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Background: Emotional distress is frequent in patients with acute traumatic hand injury during the first weeks after the accident. Knowledge of coping in relation to emotional distress could help to identify those who need support., Objectives: To describe the different kinds of coping used by patients in the early stage of recovery following an acute traumatic hand injury and to investigate differences in coping patterns in patients with and without symptoms of emotional distress., Design: Questionnaire survey with a descriptive and comparative design., Setting/participants: A total of 112 patients with acute traumatic hand injury requiring inpatient treatment at the hand surgical clinic. Those with injuries caused by a suicide attempt or with known drug abuse were excluded. Method/main outcome measures: The patients answered a postal questionnaire at home 1-2 weeks after the accident. Emotional distress was assessed with the Hospital Anxiety and Depression scale. Coping was measured with the Jalowiec Coping Scale-40., Results: Coping by "trying to keep the situation under control" and "trying to look at the problems objectively and see all sides" were most frequent. These strategies are typical for the confrontive coping style, which dominated in the actual illness-situation. Symptoms of emotional distress occurred in 32% of the patients. These patients used significantly more kinds of coping strategies and used confrontive and emotive coping strategies more often than the others. Coping by "hoping for improvement", "working tension off with physical activity", "trying to put the problem out of one's mind", "worrying", "getting nervous or angry" and "taking off by one self" were associated with emotional distress. Coping by "accepting the situation as it is" and "thinking that it is nothing to worry about" were more frequent in patients without emotional distress., Conclusions: Observations of the coping strategies associated with emotional distress in this study could help to identify patients in clinical practice that need nursing support. Coping associated with less emotional distress should be encouraged.

Recovery has been identified as a focus for mental health care. Recovery requires learning to live again after a life-altering acute event or during a chronic illness, mental or physical. By analyzing within-person change over time, utilizing multiple sources of evidence, two cases illustrated particular dimensions that influenced the recovery process after stroke, within a biopsychosocial framework. Restoration of the self, through co-occurring, dual processes of grief and reconstruction, appeared to be an essential dimension in the recovery process. Suggestions for integrating this concept into current adult clinical practice are congruent with current models of disease management of several chronic conditions.

Objectives: Studies examining the early postoperative period after endoscopic sinus surgery (ESS) are lacking. The objectives were to determine patient expectations of recovery following ESS and compare these expectations to actual outcomes., Study Design: A prospective study. An 11-item survey regarding recovery from anesthesia and sinonasal outcomes was administered after ESS over postoperative days (POD) #1, #7, and #14. Preoperative surveys established baseline levels and explored patient expectations of POD #1 outcomes., Results: Forty-six patients participated. Individual expectations generally did not correlate with POD #1 outcomes. Sinonasal symptoms, narcotic usage, and activity level (P < 0.05) demonstrated significant improvement over the postoperative period. Within one week, 75% of patients returned to work. By POD #14, nasal obstruction, discharge, fatigue, and overall health (P < 0.05) had improved over preoperative levels. Patients undergoing concomitant septoplasty had a more difficult postoperative course., Conclusion: Patient expectations of ESS vary widely, although this surgery is generally well tolerated with a brief recovery period., Ebm Rating: C-4.

Communication with patients and their relatives as well as with colleagues is an integrated part of nursing profession. In order to reach a satisfactory communication, nurses should be aware of some elementary psychological principles of social interaction. Prejudices, misunderstandings, stress, opposed characters and mentalities are often raising problems, which can only be overcome by one manner: to be on speaking terms. But how good are we in talking to and dealing with each other? What do patients require for their well-being besides an optimum medication? What is the impact of both human relations and social backgrounds on the process of convalescence? Discussing these questions and feasible answers, the conclusion has to be drawn, that there are indeed some options, which facilitate a satisfactory communication.

Major depression is a common illness, with a lifetime prevalence rate of 10-13% for men and 21-24% for women. The experience of having a serious illness such as major depression affects the individual's quality of life and requires significant adaptation in order to cope. The aim of this study was to explore sense of coherence and social support in patients treated for a first episode of major depression in a 1-year follow up. The study design was prospective and longitudinal. A total of 24 patients, aged 18 years or over, with a first episode of major depression were included. Semi-structured interviews and self-assessment questionnaires were used at baseline as well as in a 1-year follow up in order to measure the level of severity of the depression, social support, and sense of coherence. The result showed that 71% of the patients had recovered at follow up. The sense of coherence scores were low at baseline, although the patients who recovered increased their sense of coherence scores significantly. Another factor of importance for recovery was a significant increase in social support. Social support is an important cornerstone in the restoration of a person's sense of coherence. It can be used in interventions that include the patient's family or close social network in combination with support to assist the patient to view his/her situation as comprehensible, manageable, and meaningful, thereby promoting or improving health. Mental health nurses are in a key position to identify patients' strengths and weaknesses so that the support and interventions provided can be tailored to meet the needs of each patient.

The study gives a theoretical explanation of how people living with schizophrenia recover. The 41-participant study (clients, family and health professional) was conducted using the grounded theory approach, in three different settings. Based on analyses of the empirical data, the authors identified seven closely interrelated categories defining the participants' experiences and came up with a theory explaining how certain individuals manage to recover. Their theory may guide researchers and clinicians interested in understanding this phenomenon from a nursing point of view based on human responses to a disease.

