The support gap for dual clergy couples

Within this study six levels of support for dual clergy couples with and without children were investigated. Seven dual clergy couples of several synods of the Lutheran Church in two western Canadian provinces were asked open-ended questions about the support they had received in several employment and family related areas. While findings in each of the areas varied, overall, most individuals received the most support from their spouse and little from close friends and relatives often due to physical distance. Support provided by other clergy and church administrators was mixed. Only one major difference was found between couples with and without children. The group without children were more optimistic about the support that would be provided by family and friends in the area of child care while couples with children failed to mention support from friends and family.     

Spiritual Experiences of Muslim Critical Care Nurses

The purpose of this study was to determine the experiences and perceptions of intensive care nurses (ICNs) about spirituality and spiritual care, as well as the effective factors, and increase the sensitivity to the subject. In this study, we examined spiritual experiences, using McSherry et al. (Int J Nurs Stud 39:723–734, 2002) Spirituality and spiritual care rating scale (SSCRS), among 145 ICNs. 44.8% of the nurses stated that they received spiritual care training and 64.1% provided spiritual care to their patients. ICNs had a total score average of 57.62 ± 12.00 in SSCRS. As a consequence, it was determined that intensive care nurses participating in the study had insufficient knowledge about spirituality and spiritual care, but only the nurses with sufficient knowledge provided the spiritual care to their patients.     

Shared caregiving: comparisons between home and child-care settings

The experiences of 84 German toddlers (12-24 months old) who were either enrolled or not enrolled in child care were described with observational checklists from the time they woke up until they went to bed. The total amount of care experienced over the course of a weekday by 35 pairs of toddlers (1 member of each pair in child care, 1 member not) did not differ according to whether the toddlers spent time in child care. Although the child-care toddlers received lower levels of care from care providers in the centers, their mothers engaged them in more social interactions during nonworking hours than did the mothers of home-only toddlers, which suggests that families using child care provided different patterns of care than families not using child care. Child-care toddlers experienced high levels of emotional support at home, although they experienced less prompt responses to their distress signals. Mothers' ages were unrelated to the amounts of time toddlers spent with them, but older mothers initiated more proximity.     

Inpatient Standards of Care and the Suicidal Patient Part II: An Integration with Clinical Risk Management

The authors elaborate on the standards of care for the assessment, management, and treatment of hospitalized suicidal patients. The authors attempt to synthesize the concepts of the minimal standard of care with clinical risk management and clinical judgment. They point out the areas of overlap and where optimum care diverges from legal standards of care. Case examples are provided to illustrate major areas of concern. Alleged failures of omission and commission are discussed. Tables are provided that differentiate duties and responsibilities between and among clinicians, hospital staff, and hospital administration.     

Programmatic staff care in an outpatient setting

Traditionally, chaplains have provided care for staff through consultation, informal conversation, grief work, and more formal counsel and ritual. This article discusses four programmatic approaches to staff care created in response to particular assessed needs: "Finding Soul" addresses staff care needs to find meaning and joy in their work and to contribute to the "soul" of the institution. "Existential Expedition" helps staff both deal with their accumulated grief and provide better direct care around existential issues being faced by their patients. "After Book" provides a way for staff to have closure with parents/families and to provide holistic care to families after discharge from the system. "The Labyrinth Program" provides staff with an opportunity to de-stress and to attend to their emotional and spiritual well-being. Focused upon staff care, these programs also secondarily benefit both patients/families and the vision and mission of the institution.     

Psychosoziale Versorgung von Krebspatienten

Objectives

The aim of this study was to determine rates of psychooncological care for cancer inpatients and outpatients under routine conditions in a large University hospital. The percentage of patients who received care was analyzed and compared with self-rated and expert rated supportive care needs.

Methods

The percentage of inpatients who received psychooncological care was calculated by comparing the number of cancer patients treated at the hospital as documented by the local tumor registry (n=1,979) with the number of patients treated by a psychooncologist in that hospital as documented by the hospital??s psychooncological consultation liaison service. The percentage of outpatients who received psychooncological care was calculated by comparing the number of incident cancer cases as documented by the local tumor registry (n=5,886) with the number of patients who received at least one consultation at the local tumor counseling centre. Supportive care needs were estimated by analyzing data of a prospective patient survey in the same hospital (n=1,803) using the Hospital Anxiety and Depression Scale and single items to determine social burden and the wish for emotional support.

Results

The results showed that 11% of inpatients and outpatients (n=234 and n=638, respectively) received psychooncological care. Social care needs were prevalent in 37% and psychological care needs in 52% of the patients during the stay in hospital and in 42% (social and psychological) 6 months later. Of the patients 41% expressed the need to see a social worker and 29% to see a psychologist. Large differences were found between patients with different tumor entities.

