Illness Situation Research Articles

Health, helping networks and well-being

This article examines the mediating effect of illness specific helping networks on the relationship between health and subjective well-being. The three illness specific contexts studied are available helpers: to call on in health emergencies; to assist with common ailments; and to assist with functional disabilities. Data collected from samples of users of two different services (day hospitals and senior centres) are analyzed. The analyses did not reveal who helps to mediate the relationship between health and well-being. However, who helps in health emergencies and common ailments was found to have a direct effect on well-being. In the former situation, the child represents security; in the latter the spouse provides consultation and assistance. None of the helping variables were significantly related to well-being among elders with functional disabilities, perhaps indicating the over-riding importance of functioning to well-being. Future studies could benefit from the inclusion of measures sensitive to the salience of the types of illness situations for the individuals involved. Nevertheless, these data point to the importance of studying helping networks across the different illness situations. Who helps is related to happiness but differentially depending on the type of illness examined.

Health and Helping among the Elderly

This article compares helping networks of men and women for four different illness situations among a random sample of elderly individuals aged 60 and over living in an urban center on the Canadian Prairies (N = 743). Helping networks vary depending on the illness situation. Gender differences are also evident in helping networks, reflecting gender differences in overall interaction patterns. Men are more likely to receive assistance from spouses, and women are more likely to receive assistance from nonspousal others, even when taking availability into account. These gender differences in helping networks are evident for less serious illness situations, such as potential availability during health emergencies and assistance with common ailments. For more serious illness situations (serious conditions and functional disability), many of these gender differences disappear. That is, in the face of serious health threats differential societal expectations for men and women dissipate.

病位と熱寒弁証因子 とくに年齢および尿中プロスタグランディンＦ１α排せつ量の関連について

病位と熱寒弁証因子 とくに年齢および尿中プロスタグランディンＦ１α排せつ量の関連について

Social Support and the Chronically III Individual

Nurses caring for the chronically ill need to be alert for the problems of social isolation and social impairment. Families often respond initially to serious illness by becoming over-protective and fostering dependence and a sense of impaired competence in the ill person. As the illness continues, families often experience exhaustion because of the demands of new roles, depleted finances, and other aspects of a changed lifestyle. Feelings of anger, guilt, and helplessness occur in the network, often leading to withdrawal of support—especially as the ill person's ability to reciprocate support is impaired. Nursing interventions in situations of social isolation focus on reducing isolation by promoting social interaction as appropriate, and by directly or indirectly mobilizing or expanding the social network. The problem of impaired social interaction may occur secondary to the personality changes that often accompany chronic illnesses, or as a function of the chronic illness or disability itself, as in the case of mental illnesses. Social impairment is an appropriate nursing diagnosis in abusive families. Nursing interventions range from educational programs for social skill development to reduction of the amount of contact within the network to involvement of protective and psychotherapy services. Chronic illness has profound effects on social support and the social network of both the ill person and his or her family. As both long-term illnesses and family involvement in care giving increase, nursing care in situations of chronic illness must include attention to issues of social support. Nursing diagnosis provides a framework for nurses to include social support in their care of the chronically ill patient. Social isolation and social impairment can be reduced by nursing interventions.

On the Prevalence of Causal Search in Illness Situations

The prevalence of causal search was examined in two samples, one of chronically ill patients, the other of acutely ill patients. In contrast to the assumption that causal search occurs in important or unexpected life events, the results indicated that such a search was reported by only about half of 296 long-term diabetic, hypertensive, and arthritic patients and 83 newly diagnosed myocardial infarction patients. Moreover, in both samples, affect and expectancies for the future were better for those who had not engaged in causal search. Further research to examine the questions used to elicit causal responses and to test the assumption that causal thinking takes place is suggested.

Coping with breast cancer--a longitudinal prospective study.

