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PubMedDate not supplied

The search for meaning and its potential for affecting growth in bereaved parents.

Because of the unique relationship between parent and child, the death of a child is a profound human loss which ultimately sends bereaved parents into a deep and painful existential "search for meaning." This search may ultimately be a key factor in a positive "growth" versus a negative "despair" resolution of the grief experience. This paper examines data from open-ended questions collected in three separate studies which asked bereaved parents in various ways to describe themselves. The purpose of this descriptive analysis was to seek clues in these self-descriptions regarding both positive and negative resolutions following the death of a child. Although the findings must be considered with caution because of convenience sample and the indirect methods of data collection, the findings indicate that many of the comments given by the parents suggest potentially positive outcomes.

Adult↗
PubMed1985

New Testament story presents model for health care ministry.

Those who minister to the sick and the aged can learn several lessons from the experience of two disciples who met Jesus on the road to Emmaus. Though the men, who were leaving Jerusalem to escape the confusion caused by Jesus' crucifixion, did not initially recognize him, Jesus walked alongside them and drew them into conversation about the preceding days' events. His attentive listening and perceptive questioning, which allowed them to vent their feelings, helped the men to deal with the reality of their suffering. When they asked Christ to remain, he accepted their invitation, knowing that they needed additional support. As they broke bread together that evening, the disciples recognized Jesus, "whereupon he vanished from their sight." Care givers, too, at times need to walk away from their work, not only to allow time for reflection but also to enable patients to experience God's presence. They must be alert to everything a patient says so that words meant to comfort do not cause suffering, and they must learn to recognize the subtle ways in which patients ask them to stay with them. Helping patients face the truth requires courage and the ability to help another appreciate his or her self-worth. Just as the disciples recognized Jesus' presence in those they encountered, so, too, must care givers allow themselves to be transformed at the eucharistic table and to see in others--even the unlovely-an existential, holistic love.

Bible↗
PubMed1986

Study measures nurses' attitudes about providing spiritual care.

Although spiritual care of patients has been reemphasized recently, it remains a sorely neglected aspect of nursing responsibility. The research described in this article focused on one of the major explanations advanced for this neglect: that many nurses personally lack the spiritual resources and the spiritual well-being to effectively meet patients' needs in this regard. Twenty-four graduate nursing students and 29 nursing students in their senior year were surveyed. Two research instruments were used: the Spiritual Well-Being (SWB) Scale, which measures an individual's religious and existential welfare; and the Health Professional's Spiritual Role (HPSR) Scale, which measures attitudes regarding the part that care providers should play in patients' spiritual care. The study confirmed the correlation between a nurses' spiritual well-being and his or her views about the provision of spiritual care by health professionals. The research has several important implications. For example, the SWB Scale can be used by nurses to assess patients' spiritual needs and to determine which nursing interventions are most effective in meeting these needs. Moreover, nurses who score high in the SWB and HPSR scales can be trained as "spiritual specialists," in the same way that nurses are trained in other health care specialties.

Attitude of Health Personnel↗
PubMed1976

Thoughts on love, sex, and commitment.

The effort is made to delineate some of the key issues involved in the interaction of love, sex, and commitment. Coupling is viewed from an ethological perspective that suggests that, in addition to the developmental contribution of the parent-child experience, peer-peer relating is a major determinant of adult hetrosexual relatedness. Couples are next considered as responding to social and economic forces that influence powerfully what types and duration of relationships have survival value. Finally, the nature of the inner experience of couples, their existential awareness of themselves and the other, and the meaning that they attribute to it is discussed. Being a member of a couple is participating in a story, sometimes a "love story," and whether or not it is seen as a good story depends on one's critical vantage point. Finally, the analysis of relationships is contrasted with the experience of a relationship as a gestalt, a whole; not as the sum of its parts.

Female↗
PubMed1999

[Hope].

This article deals with the phenomenon of hope in seriously ill and dying patients. Uncertainty is seen as a prerequisite for hope, fear as the "negative" side of hope. A scheme involving three particular kinds of hope is introduced: Hope on a daily basis; hope concerning a possible eternity; and hope based upon unrealistic premises. In a clinical setting, the question is: Taking into consideration the issues of how to inform and communicate with patients, how may the physician help the patient to express hope, and how may the physician contribute to reinforcing the patient's hope? Within palliative medicine, treatment may involve many aspects of a patient's life. It should be directed against the physical aspects of the disease, as well as the psychological, social, spiritual and existential dimensions of life. There are two fundamental questions patients with terminal cancer disease almost always ask: "Will the disease eventually cause my death?"; and, "Am I going to experience great pain and suffering?" These questions are clearly marked by hope. The hope that there will be little pain, for example, may not only relate to physical pain but to psychological and social pain as well.