Problem: Little is known about the conditions that must be in place to help adolescent patients and their families gain the confidence needed to continue recovery at home, following the adolescents' hospitalization for anorexia nervosa., Methods: Beliefs about discharge readiness were obtained through an open-ended questionnaire following the patients' first weekend pass home from an in-patient unit. The perceptions of patients, parents, and registered nurses were obtained using parallel versions of a questionnaire., Findings: An examination of the responses revealed four themes; medical stability, education, psychological changes, and community resource planning, that were common to all respondents, as well as themes specific to adolescents and to nurses., Conclusions: The findings suggest that each group of respondents has unique discharge readiness needs and that registered nurses have an important role to play in helping patients and families make the transition home as successful as possible. Implications for nursing practice are highlighted.

Very little is known about cardiovascular disease (CVD) in women and their specific needs throughout their recovery process. This study aimed to explore the experiences and adjustments of women following their first AMI. Naturalistic inquiry was used and six women were interviewed post their first AMI. Two major themes were identified: (1) 'the initial experience/event' which identifies events and emotions leading up to, and during, the hospital admission; and (2) 'support: for who and how' exploring the importance of support throughout the recovery process. The women in this study did not see themselves at risk of an AMI regardless of their lifestyles and when it did occur they adopted a variety of coping mechanisms in order to adjust to their trauma. The findings highlight the need for an increase in community awareness and education surrounding the risk factors of heart disease and its signs and symptoms, to minimize delayed hospital presentations.

Purpose: The purpose of this study was to describe the experience of adults with osteoarthritis who had undergone a total knee joint arthroplasty., Method: Grounded theory qualitative methodology was applied., Sample: Purposive and theoretical sample of nine participants., Findings: In managing the experience of total knee joint arthroplasty, participants expressed the basic psychosocial process, "Getting back to the future." There were three main categories identified within this process, "enduring," "thinking twice," and "keeping faith." "Enduring" conceptualized the way the participants lived their daily lives. "Thinking twice" captured the participants' processes of adaptation and problem solving. "Keeping faith" was the combination of determination, trust, and optimism that sustained participants as they progressed through the total knee joint arthroplasty experience to rehabilitation., Conclusion: The study provides a grounded theory of the participants' perspectives of undergoing total knee joint arthroplasty, making the process more visible for those involved in their care. Prehabilitation, postoperative care, and discharge planning can facilitate the patients' optimism and motivation to self-help. Further research to explore the process from the perspective of patients with rheumatoid arthritis and patients who have complications is recommended.

Background: Several studies have claimed that patients have unmet information needs after discharge following acute myocardial infarction (AMI). Our overall goal is to develop a post-discharge nursing intervention program to provide patients with appropriate information and support in contexts where existing follow-up services are poorly developed., Aims: To explore the information needs of inpatients with AMI and their preferences for follow-up contact after discharge from hospital., Methods: Fourteen AMI patients aged 42-69 years participated in one of three focus groups, held between 3 and 5 months after their discharge., Results and Conclusions: The findings are grouped into three themes corresponding to the major topics in the interview guide: the hospital stay, coming home, and patients' follow-up preferences. The data support the findings of previous studies that there is a systemic failure to meet patients' in-hospital and post-discharge information needs. Most importantly, our participants' follow-up preferences favoured open telephone lines and telephone follow-up. The results of this study provide some of the knowledge that is necessary to improve patient information and support following AMI.

This study examined the effect of gender on symptom evaluation, symptom response, and physical functioning following coronary artery bypass graft surgery. Symptom evaluation and symptom response were measured at baseline and 2, 4, and 6 weeks and 3 months following surgery, and physical functioning was measured at baseline, 6 weeks, and 3 months. The sample included 46 men and 19 women randomly assigned to the routine care group of a larger study examining symptom management intervention influence on recovery outcomes in elderly coronary artery bypass graft patients. No significant differences were found in symptom evaluation, symptom response, or physical functioning by gender over time. Women reported consistently higher symptom evaluation scores for shortness of breath, fatigue, depression, sleep disturbance, swelling, and anxiety and lower mean physical and vitality subscale scores than men at every time point. Gender-specific symptom management strategies should be developed and tested to address the differences in the reporting of symptoms by men and women.

We investigated the process of recovery from anorexia nervosa using grounded theory. Open-ended interviews conducted with 9 women who had recovered from anorexia nervosa revealed that recovery focused on rediscovery and redefinition of the self and included the following: (1) seeing the dangers, (2) inching out of anorexia, (3) tolerating exposure without anorexia, (4) gaining perspective by changing the anorexia mindset, and (5) discovering and reclaiming self as "good enough." The process of recovery described in this study may provide a useful framework for helping women understand their own process of recovery efforts. The findings also support therapies that foster therapeutic alliance, acknowledge readiness for change, and promote a senses of autonomy.

Background: Ulcerative colitis is a chronic disease of unknown aetiology characterized by alternating periods of remission and relapses. The difficulties in the patients with ulcerative colitis daily life mostly arise from symptoms associated with bowel inflammation but there are many patients who have difficulties despite being in the remission phase. This study was conducted to elucidate factors that influence perception of difficulties of life and psychological well being of patients with ulcerative colitis in remission., Methods: A questionnaire survey was carried out in 72 outpatients with ulcerative colitis in remission. The perception of difficulties of life was assessed using the scale developed by Tanaka et al. Psychological well being was assessed using the Japanese version of the 'profile of mood states'. Physical condition, demographic attributes and psychosociological states were also investigated as related factors., Results: There was no outstanding aspect of psychological well being, but a relatively large number of patients perceived a 'decline of vitality or vigour' despite being in the remission phase. In the presence of irritable bowel syndrome-like symptoms, the scores for 'difficulties of life in society' or 'difficulties concerned with bowel movements' were high. Scores for 'decline of vitality or vigour' were high when the emotive coping scores were high, social support was lower, disease durations were short and relapses occurred more than once. When the emotive coping scores were high, psychological well being was not fine., Relevance to Clinical Practice: Strategies need to be developed to allow patients to recover and maintain their strength in the remission phase. Further, the strategies should take the above factors into consideration.

