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Biomedical subjects

D Freshwater

Publications and source records attributed to D Freshwater.

17 recordsLinked to original sources
PubMed2006

Pegylated interferon alpha-2b for patients with HCV recurrence and graft fibrosis following liver transplantation.

Chronic hepatitis C is a principal indication for liver transplantation. Recurrent viral infection is inevitable and graft disease is common. We report tolerability, safety and efficacy of pegylated interferon alpha 2b (PEG-IFN) monotherapy for patients with hepatitis C virus (HCV) recurrence and fibrosis after liver transplantation. Repeated measurements of serum HCV titer permitted assessment of the kinetics of the antiviral response for all patients. We screened 63 patients transplanted for HCV at our center for antiviral treatment, 14 were eligible and treated, but only 6 completed the proposed 52 weeks of therapy. Eight were withdrawn because of severe/life-threatening side effects/events, including liver dysfunction (4 patients). None of those 8 achieved a sustained virological response (SVR). Five of 6 who completed treatment were HCV RNA negative at the end of treatment, and 2 achieved an SVR. Viral kinetics were similar to published observations for treatment of non-transplanted HCV patients. Patients with genotype non-1 infection displayed a more rapid decline of viral titer than was observed for genotype 1 infection. Post-transplant HCV patients are frequently unsuitable for, or intolerant of PEG-IFN. Liver dysfunction was a major concern.

Adult↗
PubMed2004

Paediatric nurses' attitudes to massage and aromatherapy massage.

Complementary therapies have continued to increase in popularity in healthcare and it is widely accepted that they can be incorporated into the nursing role. However, this acceptance does not necessarily mean that the introduction of therapies into the nursing arena has been without confusion and without professional and legal implications. Consequently, this small-scale, qualitative study aimed to explore the perceptions and lived experiences of paediatric nurses of two therapies, namely massage and aromatherapy massage. There is a dearth of literature exploring nurses' perceptions to the incorporation of these therapies, especially in the arena of paediatric nursing where massage and aromatherapy massage are common practice. Semi-structured interviews were undertaken with qualified nurses and revealed the themes of 'benefit', 'family centred care', 'nursing care' and 'being held back'. It was found that at some stage during their professional career each nurse had performed massage and/or aromatherapy massage. All nurses were able to recall certain benefits of the therapies for the children that they had observed and many discussed the importance of involving the family as a way of including them in to the care of their child. However, for the nurses in this study, it was evident that the incorporation of complementary therapies into the nursing role was determined by the context in which they practised. Due to the dominance of the medical model, nurses faced pressures and conflicts in the realities of their nursing work, which meant they were often unable to carry out these therapies.

Anecdotes as Topic↗
PubMed2001

The integration of complementary therapies into conventional medicine focuses primarily upon symptomatic care of the body with scant attention given to any interrelationship of the spirit and mind upon health and well-being.

We are pleased to continue our series of debates addressing topical issues currently under scrutiny in the field of complementary medicine. In selected issues, two people are invited to argue the case for or against a specific statement. In certain instances the position taken may not necessarily reflect the personal views of the authors. They have been asked to take a specific stance in order to stimulate debate and reflection about particular aspects of complementary and alternative medicine.

Attitude of Health Personnel↗
PubMed2000

Crosscurrents: against cultural narration in nursing.

Nurses, like other groups throughout history, have been described as an oppressed group. Writers who describe nurses as lacking in self-esteem, autonomy, accountability and power support this view in the literature. Indeed the cultural narration of nursing is for nurses to be subordinate. This article explores the emergence of horizontal violence within nursing and suggests that it is a result of unexpressed conflict within an oppressed group. The author aims to raise the awareness of horizontal violence in nursing so that practitioners come to understand how this in itself can be an expression of power. Drawing upon theories of reflective practice, the article examines how the educational system in nursing may have contributed to the felt oppression within the group by colluding with the cultural narrative. The crosscurrents of cultural narration are strong and it is argued here that the nurse needs to feel empowered in order to take action to swim against the tide. The author proposes that a model of transformatory learning based upon critical theory creates the possibility of emancipatory action in nursing, both locally and globally.

Conflict, Psychological↗
PubMed2000

Clinical supervision as an emancipatory process: avoiding inappropriate intent.

As clinical supervision becomes more widely implemented in the United Kingdom with concerns and resistances being eroded as practitioners discover its benefits, it is important that potential limitations and perhaps failures are avoided. This paper utilizes Johns' (1996) intent-emphasis axis to explore how a technical interest, misunderstanding of expert practice, and confusion of self awareness with counselling, can detract from the supervisory process. Several of the criticisms of reflective practice will be examined to demonstrate where concerns are valid and where they may be based on misunderstandings and the need to control clinical supervision. Greater awareness of inappropriate emphasis and intent should enable even relatively inexperienced supervisors to help their supervisees move towards independence, emancipation and evolving expertise.

Attitude of Health Personnel↗
PubMed1999

Trends in nursing and midwifery research and the need for change in complementary therapy research.