In a prospective longitudinal study over several years, 58 patients with breast cancer are compared to 52 patients with fibrocystic disease and 24 patients with mastodynia. Results of coping (as assessed with the Bernese Coping Modes) are presented for the illness course of the first 6 months: (1) There is considerable variation of coping depending on illness situation and illness state. A core group of coping modes is predominant in most situations: 'attention & care', 'problem analysis', and 'Tackling'. In average 10 different coping modes were used by patients per given illness situation. (2) The different aspects of illness (in the same organ) ask for different coping. In the initial evaluation phase, however, the possibly fatal diagnosis overrides these differences. (3) Change over time (first 6 months) is net. Besides the core group of coping modes mentioned above, there is more variability in coping; in cancer a trend from a more fighting to a more accepting attitude is obvious; in fibrocystic disease more restricted coping is observed. Interdependence of coping with emotional stability and social adaptation will be studied as well.

Lay beliefs about the causes of rheumatoid arthritis: their implications for rehabilitation.

This paper reports research based on interviews with 29 people with rheumatoid arthritis of at least 5 years duration. One of the topics covered was the respondents' understanding of the cause of their condition in the light of continuing medical uncertainty about aetiology. The evidence suggests that, in developing explanations, individuals will combine elements of medical knowledge with "common-sense" beliefs derived from other sources. The difference between lay and professional concepts contributes to communication problems and, in situations of chronic illness, communication may be one of the most potent components of rehabilitation. It is suggested that better appreciation of the individual's beliefs about causality could help to overcome the difficulties.

The relationship of pathogenetic mechanisms to treatment in patients with pain.

Pain is the somatic symptom par excellence, legitimizing more than any other the sick role and illness behavior. The functions and implications of pain are clearest in situations of acute illness or injury or in chronic, organically based conditions in which actual or threatened tissue damage is signaled by its report. Much greater complexity is found in a variety of clinical presentations (conversion hysteria, hypochondriasis, chronic pain syndromes, Briquet's syndrome, Munchausen's syndrome) in which pain may form part or all of the clinical picture. In such conditions the relationship of the patient's report of pain to other phenomena (tissue damage, physiopathology, perceptual and cognitive styles, personality type, individual and family psychodynamics, anxiety, depression, behavioral patterns, social and economic factors, cultural influences) is important in elucidating pathogenetic mechanisms of which several may be operating in any one case. Awareness of the existence and interaction of these mechanisms facilitates the development and integration of treatment approaches.

An Exploratory Investigation of Causal Thinking of Arthritics

Research in academic achievement situations suggests that the causes people give for achievement events are linked to subsequent behaviors, emotions, and expectations. An attributional analysis of the causes arthritics gave for their condition tested the limits of the attributional model in the situation of chronic illness. Results indicated that the assumption that causal thinking occurs needs further testing. Fifteen percent of the subjects did not give causes. Those not giving causes were significantly more anxious, more depressed, and more hostile than those who had constructed causes. In terms of the dimensions of attribution theory, the results suggest that when causes are given, they do not easily fit within the classification scheme currently proposed. Suggestions for testing of the attributional model in clinical situations are offered.

Stress and psychosomatic illness.

Increasing attention has been addressed to the relationship of stress and illness during the past several decades. Despite extensive and intensive research in this area leading to statistically significant correlations, the specificity of the relationship remains vague. Some of the difficulty evolves from the definition of stress and illness. What is stress? How is it defined? Can it be defined independent of an identifiable reaction or change in behavior? How is illness defined? How does stress as a phenomenon relate to its perception and cognition and on what levels? To what extent do the physiological-worded concepts of Selye and Levi relate to the social and psychological ones of Holmes, Rahe and others? What do we mean by psychosomatic illness? How specific is it in terms of discrete entities. If we are in agreement that there is something there--something relating to change in behavior, conceptualized in social, psychological and biological terms with an event occurring external or internal to the individual, what greater precision can we strive for in determining and identifying specificity and the particulate? Is it possible to define a new model of relationships that will assist in identifying, determining and intervening in stress-related illness situations?

Practitioner or Patient - Who's in Charge?

