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.     

Health-Related Quality of Life is Associated with Positive Affect in Patients with Coronary Heart Disease Entering Cardiac Rehabilitation

Health-related quality of life (QoL) is an important and widely used outcome measure in cardiac populations. We examined the relationship between positive affect and health-related quality of life, controlling for traditional cardiovascular risk factors, clinical variables and negative affect. We further investigated the role of gender in this relationship given the well-known gender differences in cardiovascular health. We enrolled 746 patients with coronary heart disease (CHD) before they entered outpatient cardiac rehabilitation. All patients completed the Global Mood Scale and the SF-36 Health Survey. Positive affect was independently associated with mental (p < .001) and physical QoL (p < .001) after controlling for control variables. Gender moderated the relationship between positive affect and physical QoL (p = .009) but not mental QoL (p = .60). Positive affect was positively associated with physical QoL in men (p < .001) but not in women (p = .44). The health-related QoL of patients with CHD is associated with a person’s level of positive affect.     

Personality and symptom change in treatment-refractory inpatients: evaluation of the phase model of change using Rorschach,TAT, and DSM-IV Axis V

In this study, we examined global treatment outcomes during 16 months of intensive, psychodynamic treatment for 77 inpatients suffering from treatment-refractory disorders. Hypotheses based on the phase model of treatment change (Howard, Lueger, Maling, & Martinovich, 1993; Howard, Moras, Brill, Martinovich, & Lutz, 1996) were supported in the study results. Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) Axis V scales assessing behavioral functioning demonstrated large and medium effect size change, whereas stable, enduring personality functioning assessed by psychoanalytic Rorschach scales and the Social Cognition and Object Relations Scale (Westen, 1995) for the Thematic Apperception Test (Murray, 1943) demonstrated small and medium effect size change. We also report assessment of reliable change index and clinical significance. The ecological validity of Rorschach measures is supported by significant validity coefficients (in the hypothesized directions) between implicit measures of personality functioning and behavioral ratings.     

Motor adaptation to different dynamic environments is facilitated by indicative context stimuli

When humans are exposed to external forces while performing arm movements, they adapt by compensating for these novel forces. The basis of this learning process is thought to be a neural representation that models the relation between all forces acting upon the system and the kinematic effects they produce, called inverse dynamic model (IDM). The present study investigated whether and how the predictability of a given external force affects the selection of an appropriate motor response to compensate for such force. Adult human subjects (N=32) held a handle that could rotate around the elbow joint and learned to perform goal-directed forearm flexion movements, while an external velocity-dependent negative damping force was applied that assisted forearm movement. Subjects were randomly assigned to two groups. In the associative group, the applied damping force was always associated with a specific initial position. Thus, after initial learning, the force application became predictable. In the non-associative group, where the same movements were performed, the applied force was independent of the initial position, so that no association between force and location could be formed. We found that only the associative group significantly reduced target error when damping was present. That is, the location cue aided these subjects in generating dynamic responses in the appropriate limb. Our results indicate that motor adaptation to different dynamic environments can be facilitated by indicative stimuli.     

The role of primary and secondary control in adaptation to age-related vision loss: a study of older adults with macular degeneration

This study examines the effect of primary and secondary control on 3 major outcomes experienced by visually impaired older adults, that is, functional ability, adaptation to vision loss, and positive affect. The authors' theoretical model is based on the J. Heckhausen and R. Schulz (1995) control framework, as well as a conceptual integration of these outcomes, and they hypothesized that control beliefs can substantially contribute to explaining interindividual differences in these outcomes. A path model applied to data from a sample (N = 90) of visually impaired older adults, suffering from age-related macular degeneration, the major cause of vision loss in old age, generally supports this expectation.     

Age differences in the effects of social influence on children's eyewitness performance and their metacognitive monitoring

The current work investigated the effects of social influence on children's recall accuracy and metacognitive monitoring. Two studies were conducted in which 8- and 10-year-olds were confronted with postevent information in an interview situation. An interviewer (Study 1) or a confederate (Study 2) provided postevent information with two levels of assertiveness, inducing (a) a variation of conformity pressure and (b) a variation of information credibility. Afterwards, children's confidence judgments were assessed. The results revealed significant age differences in children's ability to adequately cope with variations of social influence. Although conformity pressure was especially important for the 8-year-olds, effects of informative social influence were independent of age. However, 10-year-olds were also able to act appropriately on low credibility, thereby demonstrating a more sophisticated consideration of social influence sources. Moreover, varying assertiveness also affected the quality of children's confidence judgments by improving their metacognitive differentiation skills.     

