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PubMed1999

Caring for and about cancer patients: identifying the meaning of the phenomenon "caring" through narratives.

For several decades nurses have been using the terms "caring" and "nursing." Caring, considered to be a universal phenomenon, has been seen as a nursing term, including all aspects of delivering nursing care to patients. Ten registered nurses selected from hematologic, oncologic, and lung medicine wards were asked to narrate one situation in which they had been able to supply good caring and one situation wherein they had not been able to provide good caring for the patient. To identify the meaning of the caring phenomenon as experienced and expressed by nurses working with patients who have cancer, a qualitative analysis using phenomenologic hermeneutics was used. The narrated interviews, tape-recorded and transcribed verbatim, were analyzed, and a theme was interpreted: developing and maintaining a helping-trusting interpersonal relationship. Five subthemes also were identified: creating an interaction with the patient and the next of kin, acting to satisfy the needs of the patient and next of kin, feeling frustration in the role of caring, being affected by time aspects, and developing self and acquiring insight. It is in caring that nurses and patients connect with one another, are fulfilled, and experience growth. If they work actively with this perspective, nurses will feel fulfilled, not frustrated.

Adult↗
PubMed2001

Health related quality of life in patients with dysvascular transtibial amputation.

Sixty adults with transtibial amputations completed a validated outcomes instrument assessing their prosthesis related quality of life. All had their amputations because of peripheral vascular disease or nonsalvageable diabetic foot infection. Of the patients, 46 were male and 14 were female. Forty-four had diabetes. All of the subjects used a prosthesis for a minimum of 6 months. The Prosthetic Evaluation Questionnaire measured prosthesis function (usefulness, residual limb health, and appearance), mobility (ambulation and transfers), psychosocial response (perceived responses, frustration, and social burden), well-being, and satisfaction. Scoring was accomplished using a linear analog scale, with poor responses rated as 0 and excellent responses rated as 100. Mobility scores were the lowest (ambulation, 55.3; transfer, 64.6). Functional scores were slightly better (usefulness, 65.7; residual limb health, 79.7; and appearance, 73.3). Psychosocial response scored best (perceived responses, 86.6; frustration, 69.1; and social burden, 66.4). The overall well-being scale graded at 67.0, and overall satisfaction scored at 65.2. Although experts in rehabilitation would expect function and mobility scores to be highest and psychosocial scores to be lowest, this population actually perceived the reverse to be true. These data provide realistic expectations for patients faced with transtibial amputation and a benchmark to measure newer treatment modalities or technical innovations.

Aged↗
PubMed1993

Pediatric intensive care training: confronting the dark side.

PURPOSE: To describe the dark side of pediatric intensive care fellowship training and offer educational approaches for understanding feelings of fallibility, anger, frustration, and loss. DATA SOURCES: Listening and observing fellows in the courses of their pediatric intensive care training and later careers. STUDY SELECTION: Studies that discussed pediatric residency and fellowship training, especially in the context of intensive care. DATA EXTRACTION: From group meetings, unit conferences, rounds, individual discussions, and child psychiatric consultations. RESULTS OF DATA SYNTHESIS: Pediatric intensive care unit (ICU) fellows gain a sense of mastery from the nature of their work: complex, technological, and frequently lifesaving. They face the usual personal stresses of extended training, including long work hours, limited financial resources, and relative isolation from family and friends. Pediatric ICU fellows confront deeper, "dark" feelings regarding their own high expectations, fallibility, anger, sense of loss, frustration, limited control, and the need to work closely with tense, grieving families. If the dark side is not acknowledged, fellows, team members, and faculty are likely to experience anger, detachment, and depression that may extend beyond work into their personal lives. CONCLUSIONS: Since the dark side is expected, normal, and inevitable, fellowship training programs should help fellows cope with and understand these feelings. Such understanding requires a sense of trust among intensive care staff and can be gained through group discussions, mentorship, specific team conferences, and child psychiatric consultation.

Adaptation, Psychological↗
PubMed2001

A comparison of the positive and negative work attitudes of home health care and hospital nurses.