Unlabelled: The purpose of this study was to investigate the nature of recovery from stuttering based on the experiences of adults who recovered without treatment. Using a semi-structured, open-ended interview format, 15 speakers verified as persons who recovered without treatment were asked to describe their status as everyday speakers. Seven speakers reported that they no longer stuttered and eight reported that they still stuttered on occasion. Interview material was coded and analyzed by the investigators and checked by independent judges. Results suggested that complete recovery was possible for speakers who reported that they no longer stuttered; whereas, those who still stuttered occasionally appeared to no longer be handicapped by stuttering, but required some vigilance to maintain their relatively fluent speech., Educational Objectives: After completing this activity, the learner will be able to: (1) describe the relevance of self-report data for evaluating the nature of recovery from stuttering without treatment; (2) describe the differences in self-perception concerning the nature of recovery for those who no longer have any tendency to stutter compared to those who still have an occasional tendency to stutter; and (3) suggest the possible implications for understanding the nature of recovery from persistent stuttering based on investigations of late recovery without treatment.

Purpose: To clarify the definition of integration and to identify universal aspects of the experience of integration related to healing, health, and nursing care., Design: An integrative review concept analysis method was used. Relevant reports were identified by a computer-assisted search using the keyword integration in CINAHL from 1966 to 2004 and by reviewing the reference lists of retrieved reports. The final sample included 56 reports; 36 were empirical and 20 were theoretical., Methods: Data were extracted from primary sources on the definition of integration, aspects of the process, antecedents, consequences, and facilitators. Data display matrices were used and were iteratively compared to derive a process model of integration related to health., Findings: A wide range of primary sources indicated that integration is an important aspect of healing or recovery from illness. Integration is defined as a complex person-environment interaction whereby new life experiences (i.e., illness) are assimilated into the self and activities of daily living, thereby contributing to overall life balance., Conclusions: Results of this analysis indicate the importance of the concept of integration to the science and practice of nursing. The process of integration appears to be a significant phase that occurs between a diagnosis of illness and subsequent physical and emotional healing.

Unlabelled: Women experience higher levels of distress than men (depression, anxiety, poor quality of life) after a first myocardial infarction. Sex differences in distress are not present in predominantly female diseases such as arthritis. This study explored the possibility that the predominantly male treatment environment for heart disease accounted for some of the sex differences in distress., Methods: Men and women who had experienced a first-MI were asked to complete the Bem Sex Role Inventory (BSRI), a modified version of the Moos Ward Atmosphere Scale (WAS) and measures of illness intrusiveness, depression, anxiety and quality of life. Gender syntony was defined as a match between patient gender (BSRI) and the perceived gender of the treatment environment (WAS)., Results: Women experienced higher levels of distress than men and were more likely to experience discordance between their gender and the perceived gender of the care environment (73% of women versus 32% of men). The presence of gender dystony (a mismatch between gender and treatment environment) was related to higher levels of illness intrusiveness and overall distress., Conclusions: Modification of the heart disease treatment environment so that it better meets the needs of women may reduce sex differences in distress.

Many patients experience posttraumatic stress disorder following a stay in intensive care; this can be due to a lack of recall of their stay. Retrospective patient diaries (n = 8) with follow-up have been used to try and help patients' recovery but have been found to be impersonal. Prospective diaries (n= 35) were implemented and trialled with follow-up at 2, 6 and 12 months postdischarge. Patients' and relatives' initial feedback regarding diaries is extremely positive. Benefits included better understanding of the events of the critical illness, helping with more realistic goal setting during the recovery period, improving communication within families through discussion of the diary and providing a source of comfort for the bereaved. More formal audit of these diaries is required and is currently being undertaken.

This study assessed patient perceptions of immediate post-operative recovery after the surgical exposure of impacted maxillary teeth with an open-eruption technique. Thirty patients (24 females and six males) underwent surgical exposure of 39 impacted maxillary teeth using this technique. After surgery the patients were contacted by telephone daily for 7 days, to complete a health-related quality of life (HRQOL) questionnaire, which assessed their perception of recovery in four main areas: pain, oral function, general activity, and other symptoms. Severe pain was reported by 30 per cent of the patients in the first post-operative day (POD 1), which declined to 6.7 per cent by POD 6. Consumption of analgesics declined gradually over the post-operative days (POD 1: 80 per cent, POD 7: 20 per cent). Difficulty in eating required 5 days to reach minimal levels; enjoying everyday food, 2.5 days; school attendance, limitations in daily routine, swallowing, and speech, 2 days each; swelling, bad taste/smell, 1.5 days each; within 1 day all other measures attained minimal levels. The need for bone removal during the exposure resulted in delayed recovery with regard to the ability to eat. In general, females reported delayed recovery for pain. The present data may serve as basic guidelines against which future studies which assess post-operative management of patients after surgical exposure of impacted teeth by an open-eruption technique may be compared.

This study aimed to examine the short-term adjustment outcomes including distress, self-esteem, and quality of life among Chinese patients after 1-month recovery from severe acute respiratory syndrome (SARS) in Hong Kong and to investigate the predictive abilities of a set of selected variables on the outcomes. At 1-month recovery, 100 SARS survivors (mean age = 37; 66 women) and 184 community subjects completed self-administered questionnaires. In the General Health Questionnaire-28, 61% of the SARS survivors were identified as distressed cases under a conservative cutoff score of 6. Compared with the community sample, SARS survivors had significantly more distress and poor quality of life. Being a healthcare worker, severity of SARS symptoms, steroid dosage, and social support accounted for a portion of variances of different measures. Early psychiatric screening and intervention may be beneficial for the adjustment of SARS survivors after short-term recovery. Future research on the long-term impact of SARS is recommended.

