Caregiver Training Courses

Caregiver Training Ebooks

The caregiver training e-book gives a training course on how to provideassistance to another person who is ill, disabled or needs help with daily activities. It can also serve as a useful guide to the individuals in the need of help. The product deals in physical, mental, social, and psychological needs and well-being of both the caregivers and the elderly person requiring care. Everyone needs a little help from time to time and while many seniors lean on the friends and family members for support, there may be some instances in which it's necessary to seek additional assistance or long-term care which was why this product was created by the author. This caregiver product is a practical guide created by the author who is an expert in the field. This product embeds in it several training sections in which each section gives detailed information on how to provide assistance to people who are ill, disabled, or aged. This product is a trusted and 100% guarantee to provide the necessary details needed in caring for the physically challenged, aged and ill individuals. The product is also an essential overview of issues from Alzheimer's to diabetes to strokes. Read more...

Caregiver Training Ebooks Summary


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Recently several visitors of websites have asked me about this ebook, which is being promoted quite widely across the Internet. So I bought a copy myself to figure out what all the excitement was about.

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Question 5 Were caregivers blinded to treatment assignment

When caregivers and physicians are aware of the treatment group to which patients are assigned, they may treat the patients in the two groups differently. For example, a clinician who knows his patient is on a placebo may worry and decide to take better care Tip To decide if caregivers were blinded in the conduct of the trial, look for use of identical preparations. Again, blinding is not always possible. It can be very difficult when the interventions involve diet, educational manoeuvres, or surgical procedures.

The Anesthesia Caregiver

A recurrent theme in this book is that the quality of your anesthesia provider does matter. The anesthesia caregiver will be monitoring and managing your vital functions during surgery in addition to making sure you are adequately anesthetized for the contemplated procedure. It is essential that the person caring for you is competent to do that. To find out the credentials of your anesthesia caregiver, all you need to do is ask. Anesthesia specialists are proud to tell you the amount of training that was required to become an M.D. anesthesiologist or a CRNA.

Death of a grandparent when grandparent has been primary parentcaregiver

For various reasons and circumstances, grandparents have assumed parenting roles for their grandchildren. Often an adult child returns home after a relationship ends, works outside the home, and depends on a parent grandparent to take on a caregiver role. Other times a biological parent might be declared emotionally or physically unable to care for their own children and the grandparents are given legal custody. Reconstructed families that put grandparents into parental roles have the potential to provide consistent nurturing environments and secure attachments that are crucial for a child's development. However, based on the age and well-being of the grandparents, these situations may present a threat of an additional loss. For youth who are still dependent on adults, losing a grandparent during this time creates additional developmental complications and risks. Thus, assessment and treatment strategies for these individuals must consider normal developmental tasks, family structure...

Factitious Disorder by Proxy in the Caregiver

The psychiatric condition of the perpetrator, as indicated by motivation, willfulness, and clinical presentation, is an important component of MBP and is called factitious disorder by proxy (FDP). Care-givers with FDP intentionally falsify history, signs, and or symptoms in their children to meet their own self-serving psychological needs to maintain the caregiving role. (See Table 12-1 for a summary of common characteristics.) According to the current literature, between 93 and 98 of perpetrators are women the vast majority of them are the children's biological mothers (Rosenberg 1987 Sheridan 2003). Although women with FDP do not have a single profile, they have some common characteristics. Many women with FDP are from highly dysfunctional families of origin and experienced significant abuse as children (Ayoub 2006 Gray and Bentovim 1996 Lasher and Sheridan 2004). They typically come from families that value the appearance of propriety, although within the closed family system, the...

Caregiver and Family Factors

Studies have found significant relationships between caregiver adaptation and child adaptation in terms of overall psychological adjustment and use of coping strategies. Thompson et al. (1993, 1994) and Brown et al. (2000b) documented that approximately one-third of caregivers of children with SCD reported distress or adjustment difficulties on self-report measures. Furthermore, caregiver maladjustment was related to psychosocial factors, including daily stress, palliative and disengagement coping strategies, and lower family support. Adjustment difficulties in caregivers are important to consider in relation to child well-being, because interactions between maternal and child distress have been documented (Thompson et al. 1999), and coping strategies in caregivers have been associated with children's adjustment (Brown et al. 2000b).

Medication Administration to Pediatric Patients and Caregiver Education

Considering the challenges in cooperation from infants and younger children, medication administration can become a difficult task for any parent or caregiver. Clinicians should consider ease of measurement and administration when selecting and dosing The means or devices for measuring and administering medications by the care-givers should also be closely considered. Special measuring devices as well as clear and complete education about their use are essential. Oral syringes are accurate and offered at most community pharmacies for measurement of oral liquid medications. Oral droppers that are included specifically with a medication may be appropriate for use in infants and young children. Medicine cups are not recommended for measuring doses for infants and young children due to possible inaccuracy of measuring smaller doses. Household dining or measuring spoons are not accurate or consistent and should not be used for administration of oral liquids. Comprehensive and clear parent...

Caregiver Adjustment

Caregiver adjustment to a child's chronic illness is critical not only for parental well-being but also for child coping and adjustment. Indeed, several studies have determined that parental adjustment can be a key factor in determining child adjustment (e.g., Brown et al. 2000b Hocking and Lochman 2005). Caregivers are typically responsible for many aspects of the child's medical care, including day-today responsibilities such as medication administration, management of painful episodes, and nutrition management, and they help the child to cope with the social and academic difficulties associated with the disease (levers-Landis et al. 2001). Indeed, studies have suggested that care demands for a child with SCD may add as much as an additional 2 hours per day, and that the burden of care as perceived by parents is particularly high (Moskowitz et al. 2007).

Whos the Person Giving My Anesthesia Do Credentials Matter

Most patients assume that their surgeon or dentist has pre-screened the person administering the anesthesia and would not be working with them if they were unqualified. This is a reasonable assumption, but it's often wrong. Patients don't interview and select their anesthesia caregiver in the same way they choose their surgeon or dentist. It's amazing that patients, or the parents of children scheduled for anesthesia, do not routinely ask the qualifications of their anesthesia caregiver, yet the anesthetic is often associated with more risk than the procedure. Patients know far more about the person who cuts their hair than they know about the person who is responsible for keeping them (or their child) safely anesthetized during surgery. Individuals administering anesthesia in the United States have widely different levels of training, competence, and standards of practice. Studies have demonstrated that the risk of anesthesia is related to the level of training of the person who...

Surviving Prostate Cancer

The information and suggestions contained in this book are not intended to replace the services of your physician or caregiver. Because each person and each medical situation is unique, you should consult your own physician to get answers to your personal questions, to evaluate any symptoms you may have, or to receive suggestions on appropriate medications.

Beliefs on Which It Is Based

Native American healing is characterized also by its communal nature. Many healing ceremonies are conducted in groups, and individual patients often are surrounded by chanting or praying family members when receiving treatment at home or in a hospital. This is in marked contrast to healing in many other systems, which presume a one-on-one relationship between care-giver and patient. It differs also from Western systems that encourage a high degree of confidentiality between doctor and patient.

Clinical Manifestations

Certain behavioral and physical signs should raise suspicion for elder abuse. Behavioral signs in the caregiver include answering for the patient, insisting on being present for the entire visit, failing to offer assistance, and displaying indifference or anger. Behavioral signs in the elderly patient include poor eye contact, hesitation to talk openly, or fearfulness toward the caregiver. Other indicators of possible abuse include confusion, paranoia, anxiety, anger, and low self-esteem. Physical signs that may signal neglect include poor hygiene, malnutrition, dehydration, pressure ulcers, and injuries (Table 4-7). Medication nonadherence may also be a warning sign for abuse.

