Alternate Reality Conceptualization: Venturing Along the Fine Line Between Genius and Madness

This article presents a discourse analysis of a woman's written account of mental illness and homelessness. In her preparation as a co-presenter at a conference for decision- and policy-makers, Anna wrote eight distinct drafts of her speaking notes; each time emphasizing different aspects of her experiences with mental illness and homelessness. By sharing her preparatory writings, Anna offers a rare insight into the ‘evolution’ of the thinking that went into representing her story to an audience of professionals. In addition, this analysis represents an interpretation and alternative forum to learn from Anna's story.     

Book review

The evidence against equating night dreams and hypnotic dreams is reviewed in the light of 2 developments in dream research—Dement and Kleitman's (1957a; 1957b) physiological and behavioral indicators of dreaming and Hall's (1951; 1963) quantitative studies of dream content.

It is concluded that the equivalence of the EEG patterns of the hypnotic trance and the “dream” stage of sleep (Stage I) cannot be ruled out. It is further concluded that the psychologically-important question of content differences between night and hypnotic dreams has never been examined in a controlled, quantitative manner.     

Reflective inquiry in nursing practice or 'revealing images'

Reflective inquiry in nursing practice or 'revealing images' Nurses live and work in complex practice worlds; worlds of shrinking resources and expanding needs. Reflection through journaling offers unique opportunities to gain insight into practice. What might we learn from one's journal? A reflective journal can be a source of interplay between the self as written and the self as other. Likewise, the journal may act to situate ourselves in practice, while at the same time enabling us to illuminate how and in what ways our understandings have become distorted. The extent to which one's journal is educative depends upon the manner in which one chooses to use it as a transformative tool, a tool that might well be described as a process of healing and enlightenment. In order to illustrate the reflexive nature of journaling, this paper is presented as a play reading, where a conversation about practice stories between the different aspects of the nurse's self is depicted. In adopting a play reading, an alternative pedagogical tool is used to illustrate different methodologies exemplifying the emergence of how and in what ways we develop and reconstruct our understanding in nursing.     

Decisional conflict and regret: Consequences of surrogate decision making for the chronically critically ill

Decisional conflict may predispose surrogate decision makers (SDMs) of the chronically critically ill (CCI) to making health care decisions that are not aligned with the patient's health care preferences and increase the SDM's likelihood of experiencing decision regret. This study establishes the relationship between decisional conflict and decision regret and offers insight on tailoring decision support interventions to the preferences of SDMs of CCI patients.     

"THIS IS NOT DEATH,IT IS SOMETHING SAFER": A PSYCHODYNAMIC APPROACH TO SYLVIA PLATH

An attempt is made to illustrate the chronic suicidality and the separation-individuation conflict in the life and work of Sylvia Plath. Explanations of female suicidality in prevailing suicidality research are primarily influenced by male fantasms and gender role cliches. Plath's work, however, not only enables insight into her individual fate, but also offers a differentiated perception of suicidality among women. It becomes apparent that the texts in question are centered on specific conflict areas, in the sense of the formation of female identity and subjectivity, which affect current discussion on imagined concepts of femininity, and which are closely interwoven with the problems of female suicidality.     

Muscle Tone Abnormalities

Rehabilitation nurses frequently encounter clients with neurological disorders that adversely affect muscle tone. By understanding the physiological etiology of abnormal muscle tone, individual practitioners can design nursing interventions for various care settings that appropriately protect clients from injury and that can help clients and caregivers learn effective techniques for managing muscle tone problems. This article explains muscle tone abnormalities in detail and offers insight into how rehabilitation nurses can play a key role in managing clients' alterations in muscle tone.     

Instructional strategies: Teaching nursing in today's diverse and inclusive landscape

In today's university and college programs, it is crucial for nurse educators to value and embrace diversity and inclusion. Positive student learning outcomes result when all learners are valued, respected, and appreciated. Therefore, faculty training on the importance of diversity and inclusion and the use of evidence-based instructional strategies in the classroom setting is vital towards encompassing a learning environment that embraces diversity and inclusion for all. Additionally, faculty training that incorporates self-reflection with the purpose of gaining insight into one's cultural views and upbringing, is valuable to identifying any potential biases. This article benefits nurse educators at all program degree levels and settings as it provides insight into creating a diverse and inclusive learning environment. Furthermore, aids in discovery of own potential stereotypes and biases, and equips educators with evidence-based strategies to manage, foster, and promote optimal learning environments for all students.     

