Perspectives of bereaved partners of lung cancer patients on the role of mindfulness in dying and grieving: A qualitative study.

BACKGROUND: Mindfulness-Based Stress Reduction (MBSR) has been shown to reduce psychological distress in cancer patients but not their partners. Whether MBSR can support patients and partners in coping with the dying and grieving process is less well examined. AIM: We aimed to gain more insight in the role of mindfulness in the dying and grieving process from the perspective of the partner after the patient's death. DESIGN: As part of a pilot study or subsequent randomized controlled trial, partners had participated together with the patient in MBSR. After the patient's death partners were invited for qualitative in-depth interviews. Data from the interviews was analyzed using the grounded theory approach. SETTING/PARTICIPANTS: Interviews were conducted with 11 partners in their homes, on average 11 months after the patient's death (SD = 7.8). RESULTS: Mindfulness helped couples to allow and regulate difficult thoughts and feelings, which in turn helped them to accept the patient's impending death. It also facilitated them to enjoy things together and communicate more openly. For a few couples, however, participation was physically too burdensome or emotionally too confrontational. During the partners' grieving process, mindfulness helped allowing difficult thoughts and feelings, and taking the time to grieve, which helped them to take good care of themselves, giving them faith in the future. CONCLUSION: The present study showed that MBSR can facilitate lung cancer patients and their partners in accepting the forthcoming death and openly communicating about this, which can support a peaceful death and healthy grieving process.

Spouses' existential loneliness when caring for a frail partner late in life - a hermeneutical approach.

Purpose: Spouses are in a vulnerable situation when caring for a frail partner late in life. Exploring their existential loneliness can be a way to understand more about their existential needs.Method: A hermeneutic approach was used. Multistage focus group interviews were conducted with two groups consisting of five spouses, respectively, who met three times each. To work with the text, an approach was adapted where quotations are converted into poems in a linguistic manner.Results: Existential loneliness can be understood as the following: 1) being in a transition from us to merely me, 2) being forced to make decisions and feeling excluded, 3) navigating in an unfamiliar situation and questioning oneself, and 4) longing for togetherness but lacking the energy to encounter other people. The main interpretation is that existential loneliness emerges when one is in moments of inner struggle, when one is forced to make impossible choices, when one is approaching and is in limit situations, and when one is experiencing the endless loss of the other.Conclusion: For health care professionals to achieve a holistic picture, person-centeredness can be a way to make the spouses' existential needs visible and to provide support based on their needs.

Determinants of Vitamin D Status of Women of Reproductive Age in Dhaka, Bangladesh: Insights from Husband-Wife Comparisons.

BACKGROUND: Vitamin D deficiency is common among women of reproductive age (WRA) in Bangladesh, but the causes remain unclear. OBJECTIVE: To explain the high prevalence of vitamin D deficiency in WRA in Dhaka, Bangladesh, we compared the vitamin D status of pregnant women with that of their husbands and between pregnant and nonpregnant states. METHODS: This study was an observational substudy of the Maternal Vitamin D for Infant Growth trial conducted in Dhaka, Bangladesh. Women (n = 1300) were enrolled in the second trimester of pregnancy and randomly assigned to 1 of 5 arms consisting of different doses of vitamin D supplements or placebo, with 1 arm continuing supplementation until 6 mo postpartum. A subgroup of trial participants and their husbands with plasma 25-hydroxyvitamin D [25(OH)D] concentration measurements (n = 84), and placebo-group trial participants with serum 25(OH)D measured in the second trimester of pregnancy and 6 mo postpartum (n = 89) were studied using linear mixed-effects regression models. RESULTS: The mean ± SD plasma 25(OH)D in pregnant women in the second trimester was 23 ± 11 nmol/L. Adjusting for age and season, 25(OH)D of pregnant women was 30 nmol/L lower (95% CI: -36, -25 nmol/L) than that of men. Only 9% of total variance in 25(OH)D was explained by factors shared by spousal pairs. Selected nonshared factors (BMI, time spent outdoors, involvement in an outdoor job, sunscreen use) did not explain the association of sex with 25(OH)D. Adjusting for age, season, and BMI, 25(OH)D was similar during pregnancy and 6 mo postpartum (mean difference: -2.4 nmol/L; 95% CI: -5.3, 0.4 nmol/L). CONCLUSIONS: In Dhaka, WRA have substantially poorer vitamin D status than men. Variation in 25(OH)D is not greatly influenced by determinants shared by spouses. Measured nonshared characteristics or pregnancy did not account for the gender differential in 25(OH)D. This trial was registered at clinicaltrials.gov as NCT01924013.

