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Immigrant women speak of chronic illness: the social construction of the devalued self.

This inquiry into the existential experience of chronic illness by immigrant women begins from a phenomenological perspective, and proceeds to examine the context in which women's experiences are embedded. It is argued that multiple factors influence the ability to manage illness. Not least among them are the emotions that are an integral part of daily existence, and the sense of self that is constructed during the course of a chronic illness. These emotions, and the definitions of self embodied within the illness experience, are produced in ongoing social interactions. For the immigrant woman, the difficulties in living with a chronic illness are exacerbated by the experience of uprooting from her homeland and resettling in a new country. She must deal with her marginality, social isolation and alienation in a foreign culture. The feeling of being devalued arises not only from the chronic illness experience, but also from the definition of self that is constructed in dealing with the migration experience. The implications that this research study has for the profession of nursing are discussed.

Acculturation↗

Two portraits of caring: a comparison of the artists, Leininger and Watson.

Two nursing leaders, Madeleine Leininger and Jean Watson, have devoted their careers to studying and evolving the meaning of caring. The theme of caring as presented by each theorist was explored along with their views of the nature of nursing, use of theory development strategies, and their individual contributions to the development of nursing knowledge. Both identify nursing as a humanistic science, with the concept of caring being the central unifying domain of nursing. Consistent with their belief that the humanistic sciences require a different research methodology to study that which is uniquely human, both have utilized qualitative research methodologies in their study of care. The evolution of each theorist perspective of care reflects their own background and experiences. Each theorist, therefore, has painted a different portrait of caring, demonstrating a differing emphasis on philosophical, cultural and empirical concerns. For Leininger, caring must be placed in a cultural context since caring patterns can differ transculturally. Watson has focused on the philosophic (existential--phenomenological) and spiritual basis of caring and sees caring as the ethical and moral ideal of nursing. Both Leininger and Watson have demonstrated their artistry in their individual portraits of caring and in their contributions to the development of nursing knowledge.

Empathy↗

Abbreviated instrument to measure hope: development and psychometric evaluation.

The purpose of this research was to develop and evaluate psychometrically an abbreviated instrument to assess hope in adults in clinical settings. The Herth Hope Index (HHI), a 12-item adapted version of the Herth Hope Scale (HHS), was tested with a convenience sample of 172 ill adults. Alpha coefficient was 0.97 with a 2-week test-retest reliability of 0.91. Criterion-related validity was established by correlating the HHI with the parent HHS (r = 0.92), the Existential Well-Being Scale (r = 0.84) and the Nowotny Hope Scale (r = 0.81). Divergent validity with the Hopelessness Scale was established (r = -0.73). Construct validity was supported through the factorial isolation of three factors: (a) temporality and future; (b) positive readiness and expectancy; (c) interconnectedness. These three factors accounted for 41% of the total variance in the measure.

Adult↗

Cardiac nurses' preparedness to use self-help groups as a support strategy.

Self-help groups are lay, mutual support groups in which people who share some long-term existential problems in their lives meet regularly to support each other empathetically. These groups can be viewed as supplementary sources of support outside patients' existing social networks. As such, it is of importance to be aware of them when planning nursing care. The aim of this study was to examine cardiac nurses' preparedness to use self-help groups as a support strategy. A qualitative research method was used and 12 registered nurses from two coronary care units were interviewed. The findings showed that nurses knowledge of social support, self-help groups and of patients' social circumstances as well as their attitudes to their own roles as nurses were of importance in their preparedness to use self-help groups as a support strategy. Lack of knowledge of social support and self-help groups affected the nurses' attitudes towards lay care and was probably the reason for not using self-help groups as a support strategy. Most of the nurses were well informed about their patients' social circumstances, they had an explicit family nursing approach and were not at all against further expansion of their nursing role. However, there is a need for education in innovative ways of working that respond to and interact with informal support networks if nurses are to be able to contribute to empowerment of their patients.

Adult↗

Women's experience of living with cancer.

