Down but not out: supporting the older person with depression

Gillian, 74, worked for 30 years as a school cook which she enjoyed. After retiring, she suffered a series of health problems and today has difficulty walking. Her husband died two years ago and she struggles to socialize on her own as they used to do everything together. Her family have moved away and she often feels lonely. Recently Gillian has become teary and doesn't want to get out of bed. She knows something is wrong with her, but is ashamed to tell anyone about it.     

Contraception--a woman's dilemma

The case history of a 36-year-old West German woman--Elsa--who had an abortion is recounted along with information obtained from other members of staff involved with her care--a medical social worker, a family planning nurse, and a doctor. Conversation with Elsa revealed that she had ambivalent feelings about birth control. When Elsa learned she was pregnant, she seriously considered her subsequent decision to have an abortion. Actually, she would have preferred to have the baby if she could have depended on her boyfriend's encouragement and his commitment to being a father. At the clinic, Elsa was found to be in good physical condition. She informed the doctor that she had already had 2 terminations of pregnancy, 15 and 11 years ago. Following the birth of her son she had taken an oral contraceptive (OC) for 4 years, but had stopped taking it in 1976 because she thought she was too old for the pill and had been taking it too long. She had then used an IUD, but this had supposedly been removed 10 weeks before the abortion, after she had suffered from recurrent menorrhagia and heavy vaginal discharge. Elsa was then fitted with a diaphragm which she had been using when she became pregnant. After the abortion, Elsa continued to be undecided about what form of contraception to use in the future. She did not want to become pregnant again before she was in a position to have the baby. Elsa had good reason for concern about using OC, i.e. OCs containing estrogen and progestogen, at the age of 36. Along with discussion about the use of OC, Elsa sought more information about the diaphragm. Elsa finally decided to use OCs, but it is doubtful if she will ever be content with either this method or the diaphragm. Family planning nurses have an important role to play in educating people about contraceptives and their use, but they should never tell people that they should or should not be controlling their fertility.     

Liver failure, life support, family support, and palliation: an inside story

My sister was admitted to the intensive-care-unit (ICU) five months before she died. At the time of admission her life-support wishes were not discussed with her. During her time in the ICU, we, the family, were given hope that she may survive. As with most families, we wanted my sister to live. During her progression from ICU to step-down unit to ward unit, the plan of care was not discussed, and goals were not set. Many medical teams were involved in my sister's care, and many looked at individual body parts instead of the whole person. I am a Registered Nurse at the same hospital where my sister was being cared for. Through many family meetings I was regarded as a medical professional, not as a sister. Knowing the medical system yet going through this as a family member has given me the opportunity to gain insight into what should have happened. If code status had been discussed we would have known my sisters wishes. If relevant literature pertaining to her disease and her slim chance of recovery had been brought to our attention, my sister could have died at home as she wished, and perhaps could have lived her final days in comfort.     

A Changing Force in My Life

Monika Ahuja was diagnosed with a sarcoma of the left leg that eventually metastasized to the lungs and brain. Eventually as the truth unfolded to her that life is limited, she was unable to discuss with her family her thoughts about her illness due to their reluctance to accept the inevitable, and she started to convey through her songs how broken she feels inside and how deeply she wishes that this suffering will come to an end. She sings songs preparing all those dear to her of how to live and move on in life without her. Such preparedness for death is breathtaking for the author and the rest of the hospice team, and it makes them wonder if they would be able to prepare for their own death in the exemplary manner that Monika is setting. Monika has very strongly reinforced the lessons of life to the author, who wants to pass them on to family, friends, and all those working in health care.     

Using Roy's model in a special hospital

Using a nursing model to help systematise the care of a young patient in a special hospital resulted in tangible improvements in his behaviour, yet Francesca Miller found that it raised questions about the function and value of nursing for this client group. Her study reveals how she had to cope with her own negative feelings about the nature of her patient's offences and how the use of basic counselling skills, and encouraging the patient to take responsibility for his own care, achieved notable developments in his social skills. But despite this, she is left to ponder, 'at what cost?'     

