Transition to RN Exc Word Scramble
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| Question | Answer |
| who sets the standards for nursing practice | The American Nurse Associations Standards of Nursing Practice. |
| Nursing is the synthesis of many theories. | BLANK |
| did a study which resulted in establishment of associate degree nursing education | Mildred Montag |
| the major concepts in a discipline that names the phenomena of concern | Meta-paradigm |
| Earliest organization for Men in Nursing. Raised standards of education, culture. Care of the sick was above others duties of Monk. Emphasized Bathing | Monastic Orders |
| 4 types of Qualiative Research Methods | PHENOMENOLOGY- describes exp as they are lived by the subjects being studied GROUDED THEORY- how people describe their own reality & how their beliefs are r/t actions in a social scene other 2 on next card |
| Neuman's theory re: nursing | unique profession in that it is concerned with all variables affecting an individual's response to stressors, which are intra, inter & extra personal in nature. THe nurse helps the pt through primary, secondary & tertiary prevention to maintain stability |
| She developed the theory of the Science of Unitary Human Beings, in which the person is a unified whole, greater than the sum of parts. | Martha Rogers |
| *Military* *M* MilitaryNursing Service formed, Florenece Nightingale cleaned up the hosp, orderlies scrubbed often, camp followers scrubbed clothes, and vermin were under control | Crimean War |
| written form of defamation | libel |
| Created FNS Frontier Nursing Service- 1st midwifery training school | Mary Breckinridge |
| This is used to address more narrowy defined phenomena and can be used to suggest an intervention | Middle-range theory |
| She is recognized as the first nurse theorist. She describe nursing as both an art and science. She recommeded adjusting the environment to improve a person's health. | Florence Nightingale |
| info the researcer collects from subjects in the study- expressed in numbers | Data |
| a set of guidelines for provding high-quality nuring care & criteria for evaluating care | Standards of nursing practice |
| Outcome Measures | are the actual healt results in pts & communities served. key indicators or QI (quality indicators) show effectiveness of the system as a whole & indicate whether access to services are available. |
| intentional & unlawful offer to touch a person in an offensive, insulting or physically intimidating manner. | Assult |
| * other 2 methods | -ETHNOGRAPHY- examines issues of a culure that are of interest to nursing -HISTORICAL- examinesevents of te passt to generate understanding of nursing profession |
| Elements of a valid contract | PREAMBLE- an explanation or summary of the contract TERMINATION CLAUSE- a portion of a contract that explains the rights of the parties to terminate, or cancel, their contract. |
| Basics of a critical pathway | -represents a sequential, interdisciplinary, minimal practice standard for specific pt population -provides flexibility to alter care to meet ind. pt needs -abbreviated format, broad prospective -phase or episode driven -ability to measure cause & eff |
| Provides a legal regulatory bodies of all states to act together re: boards, exams, licensing | NCSBN- National Council of State Boards of Nursing |
| 3 models of action in Leininger's theory | culture care preservation, culture care accomidation, and culture care re-patterning |
| Madeleine Leininger - cultural care diversity & universality theory | P- Human beings are caring & capable of feeling concern E- *none* H- a state of well being that is culturally defined, valued & practiced N- uses problem solving approach, 3 models of action- see next card |
| statement of relationships between the independent & dependent variables that the researcher expects to find | Hypothesis |
| Risk Management | an effort to reduce & assess risks to pts, staff, & organizational assets withina health care institution. They identify risks and review & apprase safety protocols |
| longer than 30 days for chronic illness may be for a lifetime or recovery period | Long term Care |
| Was formed to provide accrediation | CCNE- Commission on Collegiate Nursing Education |
| Purpose is to work toward uiform terminology and definitions in nursing diagnosis, and t share these ideas. | NANDA- North American Nursing Diagnosis Association |
| service that does observation, assessment, teaching and training, direct skilled nursing such as tube feedings, vents, RN must be in charge of care | Skilled Nursing Care |
| Organization for nurses who design, facilitate, and manage care | AONE- American Organization of Nurse Executives |
| the systematic collection & analysis of more SUBJECTIVE narrative materials | Qualiative Research which os used to gain greater understanding of the experience of the pt & family and may help the nurse t identify areas to explore with pt & family |
| There are 4 levels of KNOWING: | empirical, aesthetic, personal, ethical |
