Thesis advisor: Callista Roy / The purpose of this secondary analysis was to understand the coping and adaptation processes of reservist soldiers and one family member throughout the first year following deployment to Iraq. A directed content analysis based on the Roy (2009, 2011) conceptualization of coping and adaptation was accomplished on 75 interviews from 20 Army Reserve and family participants. Research questions were; which contextual stimuli affected the coping capacity for dealing with focal stimuli; military deployment and reintegration. Second, whether resourceful and focused coping at Wave 1 positively influenced the adaptation level at 52 weeks. Third, whether physical and fixed coping at Wave 1 negatively affected the adaptation level at 52 weeks. Fourth, whether coping capacity varied during the reintegration year. Findings confirmed primary study outcomes (MacDermid, 2006) where participants described individualized reintegration. Informants' depictions were different from the previously published, "New Emotional Cycles of Deployment." Contextual stimuli were complicating or protective and exerted substantial influence on managing the deployment and reintegration. Cognitive-emotional processing the meaning and repercussions of the deployment is part of the reintegration process. Resourceful and focused coping positively affected the adaptation level at 52 weeks. Insufficient reports of physical and fixed coping precluded determining its effect. Coping efforts were a discrete measure of coping extrapolated from narratives, and were found to fluctuate throughout the year. When demands intensified, participants accelerated their coping efforts as predicted by the Roy adaptation model (2009). Coping strategies were effective or ineffective. Concepts of transcendence, transformation, and hope were understood in new ways within the Roy model. Transcendence in individuals and groups was further explicated. Spirit was another concept from Roy's work that was observed in the participants. Implications for policy, theory, nursing practice, education and research are discussed. Keywords: adaptation, adaptation level, coping, coping efforts, Roy adaptation model, spirit, transcendence, transformation, hope, military deployment, post-deployment, reintegration, Reservist, military family, deployment cycle, directed content analysis / Thesis (PhD) — Boston College, 2012. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Bakgrund: Arbetsrelaterad stress som sjuksköterskor upplever kan få stora konsekvenserför enskilda individer. Stress leder till en stressrespons både fysisk och psykiskt vilketpåverkar sjuksköterskors arbetsuppgifter, men även arbetsplatsen och patienterna.Stress är ett komplext ämne där flertal faktorer spelar in såsom personliga egenskaper,socialt stöd, miljö samt ledarskap. För att kunna beskriva stressresponsen har Roysadapation theory använts. Syfte: Att beskriva sjuksköterskors upplevelse avarbetsrelaterad stress. Metod: beskrivande litteraturstudie med 10 artiklar inkluderades,samtliga med kvalitativ ansats som söktes fram i Medline via PubMed. Huvudresultat:Huvudteman som kom fram var hög arbetsbelastning, sömnproblem, trötthet, påverkanpå privata relationer, patientrelaterad stress, utbildning samt copingstrategier. Slutsats:Det finns många anledningar till att en person utvecklar arbetsrelaterad stress. Genom attkänna till vilka faktorer som påverkar kan arbetsmiljön anpassas för att motverka dessafaktorer. Genom att förebygga stress kan patientsäkerheten och sjuksköterskorsvälbefinnande och hälsa förbättras.

