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PubMed2001

Spirituality and meaning in supportive care: spirituality- and meaning-centered group psychotherapy interventions in advanced cancer.

Existential and spiritual issues are at the frontier of new clinical and research focus in palliative and supportive care of cancer patients. As concepts of adequate supportive care expand beyond a focus on pain and physical symptom control, existential and spiritual issues such as meaning, hope and spirituality in general have received increased attention from supportive care clinicians and clinical researchers. This paper reviews the topics of spirituality and end-of-life care, defines spirituality, and suggests measures of spirituality that deal with two of its main components: faith/religious beliefs and meaning/spiritual well-being. These two constructs of spirituality are reviewed in terms of their role in supportive care. Finally, a review of existing psychotherapeutic interventions for spiritual suffering are reviewed and a novel meaning-centered group psychotherapy for advanced cancer patients is described.

Attitude to Health↗
PubMed1995

When passives are easier than actives: two case studies of aphasic comprehension.

We outline a range of previous theoretical accounts of agrammatic comprehension in patients with Broca's aphasia. Specific attention is paid to patterns of preserved and impaired understanding of reversible actives and passives. We note that no prior account will allow for the existence of patients who show better comprehension of passives than actives. In three experiments, we compare and contrast the performance of two patients whose syntactic comprehension ability is in complementary distribution. The first patient (M.H.) performs well on simple actives, active questions, and active existentials, but is below chance on their corresponding passives. The second patient (B.M.) is at chance on simple actives, active questions and active existentials while scoring significantly above chance on their respective passives. We interpret both patterns of response in terms of the distinction drawn by Case theory between structural and inherent Case. The first patient's grammar cannot assign either structural or inherent Case and she must accordingly apply a non-linguistic linear strategy to assign thematic roles in all sentences. The second patient (B.M.) has a specific impairment of structural Case; he can accordingly not interpret actives (where Case is assigned configurationally) but can interpret passives (where Case is assigned lexically).

Adult↗
PubMedDate not supplied

Factors associated with adherence to antiretroviral therapy.

The purpose of this study was to examine the relationship of sociodemographic characteristics, patient perceptions, and patient characteristics including spirituality, self-reported adherence, and highly active antiretroviral therapy. The convenience sample consisted of 120 English-speaking adults (60% male, 35% female, 5% transgendered) with HIV/AIDS from two HIV service agencies in a large metropolitan city in the southeastern United States. The mean self-reported adherence was 83.1% (SD = 15.7%). Adherence was significantly correlated with perceived support and absence of barriers, strong intentions to adhere, perceived effectiveness of the medications, higher levels of perceived general health, fewer years of HIV disease, and fewer years on antiretroviral medications. Existential well-being (e.g., viewing life as positive and having meaning) was a weak significant correlate. Backward regression analysis was conducted to identify a parsimonious model of predictors of adherence. The final model included presence of support and absence of barriers, fewer years of HIV infection, no current alcohol use, perceived severity of HIV, existential well-being, and male gender. This model explained 19.4% of the variance in adherence (observed F[6, 100] = 5.6, p < .0001).

Adult↗
PubMed2006

Personality, neuroticism, and coping towards the end of life.

The influence of personality characteristics on how patients cope with various challenges at the end of life has not been extensively studied. In order to examine the association between end-of-life experience and neuroticism (defined within the personality literature as a trait tendency to experience psychological distress), a measure of neuroticism was administered to a cohort of dying cancer patients. Various other measures of physical, psychological, and existential distress were also measured to explore their possible connection to patient personality style. The personality characteristic neuroticism demonstrated a significant relationship with several end-of-life sources of distress, including depression, anxiety, sense of dignity, quality of life (rating and satisfaction), hopelessness, concentration, and outlook on the future. Neuroticism appears to have a significant association with the dying experience. This association is expressed across the psychological, existential and, to a lesser extent, physical and social domains of end-of-life distress. This may help clinicians identify vulnerable individuals who are most likely to have poorer adjustments and may benefit from earlier targeted interventional approaches. Exploring the relationship between various facets of personality and end-of-life distress, and mapping this information against optimal therapeutic responses, remains the challenge for future research broaching this intriguing and largely ignored area of palliative care.

