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PubMed2004

Lived experience of Korean women suffering from rheumatoid arthritis: a phenomenological approach.

Rheumatoid arthritis (RA) sufferers number approximately 200 million people around the world. In Korea, there is no accurate statistical information, but 1-2% of the total population have been estimated to be suffering from RA. Current research studies related to RA have been limited to quantitative approaches. In qualitative studies, most research has been focused on one aspect of the experience of patients with RA, such as pain or fatigue. In order to address the problems of patients with chronic disease, like RA, a comprehensive approach should be demanded concerning various aspects of the patient's life in terms of perspectives of the patients with RA. The purpose of this study was to explore and describe the illness experience of women with RA in Korea using a phenomenological methodology. Participants were five women who were diagnosed with RA. The transcripts were analyzed using Colaizzi's (In: Vails, R.S., King, M. (Eds.), Existential Phenomenological Alternatives for Psychology. Oxford University Press, New York, 1978) method. The results of this study identified 8 major theme clusters, which were 'severe pain', 'self-esteem', 'negative feelings', 'reflect the past life', 'concentrate on recovery from disease', 'a comfortable mind in pain', 'support of family and others', and 'new life'. These results may provide important information to establish effective interventions for women with RA, their families, and health providers through understanding various aspects of the lived experience of women with RA. The implications for nursing practice in this area of chronic illness such as RA, should be how patients can be empowered to believe they can take control of their disease and their lives.

Activities of Daily Living↗
PubMed1997

Effectiveness of a short-term group psychotherapy program on endocrine and immune function in breast cancer patients: an exploratory study.

Cancer patients who had been treated for early stage breast cancer and were diagnosed with either positive axillary lymph nodes or distant metastases were randomly assigned to either a 13-week experiential-existential group psychotherapy (EEGP) program or a waiting list control (WLC) condition. Endocrine and immune measures were obtained before and after the intervention period. The findings of this study are that, after the 13 weeks of the experiment, patients in the EEGP group showed lower levels of plasma cortisol and lower levels of prolactin as well as lower percentages of natural killer cells, CD8 cells, and CD4 cells in addition to a lower proliferative response to pokeweed mitogen than patients in the WLC group. Importantly, this was only found in those breast cancer patients presenting relatively high endocrine and immune baseline levels, suggesting that the patients' profile with regard to endocrine and immune function at the start of a program can have an important effect. If replicated on a larger scale, the current results may be relevant for the treatment of breast cancer.

Adrenocorticotropic Hormone↗
PubMed2004

Obsessive-compulsive bipolar comorbidity: focus on children and adolescents.

BACKGROUND: Growing evidence documents the frequent co-morbidity between Obsessive Compulsive Disorder (OCD) and Bipolar Disorder (BP) in adults. The aim of the present study is to explore some clinical aspects of this interface in children and adolescents, as it appears in a setting of routine clinical practice. METHOD: The sample comprised 102 consecutively referred children and adolescents, both inpatients and outpatients, with BP, OCD or co-morbid BP-OCD during a 3-year period. The mean age was 14.2 (SD=3.2); 65 (63.7%) were males. Diagnoses and clinical features were collected by means of structured interview according to DSM-IV (DICA-R) and a rating scale for OCD (CY-BOCS). Clinical outcome was evaluated prospectively by means of clinical global impression (CGI) as part of routine clinical care, throughout the follow-up. RESULTS: Thirty-seven (36.3%) patients (21 males and 16 females) were diagnosed as BP, 35 (34.3%) patients (26 males and 9 females) were diagnosed as OCD and 30 (29.4%) patients (18 males and 12 females) were diagnosed as BP-OCD. BP II, was more frequent in the BP-OCD than in BP. When OCD was co-morbid with BP, age of onset was significantly earlier than in the 'pure' OCD patients. On the contrary, age of onset of BP was not affected by co-morbid OCD. According to CGI baseline scores, OCD patients were significantly less impaired than BP-OCD and BP patients, while the severity of the symptomatology was similar in the last two groups. Severity scores at the end of the follow-up were significantly higher in BP-OCD patients than in OCD patients. Patients with pure BP showed lower rates of panic disorder-agoraphobia than BP-OCD patients and higher rates of ADHD-conduct disorder. Pure OCD patients showed lower rates of ADHD and higher rates of Generalized Anxiety Disorder. The number of obsessions did not differentiate the two groups, whereas pure OCD patients showed significantly more compulsions. 'Other' obsessions-e.g., existential, philosophical, odd and/or superstitious-were significantly more frequent in BP-OCD than in pure OCD patients. Ordering compulsions were significantly more frequent in pure OCD patients. LIMITATIONS: Possible low reliability of children's and their parents' recall of past episodes of mental disorder. CONCLUSIONS: In a tertiary care center, co-morbidity between OCD and BP is a significant clinical problem affecting a large number of patients. The correct identification of OCD-bipolar co-morbidity has relevant clinical implications as far as other concomitant disorders, symptomatological features, course, complications, and treatment management and outcome are concerned.

