The illness reframing process in an ethnic-majority population of older people with incurable cancer: variations of cultural- and existential meaning-making adjustments

Increasing numbers of older people in Western countries are living with incurable cancer as a chronic disease, receiving palliative care from specialised healthcare contexts. The study's aim was to understand variations of cultural- and existential meaning-making adjustments in a Norwegian majority population of older people with incurable cancer. Semi-structured interviews from 21 participants, aged 70–88, were analysed according to three identified types of belief frames: atheistic/humanistic, religious, and spiritual. Kleinman's medical anthropology cultural framework was adapted and applied deductively together with a reframing metaphor concept in a four-part analytic process. Independent of the differences among the types of belief frames and heterogeneous illness reframing processes, changes in the existential cultural dimension seemed to facilitate psychosocial adjustments in relation to illness, daily living, relationships, and surroundings. The results point to the need for collecting and assessing the function of this type of patient information for better understanding the patient's framework of interpretation, and for identifying treatment-planning resources.     

Alcohol use: Views of people receiving in-patient care for mental health conditions

This study explored the perceptions of psychiatric in-patients concerning their use of alcohol in a context of community living. A total of 70 psychiatric in-patients at an Ethiopian hospital were the informants in this study (males = 73%; females = 27%, majority diagnosis schizophrenia = 63%). The patients completed a structured interview on possible reasons for and effects associated with alcohol use in psychiatric illness. These were thematically analysed. The patients cited positive features when using alcohol to include keeping one warm, acting as a digestive, controlling the side effects of psychotropic drugs, alleviating boredom or anxiety and improving one’s mood. They noted negative aspects of alcohol consumption as being the risk of bodily harm, absenteeism from work, familial neglect and a loss of control of one’s life. Some patients believed that the use of alcohol while they were under psychiatric care carried the risk of social exclusion and discrimination; yet they also believed that abstinence from alcohol would be difficult for them.     

Factors leading to orphans and vulnerable children living in community-based homes

This study explored the influences on living arrangements of orphans and vulnerable children (OVC) housed at a community-based home in Johannesburg, South Africa. A total of 50 OVC (males = 36%, females = 64%; age range 11 to 18 years) completed an open-ended questionnaire, while some of them also participated in individual interviews and focus group discussions on how they became residents of the community-based home. The data were thematically analysed. Findings suggest their choice to live in a community-based care setting to have been influenced by homelessness with accompanying poverty, health issues, experiences of child abuse and neglect, discrimination, and domestic violence. School psychologists working with OVC from community-based homes should consider pathways by which the children could be provided with needed support for resilient health and wellness.     

Balancing Legitimate Critical-Care Interests: Setting Defensible Care Limits Through Policy Development

Critical-care decision making is highly complex, given the need for health care providers and organizations to consider, and constructively respond to, the diverse interests and perspectives of a variety of legitimate stakeholders. Insights derived from an identified set of ethics-related considerations have the potential to meaningfully inform inclusive and deliberative policy development that aims to optimally balance the competing obligations that arise in this challenging, clinical decision-making domain. A potential, constructive outcome of such policy engagement is the collaborative development of an as-fair-as-possible dispute resolution process that incorporates an appropriated-justified, defensible critical-care obligation threshold.     

Prevalence of Cognitively Intact Individuals Residing in Extended Care Nursing Facilities

There appears to be a relative absence of studies that have examined the prevalence of cognitively intact individuals who reside in extended care facilities. Prevalence data were collected on 296 persons who resided in 3 extended care nursing facilities in Central Virginia. Cognitive intactness was evaluated via the Minimum Data Set Cognitive Performance Scale (CPS) and an author-generated survey (i.e., Cognitively Intact Survey [CI Survey]) of select nursing staff members at each facility. The Mini-Mental State Examination (MMSE) was utilized to examine the accuracy of the two measures in identifying cognitive intactness. Findings indicated that prevalence rates of cognitively intact residents varied as a function of the measures utilized to assess intactness. Specifically, a significantly greater proportion of the total sample of residents was judged to be cognitively intact via the CI Survey (34.12%) as compared to the CPS (26.01%). The level of interjudge agreement between the two measures was found to be moderately high (K = 0.68). When the MMSE was employed to verify individuals' levels of intactness, the percentages of residents predicted to actually be cognitively intact were somewhat lower for each measure. Specifically, based on the data obtained via the CI Survey, 22.75% of the total sample were predicted to actually be cognitively intact, whereas 17.85% of the sample were predicted to be intact based on the CPS results. Findings are discussed in light of factors that may have contributed to the differential prevalence rates of cognitively intact individuals obtained across the measures utilized in this study. Concerns regarding the utilization of the MMSE as a criterion measure of cognitive intactness in persons residing in extended care nursing facilities are provided, along with data on the living environments/roommate statuses of those residents judged to be intact via the CI Survey. Implications for the design of future extended care nursing units, as well as future research, are also included.     