Adaptation, Psychological↗
PubMed2006

Meaning-making intervention during breast or colorectal cancer treatment improves self-esteem, optimism, and self-efficacy.

Existential issues often accompany a diagnosis of cancer and remain one aspect of psychosocial oncology care for which there is a need for focused, empirically tested interventions. This study examined the efficacy of a novel psychological intervention specifically designed to address existential issues through the use of meaning-making coping strategies on psychological adjustment to cancer. Eighty-two breast or colorectal cancer patients were randomly chosen to receive routine care (control group) or up to four sessions that explored the meaning of the emotional responses and cognitive appraisals of each individual's cancer experience within the context of past life events and future goals (experimental group). This paper reports the results from 74 patients who completed and returned pre- and post-test measures for self-esteem, optimism, and self-efficacy. After controlling for baseline scores, the experimental group participants demonstrated significantly higher levels of self-esteem, optimism, and self-efficacy compared to the control group. The results are discussed in light of the theoretical and clinical implications of meaning-making coping in the context of stress and illness.

Adaptation, Psychological↗
PubMed2002

Smoking and quitting: a qualitative study with community-living psychiatric clients.

This paper reports the findings of a study investigating the smoking behaviours of a community-based psychiatric population. Using a qualitative, grounded theory approach, the four diagnostic categories of schizophrenia, bi-polar affective disorder, depression, and personality disorder were studied (24 interviews in total) in order to identify similarities and differences in smoking behaviours and perceptions of links between illness and cigarette smoking. A number of theoretical constructs emerged from the data, many of which confirm and enhance current understandings of issues, such as the role of cigarettes in managing the symptoms of illness. However, several themes not found in the existing literature also emerged. Smoking was found to play a significant existential role in the lives of participants: alleviating the effects of stigma, promoting positive and negative freedoms, and providing core needs as part of quality of life decisions. Perceptions of the nature and degree of interaction between psychiatric symptoms and the 'need' to smoke were also found to be significant. Variations in smoking between the different diagnostic groups were also found, in particular in the process of smoking itself the nature of the nicotine dependence as predominantly physical or psychological, attitudes towards the quitting process and sense of control, and the degree of significance of existential factors. The research findings suggest that we may be able to add new methods to our current ways of intervening to assist people with a mental illness who want to quit smoking. Differences in perceptions and patterns of use suggest that intervention may be more effective if psychiatric diagnosis is also taken into consideration. Because the paper is descriptive and hypothesis generating, its findings need to be tested using a larger sample.

Adult↗
PubMed2002

Quality of life of palliative care patients in the last two weeks of life.

Quality of life (QOL) is the main consideration in caring for advanced cancer patients, yet little is known about the QOL in the terminal phase. We profiled the QOL of 58 advanced cancer patients during their last 2 weeks of life using the McGill QOL questionnaire-Hong Kong version. The patients provided ratings of QOL an average of 5.6 (median 6) days pre-death. Palliative care services were successful in maintaining the total QOL score during the dying phase. The mean score was 7.0 of 10. Among the various domains, the physical and existential domains scored relatively poorly at 5.9 and 6 of 10, respectively. The worst physical symptom and meaning of life were the individual items with the poorest scores (4.8 and 5.4 of 10, respectively). Compared with admission, there was statistically significant improvement in the worst physical symptom (P = 0.02) and eating item (P = 0.002), but deterioration in physical well-being (P = 0.03), meaning of existence (P = 0.007), and satisfaction with oneself (P = 0.04). In conclusion, QOL evaluation during the terminal phase identifies important aspects requiring improvement during the last two weeks of life. Physical and existential domains of dying cancer patients needed more attention.

Humans↗
PubMed1998

The role of advocacy in critical care nursing: a caring response to another.

With the aim of clarifying critical care nursing, six critical care nurses, working in a Swedish intensive care unit (ICU) were each asked to narrate a care situation with which they had been satisfied or dissatisfied. The stories were tape-recorded and analysed using a phenomenological-hermeneutic approach inspired by the philosophy of Ricoeur. The themes uncovered in the analysis describe the nurse's role of advocacy as: to build a caring relationship, to carry out a commitment, to empower, to make room for and interconnect, to be a risk-taker, to be a moral agent and to create a trusting atmosphere conducive to recovery. The meaning of the role of advocacy lies in a moral and existential response to another human being, an expression of caring. Advocacy rests on the patient-nurse relationship and occurs as an outspoken demand of another human being whose autonomy is threatened. The results are discussed from the ethical perspectives of Lögstrup, Watson's concept of care, and existential advocacy as expressed by Gadow.

