An understanding of negative reflective functioning,the image and the art psychotherapeutic group

Abstract

This paper will look at a client diagnosed with schizophrenia functioning at a negative reflective functioning (RF) level. Schaverien depicts a model of successive stages in the life of the picture. For some clients whose inner worlds are very fragmented the stage of ‘familiarisation’, the ‘immanent articulation’ may be the limits of their therapy. I propose that with the help of the group and its reflective functioning process, a client working at a negative reflective functioning level can be assisted in moving past the stage of ‘familiarisation’. I will consider how the art psychotherapy group may work as a way of exploring the mind. Furthermore, I suggest that such a client who has moved past the stage of ‘familiarisation’ can further progress into subsequent stages. I will present clinical vignettes of three art psychotherapy group sessions to illustrate this process. These groups will cover the first session, the fourth session and the thirty-second art psychotherapy session.     

Beyond the medical record

BACKGROUND: Studies before and since the 1999 Institute of Medicine report have noted the limitations of using medical record reporting for reliably quantifying and understanding medical error. Quantitative macro analyses of large datasets should be supplemented by small-scale qualitative studies to provide insight into micro-level daily events in clinical and hospital practice that contribute to errors and adverse events and how they are reported. DESIGN: The study design involved semistructured face-to-face interviews with residents about the medical errors in which they recently had been involved and included questions regarding how those errors were acknowledged. OBJECTIVE: This paper reports the ways in which medical error is or is not reported and residents' responses to a perceived medical error. PARTICIPANTS: Twenty-six residents were randomly sampled from a total population of 85 residents working in a 600-bed teaching hospital. MEASUREMENTS: Outcome measures were based on analysis of cases residents described. Using Ethnograph and traditional methods of content analysis, cases were categorized as Documented, Discussed, and Uncertain. RESULTS: Of 73 cases, 30 (41.1%) were formally acknowledged and Documented in the medical record; 24 (32.9%) were addressed through Discussions but not documented; 19 cases (26%) cases were classified as Uncertain. Twelve cases involved medication errors, which were acknowledged in different categories. CONCLUSIONS: The supervisory discussion, the informal discussion, and near-miss contain important information for improving clinical care. Our study also shows the need to improve residents' education to prepare them to recognize and address medical errors.     

用合同法诠释手术知情同意

依据合同法、执业医师法、医疗机构管理条例及其实施细则、医疗事故处理条例、病历书写规范等法律、法规、部门规章,诠释手术知情同意的法学渊源,旨在阐述手术知情同意的法律依据及规范手术知情同意,以保障医患双方的合法权益,减少医患纠纷.     

创伤经历者的网络自助干预程序的试用研究

目的:检验网络自助干预程序的使用价值,了解创伤症状水平、社会认可度、创伤暴露态度与程序使用的关系,为未来的网络干预研究提供参考.方法:通过网络广告征集428名创伤经历者,其中103人成为被试,随机分入干预组和等待组,进行1个月的网络自助干预.等待组在后测之后进行延迟自助干预.对两组被试在干预前的流失率、使用干预程序的程度(访问天数、访问网页数)和后续流失率进行考察.用创伤后压力诊断量表(PDS)、创伤暴露问卷(DTQ)和社会认可问卷(SAQ)进行测量.结果:干预开始前,被试流失率为40.8％.与使用网站的被试相比,干预前流失的被试在DTQ的谈论冲动维度上得分更高[(2.1±1.2)vs.(1.5±1.0),P ＜0.05],并且女性所占比例更高(86％ vs.69％,P=0.050).在61名使用网站的被试中,访问网站的人数第1周为61名(100％),第2周为19名(31％),之后人数较平稳；在1个月内,51名(84％)被试访问网站的天数为≤5天,4名(7％)被试访问天数＞10天(最大值为12天)；在网页总数为118的网站上,被试访问的网页数平均值为(81.3 ±77.1),其中18名(30％)被试(重复)访问超过100个网页(最大值为295).回归分析显示,被试访问网站的天数与SAQ的家庭不认可维度得分正相关(β=0.31,P＜0.05)；访问网页数与SAQ的一般不认可维度得分正相关(β=0.31,P＜0.05).结论:创伤经历者的谈论冲动可能是其选择网络自助干预的一个因素；在开始使用干预程序后,使用者可能在少数几次登录中重复阅读部分或全部内容,从家庭中、社会上感受到的不认可态度可能是其坚持使用干预程序的一个促进因素.     