Conclusion

Psychooncological care delivered to cancer patients under routine conditions was below the actual rate required as estimated by screening instruments and as expressed by the patients.     

Counselling and the schizophrenias

Schizophrenia is the collective name given to allied psychiatric disorders each of which has received a number of different professional interpretations. A primary counselling task is to help staff resolve conflicts over treatment, and give them support during their care of patients. Counselling patients and families, particularly through opportunities provided by self-help groups, is also discussed. The specialised work of genetic, psychoanalytical and behavioural counselling is considered, and stress is laid on the importance of counselling the adolescent schizophrenic for whom early help is vital to prevent deterioration. The article focuses on those areas where marriage guidance counsellors, social workers and probation officers are most likely to be consulted.     

Another look at physicians' treatment of men and women with common complaints

A recent study of San Diego patients found that men received more extensive and appropriate diagnostic workups than women did for five common complaints (Armitage, K. J., Schneiderman, L. J., & Bass, R. A. Journal of the American Medical Association 1979, 241 2186–2187). This article is a broader analysis of medical care given to men and women for those complaints (fatigue, headache, vertigo/dizziness, chest pain, back pain), and it uses a national survey of ambulatory-care visits. We find that medical care is usually similar for men and women. When significant sex differences do appear, they often show that women receive more medical care during a visit. To some extent, differential care stems from different medical needs that men and women with a complaint have; when some medically relevant factors are controlled, half of the significant sex differences disappear. But half persist, and this suggests that psychosocial factors also underlie differential care for men and women. These may originate with patients (for example, their requests for particular services) or with physicians (for example stereotypes of men and women patients). In contrast to the San Diego study, the national data show that (1) women sometimes receive more diagnostic workups for the five complaints, and (2) when medical factors are controlled, sex differences in the extent and content of workups disappear. The only exception is that men with vertigo/dizziness receive more appropriate workups.     

Counselling in primary care: a systematic review of the research evidence

Counselling in primary care in the UK is expanding rapidly, and its evidence base needs to be established. We present the rationale for conducting controlled trials of counselling in primary care, and suggest that a systematic review of controlled trials of counselling in primary care is timely. We describe the process of conducting the review in accordance with Cochrane Collaboration guidelines. The review aimed to assess the effectiveness and cost-effectiveness of counselling in primary care, by systematically reviewing cost and outcome data from randomised controlled trials and controlled patient preference trials of counselling interventions, for patients with psychological and psychosocial problems considered suitable for counselling. The search strategy, inclusion and exclusion criteria, data collection and data analysis are described. The results of the review are presented. The review included only controlled trials of counselling in which counsellors accredited by the British Association for Counselling (or equivalent) provided non-directive counselling in primary care. Four trials met the inclusion criteria. Results indicated that patients who receive counselling show a modest but significant improvement in symptom levels compared with those who receive GP care. Levels of satisfaction with counselling are high. There is very tentative evidence to suggest that counselled patients are more likely to be considered recovered than usual GP care patients. There is limited information about the cost-effectiveness of counselling. We conclude by reflecting upon the results of the review and their implications for counselling research.     

Mom told me scary things about this animal: Parents installing fear beliefs in their children via the verbal information pathway

This study investigated whether fear beliefs can be installed in children after parents had received negatively tinted information about a novel stimulus. Parents of children aged 8-13 years (N = 88) were presented with negative, positive, or ambiguous information about an unknown animal and then given a number of open-ended vignettes describing confrontations with the animal with the instruction to tell their children what would happen in these situations. Results indicated that children's fear beliefs were influenced by the information that was provided to the parent. That is, parents who had received negative information provided more threatening narratives about the animal and hence installed higher levels of fear beliefs in their children than parents who had received positive information. In the case of ambiguous information, the transmission of fear was dependent on parents' trait anxiety levels. More precisely, high trait anxious parents told more negative stories about the unknown animal, which produced higher fear levels in children.     

Women's knowledge of prenatal ultrasound and informed choice

This study evaluated women's understanding of prenatal ultrasound in terms of meeting the requirements for informed choice. A cross-sectional survey was conducted to evaluate (1) how information is provided, (2) women's perceived value of the information received and, (3) their understanding of ultrasound in relation to the principles of informed choice. Women (n = 113) completed a questionnaire prior to their 18-week ultrasound. Fifty-five percent stated they received no information from their care provider. Only 31.9% considered health care providers as a very helpful source of information. Yet, 69.0% stated their care provider gave them information that facilitated their understanding. Gaps were identified in women's understanding of ultrasound. Specifically, 46.0% did not view ultrasound as a screen for anomalies; some were uncertain about the safety (18.6%), diagnostic capabilities (26.5%), and limitations of testing (37.2%). These results suggest that women's understanding of ultrasound does not meet the requirements of informed choice.     

