Religion, spirituality and the well-being of informal caregivers: a review, critique, and research prospectus.

The purpose of this article is to review and critique the published literature examining the relationships between religion/spirituality and caregiver well-being and to provide directions for future research. A systematic search was conducted using bibliographic databases, reference sections of articles, and by contacting experts in the field. Articles were reviewed for measurement, theoretical, and design limitations. Eighty-three studies were retrieved. Research on religion/spirituality and caregiver well-being is a burgeoning area of investigation; 37% of the articles were published in the last five years. Evidence for the effects of religion/spirituality were unclear; the preponderance (n = 71, 86%) of studies found no or a mixed association (i.e., a combination of positive, negative, or non-significant results) between religion/spirituality and well-being. These ambiguous results are a reflection of the multidimensionality of religion/spirituality and the diversity of well-being outcomes examined. They also partially reflect the frequent use of unrefined measures of religion/spirituality and of atheoretical approaches to studying this topic. Investigators have a fairly large number of studies on religion/spirituality and caregiver well-being on which to build. Future studies should be theory driven and utilize psychometrically sound measures of religion/spirituality. Suggestions are provided to help guide future work.

Elements of the art of practice in mental health.

OBJECTIVE: This qualitative study explored elements of artful practice of therapists practicing in mental health treatment settings. METHOD: In-depth interviews were conducted with three occupational therapists practicing in mental health who were considered exemplars of artful practice. Themes pertaining to their perspectives and approaches to practice were synthesized from interview data. RESULTS: The prevailing themes--therapeutic work as a vehicle for healing, collaborative guidance, and the Zen of therapy--are seen as elements forged by the therapist's compassion and unique personal style into a dynamic therapist-client interplay that creates a space for growth and healing to occur. Results affirmed the view of the art of practice in mental health as an intricate interplay of personal traits, interpersonal skills, and skilled use of meaningful activities within the context of a client's environment. CONCLUSION: The art of practice is a fluid, experiential process that takes place on a developmental continuum. The therapist's inner awareness of the subtlety of a multilayered healing process is an important basis of artful practice. One's practice art can be informed by knowledge of specific elements that contribute to artful practice and can be developed through education, self-reflection, personal growth, and the maturation process.

Graduate health administration field experiences: a university and health service delivery systems partnership.

The importance of experiential components of education to professional preparation has been evidenced in the curricula of academic institutions in several disciplines. Graduate programs in health administration offer a variety of alternative residency, internship, and other field experiences for students to apply academic theory to practical phenomena. Using a case study approach, this article presents the advantages of field experience options to both students and health care delivery sites. Components of a model of experiential alternatives in a graduate health administration program are described.

Use of hypnosis before and during angioplasty.

In this study, 16 patients matched with 16 controls were hypnotized prior to angioplasty. The hypnotized patients had a 25% increase in the time the cardiologist was able to keep the balloon inflated compared to the controls. Of the hypnotized patients, 13% required additional narcotic pain medication during the procedure as compared to 44% for the controls. Although we found no differences in rhythm, ischemia, blood pressure, or pulse between the two groups, the results of arterial catecholamine levels drawn at the start and at the end of the procedure were unexpected and seemed paradoxical. Norepinephrine levels were significantly higher in the hypnotized group (432 pg/ml, SE 51) than in the control group (281 pg/ml, SE 23) at the start of the procedure and fell more during the procedure than in control patients. Because catecholamines reportedly act as a barometer of neuroanxiety, further studies defining their role are needed.

The effect of stimulus significance on relatively sustained (tonic-like) and relatively transient (phasic-like) aspects of electrodermal, heart rate, and eyeblink response.

To examine the influence of stimulus significance on more sustained as well as transient aspects of electrodermal, cardiac (HR), and eyeblink response, a 21-sec tone was sounded in one ear or the other. A click occurred during many tones, and a light followed offset by 9 sec. Four groups were studied: one pressed a pedal immediately on hearing any click; another only on click during tone in a specified ear; a third also responded only to the specified ear, but withheld press until the light; a fourth listened without any response. Results confirmed the important role of stimulus significance in each system whether between- or within-subject comparisons were made. Sustained responses were seen only when a significant signal was sought, involving in each case sustained HR deceleration, slowed blink rate, and heightened electrodermal level. Transient response to click and light also appeared only when there were significant signals. Response to tone-onset gave more ambiguous results. ANOVAs of response magnitude suggested that onset of nonsignificant tones might have elicited ORs, while binomial tests indicated these were not elicited with better than random frequency anywhere but on those trials occurring more frequently at the experiment's onset. Interpretations consistent with both the significance hypothesis and with a distinction between automatic and voluntary ORs can be made only here. Motor response had no effect on electrodermal or eyeblink response, and on HR was associated only with increased acceleration 1-2 sec after pedal-press. Studies using small motor responses to establish stimulus significance are therefore not likely to be substantially biased by the response itself.