Geriatric nurses and models of help orientation.
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Adult↗
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Results for “Helping Behavior”
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What's it all about, empathy?
This paper investigates the concept of empathy, a core element of all helping relationships. A discussion of its prevalence in the nursing literature is traced, before a discussion ensues as to whether it is a naturally acquired ability which develops with maturity, or whether it is a skill that can be taught and learnt. It is concluded that empathy remains a poorly defined, multidimensional concept which still remains not fully identified.
Education, Nursing↗
Fathers' experiences of childbirth.
OBJECTIVE: To describe how fathers who are present during childbirth experience the event, what they feel during childbirth and how they understand the meaning of childbirth. DESIGN: Survey using questionnaire. SETTING: Maternity unit in Finland. PARTICIPANTS: A non-random sample of fathers (n = 137) who were present at the birth of their baby at one university hospital in Finland. The response rate was 81% (n = 107). MEASUREMENTS AND FINDINGS: Young fathers and those expecting their first baby reported feeling uncomfortable during delivery more frequently than others. Almost all said that they had plenty of good experiences, younger fathers more so than older fathers. The fathers expressed their confidence in the staff and described the environment at the hospital as pleasant. They said their presence at delivery was important for their growth into fatherhood. The best experience was the moment that the baby entered the world. The hardest things were the pain experienced by their partner and being unable to help. Most of the fathers were very pleased with current midwifery practices followed in childbirth, however, it was felt that more attention ought to be paid to pain relief and to supporting and providing guidance to the father during delivery. IMPLICATIONS FOR PRACTICE: The work of midwives should be planned so that fathers can feel secure and comfortable. Further studies are needed into the ability of midwives to support fathers in their fatherhood.
Adolescent↗
Social capital and violence in the United States, 1974-1993.
Social capital is a characteristic of communities. Cross-sectional studies have shown that social capital is inversely associated with homicide and violent crime. We hypothesized that variations in social capital in US states over time can predict variations in regional homicide mortality both across and within time periods. We analyzed serial cross-sectional data for measures of social capital and age-adjusted homicide rates between 1974 and 1993. We used perception of social trust and per capita membership in voluntary associations, obtained from responses to the General Social Surveys, as the principal measures of social capital. We controlled for potential confounding by mean levels of income, urbanization, and region. Measures of perceived trust were strongly inversely correlated with homicide rates in an aggregate cross-sectional analysis (r=-0.51, p<0.001) and also within each time period. Social capital was an independent predictor of rates of violence when controlling for income, region, and urbanization (p<0.001). Homicide rates also predicted levels of social capital in adjusted models (p<0.001). To investigate directionality of this relationship we developed Markov transition matrices that described the change in the states' levels of social capital and homicide across time intervals. Analysis of the transitional probabilities confirmed that a simple unidirectional association between social capital and violence was not sufficient to describe this association. There is likely an impact of violence on levels of perceived trust in communities that complements the hypothesized effect of social capital on homicide. We conclude that the relationship between social capital and violence over time is non-linear and dynamic. More complex analytic models describing the relationship between violence and ecological social determinants need to be considered.
Adult↗
Understanding donors' motivations: a study of unrelated bone marrow donors.
Medical advances in bone marrow transplantation techniques and immunosuppressive medications have dramatically increased the number of such transplants performed each year, and consequently, the demand for bone marrow from unrelated donors. Although physiological aspects of bone marrow donation have been thoroughly investigated, very few studies have examined psychosocial factors that may impact individuals' donation decisions and outcomes. To examine one particular set of donor psychosocial issues, this study investigated motives for bone marrow donation among 343 unrelated bone marrow donors who donated through the National Marrow Donor Program. Six distinct types of donor motives were identified from open-ended questionnaire responses. Donors most frequently reported motives reflecting some awareness of both the costs (to themselves) and potential benefits (to themselves and the recipient) of donation. A desire to act in accordance with social or religious precepts, expected positive feelings about donating, empathy for the recipient, and the simple desire to help another person were also commonly cited reasons for donating. Among a series of donor background characteristics, donors' gender was the variable most strongly associated with motive type; women were most likely to cite expected positive feelings, empathy, and the desire to help someone. Central study findings indicated that donor motives predicted donors reactions to donation even after the effects of donor background characteristics (including gender) were controlled. Donors who reported exchange motives (weighing costs and benefits) and donors who reported simple (or idealized) helping motives experienced the donation as less positive in terms of higher predonation ambivalence and negative postdonation psychological reactions than did remaining donors. Donors who reported positive feeling and empathy motives had the most positive donation reactions in terms of lower ambivalence, and feeling like better persons postdonation. These finding add substantially to the body of work concerning medical volunteerism generally, and also have important practical implications for the recruitment and education of potential bone marrow donors.
Adult↗
Assessing the helping alliance and its impact in the treatment of opiate dependence.
