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PubMedDate not supplied

[Religious dimensions and optimistic perception of the future in a sample of students].

Religiosity and the less circumscribed construct of spirituality may be related to resilience and salutogenesis. Most inventories focus more on religious practice, as prayer or visiting church, than systems of belief. The relationship between "existential well-being" and "religious well-being" has been investigated in a sample of young students by using the "Religious" and the "Existential Well-Being Scale" (Ellison u. Paloutzian 1982). Optimistic perception of the own future was unrelated to any of the religious well-being items.

Adolescent↗
PubMed2004

Beyond health care accountability: the gift of medicine.

E. Haavi Morreim's book, Holding Health Care Accountable, insightfully describes several features of the current crisis in malpractice in relation to the health care marketplace. In this essay, I delineate the key and eminently practical guide for reform that she lays out. I argue that her insights bring us to more fundamental aspects than immanent medical economy and accountability--aspects that are ignored at present. I describe the features of immanent economy and how they tend to cover over epistemological and existential finitude in medicine, show how economy can in fact create new medical knowledge, and show that necessary error is a real feature of day-to-day medical practice. The current system, even with Morreim's reforms, remains at the level of immanent economy, but with modifications may point to the features of medicine that transcend medical knowledge and economy. The gifts of medicine cannot be reduced to the immanent medical economy, and any attempt to do so results in crisis. A health care that points to finitude and fallibility is one that points to the mystery of human existence and mortality. Any health care financing system that helps to delineate finitude--both epistemological and existential--is one that will give patients a new lease on living and dying.

Evidence-Based Medicine↗
PubMed2002

The enigma of severe mental illness: a Swedish perspective.

Today mental health professionals are challenged in supporting people with severe mental illness that live within their communities. The community treatment is, however, characterized by an uncertainty about how to best support them in their everyday lives, and professionals from different disciplines often have divergent opinions about the care. The aim of this study is to explicate the existential meaning of living with severe mental illness. Interviews with persons who relocated from an institutional setting to a community placement were analyzed within an interpretive approach. The results of the study found that people with severe mental illness experience an existential loneliness due to difficulties in changing previous suppositions about human relationships. They do not develop connections through shared new experiences with other people in their lives. One central implication of the findings is that because people with severe mental illness seem unable to benefit from new experiences, mental health nurses should consider relational aspects when planning, implementing, and evaluating nursing care.

Female↗
PubMedDate not supplied

Clinical judgments of high-risk behavior during recovery.

This study utilized focus group research to explore high-risk behavior during recovery from drugs and alcohol. Participants in the focus group were professional substance abuse counselors. The findings identified specific high-risk behaviors and began an exploration of the processes that support them. Specific information is included on such issues as causes, time frames, developmental issues, and other factors associated with high-risk behavior. Attention was paid to existential issues in recovery, as well as childhood factors such as sexual abuse. High-risk behavior was seen as a means to avoid the existential dilemma of continuing in recovery or returning to drug use and as a possible means to leave this crisis unresolved without actual relapse to drug use, or dealing with the issues of advancing in recovery.

Adult↗
PubMed1989

Measurement of spiritual well-being: a hospice caregiver sample.

This is a methodological study designed to assess the reliability and validity of Paloutzian and Ellison's (1982) Spiritual Well-being Scale. The scale was administered to 70 family members caring for a terminally ill relative. The 20 item measure yields three scores: spiritual well-being (overall score), existential well-being and religious well-being (overall score), existential well-being and religious well-being. The Cronbach's alpha coefficients were .95, .94, and .84 respectively. Construct validity of the measure is discussed in relation to Bradburn's Affect Balance Scale, qualitative data obtained during the interviews and a review of relevant literature related to spiritual well-being. Evidence in support of construct validity of the Spiritual Well-being Scale is lacking.

Aged↗
PubMed2006

Concerns about losing control when breaking bad news to terminally ill patients with cancer: physicians' perspective.

OBJECTIVE: To study and explore problems perceived by physicians when breaking bad news to advanced cancer patients about discontinuing or not offering tumor-specific treatment due to incurable cancer. DESIGN: A qualitative phenomenographic interview study. SETTING: The county of Ostergötland in Sweden. PARTICIPANTS: Thirty physicians with different demographic characteristics. RESULTS: According to the physicians' answers breaking bad news was perceived as involving a risk of losing control in different ways, regarding emotions, oneself, confidence, professionalism and patient trust. Four different main categories described as problems were identified; perceptions focusing on existential thoughts, relationships, knowledge, and perceptions related to time and environmental disturbances. CONCLUSION: Physicians perceived that breaking bad news to dying patients with cancer involved a risk of losing control. Existential thoughts and a lack of knowledge contribute to this risk. Theoretical education in existentiality/spirituality and clinical practice in a palliative context may help maintaining control.

