Experiences of carers supporting dying renal patients managed without dialysis

Aim: To explore the impact of being a family carer to patients with stage 5 chronic kidney disease managed without dialysis.
Background: Increasing numbers of patients with renal disease worldwide are making the decision not to embark on dialysis. This group has significant physical and psychological symptom burdens similar to or greater than those in advanced cancer patients. Little is known about the impact on family carers.
Design: Exploratory, qualitative design.
Methods: The study was undertaken with 19 carers caring for patients managed in a Renal Supportive Care Service in the UK between 2006–2008. Sixty-one semi-structured interviews and detailed field notes inform the analysis.
Findings: ‘Caring from diagnosis to death’ was the overarching theme illustrated by three sub-themes: (i) Caregiver's plight – making sense of the disease and potential deterioration; (ii) Having to care indefinitely; and (iii) Avoiding talk of death. ‘Caring from diagnosis to death’ coincides with an original concept analysis of renal supportive care, which is considered an adjunct to the management of patients with renal disease at all stages of their illness.
Conclusion: There is a clear need for further research internationally and theory-based nursing interventions to support carers of patients managed without dialysis. The development of a holistic, integrated care pathway based on carer perspectives, which includes identification of information needs related to original diagnosis, associated comorbidities, treatment options, prognosis, and assistance in developing strategies to manage communication with patients as the end of life approaches, is required.

Social Dance for Successful Aging:The Practice of Health, Happiness, and Social Inclusion Amongst Senior Citizens

This article presents findings from a qualitative study of social
dancing for successful aging amongst senior citizens in three locales:
in Blackpool (GB), around Belfast (NI), and in Sacramento (US). Social
dancers are found to navigate an intense space in society, one of
wellbeing accompanied by a beneficial sense of youthfulness. Besides
such renewal and self-actualisation, findings also attest to the perceived
social, psychological and health benefits of social dancing amongst senior
citizens. They also articulate three different social dancing practices:
social dance as tea dance (Sacramento), social dance as practice dance
(Blackpool), social dance as motility (Belfast and environs).

Bolivian health and social care professionals' experiences of decision-making in oncology and palliative care

In the UK, end-of-life care strategies recommend patients and families are involved in decision making around treatment and care. In Bolivia, such strategies do not exist, and access to oncology services depends on finance, geography, education and culture. Compared to more developed countries, the delivery of oncology services in Latin America may result in a higher percentage of patients presenting with advanced incurable disease. The objective of this study was to explore decision-making experiences of health and social care professionals who cared for oncology and palliative care patients attending the Instituto Oncológico Nacional, Cochabamba (Bolivia). Patients were predominantly from the Quechua tradition, which has its own ethnic diversity, linguistic distinctions and economic systems. Qualitative data were collected during focus groups. Data analysis was conducted using Interpretative Phenomenological Analysis. Three interrelated themes emerged: (i) making sense of structures of experience and relationality; (ii) frustration with the system; and (iii) the challenges of promoting shared decision making. The study uncovered participants' lived experiences, emotions and perceptions of providing care for Quechua patients. There was evidence of structural inequalities, the marginalisation of Quechua patients and areas of concern that social workers might well be equipped to respond to, such as accessing finances for treatment/care, education and alleviating psychological or spiritual suffering.

Stated choices and benefit estimates in the context of traffic calming schemes:Utility maximization, regret minimization, or both?

This paper proposes a discrete mixture model which assigns individuals, up to a probability, to either a class of random utility (RU) maximizers or a class of random regret (RR) minimizers, on the basis of their sequence of observed choices. Our proposed model advances the state of the art of RU-RR mixture models by (i) adding and simultaneously estimating a membership model which predicts the probability of belonging to a RU or RR class; (ii) adding a layer of random taste heterogeneity within each behavioural class; and (iii) deriving a welfare measure associated with the RU-RR mixture model and consistent with referendum-voting, which is the adequate mechanism of provision for such local public goods. The context of our empirical application is a stated choice experiment concerning traffic calming schemes. We find that the random parameter RU-RR mixture model not only outperforms its fixed coefficient counterpart in terms of fit-as expected-but also in terms of plausibility of membership determinants of behavioural class. In line with psychological theories of regret, we find that, compared to respondents who are familiar with the choice context (i.e. the traffic calming scheme), unfamiliar respondents are more likely to be regret minimizers than utility maximizers. © 2014 Elsevier Ltd.