This paper is drawn from a piece of empirical research which set out to give three women the opportunity to speak on their own behalf about how they experience having cancer in a sexual organ, using a feminist methodology to produce autobiographical stories. The stories describe the process of diagnosis and treatment and also convey the catastrophic nature of a diagnosis of cancer, which leads to a painful, existential crisis and feelings of bewilderment, powerlessness and isolation. The work was prompted by attendance at a workshop about cancer, body image and sexuality for sufferers and carers, which had indicated a depth of pain greater than is usually acknowledged. This pain suggested a fundamental link between body image and the posited concept of woman image; the existence of a common identity through the category woman as it is traditionally structured in society. This link is explored in relation to the evident changes in body image and the compromised sexualities of the women. The disabling consequences of female sexual stereotyping are elaborated and discussed as synergistic with the more fundamental stigma shadow cast by the prospect of dying. The paper discusses possible reasons for this in the context of a transformative rather than restorative model of living with cancer. It suggests that being thrown into self-conscious living could be a source of energy for renegotiation for women especially. The inadequacy of the medical model of disease is exposed and a more holistic approach is shown to be essential to address the needs of cancer patients, as is a critical appraisal and adjustment of existing social attitudes and relations.

Attitude to Death↗

On becoming dependent on home mechanical ventilation.

AIM: The aim of this paper is to illuminate meanings of becoming dependent on home mechanical ventilator treatment. BACKGROUND: People suffering from chronic alveolar hypoventilation and requiring home mechanical ventilation represent a small but increasing group in society, and are some of the most vulnerable individuals with chronic disabilities. METHOD: Thirteen people about to begin ventilator treatment at home were interviewed. Data were tape-recorded and analysed according to a phenomenological-hermeneutic method. FINDINGS: Findings revealed two contrasting meanings of being in the process of becoming dependent on a ventilator, interpreted as getting breath or holding breath. This interpretation is presented in two composite stories. CONCLUSIONS: The findings imply possibilities and deficiencies in meeting patients' existential needs, such as helping them to breathe spiritually by supporting them as they get their breath after such a life-changing event as becoming dependent on a ventilator.

Adaptation, Psychological↗

Ways of talking about experiences of pain among older patients following orthopaedic surgery.

AIM: The aim of this study was to examine how older patients who had undergone hip surgery described their experience of pain. BACKGROUND: A verbal report of pain is considered to be the single most reliable indicator of a person's pain experience. When assessing pain, healthcare professionals must be able to interpret the content of pain reports in order to understand older patient's pain experiences. METHODS: The study was carried out in two orthopaedic and two elder care wards in a large university hospital in Sweden in 2000. Altogether, 38 patients with hip replacement (mean age = 75) and 22 patients with hip fracture (mean age = 81) took part. A face-to-face interview was conducted with each patient on the second day after operation. Data were transcribed and analysed using descriptive qualitative content analysis. FINDINGS: Participants expressed their pain in a nuanced and detailed way in everyday language. Four main themes with sub-themes emerged: (a) objectification (localizing; quantifying; characterizing; temporalizing); (b) compensating (substitution; picturing); (c) explaining (functionalizing pain and its relief; externalizing pain and its relief); (d) existentializing (present pain orientation; future pain orientation). CONCLUSIONS: Exploring the ways older patients talk about pain is expected to result in a better understanding of the older patient's need of empathic individualized care and in the optimization of pain management.

Aged↗

'Preparative waiting' and coping theory with patients going through gastric diagnosis.

AIM: This paper reports a study of how hospitalized patients with gastro-intestinal problems going through diagnostic workups experience and handle the situation. It presents a theory of 'preparative waiting' and discusses it in relation to Lazarus' theory of appraisal, stress and coping. BACKGROUND: The pre-diagnostic phase is reported to be the most stressful time of the illness for patients, but there is little research on this with patients in gastric units. According to Lazarus, appraisal and coping are concurrent, and stress must be understood as both an intra- and an inter-personal process. METHOD: A grounded theory design was chosen to conduct and analyse 18 in-depth interviews with 15 patients in a gastric unit at a Norwegian university hospital. The data were collected in 2002-2003. FINDINGS: Participants' main concern was found to be how to prepare themselves for the results of the investigation and for life afterwards. The substantive grounded theory of 'Preparative waiting' presented here explains how they acted to do so. To be in the diagnostic phase meant to be in a process of continuously attempting to make sense of one's situation. Participants could judge their case to be harmful, a threat, a challenge, a benefit, or combinations of these. Their searches for realistic interpretation were balanced with searches for hopeful signs. This, together with lowering and rising of awareness, prevented them from despair. The process of understanding and handling the situation was concurrent, and was influenced by their relationships with family, friends, fellow patients, healthcare personnel and God. CONCLUSION: To the degree that patients trusted that nurses understood and were sensitive to the complex processes of appraising and coping, they became patients' key support persons. By providing adjusted information, coordinating care and examinations, respecting privacy, and inquiring about existential concerns, nurses could promote patients' ability to prepare for receiving the diagnosis and life after.

