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PubMed1993

Medical students' experiences with and perceptions of chronic illness prior to medical school.

Concerns have been expressed about the failure of the medical curriculum to address the health-care needs of the chronically ill. It has been shown in the literature that medical students develop cynicism and negative feelings towards chronic illness as they progress through their training, perhaps as a result of the attitudes and frustrations of their teachers. What has been inadequately addressed are the experiences with and perceptions about chronic illness that medical students have before entering medical school. Some recommendations are made for curriculum changes based on the findings reported.

Attitude to Health↗
PubMed1996

Concepts related to Chinese patients' perceptions of health, illness and person: issues of conceptual clarity.

Since most health professionals who care for Chinese patients are trained using Western medical educational systems, they are often unaware of the complex Chinese culture that influences their patients' responses to care. Discrepancies often exist between health professionals' and Chinese patients' perceptions of health and evaluations of the quality of care. In order to provide culturally sensitive care for this population, the complex Chinese traditional philosophies, such as the theory of yin and yang and the five phases, as well as the philosophies related to the concept of personhood including Confucianism, Taoism and Buddhism are examined first. This is because these theories and philosophies not only influence Chinese patients' values and beliefs, but also determine their perceptions of health, illness and nursing care. The discussion of implications for surgical cardiovascular nursing practice for this particular population are followed.

Attitude to Health↗
PubMed1999

Therapeutic paralysis of critically ill trauma patients: perceptions of patients and their family members.

BACKGROUND: Neuromuscular blocking agents are used in critically ill patients to induce therapeutic paralysis. These drugs leave patients fully immobile but conscious. Analgesics and sedatives are concomitantly administered with the paralytic agents. Little is known about what patients remember when they receive these combinations of drugs. Even less is known about the experiences and needs of the patients' family members during the patients' paralysis. OBJECTIVES: To obtain recollections of therapeutic paralysis in critically ill adult trauma patients and to determine the psychological, emotional, and educational needs of the patients' family members during the time the patients were paralyzed. METHODS: A qualitative phenomenological approach was used to investigate the "lived" experience of therapeutic paralysis of 11 pairs of subjects. Each pair consisted of one critically ill adult trauma patient and one member of the patient's family. RESULTS: The patients recalled their experience of therapeutic paralysis with vagueness, as if they had been dreaming. Few recalled pain or painful procedures. Patients remembered having nurses and family members provide emotional support and encouragement. Family members understood the rationale for use of the drugs. They remembered being encouraged to touch and talk with patients. The subjects suggested providing additional education about events that occur when paralysis is being reversed. CONCLUSIONS: Two confounding variables may have affected these findings: a liberalized visiting policy and use of effective pain and sedation protocols. Healthcare professionals and patients' family members should monitor bedside conversations and use touch and words of encouragement to support patients during therapeutic paralysis.

Adaptation, Psychological↗
PubMedDate not supplied

General practitioners' perceptions of the illness behaviour and health needs of South Asian women with menorrhagia.

OBJECTIVES: A study of general practitioners' (GPs) perceptions of the health needs of women of South Asian descent who suffer from menorrhagia. METHOD: A qualitative study using semi-structured interviews with 50 GPs in two British towns. FINDINGS: This study suggest that some women of South Asian descent may not consult their GPs even though suffering severe menorrhagia. Moreover, some GPs perceive that women may suffer from anaemia as the result of such illness behaviour. One reason for this reluctance to consult for menorrhagia may be the fact that some women of South Asian descent prefer to be examined by female doctors, yet may attend practices that lack a female partner. The study also shows that South Asian women, who consult male GPs for menorrhagia, are sometimes referred to hospital outpatients without internal examinations, and that women may be reluctant to keep their hospital appointments because of the lack of female gynaecologists. The study also indicates that a shortage of female interpreters may make communication difficult between some health care professionals and their patients, particularly when a complex and sensitive subject such as menorrhagia needs to be discussed. CONCLUSION: Women of South Asian descent may suffer serious problems such as iron deficiency anaemia, partly due to untreated menorrhagia. Since this was a study of GPs' perceptions of the health needs of South Asian women, it is now important to interview women themselves, to learn more about their perceptions of menorrhagia, and their perceptions of any subsequent contact with health care professionals.

Anemia, Iron-Deficiency↗
PubMed2003

A Vietnamese man with selective mutism: the relevance of multiple interacting 'cultures' in clinical psychiatry.

Multiple cultural variables have effects on the psychobiology and behavioral manifestations of illness, as do patient and physician perceptions of illness. The interaction among these variables is at the heart of clinical psychiatry. This case of a Vietnamese man with selective mutism underscores the relevance of the 'cultures' of medicine, psychiatry, and war and trauma on the manifestations of illness and illness perceptions by patient and physician. The discussion focuses on how these cultures interact and play a crucial role in formulating diagnosis and treatment planning. Suggestions are given for shifts in medical education that will encourage relevant cultural paradigms to make their way into educational and clinical systems, which in turn should improve cultural competence in clinical psychiatry.

Adult↗
PubMed2003

Application of the high risk model of threat perception to medical illness and service utilization in a family practice.

This study was designed to test the High Risk Model of Threat Perception in a family practice population. Predisposing, triggering, and buffering factors were assessed in 165 patients using psychological inventories. The relationship between these factors and self-reported symptoms, diagnosed chronic problems, and utilization was assessed. Negative affect and number and intensity of life events increased the risk for chronic illness and reported symptoms, while social support and approach style of coping decreased the apparent risk. The numbers of encounters and telephone calls to the office, obtained from the office database, were statistically correlated with negative affect and inversely with social support. The regression analysis predicted 27% of the variance in reported symptoms with negative affect, life events, and avoidance coping as significant predictors. Only 8% and 16% of the variance of telephone calls and office visits, respectively, could be predicted with a similar regression model. These results emphasize the importance of psychosocial factors in medical illness. Routine assessment of psychosocial risk factors in family practice patients is suggested.

