The purpose of this study was to investigate breast cancer patients’ experiences of their illness and of traditional nursing care (TNC) or supportive nursing care (SNC) respectively, as well as nurses' experiences of support and of caring for cancer patients. An intervention including extended co-operation between the surgical ward and primary health care, shorter waiting times, and changed routines concerning the information about the diagnosis, as well as training and systematic clinical supervision for the nurses, was implemented. Newly diagnosed breast cancer patients (n=47) from two county councils in the south-east of Sweden were interviewed (IV, V). Thirty-four of them completed scales about well-being, burnout, hopelessness, anxiety and depression (VII). The women who had TNC reported lack of professional support during the initial phase of the disease and suggested changes in the care similar to those implemented in the SNC. In the SNC group the women expressed feelings of safety and security after the professional support and the organizational changes in the care. There were significantly more single women and women who had had breast conserving surgery in the SNC group than in the TNC (VII). The hopelessness scores in the SNC group were significantly higher than in the TNC group. Thirty-nine district nurses (DNs) were interviewed at baseline (I), and thirty-three of them completed scales about burnout, empathy, and sense of coherence (SOC) before and after systematic clinical supervision (VI). Twenty-three of the 39 DNs, as well as 9 hospital nurses (HNs) who participated in the clinical supervision, were interviewed about their experiences of this intervention (III). Twenty-nine tape-recorded supervision sessions in three groups of DNs (n=23) were analysed (II). Baseline interviews and analyses of the content of the supervisory sessions strongly emphasized that DNs experienced problems in the home care of seriously ill cancer patients. Deep human contacts were a source of both strain and enrichment. The clinical supervision was said to provide relief from undesirable thoughts and feelings, confirmation of themselves both as individuals and in their professional role, a broader and deeper knowledge and increased self-confidence. There were no significant differences in the burnout, empathy, and SOC scores between the supervisory group (n=21) and a comparison group (n=12) at the first and second measures, nor over time within the groups. There were some correlations between these phenomena and the Karolinska scales of personality, as well as cor­relations between burnout, empathy and SOC. The groups of women were not entirely similar as regards demographic and medical characteristics, and the sample size of patients and nurses was small. It is obvious that patients in the TNC missed those factors that were implemented in the SNC, at the same time the latter women expressed hopelessness more often than those who had received TNC. This result may be due to the fact that support from nurses had made the women more prepared to express their feelings, that support had not been provided to an adequate extent or in the right way, or that the applied scales were not appropriate. The finding that the nurses experienced the clinical supervision as very positive but that, despite this, there were no significant differences in attitudes measured by scales within or between the groups, can be interpreted in a similar way. Consequently, further research is needed to judge the effects of intervention. The study has, above all, produced qualitative descriptions of patients' experiences of the nursing care after discharge from hospital, and of DNs’ experiences of the care of cancer patients in their homes, and of systematic clinical supervision. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1995, härtill 7 uppsatser.</p> / digitalisering@umu

This insider research journey explores the meaning-making processes of female spousal caregivers in anticipatory mourning and the knowledges which they have gained in retrospect. The research traces the social constructions of meaning and how they influence the process of meaning-making. A phenomenological study was undertaken in which unstructured interviews were conducted with five bereaved participants, highlighting the unique way in which each woman made meaning of loss in anticipatory mourning. The main phenomenological themes to emerge from their meaning-making were: a) the significance of time; b) challenges and gifts; c) witnessing the decline; d) paradoxes; e) the significance of the spousal relationship; and f) spirituality. The therapeutic effect of telling the life story is explored in this study and the need for contextual pastoral care that is specific to the state of anticipatory mourning is highlighted. Finally, possibilities for co-constructive pastoral care are raised in the light of the research findings. / Practical Theology / M. Th. ( Practical Theology, with Specialisation in Pastoral Therapy)