Constraintinduced movement therapy approach

Should be at least 2 weeks post stroke onset, have at least 10 degrees of voluntary finger extension, have good cognition and be independently mobile before CIMT is considered (ISWP, 2008). In trials such as Wolf et al. (2006), Taub et al. (2006) and Fritz et al. (2005), the patients received 6 hours of CIMT and wore the restraint for 90 of the waking day for 2 or more weeks. In addition to restraint and intensive task-oriented practice, CIMT includes the use of a 'transfer package' of behavioural methods to facilitate transfer of training outside the clinical setting. The package includes a behaviour contract (for both the patient and the caregiver providing support), daily diary of activities to address psychosocial barriers, Motor Activity log, personalised home skill assignment and daily home practice (Blanton et al., 2008).

Will the Anesthesiologist Be Present and Watching Me Throughout Surgery

If you are curious about this issue, you are actually asking two questions. The first refers to the continuous physical presence by the anesthesia caregiver during your procedure. The second refers to whether the anesthesiologist will be watching you while physically present in the operating room. Both issues are important for the safe administration of anesthesia. The importance of the anesthesiologist as your primary monitor during anesthesia cannot be overstated. No instrument or electronic monitor can take the place of an alert, vigilant anesthesia caregiver. For the first 100 years of the practice of anesthesia, the primary method of monitoring the patient was the astute observation by the anesthesia caregiver. The anesthesia caregiver would observe the depth and frequency of the patient's respiration to assess ventilation, skin color to assess blood flow and oxygenation, and pulse for rate and strength to assess heart function. The key to safety during anesthesia was sustained...

Boredom Distraction Fatigue and Vigilance

Other anesthesia caregivers will participate in activities to combat boredom that distract attention away from you. Distractions are a threat to vigilance and contribute to human error. Some distractions in the operating room are unavoidable, but most are completely avoidable. Activities that may distract anesthesiologists include reading a book, extended conversations on the telephone (most often about matters completely unrelated to your care or medical issues), completing crossword puzzles, listening to talk radio with headphones, paying bills, browsing the Internet with a laptop computer, and, rarely, watching a DVD movie. This list is by no means exhaustive. Some anesthesiologists report that these activities decrease boredom. This is true, but there are abundant studies that show distractions from any cause will create an environment prone to accidents and errors, and some of those errors will be catastrophic.

Clinical Examples Of The Anatomic Paradigm In Practice

Beyond the generic limitations of randomized trials, there are additional limitations on trials of procedures. In revascularization trials, blinding of subjects or caregivers is impossible. Because caregiv-ers provide medications and patients choose whether to use them, undergoing a procedure can bias the subsequent use of medications known to alter survival among patients with CAD. Put another way, it can be said that any good clinician is trying to bias the outcome of his or her patients toward a favorable result. The clinician does this by prescribing and encouraging compliance with evidence-based medical therapy, among many other ways.

Introduction About Alzheimers Disease

More than four million people in the United States now have Alzheimer's, and projections by the federal government indicate that some 20 to 35 million people in our aging population will have it by the year 2050. Because it afflicts the elderly, the disease also burdens the young, who are called on to provide increasingly demanding care for their parents and grandparents. Nonetheless, as new medical treatments are emerging to alleviate some of the suffering, care in the home is clearly an option that many caregivers and care receivers prefer. Not long ago, I attended an Alzheimer's meeting that brought together experts and care-givers to share experiences. I was one of maybe a thousand attendees who were listening and seeking advice from a distinguished panel of experts. When the panel called for questions from the audience, I stepped to the microphone and asked, How can I modify my home to help me care for a person with Alzheimer's disease offers no cure. But many problems related to...

Stresses of Physical Illness

Medical hospitalization is associated with a diverse group of stressors. In addition to any distress associated with particular procedures and the discomfort they may cause, hospitalization is a uniquely challenging experience for children and adolescents because it involves loss of privacy and independence, separation from caregivers, and disruption of important daily routines (R.H. Thompson 1986). Considerable evidence indicates that hospitalization is associated with changes in patients' behavior, subjective assessments, and physiological indicators, as well as their perceptions of fear or pain, psychometric indices, and in some cases cognitive functioning (e.g., R.H. Thompson 1986). Classic studies in this area have found that hospitalization results in increases in separation anxiety, sleep anxiety, and aggression toward authority (Vernon et al. 1966). Of these, separation anxiety has been the most effectively addressed over the past several decades (R.H. Thompson 1986)....

Typical Responses to Illness and Hospitalization

Regardless of individual characteristics, illness characteristics, or coping style, some responses to physical illness and hospitalization are common. During the preschool years, children may react to the concept of illness as punishment for bad behavior and may believe that adults could cure them if they wished to (Magrab 1985). Hospitalization may be similarly viewed as punishment and can also be seen as rejection by caregivers if they are not present. During the school-age years, children view hospitalization as a threat to bodily control and mastery. As a result of these feelings of inadequacy, a child may become rebellious, angry, or difficult to control. However, increased understanding of the illness and reasons for hospitalization lead to decreased anxiety and guilt. For adolescents, denial is a primary coping strategy because the illness may be seen as a threat to independence. In addition, conflicts with caregivers over control while in the hospital or during treatments are...

Long Term Adaptation to

An individual's or a family's health locus of control may change over time. Often, a chronically ill child will develop an increasingly external health locus of control as time passes. This may be because the child experiences a loss of control due to living with a physical condition characterized by hospitalizations and an unpredictable course (Williams and Koocher 1998). Health locus of control interacts with other dimensions discussed in this chapter, such as a child's developmental level (e.g., younger children rely heavily on caregivers), a family's background and cultural beliefs, and a child's anxious temperament (Williams and Koocher 1998).

School Age Children Ages 512 Years

School-age children often feel anxiety and dread as they learn more about their chronic illness, and these reactions may mimic those of their parents earlier on in development (Donovan 1989). Potential difficulties with motor skills, separation from the primary caregiver, fear, and anger continue in this age group, and the introduction of significant peer relationships during this developmental period can be problematic and difficult. Parents of schoolage children often become aware of their children's fears and concerns related to symptoms, as well as their children's suffering related to illness.

Counseling and Anticipatory Guidance

Anticipatory guidance appropriately targeted to a child's developmental stage is a critical component of preventive care. Also, although good-quality evidence supporting the efficacy of most anticipatory guidance is limited, the standard of care is to provide such advice and counseling for parents (Moyer and Butler, 2004). Anticipatory guidance involves counseling caregivers to prepare for future normal child growth and development and to prepare caregivers for how these changes may need to be accommodated to promote development and to prevent injury or harm. Examples of anticipatory guidance include providing counseling to caregivers about various safety issues (e.g., use of infant and child car seats, bicycle helmets, water safety, poisoning prevention, childproofing the home), nutrition, appropriate dental care, and physical activity. Injury prevention is particularly important because unintentional injury is the leading cause of death for children and adolescents. In children 1 to...

Specific Lines of Development

In looking at organizational levels, one also may consider the development of human relationships. The infant progresses from a general interest in both the inanimate and the human world, to a specific and preferred interest in primary caregivers (engagement), to a capacity to be intentional with and differentiate the primary caregivers from others, to an ability to relate to the primary caregivers with a deepening sense of pleasure as well as protest and assertion. We observe, for example, the toddler develop as part of his or her unfolding relationship capacities the ability to communicate through complex gestures desires for closeness, intimacy, and dependency and an interest in curious, independent, assertive exploration of the world. It is also possible to delineate the age-appropriate organizational levels and unique experiential patterns for affects such as anxiety and thematic communication capacities. It is important to keep in mind the distinction between the child's...

Therapeutic Interventions

Write a letter to each primary caregiver describing the childhood abuse and current feelings, wishes, and wants. (21) 21. Assist the client in writing a letter to each parent or primary care-giver, detailing his her childhood abuse and sharing what the client wants from each person in recovery.

What to Expect from Doctors

Although it may be difficult for a patient or caregiver to take the active role endorsed here, especially if it is discouraged by the doctor and staff's behavior, strongly consider it anyway. The well-being and survival of a loved one are at stake. Moreover, when appropriate areas of concern are approached directly but with sensitivity, not only is the issue usually resolved, but the process often will favorably shape future interactions, as the patient realizes he has earned the provider's additional respect.