Adaptation, Psychological↗
PubMedDate not supplied

Mothers of chronically ill children and perceptions of environmental variables.

Environment plays a critical role in supporting families, but the influence of the environment on families with a chronically ill child has remained relatively unexplored. This paper presents a study that examined the role of the environment in families with a chronically ill child. This study, using a secondary analysis of two existing data bases (Holaday & Turner-Henson, 1991; U.S. Bureau of the Census, 1980), examined the influence of selected environmental factors on mothers' perceptions of the environment as supportive, resourceful, safe, and accessible. A presentation of the study findings, as well as implications for nursing practice, is presented.

Adult↗
PubMed2005

Perception of dental illness among persons receiving public assistance in Montreal.

OBJECTIVES: We examined rationales for behaviors related to dental care among persons receiving public assistance in Montreal, Quebec. METHODS: Fifty-seven persons receiving public assistance participated in 8 focus groups conducted in 2002. Sessions were recorded on audiotape and transcribed; analyses included debriefing sessions and coding and interpreting transcribed data. RESULTS: In the absence of dental pain and any visible cavity, persons receiving public assistance believed they were free of dental illness. However, they knew that dental pain signals a pathological process that progressively leads to tooth decay and, therefore, should be treated by a dentist. However, when in pain, despite recognizing that they needed professional treatment, they preferred to wait and suffer because of a fear of painful dental treatments and a reluctance to undertake certain procedures. CONCLUSIONS: Persons receiving public assistance have perceptions about dental health and illness that prevent them from receiving early treatment for tooth decay, which may lead to disagreements with dentists when planning dental treatments.

Adult↗
PubMed1992

Patients with cancer and their spouse caregivers. Perceptions of the illness experience.

This study focuses on patterns of response between patients with cancer and their spouse caregivers to examine the reliability of spouse informants in research and clinical settings. Thirty dyads (patient with cancer-spouse caregiver couples; total n = 60) were interviewed concurrently in their homes concerning patient functioning, psychologic distress, physical symptoms, caregiver perceptions of patient functioning, and marriage quality. Couples had been married an average of 32 years. Patients had either the lung or colon as their primary cancer site, and one third had metastasis. Correlations between 14 variable pairs and cross-tabulation of scale scores suggest that spouse caregivers agree with patients on objective measures with observable referents (e.g., ability to dress independently). Partners disagree on subjective aspects of patient functioning (e.g., depression, fear of future, and confidence in treatment) and marriage quality. Almost without exception, caregivers viewed patients' functioning more negatively than patients described themselves. Patients, however, viewed marital quality more negatively than did caregivers. It was concluded that caregivers can serve as proxies for patients with cancer in research and clinical settings when objective data are sought. Data from both spouses are needed, however, to complete the picture of subjective illness experiences in patients with cancer, including perceptions of pain and disease symptoms.

Activities of Daily Living↗
PubMedDate not supplied

Health benefits for the terminally ill: reality and perception.

This paper examines the availability and scope of hospice benefits as well as employers' attitudes and knowledge about care for the terminally ill. Data are drawn from a national random sample of 1,502 employers with 200 or more workers and from focus groups with employee benefits managers and their insurance advisers, brokers, and consultants. Major findings are that 83 percent of employers offer explicit hospice benefits, with most other firms covering hospice through high-cost case management. Most employers support the concept of hospice care because they believe that it reduces medical expenses.

Attitude to Health↗
PubMedDate not supplied

Depressive symptoms and mentally ill chemical abusers' perception of the treatment environment in residential settings.

In assessing the socioenvironmental characteristics of psychiatric treatment programs, researchers typically assume that their measurements are unaffected by client characteristics. However, our analysis among mentally ill chemical abusers in a therapeutic community and community residences found significant associations between subscales of the Community Oriented Program Evaluation Scale (COPES) and depressive symptoms, as measured by the CES-D, after 2, 6, and 12 months of treatment. Investigators of treatment environments should consider depressive symptoms as a possible threat to the validity of their findings.

Adult↗
PubMed2000

Demands of illness in people treated for colorectal cancer.

PURPOSE/OBJECTIVES: To describe the most common and most intense demands of illness in people with colorectal cancer. DESIGN: Descriptive, comparative. SETTING: People with colorectal cancer were accrued through weekly online computer postings. SAMPLE: 121 people (68 men and 53 women) from 35 states (n = 106) and six other countries (n = 15) who were treated for colon, rectal, or anal cancer. METHODS: Mailed questionnaires included a 125-item, self-report instrument with seven subscales (Demands of Illness Inventory (DOII) and a 14-item demographic form. MAIN RESEARCH VARIABLES: Demands of illness, time since treatment, perception of illness state, activity level, and age. FINDINGS: Demands of illness were greatest in the personal meaning domain, with more than 93% of subjects reporting that they thought about the value of life and how long they might live. More than 85% reported uncertainty in six similar areas. The 10 most intense demands were predominately psychosocial and existential concerns. Respondents in the youngest age group (< 45 years) reported significantly greater demands in six of seven domains of the DOII than the middle and older groups. Three variables (time since treatment, perception of illness, activity level) accounted for 45% of the variance in DOII scores. CONCLUSIONS: Colorectal cancer imposed significant psychosocial and existential concerns on respondents, especially the youngest age group. IMPLICATIONS FOR NURSING PRACTICE: Nurses should address these concerns with patients while continuing to identify and scientifically test creative strategies to minimize psychosocial morbidity.

Adaptation, Psychological↗