The purpose of this research is to explore how narrative practices can be meaningful in pastoral conversations with women living with breast cancer. A theoretical collaboration between narrative therapy, feminism and pastoral theology has been used in order to facilitate meaning-making, to give ‘voice’ to local knowledge, and to co-create a more holistic understanding of the experiences of illness narratives and breast cancer. The methodology of this research is ‘interdisciplinary’ and uses qualitative, co-participatory action research and reflexivity as its research design. Conversations with the co-researchers explore illness narratives, breast cancer, spirituality and faith, life-giving relationships, femininity and body image, socially constructed discourses and pivotal moments that enable alternative stories. Values of respect, curiosity and listening have been upheld in order to provide a safe place for the co-researchers to give voice to their stories and experiences of breast cancer in a way that supports the researcher position of ‘witness’. / Practical Theology / M. Th. (Practical Theology, with specialisation in Pastoral Therapy)

Introduction This thesis describes a research study designed to examine the consequences of disability arising out of spinal cord compression secondary to cancer, and to examine the rehabilitation services available to patients. Research aims and questions The study was intended to achieve the following: 1. To ascertain what might constitute effective rehabilitation interventions for patients with metastatic spinal cord compression. 2. To identify the conditions in which these intervention might be delivered. 3. To ground proposals in spinal cord compression patients’ experience of disability. The following research questions were posed: 1. What are the consequences of disability for patients with metastatic spinal cord compression? 2. What strategies do patients themselves use to manage disability? 3. What do health care staff, particularly rehabilitation professionals, understand to be the consequences of disability for this patient group, and correspondingly, what are their views on the significance and provision of rehabilitation? 4. To what extent is rehabilitation being provided to these patients, and with what effect? 5. Where rehabilitation is not being provided, why is this the case? Study design The study had two components: • A series of nine in-depth interview-based case studies, which involved talking to patients about their experiences of living with spinal cord compression, as well as gaining the perspectives of family members and the health professionals who provided care and services. • A retrospective audit of the medical records of 73 spinal cord compression patients admitted to a radiotherapy in-patient unit (the Frank Ellis Unit at the Churchill Hospital in Oxford) over a two year period (July 2003 – June 2005), identifying disability-related problems and the measures taken to address them. This was a Phase I modelling study in terms of the Medical Research Council’s framework for evaluating complex interventions, with Pawson and Tilley’s (1997) Context-Mechanism-Outcome configuration adopted as a conceptual basis for data collection. Within-case analysis was informed by George and Bennett’s (2004) account of process tracing, and between-case analysis was modelled on the constant comparative method of Glaser and Strauss (1967) with an analysis of narrative as a variation on that theme. Results Disability is a serious problem for patients with spinal cord compression, but it is one problem among many others, not the least of which are the physical and emotional consequences of life-threatening illness. In response to disability, patients ‘twin-track’ their attitudes to it, acknowledging but also resisting the idea of themselves as disabled, and adopting a series of psychological devices to manage the tension. In effect, patients recognise that something significant has changed and that, as a consequence, new self-management skills must be learned, functional boundaries must be explored, useful information must be sought. At the same time, they display a determination to hold on to an established identity, associated with a sense of normality. This identity embraces the idea of competence and resourcefulness, the events, activities and pleasures that one looks forward to, and the wish to avoid burdening others. It is not a ‘disabled’ identity. To some extent, these two attitudes are in tension, as one acknowledges disability while the other, implicitly or explicitly, resists it. Consequently, patients try to find ways of resolving this tension, by ‘revising downwards’ their expectations, by constantly deferring the anticipated pleasures, and by avoiding situations in which their abilities might be put to the test, or the sense of normality be disconfirmed. Health care professionals are likely to construe the patient’s response as indicative of a certain type of character – ‘realistic’ on one hand, and ‘unrealistic’ on the other. They do not see ‘acknowledging / not acknowledging’ as twin facets of a complex response to circumstances, or as something which every patient engages in to one degree or another. Patients are motivated not to recognise rehabilitation as something they need, a view which is confirmed by the cursory form of rehabilitation experienced in hospital, and by the marginal significance attributed to it by nursing and medical staff. On discharge, hospital staff assume that rehabilitation needs will be identified in the community, although the way in which community rehabilitation services are organised virtually guarantees that this will not happen, unless a specific referral is made (as it is in only 5% of cases). The patient, meanwhile, remains unaware of the potential value of rehabilitation, and has no incentive to request rehabilitation if no-one offers it. They are consequently unprepared for life post-discharge, and assume that they (and their families) must manage on their own. Conclusions Like the patients, health care professionals may have to ‘twin-track’ if they are to provide rehabilitation in a way that is acceptable to patients with metastatic spinal cord compression. Instead of categorising patients as ‘realistic’ or ‘unrealistic’, they should work towards sustaining patients’ ‘positive illusions’, while at the same time taking whatever opportunities arise to enhance the patient’s day-to-day ability to function in a ‘safe’ space. This entails revising some deeply entrenched ideas about working with patients who have a disability: patient-centredness, the importance of goal setting, and the need for adjustment.