Preventable Causes of Awareness

Awareness is preventable in many cases, but not all. Prevention of awareness may be accomplished by the anesthesia caregiver thoroughly checking the anesthesia machine prior to starting the case, by vigilance during the case to be certain anesthetic agents are being delivered in sufficient quantities to reasonably predict the patient will be asleep, and by using muscle-relaxant drugs only when indicated and necessary during surgery. In about one-fourth of the cases of awareness reviewed in one study, the anesthesia caregiver mistakenly administered a muscle-relaxant drug to the patient instead of the intended drug to induce general anesthesia. This is called a syringe swap in anesthesia lingo, and it leaves the patient wide awake and paralyzed. When an anesthesiologist is informed postoperatively that a patient under her care is reporting that he was awake during surgery, there is a natural tendency toward denial or avoidance. The typical first response is for the anesthesiologist to...

Developmental Structuralist Model and the Developmental Individual Difference Relationship Based Approach

The developmental structuralist model has given birth to the developmental, individual-difference, relationship-based (DIR) approach to assessment and treatment. The DIR model, which is a developmental biopsychosocial approach, attempts to facilitate understanding of children and their families by identifying and systematizing the child's essential functional developmental capacities. These include the child's 1) functional-emotional developmental level 2) individual differences in sensory reactivity, processing, and motor planning and 3) relationships and interactions with caregivers, family members, and others.

Summary Heuristicsquestions For Future Research

Cognitive-extended forms with the help of symbolic language acquisition. Neu-rodevelopmental research into the fundamental mechanisms of consciousness in infants is understandably modest for obvious epistemological ethical reasons, as much of the current neuroscientific work focuses on neural correlates of higher conscious and cognitive activity in adult brains. This suggests that basic research will have to refocus attention on basic neural processes taking place in the first year of life, as core component processes must be brought on-line to operate in an integrated fashion very early in neurodevelopment. Such research into early development will also likely pay dividends clinically in terms of an increased ability to understand and treat disorders of consciousness, such as coma and persistent vegetative state, but also lesser forms of akinetic mutism, autism, and schizophrenia. We suspect that the substrates for the early orienting affective responses of the infant in its...

Sociology of Mental Health

Recent research also shows how, as Durkheim predicted, too enveloping or too many social obligations can lead to distress (Thoits, 1986 Schwartz, 1991). Participation in all-encompassing religious cults, for example, often heightens self-destructive behavior (Pescosolido & Georgianna, 1989). Or, role overload creates burdens that can overwhelm individual abilities to meet demands. Family caregivers, for example, find it difficult to simultaneous meet their obligations as providers of support and as workers (Pearlin, Aneshensel, & LeBlanc, 1997). Working women with small children and husbands who do not share childcare responsibilities also have more distress than those either without children or with cooperative husbands (Mirowsky & Ross, 2003). This overload in part explains why Durkheim incorrectly expected that the presence of children would have a uniformly positive impact on mental health. Problems in fulfilling conflicting social roles stem less from individual...

Differential Diagnosis

Atric delirium may be associated with subtle neuro-psychiatric signs, including inattention, decreased awareness of the caregiver or surroundings, purposeless actions, restlessness, irritability, and inconsol-ability (Schieveld et al. 2007). Hallucinations occur in about 40 of pediatric patients with delirium, and visual, auditory, and tactile hallucinations are more common than olfactory and gustatory hallucinations (Rummans et al. 1995 Turkel and Tavare 2003).

Evolutionary Perspectives

Durkheim believed that human instincts inherently conflicted with social institutions so that strong social ties were necessary to control insatiable human desires. Attachment theory, however, shows that needs for strong social attachments are innate aspects of human nature. Conversely, the absence of these ties is the source of misery. The many studies of the British psychiatrist John Bowlby and the large school of his followers indicate that humans are genetically programmed to acquire stable and secure attachments with parental figures during the first years of life (e.g. Bowlby, 1969 1982). Bowlby emphasized that infants are designed to need strong attachment bonds when they are separated from their primary care-givers they develop intense sadness responses. He observed that healthy infants who were separated from their mothers initially reacted through crying and other expressions of despair. They protested the separation and searched for the lost attachment object. Their...

Attachment and Locomotion

It's a familiar dynamic where a child ventures away from mother (either by crawling or toddling) until some impulse prompts him to turn around and check to see whether mother is still close by. If she's still where he left her, he may keep going. Or he may come back to touch base before restarting his exploration. The attachment bonding process permits children to regulate their urges to explore or to cling to that special adult by internalizing what Bowlby called working models of their caregivers. One such working model in the previous situation is It's okay. Mom will be there if I crawl farther. Another might be I can't go too far, she may leave me it's too scary. Babies form one or another model based on their mothers' behaviors over time.

Age Considerations for the Interview

Parents tend to know when there is something wrong with their child. Pay attention to their concerns. 10. Perform as much of the examination as possible with the baby in the caregiver's arms before moving to the examination table. 2. As you visit with the caregiver about the reason for the visit, observe the child for the current level of activity (e.g., sleepy, fussy, irritable, lethargic) and for developmental milestones. However, keep your attention on the caregiver while gathering history. Do not be distracted by a rambunctious child. If your eyes wander to the child, the parent may lose track of what he or she is thinking. The parent will focus attention on the child's behavior and may interpret your gaze as disapproval of the child's behavior. This subtle glance at the child is not a good way to maintain a positive relationship with the parent. 2. Next, greet the patient's caregiver-spouse, adult child, or nursing home staff member as you would...

Listing relevant outcomes

Outcomes may include survival (mortality), clinical events (e.g. strokes or myocardial infarction), patient-reported outcomes (e.g. symptoms, quality of life), adverse events, burdens (e.g. demands on caregivers, frequency of tests, restrictions on lifestyle) and economic outcomes (e.g. cost and resource use). It is critical that outcomes used to assess adverse effects as well as outcomes used to assess beneficial effects are among those addressed by a review (see Chapter 14). If combinations of outcomes will be considered, these need to be specified. For example, if a study fails to make a distinction between non-fatal and fatal strokes, will these data be included in a meta-analysis if the question specifically relates to stroke death

Relationships and Interactions

Relationship and affective interaction patterns include developmentally appropriate, or inappropriate, interactive relationships with caregiver, parent, and family patterns. Interaction patterns between the child and caregivers and family members bring the child's biology into the larger developmental progression and can contribute to the negotiation of the child's functional developmental capacities. Developmentally appropriate interactions mobilize the child's intentions and affects and enable the child to broaden his or her range of experience at each level of development and move from one functional developmental level to the next. In contrast, interactions that do not deal with the child's functional developmental level or individual differences can undermine progress. For example, a caregiver who is aloof may not be able to engage an infant who is underreactive and self-absorbed.

The Factors Affecting Your Risk of Anesthesia and Surgery

What did anesthesiologists learn from the studies of anesthesia mortality We learned that assigning an individual patient a numerical risk of anesthesia is difficult, if not impossible, because there are so many factors that influence risk. Your risk of anesthesia depends on a variety of factors related to your underlying diseases, the surgery you are having, and your anesthesia. In fact, your risk of anesthesia will differ from surgery to surgery depending on these factors. For example, if you have high blood pressure, diabetes, and coronary artery disease, your risk will substantially differ if you are having a hernia repair versus if you are having four-vessel coronary artery bypass surgery. Add to the equation other factors that influence risk, like the location where you are having surgery, the credentials of your anesthesia caregiver, and the credentials of your surgeon.

End Stage Renal Disease

Chronic kidney disease differs from other physical illnesses in that patients are extremely dependent on artificial means for survival and need to adhere to complex treatment protocols that require significant time demands, lifestyle adjustments, and behavior changes for the child and family. In this context, chronic kidney disease stands out among physical illnesses, with psychosocial factors having an especially strong influence on adherence and medical outcomes, including mortality and psychological distress (Christensen and Ehlers 2002). Evidence suggests that pediatric patients have higher rates of psychiatric disorder and psychosocial adjustment difficulties (Fukunushi and Kudo 1995 Simoni et al. 1997). The evidence further suggests that increased mental health burdens and family distress are experienced by the caregivers of children with chronic kidney disease (Brownbridge and Fielding 1994).

