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Symptom management is one of the primary goals of care for advanced pancreatic cancer (APC) patients. The purpose of this study was to examine recorded healthcare encounters to better understand the symptom experiences of APC patients as told to healthcare providers (HCP). In this qualitative descriptive study, content analysis was used to analyze 37 transcripts of audio-recorded, naturally occurring encounters among APC patients, caregivers, and HCP. Transcripts were drawn from a larger randomized controlled study, which recruited advanced cancer patients and caregivers across the United States. Findings revealed that APC patients and caregivers experienced multiple troubling symptoms. Thirty-seven APC patients and 34 caregivers discussed 10 types of symptoms: pain, fatigue, abnormal bowel movements, decreased appetite, nausea and vomiting, sleeping problems, neurological problems, skin problems, psychological distress, and taste changes. The patients and caregivers discussed various aspects of the symptoms, including the nature of the symptoms, how the symptoms affected their lives, and the way they managed symptoms. Some symptoms were described as severe, life-changing, and highly distressing. HCP should be attuned to the wide variety of ways in which APC patients experience, manage, and live with symptoms. A systematic approach to address symptoms during encounters may improve care and efficiency.

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An estimated 40-60% of children in mental health treatment drop out before completing their treatment plans, resulting in increased risk for ongoing clinical symptoms and functional impairment, lower satisfaction with treatment, and other poor outcomes. Research has focused predominately on child, caregiver, and family factors that affect treatment participation in this population and relatively less on organizational factors. Findings are limited by focus on children between 3 and 14 years of age and included only caregivers' and/or therapists' perspectives. The purpose of this descriptive qualitative study was to identify organizational factors that influenced participation in treatment, with special attention to factors that contributed to dropout in adolescents. The sample included 12 adolescent-caregiver dyads drawn from two groups in a large public mental health provider database. Analysis of focus group interview data revealed several perceived facilitators and barriers to adolescent participation in treatment and provided several practical suggestions for improving treatment participation. Implications of the findings for psychiatric mental health nurses and other clinicians who provide services to families of adolescents with mental health concerns are discussed.

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The purpose of this study was to explore how women find meaning in experiences of sexual violence committed by men close to them. Data were provided by 44 women who had participated in one of three studies I had conducted on women's responses to sexual abuse and assault by intimate others. The women's explanations for the violence they experienced, discussions of how they made sense of the violence, and references to the meaning or purpose of the violence in their lives were analyzed using grounded theory methods. The women indicated that their victimizing experiences had taught them "the harsh realities of life"; that is, the world is violent and society tolerates and, in some cases, promotes violence against women. This lesson forced them to take it upon themselves to create a better life. This psychosocial process of "taking it upon oneself" involved three tasks: pursuing one's own safety, taking justice into one's own hand, and making something good out of something bad. By accomplishing these tasks, the women found meaning in their suffering.

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Because an experience of childhood sexual abuse may affect a woman's symptom presentation and response to treatment, it is recommended that orthopaedic nurses be aware of the long-term effects of sexual abuse and inquire about abuse if a patient exhibits problems and symptoms that may be suggestive of an abuse history. Patients in orthopaedic settings who have been sexually abused may have particular difficulty trusting health care providers, undergoing invasive or confining procedures, and tolerating pain or somatic discomfort. Recommended nursing interventions are aimed at establishing a trusting relationship, increasing survivors' sense of personal control and minimizing threatening intrusions, facilitating pain management, and if indicated, referring for psychotherapy.

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The purpose of this grounded theory study was to devise a theoretical framework that describes the problem of sexual violence by male intimates from the point of view of 23 women who have experienced such violence at some time in their adult lives. The core variable, forging ahead in a dangerous world, reflects the women's descriptions of life after violence as a struggle to get on with their lives in a social world they know through first-hand experience to be unsafe. The theoretical framework includes three variations of forging ahead (getting back on track, starting over again, and surviving the long, hard road) described by three subgroups of women who experienced different types of sexual violence. The framework also outlines three common processes used to forge ahead: telling others, making sense of the violence, and creating a safer life. The nature and meaning of these processes differ according to group.

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The purpose of the Heideggerian hermeneutical project, from which this article stems, was to describe women's experience of sexual violence by male intimates. Ten women who had encountered sexual violence by a male they knew well were interviewed about the effects of that experience on their everyday lives. The women described "knowing what to do" to manage their lives by using practical, everyday activities to cope with the violence. Their narratives were interpreted according to the Heideggerian concept of understanding as know-how. For Heidegger, understanding is not a cognitive process; rather, it is an implicit "knowing how" to do what is appropriate in each situation. Professionals who work with women who have experienced intimate sexual violence should seek to understand the women's intuitive understanding of what is possible and to appreciate the common sense ways they cope with life in a violent world.