Behavior Problems, Academic Skill Delays and School Failure Among School-Aged Children in Foster Care: Their Relationship to Placement Characteristics

We describe the level of behavior problems, academic skill delays, and school failure among school-aged children in foster care. We also examine how behavior problems are associated with academic problems, and explore how these outcomes are related to children's placement characteristics. Foster parent and child home interviews, as well as teacher telephone interviews were conducted from a randomly selected sample of 302 children aged 6 through 12 years living in out-of-home placement. Interviews included standardized screening measures. Results showed that 27% of the children scored in the clinical range for a behavior problem, and 34% were rated as having at least one behavior problem in the classroom. Twenty-three percent of the children had severe delays in reading or math, 13% had repeated a grade, and 14% had a history of school suspension and/or expulsion. Behavior problems by foster parent report were related to child suspension and/or expulsion from school, but were not associated with severe academic delays or grade retention. Placement characteristics were only sometimes related to these outcomes. Future studies examining the mental health and educational needs of this population should take into account the child's sociodemographic and placement characteristics.     

Parent–infant co‐sleeping: fathers' roles and perspectives

Dyadic co‐sleeping (mother–baby) is a common strategy for night‐time infant care in the majority of world cultures. Triadic co‐sleeping (mother–father–baby) is less common, although still widely practised cross‐culturally. This paper examines triadic co‐sleeping in an opportunistic sample of parents from the North Tees region of England, and explores fathers' expectations and experiences of sleeping with their babies. Using a prospective study design, 36 sets of parents, pre‐ and post‐natally, were interviewed about infant care strategies, particularly at night. Although they did not anticipate sleeping with their infants at the pre‐natal interview, the majority of fathers (81%) had done so by the time of the second interview. First‐time fathers were afraid that they would squash or suffocate the baby in their sleep, and some were concerned that the infant's presence would adversely affect their own sleep. Fathers used a variety of strategies to help overcome their initial fears of co‐sleeping. Among those for whom triadic co‐sleeping became a regular night‐time infant care strategy, the pleasures of prolonged intimate contact with their infant were clearly apparent. It is suggested that the experience of sleeping with their infant ameliorates some of the distancing effects felt by fathers outside the breast‐feeding relationship, and helps encourage paternal involvement in night‐time infant care‐giving. Copyright © 2000 John Wiley & Sons, Ltd.     

Dismantling institutional racism: theory and action

Despite a strong commitment to promoting social change and liberation, there are few community psychology models for creating systems change to address oppression. Given how embedded racism is in institutions such as healthcare, a significant shift in the system's policies, practices, and procedures is required to address institutional racism and create organizational and institutional change. This paper describes a systemic intervention to address racial inequities in healthcare quality called dismantling racism. The dismantling racism approach assumes healthcare disparities are the result of the intersection of a complex system (healthcare) and a complex problem (racism). Thus, dismantling racism is a systemic and systematic intervention designed to illuminate where and how to intervene in a given healthcare system to address proximal and distal factors associated with healthcare disparities. This paper describes the theory behind dismantling racism, the elements of the intervention strategy, and the strengths and limitations of this systems change approach.     

Spiritual Tools for Enhancing the Pastoral Visit to Hospitalized Patients

The tradition of visiting the sick is a practice that brings comfort to patients who are suffering, offers prayers for healing, and keeps the connection with family and community alive. It is a practice recognized from ancient times through today, one which underscores the mission of the field of Pastoral Care. This paper describes the creative use of multi-sensory spiritual tools, such as music, singing, personal prayer, psalms, and traditional texts, to enhance the sick visit to the hospitalized patient. This brief structured model is replicable and teachable to lay and professional caregivers. Both patient, family members, and caregivers can benefit from sharing in these moments of inner spiritual attunement and connection with others. Israela Meyerstein, LCSW-C, LMFT, is a social worker and family therapist in private practice in Baltimore, Maryland. An Approved Supervisor for the American Association for Marriage and Family Therapy, Ms. Meyerstein has trained therapists of all disciplines and has published over two dozen articles relating to Family therapy, medical issues, and spirituality. She is co-founder of the Baltimore Jewish Healing Network. Correspondence to Israela Meyerstein, Imeyerstein@hotmail.com. Gila Ruskin has served as a congregational rabbi, psychiatric hospital chaplain, adult and day school educator, and pastoral counselor. Rabbi Ruskin currently teaches Bible, Holocaust Studies, and Creative Writing at the St. Francis Academy in Baltimore, Maryland. She is co-founder of the Baltimore Jewish Healing Network.     

Should Extremely Premature Babies Get Ventilators During the COVID-19 Crisis?

Abstract

In a crisis, societal needs take precedence over a patient’s best interests. Triage guidelines, however, differ on whether limited resources should focus on maximizing lives or life-years. Choosing between these two approaches has implications for neonatology. Neonatal units have ventilators, some adaptable for adults. This raises the question of whether, in crisis conditions, guidelines for treating extremely premature babies should be altered to free-up ventilators. Some adults who need ventilators will have a survival rate higher than some extremely premature babies. But surviving babies will likely live longer, maximizing life-years. Empiric evidence demonstrates that these babies can derive significant survival benefits from ventilation when compared to adults. When “triaging” or choosing between patients, justice demands fair guidelines. Premature babies do not deserve special consideration; they deserve equal consideration. Solidarity is crucial but must consider needs specific to patient populations and avoid biases against people with disabilities and extremely premature babies.