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PubMed2006

Going on a journey: understanding palliative care nursing.

AIM: To describe the qualitatively different ways a group of Australian nurses understood their experience of being a palliative care nurse. DESIGN: The research approach chosen was phenomenography. Fifteen nurses caring for people in a specialist palliative care unit in regional Australia were interviewed and transcribed interview data were analysed in order to identify understanding of experience. FINDINGS: The research identified and described five ways of understanding the experience of being a palliative care nurse: doing everything you can; developing closeness; working as a team; creating meaning about life; and maintaining myself. CONCLUSION: The group of palliative care nurses involved in this research understood their experience as journeying with their patients through the final phases of the person's life. The journey involved the patient, his/her family and members of the healthcare team. The journey was described further as a process of personal development which influenced how nurses construct meaning about life and maintain a sense of self. The experiences described reveal a great deal about palliative care nursing and provide useful knowledge and insights to assist practitioners, managers and educators.

Adaptation, Psychological↗
PubMed1985

[Psychotherapeutic possibilities in patients with definitive movement disorders].

Since traumas leading to severe and permanent physical handicaps affect the whole personality, the psychological approach plays a major role in the rehabilitation of patients with locomotory handicaps owing to injury. The harmful effects become apparently more easily on account of the disturbed personality development of the cripple, and the consequent mental changes complicate his or her reintegration into society. Rehabilitation measures intended to restore, as far as possible, the physical functions can only yield satisfactory results if they prepare the whole personality of the cripple--as a combined psychological and somatic entity--for life of a different quality.

Combined Modality Therapy↗
PubMed2005

Personal and professional development in undergraduate health sciences education.

During the last decade, ''medical professionalism'' has been scrutinized as a consequence of pressures from within and outside the health sciences professions. In response, professional organizations have reviewed ethical principles and developed explicit guidelines for the behavior of their members. Medical educators have revised undergraduate curricula with a view to supporting the development and maintenance of these essential professional behaviors. This article outlines perspectives on professionalism before describing the evolution of personal and professional development curricula in undergraduate health science education. While the bulk of data on personal and professional development in the health sciences has come from human medicine, the principles are being recognized as applying to the breadth of the health professions. In the veterinary profession, the dyad of the physician-patient relationship of human medicine is expanded to the triad of the veterinarian-patient-client relationship, and this brings with it an added set of professional relationships and responsibilities. In order to be faithful to the primary literature and not expand beyond the various authors' data and conclusions, this article is presented principally in the terms of human medical education. For those in veterinary education, it is hoped that the inferences and applications will be readily apparent. In this article, challenges associated with defining content and educational methods are outlined, as well as selection criteria for medical school and promoting the value of PPD to students. Approaches to assessment, implementation, and evaluation of PPD curricula are also discussed. Two case studies are presented. The article concludes with suggestions for curriculum development.

Animals↗
PubMed1991

[Preliminary study of early sexual abuse].

The long term effects of sexual abuse are often measured by measuring behaviours such as social adjustment, job stability and marriage. This study was conducted to add to these internal measures. Using a semi-prospective instrument adapted from G. Kelly's repertory grid, the adolescents' perceptions of themselves and significant others are measured. Three hundred and twelve female adolescents between the ages of 13 and 19 (average age = 16) participated in the study; 79 presented with non sexual behaviour disorders (delinquency, stealing, etc.), 56 presented with serious sexual behaviour disorders (prostitution, persistent sexual promiscuity) and 177 presented with no problems requiring psychosocial intervention. Various analyses (descriptive, multiple variance, regression analysis) showed that sexual abuse significantly affects many of the adolescents' perceptions. Sexually abused adolescents perceived their two real parents as less competent and their ideal mother and father as less protective than adolescents who had not been abused. In contrast, their perception of self and the ideal self was not affected by the sexual abuse, a finding which will spark discussion.

Adolescent↗
PubMed1999

Mother-loss: recreating relationship and meaning.

