-
International Journal of Nursing Studies Feb 2024Unclear illness perceptions are common in heart failure. The self-regulation model of illness behaviour highlights factors that may impact how people with chronic...
BACKGROUND
Unclear illness perceptions are common in heart failure. The self-regulation model of illness behaviour highlights factors that may impact how people with chronic illness choose to cope with or manage their condition and has been used to study pre-hospital delay for stroke and acute myocardial infarction. The principles of self-regulation can be applied in heart failure to help illuminate the link between unclear illness perceptions and sub-optimal symptom self-management.
OBJECTIVE
Informed by the self-regulation model of illness behaviour, this study examines the role of illness perceptions in coping responses that lead to delayed care-seeking for heart failure symptoms.
DESIGN
Mixed-methods phenomenological study.
SETTING(S)
Quaternary referral hospital - centre of excellence for cardiovascular care and heart transplantation.
PARTICIPANTS
Seventy-two symptomatic patients with heart failure participated in a survey assessing illness perceptions. A subset of fifteen individuals was invited to participate in semi-structured interviews.
METHODS
Illness perceptions were assessed using the Brief Illness Perception Questionnaire. In-depth semi-structured interviews were conducted to elicit previous care-seeking experiences and decision-making that led to a passive, or active coping response to worsening symptoms. Descriptive statistics were used to report questionnaire findings, and open-ended responses were grouped into descriptive categories. Interpretative phenomenological analysis was undertaken on interview transcripts.
RESULTS
Participants perceived little personal control over their condition and mostly attributed heart failure to lifestyle factors such as diet and lack of activity. Cognitive dissonance between perceived self-identity and heart failure-identity led to a highly emotional response which drove coping towards avoidance strategies and denial.
CONCLUSIONS
This study demonstrates the use of the principles of self-regulation in heart failure and offers a framework to understand how patient representations and emotional responses can inform behaviour in illness. Findings highlight the value of empowering patients to take control of their health and the need to help align values (e.g. independence) with behaviours (e.g. actively addressing problems) to facilitate optimal symptom self-management.
Topics: Humans; Adaptation, Psychological; Heart Failure; Patient Acceptance of Health Care; Emotions; Surveys and Questionnaires; Qualitative Research
PubMed: 38016267
DOI: 10.1016/j.ijnurstu.2023.104644 -
Sante Publique (Vandoeuvre-les-Nancy,... Aug 2023In Morocco, maternal mortality is a crucial public health problem with a current rate of 72.6/100000 live births. This phenomenon is emotionally overwhelming, and the...
INTRODUCTION
In Morocco, maternal mortality is a crucial public health problem with a current rate of 72.6/100000 live births. This phenomenon is emotionally overwhelming, and the midwife’s experience of this drama is disordering.
PURPOSE OF RESEARCH
To explore how midwives experience maternal death, the resulting consequences, and the coping strategies used to overcome it.
RESULTS
19 midwives were interviewed and reported 39 cases of maternal death. The results show that no midwife remains indifferent to maternal death. The experience is painful, and the grief of the families is transferred to the midwife. Sadness, denial, fear, feelings of guilt and failure have characterized almost all the victims. In the face of her suffering, the midwife mobilizes coping strategies. The consequences are diverse: psychological, somatic, and professional.
CONCLUSIONS
The experience of maternal death associated with unfavorable working conditions and lack of recognition increases stress and leads to the intention to abandon the profession. The improvement of working conditions, the focus on teamwork, the implementation of discussion groups, professionalize the experience of maternal death.
Topics: Pregnancy; Female; Humans; Midwifery; Maternal Death; Maternal Mortality; Adaptation, Psychological; Surveys and Questionnaires; Qualitative Research
PubMed: 37558619
DOI: 10.3917/spub.232.0139 -
Psychiatry 2023While recovery from psychosis is possible, recovery is a multidimensional construct driven by various factors. One relevant factor to recovery from psychosis that has... (Review)
Review
While recovery from psychosis is possible, recovery is a multidimensional construct driven by various factors. One relevant factor to recovery from psychosis that has often been overlooked in the psychotherapy literature is the importance of facing loss and processing grief in relation to psychosis. A review of the existing empirical literature on grief associated with psychosis was conducted. Clinicians with significant therapeutic experience working with persons with psychosis reviewed cases to examine the losses the patients had suffered and how they responded to these losses. The clinicians considered essential principles that are relevant when helping patients with psychosis integrate loss and process grief. Persons who have experienced psychosis often experience the loss of role functioning, interpersonal relationships, cognition, and self-concept. However, when these losses are not fully integrated into the person's identity, it can result in either more losses due to denial and metacognitive impairments or increased hopelessness and depression due to internalized stigma. Five elements in psychotherapy of psychosis were identified that can facilitate the integration of loss and processing of grief: understand the personal experience of the psychotic episode, attend to feelings of grief and the primary loss, explore the meaning of psychotic symptoms and identity implications, integrate psychotic vulnerabilities into the sense of self, and foster realistic hope in the face of an uncertain future. Psychotherapy can enable persons with psychosis to make meaning of their losses, process their grief, integrate their psychotic vulnerability into their sense of self, and develop realistic hope.
