This study, in collaboration with the Montreal Deaf Community, used an anthropological perspective to explore the health care experiences of deaf persons and identify the strategies they use to meet their health needs. Narratives were qualitatively analyzed. Deaf persons see their world as separate from the hearing world of health services. The latter is perceived as lacking understanding of deaf persons, leading to their feeling of exclusion and powerlessness. What is supposed to be a source of support becomes one of anxiety. Nevertheless, deaf people show courage and versatility in coping strategies including affiliation and the notion of culture. The health system focus on 'normalization' contradicts deaf persons' perceptions of deafness as a meaningful human reality. The differing values have implications for health professionals and the organization of services. The McGill Model of Nursing offers an organizational framework for planning accessible health services for deaf persons.

The purpose of this study was to assess the impact of a Maternity Cooperative Care Program (MCCP) on the prevalence of maternal and infant complications, maternal competence, social support, stress, and first-time-mothers' descriptions of their postpartum experience. Forty-one healthy, primiparous mothers who participated in a MCCP and forty-three healthy, primiparous mothers who received traditional maternity care were asked to complete the Perceived Competence Questionnaire, the Personal Resource Questionnaire, "The Help I Get" Questionnaire (spousal support), and three numerical rating scales relating to stress in general, as well as self- and infant-care stress 24-48 hours postpartum while in hospital and over the telephone at two weeks postpartum. Ten randomly selected mothers from each group also answered twelve open-ended questions during a home visit at 2-3 weeks postpartum. There were no statistically significant differences between the two groups for any of the outcome variables assessed. For both groups, competence with self- and infant-care increased over the two weeks postpartum, while support and stress remained stable. Interviews with the mothers revealed that the number of stressors increased once at home, while support continued to be of value in relieving stress and helping maternal adjustment and confidence. Results of a qualitative comparison between the groups suggests that the MCCP mothers felt more prepared to be discharged home, and identified their partner more often as an active participant during hospitalization.

Chronic heart failure is an increasingly prevalent condition associated with high mortality and a heavy burden on patients, families, and society. Despite evidence that psychosocial variables are associated with the clinical evolution of other forms of cardiac disease, little is known about the prognostic impact of these factors for patients with asymptomatic left ventricular dysfunction (LVD) or overt heart failure. The purpose of this study was to evaluate social isolation, mood (anxiety, depression, and vigor), low socioeconomic status, non-White ethnicity (in U.S. patients), life stress, and poor self-rated health as possible correlates of health outcomes for patients with systolic LVD. / A secondary analysis was performed on clinical and psychosocial data for 4991 (of 6797) American, Canadian and Belgian patients aged 21 to 80 with left ventricular ejection fractions ≤35% enrolled in the Studies of Left Ventricular Dysfunction (SOLVD) clinical trials. Psychosocial correlates of mortality, clinical deterioration, arrhythmias, hospitalizations, and quality of life (functional status, life satisfaction, and symptom levels) were examined using logistic and Cox proportional hazards model regressions, before and after adjustment for patient clinical characteristics. / Results showed that some measures of social isolation (being unmarried, making visits to and receiving visits from others infrequently) were associated with the majority of the negative health outcomes studied. Contrary to expectations, neither high depression, nor high anxiety predicted risk of either cardiac-related mortality or ventricular arrhythmias. However, both depression and anxiety were linked with measures of clinical deterioration, hospitalizations for any cardiac cause, as well as poor quality of life at 1 year. Low vigor, low socioeconomic status, non-White ethnicity, and low self-rated health were all consistently associated with poor quality of life and heightened risk of all of the adverse events studied except arrhythmias. / Psychosocial factors appear to be independent predictors of mortality and morbidity in advanced cardiac disease characterized by moderate to severe LVD. This suggests that it is worth evaluating these parameters in patients with, or at risk for, heart failure and tailoring clinical interventions to address the impacts these factors may have on different health outcomes.

