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PubMed1997

Applying what burn survivors have to say to future therapeutic interventions.

Statements by caregivers can be beneficial to paediatric burn patients, facilitating their psychological adaptation. However, the concerns of the burned child are not always obvious, and caregivers may flounder, not knowing how to elicit the concerns of the patient. The purpose of this paper is to examine whether universal concerns of the postburn survivor can be detected through one type of psychological assessment tool, a sentence completion task. Sixty paediatric burn survivors, ages 6-19, were administered a 30-item Incomplete Sentences measure. Five major aspects of postburn life were identified and proscribed the following descriptive labels: (1) preoccupation with health; (2) the struggle for internal acceptance; (3) reconstruction of one's life map; (4) changing relationships; and (5) redefining the world. These five dimensions of postburn life are discussed, as well as applications for each.

Adaptation, Psychological↗

PubMed2005

The lived experience post-autologous haematopoietic stem cell transplant (HSCT): a phenomenological study.

Autologous haematopoietic stem cell transplant (HSCT) has a high physical and emotional morbidity. This study using Husserlian phenomenological methodology and using Giorgi's (Phenomenology and Psychological Research, Dusquesne University Press, Pittsburgh, 1985) method of analysis was undertaken to attempt to gain some understanding of the patient's experience. Five adult patients who had previously undergone autologous transplantation for a haematological malignancy at least 6 months before participated in the study. Interviews with the participants were audio taped and then transcribed verbatim. Nine themes emerged from the participants' stories and included psychological cost, physical and psychological adaptation, reprioritisation and a sense of isolation. The transplant experience can be separated into a discrete period of time and the findings illustrate that the experience of transplantation impacts on the life of the person for an undetermined period of time. The changes experienced may be permanent and the post-transplant person, emotionally, psychologically and physically, is not the same person who entered into transplant. For nurses and other health care professionals to improve practice it is imperative that they understand the lived experience their patients have undergone. Pretransplant preparation and post-transplant rehabilitation can be enhanced by having a greater depth of understanding.

Activities of Daily Living↗

PubMed2003

Changes in psychological distress of women in long-term remission from breast cancer in two different geographical settings: a randomized study.

GOALS OF WORK: Psychological distress and coping styles in women diagnosed with stages I and II breast cancer have attracted substantial clinical and research attention over the last several decades. The contradictory and, at times, controversial findings stimulated the present randomized research whose purpose was to explore the possibility and probability of predicting which variables affect the psychological distress level of women with breast cancer 1 to 5 years after diagnosis (time period 1) and 6 to 8 months after period 1 (time period 2). PATIENTS AND METHODS: The study was conducted in two large oncology centers in Graz, Austria, and Jerusalem, Israel, with a sample population comprising 424 patients. MAIN RESULTS: The only variables that significantly predicted change in the psychological distress levels (Grand Severity Index, GSI; except for the GSI level during period 1) were Fighting Spirit (Mental Adjustment to Cancer, MAC) in the Graz sample and Perceived Family Support (PFS) in the Jerusalem sample. These results are discussed in relation to other findings. CONCLUSIONS: In light of these findings, it is highly important to preliminarily identify women with less adaptive psychological coping mechanisms and to provide them with efficacy tools for behavioral and cognitive changes within their own network of social and health resources.

Adaptation, Psychological↗

PubMed1999

Self-perceptions of health: a prospective analysis of mortality, control, and health.

A growing number of studies show that self-perceptions of health are an important predictor of mortality. The present study was designed to extend this research by examining the relation between health perceptions and a range of other outcome measures besides mortality, including control beliefs and morbidity. The results show that older adults who rated their health as "bad/poor" and "fair" were more than twice as likely to die within three to three-and-a-half years following the initial survey than those who perceived their health as "excellent." However, although health perceptions assessed in 1991/92 were related to health perceptions four years later, they did not predict morbidity. Health perceptions also predicted perceived control and use of control-enhancing strategies in dealing with age-related challenges, as assessed in 1995. These findings contribute to our understanding of the benefits of positive health perceptions by showing that they are connected to an adaptive psychological profile including perceptions of control and use of control-enhancing strategies that are linked to health and well-being.

