This study explored the relationship of physical mobility; social integration with children, siblings, other relatives, and close friends; and social satisfaction with friend and family relations to the well-being of unmarried Canadians age 75 and older. This study also explored the relationship between each of four social integration measures and physical mobility in potentiating well-being. To take into account any possible effects of demographics the following were included in a multiple regression analysis with the major study variables; age, gender, marital status and living arrangements. A correlational cross-sectional design, using a subsample of 754 unmarried persons living in the community was selected from an archived data set, Statistics Canada's 1985 General Social Survey. No significant interactions were identified between social integration and physical mobility. The results lend support to the importance of physical mobility and the quality of relationships to the older person's well-being. Physical mobility, satisfaction with friendships, being older, and satisfaction with family relations were identified as constituting the best set of variables most strongly related to well-being. Together they accounted for 40% of the variance (p $<$.01). Physical mobility was more strongly related to the well-being of men age 75 to 79 than that of any other gender-age group. Practice and research implications are discussed.

This study explored the utilization and evaluation of formal support services among caregivers of the elderly who suffer from dementia. Data for the analyses were obtained from the Canadian Study on Health and Aging, funded by Health and Welfare Canada (1991-92). The sample consisted of 327 informal caregivers of non-institutionalized elderly with dementia. / Results indicated that formal support service users cared for demented elderly who had greater ADL/IADL functional limitations, reported more burden, tended to be husbands, tended not to live with the care recipient, reported less informal support, and tended to live in the Prairie region. They also tended to perceive their health to be better than a year ago. Service users' reports indicated that utilization of in-home services was considerably greater than that of out-of-home services. Out-of-home respite and caregiver support groups had the largest number of barriers to use. The most common barriers identified for all services included cost and perceived lack of effectiveness.

This study explored the role of potential risk variables, measured during the acute stage of pain, in predicting two development of chronic pain. Linear discriminant function analyses were performed on a subset of data from a large prospective pain prevalence study. The relationships among selected demographic, medical, psychological, and cognitive variables with the development of chronic pain was examined in 371 hospitalized patients experiencing acute pain at the initial interview. Pain was assessed at follow-up interviews (3 weeks, 3 and 6 months). A prediction equation maximizing the differences between the group who subsequently developed chronic pain and the group whose pain resolved was developed. Patients who developed chronic pain reported significantly higher pain intensity levels continuing to the 3-week follow-up, higher anxiety and distress levels continuing to the 3-week follow-up, less certainty that their pain would resolve, had been hospitalized for a longer period of time in the past year, were less independent in their ambulation, and were more likely to have a diagnosis of trauma and not to have undergone surgery. Multiple factors contributed to the development of chronic pain. An awareness of these factors could lead to early identification of those individuals with acute pain who are at risk for developing chronic pain.

The grief reactions of bereaved mothers and fathers and their perception of their marital relationship following the death of their infant were examined and compared with nonbereaved couples. The correlation between bereaved parents' grief reactions and their marital intimacy was also explored. / A total of 114 couples participated in the study, 57 bereaved couples and 57 nonbereaved. Bereaved couples had lost an infant ($>$20 weeks gestation and $<$1 year of age) within 24 months of the home visit. Bereaved women rated their grief reactions higher than their spouse. Bereaved women also differed in their perceptions of their marital intimacy compared to their husbands. / Although no differences were found between bereaved and nonbereaved couples' ratings of their marital intimacy, aspects of the marital relationship emerged as predictors of mothers' and fathers' grief reactions. Thus, it would appear that the expressions of grief of bereaved parents and their relationship with each other are closely linked following the death of their infant.

No description available.

