Individual Life Situation Research Articles

Originalbeiträge (Originals). Belastung(sgrenz)en für Psychotherapeut:innen nach der Reform

Of 128 psychotherapists approached, 41 (32 %) agreed to study participation. Semistructured interviews were examined via qualitative content analysis. 83 % (n = 34) expressed some kind of burden. Burdens in terms of time, pressure/ stress and having to decline patients were named most frequently. 54 % of the participants (n = 22) pointed out various limits to what they can accomplish, mostly related to shortened waiting times and treatment availability. Burdens were more common among psychotherapists with a half care license and behavioural therapy; there were no major differences between urban or rural residents. Burdens for psychotherapists may result from individual life situations and resources of treatment availability.

The genesis of the casual interpretation of legal norms

The author examines the evolutionary development of ideas about the casual interpretation of legal norms. The subject of the study is the legal understanding of casual interpretation in the process of formation of state and legal institutions. The object of the research is scientific publications, monographs, textbooks, treatises and other historical sources containing conceptual information on hermeneutics, legal interpretation and, in particular, on the casual interpretation of legal norms. The purpose of the research is to reveal the paradigms of the emergence and causes of the transformation of views on the casual interpretation of the legal text. The coverage of the present issue determines the initial appeal to the origins of the formation of the hermeneutical methodology itself. The author focuses on such aspects of the subject as the initial object of hermeneutics; its main historical variations; the close connection between the emergence of hermeneutical ideas with the gradual transformation of society and its forms of organization; the problem of establishing criteria for the implementation of true interpretation. The methodological basis of the work consists in the application of a historical, logical, comparative and systematic approach. The result of the research is expressed in the establishment of dominant events that are significant for the formation of the concept of the casual interpretation of legal norms at various stages of the historical development of society. The novelty of the research is predetermined by an innovative view of the formation of the hermeneutics in the context of the development of legal casuistry and legal understanding of individual life situations. The author notes that the emergence of hermeneutical methodology most vividly correlates with the desire of the subject of law to use various interpretations of emerging incidents, including legal ones. The improvement of methods of interpretation of dreams, predictions, signs, and subsequently words and text led to the emergence and doctrinal formulation of the concept of casual interpretation of normative prescriptions. In conclusion, the author summarizes that today there is a similar general theoretical understanding of the casual interpretation of the norms of law as an independent type of interpretation.

Socio-economic factors, mood, primary care utilization, and quality of life as predictors of intervention cessation and chronic stress in a type 2 diabetes prevention intervention (PREVIEW Study)

BackgroundSedentary lifestyle and unhealthy diet combined with overweight are risk factors for type 2 diabetes (T2D). Lifestyle interventions with weight-loss are effective in T2D-prevention, but unsuccessful completion and chronic stress may hinder efficacy. Determinants of chronic stress and premature cessation at the start of the 3-year PREVIEW study were examined.MethodsBaseline Quality of Life (QoL), social support, primary care utilization, and mood were examined as predictors of intervention cessation and chronic stress for participants aged 25 to 70 with prediabetes (n = 2,220). Moderating effects of sex and socio-economic status (SES) and independence of predictor variables of BMI were tested.ResultsParticipants with children, women, and higher SES quitted intervention earlier than those without children, lower SES, and men. Lower QoL, lack of family support, and primary care utilization were associated with cessation. Lower QoL and higher mood disturbances were associated with chronic stress. Predictor variables were independent (p ≤ .001) from BMI, but moderated by sex and SES.ConclusionsPolicy-based strategy in public health should consider how preventive interventions may better accommodate different individual states and life situations, which could influence intervention completion. Intervention designs should enable in-built flexibility in delivery enabling response to individual needs.Trial registrationClinicalTrials.gov Identifier: NCT01777893.

Development of a subset of the international classification of functioning, disability and health as a basis for a questionnaire for community-dwelling older adults aged 75 and above in primary care: a consensus study

ObjectivesFunctioning of older adults needs to be adequately described before it can become the focus of care. The International Classification of Functioning, Disability and Health (ICF) provides a basis for...

"I Should at Least Have the Feeling That It […] Really Comes from Within": Professional Nursing Views on Assisted Suicide.

