Professional Documents
Culture Documents
SIXTH EDITION
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Preface
The health care system in the United States is chang- boxes, a special feature used in this text, are designed
ing and evolving to best serve the needs of the to draw the reader’s attention to important facts.
people. The focus will remain on health promotion, Other pedagogical features include tables, boxes,
maintenance, and restoration. In this new health illustrations, and photographs.
delivery system, health care workers are expected to At the conclusion of each chapter, a chapter
provide care to individuals in a variety of settings summary highlights key points, followed by one or
throughout their life span. The authors present more Critical Thinking exercises and Critical Ques-
material based on research, clinical experience, and tions to increase awareness and to challenge thinking.
their own experience. We have tried to be objective NCLEX-style questions at the end of each chapter
and respectful of others’ beliefs and ideas. help students test their content understanding.
This textbook is designed to assist students in The following resources are included for faculty:
their study of the life cycle from conception to old
• Active Classroom Instructor Guide (ACIG) pro-
age. Instead of having to read only certain sections
vides pre-, during, and post-class suggestions for
of a core text or portions of a pediatric or maternity
activities and assignments, focusing on the active
text, students can now see the complete presenta-
classroom
tion of growth and development across the life
• eBook
span. We hope this will be meaningful and will
• NCLEX-style test bank
assist students in developing an appreciation for
• PowerPoint presentations
individuals in their struggle to maintain, promote,
and restore health. We wish to point out that the names of persons
This edition has 14 chapters, each designed to used in Critical Thinking exercises and in case stud-
make the book user-friendly. The last chapter deals ies are fictional and that any resemblance to names
with the topics of death, dying, and bereavement. of actual persons is coincidental.
The authors hope that readers will find comfort and It is our hope that students will find this text easy
guidance from this chapter when dealing with either to read and applicable to clinical practice and per-
personal or professional losses. Chapter concepts, sonal growth.
learning outcomes, and a list of key terms, which are —Elaine U. Polan, RN, MS, PhD
considered important to the reader’s understanding —Daphne R. Taylor, RN, MS
of the material, begin each chapter. Helpful Hints
vii
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Reviewers
Janice Ankenmann, RN, MSN, CCRN, FNP-C Polly Reynolds, BSN, RN
Vocational Nursing Program Director Nursing Faculty
Napa Valley College Galen College of Nursing
Napa, California Louisville, Kentucky
Linda M. Fleshman, MSN, HCNE, MST, RN Diane Roney, RN, BSN, MSN, Certificate of
Director/Instructor Nursing Administration
Mt. Hood Community College Professor; Program Director of the Practical
Gresham, Oregon Nursing Program
Eastern Gateway Community College, Jefferson
Sharon Moore, RN, MSN-Ed
Campus
Practical Nursing Program Chair
Steubenville, Ohio
Forsyth Technical Community College
Winston Salem, North Carolina
Robin Pearson, BSN
Nursing Instructor
North Florida Community College
Madison, Florida
ix
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Contents
1 Healthy Lifestyles, 1 Neurological Characteristics, 80
History of Health Care, 1 Vital Signs, 82
Health Care Delivery, 2 Developmental Milestones, 82
The Concept of Health, 5 Nutrition, 86
Promoting, Maintaining, and Restoring Health, 6 Sleep and Rest, 88
Healthy Lifestyles, 8 Play, 90
Role of the Nurse in Health Promotion, 15 Safety, 90
2 Communication, 18 Health Promotion, 92
The Communication Process, 18 7 Toddlerhood, 98
Types and Styles of Communication, 19 Physical Characteristics, 98
Therapeutic Communication, 21 Vital Signs, 100
Factors Affecting Communication, 22 Developmental Milestones, 100
Blocks to Communication, 23 Nutrition, 106
Techniques Used to Enhance Communication, 24 Sleep and Rest, 107
Communication in the Workplace, 25 Play, 108
3 Culture, 29 Safety, 109
Culture, Race, and Ethnicity, 29 Health Promotion, 111
Characteristics of Culture, 30 8 Preschool, 116
Cultural Elements, 31 Physical Characteristics, 116
Culture in Health Care, 32 Vital Signs, 117
Cultural Assessment in the Health Care Setting, 34 Developmental Milestones, 117
Cultural Barriers to Health Care, 35 Nutrition, 123
Spirituality and Religion, 35 Sleep and Rest, 124
4 The Family, 40 Play, 125
