Practicing out of the box: rituals and threads of evidence.
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Ritualistic sexual mutilation of females dates back to the fifth century B.C. This traditional practice is a social as well as a health issue that affects the physical and mental well being of the women who undergo it. Although practiced mostly in African countries north of the equator and the Middle-East, concern has recently been expressed that female genital mutilation is also being practiced in the U.S., Europe, and other western countries by immigrants from these countries. This review describes the various types of female genital mutilation and presents the historical and cultural background of the tradition, outlines the medical, psychological and sexual problems, and discusses the current status and future outlook for this tradition, emphasizing social, medical, and legislative aspects.
Common barriers to research utilization in nursing include characteristics of the setting in which nurses practice, nurses themselves, and nursing's dependence on rituals and traditions in practice. Nurses can overcome these barriers by questioning their practice and adopting attitudes and values that prioritize research utilization. The "Power of One" Model of Research Utilization guides nurses to examine everyday practices, assess their research foundations, and implement and evaluate changes to research-based practice.
There is a popular consensus in the medical profession and the laity that spontaneous and induced abortions have few psychologic sequelae. A review of the literature reveals that this is not true; the incidence of symptoms ranges from 7% to 41%. Even when symptoms occur, they are said to be negated by the positive emotional responses that occur. We have accumulated clinical experience relating these experiences to the development of severe psychopathology that we believe arises out of unresolved grief. Abortions affect not only the women but also their "significant others." We present case reports that illustrate some of the sequelae, and we offer a method of treatment using spiritual intervention to resolve the grief.
The purposes of this article are to examine the epistemic nature of myth and its relationship to nursing ontology, practice, and knowledge development, and to interpret the myth of the hero journey as it relates to the meaning of health and healing within the unitary-transformative paradigm. A discussion of the qualities of myth as a path toward understanding is followed by an analysis of the relationship of myth to nursing's ontology within the unitary-transformative paradigm. Joseph Campbell's depiction of the myth of the hero journey is elaborated and related to literature on health and healing. Reflections on possible implications for nursing practice and knowledge development are shared. The mythic hero journey calls for a particular way of being a nurse. Nurse as guide, sojourner, and midwife are offered as metaphors for this way of being.
Although rituals are considered in the anthropological and sociological literature, less attention is given to associated biophysical and health perspectives. Three ethnographic studies were conducted to identify the ways family health was defined and practiced. Findings indicated that routines were an important aspect of family health. Families described routines linked to family health and discussed how they evolved, ways they were modified over time, and how families recreated them when stress and change were encountered. Findings indicated that routines provide a structural perspective for assessments, interventions, and outcome evaluations related to health and useful to nursing practice. This article explains some of what is known about family routines, describes the author's findings, and suggests implications for nursing.
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Surgeons have conducted placebo-controlled double-blind investigations to determine the value of surgical procedures by comparing the results of real operations with sham operations. The sham operation served as a placebo control, permitting analysis of the alleged benefit of the real operation by eliminating the effect caused by the rest of the surgical experience. A modern operation starts with a series of events resembling ritualistic practices used by shamans. Shamans are traditional healers in cultures that believe communication with the gods and spirits influences health and well being. Shamanistic healing measures include: journeying to a healing place, fasting, wearing ritual garb, ingesting psychotrophic substances, anointment with purifying liquid, an encounter with a masked healer, and inhaling stupefactive vapors. These steps are followed by a central ritual activity that may include extracorporeal, surface, and penetrative components. Postoperative ritual activities reinforce the suggestive value of the healing. These experiences increase a patient's suggestibility, thereby enhancing the likelihood of a favorable outcome. Any research on the effectiveness of surgical procedures, especially those designed to relieve pain, must consider the strongly suggestive effect of the elaborate perioperative ritual.