Background A gap exists within healthcare between identifying and treating adverse psychological outcomes to abortion. Meanwhile, 30% of women worldwide experience significant emotional distress after abortion. Specifically, younger women are at the highest risk for developing mental health problems after abortion. No empirical data for interventions to relieve psychological distress after abortion were found. Goal: This thesis provides a framework to identify and treat psychological distress after legal, induced, voluntary abortion. It proposes a first of a kind evidence-based and patient-centered intervention to relieve psychological distress after abortion among university students. The thesis proposes a theory and conceptual model to understand negative psychological responses to abortion. Population-specific evidence and preference for services support the theory. Methods The United Kingdom Medical Research Guidelines were used to develop the intervention. Two phases of the five-phase method were used. First, the Pre-Clinical Phase developed: (a) the theoretical and (b) evidential basis for target symptoms of the intervention. Next, using these results, the Modeling Phase established (c) the design, (d) patient preferences, and (e) feasibility for delivering the intervention. The thesis is formatted as three manuscripts. ResultsThe Pre-Clinical Phase applied psychological stress theory to guide the intervention. It also generated evidence from a cross sectional study of N=151 participants who identified target symptoms. Participants who preferred treatment for distress after abortion demonstrated severe psychological stress (Impact of Event Scores of >26) and moderate perinatal grief (Perinatal Grief scores > 60) focused on the pregnancy and abortion. The Modeling Phase designed the intervention based on patient preferences for a group treatment addressing unanticipated guilt, enhanced coping skills, and education of psychological distress reactions after abortion. Significance and Conclusions The thesis is a series of studies that were used to develop a targeted and acceptable intervention for university students who had an abortion, reported distress afterward, and preferred treatment to relieve it if such treatment was available. The thesis provides a mechanism within nursing to understand, identify, and treat psychological distress after abortion that is population-focused, and currently does not exist. The intervention can be tested for efficacy and replicated on larger samples. Effective interventions after abortion have the potential to reduce psychiatric morbidity and mortality after abortion within a university student population. / Découvert Il existe dans le domaine médical une lacune entre la science et la pratique pour comprendre, identifier et traiter les conséquences psychologiques après un avortement. En effet, 30% des femmes du monde qui ont choisi un avortement subissent des conséquences psychologiques significatives. C'est surtout évident parmi les jeunes femmes que l'on trouve les risques les plus élevés pour ces problèmes psychologiques. Les données empiriques pour les interventions qui adressent ce problème n'ont pas été découvertes. ObjectifCette thèse a comme but de fournir une base de connaissance et pratique pour traiter les problèmes psychologiques, qui existent après un avortement. L'intervention proposée, unique en son genre, est basée sur les éléments de preuves recueillis des étudiantes universitaires qui ont éprouvé des effets négatifs après un avortement et qui accepteraient un traitement pour leur désordre. Cette thèse propose une théorie et un modèle pour mieux comprendre les mauvais effets psychologiques après un avortement. L'évidence accumulée et les préférences des clients, concentres sur la population du groupe de contrôle, soutient la thèse.MéthodesThe United Kingdom Medical Research Guideline a fourni la méthode pour l'élaboration des interventions. Parmi les cinq phases proposés dans ce guide, les deux premiers ont été utilisés: la phase préclinique et la phase modèle. La phase préclinique développe (a) une théorie pour la détresse après un avortement et (b) les symptômes ciblés pour l'intervention. Avec cette évidence comme base, la deuxième phase a été élaborée : (c) plan de l'intervention ; (d) les préférences du client pour une intervention spécifique et (e) la faisabilité et l'application du traitement. RésultatsLa phase préclinique, a déterminé une théorie du désordre psychologique comme base de l'intervention. En plus, une étude descriptive d'un groupe (N=151) de participants fournit l'évidence des symptômes ciblés. Les participants qui cherchaient un traitement, avaient démontré une sévère détresse psychologique (Impact de Grands Nombres d'Evénement >26 et deuil périnatal modéré >60), spécifique à la grossesse et l'avortement. L'évidence ramassée dans la phase préclinique a été utilisé pour déterminer une intervention appropriée. Parmi ces interventions préférées parmi des clients étaient : le service d'une thérapie en groupe pour la culpabilité non anticipée, le succès des compétences, et l'enseignement sur les effets psychologiques après un avortement. Signification et conclusionLa thèse actuelle représente une série d'études utilisée pour développer une intervention ciblée et acceptée par les étudiants universitaires qui, après avoir subi un avortement, ont éprouvé des conséquences psychologiques négatives et qui cherchaient un traitement médical. Cette thèse pourvoit une base de connaissance cohérente dans la profession d'infirmière à comprendre, identifier, et traiter la détresse psychologique après un avortement. Cette connaissance, concentrée dans la population, n'existe pas encore. L'intervention développée pourrait être examinée pour l'efficacité et répliquée parmi les groupes plus nombreux. Les interventions efficaces, qui réduisent la détresse après un avortement pourraient aussi réduire la portée de morbidité psychiatrique et mortalité après l'avortement dans la population du niveau universitaire.