Family Functions, 41 Safety, 125
Family Loss and Breakdown, 42 Health Promotion, 126
Family Types, 44 9 School Age, 132
Family Stages, 46 Physical Characteristics, 132
Family Size, Birth Order, and Gender Vital Signs, 134
of Children, 48 Developmental Milestones, 134
Family Patterns, 49 Cognitive Development, 140
Functional and Dysfunctional Families, 50 Moral Development , 142
5 Theories of Growth and Development, 54 Nutrition, 143
Characteristics of Growth and Development, 54 Sleep and Rest, 144
Psychoanalytical Theory, 56 Play, 145
Defense Mechanisms, 57 Safety, 145
Freud’s Stages of Psychosexual Development, 59 Health Promotion, 146
Psychosocial Theory, 61 10 Puberty and Adolescence, 151
Cognitive Theory, 63 Physical Characteristics, 152
Human Needs Theory, 65 Vital Signs, 154
Theory of Moral Development, 65 Developmental Milestones, 154
6 Prenatal Period to 1 Year, 70 Nutrition, 162
Heredity, 71 Sleep and Rest, 163
Environment, 72 Exercise and Leisure, 163
The Prenatal Period, 73 Safety, 163
Physical Characteristics, 76 Health Promotion, 164
xi
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xii Contents
CHAPTER 1
Healthy Lifestyles
KEY TERMS LEARNING OUTCOMES
anxiety 1. Describe the history of health.
apathy 2. Describe the model for the nation’s health as
disease proposed by Healthy People 2020.
disease prevention 3. Describe the concept of health.
emotions 4. List five healthy lifestyle practices.
empowerment 5. State the role of the practical nurse in health
equilibrium promotion.
fight-or-flight response 6. List two factors that interfere with people’s abilities
general adaptation syndrome (GAS) to change their personal habits.
health
health promotion
health restoration HISTORY OF HEALTH CARE
holistic
life expectancy Early civilization was concerned with health and diseases.
malnutrition Illness was often attributed to natural and supernatural
nutrition forces. Sometimes illness was thought to be the result of
regression some evil wrongdoing. Diseases were often warded off by
stress incantations, magic, or charms or with the use of herbal
substance abuse concoctions. At times, drastic measures were taken to rid
wellness the body of demons, such as beating, torturing, or starving
the sick. Other cures relied on folk remedies. Even prim-
CHAPTER CONCEPTS itive surgery existed before the advent of Greek medicine.
In about the 6th century BCE, medical schools were
Health Promotion established in Greece. Hippocrates was the first physician
HealthCare System to propose that treatment should be based on the belief
Nutrition that nature has a strong healing component. Diet, exercise,
and hygiene became important to treatment.
Throughout the Middle Ages, medicine and religion
were interwoven. Plagues and epidemics killed millions
of people. Understanding of disease processes did not
occur until the development of bacteriology, which took
place in the 19th century. Louis Pasteur, Robert Koch, and
Joseph Lister are some of the important scientists who
contributed to the scientific understanding of health and
disease during this time. During the 20th century, a major
cause of death was infectious diseases, but improvements
1
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in sanitation, water quality, and food supply helped is the average number of years a person is expected
to enhance the quality and extend the length of life. to live. Life expectancy has increased from 47.3 years
Between the years 1936 and 1954, the invention and at the beginning of the 20th century to nearly 79 years
widespread use of vaccines and antibiotics further re- today. Healthy People 2010 sought not only to ex-
duced the number of deaths from infectious diseases. tend life expectancy but also to improve the quality
Despite all the improvements limiting the inci- of life. The second goal was to eliminate the health
dence and number of deaths from infectious diseases, disparities among persons that exist according to
several diseases appeared or reappeared in the 20th gender, race, ethnicity, education, income, disability,
century. Diseases such as tuberculosis and measles location, and sexual orientation. This initiative was
resurfaced, and new infectious diseases such as HIV, dedicated to making certain that all persons in our
AIDS, Ebola virus, and drug-resistant strains of nation, regardless of difference, have equal access to
organisms (Staphylococcus aureus, Streptococcus fulfilling their health care needs.
pneumonia, and Salmonella) challenge the global Healthy People 2020, published in December
population today. 2010, promotes health and disease prevention ser-
Many other achievements have contributed to vices aimed at improving the health of all Americans.
