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PubMed2006

"Crying alone with my child:" parenting a school age child diagnosed with bipolar disorder.

Recent years have seen a rise in the number of children diagnosed at an early age with bipolar disorder and evidence is increasing that parents are performing most of the caregiving and illness management. This existential phenomenological study describes the personal experience of the parents whose children, age 6-11 years, are diagnosed with Bipolar Disorder. The thematic structure that emerged revealed that the parents in this study, strong advocates for their children, were experiencing unrelenting fear, frustration, loneliness, and hurt. The considerable health implications, affecting both the parent and the child, of lack of respite, loss of self, asynchrony, and chronic fear are discussed. Based on the findings of this study, the psychiatric nurse is in an ideal position to increase interventions that are supportive of parents.

Adaptation, Psychological↗
PubMed2005

Beyond weeping and crying: a gender analysis of expressions of depression.

OBJECTIVE: To explore depression from a gender perspective, by capturing depressed women's and men's formulations of their experiences and understanding of their situation. DESIGN: Qualitative interview study. SETTING: A healthcare centre in northern Sweden. SUBJECTS: Eighteen patients who had been diagnosed with depression and treated for at least 6 months were interviewed in depth, both women and men of different ages and social status. Open questions were posed around the themes of Malterud's key questions, focusing especially on how the informants conveyed their experiences. Interviewing and qualitative data analysis went on simultaneously. RESULTS: The experience of depression held similarities for men and women, but the outward manifestations differed by gender as well as socioeconomic status. Though experiences of high demands underlay the narratives of all informants, home or work had different priority. Men talked more easily about physical distress--often the heart--than about emotions. Women verbalized more readily emotional distress--shame and guilt--while physical symptoms often revolved around the stomach. Men dealt with insecurity by aggrandizing their previous competence, women by self-effacement. CONCLUSION. As clinicians we must listen attentively not only to the manifest but to the avoided or unarticulated. By doing so we might counteract normative gender patterns that highlight the depression of women and conceal that of men.

Adult↗
PubMed2005

"If we didn't use humor, we'd cry": humorous coping communication in health care settings.

Folkman and Lazarus's transactional theory of emotion and coping was used to explain how humor influences job satisfaction among health care providers. One hundred forty-two nurses completed measures of humor orientation (HO), coping efficacy, job satisfaction, and open-ended questions about their use of humor to relieve job tensions. This produced 9 categories of producing humor and 8 types of work situations identified in which humor was used to cope. Nurses (21.4%) reported using humor the most often during "patient care" situations (e.g., providing medicines, moving patients, physical therapy, and so on). More than one third (38.66%) of the nurses reported using "word-play/language" as a humorous coping strategy. Higher HO was associated with higher ratings of humor effectiveness, greater self-perceived coping efficacy, and higher emotional expressivity. Path analysis demonstrated that, as the transactional theory would predict, trait HO influences job satisfaction through its effect on heightened coping efficacy. Study limitations include the use of self-report methods and the limited number of responses to the open-ended items. Subsequent research in this area should attempt to validate the categories identified in this study and determine the most effective means of coping. Researchers also should explore differences in health care providers' coping communication based on gender, years of experience, and profession.

Adaptation, Psychological↗
PubMed1996

"I've been crying my way"--qualitative analysis of a group of female patients' consultation experiences.

BACKGROUND AND OBJECTIVES: What do women patients, sick-listed for biomedically undefined musculoskeletal disorders, expect and experience when they consult a doctor? With the purpose to learn more about this, a qualitative interview study was conducted. METHODS: Twenty women participated. They were patients at an urban health care centre in northern Sweden. Data were gained through repeated, semi-structured interviews, and analysed according to grounded theory. RESULTS: The participants described an atmosphere of distrust in the consultation. They had felt ignored, disregarded and rejected by doctors, and had worked out strategies to keep up medical attention in their search for a creditable diagnosis. They were somatizing, claiming under cover, and pleading, to catch the doctor's interest. In addition, they upheld their self-respect by mystifying and martyrizing themselves and their symptoms, and by condemning physicians as ignorant. DISCUSSION: The patient's consultation experiences are discussed from different aspects; the biomedical framework, the power asymmetry, and the gendered positions of patient and doctor. The findings indicate the importance of making doctors aware of the context behind frustrations in doctor-patient interaction.