Topics: Humans; Psychotic Disorders; Grief; Psychotherapy; Self Concept; Emotions
PubMed: 36688824
DOI: 10.1080/00332747.2022.2161261 -
Psycho-oncology Jul 2023This study was conducted to determine the relationship between religious attitudes and spirituality levels of geriatric oncology patients and their psychological...
AIM
This study was conducted to determine the relationship between religious attitudes and spirituality levels of geriatric oncology patients and their psychological reactions to cancer.
METHODS
The sample consisted of 261 geriatric oncology patients who were inpatients in oncology and hematology clinics of a university hospital. The research was conducted between 30 July 2020 and 26 January 2022. Data were collected using the Mental Adjustment to Cancer (MAC) scale, the Ok-Religious Attitude (ORA) scale, and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being (FACIT-SP) scale. The effect of the ORA scale and FACIT-SP scale scores on the MAC scale were analyzed using path analysis.
RESULTS
A positive relationship was found between Spiritual Well-Being and Fighting (β = 0.028, p < 0.001) and Anxious Anticipation (β = 0.024, p < 0.001); a negative relationship was found between Fatalism (β = -0.023, p < 0.001), Helplessness/Hopelessness (β = -0.04, p < 0.001) and Denial/Avoidance (β = -0.026; p < 0.001). A positive relationship was found between Religious Attitude and Fighting Spirit (β = 0.154, p = 0.009) and Anxious Anticipation (β = 0.231, p < 0.001), while a negative relationship was found between Religious Attitude and Despair/Hopelessness (β = -0.413, p < 0.001).
CONCLUSIONS
Patients' religious attitudes and spiritual well-being levels affected their psychological reactions to cancer, increased their "fighting spirit" and their "anxious preoccupation" about the disease, and decreased their helplessness/hopelessness, fatalism, denial and avoidance.
Topics: Humans; Aged; Spirituality; Adaptation, Psychological; Spiritual Therapies; Neoplasms; Attitude
PubMed: 37062928
DOI: 10.1002/pon.6144 -
British Journal of Nursing (Mark Allen... Aug 2023The impact of racism on health is undeniable. However, undergraduate nurse education in the UK is not adequately addressing the racism within the profession. Literature... (Review)
Review
The impact of racism on health is undeniable. However, undergraduate nurse education in the UK is not adequately addressing the racism within the profession. Literature on anti-racist nursing education was reviewed to uncover the most effective strategies for nurse educators to develop this approach. The literature describes a climate of denial and defensiveness among nurse educators. It urges nurse educators to develop racial literacy, and explores nursing curricula, recommending intersectionality as a way to teach about health disparities, with a move away from a culturalist perspective. There is growing recognition that institutions need to address issues around the retention of Black students, and robust reporting systems are required to respond to allegations of racism. Institutions also need to provide evidence-based anti-racist training for staff. The conclusion here is that, without institutional support, there is little nurse educators can do alone to change the culture of racism in nurse education. Thus, this review is a starting point for nurse educators interested in anti-racist nursing education.
Topics: Humans; Black People; Curriculum; Education, Nursing, Baccalaureate; Students, Nursing; Antiracism
PubMed: 37596088
DOI: 10.12968/bjon.2023.32.15.736 -
Bioethics Jul 2023In 2011, bioethicists turned their attention to the question of whether prisoners on death row ought to be allowed to be organ donors. The discussion began with a...
In 2011, bioethicists turned their attention to the question of whether prisoners on death row ought to be allowed to be organ donors. The discussion began with a provocative anti-procurement article by Arthur Caplan and prompted responses from an impressive lineup of commentators. In the 10 years since, the situation for death-row inmates seeking to donate has hardly changed: U.S. prison authorities consistently refuse to allow death-row procurement. We believe that it is time to revisit the issue. While Caplan's commentators rebutted his narrow contention that organ procurement would undermine the goals of deterrence and retribution, none of them attempted to make a positive, nonconsequentialist case for organ donation as a right of death-row inmates. That is the task we take up in this paper. After sketching and briefly defending a theory of punishment, we show how denial of organ donation is inconsistent with punishment's basic logic.