Background An admission to the intensive care unit causes major physical and psychological stress for children. Pain contributes significantly to this distressing experience. To optimize pain relief, a sound pain assessment tool is essential. Although this need is recognized, only a few pain assessment instruments have been thoroughly tested with this population using a rigorous scientific approach, and none have been shown to be superior to the other. Recent studies using near-infrared spectroscopy (NIRS) in term and premature infants indicate that nociceptive stimuli cause haemodynamic changes in specific cortical regions. This suggests a new avenue for assessing and quantifying pain processing in critically ill infants that could be more sensitive and specific to the nociceptive response. Aims In this series of studies we examined regional cerebral and systemic haemodynamic changes, as well as behavioural reactions in critically ill infants with congenital heart defect (CHD) during chest drain removal following open heart surgery. Specifically, we examined changes within subjects, as well as individual factors (age, sex, medication) affecting the change and associations between cerebral haemodynamic changes, systemic physiological changes, and Face Legs Activity Cry Consolability (FLACC) pain scores. Subjects Critically ill infants less than 12 months of age admitted to a cardiac intensive care unit after cardiac surgery for CHB comprised the sample. Outcome measures Changes in cerebrovascular haemoglobin concentrations (NIRS), as well as heart rate (ECG), systemic arterial oxygen saturation (pulse oximetry), and mean arterial blood pressure (arterial line) were recorded during three distinct epochs (Baseline, Tactile stimulation, and Chest-drain removal). Behavioural manifestations were also captured through video and were subsequently rated for pain with the FLACC scale. Design Descriptive correlational design. Results We studied 32 infants with CHD and obtained FLACC pain scores in 20 of these infants. Cerebral deoxygenated haemoglobin concentrations significantly increased across the epochs (p&lt;.01). Physiological systemic responses were not found to be associated with the cerebral haemodynamic parameters. Mean FLACC pain scores significantly increased across the epochs (p &lt; .001) with a mean score of 7/10 during the noxious procedure, despite administration of an analgesic agent (morphine). Sex of patients was found to be a determining factor in the cerebral haemodynamic responses and pain FLACC scores. Pharmacological treatments, age and weight of patients were significantly associated with cerebral and systemic haemodynamic responses, as well as the FLACC pain scores. The administration of a sedating agent (midazolam) had a significant dampening effect on the pain behaviours as assessed by the FLACC scale.ConclusionsUsing a multidimensional pain measurement approach, we demonstrated that significant cerebral, physiological and behavioural activity was present in response to a noxious procedure in critically ill infants despite the administration of analgesic treatment. Although pain behaviours were significantly dampened by the sedating agent, the cerebral response was still evident. Thus, assessment of cerebral haemodynamics in the context of pain seems to be an important addition when a sedating agent is administered. Our data suggest that NIRS is a potentially useful technique for assessing pain evoked cerebral activation in critically ill infants. / Introduction Une admission à l'unité des soins intensifs est une source de stress physique et psychologique chez l'enfant. La douleur contribue grandement à cette expérience affligeante. Pour optimiser le soulagement de la douleur, un bon outil de mesure est essentiel. Malgré que ce besoin soit reconnu, très peu d'instruments ont subi des tests scientifiques rigoureux auprès de cette population et aucun outil ne s'est démarqué des autres. Des études récentes utilisant la spectroscopie par infrarouge (SPIR) chez les nouveau-nés à terme et prématurés ont indiqué que des stimuli nociceptifs causent des changements hémodynamiques dans des régions cérébrales spécifiques. Cette approche semble prometteuse auprès des jeunes enfants gravement malades. Objectifs Nous avons examiné les changements hémodynamiques cérébraux et systémiques, ainsi que les réactions comportementales reliés au retrait d'un drain thoracique chez de jeunes enfants ayant subi une chirurgie à cœur ouvert pour une cardiopathie congénitale. Spécifiquement, nous avons exploré et comparé les changements de chaque enfant, ainsi que les facteurs individuels (âge, sexe, médication) affectant ces changements. De plus, les associations entre les changements hémodynamiques cérébraux et physiologiques, ainsi que les scores de douleur selon l'échelle Face Legs Activity Cry Consolability (FLACC) furent étudiées. Échantillon L'échantillon comprenait de jeunes enfants gravement malades âgés de moins de 12 mois admis à l'unité des soins intensifs cardiaques. Mesure des paramètres Les changements de concentrations en oxygène de l'hémoglobine (SPIR), ainsi que le rythme cardiaque (ECG), la saturation artérielle en oxygène (oxymétrie pulsatile), et la pression artérielle moyenne (ligne artérielle) furent recueillis pendant trois périodes distinctes (mesures initiales, stimulation tactile et retrait drain thoracique). Les manifestations comportementales furent obtenues par vidéo et évaluées, subséquemment, pour la douleur à l'aide de l'échelle FLACC. Devis Devis descriptif corrélationnel. Résults Nous avons étudié 32 enfants avec cardiopathie congénitale et avons obtenu des scores de douleur FLACC auprès de 20 de ces enfants. La concentration cérébrale de désoxygénation de l'hémoglobine a significativement augmenté entre les trois périodes (p&lt;.01). Les réponses physiologiques systémiques ne furent pas associées aux paramètres hémodynamiques cérébraux. Les scores de douleur FLACC moyens ont significativement augmentés entre les périodes (p &lt; .001), dont la moyenne était de 7/10 en réponse à la procédure douloureuse, malgré l'administration d'un agent analgésique (morphine). Le sexe des participants fut un facteur déterminant de la réponse hémodynamique cérébrale ainsi que pour les scores de douleur FLACC. L'administration de traitements pharmacologiques, l'âge et le poids des enfants furent associés de façon significative aux changements hémodynamiques cérébraux et systémiques, ainsi que ceux des scores de douleur FLACC. L'administration d'un agent sédatif (midazolam) a eu un effet atténuant significatif sur les comportements de douleur tels que mesurés par l'échelle FLACC. Conclusions Nous avons démontré, à l'aide d'une approche multidimensionnelle, que des manifestations cérébrales, physiologiques et comportementales significatives étaient présentes en réponse à une procédure nociceptive chez le jeune enfant gravement malade, et ce, malgré l'administration d'un traitement analgésique. Les comportements communiquant une douleur furent significativement atténués par l'administration d'un agent sédatif. Par conséquent, l'évaluation de l'activité hémodynamique cérébrale lors de situation douloureuse s'avère être un important ajout lorsque des médicaments sédatifs sont administrés. Il semble que la SPIR soit une technique potentielle pour évaluer l'activation cérébrale évoquée par une stimulation nociceptive chez le jeune enfant gravement malade.