Attitude of Health Personnel↗
PubMedDate not supplied

Nurses' judgment as they care for persons who exhibit impaired judgment: a phenomenological study.

The purpose of this phenomenological study was to discover the process by which psychiatric nurses make judgments as they care for persons who exhibit impaired judgment. Data were collected from six experienced psychiatric nurses in a private room and were audiotaped. These data were analyzed using Spiegelberg's (1976) phenomenological method. The data yielded an overarching theme: all the nurses presented judgment as a personal responsibility. Within this overarching theme, were four major themes: (1) closeness to the clinical data; (2) critical reflection; (3) respect for one's knowledge and ignorance; and (4) existential nature of judgment. Categories within theme (1) closeness to the clinical data were nurse as knower and focus on the patient; within theme (2), critical reflection were experience and understanding; within theme (3), respect for one's knowledge and ignorance were self-consciousness and expectation of self; and within theme (4), existential nature of judgment were alone facing the unknown and "Eureka! I've got it!" Essentially, judgment occurred privately within the mind of the nurse, making it both the creation and responsibility of the nurse. For these nurses judgment was the pivotal event in nursing inquiry beginning in the desire to know, proceeding through understanding and presentation of a nursing problem and then determining the question, "What is it?" in a "Eureka!" moment. With this experience of "I've got it!" the nurse crossed from the unknown to the known. Judgment which began in the desire to know began again with a new question.

Decision Making↗
PubMed1995

Plausibility or truth? An essay on medicine and world view.

This paper introduces the notion of plausibility as a decisive condition for the acceptance by groups in society of fundamental ideas concerning the nature of illness. Plausibility, it is argued, helps to explain both transition from one system of fundamental ideas to another in history, and coexistence of different such systems in a single civilization. Hence this paper challenges an interpretation of medicine prevalent, especially in medical anthropology, since the 1940s, when Erwin Ackerknecht introduced the idea of medicine as an integrated aspect of a society's or community's culture. Because early research focused on small-scale communities where a majority, if not all, of the members adhered to one world view and experienced one and the same existential environment, medicine came to be identified as a cultural system representative of entire communities and, later, societies. Hence we speak of Chinese medicine as if there were one system of therapeutic ideas and practices representative of China as a whole. The fact is that even though medicine is indeed a cultural system, it is representative only of the culture developed by people sharing identical environments and experiences. That is, if within one civilization different groups coexist in different existential realities entailing different notions of what causes crisis and how to maintain harmony, then these groups will believe in different systems of ideas concerning the generation, treatment, and prevention of illness. Such systems of ideas are therefore always metaphorical reflections of a real social environment or of one aspired to. It is not truth (Wahrheit) that leads to an acceptance of basic therapeutic ideas but plausibility (Wahrschein).

China↗
PubMed2006

Stress and coping with advanced cancer.

OBJECTIVE: For people with advanced cancer, the months preceding death can be very stressful. Moreover, cancer-related stressors can arise within multiple dimensions. However, little research has examined how people cope differentially with different types of stressors. The goal of this study was to examine patterns of coping across different dimensions of stress. METHOD: Fifty-two patients who were receiving palliative care for cancer were asked to indicate their most significant stressors within social, physical, and existential dimensions. A structured interview was then conducted to describe how the participants coped with these stressors. RESULTS: Overall, stressor severity ratings were correlated significantly across the three dimensions, although physical symptoms received the highest mean rating. Participants generally used a range of coping strategies to deal with their stressors, but there were clear differences across dimensions in the relative use of problem-focused versus emotion-focused strategies. Problem-focused coping was less frequent for existential issues, whereas emotion-focused strategies were used less frequently for physical stressors. Coping efforts were not clearly related to psychological distress. SIGNIFICANCE OF RESULTS: Although coping is an important research theme within psycho-oncology, it may be overly broad to ask, "How do people cope with cancer"? In fact, different cancer-related stressors are coped with in very different ways. There is not necessarily any particular pattern of coping that is best for relieving psychological distress.

