The hospice: Humane care for the dying

The hospice movement arose as a reaction to the dehumanizing atmosphere of acute-care hospitals, where excessive utilization of life support equipment deprived dying patients of a meaningful vision of their destiny. Respecting the spiritual quest of the terminally ill for wholeness and dignity, the hospice concept prescribes the rendering of compassionate and pastoral care by a benevolent community of family, health care staff, friends, and clergy. Approximately 800 hospice programs are currently evolving in the United States. St. Mary's (formerly “Hillhaven”) Hospice in Tucson, Arizona, offers the most comprehensive program of services, including home care, inpatient care, and artistic media through which the dying express their creativity. Numerous demonstration projects funded by several government agencies, principally the Health Care Financing Administration (HCFA), are expected to result in the legislative actions eliminating barriers to reimbursement of the cost of hospice services by Medicare, Medicaid, and other third-party payers. Existential analysis reveals the value of religion and spiritual support in enabling the dying to banish anxiety and muster the hope requisite for fully appreciating the authentic meaning of their destiny.     

The hospice: Humane care for the dying

The hospice movement arose as a reaction to the dehumanizing atmosphere of acute-care hospitals, where excessive utilization of life support equipment deprived dying patients of a meaningful vision of their destiny. Respecting the spiritual quest of the terminally ill for wholeness and dignity, the hospice concept prescribes the rendering of compassionate and pastoral care by a benevolent community of family, health care staff, friends, and clergy. Approximately 800 hospice programs are currently evolving in the United States. St. Mary's (formerly Hillhaven) Hospice in Tucson, Arizona, offers the most comprehensive program of services, including home care, inpatient care, and artistic media through which the dying express their creativity. Numerous demonstration projects funded by several government agencies, principally the Health Care Financing Administration (HCFA), are expected to result in legislative actions eliminating barriers to reimbursement of the cost of hospice services by Medicare, Medicaid, and other third-party payers. Existential analysis reveals the value of religion and spiritual support in enabling the dying to banish anxiety and muster the hope requisite for fully appreciating the authentic meaning of their destiny.     

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.     

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.     

'You can spend your life dying or you can spend your life living': identity transition in people who are HIV-positive

This article examines, through the lenses of HIV-positive people, the unique phenomenon of identity transition. This research proposes that life-changing illnesses, such as HIV, are an undesired 'possession' that people accept to varying degrees, which we refer to as 'ownership'. While illnesses, such as HIV compel individuals to undergo a transformation process that usually begins with a deep feeling of detachment, and then proceeds to acceptance of their illness, and to feeling empowered and in control of their HIV status and lives, this process is very complex and non-linear as it involves many iterative progressions in identity transition. These transitions are highly individualistic; however, the underlying theme is that the more positive trajectories were those of people who focus on their new lives, living with HIV (i.e. taking ownership of their illness), rather than focusing on what they have lost when they became HIV-positive. The findings demonstrate that identity transition is a result of the ways that individuals rework, negotiate and transform their roles, actions and behaviours through their active engagement with support mechanisms. This study suggests that it is vital to promote positive interactions with support mechanisms to ensure that those with HIV view themselves positively.     

The TAR effect: when the ones who dislike become the ones who are disliked

Four studies tested whether a source's evaluations of other individuals can recursively transfer to the source, such that people who like others acquire a positive valence, whereas people who dislike others acquire a negative valence (Transfer of Attitudes Recursively; TAR). Experiment 1 provides first evidence for TAR effects, showing recursive transfers of evaluations regardless of whether participants did or did not have prior knowledge about the (dis)liking source. Experiment 2 shows that previously but not subsequently acquired knowledge about targets that were (dis)liked by a source overrode TAR effects in a manner consistent with cognitive balance. Finally, Experiments 3 and 4 demonstrate that TAR effects are mediated by higher order propositional inferences (in contrast to lower order associative processes), in that TAR effects on implicit attitude measures were fully mediated by TAR effects on explicit attitude measures. Commonalities and differences between the TAR effect and previously established phenomena are discussed.     

Masculine and feminine voices: Making ethical decisions in the care of the dying

Drawing on the example of one specific Ethics Committee, the author delineates feminine and masculine styles of ethical decision making and work with the dying as two sides of what it means to be humanistic in patient care. The author draws particularly on the work of Carol Gilligan to differentiate feminine from masculine approaches.     