The meaning of work for nursing assistants who stay in long‐term care

Aims and objectives. The purpose of this study was to investigate the meaning of work for nursing assistants who stay in long‐term care. Background. Nursing assistants are important caregivers in long‐term agencies. While studies have examined why nursing assistants leave, their motivation to stay has not been well studied. Design. An existential‐phenomenological study was conducted using Pollio's approach. Methods. In‐depth interviews were conducted with 11 nursing assistants in four nursing homes. Interviews were analysed within the context of an interpretive research group. Findings were represented in a diagram of interrelated figural/ground themes. Conclusions. The meaning of work emerged as an experience of family, pride and control, in spite of an environment fraught with hostility, disrespect and lack of control. Relevance to clinical practice. Nursing assistants provide most of the care to residents of long‐term facilities. Understanding their perspective offers insight into nursing administrators in creating environments in which safe, compassionate and cost‐effective care co‐exist. Implications for clinical practice are framed within King's theory of goal attainment.     

How do patients with exacerbated chronic obstructive pulmonary disease experience care in the intensive care unit?

The aim was to gain insight into how patients with advanced chronic obstructive pulmonary disease (COPD) experience care in the acute phase. The study has a qualitative design with a phenomenological approach. The empirics consist of qualitative in‐depth interviews with ten patients admitted to the intensive care units in two Norwegian hospitals. The interviews were carried out from November 2009 to June 2011. The data have been analysed through meaning condensation, in accordance with Amadeo Giorgi's four‐step method. Kari Martinsen's phenomenological philosophy of nursing has inspired the study. An essential structure of the patients' experiences of care in the intensive care unit by acute COPD‐exacerbation may be described as: Feelings of being trapped in a life‐threatening situation in which the care system assumes control over their lives. This experience is conditioned not only by the medical treatment, but also by the entire interaction with the caregivers. The essence of the phenomenon is presented through three themes which describe the patient's lived experience: preserving the breath of life, vulnerable interactions and opportunities for better health. Acute COPD‐exacerbation is a traumatic experience and the patients become particularly vulnerable when they depend on others for breathing support. The phenomenological analysis shows that the patients experience good care during breath of life preservation when the care is performed in a way that gives patients more insight into their illness and gives new opportunities for the future.     

The Conceptualisation of Dreams by People with Intellectual Disabilities

In order to investigate the conceptualisation of dreams in adults with mild and moderate intellectual disabilities, the paradigm introduced by Woolley & Wellman (1992) was employed in addition to a number of open-ended questions. Fifty-four people participated in the study and it was found that 40% of their replies in answer to questions regarding the non-physical, private nature of dreams were incorrect and that less than a third of the sample (N= 16) were confident that individuals cannot share the same dream. Furthermore, a large proportion of the sample did not consider it possible to dream about fictional entities. The results are discussed in the context of the benefits and barriers for therapists who wish to incorporate clients' reported dreams and nightmares into their therapeutic interactions.     

Changes in Persistent Delusions in Schizophrenia Using Guided Self-Determination: A Single Case Study

Delusions in persons with schizophrenia who have limited insight have been targeted with different treatment modalities with equivocal results. Working with the Guided Self-Determination method used in shared decision-making and problem solving, a 55-year-old male diagnosed with schizophrenia gained insight into his own delusions during a period of six weeks with individual training. The case study is based on qualitative data, reflection sheets, and interview and field notes from the Guided Self-Determination training. The patient's new insight developed in a process from resistance to receptiveness and then from doubt to reaching a new system in his thoughts.     