Due to a decision by the German Federal Constitutional Court of February 26, 2020, it is currently possible in Germany to avail of assisted suicide. The ruling has given rise to a controversial debate within the professional community as well as in society in general. Within this debate, little attention has been given to the role of nursing staff in assisted suicide. However, international studies show that nurses play an important role in assisted suicide. The aim of this study is to assess the views and attitudes of nurses from different care settings in Germany toward assisted suicide. A qualitative research design was chosen to capture the subjective experience of nursing staff on suicide assistance. This was analyzed using the grounded theory method. With the help of a semi-structured, narrative-generating interview guide, in which five case vignettes are integrated, 20 interviews were conducted with nursing professionals from different care settings throughout Germany. The analyzed phenomenon shows that nursing professionals need to understand the desire to die for themselves. The individual life situation of the respective patient is decisive. The action strategy based on being able to tolerate the wish to die determines how intensively they want to be involved before, during, and after assisted suicide. For nurses, however, it is undisputed that it is their professional role to accompany the patient in their "existence" and thus also in the context of assisted suicide. In view of the future development of assisted suicide in Germany, it seems necessary to prepare nursing professionals for activities related to assisted suicide by means of a curricular offer. In addition, nursing professionals should be supported in forming their own attitude to the issue.

Practitioners' ability to remotely develop understanding for personalised care and support planning: a thematic analysis of multiple data sources from the feasibility phase of the Dementia Personalised Care Team (D-PACT) intervention.

Practitioner understanding of patients' preferences, wishes and needs is essential for personalised health care i.e., focusing on 'what matters' to people based on their individual life situation. To develop such an understanding, dementia practitioners need to use communication practices that help people share their experiences, preferences, and priorities. Following the COVID-19 pandemic, dementia support is likely to continue to be delivered both remotely and in-person. This study analysed multiple sources of qualitative data to examine the views of practitioners, people living with dementia and carers, and researchers on how an understanding of what matters to people living with dementia can be developed remotely via telephone and video call. Access to environmental stimuli, the remote use of visual tools, peoples' tendency to downplay or omit details about their troubles and carers' ability to disclose privately were interpreted, through thematic analysis, to be factors affecting how practitioners sought to develop understanding remotely. Cumulatively, findings show that while remote support created unique challenges to practitioners' ability to develop understanding for personalised care, practitioners developed adaptive strategies to overcome some of these challenges. Further research should examine how, when and for whom these adapted practices for remote personalised care work, informing the development of evidence-based guidance and training on how practitioners can remotely develop the understanding required for personalised care.

Evolutionary psychiatry: foundations, progress and challenges.

Evolutionary biology provides a crucial foundation for medicine and behavioral science that has been missing from psychiatry. Its absence helps to explain slow progress; its advent promises major advances. Instead of offering a new kind of treatment, evolutionary psychiatry provides a scientific foundation useful for all kinds of treatment. It expands the search for causes from mechanistic explanations for disease in some individuals to evolutionary explanations for traits that make all members of a species vulnerable to disease. For instance, capacities for symptoms such as pain, cough, anxiety and low mood are universal because they are useful in certain situations. Failing to recognize the utility of anxiety and low mood is at the root of many problems in psychiatry. Determining if an emotion is normal and if it is useful requires understanding an individual's life situation. Conducting a review of social systems, parallel to the review of systems in the rest of medicine, can help achieve that understanding. Coping with substance abuse is advanced by acknowledging how substances available in modern environments hijack chemically mediated learning mechanisms. Understanding why eating spirals out of control in modern environments is aided by recognizing the motivations for caloric restriction and how it arouses famine protection mechanisms that induce binge eating. Finally, explaining the persistence of alleles that cause serious mental disorders requires evolutionary explanations of why some systems are intrinsically vulnerable to failure. The thrill of finding functions for apparent diseases is evolutionary psychiatry's greatest strength and weakness. Recognizing bad feelings as evolved adaptations corrects psychiatry's pervasive mistake of viewing all symptoms as if they were disease manifestations. However, viewing diseases such as panic disorder, melancholia and schizophrenia as if they are adaptations is an equally serious mistake in evolutionary psychiatry. Progress will come from framing and testing specific hypotheses about why natural selection left us vulnerable to mental disorders. The efforts of many people over many years will be needed before we will know if evolutionary biology can provide a new paradigm for understanding and treating mental disorders.

Collective Competence as an Enabler for Service Integration in Health and Social Care Services.

