Patient's Attitudes Towards the Use of Complementary and Alternative Medicine in Finland: an Ethnomedical Insight Based on Cancer Narratives

As in many other countries, the second half of the 19th century and the first half of the 20th century marked times of modernisation in Finland. Rapid changes also took place in the health care system at this time. Until the 1920s most health concerns were addressed using the ethnomedical practices. New legislation gave the dominant position in health care to the Western (evidence based) health care system. According to the official record, the majority of ethnomedical treatments were declared marginal and generally useless and the state began to support the construction of hospitals. The slow pace of development in social health care held up the treatments given by legally approved medical practitioners. All of which supported a deliberate shift towards the modernisation of the health care system leading to primary health concerns being solved in local health care centres by doctors trained according to the conventions of evidence based medicine. Unlike many other countries, where the representatives of conventional medicine also consider complementary and alternative medicine as a part of their treatment, the use of non-evidence based medicine is extremely unusual in Finland. However, patients with long-term illnesses are eager to try all available cures in their desire to become well and this leads to a situation in which complementary treatments are used in a somewhat secretive manner. The article follows the discussion concerning the use of complementary and alternative medicine in cancer narratives in order to point out its significance as a part of a self-negotiation process characteristic to the patients with long-term illnesses

“Tühi tuba” ehk eneserefleksioon ja visuaal-tekstuaalne juhtumiuuring hingelise abi andmise õpetamisest ja õppimisest

According to the vision of the World Health Organization, spirituality is an integral part of human existence. Spirituality is even seen as an all-encompassing essence of the human being that requires appreciation and respect. Spirituality is closely linked to the search for meaning, the sense of connection and the feeling and experience of belonging. The article explores the question of whether and how it is possible to teach and learn spiritual care when one is ‘not spiritual’ oneself. The case study, based on the student’s self-reflection, is theoretically inspired by Ricoeur’s theory of narrative meaning-making and a search for explanations of life issues. It is a visual-textual case study, which also explains the appropriateness of the chosen method of self-reflection and analysis for recording and making sense of emotional-social-relational experiences