Adaptation, Psychological↗
PubMed2004

Anatomy of regret: a developmental view of the depressive position and a critical turn toward love and creativity in the transforming schizoid personality.

This article deals with critical psychic transformation in a schizoid personality disorder that evolves in an object relations psychoanalysis in which "developmental mourning" plays a central role. Within a mourning process that allows for the grieving of loss related to arrested separation-individuation development, the analysand confronts the existential grief of regret that had always unconsciously haunted her. The unconscious guilt related to the existential grief of regret had caused much dissociation of self-experience and affect states. The analysand acknowledges her own part in the destruction of primal and current relationships after the traumatic impact of her early life is understood. This allows her to repair current relationships, both within her internal and external worlds so that she can open to capacities for love and creativity. The analysand's courage to consciously grapple with her regret (loss and guilt combined) allows her to relinquish self-sabotaging character defenses such as contempt and emotional withdrawl. Consequently, a second marriage is salvaged and enriched, and the analysand's relationship with her two children is dramatically improved.

Adult↗
PubMed1998

Clinical supervision with community Macmillan nurses: some theoretical suppositions and case work reports.

This paper explores clinical supervision undertaken with community Macmillan Clinical Nurse Specialists in the UK. The philosophical motor is embedded in a Heideggerian existential-phenomenological framework, influenced by psychoanalytical thinking as described by Yalom. The discussion is derived from a qualitative research study designed to reach the lived-experience of five Macmillan Clinical Nurse Specialists. The author explores, in context, issues related to authenticity and project. Ideas are linked to contemporary concerns with reflective practice. The recommendation of this paper is that clinical supervision, through whatever method, reaches the vital experience of nursing practice. Realising tacit knowledge has potential to inform professional practice through powerful synergies of theoretical ways, understanding and lived experience. In addition, nurses might attain the existential idea of a boundary experience and so identify constructive ways to address issues arising out of professional practice.

Attitude of Health Personnel↗
PubMed2001

Some experiences of professional practice and beneficial changes derived from clinical supervision by community Macmillan nurses.

This is a report of an interpretative study that explored some 'lived experiences' of community Macmillan nurses as they recounted them during clinical supervision meetings. This discussion is concerned with serious illness, dying and bereavement and the potential of supervision to reach the 'life-world' of professional practice but also potential benefits for Macmillan nurses. Accounts of professional practice are considered in the context of clinical supervision meetings. Five nurses--four women and one man--undertook individual clinical supervision with the researcher for 6 months over three phases for 18 months in total. Meetings took place in the clinics and health centres in which the Macmillan nurses worked. The method of clinical supervision drew on and developed established ideas from the health science literatures to guide supervisory practice. A synthesis of psychoanalytic ways of thinking and existential phenomenology provided a framework for understanding the data. Five salient themes were identified as emerging from accounts of professional practice: Biographical Determinants, Compulsion, Existential Concerns, Empathic Insufficiency in the Organisation of Palliative Care and Empathic Attainment in the Organisation of Palliative Care. The study shows a need to consider structuring environments that both help and protect community Macmillan nurses and fellow workers. Methods of clinical supervision should be informed by and complement lived experiences of working with serious illness, dying and bereavement.

Empathy↗
PubMed1997

Snapshots of experience: vignettes from a nursing home.

The specific aim of this research project was to examine and describe the experience of living in a nursing home for six people of 80 years and older. 'Visit' is presented as a means of developing nursing knowledge. This research method is founded on the belief that the act of nursing involves the development of a relationship, and was created out of the author's desire for a relational research method. Philosophical support for the method is provided by Maurice Merleau-Ponty's existentialism, Sally Gadow's existential advocacy, and Jean Watson's Human Caring Theory. Authenticity is proposed as an alternative to the concepts of reliability and validity for judging the scientific merit of the method. Whether the nursing role is researcher, practitioner or educator, each person's unique and inexhaustible story provides the basis for nursing care. Nurse researchers using 'Visit' as a method of inquiry can illustrate these unique differences through a story, through the images or pictures each individual creates with his or her own words.