Adult↗
PubMed2003

Musculoskeletal assessment of general medical in-patients--joints still crying out for attention.

OBJECTIVES: The aim of this study was to assess the extent of musculoskeletal assessment (history and examination) amongst medical in-patients and to determine the effects that GALS (gait, arms, legs, spine) teaching has had on this. METHODS: General medical in-patients were interviewed and examined. Case notes were reviewed to determine diagnoses and assess documentation of clinical signs and/or symptoms. Doctors were interviewed to determine whether they had been taught the GALS locomotor screen, assess their confidence in examining the musculoskeletal system and explore their attitudes to musculoskeletal problems. RESULTS: The presence or absence of locomotor symptoms was recorded in 50% of the 100 patients, whilst signs were recorded in 20%; 63% of all the patients had locomotor symptoms and/or signs. Relevant musculoskeletal history was missed in 49% of the patients, whilst signs were missed in 78%; 42% of those with musculoskeletal conditions would have benefited from additional treatment. Teaching of the GALS screen significantly increased doctors' confidence in examination of the locomotor system. CONCLUSIONS: Active musculoskeletal problems are seen frequently amongst medical in-patients. There is a significant discrepancy between the number of patients with clinical symptoms and signs and the frequency with which they are detected and treated.

Education, Medical, Graduate↗
PubMed2004

More 'cries from the joints': assessment of the musculoskeletal system is poorly documented in routine paediatric clerking.

OBJECTIVES: The aim of this study was to describe the assessment of the musculoskeletal (MSK) system in comparison with other systems in routine paediatric medical clerking. Furthermore, to survey trainee paediatricians (SPRs, specialist registrars) about their self-rated confidence in assessing the MSK system. METHODS: Case notes of consecutive general paediatric medical patients admitted to three UK hospitals over a 4-week period were assessed using a standard pro forma. All patients had been assessed by a consultant paediatrician during their admission. A postal questionnaire was sent to all SPRs in training in each of the hospitals, regarding their confidence in assessing the MSK system compared with other systems and their exposure to MSK teaching. RESULTS: Case notes of 257 patients [117 females, median age 3 yr (range 1-18 yr)] were reviewed. The most common reason for admission was acute infection, although the spectrum of other recorded diagnoses varied between hospitals. Thirteen children (5%) had an acute problem (e.g. infection) against a background of chronic disease. The case note documentation showed that cardiovascular (CVS), respiratory (RS) and gastrointestinal (GI) systems were assessed in the vast majority (>90%) of patients, irrespective of the underlying diagnosis. However, other systems were less well recorded; the trend being the same in each hospital and in descending order, the neurological system (38%), skin (32%), eyes (10%) and musculoskeletal system (4%). Only 2.7% (7/257) patients were documented to have been asked about MSK symptoms, and only 1.6% (4/257) had any documentation of joint examination--in all cases this was limited (e.g. range of movement of the knee only), and no patients had documentation of gait being examined, even in those children presenting with 'limp'. The response rate to the postal questionnaire was 60% (67/112). The self-rated confidence in MSK assessment was markedly low in comparison with other systems, even though 61/67 recalled some teaching of the MSK system as an undergraduate (61/67) or postgraduate (50/67). Of note none could recall teaching as an undergraduate in paediatric MSK assessment and where there had been postgraduate rheumatology MSK teaching this had been delivered by paediatric rheumatologists in many cases (34/50), reflecting the centres participating in the study. CONCLUSIONS: In routine general paediatric medical in-patient clerking and throughout the admission, MSK assessment was rarely documented, and even where present was limited. This contrasts markedly with other systems which were examined in most children irrespective of the presenting complaint. Self-rated confidence in MSK assessment is low amongst SPRs compared with other systems, despite most recalling some teaching. This discrepancy between teaching and clinical practice needs to be addressed in undergraduate and postgraduate training.

Adolescent↗