Neurodevelopmental care in the NICU

Neurodevelopmental care, which is any NICU intervention undertaken to improve neurodevelopmental outcome, includes NICU design, nursing routines, nursing care plans, management of pain, feeding methods and, most importantly, encouraging parental involvement with their NICU infant. Recognition that sensory stimulation can overwhelm preterm infants and increase physiologic signs of stress led to attempts to reduce sensory input. More recent approaches judiciously add back soothing sensory input (e.g., therapeutic touch, soft music). Circadian light/dark cycles and physical activity improve preterm growth. Attention to infant positioning and handling affects physiologic variables and joint mobility, if not functional motor abilities. A highly organized system of care for NICU infants is Als' NIDCAP (i.e., Neonatal Individualized Developmental Care and Assessment Program). Although NIDCAP may reduce need for respiratory support and hospital length of stay, it does not significantly influence neurodevelopmental outcome at 2-3 years. Pain management includes benign interventions (e.g., nonnutritive sucking, oral glucose), but the prolonged use of narcotics must be balanced against the consequences of sedation and dependency. The foremost challenge for NICUs remains parent disenfranchisement. Kangaroo care, which involves parent/infant skin-to-skin contact, improves preterm growth, decreases nosocomial infections and may shorten hospital length of stay. A great deal of work needs to be done to identify and demonstrate efficacy of specific interventions and changes that humanize the NICU, encourage parental involvement, support infant development and optimize preterm neurodevelopmental outcomes.     

Measuring the quality of residential care

Administrative personnel require objective, reliable and valid information in order to monitor the effects of allocating resources to different components of the service that they are providing. The initial problem is to define and measure the dependent variable—the ‘quality of care’ —against which the effects of changing various independent variables can be evaluated. The paper describes an attempt to use the operant conditioning model as a basis for constructing such a measure of the quality of care provided in residential settings for severely mentally handicapped people. The rationale for adopting this model is described, against a background of other studies in which the same problem has been addressed. The hypothesis, the tasks generated, and the methodological problems encountered, are outlined and discussed.

A subsequent paper will present the results obtained when using the method to measure the quality of care, so defined, in two residential units for severely mentally handicapped children.     

Pastoral care of the dying patient

Conclusion and Summary The ministerial role appears to involve four basic aspects or functions: personal, counseling, pastoral, and theologizing. In order to be a minister, one must be available as a fellow human, with some psychological skill, able to share spiritual or religious activity, and willing to articulate theologically to himself the meaning of his experiences for his personal faith. These aspects of the ministerial role are exemplified in the encounters of divinity students with disabled and dying patients. Because of the challenge that life presents to sincere faith, and because one or more of the four functions are often stressed in an isolated way, offensive stereotypes of the minister are pervasive. p ]Abhorrence of being identified as such a person made the ministerial candidates in this report reluctant to act or even speak in any religious way. The desire to become a psychologist or counselor and avoid theological topics, strong in the beginning, tended to disappear toward the end of the year. These phenomena were seen as natural phases of sequential growth in the struggle to understand the needs of other persons for a minister. As shift from self-concern to concern for the other occurred, the students became more open to learning from the patients how human and religious needs can be served without desecration to either.     

老年闲暇的伦理关怀

闲暇是老年人的主要生活方式.忽视老年人的闲暇生活需求,或者视之为一种纯粹的时间消磨,或者为老年人闲暇生活提供的社会支持系统薄弱,都是老年人闲暇生活缺失伦理关怀的表现.充满伦理关怀的老年人闲暇方式旨在寻求老年生命的意义和与社会的融合.所以,建构伦理关怀型老年人闲暇生活方式势在必行,这项系统工程需要政府制定相关政策,社区构建和谐环境,老年人接受闲暇教育,以及老年社会工作的开展.     

Spiritual growth through care of the dying

One of the most difficult issues with which clergy must deal is that of theodicy, the reconciliation of a good God with evil in this world. The case of L.R. is that of a good thirty-nine-year-old man dying of cancer. This paper examines the role of the clergy in working with the dying patient, traditional responses to the questions of theodicy, and a proposal for an adequate contemporary solution to the issue of theodicy. One key factor in caring for the dying is the mutual spiritual growth of the dying patient and the clergy care giver.     

Pastoral care of the discharged psychiatric patient

Pastoral Psychology -     

Pastoral care and the eight deadly vices

Pastoral Psychology -     

Paternalism in the neonatal intensive care unit

Two factors are discussed which have important implications for the issue of paternalism in the neonatal intensive care unit (NICU): the physician's role as advocate for the patient; and the range of typical responses of parents who learn that their neonate has a serious illness. These factors are pertinent to the task of identifying those actions which are paternalistic, as well as to the question of whether paternalism is justified. It is argued that certain behavior by physicians which is often thought to be paternalistic is not in fact so. Furthermore, an argument in defense of paternalism which has largely been overlooked is presented. Examples are given to illustrate how paternalism actually arises in the NICU, and it is argued that paternalism is justified in some cases.     

Rehabilitating care

The feminist ethic of care has often been criticized for its inability to address four problems--the problem of exploitation as it threatens care givers, the problem of sustaining care-giver integrity, the dangers of conceiving the mother-child dyad normatively as a paradigm for human relationships, and the problem of security social justice on a broad scale among relative strangers. We argue that there are resources within the ethic of care for addressing each of these problems, and we sketch strategies for developing the ethic more fully.     

Health care and the prospective Pareto principle

Issues of social justice in access to health care are examined from the standpoint of the "prospective," or "ex ante," Pareto principle, an ethical principle which holds that one policy is to be preferred over another if it betters the prospects of some persons while the alternative betters no one's prospects. It is suggested that this principle may validate a form of utilitarianism in health policy decisions, with equity demanding that everyone have access to a decent minimum of care but not necessarily to all highly expensive treatments.     

Pastoral care and the eight deadly vices

This study augments Erik Erikson's developmental schedule of virtures with a corresponding schedule of vices. Eight major vices are correlated with the eight stages of the life cycle. The vices, derived from traditional classifications of the “deadly sins,” include (in order) gluttony, anger, greed, envy, pride, lust, indifference, and melancholy. Implications of this schedule of vices for pastoral care are suggested.