This article compares the positive and negative stress response work attitudes of 126 home health care registered nurses (RNs) and 145 hospital RNs. Home health care nurses reported significantly lower levels of the negative work attitudes, anger/hostility, and frustration with the system. There was no significant difference between the two groups of RNs among the positive work attitudes of job satisfaction, positive affect, hope, meaningfulness, manageability, and trust in the supervisor and the negative work attitudes frustration with the supervisor, job alienation, and negative affect.

Adult↗
PubMed1995

Adolescents' image of their suicide attempt.

OBJECTIVE: To inventory the reasons adolescents give for their perceptions of events, thoughts, and feelings in the last days and hours before and during the attempt. METHOD: A semistructured interview also included the administration of an instrument that contained the formulation of reasons. RESULTS: The most frequently mentioned reasons for attempting suicide concerned the cessation of (an unbearable) consciousness. The motivation most frequently named for "crossing the bridge" between thinking about and attempting suicide involved an escalation of frustration and tension. CONCLUSIONS: Special emphasis should be given to family relationships, relationships with peers and friends, frustration tolerance, and the way in which adolescents handle their problems.

Adolescent↗
PubMed1999

The effect of patient-focused redesign on midlevel nurse managers' role responsibilities and work environment.

OBJECTIVE: The authors determine the effect of patient-focused redesign on midlevel nurse managers' role responsibilities and perceptions of work environment. BACKGROUND: Patient-focused redesign models have been initiated in a number of hospitals over the past 10 years. Few studies of the impact of these models on nurse leaders' roles and work responsibilities have been conducted. METHODS: Nine midlevel nurse managers were interviewed about their redesigned leadership roles and the challenges they experienced in implementing patient-focused redesign. RESULTS: Several themes emerged from the data. These themes focused on role change, ambiguity, position power, and environmental uncertainty and turbulence. Each of the nurse managers described feelings of frustration, disconnectedness, and inadequacy and spoke of how difficult it was to be the central figure in the eye of the storm. They noted that previously successful administrative strategies were not producing the same effect as in the past. CONCLUSION: This study provides beginning information about the magnitude of the impact of organizational redesign on midlevel nurse managers. Midlevel managers in this study struggled to keep up with the demands of the change and their own recognition of the importance of remaining committed to the uncertain goals of the institution. They were frustrated by their perceived inability to fix the situation and to meet the multiple needs of the staff. Nonetheless, they supported senior executives and attempted reasonable solutions to the problem.

Humans↗
PubMed1999

Quality of life in children with Crohn's disease: a pilot study.

BACKGROUND: Focus group meetings were held with two groups, each containing 12 children with Crohn's disease aged 8 to 12 and 12 to 17 years. The children were asked broad questions about how Crohn's disease and its treatment affected their lives. To explore these areas in more detail, an 88-item questionnaire was developed and read to an additional 16 of 20 children with Crohn's disease selected at random from outpatients. At first, many of the children denied that Crohn's disease affected their lives at all, but it soon became apparent that many were frustrated or angry about physical symptoms, lack of understanding about Crohn's disease, unpleasant investigations, treatment, and hospitalisation. METHODS: The questionnaire covered six domains of health-related quality of life including symptoms and treatment, social, emotional, family, educational, and future aspects. RESULTS: Elemental diet was the preferred treatment, although surgery was more effective in controlling symptoms. Children receiving steroids had more depressive symptoms. Absenteeism from school and inability to engage in school sports, swimming, and running were frequent problems. There were also difficulties with taking holidays and staying at friends' houses. Worry was reported in 14 of 16 children, anger and frustration and feeling fed up in 12 of 16. CONCLUSIONS: In addition to being a symptomatically disabling condition, Crohn's disease has a great impact on the health-related quality of life of affected children. Future studies of treatment in children with inflammatory bowel disease should include an attempt to assess the impact on the child's health-related quality of life.

Adolescent↗
PubMedDate not supplied

Personality predictors of dimensions of psychosocial adjustment after surgery.