Syöpäkertomukset

Since the second half of the 20th century, cancer has become a dominant disease in Western countries, endangering people regardless of age, gender, race or social status. Every year almost eight million people die of cancer worldwide. In Finland every fourth person is expected to fall ill with cancer at some stage of his or her life. During the 20th century, along with rapid changes in the medical system, people s awareness of cancer has increased a great deal. This has also influenced the image of cancer in popular discourse over the past decades. However, from the scientific point of view there is still much that is unclear about the disease. This thesis shows that this is a big problem for ordinary people, as, according to culture-bound illness ideology, people need an explanation about the origin of their illness in order to help them cope. The main aim of this thesis is to examine the process of being ill with cancer from the patient s point of view, in order to analyse attitudes and behaviour towards cancer and its significance and culture-bound images. This narrative-based study concentrates on patients voicings , which are important in understanding the cancer experience and when attempting to make it more open within current cultural and societal settings. The Kun sairastuin syöpään ( when I fell ill with cancer ) writing competition organised by Suomen Syöpäpotilaat ry (the Finnish Cancer Patients Association), Suomen Syöpäyhdistys ry (the Finnish Cancer Union), and Suomalaisen Kirjallisuuden Seuran kansanrunousarkisto (the Finnish Literary Society Folklore Archive) was announced on the 1st of May 1994 and lasted until the 30th of September 1994. As a result, a total of 672 cancer narratives, totalling 6384 pages, were received, filled with experiences relating to cancer. Written cancer narratives form a body of empirical data that is suitable for content or textual analysis. In this thesis, content analysis is adopted in order to become familiar with the texts and to preselect the themes and analytical units for further examination. I use multiple perspectives in order to interpret cancer patients ideas and reasoning. The ethnomedical approach unites popular health beliefs that originated in Finnish folk medicine, as well as connecting alternative medicine, which patients make use of, with biomedicine, the dominant form of medicine today. In addition to this, patients narratives, which are composed of various structural segments, are approached from the folklorist s perspective. In this way they can be seen as short pathographies, reconstructions of self-negotiation and individual decision making during the illness process. Above all, cancer patients writing describe their feelings, thoughts and experiences. Factors that appear insignificant to modern medicine, overwhelmed as it is by medical technologies that concentrate on dysfunctional tissue within diseased bodies. Ethnomedical study of cancer patients writings gives access to the human side of cancer discourse, and combines both medical, and popular, knowledge of cancer. In my view, the natural world and glimpses of tradition are bound together with one general aim within cancer narratives: to tackle the illness and mediate its meanings. Furthermore, the narrative approach reveals that participants write with the hope of offering a different interpretation of the cancer experience, and thus of confronting culturally pre-defined images and ideologies.Tutkimuksen keskeinen aineisto syöpäkertomukset käsittelevät kirjoitettujen kertomuksien muodossa suomalaisten kulttuurisidonnaisia näkemyksiä syövästä ja syöpäsairaudesta. Sairaudesta puhuminen tai sairauskokemuksen tulkinta on potilaalle mahdollisuus yhdistää sisäinen tunne-elämänsä ja ajatusmaailmansa ulkoiseen kulttuurisidonnaiseen tietämykseensä ja todellisiin tapahtumiin. Henkilökohtaisia ajatuksia, tunteita ja kokemuksia kuvaavat kertomuksia voidaan käsitellä aitoina ja rehellisinä representaatioina syövästä ja syöpään sairastumisesta. Suomalaisten syöpäkertomuksissa korostuvat keskeisemmät ongelmat syöpäpotilaiden arjessa, joita kirjoittajat pohtivat henkilökohtaisen kokemuksen valossa. Näin syöpäkertomukset tarjoavat erinomaisen mahdollisuuden tutkia syövän kulttuurisia ja henkilökohtaisia merkityksiä. Käyttäen folkloristiikan alan tutkimusmenetelmiä pohdin mistä, miksi ja miten ihmiset kirjoittavat henkilökohtaisista syöpäkokemuksista kirjoituksen muodossa. Syöpäpotilaiden ja heidän ystävien-läheisten henkilökohtaiset kirjoitukset ovat osoittaneet ihmisten tarvetta kommunikoida vakavan sairauden aiheuttamista ongelmista sekä yhteiskunnan että henkilökohtaisella tasolla. Kirjoituksissa ilmenee myös syöpä sanan merkityksellisyys. Monet kirjoittajat ovat ilmaisseet syöpä sanalla olevan kuoleman kaiun. Kirjoituksissa esiintyvien esimerkkien avulla on mahdollista päätä, että syöpää sairastavia kartetaan, koska kansainomaisen ajattelumallin mukaan syöpä pidetään jopa eräänlaisena tartuntatautina tai ruttona. Syöpää kuvitellaan myös ihmisen elämäntavoista tai luonteesta johtuvaksi. Uskotaan myös, että on olemassa tietynlaisia syöpä-ihmisiä. Näin syövästä voi puhua modernina mytologisena sairautena, jolla on biolääketieteen määrittelemä rationaalinen ja kansainomainen epärationaalinen selitys tai etiologia. Yksi kirjoituksissa esiintyvistä tärkeistä teemoista on kokonaisvaltaisen hoidon puute. Tavallisimmin kiireiset lääkärit hoitavat syövän aiheuttamia solumuutoksia. Hoitotilanteessa potilaan ruumis nähdään vaan taudinkantajana. Henkilökohtaisissa kirjoituksissa heijastuvat potilaiden ja läheisten odotukset, jossa toivotaan, että lääkärit näkisivät ja kokisivat potilaan ihmisenä, jolla on oma näkemys elämästä ja myös toivomuksia omasta tulevaisuudesta. Koska kirjoituksissa pohditaan paljon vaihtoehtohoitojen käyttöä virallisten hoitojen rinnalla, esitän myös syöpäpotilaiden näkemyksiä virallisen ja vaihtoehtoisten hoitomuotojen roolista kokonaisvaltaisessa parannusprosessissa. Sairastuessaan tärkeät ihmissuhteet korostuvat, ihminen huomaa luonnon kauneuden ja hahmottaa elämän arvon. Aika monelle kirjoittajalle sairastumisen kokemus antaa enemmän aikaa ja tarjoa mahdollisuuden tehdä ja kokea aivan uusia asioita elämässä. Tutkimuksessani osoitan, että vaikka sairaus on niin henkisesti kuin ruumiillisesti koetteleva, henkilökohtaisena kokemuksena syöpä voidaan kokea myös positiivisena haastena. Sairastuminen antaa mahdollisuuden pysähtyä ja katsoa maailmaa uusiin silmin , kuten monet kirjoittajat ovat ilmaisseet