Traditionally, the sociological concept of the relationship between practitioner and patient has been the sick role, in which the physician as practitioner is in charge, and the patient is obligated to cooperate with the physician's prescribed regimen. More recently, this power relationship has been redefined by some from a consumerist perspective, in which physician and patient bargain over the terms of the relationship. Although each brings different resources to the encounter, neither participant is automatically in charge. Data from a sample of 466 members of the public and 86 physicians are used to assess the extent of reported public attitudes and behaviors that challenge the physician's traditional power, as well as physicians' reported response to such attitudes and events, as evidence of the public's propensity to a consumerist relationship and physicians' willingness to accept it. Among both the public and physicians, substantial minorities express beliefs and report actions congruent with this consumerist perspective. However, different demographic and health belief variables emerge in the two groups as explanatory factors. Doctor-patient power relationships are seen to depend on characteristics of the actors as well as on the illness situation.

Familial coping with chronic and severe childhood illness: The case of cystic fibrosis

While families tend to report similar initial reactions to a diagnosis of severe childhood illness, study data suggests that longterm familial responses are more varied. Based upon the perceptions of parents representing 100 families managing childhood cystic fibrosis for several years, the present study revealed that coping strategies utilized to minimize the illness related hardships were statistically significantly associated with longterm adequacy of family functioning. It is suggested that professionals providing support to families facing chronic hardships could strengthen continuous familial interaction by encouraging familial sharing of the burdens of the stressful situation and promoting familial ability to endow the illness situation with a personally significant meaning.

Psychodynamics and therapeutic aspects of anorexia nervosa. A study of family dynamics and prognosis.

38 patients who had suffered from anorexia nervosa were examined and followed up in a catamnestic study, and their biography, family dynamics, eliciting situation and history of illness were studied. The investigation was carried out by means of interviews, questionnaires and personality tests. As to biography and family dynamics, our results are partly complementary and partly contradictory to previously published results of other investigations. Our patients received inpatient psychotherapy over an average period of 3 months and were followed up 2-5 years later. The following prognostic criteria proved to be significant: vomiting as part of the symptoms; chronification (psychotherapy delay), and ability to achieve a constructive therapist/patient alliance. Patients whose weight was largely back to normal by the end of therapy, but were still amenorrhoeic, showed unfavourable development in psychosocial relations. The catamnestic results improved with increasing time lapse between the end of therapy and follow-up investigation.

Liaison Psychiatry as a Systems Approach to Behavior

In this overview, the psychosomatic theory is discussed from an evolutionary perspective. From its initial concern with relationship between emotions and physiology through psychopathology and anatomo-physio-pathology to socio-psycho-pathophysiology, psychosomatic medicine and its theory is presently viewed as an empiric science utilizing a number of conceptual approaches derived from developmental psychology, classical psychiatry, physiology, sociology and anthropology. These are applied to the study and care of patients in ambulatory and inpatient settings, which are the arenas of the consultation-liaison activity and may be viewed as the clinical laboratories of psychosomatic medicine. In these laboratories, a new language has developed which is largely phenomenological and which attempts to utilize theoretical concepts from several disciplines in explaining the illness illness phenomenon in the present. As such, the practitioner of Liaison Psychiatry is a general systems analyst who analyzes the illness situation of the patient and his attendants in an attempt to decipher the identified problem, explaining it by utilizing selected theoretical concepts from the basic sciences of behavior. Psychosomatic theory is seen as an evolving and bridging science attempting to integrate and combine particulate theory into a more comprehensive synthesis.

Psychiatry in everyday medical practice.

The general practitioner's awareness of the psychotherapeutic aspects of every doctor-patient transaction would allow him more effectively to apply the principles of preventive psychiatry to his everyday medical practice. The experience of one physician's practice is drawn upon to demonstrate how some of Balint's techniques apply to cases in general practice. The categorization of presenting complaints into “no illness situation,” “unorganized illness,” or “organized illness” helps the physician to make distinctions between “traditional diagnosis” and “overall diagnosis.” This method is illustrated with several case examples showing how the physician helped the patient to move from a narrow physical focus to an exploration of broader emotional problems.

