over 20 seconds had elapsed. And, although 75% of the participants who were working alone reported the smoke within 4 minutes, the smoke was reported in only 12% of the groups by that time. In fact, in only 3 of the 8 groups did anyone report the smoke, even after it had filled the room. You can see that the social situation has a powerful influence on noticing; we simply don‘t see emergencies when other people are with us. Were the cries of Kitty Genovese really calls for help, or were they simply an argument with a boyfriend? The problem is compounded when others are present, because when we are unsure how to interpret events we normally look to others to help us understand them, and at the same time they are looking to us for information. The problem is that each bystander thinks that other people aren‘t acting because they don‘t see an emergency. Believing that the others know something that they don‘t, each observer concludes that help is not required. Even if we have noticed the emergency and interpret it as being one, this does not necessarily mean that we will come to the rescue of the other person. The problem is that when we see others around, it is easy to assume that they are going to do something, and that we don‘t need to do anything ourselves. Diffusion of responsibility occurs when we assume that others will take action and therefore we do not take action ourselves. The irony again, of course, is that people are more likely to help when they are the only ones in the situation than when there are others around. Perhaps you have noticed diffusion of responsibility if you participated in an Internet users group where people asked questions of the other users. Did you find that it was easier to get help if you directed your request to a smaller set of users than when you directed it to a larger number of  people? Markey (2000) found that people received help more quickly (in about 37 seconds) when they asked for help by specifying a participant‘s name than when no name was specified (51 seconds). Of course, for many of us the ways to best help another person in an emergency are not that clear; we are not professionals and we have little training in how to help in emergencies. People who do have training in how to act in emergencies are more likely to help, whereas the rest of us just don‘t know what to do, and therefore we may simply walk by.
Laggards may be won over cheap quibron-t 400mg allergy shots how often, albeit reluctantly cheap quibron-t 400mg with visa allergy forecast key west, possibly attempting to undermine initiatives; superficial acceptance of change may be reversed at an early opportunity buy cheap quibron-t on-line allergy testing worcester. Laggards may prove to be more problematic than the rejecters purchase quibron-t cheap online allergy shots nhs, who are usually open with their opposition and unlikely to be convinced. Active resistance is deliberate, but open; passive resistance is usually caused by apathy, with initiatives failing from lack of active support. Passive resistance can be difficult to overcome as it necessitates motivating others. Resistance is usually caused by how change is introduced rather than by the change itself (Closs 1996). Change, and the unknown, are threatening; people fearing they will not cope seek refuge in, and defend, the status quo. Motivation for resistance should therefore be acknowledged and respected; belittling resisters increases the threat, damages morale, and may cause them to leave. As their confidence develops, resisters may share ownership of change, gain a sense of achievement and join the (very) later majority. Change is not always beneficial; enthusiasm can blind change agents to any faults. Opposition can stimulate healthy debate, possibly even finding better ways forward. Change agents unwilling to consider that the change they have made might subsequently need changing become tyrants; resistance can usefully moderate misplaced enthusiasm (Wright 1998). If change proves beneficial, and becomes the norm, continuing resistance may prove destructive. Once other avenues are exhausted, persistent resisters may leave; their resignation may be the best compromise for everyone. Lewin’s strategy Lewin’s (1952) classic work on change management includes: ■ field theory ■ stages of change Lewin’s field theory suggests that opposing forces both drive and restrain change. Habit, often enshrined in rituals (Walsh & Ford 1989; Ford & Walsh 1994) is a major restraining force. More widely cited is Lewin’s three stages of change: Intensive care nursing 452 ■ unfreezing (destabilising) ■ moving (changing) ■ refreezing (re-establishing) Unfreezing, breaking habits and rituals, creates motivation for change. Wright (1998) suggests that unfreezing may occur when: ■ expectations have not been met ■ staff have uncomfortable feelings about something ■ obstacles to change are removed (‘psychological safety’) Moving occurs when change is planned and initiated. Stability may have been possible when Lewin published his ideas in 1952, but if change and instability are now the norm (Toffler 1970), unfreezing may be unnecessary and