The purpose of this cross-sectional, correlational comparative study was to explore the relationship between selected features of the maternal chronic pain experience and the health of the adolescent family member. Twenty-seven adolescents living with mothers who had persistent chronic pain were matched on age, gender and maternal education with 26 adolescents whose mothers had no chronic illness. The two groups of adolescents completed questionnaires measuring their levels of depression (Beck Depression Inventory), life satisfaction (Cantril Ladder) and perceived level of maternal support (Maternal Support Questionnaire). Mothers completed questionnaires measuring pain intensity (VAS), pain distress (VAS), disability (3 item questionnaire) and depression (Beck Depression Inventory). / The two adolescent groups did not differ in terms of depression, life satisfaction or perceived maternal support. Maternal support, however, was demonstrated to be related to the level of depression and life satisfaction for adolescents whose mothers had chronic pain. The results of this study demonstrated that the health status of the adolescent whose mothers had chronic pain was comparable to those adolescents whose mothers had no chronic illness. / Possible explanations for the results may be related to the sample, measurement issues or the age of the adolescents. The study extends current research findings by considering maternal support to be associated with the maternal chronic pain experience and the adolescent health status.

Children who are hospitalized in a pediatric intensive care unit (PICU) are subjected to a barrage of highly invasive, often painful interventions necessary in overcoming the critical period of their illness. While the majority of these children survive, little is known about the impact of critical illness on their subsequent psychological adjustment. The purposes of this study were (a) to compare the psychological responses of children hospitalized in a Pediatric Intensive Care Unit (PICU) with those of children hospitalized on a general ward; and (b) to determine whether there was a relationship between children's psychological responses post-hospital discharge and their age, the number and type of invasive procedures to which they were exposed during hospitalization, severity of illness, and length of hospital stay. A prospective cohort design was used to study two groups of children (N = 120). The study group included 60 children who had been hospitalized in a PICU, and the comparison group 60 children hospitalized on a general ward. Data were collected just prior to discharge, at six weeks and six months following discharge, from two metropolitan children's hospitals. Groups were compared on the following psychological responses: (a) the child's sense of control over his or her health; (b) the child's medical fears; (c) intrusive thoughts and avoidance behaviors related to hospitalization, as indicators of post-traumatic stress; and (d) changes in the child's behavior following hospitalization. In order to examine the possibility of post-traumatic stress responses in these children, the 'Child Impact of Event Scale' was developed in this study as a modified version of an adult measure originally developed by Horowitz and colleagues (1979). Other psychological responses were measured using established instruments. Relationships between the children's psychological responses and their age, the number and type of invasive procedures to which they were exposed d

A qualitative study that utilized a convenience sample of 29 individuals was conducted to uncover the meaning of health as it is experienced by homeless persons. Analysis revealed that homeless persons have two distinct conceptions of health: the characteristics that describe health, and a comprehensive view of the totality of health expressed in different combinations of health dimensions. A total of ten characteristics that described the essence of health were identified. These characteristics included satisfying basic human needs, having no illness related complaints, doing the work of health, fulfilling a functional role, having a positive self-image and outlook, and being fit. The four distinct perceptions of health that were revealed are: physical dimensions of health exclusively, physical and mental/emotional dimensions of health considered separately, physical and mental/emotional dimensions of health coexistent, and health as a multidimensional process of well being. Respondents also indicated that acute life events associated with feelings of loss preceded their state of homelessness. Generally, the respondents in this study considered themselves healthy.

This study was designed to characterize postcesarean pain and examine its relationship with surgical anesthesia. Pain intensity was measured using a 0 to 10 numerical rating scale. The Short-Form McGill Pain Questionnaire was used to measure quality. The most common pain types reported were movement-associated and constant incisional pain (100% of subjects), gas pain (88.1%), and uterine contraction pain (83.3%). Each pain type differed in its intensity, duration and quality. Movement-associated incisional pain was the most intense and long-lasting pain type reported. On postoperative days 2 to 4, mothers who received complete epidural anesthesia during surgery reported less intense movement-associated incisional pain than those who received general or incomplete epidural anesthesia. However, statistical significance was not often obtained. These findings demonstrate the uniqueness of each pain type composing the postcesarean pain experience. The clinical data also support the hypothesis that epidural anesthesia diminishes the sustained hyperexcitability of the central nervous system caused by surgery.