Sexual Disharmony in Menopausal Women and Their Husband: A Qualitative Study of Reasons, Strategies, and Ramifications.

OBJECTIVES: The goal of this study was to explore perceptions and experiences of general practitioners and midwives during sexual dialogue with menopausal women. METHODS: In a descriptive exploratory qualitative study, 13 midwives and 12 general practitioners were selected using a semi-structured interview and purposive sampling method. Data analysis was conducted using qualitative content analysis adopted by Graneheim and Lundman. RESULTS: Through data analysis "sexual disharmony" emerged as a central theme, which included three categories of reasons, strategies, and ramifications of sexual disharmony. Reasons for sexual disharmony included subcategories of aging and health related-problems, marital problems, and stereotypical perceptions regarding menopause and sexuality and daily concerns. Strategies used by couples to address sexual disharmony consisted of changing roles and values, pretending to reach orgasm, suppressing sexual desire, meeting sexual needs of husbands in accordance with religious rules, seeking help of peers, seeking friends or traditional medicine and health providers, seeking a help charmer, engaging in sex with other women to fulfill sexual needs, pretending to be moody to alleviate sexual tension. Sexual disharmony may lead to spending money on a prostitute instead of engaging in sex out of wedlock or a surge in social pathologies such as sexually transmitted disease. CONCLUSIONS: Healthcare providers must be aware of various sexual behavior of menopausal women and their husbands when they detect sexual disharmony in their patients. Results of this study can facilitate development of restricted guidelines for sexual discussion with menopausal women.

Sexual Disharmony in Menopausal Women and Their Husband: A Qualitative Study of Reasons, Strategies, and Ramifications

OBJECTIVES: The goal of this study was to explore perceptions and experiences of general practitioners and midwives during sexual dialogue with menopausal women. METHODS: In a descriptive exploratory qualitative study, 13 midwives and 12 general practitioners were selected using a semi-structured interview and purposive sampling method. Data analysis was conducted using qualitative content analysis adopted by Graneheim and Lundman. RESULTS: Through data analysis “sexual disharmony” emerged as a central theme, which included three categories of reasons, strategies, and ramifications of sexual disharmony. Reasons for sexual disharmony included subcategories of aging and health related-problems, marital problems, and stereotypical perceptions regarding menopause and sexuality and daily concerns. Strategies used by couples to address sexual disharmony consisted of changing roles and values, pretending to reach orgasm, suppressing sexual desire, meeting sexual needs of husbands in accordance with religious rules, seeking help of peers, seeking friends or traditional medicine and health providers, seeking a help charmer, engaging in sex with other women to fulfill sexual needs, pretending to be moody to alleviate sexual tension. Sexual disharmony may lead to spending money on a prostitute instead of engaging in sex out of wedlock or a surge in social pathologies such as sexually transmitted disease. CONCLUSIONS: Healthcare providers must be aware of various sexual behavior of menopausal women and their husbands when they detect sexual disharmony in their patients. Results of this study can facilitate development of restricted guidelines for sexual discussion with menopausal women.

[Life Experiences of Uninfected Women Living with HIV-Infected Husbands: A Phenomenological Study].

PURPOSE: This study aimed to understand the meaning and essence of the life experiences of uninfected women living with HIV-infected husbands. METHODS: This qualitative study adopted van Manen's hermeneutic phenomenological method. Study participants were 8 females whose husband had been diagnosed with HIV for longer than 6 months, who had known about their husband's infection for more than 6 months, who were in a legal or common-law marriage and were living with their husbands at the time of interview for this study, and whose HIV antibody test results were negative. Data were collected from in-depth individual interviews with the participants from May to August 2016, and from related idiomatic expressions, literature, artwork, and phenomenological references. RESULTS: The following essential themes were identified regarding the life experiences of uninfected women living with HIV-infected husbands: 'experiencing an abrupt change that came out of the blue and caused confusion', 'accepting one's fate and making desperate efforts to maintain one's family', 'dealing with a heavy burden alone', 'experiencing the harsh reality and fearful future', and 'finding consolation in the ordeal'. CONCLUSION: This study provided a holistic and in-depth understanding of the meaning and essence of the life experiences of uninfected women living with HIV-infected husbands. Thus, this study recognizes these unnoticed women as new nursing subjects. Further, the present findings can be used as important basic data for the development of nursing interventions and national policy guidelines for uninfected women living with HIV-infected husbands.

