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PubMed1996

[Humanistic care--a vital dialog with myself as a nurse].

The author documents the use of "humanistic care" as described by Paterson & Zderad (1988) and presents two case studies. Humanistic care is a transactional process, the carer entering into a relationship with the person for whom he/she cares. At the same time the carer embarks on a conscious dialogue with him/her self. To be "present" means being conscious of ones own thoughts, feelings, impressions and reactions. During a course of graduate study in Canada, the author enrolled in a "self-directed learning programme". She set herself the task of self-analysis. She conducted interviews with two patients suffering from cancer and with their relatives. She hoped that she would be able to reexamine, in this new situation, feelings and emotions which she had repressed earlier in her hospital nursing experience. The goal of the learning experience was to develop personal "authenticity" by becoming aware of existential experiences (her own and others').

Education, Nursing, Continuing↗
PubMed1996

[Coping with AIDS in a support group--an encounter with the health system].

We present the first documentation of a short-term support group for the HIV-infected and those with AIDS in Israel. The group enabled its members to cope with existential issues and with the psychological, social and medical hardships of these conditions, thus becoming an essential support factor in their lives. Participation in the group resulted in better compliance with medical treatment and helped improve psychological symptoms. It is important to stress the contribution such a support group can offer these people. The image of the health system in their eyes is presented. The 4 main areas of hardship in the encounter between the HIV-infected and those with AIDS with the health system are: ensuring privacy, consistency in procedures and in providing information, sensitivity to the emotional state of the individuals, and communication between physician and patient. It is important to bring the distress of these people to the attention of physicians so that they can show a sensitive and empathetic attitude and facilitate dialogue with the patient. It is important for medical teams to be both consistent in procedures involving the HIV-infected and patients with AIDS and in providing information, as well as ensuring privacy.

Acquired Immunodeficiency Syndrome↗
PubMed1996

[Oncogenetic consultation: various relational, psychological and ethical aspects].

The authors describe the gap between the implementation of a new technology in medicine and the development of a psychological and ethical framework that is thought to complement this implementation in order to guarantee the conditions for an optimal information of the patient and his relatives. As a second goal, the authors tries to anticipate the individual and systemic psychological impact these new technologies may have and the possibilities to overcome potential negative impacts. To conclude, a modification of the relations between physicians and patients and a different distribution of their roles and responsibilities is predicted permitting to face a medicine of the future, which will lead to considerable existential challenges.

Ethics, Medical↗
PubMed1996

Chaplaincy: a continuum of caring.

A diagnosis of cancer evokes a patient's ultimate existential and spiritual concerns. These concerns can be quite pronounced in the patient with pancreatic cancer due to the generally advanced stage of the disease at diagnosis and the short life expectancy. The role of the chaplain is to maximize the patient's ability to use religious resources as a source of coping with pain and suffering throughout the course of the disease and its treatment. When a patient enters the health-care setting, the chaplain can perform a spiritual assessment and identify patients at "high risk" as a result of a disturbance in the functioning of their belief system. The chaplain can assist these patients by offering alternatives to beliefs that cause suffering and strengthening beliefs that ward off distress. Chaplains also minister to the needs of the patient's family and members of the medical center. Ritual and discussions about hope or suffering apply equally to staff, patients, and patients' families.

Adaptation, Psychological↗
PubMed1995

The Little Mermaid: an icon of woman's condition in patriarchy, and the human condition of castration.

Hans Christian Andersen's story 'The Little Mermaid' is read as a creation myth and a metaphor for woman's condition in patriarchy, broadly conceptualised within a Lacanian framework. In the first part, the psychoanalytic concept of castration (broadly conceptualised as containing any existential severance which forms the basis for sexual difference and subjectivity) is utilised to argue that the myth is about a construction of (mostly female) subjectivity through a series of separations or splits: (1) birth, (2) growing up, (3) desire and (4) death. Birth and death are read as representing real separations. Growing up is read as structured around a symbolic castration of tongue and voice, while desire is read as structured around lack. In the second part the ideological implications of Disney's adaptation of the original for its symbolic status are explored. It is argued that by simplifying and externalising internal complex conflicts in the Andersen story, Disney's version reduces the myth to a fairy tale, and reproduces the ideology of romantic love.

Fantasy↗
PubMed1996

[The psychopathological structure of depressions].