Adaptation, Psychological↗

Patients' experiences of living with oesophageal cancer.

AIMS: The aim of this study is to describe patients' experiences of living with oesophageal cancer and how they seek information. BACKGROUND: Oesophageal cancer is a devastating disease with poor prognosis. Nursing care for individuals with oesophageal cancer requires increased knowledge of how they experience illness and how it affects them. METHOD: Data were collected by semi-structured, qualitative interviews with 13 participants. Content analysis was used to analyse data. RESULTS: Four themes were identified: (i) Experiences of becoming a patient diagnosed with oesophageal cancer is distinguished by the participants' experiences of vague symptoms, of receiving the diagnosis and of existential concerns evoked by the illness. (ii) Experiences of undergoing investigations and treatment consist of the participants' experiences of extreme tiredness in relation to investigations and treatment. (iii) Experiences of intrusions in daily life is conceptualized by the participants' experiences of how the illness influenced their daily life. (iv) Managing a life-threatening illness consists of a variety of strategies, which the participants employed to manage their life-threatening illness. CONCLUSIONS: The participants were unprepared of receiving a diagnosis of oesophageal cancer. Dysphagia, fatigue and uncertainty influenced the participants' everyday life. To manage the illness one of their strategies was seeking for information. The physicians were considered the main source of information, but family as well as friends with medical knowledge were also acknowledged as valuable sources. RELEVANCE TO CLINICAL PRACTICE: Understanding patients' experiences of living with oesophageal cancer is important to improve nursing care. When caring for these patients, focus ought to be on the whole family. In nursing care, it is important to be aware of the effects of dysphagia and fatigue. Health-care professionals ought to organize meetings with fellow patients and recommend literature and websites that provide patients with high quality information.

Activities of Daily Living↗

East meets West: applying Eastern spirituality in clinical practice.

AIMS AND OBJECTIVES: The paper discusses the application of the Eastern body-mind-spirit approach in healthcare practice. BACKGROUND: Traumas, sufferings and losses may induce immense distress in patients and their families, as well as apathy and exhaustion in healthcare workers. Over-specialization and compartmentalization of services may provide a convenient shelter for healthcare workers to be detached and to simply focus on a narrowly defined scope of intervention. However, the existential problems are still there. Based upon eastern philosophies and holistic health practices, we propose the body-mind-spirit approach in healthcare settings. METHODS: This is a review paper summarizing the application of the approach on various clinical populations. RESULTS: The approach has been trialled with promising results in a number of health conditions and psychosocial predicaments. Spirituality is not restricted to any religious practices, nor is it narrowed to the pursuit of knowledge at a high level of abstraction. The interconnectedness of the body, mind and spirit presupposes that the practice of spirituality is multidimensional and multi-levelled. CONCLUSIONS: Using the body-mind-spirit framework flexibly we can engage more clients while facilitating the important process of exploration and change. The key components include getting in touch with the inner self, coming back to our senses, connecting our body and mind and rebalancing our relationship with the natural and social environment. The ultimate goal is to move out of meaninglessness and to reach a state of mature spirituality of tranquillity and transcendence. RELEVANCE TO CLINICAL PRACTICE: The practice of spirituality can be easily applied to daily life.

Adaptation, Psychological↗

Psychiatric nurses' response to suicidal psychiatric inpatients: struggling with self and sufferer.

