Marjorie C. Dobratz

Acceptance, cognitions, and resourcefulness in women with diabetes.

The coexistence of diabetes and depression occurs frequently among young and middle-age women. Unless one is resourceful, simultaneous management of the symptoms of both conditions is especially challenging. Skills constituting resourcefulness are learned throughout life and are important for the optimal performance of daily activities. Little is known about specific factors that influence resourcefulness. In this study, contextual factors (diabetic and depressive symptoms) and cognitive factors (positive cognitions and acceptance of diabetes) were examined as antecedents of learned resourcefulness in 82 women with type 2 diabetes. Regression analyses showed that depressive symptoms and positive cognitions were significant antecedents of learned resourcefulness: Positive cognitions mediated the effects of depressive symptoms on learned resourcefulness. The findings suggest the need for interventions that focus on development of positive cognitions to better promote resourcefulness in women with type 2 diabetes who are at risk for depression.

The Pattern of the Becoming-Self in Death and Dying

As part of a triangulated study that examined psychological adaptation in home hospice patients, the grounded theory method was used to generate social-psychological processes of dying. The pattern of the becoming-self was one of seven patterns that emerged. The responses and reactions of 15 dying persons described a pattern that was shaped by self-integration, inner cognition, creation of personal meanings, and connection to others and a higher being. The becoming-self supported humanism and veritivity as defined in adaptation nursing theory.

Life-Closing Spirituality and the Philosophic Assumptions of the Roy Adaptation Model

Secondary analysis of data from a previous study that referenced spirituality was coded, categorized, and grouped into themes. Life-closing spirituality for 44 (45.4%) of 97 total participants was shaped by a core theme ofbelieving that was central to dying persons. Believing was linked to six other themes: comforting, releasing, connecting, giving, reframing, and requesting. These themes supported the philosophic assumptions and principles of humanism and veritivity as defined in the Roy adaptation model.

All my saints are within me: Expressions of end-of-life spirituality

OBJECTIVE With spirituality being one of the most important components of end-of-life (EOL) care, this study explored the oral responses of 44 dying persons who expressed spirituality. METHOD Four identified spiritual themes: religious systems of beliefs and values, life meaning, purpose and connections with others, nonreligious systems of beliefs and values, and metaphysical or transcendental phenomena served as a framework for a content analysis of 91 spiritual references. RESULTS From the content analysis, eight interrelated and separate themes emerged. Although the highest number of responses centered on religious beliefs and values, nonreligious beliefs and values that included reason, dignity, mental discipline, and communion were expressed. The themes of life meaning, purpose, and connections with others also surfaced as important aspects of EOL spirituality. SIGNIFICANCE OF RESULTS The findings support the need for hospice/palliative care professionals to approach spirituality from other than a Judeo-Christian viewpoint, help dying persons create meaning and purpose within the context of their lives, and assist them in their desire for connectedness to faith communities and other significant individuals in their lives.

Word Choices of Advanced Cancer Patients: Frequency of Nociceptive and Neuropathic Pain

The purpose of this study was to determine if nociceptive and/or neuropathic pain in advanced cancer patients could be identified by word selections made on the McGill Melzack Pain Questionnaire. Theoretical definitions for nociceptive and neuropathic pain provided a framework for categorizing the word descriptors in the McGill Melzack Pain Questionnaires sensory and miscellaneous dimensions. A description study design was used to group word frequencies by primary site and pain type. The participants were 76 advanced cancer patients who received home-based hospice services. A wide range of word choices for lung cancer patients supported both nociceptive and neuropathic pain. Individuals with colon and liver cancer selected words that described 2 types of nociceptive (visceral, somatic) pain, while those with prostate cancer noted somatic pain. A set frequency was not reached by individuals with breast, pancreatic, gastric, and other advanced cancers. This study provided evidence that advanced cancer patients select words that describe nociceptive and neuropathic pain types.