Adolescent↗
PubMed1997

Subthreshold depressions: clinical and polysomnographic validation of dysthymic, residual and masked forms.

We summarize clinical and polysomnographic findings in support of the existence of a broad and prevalent spectrum of less than syndromal or subthreshold depressive conditions that constitute subeffective disorders. Many of these conditions were previously subsumed under such rubrics as 'neurotic,' 'characterological,' and 'existential' depressions. Prospective follow-up studies of neurotic depressions (defined by a predominance of the psychological features of, in most instances, less than syndromal depression) have demonstrated their transformation into moderate to melancholic or psychotic depressive, and even bipolar, disorders. Many characterological depressives (outpatients with early insidious onset and fluctuating chronicity of subthreshold manifestations falling short of full syndromal depression), were shown to have shortened REM latency, increased REM%, redistribution of REM to the first part of the night, classic diurnality, high rates of family history for mood disorders, positive response to antidepressants and sleep deprivation, and prospective follow-up course leading to major affective episodes. Shortened REM latency and related sleep neurophysiological disturbances have also been reported to characterize so-called 'borderline' personality disorder even when examined in the absence of concomitant major depression. Finally, among primary care referrals to a sleep disorders center, short REM latency was found in a large number of patients without subjective mood change but with somatic manifestations of depression (meeting Probable Feighner Depression and/or lesser subacute manifestations). Rather than being incidental, the REM disturbances in the foregoing studies appear consistently on consecutive nights of polysomnography in the subthreshold affective group; this was not the case for patients with non-affective personality and anxiety disorders. The findings overall tend to support a common neurophysiological substrate for subthreshold and melancholic depressions and, interpreted in the context of clinical observations, family history and follow-up course, uphold the validity of dysthymic, intermittent and subsyndromal depressions.

Bipolar Disorder↗
PubMedDate not supplied

Quality of life in dependent older adults living at home.

The purpose of medical interventions today is to favor the duration of life and to assure its quality. For a proper evaluation of the quality of life (QoL) of the elderly, it is important to assess not only the health status, but also psychological, functional and existential domains. Up to now, QoL of the dependent older living at home does not seem to have received sufficient attention. This study is a population based, cross-sectional health survey, and tries to give a picture of the QoL conditions of a group of dependent elderly living at home, using a specifically designed structured interview. In addition to this interview the Activities of Daily Living (ADL) Index and the Zung rating scale for Anxiety and Depression (AD) were administered to a total of 167 elderly (60 males and 107 females). The most interesting results of the study are the following: (1) the definition of dependence is often worsen by cultural prejudices; (2) psychopathological factors show a deep negative effect on 'attitudes towards life' of the dependent elderly; (3) QoL of the dependent elderly people in this sample is mainly negatively influenced by the degree of depression. We believe that the 'QoL-oriented' therapeutic strategy should consider more articulated and multidisciplinary geriatric and psychosocial interventions in this population.

Journal Article↗
PubMed2003

ESRD patient quality of life: symptoms, spiritual beliefs, psychosocial factors, and ethnicity.

BACKGROUND: Recent research suggests that patients' perceptions may be more important than objective clinical assessments in determining quality of life (QOL) for patients with end-stage renal disease (ESRD). METHODS: We interviewed 165 hemodialysis patients from 3 sites using a QOL questionnaire that included the Satisfaction With Life Scale (SWLS) and the McGill QOL (MQOL) scale, which includes a single-item global measure of QOL (Single-Item QOL Scale [SIS]). The MQOL scale asks patients to report their most troublesome symptoms. We also initiated the use of a Support Network Scale and a Spiritual Beliefs Scale. RESULTS: Mean patient age was 60.9 years, 52% were men, 63% were white, and 33% were African American. Patients had a mean treatment time for ESRD of 44 months, mean hemoglobin level of 11.8 g/dL (118 g/L), mean albumin level of 3.7 g/dL (37 g/L), and mean Kt/V of 1.6. Forty-five percent of patients reported symptoms. Pain was the most common symptom (21% of patients). There was an inverse relationship between reported number of symptoms and SWLS (P < 0.01), MQOL scale score (P < 0.001), and SIS (P < 0.001). The Spiritual Beliefs Scale correlated with the MQOL scale score, SWLS (both P < 0.01), and SIS (P < 0.05). The Support Network Scale score correlated with the MQOL Existential (P = 0.01) and MQOL Support (P < 0.01) subscales. No clinical parameter correlated with any measure of QOL, spiritual beliefs, or social support. CONCLUSION: Symptoms, especially pain, along with psychosocial and spiritual factors, are important determinants of QOL of patients with ESRD. Additional studies, particularly a longitudinal trial, are needed to determine the reproducibility and utility of these QOL measures in assessing patient long-term outcome and their association with other QOL indices in larger and more diverse patient populations.