Background: Stroke recovery is a dynamic process for stroke survivors, and shorter lengths of stay in healthcare settings shift the care of the survivors to family caregivers. The physical and mental sequelae after stroke and the family's response to this catastrophic event may have deleterious effects on caregivers., Objective: To examine the influence of stroke survivors' motor function, their memory and behavior changes, and the family conflict surrounding stroke recovery on the mental and physical health of caregivers during the subacute recovery period., Methods: This cross-sectional, correlational study used baseline data from family caregivers (n = 132) and first-time stroke survivors enrolled in a larger multisite study., Results: The caregivers were primarily White (71%), female (74%), college-educated (73%) spouses (80%) of survivors. Most of the caregivers (66%) reported family conflict. The caregivers from families with lower family functioning scores reported worse mental health. The caregivers reported lower mental health when they were caring for stroke survivors with a combination of high memory/behavior changes and low motor function (R =.30). Family conflict appears to exacerbate the impact of memory and behavior changes on caregiver mental health. Higher caregiver education and no major health problems were associated with better caregiver physical health (R =.36). Caregiver physical health was not associated with family functioning or stroke survivor memory and behavior changes., Conclusions: These results indicate that memory and behavior changes of stroke survivors and family conflict surrounding stroke recovery are important considerations for assessment during the poststroke recovery period.

This study was conducted to describe the types and frequency of problems Australian women experience when recovering at home in the first 6 weeks following coronary artery bypass graft (CABG) surgery and the relationship between symptom experience and psychological distress. A convenience sample of 52 women (mean age 66.31 years, range 53-79 years) who had uncomplicated CABG surgery was selected from two tertiary hospitals in Sydney. A descriptive design was used with information related to post-operative problems collected by telephone interview at 1, 3 and 6 weeks post discharge using a semistructured questionnaire. Psychological distress was assessed at 12 weeks post discharge using the Hospital Anxiety and Depression Scale (HADS). Responses were categorised, collapsed and described using frequencies and percentages. Relationships were assessed by Spearman's r. The most common problems in the first and third weeks post discharge were sleeplessness and nausea or poor appetite and chest incision pain. Although problems improved over the first 6 weeks post-operatively, approximately one-quarter of the women still reported chest incision pain and almost 40% reported problems with leg wounds and oedema. The number of problems experienced at 6 weeks was significantly correlated with depression at 12 weeks. These findings support the importance of a preoperative education programme that includes anticipation of physical problems in the immediate post-operative period and a follow-up of female patients in the early transition period following hospital discharge.

Psychological research on negative symptoms in schizophrenia is scarce. The aim of this study was to explore the relationship between negative symptoms and trauma in individuals recovering from a psychotic illness. Specifically, the aim was to examine the association between negative symptoms and traumatic reactions to psychosis and to hospitalization. We were also interested in the association between traumatic reactions and autobiographical memory. The design was a cross-sectional investigation of 38 people recovering from functional psychotic illness. Hypotheses were examined using correlations between measures of negative symptoms, posttraumatic avoidance, and specificity of autobiographical retrieval. Negative symptoms were found to be significantly associated with avoidance of traumatic memories related to psychosis and hospitalization and with a lack of specificity in autobiographical recall. Further analysis showed that avoidance related to psychosis and low specificity in recall were significant predictors of negative symptoms. These data suggest that people who avoid traumatic memories of psychosis and hospitalization have more negative symptoms and retrieve fewer specific autobiographical memories. The possibility that negative symptoms may be reactive is explored, along with the implications for our theoretical and clinical understanding. The methodological limitations of the study and ideas for future research are discussed.

The trend within the Swedish healthcare system is to reduce the duration of hospital care. This means that a patient who is discharged to their home after critical illness is highly likely to be functionally impaired, and therefore, requires care-giving assistance from a family member. The aim of this study was to generate a theoretical model with regard to relatives' coping when faced with the situation of having an adult next-of-kin recovering at home after critical illness. The design incorporated grounded theory methodology. Four coping strategies exhibiting different characteristics were identified: volunteering, accepting, modulating and sacrificing. Factors determining the choice of coping strategy were the physical and psychological status of the relative, previous experience of ICU-care and the psychological status of the patient. The theoretical model described in this article can contribute to expanding healthcare professionals' understanding of the coping strategies of relatives during recovery, but also provide inspiration for social action to be taken.

The purpose of this qualitative study was to explore the responses and experiences of a sample of Swiss men after radical prostatectomy and their intimate partners. Interviews were conducted with 10 couples and analyzed using constant comparative method. Getting a grip on it was the core process that was developed. Men focused on regaining control over their lives, urinary and erectile function while wives efforts focused on being there. The results revealed that current clinical practice of follow up at 3 months may not address the serious deficits in the patient's ability to "get a grip" on incontinence and other complications of surgery.