Research on nurses' responses to suicidal patients is sparse. The purpose of this secondary analysis of qualitative data from interviews with 19 nurses employed in Norway was to describe nurses' responses to suicidal psychiatric inpatients. Thematic analyses revealed four themes: 'struggling with discernment of self and sufferer'; 'reconciling inner dialogue'; 'opening up while envisioning self from sufferer'; and 'revisioning the meaning of life revealed over time'. The main theme was 'struggling with self and sufferer'. While these findings reveal existential issues and self reflections of psychiatric nurses' struggle with the suffering of suicidal patients, they also contribute to a methodological debate. Further research is needed to examine nurses' responses to suicidal patients in various settings and to develop secondary analysis of qualitative data.

Attitude of Health Personnel↗

Sisyphus happy: the experience of depression.

Depression has been well documented, in the academic sense. This paper offers one person's experience of periods of depression. It describes symptoms and personal ideas about this commonly experienced condition. It raises questions about the legitimacy of psychiatric and psychological theorizing, and draws from various existential positions to support the text. The author suggests that depression is not, particularly a 'learning experience' and, far less, a form of personal growth.

Attitude↗

Transplanted children's experiences of daily living: children's narratives about their lives following transplantation.

Transplantation is often an appropriate choice of treatment for children with end-stage renal, liver, heart or lung disease. Over the last decade, mortality and morbidity figures have been relatively stable and quality of life fairly good in children who have undergone organ transplantation. Few studies however, have focused on the experiences of transplantation from the child's perspective. The child's view is an important factor when evaluating the 'true' outcome and quality of life after transplantation. The aim of the present study was to illuminate the meaning of transplanted children's experiences of daily living. Unstructured interviews were carried out with 18 children and adolescents, aged 4-18 yr, who had undergone organ transplantation. Their narratives were transcribed and interpreted using a phenomenologic-hermeneutic method inspired by the philosophy of Ricoeur. Two main themes emerged: Being satisfied with life, with the themes: being able to live a normal life; someone who cares; coping with one's new life; and being dissatisfied with life, with the themes: not being able to live a normal life; lacking someone who cares; not being respected; existential thoughts. Most of the children and adolescents were of the opinion that they lived a normal life while the rest strived to achieve a normal life. Social support and mental support were of great importance and, when lacking, had negative consequences. Multi-disciplinary co-operation between healthcare professionals and between the healthcare system, the school and the family is crucial in order to optimize the outcome and quality of life after organ transplantation in children.

Activities of Daily Living↗

Quality of life compared during pharmacological treatments and clinical monitoring for non-localized prostate cancer: a randomized controlled trial.

OBJECTIVES: To investigate the effects of different management strategies for non-localized prostate cancer on men's quality of life and cognitive functioning. PATIENTS, SUBJECTS AND METHODS: Men with prostate cancer were randomly assigned to one of four treatment arms: leuprorelin, goserelin, cyproterone acetate (CPA), or close clinical monitoring. In a repeated-measures design, men were assessed before treatment (baseline) and after 6 and 12 months of treatment. A community comparison group of men of the same age with no prostate cancer participated for the same length of time. The men were recruited from public and private urology departments from university teaching hospitals. All those with prostate cancer who were eligible for hormonal therapy had no symptoms requiring immediate therapy. In all, 82 patients were randomized and 62 completed the 1-year study, and of the 20 community participants, 15 completed the study. The main outcome measures were obtained from questionnaires on emotional distress, existential satisfaction, physical function and symptoms, social and role function, subjective cognitive function, and sexual function, combined with standard neuropsychological tests of memory, attention, and executive functions. RESULTS: Sexual dysfunction increased for patients on androgen-suppressing therapies, and emotional distress increased in those assigned to CPA or close clinical monitoring. Compared with before treatment there was evidence of an adverse effect of leuprorelin, goserelin, and CPA on cognitive function. CONCLUSIONS: In deciding the timing of androgen suppression therapy for prostate cancer, consideration should be given to potential adverse effects on quality of life and cognitive function.

Aged↗

Peace of mind as an important aspect of old people's health.