The theoretical model of depression has been developed on the basis of 275 psychopathological observations of the affective disorders. The primary symptom complexes of hypothymia and alienation are considered to be the obligatory components of the syndrome structure. Depressions are ranged into the system with variants according to comorbid correlations between hypothymia and alienation. The anesthetic depression (in which the signs of vital affective suppression and alienation are characterized by total symptomatological comorbidity) considered to form the center of such system. The variations of affective disorders (vital, existential, "self-torture" depressions, "depression without depression") in which the comorbidity phenomenon is just partly realized and in which one of the symptom complex is totally expressed have the marginal position.

Depression↗
PubMed1977

[Individual psychotherapy. Institutional approach].

In traditional psychiatric institutions, illness tends to become chronic: several psychiatric schools try to present this. One of them refers to institutional psychotherapy, which will vary according to the patient's pathology, the therapist's objectives, the structure of the institution and the patient's and therapist's ideology. The author describes a phenomenological-existential approach as opposed to the psychoanalytic approach, and classifies the types of therapy he applies in the institutional setting.

Humans↗
PubMed1997

Investigation of the speed of reaction on external stimulus in schizophrenic psychosis.

In 30 schizophrenic examinees, the latention time was measured. This time is referred to as an interval between the start of the stimulus and the response to the stimulus in the skin-galvanic reflex. Elementary stimulation has been applied, using device's timer tone and clapping of hands, which should simulate and associate the thunderclap. The intensity of psychosis was measured according to the Metric scale of psychotic behavior by Rogina, while the intensity of anxiety was measured by psychological tests: Rorschach's psycho-diagnostic test and Spillberger's questionnaire for anxiety. The reaction to the stimulus and latention time were registered using polygraph unit in order to record skin-galvanic reflex. The research was performed at two separate time points: prior to the therapy with derivatives of the phenothiazine group (the experimental examination group), and 25 days after the therapy (control group). The research has shown that the latention time in schizophrenic examinees does not significantly differ from the corresponding time in healthy controls, and it averages 2.30 seconds. Furthermore, no statistically significant difference in latention time before and after the therapy was observed. However, before the therapy started, i.e. in experimental group," the examinees who were psychotic to a greater extent have shown longer latention than those less psychotic. Additional finding was that the examinees from experimental group who were more anxious according to psychological tests have also shown longer latention time. After the therapy, the reaction to the external stimulus was stronger, which was expressed in increased reaction amplitude in skin-galvanic reflex. The latention time was prolonged, especially in case of examinees that were psychotic to a smaller extent before the therapy. We can conclude that so-called transformed psychotic anxiety was replaced after the therapy with a "new" anxiety-existential fear, i.e. the stronger anxious expectation and confusion appeared because the anxiety in its "free-floating" form remained very high. After the therapy, psychotic protection failed to appear and the reaction characteristics are a consequence of the delaying the confrontation with reality, which was registered as a prolonged latention time, i.e. response to external stimulus.

Adult↗
PubMed1997

[Holistic promotion in the process of nursing care in a home nursing situation--an empirical case study].

This article presents results of an empirical test of the conceptual model of "holistic promotion in the process of nursing care" (Krohwinkel, 1991, 1992, 1993a, b, 1994) in a home care situation within an empirical case study. The results show that by an integrated assessment of the client's problems/needs and the systematic integration of his abilities and those of his primary related person, as well as the application of promoting methods of nursing in the nursing process, independence and well-being can be reached in "Activities and Existential Experiences of Living" (AEDL's). This independence/well-being leads also to a relief of the primary related person, his wife, and therefore contributes to the security of the home care situation.

Activities of Daily Living↗
PubMedDate not supplied

An ovarian cancer support group.

PURPOSE: Because of the low rate of cure and high rate of relapse, the disease course of ovarian cancer can be emotionally devastating. Using psychological interventions to support patients emotionally and to enhance their quality of life should therefore be considered an important complement to medical care. OVERVIEW: The authors describe a support group for patients with ovarian cancer, which was conducted over a 2-year period. The group consisted of patients with poor prognoses whose experience ranged from initial medical treatment, remission, and relapse to the dying experience. Key themes that arose during the sessions are identified, and differences between psychotherapy groups and support groups are highlighted. In contrast to psychotherapy groups, existential issues stood out as the most important therapeutic factor in this support group. CLINICAL IMPLICATIONS: Because it is widely acknowledged that support groups have unique value in the total care of women with ovarian cancer, this description of issues related to group process hopefully will assist others who may plan to offer this type of psychological intervention for patients. With increasing technology and the resulting extension of life for patients with ovarian cancer, support groups like this may become an important aspect of care to enhance quality of life. The multidisciplinary team, including psychiatry, social work, nursing, and chaplaincy, is essential in expanding support groups in healthcare settings.