Minor Complications Associated with Anesthesia

Inability to reverse the effects of anesthesia usually refers to prolonged effect of muscle-paralyzing drugs. Sometimes, either due to abnormal metabolism in the patient or excessive doses given by the anesthesia caregiver, the effects of muscle-paralyzing drugs cannot be reversed at the end of surgery. If this were to occur to you, the anesthesiologist would place you on a mechanical ventilator until the effects of the paralyzing drug have worn off.

Primary Anxiety Disorders

Several subtypes of anxiety disorders are seen in the medical setting (see Figure 7-1). We describe the following DSM-IV-TR anxiety disorders (American Psychiatric Association 2000) as primary to the extent that they are not specifically a psychological or physical reaction to a physical illness or substance (see left-hand column of Figure 7-1). Separation anxiety disorder involves inappropriate and excessive anxiety concerning separation from caregivers and or home and is particularly common in younger children admitted to the hospital. Generalized anxiety disorder presents with a pattern of excessive anxiety and worry for 6 months or longer that is associated with symptoms of restlessness, fatigue, difficulty with concentration, irritability, muscle tension, and sleep disturbance and may also be heightened during the stress of an inpatient admission. Obsessive-compulsive disorder in the physically ill child may include obsessive preoccupation or fears about physical illness and or...

Question 6 Were outcome assessors blinded to treatment assignment

Outcome assessors can be the patients themselves, or their caregivers. They are sometimes directly involved in assessing outcomes or therapy response. For example, patients may be asked if they feel better and caregivers may be asked if they think their patients are doing well. The potential bias involved in this task can often be reduced by blinding them to treatment assignments as described in Questions 4 and 5. Because their decisions are often subjective, information on treatment assignment should be withheld from outcome assessors whenever they review a case. This is an important strategy. As mentioned in Questions 4 and 5, blinding of patients and their caregivers may be difficult or impossible in some trials. However, blinding study personnel when they assess outcomes is almost Tip First decide who is making the outcome assessment the patient, the caregiver or the investigator. If it is the patient or caregiver, tips to answer Questions 5 and 6 will apply. If it is the...

Population Aging and Kinship Structure

The family and kinship implications of rapid population aging in Japan, China, and South Korea have received some attention (Jiang 1995 Martin 1990 Zeng and George 2001). In these countries, as well as in other Asian countries, the long tradition of elderly people coresiding with an adult child is being challenged by population aging. In Japan, for example, the proportion of people over age 65 who live with a child declined from 77 in 1970 to 52 in 1991 (Brown et al. 2002 Martin 1990). In countries where adult children have provided most of the care for dependent older people, the changing supply of children challenges existing caregiving arrangements. The average number of children available to provide care for parents aged 65 to 69 in urban areas of China will decline from 3.1 in 1990 to only 1.1 in 2030 (Jiang 1995). Changing intergenerational relationships related to population aging are also occurring in the United States and Europe. their aging parents who experience...

Model of Pediatric Somatization

The process of somatization may be reinforced by attention from caregivers and physicians and or avoidance of stressful situations (e.g., attending school, participating in competitive athletics) as a consequence of the illness behavior. These feedback loops may help establish a pattern of the illness behavior that persists beyond the original reason for the symptom, whether it was physiological or psychological in nature. Psychological trauma may play an important role in amplifying and fostering so-matoform symptoms.

The Psychology of Rebellion

By rebellion, the individual both affirms uniqueness and establishes a principled connection with all of humanity. It is, for example, an appropriate and normal part of a child's development to rebel. There are at least two important phases of developmental rebellion that all or most people negotiate (1) the 'terrible twos' and (2) adolescence. Around two years of age, it is normal for the child to say 'no' to a host of demands from its caregivers. This negativism allows the child the opportunity to test the waters of autonomy. Adolescence, in addition, is notorious as a period of rebellion, and quite likely is a crucial epoch for the adolescent to establish an identity separate from the identities of others. Negativism as affirmation is part of the normal development of the self.

Twilight Anesthesia and the Anesthesiologist

The standards of patient care during MAC by a trained anesthesia caregiver are the same as those followed for general anesthesia. During MAC, the anesthesia specialist is in constant attendance during the entire procedure they use the full complement of patient-monitoring devices that are used during general anesthesia and they are experts in managing the sedated and the fully anesthetized patient. It is an axiom among trained anesthesia specialists that sedative medications given during twilight sleep, when given in larger doses or to the patient who is sensitive, will produce a state indistinguishable from general anesthesia. The anesthesia specialist is always prepared, equipped, and capable of handling the patient who unexpectedly transitions from twilight sleep to general anesthesia.

Evolution of secondary organic personality following TBI

The emergence of the personality change following TBI is a difficult matter to precisely describe. Personality changes are reported to be the most significant problems noted both by caregivers and, to a lesser extent, the individual him or herself at 1, 5, and 15 years postinjury (Livingston, Brooks, & Bond, 1985a 1985b Thomsen, 1984 Weddell, Oddy, & Jenkins, 1980), and these are often described as consistent with the notion of an exacerbation of premorbid traits (O'Shanick & O'Shanick, 1994). Another variant of this theme is represented by the suggestion that these individuals actually regress as a consequence of the injury. Childish behaviour following TBI may represent the regress to earlier forms of behavioural responding including awkward responding in social exchanges such as not taking turns in conversation, not sharing, interrupting and not inviting expansion on a conversational topic, which is relatively common in teenage communication patterns (Ehrlich & Sipesk,...

Gender Conflated Critiqued Deconstructed Reassembled

Chodorow's (1999b) early work situated gender in the object-relational matrix of mothering rather than in psychoanalytic originary discourse of the sexual instincts. Beginning with the obvious but untheorized fact that women are children's primary caregivers (every infant's first love, first witness and first boss Dinnerstein 1976, p. 281, Chodorow considered the implications of the fact that (onlyl women mother (the first two words of her text). She showed how this culturally mandated kinship arrangement produced and reproduced gender patterns, such that masculinity is defined by the not-me experience of difference (from mother and mother's femininity), whereas femininity could never escape its origins in the part of me sameness with the mother.

The Evidence of Morality in Babies

From watching babies' eye movements and behaviors, researchers have also determined that they can detect and mimic other people's moods and expressions starting a few days after birth. If a baby sees a playmate or caregiver crying, he frowns. If another child is joyful, he responds in kind. This sort of mimicking is called an empathetic response. When Charles Darwin noticed that certain animal species acted empathetically and so did his own 6-month-old son, he concluded that empathy must be innate. Demonstrations of empathy in toddlers are the basis for the belief that altruism came about as a human adaptation to assure the survival of the species.

Patient Care and Monitoring

Interview the patient and or caregivers to obtain a complete medical history, which should include family medical history, current and past prescription and nonpre-scription medications, and dietary intake. Determine whether the patient is taking medication supplements that could interfere with the therapy. 3. Educate the patient's parents and or caregivers that behavioral therapy is not as effective as stimulant therapy. Educate parents regarding the issues of growth delay and substance-abuse risks with stimulants. 6. If the patient is not responding to therapy after an adequate trial, assess compliance with the prescribed regimen. If the patient is not compliant, counsel the patient and caregivers and explore reasons for noncompliance. In some cases, switching to another stimulant formulation may improve compliance. 7. Important counseling points to convey to the patient and or caregiver

Facing Food Fears A Food Hierarchy

Although facing food fears without the help of a therapist or other caregiver can be difficult,, you can do a few things on your own to develop more realistic and accurate thoughts and feelings about food. One strategy is to create a food hierarchy such as the one below, which will help you see what you're avoiding. Once you've written down the names of foods and categorized them, it's difficult to deny what you've been thinking and how you've been behaving regarding them. This will make you accountable to yourself.

