Holistic obstetrics: the origins of "natural childbirth" in Britain.
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The term "natural childbirth" denotes an approach to childbirth characterised by a bias towards physical and mental hygiene in the management of pregnancy and labour. It emerged in Britain in the interwar period, partly as a response to the growing interventionism of mainstream obstetrics. Its appeal since then has rested on the belief that it could provide a holistic approach to maternity care, capable of addressing the needs of the "whole" patient. At the same time, "natural childbirth" has provided a means of expressing anxieties about the social, economic and political upheavals of the 20th century. This paper explores this complex set of beliefs and practices by examining the ideas of some British pioneers. (+info)
Cancer patients' needs during hospitalisation: a quantitative and qualitative study.
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BACKGROUND: The evaluation of cancer patients needs, especially during that delicate period when they are hospitalized, allows the identification of those areas of care that require to be improved. Aims of the study were to evaluate the needs in cancer inpatients and to improve the understanding of the meanings of the needs expressed. METHODS: The study was conducted during a "sample day", with all the cancer patients involved having been hospitalized at the Istituto Nazionale Tumori of Milan (INT) for at least 48 hours beforehand. The study was carried out using quantitative and qualitative methodologies. The quantitative part of the study consisted in making use of the Needs Evaluation Questionnaire (NEQ), a standardized questionnaire administered by the INT Psychology Unit members, supported by a group of volunteers from the Milan section of the Italian League Against Cancer. The aim of the qualitative part of the study, by semi-structured interviews conducted with a small sample of 8 hospitalized patients, was to improve our understanding of the meanings, implications of the needs directly described from the point of view of the patients. Such an approach determines the reasons and conditions of the dissatisfaction in the patient, and provides additional information for the planning of improvement interventions. RESULTS: Of the 224 eligible patients, 182 (81%) completed the questionnaire. Four of the top five needs expressed by 40% or more of the responders concerned information needs (diagnosis, future conditions, dialogue with doctors, economic-insurance solutions related to the disease). Only one of the 5 was concerned with improved "hotel" services (bathrooms, meals, cleanliness). Qualitative analysis showed that the most expressed need (to receive more information on their future conditions) has the meaning to know how their future life will be affected more than to know his/her actual prognosis. CONCLUSIONS: Some of the needs which emerged from this investigation could be immediately satisfied (the need for psychological support, the need for economic aid, the need for spiritual support), while others will have to be faced in the longer term; for example, the presence of a high percentage of needs in patient-physician relationships and/or information-communication issues, could be resolved by setting up structured introductory training courses for all clinicians in the institution. On the other hand, the needs related to the living infrastructure (bathrooms, meals, etc.) could encourage the Institution to improve its services. (+info)
The complete paediatrician: attributes of good practice.
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The attributes which the author considers help to make up good paediatric practice are discussed. Some of the problems associated with their achievement are examined. All of these ingredients can never be possessed by any one of us though each of us should have them as our aim. Their full spectrum, to be evident in practice, needs us to be members of a team. (+info)
How important is personal care in general practice?
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OBJECTIVES: To explore patients' perceptions of the features of personal care and how far these are shared by healthcare providers; whether a continuing relationship between a health professional and a patient is essential for personal care; and the circumstances in which a continuing relationship is important. DESIGN: Qualitative analysis of semistructured interviews using the "framework" approach. SETTING: Six general practices in Leicestershire. PARTICIPANTS: 40 patients aged > or = 18 years, 13 general practitioners, 10 practice and community nurses, and six practice administrative staff, recruited through participating practices. RESULTS: Patients' and healthcare providers' accounts cited human communication, individualised treatment or management, and whole person care as features of personal care. Personal care was described in three different contexts-a continuing relationship, a single consultation, and from the practice as a whole. The extent to which a continuing relationship was important for personal care was determined by the reason for consulting, as well as patients' consulting history and lifestyle. CONCLUSIONS: Patients, general practitioners, primary care nurses, and administrative staff hold similar views on the meaning of personal care, despite differences of emphasis reflecting their different roles. Personal care is promoted by but not always dependent on a continuing provider-patient relationship; human communication and individualised care emerged as important in making care personal whatever the context. Most respondents valued relationships in primary care and had clear ideas about when care in the context of a relationship was most valuable. (+info)
Practical treatment of wound pain and trauma: a patient-centered approach. An overview.
