published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

No description available.

This thesis identifies systematically the domains of positive consequences of illness and details the development of a measure of the positive consequences of illness- the Silver Lining Questionnaire (SLQ). Further aims of the thesis include the use of the SLQ as a predictor of health outcome and an investigation of the prevalence and correlates of positivity in illness. The first study questioned 55 people about their positive experiences of illness and uncovered 17 themes. In the second study a pilot questionnaire based on these themes was administered to the participants of the first study and an additional sample of cancer and chronic respiratory patients. Refinements to the questionnaire resulted in a 38-item measure of positivity. In study 3, the SLQ's properties of reliability and responsiveness to change were confirmed in a sample of chronic respiratory and cardiac patients in a rehabilitation setting. This study also found that positivity increased following rehabilitation. In study 4, the SLQ was used to predict the health outcome of patients with chronic fatigue syndrome. Finally, study 5, investigated the prevalence of positivity amongst respiratory patients varying in illness severity and found no significant difference between patient groups in the expression of positivity. This study identified extraversion and a sense of spirituality and religiosity as correlates of positivity. This thesis thus addresses a previously neglected field of research and presents a more comprehensive measure of positivity than existing measures. This thesis also addresses previously unanswered questions regarding the prevalence and correlates of positivity and also the potential for increasing positivity. Finally, the implications of positivity in illness for health management are highlighted.

No description available.

The sepsis syndrome is the systemic response of the body to infection. It develops from the earliest stage, Systemic Inflammatory Response Syndrome sepsis, to severe sepsis, septic shock and multi-organ dysfunction syndrome. The incidence of sepsis is growing and globally accounts for one in ten admissions to Intensive Care Units. The mortality rate for severe sepsis ranges from 25% to 67%. People with cancer are ten times more likely to develop sepsis and having developed it have a higher mortality rate. Early recognition and treatment of sepsis has been demonstrated to improve outcomes. This study sought to improve early recognition of sepsis in cancer patients receiving acute treatment. Nurses and patient assessment were the focus of this study. The design was a prospective multi-method observational study with two interventions: a teaching session for 177 nurses; the introduction of a bedside test - Procalcitonin (PCT-Q), an immunological marker of sepsis. PCT has been shown to be a reliable marker of sepsis. The PCT-Q, has been used since the late 1990s but never by ward nurses. Methods used were: qualitative interviews of ten nurses and a questionnaire survey of 177 nurses pre and post intervention; and a patient database with the PCT-Q test being used 416 times in 320 patients to diagnose sepsis. The study showed that nurses and patients recognise the early changes of deterioration before their observations change. Nurses recognise these changes because they know their patients well. Nurses' knowledge improved in several areas during the study and they used PCT-Q appropriately, diagnosing sepsis at an early stage in 66% of cases. Ordinal multi-regression analysis demonstrated that PCT was more reliable than CRP and, used together with a low WBC and high lactate, accurately predicts sepsis.

Bibliography: pages 119-139. / The purpose of this study was to identify the needs and problems that were experienced by rural cancer patients and to investigate the level of emotional stress that they reported. A further purpose was to interpret the main findings of the study according to the Biomatrix Theory. 496 Cancer patients who lived in rural areas of the Western Cape and 140 urban cancer patients were interviewed. The urban cancer patients formed a control group for comparison of the stress data. In order to consider the needs and problems of rural cancer patients from a widespread area, stratified random sampling of magisterial districts was applied and an attempt was made to interview all cancer patients who were living in each of the 21 magisterial districts sampled. Data on needs and problems were collected by use of a questionnaire, and the stress data was collected by administering a modified format of the Stress Evaluation Inventory (SEI). The findings of this study revealed that financial difficulties were the most frequently reported problem while transport difficulties and frustration of emotional support needs were also frequently reported. Patients who reported experiencing these problems also reported statistically significantly higher stress according to the SEI than those who did not.