The Rehabilitation Milieu

The rehabilitation team helps its clients articulate and achieve the short-term and long-term functional objectives that will enhance their quality of life. The family and significant others who serve as caregivers play a critical collaborative role in setting and revamping goals and in carrying out supportive and therapeutic strategies. Patients must be taught that their active participation drives the possibility of gains. Rehabilitationists do not possess holy water to pour upon their flock to heal them, unlike acute medical interventionists who can cure appendicitis with scalpel or pneumococ-cal pneumonia with antibiotic fluids. In addi The milieu created by the rehabilitation team also differs from patients' experiences during acute hospitalization. Rehabilitation services try to quell the anxieties associated with a sudden, debilitating illness and its threat of death or permanent loss of functional independence. The team can help patients break from this terrifying link by...

Rating Instruments and Feeding Scales

Areas for assessment in clinical interview with caregiver Family history of feeding problems or eating disorders Caregiver psychopathology and stress Current or recent family stressors Caregiver expectations regarding feeding, including cultural beliefs about eating and weight Table 11-1. Areas for assessment in clinical interview with caregiver (continued)

Behavioral Modification

Once the child's appetite has been manipulated to encourage eating at mealtime, a variety of behavioral modification techniques can be applied. At a basic level, the concept of differential attention is crucial in shaping a child's feeding behaviors. Simply stated, differential attention involves giving the child positive attention when engaging in appropriate behaviors and withdrawing attention for inappropriate behaviors (Kerwin 1999). For example, when the child takes in a target food, the caregiver attends to this behavior and may offer social praise. In contrast, when the child engages in an inappropriate feeding behavior, such as pushing food away, the caregiver ignores this behavior. Differential attention approaches can be supplemented with reward systems that provide the child with more tangible reinforcers for desired behavior and mild punishments for negative behavior. For children with restricted food preferences, ingesting an amount of a nonpreferred food can be rewarded...

Pediatric Condition Falsification With No Factitious Disorder by Proxy

Several conditions involve parent or caregiver abuse by pediatric condition falsification (PCF) but do not involve FDP. Although the consequences of some of these other conditions may be equally as grave as those of FDP, they should be distinguished from FDP because the interventions needed to protect the child and the course of treatment are quite different. The following are some of the more common situations of PCF that are not FDP

Psychiatric Evaluation

In carrying out a psychological assessment in a primary care setting, evaluators should be aware of the need for comprehensive integrated evaluation and acknowledge the limitations of evaluations performed during a child's relatively brief stay in the hospital. In a comprehensive integrated evaluation (Sanders and Bursch 2002 Schreier et al. 2009), the focus of the assessment is on the caregiver-child interactional patterns. The details of this evaluation are outlined in Table 12-3. For more details about forensic assessment, see Sanders and Bursch (2002).

Guidelines for Clinical Assessment

Interpersonal relationships, especially with primary caregivers, influence present and future adjustment, functioning, and self-concept. Caregiver must work with the school to ensure that child is achieving to his or her abilities and feeling sense of competence vs. inferiority. Selection of career goal establishment of relationship with opposite sex independence from family should be encouraged by caregiver failures to adapt in previous stages make this stage more difficult.

Life Course Perspectives Key Principles

The focus on linked lives meshes nicely with several key issues in the sociology of mental health. Examples include the importance of social support as a buffer of stressful experiences, the caregiving role that family members must frequently play when loved ones are mentally ill, and the mental health consequences of loss of significant others via death or estrangement and conflicted relationships.

Treatment for Custodial Fathers or Family Members

Fathers who are able to separate both physically and emotionally from the mothers' belief systems, restructure the family system to acknowledge MBP, and actively work to protect their children have been able to safely parent following a lengthy intervention period. Safe and secure parenting is contingent on the father's ability to function as the primary caregiver, a role for which many fathers in MBP cases are poorly equipped as a result, an assessment of their parenting capacity is recommended.

Understanding Factors Associated With Sexual Violence In Couples

Empirical findings indicate a high level of overlap of individual factors related to sexual violence offenders in stranger or intimate relationships. They include characteristics such as low social conscience, permissive attitudes, low levels of empathy, hypermasculinity attitudes, beliefs in rape myths, and perpetration of other forms of violence.19-24 Researchers purport that many of these attitudinal and behavioral factors that lead to a greater disposition to offend often co-occur with prior exposure to violence as a child, whether through experiencing childhood abuse or witnessing abusive behavior between parents or caregivers, which may lay a foundation for later adult behavior in relationships (Dean & Malamuth, 1997). Attempts have been made to categorize individual offenders by the pattern of sexual violence they exhibit within relationships. More recent approaches, however, have attempted to gain better insights into this behavior and in turn improve prevention and...

Evidence Based Screening Guidelines

Immunizations are an important part of well-woman care. All patients benefit from disease prevention, and women are often caregivers for children or elderly persons, who are at higher risk from vaccine-preventable illnesses. Vaccines recommended by the U.S. Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) include tetanus diphtheria pertussis (Tdap), herpes zoster, and influenza for adults over age 50 and human papillomavirus vaccine for women 26 and younger.

Neurobehavioral Scales

The Neuropsychiatric Inventory (NPI)104 was developed to assess psychopathology in people with Alzheimer's disease. It also has great potential for studies of TBI, stroke, and other diseases that affect the frontal and temporal lobes. The NPI includes 10 neurobehavioral and 2 neurovegetative domains. An informed care-giver responds yes or no to the presence of symptoms for each domain and rates their frequency, severity, and the distress they cause the caregiver.

Changes in Mental Status

Consults are frequently initiated regarding patients' mental status changes. Fluctuations in level of consciousness and orientation, affective dysregulation, and other cognitive and perceptual disturbances have been collectively coined ICU psychosis or ICU syndrome and were once thought to be caused by environmental factors specific to critical care settings (e.g., Kleck 1984). Critical care patients' increased vulnerability to mental status changes is now recognized as likely due to a confluence of factors related to the patients' underlying illness and drugs and other treatments rather than due to an exclusively environmental etiology. Environmental factors specific to the ICU that threaten patients' mental status, in interaction with other biological factors, include prolonged social isolation, unfamiliar surroundings, sleep deprivation and diurnal rhythm disruptions, and patient immobilization (Martini 2005). Such mental status changes are conceptualized within the framework of...

Measures Of Healthrelated Quality Of Life

For patients with chronic diseases and no serious cognitive dysfunction, physician and care-giver observations have generally not substituted for the patient's own perception of most QOL domains.174 A patient's cognitive and communicative impairments may, however, limit the utility of QOL tools. In one study, proxy agreement was poor for the Health Status Questionnaire in people with stroke and cognitive impairment, but good between patient and caregiver for the FIM and the FAI.175

Concerns Regarding Parents and Families

Comitant disruption in caregiving arrangements and family life, including increased stress, fearfulness, worries, sadness, or anger (Sourkes 1995 Spinnetta 1981). Because siblings can be particularly susceptible to complicated feelings of isolation, displacement, jealousy, and guilt when their sibling has a critical illness and necessarily demands so much of the parents' and family's resources to cope effectively, they can benefit greatly from psychosocial support.

The Path to Self Regulation

As researchers see it, throughout the first year and a half, a baby forms stable mental images of appropriate behavior. These are the internal working models of actions and behaviors that work best to get his needs met. They come as a direct result of his accumulated interactions with parents and other caregivers, and help him learn to regulate his own emotional states. A baby's developing frontal cortex, which makes a leap at age 1, helps regulate emotions and behaviors to meet these challenges.