| For those who have made significant contributions to nursing- honorary part of ANA | AAN- American Academy of Nursing |
| Phiadelphia Dispensary was fomed for free pt care, homes and barns were makeshift hosp, women left during war were there to care for sick and injured Controlled disease and smallpox vaccination was given | Amercan Revolution |
| a symbolic representation of a theory, shown through diagrams, words, or notations, | Conceptual model |
| Free or low cost screens & health info | Preventative services |
| components of these gidelines | -identify a specific area of concern -review the published literature -critically analyze the lit to be certain it is accurate & relevant to area of concern |
| wearable/ implantable monitors for medical conditions | physiological monitoring |
| Different financial situations change ins. coverage, ability to get care and what type of care | Rationing of health care |
| Evidence based practice guidelines | integrating individualclinical expertise with the bst available external clinical evidence from systematic research. |
| wearable/ implantable insulin or glucose pumps, medicated stents | Drug Admin |
| The structure that links concepts together, representing a unified whole. | Conceptual framwork |
| used the buildup and excitement of the World's Fair to bring together nurses and form the first nursing organization | Isabel Hampton |
| Long term quality indicators | there are 11 areas of care ith 24 quality indicators. they represent common conditions & items that are important to residents & serve as te focus for suveyors. |
| America's first trained nurse- also key figure in development of nursing education, moved from hosp to hosp an improvement campaign | Melinda Ann (Linda) Richards |
| Nursing knowledge continues to expand in a multiplicity of ways. | BLANK |
| Nursing is always in a state of change. | BLANK |
| Care is provided and then the patient is discharged soon after | Ambulatory Care also called outpatient care |
| The individual, family or group in a meta-paradigm | PERSON |
| opened FIRST birth control clinic with her sister in Brooklyn | Margaret Sanger |
| provides medical, nursing, social work, spiritual support, for pts and families during a terminal illness | Hospice Care |
| Watson's theory re: nursing- | Nursing combines the research process witht he problem solving approach & is concerned with promoting and restoring health, preventing illness & caring for the sick. |
| Roy's adaption model- Sister Callista Roy | P- a bio-psycho-social being who is constantly intereacting with the environment & who has 4 modes of adaption H- a state & process of being & becoming an integrated & whole oerson. N- care & well being of humans, rooted in beliefs about the human person |
| Theory defines what nursing is, what it does and the goals and outcomes of nursing care. | BLANK |
| Florence Nightingale's Environmental theory | P- ind. with vital reparative processes to deal with disease & desirous of health but passive in terms of influencing the environment or nurse. E- see alt card H- Health is maintained through preventions of disease from envir. factors. |
| Who focused on hygiene and sanitation and believed strongly in continuing education? | Florence Nightingale |
| examines the type & degree of relationships between 2 or more variables | Correlational Research |
| investor owned and operated by corp or stockholders | Proprietary agencies |
| these are mental images of a phenomenon | CONCEPTS |
| The continuum of wellness to terminal illness in the meta-paradigm | HEALTH |
| the willful & purposeful misrespresentaion that could cause or has caused loss or harm to a person or property. | Fraud- Misrepresentation of a product is a common fraudulent act. |
| Bolton Act created the US Caet Nurse Corps. Nurses got full military commission, post war- Hill Burton Act | World War 2 |
| examines cause & effect relationships between variables under highly contolld conditions | Experiemental Research |
| Roy's 4 modes of adaption based on | physiologic needs, self-concept, role function, and interdependence |
| When a wrong is committed against another person or property that was not intended to happen. | Unintentional tort. Most common cause of an unintentional tort is negligence. |
| When the outcome is planned, although the person involved may not have believed the outcome would be harmful | intentional tort |
| a psychiatric nurse- described Nurse- Client relationships | Hildegard Peplau |
| Florence Nightingale's theory re: nursing | Provision of optimal conditions to enhace the person's reparative process from being interupted. |
| Who organized the American Red cross and was responsible for relief operations during the Civil War? | Clara Barton |
| QUANTITIVE RESEARCH -objective -deductive * tests theories -Generalisable -Numbers | QUALITATIVE RESEARCH -Subjective -inductive * generates theories -NOT generalisable -Words |
| something that varies and has different values that can be measured | Variable |
