Lois Gonzalez

Infertility as a transformational process : a framework for psychotherapeutic support of infertile women

The purpose of this qualitative descriptive study was to investigate the phenomenon of infertility as experienced by infertile women. A purposive sample of 25 infertile women participated in the study. Data were extracted from taped interviews and the researcher?s observational field notes. Data analysis was conducted according to the techniques described by Miles and Huberman (1994). Participant responses to interviews were categorized by examining the interview transcripts and identifying significant statements and meanings. Themes which emerged from the statements were then ascertained and cross-case comparisons were made in order to confirm or to reconsider these themes. Five key themes emerged from the data: failure to fulfill a prescribed societal norm, assault on personal identity, mourning, transformation, and restitution. The women experienced infertility as a transformational process in which they mourned their loss of reproductive function and parenting roles and struggled to make restitution for the perceived stigma and powerlessness associated with nonfulfillment of a prescribed societal norm, the exclusion from cherished societal rituals, and the deprivation of ties of descent. Findings from this study have provided a framework for increased awareness of the phenomenon of infertility and for the essential components of supportive counseling or psychotherapy, regardless of the outcome of the infertility experience.

THE BURDEN OF HYPERTENSION: MENTAL REPRESENTATIONS OF AFRICAN AMERICAN WOMEN

A qualitative study using focus groups to explore African American womens mental representations of hypertension was conducted with 47 participants. The ability of participants to select and perform rational procedures for threat management also was explored. Leventhals Self-Regulation Process Model was used to guide the development of the study. African American women (mean age 50.11 years) were recruited from community settings to participate in focus groups. Transcripts from the focus groups were coded and analyzed using comparative analysis. Four themes were generated from the womens mental representations: (1) Vulnerability and Inevitability, (2) Biobehavioral Assaults, (3) Barriers to Effective Management, and (4) Culturally Relevant Remedies. Hypertension was perceived as a significant disease threat; causality was associated with risk factors interacting within the context of psychological stress. Acquiring a clear perspective of how African American women perceive hypertension and their ability to reduce risk factors can assist in developing a model for stimulating the use of health promotive behavior.

Immune responses to guided imagery during breast cancer treatment.

Background: The use of relaxation and guided imagery to reduce stress and improve immune function has great potential benefits for patients with breast cancer. Methods: This pilot study used a pretest—posttest experimental design with 28 breast cancer patients, aged 25 to 75 years, with the diagnosis of stage 0, 1, or 2 breast cancer. The experimental group received a relaxation and guided imagery intervention and the control group received standard care. The effects of the intervention on immune function were measured by natural killer (NK) cell cytotoxicity and IL-2—activated NK cell activity prior to surgery and 4 weeks postsurgery. NK cell activity was measured using a 15-hr incubation chromium release assay. Cytotoxicity of NK cells was measured against chromium-labeled K-562 target cells. IL-2 was used to enhance reactivity of NK cells against tumor cells. After incubation for 15 hr, cytotoxicity was measured through the release of radioactive chromium. Results: Significant differences between groups were found at 4 weeks postsurgery. T-tests showed increased NK cell cytotoxicity for the intervention group at 100:1, 50:1, and 25:1 effector cell: target cell ratios (E:T) (p < .01 to p < .05) and increased activation for IL-2 at 100:1, 50:1, 25:1, and 12.5:1 (E:T) (p < .01 to p < .05) for the intervention group as compared to the control group. Discussion: These findings suggest that a relaxation intervention such as guided imagery could have an effect on NK cell cytotoxicity and NK cell cytotoxicity after activation with IL-2 in patients undergoing surgery for breast cancer.

Postpartum Stressors: A Content Analysis

A qualitative content analysis was conducted on narratives written by 127 mothers at four to six weeks postpartum. This study aimed to identify and compare postpartum stressors to the Tennessee Postpartum Stress Scale (TPSS). The TPSS is a guide to common postpartum stressors and an instrument to assess postpartum stress. Most participants in this study were white (91%), married (72%), and not working (70%). Eighteen stressor categories aggregated into two themes: Stressors Arising within the Maternal-Newborn Dyad and Stressors External to the Maternal-Newborn Dyad. Sixteen of 20 items on the TPSS were identified in the narratives. No stressor categories outside the TPSS were identified.

Psychoneuroimmunology and Immune System Link for Stress, Depression, Health Behaviors, and Breast Cancer:

This article reviews the literature on psychoneuroimmunology and its theoretical underpinnings. It also reviews research related to the immune-system-link of stress, chronic stress, depression and health behaviors to breast cancer. Although the relationship between psychological characteristics and the immune system have been documented repeatedly, the significance of these effects has not been demonstrated in many studies empirically. The question whether the use of alternative therapies contributes to decreasing the progression of the diseased is often asked. Research in the area of psychoneuroimmunology can provide the answer to this question.

Preparing the Baccalaureate Student for Community-Focused Nursing

Nursing educators are being challenged to prepare baccalaureate students for the increase in community-focused health care. A collaborative approach to curriculum development was used between nursing faculty in a baccalaureate program and community agencies to create valuable home health clinical experiences for students. Home health nurses served as preceptors for two semesters, giving students the opportunity to participate actively in the care of patients in their home. Students used reflective journals to integrate practice with theory and to use the new practice environment as a meaningful learning environment. The use of registered nurse preceptors in the home setting has provided students with valuable role models and has facilitated both personal and professional growth that will prepare them for roles in a community setting.

58. Distress, control, health behaviors and immune responses to relaxation-guided imagery in breast cancer patients

P = 0.0067, t-test; FDR = 0.080) at a second site. Both CpG sites are in putative Sp1 transcription factor-binding sites. Increased CpG dinucleotide methylation in the OPRM1 promoter region may reduce the expression of l-opioid receptors and, thus, may reduce CCR5 expression. The finding of differences in percent DNA methylation between stabilized methadone maintained heroin addicts and controls might provide insights into the role of opiates in HIV infection.