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At least 991 records · Page 55Linked to original sources
PubMed2003

Patients' conceptions of how health processes are promoted in mental health nursing. A qualitative study.

The most important goal of nursing care is to promote the subjective experience of health. The health promoting efforts of mental health care nurses must be aimed at creating encounters where the patient will be confirmed both existentially and as an individual worthy of dignity. The patient in mental health care is often viewed by the nurse as nothing more than a passive recipient of care and the belief in the patient's potential is minimal. This can lead to a situation where the patient loses control in the caring situation and feels unable to improve his/her health, which conflicts with the goal of the nursing care. The aim of the study was to describe patients' conceptions of how health processes are promoted in mental health nursing. Twelve patients with experience of mental health nursing were interviewed, and the data material was analysed using a phenomenographic approach. The results show 13 different conceptions of the phenomenon, and these were summarized into four descriptive categories: interaction, attention, development and dignity. The conceptions described show that the patients need to be treated as equals and that the nurse must trust the patient's ability to make decisions and to promote his/her health process. It is suggested that mental health nursing should be built on humanistic science and its view that every individual has the ability to grow and develop. This view is one of the most important preconditions for the promotion of health processes in mental health nursing.

Adult↗
PubMed2002

Demoralization: its phenomenology and importance.

OBJECTIVE: Demoralization, as described by Jerome Frank, is experienced as a persistent inability to cope, together with associated feelings of helplessness, hopelessness, meaninglessness, subjective incompetence and diminished self-esteem. It is arguably the main reason people seek psychiatric treatment, yet is a concept largely ignored in psychiatry. The aim here is to review and summarize the literature pertaining to demoralization in order to examine the validity of the construct. METHOD: A narrative review of demoralization and the related concepts of hope, hopelessness, and meaning is presented, drawing on a range of empirical and observational studies in the medical and psychiatric literature. RESULTS: An examination of the concepts of the 'Giving Up-Given Up' syndrome (George Engel), 'suffering' (Eric Cassell), and demoralization (Jerome Frank), demonstrate considerable convergence of ideas. Demoralization has been commonly observed in the medically and psychiatrically ill and is experienced as existential despair, hopelessness, helplessness, and loss of meaning and purpose in life. Although sharing symptoms of distress, demoralization is distinguished from depression by subjective incompetence in the former and anhedonia in the latter. Demoralization can occur in people who are depressed, cancer patients who are not depressed and those with schizophrenia. Hopelessness, the hallmark of demoralization, is associated with poor outcomes in physical and psychiatric illness, and importantly, with suicidal ideation and the wish to die. CONCLUSIONS: Demoralization is an important construct with established descriptive and predictive validity. A place needs to be found for it in psychiatric nomenclature.

Humans↗
PubMed1998

Phenomenologies as research methodologies for nursing: from philosophy to researching practice.

This paper is concerned with the popularity of phenomenologies and the tensions that arise from their use as research methodologies in nursing. Among these tensions are: the troublesome issues of adapting a fundamentally philosophical means of understanding human being(s) for use as a more pragmatic and robust research approach in a practice discipline; the various types of phenomenology and the confusions that surround these and other interpretive methodologies, particularly within different intellectual and cultural traditions; and the need for nursing to find a space in which it can give voice to aspects of its practice that are silenced in less existentially oriented methodologies. Although phenomenologies are currently popular and possibly fashionable in nursing, there are important issues in relation to their use in a methodological sense that remain to be addressed.

Culture↗
PubMed2003

Moral stress and burnout: qualitative content analysis.

The aim of the present study was to describe and interpret the narrative of an Australian nurse's experience of burnout. A qualitative content analysis was used for the text of the interview. The main findings of this study concern moral stress and burnout. Three themes were identified: shortcomings and health problems; hovering between suffering and desire; and responsibility for oneself. All themes are related to the nurse's identity, the nurse's personal experience of, and reflections on, ethical problems and the existential issues of suffering, and the responsibilities and difficulties nurses face. The findings are explained and discussed in light of several theories. In conclusion, nurses' needs have to be recognized. They need both emotional support and the right to receive systematic clinical supervision to help them reflect on their practical work and interpret the needs of patients.

Attitude of Health Personnel↗
PubMedDate not supplied

Spirituality and quality of life in gynecologic oncology patients.

