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PubMed2001

Empirical validation of a teaching course on spiritual care in Taiwan.

UNLABELLED: AIM(S) OF STUDY: The aims of this study were threefold: (a) to develop the first spiritual care program for master of science in nursing degree students (MSNDS) in Taiwan, since most of these students are or will be nursing leaders in clinical practice, education, administration, or research; (b) to facilitate the MSNDS in applying the contents of this program to care of their clients; and (c) to understand the MSNDS' appraisals of the usefulness of the program in helping them provide spiritual care in clinical settings. BACKGROUND: The World Health Organization (WHO) (1998) proclaimed that health needs should include spiritual well-being in addition to physical, mental, and social domains. Nevertheless, many dominant medical educational systems have not yet encompassed spiritual care as part of their comprehensive or core curricula. DESIGN/METHODS: The methodological triangulation research design used in this project included various strategies of developing a novice course entitled 'Spirituality in Nursing Practice' which was given to the subjects over 18 weeks from September 1998 to February 1999. The course included classroom lectures, field trips, clinical implications, and presentation-appraisal. A convenience sample of 22 female MSNDS who were or had the potential to be nursing leaders from two schools of nursing in northern Taiwan was obtained. RESULTS: Four types of help were identified: (a) help in clarifying the theoretical concepts of spiritual care (100%); (b) help in providing a culturally bonded spiritual care plan (100%); (c) help in self-disclosure of the nurse's personal value systems and spiritual needs (91%); and (d) help in clarifying the symbolic meaning and the impact of religious rituals (86%). The explicit spiritual care plans and an empirical example of spiritual care were provided. CONCLUSIONS: This study presented the first spiritual care program for MSNDS in Taiwan. All subjects considered the course helpful in providing spiritual care for their clients in various clinical settings. The concept of spirituality is arousing great interest in the world, and this is evident in the spiritual care courses appearing in nursing curricula for nursing leaders in Taiwan.

Adult↗
PubMed2003

Nurse practitioner-client interaction as resource exchange in a women's health clinic: an exploratory study.

Empirical research has thoroughly documented the success of nurse practitioners (NPs) in terms of patient satisfaction and cost-effectiveness. What is missing is the in-depth knowledge of the interactive process through which this is accomplished during a clinic visit. The aim of this study was to understand the special nature and processes of NP and client encounters in the ambulatory primary care context using a resource exchange perspective. An exploratory descriptive design was used to address the following research questions: (i) What do midlife female clients expect in terms of resources to be exchanged prior to a visit with a NP in an ambulatory clinic visit? (ii) What resources are actually exchanged during the clinic visit? (iii) To what extent is there congruence between a woman's expectations and what she is actually receiving from the clinic visit in terms of resources exchanged? The participants included two women health NPs and eight midlife female clients. Data for the study were comprised of audiotaped pre- and postencounter interviews with the clients, audiotapes of the entire clinic visits with the NP and field notes recorded by the researcher of the client visits. Content analysis was conducted using ETHNOGRAPH software. Findings indicated that clients of both NPs had surprisingly similar expectations of receipt of services as well as actual receipt of services. Resources expected and received from the visits included some combination of services, health information, trust, self-disclosure, support, affirmation, time, acceptance and respect. Results of this study suggest that resource exchange theoretical formulations can be applied to NP-client interactions to understand and explain the specific nature of resources the clients expect and receive from a NP during a woman's health clinic visit.

Adult↗
PubMed2001

Recovery after stroke: a qualitative perspective.

The purpose of this study was to determine the impact of stroke on survivors of the condition and to identify their physical and psychosocial needs in rural and regional settings. Data were collected via focus group interviews with stroke survivors, carers and key informants. Data were managed using NUD*IST and analysed using a content analysis method identifying major themes related to the impact of living in the community after having a stroke. It was found that stroke survivors suffered severe physical and emotional effects. The findings also identified the vulnerability of this group and a lack of organised, on-going psychosocial and rehabilitative support. Recommendations are made to enhance the current management of stroke after the acute and subacute phases.

Adult↗
PubMed1991

Process variables mediating change in intensive group therapy training.

This investigation is based on over 400 American Group Psychotherapy Association members involved in 41 intensive, two-day training experiences for mental health professionals. The participants completed a questionnaire immediately after their group sessions to evaluate the process and leadership variables that contributed to a constructive learning experience. A similar questionnaire was mailed to participants three to four months later to explore the impact of training on group interventions within their clinical practices. One third of the trainees responded to the follow-up survey. Overall, the findings suggest that successful outcomes are related to a range of group processes, such as self-disclosure, feedback, and interpersonal support, as well as personal qualities and technical expertise modeled by the leaders of the training groups. Both the immediate and delayed assessments demonstrate that the groups were regarded as highly valuable learning opportunities.