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Chronic wound pain is distressing and influences the patient's ability to function. One of the failures of modern medicine is the inadequate assessment and treatment of pain. The clinician's approach to chronic wound pain combines the "preparing the wound bed" paradigm with chronic wound pain models. A holistic approach must include the diagnosis and treatment of the underlying cause, identification and correction of patient-centered concerns, and the three major components of local wound care (debridement, bacterial balance/prolonged inflammation, and moisture balance). The Krasner pain model defines chronic (persistent), noncyclic acute, and cyclic acute wound pain. Chronic persistent wound pain without an event or trigger often relates to the cause of the wound that needs to be corrected to relieve the pain. Noncyclic acute pain is often experienced with a surgical procedure such as sharp debridement. Cyclical acute pain may occur repeatedly with removal or application of new local wound dressings. Securing a thorough pain history focusing on pain patterns will help healthcare professionals develop specific pain relief initiatives. Pain is a component of quality of life. Patient-centered concerns need to address pain control measures until the cause of the pain can be corrected. Controlling pain, however, may not always improve quality of life scores. Each of the components of local wound care also may be responsible for the production of pain; strategies need to be implemented to ensure adequate patient comfort. (+info)
Transcending reductionism in nutrition research.
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The reductionist approach has traditionally been and continues today as the dominant approach in nutrition research. This means that parts of diet rather than the whole, or single food components rather than food habits, are studied. Even though much progress has been made with this approach, the relationship between diet and health is not yet fully understood. With the recognition about the whole being more than the sum of its parts, the limitations on the applicability of the reductionist approach, and the growing knowledge about parts of diet, another epistemological approach, such as holism, and new research strategies, such as transdisciplinarity, are needed to reveal more about the relationship between diet and health. (+info)
Quality of life as medicine. II. A pilot study of a five-day "quality of life and health" cure for patients with alcoholism.
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Alcoholism can be understood as a self-treatment for existential pain. A 5-day treatment was designed to relieve this psychological pain and existential anxiety, and thereby diminish the need for self-treatment with alcohol. The basic principle behind the treatment was holistic, restoring the quality of life (QOL) and relationship with self, which according to the life mission theory happens when life-denying views are corrected and inner emotional conflicts are solved. The method in this treatment was a course with teachings in philosophy of life, psychotherapy, and body therapy. The synergy attained was considerable and the outcome demonstrates that in the course of 1 week, people have time to revise essential life-denying views and to integrate important, unfinished life events involving negative feelings. This was demonstrated by an improved QOL and a decrease in their dependency and need for alcohol abuse. In the week before, after the 5-day course, and again after 1 and 3 months, the 16 participants completed the SEQOL questionnaire on QOL and health. This was a pilot study based on a pre-experimental design, without a control group and without clinical control. Common for the group were a low QOL, numerous health problems, and alcohol dependency in spite of treatment with Antabus (disulfiram). The study showed an increase in QOL from 57.6% before the course to 69.4% 3 months after the course, or an improvement in QOL of 11.8%. There was a 24.0% improvement in self-perceived mental health, and satisfaction with health in general was improved by 11.1%. The total sum of health symptoms in the group was reduced from 59% of maximum to 33%. It is concluded that for this small and motivated group with alcohol problems, it was possible to improve QOL and health in only 5 days with a holistic treatment that combined philosophy of life, psychotherapy, and body therapy, but the results are not final. Further research is needed. (+info)
Contextual influences on reproductive wellness in northern India.
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OBJECTIVES: There has been a growing recognition of the importance of contextual influences on health outcomes. This article examines community-level influences on 5 reproductive wellness outcomes in Uttar Pradesh, India. METHODS: Multilevel modeling is used to estimate household and community-level effects on wellness, with hierarchically organized data from a statewide survey of villages, urban blocks, households, women, health providers, and staff. RESULTS: The household and community have a strong contextual influence on wellness, although the models explain more of the variation in outcomes between households than between communities. CONCLUSIONS: Communities influence wellness outcomes through the socioeconomic environment and the characteristics of the health infrastructure. The specific dimensions of the community and health infrastructure varied between the outcomes. (+info)