Direction of affective influence in psychotherapy.

Administered a structured response questionnaire to 45 patient-therapist pairs after each of a series of individual psychotherapy sessions in which feelings experienced by each during the session were reported. Causal analyses of nonexperimental data suggested that for relatively inexperienced therapists, the patients' positive feelings were a sufficient condition for the therapists' positive feelings. The reverse was the case for more experienced therapists. For negative feelings, however, therapists' feelings of uncertainty and apprehension were generally a sufficient condition for the patient to experience dysphoric affect. Extremely positive or negative affective experiences of either participant tended to preclude and be precluded by opposite experiences in the other. (17 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The everyday experience of psychiatric hospitalization: the users' viewpoint

Using 38 focussed accounts the author reports on the hospitalization experiences of patients 18 to 38 years old in the psychiatric ward. The sample comes from the psychiatric wards of two general hospitals in the Montréal area (Canada). The data were analyzed using a qualitative method. Empirical categories were inferred from the respondents' discourse based on the broad themes which make up the psychiatric experience: admission; hospital environment and rules; daily life; medication; relations with the staff and leaving the hospital. The results shed light on the suffering, dissatisfaction and ambivalent feelings surrounding the patients' hospital experience. Based on the experience of psychiatric patients, the author identified five processes at work during psychiatric hospitalization.     

Therapeutic paralysis of critically ill trauma patients: perceptions of patients and their family members

BACKGROUND: Neuromuscular blocking agents are used in critically ill patients to induce therapeutic paralysis. These drugs leave patients fully immobile but conscious. Analgesics and sedatives are concomitantly administered with the paralytic agents. Little is known about what patients remember when they receive these combinations of drugs. Even less is known about the experiences and needs of the patients' family members during the patients' paralysis. OBJECTIVES: To obtain recollections of therapeutic paralysis in critically ill adult trauma patients and to determine the psychological, emotional, and educational needs of the patients' family members during the time the patients were paralyzed. METHODS: A qualitative phenomenological approach was used to investigate the "lived" experience of therapeutic paralysis of 11 pairs of subjects. Each pair consisted of one critically ill adult trauma patient and one member of the patient's family. RESULTS: The patients recalled their experience of therapeutic paralysis with vagueness, as if they had been dreaming. Few recalled pain or painful procedures. Patients remembered having nurses and family members provide emotional support and encouragement. Family members understood the rationale for use of the drugs. They remembered being encouraged to touch and talk with patients. The subjects suggested providing additional education about events that occur when paralysis is being reversed. CONCLUSIONS: Two confounding variables may have affected these findings: a liberalized visiting policy and use of effective pain and sedation protocols. Healthcare professionals and patients' family members should monitor bedside conversations and use touch and words of encouragement to support patients during therapeutic paralysis.     

Patients' experiences of patient-controlled analgesia

We examined patients' experiences of patient-controlled analgesia by the use of semistructured interviews in 26 patients shortly after discontinuation of the device. The options expressed by the patients were examined qualitatively to identify recurring themes in their experience of patient-controlled analgesia. The areas of interest were analgesia, factors influencing whether the patient pressed the button or not, whether they felt in control and side effects. Negative as well as the expected positive evaluations were found. The negative evaluations reflected problems with nausea and vomiting and inadequate analgesia. No clear strategy for pressing, or not pressing, the button emerged and the principle of control by the patient over their pain relief was not considered important.     

Differences in attentional strategies by novice and experienced operating theatre scrub nurses.