The nursing process in helping a family with foreign mother and hearing impaired child

This case report aims to present a nursing experience involving a child with severe hearing impairment and delayed language development. The patient was discovered during a home visit. At the time she was two and a half years old, but still had not developed any language behavior. She only used eye contact, physical touch, and body language to communicate with her family. She also did not respond to sound stimulation. The results of a Denver Developmental Screening Test (DDST) showed delayed development, especially of language. The child's mother is from Vietnam. The culture, education, language, and environment of Vietnam are totally different from Taiwan. In addition, the mother did not know how to raise her child. So the author tried to follow up on the case. Data were collected by home visits, phone calls, interviews, and communication with members of a professional health care team during the nursing care period (about six months). Data were recorded and it was written a processing analyzed. They revealed five health problems, as follows: (1) hearing impairment causing delayed language development; (2) poor family recognition deviation understanding of delayed development; (3) insufficient community resources; (4) low self-protection, limited capacity for caused by hearing impairment; (5) foreign mother's sense of helplessness about raising the child. The author provided supportive care to the patient and her family, counseled them, and transferred the child quickly to a treatment center. She also coordinated resources and the professional care team in assisting the parents in facing and adapting to the child's developmental delay. As a result, the parents gained knowledge and the ability to make judgments about developmental delay. This fostered a positive attitude on their part and acceptance of the child's admission to the treatment center. The child and family could deal with their problems appropriately because the nurse intervened at the appropriate time with the aim of reducing the obstacles to their doing so. This enabled the child's handicap to be minimized and her potential to be developed.     

Pain in Bali

There is a lot of unrelieved pain in developing countries. Here is a story from Bali, Indonesia, about a woman with advanced malignancy, who is in unbelievable agony. Expensive chemotherapy is available to her. But although the necessary medications for relieving her pain are available in hospitals, they do not reach the patient, in her home, or even when she is admitted to the hospital, because of ignorance of the medical profession about pain management and because of unnecessary regulatory restrictions. The woman's pain affects the whole family, endangering the family's income and the future of her children. The intervention of palliative care during part of her life gives her some relief, only for the agony to be repeated by pointless chemotherapy and neglect of the suffering during admission to the hospital. Whatever relief could be given to her was because of the intervention of a volunteer with no schooling in medicine or palliative care.     

Evaluating movement for switch use in an adult with severe physical and cognitive impairments

Miranda's family members are most supportive of the goal for her to have a powered wheelchair and encourage her when they visit. Motivation has been the key to Miranda's success at learning to operate switches in order to explore and learn from her environment. As long as the outcome available from operation of a switch is desirable for Miranda, she works hard at controlling her movements so as to activate it. Conversely, if the ultimate advantage of operating the switch is unclear to her, she is unwilling to make the effort. The occupational therapist's role is crucial, in that she realizes the importance of motivation and consequently designs activities and rewards that are important and meaningful for Miranda. Miranda's life has been considerably enriched by the introduction of mechanical aids into her leisure sphere. She has become more interested in her surroundings and is excited about exploring possibilities for future rewarding activities, such as academics. A notable additional benefit has been that Miranda now displays a more assertive attitude on her own behalf.     

A mother’s reflections of living with an adolescent drug abuser: A case report

Background: Mothers of adolescents with substance abuse problems experience significant distress as a result of the adolescent’s behaviours. Methods: Using an interpretative phenomenological methodology, this paper describes the lived experience of a mother coping with an adolescent who has a drug use problem in the form of a case report. Results: The mother experienced a range of psychosocial challenges in trying to cope with her son’s behaviour and her own emotional distress. This included a desperate cry for help in the form of an attempt at suicide which ultimately led her to obtain the support she required to attend to her distress. Conclusion: The findings are discussed in relation to the literature with the intention to draw attention to the importance of coping support for mothers affected by adolescent substance abuse.     

Common psychological challenges for patients with newly acquired disability

A patient's attitude to a newly acquired disability can often be the determining factor in successful rehabilitation. This attitude is determined by his or her perceived ability to manage symptoms, deal with hospital procedures, form and maintain relationships and manage his or her feelings about the disability. Because of this complexity, psychological aspects of patient rehabilitation are often regarded as vague and difficult to negotiate. This article describes seven common psychological challenges that patients experience with a newly acquired disability or during recovery from major illness (Moos and Schaefer 1984). Strategies are outlined to assist patients to come to terms with their disability and to cope more effectively during rehabilitation.     

Surviving suicide: A psychiatrist’s journey

This article is a personal narrative by Diane Roston, M.D. of the suicide of her husband, David, in 2008. It is a powerful and intimate recounting of her thoughts, emotions, and behaviors from the day of her husband’s death, up to the present time, as she tries to cope with the shock, trauma, confusion, horror, and intense grief produced by this life-changing event. It also includes her thoughtful reflections on how this experience has changed her personal and her professional life and has led to a hard-won sense of meaning and acceptance of the death.     

