Reactions to impaired fertility: the vicissitudes of primary and secondary control appraisals

Recent formulations about how perceived control influences adaptation to chronic medical conditions suggest that although a sense of personal (primary) control may decline over time, there are ample opportunities for individuals to make other adaptation-enhancing "secondary control" appraisals such as construing benefits or finding meaning in their threatening circumstance. We describe a longitudinal study of men and women with impaired fertility that evaluates a dynamic relation between primary and secondary control--one in which anticipated benefits increase over time as failed efforts to achieve a desired pregnancy lead to declines in primary control. Forty-six men and women with impaired fertility rated their sense of personal control over fertility outcomes, the extent to which they anticipated benefits in this situation and their outcome expectancy on two occasions separated by 14 months. As predicted, perceived control diminished over time. Changes in anticipated benefits were unrelated to changes in personal control. Anticipating benefits, however, was inversely related to changes in outcome expectancy, such that a more pessimistic expectancy over time was associated with an increase in anticipated benefits. This relation was independent of perceived control and was not mood dependent. We discuss these findings in terms of current theories of control, the need for further longitudinal investigations to evaluate the temporal relations between primary and secondary control appraisals, and implications for infertility research.     

Osteoporosis: a concern for cancer survivors

PURPOSE/OBJECTIVES: To describe the risk factors, prevention, diagnosis, management, and impact of osteoporosis on the lives of women who have survived breast and endometrial cancer. DATA SOURCES: Journal articles, selected textbooks, prescribing information, and conference proceedings. DATA SYNTHESIS: Women who have not been able to have estrogen-replacement therapy (including women who have survived breast and endometrial cancer) are at higher risk for developing osteoporosis. Osteoporosis is associated with significant medical costs and can have a detrimental effect on long-term quality of life (QOL) as well as increased mortality. Recently, significant advances have been made in the ability to detect and manage osteoporosis. CONCLUSIONS: Thorough assessment, appropriate evaluation, and treatment of osteoporosis can reduce the complications of this condition and ultimately improve the QOL for women surviving cancer. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses should include assessment of risk for osteoporosis into their practice. Education about the prevention of osteoporosis should be included with other wellness education. Women at higher risk for the development of osteoporosis should be referred for a diagnostic evaluation. Oncology nurses can provide women with osteoporosis with education about treatment as well as psychosocial support.     

Shoshin syndrome: two case reports representing opposite ends of the same disease spectrum

The purpose of this article is to describe how nurses can assist the new mother of a high-risk infant, especially a preterm infant, in identifying and obtaining the social support needed to help the family adapt in the first few weeks after the birth. The interventions recommended are based on a research study conducted by the authors and colleagues and summarized within this article. Because support was more important than these mothers expected it to be, it is important that nurses in prenatal, postpartum, neonatal, home health, and extended care settings recognize the need to assist women in identifying their support needs. In addition, nurses can help the mothers identify individuals within their social network who could assist them with those needs. Meeting the social support needs of a mother is important for her own mental and physical health and well-being. It also helps her meet the social and developmental needs of her infant.     

Reactions to predictive testing in Huntington disease: case reports of coping with a new genetic status

A predictive testing program for Huntington disease has been available in Stockholm, Sweden since October 1990. Psychosocial assessments were performed throughout the testing program to evaluate the impact of the risk situation itself and the effect of predictive testing, and to identify those individuals who were most vulnerable to severe stress and anxiety reactions. All subjects underwent neurological, neuropsychological, and psychiatric examinations. Individuals undergoing predictive testing were assessed twice by a genetic counsellor before receiving their results, and at 10 days (gene carriers only) and then 2, 6, 12, and 24 months after receiving the results. The process of coping with the test results and the psychological adjustment to knowledge about new genetic status have been shown to vary considerably. In this report, we describe the results obtained from two gene carriers and two noncarriers. The four persons chosen represent different ways of coping with the outcome of the test and of integrating knowledge about their genetic status into everyday life. These cases illustrate common themes and recurrent problems often surfacing during the counselling and testing process. The longitudinal evaluations provide information about the impact, adaptation, and long-term effects of living with a new genetic status.     

Self-care independence in children with neurological disorders: An interactional model of adaptive demands and executive dysfunction.