PURPOSE: The inclusion of spiritual well-being in healthcare assessments can provide insight into patients' needs and coping resources. This study explored the relationship between spiritual well-being and quality of life (QOL) in gynecologic oncology patients in an attempt to clarify the significance of spiritual well-being in the assessment process. DESCRIPTION OF STUDY: Eighteen women with gynecologic cancer completed a self-administered questionnaire that obtained sociodemographic, medical, spiritual, and functional information. The Spiritual Well-being Scale was used to assess spiritual well-being, and the Functional Living Index: Cancer (FLIC) measured QOL. Data were analyzed using descriptive statistics, comparison of means, and analysis of variance. RESULTS: Patients with gynecologic cancers other than ovarian reported a better QOL and a higher degree of spiritual, existential, and religious well-being. Older patients consistently reported higher degrees of spiritual well-being and QOL than did younger patients. Married patients consistently reported higher degrees of spiritual well-being than patients who were not married (never married or separated). Catholic patients scored higher in degrees of religious and spiritual well-being as well as in FLIC scores than other patients. CLINICAL IMPLICATIONS: Health professionals do not generally assess spiritual well-being in their evaluations of patients' needs. The findings from this study support the inclusion of spirituality as part of routine patient assessment and intervention. Clinical intervention that would increase a patient's level of spiritual awareness and his or her level of comfort associated with a personal perspective on death could help decrease the patient's level of psychosocial distress. Despite the medical establishment's bias to the contrary, religion and spirituality are positively associated with both physical and mental health and may be particularly significant to terminally ill patients. The curricula of medical, nursing, and other health schools should be redesigned appropriately.

Activities of Daily Living↗
PubMedDate not supplied

Tapestry: a retreat program of support for persons living with cancer.

PURPOSE: In an effort to mitigate the negative psychological sequelae of a cancer diagnosis and cancer treatment, efforts have been made to explore a variety of psychosocial issues and interventions. This article describes the provision and preliminary evaluation of a novel psychosocial service delivery, a residential "retreat" program called Tapestry, which is run under the aegis of the established cancer care community in Alberta, Canada. OVERVIEW: Retreat programs offer a novel way to provide psychosocial support for those persons who are living with cancer. The retreats are unique in the provision of a respite and the opportunity to address the isolation and other existential issues arising from a cancer diagnosis. The program described in this article has provided such a service six times per year since 1998. The intervention is described, and preliminary evaluation data are presented. CLINICAL IMPLICATIONS: Cancer care has begun to move beyond a solely biomedical paradigm toward a more holistic ethos in service delivery and research orientation. While the face value of and demand for such programming continues to grow, few residential psychosocial programs are offered under the auspices of conventional cancer care centers, and little work has been done to examine the nature and possible efficacy of retreat programs as a valid forum for psychosocial service delivery.

Complementary Therapies↗
PubMed2005

Sedation for the relief of refractory symptoms in the imminently dying: a fine intentional line.

There is a continuum of the goals of comfort and function in palliative care that begins with comfort and function being equal priorities and sedation being unacceptable. As disease progresses, the goals and preferences of the patient turn to coping with the loss of function caused by the disease and acceptance of unintentional sedation from the disease, its therapies, or symptom relief interventions. As patients approach the end of life, they may need intentional sedation for the relief of refractory symptoms. Such sedation can be divided into three categories: routine, infrequent, and extraordinary with respect to the frequency, difficulty, and risks involved with the drugs and routes of administration required to induce and maintain a level of sedation that relieves the patient's physical and existential symptoms. Extraordinary sedation with continuous infusions of midazolam, thiopental, and propofol can relieve refractory symptoms in most patients in their final days of life. Palliative care clinicians should become comfortable with the ethical justification and technical expertise needed to provide this essential, extraordinary care to the small but deserving number of patients in whom routine and infrequent sedation does not adequately relieve their suffering.

Procedural Sedation↗
PubMed1999

Interference of amino acid patterns and tissue-specific amino acids absorption dominance under the influence of tumor cell protein degradation toxins.

