Parenting a young person with mental health problems: temporal disruption and reconstruction

The article explores the experiences of parents living with a young person with mental health problems. Qualitative interviews were conducted with 25 parents (18 mothers and 7 fathers) whose child had a diagnosed psychiatric condition. It is argued that the parents engaged in a form of narrative reconstruction of their dual roles as parents and carers as they tried to make sense of the illness in their lives by reconstructing their past, present and future experiences. The concept 'responsibility' was threaded through the parents' narratives and is discussed in relation to three key dimensions - moral responsibility; causal responsibility; and responsibility for self. It is argued that the moral imperative to care for their child was the dominant theme in the parents' narratives but that this was challenged by their lack of knowledge of psychiatric conditions; their interactions with healthcare professionals; their relationships with their child; and their difficulties in coping with the extended parental responsibility that arose from their caring role.     

LIFE AS MOTHERS IN A NEW LAND: THE EXPERIENCE OF MOTHERHOOD AMONG THAI WOMEN IN AUSTRALIA

In this article, we examine the accounts of 30 migrant Thai women in Australia who had become mothers. The women recognized that they had entered a new environment, which was different from their previous one. This had a marked impact on their lives as wives and mothers. Cultural differences play a major role in their coping with motherhood and the mothering role. We find that the women had several main concerns in their new land: social isolation, different childrearing and child disciplinary practices, and the desire to preserve Thai culture. Most women wish to have more children in their new land, but others are concerned about social and political environments in Australia. We also find that the social class of the women and the ethnic background of their spouses play an important role in their coping with motherhood and childrearing. We conclude that motherhood and mothering is a great challenge, which is made more complex when it is combined with migration. This is important if we are to understand motherhood from an ethnicity perspective. Only then may we see better health care for immigrant women who choose to become a mother in their new land.     

Are doctors unhappy? A study of residents with an open interview form

Several recent reports show that many physicians feel discontented and unhappy with their work situation. This could in part be due to a decline in status, loss of influence on health care organization, reduced wages etc. It is important to find ways to better understand their experiences of working life to get more facets of this issue. The Medical Management Centre at the Karolinska Institute in Stockholm offers courses in leadership for physicians in specialty training (residency). Participants in 2 courses were used in a study of their views of their work situation and their employer, using an open interview form. The results with the residents in the present study do not support the statement that physicians are unhappy. On the contrary, findings in the study indicate that they have a predominantly positive view of their work situation and of their employer. It is proposed that the mixed feelings they show to some extent is a natural stage in professional development. A possible way for achieving a better dialogue between physicians and managers is suggested.     

Self-sacrifice, self-transcendence and nurses' professional self

Abstract  In this paper I elaborate a notion of nurses' professional self as one who is attracted towards intrinsic value. My previous work in 2003 has shown how nurses, who see intrinsic value in their work, experience self-affirmation when they believe that they have made a difference to that which they see to have value. The aim of this work is to reveal a further aspect of nurses' professional self. I argue that nurses' desire towards that which they see to have intrinsic value, is a necessary and self-transcending aspect of a nurses' professional self. I argue further that nurses' desire towards intrinsic value inevitably involves their vulnerability. Nurses who see intrinsic value are shown to be vulnerable to self-sacrifice in their inclination to work for the good of their patients, at the expense of themselves. Yet an ability to transcend their self in this way remains a necessary aspect of a nurse's professional self, which requires nurture and support through nurse education.     

Life as mothers in a new land: the experience of motherhood among Thai women in Australia

In this article, we examine the accounts of 30 migrant Thai women in Australia who had become mothers. The women recognized that they had entered a new environment, which was different from their previous one. This had a marked impact on their lives as wives and mothers. Cultural differences play a major role in their coping with motherhood and the mothering role. We find that the women had several main concerns in their new land: social isolation, different childrearing and child disciplinary practices, and the desire to preserve Thai culture. Most women wish to have more children in their new land, but others are concerned about social and political environments in Australia. We also find that the social class of the women and the ethnic background of their spouses play an important role in their coping with motherhood and childrearing. We conclude that motherhood and mothering is a great challenge, which is made more complex when it is combined with migration. This is important if we are to understand motherhood from an ethnicity perspective. Only then may we see better health care for immigrant women who choose to become a mother in their new land.     