School children’s experience of being bullied – and how they envisage their dream day

Scand J Caring Sci; 2010; 24; 791–798 School children’s experience of being bullied – and how they envisage their dream day Bullying may have a number of negative health impacts on children. Previous studies have mainly explored negative health consequences related to being bullied. A different approach is to explore how these phenomena are related to the school child’s quality of life (QOL). The role of the school nurse is to promote health and prevent sickness, and school nurses therefore need knowledge of what promotes or threatens QOL in children. No previous research has explored how bullied children envisage their dream day or a day with good QOL. There is a need for more qualitative research on how school children experience being bullied and the kind of help they need from their school, and school nurse, to realize their dream day. The aim of this study was to explore how school children experience bullying in their everyday lives, what constitutes their dream day and what kind of help they need. An explorative qualitative design was chosen, and data were collected through focus group interviews. Data collection was conducted throughout 2007 and during the spring of 2008. The sample consisted of 17 school children, aged 12–13 years, in four different groups. An interview guide was used, and the group responses were audio‐taped, transcribed and coded into themes. The data were analysed according to Kvale’s three contexts of interpretation within a phenomenological and hermeneutic framework. Four main themes were identified: teasing and fighting, emotional reactions to being left alone or excluded, the need for friends to achieve the dream day and stopping the bullying immediately. The participants said that being bullied made them feel helpless, lonely and excluded. They wanted the bullying to be recognized, assistance from the school staff to stop the bullying, and to be included by their peers.     

Genetics and Disease Prevention: Complementary or Contradictory?

Clinicians may feel that nothing can be done to change genes, so prevention in a genetic context seems ridiculous. The reality is that genetic preventive healthcare has been a part of clinical practice for years and that future applications are almost limitless. It will soon be possible to sequence an individual's genome, scan it for important gene variations, and create an individualized health plan to modify the effects of these variations, optimizing that individual's health over a lifetime. This article presents an overview of selected clinical disorders, describes ways in which genetics is already being used to improve clinical outcomes, and offers a glimpse into the future of personalized medicine.     

Children's nurses and nurse prescribing: a case study identifying issues for developing training programmes in the UK

Aims and objectives. (1) To develop an insight into the opportunities and barriers to nurse prescribing for a case study of children's nurses. (2) To consider the implications of independent nurse prescribing for children's nurses and the potential for nurse prescribing to be developed in acute children's care settings. (3) To use research data to develop a training strategy. Background. Nurse prescribing in the UK is evolving and current initiatives aim to extend the range and scope of prescribing. Children's nursing presents interesting challenges because of off‐license drugs. Successful nurse prescribing lies in practice area preparation, local policy and practice development and identifying precourse training needs. Design. Case study. Research questions. (1) What opportunities do children's nurses identify as being appropriate for nurse prescribing? (2) Can children's nurses identify the benefits of patient group directives and the different levels of nurse prescribing? (3) What preparation do children's nurses need for nurse prescribing? Methods. Focus group of health visitors/district nurses to inform a survey of 500 nurses working in acute and specialist care settings in a large Children's Hospital. Results. Focus group main themes – training, supervision and the development of confidence, record keeping, benefits of nurse prescribing, autonomous practice, the formulary and its use in practice. Response rate was 27%. Senior nurses and specialists identified potential benefits for their practice. Course content needed to focus on children, i.e. children's physiology and pharmokinetics. Children's nurses frequently advise junior medical colleagues on prescribing issues. Patient group directives are a useful alternative to prescribing. Conclusions. The results provide an insight into the training needs of children's nurses and specialist nurses which may be used to develop nurse prescribing training and practice. Training may need to be targeted at senior nurses/specialist nurses initially to develop a critical mass to change organizational culture. Relevance to clinical practice. Pertinent for senior nurses responsible for developing children's nursing practice and services for children in acute settings.     

