Exploration of nurses' lived-experiences and understandings of the concept of healing

Explores nurses' understandings of the concept of healing, within the context of a nurse/patient relationship. Hermeneutic phenomenology is the research methodology and story-telling the means of data collection. From these descriptions, new understandings have been sought and therapeutic possibilities actively explored.

The view from the cushion : zen challenges to duality in the contemporary practice situation

Based on participant-observation fieldwork, interviews with western Zen practitioners, public dharma talks and personal interviews given by two contemporary Sōtō Zen teachers (Hōgen Yamahata and Ekai Korematsu), this paper explores the challenges to 'everyday' dualistic thought structures that Zen practice poses to the questioning student and the ontological and epistemological significance of these challenges to the worldview of the experiencing student. First, the teaching styles and non-dual emphases of the two teachers in the context of teacher/student exchanges are examined; and, secondly, the experiential challenges and changes in worldview from the practitioner's point of view are phenomenologically explored. By teasing out the parallels and links between the phenomenology of Zen practice and the philosophical underpinnings of Zen practice instructions, foundational philosophical tenets can be shown 'in action' in the contemporary practice situation and a window is opened on the ontological and epistemological significance of the experiential impact of Zen teachings.

Depression and pain : an overview

Background: Depression and pain are both burdensome ailments that affect a major proportion of the population. It is evident that depression and pain frequently coexist, with treatment and outcome implications.

Objective: To review the literature on the nature, prevalence and co-morbidity of depression and pain, the biological and psychological mechanisms involved and treatment options, thus presenting a broad overview of the current information available.

Methods: Relevant sources were identified from PubMed and Medline databases using a combination of keywords including depression, pain, prevalence, co-morbidity, biological and psychological mechanisms, serotonin (5-HT), norepinephrine (NE), hypothalamic-pituitary-adrenal (HPA) axis, amygdala, functional magnetic resonance imaging (fMRI), antidepressant and psychological therapy.

Results: It is evident from the research that depression and pain are common co-morbidities. Pain as a physical symptom of depression affects approximately 65% of patients, leading to less favourable outcomes and greater health care utilization. Moreover, depression is a common feature in chronic pain patients and can affect pain threshold and tolerance. Evidence from biological and psychological studies has revealed mechanisms that link chronic pain to depression. Several classes of anti-depressants and psychological interventions have been used successfully in the treatment of somatic symptoms of depression and for a variety of pain syndromes.

Conclusions: Pain and depression are linked by overlapping phenomenology, neurobiology and therapy. They are mutually interacting, and the interaction has significant treatment and outcome implications.

Diagnosing bipolar disorder : how can we do it better?

• Accurate diagnosis of bipolar disorder is essential for effective treatment.

• The diagnosis of bipolar disorder is particularly complex, resulting in lengthy delays between first presentation and initiation of appropriate therapy. Inappropriate therapy destabilises the course and outcome of the disease.

• Although the defining features of bipolar disorder are manic or hypomanic episodes, patients typically present for treatment of depression and commonly deny symptoms of mood elevation.

• A correct diagnosis can easily be masked by comorbidities, personality issues and complex phenomenology.

• A diagnosis of bipolar disorder can be assisted by:

   → asking about symptoms of mania or hypomania in every patient presenting with symptoms of depression.

   → recognising mixed states in which manic and depressive symptoms occur simultaneously.

   → identifying the features of bipolar depression that distinguish it from unipolar depression.

• There is a risk of over-diagnosis of bipolar disorder among patients who are histrionic, show abnormal illness behaviour MJA 2006; 184: 459–462 and/or have issues of secondary gain.

The validity and internal structure of the bipolar depression rating scale (BDRS): data from a clinical trial of N-acetylcysteine as adjunctive therapy in bipolar disorder

Background: The phenomenology of unipolar and bipolar disorders differ in a number of ways, such as the presence of mixed states and atypical features. Conventional depression rating instruments are designed to capture the characteristics of unipolar depression and have limitations in capturing the breadth of bipolar disorder.

Method: The Bipolar Depression Rating Scale (BDRS) was administered together with the Montgomery Asberg Rating Scale (MADRS) and Young Mania Rating Scale (YMRS) in a double-blind randomised placebo-controlled clinical trial of N-acetyl cysteine for bipolar disorder (N = 75).

Results: A factor analysis showed a two-factor solution: depression and mixed symptom clusters. The BDRS has strong internal consistency (Cronbach's alpha = 0.917), the depression cluster showed robust correlation with the MADRS (r = 0.865) and the mixed subscale correlated with the YMRS (r = 0.750).

Conclusion: The BDRS has good internal validity and inter-rater reliability and is sensitive to change in the context of a clinical trial.

Influence of grain size on twinning in two hcp metals

Deformation twinning behaviour in differently grain sized samples of a commercial pure titanium and a magenisum alloy is investigated. In some aspects the phenomenology of twinning differs between the two materials while in others both materials show a similar response. Nucleation density per unit of nucleating interface and twin aspect ratio scale with applied stress. The impact of grain size on twin volume fraction is modelled analytically.

Photography at the chiasm

 This paper works across a number of theories from phenomenology, 'ecological perception' and psychogeography to demonstrate from recent experiments how contemporary photomedia qua the static image, deals with being (noun and verb), and moving, in space. The author presents research findings from inviestigations into photography employing slow shutter speeds and axial panning to render 2D images of 3D spatial effects to show how with one-eyed viewing the images effectively restore the spatial relationships and observer location of the photographed situation.