Staff and Systems Issues

The pediatric critical care workload is physically, technically, and psychologically demanding and carries a heavy emotional toll by virtue of staff members' continual exposure to critical illness, death, and the intimate personal lives of strangers (Beari-son 2006 Colville 2001 DeMaso and Meyer 1996 Ferrell and Coyle 2008). Through prolonged and persistent exposure to the suffering of children and families, high levels of acuity, and frequent encounters around death and dying, clinical staff are vulnerable to compassion fatigue (Meadors and Lamson 2008). Caregivers are particularly vulnerable when they have increased involvement in long-lasting and or complicated cases, personal identification with a child or family, underdeveloped coping strategies, or previous history of trauma (DeMaso and Meyer 1996 Meadors and Lamson 2008). The unremitting stress of the pediatric critical care setting can also contribute to problems in communication and collaboration among care providers, and...

Complexity of Adaptation

Trauma early in the life cycle, particularly when it is recurrent and when it occurs in the context of an inadequate caregiving system, has pervasive effects on cognition, socialization, and the capacity for affect regulation (Cicchetti and Beeghly, 1996 Putnam and Trickett, 1993 van der Kolk and Fisler, 1995). Children exposed to abuse and neglect are at increased risk to develop depression and anxiety disorders. They have a high incidence of aggression against self and others, are vulnerable to develop disturbances in food intake, as in anorexia and bulimia, and suffer from a high incidence of drug and alcohol addiction (van der Kolk et al., 1996b Felitti et al., 1998). It is thought that early and persistent sensitization of CNS circuits involved in the regulation of stress and emotion produces an increased vulnerability to subsequent stress by means of persistent hyper(re)activity of neurotransmitter systems, including corticotropin-releasing factor (CRF) (Heim and Nemeroff,...

What is the role of a clean intermittent catheterization in the treatment of BPH

Catheter into the bladder to drain urine from the bladder. This procedure is performed anywhere from 3 to 6 times per day, depending on how much urine is drained with each catheterization. The catheters are cleaned in between each catheterization and the same catheter may be used for up to a month before changing to a new catheter. If an individual is unable or unwilling to perform self-catheterization, a family member or care-giver can be taught how to perform clean intermittent catheterization.

Mental Health Evaluation

During infancy and toddlerhood, children hold little, if any, understanding of death rather, death is equated with separation from caregivers. By preschool age, children develop an awareness of death however, they are unlikely to recognize that death is universal, an inevitable outcome for all living things including themselves and loved ones (Poltorak and Glazer 2006). Lacking the concept of irreversibility, young children are also unlikely to understand the

Cultural Considerations

As liaison between the adolescent, family, and or treatment team, the mental health clinician must evaluate culturally defined characteristics of each family. Some important areas to explore in this regard include 1) how the family's ethnic, cultural, or national background impacts their experience in the hospital and with caregivers 2) whether the family is a member of the dominant ethnicity in the medical environment or is in the minority (special attention should be directed to immigrant and minority families) 3) whether cultural or linguistic barriers, overt or covert, may affect their experience 4) what their beliefs and values are in relation to childhood illness, death, medical care, and family involvement and 5) what unique roles the patient family and extended community play in their culture.

What It Can Do for You

Both the Alexander technique and the Pilates method have prospered in terms of increased popularity in the number of teachers and students it attracts. Both techniques have been validated through research. Both are gentle and not likely to cause harm, although people with chronic pain, joint difficulties or a serious illness should consult with their primary caregivers. It is important to make certain that these or any other exercise regimens are safe given your specific condition.

Summary of Psychosocial Adjustment

Research findings consistently support the importance of assessing psychosocial functioning in youth with SCD, indicating that the combined stress of chronic illness and other psychosocial challenges can lead to difficulties for these youth and their families (see Table 17-2 for a summary of psychosocial difficulties in SCD). However, significant variability exists within children who have SCD, with many children and their caregivers exhibiting remarkable strength and resilience while coping with this disease (Barakat et al. 2006 levers-Landis et al. 2001). Psychosocial interventions should therefore be developed with considerations of both the unique risks and protective factors that affect psychosocial well-being in children with SCD and their families.

Psychological Factors

Research suggests that the psychosocial adjustment of children with SCD is determined by multiple disease-related and psychosocial factors. To examine these factors, researchers have applied the following biopsychosocial models of stress and coping to study children with SCD 1) the transactional stress and coping model (Hocking and Lochman 2005 Thompson and Gustafson 1996 Thompson et al. 1993, 1994) and 2) the risk-resistance adaptation model (Brown et al. 2000b Wallander and Varni 1992 Wallander et al. 1988, 1989). Although a full review of the literature is beyond the scope of this chapter, several factors are particularly important to psychosocial outcomes for children with SCD gender and age, health-related coping, stress appraisal, and caregiver and family factors (Barakat et al. 2006 Hocking and Lochman 2005).

Toward The Invisible Parent

Characteristic pattern that could be labeled self-actualization guilt in which parents use negative emotion to punish themselves for giving priority to their own program of self-fulfillment. Some parents engage in a daily routine of mourning for their children as they deposit them with their care givers residual guilt stays with them the rest of the day. The mourning-guilt syndrome is especially prevalent in women who are choosing to work because it is more satisfying and pleasurable than being at home.

Relationships as Fundamental Motivators and Organizers

There is now consensus among development researchers that the relationship between infant and parent is the fundamental unit in which development takes place and that the creation and maintenance of ties to other people are central motivations for infants. Humans are prepared, from birth onward, to communicate so as to promote caregiving and the formation of significant emotional ties (see, e.g., Ekman and Fricsen 1969 Stern 1985). Over time, through evolving sequences of signals and responses, infants and caregivers continually influence and regulate each other's internal states and behaviors. Similar patterns of self-regulation, mutual regulation, and mutual influence apply in later childhood and adulthood, albeit in more sophisticated and complex forms. These early interaction patterns have been shown to exert an influence into adulthood (faffe et al. 2001 Main 2000). (For excellent reviews of die developmental research, see Schore 1994 Stern 1985 and Wallin 2007, among others.)

Preschool Friendships

In order to form friendships, the 3- to 6-year-old child needs opportunities to socialize with peers. If they don't attend preschool, children of this age make their first friends during other social contacts usually arranged and supervised by parents or other caregivers. These include prearranged playgroups, interaction in playground settings, or casual encounters with neighboring children. In choosing their friends, a preschooler's personal preferences are already at work. By and

Family Based Interventions

The feasibility and efficacy of family-based interventions in treating children and adolescents with SCD have also been examined. Research has shown connections between parent and child coping strategies (Gil et al. 1991) and suggested that families of children with chronic illness play an important role in coping with illness-related stressors (Kazak and Drotar 1997). Kaslow et al. (2000) conducted a trial of a family-based coping intervention that included disease education, coping skills training, and strategies to improve interpersonal and family relationships. Results showed that SCD knowledge increased, although no significant effects of the treatment were found on measures of psychological adjustment. In addition, Kaslow et al. (2000) documented the importance of developing treatments that take the sociocultural context of families into account and that allow for flexibility and ongoing adaptation in treatment procedures. Powers et al. (2002) conducted a small pilot study (N 3)...

Nonverbal Dimensions of Early Experience

Nonverbal communication is an essential organizer of experience from infancy through the life span (Damasio 1999 Emde 1988 Trevarthen 2009). The infant relies on motor activity, affect, and sensation to communicate with and make sense of his or her relationship with the caregiver. In the past, researchers and therapists e.g., Piaget) have often underestimated or over simplified these basic dimensions of experience. This misapprehension has also encouraged the view of infancy as a primitive stage (Freud 1920 Klein 1946). In fact, nonverbal systems can be complex and highly organized. Affect, proprioceptive, kinesthetic, somatosensory, and autonomic experiences are integrated into an early sense of self in infancy The infant communicates to the caregiver by movements of arms, legs, head, and neck by facial expressions and by vocalizations through crying, cooing, and babbling. The caregiver responds in corresponding modalities, through body temperature, skin tension, and heart and...