Thesis advisor: Barbara E. Wolfe / Despite the chronicity and less than optimal outcomes of inpatient treatment (IPT) for anorexia nervosa (AN), treatment guidelines continue to reflect the common notion of one-size-fits-all and the process of weight restoration continues to be poorly understood. Weight restoration, a primary goal of IPT for AN, does not occur in isolation but rather reflects an adaptation process within internal and external environments. It is unknown whether or not there are unique patterns of change in body weight that are associated with factors identified in the existing literature as being predictors of weight gain. The purpose of this study was to explore the extent to which patterns of change in body weight existed among individuals during IPT for AN, and the relationship with factors identified in the existing literature as being predictors of weight gain (i.e., age at time of admission, admission caloric intake, percent of ideal body weight [IBW] at time of admission, body weight at time of discharge, body mass index [BMI] at time of discharge). Individuals who were diagnosed with AN and admitted to the inpatient unit of an eating disorder treatment facility in the Northeast between January 1, 2012 to December 31, 2015 were included in this retrospective, exploratory study (N = 500). Group-based trajectory modeling (GBTM) was used to identify distinct trajectories of change in body weight, and to determine the risk of being in a particular trajectory. Four distinct trajectories were identified: weight gain (n = 197), weight loss (n = 177), weight plateau (n = 82), and weight fluctuate (n = 44) groups. Significant predictors of trajectories were age, history of prior IPT for AN, admission caloric intake, body weight at time of admission and discharge, and length of stay. Results from this study suggest that a further understanding of patterns of change in body weight among individuals with AN, will help guide assessment and treatment interventions and consequently influence outcomes. Additionally, there is an opportunity to update treatment guidelines and recommendations for AN. / Thesis (PhD) — Boston College, 2016. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Thesis advisor: Callista Roy / <bold>Problem</bold>: Cancer patients lack information and support needed to make the transition to survivorship. This problem was addressed by testing a psycho-educational group intervention, the Mid-Life Directions Workshop, for its effect on hope and quality of life in midlife cancer survivors. <bold>Participants</bold>: Twenty-six midlife adults (23 women, 3 men, mean age = 54.3 years, range 40-65) with breast cancer (n = 19), colorectal cancer (n = 4), lung cancer (n = 2), and malignant melanoma (n = 1) stages I, II and III were recruited from two hospital-affiliated Cancer Centers in the Northeastern United States. Mean time since completion of active primary treatment was 11.5 months (SD = 6.67, range, 0-28 months). Most participants were non-Hispanic (96.2%) and white (100%) with some college or a college degree (88.5%). <bold>Method</bold>: A multimethod experimental design randomly assigned 17 participants to the treatment group, receiving the workshop in six 2-hour sessions, and 9 participants to the control group, receiving a nutrition program in six 1-hour sessions. Hope was measured pre- and post-intervention using the Herth Hope Index as was quality of life using the Quality of Life Instrument, Patient/Cancer Survivor Version. Written reflections were created by treatment group participants post-intervention. <bold>Findings</bold>: The quantitative measures revealed a significant increase in hope (p = .047) for the control group. The treatment group reported positive effects on hope and quality of life by means of written reflections. Six themes emerged: 1) examining what is, 2) feeling connected, 3) accepting what is, even the painful, 4) embracing one's life experiences, 5) exploring new possibilities, and 6) moving forward with enthusiasm. <bold>Implications</bold>: The Mid-Life Directions Workshop demonstrated positive effects on hope and quality of life for this group of midlife cancer survivors. The richness of the qualitative findings highlights the importance of multimethod design for future studies. The Nutrition Program also merits further study. This study provides an increased understanding of interventions that may support hope in midlife cancer survivors following active primary treatment. / Thesis (PhD) — Boston College, 2012. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Krūties vėžys jau daugelį metų yra dažniausia moterų onkologinė liga bei opiausia ir aktualiausia jų sveikatos problema. Problemos aktualumą lemia vis didėjantys susirgimo mastai bei nepaliaujamas sergamumo krūties vėžiu augimas. Atlikus darbą bus išsiaiškinta su kokiais adaptacijos poreikiais susiduria sergančios moterys 1- 4 parą po operacijos (ankstyvuoju pooperaciniu laikotarpiu) ir išvykusios į namus (vėlyvuoju pooperaciniu laikotarpiu). Išsiaiškinus adaptacijos poreikius, būtų galima greičiau bei efektyviau padėti pacientėms susidoroti su iškilusiomis adaptacijos problemomis. Darbo tikslas - įvertinti ir palyginti moterų, sergančių krūties vėžiu, adaptacijos poreikius ankstyvuoju ir vėlyvuoju pooperaciniu laikotarpiu. Šiam tikslui pasiekti buvo naudojami 3 uždaviniai: 1. Palyginti moterų, sergančių krūties vėžiu fizinės adaptacijos poreikius ankstyvuoju bei vėlyvuoju pooperaciniu laikotarpiu remiantis C. Roy adaptacijos modeliu. 2. Palyginti moterų, sergančių krūties vėžiu vaidmens poreikius ankstyvuoju bei vėlyvuoju pooperaciniu laikotarpiu remiantis C. Roy adaptacijos modeliu. 3. Palyginti moterų, sergančių krūties vėžiu tarpusavio ryšio poreikius ankstyvuoju bei vėlyvuoju pooperaciniu laikotarpiu remiantis C. Roy adaptacijos modeliu. 4. Palyginti moterų, sergančių krūties vėžiu asmens tapatumo poreikius ankstyvuoju bei vėlyvuoju pooperaciniu laikotarpiu remiantis C. Roy adaptacijos modeliu. Tyrimo objektas - 25 – 55 metų amžiaus pacientės, sergančios I – II... [toliau žr. visą tekstą] / A breast cancer is the most common malignant disease of women and the most serious and relevant problem of their health. The actuality of this problem depends on the extent of this disease and continuous growth of the incidence of breast cancer. Following the work will clarify what are the adaptation needs for women after 1 – 4 day from surgery (early postoperative period), and during the period of backing home (the late postoperative period). Clarifying the adaptation needs leads the faster and more efficient way to help patients cope with adaptation problems. The objective of the work is to assess and compare the adaptation needs in the early and late postoperative period of the women with breast cancer. To accomplish the object of work was used three tasks: 1. Compare physiological adaptation needs in the early and late postoperative period based on C. Roy adaptation model for women with breast cancer. 2. Compare the self-concept function of early and late postoperative period based on C. Roy adaptation model for women with breast cancer. 3. Compare the needs of interrelation in the early and late postoperative period based on C. Roy adaptation model for women with breast cancer. 4. Compare personal interdependence needs in early and late postoperative period based on C. Roy adaptation model for women with breast cancer. The object of investigation - 25 - 55 year-old patients, suffering from I - II-stage breast cancer, which has been operated and treated at the LSMU KK... [to full text]

Background: COVID-19 was declared a pandemic by WHO in March 2020. Intensive care nurses challenges were to treat critically ill infected with the virus, were the knowledge of treatment, protective gear, spread of infection and mortality was unknown. They were unsure about how the pandemic would progress and the information was inexplicit. To work as an intensive care nurse during a pandemic can lead to negative experiences and psychological distress.  Motive: By analyzing and describe experiences of working during the COVID-19 pandemic, a deeper understanding is created and can be used as basis for creating new and improved routines.   Aim: To describe intensive care nurses’ experiences of working during the COVID-19 pandemic.  Methods: Metasynthesis, sample process inspired by the SBU: s method. The databases PsycINFO, Cinahl and PubMed were used. Inclusion criteria; qualitative method including intensive care/critical care nurses, nurses working with COVID-19 patients that requires intensive care, and that the study includes experiences of working during the COVID-19 pandemic, Moderate quality according to the SBU: s Quality audit, Peer-reviewed and written in English or Swedish.  Result: The analysis was made using qualitative content analysis. Resulted in five categories; Organizational challenges, Effect on life outside the intensive care unit, Challenges of using the personal protective gear, A struggle to keep up motivation, and Challenges in providing holistic care with fourteen subcategories.  Conclusion: Intensive care nurses experienced that the COVID-19 pandemic affected them both mentally, physically, inside and outside the hospital. They experienced lack of support from the organization, struggles with the constant changes, lack of education and experience, heavy workload, fear of getting infected or infection one’s own family, lack of and use of personal protective gear. This effected the care the patient and the patients’ family in a negative way. Despite this the intensive care nurse had hope for the future and professional pride.