Theresa Marie Schiavo's long road to peace

The death of Theresa Marie Schiavo came about only after almost 7 years of argument among her family members. Her husband, Michael Schiavo, was convinced that she would have refused the medically supplied nutrition and hydration maintaining her life. Her parents, Robert and Mary Schindler, and her siblings were equally convinced that her condition was not so hopeless that she would have chosen to refuse treatment. The result was a bitter battle reaching through state and federal court systems, legislatures, and chief executives' offices. This article provides introductory factual background for the articles that discuss the Schiavo case in this special issue of Death Studies.     

Underage contraception

This article discusses the ethical and legal dilemmas confronting general practitioners in regard to contraceptive advice for adolescents. When a teenage girl comes to a physician for advice, she alone is the patient and the physician has an obligation to her. However, this obligation must be reconociled with the obligation to her parents. A UK parent, Victoria Gillick, sought declarations in the High Court against a National Health Service Notice concerning family planning services for adolescents. She argued: 1) that physicians who give family planning advice to girls under 16 years of age witout parental consent are guilty of causing or encouraging unlawful sexual intercourse; and 2) the doctor's actions interfere with the rights of the child's parents and undermine their ability to carry out their duties of supervising the physical and moral welfare of their children. If Gillick's position is adopted by society, no minor will be able to consult a physician without the parent being present. In practice, many physicians consulted by teenagers under 16 attempt to determine whether the girl has reached a stage in her development where she is capable of behaving as an autonomous agent, with the rights and responsibilities this entails. In the US, the concept of the mature minor doctrine has been developed. This approach recognizes that some teenagers mature more rapidly than others, and leaves it to the judgment of the physician to determine whether a given adolescent has reached a stage at which she can be considered competent to make decisions about her health care. Moreover, it is noted that when young teenagers ask for contraception, they are likely to be already sexually active and at risk for pregnancy. Given the difficult issues involved, physicians who want to respect an adolescent's autonomy yet consider her parents' feelings must be clear about the ethical basis on which they practice.     

Oral mucositis

CASE STUDY: Ms. J is a 55-year-old woman who was diagnosed with stage IIIA colon cancer three months ago. Prior to her diagnosis, she experienced an unintentional 17-pound weight loss. She underwent an exploratory laparotomy with colon resection. Following recovery from her surgery, she began an adjuvant chemotherapy regimen of 5-fluorouracil, leucovorin, and oxaliplatin. She presents to the clinic today for her third chemotherapy treatment.     

An insider's view on person-centred rehabilitation: A case study

Purpose. The author, a rehabilitation specialist of more than 30 years, presents her observations of the medical and rehabilitation services her husband received after a ruptured abdominal aortic aneurysm. Building on the person-centred approach, she identified several problems and describes theory-based strategies how she and her husband (patient) addressed these problems. In addition, she provides insight in the complex role she fulfilled as family caregiver: liaison, advocate and as personal health manager (taking care of her own health).

Method. A qualitative analysis and interpretation based on personal observations and discussions with medical and rehabilitation professionals.

Results. The author argues that the culture of the institution (knowledge and compassion) and the role of the patient advocate have major implications on the outcome of a patient's functional gains. The International Classification of Functioning, Disability and Health can be a useful tool to enhance transparency within the patient-centred approach.

Conclusion. Although this case study is described from the perspective of one case, the information shared in this paper may stimulate further discussion and research in the concept and implementation of person-centred rehabilitation.     

Personal experience: being depressed is worse than having advanced cancer

This short paper addresses the experiences of a recently retired mental health nurse who has suffered from several episodes of depression during her long career and is now experiencing a life‐limiting illness. Rather than feeling safe within the embrace of the health profession family, the author feared negative consequences of exposing her mental health difficulties to her colleagues. Comparing the anguish of depression to the knowledge that she will die fairly soon has lead the author to question which experience is worse (for her, depression), thus emphasizing how trivializing depression may be a consequence of professional stigma and organizational neglect, as depression is not always prioritized in UK mental health services. Both of these matters may add layers of shame and fear to the sufferer's experience. The author argues that care workers should not take their criticism of stigma as a matter to be taken for granted but instead should be brave enough to face their own assumptions about who service users are and just what they experience. Stigma has real‐life consequences for those with mental health problems, particularly with regard to help‐seeking behaviour.     

