Pastaraisiais metais tapatumas apibrėžiamas kaip dinamiška save apibrėžianti sistema, besiformuojanti santykiuose, kurios pagrindas yra emocijos. O tapatumo formavimasis – tai intrapsichinių pasikeitimų paauglystėje visuma – atsiskyrimo ir individuacijos procesas, patyrimų integracija bei ego tęstinumo įtvirtinimas. Todėl siekiant suprasti, kaip sunkumai artimuose santykiuose susiję su tapatumo išgyvenimu paauglystėje, buvo atliktas kokybinis tyrimas, naudojant biografinio pasakojimo interpretacinį metodą. Metodika. Tyrime dalyvavo šeši (3 merginos ir 3 vaikinai) 15-16 metų paaugliai, gyvenantys globos namuose. Naudoti metodai: biografinio pasakojimo interpretacinis metodas, dokumentų analizė ir trauminių įvykių anketa. Rezultatai. Tyrimo rezultatų turinio interpretacinė analizė atskleidė tris tapatumo išgyvenimo tipus: tapatumo išgyvenimas pagrįstas vidiniu konfliktu: konfrontacija su siekiant įrodyt savo vertę; tapatumo išgyvenimas pagrįstas idealizacija ir nuvertinimu: fantazijos ir svajonės – kaip būdas atlaikyti realybę ir tapatumo išgyvenimas pagrįstas fragmentacija: izoliuotas subjektyvumas. Šiame darbe keliamos hipotezės, kad skirtingi biografinio pasakojimo tipai atskleidžia skirtingą tapatumo formavimosi paauglystėje dinamiką. Taip pat patvirtinama artimų ir ilgalaikių santykių svarba tapatumo išgyvenimo ir trauminio patyrimo įveikos procese. / Nowadays identity is defined as rooted in emotion, emerging in relationship and developing as dynamic, self-organizing system. And identity formation is a intrapsychic changes during adolescence: separation individuation process, experience integration and establishment of ego continuity. It is necessary to use new methods for identity evaluation in order to understand it’s development in relational context. Qualitative research: biographical narrative interpretative analysis, was made to understand identity formation in adolescence who live in foster care. Method: six, 15-16 years old teenagers (3 girls, 3 boys) participated in research. Biographical narrative interpretative method was used to collect and interpret data, additional methods: document analysis and traumatic events questionnaire. Results: data analysis revealed three types of identity experience: identity experience based on inner conflict: fight as way to survive; identity experience based on idealization and devaluation: fantasy– the way which helps to deal with reality and identity experience based on fragmentation: isolated subjectivity. It is hypothesized that different types of told life stories are connected with different dynamic of identity experience in adolescence. It is confirmed importance of close and long lasting relationship in a process of coping with traumatic experience.

This project investigates the English-language life writing of diasporic Iranian Jewish women. It examines how these women have differentially imagined their diasporic lives and travels, and how they have in turn been imagined and accepted or rejected by their audiences. In the first chapter, I use “home” as a lens for understanding three distinct life writing texts, showing how the authors write about what it means to have a home and to be at home in contrasting and even contradictory ways. I show how, despite potential hegemonic readings that perpetuate unequal relationships and a normative definition of the ideal home, the texts are open to multiple contestatory readings that create spaces for new formulations and understandings. In the second chapter, I look more closely at the intersections between trauma stories and the life writing of Iranian Jewish women, and I argue that readers use life writing texts about trauma to support an egocentric reconstruction of American democracy and dominance. I also show how a critical frame for understanding trauma can yield interpretations that highlight, rather than ignore, relationships of power and privilege. In the final chapter of the thesis, I present a case study of two online reading groups, and I show that communal reading environments, though they participate in dominant discourses, are also spaces where resistance and subversion can develop. / Thesis (Master, Gender Studies) -- Queen's University, 2011-09-08 22:54:33.728