The purpose of this investigation was to describe adult women's experiences in losing their mother. Using an interpretive phenomenological frame of inquiry, 5 women were purposively selected to share their loss experience. Memories of the mother-daughter relationship were explored, and the meanings the daughters attached to their loss described, in written narratives, 2 in-depth interviews, and 1 group session. Seven themes emerged: Recalling, Holding On, Saying Goodbye, Longings of the Heart, Shifting Patterns of Relationship, Recreating the Dialogue, and Honouring Our Mothers/Ourselves. The loss of one's mother represents the loss of one's first intimate relationship, a relationship that has a unique meaning for daughters because their personal development is profoundly and uniquely shaped by it. This potentially pervasive and transforming life experience is best understood from an in-depth exploration and understanding of the nature of the mother-daughter relationship. Nurses who come to understand the dynamic interaction of grief and development through women's experience of mother-loss can more successfully offer their presence, their understanding of the complexity of the mother-daughter relationship, and their skills in bereavement care to facilitate healing and to promote health and personal growth.

Adult↗
PubMed1994

The development of emotion regulation and dysregulation: a clinical perspective.

Clinical conceptualizations of emotion that stress its disruptive influences and functional models of emotion that emphasize its adaptive aspects can be integrated into a developmental psychopathology framework. Under certain conditions, emotion regulation may develop dysregulatory aspects that can become a characteristic of an individual's coping style. This style may then jeopardize or impair functioning and become associated with symptomatic, disordered functioning. Emotional development provides a critical vantage point from which to study the development of symptomatology and psychopathology, particularly given the prevalence of emotional symptoms in various forms of psychopathology. Dimensions of emotionality that can be used to characterize dysregulation include access to the range of emotions, flexible modulation of intensity, duration, and transitions between emotions, acquisition and use of cultural display rules, and the ability to reflect on the complexity and value of one's own emotions in a self-supporting manner. Developmental psychopathology provides a framework within which to examine how emotions are regulatory, how their regulation changes over time, and under what conditions an adaptive emotion process can develop into a pattern of dysregulation that then becomes, or sustains, some symptoms of mental disorders. Such research requires samples that include children with and without risk or presence of particular mental health problems, paradigms that allow the examination of dimensions of emotionality in context and provide multiple assessments that include observations of children's reactions beyond what they themselves can report, and analyses that extend beyond simple global aggregates such as positive and negative emotion. We believe that it is particularly important to study children and their families in situations that challenge their emotional adaptation. The developmental tasks of emotional life evolve in exchanges between the child and the world of events and relationships. The emotional conditions of early childhood appear to be very important in optimizing or interfering with how the child's emotionality regulates his or her interpersonal and intrapsychic functioning and how the child learns to regulate emotion. The experiences that accrue around emotional events influence the stable aspects of the developing personality and become trait-like aspects of the person (Malatesta & Wilson, 1988). Dysregulation occurs when an emotional reaction loses breadth and flexibility. If a dysregulatory pattern becomes stabilized and part of the emotional repertoire, it is likely that this pattern is a symptom and supports other symptoms. When development and adaptation are compromised, the dysregulation has evolved into a form of psychopathology. The line between normative variations and clinical conditions is not clearly drawn.(ABSTRACT TRUNCATED AT 400 WORDS)

Affect↗
PubMedDate not supplied

Ethical issues and the patient-provider relationship.

In enabling disabled persons to gain increased function and independence, rehabilitation practitioners try to emphasize the patient's goals by providing the patient with some control over the process. As the patient enters the active rehabilitation phase, the patient actively becomes involved with the design of the treatment plan. If the patient does not fully participate in this plan, his/her motivation may be questioned. Rehabilitation professionals prefer patients who comply with the original treatment plan. Conflicts arise when patients do not comply, and the war between patient autonomy and medical paternalism ensues. When the disabled person becomes an outpatient, we must learn to measure the quality of life, not just the functional outcome. Rehabilitation professionals have become masters of inpatient rehabilitation but are less prepared to facilitate comprehensive rehabilitation care in the outpatient setting. Outpatient rehabilitation also needs to measure community reintegration. In the continuum of chronic disability, the care-giver and the disabled person develop an intermittent interdependence with an alternating relationship between autonomy and paternalism. Mutal respect such as that experienced in friendship provides a useful model for this idealized patient-care enabler team. To understand more of the essence of the disabled person's life is the responsibility of the rehabilitation provider.

