자연주의적 탐구조사(Naturalistic Inquiry)

Let's read! We will often find out this sentence everywhere. When still being a kid, mom used to order us to always read, so did the teacher. Some books are fully read in a week and we need the obligation to support reading. What about now? Do you still love reading? Is reading only for you who have obligation? Absolutely not! We here offer you a new book enPDFd preventing chronic diseases a vital investment to read.

Preventing Chronic Diseases: A Vital Investment

Importance Caregiver burden may result from providing care for patients with chronic illness. It can occur in any of the 43.5 million individuals providing support to midlife and older adults. Caregiver burden is frequently overlooked by clinicians. Objectives To outline the epidemiology of caregiver burden; to provide strategies to diagnose, assess, and intervene for caregiver burden in clinical practice; and to evaluate evidence on interventions intended to avert or mitigate caregiver burden and related caregiver distress. Evidence Cohort studies examining the relation between demographic and social risk factors and adverse outcomes of caregiver burden were reviewed. Review of recent meta-analyses to summarize the effectiveness of caregiver burden interventions were identified by searching Ovid MEDLINE, AgeLine, and the Cochrane Library. Results Risk factors for caregiver burden include female sex, low educational attainment, residence with the care recipient, higher number of hours spent caregiving, depression, social isolation, financial stress, and lack of choice in being a caregiver. Practical assessment strategies for caregiver burden exist to evaluate caregivers, their care recipients, and the care recipient’s overall caregiving needs. A variety of psychosocial and pharmacological interventions have shown mild to modest efficacy in mitigating caregiver burden and associated manifestations of caregiver distress in high-quality meta-analyses. Psychosocial interventions include support groups or psychoeducational interventions for caregivers of dementia patients (effect size, 0.09-0.23). Pharmacologic interventions include use of anticholinergics or antipsychotic medications for dementia or dementia-related behaviors in the care recipient (effect size, 0.18-0.27). Many studies showed improvements in caregiver burden–associated symptoms (eg, mood, coping, self-efficacy) even when caregiver burden itself was minimally improved. Conclusions and Relevance Physicians have a responsibility to recognize caregiver burden. Caregiver assessment and intervention should be tailored to the individual circumstances and contexts in which caregiver burden occurs.

Caregiver Burden: A Clinical Review

Despite the profound and pervasive importance of trust in medical settings, there is no commonly shared understanding of what trust means, and little is known about what difference trust actually makes, what factors affect trust, and how trust relates to other similar attitudes and behaviors. To address this gap in understanding, the emerging theoretical, empirical, and public policy literature on trust in physicians and in medical institutions is reviewed and synthesized. Based on this review and additional research and analysis, a formal definition and conceptual model of trust is presented, with a review of the extent to which this model has been confirmed by empirical studies. This conceptual and empirical understanding has significance for ethics, law, and public policy.

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Trust in physicians and medical institutions: what is it, can it be measured, and does it matter?

Preface (1999) Preface (1990) 1. Subjects of Sex/Gender/Desire I. 'Women' as the Subject of Feminism II. The Compulsory Order of Sex/Gender/Desire III. Gender: The Circular Ruins of Contemporary Debate IV. Theorizing the Binary, the Unitary and Beyond V. Identity, Sex and the Metaphysics of Substance VI. Language, Power and the Strategies of Displacement 2. Prohibition, Psychoanalysis, and the Production of the Heterosexual Matrix I. Structuralism's Critical Exchange II. Lacan, Riviere, and the Strategies of Masquerade III. Freud and the Melancholia of Gender IV. Gender Complexity and the Limits of Identification V. Reformulating Prohibition as Power 3. Subversive Bodily Acts I. The Body Politics of Julia Kristeva II. Foucault, Herculine, and the Politics of Sexual Discontinuity III. Monique Wittig - Bodily Disintegration and Fictive Sex IV. Bodily Inscriptions, Performative Subversions Conclusion - From Parody to Politics

Postmodern Subjects, Postmodern BodiesThinking Fragments: Psychoanalysis, Feminism, and Postmodernism in the Contemporary WestYearning: Race, Gender, and Cultural PoliticsGender Trouble: Feminism and the Subversion of Identity

One way that families and individuals manage living with a chronic condition is to construct and live a story of "life as normal." The conceptualization of this process is based on constant comparative analysis of accounts of individuals and family members who are managing chronic conditions. The process begins with construction of the story of life as normal and continues as the story is lived over time. As the story is enacted, persons reauthor their lives. Thus the reciprocal nature of the process becomes evident. Specifically, how individuals and families construct and enact the story is discussed along with the role of health care professionals in the process and associated costs and benefits.