| Misc Others- | National Associations of Hispanic, Black Nurses American Assembly for men in nursing NAPNES- for LPN's American Associations of : Critical Care Nurses, PeriOperative RN's, Occupational Health Nurses, Religious Oriented Organzations and Educational Ori |
| Elements of the nursing care plan | NANDA nursing dx with related factors & diagnostic criteria -nursing outcome classifications with specified outcomes to be achieved including deadlines -Nursing intervention classifications with specified interventions |
| A theory is a set of concepts & propositions that provides an orderly way to view phenomena. | BLANK |
| Born into slavery, nursed Union soldiers, worked to improve sanitary conditions, got food and clothing for black soldiers | Sojourner Truth |
| Therapeutic communication includes; | listening, clarifying, & problem solving |
| an agreement between 2 parties or more, especially one that is written & enforceable by law | contract- these are often implied with pts. Courts will uphold that an implied contract exists obligating the nurse to be competent & to provide responsible care. |
| This is an example of middle-range theory and uses 11 functional health patterns to provide a framework for assessment, nursing dx, and a plan of car. | Gordon's Functional Health Patterns |
| laws in each state that are instrumental in defining the scope of nursing practice. They protect public health, safety and welfare. State boards of nursing oversee this stautory law | Nurse Practice Acts |
| Tools or guidelines that diret are by identifying expected outcomes | Critical Pathway |
| a medicare/ medicaid review organization that evals preadmission, pre-procedure, concurrent or retrospective review. | PRO- Peer Review Organization. The purpose is to determine if care given was necessary & appropriate. |
| Healthcare provided in defined demo area. Is centered to individuals and family | Community based care |
| Orem's theory regarding Nursing | Nursing is a deliberate action, a function of the practical intelligence of nurses & action to bring mundanely desirable conditions. |
| Med/ Surg, OB, ER and diagnostic center plus lab services | General or Community Hospital |
| Was formed to assist collegiate schoold of nursing to improve higher education for nursing. | AACN- American Association of Colleges of Nursing |
| Conductor of undergrown railraod who assisted Clara Barton to tend to wounded soldiers during the Civil War. | Harriet Ross Tubman |
| contact with pt. is minutes to hours | In and Out Care (ex- ER, office visits) |
| Religion- *R* Protestant Churches- women subordinate to men- nurse most menial of servants | The Reformation |
| agencies that seek Medicare/ Medicaid funding must meet specific standards and also have many DEEMED STATUS agencies that services need this certification | Medicare/ Medicaid Certification |
| Virginia Henderson- definition of nursing | P- complete being who has 14 fundamental needs E- aggregate the external conditions & influences H- Requires independence 7 interdependence Must be able to do the 14 basics unaided N- to assist those who cannot do by themselves |
| The actions; interactions of the nurse with the person in a meta-paradigm | NURSING |
| making a person stay in a place against their wishes | False Imprisonment- the law always requires the least restrictive measures in care including with restrainsts (physical or medical) |
| devices used to collect & record the data | Instruments |
| any eval of services providd & the results achieved are compared with acceped standards | Quality Management/ Quality Improvement 1st- actual results are compared with standard results then any deficiencies noted or identified serve to prompt recommendations for improvement |
| Nursing schools were already established and Isabel Robb developed a plan for managing nurses | Spanish-American War and the Boer War |
| Who was the nurse who became responsible for construction of state psychiatric hospitals? | Dorothea Dix |
| She developed the theory of Human Caring and described 10 carative factors. | Jean Watson |
| Public saw the need for trained nurses, Clara Barton, Harriet Tubman, Sojourner Truth tended to the soldiers | American Civil War |
| explores and describes events in real life situations, describing concepts | Descriptive Research |
| care is more than 24 hours but less than 30 days | Acute care |
| a study in which items can be counted or measured & statistics can be used to analyze the results | Quanitative research |
| Nursing care plans are based on nursing process | they outline the nursing care to be provided. It is a set of actions the nurse will implement to resolve nursing problems identified by assessment. |
| King;s 3 interacting systems | Individuals (personal), groups (interpersonal), and society (social) systems. |
| First Nursing Organization in the US. 5 Goals- nursing education development and improvement, faculty development, nursing ed research, data collection, assessment & evaluation | NLN- National League for Nursing |