Fragmentation in health and social care services can result in poor access to services, lack of continuity and inadequate provision for needs. A focus on integration of services are thus suggested to prevent negative consequences of fragmentation for service recipients. There are, however, few studies that explore the competence needed for integration of services in municipal health and social care organizations. This study explores which types of competence stakeholders require and how collective competence can promote service integration. This is a single-case study, and the data consist of focus group interviews and individual interviews with service recipients, family caregivers, professionals and managers. The data were analysed both inductively and deductively. The analysis resulted in four main themes: 1) Knowledge about individual life situations and organization and system, 2) investigation competence, 3) person-centred collaboration competence and 4) facilitating competence. The themes form the basis for a collective competence framework that can promote service integration. As service integration involves a high degree of interlinked activities between professionals and organizational units, a collective approach to the concept of competence is presumably applicable. When service integration competence is approached as a collective attribute of a network within and between organizational units, the organization can facilitate this competence by encouraging an active exchange of knowledge between professionals. We also argue that service integration competence increases connectivity and interdependency between professionals and organizational units, and includes service recipients and family caregivers as legitimate extra-professional parts of the collaborative network.

First Insights into Barriers and Facilitators from the Perspective of Persons with Multiple Sclerosis: A Multiple Case Study.

Multiple Sclerosis (MS) is a complex, lifelong disease. Its effects span across different areas of life and vary strongly. In Switzerland, there is an intense discussion on how to optimize quality of care and patient safety. Patients should be more involved in the management of health care to improve the quality of care from the patient’s perspective and form a more comprehensive perspective. This multiple-case study explores the question of how persons with MS experience and describe functioning related barriers, facilitating factors, and ethically relevant conflicts. To address this from a comprehensive perspective, the MS core set of the International Classification for Functioning, Disability, and Health (ICF) is used as theoretical framework. To explore barriers, facilitators, and relevant ethical issues, different narrative sources were used for thematic analysis and ICF coding: (a) MS transcripts from DIPEx interviews and (b) an autobiographical book of persons living with MS. Insights that were meaningful for daily practice and education were identified: (a) understanding the importance of environmental circumstances based on narrative sources; (b) understanding the importance of a person’s individual life situation, and the ability to switch perspectives in the medical field; (c) respect for PwMS’ individuality in health care settings; (d) creating meaningful relationships for disease management and treatment, as well as building trust.

The difference and its study of the cultures of West and East Germany around the reunification in 1989

The then West and East Germany originated from one nation, but there was big difference between their cultures before and immediately after the reunification in 1989. The difference is embodied in many aspects of the society, affecting deeply the individual life and national situation. Their formation has multiple causes, and various measures need to be made to bridge these gaps to reach the balance, so that Germany after the fall of Berlin wall can go ahead prosperously, and brings benefits to all its people.

Rehabilitation Through Physical Activity and Sport in Light of the International Classification of Functioning, Disability, and Health-Current Research Perspectives.

The implementation of functioning by the World Health Organization (WHO) as the third global health indicator, along with mortality and morbidity, represents a promising advancement for a comprehensive assessment of international health systems and health strategies. The description of a person's health state operationalized by both biological and lived health via functioning provides a holistic picture of an individual's life situation and proved to be successful in building a framework for formulating therapy goals, achievable activities, and participational aspects against the background of an individual's life situation. Furthermore, improving an individual's functional ability and wellbeing could potentially affect the health indicators of morbidity and mortality and will be codable beyond the ICF in ICD-11. This methodological perspective emphasizes the use of ICF applications on the wider and narrower level of international rehabilitation systems and highlights the incorporation of the term functioning in rehabilitation through physical activity and sport. Current research perspectives in applying the ICF and functioning in clinical and rehabilitation practices are discussed and a current explorative study is presented, which applies the holistic orientation of functioning and the biopsychosocial model to the specific case by an individualized sports coaching intervention in rehabilitation. Subsequently, a unifying ICF- oriented language in rehabilitation is considered as a powerful foundation for a consistent international research strategy concerning increased international collaborations and future research perspectives.

Новое вино в старые мехи: высший смысл для современного экзистенциализма

The author of the paper investigates the existential theory by Victor Frankl, which includes two main variations of life meaning - the so-called super meaning (higher meaning) and the meaning of individual life situations. The author's conclusions mark the essential drawbacks of the Franklian conception, which deal with the declared impossibility of a human mind to know the above-mentioned super meaning, though the latest one greatly influences the more private and more concrete meanings of individual life situations. For the above reason, the level of the higher meaning cannot be excluded from logotherapy because it will have negative impact on a person's (cliental) general motivation in the search of one's own life meaning - as well as the meaning of its concrete situations. The author of the paper has solved the given problem by endowing the level of a higher meaning with a new concrete content. Firstly, such an operation has made super meaning a much more rational and understandable notion. Secondly, the new meaning has preserved its former importance due to an integration of a number of important scientific (mostly, biological and psychological) regularities known about human nature by now. We used the idea of a human self-improvement as the central concept at the super meaning level. Such a notion brings a number of advantages while playing a role of a higher meaning. First, it is suitable for almost any person regardless of their religious beliefs. Self-improvement is a very capacious word, which can be compared with meaning by its volume and content. And besides, the idea of self-improvement has a great motivating power. The use of this notion in the applied (psychotherapeutic) aspect enables a therapist to interpret a client's efforts on overcoming his difficulties as those, which correspond to self-improvement (in a broad sense) and thus bring higher meaning into one's life. We make a general conclusion that an operation made has several theoretical and practical advantages and at the same time does not create negative side effects.