Note: / The significant health benefits of breastfeeding are extensively documented, and it is now recommended to breastfeed exclusively (Le., feed infants nothing but breastmilk) for the first 6 months of life. Guided by the Interactional Model (Loiselle, 2001), this prospective correlational study explored the predictive and interactive influence of potentially modifiable personal (Le., breastfeeding self-efficacy, maternal infant feeding beliefs, perceived infant satisfaction with breastfeeding) and contextual factors (i.e., paternal infant feeding beliefs, breastfeeding informational support, general postpartum support) on breastfeeding duration and exclusivity among a convenience sample of 189 primiparous breastfeeding mothers. Personal, contextual, and control factors were assessed by self-report questionnaires and/or interviews during postpartum hospitalization, at 6 weeks, and at 4 months postpartum. Breastfeeding outcomes were assessed via telephone interview at 6 weeks, 4 months, and 6 months postpartum. [...] / Les importants benefices de I' allaitement maternel pour la sante sont tres bien documentes, et on recommande a. l'heure actuelle d'allaiter exclusivement (c.-a.-d. de ne donner que du lait maternel au nourisson) durant les six premiers mois de vie. Guidee par Ie modele interactionnel (Loiselle, 2001), cette etude prospective corelationnelle a examine l'influence predictive et interactive de facteurs potentiellement modifiables personnels (la confiance en l'allaitement, les croyances des meres face a. I'allaitement, la perception de la satisfaction du bebe qui allaite) et contextuels (les croyances des peres face a. l'allaitement, l'information disponible sur l'allaitement, Ie soutien en matiere de post-partum) conditionnant la duree et l'exclusivite de l'allaitement maternel d'un echantillon de convenance de 189 meres primipares allaitantes. Les facteurs personnels, contextuels, et de contr6le ont ete evalues en fonction de questionnaires d'auto-evaluation remplis durant l'hospitalisation, a. 6 semaines et a. 4 mois post-partum.[...]

