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The purpose of this research was to through empirical nursing research order 200mg extra super viagra fast delivery erectile dysfunction treatment at home, that hospitals continue the study of the nurse-patient relation- with a higher organizational caring score have in- ship as an economic interpersonal resource cheap extra super viagra 200 mg line erectile dysfunction due diabetes. Findings from this study identified that the nurse- patient relationship was both outcome and process. Categories, which emerged during data analysis, Economic/Political Implications included relationships, caring, and costs. The formal nomic dimension of bureaucratic caring can be theory of relational caring complexity illustrated used to guide administrative practice within that the caring relationship between the nurse, the health-care organizations. As a dimension of her patient, and the administrator is complex and research, Turkel (1997) interviewed eight top-level cocreative, is both process and outcome, and is hospital and corporate-level administrators to gain a function of a set of economic variables and a an understanding of how they viewed the experi- set of nurse-patient relational caring variables. Economic variables are depicted as time, technical, Administrators were chosen to be interviewed be- and organizational resources. Nurse-patient rela- cause they make the ultimate decision on how to al- tional caring variables are caring, relationships, and locate scarce human and economic resources education (Turkel & Ray, 2000). One administrator (1999) developed and tested a professional and shared the following with the researcher: patient questionnaire designed to measure organi- zational caring. The Organizational Caring ques- Lying in a bed like that, people feel vulnerable and are vulnerable, and they want to know that someone is tionnaire is a 26-item professional and an 18-item there for them and will share with them what’s going patient questionnaire designed from qualitative on. I hear [patients research (Ray & Turkel, 1995, 1997, 1999) and vali- say] that my nurse cared, she listened, and she kept dated and established as reliable through quantita- me informed. The three positive comments I receive from patients have to do subscales are caring, trust, and economics. What comes back to me questionnaire has been distributed in five different is they cared about me, they took time to talk to me, hospitals to over 500 participants. Given this, professional nursing practice remains in the forefront of organizational profit- must embrace and illuminate the caring philosophy. The issue of time constraints Staff nurses describe the essence of nursing as and inadequate staffing has been identified as prob- the caring relationship between nurse and patient lematic. However, nurses are practicing hindrance to forming a caring nurse-patient rela- in an environment where the economics and costs tionship. This points out the need for administra- of health care permeate discussions and clinical de- tors to restructure the organization so that the cisions. The focus on costs is not a transient re- maximum of nursing time is focused on direct sponse to shrinking reimbursement; instead, it has nurse-patient interactions. Hospital administrators become the catalyst for change within corporate desire high levels of quality care and see financial health-care organizations. With a system goal of decreasing administrators must maintain adequate staffing ra- length of stay and increasing staffing ratios, nurses tios in order to allow time for nurses to be with need to establish trust and initiate a relationship their patients. As this In the research conducted by Turkel and Ray relationship is being established, nurses need to (2000, 2001, 2003), administrator participants con- focus on being, knowing, and doing all at once firmed the above but also discussed the concomi- (Turkel, 1997) and being there from a patient per- tant need for maintaining care and quality. For the nurses, this means completing a challenge facing administrators in a managed care task while simultaneously engaging with a patient. Ray (1989) asserted that this the patient as a person in all his or her complexity can be accomplished if administrators consider and then identifying the needs for professional both the tangible and intangible benefits of services nursing as they arise. Changes that incorporated the human caring di- Administrators need to recognize caring as a mension and the critical nature that human rela- value-added interaction. From this point of view, tionships play in hospital organizations were the benefits of the interaction outweigh the expense identified by Ray over two decades ago. Caring can be viewed as an described the problems associated with economic “opportunity cost” or the cost of doing it right. This changes in health care and the negative impact eco- concept is applicable to contemporary health-care nomics would have on nurse caring. If people don’t come back to a Current research (Turkel & Ray, 2000, 2001, hospital (because of poor care), “you’ve lost an 2003) on the economics of the nurse-patient rela- opportunity. The re- The economic and political dimensions of bureau- searchers recommend that administrators recog- cratic caring can be used to guide practice. Now is nize and respect the contributions nursing could the time for professional nurses to become proac- make in developing hospital organizations as polit- tive and use theory-based practice to shape their ically moral, caring organizations.