The purpose of this study was to examine the relationship between a family's use of normalization and the psychosocial adjustment (personal adjustment, role skills, and perceived competence) of children with chronic physical disorders (CPD). Seventy-six mothers and their CPD children participated in the study. Families' use of normalization was related to CPD child's psychosocial adjustment. Specifically, mothers' perceptions that their families and other people perceived their family and CPD child as normal were strongly related to overall high personal adjustment, better peer relationships, and better productivity in the CPD child as well as less reported anxiety and depression, less dependence, less withdrawal, and less hostility. However, a family's use of normalization was not related to the CPD child's perception of self-competence in this study.

Background. Maternal skin contact during a tissue breaking procedure lowers pain reactivity and enhances physiological recovery. It is uncertain if this comfort is derived solely from maternal presence or from stabilization of regulatory processes from direct skin contact. No studies have examined whether the contact or presence of a twin would have a similar comforting effect.Purpose. To compare the comfort effect of co-bedding by contrasting preterm twins who are co-bedding and those who are not on pain response during a tissue breaking procedure (heel lance). Methods. Following consent, 67 eligible twin sets, admitted to the Neonatal Intensive Care Unit (NICU) were stratified in pairs by gestational age (≤ 31 6/7 weeks or  32 weeks) and site and then randomly assigned to a co-bedding group, n=36, (cared for in the same incubator or crib) or a standard care group, n=31, (cared for in a separate incubator or crib). Pain response was determined by physiologic and videotaped facial reaction in accordance with the Premature Infant Pain Profile (PIPP). Additional outcomes included physiologic time to recovery, alterations in salivary cortisol, heart rate variability, frequency of additional 24% sucrose doses required, and response of the co-twin. Sample size was calculated using a 2-sided alpha error of 0.05 and a power of 80 percent. Sixty four sets of twins or a total of 128 infants were needed to detect a difference of 1 point or greater change (SD 2.0) in the PIPP scores if such a difference is in fact caused by co-bedding. Analysis was based on the intention-to-treat principle and compared the means in the two groups before and after treatment and contrasted the mean difference between groups using 95 percent confidence intervals and a 2 sided P value of 0.05. Results. Mean PIPP scores were highest at 30 seconds post lance and not significantly different between the groups, 7.1 (SD 2.8) in the co-bedding group and 7.2 (SD 3.4) in the standard care group, P=0.91. Nor were they significantly different at 60 or 120 seconds. At 90 seconds, mean scores were higher in the co-bedding group, 6.0 (SD 3.0) vs. 5.0 (SD 1.8), P=0.04, [95% CI -1.99 to -0.02] in the standard care group. Recovery time post lance was over a minute shorter, M=75.6 seconds (SD 70.0), in the co-bedding condition compared to standard care, M=142.1 seconds (SD 138.1), P=0.001, mean difference of 64.5 seconds (95% CI. 25.6-103.3). No group differences were noted in baseline cortisol levels (0.36 ug/dl if assigned to receive co-bedding and 0.43 ug/dl in the standard group) while cortisol levels 20 minutes post lance were significantly lower in the co-bedding group, 0.28 ug/dl (SD 0.25) versus 0.50 ug/dl (SD 0.73). Similarly, mean change in cortisol from baseline was lower in the co-bedding group, -0.06 ug/dl compared to the standard care group, 0.14 ug/dl, P=0.05. Co-bedding infants were significantly less likely to receive any form of additional non-pharmacologic strategy (non-nutritive sucking, swaddling or facilitated tucking), 58.2% versus 95%, P<0.001. Heart variability, frequency of additional sucrose dosages, co-twin response and incidence of adverse events were not significantly different between the groups. Conclusions. The results of this randomized controlled trial provide evidence that co-bedding enhances physiologic recovery and diminishes the stress response of preterm twins