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PubMedDate not supplied

Depression and anxiety in the heart transplant patient: a case study.

Depression and anxiety are potential psychological problems that a heart transplant patient may face both before and after transplant. In addition, there is the potential for difficulty in adjusting to life after transplantation. Anxiety and depression and their effects, both pretransplant and posttransplant, are explored. A case study is used to illustrate the psychological effects of trans plantation.

Adaptation, Psychological↗
PubMedDate not supplied

Parental experience of family stress during hematopoietic stem cell transplantation of pediatric patients in germ-free isolation in Taiwan.

This qualitative inquiry study used convenience sampling through in-depth interviews to obtain life experiences and feelings of parents while their children underwent hematopoietic stem cell transplantation. Eleven parents of children younger than 18 years undergoing hematopoietic stem cell transplantation in a medical center in north Taiwan consented to participate in this study and provide oral and written responses in Mandarin or Taiwanese. Semistructured interviews lasting 60 minutes were conducted privately and audiotaped. Verbatim transcriptions of the interviews were examined by the content analysis method. The trustworthiness of the data was examined by Lincoln and Guba (Naturalistic Inquiry. Newbury Park, Calif: Sage; 1985) principles. Results indicated that family stress experiences of parents of children undergoing hematopoietic stem cell transplants include 4 themes: parental psychological distress, family lifestyle disturbances, parents' coping patterns, and family resources. The results of this study provide evidence of the nature of parents' experiences while their children undergo hematopoietic stem cell transplantation and provide guidelines for family-centered nursing care.

Adaptation, Psychological↗
PubMedDate not supplied

Developing a plan for pediatric spiritual care.

During life-changing events, people turn to spirituality for comfort, hope, and relief. This article raises nurses' awareness of and intent to provide spiritual care for children and families as part of overall quality care. Essential nursing knowledge for the development of a plan of care that includes the child's spirituality, religion, and culture, developmental stage, age-appropriate spiritual care activities, and the needs of the family are presented.

Child↗
PubMedDate not supplied

The healing effects of crying.

How does crying improve and enhance the emotional state? A personal, life-changing event experienced by the author helped postulate an answer to this question. This article explores tear production, crying across cultures and eras, the gender factor in tears and crying, and the author's ethnographic study of Pakistani men and women's views of crying in terms of its spiritual, cultural, and psychosomatic ramifications. Greater understanding of natural human emotions and the language of tears benefits the nursing profession and gives a better understanding of the phenomenon of crying.

Adult↗
PubMed1997

The near-death experience as a focus of clinical attention.

Near-death experiences (NDEs) often produce profound changes in attitudes and behavior that can lead to psychosocial and psychospiritual problems. The diagnostic label of religious or spiritual problem, included in DSM-IV under the category of other conditions that may be a focus of clinical attention, was originally proposed to encompass NDEs and their aftereffects. Four cases are discussed in which patients presented with NDE-related problems, and differential diagnosis and current treatment strategies are reviewed. The inclusion of this new diagnostic category in the DSM-IV permits differentiation of NDEs and similar experiences from mental disorders and may lead to research into more effective treatment strategies.

Adolescent↗
PubMedDate not supplied

Decision making in laboring women: ethical issues for perinatal nurses.

The decision-making process in childbearing women regarding birth preferences raises ethical dilemmas related to caring for women during labor and birth. Giving birth is a powerful, life-changing event that leaves a lasting impact on the childbearing woman. The birth experience may be perceived positively or negatively or with feelings of ambivalence. This descriptive qualitative study asked what factors influence a woman's change in her stated birth preference from an unmedicated birth to a medicated birth. A purposive convenience sample of 33 primiparous and multiparous childbearing women who had changed their stated birth preference for pain management during labor participated in interviews conducted within a month of giving birth. Themes included wanting an unmedicated birth; changing to a medicated birth; feeling disappointed, ambivalent, or satisfied; and reflecting on the change. Changing birth preferences is a result of many complex factors, including the influence of professional support by nurses. Ethical principles such as autonomy, veracity, beneficence, informed consent, standard of best interest, and obligations should be applied when caring for laboring women, framed by the ethics of caring.

Adult↗
PubMedDate not supplied

The voices of teen mothers: the experience of repeat pregnancy.