The purpose of this study was to investigate what concept of health was relevant for old people. Interviews were made with men and women aged over 60, institutionalised for somatic long-term care. Data were gathered in unstructured interviews and analysed by means of the ethnonursing method. The interviewees' descriptions of health were arranged as a concept model, consisting of three hierarchical levels. The first level dealt with the possibility of living a fairly comfortable life. The second level was concerned with positive self-esteem and the third and most crucial one described the existence or non-existence of a mental state of mind defined as peace of mind. The results were compared with existing health definitions and psychological/philosophical theories. The conclusion was that health definitions stressing physical, mental, and social perfection were not relevant for old people, whereas multidimensional health models such as those of Eriksson and Smith appeared to be adequate measures in planning for old people. The comparison with Homburger Erikson's theory and with existentialism revealed many corresponding traits, which might explain some of the differences between the patients and might also give the hope of a possibility of adequate nursing support. Religion was no discriminating factor in this material. As the third level was presented as the most important one and nursing support seemed possible, further investigations were suggested.

Adaptation, Psychological↗

Physiotherapeutic treatment in out-patient psychiatric care.

The present paper aims at describing historical features, developmental trends and key concepts in psychiatric physiotherapy (PPT). PPT was offered as an additional treatment to conventional psychiatric care and the aim was to examine the possibility of carrying out PPT with ten unselected patients (n = 10) in an out-patient psychiatric clinic. Symptoms presented: anxiety and phobic states, depression and crisis reactions. The purpose of four individual sessions was to stimulate curiosity and offer exercises concerning body-mind interactions. In examination of data qualitative research methods were used. All patients accepted the offer of PPT and participated in all sessions. Nine reported great or moderate symptom reduction. Of greatest importance for relief of symptoms was the patient's level of 'engagement'. PPT implies physical proximity and an encounter on an existential level. The impact of a complementary physical approach in psychiatric care needs to be further elucidated.

Adult↗

Changes in religiousness and spirituality attributed to HIV/AIDS: are there sex and race differences?

BACKGROUND/OBJECTIVE: Having a serious illness such as HIV/AIDS raises existential issues, which are potentially manifested as changes in religiousness and spirituality. The objective of this study was (1) to describe changes in religiousness and spirituality of people with HIV/AIDS, and (2) to determine if these changes differed by sex and race. METHODS: Three-hundred and forty-seven adults with HIV/AIDS from 4 sites were asked demographic, clinical, and religious/spiritual questions. Six religious/spiritual questions assessed personal and social domains of religiousness and spirituality. RESULTS: Eighty-eight participants (25%) reported being "more religious" and 142 (41%) reported being "more spiritual" since being diagnosed with HIV/AIDS. Approximately 1 in 4 participants also reported that they felt more alienated by a religious group since their HIV/AIDS diagnosis and approximately 1 in 10 reported changing their place of religious worship because of HIV/AIDS. A total of 174 participants (50%) believed that their religiousness/spirituality helped them live longer. Fewer Caucasians than African Americans reported becoming more spiritual since their HIV/AIDS diagnosis (37% vs 52%, respectively; P<.015), more Caucasians than African Americans felt alienated from religious communities (44% vs 21%, respectively; P<.001), and fewer Caucasians than African Americans believed that their religiousness/spirituality helped them live longer (41% vs 68% respectively; P<.001). There were no significantly different reported changes in religious and spiritual experiences by sex. CONCLUSIONS: Many participants report having become more spiritual or religious since contracting HIV/AIDS, though many have felt alienated by a religious group-some to the point of changing their place of worship. Clinicians conducting spiritual assessments should be aware that changes in religious and spiritual experiences attributed to HIV/AIDS might differ between Caucasian and African Americans.

Adult↗

Family therapy after the divorce: developing a strategy.

Family therapy with the whole family after a divorce has taken place provides a unique opportunity for intervention. Though the spouses have legally terminated their relationship, their parenting function remains. However, this reality is often clouded by the emotional conflicts generated by the divorce. Family therapy can be useful in facilitating life in the post-divorce period. A four-part model for intervention is described. The first task is to redefine the family as existentially including all members. Next, generational boundaries are firmed in order to reduce the parentification process, often intensified by the parent's physical absence. Third, the family needs to have a replay of the history of the marriage to correct developmental distortions and offer a changce to mourn the loss of the intact family. Finally, the therapists attempt to facilitate an emotional divorce. A case study is presented to elucidate the manner in which these steps unfold in treatment.

Child Development↗