Indiana University-Purdue University Indianapolis (IUPUI) / Atypical symptoms, multiple co-morbidities and a lack of public awareness make it difficult for older adults to know when to seek help for sepsis. Diagnosis delays contribute to older adults’ higher sepsis mortality rates. This research describes patients’ and caregivers’ experiences with the symptom appraisal process, self-management strategies, provider-nurse-patient interactions, and barriers when seeking sepsis care. Convenience and purposive stratified sampling were utilized on two data sources. A nurse-patient and nurse-family caregivers were interviewed. Online stories by older adult patient survivors or family members from the Faces of Sepsis ™ Sepsis Alliance website were analyzed. Emergent themes were identified using qualitative descriptive methods. Listlessness and fatigue were most bothersome symptoms for the nurse-family caregivers. Fever, pain and low blood pressure were most common complaints, followed by breathing difficulty, mental status changes and weakness. Patients expressed “excruciating pain” with abdominal and soft tissue sources of infection, and with post-operative sepsis. Concern was expressed that self-management strategies and medications create barriers by masking typical sepsis signs. Health care providers’ interpersonal interactions, lack of awareness of sepsis symptoms and guidelines, complacency towards older adults, and denial by patients were barriers. Further barriers were staff inexperience, delays, care omissions, and tension between health care providers, patients and caregivers—with emerging advocacy by patients and family. In conclusion, providers should assess previous self-management strategies when evaluating symptoms. At primary care visits or hospital discharge, older patients with risk factors need anticipatory guidance for sepsis symptoms and possible emergent infections--specifically patients with pre-existing risk factors such as urinary tract infections, pneumonia, or operative events. Public and professional education are needed to overcome a lack of urgency and understanding of symptoms for diagnosis, treatment and guideline adherence for inpatients and outpatient clinics. Further research on subjective sepsis symptoms may improve patient-clinician communications when evaluating sepsis in older adults.

No description available.

English speaking skills and the ability to collaborate with others are essential in our global society. Students need to be provided with the knowledge to actively participate in society and develop the ability to use different strategies to support their communication. However, speaking anxiety and not knowing how to cope with speaking anxiety could pose a problem for language learners, affecting their academic achievement. This quantitative study investigated students’ perceptions of speaking anxiety and working in groups or pairs in the foreign English classroom. A questionnaire was used and answered by secondary school students, attending their last year at two different schools. The study identified which strategies students use to cope with speaking anxiety. It was found that the majority of the participants experienced working collaboratively had positive outcomes on their experienced speaking anxiety and over a half of the language learner’s believed working in groups made them speak and participate more during English lessons. Fear of negative evaluation showed being the lowest source for experienced speaking anxiety while the most anxiety-provoking situation was having to speak publicly in class. In addition, the study showed that actively encourage oneself by taking risks in the language classroom was the most common used strategy to cope with speaking anxiety in the language classroom. Moreover, a third of the participants expressed they did not know any strategy to use to cope with their speaking anxiety.

No description available.

While self-determination researchers emphasize the importance of pursuing internally motivated goals for self-regulation, cybernetic theorists instead highlight the structural features of goal systems and the manner in which such structural features should facilitate controlled behavior in daily life. However, it was our intuition that a consideration of both these literatures might best explain self-regulatory processes in daily life. Along these lines, we conducted two studies in which we measured the degree to which a person's goals are organized in hierarchical manner with respect to their intrinsic versus extrinsic properties. In Study 1, we found that individuals with hierarchical goal structures were less likely to experience increased motivation to quit following frustrating events. Consistent with this pattern, in Study 2 we found that negative feedback concerning goal progress adversely affected only those without hierarchical goal structures. Implications of these findings for perspectives on self-regulation are discussed, as well as potential new directions for testing cybernetic concepts within human functioning.

No description available.

No description available.

No description available.

Background: Menopause is a natural part of life which can affect a woman's physical and mental health. Women's experience and knowledge of menopause varies globally, and insufficient knowledge can lead to unnecessary suffering. Knowledge of the menopause is important, both for the women themselves and for the healthcare system in order to guide the women to appropriate self-care methods, which can be crucial to health in this new phase of life. Purpose: The aim was to account for the effect health education, has on health and quality of life onwomen in menopause. Method: A general literature study consisting of quantitative studies which included four randomized controlled studies, five quasi and one semi-experimental study, without a control group. Results: The results showed that the knowledge that the women acquired during the educational interventions had a positive effect by improving the women's awareness and attitude towards the menopause, which empowered them to improve their lifestyles, and through this develop an increased health and thus a better quality of life. Conclusion: Knowledge is the key to an improved quality of life. Through a structured education, the nursing care can increase the awareness and knowledge of women regarding their self-care during the menopause. This strengthens women's autonomy and is cost-effective for healthcare.

The Canadian healthcare system, by design, has been historically oriented to delivering acute and symptom-driven care; however, the current cost of treating chronic disease has risen to an average of nearly 45% of direct costs of the national health budget. As a consequence more attention is being directed to the diagnosis and treatment of chronically ill patients who also may suffer from disabilities, illiteracy, impairment in judgment, depression, or multiple co-morbidities. This has also resulted in a new emphasis on health and disease self-management, to help patients to mitigate and manage the impacts of chronic diseases. This approach affects and involves the patient’s entire circle of care including the patient, healthcare providers, and the patient’s family and friends. This study discusses how support elements (i.e. decision support, education and training, family and community support) and sustainability elements (i.e. recreation and entertainment, rewards systems, online social networks) combined with online technological support can help to support and provide motivation for chronically ill patients to adopt self-management in a sustainable manner. The PLS (Partial Least Squares) statistical approach was used to validate a proposed SEM (Structural Equation Model) research model with data collected from 198 participants across North America without any prior exposure to our proposed system. The research model hypothesized that support and sustainability constructs have a strong positive influence on the willingness of users to adopt and use the proposed system. The model results in a very good fit for Behavioural Intention to Adopt for patients with no caregiver support (R2=0.71), and for patients with such support (R2=0.65). The results clearly validate our proposed model including a high predictive relevance for endogenous variables. This research provides useful theoretical and practical insights and understanding for design, development and promotion of chronic care self-management systems as well as the perceptions of users regarding the adoption and use of such systems. / Dissertation / Doctor of Philosophy (PhD)