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PubMed2005

Self-care of women growing older with HIV and/or AIDS.

The purpose of this report is to describe the ways older women living with HIV perceive of and practice self-care. Data are taken from a culturally diverse subsample of 9 women age 50 years or older who participated in a larger longitudinal qualitative study of women who were HIV infected. During a period of 2 years, 10 semistructured narrative interviews were conducted with each of the 9 participants to gain an in-depth understanding of their experiences with symptom management, adherence to medical regimens, reduction of HIV risk, access to health care and social services, and personal efforts to maintain their health. Transcribed data were managed using Nvivo software and analyzed using multistaged narrative analysis. Findings suggest that mature women living with HIV integrate actions to maintain bodily comfort and improve physical well-being with actions that champion and conserve the existential self. Excerpts from their interviews illustrate this dialectical understanding of self-care.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Issues of control in patients with cancer pain.

The enhancement of patient control is frequently cited in nursing literature as an important area of nursing intervention. In this article, the concept of control, from the perspective of the patient with cancer pain, the primary family caregiver, and the home-care nurse, is discussed. Lewis identified five types of control: processual control, contingency control, cognitive control, behavioral control, and existential control. Lewis's typology of control was used as an organizing analytical framework, in this study, for interpreting the interview responses of each member of the triad. Similarities and differences in the perspectives of each member are discussed and examples of interventions that may be used to increase control in the management of pain are presented.

Community Health Nursing↗
PubMed2006

Desire for hastened death in patients with advanced disease and the evidence base of clinical guidelines: a systematic review.

PURPOSE: Patients' desire for hastened death within the context of advanced disease and palliative care is a controversial topic, frequently discussed in the international literature. Much of the discussion has focused on opinion and debate about ethical matters related to hastened death. Not many research studies seem to have specifically targeted why palliative care patients may desire hastened death, and few have focused on clinical guidelines for responding to such requests. METHODS: Using a systematic literature review process, we evaluated the research evidence related to the reasons patients express a desire for a hastened death, and the quality of clinical guidelines in this area. RESULTS: Thirty-five research studies met the inclusion criteria related to reasons associated with a desire for hastened death. The factors associated with a desire to die were often complex and multifactorial; however, psychological, existential and social reasons seem to be more prominent than those directly related to physical symptoms, such as pain. Much of the evidence supporting the reasons for these statements is based on: (a) patients' perceptions of how they may feel in the future, and (b) health professionals' and families' interpretations of why desire to die statements may have been made. Several publications provided expert opinion for responding to requests for physician-assisted suicide and euthanasia. In keeping with this limited research base, there is a lack of evidence-based guidelines for clinical care that addresses the desire to die among terminally ill patients. Most literature has focused on discipline specific responses, with minimal exploration of how clinicians might respond initially to a statement from a patient regarding a desire to die. CONCLUSIONS: In order to advance understanding of the complex issue of desire for hastened death in the context of palliative care, research should focus on studies with patients who have actually made a desire to die statement and the development of guidelines to help health professionals respond. Direction for research in this area is described.

Attitude to Death↗
PubMed2006

Measurement of psychological distress in palliative care.

Research investigating the psychological distress of palliative care patients has contributed to our understanding of the needs and experiences of individuals approaching death. This paper aims to provide a brief review of such measurement of psychological distress in palliative care, focusing on established psychiatric and psychological research tools, and quantitative research methods. This includes clinical screening and diagnostic assessment instruments used to identify key distress-related symptoms and the presence of common clinical syndromes, such as depression, anxiety, delirium, as well as the broader psychological dimensions of suffering, such as existential concerns, spirituality, hope and demoralisation. There are important considerations in undertaking psychological research in palliative care, such as maintaining a balance between the methods and measurements that will address key research questions, and sensitivity to the range of physical and emotional demands facing individuals at the point of receiving palliative care. The clinical application of psychological and psychiatric research tools and methods can aid the detection of psychological distress, aid the thorough assessment of the psychological dimension of the patients' illness and care, aid the identification of individuals who would benefit from specific psychotherapeutic or pharmacologic interventions, and the evaluation of response to treatments.