<p>Much has been researched in South Africa about the trauma of losing one&rsquo / s home, one&rsquo / s community and rebuilding one&rsquo / s life in a new environment. Several books have been published tracking the lives of the forcibly removed and their responses to leaving District Six. My research focuses on a different group namely those who had been forcibly removed from the centre of Stellenbosch, called &ldquo / Die Vlakte&rdquo / during that time. Living and working with and among people who have experienced this removal, I was keen to research whether the impact of the trauma is currently&nbsp / manifesting in this specific community and if so, what the symptoms would be. This qualitative inquiry focuses on one particular individual, Mr. Hilton Biscombe. I selected him because he, who experienced the removal as a teenager, spent most of his later life determinedly collecting stories and documents relating to this incident. Mr. Biscombe is also the only person of whom I am aware who responded personally through compiling a book, making a DVD, writing poetry as well as an autobiography relating to this event. My inquiry into the ways trauma manifests in a narrative, will be based on two interviews: one conducted by a white man from the University of Stellenbosch thirty years after the event / and another interview, six years later, conducted by myself.Our understanding of trauma is usually associated with a death or injury or the possibility thereof, but it could also include the victim&rsquo / s response to extreme fear, serious harm or threat to&nbsp / family members. According to van der Merwe and Vienings, people also become traumatized when witnessing harm, physical violence or death or the sudden loss or destruction of a victim&rsquo / s home (van der Merwe &amp / Vienings, 2001). So the issue of trauma is not in question, nor the fact that forced removals cause trauma. I am exploring testimony in the form of interviews for possible current manifestations of this trauma thirty-six years down the line.</p>

Tyrimo aktualumas. Apie 80 procentų pacientų su stuburo smegenų pažeidimais yra vyrai, paaugliai ir jauni suaugusieji. Dauguma jų yra aktyvūs, socialūs asmenys, kurių reabilitacijos tikslas po nugaros smegenų pažeidimo – grįžti į normalų gyvenimą pas šeimą, draugus, bendraamžius. Mokslininkai teigia, kad tradicinis vyriškas vaidmuo visuomenėje – tokie bruožai kaip stiprumas, emocijų kontrolė, savarankiškumas, jėga ir dominavimas trukdo vyrams ieškoti pagalbos. Be to, tradicinės vyriškumo savybės, įskaitant nepriklausomumą, sėkmę darbe, yra susijusios su bendru savęs vertinimu, todėl pakitimai gali turėti žymų poveikį. Teorinėje dalyje pristatoma identiteto samprata, tapatumą aiškinančios teorijos, kentėjimo trajektorijos samprata. Skiriamas vaidmuo nehegemoninio vyriškumo aptarimui, vyriškumo ir negalios sankirtų perspektyvai. Remiantis autorių įžvalgomis bandoma apibūdinti skirtingas vyriškumo formas. Analizuojama vyrų, patyrusių stuburo traumą, biografinė perspektyva, kaip įvykis, pertvarkantis ir perstruktūruojantis visą jų gyvenimą, keičiantis vyrų identitetą. Analizuojamas socialinis darbas, komandinis darbas reabilitacijos įstaigose. Darbe apžvelgiami fiziologiniai procesai, kurie aiškina fiziologines stuburo smegenų pažeidimo pasekmes, be kurių negalima paaiškinti psichosocialinių aspektų. Baigiamasis darbas nagrinėja vyrų, patyrusių stuburo traumą, patirtis, jų biografinę situaciją. Tyrimo tikslas – atskleisti vyrų, patyrusių stuburo traumą, biografinio ,,darbo“... [toliau žr. visą tekstą] / Topicalityoftheresearch. Approximately 80 percentofpatientswhohavesufferedspinalcordinjuries are men, teenagersoryoungadults. Majorityofthem are active, socialpersonswhoserehabilitationaimafterthespinalcordinjuryis to return to normallifeintheirfamilies, withtheirfriends, andcontemporaries. Scientistsstatethatthetraditionalman's role inthesociety - suchfeaturesasdiligence, controlofemotions, independence, poweranddomination - preventsthemfromsearchingforhelp. Moreover, thetraditionalmasculinitycharacteristics, includingindependence, success at work, isrelated to thegeneralself-evaluation,thus, changesmayhavesignificanteffect. Thetheoreticpartpresentstheconceptofidentity, theoriesexplainingpersonalidentity, theconceptofsufferingtrajectory. Attentionispaid to non-hegemonicdiscussionofmasculinity, theperspectiveofmasculinityanddisabilitycrossing. Onthebasisoftheauthors' insightsattempts are made to describeseparateformsofmasculinity. Thebiographicalperspectiveofmenwhohavesuffered spine trauma isanalyzedasaneventrearrangingandrestructuringtheirentirelife, changemen’sidentity. Socialworkandteamworkinrehabilitationinstitutions are analyzed. Theworksurveysthephysiologicalprocessesexplainingtheconsequencesofspinalcordinjurywithoutwhichthepsychologicalaspectscannot be explained. Thefinalworkanalyzestheexperienceofmenwhohavesuffered spine trauma, theirbiographicalsituation. Objectoftheresearch – to revealthebiographicalworkexperienceofmenwhohavesuffered spine trauma byapplying art... [to full text]