Activities of Daily Living↗
PubMed1989

Volatile substance abuse within a health education context.

1. Drug education has to involve exposure not only to knowledge about drug and volatile substance abuse, but also to the effect that attitudes, values, external influences and personal and social skills have on drug behaviour. 2. Such education has also to consider the methods used, the learning process itself, and the need for self-esteem to be enhanced during this process. 3. There is a need to develop personal and social skills which will form the foundation for considering areas such as volatile substance abuse. The school must be supported by the home and by the community. 4. A range of practical resources produced by TACADE (The Advisory Council on Alcohol and Drug Education) allow the translation of this theory of drug education into a practical approach within education.

Adolescent↗
PubMed2000

Alcoholism in the elderly.

Alcohol abuse and alcoholism are common but underrecognized problems among older adults. One third of older alcoholic persons develop a problem with alcohol in later life, while the other two thirds grow older with the medical and psychosocial sequelae of early-onset alcoholism. The common definitions of alcohol abuse and dependence may not apply as readily to older persons who have retired or have few social contacts. Screening instruments can be used by family physicians to identify older patients who have problems related to alcohol. The effects of alcohol may be increased in elderly patients because of pharmacologic changes associated with aging. Interactions between alcohol and drugs, prescription and over-the-counter, may also be more serious in elderly persons. Physiologic changes related to aging can alter the presentation of medical complications of alcoholism. Management of alcohol withdrawal in elderly persons should be closely supervised by a health care professional. Alcohol treatment programs with an elder-specific focus may improve outcomes in some patients.

Aged↗
PubMed1990

Dissociation and displacement: where goes the "ouch?".

Hypnosis is widely used to relieve pain. Current theory emphasizes its dissociative features. Multiple personality patients can eliminate pain in the primary personality by displacing it into underlying alters. The Hilgards demonstrated that normal hypnotized subjects can similarly dissociate pain into a covert cognitive structural system which they called the "hidden observer." The Watkins discovered that "hidden observers" appeared to be the same phenomenon as "ego states." "Ego-state theory" assumes that human personality develops through integration and differentiation. At one end of the continuum, "differentiation" is adaptive. Ego states possess relatively permeable boundaries as in normal moods. At the other end ego-state boundaries become less permeable. Normal "differentiation" becomes maladaptive "dissociation" and multiple personalities may be created. In the intermediate range of the differentiation/dissociation continuum, "covert" ego states can be found in many normal subjects who volunteer for hypnotic laboratory experiments. Normal individuals, like multiple personalities and "hidden observer" subjects, can displace (dissociate) pain into "covert" ego states. The pain is not eliminated. This suggests that when we remove pain by hypnosis we may not be getting away "scot-free."

Dissociative Disorders↗
PubMed1989

Gender and perceptions of grandparenthood.

Grandparents (N = 301) were interviewed concerning their relationship with one grandchild; topics included the meaning of the relationship, responsibility toward the grandchild, and satisfaction with the relationship. Grandparent gender by grandchild gender by maternal/paternal grandparent MANOVA's revealed no differences in the relationships associated with grandchild gender or with maternal/paternal grandparent status; nor were there significant interaction effects. Grandmothers expressed greater satisfaction than did grandfathers; grandfathers stressed family extension through grandchildren and the pleasures of indulging grandchildren to a greater extent than did grandmothers. These gender differences may reflect personality development in adulthood and the cultural context of the research.

Adult↗
PubMed2006

The relationship of personality and behavioral development from adolescence to young adulthood and subsequent parenting behavior.