Bakgrund: Hot och våld är något som blir mer vanligt i samhället och så även i ambulanssjukvården. Arbetsrelaterat våld innefattar att utsättas för ohövligheter, mobbning, verbala och fysiska aggressioner, hotfulla ord eller aktioner, sexuella trakasserier och fysisk misshandel under sin arbetstid. Ambulanspersonalen har i tidigare forskning visat sig vara en utsatt personalkategori då de väldigt ofta arbetar ensamma i främmande miljöer med patienter med stor variation av sjukdomstillstånd. Syfte: Studiens syfte var att beskriva ambulanspersonalens utsatthet för arbetsrelaterat våld och hur omvårdnaden kan påverkas. Metod: Studien utfördes som en litteraturstudie genom systematisk ansats och med en integrerad analys av 14 artiklar med kvalitativ, kvantitativ och mixad metod. Resultat: Mellan 66 och 75 procent av ambulanspersonalen hade utsatts för någon typ av hot eller våld i sin yrkesutövning. Verbala hotfulla yttranden var vanligast. Att utsättas för hot eller våld i sitt arbete ger psykiska och fysiska konsekvenser inte bara i mötet med patienter och i yrkesutövningen, på kort eller längre sikt, utan även på privatlivet och i integrationen med andra människor. Rädsla, uppgivenhet, frustration och ilska är vanligt förekommande hos ambulanspersonalen som blivit utsatt. Detta kan påverka vårdandet av patienten då ambulanspersonalen blir mer vaksam för att skydda sig själv och sin kollega men även en minskad empati och tålamod. Slutsats: Arbetsrelaterat våld inom akutsjukvården är vanligt förekommande och ambulanssjukvården är inget undantag. Det arbetsrelaterade våldet påverkar inte bara personalens hälsa och välbefinnande utan även omvårdnaden av patienten genom att vårdrelationen riskerar att försämras. Då studier tyder på att det arbetsrelaterade våldet har en tendens att öka så behövs förebyggande arbete, utbildning och uppföljande samtal för att på så sätt bibehålla en god omvårdnad och ambulanspersonalens välbefinnande. / Background: Threats and violence are something that is becoming more common in society and so also in ambulance care. Ambulance personnel are a vulnerable category of personnel as they very often work alone in foreign environments. Increased resources are needed to protect staff and also the patient. Aim: The aim of the study was to describe the ambulance staff's exposure to work-related violence and how nursing can be affected. Method: The study was conducted as a literature study through a systematic approach and with an integrated analysis of 14 articles with qualitative, quantitative and mixed method. Results: Between 66 and 75 percent of the ambulance staff had been exposed to some type of threat or violence in their professional practice. Verbal threatening statements were most common. Being exposed to threats or violence in their work has psychological and physical consequences not only in the meeting with patients and in the professional practice, in the short or long term, but also in private life and in the integration with other people. Fear, despair, frustration and anger are common among ambulance personnel who have been exposed. This can affect the care of the patient as the ambulance staff becomes more vigilant to protect themselves and their colleague but also a reduced empathy and patience. Conclusion: Work-related violence in emergency care is common and ambulance care is no exception. Work-related violence affects not only the health and well-being of staff but also the care of the patient as the care relationship risks deteriorating. As studies indicate that work-related violence has a tendency to increase, preventive work, education and follow-up conversations are needed in order to maintain good nursing and the well-being of ambulance staff.

Résumé : La schizophrénie est un trouble mental grave qui affecte toutes les facettes de la vie de la personne. En outre, le manque de soutien social est un problème important qui contribue à l’aggravation de la maladie, notamment en influençant négativement la capacité d’adaptation. Chez les personnes atteintes de schizophrénie, la capacité à utiliser des stratégies d’adaptation adéquates et efficaces est essentielle afin d’améliorer la santé, le bien-être et la prévention des rechutes. Cette recherche utilise la conception de l’adaptation de Roy (2009). De nombreuses études confirment la présence de difficultés d’adaptation chez ces personnes. De plus, le processus d’adaptation lui-même reste mal connu. La question de recherche était : Quel est le processus d’adaptation des personnes vivant avec la schizophrénie lorsque leur soutien social est limité ? Cette question sous-tendait deux objectifs : 1) décrire le processus d’adaptation des personnes atteintes de schizophrénie dans un contexte de soutien social limité et 2) contribuer au développement du modèle de Roy dans le contexte des troubles mentaux graves. Le devis de recherche était la théorisation ancrée constructiviste, auprès de 30 personnes vivant avec la schizophrénie. Les données étaient composées d’entrevues et de résultats de trois questionnaires qui ont contribué à décrire de façon plus détaillée le profil des participants. Les