longevity and health. Improvements and advance- Healthy People 2020 encourages collaboration across
ments in maternal care have led to decreases in communities to disseminate health information
maternal and infant mortality rates globally. In the needed to empower the individual to make decisions
United States, however, maternal mortality rates, about his or her health. The outcomes of these pre-
which had decreased, have begun to increase. Great ventative health strategies are also continuously
numbers of childbearing women do not seek prenatal measured and evaluated.
care during pregnancy, increasing the risk for both The overarching goals of Healthy People 2020 are
themselves and their infants. Better nutrition, better to improve the quality of life of all Americans and
hygiene, and improved technology have reduced the keep them free of preventable diseases, disability, in-
risks to both mothers and infants during the first year jury, and premature death. Equity in health care and
of life. Still, the issue of access to health care for all the elimination of disparities among different groups
remains a concern. will improve the health of all Americans. Emphasis
Other areas of improvement include education is also placed on maintaining a good quality of life
about the risks of tobacco use, genetic counseling, and engaging in healthy behaviors at all stages of
motor vehicle safety, and advances in the diagnosis development across the life span for all individuals.
of and treatment for heart disease and strokes. Im- Health indicators spotlight the major health pri-
provements in the workplace regarding safety and orities for the nation. The Leading Health Indicators
job-related hazards have helped further reduce mor- are listed in Box 1.1.
tality rates. The workplace mortality (death) rate
today is lower than at any other time in history. HEALTH CARE DELIVERY
Healthy People The U.S. health care system in the 19th and early
For three decades, the U.S. Department of Health 20th centuries was dominated by physicians and
and Human Services has published a 10-year agenda hospitals. In those times, there was a close relation-
for improving the nation’s health called Healthy ship between patient and doctor. Physicians set
People. Healthy People provides the scientific base fees, billed, or collected payments. Often physi-
for a 10-year projection that addresses national cians adjusted fees based on the patient’s ability to
health care goals and objectives. The first volume pay. For many years, the American Medical Asso-
published was Healthy People 2000, and its aim was ciation (AMA) fought against having any third
to reduce health disparities among Americans. party interfere or come between the patient and
Building on the objectives first identified in physician regarding any medical matter.
Healthy People 2000, Healthy People 2010 contin- In the early part of the 19th century, some indi-
ued to promote a systematic approach to improving viduals had medical insurance from their trade union,
health. Healthy People 2010 identified two major na- fraternal order, or some commercial carrier. This
tional health goals. The first goal was to increase the “sickness insurance,” as it was first known, was sim-
quality and years of a healthy life. Life expectancy ple coverage for lost time during sickness or injury.
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Other plans are available that mimic features found their employer or other types of entitlement pro-
in HMOs and in individual choice systems. In these grams to shop for health insurance coverage.
plans, known as point-of-service (POS) plans,
Many factors influence the financing of the health
providers are paid a pre-set payment based on mem-
care system today, including providers, employers,
bership or a risk-based system. Individuals may also
purchasers, consumers, and politicians. Controlling
choose their own provider at their own financial risk.
the rising costs and making provisions for the esti-
Official and voluntary public health agencies op-
mated 48 million Americans who are underinsured or
erate at the state, federal, and local levels. Health
uninsured are the two most pressing concerns today.
promotion, disease prevention, and education are key
At this time, Congress is debating and attempting to
aspects of these agencies.
revise or replace the ACA, but consensus has not
In 1996, the U.S. Congress introduced the Consol-
been reached. It remains to be seen how this act will
idated Omnibus Budget Reconciliation Act (COBRA)
change in the near future.
and Health Insurance Portability and Accountability
Act (HIPAA). COBRA provides health insurance pro-
tection for people who have to leave their jobs. HIPAA
Comparison of U.S. and Canadian
holds health care facilities and health care workers re-
Health Care Systems
The health care systems of Canada and the United
sponsible for protecting sensitive patient data. HIPAA
States are often compared. The two countries had
mandates creating standards for the exchange of pa-
somewhat similar systems until the 1970s, when
tient information, including electronic information.
Canada reformed its health care system into a group of
This act protects the privacy and confidentiality of
socialized insurance plans that offer coverage to all
patient records for all citizens.