AN EXPERIMENTAL STUDY OF THE INFLUENCE OF KIDNEY EXTRACTS AND OF THE SERUM OF ANIMALS WITH RENAL LESIONS UPON THE BLOOD PRESSURE

1. Extracts of the rabbit''s kidney injected into the rabbit cause a slight, increase in blood pressure which is barely more than that due to the mechanical effect of the injection. 2. Extracts of the dog''s kidney injected into the dog cause a decided fall in pressure; an equal fall may be caused by the dog''s urine. A series of control experiments indicates that the fall caused by the kidney extract may be due to the urinary salts which it contains. 3. Extracts of cat''s kidney cause a rise in pressure. As the cat''s urine causes a fall, this rise in pressure indicates the possibility of a kidney extract containing a pressor substance which cannot be influenced by the depressor substance of the urine. 4. Rabbit''s kidney, which in the rabbit produces a slight rise, when injected into the dog causes a drop comparable to that caused by the dog''s kidney itself. Similarly, the dog''s kidney, which injected into the dog causes a drop, produces in the rabbit a rise analogous to that produced by rabbit''s kidney. It is evident therefore that these pressor and depressor substances of the kidneys in question do not have a constant effect on all animals as do the extracts of the adrenal gland. 5. Extracts of kidneys which are the seat of various forms of nephritis cause the same effect as extracts of normal kidneys. 6. The serum of dogs with considerable reduction of kidney substance causes a slight fall in pressure; the serum of dogs with spontaneous nephritis gives divergent results, as does also the serum of rabbits with various forms of acute nephritis. The serum of dogs with chromate nephritis causes a slight rise, while that of dogs with uranium nephritis produces a sharp and decided fall in pressure. Although there is no uniformity in these results, their general character, and especially the experience with uranium and chromate sera of the dog, suggests that pressure-disturbing substances are present in the serum as the result of the kidney lesion. The very slight evidence of the constant presence of a pressor substance, however, offers little support to the theory that such a substance is furnished by the diseased kidney or is due to disturbances of metabolism caused by disease of the kidney.     

Suicide in older people: Revisioning new approaches

This discussion paper identifies and examines several tensions inherent in traditional approaches to understanding older people's suicide. Predicted future increases in the absolute number of elderly suicides are subject to careful interpretation due to the underreporting of suicides in older age groups. Furthermore, a significant number of studies of older people's death by suicide examine risk factors or a combination of risk factors in retrospect only, while current approaches to suicide prevention in the elderly place disproportionate emphasis on the identification and treatment of depression. Taken together, such tensions give rise to a monologic view of research and practice, ultimately limiting our potential for understanding older people's experience of suicide and suicidal behaviour. New approaches are necessary if we are to move beyond the current narrow focus that prevails. Fresh thinking, which draws on older people's experience of attempting to die by suicide, might offer critical insight into socially‐constructed meanings attributed to suicide and suicidal behaviour by older people. Specifically, identification through research into the protective mechanisms that are relevant and available to older people who have been suicidal is urgently needed to effectively guide mental health nurses and health‐care professionals in therapeutic engagement and intervention.     

Understanding pre-entry baccalaureate nursing students' academic failure: Applying Kübler-Ross's stages of grief

Prelicensure nursing students' academic failure has attracted growing interest because of its economic implications, the projected nursing shortage, students' performance on curricular benchmark exams, and NCLEX-RN pass rates. However, students' academic failure also has personal implications. They can experience grief and loss following academic failure. Kubler-Ross's Five Stages of Grief provide a lens for nurse educators to identify students' experience with grief and loss related to academic failure and supportive strategies that promote success with program completion. This article reflects on nursing students' experiences with grief and loss associated with academic failure. Kubler-Ross's Five Stages of Grief can offer nurse educators insight into the cognitive, emotional, and behavioral experiences of nursing students who experience academic failure.     

Historical thinking in clinical medicine: lessons from R.G. Collingwood's philosophy of history

The aim of this article is to create a space for historical thinking in medical practice. To this end, we draw on the ideas of R.G. Collingwood (1889–1943), the renowned British philosopher of history, and explore the implications of his philosophy for clinical medicine. We show how Collingwood's philosophy provides a compelling argument for the re‐centring of medical practice around the patient history as a means of restoring to the clinical encounter the human meaning that is too often lost in modern medicine. Furthermore, we examine how Collingwood's historical thinking offers a patient‐centred epistemology and a more pluralistic concept of evidence that includes the qualitative, narrative evidence necessary for human understanding. We suggest that clinical medicine can benefit from Collingwood's historical thinking, and, more generally, illustrates how a philosophy of medicine that draws on diverse sources from the humanities offers a richer, more empathetic clinical practice.