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PubMedDate not supplied

Becoming and being courageous in the chronically ill elderly.

This grounded theory study was conducted to develop a conceptual framework of courage in the chronically ill elderly. Theoretical sampling was utilized, and 21 individuals who were 67 to 94 years of age were interviewed. The interviews were audio-recorded and transcribed verbatim. Data analysis was conducted using the constant comparative method. Based on the findings, becoming and being courageous is a lifelong process that includes a variety of learning experiences. Problem solving is involved, and it is thought to enable the transformation of struggles into challenges. Courageous behaviors are identifiable, and can be maintained with the help of nursing interventions. Outcomes of being courageous include a sense of equanimity and personal integrity.

Adaptation, Psychological↗
PubMed2006

Catching the wrong leopard: courage and masochism in the psychoanalytic situation.

This paper introduces the subject of courage into the psychoanalytic discourse about masochism and also demonstrates that ordinary ethical and axiological concerns can and should be included in our psychoanalytic language and practice. At each stage of a psychoanalysis, it may be helpful to consider whether the patient's experience might be that taking a step deeper into the psychoanalytic relationship is both courageous and masochistic. This consideration can open the door to exploration of conscious beliefs and how they are related to unconscious fantasies and assumptions. Considering the possibility that even a sadomasochistic enactment may simultaneously represent a courageous attempt to rework conflict or trauma can enrich the way analysts listen to both manifest and latent material.

Fantasy↗
PubMed1998

Examining the validity and reliability of childhood abuse scales: putting The Courage To Heal to the test.

OBJECTIVE: The main purpose of the current study was to examine the validity and reliability of The Courage To Heal Workbook checklist (Davis, 1990) in part, through examining the internal consistency and studying whether the CTHC distinguished between the participants reporting sexual abuse histories and those who did not. METHOD: Two hundred and seventy-nine college students were surveyed utilizing the symptom checklist from the Courage to Heal Workbook, Trauma Symptom Checklist-40 (TSC-40), Abusive Behavior Inventory (ABI), and questions related to participants' beliefs that they had been abused as a child. RESULTS: Results indicated that the Courage to Heal Checklist (CTHC) has robust reliability (alpha = .97) and can significantly discriminate between reported abuse survivors and nonsurvivors. Fifty-five percent of those participants reporting sexual abuse, 47% of those reporting physical abuse, and 34% of those reporting emotional abuse indicated a period of time during which they did not remember the abuse. CONCLUSION: Results indicate that the CTHC reliably differentiated between participants reporting past sexual abuse and those who did not. Mounting evidence continues to support that adult symptom profiles are able to indicate that some form of trauma is likely to have occurred in the past; however, differentiating between types of abuse based on symptom profiles may be impossible.

Adolescent↗
PubMed1977

The new psychotherapies: the courage to be.

The past decade has seen the emergence of popular "new psychotherapies" such as Gestalt Therapy, Transactional Analysis, and Primal Therapy, each with substantial followings. This paper puts forward a hypothesis about what these divergent systems may possess in common. Certain aspects of these therapy systems, in particular the induction of new patients and trainees, are examined in terms of Paul Tillich's concepts of the universal necessity of a rationale for courage. The significance of Tillich's analysis of courage for various historical movements is reviewed. In each system an element of unconditional commitment to a particular world view is required, as evidenced in the writings of the proponents of these systems, for the patient to be accepted into the particular system. These theoretically divergent systems possess, in common, a factor of an initial commitment to and induction into a collective belief system comparable to what Tillich describes as "the courage to be as a part".

Gestalt Therapy↗
PubMed2002

Having courage: a lived experience of human becoming.

The purposes of this research were to discover the structure of the experience of having courage and to contribute to knowledge about human becoming. Participants were 10 persons with spinal cord injuries. The Parse research method was used to answer the research question, What is the structure of the lived experience of having courage? The central finding of this study is the following structure: The lived experience of having courage is a fortifying tenacity arising with triumph amid the burdensome, while guarded confidence emerges with the treasured. The findings are discussed in relation to human becoming, relevant literature, and future research.

Adaptation, Psychological↗
PubMed2006

Design and rationale of the Clinical Outcomes Utilizing Revascularization and Aggressive DruG Evaluation (COURAGE) trial Veterans Affairs Cooperative Studies Program no. 424.

