Student Healthcare Clinicians' Illness Narratives: Professional Identity Development and Relational Practice

ABSTRACT

In this qualitative, grounded theory study we examine how the intersection of self-reflection, illness narratives and perceived messages of professional identity inform care provided by medical, nursing, and medical family therapy students to patients and families. We discovered four common challenges students faced navigating personal experiences of illness and connecting to patients: 1) discrepancies between ideal and lived experiences, 2) challenges of healthcare work and culture, 3) navigating power and hierarchy, and 4) developing a shell of privacy. Discussion and implications include interdisciplinary training and collaboration and the unique role of medical family therapists in healthcare.     

Caregiver Demand and Parent Distress in Juvenile Rheumatic Disease: The Mediating Effect of Parent Attitude Toward Illness

Parents of youth with juvenile rheumatic diseases (JRD) often take on illness management responsibilities that can become burdensome, potentially resulting in poor parent adjustment outcomes. However, not all caregivers will experience increased distress as a result of variability in stress appraisals. The current study examined the role of parent illness attitudes in the relation between perceived caregiver demand and parental distress. Youth (N = 70) ages 7–18 years diagnosed with a JRD and their parents were recruited from a pediatric rheumatology clinic. Parents completed measures of caregiver demand, parental distress, and illness attitudes. Hierarchical regression revealed a relationship between caregiver demand and parental distress. A significant relationship was also found between caregiver demand and parent illness attitudes, as well as parent illness attitudes and parental distress. Thus, parent illness attitudes mediated the relationship between caregiver demand and parental distress. Techniques aimed at altering negative illness attitudes may help parents cope with their caregiving responsibilities.     

Mouse vocal communication system: Are ultrasounds learned or innate?

Mouse ultrasonic vocalizations (USVs) are often used as behavioral readouts of internal states, to measure effects of social and pharmacological manipulations, and for behavioral phenotyping of mouse models for neuropsychiatric and neurodegenerative disorders. However, little is known about the neurobiological mechanisms of rodent USV production. Here we discuss the available data to assess whether male mouse song behavior and the supporting brain circuits resemble those of known vocal non-learning or vocal learning species. Recent neurobiology studies have demonstrated that the mouse USV brain system includes motor cortex and striatal regions, and that the vocal motor cortex sends a direct sparse projection to the brainstem vocal motor nucleus ambiguous, a projection previously thought be unique to humans among mammals. Recent behavioral studies have reported opposing conclusions on mouse vocal plasticity, including vocal ontogeny changes in USVs over early development that might not be explained by innate maturation processes, evidence for and against a role for auditory feedback in developing and maintaining normal mouse USVs, and evidence for and against limited vocal imitation of song pitch. To reconcile these findings, we suggest that the trait of vocal learning may not be dichotomous but encompass a broad spectrum of behavioral and neural traits we call the continuum hypothesis, and that mice possess some of the traits associated with a capacity for limited vocal learning.     

Verbal Memory Abilities of Children With Brain Tumors

Several critical neuroanatomical structures and pathways for memory performance are located in the third ventricle region. This led us to predict that verbal memory abilities would be more impaired in children treated for third ventricle tumors compared to those treated for cerebellar tumors. Archival data was obtained from 24 pediatric patients with third ventricle region tumors and 18 pediatric patients with cerebellar tumors. Neuroradiological verifications of tumor involvement and hydrocephalus severity (i.e., Evans Index) on preoperative scans and MRIs proximal to the time of the neuropsychological evaluation were conducted. The potential confounds of hydrocephalus severity, seizure medication, age, radiation treatment, and chemotherapy were addressed. Verbal IQ was comparable between tumor groups and in the Average range. The third ventricle region group performed significantly worse on list learning and delayed list recall compared to the cerebellar group. Their mean performance was in the clinically impaired range on both trials. The third ventricle region tumor group performed better than the cerebellar tumor group on Digit Span, a basic repetition, attention span task. These findings support the hypothesis that pediatric patients with third ventricle region brain tumors are more likely to be impaired on verbal recall tasks compared to pediatric patients with cerebellar brain tumors. In contrast, patients who were treated for cerebellar tumors were more impaired on the basic repetition, attention span task compared to patients who were treated for third ventricle tumors. Future studies should examine the specific neuroanatomical structures and pathways that are damaged and may influence differential cognitive impairments in children.     