Whose informational needs are considered? A comparison between cancer patients and their spouses' perceptions of their own and their partners' knowledge and informational needs

The present study examines information exchange patterns between 98 married couples in Israel where one is a cancer patient and the other is the main caregiver. Specifically, the accuracy of each spouse's perception of the extent of knowledge and the need to receive more disease-related information is examined as a function of the role (patient-caregiver) and gender of the participants. The results showed that women, regardless of their role, were inaccurate in their perception of their husbands' knowledge and motivation to know more. For men, a difference between the roles was found for the perception of their wives' knowledge. As caregivers, they were inaccurate while as patients they were accurate in this estimation. Their perception of their wives' needs to know more was accurate. Moreover, female patients, more than male, relied on their perception of themselves when assessing their spouse's knowledge and informational needs. Thus, it is concluded that female patients were more egocentric and their perception of their spouse's preferences was influenced by their own needs. The results demonstrated that in the context of cancer patients and their spouse as caregivers, neither partner considered the informational needs of his or her spouse.     

Barriers to acceptance of medical error: the case for a teaching programme

There is need for a teaching programme aiming to impart a tolerance of error to undergraduate medical students. The implementation of such a programme may have to challenge the institutional norms that encourage authoritarianism, intolerance of uncertainty and denial of error. Acceptance of error is a prerequisite for its candid reporting, and reporting of errors is a prerequisite for their analysis with a view to their prevention. A curriculum on medical error may, therefore, not only help medical students cope with their future mistakes, but also reduce their frequency. Teaching intervention aiming to promote an acceptance of medical error as both inevitable and reducible may also encourage students' epistemological development by making them realize that their doubts and uncertainties are shared by their peers and instructors.     

Still appetite and still confused: Riposte to Bodenlos, Borckardt and George.

In their defence of their original paper, Bodenlos, Borckardt and George (2007) maintain that there is little consensus in measurement of food craving and their own measure bears some resemblance to others. However, we argue that a useful concept of craving, and its measurement, must be distinguished from more general measures of appetite. Furthermore, we believe that their defence of their own significant finding misses the point that it is size, but not direction, of change that is altered by VNS. Finally, their multiple regression cannot be meaningfully interpreted with any confidence, not just because of the likelihood of overdetermination, but because the dependent variable, i.e. the direction of change of appetitive ratings, was not shown to be a reliable change, let alone an effect of VNS.     

Reflections of a Guardian Ad Litem on the Participation of Looked-after Children in Public Law Proceedings

There is much debate about the rights of children relating to the nature and degree of their participation in Public Law Proceedings. Articles 12 (1) and 12 (2) of the United Nations Convention on the Rights of the Child 1989 emphasise that children should be involved in decision-making about their welfare; and children who are capable of expressing their views should be given an opportunity to be heard in legal proceedings. This article is based on the reflective experience of a Guardian Ad Litem regarding the participation of “looked-after children” in Public Law Proceedings. It considers the nature and extent of variation in the elicitation, interpretation and use of a child's views, including the various expectations and misconceptions that may arise due to a lack of understanding and appreciation about the way in which to “weight” and use respectfully a child's wishes and feelings. There appears to be considerable variation in the way in which a child's expression of their “wishes and feelings” is used in the decision-making process. For example, one approach perceives a child as having an unequivocal right to have their views considered as the primary factor in decisions about their welfare while another approach holds that the views of relevant adults relative to children's views should have prominence in the decision-making process. Whilst it is important and beneficial to elicit children's views, due attention and care needs to be given to informing children appropriately about the weight that will be given to the expression of their wishes and feelings in decisions about their welfare, including the possibility that a final decision may not concur with their views.     

Donor conceived offspring conceive of the donor: The relevance of age,awareness, and family form

Rarely have donor conceived offspring been studied. Recently, it has become more common for parents to disclose the nature of conception to their offspring. This new development raises questions about the donor's place in the offspring's life and identity. Using surveys collected by the Donor Sibling Registry, the largest U.S. web-based registry, during a 15 week period from October 2009 to January 2010, we found that donor offspring view the donor as a whole person, rather than as simple genetic material (he can know you; he has looks; he can teach you about yourself); they also believe that the donor should act on his humanity (he should know about you and not remain an anonymous genetic contributor). Other new issues that emerge from this research include the findings that offspring may want to control the decision about contacting their sperm donor in order to facilitate a bond between themselves and the donor that is separate from their relationship with their parents. They also wish to assure their parents that their natal families are primary and will not be disrupted. We discuss how the age at which offspring learned about their donor conception and their current age each make a difference in their responses to what they want from contact with their donor. Family form (heterosexual two-parent families and lesbian two-parent families) also affects donor terminology. The role of the genetic father is reconsidered in both types of families. Donor conceived offspring raised in heterosexual families discover that their natal father no longer carries biological information and he is relegated to being “only” a social father. Offspring raised by lesbian couples experience a dissipation of the family narrative that they have no father. The donor, an imagined father, offers clues to the offspring's personal identity. The natal family is no longer the sole keeper of identity or ancestry.     