Canadian citizens. This system is publicly funded and
In 1997, funds from the U.S. Department of Health
covers preventive medical treatment through primary
and Human Services were used to establish the Chil-
care physicians, hospitals, dentists, and other providers.
dren’s Health Insurance Program (CHIP), providing
Most Canadians qualify for coverage regardless
coverage to millions of children in low-income fami-
of medical history, income, and standard of living.
lies that do not qualify for Medicaid. This insurance
Statistics indicate that Canadians have a longer life
is funded by state and federal governments. Each state
expectancy and lower infant mortality rate than
is responsible for the administration of its program; as
Americans. However, many factors are believed to
a result, some states also cover pregnant women.
contribute to these statistics, including different
In 2010, the Affordable Care Act (ACA) was in-
racial makeup, alcoholism rates, and obesity rates.
troduced. The goal was to offer health insurance to the
Similarities also exist between the countries, includ-
millions of Americans who are uninsured and to im-
ing health care costs that are rising faster than the
prove the coverage of those who have insurance. One
rate of inflation.
main objective of the ACA was to move away from a
focus on illness and toward a focus on prevention and
wellness. Another was to create equal access to health
World Health Organization
The World Health Organization (WHO) is part of the
care. The act also emphasized improving the quality
United Nations and exists at the international level. It
of care, patient outcomes, and accountability and
is concerned with worldwide health promotion, in-
reducing costs. The ACA also expanded Medicaid.
cluding disease prevention, early detection of disease,
Provisions under the ACA are as follows:
and treatment. The WHO also strives to improve ac-
• Families are eligible for certain preventive health cess to health care in some local communities because
services at no cost. a lack of access impacts all aspects of a person’s phys-
• Insurance companies are no longer able to refuse ical, mental, and social health. The organization
health insurance to individuals with pre-existing coordinates global health care efforts against public
health conditions. health threats, such as the severe acute respiratory syn-
• Uninsured children will be covered by their drome (SARS) and H1N1 (swine flu) outbreaks, and
parents’ insurance until age 26. emergencies that require humanitarian aid. The WHO
• All companies with 50 or more employees must monitors global health care issues, such as the re-
provide health insurance. emergence of infectious diseases like tuberculosis and
• State health care exchange programs will be cre- others related to increased international travel and
ated to allow consumers who are not covered by commerce.
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The Centers for Disease Control growth and development. These theorists include
and Prevention (CDC) Freud (psychoanalytic theory), Erikson (psychoso-
The CDC is a federal agency under the Department cial theory), Piaget (cognitive theory), Maslow
of Health and Human Services that promotes disease (human needs theory), and Kohlberg (moral theory).
prevention primarily in the United States but also The holistic approach to health, which recognizes in-
globally. The objective of the CDC is to improve pub- dividuals as whole beings, promotes consideration
lic health by setting guidelines for the public and of all aspects of a person’s life. This approach helps
health care agencies, preventing disease and disability, the practical nurse to understand each person and at-
supporting infection control, and providing safety. tach significance, value, and meaning to each life.
The CDC also performs research and disseminates The holistic view further helps identify similarities
information to the public. The CDC has a new plan and differences among people, allowing decision
to improve community health in the next 5 years, in- making from the person’s own unique perspective.
cluding school-based programs targeting violence Positive nursing outcomes using the holistic approach
prevention, safe routes to school, and other commu- emphasize patient independence and maximize patient
nity interventions to promote health. potential.
Throughout this text, we use the terms health and
National Institutes of Health (NIH) wellness synonymously. We believe that health,
The NIH also falls under the Department of Health from the holistic perspective, is a balance of internal
and Human Service and is the agency that is funded and external forces that leads to optimal functioning
to conduct public health and medical research. The (Table 1.1). True health produces a state in which in-
research is used to promote health, reduce the occur- dividuals are able to meet their needs and interact
rence of disease and disability, and lengthen the life with their environments in a mutually beneficial
span. The research information gathered by the NIH manner. Healthy individuals exhibit effective coping
is shared with health care workers and the public. patterns and experience a certain degree of comfort
and pleasure in their activities. Health may be visu-
alized on a scale or continuum (Fig. 1.1). One end of
THE CONCEPT OF HEALTH the continuum depicts optimal health or wellness; the
other end shows disease, total disability, or death.
Today’s nurse must be knowledgeable about what con-
Disease refers to an imbalance between the internal
stitutes health because one of the primary goals of
and external forces. Individuals find that, throughout
nursing is to assist the individual in achieving the high-
the life cycle, health is not static but dynamic and
est level of health. In 1947, the WHO defined health
can move backward and forward from a state of
as “a state of complete physical, mental, and social
wellness to illness or disease.
well-being, not merely the absence of disease or infir-
Traditionally, health care has focused on an ill-
mity.” The holistic approach to health presented in this
ness model, in which the primary role of the nurse is
text considers not only the physical aspects but also
to relieve pain and suffering. Today, disease preven-
psychological, social, cognitive, and environmental in-
tion is evolving as an area of nursing concern. This
fluences. Physical health is influenced by our genetic
change places new demands on the practical nurse,
makeup, which includes all the characteristics that peo-
ple inherit from their parents. These characteristics not
only include physical features but also may encompass
genetic weaknesses or disease. (Genetic inheritance is Table 1.1
further explored in Chapter 6.) Psychological health A Holistic Model of Health
refers to how a person feels and expresses emotions.
