Empowering counseling--a case study: nurse-patient encounter in a hospital.
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This study illustrates practices that a nurse uses in order to empower patients. The emphasis is on speech formulae that encourage patients to discuss their concerns and to solicit information about impending surgery. The study is a part of a larger research project and a single case was selected for presentation in this article because it differed from the rest of the data by manifesting empowering practice. A videotaped nurse-patient health counseling session was conducted in a hospital and transcribed verbatim. The investigator interviewed the nurse and the patient after the conversation, and these interviews were transcribed as well. The encounter that is presented here as a case study is a concrete example of a counseling session during which the patient is free to discuss with the nurse. The empowering practices that the nurse employed were as follows: encouraging the patient to speak out, tactfully sounding out the patient's concerns and knowledge of impending surgery, listening to feedback, and building a positive vision of the future for the patient. We suggest that nurses should pay attention to verbal expression and forms of language. This enables them to gain self-awareness and discover new tools to work with. (+info)
The motor output and behavior produced by rhythmogenic sacrocaudal networks in spinal cords of neonatal rats.
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The characteristics of the rhythmic motor output and behavior produced by intrinsic sacrocaudal networks were studied in isolated tail-spinal cord preparations of neonatal rats. An alternating left-right rhythm could be induced in the sacral cord by stimulus trains applied to sacrocaudal afferents at various intensities. Strengthening the stimulation intensity enhanced the rhythmic efferent firing and accelerated the rhythm by < or =30%. High stimulation intensities induced tonic excitation or inhibition and thereby perturbed the rhythm. Increasing the stimulation frequency from 1 to 10 Hz decreased the cycle time of the rhythm by 36%. The rhythm was blocked during prolonged afferent stimulation but could be restored by stimulation of contralateral afferents. Sacrocaudal afferent activation produced ventroflexion accompanied by either low- or high-amplitude rhythmic abduction of the tail. The low-amplitude abductions were produced by alternating flexor bursts during long stimulus trains. The activity of abductors and extensors was substantially reduced during these trains, their recruitment lagged after that of the flexors, and their activity bursts were much shorter. It is suggested that tail extensor/abductor motoneurons were suppressed during the stimulus train by inhibitory afferent projections. The high-amplitude abductions appeared after cessation of stimulus trains. Alternating left-right activation of the tail muscles, and coactivation of the principal muscles on each side of the tail were observed during these abductions. It is suggested that flexors and extensors assist the abductors to produce the high-amplitude abductions. This suggestion is supported by the finding that tail abduction could be produced by direct unilateral stimulation of any of the principal tail muscles. The relevance of the findings described in the preceding text to the use of regional sacral circuits in generation of stereotypic motor behaviors and to future studies of rhythmogenic sacrocaudal networks is discussed. (+info)
Throwing accuracy in the vertical direction during prism adaptation: not simply timing of ball release.
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In a previous study, others have hypothesized that the variance in vertical errors that occurs while throwing at visual targets is caused by changes in any of three throw parameters: hand location in space, hand translational velocity, and hand orientation. From an analysis of skilled throwers, those authors concluded that vertical error is best correlated with variance in hand orientation, which in turn is related to the timing of ball release. We used a vertical prism adaptation paradigm to investigate which of these throwing parameters subjects use when adapting to external perturbation. Our subjects showed no correlation between hand position or hand translational velocity and ball impact height in normal, over-practiced throwing. However, video-based motion analysis showed that modifications both of position and speed of the hand play an important role when subjects are forced to compensate for a vertically shifting prism perturbation during a dart-like throw (these factors contribute approximately 30% of the adaptation). We concluded that, during adaptation, more degrees of freedom and more sources of potential error are modified to achieve the gaze-throw recalibration required to hit the target than are employed in this type of throw during normal conditions. (+info)
Correlation of abnormal intracranial vessel velocity, measured by transcranial Doppler ultrasonography, with abnormal conjunctival vessel velocity, measured by computer-assisted intravital microscopy, in sickle cell disease.
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The Stroke Prevention Trial has confirmed that utilization of transcranial Doppler ultrasonography (TCD), which examines blood flow in large intracranial vessels, can identify children with sickle cell disease (SCD) who are at high risk of developing a premature stroke. It is not known to what extent the vasculopathy in SCD involves small vessels and whether the abnormalities, if present, correlate with large-vessel vasculopathy. Eighteen children with SCD were examined with TCD to determine middle cerebral artery (MCA) velocity and computer-assisted intravital microscopy (CAIM) to determine bulbar conjunctival vessel velocity during the same visit for vasculopathy correlation. High MCA velocity (> or = 200 cm/sec) was found by TCD in 4 patients who also showed abnormal conjunctival velocity (< 0.2 mm/sec or intermittent trickle flow) by CAIM. Three patients had conditional (> or = 170 cm/sec and < 200 cm/sec) MCA velocity: 2 showed abnormal (trickle) and 1 showed normal conjunctival velocity (1.9 mm/sec). One patient with unmeasurable MCA velocity had abnormal (trickle) conjunctival velocity. Of the remaining 10 patients who had normal MCA velocity, 2 showed abnormal (0.05 mm/sec and 0.1 mm/sec) and 8 showed normal conjunctival velocities (1.1-2.4 mm/sec). The MCA velocities correlated significantly with bulbar conjunctival flow velocities (P < or =.008, Fisher exact test). A correlation exists between MCA (large-vessel) and conjunctival (small-vessel) flow velocities. CAIM is a noninvasive quantitative technique that might contribute to the identification of SCD patients at high risk of stroke. Small-vessel vasculopathy might be an important pathological indicator and should be further explored in a large-scale study. (Blood. 2001;97:3401-3404) (+info)
Interaction of angiotensin II and nitric oxide in isolated perfused afferent arterioles of mice.