Activities of Daily Living↗

PubMed1990

Acculturation and adaptation: health consequences of culture contact among circumpolar peoples.

An overview is presented of the processes of acculturation and adaptation. Research with a variety of acculturating groups (including Refugees, Immigrants, Sojourners, Native Peoples and Ethnic Groups) shows that satisfactory adaptations are possible given appropriate conditions in the host or settlement countries. These conditions are largely under the potential control of policy makers and programm developers, and hence healthy outcomes are within reach. When these findings and conclusions are applied to Native Peoples in Circumpolar regions, some particular experiences stand out, resulting in the potential for difficult social and psychological adaptations. However, the literature shows that like all other acculturating groups, successful adaptations are possible for Circumpolar peoples, especially when they are in a position to understand and control the process.

Acculturation↗

PubMed2001

Healing through the mind: extending our theories, research, and clinical practice.

This paper was prompted by experience with 2 kinds of experimental designs used to investigate the impact of psychological therapies on longevity in patients with metastatic cancers. The more conventional design, a randomized controlled trial, gave a null result, and the associated psychometric tests yielded essentially no useful information on qualities of patients that might favor healing. By contrast, the second study, using a mixed qualitative/quantitative analysis of data, and a basically correlative design, produced a wealth of information on the modes of psychological adaptation of different patients to their cancer, and on the relationship of many of these qualities to longer survival. This would seem to constitute an argument for more studies of this kind in research on healing. Drawing on this experience, I discuss some general principles for research, clinical practice, and theory building in this area, among them: the value of detailed, qualitative examination of subjects case by case; ways of applying quantitative measurements to rather ill-defined psychological variables; the need for intensive psychoeducational therapy designed to foster personal growth and change; importance of the spiritual component in therapy; the validity of psychological prognoses for medical conditions; the value of higher order constructs (for example, "involvement in self-help"); and conceptualization of healing as a progressive, developmental process, in which stages may be recognized. Some definitions and distinctions between different kinds of healing are also offered, in particular, distinguishing between spontaneous, externally-assisted, and internally-assisted healing, the last being what is meant by "healing through the mind."

Adaptation, Psychological↗

PubMed1999

Psychological changes in hundred-day remote Antarctic field groups.

Psychological adaptation to extreme environments has been examined from several perspectives. In this study, two Australian teams, each consisting of six male crew members, completed computer-administered questionnaires twice weekly during 100-day traverses around the Lambert Glacier Basin, Antarctica. Only small trends were noted when data were aggregated at the group level, which is consistent with the findings of others. Data were then analyzed using pooled time-series regression. These analyses incorporated personality characteristics, environmental factors, and interpersonal factors as predictors of Group Tensions, Personal Morale, Emotional State, Cognitive Readiness, and the Team's Work Life. Most of the psychological discomfort and problems that occurred appeared to be within the individual or between individuals. They did not affect all members of the group equally.

Adaptation, Psychological↗

PubMed1975

Aging and adaptation to illness.

The relation of age, adaptation to illness, and the severity of cerebral dysfunction was evaluated for persons having suffered cerebrovascular accidents (CVA). All (89) subjects (age range 38 to 84 years, mean 62) were interviewed at least 1 mo. following onset of illness. It was found that older persons were more likely to manifest mental impairment following a DVA but that measures of sensory and motor functions were not similarly affected. The association of age and psychological adaptation varied, depending on the severity of brain dysfunction. Among a minimally impaired group, older persons tended to be more depressed and to use less denial than younger subjects. While denial was increasingly manifested by all persons with severe degrees of cerebral dysfunction, this change was shown to a greater extent by older subjects. The findings suggest that the severity of cerebral dysfunction may be a more critical factor in determining adaptation to illness than chronological age.

Adaptation, Psychological↗

PubMed1997

Cross-species comparisons.