Social health deals with everyday issues of economics, Internal Forces External Forces
religion, and culture and the interactions of people liv-
Body systems Culture
ing together. Cognitive health encompasses a person’s
ability to learn and develop. Environmental concerns Mind Community
include such issues as water and air quality, noise, and
Neurochemistry Family
biochemical pollution.
Throughout this text, we refer to specific devel- Heredity Biosphere
opmental theorists to support the holistic view of
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emphasizing his or her role in patient education and ethnic and racial groups, and (3) access to preventive
health promotion throughout all stages of the life cycle. services for everyone. The essential component of
health promotion begins with the sharing of knowl-
edge. The acquisition of knowledge then influences
PROMOTING, MAINTAINING, attitudes and leads to a change in behavior. Health
AND RESTORING HEALTH promotion is most successful when placed in a sup-
portive social environment. This environment first
Health promotion means health care directed toward
begins within the home and extends into the commu-
the goal of increasing one’s optimal level of wellness.
nity. The community includes schools, churches, and
Leading a healthy life means having full functional
businesses. Schools provide the location for the dis-
capacity at each stage of the life cycle, from infancy
semination of health information among the young.
through old age (Fig. 1.2). Promotion of health can
More than 85% of American adults spend the greater
occur at any time and relates to individual lifestyles
part of the day in the workplace. The workplace,
and personal choices. Health promotion allows people
therefore, is another excellent site to continue educat-
to enter into satisfying relationships at work and play.
ing adults on health issues. Health promotion empha-
Health means being vital, productive, and creative and
sizes nutrition, exercise, mental health, and avoidance
having the capacity to contribute to society.
of substance abuse. These health promotion issues are
The national aspirations for health promotion in-
addressed throughout the text as they relate to specific
clude three goals: (1) healthy lives for more Americans,
age groups (Fig. 1.3).
(2) elimination of health care disparities among all
Box 1.4
Nutrients
Proteins better types of fats to eat and cook with. Saturated fats
Proteins are broken down in the body into amino acids, raise the body’s cholesterol levels. Sources of fats
which are the building blocks needed for repairing the include meats, nuts, vegetables, and milk.
body’s cells and tissue. Sources of protein include
meat, fish, eggs, legumes, milk, cheese, and nuts. Vitamins
Vitamins are organic compounds that assist in building
Carbohydrates body tissues and are important in all chemical reactions
Carbohydrates are starches and dietary fiber that provide in the body. They are found in a wide range of foods.
fuel for energy in the body. Carbohydrates are needed Vitamin K is made by bacteria in the bowel.
for brain, muscle, and heart function. They are divided
into simple and complex forms. Simple carbohydrates Minerals
are simple sugars found in fruits, whereas complex car- Minerals are inorganic substances that come from the
bohydrates come from grains. Other sources of carbohy- earth and are important in body functions. Calcium
drates are breads, cereals, and vegetables. The fiber intake aids in the conversion of foods to energy;
from carbohydrates is very important in lowering strengthens bones, teeth, and muscles; and aids in
blood cholesterol levels. blood clotting. Iron is needed to make hemoglobin to
carry oxygen to tissues. Minerals are found in a wide
Fats range of foods.
Fats, also called lipids, cushion and provide insulation
for the vital organs in the body. Fats also aid in the ab- Water
sorption of vitamins. They are divided into saturated or Water aids in the regulation of body temperature, lubri-
unsaturated. Saturated fats are those oils that are solid cates and cushions joints, protects the spinal cord, and
at room temperature, and unsaturated fats are oils that eliminates waste from the body via urine, perspiration,
are liquid at room temperature. Unsaturated fats are the and bowel movements.