résultats sont une modélisation du processus d’adaptation nommée « les filtres dans le processus d’adaptation des personnes vivant avec la schizophrénie ». Cette modélisation met en lumière le fait que le potentiel d’adaptation des personnes vivant avec la schizophrénie est affecté à la fois par des éléments de l’environnement social et des éléments inhérents à la maladie elle-même. Ces éléments altèrent la possibilité et la capacité à utiliser des stratégies d’adaptation adéquates et efficaces. Ces résultats de recherche pourraient permettre d’améliorer l’évaluation des personnes atteintes de schizophrénie et de diminuer les « inconnues » dans l’effet des interventions, tout comme de favoriser les actions visant à lutter contre les conditions sociales qui nuisent à l’adaptation. / Abstract : Schizophrenia is a severe mental disorder that affects all human facets of life. In addition, the lack of social support is an important problem that contributes to the worsening of the disease by negatively influencing the capacity to adapt. For people with schizophrenia, ability to use appropriate and effective coping strategies is essential to improve health, well-being and preventing relapse. This research uses Roy’s adaptation model (2009). Numerous studies confirm the presence of adaptation problems for those persons. Furthermore, the adaptation process itself remains unclear. The research question was: what is the adaptation process of people with schizophrenia when social support is limited? This question underpinned two objectives: 1) describe the adaptation process of people with schizophrenia in a limited social support context and 2) contribute to the development of Roy’s adaptation model in severe mental disorders context. The research design was a constructivist grounded theory, with 30 people with schizophrenia. The data were consisted of interviews and results of three questionnaires that were helping to detail the participants profile. The results show a construct of an adaptation process called "the filters in the adaptation process of someone living with schizophrenia". This construct highlights the fact that the adaptation potential of people with schizophrenia is affected both by elements of the social environment and elements that are inherent to the disease itself. These elements affect the possibility and the ability to use appropriate and effective coping strategies. The research findings could facilitate the assessment of people with schizophrenia and reduce the unknowns in the impact of interventions, as well as fighting against social conditions that can interfere with their capacity to adapt.

Thesis advisor: Sr. Callista Roy / Social Cognition and the Impact of Race and Ethnicity on Clinical Decision Making Most literature reflects the persistent existence of unequal treatment in the care provided to ethnic and racial minorities. Comparatively little about ethnic bias in the literature goes beyond the retrospective study as the most frequently encountered method of inquiry. Access to providers and the ability to pay only provide partial explanation in the known data. A more controversial hypothesis is the one offered in this dissertation. This qualitative research explored the cognitive processes of ethnic bias as a phenomenon in clinical decision making. The method was a simulation that captured events as they occurred with a sample of nurse participants. The racial and ethnically related cognitive content of participants was evoked through the interactive process of playing a board game. Immediately following that activity, a video vignette of an ambiguous pain management situation involving an African American male was viewed by each nurse who was then asked to make a "treat" or "not treat" clinical decision. The dialogues during playing of the board game in addition to the rationale for the treatment decision provided data for analysis. Content analysis is the primary approach for using the data to answer the research question. Themes of latent and manifest content were described for those who made the decision to treat and those who decided not to treat. / Thesis (PhD) — Boston College, 2012. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Introdução. Cuidar de uma pessoa com doença crônica pode afetar significativamente o bem-estar de quem cuida, assim como perturbar ou deteriorar sua saúde física e emocional, sua dinâmica familiar e social e seus recursos econômicos. Infelizmente na América Latina, o sistema de saúde não responde às demandas e necessidades dos cuidadores familiares. Dispor de evidências oriundas de pesquisas rigorosamente delineadas e conduzidas com cuidadores com o diagnóstico de Tensão do Papel Cuidador contribui para o desenvolvimento de intervenções para melhorar o bem estar e qualidade de vida dessa população. Objetivos. Desenvolver um programa de intervenção de enfermagem que promova a adaptação dos cuidadores familiares com tensão do papel de cuidador; determinar a efetividade de um programa de intervenção aplicado por telefone para promover a adaptação de cuidadores familiares colombianos e brasileiros com Tensão