This study assesses the relationship between the patient-counselor helping alliance (HA) and progress in methadone maintenance treatment. Questionnaire measures of HA were administered to 57 patients 1 and 3 months after admission. Three-month HA measures (especially counselors' ratings) predicted reductions in drug use as measured by weekly urinalysis results and 6-month self-report data. HA was unrelated to treatment retention or improvement in psychiatric symptomatology. Moreover, controlling for urinalysis results in the previous month rendered insignificant the correlations between 3-month HA and subsequent drug use. Thus, this evaluation of the HA's unique contribution to the prediction of outcome suggests that the development of a positive HA may be more a marker of treatment progress than a necessary precursor of positive outcomes in the methadone maintenance treatment setting.
Adult↗
Is anxiety a suitable measure of decision aid effectiveness: a systematic review?
Several trials have employed anxiety measures to assess decision aid effectiveness. This study employed a systematic review method to integrate their findings. The affective impact of decision aids and the appropriateness of anxiety as a measure of decision aid effectiveness are explored. From 11,361 citations generated from searching electronic databases and journals, 26 randomised controlled trials evaluated patient decision aids; 10 included anxiety measures (HADS; STAI). The data were too heterogeneous to integrate statistically. No studies showed an increase in anxiety from exposure to decision aids versus usual care. Some patterns emerged between level of anxiety and characteristics of the decision. As raised levels of anxiety are associated with both more effective decision strategies and stressful health interventions, anxiety is an inappropriate measure to employ when evaluating decision aids. Future research needs to investigate the relationship between affect, cognition and decision aids in order to facilitate effective patient decision making.
Adolescent↗
Judgments of laypersons and general practitioners on justifiability and legality of providing assistance to die to a terminally ill patient: a view from New Zealand.
As part of a larger study, four decisions related to a vignette scenario of the elective death of a terminally ill patient suffering intractable pain are examined (doctor supplying information and drugs, assisting patient to take the drugs, or administering a lethal injection). Judgments on justifiability and legality of actions were obtained from laypersons and general practitioners (GPs) in Auckland, New Zealand. The results show that over 72% of laypersons and over 30% of GPs judged all four actions justified. Despite illegality a significant number of laypersons and some doctors were unsure of the legal status of actions. The current law in New Zealand prohibiting physician-assisted death may not reflect judgments by the majority of laypersons or 30% of general practitioners on the justifiability of elective death options for a terminally ill patient with intractable pain. Judgments on justifiability may be related to confusion over the legality of actions.
Adolescent↗
Analysis model for planning chemical dependence treatment systems.
Statewide needs assessments commonly generate a single estimate of the number of persons needing chemical dependence treatment. The present analysis utilizes help-seeking behavior models and patient placement concepts to break a single statewide need estimate into operational units of services and costs that can be used for planning and resource allocation. The analyses are presented as allocation models for placements, service populations, service capacities, and costs. The guide was tested using state data for a target year and the results were compared to actual treatment admissions, which revealed a lack of convergence. Only 9% of persons were estimated to need intensive residential treatment whereas actual admissions to intensive residential treatment accounted for 29% of all admissions. The disparities may be accounted for by sampling bias of the needs estimate and by the likelihood that persons with more severe problems may be overrepresented when only a small proportion of treatment need is being met. These findings suggest that if resources become available to narrow the treatment gap, a larger proportion of outpatient services and less intensive services may be appropriate for the expanded clientele.
Health Planning↗
Help-seeking for intimate partner violence and forced sex in South Carolina.
PURPOSE: In this population-based, random-digit-dial, cross-sectional survey, we assessed the lifetime victimization of intimate partner violence (IPV) and forced or coerced sex among 556 women and men in South Carolina, and the help-seeking behaviors of victims. RESULTS: Among women, 25.3% experienced IPV (sexual, physical, or emotional violence) compared with 13.2% of men. Although women were significantly more likely to report physical or sexual IPV (17.8%) than were men (4.9%), men (8.3%) were as likely as women (7.4%) to report perceived emotional abuse without physical or sexual IPV. One half of men and women with annual incomes <$15, 000 reported IPV. Among women experiencing physical or sexual IPV, 53% sought community-based or professional services for IPV; women with higher education levels and those experiencing more severe violence were most likely to seek services. CONCLUSIONS: These data show that IPV is common and that most victims do not receive services to address this violence.
Adolescent↗
Compensatory parenting: how mothers describe parenting their 3-year-old, prematurely born children.
Premature infants and their mothers experience difficulties in establishing their relationships. The effect of these early problems on later parenting is not known. This study explored whether mothers' recollections surrounding the birth and hospitalization of a preterm infant affected their perceptions and their parenting of these children at 3 years of age. Twenty-seven primary caregivers of 30 prematurely born children completed three questionnaires on their perceptions of their children and were interviewed about parenting experiences. The core concept identified in analysis was compensatory parenting, a parenting style in which mothers provided special experiences and avoided others in an attempt to compensate the children for their neonatal experiences. Compensatory parenting was influenced by the view of these prematurely born children as both special and normal and by salient prenatal, labor, and delivery experiences; memories of the neonatal intensive care unit experience; the sequelae of emotional responses to these experiences; and subsequent health problems after discharge. Prospective research is needed to further study compensatory parenting and to develop interventions.