undergoing heel lance in the NICU but did not lead to lower pain scores. Co-bedding did not decrease the frequency of additional 24% sucrose doses. Nor did co-bedding contribute to higher adverse effects for the twin undergoing heel lance or his/her co-twin.Clinical Trial Registry - NCT00917631 / Introduction. Durant une procédure causant un dommage tissulaire, le contact de peau entre un bébé prématuré et sa mère diminue les réactions de douleur de celui-ci et l'aide à récupérer plus rapidement au niveau physiologique. Aucune étude n'a examiné si le contact ou la présence d'un jumeau prématuré pourrait avoir un effet réconfortant sur son jumeau. Objectif. Lors d'une procédure causant un dommage tissulaire (ponction au talon), comparer l'effet réconfortant du partage de lit entre jumeaux, le co-bedding, sur la réponse à la douleur en contrastant les bébés qui sont en co-bedding avec ceux qui ne le sont pas. Méthodes. Après avoir obtenu le consentement, 67 ensembles de jumeaux éligibles admis à l'unité des soins intensifs de néonatalogie furent stratifiés en pairs par âge gestationnel (≤ 31 6/7 semaines ou  32 semaines) et le site. Ceux-ci furent randomisés au groupe de co-bedding, n=36 ou au groupe de soins standards, n=31. La réponse douloureuse fut déterminée par les réactions physiologiques et faciales (captées par vidéo) en lien avec l'échelle de douleur Premature Infant Pain Profile (PIPP). Des résultats additionnels furent collectés tels que le temps de récupération physiologique, altérations du niveau de cortisol salivaire, variabilité du rythme cardiaque, nombre de doses de sucrose 24% administrées, ainsi que la réponse de l'autre jumeau. La taille de l'échantillon fut calculée en utilisant une marge d'erreur à 5% et une puissance de 80%. Soixante-quatre ensembles de jumeaux ou un total de 128 nourrissons étaient nécessaires pour détecter une différence de 1 point ou plus (écart type (ÉT) 2.0) du score PIPP afin de déterminer si ce changement est bel et bien dû au co-bedding. Les analyses furent basées sur le principe de l'intention-à-traiter et ont comparé les moyennes des deux groupes avant et après le traitement, ainsi que les différences moyennes en utilisant un niveau de confiance de 95% et une valeur bilatérale de P à 0.05. Résultats. Les moyennes des scores PIPP furent à leur plus haut 30 secondes suivant la ponction au talon et ne furent pas significativement différentes entre les deux groups, 7.1 (ÉT 2.8) pour le groupe co-bedding et 7.2 (ÉT 3.4) pour le groupe de soins standards, P=0.91. Ces scores ne furent pas significativement différents à 60 ou 120 secondes. À 90 secondes, les scores moyens furent plus élevés dans le groupe de co-bedding, 6.0 (ÉT 3.0) vs. 5.0 (ÉT 1.8), P=0.04, [CI -1.99 à -0.02] pour le groupe de soins standards. Le temps de récupération après la ponction au talon fut de plus de 1 minute, M=75.6 secondes (ÉT 70.0), pour le groupe en co-bedding comparativement au groupe en soins standards, M=142.1 secondes (ÉT 138.1), P=0.001, différence moyenne de 64.5 secondes (CI. 25.6-103.3). Aucune différence entre les groupes fut notée entre les niveaux de bases de cortisol.Les niveaux de cortisol 20 minutes après la ponction au talon furent significativement plus bas dans le groupe du co-bedding, 0.28 ug/dl (ÉT 0.25) versus 0.50 ug/dl (ÉT 0.73). Similairement, la moyenne du changement du niveau de base du cortisol était plus basse dans le groupe du co-bedding, -0.06 ug/dl et 0.14 ug/dl, pour le groupe de soins standards, P=0.05. Les bébés en co-bedding ont eu moins tendance à recevoir des traitements non-pharmacologiques additionnels (succion avec tétine, enveloppement toucher), soit 58.2% versus 95%, P<0.001. La variabilité du rythme cardiaque, la fréquence de doses additionnelles de sucrose, la réponse de l'autre jumeau, ainsi que l'incidence d'événements néfastes ne furent pas significativement différentes entre les deux groupes. Conclusions. Les résultats de cette étude contrôlée randomisée démontrent que le co-bedding entre jumeaux prématurés accroît leur récupération physiologique et diminue leur réponse de stress lors d'une ponction au talon mais sans mener à une réduction de leurs scores de douleur. [NCT00917631]

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