A case of occupational allergic bronchopulmonary aspergillosis unique to Japan

A 15-year-old female was diagnosed in 1980 as having allergic bronchopulmonary aspergillosis (ABPA) due to Aspergillus fumigatus based on Rosenberg and Patterson's criteria for the disease. The patient is the eldest daughter of a family of domestic brewers of soy sauce and bean paste in a small village, an occupation unique to Japan. The brewing process involved the use of Aspergillus oryzae as a fermenting agent. The patient had experienced episodic wheezing and pulmonary infiltrates during the same seasons in the previous three years, corresponding to the time of the highest A oryzae spore concentrations in the living area, suggesting high exposure to the Aspergillus spores in the aetiology of her exacerbations. She had a prominent family history of atopy and was demonstrated to be sensitive to a variety of aeroallergens in addition to A fumigatus. She was treated effectively by bronchial toiletting via broncho-fibrescope and theophylline medication until April 1981, when she moved to another city. During her life there, chest X-rays repeatedly showed abnormal shadows, and she was treated with inhalations of amphotericin B and bronchial toiletting several times at a hospital. She returned to her home town after seven years in April 1988 and visited the hospital to check her condition. Although she had been away from heavy exposure to A oryzae spores for seven years, precipitins to the culture medium of A oryzae were demonstrated to be far more prominent than those to A fumigatus antigen. Although her family had been exposed to A oryzae spores continuously, the patient was the only family member with ABPA due to A fumigatus and possibly due to A oryzae.(ABSTRACT TRUNCATED AT 250 WORDS)     

Florence Nightingale, feminism and nursing

Three key aspects of Florence Nightingale's remarkable life are examined. First, the influences during her formative years: the education and guidance provided by her father, the resistance by her family when she decided to become a nurse; and the rejection by Nightingale of the societal expectations of a woman in the Victorian era. Secondly, her professional life is examined, in particular how she appears to have been viewed by certain members of society, and how in turn she viewed them. It is anticipated that her position as an early feminist will be postulated and illuminated. Thirdly, an analysis of her personal and professional life indicates a way forward for the nursing profession.     

Deciphering a schizophrenic's disguised communication: a task for clinical supervisory conference

As the relationship between Judy and her nursing student drew to a close, Judy talked more and more clearly about her feelings toward her mother. When she had previously made excuses for her mother, upon being disappointed or feeling angry, she began to deal more openly with the effects her mother's behaviour had upon her. In evaluating the session presented above, the nursing student verbalized her concern that the short term nature of their relationship would probably make it impossible for her to help Judy to resolve any of her deep-seated conflicts and ambivalence toward her mother and their past relationship. At this point her clinical teacher asked her to view the goal of nursing therapy as making communication with another person in the present here and now more rewarding. Arieti states that “understanding the past does not in itself shift the balance to make pathology unrewarding and healthy functioning rewarding”.⁽¹⁵⁾ The nursing student offered Judy the opportunity to be understood about matters which were currently active. This was a gratifying experience for Judy and provided her with a sense of mastery that she previously lacked. The student added that in her last few meetings with Judy her diminished anxiety was noticeable and her sense of power amplified. Such changes might easily be attributed to the support, consideration and corrective feedback the nursing student contributed. The nursing student acknowledged at the termination of her final supervisory conference the satisfaction she felt in realizing that prior to her intervention with this patient, Judy had been essentially incommunicado—cut off from relatedness by virtue of her disordered communication. In this student's efforts to establish real communication with Judy, even though the student's academic schedule limited their relationship to a short term one, Judy had the experience of being understood and moved a few steps closer to transcending the loneliness she faced because of her disguised communication.     

Effectiveness of yoga in eating disorders – A case report

Eating disorders are among the most common psychosomatic diseases and are often associated with negative health consequences. The use of yoga as a treatment method in eating disorders is controversial discussed. The interviewee was a 38 year old female patient suffering on anorexia nervosa and various psychosomatic-psychiatric diagnoses in her medical history. The patient reported that yoga recovered the soul contact which she lost and she had learned to perceive and feel herself again. She stated that yoga helped her to find access to her body and its needs and to cope with her traumatic experiences. She also reported that attitudes have changed in relation to her stomach in the treatment of her anorexia. The case report confirmed the positive effect of yoga on eating disorders. Research should pay particular attention to taking into account the influence of individual’s co-morbidities, as eating disorders usually occur in association with co-morbidities.