| "The act of utilizing the environment of the patient to assist him in his recovery" | Florence Nightingale |
| sisters that visited pt's in homes, hosp, and poorhouses and asylums. Deveoped educational programs for Nurses | Sisters of Charity |
| Roger's theory regarding Nursing | A humanistic science dedicated to compassionate concern with maintaining & promoting health, preventing illness, & caring for & rehabilitating the sick and disabled. |
| Concepts and Propositions are the structural elements of a theoretical foundation | BLANK |
| Places offering healthcare must ne approved by the gov't agency, usually the Dept of Health they need this cert | Governmental Approval |
| "The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to the health or its recovery" that would do for themselves if they could | Virginia Henderson |
| Operated by universities, religious organizations, fraternal groups. All profit above that needed for maint. and operations must go to improvement and growth | Non-Profit Agencies |
| a plan of care based on standards that reflect optimal timing of sequential steps provided by all members of the team or managing chronic health problems | Care Map/ clinical pathways |
| Offers only a particular tyoe of care such as Psych, or Peds | Specialty Hosp |
| the variable being studied, determined as a result of a study | Dependent variable |
| also called practical research, it is designed to directly influence or improve clinical practice | applied research |
| Organization that provides voluntary accreditation. Has a peer-reviewed process | CHAP- Community Health Accreditation Program |
| Made up of concepts and propositions | THEORIES |
| Healtth Maintainance Program which are prepaid, group managed care, usually have to stay "in network of md's" | HMO- Health Maintenance Organizations |
| 4 types of quantitive research | Descriptive, correlational, Quasi-experimental, and Experimental |
| Roman Catholic society - sister nurses nursed cholera pt's Mercy Hospitals | Sisters of Mercy |
| She emphasized understanding the person's lived experiences as related to health. | Rosemary Parse |
| Used to describe a client's condition | Acuity |
| She used her contacts with powerful men in govt to obtain supplies and personnel needed to care for the wounded during Crimean War | Florence Nightingale |
| *Nursing Organizations Concerns itself with social and economic welfare of nurses, the role of the nurse, the nursing organizations and their their gverning bodies | ICN- International Council of Nurses |
| Early theorist who taught "a patient is a person who requires help toward independence" | Virginia Henderson |
| She described 4 conservatin principles for nursing, specifically the conervation of energy, structural integrity, personal integrity, and social stability. She also stated people need nursing when they are unable to care for themselves. | Myra Levine |
| system in which the use of healthcare services are controlled and monitored there are usually protocols for tx and is usually preapproved | Managed Care |
| This reviews and evaluates HMO's it provides HEDIS- Health Plan EMployer Data & info Set to compare HMO's | National Committee for Quality Assurance (NCQA) |
| type of service that is often a special unit in a hospital usually less than 30 days | Sub Acute Care |
| The place or community where care is provided in a meta-paradigm | ENVIRONMENT |
| used by HMO's & PPO's to keep costs low - usually seen as a way to deny tx | Capitation |
| the touching of another person without the person's consent. | BATTERY |
| Baccalaureate program honorary organization for exceptional standards | Sigma Theta Tau (STTI) |
| abandonment | - each state has different definitions. Nurses cannot leave their patients when they are needed. |
| Radical changes in nursing education, reduced student work day from 10 to 8 and eliminated FREE private duty services | Isabel Hampton Robb |
| Nursing leader and women's right activist giving women the right to vote- also a key figure in community nursing and introduced nuring in schools | Lavinia Dock |
| Elements of Malpractice | 1. Harm to an individual 2. Breech of duty b the professional 3. duty of a professional toward an individual 4. breech of duty as the casue of harm |
| Neuman's systems model- Betty Neuman | P- the total person is mad eof physiologic, socio-cultural & developmental varibales. E- people maintain varying degrees of harmony & balance H- Illness = lack of harmony among parts & subparts of the system |
| causes or conditions tht are mainpulated or identified to determine the effects on the dependent varable | Independent variable |
| Defines nursing, describes what nurses do, and provides goals and outcomes of care | Nursing Theory |
| a particular viewpoint or perspective "a worldview" | Paradigm |
| is derived from common usage, custom or judical law. it is based on occurances of events, it is less clear & exact that stauutory law | Common law- ( FYI- statutory law & regulatory law carry more weight in court than common law does) |