Specific Contributions From Attachment Theory and Research

The terms attachment and attachment theory refer to a specific body of theory and research that began with John Bowlby's (1969, 1980, 1988) seminal work of the first post-World War II decades. Drawing on primate research and direct observation of young children, he asserted that the child's tie to its parents or other caregivers is a primary, autonomous system rather than secondary to the drives and phantasies that traditional Freudians had held to be the core motivations. Bowrlby went on to reformulate the analytic theories of separation and defense in accord with emerging regulatory systems models, stressing the importance of affects, especially fear. Bowlby also proposed that parental care is a core requirement for species reproduction, embedding social motivation in a broader evolutionary-biological perspective. sification in the second year of life Main 2000- Main et al. 2005). In addition, AAI classifications of prepartum mothers predict their toddlers' attachment...

Selecting outcomes for Summary of findings tables

Important outcomes are likely to include widely familiar events such as mortality and major morbidity (such as strokes and myocardial infarction). However, they may also represent frequent minor and rare major side effects, symptoms and quality of life, burdens associated with treatment, and resource issues (costs). Burdens include the demands of adhering to an intervention that patients or caregivers (e.g. family) may dislike, such as having to undergo more frequent tests, or restrictions on lifestyle that certain interventions require.

Evidence Based Treatment Approaches

Patients and families should be helped to understand that although scientifically valid information about treatment for FAP is limited, some basic principles of care do appear to be helpful and a few treatments that have been studied show promise. Professional efforts to review what is and is not known about treatment can help to create informed consumers of care and to establish an active treatment alliance, and clinicians can feel comfortable instilling hope and positive expectations for improvement in patients and their families. Some consensus appears to support the value of helping patients and caregivers develop a rehabilitative mind-set focused on coping with and overcoming the illness by returning to usual activities and responsibilities rather than simply waiting for a cure. The clinician should help create the expectation that the patients should return to developmentally appropriate functioning regardless of the presence of FAP by helping families identify and reward...

The Five Core Components of Teamwork

Redesigning any part of the resident learning process is a challenge. To eliminate preventable adverse events and intercept other errors before they harm the patient, it is important to have in place an environment that is both mindful of errors and nonpunitive, as well as leaders willing to consider redesign of the institutions' systems and processes as necessary to reduce risks. The emphasis on handovers, blame-free error reporting, and teamwork does not mean that individual residents are not expected to develop a sense of loyalty or personal responsibility for individual patient care, but it helps ensure that the best information is available at all times for patient care given that a resident or any caregiver cannot be at the bedside 24 hours a day, 7 days week. It may not be possible to eliminate discontinuity altogether in healthcare settings, but the training system can strive to minimize its effects by enhancing the quality of handovers and error reporting, promoting...

Dealing with Other Side Effects and Discomforts

Patients with cancer, even the same cancer, can have very different experiences, some of them more distressing than others. Many families will find over time that the status of their ill loved one will unexpectedly change. Families frequently feel unprepared and may be caught off guard about how to help when what feels like an emergency occurs (sudden nausea, difficulty breathing, coughing spells, increased pain, etc.). Caregivers should not be alarmed that there are so many different symptoms described here it is unlikely that a given patient will experience many of them. Even when these symptoms do occur, their intensity, frequency, and duration vary greatly among patients.

Meaning in the Stress Process

Finally, most in keeping with symbolic interactionist principles, another group of researchers has argued for an approach to meaning that more directly considers identity, beliefs, and values (Pearlin, 1989 Simon, 2000 Thoits, 1992). Thoits (1992) proposed that the meanings of stressors depend on the importance of the identity domain in which they occur. Pearlin (1989) asserted that social values shape the meaning of stressors. Extending that point, Simon (1995, 2000) directed attention to gender-linked cultural norms, values, expectations, and beliefs (2000, p. 73) as they influence men's and women's subjective interpretations of potentially stressful role-based experiences. She found, for example, that working women were more distressed by work-family conflict than were working men because women perceived their roles as workers as in conflict with their roles as caregivers whereas men did not.

Theories of attachment

The adult caregiver is genetically programmed to form an attachment with the infant in order to protect it. Attachment gives the child the opportunity to be around adults and therefore provides a safe base from which the infant can explore the world. The attachment develops between the infant and caregiver because the infant displays 'social releasers' - these are behaviours that elicit produce a reaction from the caregiver, and include crying, smiling, etc. Attachment is a biological (innate) process and there is a critical period of development. This means that if the attachment is not formed within the first 2.5 years it will not occur at all. A 'monotrophic bond' is formed - that is a special bond with just one other person. The mother is therefore unique. Bowlby believes that if this bond is not formed, or is broken, then there will be permanent emotional damage because children only develop socially and emotionally when an attachment provides them with feelings of security. High...

Social Roles in the Stress Process

We use the example of work-family conflict to illustrate the utility of integrating contemporary conceptualizations of social roles into stress research. Several studies document that combining work and family roles can be stressful, particularly for women (Menaghan, 1989 Thoits, 1986). Simon's (1995) research usefully builds upon this work by demonstrating that the meaning of the combination of work and family roles varies by sex due to different normative expectations regarding men's and women's roles within the family. Integrating the more interactionally based processes of role-making and role-using into this line of research could add further richness to our understanding the meaning of family-related stress. For example, despite a general tendency for women in Simon's study to be more distressed by work-family conflict than men, some women perceived work and family roles as interdependent and, thereby, avoided distress. Drawing on our understanding of role-making, we might...

Asthma Etiology An Epigenetic Framework

Problematic parenting appears to increase risk of asthma onset in children at genetic risk (Klinnert et al. 1994, 2001). Developmentally relevant stressful events and or the quality of caregiving may alter the emotional and physiological regulation of the infant in the direction of increased allergic response. Klinnert et al. (2007) reported that the development and onset of asthma may be affected by genetic risk, environmental exposure, and psychological factors such as parent-child interactions. This suggestion is consistent with early observations of association between family dysfunction and childhood asthma (Minuchin et al. 1975 Purcell et al. 1969).

Problems in Asthma Knowledge and Adherence

Patient and caregiver deficits in knowledge and information clearly play a limiting role in adherence to recommended asthma management. Poor understanding of medication usage, incorrect beliefs about management and asthma triggers, and lack of planning for asthma exacerbations are common. Several educational programs have failed in the past to make significant gains, probably because they failed to ad dress the psychosocial obstacles to the patient and caregiver acquiring the necessary information and knowledge. Educational approaches that emphasize self-management are now recognized to yield a number of positive effects, including reduction in health care utilization (Bartholomew et al. 2000 DePue et al. 2007) and improved symptom control (Bonner et al. 2002 Clark et al. 2004). Interventions designed to bring about behavior change are more likely to be efficacious than merely providing information (Gibson et al. 2002).

Stress Reduction Programs and Psychosocial Intervention

Chronic stress, acute trauma, and emotional compromise in the child, caregivers, or family affect asthma outcomes through impairment of adherence and direct psychobiological pathways. Therefore, interventions that target stress, emotional compromise, and family relational distress are likely to improve adherence- and stress-compromised asthma disease. Despite the lack of truly evidence-based psychosocial treatments for asthma, several avenues of intervention are promising. Researchers are beginning to empirically test family-based interventions. Given that the family provides the main caregiving, problem-solving, stress-buffering (or stress-exacerbating), and developmental relational contexts for the child, the most effective treatments will likely have at least some family-based component. Family interventions based on improving problem solving (Walders et al. 2006), family empowerment for optimal illness management (Canino et al. 2008 Warman et al. 2006), and developmentally...

Outpatient Rehabilitation

In the 3 months after discharge, UDSmr data show approximately 10 gains in FIM scores. At 6 months to years later, most patients discharged to home report maintained or modestly improved gains.98,99 When self-care skills decline after discharge, the cause, in the absence of new neuromedical problems, is often the caregiver's ability to provide more efficient and convenient assistance for ADL than the patient can accomplish independently.