Cognitive and neural adaptations in animals have been analysed using the comparative method. Comparisons between closely related species that differ in a cognitive or neural character, and comparison between distantly related species that share a cognitive or neural character, can be used to identify adaptations. Recent research has identified adaptive modifications of memory and the hippocampus that have evolved convergently in two clades of food-storing birds, the chickadees and tits (Paridae), and the jays and nutcrackers (Corvidae). Similar modifications of the hippocampus occur in other groups of animals, such as the cowbird brood parasites, in which there has been selection for spatial memory. Three general patterns that emerge from the comparative study of animal cognition provide a framework for research on human psychological adaptations: the existence of both specialized and general cognitive capacities; a clear relation between specialized capacities and specific selective pressures; and evolutionary change in the relative size of brain areas with cognitive functions.

Adaptation, Psychological↗

PubMed2001

Evolutionary recasting: ADHD, mania and its variants.

This paper reviews clinical observations and evolutionary theory in relation to attention deficit hyperactivity disorder (ADHD) on the one hand and mania and its variants on the other. Both groups of disorders resemble each other in regard to high levels of motor activity, perhaps occurring together more often than not, and are confounded in most existing research. Making distinctions requires isolating the contribution of activity level from other characteristics such as those of flawed executive functions for ADHD or grandiosity and lapses in reciprocity for mania. High activity level is an asset throughout nature except in extreme intensities or when it amplifies the characteristics of psychopathology. Fitness, social displays, and behavioral adaptations for survival are clues to some aspects of hypomania and ADHD. While hypomania can be a competitive advantage in certain niches, it appears there can be few opportunities for ADHD to do so. Indeed, the impulsiveness seen in ADHD is probably the outcome of flaws in executive functions rather than being the cause of them. Neither lapses in executive functions nor in reciprocity are apt to be domain general but may interact sharply with each person's repertoire of psychological adaptations. The author submits that a theoretical orientation as outlined here would not only help in better understanding the disorders under consideration, but could be useful in providing new directions to treatment decisions.

Adaptation, Psychological↗

PubMed2003

Renal transplantation: long-term adaptation and the children's own reflections.

Twenty children, 9-19 yr of age, having undergone renal transplantation, were interviewed (according to a semi-structured inquiry manual) with the aim of investigating their emotional and psychosocial adaptation. The children reported about a rather unaffected life considering the circumstances. Few of them described a negative identity in the form of feeling sick or different, and their experienced limitations appeared to be moderate. Anxiety about the future was more salient, but nevertheless the children seemed to have found a good way of living with this anxiety. When comments were made on the relationship to the donor, they were of a positive character; the relationship had been improved by the donation. Only one child - who had received a kidney from a deceased person - described fantasies of the alien kidney of a markedly unpleasant character. The psychological adaptation of the children frequently seemed to imply the use of potentially dysfunctional defense mechanisms like denial and avoidance.

Adaptation, Psychological↗

PubMed1998

A naturalistic study of the chronic fatigue syndrome among women in primary care.

Chronic fatigue syndrome (CFS), a controversial illness without clear etiology, causes profound debilitation in its sufferers. This study explored subjects' perceptions of the variables that mediated the course of their illness and identified coping strategies in 15 women with CFS referred from the practice of a primary care physician. Exploratory semistructured interviews were adapted from Kleinman's Illness Narratives. Four instruments were used: the Beck Depression Inventory, the Sickness Impact Profile, a modified Karnofsky scale, and the Defense Mechanism Rating Scale. Of the 15 women, 60% reported improvement and/or recovery at the time of the interview. Improvement was associated with social support and lower levels of depressive symptoms. Health status was influenced by how subjects perceived their illness, their future, and the doctor's prognosis; and by the physician's early diagnosis, validation of the CFS, and intensive medical follow-up. Obsessional and healthy neurotic defense levels predominated, which differs from historical comparison groups with dysthymia and panic disorder. Psychological adaptation to CFS is similar to adaptive coping in other chronic illnesses: subjective perceptions of health status can predict functional status. Physician validation is particularly important given the controversial status of CFS. Maintaining relationships with others--doctor, work, family, and group/spiritual activities reflected healthy coping strategies that promoted hope and attitudinal shifts. The finding of a mixture of neurotic and healthy defenses and a low proportion of defenses associated with personality disorders has not been previously reported in the CFS literature and warrants further investigation.

