Alfredo's story is part of a larger phenomenological study of nursing, self care, and HIV disease that incorporated the anthropological tradition of reconstructing a life-story in the person's own words. This exemplar emphasizes Alfredo's shifts perspective organized around three turnings, or shifts in perspective, which are illustrated with narrative text and discussed. The three turnings include becoming HIV-infected, becoming a positive force, and reclaiming self. Implications for nursing include the importance of story telling in life history, the value of knowing the patient as a person, the positive impact of negative events, and the educational impact of a paradigm case.

Adaptation, Psychological↗

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Managing depression among people with HIV disease.

Many people with HIV suffer from depression, which responds to antidepressants, counseling, education, and cognitive strategies. Untreated depression hinders treatment compliance and increases risk of suicide. Management and complications of major depression are described. The evaluation of rational suicide is examined. Clinicians who treat this population need to respond therapeutically to patients with depression and suicidal ideas.

Antidepressive Agents↗

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End-of-life issues.

A patient's desire to discuss end-of-life (EOL) choices may be among the most stressful situations for clinicians. Research confirms the importance of discussions between caregivers and patients or their surrogates about options for current and future care. Often, terminally ill patients want to discuss EOL options to avoid undue suffering, pain, and other symptoms and want some reassurance that caregivers can provide effective physical, psychosocial, and spiritual care. Patients often approach nurses first and ask for their assistance before they ask other professionals; they are more likely to ask nurses in home care than in other settings.

Decision Making↗

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Children, adolescents and nuclear war anxiety.

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Adaptation, Psychological↗

PubMedDate not supplied

Adolescent suicide: assessment and intervention.

Understanding how to prevent suicide, the third leading cause of adolescent death, is the focus of this article. To prevent suicide, the nurse assesses risk factors, covert messages, overt suicide clues, and intervenes with the adolescent and family. Suicide risk and hopelessness decrease as suicidal youths learn to clarify problems, rally significant others, expand resources and use safe coping strategies. Interventions include a no-suicide contract, family therapy and school suicide prevention programs. Nurses can identify the youth at risk for suicide and, in many cases, provide the therapy that helps prevent suicide. Vignettes illustrate strategies that effectively reduce suicide risk.

Adolescent↗

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The challenge of ritualistic child abuse.

Survivors of ritual abuse have endured physical and psychosexual trauma typically compounded by mind-altering drugs. Some abused children have never known a trustworthy adult to protect them from harm. Children often cope with the anxiety and terror of abuse through psychological defenses such as denial, self-hypnosis, and dissociation, but more extreme responses such as self-mutilation or multiple personalities may occur. Reports of ritual abuse of children are so shocking and bizarre that professionals initially respond with confusion and disbelief (Cozolino, 1989). Nurses need to assess clues and detect symbols of abuse in drawings or flashbacks, to build trust, and to monitor their attitudes and countertransference. Nurses are in a critical position to detect and begin healing wounds of ritual abuse.

Adolescent↗

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Using hypnosis with children for pain management.

Although nurses are in a strategic position to use hypnosis to manage a child's cancer pain, many lack the knowledge, the skill, or the exposure to the clinical effectiveness of hypnosis. Hypnosis has been a potent analgesic and anesthetic agent for more than 100 years; it reduces a child's cancer pain and the pain associated with painful procedures. Nurses can use hypnosis to help children diminish pain and cope with lumbar punctures (LPs), bone marrow aspirations (BMAs), and nausea or vomiting from chemotherapy. This article's purpose is to discuss myths, contraindications, research, processes, and effectiveness of hypnosis as a strategy for managing the cancer pain of school-age children. Vignettes from the author's clinical practice illustrate concepts and procedures.

Autosuggestion↗

PubMedDate not supplied

Cancer and suicide.

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Depression↗