Adaptation, Psychological↗
PubMed1998

Active listening to cancer patients' stories.

Approximately two thirds of all Dutch cancer patients have severe emotional problems; shortly after their change from the treatment regime into the regime of medical controls. Half of them even need professional support. It is, therefore, important that a professional listens with empathy to the patient's version of the illness story. Story telling helps to overcome the existential crisis of being a cancer patient; it is an essential step in the revalidation process. Themes and open questions which structure the communication are suggested in this article.

Female↗
PubMed2002

Patient self-reporting questionnaire on urological morbidity and bother after radical retropubic prostatectomy.

OBJECTIVES: We assessed the incidence of morbidity and bother on quality-of-life (QL) after radical retropubic prostatectomy for prostate cancer. METHODS: At least 12 months after surgery, self-reporting questionnaires were completed and returned by 368 (77.8%) of 473 eligible patients. Surgery related morbidity was evaluated by adhoc constructed questions. QL was assessed by the European Organization for Research and Treatment of Cancer QL core questionnaire (EORTC QLQ-C30). Multivariate and univariate analysis as well as regression analysis were used to assess the bother factors. RESULTS: Postoperative urinary incontinence significant enough for the patient to use some kind of protection was reported by 27.2%. After surgery, 14.2% of preoperative potent men were able to get and maintain an erection sufficient enough for sexual intercourse without any aid. Overall 10.6% of respondents had undergone surgery for anastomotic stricture and 23.6% reported on adjuvant therapy. Furthermore, 43.2% reported on fear of not being cured from cancer. Postoperative urinary incontinence and fear of not being cured were associated with significant lower global QL scores and turned out as independent predictors for global QL. In contrast, postoperative erectile dysfunction, anastomotic stricture and adjuvant therapy were not independent predictors. In addition, 82.1% would vote for surgery again. CONCLUSION: The majority of the patients would opt for surgical treatment again, although morbidity is common after radical prostatectomy and may impair QL. Particularly urinary incontinence and fear of not being cured are independent predictors for global QL after surgery. Therefore, surgical techniques with a low morbidity are requested as well as some kind of psychological support in order to cope with existential fear.

Aged↗
PubMed2003

The illness experiences of patients after a first time myocardial infarction.

The purpose of this study was to investigate illness experiences of patients after a first myocardial infarction (MI), focusing on life situation and the recovery process over time. Thirty patients were interviewed within the first 3 days of hospitalisation, and again 17 weeks after discharge. The interviews were tape-recorded verbatim and the transcriptions were analysed and categorised using qualitative content analysis. The main category was Uncertainty of the life situation that was combined with and articulated the superior theme in both interviews. Analyses revealed uncertainty focused on problems related to: treatment-seeking behaviour; existential threat; preventing another coronary and need for knowledge and support, which the patients considered important for their case and future life. The findings are fundamental for the health care when education and counselling are planned and challenge health care personnel to listen to MI-patients' own experiences.

Adaptation, Psychological↗
PubMed2002

Ketamine psychotherapy for heroin addiction: immediate effects and two-year follow-up.

Seventy detoxified heroin-addicted patients were randomly assigned to one of two groups receiving ketamine psychotherapy (KPT) involving two different doses of ketamine. The patients of the experimental group received existentially oriented psychotherapy in combination with a hallucinogenic ("psychedelic") dose of ketamine (2.0 mg/kg im). The patients of the control group received the same psychotherapy combined with a low, non-hallucinogenic (non-psychedelic), dose of ketamine (0.2 mg/kg im). Both the psychotherapist and patient were blind to the dose of ketamine. The therapy included preparation for the ketamine session, the ketamine session itself, and the post session psychotherapy aimed to help patients to integrate insights from their ketamine session into everyday life. The results of this double blind randomized clinical trial of KPT for heroin addiction showed that high dose (2.0 mg/kg) KPT elicits a full psychedelic experience in heroin addicts as assessed quantitatively by the Hallucinogen Rating Scale. On the other hand, low dose KPT (0.2 mg/kg) elicits "sub-psychedelic" experiences and functions as ketamine-facilitated guided imagery. High dose KPT produced a significantly greater rate of abstinence in heroin addicts within the first two years of follow-up, a greater and longer-lasting reduction in craving for heroin, as well as greater positive change in nonverbal unconscious emotional attitudes than did low dose KPT.