The Applicability of Two Strengths-based Systemic Psychotherapy Models for Young People Following Type 1 Trauma

This paper will consider the inter-relationship of a number of overlapping disciplinary theoretical concepts relevant to a strengths-based orientation, including well-being, salutogenesis, sense of coherence, quality of life and resilience. Psychological trauma will be referenced and the current evidence base for interventions with children and young people outlined and critiqued. The relational impact of trauma on family relationships is emphasised, providing a rationale for systemic psychotherapeutic interventions as part of a holistic approach to managing the effects of trauma. The congruence between second-order systemic psychotherapy models and a strengths-based philosophy is noted, with particular reference to solution-focused brief therapy and narrative therapy, and illustrated; via a description of the process of helping someone move from a victim position to a survivor identity using solution-focused brief therapy, and through a case example applying a narrative therapy approach to a teenage boy who suffered a serious assault. The benefits of a strength-based approach to psychological trauma for the clients and therapists will be summarised and a number of potential pitfalls articulated.

Late effects of cancer and cancer treatment-the perspective of the patient

PURPOSE: Understanding the experience of late effects from the perspective of cancer survivors is essential to inform patient-centred care. This study investigated the nature and onset of late effects experienced by survivors and the manner in which late effects have affected their lives.

METHODS: Sixteen purposively selected cancer survivors participated in a qualitative interview study. The data were analysed inductively using a narrative schema in order to derive the main themes that characterised patients' accounts of late effects.

RESULTS: Individual survivors tended to experience more than one late effect spanning a range of physical and psychological effects. Late effects impacted on relationships, working life, finances and the ability to undertake daily activities. Survivors reported experiencing psychological late effects from around the end of treatment whereas the onset of physical effects occurred later during the post-treatment period. Late effects were managed using formal health services, informal social support and use of 'wellbeing strategies'. Survivors engaged in a process of searching for reasons for experiencing late effects and struggled to make sense of their situation. In particular, a process of 'peer-patient comparison' was used by survivors to help them make sense of, or cope with, their late effects. There appeared to be an association between personal disposition and adaptation and adjustment to the impact of late effects.

CONCLUSIONS: Cancer survivors identified potential components for supported self-management or intervention programmes, as well as important considerations in terms of peer comparisons, personal disposition and making sense of experienced late effects.

Systematic review of interventions to improve the psychological well-being of general practitioners

BACKGROUND: The health of doctors who work in primary care is threatened by workforce and workload issues. There is a need to find and appraise ways in which to protect their mental health, including how to achieve the broader, positive outcome of well-being. Our primary outcome was to evaluate systematically the research evidence regarding the effectiveness of interventions designed to improve General Practitioner (GP) well-being across two continua; psychopathology (mental ill-health focus) and 'languishing to flourishing' (positive mental health focus). In addition we explored the extent to which developments in well-being research may be integrated within existing approaches to design an intervention that will promote mental health and prevent mental illness among these doctors.

METHODS: Medline, Embase, Cinahl, PsychINFO, Cochrane Register of Trials and Web of Science were searched from inception to January 2015 for studies where General Practitioners and synonyms were the primary participants. Eligible interventions included mental ill-health prevention strategies (e.g. promotion of early help-seeking) and mental health promotion programmes (e.g. targeting the development of protective factors at individual and organizational levels). A control group was the minimum design requirement for study inclusion and primary outcomes had to be assessed by validated measures of well-being or mental ill-health. Titles and abstracts were assessed independently by two reviewers with 99 % agreement and full papers were appraised critically using validated tools.

RESULTS: Only four studies (with a total of 997 GPs) from 5392 titles met inclusion criteria. The studies reported statistically significant improvement in self-reported mental ill-health. Two interventions used cognitive-behavioural techniques, one was mindfulness-based and one fed-back GHQ scores and self-help information.

CONCLUSION: There is an urgent need for high quality, controlled studies in GP well-being. Research on improving GP well-being is limited by focusing mainly on stressors and not giving systematic attention to the development of positive mental health.