Adaptation, Psychological↗

PubMed2001

Use of alternative/complementary therapy in breast cancer patients--a psychological perspective.

The objectives of this study were to assess the additional use of alternative (complementary) therapies in patients with breast cancer who were receiving conventional treatment and to compare patients using alternative therapies with patients receiving only conventional treatment with special reference to psychological adaptation, causal attribution and quality of life. A sample of 117 female out-patients with a diagnosis of breast cancer filled in the following assessment instruments: FQCI (Freiburg Questionnaire for Coping with Illness), PUK (Causal Attribution Questionnaire), EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire), POMS (Profile of Mood States), and a self-developed questionnaire on alternative therapies. Nearly half the patients (47%, n = 55) reported that they had used alternative therapies in addition to conventional treatment. The methods applied most frequently were nutrition-related measures (special drinks, vitamin preparations and whole-foods - each applied by about 50% of users), mistletoe preparations (49%), trace elements (47%), and homeopathy (31%). Compared with patients receiving only conventional treatment, the users of alternative therapy were younger and better educated. Users developed a more active style of illness coping than nonusers and showed more religious involvement. Patients using a large number of alternative therapies (>3) tended to adopt a more depressive coping style than those using only a small number (< or =3). For a substantial proportion of cancer patients alternative therapies apparently fulfil an important psychological need. However, a subgroup of patients using many alternative therapies seem to have considerable adjustment problems. In dealing with cancer patients the treatment team should be aware of both these groups.

Adaptation, Psychological↗

PubMed2005

Smoking, health, risk, and perception.

We provide a description of health-related incentives faced by a rational smoker by considering the role of perception in both immediate quality-of-life effects of smoking and future risk of mortality. A person who adapts psychologically to a lowered health state, smokes more early in life and shifts demands for health investments and health-complementary activities later in life. He also smokes more in total. Someone aware of the full mortality consequences of smoking, smokes less and demands less medical care than someone who believes that these effects are highly reversible. The impacts of new information on mortality risk are most valuable early in life. Lastly, someone endowed with a longer life expectancy smokes more in the first part of life but conditional on access to medical care.

Adaptation, Psychological↗

PubMed1995

Parental bereavement after suicide and accident: a comparative study.

In what way is the bereavement process following suicide different from other types of bereavement? The participants were 30 survivors of suicide and 30 survivors of car accidents who were interviewed twice at an average of six months, and the second measure was taken at an average of nine months after the death, with standardized questionnaires to measure depression and grief reaction. Measures of shame, social support, family adaptation, psychological distress, and prior losses were also obtained during the second interview. All survivors were parents who had lost a son aged between 18 and 35 years. The results indicate that suicide survivors were more depressed than accident survivors at the first measure but this difference disappeared at the second measure. Survivors of suicide experienced greater feelings of shame and had experienced more life events after the death than did accident survivors. There was also a greater history of loss in parents bereaved by suicide. Parental bereavement after suicide appears to differ in several ways from other types of bereavement and appears to happen more often in vulnerable families.

Accidents, Traffic↗

PubMed1999

Clarifying the concept of normalization.