refreezing impossible; change agents may only have to plan the moving stage. Human needs Change causes stress for everyone, including (often especially) change agents. Failed initiatives can leave change agents physically and emotionally exhausted, while ‘shifting sand’ quickly buries their ideas. Familiarity breeds contempt (the ‘wallpaper effect’ (Wright 1998): we cease to notice familiar problems); change agents may become conservative, defending their own change against any subsequent developments. However, safety needs should be balanced against the benefits of taking risks; this does not mean turning off ventilators each shift to see whether patients can breathe on their own, but it does include taking calculated risks when the likely benefits appear to outweigh the possible dangers. Nursing has inherited a culture of negative criticism, which undermines the confidence of nurses who usually only receive feedback when they have done something wrong. Pressures should be recognised, and Managing change 453 planned for; actions should be specific and timetabled, with achievable targets for everyone to work towards. It is necessary therefore to plan: who will achieve something by what date how all staff will be made aware of changes how they will be achieved, and where specific events will occur Plans which remain flexible and adaptable are more likely to succeed (Wilkinson 1994); targets may need modification later. Evaluation However good ideas may sound, their effects in practice, together with their strengths and weaknesses, should be evaluated and, if necessary, the ideas should be modified, developed further, or even abandoned. Evaluations may be achieved through questionnaires, interviews, or more informal approaches. Beyond change Having successfully seen through changes, staff should gain satisfaction (boosting morale) from positively contributing to practice. Experience may be disseminated within the hospital, and beyond—for instance, are there hospital-wide forums where you work? If not, consider the mounting of study sessions/days, or the publication of articles. Extending practice should be part of each nurse’s professional development, and so relevant material, with written reflections on the process, can provide valuable additions to professional profiles. Implications for practice ■ change will occur, and the rate of change will increase ■ nurses can either proactively manage change or reactively be managed by others Intensive care nursing 454 ■ any change forced on people against their will is usually overturned at the earliest opportunity ■ change management should therefore seek to alter values ■ bottom-up approaches are more likely to succeed, as they adopt the norms of majorities ■ change is stressful for all concerned, and so should be carefully planned ■ detailed planning, with specific target dates and achievable goals, helps to prevent procrastination ■ change agents should facilitate informed decision making ■ change agents should acknowledge their own and others’ limitations ■ all staff are likely to need support through the stressful time of change ■ opposition to change can provide a forum for constructive debate ■ change agents should pre-plan how and when their initiative will be evaluated, and be prepared to modify plans where necessary Summary The pace of change is accelerating; nurses and nursing can choose between managing change or being managed by others. Other chapters in this book may have triggered ideas that readers wish to translate into practice. Changes are more likely to succeed if carefully planned, and so this chapter has described models and strategies to help them succeed in introducing change. Further reading Wright (1998) provides a practical description of change management; action research (Webb 1989) offers a way to develop change through practice. Toffler (1970) remains challenging, developing wider perspectives (although providing little immediate help for nurses wishing to make changes). The problems of ritualised nursing are illustrated by Walsh and Ford (1989) and Ford and Walsh (1994). Journals specialising in nursing management frequently include articles on change management (e. How are nurses or other members of healthcare teams (doctors, pharmacists, cleaners, porters) affected by these changes? Using your own example: (a) Identify the style and approaches used (top-down, bottom-up, etc. This chapter provides a trouble-shooting introduction for staff not normally in charge of their units (hence the direct address to readers). The terms manager and management in this chapter normally refer to the nurse-in-charge of the shift, rather than to more senior management; where appropriate, senior management is specifically identified. Some information may be factual, but much of it will be a matter of sharing experience and ideas in order to help others make clinical decisions. Hence, for the most part, options, rather than answers, are provided, and the issues will serve their purpose if they help readers to clarify their own values. Starting to manage Much has been written about management, mostly from industrial