Adult↗
PubMed1991

Finding meaning: an alternative paradigm for Alzheimer's disease family caregivers.

Theoretical formulations of stress and coping, family systems, crisis intervention, and loss and grief have inadequately explained how persons might grow and find meaning through their caregiving experiences. An existential theoretical framework guided the data interpretation in a qualitative study of 94 dementia family caregivers. Results suggest that an existential framework provides an alternative paradigm for understanding the caregiving experience.

Adaptation, Psychological↗
PubMed2003

Quality of life as medicine. II. A pilot study of a five-day "quality of life and health" cure for patients with alcoholism.

Alcoholism can be understood as a self-treatment for existential pain. A 5-day treatment was designed to relieve this psychological pain and existential anxiety, and thereby diminish the need for self-treatment with alcohol. The basic principle behind the treatment was holistic, restoring the quality of life (QOL) and relationship with self, which according to the life mission theory happens when life-denying views are corrected and inner emotional conflicts are solved. The method in this treatment was a course with teachings in philosophy of life, psychotherapy, and body therapy. The synergy attained was considerable and the outcome demonstrates that in the course of 1 week, people have time to revise essential life-denying views and to integrate important, unfinished life events involving negative feelings. This was demonstrated by an improved QOL and a decrease in their dependency and need for alcohol abuse. In the week before, after the 5-day course, and again after 1 and 3 months, the 16 participants completed the SEQOL questionnaire on QOL and health. This was a pilot study based on a pre-experimental design, without a control group and without clinical control. Common for the group were a low QOL, numerous health problems, and alcohol dependency in spite of treatment with Antabus (disulfiram). The study showed an increase in QOL from 57.6% before the course to 69.4% 3 months after the course, or an improvement in QOL of 11.8%. There was a 24.0% improvement in self-perceived mental health, and satisfaction with health in general was improved by 11.1%. The total sum of health symptoms in the group was reduced from 59% of maximum to 33%. It is concluded that for this small and motivated group with alcohol problems, it was possible to improve QOL and health in only 5 days with a holistic treatment that combined philosophy of life, psychotherapy, and body therapy, but the results are not final. Further research is needed.

Alcoholism↗
PubMed2003

Quality of life theory I. The IQOL theory: an integrative theory of the global quality of life concept.

Quality of life (QOL) means a good life and we believe that a good life is the same as living a life with a high quality. This paper presents the theoretical and philosophical framework of the Danish Quality of Life Survey, and of the SEQOL, QOL5, and QOL1 questionnaires. The notion of a good life can be observed from subjective to the objective, where this spectrum incorporates a number of existing quality of life theories. We call this spectrum the integrative quality-of-life (IQOL) theory and discuss the following aspects in this paper: well being, satisfaction with life, happiness, meaning in life, the biological information system ("balance"), realizing life potential, fulfillment of needs, and objective factors. The philosophy of life outlined in this paper tries to measure the global quality of life with questions derived from the integrative theory of the quality of life. The IQOL theory is an overall theory or meta-theory encompassing eight more factual theories in a subjective-existential-objective spectrum. Other philosophies of life can stress other aspects of life, but by this notion of introducing such an existential depth into the health and social sciences, we believe to have taken a necessary step towards a new humility and respect for the richness and complexity of life.

Humans↗
PubMed2004

Clinical holistic medicine: problems in sex and living together.

When the problems of sex and living together are understood as symptoms of underlying old existential wounds in need of healing, and when the physician accepts the role as coach supporting the patient to confront these emotional pains, then the patient can heal existentially in order to obtain the wanted closeness and intimacy. The change of perspective from: "He or she is not all right in..." to "I see that this is really about me, and what I have to learn is..." is where the patient assumes responsibility and this is often efficient in helping the patient with problems in his/her sex- and love life. Intimacy is the most difficult art, where sexuality cannot exist without trust, vulnerability, and surrender. This is often only possible after the patient has found his or her true self, including the purpose of life. The physician who will give "holding" (care) and processing to the patient with the intention of healing the "wounded child inside" who cannot love and open up, can often help the patient to improve self-insight and change the whole quality and atmosphere of the relationship. The healing will end a series of symptoms of poor thriving, physically, emotionally, and mentally, and make life worth living. Sometimes a few successful holistic sessions are enough to change the whole picture and solve an emotional "knot" that has the potential to destroy the relationship.

Clinical Medicine↗
PubMed2004

Clinical holistic medicine: metastatic cancer.