Receiving and providing support in couples dealing with multiple sclerosis: A diary study using an equity perspective

This study examined the effects of daily support exchanges in couples facing multiple sclerosis (MS). Two issues were examined: the imbalance between received and provided support, and the extent to which reciprocal exchanges of received and provided support are associated with end‐of‐day well‐being (positive and negative mood and self‐esteem). Guided by equity theory, we expected that one‐sided support provision or receipt would be harmful for well‐being for both patients and partners. We argued that these negative outcomes could be offset by reciprocating support, that is, when both partners receive and provide support. Sixty‐one patients and their partners filled out questionnaires on demographics and disease‐related characteristics and subsequently completed computerized daily diaries for 14 days. At the end of each day, both partners completed diaries on end‐of‐day mood, self‐esteem, received and provided emotional and instrumental support, and several control variables (daily hassles and MS‐related symptoms for patients). Reciprocity in instrumental support transactions was associated with higher levels of self‐esteem among both patients and partners. However, the other results all showed independent effects of support received and provided. Patients’ well‐being was related to providing emotional support and instrumental support, whereas partners’ well‐being was related to receiving emotional support from patients.     

Outpatient Psychotropic Medication Use in the US: A Comparison Based on Foster Care Status

Using data from the Client/Patient Sample Survey, a nationally representative study of outpatient mental health service utilization, the prevalence and correlates of psychotropic medication receipt for youth who live with families and in foster care are compared. The medication rate is similar for both groups, with slightly more than one-third of youth treated with medication. Additionally, when medication is prescribed, it is the sole intervention provided for close to one half of each group, and the distribution of other services received (such as clinical case management and collateral services) is similar, regardless of living situation. However, the predictors of medication use differ for the two groups. Among foster care youth, only presenting problems of depressed mood, being withdrawn, and suicidality significantly increase the odds of medication; among youth with families, sociodemographic characteristics (male gender), and a range of clinical factors (disruptive behavior disorder, presenting problems of hyperactivity and sleep disturbance, prior mental health service receipt, and inpatient or residential care referral sources) increase the likelihood of medication. The conclusion that distinct sets of factors predict medication for the two groups was reinforced by results of multivariate analyses; foster care status moderates the association between medication receipt and only one of the correlates examined (gender). Implications, limitations, and areas for future research are presented.     

The Spiritual Needs and Resources of Hospitalized Primary Care Patients

Previous studies have recognized the importance of hospitalized primary care patients’ spiritual issues and needs. The sources patients consult to address these spiritual issues, including the role of their attending physician, have been largely unstudied. We sought to study patients’ internal and external resources for addressing spiritual questions, while also exploring the physician’s role in providing spiritual care. Our multicenter observational study evaluated 326 inpatients admitted to primary care physicians in four midwestern hospitals. We assessed how frequently these patients identified spiritual concerns during their hospitalization, the manner in which spiritual questions were addressed, patients’ desires for spiritual interaction, and patient outcome measures associated with spiritual care. Nearly 30% of respondents (referred to as “R/S respondents”) reported religious struggle or spiritual issues associated specifically with their hospitalization. Eight-three percent utilized internal religious coping for dealing with spiritual issues. Chaplains, clergy, or church members visited 54% of R/S respondents; 94% found those visits helpful. Family provided spiritual support to 45% of R/S respondents. Eight percent of R/S respondents desired, but only one patient actually received, spiritual interaction with their physician, even though 64% of these patients’ physicians agreed that doctors should address spiritual issues with their patients. We conclude that inpatients quite commonly utilize internal resources and quite rarely utilize physicians for addressing their spiritual issues. Spiritual caregiving is well received and is primarily accomplished by professionals, dedicated laypersons, or family members. A significantly higher percentage of R/S patients desire spiritual interaction with their physician than those who actually receive it.     

Child care in rural areas: Needs,attitudes, and preferences

The purpose of this research was to assess the needs and preferences for child care services in rural areas. We examined data from interviews with 525 mothers of children up to 12 years of age in two southeastern states. Results indicated that, while rural mothers expressed a desire for more child care services, many were ambivalent about other-than-mother care. On the one hand, they had limited knowledge about and experience with a variety of child care arrangements; on the other hand, they could identify their preferences for types and specific features of day care they desired. These preferences were summarized to form a hypothetical "ideal type" of child care for rural mothers.     