Psychosocial Adjustment

Patients with cystic fibrosis and parent caregivers is under way to gather data on the prevalence of these symptoms (see Nevertheless, even if mental health problems are not more prevalent, when they are present, these problems can significantly impact health outcomes. and Lester 2002 Quittner et al. 1998). A meta-analysis found evidence that parents of children with cystic fibrosis have decreased marital satisfaction, which was related to reduced time together, decreased communication, decreased sexual intimacy, and the strain between caregiving and parenting (Berge and Patterson 2004).

Community Reintegration

Sudden disability from stroke potentially creates havoc, especially for the family of the geriatric patient. All too often, the burden of decision-making falls on an elderly spouse or upon children who have not been involved in the daily lives of their parent. A randomized trial of 185 patients who were well matched showed that caregiver counseling with problem solving by a social worker led to better patient and family adjustment than classroom education about stroke care. Both approaches were more effective than routine medical and nursing care at 6 and 12 months after a stroke.123

Task Oriented Approaches

The evidence favoring task-specific practice is increasing, especially for patients with modest impairments. One trial randomized 185 patients within 1 month of a stroke to either up to 5 months of home-based therapy with an occupational therapist or to no therapy.220 The number of visits ranged from 1 to 15 with a mean of only 6 visits per patient. None of the subjects had been admitted to a hospital for the stroke. Their median BI scores were 18 (approximately 90 on the American version of the test), so they were minimally disabled. Blinded outcomes revealed significant gains made by the group that received therapy. Instrumental ADLs were clearly better and handicap decreased. The investigators also found a significant if modest gain in ADLs, along with a decrease in reported caregiver strain. The quality of life measure did not differ between groups.

Family and Social Functioning

The effect of pediatric heart disease on mothers appears to vary depending on the level of reported stress and the type of coping used to address these stressors (Davis et al. 1998). A stressful component of parenting a child with a heart defect is the decision-making process associated with the heart surgery, which may cause caregivers and families to experience significant psychological distress, role reorganization, and remodeling of functioning (Lan et al. 2007). Maternal attachment style has been associated with maternal and child psychiatric outcomes. For example, maternal avoidant attachment has been associated with the deterioration of maternal mental health and marital satisfaction, as well as child emotional difficulties and poor self-image at age 7 years (Berant et al. 2008).

Treatment Interventions

Investigations have shown some success in improving adherence to fluid restriction in adults. Hegel et al. (1992) compared a cognitive intervention with a behavioral intervention of positive reinforcement, shaping, and self-monitoring. They reported that the behavioral intervention was superior to the cognitive intervention in preventing long-term weight gain but that those subjects who received combined cognitive and behavioral interventions experienced no added benefit. Fisher et al. (2006) demonstrated long-term success in reducing volume overload in a small group of hemodialysis patients by using CBT techniques and motivational interviewing. Tong et al. (2008) conducted a systematic review of interventions for informal caregivers (family or friends) who care for CKD patients. They identified only three studies, all of which focused on the effect of educational material on caregivers' knowledge, and found that the provision of infor mation improved caregivers' knowledge. Further...

Decisions Not To Leave Home

Decisions not to leave home are made more and more frequently today.1819 Under proper conditions, these decisions represent a reasoned judgment made by patients in concert with their families and caregivers not to seek hospital care but to remain and die at home. More is involved here than in other cases in which patients ask not to be resuscitated. Since patients who decide against institutionalization remain at home, their families and loved ones are intimately and critically involved. It is the patient who chooses to remain at home, but it is the family and other caregivers who provide the necessary conditions by which remaining at home is made possible. Decisions to remain at home are therefore invariably communal decisions involving a number of people joined in and working towards a common enterprise. A patient's wish to die at home is, given today's conditions of living, not always one that can be implemented but when it is the patient's wish and when it can without serious...

Donald L Price1234 Tong Li14 Huaibin Cai5 and Philip C Wong134

Alzheimer's Disease (AD)' the most common disease manifesting as memory loss and dementia in the elderly' affects more than 4 million elderly individuals in the United States (Brookmeyer et alv 1998 MayeuX' 2003 Cummings' 2004). Due to increased life expectancy and the baby boom' the elderly are the most rapidly growing segment of our society. Thus' over the next several decades' the number of persons with AD in the United States will triple. Because of its prevalence' costs' lack of mechanism-based treatments' and impact on individuals and caregivers' AD is one of the most challenging diseases in medicine (Price et alv 1998 Wong et alv 2002 Citron' 2004 Walsh and Selkoe' 2004). The development of effective new therapies will have a significant impact on the health and care of the elderly. This review focuses on important research relevant to AD' including the diagnosis of clinical syndrome value of laboratory studies' particularly new imaging efforts advances in genetics and...

The Social Context of Recollection

Importantly, parental reminiscing style is context-specific. That is, parents who are more elaborative in reminiscing contexts are not necessarily more talkative overall, nor are they more elaborative in other conversational contexts such as book reading, free play, or caregiving routines (Haden & Fivush, 1996 Hoff-Ginsburg, 1991). Moreover, parental reminiscing style uniquely predicts children's narrative recall even when children's language skills and temperament are controlled (Farrant & Reese, 1996 Reese, 2002a, 2002b). Finally, more experimental studies in which mothers are instructed to be more elaborative demonstrate that maternal elaborative reminiscing directly predicts children's narrative recall (Peterson, Jesso, & McCabe, 1999). Relevant studies with fathers have not been conducted. Thus it is clear that children are learning how to narrate their personal experiences through participating in parent-guided reminiscing about the past.

Unconscious Motivation and Intentionality

Psychoanalytic developmental approaches share an emphasis on the importance of unconscious motivation and intentionality, consistent with contemporary theoretical models in neurosciencc (Lieberman 2007) and cognitive science (Westcn and Gabbard 2002a). This view entails a focus on the dynamics involved in development, because both psychoanalytic and contemporary' cognitive science (Rumclhart and McClelland 1986) approaches emphasize the coexistence of processing units from different developmental stages, the ubiquity of conflict between these units, and the desirability of adaptive resolution of these conflicts as part of die developmental process. Attachment researchers, for instance, have provided some of the most dramatic confirmation of the unconscious dynamics associated with representations based on interactions with caregivers, influencing various stages of information processing in an attempt to cope with feelings of attachment distress and anxiety (Mikulincer and Shaver 2007 .

Dementia And Limiting Treatment

Severe and permanent dementia (in which all reversible causes have been excluded, in which no reasonable doubt as to diagnosis or prognosis remains, and in which there is an evident and progressive lack of meaningful thought processes) is a very troublesome problem. A sometimes long road separates its early stages from the ultimate, lingering non-being of the vegetative state. Along this road, various problems and options will inevitably present themselves and will need to be dealt with. Alzheimer's disease is one of the ways in which dementia most frequently presents itself, but it is not the only one. It can be an inborn state of affairs in which a severely retarded person can neither speak nor socially interconnect in any way it can occur due to accident or illness. Whatever its mechanism, dealing with permanent dementia is one of the more frequent and more troubling ethical problems in medicine. For caregivers no matter how loving it often represents a sometimes infuriating...

Models of Intervention Hospice programs

Hospice programs are among the most widely known approaches to caring for dying patients and those who will be involved with them during their last days. Dr Cicely Saunders, a British physician, began the modern hospice movement when she opened St Christopher's Hospice near London in 1967. The first hospice in the United States began in 1974 in New Haven, Connecticut. In the United States individuals are eligible for hospice care when a prognosis has been determined that cure is no longer viable, and that there are six months or less to live. Hospice care is palliative, with pain control as a primary goal of medical intervention. In addition to the medical professionals, a hospice program usually includes a team of mental health caregivers counsellors, social workers, clergy, and volunteers for respite care. Most hospice care programs in the United States take place within the home environment of the patient and family. At least one person must assume the responsibility of being the...

Issues for Children and Adolescents who have Lifethreatening Chronic or Terminal Illnesses

Adolescents who are seriously ill present a different challenge for professional caregivers. Simultaneously they are working on issues of development as well as fears of their non-being. Adolescents with life-threatening illnesses have a unique developmental confrontation

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