Attitudes of medical students to medical ethics in their curriculum

One hundred and one students at different levels of their medical education were surveyed as to their views about inclusion of medical ethics in their curriculum. The results showed that 88% of the students feel that medical ethics has a place in their curriculum, and 84% rated medical ethics to be of High to Critical Importance to good medical care. They tended to read infrequently about medical ethics, which they would like integrated at all levels of the curriculum, particularly the clinical years. The more senior students were less sensitive to ethical issues. The students mentioned only dramatic issues in their accounts of encounters with cases involving ethical issues. It is felt that a wide gap is left in the education of these students if medical ethics is not included in a positive way in their curriculum.     

From specialty-based to practice-based: a new blueprint for the American Board of Family Medicine cognitive examination

The American Board of Family Medicine (ABFM) is committed to offering cognitive examinations that are both pertinent to the specialty of family medicine and psychometrically sound. This article reviews the history of the development of the blueprint of the ABFM certification and recertification cognitive examinations and describes the creation of a new one. The design of the new blueprint represents a significant change. The intention of the new plan is to create a continuously evolving approach that will assure family physicians that the content of their specialty board certification/recertification examination is relevant to their practices and to the discipline. The ABFM anticipates that assessments based on the new blueprint will assist family physicians in attaining and maintaining the knowledge required to practice high quality family medicine by focusing their certification and recertification examinations and, therefore, studies for those examinations on material that is relevant to their practices.     

Children's perceptions of strategies for resolving community health problems

We examine children's perceptions of the strategies they would use to resolve community health problems. Qualitative analysis using a grounded theory approach showed that 9- to 10-year-old children could conceptualize a range of solutions to hypothetical community health problems. Children's responses reflected an egocentric perspective, one that was centered on self and peers acting on short-term solutions to the immediate problem. Less frequently, children conceptualized broader structural interventions aimed at removing the problem altogether. Children could name resource persons including their friends, family, school personnel and other people in the community. However, outside of their family and peers, their knowledge was non-specific, i.e. it is doubtful that they would actually be able to access the resources. In light of our findings we discuss several important implications for future research. We note that children are interested in changing community conditions that affect their heath. However, their recognition of their marginalized position in adult society and their perception that adults do not take them seriously may be significant barriers to their participation. We suggest that society must rethink the position and roles that are assigned to children so that their valuable potential is not lost.     

Helping students with learning difficulties in medical and health-care education

In health profession education many more students than is currently acknowledged experience often extreme difficulties with their studying. This booklet is intended to help them. It outlines an approach being adopted in the Faculty of Medicine at the University of Southampton by which students are encouraged to reflect on and discuss their approaches to studying, identifying their perception of their task and where necessary changing this. It is shown that students need to elaborate their knowledge, that is to structure the factual information they are receiving and to relate it to their practical experiences. A number of suggestions are made to encourage this, and their theoretical underpinnings are discussed. It is concluded that while inappropriate curricula and teaching methods and not some weakness on the part of students are largely the cause of learning difficulties, it will take time to change these. Establishing a kind of 'clinic' for helping students cope can be of value immediately.     

Skin disease and handicap: an analysis of the impact of skin conditions

This research sought to quantify the handicapping effect of skin conditions in a far more rigorous way than had previously been attempted. One hundred people who had attended a hospital outpatient clinic during a specified period for treatment of their acne, psoriasis or eczema were interviewed in their homes. A comprehensive and structured interview schedule was used and interviewees were encouraged to talk at length about the impact that their skin conditions had had on their lives. Detailed data were collected that show the serious effect that these diseases can have in several domains. The findings record not only the physical discomfort and inconvenience sufferers may meet but also the consequences for their personal and social life and daily functioning. There is evidence from interviewees' employment experiences of limited opportunities, and functional and interpersonal difficulties in the workplace. 64% of people said that their skin disease affected their socio-economic activity. The extent to which sufferers experienced embarrassment, anxiety, a lack of confidence and depression is documented. 40% of people felt that their social life was affected and there was evidence of particular stresses and demands in personal relationships. The social impact of skin disease is discussed.     