It's not who you are but who you're with: Self-Confidence in achievement settings

This study examined the effects of two social cues on women's and men's self-confidence: the sex and performance of another in an achievement setting. Before trying to solve 60 anagrams, women expected to perform more poorly than men. In addition, both sexes expected to perform more poorly when paired with a male confederate than when paired with a female confederate. The effect of the partner's sex showed up in anagram performance: people with a female partner solved more anagrams than people with a male partner. The effect of subject's sex on performance was unexpected: women solved more anagrams than men. After the task, sex differences in self-confidence disappeared; neither sex of subject nor sex of partner influenced self-confidence. The partner's performance, however, had a strong effect on everyone: people were less self-confident if they had worked with a high-scoring partner. The pattern of results suggests that sex-of-subject differences in self-confidence, while important, are less powerful than the effects wielded by the sex of others in achievement settings.     

Behavioural problems in adolescents who are in adoption, residential care, and grandparent fostering

The aim of this research is to identify the severity and type of behavioural problems found in a sample of 181 Spanish adolescents, aged 11 and 18, who have been, or still are in the protective system and to provide give up-to-date figures about behavioural problem situations of children are living under protective measures, and to determine the existence of diverse behavioural problems concerning the kind of care the adolescents are receiving (adoption, residential care, or with grandparent fostering). The Child Behavior Checklist (CBCL) was used in this study. The results show that most of the adolescents scored within the normal range and only a small percentage of them had important behavioural problems and were therefore situated within the clinical range of the trial. The adopted adolescents scored higher than the adolescents who were either fostered by their extended families or in residential care. The main problems identified in each section are discussed, along with the results, in the context of modernising the Spanish protection system.     

Work with dying patients: Team dynamics and team work

SUMMARY

This paper addresses some issues in palliative-care work that emerged in a short-term staff-support group, and shows that work with terminally-ill cancer patients had an impact on the staff and team as a whole. In dealing with distressing and disturbing feelings related to work with dying patients, the staff used manic defences and denial of differences within the team.     

Attributions about spouse abuse: It matters who the batterers and victims are

The present study examined college students' (86% white) reactions to scenarios of three types of domestic violence situations. Subjects read a brief newspaper report of a battering incident and afterwards rated the situation and participants on a variety of scales. The scenario described either a (1) husband battering his wife, (2) wife battering her husband, or (3) gay male battering his lover. In addition, there was or was not an apparent verbal provocation by the victim. Results showed the harshest evaluation of a batterer who was not provoked. A greater responsibility was placed on the victim in the battered husband scenario, which generally was taken less seriously than the battered wife case. Results suggest the need to examine a diversity of battering situations and variables in order to fully understand attributions made about such situations.     

Dropping the weight stigma: Nostalgia improves attitudes toward persons who are overweight

Weight stigma, a negative attitude toward persons who are overweight, can lead to emotional detriment (increased vulnerability to depression and anxiety, decreased self-esteem) and discriminatory practices (denial of employment, lower wages, refusal of job promotion or college admission, healthcare deprivation), which have increased dramatically in the United States over the past decade. We report two experiments that implicate nostalgia as a resource or strategy for weight stigma reduction. We hypothesized and found that nostalgia about an encounter with a person who is overweight improves attitudes toward the group “overweight.” Undergraduates who recalled a nostalgic (vs. ordinary) interaction with an overweight person subsequently showed more positive outgroup attitudes. The effect of nostalgia on outgroup attitudes was mediated by greater inclusion of the outgroup in the self and increased outgroup trust (Experiments 1 and 2), as well as reduced intergroup anxiety and greater perceptions of a common ingroup identity (Experiment 2). The findings have interventional potential.     

The development of academic competence among adolescents who bully and who are bullied

Using data from the first three waves (Grades 5, 6, and 7) of the 4-H Study of Positive Youth Development, this study assessed if being a bully or being a victim accounts for an adolescent's academic competence, if selected contextual and individual variables impact an adolescent's academic competence, and if such impact differs in relation to an adolescent's bullying status. The results of random coefficient hierarchical regression analyses indicated that being a bully predicted lower grades across time, and that being a bully was more detrimental for girls than for boys. Being a bully and being a victim negatively predicted self-perceived academic competence, but these predictive effects did not change over time or differ by sex. Teacher support positively predicted grades and greater parent support and teacher support independently predicted higher self-perceive academic competence. Greater educational expectations and school engagement independently predicted higher self-reported grades, while these two predictors positively interacted in explaining self-perceived academic competence. Unexpectedly, peer support negatively predicted self-reported grades for victims, and negatively predicted self-perceived academic competence for bullies. We discuss the importance of addressing the issue of academic competence in bullying interventions, as well as the utility of capitalizing on developmental assets in promoting academic competence among adolescents who bully and who are bullied.