| King's theory re: nursing- | a helping profession that assists individuals & groups in society to attain, maintain, & restore health or to help individuals die with dignity. |
| Provides care to pts where stay is less than 24 hours | Short- Stay |
| the carelessness or failure to act as a prudent person would normally act under the same circumstance; unintended failure of a person to act or not act as a reasonable person would/would not act in a similar scenario | Negligence |
| LEGAL- addresses tje general welfare of the public. A violation of this law is a called a crime & is prosecuted by the gov't. | CRIMINAL LAW |
| care that is provided outside of a health care clinic, hosp. usually provided in the home | Home Health Care |
| Founded during Crusades- staffed 2 hospitals in Jerusalem | Military Nursing Orders |
| Breech of duty | includes either doing or not doing what should have been done (commission of an inappropriate action) or not done. Failing to act as a resonable prudent person. Failure to peform an act required by law or performing in an unlawful way |
| Hildegard Peplau- Peplau's interpersonal relations model *environment not defined | P- Focus on the individual- they live in an unsatble equilibrium & strive to reduce anxiety H- Moving toward a directon of beong creative, constructive, productive, & personal and community living N- Sick person and nurse therapeutic communication |
| Increased demand for nurses, Army School of Nursing - nurses needed to be unmarried and of good moral character | World War 1 |
| For RN'S- Is involved in all issues that nursing has confronted with Legislation, Collective bargaining, advancement of profession | ANA- American Nurse's Association |
| these may be established for the careof pts with specific illness, treatments, or surgical procedures. | Evidence based guidelines |
| Hosp and nursing homes get this accreditation | JCAHO- Joint Commission on Accreditation of Healthcare ORganizations |
| invasion of privacy | all info re: pt's is confidential or private whether it is on paper, computer or spoken. this includes; unnecessary exposure of pt's during care, talking with pt's in rooms that aren't sundproof, sharing pt info, interacting with pt's family re: HIPPA |
| Was able to fight incompetence & obtain decent care for the wounded Civil War soldiers by using influential people in Washington | Hannah Ropes |
| a process that uses observable & verifiable info, colected in a systematic manner to describe, explain, or predict events | Research |
| This law regulated condeuct between private individuals or businesses & is enforced through the courts as damages or monetary compensation. | CIVIL LAW |
| Purpose of this was to establish national goals to serve as a focus by individuals, organizaations, & the governmnt. | National Health Indicators |
| include infection rates & morbidity/mortality rates associated with specific hospitals & procedures. | Hospital Healthcare Outcomes |
| used to identify a specific type of negligence of a specifically trained or educated person in the performance of his/her job | Malpractice. to prevent this maintain a high standard of care, excellent communication with pt and family, be aware of policy & procedures. they are an adequate defense against a claim. Avoid short cuts & work arounds. |
| pure or lab research that is designed to generate & refine theory | basic research |
| Level 1 Trauma Center, Burn Center, Oncology, and other levels of care | Tertiary care hospital |
| oral form of defamation | slander |
| Florenece Nighingale's major concepts of health | ventilation, warmth, light, diet, cleanliness, and absence of noise |
| this describes the relationship between concepts | PROPOSITIONS |
| 14 funadmental needs | breathing, eat, drink, eliminate, move & maintain posture, sleep & rest, dress & undress, maintain body temp, keep clean, avoid danger, communicate, worship, work, play and learn |
| 4 essential characteristics of negligence | 1. harm must have occurred. 2. the negligent person must have been in a situation where they held a duty toward the person harmed. 3. Breach of duty 4. the harm must be shown to have been caused by a breech of duty. |
| National Health Indicators do this | Process-Identify Need- Assemble Team- Collect data- use nursing audits or peer review- establish outcomes- Evaluate |
| Founder of public health nursing - established a neighborhood nursing service in NYC | Lillian Wald |
| IVD computer analysis speeds diagnosis ( blood, urine, body tissue samples) | Diagnostic techniques |
| these are civil wrongs committed by 1 person against another person or their property. It can include physical harm, pychological harm, harm to livelyhood, or some other less tangible value such as harm to repuation. | TORT- it can also be a crime- gross negligance that demonstrates that offender is guilty of complete disregard for another's life may be tried as both a civil & a criminal action & is oprosecuted under criminal & civil law. |