Mothers, daughters and sexual agency in one low-income South African community

Statistics indicate that sexual health problems like HIV/AIDS and teenage pregnancies are prevalent among young South African low-income women. To improve the effectiveness of preventative programmes for adolescents it is important to focus on adolescents' own understanding and experience of their sexual behaviour within the contexts in which it occurs. Female adolescents' experiences of their own sexuality are shaped by a range of contexts: from the very specific context of their intimate relationships to the broader contexts of gender, ethnicity and social class. It is therefore imperative to adopt a research approach that stratifies groups and develops interventions that are based on the needs, interests, sexual beliefs and behaviours of specific communities rather than developing general educational messages. The current paper is part of a larger study exploring female adolescent sexuality in a South African low-income rural coloured community. Twenty-five adolescent coloured women aged 14-18 years were interviewed about how they viewed their sexuality. The grounded theory analysis indicated that the participants demonstrated a limited sense of sexual agency in these constructions of their sexuality. The mothers of these young women were powerful agents in the young womens' constructions of their own sexuality and they unintentionally contributed to their daughters' limited sense of sexual agency. Mothers presented sex as a dangerous activity to their daughters. This discourse of sex as danger contributed towards a mutual understanding that sex should not be talked about. Daughters' deception of their mothers about their sexual activity maintained mother-daughter connections, but left them without an interactional space where they could talk freely to their mothers about sexuality.     

The role familiarity with science and medicine plays in parents' decision making about enrolling a child in vaccine research

Parental consent to children's participation in vaccine research has resulted in the licensure of essential vaccines. Recruitment to this type of research is typically difficult, however, and many parents decline. In this study, the authors interviewed parents about their decision for or against enrolling their child in a vaccine study. The data analysis suggests that parents' ability to evaluate a vaccine study depends on how attuned they are with science and medicine, either professionally or as consumers of health services. Familiarity does not predispose parents to enrolling their child in research; rather, it is a predictor of parents' confidence in their decision making. Many parents were motivated by altruism and trust, which, if uninformed, can leave the parents prone to exploitation. It is vital to ensure that parents are confident in their judgment of a study and its potential benefit to their child and society.     

Menorrhagia in general practice--disease or illness

Menorrhagia is a common presentation in primary care. The gynaecological literature defines menorrhagia, as the loss of 80 ml or more of blood per period and guidelines for treatment are based on this definition. There is extensive evidence that the majority of women who complain of heavy bleeding do not fit the medical definition. We interviewed women presenting with menorrhagia to explore their perceptions and their initial interaction with the medical profession. A distinct illness model emerged. Women had a precise understanding of their complaint, so that a change in her cycle was indicative of a problem to many women, without reference to outside criteria. Women attached particular importance to how they felt and to their ability to function and they rejected the medical emphasis on blood loss evaluation. Many women were dissatisfied with the consultation and experienced doctors as being dismissive of their problem. They were seeking an explanation for why their periods had changed and had concerns that related to their understanding of menstrual bleeding. Interviewees were unsure whether period problems could be described as illness, and what range of disturbance was normal. It is suggested that the disease model of menorrhagia is not relevant to the majority of women with this complaint. It is proposed that the disease model be replaced with illness models.     

Methodological issues when using the draw and write technique with children aged 6 to 12 years

Researchers are responsible for using techniques that allow children to contribute their perspectives in a way that is most suited to their strengths and preferences. The draw and write technique is a method that needs to be used carefully and sensitively if children are to become active participants in revealing their world as they see it. In this article, we explore the issues for the child and researcher of using the draw and write technique as a participatory research methodology. Reflections on the technique are drawn from our experience of using it with children aged 6 to 12 years. This was part of a larger study undertaken to enable children aged 4 to 18 years with a diagnosis of cancer to give their views about hospital care. The participating children's verbal and artistic contributions illustrate how children are able to convey their opinions when there is an enabling climate created.     

When there is nothing left to do, there is everything left to do

Circle of Life Hospice in Reno, Nevada is not only a special place for patients and their families to find peace through a sense of meaning and purpose at the end of their life but is also an important place for staff to take care of each other as they take care of those who are dying. The Circle of Life Hospice provides a unique opportunity to examine carefully the power of providing an outlet for hospice staff to process their grief and offer support for one another so that they can continue to give the "everything that there is to do to" to their patients.