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The present study was performed to evaluate angiotensin II (Ang II)-nitric oxide (NO) interaction in afferent arterioles (Af) of wild-type mice and mice that are homozygous (-/-) for disruption of the endothelial NO synthase (eNOS) gene. Af were microperfused, and the dose responses were assessed for the NO precursor L-arginine (n = 4), NO inhibitor NG-nitro-L-arginine methyl ester (L-NAME, n = 5), L-NAME after pretreatment with L-arginine (n = 5), Ang II (n = 8), and Ang II after pretreatment with L-NAME (n = 7). Acute administration of L-arginine and L-NAME (both in doses from 10(-6) to 10(-3) mol/L) did not change arteriolar diameter. Moreover, pretreatment with L-arginine did not change the response to L-NAME. However, Ang II, applied in doses of 10(-12), 10(-10), 10(-8), and 10(-6) mol/L, significantly reduced the lumen to 66.5 +/- 7.0% and 62.2 +/- 8.0% at 10(-8) and 10(-6) mol/L Ang II, respectively. The contraction was augmented after L-NAME pretreatment (19.5 +/- 13.6% and 25.5 +/- 10.2% at 10(-8) and 10(-6) mol/L Ang II, respectively). In eNOS (-/-) mice (n = 8), the response to Ang II also was enhanced (9.1 +/- 6.0% and 11.2 +/- 8.2% at 10(-8) and 10(-6) mol/L Ang II, respectively). Female mice did not differ from male mice in their reactivity to Ang II (n = 9) and Ang II + L-NAME pretreatment (n = 11). The study shows that (1) it is feasible to microperfuse mouse Af, (2) the basal production of endothelial NO is very low and not inducible by L-arginine in Af of mice, and (3) a counteracting effect of NO is initiated by Ang II. High Ang II sensitivity in eNOS (-/-) mice underscores the considerable role of endothelial-derived NO to balance Ang II vasoconstriction in Af. (+info)
Cross-cultural implementation of a Chinese version of the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) in Taiwan.
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BACKGROUND: There are no published reports of cross-cultural equivalence and interrater reliability at the level of individual symptom items assessed by a semi-structured clinical interview employing operationalised clinician ratings. AIMS: To assess the cross-cultural clinical equivalence and reliability of a Chinese version of the World Health Organization Schedules for Clinical Assessment in Neuropsychiatry (SCAN). METHOD: UK-US and Taiwanese groups of psychiatrists used Chinese and English transcripts of videotape interviews of Taiwanese patients to discuss cross-cultural issues and ratings of SCAN items. Item ratings were compared quantitatively individually and pooled by SCAN section. RESULTS: Chinese equivalents were found for all SCAN items. No between-group differences were found for most individual items, but there were differences for some scaled items. Average agreement between the two groups was 69-100%. CONCLUSIONS: Cross-cultural implementation based on SCAN in Taiwan appears valid. (+info)
Mother-infant interaction at 12 months in prenatally cocaine-exposed children.
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This study examined mother-infant interactions of 12-month-old African-American prenatally cocaine-exposed infants and their mothers. Videotaped observations were made during a free-play dyadic interaction, a brief separation, and a reunion period. Videotapes were coded for maternal and child behaviors during each phase of the procedure. Although there were few differences in interactive behaviors between prenatally cocaine-exposed and nonexposed children and their mothers, children who were prenatally exposed to cocaine ignored their mother's departure (odds ratio [OR] = 3.0, p < .05) during separation significantly more often than nonexposed subjects. In addition, mothers who abused cocaine engaged in significantly more verbal behavior (F(2,104) = 7.00, p < .001) with their children than mothers of nonexposed children. These findings indicate that women who used cocaine during pregnancy may not differ from nonusers in their interactions with their 12-month-old infants. (+info)
The evaluation of two methods to facilitate shared decision making for men considering the prostate-specific antigen test.
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OBJECTIVE: California law (Grant H. Kenyon Prostate Cancer Detection Act) requires physicians to inform all patients older than aged 50 years who receive a prostate examination about the availability of the prostate-specific antigen (PSA) test. Physicians are not given guidance on how this information should be presented. We sought to evaluate the effects upon PSA screening rates of informing patients about PSA testing by 2 different techniques. DESIGN: Factorial comparison of discussion versus video formats for presenting information about the PSA test. SETTING: Patients were recruited through the Health Appraisal screening program in the Department for Preventive Medicine, Kaiser Permanente, San Diego, Calif. PARTICIPANTS: Male patients undergoing health appraisal screening participated in 1 of 4 groups providing information about PSA screening: usual care ( n=43), discussion about risks and benefits of PSA ( n=45), shared decision-making video ( n=46), or video plus discussion ( n=42). Participants were sequentially assigned to 1 of the 4 groups. RESULTS: No significant differences in demographics or family history was demonstrated between the groups at the time of group assignment. Participants in the intervention groups rated the information as clear, balanced, and fair. There were significant differences in the number of men requesting a PSA test, with the highest rate in the usual care group (97.7%), followed by discussion (82.2%), video (60.0%), and video plus discussion (50.0%). CONCLUSION: Providing information about PSA screening in the form of video or discussion is feasible and significantly alters PSA screening rates. (+info)