This paper reports the findings of a grounded theory study investigating drug users' concerns and experiences of their oral health. The aim of this paper is to demonstrate how the findings relate to various strands of literature which focus on processes and discourses of recovery from problematic drug use (biographical reconstruction), the chronic illness literature (biographical disruption), public/private discourses and the myth of addiction. Data were collected from four focus groups containing a total of 25 participants, and 15 in-depth interviews. Participants were recruited from drug detoxification programmes (27), recovery units following detoxification (9) and a drug rehabilitation unit (4). Data analysis revealed that the core concern of drug users' was talking about the 'entangled' nature of their identity whilst they were on drugs. Such 'entangled identities' emerged through what appeared to be a gradual sedimentation process of drug-using habits and routines that replaced those of the everyday self. Other concerns were distancing one's self from the drug using self (involving expressions of disgust) and recovery processes (disentangling). The paper discusses each of these core problems in the light of the literature on the recovery from drug use, the chronic illness literature and the myth of addiction. It concludes by briefly reflecting on problematic psychotropic substance use as another form of biographical disruption formed on the basis of a dialectic between private discourses of the entangled self and public discourses of addiction. It suggests that further work should be conducted in these areas.

This prospective study evaluated patients' perceptions of recovery after surgical exposure of impacted teeth treated with a closed-eruption surgical-orthodontic technique. Twenty-nine patients (16 female, 13 male; mean age, 16 +/- 2.8 years) were given a health-related quality of life questionnaire to be completed each postoperative day (POD) for 7 days. The questionnaire was designed to assess the patient's perception of recovery: pain, oral function, general activity, and other parameters. The impact of possible predictor variables, such as age, sex, length of surgical procedure, tooth location, height of impaction, and need for bone removal were assessed. Severe pain (27.6%, 13.8%, 3.4%) and consumption of analgesics (76%, 41%, 17%) declined gradually over the first 3 PODs. Improvement in oral function and other symptoms was evident by PODs 3 and 4. Absence from school outweighed interference in daily activity by 3 days (POD 6 vs POD 3). Buccolingual tooth location was the most significant predictor variable, with results showing a delayed recovery for patients with buccally impacted teeth. The most striking difference was reported with regard to swelling (P <.0001), followed by mouth opening (P =.008) and speech (P =.05). When the surgical procedure lasted 30 minutes or longer, there was prolonged recovery from pain (P =.01). This study provides information to patients and clinicians on postoperative recovery after surgical exposure of impacted teeth by the closed-eruption surgical-orthodontic technique.

Context: Hematopoietic cell transplantation (HCT) is an effective and widely used treatment for hematologic malignancies. The rate and predictors of physical and emotional recovery after HCT have not been adequately defined in prospective long-term studies., Objective: To examine the course of recovery and return to work after HCT., Design, Setting, and Patients: Prospective, longitudinal cohort study at a US academic center specializing in HCT. Function was assessed from pretransplantation to 5-year follow-up for 319 adults who had myeloablative HCT for treatment of leukemia or lymphoma and spoke English. Of the 99 long-term survivors who had no recurrent malignancy, 94 completed 5-year follow-up., Main Outcome Measures: Physical limitations, return to work, depression, and distress related to treatment or disease were evaluated before transplantation, at 90 days, and at 1, 3, and 5 years after HCT., Results: Physical recovery occurred earlier than psychological or work recovery. Only 21 patients (19%) recovered on all outcomes at 1 year. The proportion without major limitations increased to 63% (n = 57) by 5 years. Among survivors without recurrent malignancy, 84% (n = 74) returned to full-time work by 5 years. Patients with slower physical recovery had higher medical risk and were more depressed before HCT (P< or =.001). Patients with chronic graft-vs-host disease (P =.01), with less social support before HCT (P =.001), and women (P<.001) were more depressed after transplantation. Transplant-related distress was slower to recover for allogeneic transplant recipients and those with less social support before HCT (P< or =.01). Patients who had more experience with cancer treatment before beginning HCT had more rapid recovery from depression (P =.04) and treatment-related distress (P =.009)., Conclusions: Full recovery after HCT is a 3- to 5-year process. Recovery might be accelerated by more effective interventions to increase work-related capabilities, improve social support, and manage depression.

During recent years, numerous studies have found an association between minor depressive symptoms and physical functioning for older adults recuperating from illness or injury Whereas earlier research has focused on the effects of minor depression during rehabilitation in acute or long-term settings, this study examined 209 patients receiving subacute physical therapy. The dependent measures were total score changes on the Functional Independence Measure (FIM) obtained at admission, discharge, and 3-month follow-up. The independent measure was minor depressive symptoms, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, obtained within 5 days of admission. A binary logistic regression analysis was conducted with dichotomized FIM scores and the presence/absence of minor depressive symnptoms. The results indicated a statistically significant relationship between FIM score change and minor depression from admission to discharge, but not from discharge to follow-up.

Most cases of elective surgery in the UK are now undertaken in day-case facilities, and the trend is set to increase. Surgical and anaesthetic health care is changing rapidly. Traditional pre- and post-operative nursing intervention, once commonly taught and practised, must now be re-evaluated as a result of such transformations. However, undertaking research in order to investigate the fresh challenges facing nursing in the modern surgical environment may present many difficulties. Methodological issues, such as the application of research approaches, time for adequate data collection, and the utilisation of patients as participants undergoing modern surgery, will present numerous barriers. In this article, Mark Mitchell identifies and discusses three problematic methodological issues that currently challenge the effective study of psychological recovery from modern surgery in the UK.