AIM: To extend previous reviews by assessing the acute systemic toxicity and psychological hazards of a dimethyltryptamine and beta-carboline brew (ayahuasca/hoasca) used in religious ceremonies. METHOD: A systematic literature search, supplemented by interviews with ceremony participants. RESULTS: No laboratory animal models were located that tested the acute toxicity or the abuse potential of ayahuasca. Separate animal studies of the median lethal dose of dimethyltryptamine (DMT) and of several harmala alkaloids indicated that a lethal dose of these substances in humans is probably greater than 20 times the typical ceremonial dose. Adverse health effects may occur from casual use of ayahuasca, particularly when serotonergic substances are used in conjunction. DMT is capable of inducing aversive psychological reactions or transient psychotic episodes that resolve spontaneously in a few hours. There was no evidence that ayahuasca has substantial or persistent abuse potential. Long-term psychological benefits have been documented when ayahuasca is used in a well-established social context. CONCLUSION: A decoction of DMT and harmala alkaloids used in religious ceremonies has a safety margin comparable to codeine, mescaline or methadone. The dependence potential of oral DMT and the risk of sustained psychological disturbance are minimal.
The Intensive Care Society (1998) recommends that facilities should be available to follow up bereaved relatives. As part of bereavement follow up, a memorial service has been held at Royal Preston Hospital for the last three years. Over 300 people attended in 2003. A memorial service is often referred to as a ritual. Rituals seem to meet certain universal needs, such as confirming the reality of the death, assisting in the expression of feelings, stimulating memories of the deceased and providing support to the family and friends of the deceased. An audit in 2003 has confirmed the value of the service: 97% of attendees were glad they attended the service and 72% would like to be invited to the service again next year.
Transferring end of shift information between nurses via both verbal and written routes in an intensive therapy unit (ITU) setting is complex and multifaceted. Some authors have taken ethnographic approaches and explored the verbal handover as an example of a nursing ritual. The written route involves various textual materials, which, in addition to conveying essential information about the patient's status, also represent other messages. This article considers two key areas of end of shift information transmission - verbal bedside handovers and written accounts - arguing that in addition to the manifest purposes of transferring essential information between nurses, both modes of reporting also have important latent functions. It will explore and interpret elements of ritual and symbolism inherent in both forms of handover. The article reports on particular findings from a larger ethnographic study of nursing culture, which was accomplished through participant observation over a 12-month period in ITU. Subsidiary components of the ethnography were the interviews with 15 nurses and the examination of documentary material. The findings suggest that both verbal and written reports, in addition to ensuring that nurses taking over the care of the patient receive the necessary information to enable them to safely provide continuity of care, also convey essential meanings and articulate group values. Both modes of handover reporting are also visual and/ or audible symbolic representations of nursing care in ITU and as such confirm and validate that care, expressing the value of nursing work in this unit.
BACKGROUND: Unable to resolve a medical problem, gastroenterologists occasionally choose an ineffectual intervention instead. The elusive path to effectual management becomes substituted with an ineffectual but readily available medical ritual. The term 'ritual' refers to the utilization of an ineffectual intervention with little chances of achieving a medically relevant goal. AIM: The aim of the article is to analyse the cost-benefit relationship of rituals in gastroenterology and the reasons why gastroenterologists utilize them. METHODS: Ritualistic disease management is described in terms of medical decision and threshold analysis. RESULTS: If the perceived benefit of a ritual exceeds its cost, the ineffectual path becomes more attractive than expectant management or doing nothing. To engage in an ineffectual intervention, the threshold probability for success needs to exceed its cost-benefit difference divided by the benefit associated with success. In choosing an ineffectual intervention, doctors tend to underestimate the true costs of a ritual and overestimate its probability of success. The availability of an effectual path leads to more stringent conditions for the benefit associated with an ineffectual path. CONCLUSIONS: A better understanding of their economical underpinnings should lead to more restricted utilization of rituals in gastroenterology, especially, in situations where they drain scarce resources disproportionately to their perceived benefit.
Menzies argues that nursing hierarchies and ritual practices protect nurses from the anxieties provoked by encountering human suffering. This proposition is examined with particular reference to ritual practices in nursing. It is argued that Menzies studied nurses in isolation from the societal and subcultural norms and values which direct hospital activity. Her psychodynamic model is contrasted with a sociological model of human conduct and action. The characteristics of ritual and rational action, and the difference between non-rational and irrational rituals, is explored. The findings of three 5-month periods of participant observation are presented as illustrative case material to support the authors view, that ritual procedures are not only defence mechanisms against anxiety, but social acts which generate and convey meaning. Ritual practices described in this analysis include rituals surrounding birth, death, status and power. It is concluded that if nurses wish to change or alter ritual nursing practices in hospital it is necessary to understand their social as well as their psychological meaning.