Anxiety↗
PubMed1997

Does being religious help or hinder coping with chronic illness? A critical literature review.

This paper reviews a number of studies relating to religion and coping with chronic illness, emphasizing those aspects relevant to palliative care. After pointing out that religious and existential needs are common in chronic illness, a critical examination is made of those studies which purport to demonstrate associations between spiritual beliefs, religious practices and psychological prognosis. Recommendations are made as to how religious issues can be dealt with in clinical practice, with particular relevance to the multidisciplinary palliative care team.

Adaptation, Psychological↗
PubMedDate not supplied

Suicide and suicidal thoughts in cancer patients.

BACKGROUND: [corrected] Many factors increase vulnerability to suicide in cancer patients. Uncontrolled pain and other physical symptoms, psychological distress, and existential suffering are related to suicide in oncology. There is a strong consensus that physicians and nurses are not adequately trained to manage the potential suicide patient. This paper offers suggestions for the early recognition of cancer patients at risk of suicide, for the planning of crisis intervention and a physician-patient communication strategy. METHODS: A review of the literature about suicide in cancer patients was carried out by MEDLINE and PSYLIT and peer contacts. RESULTS: Through a review of the literature and their clinical experience, the authors outline a number of vulnerability factors of suicide with the intention to help health professionals to face the dilemma of suicide in cancer patients. Clinical vignettes reveal how a patient may reject his/her suicidal intention if adequate pharmacological and psychosocial supports are offered. Other case reports of patients refusing cancer therapy show that suicide is a complex phenomenon touching ethical, sociological, medical and psychiatric issues. CONCLUSIONS: Our findings support the hypothesis that improved patient-physician communication, to supply adequate psychological crisis intervention, respect for patient-centered care, familiarity with the tenets of palliative medicine alongside effective education in suicidology, and the routine use of teamwork may reduce the need of suicide in cancer patients and probably the need to hasten death.

Crisis Intervention↗
PubMed2003

Female repeat offenders negotiating identity.

This study examines the process of identity negotiation for Israeli female ex-convicts who were separated for extensive periods of time from their children and eventually lost custody over them. The content analysis of in-depth interviews reveals that these women were able to reconstruct their biographies and retrospectively account for their crimes and drug addiction in terms of the sexual, physical, and economic abuse they had endured and by appeal to higher loyalties, their children who they had to provide for. However, when having to account for their fallings as mothers, all biographical reconstruction, external blame, and accusation collapsed. Looking at themselves through their children's eyes, female offenders were simply unable to renegotiate the imputed identity of incompetent mother. They could neither confront their children's anger nor explain to them why they had abandoned them. Permanently alienated from the center of motherhood, these women were doomed to an existential chaos.

Adult↗
PubMed2005

Exploring the type-of-crime hypothesis, religiosity, and spirituality in an adult male prison population.

This study examined the association between measures of spirituality and religiosity and characteristics of current criminal conviction in a male prison population. Spirituality was operationalized as spiritual well-being and existential well-being. Religiosity was operationalized as frequency of religious service attendance, whether an individual considered himself to be religious, and how strongly an individual believed his religious beliefs influenced his behavior. Inmates whose convictions were property related reported greater spiritual wellbeing, were more likely to consider themselves religious, and to say that religious beliefs influenced their behavior than inmates whose crimes were not property related. Inmates whose convictions were drug related were less likely to consider themselves religious, and inmates whose conviction involved violence were more likely to consider themselves religious but less likely to endorse statements that religious beliefs influenced their behavior. The distinction between religiosity and spirituality is discussed in terms of the type-of-crime hypothesis.

Adult↗
PubMed1978

Encounter and psychotherapy: a look at the overlap.

Human relations training has moved from the original T-group emphasis on group process, through focusing on the individual's mode of interacting in the group, to the use of the encounter situation for fostering personality change. Psychotherapy is moving out of the dyadic relationship into groups using increasing degrees of confrontation. The resulting overlap in group techniques calls for examination of the part each can play in the overlap area between the clear-cut functions of each specialty. The theoretical basis for differentiation lies in the respective models of awkward ("neurotic") behaviour: psychotherapy starts from the pathological and emphasizes intrapersonal structure, while encounter starts from full-functioning behaviour and emphasizes interpersonal interaction. Practical responsibilities can be divided between encounter and psychotherapy on the basis of the level achieved by an individual moving through a hierarchy of ascending personal achievement levels. Because of the high probability of individuals interchanging between encounter and psychotherapy, practitioners will need to have at least basic knowledge of both systems. Rapprochement could eventually come through the systematic extension of existential psychotherapy.