AVOIDING PEDIATRIC PATHOGENESIS IN THE MANAGEMENT OF ACUTE MINOR ILLNESS

The management of acute minor illnesses constitutes a major portion of a physician's work. The impact of such illness on the child's development and the physician's positive or negative influence on the child's and the parents' emotional adjustment are considered here. Very few data are available in the literature. Suggestions for management and research are presented. Diagnosis and therapy of acute minor illness are far from uniform or agreed upon. Accurate diagnosis and reasonable treatment are the pediatrician's first responsibility. Over-, under-, and misdiagnosing and treating are to be avoided. Secondly, he should nurture the sick child by reducing stress and by promoting his adjustment to the illness situation. The child's emotional health suffers from the pediatrician's neglect, over-involvement with or mismanagement of his feelings during illness. Thirdly, the pediatrician should support the parents by helping them to deal with the specific illness and by promoting their capacity to cope with illness in general. If, instead, the pediatrician is overly dominant or submissive, neglectful or punitive in handling the parents' needs, they may become frightened, dependent, demanding, confused, or angry. Their feelings of incompetence in handling illnesses affect their general child-rearing abilities.

Communication With the Fatally Ill.

This is a small but important volume devoted to a specific situation in medical practice. Written by a psychiatrist and psychoanalyst who has obviously acquired a great deal of professional experience in terminal illness situations, the book is directed toward the physician who has primary responsibility for a dying patient. All phases of fatal illness, from initial symptoms through the patient's awareness of his dis ease to eventual death, are carefully considered. Explanations and therapeutic suggestions are advanced in a style that is extremely readable and refreshingly free of jargon. Because of this, the material will also be informative for those in other professions, such as clergymen and nurses, who find themselves involved in caring for the fatally ill. The book beings with a discussion of the meaning of death. The author considers the special problems of dealing with this phenomenon in a culture which is largely organized away from

Handbook of Pediatric Medical Emergencies.

This is an inexpensive book which would be particularly useful to the busy practitioner who does not have immediate access to adequate library facilities when faced with a medical emergency. It contains a great deal of information pertaining to the diagnosis as well as the treatment of various situations of acute illness in infants and children. Doses of antibiotics and numerous medications for pediatric patients are adequately discussed. The subject material covers a wide span of emergencies, including the cardiovascular, genitourinary, nervous, and respiratory systems. Numerous other problems which commonly confront physicians are reviewed, such as poisonings, epistaxis, and insect, animal, and human bites. A chapter describing techniques of a number of procedures essential in pediatric care, such as venapunctures, aspiration of subdural hematoma, and paracenteses, is made quite lucid by photographs and diagrams. At the conclusion of each chapter a list of recommended references is presented where the reader

Anomalous Pulmonary Venous Drainage

Primary care givers commonly interpret shortages of time with patients as placing them between a rock and a hard place in respect of their professional obligations to fairly distribute available healthcare resources (justice) and to offer a quality of attentive care appropriate to patients’ states of personal vulnerability (compassion). The author argues that this a false and highly misleading conceptualisation of the basic structure of the ethical dilemma raised by the rationing of time in clinical settings. Drawing on an analysis of the Aristotelian virtue of <i>nemesis</i>, or “the sense of justice”, it is argued that, far from being a moral orientation distinct from justice, compassion is a justice response insofar as it is conceptualised as a rational, appropriate response to others’ adversity. The author then proceeds to point out that the perspective on justice and compassion as attributes of healthcare professionalism suggests a novel critical viewpoint on the ethics of managed forms of clinical rationing and the “scarcity paradigm” they engender: clinical conditions where primary care givers’ time is intentionally rendered a commodity in chronically short supply run a deficit of justice, because they fail to make adequate accommodations for the provision of the quality of care human beings deserve in situations of illness and injury, and when they are dying.