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Participation in research on sexual trauma may provoke disturbing memories and distressing emotions. Despite the proliferation of research on sexual violence during the last decade, little is known about the effects of study involvement on participants. Based on a review of the literature, the author's experiences as a sexual as a violence, researcher, and reflections of women who have participated in such research, this article explores the emotional impact of sexual violence research on participants. Although the risk of lasting harm stemming from participation in trauma research is a legitimate concern, the benefits of confiding a traumatic experience to a trustworthy other seem to outweigh the immediate distress that accompanies discussion of painful experiences. A useful framework for understanding the responses of research participants who talk or write about traumatic experiences is discussed.

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Within the past decade, over 25 research reports claiming to be based on Heideggerian interpretive phenomenology have been published in the nursing literature. This article reviews this research focusing on two critical issues. First, do the reports reflect a convergence of researcher understanding and participant narratives as called for by the Heideggerian tradition? Second, do Heideggerian ideas inform and enrich the studies' findings? The review reveals wide variations with regard to how these two issues are reflected in published reports. The author recommends that Heideggerian nurse researchers (a) seek to create a new narrative literature that allows for flexible and creative presentation of interpretive findings, while demanding adherence to sound interpretive scholarship, and (b) strengthen their partnerships with philosophers and other scholars so that ideas from Heideggerian interpretive phenomenology and other sources can not only guide their methods, but enrich their findings.

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PROBLEM: Despite the significant emotional repercussions of sexual assault, women survivors often avoid formal mental health treatment. Little is known about why survivors are reluctant to use professional services to facilitate recovery. METHODS: A descriptive study used content analysis to describe the therapy experiences and self-perceived psychotherapeutic needs of 33 women who survived sexual assault by male intimates. FINDINGS: With regard to professional services, the participants were most concerned about the quality of the therapeutic relationship and advised clinicians to appreciate the strengths and resources women bring to their own recovery. The participants' specific psychotherapeutic needs were influenced by the pervasiveness of the violence in their lives. CONCLUSIONS: Clinicians should not focus exclusively on the amelioration of symptoms but should provide support, validation, and empowerment for sexual assault survivors who seek treatment.

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Stalking is a form of interpersonal victimization that can have profound effects on targeted individuals by necessitating unwanted life changes and instilling fear that may persist long after the stalking has stopped. This article reviews current literature on stalking, presents a case study of a woman who was stalked for 3 years by a near-stranger, and offers recommendations for nurses and other mental health clinicians who work with victims of stalking.

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PURPOSE: To explore the Heideggerian concept of dwelling as revealed in the lives of women who have experienced sexual violence. Sexual violence against women by men known to them is a significant health problem, yet little is known about how such violence affects women's everyday experience. METHODS: Phenomenologic, integrating (a) data collected in 1996 and 1997 from 10 American women who had experienced sexual violence, (b) Heideggerian philosophy, (c) other literature, and (d) excerpts from the communications media. In-depth, open-ended interviews with women, followed by analysis of transcripts using Heideggerian hermeneutics. FINDINGS: Women "dwelling with violence" were living among and inseparable from violence, abuse, and maltreatment. Violence resulted in their "living-in-exile"--feeling uprooted, unsettled, unprotected, and distrustful. Yet their stories were about "preserving and sparing amidst violence"--caring for things they value, creating a safe place for themselves, guarding that which is essential to their nature, and seeking to protect others. CONCLUSIONS: Sexual violence can profoundly affect the lives of women. Women's narratives indicate complex and creative response to living in a violent environment. Nurses who seek to understand the effects of violence on a woman's daily life should focus not only on symptomatic responses to a single violent event, but also should consider her life history, the social context of her daily experiences, the degree to which violence has alienated her from others, and her unique way of responding to violence.

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Narrative therapy is proposed as a possible treatment approach for women who have had multiple experiences of sexual violence and abuse within the context of their intimate relationships. Narrative therapists elicit discussion of unique outcomes, which are moments of strength, autonomy, and emotional vitality hidden in life stories that are otherwise saturated with suffering and oppression, to open up possibilities for constructing new life narratives. Examples of such unique outcomes revealed to the author by individuals participating in a research project concerned with women's responses to sexual violence by male intimates are given.

