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PubMed1995

Narrative and exploration: toward a poetics of knowledge in nursing.

The dualism of subject and object has been a traditional model for nursing knowledge. That model is portrayed here as an epistemological exile. Our self-imposed exile from the lived world of nursing can be remedied by inquiry based on engagement rather than distance. One model for engaged inquiry is explorers' journeys in remote regions. Knowledge of a region can be local or colonial, according to the explorer's stake in the region as homeland or territory. Nursing is an existential region where people live. In the exploration of nursing as homeland, knowledge takes the form of local narrative, the story of a place told by its inhabitants. Narrative inquiry offers nursing an epistemology that is both ethically and aesthetically congruent with its practice of engagement.

Existentialism↗
PubMed2004

The problem of pain management among persons with dementia, personhood, and the ontology of relationships.

While pain is common among seniors, it is not adequately treated or managed. In particular, pain in seniors with dementia is often undertreated and undermanaged. Although the undertreatment of pain among persons with cognitive impairments represents a serious ethical concern for pain clinicians, most writers in the area explain the undertreatment of pain by focusing on issues related to liability, fears of addiction to opioids, and erroneous beliefs that pain is a normal part of the ageing process. We argue that the philosophical notion of personhood must also be given careful attention when considering the problem of pain undermanagement. In this paper, we consider the undertreatment of pain among seniors with dementia, while focusing on the ontology of relationships and on existential philosophy. Moreover, we outline a series of recommendations to help minimize the probability of pain undertreatment in this population and to encourage considerations relating to personhood when treating people with dementia.

Aged↗
PubMed2005

Can there be a 'cosmetic' psychopharmacology? Prozac unplugged: the search for an ontologically distinct cosmetic psychopharmacology.

'Cosmetic psychopharmacology' is a term coined by Peter Kramer in his 1993 best-seller, Listening to Prozac. It has come to refer to the use of psychoactive substances to effect changes in function for conditions that are either normal or subclinical variants. In this paper, I ask: What distinguishes an existential ailment from clinical depression, or either of those from normal depressed mood, melancholic temperament, dysthymia or other depressive disorders? Can we reliably distinguish one from the other? Are the boundaries of illness and disorder really so distinct? If not, how can we know that treatment of 'depression' with Prozac in any given instance constitutes a cosmetic as opposed to, say, a medical or clinical use of psychopharmacology - a distinction that seems to turn on our ability to clearly differentiate the clinical from the cosmetic. If we cannot reliably distinguish between such conditions, can we even have a cosmetic psychopharmacology that is not a form of malpractice, broadly speaking? What if we unplugged Prozac from all the amplitude and hype that resulted in Listening to Prozac becoming an instant best-seller and simply asked whether or not we can clearly distinguish an appropriate cosmetic use of Prozac for 'depression' from an inappropriate cosmetic use of Prozac, and both of those from Prozac's appropriate clinical, that is, non-cosmetic uses? If we cannot make these distinctions, perhaps it is too early to say there can be such a thing as a cosmetic psychopharmacology.

Affect↗
PubMed2006

The phenomenology of life phenomena--in a nursing context.

The purpose of this article is to describe and develop knowledge about life phenomena in a life-philosophical and nursing context. Knowledge about life phenomena is part of a care-ethical understanding with a focus on relations. Life phenomena are to be understood as a generalized label for the various phenomena which are given with human existence. The Danish life philosophical tradition with the perspective of life as experienced has something to say in relation to a further refinement of the phenomenology of life phenomena. The refinement will be described as an ethical and existential understanding of the phenomena of nursing. The first part of the article takes a philosophical approach to the phenomenology of life phenomena. It attempts to locate life phenomena in relation to, respectively, needs, senses, and feelings. In order to maintain an overview, the attempt is made to separate needs, senses, and feelings, although in real life these are closely interwoven. The article also describes philosophy and life phenomena in relation to nursing as an empirical field. In nursing there is a risk that life phenomena become invisible to those whose task is to help the ill person adjust to a new life situation. For the nurse, it will be a continuing task, never completed, to develop a sensory-based, situation-determined attention to the patient. And the nurse must be continually aware of whether mere 'need-oriented' nursing is controlling her professional actions as a nurse. Taking a point of departure in the nurse's sensory, situationally determined attention, the last part of the article focuses on needs, senses, and feelings in connection with the nurse being able to direct her attention to the patient's life phenomena.

Attention↗
PubMed2003

Measuring continuity and discontinuity following stroke.