No description available.

When a child is diagnosed with cancer, the roles and responsibilities of family members change to accommodate the demands of the illness. The current study aimed to explore the experiences of mothers of children with cancer, focusing on their constructed roles within the family context and their social support. A case study design within the qualitative research approach was employed, underpinned by social constructionism as a theoretical framework. Three mothers were selected, using a combination of purposive and snowball sample techniques. Rich descriptive data were collected from three mothers through semi-structured interviews and reflective essays, and analysed using thematic analysis techniques. Results showed that although mothers of children with cancer experience some common themes, there are contextual differences influencing how they construct their stories. The following main themes were identified in the comparative analysis: events leading to the diagnosis, emotions, life changes, the effect of the illness and coping. / Psychology / M.A. (Psychology)

This insider research journey explores the meaning-making processes of female spousal caregivers in anticipatory mourning and the knowledges which they have gained in retrospect. The research traces the social constructions of meaning and how they influence the process of meaning-making. A phenomenological study was undertaken in which unstructured interviews were conducted with five bereaved participants, highlighting the unique way in which each woman made meaning of loss in anticipatory mourning. The main phenomenological themes to emerge from their meaning-making were: a) the significance of time; b) challenges and gifts; c) witnessing the decline; d) paradoxes; e) the significance of the spousal relationship; and f) spirituality. The therapeutic effect of telling the life story is explored in this study and the need for contextual pastoral care that is specific to the state of anticipatory mourning is highlighted. Finally, possibilities for co-constructive pastoral care are raised in the light of the research findings. / Philosophy, Practical and Systematic Theology / M. Th. ( Practical Theology, with Specialisation in Pastoral Therapy)

The purpose of this research is to explore how narrative practices can be meaningful in pastoral conversations with women living with breast cancer. A theoretical collaboration between narrative therapy, feminism and pastoral theology has been used in order to facilitate meaning-making, to give ‘voice’ to local knowledge, and to co-create a more holistic understanding of the experiences of illness narratives and breast cancer. The methodology of this research is ‘interdisciplinary’ and uses qualitative, co-participatory action research and reflexivity as its research design. Conversations with the co-researchers explore illness narratives, breast cancer, spirituality and faith, life-giving relationships, femininity and body image, socially constructed discourses and pivotal moments that enable alternative stories. Values of respect, curiosity and listening have been upheld in order to provide a safe place for the co-researchers to give voice to their stories and experiences of breast cancer in a way that supports the researcher position of ‘witness’. / Philosophy, Practical and Systematic Theology / M. Th. (Practical Theology, with specialisation in Pastoral Therapy)