Attitude to Death↗
PubMed1999

[On love in medicine].

The message of this essay is that love can be regarded as an essential feature of the practice of medicine. One of the doctor's tasks is to build a bridge between medicine as an "objective" science and the patient as a unique and vulnerable individual. In most medical encounters, the doctor-patient relationship needs not reach down to an existential level. The bridge between medicine and patient may then be minimalistic, based on general competence and respect. On other occasions the nature of the patient's problem requires a bridge able to withstand far stronger emotional forces in order to enable effective and health promoting communication. Building such a bridge is a unique challenge that requires the doctor to invest something of himself--which may be seen as an act of love. The doctor has to be open for whatever the patient has to say and willing to encounter the pain that is hidden deep in many patients' lives. The article includes a patient story (from psychiatry) that illustrates how helping a person reveal a traumatic story from the hidden past can be the first step on the path of recovery. Another aspect of practising medicine with love is not hurting the patient or violating his integrity. This even applies in settings where the doctor-patient relationship is supposedly "neutral". The article contains a second patient story (from maternity care) that illustrates how routine use of advanced medical technology may put the patient (here: her unborn child) in an unforeseen and stressful "risk" category upon which the patient has no possibility to act. The story illustrates the importance of the doctor taking on the responsibility of interpreting such diagnostic uncertainties in a language that the patient can handle intellectually and emotionally. The author suggests the concept of "the grandpa' factor" to describe a working tool in relation to such patients: The "medical grandfather" does not withhold information but deliberately ends his explanations by summing up his view of the situation with an optimistic "prophecy" for the future.

Emotions↗
PubMed1999

Trauma and reconstruction in a large group of refugees.

The study is a continuation of a research which the expert team started in refugee and displaced persons' settlements in Croatia. By studying a group of refugees in its entirety we could not avoid noticing its extremely regressive position. Faced with the refugees' numerous existential problems we took the role of good, caring and tender mother (a good object) who will protect her children, give them security, meet their essential needs. Looking at the group dynamics, in the light of Melanie Klein's theory, we noticed the existence of schizo-paranoid and depressive position in the group, manifesting itself through the gap occuring as defense from its self-destructiveness, i.e. as the protection of introjected object which has be saved from destruction because the true "good object" was destroyed. Through the analysis of schizo-paranoid and depressive position of large group of refugees the aim of our work was to enable the group to gradually overcome the schizo-paranoid position and transfer into a more mature phase of development, thus creating a favorable atmosphere for maturation and self-protection.

Adaptation, Psychological↗
PubMed1999

[Suffering of the heart, song of the lips--some examples from the history of melancholia].

Melancholy--the word has many and varied significations. It has more or less disappeared from the medical vocabulary; in ICD-10 it is only used for depressions with somatic symptoms. However, the concept continues to live on in cultural contexts; in the newspaper as a classification of an artist or his work as a distinguished form of moody creativity, or in cultural theory as an existential or philosophical category. In this article, the historical basis for this remarkable variety of significations is traced. From its beginnings in antiquity with Hippocrates and the humoral theory, through the renaissance focus on the genius, to the separation of humanist and medical disciplines, the concept lives on and takes on new meanings on its way.

Concept Formation↗
PubMed1999

[Psychorelational aspects of the end of life].

The patient nearing the end of life should be considered as a living being who is suffering and who has needs. Overall the suffering is physical, psychological and spiritual. The patient undergoes this final existential crisis filled with both anxiety and hope. Each person has unique mechanisms of defense and adaptation, linked to his personality and background. These unique reactions must be recognised and taken into account in care and in communication in order to maintain a living relationship to the end.

Adaptation, Psychological↗
PubMed1999

Psychiatry by videophone: a trial service in north west England.

In this paper we report on the use of a video link between two general practices and a hospital based mental health team in North West England to provide a trial telepsychiatry service for individuals with depression and anxiety related disorders. Patients (n = 16) took part in an evaluation of the service by both structured questionnaire and semi-structured interview. The results of the evaluation study suggest that patients may be highly critical of telemedicine systems and that they do so not simply on the grounds of the technical quality of video links, but also because the remote link increases the difficulty that the patient faces in expressing deep scated emotional and existential problems. It is not, therefore, simply a matter of technical quality in the link, but also a question of the quality of interpersonal relations perceived by the patient.

Adult↗
PubMed1999

[The nursing diagnosis of "spiritual distress", a necessary re-evaluation].