Humans↗
PubMed2005

Attributes of spiritual care in nursing practice.

Nurses are increasingly being called on to engage in spiritual care with their patients. A diverse body of theoretical and empirical literature addresses spirituality as it relates to nursing practice, yet there is little consensus about what spiritual nursing care entails. The purpose of this article is to conceptualize spiritual care in relation to nursing practice. A brief historical review indicates that our current understandings of spiritual nursing care have been shaped by three eras characterized by particular approaches: the religious approach, the scientific approach, and the existential approach. We draw elements from each of these approaches to propose attributes of spiritual care in the context of nursing practice. We propose that spiritual nursing care is an intuitive, interpersonal, altruistic, and integrative expression that is contingent on the nurse's awareness of the transcendent dimension of life but that reflects the patient's reality.

Holistic Nursing↗
PubMed1996

Swedish Health care personnel's perceptions of disease and treatment-related problems experienced by children with cancer and their families.

In recent decades, the intensification of treatment of children with cancer has resulted in a considerable increase in the number of those cured. The intensive treatment has also led to several problems for the children and their families. The aim of the present study was to identify the physical, psychological, social, and existential problems; symptoms and inconvenience caused by the disease and treatment or the hospital stay determined by Swedish health care personnel to be the most troublesome for children with cancer and their families. A modified three-round Delphi technique was used. In this way, 207 different problems were identified by 24 health care personnel. According to the personnel, the child is most troubled by physical symptoms, and family members are most troubled by feelings of anxiety about future events or possible events. The personnel interpreted the family members' problems as significantly worse than the child's. The results are related to the age and the diagnosis of the child.

Adult↗
PubMed2003

Embracing uncertainty: an exploration of the experiences of childhood cancer survivors.

Uncertainty is a central theme in the cancer survivorship and coping literature. Existing research on cancer-related uncertainty has primarily documented the adverse effects of existential uncertainty on survivors' well-being and located uncertainty within the stress and coping paradigm. Using in-depth qualitative interviews, the authors explores the paradoxical meanings and impact of uncertainty in the lives of long-term survivors of childhood cancer. The findings suggest that although uncertainty can be a source of distress, it can also be a catalyst for growth, a deepened appreciation for life, greater awareness of life purpose, development of confidence and resilience, and optimism. The results suggest that uncertainty is a dialectic phenomenon located within larger contexts of both stress and coping, and psychospiritual growth.

Adaptation, Psychological↗
PubMed2003

The hidden suffering among breast cancer patients: a qualitative metasynthesis.

The aim of this study was to review literature on how the lived experience of breast cancer and suffering was described in nursing/caring literature between 1990 and 2000, and to interpret and discuss the result from the perspective of suffering. The frequent reports of changing courses, called by various names, such as transition, transformation, transcendence, and finding meaning, were found as paths whereby the person regained integrity, balance, and wholeness. When findings were interpreted from the perspective of suffering and an ontological health model, actions, values, and existential concerns were understood as both expedients for alleviating suffering and a sign of the patient's inner struggle.

Breast Neoplasms↗
PubMed2006

Lived experience of chronic pain and fibromyalgia: women's stories from daily life.

The hermeneutic-phenomenological study presented in this article is grounded in a lifeworld perspective. The authors aimed at rich descriptions of women's lived experience of chronic pain and fibromyalgia. They conducted individual life-form interviews with 12 women with fibromyalgia. On the basis of the women's stories, three typologies were developed: at the will of the treacherous body-powerlessness; struggling to escape the treacherous body- ambivalence; and caring for the treacherous body-coping. The lived experience described in the typologies were further interpreted according to the existentials: lived body, lived time and space, and lived relations. The women's stories point to a world experienced as fundamentally changed by a body in chronic pain, describing a struggle in which they feel that their existence is at stake.