Adaptation, Psychological↗
Being a case manager for persons with borderline personality disorder: perspectives of community mental health center clinicians.
The scope of case management has expanded to include persons with chronic, nonpsychotic disorders, in particular, persons diagnosed with borderline personality disorder. Despite more widespread use, literature about case management for persons with this disorder is limited. To address this gap in knowledge, a study of the day-to-day experiences of case managers who care for persons with borderline personality disorder was conducted. Seventeen community mental health center case managers gave their informed consent to participate in individual, in-depth interviews. The interviews were analyzed using an interpretive phenomenological research approach. The analysis showed a pattern of monitoring self-involvement. The case managers monitored themselves in terms of expressing concern and setting boundaries. These shared practices highlight a central and unique component of being a case manager for persons with borderline personality disorder, that is, the case manager's focus of attention is on self. By focusing on the self, case managers seek to retain control of the nature of the relationship. The author asserts that the matter to be resolved is not to determine whether retaining or relinquishing control is better, but rather, how best to help practitioners maintain a helpful relationship over time with persons who have borderline personality disorder. In an effort to accomplish this goal, questions about current helping practices and suggestions for working collaboratively with persons who have this diagnosis are provided.
Attitude of Health Personnel↗
Codependency in male and female helping professionals.
The purpose of this study is to determine and compare the prevalence of codependency in a group of 77 female and a group of 72 male helping professionals. Relatively low rates of codependency were observed in this sample, and the five-factor structure of the Codependency Assessment Tool (CODAT) was replicated. Males showed slightly higher codependency than females on the total CODAT and on the Hiding Self and Family of Origin Issues subscales. The CODAT was shown to be relevant to both males and females. Further research is needed to determine if a general population of male and female subjects would yield similar results.
Adult↗
Rationing of health care: clinical decision making in an outpatient clinic for anxiety disorders.
Anxiety disorders are prevalent and disabling and despite the fact that effective interventions are available, many people do not access effective treatment. Clinician decisions are fundamental determinants of access to this treatment. Despite this, treatment decisions have never been examined specifically in this group and are rarely examined in outpatient settings. The present study assessed 550 consecutive referrals to an anxiety disorders clinic in Sydney, Australia. Logistic regression was used to examine the predictors of decisions about treatment. Clinical patient variables (diagnosis and disability) were the strongest predictors of an offer of treatment but demographics and resource availability were also significant. Some of the same factors have been shown to influence the decision to seek treatment for anxiety. Both help-seeking behavior and treatment decision making are important determinants of access to care and both should be examined in future studies.
Ambulatory Care Facilities↗
Problem drinkers: evaluation of a stepped-care approach.
The present study evaluated a stepped-care model for the treatment of problem drinkers; those not severely dependent on alcohol. The initial treatment consisted of a motivationally based, four-session outpatient treatment. Based on previous research, treatment nonresponders were defined as having consumed more than 12 drinks per week between the assessment and third session. Six-month follow-up interviews were conducted on three groups of problem drinkers: (1) those who responded to the initial intervention (n = 67); (2) those who did not respond to the initial treatment (n = 36); and (3) those who did not respond to the initial treatment and received a supplemental intervention (n = 33). The last two groups were used to evaluate whether providing treatment nonresponders with an additional "step" would improve treatment outcomes. The primary dependent measures were posttreatment percent days abstinent and posttreatment drinks per drinking day. Results suggested that (1) within treatment drinking can help identify treatment nonresponse in stepped-care models; (2) the supplemental intervention did not influence posttreatment drinking; (3) treatment responders and nonresponders sought additional help at the same rate. The present study is the first study on stepped-care for alcohol treatment and provides a methodology for evaluating stepped interventions. Recommendations for future research in this area include more attention to assessing the needs of treatment nonresponders and help seeking behavior of both responders and nonresponders after an initial intervention.
Adult↗
Altruism and payment in blood donation.
Paid blood donation still has its defenders, who cite economic doctrines denying the existence of altruism per se, the inability of most countries with exclusively voluntary donations to achieve self-sufficiency and the supposedly successful use of selected groups of paid donors. This paper argues that blood donation is an example of genuine altruism where the altruistic behaviour is incorporated into the self as a role. Unpaid donation is proven to be much safer for receivers and supply problems can be attributed fundamentally to inefficiencies in the organization of transfusion services. Voluntary and non-remunerated donation may be sufficient for a country/region to cover all its blood product needs, but requires an efficient organization and the elimination of "spurious altruism", nonmonetary forms of compensation that harm the social image of voluntary donation and obstruct its further development.
Altruism↗
The right to be accompanied at birth: new laws in Argentina and Uruguay.
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Argentina↗
Helping the bereaved at the emergency department: a study at the Brussels University Hospital.
An evaluation was conducted of the emergency staff who cared for relatives of patients who had died suddenly. Physicians and nurses completed questionnaires and participated in follow-up meetings to discuss the results of the survey and to recommend actions to improve care for both bereaved families and staff. An informational brochure was developed that provides standard and customized information for families.
Adult↗