OBJECTIVE: Although many studies have examined the relationship between personality factors and adjustment after surgery, most of them have had very short follow-up periods. The present prospective study examines whether preoperative psychodynamic assessment of personality traits enhances prediction of various areas of psychosocial adjustment assessed at least 1 year after surgery. METHODS: In 53 patients undergoing pelvic pouch surgery for ulcerative colitis, we examined the relationship between personality traits measured before surgery, and postoperative psychosocial adjustment assessed at a median of 17 months postoperatively, controlling for the effect of surgical functional outcome. Personality traits were assessed with the Karolinska Psychodynamic Profile (KAPP). Surgical functional outcome scales and the Psychosocial Adjustment to Illness Scale (PAIS) were used. RESULTS: Problems with sexual satisfaction, perfectionistic body ideals, lack of alexithymia, and poor frustration tolerance predicted poor postoperative adjustment in various areas, beyond what was predicted by surgical functional outcome alone. Moreover, moderate preoperative levels of alexithymia were beneficial to postoperative adjustment in the area of psychological distress. CONCLUSIONS: The findings suggest that the preoperative assessment of the patient's long-term sexual functioning and satisfaction, the importance attached to his or her appearance, level of alexithymia, and general capacity to tolerate frustration and set-backs in life, might alert both the surgeon and the patient to potential risk factors for poor postsurgical adjustment.

Activities of Daily Living↗
PubMed2004

Use of self-expanding, hydrophilic osmotic expanders (hydrogel) in the reconstruction of congenital clinical anophthalmos.

PURPOSE OF REVIEW: Rehabilitation of the congenitally anophthalmic orbit is frustrating to both the parents and physician. Traditional methods involve using progressively enlarging static acrylic conformers to expand the conjunctival socket, followed by placement of conventional static spherical orbital implants, dermis-fat grafts, or inflatable balloon expanders for orbital enlargement. Limitations of these methods typically result in less-than-optimal cosmetic outcomes, with retardation of bony orbital and overlying soft tissue growth adversely affecting midfacial growth and symmetry. Recent advances in tissue expansion technology may offer additional, novel alternatives to conventional therapies. RECENT FINDINGS: Hydrogel tissue expanders were recently adapted for use in congenital anophthalmia. The expanders are placed in their dry, contracted states, and expand gradually to their full size via osmosis of surrounding tissue fluid, with up to a 10-fold increase in volume. Offering the benefit of predictable and controllable self-expansion, hydrogel expanders may offer yet another alternative or adjunctive therapy to the early rehabilitation of the contracted socket. Separate appliances are used for conjunctival and orbital reconstruction. Initial results appear promising. Tempering the enthusiasm for their use, however-particularly in terms of implanted orbital expanders-is the recent spate of long-term complications reported from previous uses of hydrogels as scleral buckling material. SUMMARY: Self-expanding hydrogel tissue expanders appear to offer an intriguing reconstructive alternative to the frustrating condition of congenital anophthalmia. Long-term safety of the material as an orbital implant has not yet been demonstrated, but early results are promising.

Anophthalmos↗
PubMed2006

Nonurgent use of a pediatric emergency department: a preliminary qualitative study.

OBJECTIVES: To understand patterns of decision making among families presenting to a pediatric emergency department (ED) for nonacute care and to understand pediatric ED staff responses. METHODS: Cross-sectional qualitative study using in-depth interviews, direct observations, and nonidentifying demographic data. RESULTS: Eleven percent of visits made during the study period were identified as nonacute. All were made by families from low-income areas. Three main themes emerged: (1) most families had been referred by their primary care providers; (2) the complexity of living in low-income areas makes the ED a choice of convenience for these stressed families; and (3) mistrust of primary health services was not identified by our respondents as a motivator for ED utilization, in contrast with other published data. Two themes emerged from ED staff: (1) actual nonurgent visit rates were lower than staff estimates; and (2) these visits produced frustration among staff members, although their degrees of insight and understanding of factors motivating these visits were variable. CONCLUSIONS: In this setting, nonacute visits occurred with lower than perceived frequency and caused disproportionate frustration among staff and families. These visits appear to be driven more by consequences of system design and structure than by family members' decision making. Mistrust of primary care services was not a strong family decision-making factor; the study's setting may have limited its ability to capture such data. Recommended system changes to lower barriers to primary care include expanded office hours, subsidized staffing for offices in medically underserved areas, and lowering barriers to sick care.