Gyration

European Renaissance and Romantic landscape appeared in vistas. The conditions of the industrial revolution and, according to Patrick Maynard and Jonathon Crary, the film camera especially, led to a Modernist re-vision vividly recorded in Xavier Herbert’s contrary Modernist vision, prompted by seeing the Australian bush, its ‘... stunted trees, the mulga and the wilga and the gimlet gum, doing a kind of dance, spinning past, seeming to swing away from the train to the horizon and race ahead, to come back...the same set of trees in endless gyration’.

Ways in which 'community' benefits frail older women's well-being : '... we are much happier when we feel we belong'

Aim: This paper aims to explore frail older women’s lived experiences of ‘community’ and which aspects of ‘community’ they perceive as beneficial to their well-being.

Method: This qualitative project used a mixed methodological approach which integrated aspects of descriptive phenomenology and grounded theory. Ten frail, older women residing in South East Melbourne, Australia participated in in-depth interviews.

Results: This research obtained a rich and detailed account of the aspects of ‘community’ identified by participants as enhancing their well-being. These included: social contact, community dynamics, feelings of support and positive orientation.

Conclusion: This paper has increased our understanding of the factors supporting well-being of frail older women. Service providers should actively consider how they can strengthen these factors to improve social connectedness for frail older women by the use of volunteers, developing social networks and increasing availability and quality of community-based activities.

A Steinian approach to an empathic understanding of hope among patients and clinicians in the culture of palliative care

Aim. This article presents a discussion of empathy in the context of human person, reason and hopes in the clinical setting.

Background. Empathy was introduced to nursing as part of an ethical and philosophical foundation for caring. It helped to solve the tension and meet the demands that empathy placed upon nursing practice.

Data sources. This article is based on two studies undertaken between 2008 and 2010 to understand the concept of hope and empathy among people with terminal cancer and doctors who care for them. Doctoral dissertations and theses of Edith Stein (1916–1917), Marianne Sawicki [Body, Text and Science. The Literary of Investigative Practices and the Phenomenology of Edith Stein (1997) Kluwer Academic Publisher, Dordrecht], and Sister M. Judith Parsons (2005) have been used to examine: ‘the essence of acts of empathy’, ‘the constitution of the psycho-physical individual’ and ‘empathy as understanding of intellectual persons’. CINAHL, MEDLINE and PROQUEST have provided further supporting data.

Discussion. Steinian empathy requires that we use affective resonance, cognitive understanding and distance, as we grasp another person’s emotional and situational reality while in the caring role as nurses.

Implications for current nursing. Steinian empathy is about recognizing a lived experience and standing side-by-side with that person. Nurses can transmit this knowledge to enable and support courage and wisdom to reduce feelings of helplessness when caring for people with terminal illness.

Conclusion. Not only is empathy a safe and permissible emotion, it is the linchpin to a caring patient–nurse relationship and we must embrace this.

Sensitivity of deformation twinning to grain size in titanium and magnesium

The impact of grain size on deformation twinning in commercial purity titanium and magnesium alloy Mg–3Al–1Zn (AZ31) is investigated. Tensile tests were carried out for the titanium samples; compression testing was employed for the magnesium specimens. Average values of the true twin length, true twin thickness and the number density of twins were determined using stereology. A key difference between these two materials is that twinning contributes little to the plastic strain in the titanium while it accounts for nearly all of the early plastic strain in the magnesium. In some respects (e.g. volume fraction and number density) the phenomenology of twinning differed between the two materials, while in others (e.g. twin shape and size) both materials showed a similar response. It is found that in both materials, twins span the entirety of their parent grains only for grain sizes less than ∼30 μm. Both the nucleation density per unit of nucleating interface (i.e. grain and twin boundaries) and the aspect ratio of twins scale with applied stress. The impact of grain size on twin volume fraction is modelled analytically.

Depression and sickness behavior are Janus-faced responses to shared inflammatory pathways

It is of considerable translational importance whether depression is a form or a consequence of sickness behavior. Sickness behavior is a behavioral complex induced by infections and immune trauma and mediated by pro-inflammatory cytokines. It is an adaptive response that enhances recovery by conserving energy to combat acute inflammation. There are considerable phenomenological similarities between sickness behavior and depression, for example, behavioral inhibition, anorexia and weight loss, and melancholic (anhedonia), physio-somatic (fatigue, hyperalgesia, malaise), anxiety and neurocognitive symptoms. In clinical depression, however, a transition occurs to sensitization of immuno-inflammatory pathways, progressive damage by oxidative and nitrosative stress to lipids, proteins, and DNA, and autoimmune responses directed against self-epitopes. The latter mechanisms are the substrate of a neuroprogressive process, whereby multiple depressive episodes cause neural tissue damage and consequent functional and cognitive sequelae. Thus, shared immuno-inflammatory pathways underpin the physiology of sickness behavior and the pathophysiology of clinical depression explaining their partially overlapping phenomenology. Inflammation may provoke a Janus-faced response with a good, acute side, generating protective inflammation through sickness behavior and a bad, chronic side, for example, clinical depression, a lifelong disorder with positive feedback loops between (neuro)inflammation and (neuro)degenerative processes following less well defined triggers.

Hope through the viewfinder : patients with cancer and their clinicians

Hope-work is a viatl part of palliative care and this thesis aimed to increase understanding of the concept of hope, from the patients' and clinicians' points of view. Findings from descriptive and interpretative phenomenology revealed much about the way people consider hope, and maintain positivity when facing death.