The excessively rapid degradation of proteins leads to an excess of amino acids which causes an impairment of the functions of normal cells of the tumor-bearing host specifically programmed amino acids absorption dominance which is of existential importance for tumor cells. This mechanism can be considered the result of the initiating effect of a protein degradation toxin (PDT) secreted from tumor cells. This is not only capable of attacking body protein, but also of attacking cells of another tumor. According to clinical observations, changes in biochemical processes which counteract the formation of an excess of amino acids indicate a tumor-repressive effect and can form the basis for the development of appropriate therapy concepts.

Amino Acids↗
PubMed2000

[Self-certitude and self-being in schizophrenic delusional patients].

When asking how a schizophrenic delusional patient can achieve a new, psychotically determined entity of his existence, we can differentiate the following aspects: 1. A quasi-transcendental organization of the delusional experience establishing the patient's singular self-certitude and the absoluteness of the delusion. 2. A reflexive self-confrontation and self-disclosure within his psychotic experience as the basis of the patient's new, psychotically different self-being. 3. The directly intrusive experience of becoming psychotic as a fundamental transformation of oneself may trigger the awareness of a specific new-beginning and therefore of a radical change in personal self-being. This means as well an existential self-seclusion.

Delusions↗
PubMed2001

["The illness has totally changed our lives"--stress in partners of schizophrenic patients at the onset of illness].

OBJECTIVE AND METHOD: The aim of this study was to investigate how spouses of schizophrenic patients experience the onset of the disease. Based on the narrative analysis of 23 in-depth interviews, the article highlights different aspects of this stressful life event. RESULTS: The first episode of a schizophrenic disorder leads to severe distress in the spouse of the patient. Emotions of fear, despair and loss of control are especially pronounced if spouses feel that neither their information about the disease nor their supportive resources are sufficient. The illness is often viewed as an existential threat to marriage and family life. DISCUSSION: Supportive services for spouses of schizophrenic patients should be offered very closely to the onset of schizophrenia, because the situation is especially burdensome in this period. Interventions should meet the particular needs of spouses. In addition to information about the illness and coping strategies intervention programs should consider issues which are relevant for partnership and parenting roles.

Adaptation, Psychological↗
PubMedDate not supplied

[Between heaven and hell - children's emotional perception of stemcell transplantation].

The following paper is the manuscript of an oral presentation during the annual GPOH meeting on May 22nd, 2000 in Berlin. Following her experiences as a member of the psychosocial care team of a children's cancer unit the author discusses the emotional impact of stemcell or bone marrow transplantation in children. Psychosocial care is identified as a way to support children emotionally during a situation of existential crisis, and to help them share their inner feelings and experiences.

Adolescent↗
PubMed1984

[Untruth and self-deception as fundamental dimensions of human existence: the problem of the unconscious].

The models of Freud on unconsciousness lead to logical contradictions or to a fragmentation of the person if the causal energetic view of mental organization is abandoned in favour of a metaphorical interpretation of Freud's concept. On the other hand, the person is eliminated in such an causel energetic model. Existential psychotherapies refer to Heidegger who claims that consciousness is not completely self-transparent and may conceal itself by forgetting and remembering in correspondence with the interests of the person. Self- concealment of consciousness as a source of unconsciousness is a process of disintegration of sense. Therefore, the therapy should lead the patient to discover his potentialities, to enable him to recognize untruth and self-deception as contradictions to these potentialities. Untruth and self-deception are-as Nietzsche has already shown-dimensions of the unconsciousness.

Humans↗
PubMed1984

[Significance of the medical anthropology work of Dieter Wyss for modern psychiatry and psychotherapy].

In the first part the decrease of the psychopathological research was described and the impact on the practical psychopathology was deplored, which in its existential tendencies could be very productive for a patient-orientated psychiatrist. The writings of D. Wyss stand in contrast to that disappearance of psychopathology. The author stressed the historical development of the patient an the importance of conflict which yields the dynamics of that development. The conception of psychosis has as its basic concept that of perspective which is a fundamental union of the "interior" and "exterior" of the human person. The essay ends with a discussion of the importance of the author for a humane psychotherapy which exists in a symmetric relation to the patient.

Anthropology↗
PubMed1998

[The history and psychopathology of paranoia].