Adolescent↗
PubMed1992

Guillain-Barré syndrome: giving the patient control.

The patient with Guillain-Barré syndrome (GBS) presents a complex clinical picture. Depending on the degree of paralysis, problems with communication can be significant. The patient's inability to express fears, needs and frustrations coupled with the lengthy recovery process makes GBS one of the most difficult diseases for nurses to manage. Nursing interventions, based on Orem's self-care theory, can ease the frustration and feelings of powerlessness a patient with GBS experiences.

Communication Barriers↗
PubMed2001

Hysteresis and metastability in the quenched turbulent dynamics of the complex Ginzburg-Landau equation.

We consider the quenched dynamics of the two-dimensional complex Ginzburg-Landau equation in its turbulent regime. We initialize the system in a frustrated state and observe how frustration affects the evolution towards the turbulent state. This process is performed for parameter values where, for random initial conditions, the system evolves into the turbulent state. We observe that the glassiness of the initial condition can inhibit the occurrence of the absolute instability close to the critical point for that instability in parameter space. Sufficiently far from the critical point, the turbulent state will develop, but only after spending considerable time in a transient metastable state of fixed vortex density. The parameter distance from the critical point is found to scale as an exponential of a power of the lifetime of the metastable state, and with a power exponent depending on the "depth" of the original quench. The limiting regimes of shallow and deep quench are identified by their respective values of the exponent, and the distinct mechanisms leading to the relaxation to turbulence in each case are highlighted.

Journal Article↗
PubMed2002

Acceleration effect of coupled oscillator systems.

We have developed a curved isochron clock (CIC) by modifying the radial isochron clock to provide a clean example of the acceleration (deceleration) effect. By analyzing a two-body system of coupled CICs, we determined that an unbalanced mutual interaction caused by curved isochron sets is the minimum mechanism needed for generating the acceleration (deceleration) effect in coupled oscillator systems. From this we can see that the Sakaguchi and Kuramoto (SK) model, which is a class of nonfrustrated mean field model, has an acceleration (deceleration) effect mechanism. To study frustrated coupled oscillator systems, we extended the SK model to two oscillator associative memory models, one with symmetric and the other with asymmetric dilution of coupling, which also have the minimum mechanism of the acceleration (deceleration) effect. We theoretically found that the Onsager reaction term (ORT), which is unique to frustrated systems, plays an important role in the acceleration (deceleration) effect. These two models are ideal for evaluating the effect of the ORT because, with the exception of the ORT, they have the same order parameter equations. We found that the two models have identical macroscopic properties, except for the acceleration effect caused by the ORT. By comparing the results of the two models, we can extract the effect of the ORT from only the rotation speeds of the oscillators.

Animals↗
PubMed2005

Two kinds of smectic-C(alpha)* subphases in a liquid crystal and their relative stability dependent on the enantiomeric excess as elucidated by electric-field-induced birefringence experiment.

The electric-field-induced birefringence has been investigated by using a photoelastic modulator, with a view to obtaining a molecular model for the subphases produced by the frustration between ferroelectricity and antiferroelectricity in the chiral smectic liquid crystals. It has been found that even in the bulk, there exist two subphases in the smectic-C(alpha)* (Sm-C(alpha)*) temperature range. By extending the Emelyanenko-Osipov model [Phys. Rev. E 68, 051703 (2003)] to include the temperature dependence of the tilt angle, we have alluded to a possible lifting of the degeneracy at the frustration point P(alpha) , where Sm-C(A)*, Sm-C*, and Sm-A have the same free energy. This leads to the appearance of uniaxial Sm-C(alpha)* characterized by short-pitch helical structures and consequently with a pitch much lower than the optical wavelength. The numerical calculations indicate that the short pitch may generally increase or decrease monotonically with temperature. Depending on the parameter value that represents the relative strength of ferroelectricity and antiferroelectricity, the short-pitch temperature variation may abruptly change from increase to decrease at a temperature; this can be assigned to the observed phase transition between the two Sm-C(alpha)* subphases.