BACKGROUND: Major improvements in medical therapy and percutaneous coronary intervention (PCI) for coronary heart disease have occurred during the past decade, but no randomized trial has compared these 2 strategies for the "hard" clinical end points of death or myocardial infarction nor have earlier studies incorporated the use of coronary stents and aggressive multifaceted medical therapy during long-term follow-up. METHODS: The COURAGE trial is a multicenter study of patients with documented myocardial ischemia and angiographically confirmed single or multivessel coronary artery disease who are randomized to a strategy of PCI plus intensive medical therapy or intensive medical therapy alone. Medical therapy in both groups is guideline-driven and includes: aspirin, clopidogrel, simvastatin (low-density lipoprotein cholesterol target 60-85 mg/dL), long-acting metoprolol and/or amlodipine, lisinopril or losartan, and long-acting nitrates, as well as lifestyle interventions. The primary end point is a composite of all-cause mortality or acute myocardial infarction, and there will be 85% power to detect an absolute 4.6% (relative 22%) difference between strategies. The principal hypothesis is that PCI plus aggressive medical therapy (projected event rate 16.4%) will be superior to aggressive medical therapy alone (projected event rate 21%) during a 2.5- to 7-year (median of 5 years) follow-up. CONCLUSIONS: COURAGE is the largest prospective randomized trial of PCI versus intensive medical therapy to date and will define the incremental benefits of PCI in the setting of contemporary optimal medical therapy for chronic coronary heart disease. A total of 2287 patients have been enrolled, and follow-up will conclude in June 2006.

Coronary Artery Disease↗
PubMed2006

The evolving pattern of symptomatic coronary artery disease in the United States and Canada: baseline characteristics of the Clinical Outcomes Utilizing Revascularization and Aggressive DruG Evaluation (COURAGE) trial.

Major improvements in medical therapy and percutaneous coronary intervention for coronary artery disease (CAD) have emerged during the previous 2 decades, but no randomized trial in patients with stable CAD has been powered to compare these 2 strategies for the hard clinical end points of death or myocardial infarction (MI), and previous studies have not evaluated the effect of coronary stents and intensive medical therapy on cardiac events during long-term follow-up. Between 1999 and 2004, 2,287 patients with documented myocardial ischemia and angiographically confirmed CAD were randomized to the Clinical Outcomes Utilizing Revascularization and Aggressive DruG Evaluation (COURAGE) trial, with a principal hypothesis that a strategy of percutaneous coronary intervention plus intensive, guideline-driven medical therapy would be superior to a strategy of intensive medical therapy alone. The primary end point was a composite of all-cause mortality or acute MI (time to first event) during a 2.5- to 7-year (median 5) follow-up. Baseline characteristics were a mean age of 62 +/- 5 years, 85% men, and 86% Caucasian. Mean duration of angina before randomization was 26 months (average 10 episodes/week), and 29% of patients were smokers, 67% had hypertension, 38% had previous MI, 71% had dyslipidemia, 34% had diabetes, 27% had previous revascularization, and 69% had multivessel CAD. Approximately 55% of patients met established criteria for the metabolic syndrome. In conclusion, baseline characteristics of the COURAGE trial study population indicate a highly symptomatic group of patients with CAD who have a significant duration and frequency of antecedent angina pectoris and a high prevalence of cardiac risk factors.

Canada↗
PubMed2006

Economics methods in the Clinical Outcomes Utilizing percutaneous coronary Revascularization and Aggressive Guideline-driven drug Evaluation (COURAGE) trial.

Percutaneous coronary intervention (PCI) remains a major therapeutic option for the treatment of chronic coronary artery disease. In the COURAGE trial, 2287 patients with chronic coronary disease were randomized between PCI with medical management and medical management alone. Embedded within the COURAGE trial is a detailed economic analysis being conducted in three health care systems: the US Veterans Administration (VA), Canada, and the US non-VA. Resource use and costs are being collected for each system and overall. Survival is assessed internally in the trial with mean follow-up of 4.5 years. Long-term mean survival will be estimated by projecting survival beyond the trial period by extrapolating the in-trial hazard rates. Utility is being assessed at baseline and at 1, 3, and 6 months and annually thereafter, using a computer-administered standard gamble. Quality-adjusted life years are calculated by multiplying survival by utility. The incremental cost-effectiveness ratio of PCI will be defined as the additional cost of PCI divided by the gain in life years and quality-adjusted life years. The 95% confidence regions of efficacy and costs will be determined by bootstrap over a range of acceptability thresholds, which will then be displayed in the cost-effectiveness plane and as a cost-effectiveness acceptability curve. A multilevel regression model will assess cost-effectiveness from a net benefit perspective. These approaches should provide the most detailed assessment available of the cost-effectiveness of PCI for coronary artery disease.

Angioplasty, Balloon, Coronary↗
PubMed2003

Courage in the development of self in women.

The author discusses the development of self in women, explores the role of courage inherent in this movement, and, employing existentialist notions of courage as authenticity, explicates how these notions may lead to the development of a stronger sense of self. Notes as well that this development of self entails a dangerous complexity and that pastoral care providers will want to aid women in holding together both autonomy and connection.

Adult↗
PubMed1990

Conscience and courage--a critical examination of professional conduct.