Purpose: There is limited research that describes the experiences of intimate partners of sudden cardiac arrest (SCA) survivors. The purposes of this article are to (1) describe the domains of concern of intimate partners of SCA survivors during the first year after internal cardioverter defibrillator (ICD) implantation and (2) outline strategies used by partners of SCA survivors in dealing with the concerns and demands of recovery in the first year after ICD implantation., Methods: This is a secondary analysis of interview data collected for the primary study "Family Experiences Following Sudden Cardiac Arrest." A grounded theory method was used to identify experiences of SCA survivors and their family members from hospitalization through the first year after ICD implantation. Data were collected from the SCA survivor and one intimate partner at 5 times: hospital discharge, and at 1, 3, 6, and 12 months postdischarge., Results: Eight Domains of Concern were identified for intimate partners following SCA and ICD implantation during the first year. These included (1) Care of the survivor, (2) My (partner) self-care, (3) Relationship, (4) ICD, (5) Money, (6) Uncertain future, (7) Health care providers, and (8) Family. Five categories of strategies to deal with the Domains of Concerns were identified (1) Care of the survivor, (2) My (partner) self-care, (3) Relationship, (4) Uncertain future, and (5) Controlling the environment., Implications: Nursing intervention programs should include the intimate partner of SCA survivors and contain education and support in the following areas: (1) information on the function of the ICD, (2) normal progression of physical and emotional recovery experiences, (3) safety and maintenance of the ICD, (4) activities of daily living after an ICD, (5) strategies to assist with the survivors care, and (6) strategies to assist with partner self care.

There is a wide variety of literature available about coronary heart disease (CHD). However much of the research related to CHD has been performed using either exclusively male populations or such small numbers of women that the results from the women studied were unable to be analysed independently. It is apparent that more researchers are focusing on research that examines women's responses to CHD and the care and treatment they receive. The following literature review explores some of the issues related to women's experience of cardiac rehabilitation and demonstrates that women's experience of cardiac rehabilitation may be different to that of men. There is a need for nurses working within this area of practice to have an understanding of women's experience of recovery from a heart attack in order to better meet their needs.

The Da-sein of Colorectal Cancer is an empirical-phenomenological study, which aimed at describing the experience of having received a diagnosis of colorectal cancer and what this means for the person concerned. Heidegger's Ontology of Dasein (1993; 1996) was selected as the philosophical frame of reference. In this study, dialogues, field notes and a diary were used as methods for data collection. Data analysis followed Colaizzi's analytic method as described by Haase (1987). Over all, seven patients who had been diagnosed with colorectal cancer were followed over a time-span of 13 months. The findings exposed that uncertainty, transitoriness, as well as locus of control are highly important in individual illness management. Upon receiving a diagnosis of colorectal cancer and subsequent therapeutic treatments uncertainty and transitoriness already become determining elements. Despite successful completion of the anti-cancer therapies, neither uncertainty, nor transitoriness will disappear completely from the patients' life. Upon disclosure of a diagnosis of colorectal cancer, the person concern defers to an external locus of control. Patients accept decisions taken by others or delegate powers of decision making. After completion of the anti-cancer therapies, returning to everyday life becomes the top priority. To find their own rhythm of life again patients work at regaining an internal locus of control. Powers of decision making are retrieved. Through The Da-sein of Colorectal Cancer the period directly before and after the disclosure of the diagnosis was investigated. The newly acquired knowledge will contribute to a better understanding and facilitate care of this patient group.

The purpose of this study was to investigate illness experiences of patients after a first myocardial infarction (MI), focusing on life situation and the recovery process over time. Thirty patients were interviewed within the first 3 days of hospitalisation, and again 17 weeks after discharge. The interviews were tape-recorded verbatim and the transcriptions were analysed and categorised using qualitative content analysis. The main category was Uncertainty of the life situation that was combined with and articulated the superior theme in both interviews. Analyses revealed uncertainty focused on problems related to: treatment-seeking behaviour; existential threat; preventing another coronary and need for knowledge and support, which the patients considered important for their case and future life. The findings are fundamental for the health care when education and counselling are planned and challenge health care personnel to listen to MI-patients' own experiences.

Elective surgical repair of an inguinal or femoral hernia is one of the most common surgical procedures. The treatment, however, presents several challenges regarding anaesthesia for the procedure, the postoperative analgesic therapy and convalescence, as well as planning of the procedure. Local, general, and regional anaesthesia are all used for hernia repair, but to different degrees, primarily depending on traditions and whether the institution has specific interest in hernia surgery. Thus, the use of local anaesthesia varies from a few percent in Sweden, 18% in Denmark and up to almost 100% in specialised institutions, dedicated to hernia surgery. The feasibility of local anaesthesia is high, as judged by the rate of conversion to general anaesthesia (< 1%), although intraoperative pain is quite common. The generally low rate of serious complications does not allow firm conclusions, but the rate of less serious complications is lower by local anaesthesia, compared to other anaesthetic techniques. Of special interest is, that the rate of urinary retention can be eliminated by the use of local anaesthesia. Local anaesthesia results, in comparative studies, in a higher degree of patient satisfaction than other anaesthetic techniques. Local anaesthesia also facilitates faster mobilisation and earlier discharge/fulfilment of discharge criteria from post anaesthetic care units than other anaesthetic techniques. Pain after hernia repair is more pronounced at mobilisation or coughing than during rest, and younger patients seem to have more pain than older patients. The pain ceases over time, and it is most pronounced the day after surgery, where two thirds have moderate or severe pain during activity, while one third still have moderate or severe pain after one week, and approximately 10% after 4 weeks. Pain after laparoscopic surgery is less pronounced than after open surgery, while different open repair techniques do not exhibit significant differences. Postoperative pain is best treated with a combination of local analgesia and peripherally acting agents (paracetamol, NSAID or their combination), while opioids should be avoided due to side effects, primarily nausea and sedation. Moderate or severe pain one year postoperatively is seen in 5-12% of patients. There seem to be no difference between different surgical or anaesthetic techniques, but the following factors have been related to a higher rate of chronic pain: previous or subsequent hernia surgery on the same side, young age, pain before surgery, high pain scores in the immediate postoperative period, and postoperative complications and prolonged convalescence. Patients should be informed about the risk of chronic pain, particularly if the hernia is asymptomatic. The duration of convalescence after hernia repair varies considerably, primarily due to variation in recommendations. No documentation is available to support that a prolonged convalescence reduces the risk of recurrence of the hernia, and most specialised institutions recommend immediate return to all usual activities. Pain seems to be the most important cause of prolonged convalescence. From all published consecutive materials with recommendations of short convalescence the mean or median duration is 6-8 days, in contrast to the two to four weeks often seen in randomised comparisons of different surgical techniques. Patients should be informed, that they can immediately resume all activity if pain permits, but also to expect that pain may limit function of activities of daily living during the first postoperative week. Hernia surgery, including treatment of recurrent hernias, can and ought to be performed as day case surgery, irrespective of the chosen anaesthetic technique, as there are no medical or surgical contraindications to this. Social causes may indicate, that overnight stay may be advisable or desirable, preferably in a patient hotel facility. Despite this, the fraction of patients operated in a day-case surgical set-up varies from 6% in France to 83% in US, and in Denmark 60% of patients have their hernia repair as a day-case procedure. A day-case hernia surgery service should be organised with standardised patient records, including descriptions of surgery performed as well as letters of discharge for the general practitioner. If clinical data are stored electronically, the basis is created for valuable clinical databases like the one behind the present thesis, and they can be used both for scientific purposes and for quality control and improvement.