SOCIAL, LEGAL AND ECONOMIC BARRIERS OF EMPLOYMENT STIMULATION IN SELECTED GROUPS OF THE UNEMPLOYED

There are a lot of determinants of registration at the labour office, many so, as many as there is individual people life situation, which are unemployed. Also exist numerous barriers of employment stimulation in selected groups of the unemployed, registered at the labour office. One can divide the barriers of employment stimulation in researched groups of unemployed into three categories: social, legal and economic. The goal of present study is presenting the interdisciplinary perspective in complex issue of employment stimulation and the barriers of taking job in selected groups of the unemployed in social, legal and economic point of view. The present article based on many years’ empirical researches, led in the labour offices.

Gesundheitsverhalten und Bedürfnisse von Menschen mit COPD während der COVID-19-Pandemie - Eine Dokumentenanalyse.

To describe the health behaviours and needs people with COPD convey during nursing phone consultations and which nursing interventions have been carried out. A document analysis of 50 nursing phone consultations was performed. The data were summarised descriptively and analysed thematically. The main topics were the adaptation of physical activity, the implementation of the recommendations to the individual life situation, the detection of a COVID-19 infection and questions concerning the planning of medical appointments. The COVID-19 pandemic poses additional challenges to the disease management of people with COPD. The increased need for care brought on by the pandemic was able to be met by the knowledge provided in the nursing phone consultations. What remains to be established is what role the consultations play in a sustainable change in behaviour and in dealing with negative emotions.

Rare Cause for Difficulty in Swallowing with Neck Swelling - Paraganglioma

Rare Cause for Difficulty in Swallowing with Neck Swelling - Paraganglioma Abstract. Pain-free lateral swelling of the neck should be taken seriously and promptly clarified by using sonography. If a cervical paraganglioma is suspected, an interdisciplinary clarification should be initiated. In addition to an MRI of the neck, a vascular-surgical, an ENT specialist and an endocrinological examination should be carried out. If there is a high degree of suspicion of a carotid body tumor, surgical removal or a prospective procedure should be used in accordance with the Shamblin classification, the genetic clarification and the patient's individual life situation. If there is suspicion of vagal paraganglioma due to the location of the tumor and the symptoms, an expectative approach with regular check-ups should be considered in a symptom-poor and elderly patient.

Psychometric properties of the Assessment Tool for Perceived Agency (ATPA-22) – utility for the rehabilitation of young adults not in education, employment or training (NEETs)

Background Promoting and supporting agency have been at the heart of the debate multidisciplinary. To promote self-awareness of young people’s agency and identify persons in need of support the Assessment Tool for Perceived Agency (ATPA-22) was developed. Aim This study aims to evaluate the psychometric properties of the ATPA-22. Participants were young adults not in education, employment or training (NEETs) and students in higher education (HEI). Materials and methods The main data analysis was implemented by Many Faceted Rasch (MFR) analysis. Results The ATPA-22 items defined a unidimensional construct with reasonable internal consistency and separation ability. The ATPA-22 was capable of detecting differences between HEI students and young adult NEETs. Nine differential functioning items emerged between the groups. Conclusions ATPA-22 shows promise as a tool to assess young adults’ perceived agency. Anyhow, as the individual life situation affects strongly to perceived agency, research on the stability of the ATPA-22 among different populations is needed. Significance The purpose of the ATPA-22 is to measure perceived agency of individuals, and to identify aspects of agency in need for support. ATPA-22 can be used as a tool for promoting self-awareness of occupational challenges.

Home care services for older persons. The views of older persons and family members: A realistic evaluation.