Aged↗
PubMed2002

Phenomenology as a method to investigate the experience lived: a perspective from Husserl and Merleau Ponty's thought.

AIM: By taking nursing as a human relationships activity, in spite of its strong technical--scientific features, this article reflects on the phenomenological method as one of the ways to develop an investigation and acquire knowledge of the topic. RATIONALE: Based on Husserl's phenomenology, which is opposed to the way of doing science based on the laws that regulate the physics and mathematics, the article introduces Merleau Ponty's existential phenomenology as the theoretical foundation for the method it proposes. My existential conceptions--people as historic beings inserted in a world over which they act but which, in its turn, determines them; the human perception as reference for our way of being in the world; the space-time structure of perception--these are the key concepts that have led to the elaboration of an approach to phenomenological research. PROPOSAL OF A METHODOLOGY: Steps are proposed for such an approach, namely phenomenological description, reduction and analysis. These lead to the building up of ideographic and nomothetic analyses, thus unveiling and describing general truths about the phenomenon studied. Finally, the possibilities for applying the methodology to nursing research are discussed, illustrated by my research into student nurses' perspectives on working on an isolation ward.

Attitude of Health Personnel↗
PubMed2002

Dental phobic patients' view of dental anxiety and experiences in dental care: a qualitative study.

Dental phobic patients' view of dental anxiety and experiences in dental care: a qualitative study The aim of this study was to explore and describe dental phobic patients' perceptions of their dental fear and experiences in dental care. The study sample consisted of 18 participants (12 women), with a mean age of 39.4 years, selected consecutively from patients applying for treatment at a specialized dental fear clinic in Göteborg, Sweden. Dental fear, assessed by the Dental Anxiety Scale, showed score levels well over established levels for severe dental fear. The method for sampling and analysis was inspired by the constant comparative method for Grounded Theory (GT). The thematized in-depth interviews took place outside the clinic and lasted for 1-1.5 h. All the interviews were conducted by the first author (KHA), audiotaped and transcribed verbatim. Three higher-order categories were developed and labelled existential threat, vulnerability and unsupportive dentist. Existential threat was identified as the core category, describing the central meaning of the subjects' experiences in dental care. The core category included two dimensions, labelled threat of violation and threat of loss of autonomy and independence. The core category and the descriptive categories are integrated in a model framing the process of dental fear, as described by the informants. In conclusion, the onset of dental fear was commonly related to individual vulnerability and to traumatic dental care experiences, where perceived negative dentist behaviour played a significant role. The patient was caught in a 'vicious circle' that was difficult to break, and where fear and anxiety were maintained by negative expectations about treatment and about patient's own ability to cope in dental care situations.

Adult↗
PubMed2003

Family-nurse co-construction of meaning: a central phenomenon of family caring.

The purpose of the study was to understand and interpret caring in the family health experience by exploring the interactional phenomenon of family-nurse co-construction of meaning in the paediatric intensive care unit (PICU). A hermeneutic phenomenological method within a framework of existentialism and symbolic interactionism was used in the investigation. The convenience sample for this study was four family-nurse dyads, that is four families of critically ill children (all with positive outcomes) and the four nurses assigned to their care who were participating in a larger study. Data were derived from semi-structured interviews regarding significant interactions throughout the child's illness and subsequent significant interactions of families with other nurses and nurses with other families. Trustworthiness of the study was addressed through the criteria of credibility, dependability, transferability and confirmability. Co-construction of meaning in the family health experience was found to have two dimensions: interdependent and independent. Both families and nurses described being like family as an essential component of the interdependent experience. Independent dimensions for families were journeying through troubled waters of learning the meaning of the illness event and sensing family comfort through the nurse's care. Independent dimensions described by nurses were journeying through troubled waters of learning to care for families and living with another's fear. The family-nurse interaction, the relational connection and the evolution of meanings that families and nurses construct, was affirmed as the major vehicle in the co-construction experience. Family caring is influenced by the existential meaning constructing, process-oriented, interactional nature of the family health experience. Caring in the family health experience is enhanced through actions the nurse performs on behalf of, and with, the family while understanding the family's unique situation. Caring enacted by nurses in participation with families holds abundant potential for enhancing the family health experience and honor the ethic of caring as central to nursing.

Adult↗