Table 1.3
Positive Effects of Exercise
System Effects
Cardiovascular system Increases blood volume and oxygen content
Increases blood supply to muscles and nerves
Decreases serum triglycerides and cholesterol levels
Reduces resting heart rate
Increases heart muscle size
Respiratory system Increases blood supply
Increases exchange of oxygen and carbon dioxide
Increases functional capacity
Neurological system Reduces stress
Improves mental health
Decreases depression
Musculoskeletal system Increases muscle mass
Reduces body fat
Increases muscle tone
Improves posture
7487_Ch01_001-017 13/11/18 10:44 AM Page 11
Mental Health
Mental health is a fluctuating state in which the in-
dividual attempts to adjust to new situations, handle
personal problems without undue stress, and still
contribute to society in a meaningful manner. Men-
tally healthy individuals see themselves and others
realistically. A person’s state of mental health fluc-
tuates from day to day but maintains a certain degree
of continuity and consistency. Certain behaviors may
be normal in moderation but unhealthy in excess. For
example, washing one’s hands as part of everyday
hygienic practices is considered desirable. However,
repeated hand washing unrelated to any activity is
seen as bizarre and mentally unhealthy.
All humans experience many emotions. What is
interesting is that human emotions are not the same
for everyone. One individual may respond differ-
ently to a situation than another individual. During FIGURE 1.5 Infants’ emotional experiences are instant
the course of a day, individuals experience a large and spontaneous.
range of different emotions.
Emotions are best defined as a feeling state. Our
degrees of intensity. In fact, different stimuli produce
emotions produce both physiological and psycholog-
different emotional responses in individuals. Com-
ical changes. The physiological changes associated
mon emotions include anger, jealousy, happiness,
with an emotion are the result of motor, glandular,
affection, fear, and anxiety. Emotional maturity
and visceral activity. Specific areas of the brain and
exists when individuals are able to control their re-
the autonomic nervous system play a huge role in
sponses and can express their emotions in socially
producing some of the physical changes one associ-
appropriate ways.
ates with an emotion. The areas of the brain known
A factor that may affect one’s mental health is
to play this role in a person’s emotional response
stress. Stress may be defined as anything that upsets
include the cerebral cortex and the limbic system.
our psychological or physiological equilibrium, or
The cerebral cortex functions by receiving incoming
balance. Responses to stress may be physiological,
sensory information. The limbic system of the brain
emotional, or intellectual.
comprises interconnected nuclei that affect memory
Some of the common physiological responses to
and emotions. Conduction pathways in the brain
stress include increased heart rate, respiratory rate, and
produce many changes in the cardiac and smooth
blood pressure. Emotional responses to stress include
muscle contractions and in the secretion of some
irritability, restlessness, and a sense of discomfort. In-
glands. Anger and fear produce an increased sympa-
tellectual responses to stress often include forgetful-
thetic activity. Increased heart rate, breathing, and
ness, preoccupation, and altered concentration.
intestinal tightening and cramping are just a few of
Many years ago, Hans Selye described three dis-
the physiological reactions to certain emotions.
tinct stages of the physiological response to stress,
At birth, infants’ emotional experiences are simple
known as the general adaptation syndrome
and spontaneous. Most of their emotional responses
(GAS):
are the result of their basic needs. For example, when
the infant is hungry, his or her emotional response is 1. Alarm stage: Hormones from the adrenal cortex
likely to consist of crying and intense physical move- place the body in a state of readiness known as
ments. Once satisfied, his or her response is one of the fight-or-flight response.
pleasure and calm. With maturation and learning, 2. State of resistance: The body attempts to adapt
emotional responses become more discriminating and to the stressors.
individualized. See Figure 1.5. 3. State of exhaustion: After prolonged exposure to
Older children’s and adults’ emotions are ex- stress, the body’s energy becomes depleted. This
pressed in a wide variety of responses with varying may result in disease or destruction.
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Wasser hervor. Zahlreiche Flüchtlinge haben sich mit ihrem Vieh
hierher gerettet. Aus kümmerlichen Schilfmatten haben sie sich
notdürftige Unterkunftsstände, die ihnen Schutz gegen die Unbilden
der Witterung bieten, geschaffen. Schwere Tage für die Armen. So
unvermutet und plötzlich ist das Wasser hereingebrochen, daß sie
kaum das nackte Leben zu retten vermochten. An Lebensmittel
konnte keiner denken; nun dürfen sie hungern, bis das Wasser
abfließt. Von der Regierung kommt ihnen keine Hilfe.