Female↗
PubMed1997

[Self-reflection, interpersonal behavior and psychoanalytic ethics].

In the middle ages, ethical practice included a metaphysical theory of value. In comparison with that, self-reflection and interpersonality should be described as principles of more individual ethics and proceeding from philosophy to psychoanalysis in modern times. Drawing a borderline between human philosophy and metaphysies, Kant defined his so-called categorial imperative as a basic phenomenon of human reciprocity. Ethical relationship to another person, however, requires realization of one's own self, i.e. self-reflection. Hegel's subsequent association of intersubjectivity and selfreflection supplied the basis for Sarte's constitution of consciousness: Existence as existing for the good of the fellow-being. Self-reflection, basing on the sight of one's own self by the other person, leads to Sartre's concept of existential psychoanalysis and to his understanding of ethics. His concept illustrates the decline of significance of philosophy for the analysis of human relationship. Habermas describes self-reflection and interpersonality as fundamental principles of the psychoanalytic therapy and its ethical demands. With the historical concept of the super-ego, Freud established therapeutical one-sidedness and abstinence from ethics; however, as therapeutical interrelationship continued to intensity, ethics of depth psychology also began to develop. This ethical demand was not expressly formulated within the context of psychoanalysis, with the exception of jung and his epigones. Nevertheless, psychoanalytic interaction implies the development of self-reflection, which definitely represents a step forward in the sense of "ethical enlightenment" represented by Kant.

Awareness↗
PubMed1997

Does doctors' own fear of dying hinder palliative care?

Humans have a deeply rooted, existential fear of death that lurks suppressed in their unconscious most of the time. Dr. Balfour Mount, a palliative care specialist, thinks this is one of the factors preventing the health care system from providing good and compassionate care for the dying.

Attitude to Death↗
PubMed1997

Psychoanalysis and culture: some contemporary challenges.

The evolution and current usage of the concept of culture is briefly discussed. Two divergent views on the initial relationship between psychoanalysis and culture are presented and the influence of the former on the latter illustrated, both in the previous decades and at present. Some general aspects of present-day western culture are then outlined, among them the great flood of information, the culture of narcissism, the temptations of conventionality, the ideology of visual media and the 'light culture', and five propositions that attempt to characterise 'post-modern sensibility'. Finally, four challenges faced today by psychoanalysis are discussed: the changing nature of philosophical and cultural cross-currents as it influences psychoanalysis as a discipline; the empiricist versus the hermeneutic approach; attacks on psychoanalysis as an elitist discipline and profession; and the movement away from the subjectivist and existential concerns and the focus on a more collectivist and pragmatic relationship to reality. The author suggests possible ways to face each of these challenges.

Culture↗
PubMedDate not supplied

[Family-oriented management of children and adolescents with cancer].

Cancer disease in a child almost implies an existential threat to all members of the family and a change in the accustomed way of life. It threatens children and adolescents at no matter which stage of development and influences their growth of development. It was realized very late, that the "healthy" family members are also affected and suffer from a double burden: at the same time they have to cope with their own concerns and give the sick child the necessary support as well. Acause to that psychosocial support systems were established in Pediatric Oncology; they orientate themselves by the needs of the entire family and work with an interdisciplinary method. A family-orientated-rehabilitation was drafted against this background. This allows all family members a physical, psychological and social rehabilitation within a four-week period. The study follows a prospective control group design on 104 families, the effect of this family-orientated rehabilitation has been evaluated. The results show a clear and significant reduction in the severity of physical and psychological symptoms of the patients as well as parents and siblings. Moreover the family rehabilitation offers the opportunity to built up resources and to meet new as a family.

Adaptation, Psychological↗
PubMedDate not supplied

[Oedipus tragedy].