This study investigated the effect of nursing experience on attention allocation and task performance during surgery. The prevention of cases of retained foreign bodies after surgery typically depends on scrub nurses, who are responsible for performing multiple tasks that impose heavy demands on the nurses' cognitive resources. However, the relationship between the level of experiences and attention allocation strategies has not been extensively studied. Eye movement data were collected from 10 novice and 10 experienced scrub nurses in the operating theater for caesarean section surgeries. Visual scanning data, analyzed by dividing the workstation into four main areas and the surgery into four stages, were compared to the optimum expected value estimated by SEEV (Salience, Effort, Expectancy, and Value) model. Both experienced and novice nurses showed significant correlations to the optimal percentage dwell time values, and significant differences were found in attention allocation optimality between experienced and novice nurses, with experienced nurses adhering significantly more to the optimal in the stages of high workload. Experienced nurses spent less time on the final count and encountered fewer interruptions during the count than novices indicating better performance in task management, whereas novice nurses switched attention between areas of interest more than experienced nurses. The results provide empirical evidence of a relationship between the application of optimal visual attention management strategies and performance, opening up possibilities to the development of visual attention and interruption training for better performance. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Communicating do-not-resuscitate orders with a computer-based system

BACKGROUND: Do-not-resuscitate (DNR) orders for critically ill patients are frequently miscommunicated between attending physicians, house staff, and nurses. A computer-based system was developed to improve the communication of a procedure-specific DNR order form. METHODS: Concordance of understanding of patients' DNR status was measured with the use of unstructured DNR orders (period 1), procedure-specific DNR order forms (period 2), and procedure-specific DNR order forms administered with a computer-based communication system (period 3). The 3 components of the DNR order assessed were (1) the clinical events to which the DNR order applied, (2) whether the DNR order withheld all elements of cardiopulmonary resuscitation, and (3) whether other treatments were to be withheld. RESULTS: For the 147 patients, the computer-based system in period 3 (n = 71) improved concordance for attending physicians and nurses or residents for all 3 of the DNR components compared with period 1 (n = 40) and some of the DNR components compared with period 2 (n = 36). Concordance was "substantial" or "almost perfect" as measured by the K statistic during period 3. The proportion of agreement for the composite of all 3 components of the DNR order increased during each period (P<.001, period 3 vs period 1). Overall agreement between all caregivers for the composite DNR order also improved from period 1 (22.2%) to period 2 (47.8%) and period 3 (61.9%; P<.001 vs period 1). Errors in order entry were detected by physicians because of the computer system and corrected in 9.9% of DNR orders in period 3. Progress note documentation of DNR status did not improve during period 3. The procedures of period 3 were considered acceptable by the physician and nursing staff. CONCLUSION: A computer-based system combined with a procedure-specific DNR order form improves communication of patients' DNR status in a critical care setting.     

A small exploratory study of the reaction of older people to an episode of delirium

Delirium or an acute confusional state, occurs as a result of disease or physiological imbalance secondary to impaired brain function. One of its main clinical features is widespread cognitive impairment, which causes patients to become disconnected from their immediate surroundings and misinterpret reality. It has a sudden onset and its duration is relatively brief. Some authors take the view that delirium might be interpreted as a precursor to dementia. The aim of the study was to retrospectively explore older peoples' experience of an episode of delirium. In particular, whether they knew what had caused and cured it; and whether it had left them with any unresolved feelings of anxiety. A cross sectional design using grounded theory methodology was chosen, as being the most appropriate method for exploring this issue. A sample of 19 patients was selected using predetermined criteria, and engaged in a semi-structured interview with the researcher, in the ward environment. The interviews were audiotaped, transcribed, and analysed using the constant comparison method. Those interviewees who had illusions and hallucinations, were often able to describe their experiences in detail. They ranged from being pleasant and entertaining, to horrible and frightening. They were also able to remember short verbal commands from nurses during the episode of altered perception. Others remembered, or chose not to remember, very little. Few interviewees appeared to know exactly what had caused and cured the delirium, although some were able to tentatively connect the experience to their present medical condition. There also appeared to be little evidence of therapeutic communication with nursing staff once the episode of delirium had resolved. Although no one connected the experience with dementia, there did seem to be some evidence of mildly disturbed feelings, on reflecting back over the episode. As interviewees were generally willing to discuss their experiences with the researcher, it suggests that it would be helpful for nurses to provide opportunities to do so. Nevertheless, interviewees appeared to regard the episode simply as a transitory event in the overall context of illness, admission to hospital and their future welfare. The latter was of prime concern; yet again it appeared that they did not always receive the information they required to maintain control over their personal destinies.     