The roots of professional power and authority lie in the claim to a specific kind of knowledge, the 'knowledge that' and the 'knowledge how'. These kinds of knowledge are included in the notion of 'science'. 'Knowledge why'- the justification for a professional action - demands a moral argument in terms of what is known and can be done (taking 'scientific' knowledge into account) but most importantly asking whether it ought to be done. It is important to ask how a nurse acquires the 'knowledge why' and thereby the means to justify his/her conduct in moral terms. This paper considers the norms of professional conduct, the professional mandate and the determination of what is, to the best of the professional's knowledge and conscience, the right act. The question is raised whether an appeal to the individual conscience can be a reliable guide to a morally justifiable action. An exploration of moral perceptions, moral reasoning and moral argument needs to be part of a professional education which requires a certain kind of courage on part of both teachers and students.

Codes of Ethics↗
PubMedDate not supplied

Having the courage to be competent: persons and families living with aphasia.

UNLABELLED: This paper provides examples and illustrations of how aphasic people can and do demonstrate their competence in managing their lives despite chronic aphasia. It discusses a number of ways in which aphasic persons and their families can learn to live fully despite the intrusion of aphasia. EDUCATIONAL OBJECTIVES: After reading this paper, participants should (1) have a more fully developed appreciation of what it means to live courageously with aphasia, (2) recognize the importance of developing a lifespan perspective following the onset of aphasia, and (3) better understand competence in aphasia.

Aphasia↗
PubMed1997

Klein's archaic Oedipus complex and its possible relationship to the myth of the labyrinth: notes on the origin of courage.

The ancient Greek myth linking the images of the labyrinth and the Minotaur provides an allegory for Melanie Klein's conception of the archaic Oedipus complex as well as a vivid illustration of Winnicott's notions of object usage and the 'subjective object'. The labyrinth is suggestive of mother's body as the first area for an infant's exploration and putative sadistic conquest. The Minotaur, in turn, suggests the infant's unconscious phantasies about the content of mother's body, namely such projective identifications onto that body as the paternal penis and the 'internal babies'. Further, the heroic dynamic personified by Theseus in the myth of the labyrinth metaphorically signifies what is here proposed as a developmental line that involves the courage to do a number of things, including to become, to create, to seek, to explore, to do, to challenge, to undertake risks, to accept, to rescue, to initiate, to think, to know and to realize. The Minotaur can thus be thought to serve as a universal subjective signifier for an 'Object of Challenge', which, if not successfully dealt with by the ego-development of the infant, transforms that default into the 'Object of Nemesis'. Ultimately, this myth of mastery speaks to the psychoanalytic process itself as well as casting light on the transformative aspects of sexual intercourse as a personal healing ritual.

Ego↗
PubMed1983

An experimental analysis of fearlessness and courage.

In an attempt to assess the performance under stress of people who had received awards for gallantry, the subjective, behavioural and psychophysiological reactions of a group of seven decorated bomb-disposal operators were measured during a conflict test. Compared to a group of seven equally experienced and successful, but non-decorated, bomb-disposal operators, the decorated subjects maintained a lower cardiac rate when making difficult discriminations under threat of shock. There were no differences between the groups on subjective reactivity or on their performance under stress. Both groups of bomb-disposal operators reported having experienced fewer fearful reactions than did a small number of comparison subjects. The implications of the results for theories of fear and of courage are considered.

Adult↗
PubMedDate not supplied

Courageous leaders. The integral force behind organizational excellence.

For more than a decade, Total Quality Management (TQM) has been used as a powerful instrument in shaping the competitive strategies of businesses, and producing quality products and services has become the credo of firms trying to defend or expand their markets. During this time, we have come to realize that without effective leadership no quality program can succeed. That is why the quality guru, W. Edwards Deming, refused to work in any organization unless he could begin with the CEO. That is why the first criterion examined for the Malcolm Baldridge National Quality Award is leadership. Focusing on quality will not guarantee success in today's rapidly changing markets. Increasingly discriminating consumers have come to expect quality in the products and services they buy, and businesses that fail to deliver it will not survive. In a very real sense, quality performance is the price you must pay simply to play the game. But consumers want more, and satisfying their expectations will determine tomorrow's winners and losers. Building organizations capable of producing superior results that consistently meet the needs of customers is the responsibility of leaders. For this reason, leaders are more important today than they have ever been before. Leaders in successful businesses must show the way for their employees by nurturing "cultures" that encourage and reward superior performance and by exhibiting personal characteristics that inspire excellence. Great leaders possess three crucial characteristics--vision, strong values and beliefs, and the courage to do the job despite seemingly insurmountable obstacles. These characteristics make the difference between excellence and "business as usual."

Consumer Behavior↗
PubMed1985

Reason, courage, and grace: notes of a death watcher.