The purpose of this dissertation was to evaluate outcomes associated with blood component (BC) transfusion in adult trauma patients. Specific aims were to: 1) explore the relationship between traumatic injury, hemorrhage, and BC transfusion, focusing on consequences of the component storage lesion through presentation of a conceptual model; 2) systematically review research literature comparing outcomes of massively transfused major trauma patients based on ratios of BCs received; 3) evaluating the relationship between type of blood transfusion trauma patients received (whole blood versus BCs) and mortality likelihood after controlling for demographic and clinical variables; 4) evaluating the relationship between volume and ratio of BCs transfused to trauma patients and development of inflammatory complications (ICs) after controlling for demographic and clinical variables. Specific aim one was addressed through the development of a conceptual model, depicting the current state of knowledge regarding the storage lesion, and short-/long-term outcomes of traumatic injury, hemorrhage, and blood transfusion. The second specific aim was addressed through a systematic review of studies that grouped critically injured, massively transfused patients based on ratios of BCs they received, and compared clinical outcomes among groups. Findings from this analysis revealed increased survival likelihood with massive transfusion of BCs in a 1:1:1 (packed red blood cells [PRBCs], fresh frozen plasma [FFP], platelets [PLTs]) fashion. The third specific aim involved a secondary analysis of the National Trauma Data Bank to evaluate the relationship between type of transfusion trauma patients received (whole blood versus BCs) and mortality. Patients who received BCs experienced a higher mortality likelihood compared with those who received whole blood. The fourth specific aim was addressed through a secondary analysis of the Inflammation and Host Response to Injury Trauma-Related Data Base, to evaluate the relationship between volume and ratio of BCs transfused and development of ICs in patients with major trauma. Findings revealed that total transfused volume of PRBCs, injury severity, and comorbidities were associated with development of ICs. There were no differences in time to complication between PRBCs:FFP or PRBCs:PLTs ratio groups.

Inledning: Forskning visar att smärta vid stora trauman är underbehandlat, vilket kan ge ett förlängt sjukdomsförlopp och leda till komplikationer för patienten. Smärtbedömning är en viktig del i smärtbehandlingen och kan göras med hjälp av observationer av fysisk status och smärtskattningsinstrument. Eftersom ett stort trauma även innebär en psykologisk påfrestning för patienten är det viktigt att lindra både smärtan och det psykiska lidandet. Syfte: Att beskriva ambulanssjuksköterskors uppfattningar om traumapatienters upplevelser av smärta samt beskriva ambulanssjuksköterskors erfarenheter av smärtbehandling och omvårdnadsåtgärder som lindrar lidande hos dessa patienter. Metod: En intervjustudie med elva ambulanssjuksköterskor. Intervjuerna analyserades med kvalitativ innehållsanalys. Resultat: Ambulanssjuksköterskans arbete vid smärtlindring vid stort trauma präglades av avvägningar och prioriteringar. Dessa gjordes utifrån ambulanssjuksköterskans egna bedömningar samt de riktlinjer som fanns inom ambulanssjukvården. Omvårdnadsåtgärder var lika viktiga som de farmakologiska åtgärderna, i arbetet för att lindra patientens smärta och lidande. Majoriteten av ambulanssjuksköterskorna upplevde smärtan vid stort trauma som underbehandlad. Detta på grund av otillräckliga läkemedelsdoser men också på grund av prioritering av livsuppehållande åtgärder. Slutsats: Studiens resultat visar att ambulanssjuksköterskans arbete stämmer väl överens med kompetensbeskrivningen. Smärtlindring vid stora trauman är komplext och de upplevda hindren är många. Ambulanssjuksköterskans egen bedömning, med utgångspunkt från gällande riktlinjer, är kärnan i deras arbete med traumapatienter. Smärtlindring vid stora trauman är ett viktigt ämne och ett relativt outforskat område. Det är därför angeläget med vidare forskning. / Introduction: Research shows that pain at major traumas are poorly treated, which can lead to a prolonged course of the disease and lead to complications for the patient. Pain assessment is an important part of pain treatment and can be done either through observations of the patient’s physical status or via pain assessment tools. A major trauma involves also a psychological stress for the patient, therefore it’s important to relieve both the physical pain as well as the mental suffering. Aim: To describe ambulance nurses’ perception regarding trauma patients’ experiences of pain and to describe ambulance nurses’ experiences of pain treatment and nursing care that ease the suffering for these patients. Method: An interview study with eleven ambulance nurses. The interviews were analyzed by using qualitative content analysis. Result: Ambulance nurses’ work with pain relief at major traumas was characterized by balancing decisions and prioritizations. These were made based on the ambulance nurses’ own judgment combined with the guidelines for the ambulance health care. The nursing care was just as important as the medical treatment in the work to ease the patient’s pain and suffering. The majority of the ambulance nurses experienced that pain at major traumas was poorly treated. The reason for this opinion was due to a restricted use off analgesics, but also due to prioritization of life support care. Conclusion: The study´s findings shows that ambulance nurse’s work are in line with the ambulance nurse’s competence description. Pain treatment at major traumas is complex and the perceived difficulties are many. The ambulance nurses’ own evaluations, with the associated guidelines, constitute the core work with trauma patients. Pain relief at major traumas is an important and relatively unexplored area and it is therefore desirable with further research in this area.