Adolescent↗
PubMed2003

Smoking cessation in the elderly.

Today, two generations after the first Surgeon General's report, and with abundant evidence of the catastrophic consequences of smoking, no serious person can be unaware that smokers risk their lives and health. We also know that quitting smoking--at any age--promises significant health benefits. When offered the tools they need, older smokers quit smoking at rates comparable to those of younger smokers despite their skepticism, fatalism, and self-doubt. Older smokers should be encouraged to enter programs that stress the health benefits derived and identify the risks they are avoiding by quitting smoking. These programs establish quit dates, use sound behavioral modification techniques, provide strategies for stress management and relaxation, treat withdrawal symptoms, and provide regular and continuing follow-up. The patient is asked to make an existential change, and the physician should provide encouragement and promote self-confidence by emphasizing that, despite setbacks, with repeated efforts, success can be achieved. Clinicians can influence patients to quit smoking, and they should.

Administration, Cutaneous↗
PubMed1997

The lifeworld of the chronic mentally ill: analysis of 40 written personal accounts.

In this study, chronicity in mental illness has been investigated as it is lived rather than how it might be conceptualized. Published first-hand accounts have provided the mechanism for direct access in coming to know the life of persons, their circumstances, and the meanings they associate with a life of persistent and enduring mental illness. These are unique and particular human experiences, and there are no empirical generalizations or law-like statements that can give such an understanding. Therefore the disclosure of meaning was sought through a hermeneutic-phenomenologic process. Four lifeworld existentials provide the framework for a combined description and interpretation of what it means to "live" chronic mental illness. The article concludes with a brief discussion of some implications for nursing practice, and commentary is made on the relevance of such insights to health care providers in both acute and community care settings.

Adult↗
PubMed1998

Being mentally ill: a phenomenological inquiry.

There have been few studies that have attempted to understand the world of one who is mentally ill. This interpretive phenomenological study, which began as a study of the meaning of being restrained, became a glimpse into mental illness. For this study, 10 psychiatric patients were questioned in unstructured interviews. The taped interviews were transcribed, and the resulting texts were analyzed with use of a modification of an eight-stage process. Heideggerian hermeneutical phenomenology provided the philosophical framework for this study. Two major themes--struggling and "why me?"--revealed what it is like for the participants to live with a serious mental illness. These participants struggled with the staff on the unit, with being restrained, and with the symptoms of their illness. As part of their struggling, they asked, "Why me?"--a question that could be interpreted existentially as, why are things the way they are and not some other way? Finally, this study underscores how important it is for the nurse caring for a psychiatric patient to enter into, and try to understand, the world of patients with mental illnesses.

Adaptation, Psychological↗
PubMed2002

Factors associated with the accuracy of family caregiver estimates of patient pain.

This study identified factors associated with inaccurate family caregiver assessments of patient pain. Participants were 31 caregiver-patient dyads receiving hospice home care. All patients had a primary diagnosis of end-stage cancer. As expected, caregivers overestimated patient pain. The degree of disparity for each dyad was calculated by subtracting the patient's pain rating from the caregiver's rating of patient pain. Caregiver knowledge of cancer pain management was not related to the degree of disparity in pain ratings, but caregivers' experience of patient pain was significantly related to accuracy of caregivers' pain ratings. Those caregivers who 1) perceived their loved one to be in a great deal of distress secondary to pain, 2) associated greater efforts at pain relief (i.e., more medication) with greater levels of pain, and 3) were themselves distressed by the patient's pain had the most inaccurate estimates of patient pain. There was a trend for greater disparity in pain estimates to be related to poorer existential quality of life for patients. Overall, the findings suggest that health care providers need to take into consideration family members' interpretation of patient pain when providing pain management education services.

Adult↗
PubMed2002

Update on anorexia and cachexia.