Taking into account Paul Ricoeur's theories, two possible hermeneutical positions in front of Oedipus' drama are considered. One is to view it as a fatalistic destiny, bred into the darkest incestuous trends any infant is fighting against, and leading to unavoidable stigmata of everlasting nature. The other is to conceive it as the response to present naked truth, resulting from deep reflexion in order to attain real consciousness of oneself. The former is the "backwards conception", having its own limitations, in its very being buried into the past. The latter, having its projections forward, centers on anguish and anxiety aroused by consciousness of oneself, seeked by the alert responsible mind, able to afford reality and truth with all their thorough implications. The author's existential position embraces the secon conception which had been already exposed by Sophocles in Oedipus in Colonna. The dialectics are set between seeing and knowing. Tiresias is blind, but he can see, because he can afford truth, and its consequence, guilt. Oedipus must fight to attain the possibility of knowing, and must go into the ordeal of losing his eyes, as the only way to reach true self realization, through facing truth and bearing anguish.

Humans↗
PubMedDate not supplied

[Effects of decreasing sick leave benefits--results of a survey of Social Health Insurance members].

In Germany, a sick employee usually continues to get his wages from his employer for six weeks either in full or reduced. After that period, he only receives "sick benefit payments" (so-called Krankengeld) from the statutory bodies, which, up to 31 December 1996, amounted to 80% of his original gross wage earnings. This has been cut down to 70% of the gross wage earnings effective 1 January 1997. The purpose of this study was to assess the consequences of this general cutdown of sick benefits. A standardised questionnaire was posted to a total of 7,036 female recipients of sick benefit who were members of a South German statutory health insurance body and who resided in various parts of Germany (membership as on 17 December 1996). 2,416 completed questionnaires were returned by 19 February 1997 (= 34.9%). The average daily sick benefit payment dropped from DM 91.95 in December 1996 to DM 82.39 in January 1997, which is equivalent to a sick benefit payment reduction by 10.4 per cent. The average extra cost caused by the illness and not covered by sick benefit amounted to DM 152 per month; one-quarter of the questioned patients were even compelled to pay DM 200 per month extra from their own pocket. Sick benefit recipients must accept a very substantial real monthly income loss. The average income of an employee who is ill for more than 6 weeks is more than a quarter below that of a healthy employee. 78.5% of the questioned persons rated the financial burden and privations caused by the sick benefit cutdown as "extremely heavy" or "considerable". It became evident that the majority of the female patients receiving sick benefit were chronically ill (62.6%). The most frequently reported diseases were diseases of the spine (30.3%) and joints (16.3%), injuries and accidents (14%) and psychiatric illnesses (8.5%). The results of the survey show that the political motive underlying the attempted modification of illness behaviour by means of economic incentives to be healthy, is far removed from reality, for the cutdown of sickness benefit severely affects a group of gainfully employed persons who are in the midst of a deep existential crisis and sorely in need of extensive physical and mental support. From the sociomedical aspect the sick benefit cutdown is highly problematical as far as this group of persons is concerned, since recovery and cure are impeded by measures that lower the status and are experienced as punitive.

Adolescent↗
PubMed1998

[Self-evaluation of knowledge and competence with regard to the treatment of pain].

In a survey completed at our hospital, 519 doctors and nurses were asked to evaluate their own knowledge and competence with regard to the treatment of various types of pain, including non-pharmacologic treatment methods. A total of 473 responded to the questionnaire. In the study, cancer-related pain and pain from causes other than cancer were assessed in separate population groups. Of the doctors, 58% evaluated their knowledge of nociceptive pain as very good or fairly good. The corresponding findings for neuropathic pain were 31%, for psychological pain 27%, for social pain 25% and for spiritual and existential aspects of pain 22%. The nurses scored lower than the doctors on knowledge and competence in relation to nociceptive and neuropathic pain (32% and 18% respectively), and higher on treatment of the psychological and social aspects of pain (44% and 36% respectively). Many of the doctors and nurses evaluated their knowledge as fairly poor or very poor with regard to nonpharmacologic treatment methods. In both professions 80% answered that depression was seen fairly often or very often among these patients.

Analgesia↗
PubMed1997

[Ambulatory surgery in the hospital: decision between national health insurance responsibility and personal job security].

The aim of outpatient surgery is to reduce costs in the health service. However, the number of surgeons working in a surgical department is dependent upon the numbers of occupied beds. This creates an existential conflict in which, by reducing the occupancy of beds in order to take on more outpatient cases, surgeons are putting their own jobs on the line. Possible solutions are here discussed.

Ambulatory Surgical Procedures↗