Life Experiences of Uninfected Women Living with HIV-Infected Husbands: A Phenomenological Study

PURPOSE: This study aimed to understand the meaning and essence of the life experiences of uninfected women living with HIV-infected husbands. METHODS: This qualitative study adopted van Manen's hermeneutic phenomenological method. Study participants were 8 females whose husband had been diagnosed with HIV for longer than 6 months, who had known about their husband's infection for more than 6 months, who were in a legal or common-law marriage and were living with their husbands at the time of interview for this study, and whose HIV antibody test results were negative. Data were collected from in-depth individual interviews with the participants from May to August 2016, and from related idiomatic expressions, literature, artwork, and phenomenological references. RESULTS: The following essential themes were identified regarding the life experiences of uninfected women living with HIV-infected husbands: ‘experiencing an abrupt change that came out of the blue and caused confusion’, ‘accepting one's fate and making desperate efforts to maintain one's family’, ‘dealing with a heavy burden alone’, ‘experiencing the harsh reality and fearful future’, and ‘finding consolation in the ordeal’. CONCLUSION: This study provided a holistic and in-depth understanding of the meaning and essence of the life experiences of uninfected women living with HIV-infected husbands. Thus, this study recognizes these unnoticed women as new nursing subjects. Further, the present findings can be used as important basic data for the development of nursing interventions and national policy guidelines for uninfected women living with HIV-infected husbands.

When do we need to care about the caregiver? Supportive care needs, anxiety, and depression among informal caregivers of patients with cancer and cancer survivors.

BACKGROUND: Cancer not only affects patients but also their caregivers. The objective of the current study was to assess the unmet needs of cancer caregivers and to identify possible predictors of their supportive care needs. METHODS: In a cross-sectional survey, 188 dyads of patients diagnosed with lung, urological, or gastrointestinal cancer and their primary caregivers were recruited. Caregivers were asked to complete the Supportive Care Needs Survey self-report questionnaire (for partners and caregivers); patients completed the corresponding questionnaire. Both groups provided information regarding their distress (National Comprehensive Cancer Network Distress Thermometer), anxiety, and depression (Patient Health Questionnaire-4). Clinical characteristics were obtained from medical records. RESULTS: The mean age of the caregivers was 57.8 years. Approximately 72.3% were female. Patients had an average age of 62.5 years, with 33.0% being male. Caregivers were more distressed (P<.01) and exhibited higher anxiety scores (P<.01) compared with patients. Approximately 14.4% of caregivers reported no unmet need and 43.6% had at least 10 needs that were unmet. Main caregiver concerns were regarding health care service and information needs followed by emotional and psychological needs. To some degree, unmet needs in patients and caregivers' anxiety predicted unmet caregiver needs. Sociodemographic and clinical variables were not found to be significant predictors. CONCLUSIONS: A substantial percentage of caregivers have unmet needs for support, mainly with regard to fears concerning the patient's condition, receiving disease-related information, and emotional support for themselves. Prediction of unmet needs in caregivers from other clinical and psychological variables was rather poor. Therefore, by means of the frequency and disparity of caregivers unmet needs, they should be systematically assessed to direct specific offers.

Effect of family constellation therapy on the spouses of female tumor patients / 现代临床护理

Objective To explore the effect of family constellation therapy on the spouses of female tumor patients . Methods Two hundred and two spouses of 202 female tumor patients were divided to the control group ( n = 43 ) and experiment group according to their wills(n=159):the former were intervened with health education and skills training and the latter trained in a workshop with family constellation by psychology training specialists in addition to health intervention and skill training intervention. After the intervention, the two groups were compared in terms of quality of life, family function and marriage status. Result The total scores of the experiment group on quality of life , social relationship and environment were all higher than those of the control group (all P<0.05) and the experiment group got higher score in trusting their spouses than the control group (P<0.05). Conclusion The family constellation can improve female tumor patients'quality of life and promote the trust in their spouses.

Women survivors of intimate partner violence: the difficult transition to independence / Mujeres supervivientes de la violencia ejercida por sus parejas: la difícil transición hacia la autonomía / Mulheres sobreviventes de violência exercida por parceiros íntimos – a difícil transição para a autonomia

Objective To understand the trajectories that women go through from entering into to leaving relationships involving intimate partner violence (IPV), and identify the stages of the transition process. Method We utilized a constructivist paradigm based on grounded theory. We ensured that the ethical guidelines of the World Health Organization for research on domestic violence were followed. The analysis focused on narratives of 28 women survivors of IPV, obtained from in-depth interviews. Results The results showed that the trajectories experienced by women were marked by gender issues, (self) silencing, hope and suffering, which continued after the end of the IPV. Conclusion The transition process consists of four stages: entry - falls in love and becomes trapped; maintenance - silences own self, consents and remains in the relationship; decides to leave - faces the problems and struggles to be rescued; (re) balance - (re) finds herself with a new life. This (long) process was developed by wanting (and being able to have) self-determination. .