Bakgrund: Immobilisering är en vedertagen omvårdnadsåtgärd inom dagens prehospitala traumavård, detta trots att det inte finns några randomiserade kontrollerade studier angående åtgärden. Många studier har dock visat att riskerna med immobilisering är många varför det är viktigt att undersöka omvårdnadshandlingen närmare. Syfte: Syftet med studien var att undersöka förekomsten av radiologiskt fastställda spinala skador hos patienter som immobiliserats prehospitalt efter trauman, samt på vilka indikationer denna immobilisering gjordes. Metod: En kvantitativ retrospektiv studie där 288 journaler granskades i ambulansens journalsystem MobiMed 3.0 och i sjukhusets journalsystem Cosmic. Därefter analyserades resultaten i SPSS deskriptivt och grafiskt, med chi2-test samt med oberoende t-test. Resultat: Resultatet visade att av de 246 patienter som genomgått en radiologisk undersökning fanns en konstaterad spinal skada hos 48 patienter, vilket motsvarade cirka 17 %. Alla inkluderade patienter hade varit utsatta för trubbigt våld och den vanligaste indikationen för immobilisering var smärta/ömhet över kotpelaren. Medelåldern hos patienterna med spinala skador var signifikant högre än medelåldern hos de utan spinala skador och en signifikant skillnad fanns mellan patienterna med spinal skada och utan spinal skada och samtidig smärta/ömhet över kotpelaren. Slutsats: Ett större antal patienter uppvisade skador i denna studie jämfört med tidigare studier, hos den stora majoriteten fanns dock inga spinala skador. Detta innebär att patienterna utsätts för en potentiellt onödig omvårdnadsåtgärd som är svagt vetenskapligt underbyggd och medför ett flertal risker. Fler studier inom området behövs för att kunna minska patienters potentiella lidande i och med att immobiliseras prehospitalt. / Background: Spinal immobilization is an established practice in today’s prehospital trauma care. This even though there is a lack of randomized controlled studies regarding this practice. Many studies points to the risks regarding spinal immobilization why it is of importance to further examine the practice. Aim: The aim of this study was to investigate the incidence of radiologically confirmed spinal injuries in patients immobilized after prehospital trauma and on what indications this immobilization was done Method: A quantitative retrospective study of 288 medical records acquired from the ambulance medical record system Mobimed 3.0 and the hospital's medical record Cosmic were examined. The results were analyzed in SPSS descriptive and graphic, with chi2-test and independent t-test. Result: The results show that of the 246 patients who underwent a radiological examination, 46 had a spinal injury, approximately 17 %. All of the included patients had been exposed to blunt trauma and the most common indication for immobilization was pain/tenderness over the spine. The mean age of the patients with spinal injuries was significantly higher than the mean age of those without spinal injuries. A significant difference was also found between patients with pain/tenderness over the spine and spinal injury and those without spinal injury. Conclusion: A greater number of patients had a spinal injury in this study compared with previous studies, although the majority of the patients had no spinal injury. This means that the majority of the patients were exposed to a potentially unnecessary procedure that lacks scientifically evidence. More studies about immobilization are required to reduce the patients' potential suffering in connection with prehospital immobilization.

Introduction: No protocol for assessing ultrasound imaging skill has been validated. We sought to develop and validate an assessment protocol for ultrasound imaging for the Focused Assessment with Sonography for Trauma. Methods: Our assessment tool consisted of task checklists, a global rating scale, and hand-motion analysis and was developed by a modified Delphi technique. Novice and expert cohorts were recruited to perform a FAST exam on a volunteer for assessment under the protocol. Results: Experts scored higher on static image acquisition (11.58 of 16 versus 6.63, p<0.0001), dynamic image acquisition (17.21 of 24 versus 11.08, p=0.0005), and our global rating scale (29.79 of 40 versus 18.42, p<0.0001); experts used fewer movements (263.0 movements versus 452.4, p=0.0216) and a shorter path length than novices (60.097 m versus 32.777 m, p=0.0041). Conclusion: Our protocol for assessing ultrasound imaging skill has criterion validity in assessing expertise and may lead to improvements to training and credentialing programs.