Halltõvega seotud tõrjevõtted ja nende liigitamine

This article is a part of my MA thesis entitled Estonian and Finnish-Karelian Ague Tradition - Analysed on the Basis of Archive Texts (University of Tartu, Department of Estonian and Comparative Folklore, 2004). In this article I will explore the aspects of practical magic connected with ague in Estonia and discuss the problem of classification in folk medicine research. Ague treatment used various archaic techniques based on analogy and contact magic. I have divided these techniques into three categories, characterised by inaccuracy, flexibility, and unfixed boundaries. Many recent studies generally consider the so-called fuzzy categories the most suitable for describing human reasoning. The first group consists of magic rituals, in which the methods of treatment are based on imagery related to ague. Along with rituals, the texts also describe the use of rational methods of treatment. The herbs to be consumed for this purpose were predominantly shaky and had a pungent smell. Animal products used for this purpose include the flesh, blood, and excrements of animals that were believed to have magical powers. Verbal spells used during a healing ritual form the third category. The healing rituals described in stories may be either common folk medicine practices or rituals characteristic of narrative tradition. Stereotypical methods of treatment include confining the disease in a tobacco pouch or taking it to a nearby farm on a horse. Although such descriptions are realistic in nature, they are fixed in certain types of narratives and used in the interest of a specific narrative. Thus, one can call them fictive rituals. The initial function of ague legends has been sharing knowledge with a certain social group. The stories were a way of acquiring basic knowledge about the causes and the symptoms of the disease, also providing guidance on how to avoid and defeat the disease. All the records of tradition reflect ways of defeating the disease, which are typical of folk medicine practices. This psychological process of delivering relevant information by means of legend is typical of agrarian tradition, and marks the possibility of defeating a disease of unknown origin by using easily available methods

Developments in spiritual care education in German - speaking countries

Background: This article examines spiritual care training provided to healthcare professionals in Germany, Austria and Switzerland. The paper reveals the current extent of available training while defining the target group(s) and teaching aims. In addition to those, we will provide an analysis of delivered competencies, applied teaching and performance assessment methods. Methods: In 2013, an anonymous online survey was conducted among the members of the International Society for Health and Spiritual Care. The survey consisted of 10 questions and an open field for best practice advice. SPSS21 was used for statistical data analysis and the MAXQDA2007 for thematic content analysis. Results: 33 participants participated in the survey. The main providers of spiritual care training are hospitals (36%, n = 18). 57% (n = 17) of spiritual care training forms part of palliative care education. 43% (n = 13) of spiritual care education is primarily bound to the Christian tradition. 36% (n = 11) of provided trainings have no direct association with any religious conviction. 64% (n = 19) of respondents admitted that they do not use any specific definition for spiritual care. 22% (n = 14) of available spiritual care education leads to some academic degree. 30% (n = 19) of training form part of an education programme leading to a formal qualification. Content analysis revealed that spiritual training for medical students, physicians in paediatrics, and chaplains take place only in the context of palliative care education. Courses provided for multidisciplinary team education may be part of palliative care training. Other themes, such as deep listening, compassionate presence, bedside spirituality or biographical work on the basis of logo-therapy, are discussed within the framework of spiritual care. Conclusions: Spiritual care is often approached as an integral part of grief management, communication/interaction training, palliative care, (medical) ethics, psychological or religious counselling or cultural competencies. Respondents point out the importance of competency based spiritual care education, practical training and maintaining the link between spiritual care education and clinical practice. Further elaboration on the specifics of spiritual care core competencies, teaching and performance assessment methods is needed

PRN Medicines Management for Older People with Long-Term Mental Health Disorders in Home Care

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Spiritual care in the training of hospice volunteers in Germany

Objective: Hospice volunteers often encounter questions related to spirituality. It is unknown whether spiritual care receives a corresponding level of attention in their training. Our survey investigated the current practice of spiritual care training in Germany. Method: An online survey sent to 1,332 hospice homecare services for adults in Germany was conducted during the summer of 2012. We employed the SPSS 21 software package for statistical evaluation. Results: All training programs included self-reflection on personal spirituality as obligatory. The definitions of spirituality used in programs differ considerably. The task of defining training objectives is randomly delegated to a supervisor, a trainer, or to the governing organization. More than half the institutions work in conjunction with an external trainer. These external trainers frequently have professional backgrounds in pastoral care/theology and/or in hospice/palliative care. While spiritual care receives great attention, the specific tasks it entails are rarely discussed. The response rate for our study was 25.0% (n = 332). Significance of results: A need exists to develop training concepts that outline distinct contents, methods, and objectives. A prospective curriculum would have to provide assistance in the development of training programs. Moreover, it would need to be adaptable to the various concepts of spiritual care employed by the respective institutions and their hospice volunteers

A qualitative exploration of cultural safety in nursing from the perspectives of Advanced Practice Nurses : meaning, barriers, and prospects

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