The anxious believer: Macaulay’s prescient theodicy

Recent feminists have critiqued G.W. Leibniz’s Theodicy for its effort to justify God’s role in undeserved human suffering over natural and moral evil. These critiques suggest that theodicies which focus on evil as suffering alone obfuscate how to thematize evil, and so they conclude that theodicies should be rejected and replaced with a secularized notion of evil that is inextricably tied to the experiences of the victim. This paper argues that the political philosophy found in the writings of Catherine Macaulay (1731–1791) can serve as a support to Leibniz’s larger claims and can also offer a more concrete, situated notion of evil that escapes the contemporary feminist critique. Macaulay’s work on natural and moral political evil, especially, will be presented as an early modern precursor to feminism, which defends divine perfection and a pre-established harmony in the face of political evil. I then identify three unique theodicical arguments in Macaulay’s work: the pragmatically beneficial defense, the eschatalogical defense, and the redemptive defense.     

Implicit ambivalence from attitude change: an exploration of the PAST model

Traditional models of attitude change have assumed that when people appear to have changed their attitudes in response to new information, their old attitudes disappear and no longer have any impact. The present research suggests that when attitudes change, the old attitude can remain in memory and influence subsequent behavior. Four experiments are reported in which initial attitudes were created and then changed (or not) with new information. In each study, the authors demonstrate that when people undergo attitude change, their old and new attitudes can interact to produce evaluative responses consistent with a state of implicit ambivalence. In Study 1, individuals whose attitudes changed were more neutral on a measure of automatic evaluation. In Study 2, attitude change led people to show less confidence on an implicit but not an explicit measure. In Studies 3 and 4, people whose attitudes changed engaged in greater processing of attitude-relevant information than did individuals whose attitudes were not changed.     

Narcissism and childhood recollections: a quantitative test of psychoanalytic predictions

Different psychotherapeutic theories provide contradictory accounts of adult narcissism as the product of either parental coldness or excessive parental admiration during childhood. Yet, none of these theories has been tested systematically in a nonclinical sample. The authors compared four structural equation models predicting overt and covert narcissism among 120 United Kingdom adults. Both forms of narcissism were predicted by both recollections of parental coldness and recollections of excessive parental admiration. Moreover, a suppression relationship was detected between these predictors: The effects of each were stronger when modeled together than separately. These effects were found after controlling for working models of attachment; covert narcissism was predicted also by attachment anxiety. This combination of childhood experiences may help to explain the paradoxical combination of grandiosity and fragility in adult narcissism.     

Cyberball: A program for use in research on interpersonal ostracism and acceptance

Since the mid-1990s, research on interpersonal acceptance and exclusion has proliferated, and several paradigms have evolved that vary in their efficiency, context specificity, and strength. This article describes one such paradigm, Cyberball, which is an ostensibly online ball-tossing game that participants believe they are playing with two or three others. In fact, the “others” are controlled by the programmer. The course and speed of the game, the frequency of inclusion, player information, and iconic representation are all options the researcher can regulate. The game was designed to manipulate independent variables (e.g., ostracism) but can also be used as a dependent measure of prejudice and discrimination. The game works on both PC and Macintosh (OS X) platforms and is freely available.     

Age of acquisition and word frequency: determinants of object-naming speed and accuracy

The combined contributions of word age of acquisition (AoA) and word frequency (rated and objective) to word retrieval speed and accuracy were investigated, using a picture-naming paradigm. Results from two fully factorial studies revealed that both AoA and word frequency reliably facilitate the speed and accuracy of word retrieval. Furthermore, word frequency and AoA interacted across delay (0, 750, 1,500, and 2,250 msec) in Experiment 2. This resulted in word frequency's playing a stronger role for late-acquired words across delays. It is concluded that both AoA and word frequency play a fundamental role in lexical retrieval. The results are also consistent with the view that both factors affect the same processing stages.