This study focused on the pastoral guidance of the emotional wounded teen on the basis of a number of broad markers from the book Ecclesiastes. From the basis–theoretical research (Chapters 2 and 3) it was clear that it is a major challenge to come to a proper understanding of the nature and problems of the teen and his experiences.It there is the necessary understanding of all the relevant aspects and if these are handled correctly, it can promote the growth process of the teen developing an intimate relationship with God, and eventually also lead to the experience of a true sense of life and joy. From Ecclesiastes a number of guidelines were identified which can assist in giving the teen the necessary perspective about his daily life struggles. Answers to the search for sense and joy in life do not lie in people and things under the sun, but in a living and intimate relationship with God, in other words in that which is above the sun (to use the imagery of Ecclesiastes). The meta–theoretical section focused on contributions from the adjacent disciplines. Here it was clear that the emotional wounding of the teen results in damage to the forming of identity and self–esteem.When the teen, in a changing environment, does not experience safety and security within healthy relationships, it quite often leads to an identity crisis and to more wounding. From the empirical research it transpired that, as a result of the burden of unresolved emotional baggage from the past, teens are inclined to have a very negative view of the challenges of life and also to experience life as senseless and without joy. In the establishment of an own identity and self–esteem they displayed a strong need for personal relationships. Their negative and weak self–esteem can furthermore be traced to the lack of role models. Another consequence of this lack is a weak relationship with God and other people, as well as an inability to make decisions and to handle crises and trauma. In the practice–theoretical section, through a hermeneutical interaction between basistheoretical guidelines and meta–theoretival perspectives, the formulation of an adapted practice theory, on the basis of guidelines from Ecclesiastes, about the pastoral guidance of the emotional wounded teen was attempted. This model, aimed at pastoral practice, presents parameters for the pastoral guidance of all unresolved trauma and the emotional pain of teens, which are aspects that inhibit spiritual advancement and emotional healing. Only then will the teen be able to truly focus on the enjoyment of life under the sun, in the light of the principles and guidelines from Ecclesiastes. / Thesis (Ph.D. (Pastoral))--North-West University, Potchefstroom Campus, 2011.

This study focused on the pastoral guidance of the emotional wounded teen on the basis of a number of broad markers from the book Ecclesiastes. From the basis–theoretical research (Chapters 2 and 3) it was clear that it is a major challenge to come to a proper understanding of the nature and problems of the teen and his experiences.It there is the necessary understanding of all the relevant aspects and if these are handled correctly, it can promote the growth process of the teen developing an intimate relationship with God, and eventually also lead to the experience of a true sense of life and joy. From Ecclesiastes a number of guidelines were identified which can assist in giving the teen the necessary perspective about his daily life struggles. Answers to the search for sense and joy in life do not lie in people and things under the sun, but in a living and intimate relationship with God, in other words in that which is above the sun (to use the imagery of Ecclesiastes). The meta–theoretical section focused on contributions from the adjacent disciplines. Here it was clear that the emotional wounding of the teen results in damage to the forming of identity and self–esteem.When the teen, in a changing environment, does not experience safety and security within healthy relationships, it quite often leads to an identity crisis and to more wounding. From the empirical research it transpired that, as a result of the burden of unresolved emotional baggage from the past, teens are inclined to have a very negative view of the challenges of life and also to experience life as senseless and without joy. In the establishment of an own identity and self–esteem they displayed a strong need for personal relationships. Their negative and weak self–esteem can furthermore be traced to the lack of role models. Another consequence of this lack is a weak relationship with God and other people, as well as an inability to make decisions and to handle crises and trauma. In the practice–theoretical section, through a hermeneutical interaction between basistheoretical guidelines and meta–theoretival perspectives, the formulation of an adapted practice theory, on the basis of guidelines from Ecclesiastes, about the pastoral guidance of the emotional wounded teen was attempted. This model, aimed at pastoral practice, presents parameters for the pastoral guidance of all unresolved trauma and the emotional pain of teens, which are aspects that inhibit spiritual advancement and emotional healing. Only then will the teen be able to truly focus on the enjoyment of life under the sun, in the light of the principles and guidelines from Ecclesiastes. / Thesis (Ph.D. (Pastoral))--North-West University, Potchefstroom Campus, 2011.