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Te forensic odontologist is able to aid in the closure process for a grieving family (see Chapter 9) buy extra super viagra 200mg low cost causes of erectile dysfunction in 40s. Te process of collection of dental information on victims in a mass disaster is identical to the processes that are used in the identifcation of a single fatality generic extra super viagra 200mg on line erectile dysfunction and diabetes leaflet. Te major diference in this process is the potential magnitude of the event and the unique set of circumstances that can surround the event. Tese may include the location, climate, and cover- age area of the event, for example, a plane crash in mountainous terrain, a tsunami in a tropical area, the collapse of multistory structures in a major city, or a hurricane in a coastal area. Each of these incidents has unique issues that must be addressed with regard to recovery, processing, and storage of remains. Personnel in all areas of the operation should have the ability and desire to be detail oriented, as errors can lead to missed or misidentifcations. A mass disaster team should be organized and trained in coordination with the local or state government to allow the most expeditious deployment of a dental team when its services are needed. Bitemarks can occur in a wide variety of substrates, although the most common of these is, unfortunately, human skin. Te proper documen- tation of a bitemark is not overly complex, and the techniques for collecting evidence are manageable by most forensic dentists with practice and atten- tion to detail. Te bite site can be evaluated in the third dimension by using a very accurate dental impression material and dental stones or resins to create a solid model for viewing under magnifcation, light microscopy, or with scanning electron microscopy. Tis three-dimensional model of the bitten area can then be compared to suspects’ dental casts. Technique shortcomings exist and include that solid models of bitemarks on skin are nonelastic. Te problems associated with bitemark analysis will be discussed more fully in Chapter 14. Healthcare practitioners are required by law in most jurisdictions to report suspected cases of abuse. Extraoral injuries consistent in shape and appearance to a hand or object are identifable. Intraoral trauma can occur as the result of strikes to the face, causing torn frena and fractured, mobile, or avulsed teeth. Intraoral sof tissue pathology may be noted following forced feeding or forced fellatio. Some cases may require the consideration of whether extensive or rampant caries are a result of the caregivers’ lack of knowledge or stem from neglect or abuse. In areas where access to dental care is an issue there will likely be a higher caries incidence that could further exacerbate the determination of whether reporting of abuse may be necessary. Deciding to report suspected abuse requires sound judgment, especially considering that the parent or scope of Forensic odontology 29 guardian may be the perpetrator. If a report is initiated, the ensuing investi- gation will be difcult for all concerned (see Chapter 15). Tese include developmental, histological, biochemical, and anthropological techniques. Anthropologists analyze the fusion of the cranial sutures of the skull, the development of the long bones, features of the pelvic girdle, and along with forensic dentists, features of the teeth. Tese techniques can be valuable when creating a profle for an unidentifed person, whether living or deceased. Estimating an individual’s age can also be helpful in assist- ing law enforcement agencies in determining the attainment of the year of majority of a living individual that will ultimately afect the individual’s treat- ment in the legal system as either a child or an adult. Te methods of age estimation using teeth include analyzing tooth devel- opment and eruption, studying tooth degradation, and measuring biochemi- cal and trace element changes in dental structures. Each of these methods has its advantages and limitations in accuracy and in the ease of use. Some can be performed through the analysis of dental or other radiographs or with clinical examination; others require laboratory testing or tooth destruction. Te individual jurisdiction’s requirements and the odontologist’s skill and knowledge will help to establish the appropriate techniques for each case (see Chapter 13). Te testimony may involve the previously mentioned areas of dental identifcation, bitemark analysis, or age estimation. Dentists participating in forensic casework should expect that at some point they will be required to provide sworn testimony. Forensic dentists also may be called to provide an opinion in standard of care, personal injury, dental fraud, or other civil cases.

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