OBJECTIVE: To describe the unique aspects of childhood grief. To provide a framework for family physicians to use in assisting children to grieve. QUALITY OF EVIDENCE: A MEDLINE search from 1966 to 1999 using the key words children, childhood, grief, mourning, and bereavement revealed mainly expert opinion articles, some non-randomized observational studies, and retrospective case-control studies. MAIN MESSAGE: Although children are influenced by similar factors and need to work through the same tasks of grief as adults, their unique psychological defences and evolving cognitive and emotional development make their grieving different from adults'. Understanding these unique childhood features will allow family physicians to more effectively help children through the tasks of acknowledging a death, working through the pain of that death, and accommodating it. CONCLUSIONS: With a framework for grief counseling that incorporates unique features of children's mourning, family physicians will be in a better position to assist their young bereaved patients. (+info)
On becoming non-judgmental: some difficulties for an ethics of counselling.
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The growth in the availability of counselling services has been accompanied by growing concern about the conduct of counsellors, which in turn has led to the expressed need for an ethics of counselling. This paper will argue that there is an inherent tension between this need and the central tenets of one variety of counselling, client-centred counselling. The tension is identifiable on the basis of an inquiry into the nature of moral judgment which results in the recognition of the implicit value base in client-centred counselling. It is only when this value base is made explicit that any adequate ethics of counselling becomes a viable possibility. (+info)
Pregnancy, autonomy and paternalism.
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Modern medicine is increasingly aware of the significance of patient autonomy in making treatment choices. This would seem to be particularly important where the therapy requested was "voluntary" as in fertility treatment or cosmetic surgery. However, the Hippocratic doctrine "Primum non nocere", seems especially relevant where the treatment sought may have a low chance of a successful outcome or even be life-threatening. Mrs A's case demonstrates the difficulty faced by the physician who wants to maximise her patient's autonomy, but "Above all, do no harm". (+info)
Counselling couples and donors for oocyte donation: the decision to use either known or anonymous oocytes.
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In order to avoid a long waiting period, the Centre for Reproductive Medicine of the Free University of Brussels suggests that couples in need of donor oocytes search for a donor among family and friends. Recipient couples can choose between two types of donation: known donation, i.e. treatment with the oocytes of the donor recruited by the couple, or anonymous donation, i.e. an exchange of the donor recruited by the couple with a donor recruited by another couple in order to ensure anonymity between donor and recipients. In total, 144 couples were counselled by a psychologist in the decision-making process with regard to the kind of donation to be used. Some 68.8% of the recipient couples preferred known donation. This choice was mainly motivated by reasons related to fears associated with anonymity, such as fear of the unknown origin of genetic material and the trust that couples had in 'their' donor. Almost one-third of the couples opted to use anonymous oocytes. The desire to establish explicit boundaries between the two families involved was the major motivation for this choice. Approximately 44% of the couples were willing to tell the child about the oocyte donation. (+info)
Does an employee assistance programme benefit employers and employees alike?
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EAPs are not a psychological sticking plaster. They are a clinically and corporately balanced service which benefits the employee, via the direct services and the employer, via the feedback in the form of usage statistics derived from the continuous tracking of the account through which organizational and employment issues are identified. Well positioned EAPs offer employees confidential counselling, and information services including legal, financial and child-based issues and are able to offer employers tailored training and consultancy. (+info)
Implementation of guidelines for HIV counseling and voluntary HIV testing of pregnant women.
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OBJECTIVES: This study assessed HIV counseling and testing among pregnant women. METHODS: A survey was administered to 9115 women who gave birth at 66 Chicago-area hospitals in 1997 and 1998. RESULTS: Fifty-eight percent of the women received HIV counseling, and 65% were offered testing. Fifty-six percent were tested for HIV. Among the women tested, 88% were given their test result. Women were more likely to be tested if they received HIV counseling and were more likely to be offered testing if they received such counseling. CONCLUSIONS: Rates of HIV counseling for, and offers of testing to, pregnant women need to be increased. (+info)
The oral effects of smokeless tobacco.
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Smokeless tobacco use has increased rapidly in North America. This form of tobacco use has many oral effects including leukoplakia, oral cancer, loss of periodontal support (recession), and staining of teeth and composite restorations. Systemic effects such as nicotine dependence, transient hypertension and cardiovascular disease may also result from smokeless tobacco use. This paper aims to guide dental practitioners in identifying oral lesions that occur due to the use of smokeless tobacco and also offer guidelines on how to counsel patients who express a desire to stop using smokeless tobacco products. (+info)
Qualitative study of interpretation of reassurance among patients attending rheumatology clinics: "just a touch of arthritis, doctor?".
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OBJECTIVES: To examine commonly used methods of reassurance by clinicians and explore their effect on patients. DESIGN: Qualitative study of tape recordings of in-depth, semistructured interviews with patients before and after consultation and of their consultations with doctors. SETTING: NHS specialist rheumatology clinics in two large British cities. PARTICIPANTS: 35 patients selected by consultant rheumatologists from general practitioner referral letters (28 women, 7 men; 24 with inflammatory arthropathies, 11 other rheumatological complaints). MAIN OUTCOME MEASURES: Patients' perceptions of reassurance. RESULTS: Reassurance was an important part of consultations, whether the diagnosis was clear or uncertain. Clinicians tried to reduce anxiety by emphasising the mildness, early stage, or non-seriousness of the disorder and the likelihood that patients would recover. Patients interpreted reassurance in the context of their own views and perceptions. Doctors' emphasis on the mildness or earliness of the condition raised the spectre of future pain and disability rather than providing reassurance. Patients who felt that their problems were properly acknowledged felt more reassured. CONCLUSIONS: Typical patterns of reassurance were not successful because of the differences in perspective of patients and doctors. A key to successful reassurance seemed to be the doctor's ability to acknowledge patients' perspectives of their difficulties. (+info)