Education, Continuing↗
PubMed1994

Intensive analysis of therapeutic factors and outcome in long-term inpatient groups.

Two long-term analytic inpatient groups comprised of severely disturbed neurotic and personality disordered patients were intensively investigated through process ratings and therapist and patient reports with regard to five therapeutic factors: cohesiveness, self-disclosure, feedback, interpersonal learning-output, and family re-enactment. The process variables were correlated with outcome assessments at 12 and 18 months following treatment. The study applied a single case (group) approach with replication to cross-validate the findings from one group to the next. Results demonstrated that all five therapeutic factors were meaningfully associated with clinical improvement. Although different treatment groups may generate unique psychological climates for producing change, the findings suggest that group cohesiveness is an important ingredient for effective group process to occur. The multimethod, multiperspective nature of this study lends considerable credence to the findings, despite the small sample size.

Adult↗
PubMed1999

Integrative processing: a biological foundation for psychotherapy.

The biological base for psychodynamic psychotherapy has been increasingly recognized as archaic--unable to provide a conceptual framework within which to place the rapid progress in the basic neurosciences and the clinical successes of modern psychopharmacology. A gradual conceptual synthesis has been occurring between the study of the formal properties of general systems, including both animate and inanimate systems and evolutionary thinking, with special emphasis on the adaptive design of the human mind/brain. That synthesis points the way to an evolutionary-based complex adaptive systems model. Such a model would reflect our understanding of the brain as a modular system, with distributed memory and no central locus of executive control. A prominent design feature would be an automatically operating process coordinating and harmonizing various specialized brain modules--integrative processing. Pennebaker's research (Opening Up: The Healing Power of Expressing Emotions, Guilford, 1997) on personal self-disclosure illustrates ways in which the concept of integrative processing can help our understanding of the brain's basic function in dealing with emotional issues. It also provides a useful way of conceptualizing the clinical effect of psychopharmacological interventions.

Adaptation, Physiological↗
PubMed1994

Sexually compulsive men and inhibited sexual desire.

Sexually compulsive males report extremely high rates of desire involving paraphiliac activity. Desire and arousal in partner sex is usually low or unstable. Cognitive-behavioral strategies and techniques are presented based on four components in the assessment/intervention process: 1) eliminating or reducing paraphiliac arousal; 2) sex education, changing sexual attitudes, self-disclosure, sexual assertiveness, and reduction of guilt and shame; 3) confronting secrecy and cognitive distortions, increasing empathy for victims, awareness of harm to others, and commitment to abstain from compulsive, abusive behavior; and 4) developing a healthy sexual desire and arousal pattern that nurtures and maintains an intimate relationship. The motivated male (especially with a partner he is comfortable with, attracted to, and trusts) can develop a pleasurable, erotic sexual pattern that allows him to maintain desire during partner sex.

Adult↗
PubMed2005

A pilot survey of junior doctors' confidence in tasks related to broad aspects of competence.

Medical authorities and society are recommending that postgraduate medical education prepare physicians for broad aspects of competence. The most effective ways to prepare physicians for these are not known. The aim of this pilot study was to survey junior doctors' growth in confidence in different physician roles. A total of 165 junior doctors in internal medicine completed a self-administered survey of confidence levels in physician roles. Confidence levels between training levels were compared. Confidence in the roles of medical expert, communicator and collaborator increased between PRHOs and SHOs. Confidence levels increased in all roles between PRHOs and SpRs, but confidence between SHOs and SpRs increased only in the roles of collaborator and scholar. Confidence in the role of professional was low and did not increase significantly between training levels. The SHO year was rated as only moderately useful in facilitating learning of the tasks. These results suggest that growth of confidence in the physician roles proceeds at different rates during postgraduate training. Additional research is needed to identify effective ways for junior doctors to learn broad aspects of competence. Longitudinal tracking will be important to evaluate the effect of educational interventions on patient care.

Clinical Competence↗
PubMed2003

Grief consolation in eulogy rhetoric: an integrative framework.

In an ever more deadly and uncertain world, rhetoric honoring the deceased is still examined as though that was its primary, if not only, function. Some critics of eulogia also identify the consolation of survivors but rarely define it precisely or analyze its rhetorical execution. This article introduces a framework for the critical analysis and production of eulogia that draws from comforting mechanisms recognized in the interpersonal communication, social psychology, and grief therapy literatures. Self-disclosure, problem-focused coping, positive reappraisal, and the affirmation and continuation of relationships with the deceased are shown to inform criticism of five contemporary eulogies. Challenges inherent in the invention and appreciation of eulogy rhetoric are thus illuminated and addressed.