The subject of the study consisted in identifying the spiritual needs of the terminally ill patients, so as to investigate and specify the implementation field of the diagnosis of "spiritual distress" by the French nurses relative to the values and beliefs. The key moments, when the spiritual needs can express themselves also had to be spotted, in order to investigate the possible role of the nurse faced with the spiritual needs of the patients. The study was carried out on a population of 27 AIDS and cancer patients, hospitalized in two units of palliative cares of the Paris region and on a population of 20 nurses of these same units. It was made during the year 1996 by means of interviews with patients, comprising 51 open or half-open questions and questionnaires for nurses, comprising 20 questions. These tools have been structured on the basis of 4 main lines namely spirituality, religion, the ill being called "spiritual distress", nursing diagnosis (for the nurses). The results from the patients show that nearly all of them have had a feeling of ill being which would be of spiritual nature, where existential questioning prevails concerning the meaning of life, of death, of pain, of illness whereas only slightly more than a third of the nurses think that it happens frequently to the patients. The spiritual distress can be described as the failure of giving a meaning to one's life. Religion is mainly evoked in terms of rites with "mosaic" beliefs specific to each individual. The big majority of the nurses concerned by this study have an intuitive knowledge of the main features of the nursing diagnosis of "spiritual distress". This knowledge does not seem to be linked really to the training they had, but rather to their professional experiences and maybe to the personal life story. This nursing diagnosis does not seem to be adapted to our western culture. Its lack of discriminatory power and of flexibility does not make it very useful for the caretaker who needs to clarify beforehand the concepts of spiritual needs and of religious needs. As for the actions, the appeal to the religion representatives or to the psychologist is not always what the patients want even though the ill being appears mainly when the patients feel lonely ... we therefore resort to actions of relation of help with an active listening and help to the rereading of life for which the nurse is in a rather good position, according to the patients.

Adult↗
PubMed2000

[Phenomenological study on the process to onset and the structure of symptoms in eating disorders].

Psychogenic experiences occurring prior to the onset of eating disorders had previously been ignored as not corresponding to the symptoms. Recently, we have been considering these experiences as outbreak conditions, and have done phenomenological analysis of the experiences themselves with the following results. We found that patients have experienced 1.) "shame", and following that, and from the phenomenological consideration of the experience of "shame", we have observed 2.) "alienation" occurring in each patients, leading to "isolation." In "isolation", the patient is driven to despair due to existential anxiety, and as the ultimate in despair, the patient shows the attitude of 3.) "One wishing to be oneself in despair." (Kierkegaard, S.), or "haughtiness" which is the attitude of "a person who understands himself or herself to be a free design, and considers others as 'existence-others' reached through this design." (Sartre, J. P.) Here, the patient shows "consumption" as a symptom in either of the forms of surfeit (bulimia) or the consumption of one's own body (anorexia): wasting. 4.) These are defined as "conspicuous consumption" (Veblen, T. B.). 5.) Conspicuous consumption has been analyzed as a primitive form of exchange by Mauss, M., and has been mentioned repeatedly in the intellectual lineage of Bataille, G., Baudrillard, J., et al. This action is concerned with the acquisition of social status in order to save one's own face, and shows what forms the depth-psychological base stratum in the "class system" of human beings, as well as illuminating the "social functions of dignity and class distribution." We have discovered a continuous course from the psychogenic experiences occurring at the onset and previously considered trifling and therefore ignored, proceeding to the symptoms and to the structure of the symptoms. In particular, by using a phenomenological analysis of shame and symptom structure, we show a new hypothesis about the structure of symptoms which is completely different from those created according to various previous opinions. Such understanding throws new light on this disease.

Adult↗
PubMed2000

Sedation in the imminently dying patient.

Sedation is a clinically important therapeutic intervention in the imminently dying patient. As the patient with an advanced, irreversible illness nears the end of life, symptoms accumulate that are progressively more difficult to manage and that may become refractory to standard medical interventions. The most common of these intractable symptoms are pain, agitated delirium, dyspnea, and existential or psychological distress. Various therapeutic options available for relieving these symptoms include physician-assisted suicide, euthanasia, acceptance of unrelieved suffering, and terminal sedation. Some commentators have voiced concerns that sedating the imminently dying patient inevitably hastens death, and that this practice, in fact, is a surrogate form of physician-assisted suicide or euthanasia. Ethical arguments invoked to support the use of terminal sedation include the principle of double effect, which draws a moral distinction between the intention of an act (in this case, to relieve suffering) and its foreseen but unintended consequence (premature death). This author views sedation as a necessary, although risk-laden, procedure that, if practiced by trained, dedicated clinicians, maintains the physician's twin obligations to benefit patients and to "do no harm."