perspectives, although there is a growing body of literature on health service management. Vaughan and Pilmoor (1989) suggest that management is getting the work done through people. The nurse-in-charge should establish constructive working conditions at the start of the shift, enabling the development of the individual strengths and skills of staff, while recognising individual needs and limitations. Managers should individually assess and proactively plan and respond to needs for each shift, rather than seeking to impose their own agendas on staff. You may remember most patients from your previous shift; if not, briefly assess patients before taking handover. You may need to walk through your unit to take handover, but if not a brief look at the unit can suggest both the number and dependency of patients (high-dependency patients usually have more equipment and people at a bedspace).
Beck (8) identifies Fortunatus Fidelis as the earliest writer on medi- cal jurisprudence purchase 400mg quibron-t allergy asthma treatment center queensbury ny, with his De Relationibus Medicorum being published in Palermo best 400 mg quibron-t allergy knoxville, Italy order quibron-t us allergy symptoms for bee stings, in 1602 buy quibron-t on line allergy shots list. Subsequently, Paulus Zacchias wrote Quaestiones Medico-Legales, described by Beck as “his great work” between 1621 and 1635. Beck also refers to the Pandects of Valentini published in Germany in 1702, which he describes as “an extensive retrospect of the opinions and deci- sions of preceding writers on legal medicine. Late 18th Century Onward Beginning in the latter part of the 18th century, several books and trea- tises were published in English concerning forensic medicine and medical History and Development 5 jurisprudence. What is remarkable is that the issues addressed by many of the authors would not be out of place in a contemporary setting. It seems odd that many of these principles are restated today as though they are new. In 1783, William Hunter (9) published an essay entitled, On the Uncer- tainty of the Signs of Murder in the Case of Bastard Children; this may be the first true forensic medicine publication from England. John Gordon Smith writes in 1821 in the preface to his own book (10): “The earliest production in this country, professing to treat of Medical Jurisprudence generaliter, was an abstract from a foreign work, comprised in a very small space. Davis (11) refers to these and to Remarks on Medical Jurispru- dence by William Dease of Dublin, as well as the Treatise on Forensic Medi- cine or Medical Jurisprudence by O. Davis considers the latter two works of poor quality, stating that the: “First original and satis- factory work” was George Male’s Epitome of Juridical or Forensic Medicine, published in 1816 (second edition, 1821). Male was a physician at Birming- ham General Hospital and is often considered the father of English medical jurisprudence. John Gordon Smith (9) stated in The Principles of Forensic Medicine Systematically Arranged and Applied to British Practice (1821) that: “Forensic Medicine—Legal, Judiciary or Juridical Medicine—and Medical Jurisprudence are synonymous terms. Beck published the first American textbook 2 years later in 1823 and a third edition (London) had been published by 1829 (8). John Gordon Smith (9) wrote that “Every medical practitioner being liable to a subpoena, should make it his business to know the relations of physi- ological and pathological principles to the facts on which he is likely to be interrogated, and likewise the principal judiciary bearings of the case. The former of these are to be found in works on Forensic Medicine; the latter in those on Jurisprudence. Personal identity Real & apparent death Identity Sudden dath Age Survivorship Sex 8. Foeticide or criminal abortion Spontaneous combustion Infanticide Death by lightning Legitimacy Death from cold 5. The first Chair of Forensic Medicine had been established in the United Kingdom in Edinburgh in 1803—the appointee being Andrew Duncan, Jr. Subse- quent nonprofessorial academic forensic medicine posts were established at Guy’s Hospital and Charing Cross Hospital, London. In 1839 and 1875, respec- tively, academic chairs of medical jurisprudence were created in Glasgow and Aberdeen (15). The relevant areas of interest to forensic medicine and medical jurispru- dence were gradually becoming better defined. Table 2 summarizes the chap- ter contents of Principles of Forensic Medicine by William Guy (16), Professor of Forensic Medicine at King’s College, London, in 1844. Much of this mate- rial is relevant to forensic physicians and forensic pathologists working today. Thus, by the end of the 19th century, a framework of forensic medicine that persists today had been established in Europe, the United Kingdom, America, and related jurisdictions. Even though medicine and law interact more frequently in cases of living individuals, forensic pathology has long been established as the academic basis for forensic medicine. It is only in the last two decades that research and academic interest in clinical forensic medi- cine have