Dying is strikingly private and personal, and it breaks the interconnectedness of all human life. It is at such a time that the physician's humanity must touch the unique personhood of the afflicted if the death is to be "good". A physician's duty does not rest on the medical profession's code of conduct; it consists of the physician's moral obligation to a specific person in a specific situation. That person's entire identity--not just the physical being--is assaulted by terminal illness; the emotional, familial, and social dimensions of selfhood are ravaged by the disease as surely as is the body. Each individual is involved in his or her suffering in a way that is unique and that cannot be understood or appreciated by anyone else. But the physician must try to bridge the distance that is placed around the sufferer by the dying process. And it is only with his or her own humanity that the care giver can accomplish this. That humanity should inform all decision making, and thus bring with it genuine control and comfort. In this way the patient can truly "own" his or her own death. The patient can thereby attain reason and courage, which together are the quality of grace.

Attitude to Death↗
PubMedDate not supplied

[Tribute to the hospital staff for their courage during the Liberation of Paris (19-27 August 1944)].

The lecture given by P. Brocq on "The Hotel-Dieu from August 19th to 27th 1944" and P. Canlorbe's doctoral dissertaion on "The Medical Services in the French Resistance" have not received the attention they deserve. I was present at the Hotel-Dieu during that period and I wish to pay a just tribute to the personnel of the Paris hospitals. Historical events such as the beginning of the insurrection in the Police Headquarters on Saturday August 19th and the reaction of the German troups still in Paris are presented in this paper, along with some medical data, the rapid organization of a complete surgical unit similar to those deployed in wartime, including fearless volunteers who picked up casualties and dispatched them to the appropriate treatment centres composed of eight surgical teams. A message of hope was dropped over the Police Headquarters at around 6 p.m. on Thursday August 24th, more than five hours before Captain Dronne's detachment reached the Hotel-de-Ville and Place Notre-Dame. On Friday August 25th, the tactical group led by Colonel P. Billotte was triumphally acclaimed when it reached the wide space in front of the church. The number of casualties indicates how fierce was the confrontation: 822 wounded (398 Frenchs and 424 Germans) were admitted to the Hotel-Dieu, of which 283 died (78 French and 205 Germans). In the other Paris hospitals of the Assistance Publique, 3,083 patients were admitted for wounds and 567 died. The personnel of those hospitals was extremely performing during this period and also paid a heavy tribute. Three members of the Hotel-Dieu died and 10 were killed at the Bichat Hospital during the Lufwaffe air raid during the night of August 26-27th 1994. Time has come, more than fifty-three years later, to commemorate the courage of the personnel of those hospitals who effectively and generously fulfilled their mission during Paris Liberation.

France↗
PubMed2003

Who let the dogs out? Managing conflict with courage and skill.

Although nurses often think in terms of clinical ability when discussing competence, strong interpersonal communication skills are also essential for effective practitioners. Conflict management skills are key to creating work environments with good retention, work satisfaction, and high-quality measures. Nurses desiring to learn to communicate with courage and directness can master these skills, contributing to environments where caregivers can collaborate in providing the highest quality care.

Communication↗
PubMed2003

[On the simile of the courageous general in Herophilos].

Herophilos of Chalcedon is certainly an outstanding representative of ancient medicine. He rightly counts the Father of anatomy. He was, nevertheless, interested in all branches of medicine and should have written on numerous special subjects. Unfortunately only scarce fragments of his writings have survived till now. A nowadays rather neglected fragment deriving from Herophilos' scripts on drugs has survived in Plin. nat XXV 57 f. It reports on the effects of helleborus albus (probably White Hellebore, i.e. Veratrum album L.) which evokes strong vomits. In a pregnant simile the remedy is compared to a courageous general who having stimulated his soldiers goes into battle in front of them. Editors and commentators do not say much about this passage, perhaps bewildered by the appropriate, but in the technical prose certainly striking simile. A surprising parallel occurs in the Gospel according to St. John 10:1-6 - the core of Jesus' self-description as the Good Shepherd. Comparing both passages leads to the conclusion that this select metaphor must have been a well-known motif in the literature of the Hellenistic and imperial periods. Moreover, a look at the ancient historiography and military writings shows that we have to do with a commonplace: both the talent to deliver a vigorous speech encouraging the soldiers to go into battle and the personal bravery in the fight are virtues necessary to an eminent military commander. Furthermore, we get insight into a general understanding of Herophilos as a writer. It was stressed frequently that Herophilos' epoch-making results in the field of medicine had found their way into the belles-lettres and poetry. Now we see that the inspiration was mutual. When Herophilos wished to give prominence to an important statement, he also did not hesitate to borrow effects of style from the poets and writers of the Kunstprosa. In his care for a literary form he exceeds what we unusually observe in the writers of 'technical' prose.

Anatomy↗