PURPOSE: To explore the insights of young mothers with regard to their life aspirations, the changes in their lives as a result of parenting, and their beliefs of the impact of repeat pregnancy on their aspirations and life course. STUDY DESIGN AND METHODS: Ethnographic, descriptive research with a purposive sample of key informants (n = 16), using semistructured interviews to solicit rich qualitative data. Iterative methods, recursive data sifting, and Ethnograph 5.0 were used in data analysis. RESULTS: Young mothers were asked questions about four domains of their lives: (a) their existing life context, including support and background characteristics, (b) their relationships, including family, friends, and intimate others, (c) their vocation, including education, work, and money, and (d) their personal characteristics and parenting. Young mothers' perceptions reflected costs, rewards, and neutral aspects associated with young mothering and repeat pregnancies. The three themes that emerged from the interview data included Looking for or finding a better life, Making a hard life harder, and No big difference in my life. CLINICAL IMPLICATIONS: Nurses may use these results to understand better the young mothers with whom they work, to develop intervention programs, and to support policies that attend to the needs of young mothers. By responding to young mothers' issues and challenges from their perspective, nurses may be more effective in preventing or delaying repeat pregnancy in the teen years.

Adaptation, Psychological↗
PubMed2000

When an employee dies.

The death of an employee is a life-changing event. Learn how you and your employees can pull together to grieve, heal, and move on.

Adaptation, Psychological↗
PubMed1999

Depression in women.

UNLABELLED: Depression is a common and serious psychiatric disorder, more common in women than in men. It can be triggered by abrupt hormonal changes, life events, or nothing at all. It causes enormous debility and significant mortality, and it costs the American economy hundreds of millions of dollars a year. Depression can be readily diagnosed and treated, but, more often than not, it is neither diagnosed nor effectively treated in the primary care setting. The stigma of mental illness and misconceptions about depression in particular, hinder recognition. The signs and symptoms of clinical depression as outlined in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, are valid and reliable. Both psychotherapeutic and psychopharmacologic treatments are effective. The obstetrician/gynecologist plays a crucial role in identifying depression, helping the patient, and sometimes her family, to understand the nature of the problem, suggesting treatment, and facilitating either referral or treatment within the Ob-Gyn setting. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES: After completion of this article, the reader will be able to understand the stigmata and misconceptions associated with a depression, to be aware of the various etiologies of depression and typical and atypical presentations, as well as the various management strategies for depression, and have a better understanding of which patients should be referred.

Depression, Postpartum↗
PubMedDate not supplied

Death of a lifestyle: the effects of social support and healthcare support on the quality of life of persons with fibromyalgia and/or chronic fatigue syndrome.

PURPOSE: The purpose of this study was to investigate how social support and healthcare support affect the quality of life of persons with fibromyalgia and chronic fatigue syndrome. METHOD: A constant comparison method was used for the qualitative portion of the research and descriptive correlational methods were used for the quantitative portion. CONCLUSION: This mixed design research study suggested that social support, unlike healthcare support, is related to Quality of Life (QOL). It was also evident that subjects suffering from CFS and/or FMS do not experience high levels of social support.

Activities of Daily Living↗
PubMedDate not supplied

Relationship of depressive symptoms to hypertension in a household survey in Harlem.

OBJECTIVE: Two possible explanations for an hypothesized association between depression and hypertension were examined: (1) shared stress-related risk factors are associated with both depression and hypertension and (2) life-style factors associated with depression lead to hypertension. METHODS: A predominantly black sample of 695 adults were interviewed in the Harlem Household Survey. Two measures of hypertension were used and compared-1) self-report and 2) elevated blood pressure (above 140/90 mm Hg)-on the basis of the mean of two blood pressure measures. Depressive symptoms were measured by use of a 24-item scale based on the Diagnostic Interview Schedule. Logistic regression models were used to test associations between hypertension and depressive symptoms, stressors, and life-style factors. RESULTS: Depressive symptoms were associated with self-reported hypertension but not with elevated blood pressure. The association between self-reported hypertension and depressive symptoms was explained partly by shared stress-related risk factors but not by life-style factors. Several stressors and life-style variables were risk factors for elevated blood pressure independently of depressive symptoms. The findings are consistent with studies that have measured hypertension variously by either self-report or blood pressure. Possible explanations were explored (labeling and help-seeking) but were not supported by the data. CONCLUSIONS: An association was found between self-reported hypertension and depressive symptoms, which was explained partly by shared stress-related risk factors. Elevated blood pressure was associated with stressors and life-style factors but not with depressive symptomatology. Research on illness representations and cultural dimensions of health suggest avenues for further investigation.

Adult↗
PubMed2004

Negative symptoms, trauma, and autobiographical memory: an investigation of individuals recovering from psychosis.