Adult↗
PubMed1999

In your skin you are different: women living with ovarian cancer during childbearing years.

The purpose of this study was to understand what it is like to live with ovarian cancer during childbearing years. The primary researcher (PR) conducted three to four in-depth interviews, lasting 60 to 90 minutes each, with five women living with ovarian cancer for 1 to 10 years. Van Manen's method of reflection and writing guided the inquiry. The process of existential investigation expanded the inquiry. Trustworthiness was assured through member checking, reflective journaling, coinvestigators checking the logic of the PR's analysis, and the achievement of consensus through dialogue. Analysis of the data revealed the themes of serendipitous diagnosis, managing treatment, horrible hair experience, hysterectomy violating one's sense of being, unfairness of menopause, body changes, intimate dreaming, being with others, being normal/different, being vigilant, being heard, and trying to make sense of it. The stories revealed provide us with a window into the experience of women with ovarian cancer.

Adult↗
PubMedDate not supplied

Dying to meet you: facing mortality and enabling patient styles.

This paper is intended to emphasize the existence of prognostic uncertainty in providing survival estimates while also providing a method for caring to those who want to authentically help dying patients. Facing one's own mortality helps one compassionately be there for dying patients. The transforming experience of death as essential to one's self as human being, recognizing that one is living a story with death necessarily a part, promises to overcome the tendency to deny the existential meaning of death for dying patients. This tendency manifests itself through dishonesty about medicine's limitations in creating prognoses, and specifically survival estimates, as well as in holding only a curative and not palliative goal of treatment. This tendency will be replaced by honest and compassionate actions with those in the process of dying. Representing this change is a focus on the patient as person, living a certain lifestyle, and defining himself by significant events and relationships in the past, present, and future. Death and dying become meaningful through incorporation into the story and style that is the patient. This meaning that is facilitated by caregivers and created by patients is central to achieving a "good death."

Adaptation, Psychological↗
PubMedDate not supplied

Inner strength among HIV-infected women: nurses can make a difference.

The purpose of this qualitative study was twofold. First, the authors examined the phenomenon of inner strength as a resource that women infected with HIV use to cope with and manage their difficult lives. Second, the authors sought the women's views on the potential impact health care workers, specifically nurses, can have on the activation of inner strength. This study was phenomenologically informed and qualitatively structured. The goal was to construct an analytical understanding of inner strength as it is perceived, defined, experienced, and activated by women infected with HIV. Data were collected by means of 19 conversational, biographical interviews. These interviews were conducted with a stratified (by ethnicity and social class) sample of women infected with HIV. The data were elicited in terms of respondents' stories of living with HIV. The women listed a number of definitions for inner strength such as "the ability to fight" and "the motivation to go on and do better." The women recommended that nurses working with them be sensitive to the following patient concerns: validation, reality, sensitivity, and autonomy. The concept of inner strength can be of great scholarly and clinical value if it is defined as follows: Inner strength refers to the different ways women with serious illnesses experience and talk about the deepest, existential resources available to and used by them to manage severe risks to self-integrity. The recommendations, although somewhat critical of nurses, are plausible because they incorporate nurses' traditional approaches to caring for patients.

Adaptation, Psychological↗
PubMed2003

Adjustment, spirituality, and health in women on hemodialysis.

End stage renal disease (ESRD) is progressive, requiring adjustment. This descriptive correlational study examined levels of and relationships between adjustment, spiritual well-being, and self-perceived health in women with ESRD. The sample included 65 women aged 24 to 82 receiving hemodialysis at five outpatient centers in a large metropolitan area. Frequencies, central tendencies, and correlations were used for analyses. Overall, these women were fairly well adjusted as measured by the Psychosocial Adjustment to Illness Scale-Self-Report. They demonstrated fairly high levels of religious, existential, and overall spiritual well-being. Self-perceived health was good Spiritual well-being variables were all positively and significantly related to overall psychosocial adjustment and psychological distress adjustment. Self-perceived health variables were all positively and significantly related to overall psychosocial adjustment. Few significant relationships were found between spiritual well-being and other adjustment domains and between self-perceived health and other types of adjustment.

Adaptation, Psychological↗