Managing Life with a Chronic Condition: The Story of Normalization

This paper examines the phenomenon of trust in health care relationships from a new perspective, that of the recipients of care for chronic illness. The authors argue that reciprocal trust is a necessary component of satisfying, effective health care relationships when the illness is of an ongoing nature. From the patient's perspective, reciprocal trust has a significant impact on the experience of being a receiver of health care and on the development of competency with illness management. Because of this, the authors claim that it is imperative for health care professionals to alter their traditional beliefs with regard to sick role and trust. With a new perspective, they may then develop the specific skills necessary to enact the caring aspect of the service they offer. The authors offer a number of suggestions for actualizing this reciprocal trust in clinical practice.

Reciprocal trust in health care relationships

After more than a decade of concerted effort by policy-makers in Canada and elsewhere to encourage older adults to age at home, there is recognition that the ageing-in-place movement has had unintended negative consequences for family members who care for seniors. This paper outlines findings of a qualitative descriptive study to investigate the health and wellness and support needs of family caregivers to persons with dementia in the Canadian policy environment. Focus groups were conducted in 2010 with 23 caregivers and the health professionals who support them in three communities in the Southern Interior of British Columbia. Thematic analysis guided by the constant comparison technique revealed two overarching themes: (1) forgotten: abandoned to care alone and indefinitely captures the perceived consequences of caregivers' failed efforts to receive recognition and adequate services to support their care-giving and (2) unrealistic expectations for caregiver self-care relates to the burden of expectations for caregivers to look after themselves. Although understanding about the concepts of caregiver burden and burnout is now quite developed, the broader sociopolitical context giving rise to these negative consequences for caregivers to individuals with dementia has not improved. If anything, the Canadian homecare policy environment has placed caregivers in more desperate circumstances. A fundamental re-orientation towards caregivers and caregiver supports is necessary, beginning with viewing caregivers as a critical health human resource in a system that depends on their contributions in order to function. This re-orientation can create a space for providing caregivers with preventive supports, rather than resorting to costly patient care for caregivers who have reached the point of burnout and care recipients who have been institutionalised.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2524.2011.01025.x

Can we move beyond burden and burnout to support the health and wellness of family caregivers to persons with dementia? Evidence from British Columbia, Canada

A multiphase, qualitative study of ongoing health care relationships from the perspective of the chronically ill patient and family confirmed that such relationships evolve over time through three predictable stages: naive trust, disenchantment and guarded alliance. In the final stage, four patterns of health care relationships were identified: hero worship, resignation, consumerism and team playing. The configuration of these relationships in guarded alliance is explained by dimensions of the core variable of reconstructed trust--patients' trust in a health care professional and their trust in their own competence.

Guarded Alliance: Health Care Relationships in Chronic Illness

Most explanations of the relationships between health care providers and health care recipients reflect perspectives and belief systems peculiar to health care professionals. In contrast, this study combined data from two separate qualitative investigations to yield an analysis of these relationships from the perspective of family members involved with chronic illness. Relationships between health care providers and health care recipients are viewed as evolving over time through a process which has identifiable stages. The utility of such a process orientation for nurses and other health care professionals is the insight it provides into the possibilities for negotiating satisfying care.

Carole A. Robinson

Papers

Managing Life with a Chronic Condition: The Story of Normalization

Reciprocal trust in health care relationships

Can we move beyond burden and burnout to support the health and wellness of family caregivers to persons with dementia? Evidence from British Columbia, Canada

Guarded Alliance: Health Care Relationships in Chronic Illness

Health care relationships: the chronic illness perspective.