patterns of Advanced Cancer Pain in Home Hospice Patients

&NA; The purpose of this descriptive study was to provide a description of advanced cancer pain in home hospice subjects. The McGill Pain Questionnaire, Parts 1 and 2, measured pain in a convenience sample of 76 patients who were terminally ill with cancer. Analysis of the McGill Pain Questionnaire Part 1 delineated the following mean scores: total score (11.24), number of words chosen (5.89), sensory (5.71), affective (3.07), evaluative (1.09), and miscellaneous (1.96). The Present Pain Intensity Scale revealed a mean of (1.66) for Part 2. Descriptive statistics were used to analyze choices from the 78 possible word selections that categorize the four dimensions of the McGill Pain Questionnaire: sensory, affective, evaluative, and miscellaneous. Subjects selected 444 words from these four pain components, and their rank order from the highest to the lowest numbers were sensory (227), affective (90), miscellaneous (75), and evaluative (52). Although a mean Present Pain Intensity score of 1.66 demonstrated good pain management, patients with advanced cancer in home hospice care chose words that described four main pain patterns: “tiring and exhausting” (11.5%), “troublesome and annoying” (8.8%), “dull and aching” (7.7%), and “nauseating and sickening” (6.8%).

A comparative study of life-closing spirituality in home hospice patients.

This secondary analysis compared two groups of home hospice patients (expressed spirituality, N = 44, and nonexpressed spirituality, N = 53) on psychological well-being and adaptation, social support, physical function, pain, and demographic variables. Independent-samples t tests found no significant differences at p < .05 for age, psychological well-being and adaptation, social support, and physical function. Three components of the McGill-Melzack Pain Questionnaire were significantly higher for the nonexpressed spirituality group: Affective Dimension, Pain Rating Index, and Number of Words Chosen. A comparative analysis of two groups of home hospice patients supported higher pain reports as significant indicators of nonexpressed spirituality in a home hospice population.

Toward Development of a Middle-Range Theory of Psychological Adaptation in Death and Dying

This paper presents a middle-range theory of psychological adaptation in death and dying that was abstracted from a series of quantitative and qualitative studies. The findings from these studies are described, a conceptual definition for end-of-life psychological adaptation is given, evidence is synthesized into a limited number of assumptions, testable hypotheses are derived, and the constructed middle-range theory is linked to the conceptual-theoretical framework of the Roy adaptation model.

The Self-Transacting Dying: Patterns of Social-Psychological Adaptation in Home Hospice Patients

This study explored the perceptions and reactions of individuals as they dealt with the dying process. As part of a triangulated methodology, the grounded theory method recorded, coded, and analyzed the spontaneous responses of 97 adult home hospice patients. The central construct that emerged was self-transactions. The self-transacting dying was represented by higher and lower patterns of social-psychological integration that reflected the cognition, feelings, and meanings of ones death as well as the supportive others who sustained them. The seven patterns of the self-transacting dying were: transcending; becoming; reconciling; agonizing; avoiding; relinquishing; and repressing. Along with the seven patterns, the self-transactions included a core concept called the integrating forces. The integrating forces were the person/environment influences and a dialectical motion between positive and negative forces of these influences.

A model of consensus formation for reconciling nursing's disciplinary matrix

With questions raised as to whether or not nursing knowledge should be developed from extant conceptual/theoretical models or from practice-based environments, this paper utilizes Kuhns disciplinary matrix and Laudans model of consensus formation to explore the changing nature of the disciplines structural matrix. Kuhns notion that a disciplines structural matrix includes symbolic generalizations, models and exemplars, and Laudans view that a maturing discipline embraces factual, methodological, and axiological (goals and aims) knowledge, and that context and discourse are also involved in advancing a discipline is described as a means for reconciling the source of nursing knowledge. This paper posits that shared axiological goals connect both theorists and practitioners, and resolve potential conflicts as to viable sources of nursing knowledge. Through shared goals that include humanization, meaning, quality of life, caring, consciousness, transcendence, and presence, which bridge both theoretical and practice approaches, nursings charge to contribute to the good of society is fulfilled.