Topics: Humans; Tissue and Organ Procurement; Tissue Donors; Prisoners; Organ Transplantation
PubMed: 37148564
DOI: 10.1111/bioe.13164 -
Current Problems in Diagnostic Radiology 2023The financial sustainability of the US healthcare system is a growing concern in an environment of declining reimbursement and rising costs. Variable Centers for...
PURPOSE
The financial sustainability of the US healthcare system is a growing concern in an environment of declining reimbursement and rising costs. Variable Centers for Medicare and Medicaid (CMS) reimbursement and denial rates for specific imaging examinations exist across sites of service, adding complexity to financial planning for healthcare organizations. Understanding the financial implications of site of service in existing CMS reimbursement for imaging may be of strategic importance for organizations going forward.
MATERIALS AND METHODS
Current Procedural Terminology (CPT) codes were obtained for common cross-sectional imaging examinations using the 2022 CMS Medicare Physician Fee Schedule. Using reimbursement rates with historical volumes and denial rates, a simulation was created to estimate the overall reimbursement of paired hospital outpatient departments (HOPD) and free-standing office (FSO) sites. A baseline simulation was performed with random allocation of imaging examinations between sites of service, and an optimized simulation was performed to estimate the maximum financial impact of targeted allocation between sites. These simulations were performed for paired CT and MR scanners separately.
RESULTS
For CT, the baseline simulation estimated annual average reimbursement for combined HOPD and FSO was $3.25M. Reimbursement increased to $3.51M after optimized reallocation of studies between sites of service, resulting in an expected gain of $260,162 for a set of paired HOPD and FSO scanners. For MR, the same approach resulted in baseline reimbursement of $2.51M, increasing to $2.60M upon reallocation between sites for an expected gain of $87,532. Assuming a stable cost of service delivery, this approach would result in improved margins of 8% for CT and 3.5% for MR. There were 28 CT and 19 MRI daily patient imaging appointments at each respective HOPD and FSO scanners, unchanged between baseline and optimized cases. Differences in reimbursement rates between sites were the dominant driver of increased margins at low denial rates, although denial rates became dominant at values greater than 50%.
CONCLUSION
Given CMS payment and denial rate variability, optimally allocating imaging studies between sites of service may improve reimbursement for the same services delivered. Although financial incentives exist for site allocation, such decisions should require physician input to assess safety and appropriate level of care. This work contributes to an understanding of financial incentives of existing reimbursement policy and may guide future policy design towards high value care.
PubMed: 37718184
DOI: 10.1067/j.cpradiol.2023.08.007 -
The Journal of Cardiovascular Nursing Sep 2023Limited knowledge exists regarding patients' denial of myocardial infarction (MI) before hospitalization for an MI.
BACKGROUND
Limited knowledge exists regarding patients' denial of myocardial infarction (MI) before hospitalization for an MI.
OBJECTIVE
The aim of this study was to determine the prevalence and correlates of denial of MI in the prehospital phase of a confirmed MI.
METHODS
This secondary analysis included 166 hospitalized patients (mean [SD] age, 54.1 [10.5] years) who developed MI outside a healthcare facility and had high congruence between their experienced and expected symptoms. Measurements included the Denial subscale of the Brief COPE Inventory, the modified Response to Symptoms Questionnaire, and a Likert scale measuring perceived risk for MI. Patients who arrived at a hospital at least 1 hour after the onset of their symptoms were considered to have prolonged prehospital delay.
RESULTS
Despite their high symptom congruence, 77% of patients denied the possibility of having an MI before hospitalization. The lower denial group was characterized by cardiac history, whereas the higher denial group was distinguished by nonsmoking, a lower perceived risk of MI, less anxiety at symptom onset, and more concerns about seeking medical help. Compared with the lower denial group, patients in the higher denial group were more likely to underestimate the seriousness of their symptoms and delay seeking medical help. The higher denial group responded to symptoms in a more passive manner (eg, waiting), whereas the lower denial group showed a more problem-solving approach (eg, contacting emergency services).
CONCLUSIONS
Denial of MI is highly prevalent in the prehospital phase and is negatively linked with cognitive, emotional, and behavioral responses to MI symptoms.
PubMed: 37738318
DOI: 10.1097/JCN.0000000000001042 -
Open Forum Infectious Diseases Jun 2024A vaccine for coccidioidomycosis is likely to undergo trials in the near future. In this paper, we raise 4 questions that should be answered before its use and offer our...
A vaccine for coccidioidomycosis is likely to undergo trials in the near future. In this paper, we raise 4 questions that should be answered before its use and offer our solutions to these questions. These include defining the goals of vaccination, determining who should be vaccinated, how to measure vaccine immunity and protection, and how to address vaccine hesitancy and denial.
PubMed: 38887487
DOI: 10.1093/ofid/ofae095