do Papel de Cuidador. Método. Para o primeiro objetivo proposto foi seguida a proposta do UK Medical Research Council para o desenvolvimento e avaliação de intervenções complexas. O programa de intervenção foi desenvolvido em três passos. No primeiro foi estabelecida a evidência existente sobre intervenções para cuidadores familiares. No segundo passo foi desenvolvida a concepção teórica do cuidador familiar visto como individuo adaptável e do programa de intervenção como estímulo contextual sob a perspectiva do modelo de Adaptação de Roy. No terceiro passo, foi modelada a primeira versão do programa de intervenção e refinada em um estudo piloto. Para atingir o segundo objetivo, foi realizado um ensaio clínico randomizado em que 208 cuidadores familiares (104 colombianos e 104 brasileiros) foram randomizados para cinco sessões de intervenção psicoeducativa aplicadas com uso de telefone (Grupo intervenção) ou o cuidado usual (Grupo controle). Na coleta de dados foram aplicados os instrumentos de caracterização do cuidador, do receptor de cuidados e do cuidado oferecido pelo cuidador, a escala de apoio social (MOS), a Escala de Tensão do Papel de Cuidador, a Escala de Bem-estar do Cuidador Familiar e a escala de avaliação da qualidade de vida WHOQol-Bref. Os participantes foram avaliados na linha de base e na 6ª e 9ª semanas de seguimento. As variáveis de desfecho foram analisadas por equações de estimação generalizada (EEG) considerando interação entre tempo e grupo. Resultados. Os dois grupos estudados apresentaram diminuição estatisticamente significante da tensão do papel ao longo do tempo (Fator tempo, p <0.01). Não houve diferenças significativas nos dois grupos ao nível das variáveis bem estar do cuidador familiar e qualidade de vida. Conclusão. O programa de intervenção aplicado com uso de telefone não foi efetivo para promover a adaptação de cuidadores familiares com tensão do papel de cuidador. Apesar dos achados deste estudo, a teoria da adaptação do cuidador familiar derivada do modelo conceptual proposto por Roy foi consistente para compreender o impacto do cuidado no cuidador familiar, além de proporcionar uma estrutura para testar a efetividade do programa. / Introduction. Caring for a person with chronic disease can significantly affect the well-being of carers, as well as disrupt or deteriorate their physical and emotional health, their family, social dynamics, and their economic resources. In Latin America, the health system does not respond to the demands and needs of familiar caregivers. Having evidence from research rigorously delineated and conducted to inform the care of caregivers with the diagnosis of caregiver role strain will contribute to the development of programs capable of meeting the needs and demands of this population. Objectives. To develop a nursing intervention program that promotes the adaptation of family caregivers with caregiver role strain; to determine the effectiveness of nursing interventions applied by telephone to promote adaptation of Colombian and Brazilian family caregivers with caregiver role strain. Method. For the first objective, the UK Medical Research Council guidelines for the development and evaluation of complex interventions were applied. The intervention program was developed in three main steps. In the first one we identified previously published data regarding interventions for family caregivers; in the second step we developed a theoretical understanding of caregiver seen an adaptive individual, and the intervention program was conceived as a contextual stimulus from the perspective of the Roy Adaptation Model. In the third step, a preliminary intervention program was modeled based on literature findings, and then it was refined in a pilot study. To achieve the second objective, a clinical trial with 208 family caregivers (104 Colombians and 104 Brazilians) randomized to five psychoeducational intervention sessions applied using telephone (intervention group) or usual care (control group) was conducted. During data collection, an instrument for caregiver, care receiver and care characteristics, the Social Support scale (MOS), the Caregiver Role Strain scale, the Caregiver Wellbeing scale, and the The World Health Organization Quality of Life (WHOQOL) scale were applied. The participants were assessed at baseline and at the 6th and 9th week of follow-up. The outcome variables were analyzed by generalized estimating equations (GEE) considering interaction between time and group. Results. The two groups had statistically significant decrease of the caregiver role strain over time (Time factor, p <0.01). There were no significant differences between groups for wellbeing of caregivers, neither for quality of life. Conclusion. The intervention program applied using telephone was not effective to promote adaptation of family caregivers with caregiver role strain. Despite the findings, the theory of adaptation of caregivers derived from the conceptual model proposed by Roy was consistent to understand the impact of care on family caregivers, as well as provided a framework to test the effectiveness of the program.