Nonmaternal care hours and temperament predict infants’ proximity-seeking behavior and attachment subgroups

Using the NICHD Early Childcare dataset (N = 1281), this study examined whether infant temperament and the amount of time infants spend in nonmaternal care independently predict (1) the likelihood that they seek comfort from their mother when needed and (2) placement in a particular subgroup of infant-mother attachment patterns. Mothers reported the number of hours their infant spent in nonmaternal care each month and their infant's difficulty adapting to novel stimuli at 6 months. The degree to which 15-month-old infants seek comfort from their mother during reunion episodes in the Strange Situation was observed using two behavioral scales (“proximity seeking” and “contact maintaining”). Their average score forms the outcome variable of “proximity-seeking behavior.” The other outcome variables were the subgroups of infant-mother attachment patterns: two subgroups for insecure babies (resistant and avoidant) and four subgroups for secure babies (B1, B2, B3, and B4). Easy adaptability to novel stimuli and long hours of nonmaternal care independently predicted a low level of proximity-seeking behavior. These predictors also increased the likelihood of an insecure infant being classified as avoidant (vs. resistant). A secure infant with these same predictors was most likely to be classified as B1, followed by B2, and then B3, with B4 being the least likely classification. Although previous studies using the NICHD dataset found that hours of nonmaternal care had no main effect on infants’ attachment security (vs. insecurity), this study demonstrates that hours of nonmaternal care predict the subcategories of infant-mother attachment.     

Maternally administered interventions for preterm infants in the NICU: Effects on maternal psychological distress and mother–infant relationship

Although studies have examined the effects of interventions focused on preterm infants, few studies have examined the effects on maternal distress (anxiety, depressive symptoms, post-traumatic stress symptoms, parenting stress) or parenting. This study examined the effects of the auditory–tactile–visual–vestibular (ATVV) intervention and kangaroo care (KC) on maternal distress and the mother–infant relationship compared to an attention control group.240 mothers from four hospitals were randomly assigned to the three groups. Maternal characteristics in the three groups were similar: 64.1% of ATVV mothers, 64.2% of KC mothers, and 76.5% of control mothers were African American; maternal age averaged 26.3 years for ATVV mothers, 28.1 for KC mothers, and 26.6 for control mothers; and years of education averaged 13.6 for ATVV and KC mothers, and 13.1 for control mothers. Mothers only differed on parity: 68.4% of ATVV and 54.7% of KC mothers were first-time mothers as compared to 43.6% of control mothers. Their infants had a similar mean gestational ages (27.0 weeks for ATVV, 27.2 for KC, and 27.4 for control) and mean birthweights (993 g for ATVV, 1022 for KC, and 1023 for control).Mothers completed questionnaires during hospitalization, and at 2, 6 and 12 months corrected age on demographic characteristics, depressive symptoms, state anxiety, post-traumatic stress symptoms, parenting stress, worry about child health, and child vulnerability (only at 12 months). At 2 and 6 months, 45-min videotapes of mother–infant interactions were made, and the HOME Inventory was scored. Behaviors coded from the videotapes and a HOME subscale were combined into five interactive dimensions: maternal positive involvement and developmental stimulation and child social behaviors, developmental maturity, and irritability.Intervention effects were examined using general linear mixed models controlling for parity and recruitment site. The groups did not differ on any maternal distress variable. Kangaroo care mothers showed a more rapid decline in worry than the other mothers. The only interactive dimensions that differed between the groups were child social behaviors and developmental maturity, which were both higher for kangaroo care infants. Change over time in several individual infant behaviors was affected by the interventions. When mothers reported on the interventions they performed, regardless of group assignment, massage (any form including ATVV) was associated with a more rapid decline in depressive symptoms and higher HOME scores. Performing either intervention was associated with lower parenting stress. These findings suggest that as short-term interventions, KC and ATVV have important effects on mothers and their preterm infants, especially in the first half of the first year.     

Client as expert: A Delphi poll of clients’ subjective experience of therapeutic alliance formation variables

This study extends prior research that identified client-derived variables believed to contribute to therapeutic alliance development. Forty-two clients participated in a three-round-modified Delphi poll in which the subjective importance of 74 client-derived, common alliance formation variables was rated using a six-point scale. Participants consensually identified 23 variables as highly important, five as moderately important and three as low in importance to the formation of a strong alliance. Variables related to validation and asking about parts of the client’s life other than the presenting concern were considered as most important by at least one-third of the sample. Limitations of the study are presented and implications for theory, measurement, practice and future research are briefly discussed.     