O propósito desta dissertação é examinar como mulheres percebem e vivenciam a experiência de serem diagnosticadas com câncer de mama. A pesquisa social de campo envolve um universo de oito mulheres que passaram por esta trajetória sendo uma delas a própria autora, que traça uma auto-análise de sua experiência com este diagnóstico. Um aspecto específico com o qual a pesquisa busca se ocupar é identificar o lugar que a espiritualidade ocupa na história das mulheres entrevistadas. O câncer de mama apresenta um alto índice da doença no Rio Grande do Sul. Conforme a Revista Gaúcha de Enfermagem, o câncer de mama é a maior causa de morte de mulheres entre 30 a 50 anos de idade. De acordo com as estatísticas do Instituto Nacional do Câncer, o câncer de mama é o segundo tipo mais freqüente de câncer do mundo. Assim sendo, o câncer de mama ainda é uma doença que leva à morte, mesmo com o enorme avanço da medicina. Mas, há quem sobreviva o temido e assustador processo da descoberta e tratamento do câncer. Com a doença do câncer vem também a angústia da finitude. O presente trabalho baseia suas reflexões teóricas em Eugen Drewermann e Paul Tillich e como os mesmos descrevem a angústia existencial do ser humano, diferenciando-a do medo real, que tem o seu objeto definido, enquanto que a angústia existencial tem como fonte de sua permanente ameaça o nada. A angústia e a culpa estão relacionadas, estando a culpa ligada ao afastamento de Deus. A aceitação do ser finito, através da coragem do ser, ato de fé por graça divina, substitui, em última análise, a angústia por confiança no Deus da Vida. Os autores, ambos os teólogos, apontam para a interdisciplinaridade. A proposta dessa pesquisa é de atuar em colaboração com outras ciências, de maneira especial com a Psicologia Analítica. Uma pessoa em crise, que trabalha seus processos interiores, poderá ter facilitado sua entrega confiante a Deus. É ainda sucintamente apresentado, conforme Drewermann, como o patológico se manifesta na vida de pessoas que, assim como todas as demais pessoas, carecem da experiência da graça de Deus para sua libertação. A pesquisa finaliza trazendo a abordagem de Erika Schuchardt, formulada no modelo de uma espiral de oito fases, pelas quais passam as pessoas em crise. / The purpose of this dissertation is to examine how women perceive and live the experience of receiving a diagnostic of breast cancer. Field research involves a total of eight women who have experienced this situation, one of them being the authors self-reflection on a cancer diagnostic. A specific aspect of the present research is to identify the place that spirituality takes in the life history of the interviewed women. The State of Rio Grande do Sul presents a high rate of breast cancer. According to the agency Revistal Gaúcha de Enfermagem, breast cancer is the death main cause among women between thirty and fifty years old. Statistics of the National Cancer Institute indicates that breast cancer occupies the second place among the different sorts of cancer. Even though medicine has shown great advance in the last decades, breast cancer still continues to be a deadly disease. However, there are people who survive the fearsome and frightening fatal process caused by this disease. With cancer comes along the human finitude anxiety. The present work bases its reflection on how Eugen Drewermann and Paul Tillich describe the human existential anxiety distinguishing it from real fear. According to the authors real fear has its object defined, while existential anguish has as source of its permanent threat, the nothingness. Anguish and guilt are connected, but guilt is associated to the alienation from God. Acceptance of the existence as finite, through the courage of Being, which is an act of faith by divine grace, replaces anguish by trust in the God of Life. The authors above, both theologians, aim at interdisciplinarity. The purpose of this research is to act in collaboration with other sciences, specially with Analytical Psychology. A person in crisis working her/his interior processes might have facilitated the confident surrender to God. It is also briefly presented, according to Drewermann, how pathology evidences itself in the life of a person who, as all other persons, lacks the experience of the grace of God to his/her liberation. Concluding, the research approaches Erika Schuchartds theory formulated in the model for working through crisis in eight spiral phases.

Doctorat en sciences psychologiques / info:eu-repo/semantics/nonPublished