Abstract: This phenomenological study describes the lived experience of pain inflicted in the context of medically prescribed treatment, explores the meanings of such pain for patients who endured it and for nurses whose actions contributed to its generation, and presents a thematic description of the phenomenon of clinically inflicted pain. The study is informed by phenomenology, both in terms of its premises and orientation, and its research design and method.The participants in the study were 14 adult patients, admitted to hospital following burn injuries, or receiving intravenous chemotherapy upon diagnosis of cancer, and 20 nurses involved in their care. Data collection took place over a period of five months and included participant observation and compilation of field notes, and a total of 89 tape-recorded interviews (48 with patients and 41 with nurses). Through the process of hermeneutic interpretation a number of themes were identified and used to describe the phenomenon of clinically inflicted pain and the structure or the lived experience of the patients and the nurses concerned.The phenomenon of clinically inflicted pain is described in terms of four isolated themes: (1) the hurt and painfulness of inflicted pain; (2) handing one's body over to others; (3) the expectation and experience of being wounded, and (4) restraining the body and the voice. These themes point to the embodied nature of pain experience and the extent to which the person is involved not only in the enduring of pain but also in its generation. The broader lifeworld of clinically inflicted pain, often as punishment and almost always a something avoidable, and in turn being constituted by their experiences in terms of losing and seeking to regain a sense of embodied self and of personal situation, and by changed experiences of lived space and lived time.Nurses who themselves helped to generate pain, frequently overlooked the patient's lived experience and thus the essential nature of inflicted pain as painful, wounding, and demanding cooperation and composure from the patient. Instead, the pain frequently become invisible to nurses involved in its infliction, or when it could not be overlooked or ignored, it was perceived inevitable , non-harmful and even as beneficial to patients' recovery. The strategic responses that nurses adopted to pain infliction included detachment from the perceived impact and consequences of their own actions and objectification of the person in pain as a body-object on whom certain tasks had to be performed. An alternative to the strategy of detachment and objectification was involvement in a therapeutic partnership between the nurse and the patient, where shared control over pain infliction and relief helped to sustain trust in the relationship and preserve personal integrity of the patient and the nurse.The study points to dangers for both patients and nurses when clinically pain is ignored, overlooked or treated with detachment. It also points a way toward nursing practice, that is guided by thoughtfulness and sensitivity to patients' lived experience, and awareness of freedom and responsibility inherent in nursing actions, including those involved in inflicting and relieving pain. The study raises questions about nurses' knowledge, attitudes, and actions in relation to clinically inflicted pain, and highlights the need for nursing education and practice to consider the contribution of a phenomenological perspective to the understanding of human experience of pain, and the nursing role in its generation, prevention and relief

Abstract: Discourse about women assuming greater control over their childbirth experience has received much attention in contemporary childbirth and womens' studies publications. Research in the domain of childbirth has shown that a sense of control over one's birth experience is related to childbirth satisfaction. More specifically, studies have used Locus of Control measures and have found a significant relationship exists between expectations for control and choice of birth place. Choice of birth place features in some articles as a factor that determines the degree to which control can be exercised. Home, as a place of birth, is considered a setting in which a woman can have optimum control over her experience. Many women are discouraged from taking up this option, based on fears about safety. Reflection on why women continue to pursue a home birth against the wishes of their care giver rekindled and interest in Locus of Control. This study was undertaken to explore the relationship between urban women's choice of birth place setting and their scores on two different measures of Locus of Control (LOC). The aims of the study were: to test whether LOC scores predict choice of birth place for women who chose hospital, home or a birthing centre as their place of birth; to test which of the two LOC scales (Levenson's generalised measure or Wallston et al's more specific scale) is the most useful in predicting the influence of LOC and choice of birth place and to explore the relationship between choice of birth place LOC, demographic and contextual factors surrounding pregnancy. The method used in the study was a descriptive correlational design. One hundred and ninety four pregnant urban women who accessed a range of maternity care providers in the greater Auckland , Wellington , Christchurch and Dunedin cities responded to a “Birth Choice Survey” between April and June 1996. Tests of significance found significant differences for powerful others and chance Locus of Control among the three groups of women who chose hospital, home or a birthing center as a place of birth. Differences were significant at p = 0.05. No significant differences were ffound in the scores for internal Locus of Control for women in the three groups. Limitations in the sample sixe prevented linear discrimination being successful in predicting the influence and choice of LOC variables and choice of birth place for both scales. A classification tree was employed to identify key variables which might affect choice of birth place and indicated that women who were extremely happy with their birth place choice were more likely to be those who chose home birth. Locus of Control measures are interesting, and if used specifically, may be helpful in relation to understanding a women's choice of birth place. However general assessment of the contextual factors appears just as relevant. Implications of this study are the while women may differ in how they perceive their outcomes are determined, an overwhelming majority of women who participated in this study value their ability to make choices about their birth location. Identifying consumer perceptions about control and the contextual factors that influence women's choice of their birth place has the potential to clarify women's preferences for responsibility in their birth experience. Limitations of the study were addressed and included suggestions to improve response rates and thus generalizability of findings. Implications for further research were also considered

Abstract: Questionnaires were completed in the work place. The participants had all experienced a chronic illness. The results revealed that the manager has the responsibility to deal openly with the staff member who is ill, and for some managers this is difficult to do