In the United States the ventricular assist device is used primarily for three groups of patients: those who cannot be weaned from cardiopulmonary bypass after a cardiac procedure; those who have an acute heart attack that results in cardiogenic shock; and the largest group, those who have end-stage heart disease and need some support while waiting for a heart transplant. In several European countries the LVAD is used as destination therapy. This is prohibited in the United States because the FDA has only approved the device as a bridge to transplant. Starting in 1973, the NIH spent approximately $10 million per year over the next decade and a half on research on LVADs for damaged hearts. The first implant of an LVAD in a patient who could not be weaned from bypass was done in August of 1966 (Goldstein et al.). In the ten days after surgery the patient’s continued improvement allowed her to be successfully weaned from the pump (DeBakey). It was not, however, until the early 1990s that a number of universities and private companies in a wide variety of countries undertook formal clinical trials of LVADs. Currently LVADs are a relatively common treatment for patients who are candidates for heart transplantation. Some info about hoodia gordonii diet you find here

The ethics committee of the Swiss Nursing Association wrote a code of ethics in the 1980s and has been instrumental in increasing nurses’ awareness of the need for more

systematic approaches to teaching ethics in nursing programs. The association includes in its annual conference papers on ethics in curriculum content and clinical practice. For some years, one nurse educator has taught courses in Switzerland and France on ethical issues in dying and death with a special focus on suffering. Nurse educators in Finland have offered seminars around the country on nursing ethics. One nurse educator has published a book on the topic. Several nurse educators in Finland and other Nordic countries have conducted research on ethical questions and have participated in multinational research projects examining selected ethical issues. The board of directors of the Center for Medical Ethics at the University of Oslo, Norway, consists of people from diverse health-related professions. It continues to work with nurse educators and nurse researchers in developing educational programs and research focused on ethical issues. Universities in both Norway and Sweden have invited nurse educators from overseas to lecture on nursing ethics. The annual, week-long seminar held in Sweden for doctoral students in nursing, which has either a primary or secondary focus on nursing ethics, has been of special interest because of its potential impact on nursing education. Extensive research on the ethics of various clinical problems with elderly patients has been undertaken at the University of Umea, Sweden. In Stockholm, two nurse educators teach and conduct research in nursing ethics.

In the United Kingdom nursing education is well developed, and higher education has been available to nurses for many years. In some colleges or departments of nursing,

ethics is either taught as a separate course or integrated into other courses. During recent decades, the Royal College of Nursing actively articulated nursing ethics. In addition, nurse educators and others have published numerous papers, research reports, and books focused on nursing ethics. A major British nursing journal includes an ethics column that deals with clinical ethical problems. The Center for Midwifery and Nursing Ethics in London publishes a newsletter, runs educational programs, and serves as a clearinghouse for ethics materials. In 1990, Swansea University, Wales, sponsored the first national conference on nursing ethics and nursing ethics education. Over the past several years, Swansea has also sponsored conferences on Nursing Philosophy and since 1999 has published a journal with this title that includes ethics articles (De Raeve). In Canada, numerous conferences have focused on nursing ethics and ethics education. An annual conference to discuss philosophy and nursing touches on many ethical themes. Several schools of nursing have invited visiting professors to teach ethics and have prepared some Canadian nursing professors to teach this subject as well. Canada has revised its own nursing code of ethics in 2002.

The use of aversion procedures (the application of subjectively unpleasant stimulation

contingent upon performance of an undesirable behavior) has been, and remains, a source of criticism of behavior therapists. Particularly when procedures such as low-level electric shocks are applied to clients who lack the ability to

offer informed consent to the use of such procedures, behavior therapists face a dilemma in which the desirability of treatment outcome goals has to be weighed against the rights of the client. Even when aversion therapy seems to be the best, most rapid means of suppressing other, perhaps more injurious, behavior, such as self-destructive behaviors in clients suffering from pervasive developmental disorders, behavior therapists are ethically bound to attempt to reduce the target behavior through nonaversive means before considering an aversion procedure. Only when the target behavior has been conclusively shown to be impervious to other

means should aversion therapy be used. The use of aversion techniques with clients for whom rapid, permanent behavior change is not essential, or for whom there may be some question as to the desire or willingness to change, raises significant ethical concerns. The application of aversion procedures to clients in powerless positions, or where the goals of the agent of behavior change seem directly counter to those of the client, requires careful assessment of the interests of all involved parties, with extra weight perhaps being given to the client’s right to be free from external influence over his or her behavior.

Practices such as those reported to have occurred in the former Soviet Union, including the use of aversion procedures or drugs for the subjugation of prisoners and psychiatric patients, are clearly not in keeping with the ethical application of behavior therapy or any other form of therapy. When aversion procedures are used, clear guidelines need to be established. Review by an institutional ethics board in order to set up extensive safeguards of client rights has to precede treatment.

From the beginning, most behavior therapists have been intensely concerned with the ethical aspects of the application of behavior therapy, the ethical implications of the

relationship between therapist and client, and the role of each in treatment. In contrast to other psychotherapeutic approaches, behavior therapy is characterized by a heavy

emphasis on the responsibility of the therapist for successful treatment outcome. In behavior therapy, failure to achieve treatment goals is presumed to be the result of therapist errors or environmental hazards beyond the therapist’s control, rather than of client resistance. The therapist is viewed as an “expert” guide who brings to the situation a body of teachable knowledge. In collegial fashion, as a mutual collaborative process, the patient is shown how to use this knowledge to bring about desired change. In this view, therapeutic failures result from several sources of therapist error, particularly: (1) errors in selection of therapeutic goals due to inadequate assessment; (2) errors in the selection, teaching, or application of techniques; (3) failure to consider client values in the selection of therapeutic goals, or the placing of societal or therapist values above those of the client in the process of goal selection; and (4) variables beyond the therapist’s control. While early behavior therapists tended to neglect the importance of a workable therapeutic relationship with the client, as the field has evolved such issues have become increasingly important in behavior therapy (see Wilson and Evans). Most behavior therapists recognize that without a therapeutic relationship characterized by mutual respect, empathy, trust, and equality, the first three types of therapist error noted above cannot be avoided, and treatment is unlikely to be successful. An increasing emphasis on thought and feeling leads to recognition that an adequate therapeutic relationship is essential to assessment and treatment. Changes in thoughts and emotions can, in and of themselves, be appropriate outcomes of treatment, as can changes in overt behavior. These changes can be facilitated by the establishment

of a good therapeutic relationship.

search

hoodia diet pills 57
MP3 Music

profile

Complete Profile

categories:

• Behavior Therapy (5)

archives:

• December-2009 (5)

calendar:

August
Sun	Mon	Tue	Wed	Thu	Fri	Sat
1	2	3	4	5	6	7
8	9	10	11	12	13	14
15	16	17	18	19	20	21
22	23	24	25	26	27	28
29	30	31