The concept of paranoia refers to a main problem of general psychopathology: Paranoia represents the prototype of a pure delusional disorder. The text reviews the descriptive psychopathological and nosological aspects of paranoia which is orientated towards the well-known historical studies by Kraepelin, Gaupp, Kretschmer and Jaspers. The systematic character of the delusional ideas and a specific emotional-affective state connected with a typical (sensitive-vulnerable) personality constitute the "classical" concept of paranoia. Furthermore, the characteristics of paranoia experience and its distinction from delusion during schizophrenic disorders are discussed. The possibility of communication with a delusional person in his autistic world calls for our understanding of the inner and existential meaning of delusion. Therefore the research into the problem of paranoia requires consideration of phenomenological, philosophical and anthropological points of view.

History, 20th Century↗
PubMed1997

[Evaluating the current status of anthropologic psychiatry].

Phenomenological psychiatry examines the variety of psychiatric diseases as regular modifications of human feeling tone experience and behaviour, which can be derived approximately from the nature of man as defined philosophically, Interdisciplinary self-conception of phenomenological psychiatry as a science calls for a constant critical dialogue with the philosophy of man and other disciplines of the humanities. The point of departure of phenomenological psychiatry is the mental or affective illness of the individual patient, with which the psychiatrist is acquainted, and reflects in interpersonal encounters in such a way that individual case studies are of central importance in this area of studies. From a methodological point of view two approaches are to be differentiated within the field of research in phenomenological psychiatry: 1. The phenomenological approach is concerned with the analysis of specific patterns of disturbance of the transcendental organisation of psychotic subjectivity. 2. The interpretative approaches are again divided into the so called "Daseinsanalyse" as a hermeneutic access to the inner biography and "Weltanschauung" of the psychiatric patient as well as the attempts of understanding the meaning of psychotic forms of experience. In this context a survey of the current fields of research of phenomenological psychiatry is given which aims at a deeper understanding of the situation of psychiatric patients and which claims to have a strong relevance for therapy. The relevance of such a phenomenological approach for current psychiatry lies in a broadening and sophistication of our experience in clinic and practice. Its main interest lies in the concentration on the patient as an individual and on the existential dimension of forms of mental and emotional diseases.

Anthropology, Cultural↗
PubMedDate not supplied

[Integration of psychosocial services into the management of the child with cancer].

The integration of colleagues from psychosocial occupations into the traditional team of doctors and nurses demands a holistic treatment concept, the general desire for interdisciplinary action, and readiness for patience in the process of mutual learning. The acceptance of the psychosocial services by the patient and his/her family is frequently determined by the acceptance by physicians and nurses. The members of the psychosocial team are confronted with the following tasks.: 1. Developing a trustful relationship with the patient and his/her parents, 2. Setting up a history of family dynamics, 3. Practical assistance in matters of hospital routines, 4. Assistance in the emotional aspects of coping with the disease, 5. Rendering support to a patient and his/her family at death, 6. Leading and moderating groups of parents who live with so called "residual fear" or are mourning a child. Colleagues of the psychosocial team, who have to be able to cope with these existentially demanding tasks within a relationship to patients and their families over an extended period of time should have sufficient professional identity, adequate professional competence, and a certain foundation of life experience.

Child↗
PubMed1992

Fairy tales as a trance experience: possible therapeutic uses.

The psychological literature contains little documentation of the therapeutic use of fairy tales. We suggest that fairy tales are uniquely suitable for hypnotherapy and for helping clients reframe existential issues. We propose that the structure of fairy tales allows the meaning of the story to be applied personally and that they also stimulate unconscious search. We examine the way in which hypnosis is achieved when fairy tales are read to children, as well as possible therapeutic uses of this learning set in therapy with both children and adults. We conclude by suggesting that fairy tales need to be given serious consideration as an alternative therapeutic trance procedure.

Child↗
PubMed2005

Hypnosis in human sexuality problems.

This is a general overview of the use of hypnosis in five aspects of human sexuality where problems or pathology may move patients to seek therapy. These are gender identity, sexual orientation, sexual preferences, sexual functioning and sexual mores. The article emphasizes two main hypnotic techniques that respect the patient's existential experiences regarding his/her own sexuality. The use of hypnosis proposed here is patient-centered, permissive and utilizing the patient's imagery and other inner resources. Several clinical vignettes illustrate the theoretical points with the intention of giving the reader an opportunity for identification with these cases.

Gender Identity↗