Adaptation, Psychological↗
PubMed2004

Fallen heroes, lifted hearts: consolation in contemporary Presidential eulogia.

A.D. Kunkel and M. R. Dennis (2003) demonstrated that examining texts for identified components of eulogia, as drawn from the comforting and social support paradigms found in psychology and communication literatures (i.e., credibility establishment, praise for the deceased, self-disclosure of emotion, prescriptions for problem-focused coping, promotion of positive reappraisal for emotion-focused coping, and the affirmation and continuation of relationships), is critical to understanding eulogistic phenomena. Analysis of three Presidential eulogies, as informed by the components, reveals calls for unity in President Ronald Wilson Reagan's 1986 eulogy for the Challenger space shuttle crew, suggestions for action in President William Jefferson Clinton's 1995 eulogy for USS Cole sailors, and positive reappraisal within astronauts' quotes offered by President George Walker Bush during his 2003 eulogy for the Columbia space shuttle crew.

Adaptation, Psychological↗
PubMed2001

Physicians' attitudes toward litigation and defensive practice: development of a scale.

The authors' threefold purpose in this article was to (a) propose a model of the relationship between the emotional aspects of physicians' attitudes to medical errors (e.g., fear of litigation) and their functional consequences (e.g., tendency to defensive practice); (b) develop a measure of some of these attitudes; and (c) provide empirical support for some of the relationships in the model. Medical students and physicians responded to a questionnaire concerning their attitudes toward uncertainty and medical error. The dependent variables were two dimensions of attitudes to uncertainty ("reluctance to disclose uncertainty" and "stress from uncertainty") and four dimensions of attitudes to medical error ("fear of litigation," "support for self-regulation," "tendency to defensive practice," and "self-disclosure of errors"). Stress from uncertainty correlated with fear of malpractice litigation and defensive practice. They concluded that interventions that aim to increase physicians' tolerance of uncertainty may also reduce their fear of malpractice litigation and their tendency to defensive practice.

Attitude↗
PubMed2001

Confrontations with the inconceivable: a therapists experience of life-threatening illness.

It is generally agreed that each therapeutic relationship is uniquely affected by both the client's and therapist's values, dynamics, and life experiences. How we, as therapists struggle with our life crises cannot help but shape our participation in the therapeutic relationship. While all therapists reveal much about themselves by chance as well as unconscious choice, this paper illustrates how the deliberate self-disclosure of a life threatening illness expanded the relationship for therapist and client alike.

Journal Article↗
PubMed2001

Helping learners become reflective practitioners.

CONTEXT: In too many schools in the health professions, students are given little or no opportunities to reflect systematically on their simulated or real experiences practicing the skills they need as clinicians (e.g. eliciting information and solving problems). In addition, they are given little or no help in learning the skills that are central to being reflective practitioners. RATIONALE: Reflecting alone or with the help of educators or others, students and residents can learn to identify and build on their existing knowledge, identify their biases and assumptions, integrate new understandings, and formulate generalizations that will enable them to make positive changes in what they do in future situations. Put another way, they can derive lessons from their experiences that will enhance their skills and enable them to provide better patient care. When learners reflect aloud on their insights and their strengths and deficiencies before their teachers give them advice or feedback, learners can make their own discoveries and have the dignity of identifying what they need to work on. The learners' self-disclosures provide educators with "diagnostic" information that can enable them to tailor their teaching to the learners' interests and needs. SUGGESTIONS: Educators can help learners become reflective practitioners by taking such steps as ensuring learners have worthy experiences on which to reflect; observing learners in action; scheduling times and places for reflection; building trust; determining the learners' prior experiences, comfort with, and attitudes toward reflection; ensuring learners understand the rationale and strategies for reflection; modeling reflection; clarifying the learning goals; encouraging learners to have questions to ask themselves; helping learners reflect on their thoughts, feelings, biases, and assumptions; helping learners consider other approaches; inviting learners to identify the lessons they've learned; and asking them to discuss how they intend to use these new understandings.

Journal Article↗
PubMedDate not supplied

Using diaries to measure parameters of transactional sex: an example from the Trans-Africa highway in Kenya.