Counselling in primary care: a systematic review of the evidence

Primary objective: To undertake a systematic review which aimed to locate, appraise and synthesise evidence to obtain a reliable overview of the clinical effectiveness, cost‐effectiveness and user perspectives regarding counselling in primary care. Main results: Evidence from 26 studies was presented as a narrative synthesis and demonstrated that counselling is effective in the short term, is as effective as CBT with typical heterogeneous primary care populations and more effective than routine primary care for the treatment of non‐specific generic psychological problems, anxiety and depression. Counselling may reduce levels of referrals to psychiatric services, but does not appear to reduce medication, the number of GP consultations or overall costs. Patients are highly satisfied with the counselling they have received in primary care and prefer counselling to medication for depression. Conclusions and implications for future research: This review demonstrates the value of counselling as a valid choice for primary care patients and as a broadly effective therapeutic intervention for a wide range of generic psychological conditions presenting in the primary care setting. More rigorous clinical and cost‐effectiveness trials are needed together with surveys of more typical users of primary care services.     

Effects of objective feedback and "single other" or "average other" social comparison feedback on performance judgments and helping behavior

In two studies, participants received positive or negative feedback about their performance on a verbal task and then provided hints to another person on a subsequent, different task. It was expected that participants would give more helpful hints after positive than after negative feedback but that this would be more apparent when the feedback was based on performance comparisons with the "average participant" than on comparisons with another person or an objective standard. This effect was expected to be mediated by judgments of one's performance on the first task. These predictions were supported. Participants seemed aware of the effect of feedback on their hint choices, and their hint choices did not alter their affect levels. Also, participants receiving comparative (single or aggregated target) feedback exhibited changes in self-ascribed importance of the performance domain. Implications for social comparison theory and self-evaluation maintenance theory are discussed.     

After School Care for Children on the Autism Spectrum

Few programs exist for after school care designed to support children with Autism Spectrum Disorder (ASD). Not only do parents often depend on after school care, but also children with ASD are likely to benefit from opportunities to generalize skills in an authentic setting and interact with typically developing peers. This lack of support occurs at a time during which there is increasing research and community awareness regarding the need for high quality after school programs to support typically developing children. This study investigates reported experiences with and needs for after school care by parents of children with ASD. Survey results (N = 54) revealed that the majority of parents surveyed desired after school programs within their child’s school but are often denied access to such services or received low quality care for their child in after school programs. Recommendations are provided for future research and program development.     

Is health-care delivery by partially trained professionals ever morally justified?

...teaching institutions should establish policies for all aspects of care provided by residents-in-training (not just for the acquisition of informed consent to treatment) and establish mechanisms to monitor how these policies are implemented and their effect on the quality of patient care and patient satisfaction with care. Clear policy on which treatments are provided by junior residents and which treatments and aspects of care are provided by senior residents is necessary for patients and their families to have control over what happens to them in the health-care institution....Teaching institutions should regularly assess whether residents are being asked to take on more responsibilities in patient care than they are prepared to do. The reasons to do this are not solely related to protecting the patient from harm. Protecting the residents-in-training from overwhelming guilt, fear, and providing them with a more humane approach to medical education should be a minimal expectation for the training of those who will be expected to provide humane care to others....     

Training Appraisees to Participate in Appraisal: Effects on Appraisers and Appraisees

This study examined the role of behavior modeling training (BMT) in enhancing appraisee participation during a performance appraisal discussion. In addition, the study examined the effects of enhanced participation on appraisee and appraiser perceptions toward several appraisal outcome variables; in particular, the fairness and accuracy of performance appraisal were of interest. The experimental design was a 2 × 3 completely crossed factorial design consisting of two levels of training (behavior modeling vs. lecture/discussion) and three levels of bogus evaluation feedback (low, neutral, and high). A series of multivariate and univariate comparisons were used to test the hypothesized outcomes. The findings suggest that appraisers exposed to the BMT group perceived appraisees as more proactive and better performers and, in addition, reported liking the appraisees more, and perceiving the appraisal process as more fair. The study also found support for the egocentric bias in perceived outcome fairness: appraisees in both training conditions who received a high evaluation perceived the appraisal evaluation as more fair than appraisees who received a low evaluation. In addition, the study found that favorable evaluations were also perceived as being more accurate. The results of the study are discussed in terms of procedural justice theory and related research examining the role of performance feedback on both the appraisee and the appraiser. Suggestions for future research in the areas of behavior modeling, voice-giving (high-input) procedures, and procedural justice are discussed.