PURPOSE: To design and test a valid, reliable, and parsimonious instrument to measure continuity and discontinuity of self following stroke. DESIGN: A 45-item scale with a 3-point response set was developed. The conceptual basis, "continuity and discontinuity in the experience of self," was derived from an existential-phenomenological study of stroke survivors. Study instruments included the Barthel Index (measure of functional abilities) and the pre- and poststroke QoL Cantril Ladder. METHODS: The instruments were administered one time, in random order, to 55 stroke survivors in the United States in rehabilitation hospitals and in the community. Data were analyzed using a principal components factor analysis. RESULTS: A 2-factor solution with 10 items per factor was derived. Cronbach's alpha for Factor 1 (discontinuity of self) was .874 and for Factor 2 (continuity of self) was .869. Continuity and discontinuity were inversely related; continuity was related to functional abilities, but discontinuity was not. CONCLUSIONS: Use of this instrument validated findings from a qualitative study, which showed that life following stroke was a paradoxical sense of both continuity and discontinuity in the experience of self. This instrument can be used to measure the effectiveness of nursing interventions aimed at increasing stroke survivors' sense of continuity.

Activities of Daily Living↗
PubMed2005

A framework for integrating NANDA, NIC, and NOC terminology in electronic patient records.

PURPOSE: To describe the methods used in design of a framework that (a) encompasses nursing knowledge, (b) functions as a cognitive map for clinicians, and (c) increases the efficiency of using the North American Nursing Diagnosis Association (NANDA), Nursing Intervention Classification (NIC), and Nursing Outcome Classification (NOC) terminologies together in the electronic patient record. METHODS: The taxonomies of the NANDA, NIC, and NOC terminologies were integrated to form a preliminary structure of domains and classes. New concepts and collocations of concepts were constructed using Walker and Avant's (1983, 1988) method for concept synthesis. The framework was validated using an expert group and clinical testing. RESULTS: A framework organized as a taxonomy with eight domains (Physiological, Functional, Psychocognitive, Safety, Existential, Lifestyle, Family, and Environment) and 29 classes. CONCLUSIONS: The framework has the potential to enhance the quality of nursing documentation, contribute to nursing research and education, and reduce job stress.

Attitude to Health↗
PubMed1990

Hope and spiritual well-being: essentials for living with AIDS.

Without a cure on the horizon there is a need to identify ways to sustain hope and spiritual well-being in patients with AIDS. This article examines the impact of AIDS on the emotional and spiritual health of its victims and summarizes current research findings on spiritual well-being in the ill. It also summarizes the authors' study on hope and existential and spiritual well-being in a group of 65 adult male patients who were either serum positive for the human immunodeficient virus or who had been diagnosed with AIDS Related Complex or AIDS.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Integrating nursing theory and ethics.

TOPIC: Integrating nursing theory and ethics PURPOSE: To delineate: (a) ethical dimensions of nursing, (b) a moral view of persons, and (c) caring as a central value for nurses SOURCE: Existential philosophy CONCLUSION: Special ethical theories are needed for nursing.

Ethics, Nursing↗
PubMedDate not supplied

Complications of complicated grief in renal failure.

This paper sets out to bring together recurrent themes in the understanding and care of patients with Chronic/End Stage Renal Failure centering on the key issue of loss. A multi-disciplinary conceptual framework is proposed based on three perspectives--Systemic, Existential and Narrative. The integrated framework for understanding the complexity of grief issues for dialysis and pre-dialysis patients focuses on the perception of self and the inter-relationship with others directly involved in their care.

Adaptation, Psychological↗
PubMed2007

Existence and pluralism: the rediscovery of Karl Jaspers.

Karl Jaspers has been recognized in psychiatry mostly for his influence on phenomenology and on certain aspects of psychopathology, such as our understanding of delusions. In this paper, I will highlight the need to rediscover Jaspers' work in terms of other important ideas that he can contribute to psychiatry, in particular the concepts of limit situations, transcendence and pluralism. Limit situations refer to the fact that human life is characterized by existential situations, or crises, which become opportunities for authentic existence. Transcendence refers to the notion that freedom is an important aspect of human existence and cannot be explained by purely scientific understanding or encompassed by any purely rationalistic system of thought. Pluralism is perhaps Jaspers' most original perspective, which has still failed to be adequately appreciated by the psychiatric profession. The idea here is that science means understanding the methods by which we obtain knowledge, along with the presuppositions and limits of those methods. Contemporary psychiatry has only a limited appreciation of Jaspers' work. In this paper, I attempt to describe these important concepts that can help us understand what we do in psychiatry, what we should be doing and why.

Attitude to Death↗
PubMed1986

An oriental point of view in psychosomatic medicine.

In many cases of 'alexithymia' there also seems to be a difficulty in the awareness and expression of bodily feelings (tentatively called 'alexisomia'). Furthermore, this insensitivity to the body obstructs one's awareness towards the laws of nature with which the body is implicitly in touch. Holistic awareness, which includes not only the intellect but also emotional, bodily and ecological (existential) aspects of man, can be the basic principle for holistic self-control. Oriental body-oriented approaches which facilitate such a holistic awareness must be reevaluated as an essential part of psychosomatic treatment.