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The purpose of this study was to test a causal model designed to identify relationships among early family life experiences, including abuse; cognitive coping mechanisms and social support; and victimization in adult women. Women (N = 622) from several communities in Northeast Ohio responded to public announcements of the study and completed a questionnaire comprised of 10 scales measuring the model variables. The theoretical structures of the original model did not fit the empirical data. Nonsignificant paths were deleted and nonestimated paths that maximally improved fit were added sequentially to reconstruct the model. The reconstructed model included a network of multiple, mediated pathways leading to the outcome variable, current victimization. Although childhood abuse experiences and victimization throughout adulthood predicted current victimization, the general emotional health of the family of origin predicted victimization beyond the effects accounted for by earlier abuse experiences. The cognitive variables mediated the relationships between early and later abuse.

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Nineteen men who were sexually abused as children were asked what advice they would give to therapists who work with male survivors. Content analysis was used to interpret their responses. The majority of the participants described specific negative experiences they had had with therapists. When discussing positive therapeutic experiences or when imparting advice to therapists, they described therapy as a journey and the therapist as a guide. The six therapist traits they described as most helpful included being informed about male sexual abuse issues, informing the client about the therapeutic process, being connected to the client, respecting the client's process, going the distance with the client, and letting the client go at the right time.

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The purpose of this study was to describe the influence of violence in the lives of women. Participants (N = 495) responded to an open-ended question asking them to describe how violence has influenced their lives. The data were analyzed using procedures of content analysis. The responses were divided into paragraphs, each reflecting a different experience with, or thought about, violence as described by the participants. The paragraphs were grouped in the following categories: childhood abuse, adult abuse, one-time stranger violence, specific risk for violence, abuse of friends or acquaintances, fear of random violence, reflections about violence in society, and no experiences with violence. The categories are described and direct quotes from the participants are included. Two themes that were salient in all categories, restriction and resolve, are identified and discussed.

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OBJECTIVE: To generate a framework of healing by male survivors of childhood sexual abuse. DESIGN: Qualitative using grounded theory methodology. POPULATION, SAMPLE, SETTING, YEARS: Population was American men living in the community who have experienced some healing from childhood sexual abuse. Sample was 19 men who were recommended by area therapists or who had publicly identified themselves as survivors. Participants were interviewed in 1993 and 1994. METHOD: Formal, unstructured interviews using open-ended questions. FINDINGS: The core variable that emerged was "Escaping the dungeon: The journey to freedom." The metaphor of "dungeon" reflects the men's experiences of powerlessness, isolation, silence and darkness, shame, and pain from their abuse. Healing was described as breaking free, living free, and freeing those left behind. CONCLUSIONS: Healing involves a struggle against an internal force, emotional pain, and against an external force, the sociocultural prescription that men should not be victims. CLINICAL IMPLICATIONS: Clinicians working with adult male survivors should consider the pervasive effects of some childhood sexual abuse experiences. Therapists can address the intrapsychic wounds of male survivors while acknowledging the context of their healing, a society where the victimization of men is often invalidated.

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Many American women who were sexually abused as children seek mental health services to help them heal from their abuse. An appreciation of the varied sources of trauma that may stem from a sexual abuse experience may guide clinicians in facilitating a meaningful discussion with survivors of the ways in which their childhood development and their current lives have been influenced by their sexual abuse. Therefore, the goal of this study was to provide a beginning delineation of possible sources of trauma in the abuse situation, based on the retrospective reflections of women who have survived abuse. One hundred and eighty-six survivors were asked to identify the most traumatic aspects of their abuse experience. A content analysis was performed on their written responses, and the following eight categories, reflecting different sources of trauma, were identified: abandonment, powerlessness, violence, betrayal, guilt and shame, loss of self, loss of childhood, and impact on sexual adjustment. Possible treatment implications and suggestions for future research are discussed.

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Willa Cather, believed to be one of America's first feminist novelists, wrote of strong, Nebraskan women who, at the start of the Industrial Age, struggled to maintain their basic values as pioneers in the face of oppression. Similarly, many nurses today fight to retain their basic values as nurses in the face of oppression from the dominant medical culture. The values shared by Cather's pioneers and some nurses of today include utilizing a woman-identified perspective, achieving power through intimacy, and encompassing multiple ways of knowing. The journey of Cather and her characters is discussed as a model for fighting oppression by maintaining the core values of one's profession--be it as nurses or as pioneers.

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