Um einen vorspringenden Huck kommt einer der flachgehenden
Flußdampfer in Sicht. Von weitem schon kündet sich das Brausen
an, mit dem klatschend die riesigen Schaufelräder das Wasser hinter
sich drücken. Nur langsam kommt er gegen den Strom an. Eine
ungeheure Rauchwolke quillt aus dem Schornstein, zieht nach Land
zu und scheint sich als eine endlose schwarze Fahne zu verlieren.
Als die beiden Schiffe noch etwa anderthalb Seemeilen voneinander
entfernt sind, gehen auf dem vordersten Mast des Dampfers
Signalflaggen hoch. Noch sind sie nicht auszumachen, da der
Westwind sie nach achtern auswehen läßt. Jedenfalls aber ist das
Signal für die „Tsingtau“ bestimmt, die nun etwas nach Steuerbord
ausschert, um das Signal ablesen zu können. Weithin leuchten die
riesigen chinesischen Schriftzeichen: Dampfer „Whampoa“ aus
Hongkong ... also ein Engländer. Am Heck flattert die rote Fahne mit
dem Union-Jack. Der Steuermannsmaat, der das internationale
Signalbuch eifrig wälzt, hat jetzt das Signal gefunden: „Habe
wichtige Post für Sie.“ Die Schiffe nähern sich, und „Tsingtau“
schlägt einen Bogen, um sich auf der Höhe des „Whampoa“ zu
halten. Beide Schiffe sind aus der Strömung in ruhigeres Wasser
gelaufen, um so das Anbordnehmen der Post zu erleichtern. Gleich
darauf stößt auch vom Engländer ein von Chinesen bedientes Boot
ab; am Heck hat ein Europäer Platz genommen. In wenigen Minuten
ist das Boot geschickt längsseit gebracht, und der Sekretär des
deutschen Konsulats in Canton kommt mit Post für den
Kommandanten an Bord. Kaum ist das kleine Fahrzeug wieder
drüben aus dem Wasser geheißt, als auch schon die Räder mit
voller Kraft zu schlagen beginnen und der Dampfer seine Fahrt
stromaufwärts fortsetzt, während „Tsingtau“ nach Osten jagt.
Während Kapitänleutnant von Möller die Post öffnet, umringt die
Mannschaft den an Deck stehenden Konsulatsbeamten, um ihn
nach neuesten Nachrichten, die aus Europa eintreffen,
auszuforschen. Was er erzählt, läßt kaum noch einen Zweifel zu.
Krieg mit Frankreich, Krieg mit Rußland, mit Serbien. Englands
Haltung ist heute wohl noch unbestimmt, aber ... Während in den
sofort sich bildenden Gruppen alle Möglichkeiten, was aus „Tsingtau“
und ihnen selbst werden soll, erörtert werden, erscheint der
Kommandant auf der Brücke und läßt „Klar Schiff“ anschlagen.
„Tsingtau“ macht gefechtsklar. Also Krieg! — Auch hier im fernen
Osten! Nach einer halben Stunde etwa sind die Vorbereitungen
beendet, und „Tsingtau“ ist bereit, einem Gegner, der sich ihr auf
dem Strom stellt, die Zähne zu zeigen. Ohne Zwischenfälle aber
geht die Fahrt weiter. Die Dunkelheit bricht herein, die Lichter von
Canton tauchen auf, und gleich darauf auch blitzen unter grünen
Bäumen die erleuchteten Häuser von Shamien, der
Fremdenniederlassung auf der gleichnamigen Insel, im Süden der
Stadt herüber. Zahlreiche Dampfer liegen auf dem Strom vor Anker.
An ihnen vorbei gleitet „Tsingtau“. Scharfe Augen spähen durch die
Nacht. Richtig, drüben, kaum hundert Meter ab, liegen die beiden
französischen Kanonenboote. Deutlich sind alle Einzelheiten an
Deck drüben zu erkennen. Offiziere und Mannschaften tauchen aus
dem Innern an Deck auf und verfolgen aufmerksam das Schiff, das
langsam an ihnen vorüberzieht. Eisiges Schweigen hüben und
drüben. Kein Pfiff ruft die Mannschaft zur militärischen
Ehrenbezeigung, keine Hand hebt sich zum Gruße. — Feinde! In der
Heimat, Tausende von Meilen entfernt, brüllen wohl schon die
Geschütze, dröhnt das Hurra der stürmenden Kameraden.