The aim of the present study was to evaluate client-centred care in older persons' home care services from the perspective of older persons and family members. The following research questions were addressed: How do home care older persons and family members perceive client-centered care in their home care services? What kind of social mechanisms are realized when home care services are implemented? Several older persons are dependent on home care services for their continued living at home. The fundamental value and best practice of home care is the client-centred care in services. The research method was realistic evaluation. Six families with six older person clients of home care and seven family members were interviewed. In the present study, the interview contained three themes (1) content and services of the home care, (2) activities and practices of the home care and (3) development of client centredness in home care. Research data were analysed with deductive content analysis. Home care service should be based on analysis of older person's individual life situation. Social mechanisms such as interaction, participation, trust and adaptation are realised in implementation of home care services. The most significant outcomes of client-centred service were timely availability of services, safe care relationship and continuity of care, ability to influence on own services and appropriate price of services. Significant factors in quality of service were unhurriedness, kindness and competence of professionals. Social mechanisms, such as participation, trust, adaptation and interaction, should be taken in account in care relationship in home care. Client centredness and methods for evaluating it should be defined in practical work. Client-centeredness competence should also be included in all stages of professional education of home care.

Does Information Become Actual Knowledge in Surgical Spine Patients? A Qualitative Study.

It is seldom questioned, if information delivered (to a patient) actually produces knowledge. There is a lack of understanding of how patients in general, surgical patients in particular, perceive, process, and translate clinical information in their everyday lives. The objective of this study was to elucidate how patients undergoing spinal fusion surgery manage and assimilate information provided by clinicians and how they adapt and embrace this information pre- and postsurgery. The study employed qualitative methods of ethnographic observation and semistructured interview with a total of 14 individuals, that is, spinal fusion patients (n = 6) and clinicians (n = 8) over a 4-month period in 2014. The results highlight that in the course of treatment, patients embrace or reject information on the basis of their previous experience, expectations, and confidence in their own ability. Overall, patients adjusting to everyday life after spinal fusion surgery used 4 strategies of information processing about their individual life situation. Patients do not use just one of these strategies but may use a number of strategies depending on the situation. Such production of knowledge is pivotal to the behavior of patients through their treatment trajectory. This study points to the challenges of supporting patients to assimilate information and affect health-related behaviors, recognizing that knowledge and behavior change are emergent processes in patients and not a linear outcome of information.

Distribution and evaluation of sense of coherence among older immigrants before and after a health promotion intervention - results from the RCT study promoting aging migrants' capability.

BackgroundThe migration process can be a threat to a person’s sense of coherence (SOC) and to their ability to experience life as comprehensible, manageable, and meaningful. Seen from a salutogenic perspective, this may have a negative impact on the experience of health.PurposeWe describe the distribution of SOC and its components among older persons with an immigrant background now aging in Sweden. In addition, we evaluated whether a group-based health promotion program with a person-centered approach could support the SOC among older persons in this group.Materials and methodsA randomized controlled trial with postintervention follow-ups at 6 and 12 months was conducted with 131 independently living persons aged ≥70 years from Finland and the Balkan Peninsula. Participants were randomly allocated to an intervention group (4 weeks of group intervention and one follow-up home visit) and a control group (no intervention but access to ordinary health care services). The outcome measure was the SOC measured by SOC-13. Chi-square and ORs were calculated.ResultsThere was a significant improvement in total SOC scores for the intervention group at 6-month follow-up. Also, the ORs for the SOC components were higher in the person-centered intervention group. However, we found no significant between-group differences nor did the effect last until the 12-month follow-up.ConclusionPersons who have lived a long time in a host country after migration seem to have a SOC similar to native-born persons. Interventions with a person-centered approach could support the SOC by capturing individual life situations. Such interventions could support older persons by making everyday life more comprehensible and manageable and helping them to cope with challenges in daily life caused by aging.

‘Maturing out’ as normative standard: qualitative interviews with young adult drinkers

ABSTRACTFramed within a life-course perspective, this paper analyses the contents of the phenomenon ‘maturing out’ of adolescent drinking. We identify five dimensions of change that young adults’ drinking habits are expected to undergo when they reach their mid-twenties: using alcohol to maintain and develop existing relationships instead of building new relationships; drinking in differentiated ways instead of always to get drunk; controlling one’s intoxication instead of transgressing limits; considering the day after drinking instead of ‘living for the night’; and drinking to ‘chill’ and not to ‘cope’. Maturing out, as described by our interviewees, is only loosely connected with the taking on of adult roles and responsibilities (related to e.g. work and family). Rather, maturing out is a powerful social norm urging young adults to change their drinking habits, regardless of their individual life situation – a status-forcing mechanism casting those who do not adapt as deviants. The analysis centres on 24 qualitative interviews with Danish 25–27-year-olds identified as ‘heavy drinkers’ in a preceding population survey.