The experience of palliative patients and their families of a family meeting utilised as an instrument for spiritual and psychosocial care: A qualitative study

Background: This study explores the experience of palliative patients and their family members of a family meeting model, utilised as an instrument for the provision of spiritual and psychosocial care. In doing so the study embraces a broad understanding of spirituality which may or may not include formal religious practice and a concept of psychosocial care that includes: social and emotional well-being, communication, self esteem, mental health and adaptation to illness. The meeting of spiritual and psychosocial needs is considered to be an important aspect of palliative care. Methods. This qualitative study, philosophically underpinned by hermeneutic phenomenology, investigates the participatory experience of palliative care patients and their significant family members of such a family meeting. People registered with two large metropolitan palliative care services, who met selection criteria, were referred by medical staff. Twelve of the 66 referred took part in family meetings which also included significant others invited by the patient. A total of 36 family members participated. The number of participants of individual family meetings ranged from two to eleven. After the family meeting every participant was invited to take part in an individual in-depth interview about their experience of the meeting. Forty seven interviews were conducted. These were audio recorded and transcribed. Results: Data analysis, utilising Ricoeur's theory of interpretation, revealed seven main themes: personal experience of the meeting, personal outcomes, observation of others' experience, observation of experience and outcomes for the family unit, meeting facilitation, how it could have been different and general applicability of the family meeting. Throughout these themes were numerous references to aspects of the web of relationships which describe the concept of spirituality as it is defined for the purpose of this study. Conclusions: The findings indicate the potential of the type of family meeting reported for use in the spiritual and psychosocial care of people receiving palliative care and their families. However further research is needed to explore its application to more culturally diverse groups and its longer term impact on family members.Heather M Tan, Anne Wilson, Ian Olver and Christopher Barto

Psychological Intrusion – An Overlooked Aspect of Dental Fear

Dental fear/anxiety is a widely recognised problem affecting a large proportion of the population. It can result in avoidance and/or difficulty accepting dental care. We believe that psychological intrusion may play a role in the aetiology and maintenance of dental fear for at least some individuals. In this narrative review we will take a developmental perspective in order to understand its impact across the lifespan. We will consider the nature of ‘self,’ parenting styles, the details of intrusive parenting or parental psychological control, and briefly touch upon child temperament and parental anxiety. Finally, we draw together the supporting (largely unrecognised) evidence available in the dental literature. We illustrate the paper with clinical examples and discuss possibly effective ways of addressing the problem. We conclude that psychological intrusion appears to play an important role in dental fear, for at least some individuals, and we call for detailed research into the extent and exact nature of the problem. A simple means of identifying individuals who are vulnerable to psychological intrusion would be useful for dentists

Adversity as opportunity : living with schizophrenia and developing a resilient self

Approximately 1% of the population is diagnosed with schizophrenia, and despite longstanding critiques of the (bio)medical model, understanding of the disorder still arises primarily through (bio)medical explanations. In turn, causation, symptoms and treatments are increasingly sophisticated and well known while understanding of other aspects of the disorder, especially the intersubjective experience of people living with schizophrenia, remains fragmented. For this reason, the present study sought to understand how people experience schizophrenia. To do this, the stories of 19 people diagnosed with the disorder were hermeneutically interpreted. These stories appeared in The Schizophrenia Bulletin – a journal which publishes ‘first person accounts’, sometimes anonymously, of people’s experience of mental illness. Within the study context, the findings indicate that facing the adversity of schizophrenia means living: (i) wisely – understanding the nature of self-with schizophrenia and of life-with-schizophrenia; (ii) mindfully – keeping understandings in conscious thought; and (iii) purposefully – acting deliberately. Doing this results in a stable and meaningful life and in a different, more resilient self

Explicating practice knowledge: A hermeneutic inquiry into adolescent mental health nursing

Through this hermeneutic study I sought to explicate the practice knowledge of nursing on residential adolescent mental health units. I did this by seeking to understand what nurse's and adolescent's stories of nursing, or being nursed, revealed about the knowledge informing practice within that context. Seven nurses and seven young people shared their experiences. Taped and written stories, and survey material, provided texts for analysis and interpretation. As stories centred around specific nurse-adolescent interactions they pointed to the knowledge informing practice within those encounters. Thus, practice knowledge was explicated through interpretation of the actual experiences of nurses and adolescents. Study findings were conceptualised as sub-elements, elements and a meta-element of practice knowledge. Ninety one ""sub-elements of practice knowledge"" were identified and defined. These subelements illustrate how nurses work with adolescents. The subelements were grouped into four ""elements of practice knowledge"" and defined. The elements are: (I) engaging in therapeutic relationships, (2) providing a therapeutic milieu, (3) guiding the potential for change, and (4) facilitating positive outcomes. These elements point to the reasons behind nursing actions. Through examination of the sub-elements and elements the ""meta-element of practice knowledge"" was developed and defined. The meta -element ""fostering a functional self' describes the aim and outcomes of adolescent mental health nursing practice by noting the way nurses foster the adolescent's reintegration and wellness. A paucity of adolescent mental health nursing research has resulted in the knowledge informing practice within the specialty remaining virtually unknown.;The study findings are thus salient as they: (l) reveal the practice knowledge of adolescent mental health nursing, (2) identify theories used in practice, (3) provide a basis for theory testing research, (4) assist nurse education by noting the how, what and why of practice and the therapeutic outcomes from the use of practice knowledge, and (5) attest to the contribution adolescent mental health nurses make to adolescents, families and society

Phenomenology and critical social psychology: directions and debates in theory and research

There has been significant growth in critical approaches to social psychology in recent years. Phenomenological, discursive and psychoanalytically informed perspectives, amongst others, have become increasingly popular alternatives to ‘mainstream’ cognitive social psychology. This paper describes the fundamental philosophy and methodology underpinning phenomenological psychology along with discussion of a number of key issues in qualitative research in social psychology. In particular, I discuss the role of interpretation, the turn to language and need for political engagement within critical social psychology. More recently, there has been a growth in phenomenologically informed narrative theories and methodologies and in this paper I introduce my own development of a critical narrative analysis. In the process I discuss some of the most pressing debates about research within the phenomenological tradition and provide rebuttals, solutions and possible future directions for phenomenological theory and research that may lead to yet greater recognition for this social psychological perspective

The experience of community mental health case management provided from an acute in-patient psychiatric unit

In Australia, case management is the cornerstone of mental health service delivery for seriously ill clients living in the community. In this study, case management was provided from an acute, inpatient psychiatric unit; a model thought to be unique. Findings from this qualitative study explicated the experience of case management from client and case manager (CM) perspectives. They note the nature, purpose, processes and outcomes of case management within that context. Findings were positive, suggesting clients and CM's develop a therapeutic alliance through which interventions are implemented and which result in clients experiencing personal (re) integration and enhanced well-being. These findings are discussed and they suggest an alternative model of service delivery well regarded by both clients and CM's