Procedural Sedation↗
PubMed2000

[Health and quality of life among long-term unemployed].

BACKGROUND: Many studies have shown an association between unemployment and poor health. MATERIAL AND METHODS: This cross-sectional survey from 1993-94 using structured interviews and questionnaires describes health and quality of life among 148 long-term unemployed in Lillesand, Norway. RESULTS: Compared with the general population, somatoform conditions and anxiety symptoms were twice as common among the unemployed, and depression three times as common. There was a higher frequency of depression among unemployed men than among unemployed women. The unemployed had a lower quality of life score than the general population; the difference was more than twice as large among men as among women. Unemployed aged 30-39 reported the strongest symptoms of anxiety and depression. INTERPRETATION: The reason why unemployed men are more often stricken by depression and report lower quality of life than women, may be that men experience the job-loss more existentially threatening than do women.

Adult↗
PubMed2000

Syndrome X, depression, and chaos: relevance to medical practice.

The low detection rate and undertreatment of depression in general medical practice is pervasive. The persistence of this problem suggests that doubt remains within elements of the medical profession that depression is a medical condition meriting medical treatment, as opposed to an existential state, inevitable for the human condition. Depression is a physical and psychological clinical disorder which affects every aspect of human physiology. As such it deserves consideration as a comorbid medical illness requiring treatment as does hypertension in relation to diabetes. This article will illustrate how clinical depression is a comorbid medical illness requiring detection and treatment through the analysis of depression's impact on two conditions called Syndrome X. Conditions labeled Syndrome X in endocrinology and cardiology demonstrate how depression amplifies the pathophysiology of endocrine and cardiac disease and diminishes functional variability (regularizes variance) found in normal physiology.

Comorbidity↗
PubMedDate not supplied

Creating an outcomes framework.

Four constructs used to build a framework for outcomes management for a large midwestern tertiary hospital are described in this article. A system framework outlining a model of clinical integration and population management based in Steven Shortell's work is discussed. This framework includes key definitions of high-risk patients, target groups, populations and community. Roles for each level of population management and how they were implemented in the health care system are described. A point of service framework centered on seven dimensions of care is the next construct applied on each nursing unit. The third construct outlines the framework for role development. Three roles for nursing were created to implement strategies for target groups that are strategic disease categories; two of those roles are described in depth. The philosophy of nursing practice is centered on caring and existential advocacy. The final construct is the modification of the Dartmouth model as a common framework for outcomes. System applications of the scorecard and lessons learned in the 2-year process of implementation are shared

Case Management↗
PubMed2001

[Reactions to torture and persecution. Traumatized refugees in the Danish health service].

The Danish health services encounter a growing number of refugees who suffer from the effects of persecution and torture. To be a traumatised refugee in a foreign culture often causes psychological reactions and biological changes, and, at the same time, adaptation to a new culture is a demanding existential challenge. The condition is rather poorly described by the diagnoses "post-traumatic stress disorder" and "enduring personality change after catastrophic experience". These conditions can cause difficulties both diagnostically and treatment-wise, as the trauma story can awaken violent reactions in the doctor, and because the symptoms can be so culturally framed they are difficult to interpret. The prognosis depends on a number of issues pertaining to the patient, the trauma, and the patient's overall state after the trauma. At best, the prognosis is relatively good, but in a number of cases the patient's state becomes chronic and disabling. At present, the recommended treatment is a combination of psychotherapy, psychopharmacological treatment, physiotherapy, and social initiatives. There is still uncertainty as to the optimal treatment, and the organisational situation regarding treatment in Denmark is unclear.

Comorbidity↗
PubMed2001

Demoralization syndrome--a relevant psychiatric diagnosis for palliative care.

Hopelessness, loss of meaning, and existential distress are proposed as the core features of the diagnostic category of demoralization syndrome. This syndrome can be differentiated from depression and is recognizable in palliative care settings. It is associated with chronic medical illness, disability, bodily disfigurement, fear of loss of dignity, social isolation, and--where there is a subjective sense of incompetence--feelings of greater dependency on others or the perception of being a burden. Because of the sense of impotence or helplessness, those with the syndrome predictably progress to a desire to die or to commit suicide. A treatment approach is described which has the potential to alleviate the distress caused by this syndrome. Overall, demoralization syndrome has satisfactory face, descriptive, predictive, construct, and divergent validity, suggesting its utility as a diagnostic category in palliative care.

Body Image↗