We believe that the consciousness-based/holistic medical toolbox has a serious additional offer to cancer patients and, as a consequence, designed a treatment for the patient with metastasized cancer. From a holistic perspective, cancer can be understood as a simple disturbance of the cells, arising from the tissue holding on to a trauma with strong emotional content. This is called "a blockage", where the function of the cells is allocated from their original function in the tissue to a function of holding emotions. We hope to be able not only to improve the quality of life, but also to improve survival and in some cases even induce spontaneous remission of the metastasized cancer. This paper describes how work with a patient with metastasized cancer can be done in the holistic clinical practice in 14 days on an individual basis, helping the patient to recover her human character, purpose of life, coherence, and will to live, thus improving quality of life and possibly also survival time. The holistic therapeutic work includes (1) teaching existential theory, (2) working with life perspective and philosophy of life, (3) helping the patient to acknowledge the state of the disease and the feelings connected to it, and finally (4) getting the patient into the holistic state of healing: (a) feeling old repressed emotions, (b) understanding why she got sick from a holistic point of view, and finally (c) letting go of the negative beliefs and decisions that made her sick according to the holistic theory of nongenetic diseases. The theory of the human character, the quality of life theories, the holistic theory of cancer, the holistic process theory of healing, the theory of (Antonovsky) coherence, and the life mission theory are the most important theories for the patient to find hope and mobilize the will to fight the cancer and survive. The patient went through the following phases: (1) finding the purpose of life and hidden resources; (2) confronting denial; (3) taking responsibility for being very ill; (4) severe existential crises with no wish to live while still fighting; (5) integration of many repressed feelings and negative decisions thus rehabilitating character; (6) confronting lack of intimacy and trust in others and this way rehabilitating the ability to love; (7) rehabilitating the will to live, breaking through and falling in love with life; (8) assuming responsibility for the social relations; and sometimes (9) quality of life is improved radically with indications of spontaneous remission of the liver tumors.

Adult↗
PubMed1994

Establishing rigour in qualitative research: the decision trail.

The aim of this paper is to show the way in which the decision trail of a qualitative research process can be maintained. It is argued that the trustworthiness (rigour) of a study may be established if the reader is able to audit the events, influences and actions of the researcher. The actual study containing the recording of this decision trail aimed to express the concerns of older patients who were admitted to the acute care sector. The study took place in two care of the elderly wards in a 1000-bed National Health Service hospital in the UK, in 1991. Eventually, 14 patients were interviewed, each on several occasions, and their concerns are expressed in themes, namely: routine geriatric style of care, depersonalization, care deprivation and geriatric segregation. I describe the preparations that were undertaken before patient interviews could commence. The literature recording the process of the interviewer's experience as data in qualitative research is scarce. I show the researcher's participation in making the data as part of an existential phenomenological research process. Existential phenomenology relies on recording influences while generating data such as significant literature, media reports, my value position and journal data.

Aged↗
PubMed2005

Maintenance haemodialysis: patients' experiences of their life situation.

AIM: The aim of this study was to examine how patients suffering from CKD on maintenance haemodialysis experience their life situation. The focus was on how treatment encroaches on time and space and how patients experience care. The rationale was that this knowledge is necessary to provide professional support that takes into consideration a person's whole life situation. BACKGROUND: The experiences of patients with chronic kidney disease (CKD) undergoing maintenance haemodialysis have been studied in many quantitative studies, which translate patients' subjective experiences into objectively quantifiable data. However, there are few qualitative studies examining the experiences of these patients' life situation and expressing their experiences within the context of a nursing and caregiver's perspective. METHOD: Data were collected by interviews with 41 patients between the ages of 29 and 86 years who participated in the study. A content analysis was used to identify common themes that describe the patients' experiences of their life situation. RESULTS: Three main themes were identified: "not finding space for living", "feelings evoked in the care situation" and, "attempting to manage restricted life". The first theme "not finding space for living" consisted of two sub-themes: "struggling with time-consuming care" and "feeling that life is restricted". The second theme "feelings evoked in the care situation" consisted of two sub-themes: "sense of emotional distance" and "feeling vulnerable". CONCLUSIONS: The patients in this study indirectly expressed an existential struggle, indicating that encroachment of time and space were important existential dimensions of CKD. The findings indicated that caregivers were not always aware of this inducing a sense of emotional distance and a sense of vulnerability in the patients. RELEVANCE TO CLINICAL PRACTICE: Caregivers in dialysis units have to consider haemodialysis patients' experience of a sense of emotional distance in their relationship to caregivers. Nurses and doctors need to create routines within nursing practice to overcome this.

