Commentary: self-care, the three-legged stool, and remembered wellness

Self-Care for Stoma Surgery: Mastering Independent Stoma Self-Care Skills in an Elderly Woman

According to Orem, active participation in caring for self contributes to the behavior of self-care. Before an individual is able to care for oneself, however, many factors must be considered. This article is based on an alert, oriented 85-year old widow, known as EL, who was recently diagnosed with rectal cancer. With postoperative hypertension and sinus tachycardia, EL is having difficulty learning self-care. This article demonstrates a scenario where Orem’s self-care deficit theory of nursing assisted in developing an effective plan of self-care for an elderly woman who underwent an ileostomy.

The placebo response complex

Placebo effects contribute to beneficial therapeutic responses and are common in anxiety and depressive disorders. It is posited that placebo effects are yielded by autonomous feeling-toned complexes capable of re-establishing background self-states of well-being. The relationship between the placebo response complex and modern neurobiological models of self is explored. The psychological roots of the placebo response complex in implicit memories of organized attachment between child and early caretakers and in Sandler's conception of the benign superego are examined. The relationships between the negative placebo (nocebo) response complex, Freud's negative therapeutic reaction, and Fordham's defence of the self are explored. Finally, it is suggested that approaches fundamental to the analytic encounter, e.g., mirroring, affectual exchanges, attunement, and containment are likely to optimize the salutary effects of both psychological and somatic therapeutic interventions.