| Nurses dervive knowledge through Carpers patterns of knowing 4 | empirical (scientific), aesthetic (creative) knowledge, personal knowledge and ethical knowledge. |
| designed to restore health and function | Rehab care |
| an intentional tort in which one party makes derogatory remarks about another that diminish the other party's reputation & is grounds for an award of civil damages | Defamation of character |
| Orem's self care theory- Dorothea E. Orem | P- a unity who can be viewed as functioning biologically, symbolically & socially, and who initiates & performs on thier own to maintain health and well being. H- Well being is used in the sense of the person's percieved condition of existance. |
| A meta-paradigm in nursing has 4 areas | Person, Health, Environment and Nursing |
| Care focused on soldiers and victims of war | Gulf War- Afganistan- Iraq |
| services owned by state, federal or local gov't may use tax dollars | Government Owned facilities (ex-VA) |
| 3 types of health organizations | Primary, Secondary and Tertiary |
| Informed consent | the pt's right to consent knowledgeably to participate in a study or tx without coercion or to refuse to participate without jeopardizing the care that he/ she will recieve. The right to confidentiality, & to be protected from harm |
| Keys to critiquing research repors | -Source -author -content -consensus |
| Characteristics of a quality nursing care plan | -It focuses on actions which are designed to solve or minimize the existing problem -it is a product of a delibrate systematic process -it relates to the future -it is based upon identifiable health & nursing problems |
| this is published in codes. it is broken down into specific rules. it includes constutional laws and enacted laws | Statutory Laws |
| Earliest counterpart to community health nurses- worldly items were of no concern to nurses, nurses required strict obedience, devotion, and setting aside themselves | Order of the Deaconesses |
| This provides an overall framwork for structuring ideas | Grand theory |
| 3 groups under HCUP- Healthcare Cost & Utilzation Project used to determine quality of care & access to care | prevention, inpatient & pt safety quality indicators |
| MASH units | Korean War and Vietnam conflicts |
| America's first African American Nurse | Mary Mahoney |
| Watson's human caring theory- Jean Watson | P- person is greater than & different from the sum of parts. Individuality is important. H- high level of physical, menatl, and social functioning. E- social, cultural and spiritual influences of society. Sets goals |
| Roger's science of unitary human beings- Martha E. Rogers | P- Different from the sum of its parts. Continous repatterning. E- Each is specific to its given human field. H- + health= wellness. |
| The creation of the nursing care plan is a ? stage of the nursing process | Intermediate- it guides in th ongoing provision of nursing cre & assists in the evaluation of that care. |
| 4 Purposes to 1. speak for associate degree nursing education and practice 2. Reinforce the value of that degree 3. maintain endorsement for grads with associte degree, 4. retain the RN exam for assocaite degree grads | NOADN- National Organization For The Associate Degree Nursing |
| Student nursing organization | NSNA- National Student Nurses' Association |
| examines cause & effect relationships between selected variables. Often conducted in nursing research t examine effects of intervenions on pt outcomes | Quasi- Experimental Research |
| ASSESS, LINK, SYNTHESIZE, DESIGN, IMPLEMENT AND EVALUATE, INTEGRATE AND MAINTAIN | ** BLANK** |
| In review & appraisal they do this | 1. STRUCTURE EVAL or audit focuses on environment in which the care is provided. Standards describe phyisical facilities & equiptment; organizational characteristics, policies & procedures, fiscal resources, prsonnel resources. |
| This document defines nursing legally, and the scope of nursing practice is outlined. | Nurse Practice Act |
| a rule or formal regulation established by the gov't legislative authority such as Congress, the state legislature or city council, that appears in writing | Statue |
| refers to care focused on meeting deficits of ADL's | Custodial Care |
| They then- PROCESS EVAL which is the nature & sequence of activities carried out by nures implementing the nursing process. Criteria make explicit acceptable levels of erformance for nursing actions r/t pt assessment, dx, planning, implemntation, & eval | OUTCOME EVAL- focuses on measurable changes in the health status of the pt or the end results of nursing care. The proper environment for care & the right nursing actions are important; the critical element is demonstratable changes in pt health status |
| King's goal attainment theory- Imogene King | P- 3 interacting systems, the personal systems is unified complex whole self who percieves, thinks, desires, imagines & decides, identifies goals & selects means to achieve it. E- is constantly changing H- continuous adaption to stress to achieve max pote |
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