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Constructivist grounded theory methods were used to explore counseling engagement in clients with strong tendencies to avoid aversive emotion. Participants initially viewed counseling as a potentially adversarial and harmful relationship. An expectation and fear of judgment, as well as shame and self‐judgment, contributed to this view. Participants also reported anxiety about addressing specific issues. Their perceptions led to withholding of personal information and minimal engagement. The participants were initially susceptible to negative or fruitless counseling episodes. However, if a trusting therapeutic relationship developed, engagement increased. Trust developed if the participants perceived their counselors as non‐judgmental and genuine. Recognizing possible benefits—in addition to risks—of counseling also contributed to their decisions to engage. The participants reported that counseling helped change their perspectives. They eventually perceived and appreciated the benefits of emotional engagement. Implications for counselors are provided. [ABSTRACT FROM AUTHOR]

Purpose Although many older adults suffer from dysphagia and are required to eat texture-modified diets, little is known about the experiences and challenges faced in doing so at home. In this study, we explored the perspectives of community-dwelling older adults as they struggled to balance dysphagia symptoms and recommended diet modifications with their preferred lifestyles. Design and Methods Using an interpretive descriptive design, we conducted 37 in-home semi-structured interviews and 5 member-checking interviews, participant observations during a meal, and reviewed the medical charts of 20 participants recruited through maximum variation purposeful sampling. Meaning units and codes were identified and synthesized into 4 themes. Results Participants faced a frightening choice between eating and breathing. Hiding dysphagia symptoms from the public eye was important to preserve self-identity. Following the recommended diet created a feeling that life was “falling apart.” We also found that adhering to the diet was not an “all or none” phenomenon. Implications Given that correct adherence to the restrictive diet is rare, to effectively manage dysphagia symptoms, clinicians must appreciate the full range of impact of dysphagia and texture-modified diets on the lives of older adults. [ABSTRACT FROM AUTHOR]

Purpose: Traditional expectations of the single attending physician who manages a patient's care do not apply in today's intensive care units (ICUs). Although many physicians and other professionals have adapted to the complexity of multiple attendings, ICU patients and families often expect the traditional, single physician model, particularly at the time of end-of-life decision making (EOLDM). Our purpose was to examine the role of ICU attending physicians in different types of ICUs and the consequences of that role for clinicians, patients, and families in the context of EOLDM. Methods: Prospective ethnographic study in a university hospital, tertiary care center. We conducted 7 months of observations including 157 interviews in each of four adult critical care units. Results: The term 'attending physician' was understood by most patients and families to signify an individual accountable person. In practice, 'the attending physician' was an ICU role, filled by multiple physicians on a rotating basis or by multiple physicians simultaneously. Clinicians noted that management of EOLDM varied in relation to these multiple and shifting attending responsibilities. The attending physician role in this practice context and in the EOLDM process created confusion for families and for some clinicians about who was making patient care decisions and with whom they should confer. Conclusions: Any intervention to improve the process of EOLDM in ICUs needs to reflect system changes that address clinician and patient/family confusion about EOLDM roles of the various attending physicians encountered in the ICU. [ABSTRACT FROM AUTHOR]