Affective Symptoms↗
PubMed1975

Some observations and questions in intensive psychotherapy.

The authors discuss their observations of acute psychiatric patients in a day hospital, noting the universality of the existential concerns that arise once the patient has confronted his illness. They discuss the problem of what determins a "cure" in emotional disturbances and suggest that the primary issue is for patients to learn to live as healthy people within the limits of their individual potential.

Acute Disease↗
PubMed1981

Twentieth-century psychiatry: a view from the sea.

The author presents a broad view of the principal forces at work in twentieth-century psychiatry. He describes the approach of the various psychiatries--psychoanalytic, biological, behaviorist, social, interpersonal, and existential--to the diagnostic enterprise and the therapeutic enterprise. He finds twentieth-century diagnosis dominated by objective-descriptive psychiatry and therapy by the extraordinary growth of psychotherapy in the industrial nations. The newer psychotherapeutic methods have made the first systematic additions since Freud to our understanding of the ways in which personal change occurs.

Community Psychiatry↗
PubMed1981

Determinism and free will: review of the literature.

During the past century various theories of mental functioning that rest on a deterministic view of man have gained dominance. However, a review of psychodynamic writing shows that there has remained a need for some concept of autonomy and inner direction, as represented by the concepts of ego autonomy and behavioral self-control. In fact, some studies of mental health and psychotherapy can be interpreted as supporting the existential view that the experience of "freedom" and "choice" is a genuine phenomenon. Although concepts of behavioral self-control may reconcile these contradictions, the author concludes that no theories of mental functioning have entirely dealt with the paradoxes of autonomy, inner direction, and choice.

Adaptation, Psychological↗
PubMed1994

Mind and mood in modern art, II: Depressive disorders, spirituality, and early deaths in the abstract expressionist artists of the New York School.

This article documents the high prevalence of mood disorders in a group of 15 of the mid-twentieth-century Abstract Expressionist artists of the New York School. These artists, using the technique of psychic automatism (based on free association) in order to reveal unconscious material, created a psychologically and spiritually significant art that addressed the mythic themes of creation, birth, life, and death. Over 50% of the 15 artists in this group had some form of psychopathology, predominantly mood disorders and preoccupation with death, often compounded by alcohol abuse. At least 40% sought treatment and 20% were hospitalized for psychiatric problems. Two committed suicide; two died in single-vehicle accidents while driving; and two others had fathers who killed themselves. Many of these artists died early deaths, and close to 50% of the group (seven of 15) were dead before the age of 60. The material presented in this article suggests the following formulation and hypothesis. Depression inevitably leads to a turning inward and to the painful reexamination of the purpose of living and the possibility of dying. Thus, by bringing the artist into direct and lonely confrontation with the ultimate existential question, whether to live or to die, depression may have put these artists in touch with the inexplicable mystery that lies at the heart of the "tragic and timeless" art that the Abstract Expressionists aspired to produce.

Adult↗
PubMed1984

Sartre and Freud.

The approaches to understanding a person's life represented by Freud's psychoanalysis and Sartre's "existential psychoanalysis" are fundamentally opposed. Starting from entirely different epistemological premises, they reach irreconcilable views on the nature of man and psychopathology, and lead to quite dissimilar and opposed formulations for psychotherapy.

Awareness↗
PubMed1997

Working through the experience of time in time-limited therapy.

The experience of time is a component in the psychic reality that can be understood from four standpoints: the cognitive, the dynamic, the existential-affective, and the life-span linked. This article presents a time-limited therapy in which the stress was on the constant interaction between the therapeutic content, which focused on the topic of time, and the singular setting of time-limited therapy. The discussion addresses the requisite conditions for turning short-term therapy into an active container for working through the sense of time, its meanings and its derivatives.

Adult↗
PubMed2003

A comparison of three views of spirituality in oncology nursing.

This article compares three views of spirituality with specific consideration for persons who live with cancer. These views represent theological, psychological, and nursing perspectives. Three dimensions of theologically inspired spirituality are discussed: institutional religious approaches, intellectual questioning, and mystical experiences. The authors review numerous psychological perspectives on the topic of spirituality, particularly from the analytic, humanistic, and existential schools of thought. A human becoming nursing theory perspective is also offered. The authors, who were friends, one a nurse and the other a person with cancer, suggest that nurses, who are able to offer true presence from a place of hope and fulfilled-emptiness, bear witness to persons in a way that can help them transfigure the experience of living with cancer.

Existentialism↗