published_or_final_version / Nursing Studies / Master / Master of Nursing

The number of patients with colorectal cancer had increased dramatically in recent years (Hong Kong cancer registry, 2012), and surgical resection is the first line treatment of colorectal. To enhance patients’recovery process, there is a need to develop a comprehensive and user-friendly, with most important, an evidence-based guideline for promoting patients’ recovery process. Traditional post-operative management is associated with different postoperative complications, delayed recovery, and lengthened hospital stay. Recent research documented that using a specific rehabilitation programme focused on education; early mobilization and early diet regime could enhance patients’ recovery. Therefore, this transitional research aims to evaluate the current evidence on the effect of adopting a specific rehabilitation programme, to formulate an evidence-based guideline, assess its implementation potential, and to develop an implementation and evaluation plan. Ten related literature were retrieved from four electronic bibliographical databases. Critical appraisal had been done to ensure the quality and validity of the selected evidences. A clinical guideline is developed based upon the information from the identified high level of literature. The implementation potential is assessed based on the similarity and the readiness of the target setting to the proposed environment. It was found that the transferability of the protocol was high and it was feasible to be implemented into the target site. Little expenditure and input was expected, as the protocol was a systematic reformation of practice, rather that developing a set of totally new practice to current clinical setting. An implementation plan was then planned, which included the communication plan with all the stakeholders. After reaching a consensus among the stakeholders, a two-month pilot study will be carried out for examining the readiness before the full-scale implementation of the program. The evaluation plan of the effectiveness of the proposed program is developed. Result will be used to provide recommendation for further adjustment on the protocol to yield a better outcome. The implementation of this nurse-led rehabilitation program is suggested to be worthy of adoption in the clinical setting for bringing benefits to patients, the hospital and staffs. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Substantial studies have investigated homogeneity of psychological distress level among cancer patients by using cross-sectional and longitudinal study design. Nonetheless, as proposed by Bonnano (2004), heterogeneity characteristics of psychological distress following stressful event could not be neglected and he further suggested that the majority of individuals were resilient in response to stressful events. To test this postulation, recent studies employed growth mixture modelling method to examine the heterogeneity characteristics of psychological distress trajectory among cancer patients. Furthermore, identifying relevant factors differentiate the psychological distress trajectories is an integral part for developing effective interventions for cancer patients in dealing with illness demands. However, only a few studies have examined these issues among Chinese colorectal cancer patients, a second most common cancer in Hong Kong. Therefore, it is of important need to address this knowledge gap. This study had two major aims: 1) to explore the patterns of psychological distress among Chinese patients with colorectal cancer from shortly after diagnosis but before surgery (i.e. 1-day prior operation) to 1-year post-surgery and to testify Bonnano’s theory on resilience; 2) to identify the effects of cancer-related intrusive thoughts, physical symptom intrusiveness and dispositional optimism on differentiating psychological distress trajectories. A total of 246 Chinese patients with colorectal cancer were recruited for the current study. Altogether, 5 consecutive face-to-face interviews were conducted on one day prior to surgery (baseline), 1-, 4-, 8- and 12-month post-surgery (T2-T5). Patients’ psychological distress (i.e. anxiety and depression), physical symptom intrusiveness, cancer-related intrusive thoughts, dispositional optimism, demographic and medical information were assessed by a standardised questionnaire with valid and reliable psychometric instruments. Growth mixture modelling was used to estimate and specify the psychological distress trajectories. Multinomial logistic regression was adopted to assess the proposed factors in relation to differentiate the trajectory patterns. Growth mixture modelling suggested three distinct trajectories were identified for both anxiety and depression model. The majority of patients with colorectal cancer were identified as resilient (i.e. maintaining low and stable distress level across time) for both models (anxiety: 82.3%, depression: 82.7%). Additionally, for anxiety trajectory model, the remaining 12.3% and 5.4% of patients were classified as moderately-low anxiety group (i.e. maintaining moderate to low distress level) and increasing anxiety group (i.e. increased from moderate level of distress at initial to subsequently high distress level) respectively. For depression trajectory model, the remaining 12.6% and 4.7% of the patients were grouped as delayed depression (i.e. delayed level of distress over time) and recovery depression (i.e. recovered from high distress level to low across time). Multinomial logistic regression showed that cancer-related negative intrusive thoughts, physical symptom intrusiveness and dispositional optimism were significant factors to differentiate anxiety and depression trajectories respectively. This study highlighted the heterogeneous feature of psychological distress among Chinese patients with colorectal cancer. Physical symptom intrusiveness, cancer-related negative intrusive thoughts and dispositional optimism played important role on predicting cancer patient’s psychological distress respectively. Nonetheless, further investigations are much needed to clarify the underlying mechanism. / published_or_final_version / Public Health / Master / Master of Philosophy