Psychological research on negative symptoms in schizophrenia is scarce. The aim of this study was to explore the relationship between negative symptoms and trauma in individuals recovering from a psychotic illness. Specifically, the aim was to examine the association between negative symptoms and traumatic reactions to psychosis and to hospitalization. We were also interested in the association between traumatic reactions and autobiographical memory. The design was a cross-sectional investigation of 38 people recovering from functional psychotic illness. Hypotheses were examined using correlations between measures of negative symptoms, posttraumatic avoidance, and specificity of autobiographical retrieval. Negative symptoms were found to be significantly associated with avoidance of traumatic memories related to psychosis and hospitalization and with a lack of specificity in autobiographical recall. Further analysis showed that avoidance related to psychosis and low specificity in recall were significant predictors of negative symptoms. These data suggest that people who avoid traumatic memories of psychosis and hospitalization have more negative symptoms and retrieve fewer specific autobiographical memories. The possibility that negative symptoms may be reactive is explored, along with the implications for our theoretical and clinical understanding. The methodological limitations of the study and ideas for future research are discussed.

Adult↗
PubMed2005

What influences parents' decisions to limit or withdraw life support?

OBJECTIVE: Decisions to forgo life support from critically ill children are commonly faced by parents and physicians. Previous research regarding parents' perspectives on the decision-making process has been limited by retrospective methods and the use of closed-ended questionnaires. We prospectively identified and described parents' self-reported influences on decisions to forgo life support from their children. Deeper understanding of parents' views will allow physicians to focus end-of-life discussions on factors important to parents and help resolve conflicts. DESIGN: Prospective, qualitative pilot study. SETTING: Pediatric intensive care unit of a university-affiliated children's hospital. PARTICIPANTS: A total of 14 parents of ten children whose pediatric intensive care unit physician had made a recommendation to limit or withdraw life support. INTERVENTIONS: : In-depth, semistructured interviews were conducted with parents during their decision-making process. MEASUREMENTS AND MAIN RESULTS: Factors influencing the parents in this study in their decision to forgo life support included their previous experience with death and end-of-life decision making for others, their personal observations of their child's suffering, their perceptions of their child's will to survive, their need to protect and advocate for their child, and the family's financial resources and concerns regarding life-long care. Parents in this study expressed the desire to do what is best for their child but struggled with feelings of selfishness, guilt, and the need to avoid agony and sorrow. Physician recommendations, review of options, and joint formulation of a plan helped parents gain a sense of control over their situation. Parents of eight children agreed to forgo life support and parents of two did not. CONCLUSIONS: Prospective interviews with open-ended questions identified factors influencing parents' decision making not previously described in the critical care literature such as parents' past experiences with end-of-life decisions and their anticipated emotional adjustments and future resources. Inclusion of these factors into discussions is important to parents and may facilitate decisions regarding the limitation or withdrawal of life support.

Adolescent↗
PubMed2005

On becoming dependent on home mechanical ventilation.

AIM: The aim of this paper is to illuminate meanings of becoming dependent on home mechanical ventilator treatment. BACKGROUND: People suffering from chronic alveolar hypoventilation and requiring home mechanical ventilation represent a small but increasing group in society, and are some of the most vulnerable individuals with chronic disabilities. METHOD: Thirteen people about to begin ventilator treatment at home were interviewed. Data were tape-recorded and analysed according to a phenomenological-hermeneutic method. FINDINGS: Findings revealed two contrasting meanings of being in the process of becoming dependent on a ventilator, interpreted as getting breath or holding breath. This interpretation is presented in two composite stories. CONCLUSIONS: The findings imply possibilities and deficiencies in meeting patients' existential needs, such as helping them to breathe spiritually by supporting them as they get their breath after such a life-changing event as becoming dependent on a ventilator.

Adaptation, Psychological↗
PubMed2006

'The intruder': spouses' narratives about life with a chronically ill partner.

AIM: The aim of this study was to illuminate the meaning of middle-aged spouse's experiences of living with a chronically ill partner. A purposive sample of four female spouses was selected for interviews using a narrative approach. BACKGROUND: When someone is diagnosed with a chronic illness, it is easy to understand that a considerable number of devastating consequences follow, both for the afflicted as well as for the family. Families often feel neglected and that their problems and needs are underestimated, if they do not personally draw attention to this fact. METHODS: A phenomenological hermeneutic method, inspired by the philosophy of Ricoeur, was used when interpreting the interview text. RESULTS: The experiences of spouses living with a chronically ill partner often brought a feeling of detachment from their partner's lives. The women experienced changes in their relationships because of their partners' disabilities; they had emotions of loneliness, despite living together as a couple. Through their actions, the women sought reassurance and support in order to maintain a meaningful partnership with their spouses and this is expressed in three themes: feelings of limitation, the struggle of everyday life and a striving for normalization. CONCLUSIONS: Middle-aged women living with a chronically sick partner are still of an active disposition and regard themselves as still being in mid-life. They wish to be loved as a wife and not as a care provider. RELEVANCE TO CLINICAL PRACTICE: The findings from this study can help increase the knowledge and understanding of the problems and concerns encountered by middle-aged spouses living with chronically ill partners and can be useful in the education and supervision of nurses and in relationship with relatives.

Adaptation, Psychological↗