The purpose of the study was to examine the association of parental personality, behavior, and substance use during adolescence and adulthood as related to the later parent-offspring relationship. The sample consisted of 297 parents (M age 32 yr.), who were first interviewed at earlier points in their lives in childhood and early adolescence at six points in time, extending from 1983 to 2002. Multiple regression models showed that parents with certain earlier personality and behavioral attributes, e.g., more rebelliousness and more frequent tobacco use, had a more difficult relationship with their children. Findings indicated an association between the cumulative number of psychosocial risk factors in the parents and difficulties in the parent-child relationship. The findings suggested that interventions designed to decrease youths' substance abuse may increase the likelihood that later when they are parents they will form nurturing relationships with their children.

Adolescent↗
PubMed2006

Can personality assessment predict future depression? A twelve-month follow-up of 631 subjects.

BACKGROUND: Personality assessment provides a description of a person's fundamental emotional needs and of the higher cognitive processes that modulate thoughts, feelings, and behavior. Prior studies by us examined personality and mood at the same time. Assessing personality may allow prediction of mood changes over time in a longitudinal study, as described in earlier prospective studies by Paula Clayton and others. METHOD: A group of 631 adults representative of the general population completed the Temperament and Character Inventory (TCI) and Center for Epidemiological Studies depression scale (CES-D) at baseline and one year later. RESULTS: TCI scores at baseline accounted for gender differences in levels of depression. TCI personality scores were strongly stable (range in r=.78 to .85 for each of seven dimensions) whereas mood was only moderately stable (r=.62) over the twelve-month follow-up. Baseline personality scores (particularly high Harm Avoidance and low Self-Directedness) explained 44% of the variance in the change in depression. Baseline levels and changes in Harm Avoidance and Self-Directedness explained 52% of the variance in the change in depression at follow-up. LIMITATIONS: The follow-up sample was representative of the target population except for slightly lower Novelty Seeking scores. CLINICAL RELEVANCE: Observable personality levels strongly predict mood changes. Personality development may reduce vulnerability to future depression.

Adolescent↗
PubMed2002

Participation in cognitively stimulating activities and risk of incident Alzheimer disease.

CONTEXT: Frequent participation in cognitively stimulating activities has been hypothesized to reduce risk of Alzheimer disease (AD), but prospective data regarding an association are lacking. OBJECTIVE: To test the hypothesis that frequent participation in cognitive activities is associated with a reduced risk of AD. DESIGN: Longitudinal cohort study with baseline evaluations performed between January 1994 and July 2001 and mean follow-up of 4.5 years. PARTICIPANTS AND SETTING: A total of 801 older Catholic nuns, priests, and brothers without dementia at enrollment, recruited from 40 groups across the United States. At baseline, they rated frequency of participation in common cognitive activities (eg, reading a newspaper), from which a previously validated composite measure of cognitive activity frequency was derived. MAIN OUTCOME MEASURES: Clinical diagnosis of AD by a board-certified neurologist using National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association criteria and change in global and specific measures of cognitive function, compared by cognitive activity score at baseline. RESULTS: Baseline scores on the composite measure of cognitive activity ranged from 1.57 to 4.71 (mean, 3.57; SD, 0.55), with higher scores indicating more frequent activity. During an average of 4.5 years of follow-up, 111 persons developed AD. In a proportional hazards model that controlled for age, sex, and education, a 1-point increase in cognitive activity score was associated with a 33% reduction in risk of AD (hazard ratio, 0.67; 95% confidence interval, 0.49-0.92). Results were comparable when persons with memory impairment at baseline were excluded and when terms for the apolipoprotein E epsilon4 allele and other medical conditions were added. In random-effects models that controlled for age, sex, education, and baseline level of cognitive function, a 1-point increase in cognitive activity was associated with reduced decline in global cognition (by 47%), working memory (by 60%), and perceptual speed (by 30%). CONCLUSION: These results suggest that frequent participation in cognitively stimulating activities is associated with reduced risk of AD.

Aged↗