Declining physical, emotional, and social function as a result of anorexia and cachexia are considerable contributors to discomfort for cancer patients and their families, and they impair the patient's ability to express optimal physical and psychosocial potential as long as possible. This decline no longer has to be accepted as an indispensable sequel to advanced cancer, just as pain is no longer considered to be unavoidable. A routine screening for anorexia and cachexia and associated symptoms is necessary, as is a careful, comprehensive assessment, because the condition is not always obvious. Decisions about anorexia and cachexia treatment are guided by prioritizing the different, concurrent physical, psychosocial, and existential problems and by considering the natural course of the cancer and the effects of antineoplastic therapies. Reversible causes for anorexia and cachexia need to be identified and treated, if appropriate. Nutritional interventions are often indicated; patients with a predominant starvation component and without inflammation may profit the most. New pharmacologic therapies for primary anorexia and cachexia syndrome are expected to enter clinical practice soon; however, until then, treatment with corticosteroids, progestins, or prokinetics may be indicated for some patients. To understand a multicausal syndrome, multimodal and interdisciplinary therapy is required. Specialist palliative care services can be helpful to provide, hand-in-hand with the disease specialists [172], assessment and management of psychophysical symptoms and sociospiritual needs of patients during the course of the illness and at the end of life [173]. Research efforts aim to better characterize subgroups of patients suffering from secondary causes of anorexia and cachexia and to elucidate the mechanisms involved in the primary anorexia and cachexia syndrome. Increasingly individualized treatments are expected with combination treatments that involve different mechanisms including nutrition.

Anorexia↗
PubMed2006

Factors related to meaning of life in Taiwanese women treated with in vitro fertilization.

BACKGROUND/PURPOSE: The meaning of life can be defined as a sense of a clear aim in life and a belief that one's daily activities are meaningful. Pregnancy is clearly an important aim of women who undergo in vitro fertilization (IVF) treatment. The purpose of this study was to evaluate the meaning of life and its related factors among women who underwent IVF treatment throughout the first treatment cycle until either pregnancy was achieved or when the attempt was abandoned. METHODS: This cross-sectional study was performed in a single medical center in Taiwan. A total of 149 subjects were recruited from women receiving IVF (n = 69) and women who had experienced IVF failure within the previous 1 year (n = 80). These women were classified into four subgroups according to their treatment stages: beginning of first IVF (n = 39); pregnancy/delivery (n = 22); continuing treatment (n = 64); and discontinuing treatment (n = 24). The Purpose in Life (PIL) test, a previously developed instrument designed to measure meaning of life, was administered to all patients at their follow-up IVF visit. RESULTS: The mean PIL score was 99.1 +/- 19.5, which indicated that all subjects had some degree of uncertainty regarding the meaning of life; however, no significant difference in PIL score was found among the four groups. Four factors were extracted from PIL by factor analysis, among which "existential frustration" (factor 4) was highest in the continuing group and those with a lower level of education; whereas "being in control" (factor 2 ) was lowest in women whose infertility had a female etiology. CONCLUSION: Treatment stage, educational level, and etiology of infertility were found to be factors influencing the meaning of life in women undergoing IVF.

Adult↗
PubMed2003

Being a non-urgent patient in an emergency care unit--a strive to maintain personal integrity.

The aim of this study was to analyse and describe experiences of being a non-urgent patient in an ECU (emergency care unit). Eleven non-urgent patients were interviewed. The research approach was inductive and interpretative. Seven tentative interpretations and an interpreted whole, i.e., an existential interpretation, revealed that the informants tried to be 'good' patients by not demanding much attention from nursing personnel, in an attempt to maintain good relations with the nurses in order to be assured of a positive reception. As health related problems jeopardize personal integrity, patients cannot afford the risk of being looked upon as inappropriate clients in the ECU.

Aged↗
PubMed1990

Public policy--power--professionalism.

This paper is based on two academic papers written for a Bachelor of Nursing program. The first part of the paper consists of an analysis of public policy in the area of Maternity Services in Australia, and more particularly, in Victoria. The analysis follows the work of Richard Simeon, a Canadian public policy analyst, who has drawn strands of both economic and social analysis together. His work asserts that socio economic factors lead to an environment in which power is held by particular groups in society. These powerful groups then have a greater input into the development of values and ideology for that society, that then effect institutions involved in the policy making process. Analysis shows that the re-emergence of Midwifery and the imminent changes in Maternity Services have occurred due to the increasing power of women in society at a time when economic constraints have forced governments to look at ways of rationalising health care. The second part of the paper identifies the traditional characteristics of profession and critically appraises these from a feminist perspective. Discussion includes the concepts of medical dominance, power, the power of caring and existential advocacy. An argument is presented that profession as traditionally portrayed is not necessary for midwives, will not solve the problem of medical dominance, will alienate consumers and will ultimately lead to disunity. Such disunity would cause fragmentation of the powerbase that has led to changes thus far.

Australia↗