In recent years there has been a change in nursing and midwifery research. Whilst many of the subjects being studied remain the same, nurses and midwives have started to employ a range of data collection methods that are relatively new to the profession. Predominantly quantitative research, which concentrates on reduction, objectivity, manipulation, categorization, passivity, control, prediction, causality and generalizability (Munhall & Oiler 1986), is starting to be replaced by other approaches perhaps more congruent with nursing, midwifery and caring. As Moody (1990) stated, 'the 1980s ushered in an array of diverse, sophisticated research methods...' with other authors adding that 'nursing is just beginning to authenticate new territory that incorporates a plurality of methods' (Nagle & Mitchell 1991). The following is an exploration of the recent apparent shift away from a focus on quantitative research in nursing and midwifery towards the use of qualitative methods which emphasize a greater degree of individuality, humanism, participation and interaction. It is suggested that the traditional quantitative research paradigm still exists in the field of complementary therapy research and that the shift that has taken place in nursing and midwifery research needs to be considered more seriously in the field of research in complementary therapies.

Complementary Therapies↗
PubMed1999

Polarity and unity in caring: the healing power of symptoms.

This article explores the idea that suffering is a key aspect of the healing process. Suffering often manifests itself as 'disease' within the body in the form of physical symptoms. It is posited here that this is the psyche's unconscious way of drawing attention to the inner tension of the conflict of opposites. Whilst this tension is often the seat of discomfort, it also holds the key to the individual's own creative potential, including that of healing. Drawing upon the work of contemporary nursing theorists Margaret Newman, Rosemary Parse, depth psychologists Thomas Moore and James Hillman this article argues that caring and suffering are unnecessarily polarized in nursing. A method of working with symptoms is discussed that honours both the poetics of the suffering and the individual's inclination towards health.

Conflict, Psychological↗
PubMed1998

Rituals: the 'soul' purpose.

Nursing has, perhaps unknowingly, given recognition to the importance of maintaining the client's normal rituals and patterns of day-to-day activity on admission to hospital. To make the client feel more at ease, comfortable and relaxed, care is aimed at adhering to their usual routine. To this end, the client's bedtime rituals, toileting habits and many other of their daily routines are explored during the hospital admission process or initiation ceremony to the ward. As nurses, we place great meaning on trying to maintain these rituals and routines for the client, recognizing that keeping a sense of normality may be of great importance. It seems almost paradoxical then, that it is we nurses who criticize ourselves for compulsively adhering to what are described as ritualistic ways of working; which it has been said, are of seemingly little value both to the client's own healing process and nursing itself. In a recent paper the notion that ritualized practice had no place in nursing and made a case for the defence of rituals was challenged. This paper expands this theme further, exploring the symbolic and ancestral necessity for rituals, drawing upon archetypal psychology to help illustrate the potential hazards for the nursing milieu of dismissing rituals without fully understanding their latent purpose.

Activities of Daily Living↗
PubMed1998

From acorn to oak tree: a neoplatonic perspective of reflection and caring.

This paper provides a meta-analysis of reflection and caring. Placed within a philosophical framework, the nurse's call to care is explored. Drawing upon Rosemarie Parse's theory of human becoming (1981) and Plato's myth of Er (Hillman, 1996), the author discusses the idea of caring as an 'innate image'. This image is expanded throughout the paper as the author uses the analogy of the acorn as containing the becoming oak tree.

Awareness↗
PubMed1997

Geopathic stress.

The idea of stress as a factor in ill health is now widely accepted and the effects on the body are relatively well-documented. The true range of the causes is not so much in evidence. Geopathic stress as a causal link to ill health is usually ignored as most people are unaware of its presence. This article explores the concept of geopathic stress, its effect on the environment and the implications of this for the individual's healing process. It is argued that geopathic stress can undermine both the body's subtle energy system (the etheric body, chakras and meridians) and the body's electrical system (brain, heart and muscles), thus delaying healing and recovery. A challenge is made to all health-care professionals who are dedicated to the development of holistic care to further their understanding and awareness of this phenomenon.

Earth, Planet↗
PubMedDate not supplied

Exploring mutuality within the nurse-patient relationship.

This article explores the concept of boundaries within the nurse-patient relationship. Drawing on child development theories the authors explore the difficulties of boundary maintenance and link this to the professional aspects of therapeutic alliance. The ability to establish clear boundaries between ourselves and others is closely related to the capacity to function as a healthy adult and as such may be said to play an important role in the development of mental health difficulties. However, it is generally accepted by psychological theorists that a certain amount of projection and transference are likely to occur in every two-person relationship and as a result boundary confusion is likely to be experienced by both parties to a greater or lesser extent in the nurse-patient relationship. If, as is currently asserted by the nursing profession, the nurse-patient relationship is based on the principle of equality then it follows that both the nurse and the patient carry equal responsibility for maintaining the boundaries within which their interactions take place. The authors argue that it may be more appropriate to think in terms of a relationship founded on the concept of 'mutuality'. Such a position enables the concept of therapeutic reciprocity to be embraced alongside the reality that ultimately it is the nurse who carries the responsibility for 'holding' the boundaries within which the relationship is 'acted out.'

Adult↗
PubMedDate not supplied

Reflective practice and guided discovery: clinical supervision.

This article explores the parallels between reflective practice as a model for clinical supervision, and guided discovery as a skill in cognitive psychotherapy. A description outlining the historical development of clinical supervision in relationship to positional papers and policies is followed by an exposé of the difficulties in developing a clear, consistent model of clinical supervision with a coherent focus; reflective practice is proposed as a model of choice for clinical supervision in nursing. The article examines the parallels and processes of a model of reflection in an individual clinical supervision session, and the use of guided discovery through Socratic dialogue with a depressed patient in cognitive psychotherapy. Extracts from both sessions are used to illuminate the subsequent discussion.

Attitude of Health Personnel↗