Mycobacterium ulcerans infection in a child from Angola: diagnosis by direct detection and culture

The purpose of this study is to listen to and interpret the experiences of independent older women in the community regarding their medication use. Their experiences were examined regarding medication information, sources of information, types of medication used, relationships with health care professionals and social support systems. The techniques used for data collection included guided qualitative semistructured interviews based on the principle of empowerment and notions of ideal and nonhierarchical communication. The emergent themes show that for these older women general practitioners were important in their medication experiences. Whilst trusted as carers in the acute care setting, registered nurses did not play a role in the medication experiences of these older women. Registered nurses are perceived as 'traditional carers' associated with medical and acute care settings. Although medication issues emerged that ideally required attention, the older women in this study generally perceived themselves to be capable of actively managing their health and medication use.     

Change ... ouch!

Through change workshops, nurses can manage their emotions experienced during restructuring, such as losing familiarity, becoming insecure in their jobs, and grieving the loss of coworkers. The workshops focused on three themes: reminiscence, survival, and celebration.     

Writing poetry: a way of knowing nursing

Carper's patterns of knowing expose the relevance and importance of different knowledge to the enterprise of nursing. She noted that the aesthetic pattern enables nurses to know unique perceptive experiences. Poetry captures particular perceptive experiences and reconstructs them into universal wholes. The opportunity for nurses to write poetry can illuminate and legitimate their perceptive experiences which often become worn or hidden in the everyday work world and in other ways of knowing. Expressing nursing experiences through writing poetry generally involves three phases: (a) creating an image of experience, (b) fully articulating the image, and (c) sharing a clear, new meaning of the image. A poem, written to express one author's unique nursing experience, is used to explore the knowledge gained through the process of writing poetry. Writing poetry can help nurses connect with and maintain their personal and professional history. Moreover, writing poetry increases our awareness of the sensibilities of nursing practice and the meanings that these sensibilities add to the depth and design of the discipline.     

The role of behavioral experience in judging risks.

This study used conditional risk assessments to examine the role of behavioral experiences in risk judgments. Adolescents and young adults (ages 10–30; N?=?577) were surveyed on their risk judgments for natural hazards and behavior-linked risks, including their personal experiences with these events. Results indicated that participants who had experienced a natural disaster or engaged in a particular risk behavior estimated their chance of experiencing a negative outcome resulting from that event or behavior as less likely than individuals without such experience. These findings challenge the notion that risk judgments motivate behavior and instead suggest that risk judgments may be reflective of behavioral experiences. The results have implications for health education and risk communication. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attenuated fibroblast sheath around the basement membrane zone in the trachea

The mass deployment of gas masks to an entire population, which occurred in Israel prior to the Persian Gulf crisis and their use in early 1991, were phenomena without precedent. In addition to the historical significance, there were considerable health and psychological ramifications. This research examines the experiences of the Israeli public during the Gulf war using a qualitative methodological approach, narrative analysis. Interviews of a convenience sample of 60 patients attending primary care clinics were audio-recorded by three family physicians using an open-ended interview guide. Encounters took place at sites located in the north, south and centre of the country during the period of Iraqi missile attacks. Patients' stories were analysed using a multistep narrative analysis protocol. Seventy per cent of subjects reported deleterious health effects related to the missile attacks or civil defence measures, mainly psychological and neurological complaints, sleep disorders, gastrointestinal and respiratory symptoms. Recurrent themes and metaphors in the narratives most often focused on the difference of this war to others, the central involvement of the family, concern for children and identification and connection to the nation. The Scud missile attacks combined with the civil defence measures had significant impact on the population, as manifested in subjects' stories, symptoms, symbols and behaviour. Narrative analysis provided an efficient method to capture the rich texture of patients' experiences.