This prospective, exploratory study examined the caregiving role that adult daughters play when a parent is hospitalized for a cardiac condition. Specifically, the study addressed the development and evolution of the caregiving role during the hospital stay and in the post-discharge period. Data were collected from 9 daughters using participant observation and unstructured and semi-structured interviews. Daughters' caregiving was characterized by a non-linear process of "knowing" that included knowledge seeking, consolidation of knowledge, and acting on the knowledge. In a secondary process of self-assessment concerning their knowledge, the participants moved back and forth among the 3 dimensions. In addition, their level of involvement was defined by 4 different caregiving styles, based on the family's caregiving culture. Nurses might collaborate more effectively with women caring for a parent by determining their position in the "knowing" process and tailoring the intervention accordingly. Nurses should also be sensitive to families' opinions and traditions regarding caregiving.

Theories and studies about the psychological processes of midlife propose a transition that may result in a more integrated personality structure throughout the second half of life. This more integrated structure includes concepts such as generativity, self-assertion, and independence. However, this structure, especially in early middle-age, can be affected by a life-threatening health disruption such as heart disease. One hundred and fifty-five women participated in a cross-sectional survey designed to investigate depression in early middle age, midlife, and elderly women who had undergone heart surgery. Women aged 40-55 years composed the early middle-age group, women aged 56-65 years composed the midlife age group, and women aged 66+ years were identified as the elderly age group. Affective components of depression were measured by asking participants to respond to three items regarding frequency of sadness, depression, and "the blues." Affective depression scores were summed and a mean score derived. Mean scores significantly differed by age group (F [2, 152] = 3.05, p =.05). Older women in the study fared better than their younger counterparts in terms of depression scores after a major cardiac health disruption. Post hoc comparisons indicated that mean scores for the early middle-age participants were significantly higher than for the midlife and older participants. Depression in the context of a cardiac health disruption appears to be linked to the developmental stage of a woman's life trajectory on which it is superimposed.

The aim of this study was to explore mother-daughter interaction as represented by provision of food during the traditional month-long postpartum convalescence. The clinical field research method was employed. A convenience sample of three pairs of mothers and postpartum daughters were recruited from a medical center. Data from recorded interviews were analyzed. Content analysis was applied to analyze the interaction between the mothers and daughters. The study demonstrated that the mothers exhibited caring behavior toward their daughters during this period. The postpartum daughters reacted to their mothers with approach, nostalgia, and appreciation behaviors. The results of this study deserve the cognitive recognition of nurses, so that they can be aware of and respect the indigenous beliefs and practices that link the events of childbearing, the health status of women, and family relationships especially between the woman and her own mother in order to provide better maternity care for postpartum women.

Purpose: To identify what women recovering from cocaine addiction think is needed of them to be good parents., Design: An exploratory descriptive design using in-depth, semistructured interviews, conducted in the woman's home or in a treatment center. Demographics and pregnancy history were collected during the interview. A convenience sample of 11 mothers recovering from cocaine addiction participated., Results: Content analysis was used to analyze the interview data. Five themes emerged from the interviews: lack of structure, abandonment, impatience/anger, lack of parenting knowledge, and repeating dysfunctional patterns from family of origin., Clinical Implications: Women addicted to cocaine who are parenting children need strong encouragement from the healthcare system to begin a recovery program and also to gain parenting skills. Discussions of child development and parenting stresses should be included during the recovery process from addiction because lack of parenting knowledge might be a major barrier for them. This study can help nurses to provide improved care for women who are parenting children while using cocaine or other drugs.