Pain requiring treatment is experienced by many cancer patients at the end of life. When these patients stay at home, family caregivers are often directly implicated in pain management. There are few studies that examine the process that these family caregivers engage in when they take on the responsibility of pain management. This means we need information on whether or not these family caregivers are prepared for management to ensure proper support and optimal pain control. / The purpose of this qualitative study was to study the process used by family caregivers at home to manage the pain of palliative cancer patients using a grounded theory approach. A total of 24 family caregivers with differing relationships to the patient and differing lengths of caregiver experience participated. Family caregivers were recruited using purposeful then theoretical sampling. The data sources were taped, transcribed (semi-structured) interviews, field notes, and memos. Data analysis used Strauss & Corbin's (1998) suggestions for substantive coding: open, axial, and selective coding. / The results lead to the proposition of an explanatory theory titled "the puzzle of pain management," which include: 1) a frame of the process of "drawing on past experiences"; 2) puzzle pieces representing the process "strategizing a game plan" which include the sub-processes of "accepting responsibility," "seeking information," and "establishing a pain management relationship"; 3) puzzle pieces representing the process of "striving to respond to pain" which include the sub-processes of "determining the characteristics of pain," "implementing a strategy for pain relief," and "verifying if pain relief strategies were successful; and 4) "gauging the best fit," a decision-making process that joins the two pieces of the puzzle. / The realization that family caregivers assemble a puzzle of processes indicates that there are factors that nurses must be aware of before creating, teaching, and implementing interventions for pain management. Furthermore, the results provide information to create and subsequently administer interventions based on caregivers' existing knowledge, identified needs for information and support, and current pain management regimens. The puzzle of pain management must be validated by further studies using this theory, in part, to help create interventions that will allow us to know how useful the theory is in practice. / Keywords: family caregivers, carers, pain management, palliative care, cancer pain, home care, grounded theory

Background: The relationship between informational support and use of health care services among individuals newly diagnosed with cancer remains little documented despite its importance for optimal care delivery. Aim: To document the role of informational support in light of patterns of health services used by women and men newly diagnosed with cancer. Method: A sequential mixed methods approach (i.e., quantitative-qualitative) was conducted among women and men newly diagnosed with either breast or prostate cancer. First, an existing quantitative database was used to determine whether an intervention relying on multimedia tool as a complement to the provision of usual cancer informational support to patients (N = 250) would modify subsequent health care service use. A follow-up qualitative inquiry with distinct individuals also newly diagnosed (N = 20) was conducted to explore this relationship further. Next, the resulting quantitative and qualitative findings were merged and reanalyzed using a quantitative-hierarchical approach to enhance our understanding of the phenomenon. Findings: Several personal and contextual factors were found to qualify the relationship between cancer informational support and health service use. Although quantitative analyses showed no significant differences in terms of overall reliance on health care services among participants who received more intense cancer informational support as opposed to those who received care as usual, several sex differences were noted in terms of number of visits to health care professionals, time spent with nurses and satisfaction with cancer information received. Qualitative findings revealed that participants reported a variety of experiences pertaining to cancer information received (e.g., positive, unsupportive or mixed) as well as several processes at play (e.g., cancer information seen as enabling, confirming, or conflicting). These differences in informational support, in turn, influenced their subsequent service utilization (e.g., more phone calls made to health professionals, reduction in face-to-face visits, reluctance to use cancer-related services). The mixed data analysis clarified further the findings allowing a broader perspective to emerge. Conclusion: Findings underscore that the relationship between cancer information and use of services is not as straightforward as initially anticipated. These findings provide initial insights that may inform future research on the topic and assist health care providers in optimizing their cancer informational interventions to guide patients in their reliance on health care services.