中美两国对国际人体受试者保护体系认证的认知差异

在国家鼓励创新药研发的积极势态下,国内各临床试验机构更加重视提高人体医学研究过程中对受试者的保护,并积极遵循医学伦理实践的规范。只有从国际人体受试者保护体系认证整体及各个认证领域不同层面深入分析,清楚了解中美两国医院对国际人体受试者保护体系认证的认知差异,才能有的放矢,做好争取国际相关组织认证的准备工作。     

Maternal predictors of children's social cognition: an attachment perspective

BACKGROUND: This paper assumes that the capacities to (1) openly acknowledge, and (2) elaborate a resourceful plan for coping with distress in the self and others are central features of social cognition. METHOD: These capacities were assessed in a sample (N = 51) of 11-year-old children whose mothers and fathers had previously provided Adult Attachment Interviews (AAIs) before their children were born. The children were shown six line-drawn sequences of child(ren), with peer(s) and/or family in diverse situations involving some moderate distress. The experimenter described the adversity shown in the sequence (e.g., bully pushing over another school-aged child in the presence of onlookers) and then invited the child to attribute thoughts and feelings to the characters, and comment upon what might happen next. RESULTS: Children whose responses scored highly for acknowledgement of the distress, and elaborating a resolution, were significantly more likely to have had mothers (but not fathers) whose AAIs were judged autonomous-secure as opposed to insecure (i.e., dismissing, preoccupied and/or unresolved). The significant influence of maternal representations of attachment upon the 11-year outcome remained even after taking account of concurrent parenting attitudes, children's verbal intelligence, as well as the previously assessed infant-parent attachment patterns. CONCLUSIONS: Discussion concerns the differential predictive power of maternal responses to the Adult Attachment Interview as related to the domain of children's social and emotional understanding.     

中学音乐教学初探

结合初中学生的心理发展特点和自己的教学实践经验,就如何提高教师的教和学生的学两个方面为目标,探讨提高中学音乐教学的方法。     

Compassion and professional care: exploring the domain

Compassion unites people during times of suffering and distress. Unfortunately, compassion cannot take away suffering. Why then, is compassion important for people who suffer? Nurses work in a domain where human suffering is evidently present. In order to give meaning to compassion in the domain of professional care, it is necessary to describe what compassion is. The purpose of this paper is to explore questions and contradictions in the debate on compassion related to nursing care. The paper reviews classical philosophers as well as contemporary scientists' main arguments on compassion. First, I will examine the relationship between compassion and suffering. Second, how does one recognize serious suffering? This issue raises questions about the role of imagination and the need for identification. Third, literature describes compassion as an emotion. Some philosophers consider emotions uncontrollable feelings; others see a clear rational dimension in emotions. In order to determine what compassion is, it is necessary to weigh these contradictional arguments. Fourth, I will discuss motives for compassion. Is compassion an act of altruism or egoism? In this debate Nietzsche and Schopenhauer are well‐known opponents. Today, analysis of their arguments leads to some surprising conclusions. Fifth, there is the issue of fault and compassion. Can we only feel compassionate when people who suffer are not to blame for their own suffering? Such a condition faces professional caretakers with a dilemma which needs a thorough analysis if compassion is to be of use in the field of professional care. Finally, I will explore the moral meaning of compassion. Compassion, described as a concept with cognitive as well as affective dimensions, also has volitional and behavioural aspects. These aspects specifically are of importance to nursing care and further research of compassion in the nursing domain.