PURPOSE: To refine and develop the concept of normalization. While firsthand accounts, clinical observation, and numerous studies suggest that parents of children with chronic conditions often strive to lead a normal family life, the distinguishing characteristics of normalization need to be understood before evaluating the feasibility and consequences. Conceptualizing these efforts as normalization, researchers have identified cognitive and behavioral strategies used by parents to normalize family life. SOURCES: A total of 33 articles representing 14 studies were selected through computer-assisted searches of the topic from 1966-1997, hand searches of nursing journals from 1970-1997, and analysis of reference lists. Key words in the searches included: adaptation, psychological; chronic disease; disabled persons; family; child; adolescence; parent-child relations; models, psychological; and nursing theory. Articles (N = 19) that applied and expanded the concept comprised the sample used in the analysis. A normalization construct was used. METHODS: Attributes for normalization were inductively derived based on the most recent methods for refining and developing concepts, with special attention to how family and illness affect manifestations of normalization. FINDINGS: The attributes identified in 1986 remained relevant, but required revision and expansion to reflect a contemporary understanding of normalization. Unique manifestations of normalization were identified within certain illness and family contexts. CONCLUSIONS: Knowledge synthesized from previous studies can enhance how normalization is used in future qualitative and quantitative research and in theory development. Findings indicate the need for researchers to build on the current state of knowledge and continue to further develop the concept. Understanding the findings can also sensitize clinicians to the complex process of normalizing when a child has a chronic condition.

Adaptation, Psychological↗

PubMed2006

Searching for meaning in negative events: concept analysis.

AIM: The aim of this paper was to synthesize the literature related to meaning and present a conceptual analysis of searching for meaning in unexpected, significant, negative events. BACKGROUND: Events or situations that are perceived as unexpected and negative (e.g. chronic and/or life-threatening illness) can disrupt life plans and lead to emotional distress. Nurses are in a key position to aid in the coping process by assisting individuals to integrate the meaning of an unexpected, negative event into the life experience. METHODS: In May 2004, a comprehensive literature search using the terms meaning, search for meaning, meaning-making, making meaning, life change events, adaptation-psychological, stress, and coping was carried out. Of 339 possible references, 86 were included in the analysis. FINDINGS: Global meaning refers to an individual's beliefs, values, and purpose/goals. Situational meaning refers to the meaning the individual attaches to a situation. When the meaning attached to the situation is not congruent with global meaning, meaning is considered shattered and a search for meaning ensues. In the search for meaning, people may attempt to change the meaning of the event (through reattributions or creating illusions) or change global meaning (through positive reappraisal, problem-solving coping, or revaluing ordinary events). CONCLUSION: Nurses are in a key position to assist people through negative events. The process of searching for meaning provides a solid foundation for the development of nursing interventions to assist individuals through difficult times. Research is needed to develop nursing interventions based on the process of the search for meaning, as well as measures reflective of the search for meaning.

Adaptation, Psychological↗

PubMed2003

Coping and caregivers of people with dementia.

PURPOSE: To critically review the research based on Lazarus and Folkman's (1984) stress and coping model, in respect to the coping of those caring for persons with dementia in the community, in an attempt to establish its implications for interventions aimed at improving caregiver adjustment. METHOD: Published material on the coping of caregivers of persons with dementia was identified through computerized literature searches (Med-line, Psych-Info) to December 1999, employing search terms including Alzheimer's disease, dementia, caregiving, caregiver burden, adaptation, psychological, coping, and stress. Studies were chosen to be considered in detail, based on the reviewer's opinion that they would contribute to an understanding of the current state of the research and its clinical implications. This material was then critically reviewed against the tenets of Lazarus and Folkman's (1984) model. RESULTS: Sixteen studies were selected to be included in the review, 12 cross-sectional and 4 longitudinal. Seven of the studies did not incorporate coping measures specific to caregiving and/or assess coping in respect of specific caregiver problems. Nine of the studies did do this. The research suggests that a general tendency towards problemsolving and acceptance styles of coping is likely to be advantageous to caregivers of people with dementia. CONCLUSIONS: Despite this finding, it is concluded that the ability of the research to inform the clinician is severely limited. It is proposed that while longitudinal studies considered specific caregiver problems which incorporate coping measures specific to the caregiving task may improve understanding, a substantial revision of methodology and perspective may be required to produce findings that are likely to influence practice.

Adaptation, Psychological↗