Role of spirituality in patients with sickle cell disease.
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BACKGROUND: Patients with sickle cell disease cope with their disease in various ways, such as psychological counseling, hypnosis, medication, and prayer. Spirituality is a coping mechanism in a variety of diseases. This study evaluates the role of spirituality in patients coping with the pain of sickle cell disease. METHODS: Seventy-one patients from the Georgia Sickle Cell Clinic completed a questionnaire addressing their ability to cope with the pain of sickle cell disease and their degree of spirituality. A descriptive cross-sectional design was used. Correlation and multiple regression analyses were calculated for the relation between coping with the pain of sickle cell disease and spirituality. RESULTS: The questionnaire provided several scales with high internal consistency for measuring spiritual well-being and its two components, existential well-being and religious well-being, that show a correlation between high levels of spirituality and life control. The study population exhibited high levels of spirituality and religiosity, but the influence of these feelings on coping with sickle cell disease was variable. Spiritual well-being was correlated with life-control but not with perceived pain severity. CONCLUSIONS: Existential well-being was associated with general coping ability. Spiritual well-being is important for some patients who must cope with the pain of sickle cell disease. (+info)
Behaviour of the dying patient.
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One hundred and ten dying patients were studied during the 24 hours before death and 250 patients during the weeks before death: 60% were well orientated in time and space 24 hours before death and 26% at 15 minutes before death. A control group of patients with serious, but not fatal, illness were also studied. There was a contrast in attitude to death between the dying patients and the ill but not dying controls. The dying were resigned to their approaching death, experienced little or no fear, and did not wish to know about their illness, whereas the control patients wanted information about their condition and feared death, though few thought they would actually die. The relief of physical symptoms in the dying is important. There was often a brief improvement in condition, with reduced need for analgesic, shortly before death. (+info)
Putting suffering into perspective: implications of the patient's world view.
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The need for suffering patients to reexamine their assumptions about life presents therapists with unique challenges and opportunities. Patients with a religious world view often struggle with whether God cares about, or has sent, their pain. Atheistic patients also search for the meaning in their lives but reject the answers offered by traditional authorities. Patients who are uncertain or ambivalent about their world view may challenge a therapist to provide an audience, insight, or direction. Using case examples, the author explores the therapist's role in helping patients with differing world views to integrate their suffering. (+info)
Losing God.
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Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded the Kenneth B. Schwartz Center. The Schwartz Center is a non-profit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient, support to caregivers, and sustenance to the healing process. The center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. Nebulous language, distrust, and dogma confound spiritual aspects of cancer care. However, existential well being is an important determinant of quality of life: finding meaning and purpose make suffering more tolerable. The case presented is of a patient who experienced "losing God" as a Hodgkin's disease survivor with metastatic prostate cancer and severe coronary artery disease. His caregivers were able to provide the sense of community in which he could re-establish his faith. Health care providers do not have to be religious in order to help patients to deal with a spiritual crisis. The clinical skills of compassion need to be deployed to diagnose and respond to spiritual suffering. Acknowledging and addressing anger or guilt, common sources of suffering, are essential to adjustment. Simply being there for the patient and being open to their hurt can help resolve their spiritual crisis, a responsibility that is shared by the whole health care team. (+info)
Assessing elemental mercury vapor exposure from cultural and religious practices.
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Use of elemental mercury in certain cultural and religious practices can cause high exposures to mercury vapor. Uses include sprinkling mercury on the floor of a home or car, burning it in a candle, and mixing it with perfume. Some uses can produce indoor air mercury concentrations one or two orders of magnitude above occupational exposure limits. Exposures resulting from other uses, such as infrequent use of a small bead of mercury, could be well below currently recognized risk levels. Metallic mercury is available at almost all of the 15 botanicas visited in New York, New Jersey, and Pennsylvania, but botanica personnel often deny having mercury for sale when approached by outsiders to these religious and cultural traditions. Actions by public health authorities have driven the mercury trade underground in some locations. Interviews indicate that mercury users are aware that mercury is hazardous, but are not aware of the inhalation exposure risk. We argue against a crackdown by health authorities because it could drive the practices further underground, because high-risk practices may be rare, and because uninformed government intervention could have unfortunate political and civic side effects for some Caribbean and Latin American immigrant groups. We recommend an outreach and education program involving religious and community leaders, botanica personnel, and other mercury users. (+info)
Reply to Ann Bradshaw.
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My original paper suggested that an ethics of care which failed to specify how, and about what, to care would be devoid of normative and descriptive content. Bradshaw's approach provides such a specification and is, therefore, not devoid of such content. However, as all ethical approaches suggest something about the 'what' and 'how' of care, they are all 'ethics of care' in this broader sense. This reinforces rather than undermines my original conclusion. Furthermore, Bradshaw's 'ethics of care' has philosophical and historical problems which I outline. (+info)
Record health care directives before terminal illness!
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Physicians share the grief and tension of families who must make decisions for incompetent, dying members. The author recorded the wishes of 1000 competent patients to guide families and the health care team during terminal illness. A questionnaire, which became part of the medical record, was used to determine views of organ donation, religious beliefs, and other directives. Patients were eager to record and discuss their wishes during an office or hospital visit; 94% of all patients wanted to participate in health care decisions. When directives for terminal care are available, families will not be forced to make blind crisis decisions for a dying member. (+info)