Introduction: Improvements in immunosuppression, and expansion of immunosuppression coverage by Medicare now necessitate beginning to define success in transplantation from a holistic or whole person approach rather than the historical emphasis on patient and graft survival alone. In a new transplant environment, efforts will have to be made to redefine practice so that kidney transplant recipients are prepared for 10 or more years of life with a transplanted graft. Currently, 83% of transplanted patients will never return to work. The purpose of this study is to determine how targeted education and specific psychosocial supports affect the transplant patient's return to normalcy 36 months after kidney transplant. Normalcy is defined as age and socially appropriate activities for that patient., Methods: This is a synopsis of a 1-year cross-sectional study of 51 patients who received kidney transplants in 1999 at or near their 36-month anniversary date. Thirty-six months was chosen because this is the date when most patients will lose their Medicare coverage for immunosuppression. In 1999, a multidisciplinary plan was initiated to restructure the transplant recipient evaluation process, such that education about kidney transplantation and expectations for return to normalcy were addressed at the initial 'introduction to transplant session'. These measures were then consistently reinforced with each subsequent contact. At the second contact, written verbal plans for medication purchase and return to normalcy were identified. The team made a conscious effort to develop relationships with the recipients and their significant others, with the intention to better empower them to return to normalcy post-transplant. These measures (education and psychosocial support) were this study's independent variables. At 36 months, all patients were contacted by telephone and a 12-item questionnaire was administered. The questionnaire sought information about the study's dependent variables - employment and insurance status, pre- and post-transplant., Results: In this study, 44% of pre-transplant patients were non-disabled compared with 62% of transplanted patients at 36 months post-transplant (P = 0.06, Chi square). Non-disabled includes persons who are employed, homemakers, students, retired or otherwise involved in age and socio-economically appropriate activities. Pre-transplant, 23% of recipients utilized Medicare and Medicaid for health insurance coverage. At 36 months post-transplant, only 11 or 20% of patients were dependent on Medicare and Medicaid. Pre-transplant, 17 recipients had private insurance coverage vs. 23 patients 36 months later (P < 0.02, Chi square). Fifty-six per cent of the patients received a living donor transplant., Conclusion: A targeted multidisciplinary programme of education and psychosocial support that emphasizes return to normalcy and non-disability, beginning with the first exposure to transplant and continuing throughout the first 6 months post-transplant, yielded high rates of return to normalcy for kidney transplant recipients.

Current literature indicates that women, and society in general, do not see coronary heart disease (CHD) as a serious concern for women. This lack of recognition seems, in part, to be related to a lack of research involving women as participants and in developing nursing knowledge specific to women and CHD. Although existing literature provides valuable insight into cardiac recovery, it does not clearly explore women's perceptions of their experiences in the early home convalescent recovery process following a myocardial infarction (MI). This study reports on the supportive-educative experiences of eight English speaking women, ages 33-61, in their early recovery process following an MI. Inductively generated data analysis has provided a means to understand the process of recovery from the perspective of these participants. Inherent in the participants' words, as they discussed their journeys with recovery, was an overwhelming sense of uncertainty while living with heart disease. For these women, their socially constructed knowledge dictated that women, and in particular, young women, did not experience heart attacks, and was, therefore, in conflict with their realities. The contradiction between the 'truths learned from others' and their MI experiences influenced, and was influenced by, the subsequent emerging themes of a 'rude awakening,' 'disconnected knowing,' and 'reconnecting self.' Feminist research challenges tradition and offers nursing an opportunity to explore and investigate issues of importance to our profession in a different way. Nurses, as well as other health care professionals, need to be aware of the social construction of cardiac illness and women's experiences, as this knowledge has great implications for patient care from prevention to rehabilitation within the cardiac experience. Based on the results of this study, implications for nursing education, research and practice are discussed.

Objective: To find out the current practice of consultant maxillofacial surgeons in the United Kingdom regarding the advice that they give to patients after the treatment of zygomatic fractures., Materials and Methods: We sent a postal questionnaire to 261 consultant maxillofacial surgeons in the United Kingdom. They were asked what advice they gave to patients about the length of time that they should refrain from contact sports after a zygomatic fracture., Results: A total of 184 replies were received (70%). Advice about the length of time to refrain from contact sports ranged from none to 13 weeks; 165 (90%) of respondents based their advice on common sense and traditional practice., Conclusions: Advice given to the patients after the treatment of zygomatic fractures varies widely. Most consultants base their advice on traditional practice and common sense. No widely accepted evidence-based guidelines exist about post-operative advice concerning duration of avoidance of contact sports after zygomatic fractures.

It is known that patients who have undergone gastrointestinal surgery as a result of a tumour experience changes in weight and intake of food and fluid. Several studies have highlighted patients' experiences owing to cancer, but there is a lack of knowledge about the recovery period from the patients' perspective. The purpose of this research is to describe patients' experiences of the recovery period 3 months after surgery. Data was collected by inviting four women and six men, between 52 and 84 years of age, to participate in an interview or dialogue 3 months after surgery. The study takes a hermeneutic approach. The framework for interpretation is the theory "Man's search for meaning" and further theories about suffering. The recovery period is characterized by feelings of being "down in the depths", lonely, abandoned and disappointed, but also feelings of support. Some patients regained strength and energy and reached a turning point, while others did not. Patients' suffering is seen as being in limbo, a fight between lack of freedom and freedom, including feelings of hope and doubts.

Background: South Asian people living in the United Kingdom are at increased risk of coronary heart disease, have higher mortality rates and are less likely to be treated when compared to the white population. There is, however, little information about the experiences and needs of this group after discharge from hospital., Aims: To explore the experiences and needs of Gujarati Hindu patients and their partners in the first month after a myocardial infarction., Methods: Using a qualitative research approach, semi-structured interviews were conducted by a Gujarati-speaking researcher with 35 patients and their partners at home during early convalescence., Results: A number of categories emerged from the data which pertained to a lack of information and advice, poor performance of activity, little lifestyle adjustment, poor expectations, lack of future plans, strong family support, dissatisfaction with the family doctor, and a significant belief in fate., Conclusion: Experiences and health care needs of Gujarati Hindu patients with myocardial infarction appear different to those of non-Asians. Cardiac aftercare and rehabilitation services should take account of such information