Journal Article↗
PubMed2005

Multiscale complexity of correlated Gaussians.

We apply a recently developed measure of multiscale complexity to the Gaussian model consisting of continuous spins with bilinear interactions for a variety of interaction matrix structures. We find two universal behaviors of the complexity profile. For systems with variables that are not frustrated, an exponential decay of multiscale complexity in the disordered regime shows the presence of small-scale fluctuations and a logarithmically diverging profile of fixed shape near the critical point describes the spectrum of collective modes. For frustrated variables, oscillations in complexity indicate the presence of global or local constraints. These observations show that the multiscale complexity may be a useful tool for interpreting the underlying structure of systems for which pair correlations can be measured.

Journal Article↗
PubMed2005

Electric-field-induced nematic-cholesteric transition and three-dimensional director structures in homeotropic cells.

We study the phase diagram of director structures in cholesteric liquid crystals of negative dielectric anisotropy in homeotropic cells of thickness d which is smaller than the cholesteric pitch p. The basic control parameters are the frustration ratio d/p and the applied voltage U. Upon increasing U, the direct transition from completely unwound homeotropic structure to the translationally invariant configuration (TIC) with uniform in-plane twist is observed at small d/p < or = 0.5. Cholesteric fingers that can be either isolated or arranged periodically occur at 0.5 < or = d/p<1 and at the intermediate U between the homeotropic unwound and TIC structures. The phase boundaries are also shifted by (1) rubbing of homeotropic substrates that produces small deviations from the vertical alignment; (2) particles that become nucleation centers for cholesteric fingers; (3) voltage driving schemes. A novel reentrant behavior of TIC is observed in the rubbed cells with frustration ratios 0.6 < or = d/p < or = 0.75, which disappears with adding nucleation sites or using modulated voltages. In addition, fluorescence confocal polarizing microscopy (FCPM) allows us to directly and unambiguously determine the three-dimensional director structures. For the cells with strictly vertical alignment, FCPM confirms the director models of the vertical cross sections of four types of fingers previously either obtained by computer simulations or proposed using symmetry considerations. For rubbed homeotropic substrates, only two types of fingers are observed, which tend to align along the rubbing direction. Finally, the new means of control are of importance for potential applications of the cholesteric structures, such as switchable gratings based on periodically arranged fingers and eyewear with tunable transparency based on TIC.

Journal Article↗
PubMed2006

Variational treatment of the Shastry-Sutherland antiferromagnet using projected entangled pair states.

We have applied a variational algorithm based on projected entangled pair states (PEPS) to a two dimensional frustrated spin system, the spin-1/2 antiferromagnetic Heisenberg model on the Shastry-Sutherland lattice. We use the class of PEPS with internal tensor dimension D=2 , the first step beyond product states (D=1 PEPS). We have found that the D=2 variational PEPS algorithm is able to capture the physics in both the valence-bond crystal and the Néel ordered state. Also the spin textures giving rise to the magnetization plateaus seen in experiments on SrCu2(BO3)(2) are well reproduced. This shows that PEPS with the smallest nontrivial internal dimension, D=2 , can provide valuable insights into frustrated spin systems.

Journal Article↗
PubMed2000

Direct measurement of interfacial curvature distributions in a bicontinuous block copolymer morphology.

Self-consistent field theory predicts that the complex phase behavior of block copolymers does not originate solely from the interface seeking constant mean curvature as once thought, but instead reflects competing minimization of interfacial tension and packing frustration. To test this prediction, we directly measure interfacial curvature distributions from a 3D image reconstruction of the bicontinuous gyroid morphology. Results obtained here reveal that the gyroid interface is not constant mean curvature and confirm the importance of packing frustration in the stabilization of such complex nanostructures.

Butadienes↗