Consumers sensory evaluation of melon sweetness and quality

CONSUMERS SENSORY EVALUATION OF MELON SWEETNESS AND QUALITY Agulheiro Santos, A.C, Rato, A.E., Laranjo, M. and Gonçalves, C. Departamento de Fitotecnia, Escola de Ciências e Tecnologia, Instituto de Ciências Agrárias e Ambientais Mediterrânicas (ICAAM), Instituto de Investigação e Formação Avançada (IIFA), Universidade de Évora, Polo da Mitra, Ap.94, 7002-554 Évora, Portugal. ABSTRACT The sensory quality of fruits is made of a range of attributes like sweetness, acidity, aroma, firmness, color. Taste perception and perception threshold of these attributes are variable according to the psychological and cultural development of individuals. To better understand the quality evaluation of melon by consumers, consumers were invited to taste melon samples, in supermarkets in Évora (South region), Lisbon (Central region) and Vila Nova de Gaia (North region). The present work explored the importance given by consumers to sweetness in order to classify the overall quality of melon. Furthermore, the relationship of the chemical evaluation of Total Soluble Solids (TSS) with sweetness of melon was studied. Fruits from the variety Melão branco picked randomly from those that were exposed for sale in supermarkets were used for analysis. Fruits were chinned along the equatorial zone and only the central part of the fruit, opposite to the part that leaned on the soil, was used to obtain homogeneous samples. Consumers were invited to taste four small pieces of each fruit, previously referenced with a code number, and answer a questionnaire with two questions related to sweetness and overall quality. Each question had five possible levels, identified from “Nothing sweet”, to “Extremely sweet”, in one case, and from “Poor” to “Excellent” in the other. Simultaneously, the values of TSS (measured in ºBrix) for each melon used in the study were evaluated by refractometry. This sensory analysis allowed us to point out the following findings: first of all, there is good agreement between the results obtained to classify “Sweetness” and “Overall Quality” (Cohen’s Kappa=53.1%, p<0.001), which means, for example, that fruits with excellent quality are in general extremely sweet. Moreover, fruits with less than 9.6 °Brix are considered of poor quality and nothing sweet, whereas fruits with values between 10 °Brix and 12 °Brix are considered good in terms of overall quality. It seems that the thresholds for the stimulus/intensity of sweetness lied between 10 °Brix to 14 °Brix for this melon variety. Acknowledgments This work was support by national funds through Fundação para a Ciência e a Tecnologia (FCT) under the Strategic Project Pest-OE/AGR/UI0115/2014 and co-funded by FEDER funds through the COMPETE Program.

‘Not like rose-tinted glasses… like taking a pair of dirty glasses off’: A pilot intervention using positive emotions in expressive writing

Studies conducted in various contexts and with varied populations have found expressive writing enhances physical and psychological wellbeing. This pilot intervention study countered the predominantly quantitative evidence by adopting a qualitative methodology, exploring the experience of using positive emotions in expressive writing. Participants (n = 10), who all had previous experience in expressive writing, were asked to select one of ten positive emotion cards (PECs) each day for three days. Participants were then asked to write expressively through the ‘lens’ of their chosen emotion. Semi-structured interviews were conducted and experiences were evaluated using Thematic Analysis. The results identified two main themes that compared the experience of expressive writing both with and without the PECs. The first theme, Processing (without the PECs) contained three sub-themes: sense of relief, habitual perspective and reactive to experience. The second main theme, Progressing (with the PECs) contained three different sub-themes: sense of direction, changed perspective and interactive with experience. This study found that, for expressive writers, positive emotions may function in three ways: to relate to others or self-expand, to move past challenges cognitively or change unconstructive perspectives, and finally as a way to interactively link or ‘bridge’ from the written subject matter to constructive action, thus breaking cycles of reactive writing and rumination. Implications of the study on the practice of expressive writing and its potential as a positive psychology intervention (PPI) are discussed.

Walls of Indifference: Arizona and the Ecology of Militarization

Thesis (Ph.D.)--University of Washington, 2013

Psychological safety, authentic leadership and social networks : A psycho-structural approach to the study of groups

Tese de Doutoramento em Psicologia na área de especialização de Psicologia das Organizações apresentada ao ISPA - Instituto Universitário

Investigation of motivation strategies used by school teachers for workplace engagement

The purpose of this study was to explore the strategies that elementary school teachers use to be engaged in their work. Participation was solicited from a random sample of schools stratified by location (i.e., urban, inner city, and rural) of a large school board. The study used an anonymous quantitative/qualitative questionnaire. The survey tool was based upon Kahn's (1990) psychological engagement framework, which presents the foundation of availability of self, meaningfulness of work, and safety while at work. Forty-one surveys were analyzed descriptively including a subgroup of self-rated highly engaged teachers. Teachers tended to favour physical and emotional strategies compared to cognitive type strategies, with the exception of the highly engaged subgroup. The theme of preferred strategies reflected a setting outside the school/workplace, that is, a preference for horne based strategies. The study's main contribution highlights the teachers' sense of importance for physical and emotional health in a profession that is heavily focused in the cognitive domain. This may influence administrative and teacher discourse regarding workplace engagement with strategies to help reduce stress and to maintain and increase teacher engagement.