Objective: To describe a neuropsychological assessment model that proposes executive functioning as a key moderator in the development of self-care independence. Setting: Inpatient and outpatient rehabilitation facilities. Participants: Transition-age youths with congenital and acquired neurological disorders. Intervention: Transition to the adaptive roles and expectations of adulthood can be challenging for adolescents with neurological disorders and other chronic medical conditions. These individuals frequently encounter functional problems related to additional time requirements, new life skill demands, and increased need for organization and planning. In addition, the neuropsychological consequences of these disorders often include deficits in motor speed and coordination as well as executive control (including planning, organization, and working memory). Consideration of the integrity of executive function skills and the presence of atypical adaptive demands is crucial during planning for transition of individuals into self-care independence and development of an approach to assessment and intervention. Conclusions: Rehabilitation psychologists have the potential to improve the quality of life of adolescents with neurological disorders as they transition into adulthood by considering the "executive burden" posed to the individuals by various combinations of executive dysfunction and atypical adaptive demands. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Theoretical assessment of family-centered care

The purpose of this study was to develop a theoretical concept system to describe family-centred care in a child welfare clinic. A hybrid model was used as a method for concept development. The aim was to test categories which describe family-centred care. The categories were based on the review of the literature and on the analyse based on the interviews of the public health nurses and their client families. The results show that family-centred care at the child welfare clinic can be described by six categories: the life situation and the living conditions of the family, the individuality of the family, the relationship between the family and the public health nurse, nursing actions, the expert knowledge of the public health nurse and her individuality. The results show the different levels of family-centered care. The child, all the members of the family or the whole family system can be chosen as a starting point of nursing. The public health nurses considered that the whole family is the starting point of the family-centered nursing.     

Latent learning in medial temporal amnesia: Evidence for disrupted representational but preserved attentional processes.

Damage to the hippocampus and medial temporal (MT) structures can lead to anterograde amnesia and may also impair latent teaming, in which prior exposure to cues affects their subsequent associability. Normally, latent teaming may reflect both representational and attentional mechanisms. Prior work has suggested that individuals with NIT amnesia have specific deficits in representational processing; thus, latent teaming that invokes primarily representational mechanisms might be especially impaired in MT amnesia. The current results provide preliminary confirmation of this prediction. In Experiment 1, a latent teaming paradigm expected to invoke representational mechanisms was impaired in individuals with MT amnesia, whereas in Experiment 2, a paradigm expected to invoke other attentional mechanisms was spared in individuals with MT amnesia. This suggests the representational and attentional components of latent teaming are dissociable and differentially affected in anterograde amnesia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Inadequate cortical feature maps: a neural circuit theory of autism

The autistic syndromes are caused by neurological dysfunctions. The capacity of autistic individuals to form representations of previous sensory impressions, useful for the processing of present information, is impaired. Self-organizing feature maps are mathematical models of cortical feature maps and may be used to simulate cortical processing. Dysfunctional self-organization, resulting in disability to extract features from stimuli, is proposed as a neural circuit theory of autism. The nature and a possible cause of dysfunction self-organization are examined. It is shown that impaired feature detection is valid for explaining the memory function in autism, the lack of drive for central coherence according to Frith's theory of autism, and a number of impairments from the diagnostic criteria. Unequal levels of impairment of different cortical feature maps can account for the typically uneven intelligence profile of autistic individuals. Excessive inhibitory lateral feedback synaptic connection strengths are presented as one factor impairing the development of feature maps. Strong or excessive inhibitory lateral feedback synaptic connection strengths also cause high sensory discrimination and abnormal sensory responses, both documented in autism. A neural circuit theory for autism has been presented. For a proof of this neural circuit theory neurological investigations are required.     

Identification, intervention and education: essential curriculum components for chemical dependency in nurses

BACKGROUND: A documented need exists for continuing education in the area of chemical dependency as it relates not only to patient care, but also to nurses who are susceptible to addiction. This is significant due to the fact that nurses are at risk for chemical dependency and many nurse peers are unable to recognize the signs of chemical dependency and therefore unable to actively intervene. CONCLUSION: According to the literature, which includes current research, nurses lack knowledge regarding specific risk factors, symptoms of chemical dependency in peers, and steps for intervention. In addition, the literature revealed that nursing curricula allot little time to chemical dependency issues. The results of a small-scale learning needs assessment support this literature finding. Continuing education courses can effectively educate nurses to be able to identify their own susceptibility and those of chemically dependent peers, intervene appropriately, and begin the healing process for the impaired nurse. This article outlines a curriculum and additional resources to address the learning needs of nurses related to chemical dependency.     

Group process in nursing: possibilities and limits

This work shows studies and reflections about the utilisation of groups in nursing assistance. As an aim sought to identify, through nurses perspective, aspects about their motivations to work with groups, their source of knowledge and relevant points of their experience with groups. The results demonstrates that nurses recognise the therapeutic value of groups in assistance and provide suitable conditions to its development. However, difficulties to handling groupal situations are limiting elements to develop this activity that reveal the human sentiment meander, indicating that nurse group co-ordinator needs, beyond theoretical establishment, to practice by their self-knowledge to provide an ambient and a interpersonal relationship able to obtain the real significance of this activity.     

