ABSTRACT
The trauma symptoms of child sexual abuse (CSA) survivors don't end with the abuse, or even with the advent of adulthood. Instead, these symptoms can persist into all the realms of a survivor's life, including education, which sets the foundation for career advancement. This retrospective study of adult survivors of childhood sexual abuse (n=260) examined the relationships between trauma symptoms, dissociation, dissociative amnesia, anxiety, depression, sleep problems and higher education attainment. The purpose of this study was to determine if these factors are associated with higher education completion for childhood sexual abuse (CSA) survivors. Linear regressions and ANOVAs suggest that many of these variables are significantly associated with survivors' educational trajectory, and multiple linear regressions show that trauma symptoms (as measured by the Trauma Symptom Checklist-40), caregivers' education levels, and age at onset of abuse are significant predictors of decreased education levels. This information can provide insight into additional risk and protective factors for CSA survivors in order to enhance acute and long-term management of trauma symptoms to increase levels ofattainment of higher education.
Subject(s)
Adult Survivors of Child Abuse/psychology , Child Abuse, Sexual/psychology , Problem Behavior , Adolescent , Adult , Age of Onset , Aged , Anxiety Disorders/etiology , Child , Depressive Disorder/etiology , Educational Status , Female , Humans , Male , Middle Aged , Retrospective Studies , Young AdultABSTRACT
OBJECTIVE: Hospice utilization lasting for 2 weeks or less before death is considered "short." Short, late-stage hospice admissions have been viewed as inadequate for providing end-stage symptom management, maximal comfort, and a comprehensive focus on life closure and as an underutilization of the Medicare Hospice Benefit. The purpose of this study was to explore psychosocial dynamics during late-stage hospice admissions by comparing the perspectives of hospice professionals and family caregivers. Salutogenic principles and concepts from Antonovsky's Sense of Coherence Theory (SOC) guided the inquiry. METHODS: This exploratory, descriptive study involved a developmental design. First, hospice professionals' perspectives about psychosocial dynamics commonly observed in late-stage admissions were gathered. Themes were distilled into a Psychosocial Factors Checklist (PFC). Second, interviews that incorporated open-ended questions and the PFC were conducted with 56 family caregivers of hospice patients who died from cancer within 2 weeks of admission. Participant responses were transcribed and entered into Atlas ti software for data management and coding. Responses to the PFC were clustered around the SOC constructs (manageability, comprehensibility, meaningfulness) to create corresponding subscales. Interitem correlations were conducted to explore the associations among items. RESULTS: Late-stage admissions were a crisis (54%), chaotic (43%), emotional (80%), and a time of open communication (80%) and meaningful conversations (73%). Hospice utilization was "just long enough" (49%) and "too short" (49%). The Manageability subscale (M = 4.09) suggested that caregivers experienced moderate difficulty. Manageability included physical challenges, emotional responses, informational needs, and benefits/resources. Comprehensibility emerged from medical results, visual signs, and hospice guidance. Meaningfulness was personal-individual, family-shared, and spiritual-existential. SIGNIFICANCE OF RESULTS: Hospice professionals and caregivers view late-stage admissions differently; they are a crisis for some but not all families. The development of a quick assessment tool for late-stage admissions has the potential for meaningful and effective intervention when time is of the essence.
Subject(s)
Caregivers/psychology , Hospice Care/psychology , Hospices/statistics & numerical data , Length of Stay , Palliative Care/psychology , Professional-Family Relations , Attitude to Death , Bereavement , Communication , Family/psychology , Humans , Interviews as Topic , Neoplasms/psychology , Patient Admission , Professional-Patient Relations , Qualitative Research , Terminal CareABSTRACT
Hospice care is available for 6 months before death but the length of use varies widely, suggesting that there are different perspectives on the appropriate timing for this transition. This qualitative study explored hospice professionals' views on the appropriate timing for and communication about hospice. Ethnography of team meetings informed the development of questions for focus groups and written follow-up surveys with 53 hospice professionals. Results suggest timely admissions are situation-specific and involve a terminal prognosis, terminal decline, and a mutual understanding. Important aspects of communication among families, physicians, and hospice teams are described.
Subject(s)
Communication , Health Personnel , Hospice Care , Hospices , Hospital-Physician Relations , Patient Admission , Patient Care Team , Physician's Role , Physician-Patient Relations , Professional-Family Relations , Professional-Patient Relations , Referral and Consultation , Time Factors , Caregivers , Continuity of Patient Care , Family , Focus Groups , Hospice Care/statistics & numerical data , Hospices/statistics & numerical data , Humans , Nurse's Role , Social Work , Terminal Care , United StatesABSTRACT
Anxiety and depressive disorders and symptoms are quite prevalent in older adults as are alcohol problems. Older adults tend to minimize psychological problems and consider psychological symptoms to be related to physical illness. Engagement of the older adult in mental health/substance abuse treatment has been found to be more successful if it occurs in collaboration with primary care treatment. Collaboration between social workers and physicians appears to be an obvious solution to meeting the needs of elderly persons with mental health and/or substance abuse problems who present for medical concerns in their physician's office.