Objetivo Conhecer as trajetórias que as mulheres percorrem desde a entrada até à saída de relações de violência exercida por parceiros íntimos (VPI), e identificar as fases do processo de transição. Método Utilizou-se um paradigma construtivista com recurso à grounded theory. Salvaguardaram-se as orientações éticas da OMS em matéria de investigação sobre violência doméstica. A análise centrou-se em narrativas de 28 mulheres sobreviventes de VPI, obtidas em entrevistas em profundidade. Resultados Referem que as trajetórias percorridas pelas mulheres foram atravessadas por questões de género, (auto)silenciamento, esperança e sofrimento, o que ultrapassou o fim da VPI. Conclusión O processo de transição é constituído por quatro fases: entrada - enamora-se e fica aprisionada; manutenção - auto-silencia-se, consente e permanece na relação; decisão de saída - enfrenta o problema e luta pelo resgate; (re)equilíbrio - (re)encontra-se com uma nova vida. Este (longo) processo foi atravessado por querer (e poder) autodeterminar-se. .

Objetivo Conhecer as trajetórias que as mulheres percorrem desde a entrada até à saída de relações de violência exercida por parceiros íntimos (VPI), e identificar as fases do processo de transição. Método Utilizou-se um paradigma construtivista com recurso à grounded theory. Salvaguardaram-se as orientações éticas da OMS em matéria de investigação sobre violência doméstica. A análise centrou-se em narrativas de 28 mulheres sobreviventes de VPI, obtidas em entrevistas em profundidade. Resultados Referem que as trajetórias percorridas pelas mulheres foram atravessadas por questões de género, (auto)silenciamento, esperança e sofrimento, o que ultrapassou o fim da VPI. Conclusão O processo de transição é constituído por quatro fases: entrada - enamora-se e fica aprisionada; manutenção - auto-silencia-se, consente e permanece na relação; decisão de saída - enfrenta o problema e luta pelo resgate; (re)equilíbrio - (re)encontra-se com uma nova vida. Este (longo) processo foi atravessado por querer (e poder) autodeterminar-se. .

CAM and energy psychology techniques remediate PTSD symptoms in veterans and spouses.

Male veterans and their spouses (N = 218) attending one of six-week-long retreats were assessed for posttraumatic stress disorder (PTSD) symptoms pre- and postintervention. Participants were evaluated using the PTSD checklist (PCL), on which, a score of >49 indicates clinical symptom levels. The mean pretest score was 61.1 (SD ± 12.5) for veterans and 42.6 (SD ± 16.5) for spouses; 83% of veterans and 29% of spouses met clinical criteria. The multimodal intervention used Emotional Freedom Techniques and other energy psychology (EP) methods to address PTSD symptoms and a variety of complementary and alternative medicine (CAM) modalities for stress reduction and resource building. Interventions were delivered in group format as well as individual counseling sessions. Data were analyzed for each retreat, as well as for the six retreats as a whole. Mean post-test PCL scores decreased to 41.8 (SE ± 1.2; p < .001) for veterans, with 28% still clinical. Spouses demonstrated substantial symptom reductions (M = 28.7, SE ± 1.0; p < .001), with 4% still clinical. A follow-up assessment (n = 63) found PTSD symptom levels dropping even further for spouses (p < .003), whereas gains were maintained for veterans. The significant reduction in PTSD symptoms is consistent with other published reports of EP treatment, though counter to the usual long-term course of the condition. The results indicate that a multimodal CAM intervention incorporating EP may offer benefits to family members as well as veterans suffering from PTSD symptoms. Recommendations are made for further research to answer the questions posed by this study.

Meaning of Life in Wives of Alcoholics: Autobiographical Method

PURPOSE: The purpose of this study was to explore and describe life-stories and meanings of life in wives of alcoholics by analyzing their autobiographies. METHODS: Autobiographies were collected from 20 participants who produced their own autobiographies in the logotherapeutic autobiography program at community alcohol counseling centers in Korea. The data were coded to identify themes of agency and communion using the manual coding system developed by McAdams, and analyzed by the existential approach. RESULTS: There were 214 coded episodes in twenty autobiographies. There were 128 agency themes and 86 communion themes. The most common themes were Love/Friendship. Five themes emerged from the autobiographical episodes on the existential perspective: 1) overcoming the suffering, 2) meaningful people and relationships, 3) spiritual maturation, 4) caring and helping, and 5) finding a meaning of life. CONCLUSION: These results showed that the wives of alcoholics who participated in the logotherapeutic autobiography program found the meaning of life through their suffering. Furthermore, a study on existential nursing interventions for people who have meaninglessness in life needs to be done.