PubMed · 14112197
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P S HOLZMAN. 1964. ON PROCRASTINATING.. https://pubmed.ncbi.nlm.nih.gov/14112197/
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AIM: The aim of this study was to establish if postregistration education and clinical experience influence nurses' inferences of patients' physical pain. BACKGROUND: Pain is a complex, subjective phenomenon making it an experience that is elusive and difficult to define. Evaluation of an individual's pain is the product of a dynamic, interactive process that frequently results in ineffective pain management. Educating nurses should address the deficit, however the clinical environment is thought to be most influential in the acquisition of knowledge. DESIGN: A series of vignettes was used to consider nurses' inferences of physical pain for six hypothetical patients; these were employed within a self-administered questionnaire that also addressed lifestyle factors of patients in pain, general attitudes and beliefs about pain management and general knowledge of pain control. METHOD: One hundred questionnaires were distributed; 86 nurses returned the questionnaire giving a response rate of 86%. Following selection of the sample 72 nurses participated in the study: 35 hospice/oncology nurses (specialist) and 37 district nurses (general). Data analysis was carried out using SPSS and qualitative analysis of the written responses. RESULTS: The specialist nurses tended to infer lower levels of physical pain than the general nurses when considering the patients in the vignettes. CONCLUSION: Education and clinical experience influence nurses' knowledge, attitudes and beliefs about pain. However, it would appear that the specialist nurses' working environment and knowledge base engenders a practice theory divide, resulting in desensitization to patients' physical pain. RELEVANCE TO CLINICAL PRACTICE: It is suggested that the specialist nurses use defence mechanisms to protect them from the conflict that arises from working within the clinical environment. These cognitive strategies have the potential to ease cognitive dissonance for the nurse, but may increase patient suffering.
In this article, envy is identified as a drive derivative, erupting as a definable behavior in the anal phase of psychosexual development, locating envy as first being experienced during the stage of self-development, separation/individuation. The aim of envy, as identified by the nature of the investment the subject makes in envied objects, is described as "aquisitiveness," or, following Klein, sadism, defined in terms of the subject wanting to incorporate the envied object, making the aim of envy narcissistic, that is, an aggrandizing of the self. The usual aim assigned to envy, destructiveness, is conceptualized as a defense against the cannibalistic hunger of envy, in response to the regulatory affect, shame. The dynamic of this defense accounts for the dyadic nature of the object of envy (as opposed to jealousy), supporting the "splitting" quality of this defense. This rendering of envy, shame, and sadism promotes the integration of narcissistic urges into normative psychosexual development and deepens an understanding of the splitting defense in pathological narcissism.
Robins' Single-item Self-esteem Inventory was compared with a single item from the Coopersmith Self-esteem. Although a new scoring format was used, there was good evidence of cross-validation in 83 current and former psychiatric patients who completed Harvey's adapted measure of stigma felt and experienced by users of mental health services. Scores on the two single-item self-esteem measures correlated .76 (p < .001), .76 and .71 with scores on the longer scales from which they were taken, and .58 and .53, respectively, with Harvey's adapted stigma scale. Complex and perhaps competing models may explain links between felt stigma and poorer self-esteem in users of mental health services.