Another advanced test of theory of mind: evidence from very high functioning adults with autism or asperger syndrome

Previous studies have found a subgroup of people with autism or Asperger Syndrome who pass second-order tests of theory of mind. However, such tests have a ceiling in developmental terms corresponding to a mental age of about 6 years. It is therefore impossible to say if such individuals are intact or impaired in their theory of mind skills. We report the performance of very high functioning adults with autism or Asperger Syndrome on an adult test of theory of mind ability. The task involved inferring the mental state of a person just from the information in photographs of a person's eyes. Relative to age-matched normal controls and a clinical control group (adults with Tourette Syndrome), the group with autism and Asperger Syndrome were significantly impaired on this task. The autism and Asperger Syndrome sample was also impaired on Happé's strange stories tasks. In contrast, they were unimpaired on two control tasks: recognising gender from the eye region of the face, and recognising basic emotions from the whole face. This provides evidence for subtle mindreading deficits in very high functioning individuals on the autistic continuum.     

The AIDS epidemic: caring for caregivers

AIDS has become a global health problem for individuals, families and health care providers. This disease has a tremendous impact on the physical and psychological well-being of these groups. Nurses are on the front line providing physical care and support for these patients and their families; but nurses also need support and caring as they carry out their important nursing roles. This article addresses the effects of AIDS on nurses and presents a model for nursing administrators to establish and maintain a supportive, caring environment for nurses.     

The registered nurse: perceptions about advance directives

The driving force behind mandates from both the American Nurses' Association and the American Medical Association is an expectation that doctors and nurses will act as advocates for the participation of the patient in end-of-life treatment decisions. This mandate assumes that both groups are knowledgeable about advance directives and can advise patients on these. Both groups are enjoined not only to facilitate the expression of the patient's wishes but also scrupulously to honor these. The literature suggests that, despite their professional mandate, nurses may feel uncertain about the legal, moral, and ethical obligations surrounding their participation in this enormously significant aspect of patient care. This study focuses on the perception of the dilemma by a sample of registered nurses at a large southeastern university medical center.     

Surgical removal of subretinal neovascular membranes

Although families can provide important support for individuals with life-threatening illnesses or injuries, the highly technological nature of critical care often limits opportunities for family involvement. While critical care nurses are seldom family specialists, they frequently provide support and assistance to patients' families. This paper describes four types of questions drawn from the family therapy literature that can be used by nurses who are not mental health specialists to support families and mobilize their problem solving skills. A case model of a head-injured child demonstrates the use of these questions with a family. These questions should be useful for the brief, problem-focused, family encounters which characterize critical care settings.     

Empowerment as a source of healing: redefining the art of nursing management

Empowerment amounts to a social process of recognizing, promoting and enhancing staff nurse abilities to meet self needs, solve their own problems and mobilize the necessary resources to gain mastery over their own professional lives. Healing, to be made whole, is a process of getting in touch with that which is impeding our realization of wholeness. Empowerment as a source of organizational healing conveys the message that in order to realize wholeness, nurses are dependent upon personal and organizational resources. As nurses learn multiple ways to interact with the work environment, they find the path to a wholeness that incorporates physical, emotional, intellectual, and spiritual aspects of themselves. As the value of wholeness is realized individually, interactions with the environment spontaneously manifest these attributes and the message permeates the nursing community. As the nursing community is empowered, it is increasingly able to empower the individual. This expanding energy can result in a synergistic pattern that brings phenomena together, and interrelates them, creating a new and greater whole from the disparate, seemingly conflicting parts. When nurses as individuals and groups are able and willing (empowered) to invest energy to that which impacts their lives so that they can move toward wholeness (heal), positive energy exponentially intensifies and permeates the environment to envelop all.     

Stair-step artifacts in three-dimensional helical CT: an experimental study

We describe 3 sibs, their father, and paternal grandfather with amelogenesis imperfecta. In 2 sibs and the father the defect is associated with a neurological syndrome which has a wide range of phenotypic variability. The proposita has ataxia, EEG abnormalities, moderate dementia, and enamel hypoplasia. This case and the affected relatives are discussed in relation to Kohlschütter-T?nz syndrome and neuroectodermal diseases. The syndrome described here, characterized by the association of a genetic enamel defect and neurological impairment, may be of considerable interest in advancing genetic and clinical knowledge on ectodermal tissues and their development.