Wenige Minuten später liegt S. M. S. „Tsingtau“ vertäut an ihren
Bojen. Von Land stoßen Boote ab. Weitere Nachrichten kommen,
die aber an den Entschlüssen des Kommandanten nichts mehr
ändern. Still und ruhig liegt das Schiff. Nichts unterscheidet es
äußerlich von dem Bilde, das es von früheren Tagen bot. Aus den
auf dem Oberdeck liegenden Messen und Wohnräumen blitzt
mitunter ein Lichtstrahl auf das dunkle Wasser des Cantonflusses
hinaus, eine Tür öffnet sich, schließt sich rasch wieder; desto reger
aber ist das Leben im Innern des Schiffes. Eifrig kramen und suchen
die Leute an ihren Kleiderspinden, schnüren Bündel, packen ein und
wieder aus. Eine schwere Arbeit, unter dem Vielen, das sich trotz
des beschränkten Raumes angesammelt hat, das Wertvollste
herauszufinden. Nur zu oft wandert so manches Stück aus dem
Spinde heraus, um schließlich doch mit einem Seufzer schweren
Herzens wieder zurückgelegt zu werden. Es geht nicht. Nur das
Notwendigste darf mitgenommen werden, lautet der Befehl.
Dunkel, in tiefer Stille brütet die Nacht über dem Strom. Aus
weiter Ferne nur klingt gedämpft das Rattern einer Winde, das
dumpfe Tuten einer Dampfpfeife herüber. Vier Glas, zwei Uhr
morgens. Unter Deck ist die Mannschaft angetreten. Der
Kommandant will sich von ihnen verabschieden. Wer weiß für wie
lange? Für immer vielleicht? — Schwere Minuten, die jedem
Einzelnen von ihnen unauslöschlich im Gedächtnis bleiben werden.
„Achtung!“ Gedämpft klingt es diesmal, nicht scharf, schneidig,
wie sonst.
Der Kommandant.
„Zusammenschließen! Rührt euch!“
Der Abschied. Lange haftet der Blick Kapitänleutnants von Möller
an den Leuten, deren jeden einzelnen er genau kennt. Sie merken,
wie unendlich schwer ihm das wird, was er sagen will, wie es in
seinem Innern arbeitet, wie er nach Worten sucht, um sie fühlen zu
lassen, wie inhaltsvoll der Augenblick ist.
„Kameraden! Ihr wißt wohl Alle, zu welchem Zweck ich euch
hierher befohlen habe. Unser Allerhöchster Kriegsherr hat gestern
die Mobilmachung von Heer und Flotte angeordnet. Trotz aller seiner
Friedensliebe ist es ihm nicht gelungen, den Ausbruch des Krieges
zu verhindern. Vom Westen und Osten stürmen die Feinde auf uns
und unsern treuen Verbündeten Österreich-Ungarn ein. Noch hat
England sich nicht entschieden, jede Stunde aber kann es in die
Reihe unserer Gegner führen. Wir sind allein. Das
Kreuzergeschwader steht in der Südsee, wir sind nur auf uns
angewiesen. Ihr wißt alle, daß wir mit unserm Schiff keine
Gelegenheit haben können, dem Feinde im Kampfe
gegenüberzutreten. Untätig zuzusehen, wie die Kameraden sich für
Deutschlands Ehre und Ruhm schlagen, ist aber nicht deutschen
Seemanns Art. Die Heimat ist unerreichbar, zu weit. Ein Stück
deutscher Boden aber liegt auch hier im fernen Osten. Ihr sollt
versuchen, euch nach Tsingtau durchzuschlagen. Sollte es auch dort
zum Kampfe kommen, so werdet ihr sicher bald Gelegenheit finden,
zu beweisen, daß auch ihr für die deutsche Flagge zu kämpfen und
zu sterben wißt. Ihr seid von der „Tsingtau“! — Vergeßt das nicht.
Haltet zusammen. Ich weiß, daß ich nur Gutes von euch hören
werde. Und nun geht mit Gott!“ — — —
Der Morgen graut, dichte Nebel liegen über dem Flusse, leise,
geräuschlos lösen sich mehrere Boote von dem Schiff und streben
dem nahen Lande zu ....
Am 19. August, bei Bekanntwerden des japanischen Ultimatums
ist die ganze Besatzung schon mehr als zweitausend Kilometer von
ihrem Schiff entfernt, um das Stück Heimat, das Stückchen
Deutschland im fernen Osten, das ihrem Schiffe seinen Namen
gegeben hat, mit ihren Leibern und mit ihrem Blute gegen weiße und
gelbe Habgier und Raublust zu verteidigen.
Nach Manila