Activities of Daily Living↗
PubMed1996

The long-lasting now: disorganization in subjective time in long-standing pain.

This paper presents a phenomenological-hermeneutical case study on long-standing pain (LP), a public health problem of great importance. Although there has been intensive research interest in this phenomenon, most studies have been based on traditional medical and cognitive-behavioral approaches. Our thesis is that new frames of reference can provide additional heuristic insights. The phenomenon of LP shows a strong association with existential factors. Our case study focuses on the meaning-structure of lived temporality, a fundamental existential constituent in the lifeworld of the pain patient. A series of in-depth interviews with four subjects showed that lived temporality is disrupted in pain experience, causing a disorganization of the patient's being in the world. The results generate several hypotheses about implications for time estimation in pain experience.

Aged↗
PubMed2005

Death brokering: constructing culturally appropriate deaths.

Death brokering refers to the activities of medical authorities to render individual deaths culturally meaningful. Social scientists and others agree that mortality provokes existential ambiguity in modern life requiring cultural coping mechanisms. In contemporary Western societies, medical professionals have sequestered the dying in institutions, and have classified the causes of death to explain suspicious death. Over the last decades, the institutionalisation of the dying process has been challenged by social movements and the sudden onset of some deaths while forensic medicine has struggled for professional legitimacy in the borderland between mainstream medicine and the legal system. I argue that medical death brokering persists in spite of challenges because medical experts offer increasingly flexible cultural scripts to render the end-of-life socially meaningful while accentuating death's existential ambiguity. Medical professionals help create the ambiguity they promise to resolve, reinforcing the cultural need for more expert death brokering.

Adaptation, Psychological↗
PubMed1993

Models of health and disease.

This paper describes and analyses six models of health and disease. These are: religious, biomedical, psychosomatic, humanistic, existential and transpersonal. Of these six models, only one was unequivocally reductionist: the biomedical. The others were all holistic. The religious, humanistic and transpersonal models could be considered as health models, the biomedical, psychosomatic and existential models as disease or illness models. The different models were assumed to depict different, but related, ways of representing health and disease. It is probable that different groups in society, including the different groups in the health service--doctors, nurses and patients--look at health and illness from partly different models. This is considered to have significant implications for the health service.

Disease↗
PubMedDate not supplied

Life crisis and the body within.

The authors take into account body involvement during the existential critical periods. The concept of body involvement considers both the biological (organic) involvement of the body, i.e. all the 'psychosomatic' (in a wider sense) dimensions, and the involvement of the mental representation of one's body. This involvement refers to some clinical conditions as 'abnormal somatic styles of existence', hypochondriasis and dysmorphophobia (all grouping in the DSM-IV 'somatoform disorders') and the anorexic states. From a structural psychogenetic point of view, this firm involvement of the body (naturally we are referring to the 'experienced body') is stressed in light of its importance in self identity construction and maintenance, especially when, as in some existential critical periods, identity physiologically faces significant modifications and hazardous movements.

Anorexia↗
PubMed2001

[Medical diagnosis of pain between myth and reality--chronic lower back pain, as an illness of upright walking].

Chronic therapy-resistant low back pain is a major problem in medical care. In Germany there are many millions concerned, and the treatment expenses range at the top. Many of these patients underwent non-successful operations at the vertebral column and suffered a long-lasting odyssey of therapies before they are treated psychosomatically for the first time. Chronic low back pain is a disease including social, psychological as well as physiological aspects, and not only a problem of bones, muscles, or intervertebral disks. The problem is similar to that of fibromyalgia. On the basis of 9,000 case reports obtained during psychosomatic orthopedic treatment, character structures, unsolved problems of life and repressed emotional disturbances such as anger, jealousy, fear, and mourning could be identified as major psychosomatic risk factors for chronic low back pain. There is a high coincidence with other psychosomatically influenced diseases such as gastric and duodenal ulcera, asthma bronchiale, migraine with depressions, anxiety disorders, character neuroses, and narcissistic and other structural disturbances of the self. Exclusively somatic treatments without considering the existential situation and psychological methods hold the danger of a symptom shifting. The inpatient treatment from 9 a.m. to 5 p.m. ('Tagesklinik') with a combination of medical, physiotherapeutic and psychotherapeutic methods promotes a social training that counteracts the increasing constrictions in the accustomed life surroundings caused by low back pain. Chronic low back pain is an 'illness of the upright walk' in an anthropological, ethical sense. Considering low back pain as a strictly somatic disease is a modern myth of a medical treatment without existential understanding of human illness. It provokes failure of treatment and an enhancement of treatment cost.

Chronic Disease↗