become an area of more focused research. The recent growth in awareness of abuses of human rights and civil lib- erties has directed attention to the conditions of detention of prisoners and to the application of justice to both victim and suspect. Examples of injustice and failure to observe basic human rights or rights enshrined in statute in which the input of medical professionals may be considered at least of poor quality and at worst criminally negligent have occurred and continue to occur worldwide. The death of Steve Biko in South Africa, the conviction of Carole Richardson in England, and the deaths of native Australians in prison are widely publicized instances of such problems. Reports from the European Committee for the Prevention of Torture and Inhuman and Degrading Treat- ment in the early 1990s drew attention to the problem of lack of indepen- dence of some police doctors. The conflicting needs and duties of those involved in the judicial system are clear, and it is sometimes believed that recognition of such conflicts is comparatively recent, which would be naïve and wrong. In England and Wales, the Human Rights Act 1998, whose pur- pose is to make it unlawful for any public authority to act in a manner incom- patible with a right defined by the European Convention of Human Rights, reinforces the need for doctors to be aware of those human rights issues that touch on prisoners and that doctors can influence. It is worth noting that this law was enacted almost 50 years after publication of the European Conven- tion of Human Rights and Fundamental Freedoms. The future role of the forensic physician within bodies, such as the recently established Interna- tional Criminal Court, is likely to expand. The forensic physician has several roles that may interplay when assess- ing a prisoner or someone detained by the state or other statutory body. Three medical care facets that may conflict have been identified: first, the role of medicolegal expert for a law enforcement agency; second, the role of a treat- ing doctor; and third, the examination and treatment of detainees who allege that they have been mistreated by the police during their arrest, interroga- tion, or the various stages of police custody (18). Grant (19), a police surgeon 8 Payne-James appointed to the Metropolitan Police in the East End of London just more than a century ago, records the following incident: “One night I was called to Shadwell [police] station to see a man charged with being drunk and disorderly, who had a number of wounds on the top of his head…I dressed them…and when I fin- ished he whispered ‘Doctor, you might come with me to the cell door’…I went with him. We were just passing the door of an empty cell, when a police con- stable with a mop slipped out and struck the man a blow over the head…Boiling over with indignation I hurried to the Inspector’s Office [and] told him what had occurred. Grant rightly recognized that he had moral, ethical, and medical duties to his patient, the prisoner. Grant was one of the earliest “police surgeons” in En- gland, the first Superintending Surgeon having been appointed to the Metro- politan Police Force on April 30, 1830. In 1951, the association was reconstituted as a national body under the leadership of Ralph Summers, so that improvements in the education and training for clinical forensic medicine could be made. The Association of Forensic Physicians, formerly the Associa- tion of Police Surgeons, remains the leading professional body of forensic phy- sicians worldwide, with more 1000 members. It shows how clinical forensic medicine operates in a variety of coun- tries and jurisdictions and also addresses key questions regarding how important aspects of such work, including forensic assessment of victims and investigations of police complaints and deaths in custody, are under- taken. The questionnaire responses were all from individuals who were familiar with the forensic medical issues within their own country or state, and the responses reflect practices of that time. The sample is small, but nu- merous key points emerge, which are compared to the responses from an earlier similar study in 1997 (20). In the previous edition of this book, the following comments were made about clinical forensic medicine, the itali- cized comments represent apparent changes since that last survey. There appears to be wider recognition of the interrelationship of the roles of forensic physician and forensic pathology, and, indeed, in many jurisdic- tions, both clinical and pathological aspects of forensic medicine are under- taken by the same individual. The use of general practitioners (primary care physicians) with a special interest in clinical forensic medicine is common; England, Wales, Northern Ireland, Scotland, Australasia, and the Netherlands all remain heavily dependent on such professionals. Academic appointments are being created, but these are often honorary, and until governments and states recognize the importance of the work by fully funding full-time academic posts and support these with funds for research, then the growth of the discipline will be slow.