Conventional methods of elicitation have severe limitations where sensitive information is being sought, resulting from both self-disclosure and recall bias. The use of diaries largely circumvents both of these problems. Four hundred and three female sex workers based on a section of the Trans-Africa Highway in Kenya completed standard diaries for consecutive 28-day periods. Variables measured included numbers and types of different clients, condom use, occupation of client, movement patterns and days of menses. Mean numbers of sexual partners, liaisons and sex acts and inter-relationships between the variables measured are analysed. The study affirms the value of diaries as an elicitation method for studying transactional sex in a resource-poor setting. Usable diaries were received from 70% of those who had agreed to participate in the study. The diaries yield detailed quantitative data that describe the characteristics and dynamics of transactional sex on a major highway in Africa and provide information that may be used to estimate HIV transmission rates.

Adolescent↗
PubMed2004

Correlates of inmates' self-reported HIV/AIDS risk behaviors, prior incarceration, and marijuana use.

The primary purpose of this study was to determine associations between measures of prior incarceration and marijuana use with self-reported HIV/AIDS risk behaviors among a sample of soon-to-be-released adult male inmates. Analyses presented exclusively involve calculating two multiple logistic regression models to test the study hypothesis. The general model specified self-reported marijuana use as an outcome with selected demographic variables including ethnicity, age, education, and income prior to incarceration as predictor variables. Significant bivariate associations were recorded for age, education, and sexual self-expectation with respect to reincarceration. Specifically, the least amount of education reported, the more likely study participants were to have been incarcerated more than once.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Alcohol use inventory: screening and assessment of first-time driving-while-impaired offenders. I. Reliability and profiles.

This study evaluated the use of the Alcohol Use Inventory (AUI) in a drink-driving offender population court-mandated to attend a screening programme. We compared offenders' scale scores, reliability statistics and profiles to those from two clinical populations on which the AUI was normed. Among offenders, males and females had similar levels of involvement with alcohol, and Native Americans had higher scale scores than other ethnic groups. Comparisons with the normative population revealed lower mean scale scores and lower reliability scores among offenders. Differences between the offender and normative populations were most pronounced for the primary scales. We also found inconsistencies in offenders' responses to certain questions. To address this, we recommend that, when using the AUI for screening offenders: (1) screeners place more emphasis on second- and third-order scales than primary scales; (2) lower cut-off points be used for identifying problem drinkers; (3) counsellors conduct in-person interviews with clients to develop rapport and encourage self-disclosure.

Adult↗
PubMed2006

Drinking histories of self-identified lifetime abstainers and occasional drinkers: findings from the 1958 British Birth Cohort Study.

AIMS: To investigate the validity of retrospective items used to distinguish people who have rarely or never consumed alcohol. METHODS: The 1958 British Birth Cohort Study has followed 9377 individuals until age 45. Previous drinking (at 16, 23, 33 and 42 years) was investigated for two groups of 45-year-old non-drinkers, those reporting never having consumed alcohol ('never drinkers', n = 143, 1.5%), and having only consumed very infrequently ('occasional-only drinkers', n = 1149, 12.3%). RESULTS: 67% of never drinkers previously reported drinking, 25% were past weekly/daily drinkers; 56% of occasional-only drinkers reported weekly/daily consumption. The validity of the retrospective items was progressively questionable when presumed to cover longer time periods. CONCLUSIONS: Substantial measurement error was evident when identifying 'occasional-only' and 'never' drinkers using retrospective items covering the lifecourse. Researchers investigating potential health benefits associated with moderate drinking need to incorporate more sophisticated methods when identifying sub-groups of non-drinkers.

Adolescent↗
PubMed2006

Social desirability is associated with some physical activity, psychosocial variables and sedentary behavior but not self-reported physical activity among adolescent males.

This study examined whether controlling for social desirability improved the association between self-reported and objectively measured physical activity among adolescent males and the extent that psychosocial variables predict physical activity after controlling for social desirability. Participants (n=447) were 10- to 14-year old Houston Boy Scouts. Participants completed self-reports of physical activity, sedentary behavior, preferences, self-efficacy and social desirability and wore an MTI accelerometer for 3 days. Correlations were conducted among variables. Regression models were performed to examine the relationships between objectively measured (accelerometer) and self-reported physical activity, objectively measured physical activity and psychosocial variables and self-reports of physical activity and psychosocial variables. All models controlled for social desirability. There were weak associations between self-reported and objectively measured physical activity measures that were slightly improved after controlling for social desirability. Psychosocial variables were strongly associated with self-reports of physical activity, but weakly associated with accelerometer physical activity. Social desirability was positively associated with physical activity preferences (r=0.169) and self-efficacy (r=0.118) and negatively associated (r=-0.158) with self-reported sedentary behavior. Differences in the strength of relationships between self-reported and objectively measured physical activity and psychosocial variables were not a function of social desirability.

Adolescent↗