Diagnostic Work through Evidence-Based Guidelines: Avoiding Gaps Between Development and Implementation of a Guideline for Problem Behaviour in Elderly Care

Diagnostic work is the reflexive work of figuring out what issues are at stake and determining the scope for action. This work is not generally accommodated by evidence-based guidelines, which generally promote a uniform, predefined approach to solving healthcare problems that risk narrowing the opportunities for diagnostic work in healthcare practice. Consequently, guidelines are often criticised as too general to solve situated, individual healthcare problems and gaps between guidelines and their implementation are often reported. The Netherlands has developed a guideline for problem behaviour in elderly care, explicitly designed for diagnostic work, thus stimulating a situated approach. Relational problem behaviour is highly embedded in its context. The guideline stimulates diagnostic work, which helps to unravel problem behaviour and is opening alternatives in elderly care. Diagnostic work does not transfer guideline development problems to healthcare practice, but simply structures the decision-making process without giving a predefined answer. Diagnostic work is thus important to consider in order to avoid a gap between guideline development and implementation.     

临床共情与护理技术结合：人性化的护理

临床共情是一种能体验患者内心世界的能力,通过患者的言语和非言语表达,觉察和认识患者情感和情绪需求,并对其做出恰当的回应.临床共情具有科学的理论和实践基础,具有缓解患者心理上的痛苦,改善护患关系,促进患者康复等作用.在当今复杂的医疗环境下,务必要重视共情培养,适时运用临床共情.然而,我们强调临床共情的重要作用,并不能忽视护理技术的根本作用,根除躯体上的病变仍有赖于护理技术的有效性.在临床护理实践中,坚持共情与护理技术的有机结合,推进人性化的护理构建.     

Adult Attachment Dimensions,World View Schemas,and the Psychological Health of Parents of Infants in a Neonatal Intensive Care Unit

This study reports the results of an exploration of the relationship of adult attachment dimensions (closeness, dependence, and anxiety) and world view assumptions (benevolence, meaningfulness, and worthiness) to psychological distress and psychological well-being in 142 parents (71 couples) of newborns recently hospitalized in a neonatal intensive care unit. The results of the Actor-Partner Interdependence Model, hierarchical multiple regression, and mediation analyses showed that parents who were more comfortable with attachment-dependence and parents who held more positive beliefs about benevolence and worthiness had less psychological distress and more well-being. In addition, parents with partners who were more comfortable with attachment-dependence had less psychological distress and more well-being. Attachment-dependence partially mediated the relationships of benevolence and worthiness with psychological distress and the relationship of benevolence with psychological well-being, whereas worthiness had a direct relationship with psychological well-being.     

Perceptions de la qualité de vie et de la bientraitance par des personnes âgées résidant en institution gériatrique et par leurs proches

Introduction

The present study focuses on patient-centered care and quality of life in dependent aging people living in nursing home.

Lower back pain in nurses working in home care: linked to work–family conflict,emotional dissonance,and appreciation?

In industrial countries home care services for elderly people living in the community are growing rapidly. Home care nursing is intensive and the nurses often suffer from musculoskeletal pain. Time pressure and job control are job-related factors linked to the risk of experiencing lower back pain (LBP) and LBP-related work impairment. This survey investigated whether work-family conflict (WFC), emotional dissonance and being appreciated at work have incremental predictive value. Responses were obtained from 125 home care nurses (63% response rate). Multiple linear regression showed that emotional dissonance and being appreciated at work predicted LBP intensity and LBP-related disability independently of time pressure and job control. WFC was not a predictor of LBP-related disability in multiple regression analyses despite a zero-order correlation with it. Redesigning the working pattern of home care nurses to reduce the emotional demands and improve appreciation of their work might reduce the incidence of LBP in this group.     

“Now there are diversities of gifts,but the same spirit.” (1Cor 12:4): images of the self and concepts of office of LGBTQ* pastors in Germany

ABSTRACT

After providing background information on the legal status and admission of LGBTIAQ* pastors in Germany, the paper focusses on experiences of LGBTQ* Protestant pastors in the major German Protestant church (Evangelische Kirche in Deutschland) to explore how they include their sexual orientation and/or gender in their pastoral work. LGBTIAQ* pastors face the challenge of managing visibility and discretion, in relation to a heteronormative setting, as well as the specific expectations of LGBTIAQ* Christians. The presumption of shared experiences and knowledge by similarly marginalized people plays a part in their ministry. The paper argues that embracing those experiences and community knowledge as part of pastoral theology can strengthen their reflection on pastoral work.     

People with severe and profound intellectual disability: Nurse carer experiences in a South African setting

We explored nurse carer experiences with people with severe and profound intellectual disability in a care and rehabilitation centre in South Africa. Informants were a convenience sample of 10 nurses (females = 7; males = 3; mean years of service = 7.8, SD = 4.8 years). They completed an unstructured interview on their care provision experiences. The data were thematically analysed using Tesch’s method of open coding. Findings resulted in the following three themes to characterise the nurse carer experiences: compassion, person-centred care, and importance of parent involvement. Compassionate and person-centred care is fundamental to the establishment of a therapeutic relationship between nurse carers and people with severe and profound intellectual disability.