Intimacy, concreteness, and the "self-reference effect"

Reference to oneself during incidental learning of words frequently results in better recall performance than reference to other persons. However, this effect occurs under different conditions with differing strength, and sometimes it is even reversed. Meta-analyses and further experimental studies suggest that increased recall performance under a self-referential encoding task occurs only if it is compared with a nonintimate other person and if abstract material is presented, irrespective of the type of previously presented words (adjectives or nouns). In the current paper, two experiments are reported which support the assumption that this intimacy effect on memory only occurs if no pictorial or concrete features of the material (nouns) to be learned can be exploited for an improvement in encoding or remembering the material. All results agree with predicted effect sizes, which were drawn from a meta-analysis and subsequently conducted experimental studies. This suggests that a recall advantage of referring to oneself compared to other persons is subordinate to the effects of concreteness or imageability. Moreover, the current results offer a theoretical explanation of some previously reported but nevertheless puzzling results from imagery instructions, which indicate decreased recall performance for self-reference compared to other-reference.     

In defense of strategic therapy

The practice of strategic therapy has raised a number of critical issues and has stimulated criticism of various sorts. Among the criticisms leveled at strategic therapy are that it involves the taking of too many risks, that it is deceptive, that it is controlling and manipulative, that it is disrespectful, and that it is superficial and narrow. Each of these five major areas of concern is discussed and addressed with case examples to illustrate a rationale and justification for the use of these less conventional methods.     

Recommendations for standardized human pedigree nomenclature

The construction of an accurate family pedigree is a fundamental component of a clinical genetic evaluation and of human genetic research. Previous surveys of genetic counselors and human genetic publications have demonstrated significant inconsistencies in the usage of common pedigree symbols representing situations such as pregnancy, termination of pregnancy, miscarriage, and adoption, as well as less common scenarios such as pregnancies conceived through assisted reproductive technologies. The Pedigree Standardization Task Force (PSTF) was organized through the Professional Issues Committee of the National Society of Genetic Counselors, to establish recommendations for universal standards in human pedigree nomenclature. Nomenclature was chosen based on current usage, consistency among symbols, computer compatibility, and the adaptability of symbols to reflect the rapid technical advances in human genetics. Preliminary recommendations were presented for review at three national meetings of human genetic professionals and sent to >100 human genetic professionals for review. On the basis of this review process, the recommendations of the PSTF for standardized human pedigree nomenclature are presented here. By incorporating these recommendations into medical genetics professional training programs, board examinations, genetic publications, and pedigree software, the adoption of uniform pedigree nomenclature can begin. Usage of standardized pedigree nomenclature will reduce the chances for incorrect interpretation of patient and family medical and genetic information. It may also improve the quality of patient care provided by genetic professionals and facilitate communication between researchers involved with genetic family studies.Reprinted with permission from theAmerican Journal of Human Genetics 56:745–752, 1995, The University of Chicago Press. © 1995 by The American Society of Human Genetics. All rights reserved.     

Weighing the Evidence: A Systematic Review on Long-Term Neurocognitive Effects of Cannabis Use in Abstinent Adolescents and Adults

Findings on neurocognitive effects of sustained cannabis use are heterogeneous. Previous work has rarely taken time of abstinence into account. In this review, we focus on understanding sustained effects of cannabis, which begin when clinical symptoms of the drug have worn off after at least 14 days. We conducted a search between 2004 and 2015 and found 38 studies with such a prolonged abstinence phase. Study-design quality in terms of evidence-based medicine is similar among studies. Studies found some attention or concentration deficits in cannabis users (CU). There is evidence that chronic CU might experience sustained deficits in memory function. Findings are mixed regarding impairments in inhibition, impulsivity and decision making for CU, but there is a trend towards worse performance. Three out of four studies found evidence that motor function remains impaired even after a time of abstinence, while no impairments in visual spatial functioning can be concluded. Functional imaging demonstrates clear differences in activation patterns between CU and controls especially in hippocampal, prefrontal and cerebellar areas. Structural differences are found in cortical areas, especially the orbitofrontal region and the hippocampus. Twenty studies (57 %) reported data on outcome effects, leading to an overall effect size of r _mean?=?.378 (CI 95 %?=?[.342; .453]). Heavy use is found to be more consistently associated with effects in diverse domains than early age of onset. Questions of causality―in view of scarce longitudinal studies, especially those targeting co-occurring psychiatric disorders―are discussed.