The relief of pain is an essential element of nursing practice. Nursing has begun to successfully use art to assess and reduce pain among hospitalized children, surgical patients, and oncology patients. Structured art projects have been used to provide distraction from pain and patient drawings have allowed nurses to assess pain. This project employed grounded theory and thematic analysis to uncover significant concepts in the artists' statements. The Roy adaptation model and Saunders' total pain theory provided the project theoretical framework. The artistic statements and the art of chronic pain patients were examined using thematic analysis to identify recurrent themes. This project explored the insights to chronic pain in the adult patient as evidenced in the posted work. The project also considered how the content of the posted artistic statements informed individual nursing practice and facilitated the reduction of pain in the adult patient suffering from chronic pain. Emergent concepts were used to develop artistic nursing interventions. Suggested modification of nursing practice included drawing as a tool in pain assessment, exploring the meaning of color choices, encouraging mask making, providing distraction, and using art to identify spiritual distress. The proposed nursing actions will allow more effective communication of pain, provide meaningful distraction, intervene in spiritual distress, and encourage creation of an artistic product. Expected outcomes include more effective pain control, greater patient autonomy, and reduced healthcare costs. The application of this new knowledge and skill will make a difference in the lives of chronic pain patients and will therefore promote positive social change.

Pain is influenced by biological, social, emotional and cognitive factors. Emotions are not simply a consequence of pain but rather a fundamental part of the pain experience. In addition, the social context cannot be isolated when constructing the meaning of the child’s pain, and in understanding the influence of mother-child interactions on children’s physiology. This research consists of two studies, study one investigated the relationship between anxiety, depression and physical functioning in children and adolescents experiencing chronic pain. The participants were 73 childen and adolescents who were referred to either the Children’s Pain Management Clinic at the Royal Children’s Hospital or the Sydney Westmead Children’s Hospital aged between 7-18 years old. The results indicated that these young people were reporting anxiety and depression within the normal range with significant anxiety and depression levels both below prevalent rates found in the normal population. Furthermore, depression but not anxiety was associated with increasing leves of physical disablity in children and adolescents. This led to the investigation of the relationship between maternal emotions on children and adolescents’ anxiety, depression, somatic symptoms and physical functioing in children and adolescents experiencing chronic pain. Study two investigated the association of maternal and child emotions in children and adolescents with chronic pain. Participants included 62 mothers and 62 children and adolescents between the ages of 7-18 years (M=13). Mothers’ emotional distress (empathy, emotional involvement, and distress) was examined as a significant factor to be associated with children’s pain sensitive temperament and functional outcomes (anxiety, depression, somatisation, and physical functioning). Children’s perceptual sensitivity and avoidance of sensation, which are components of children’s pain sensitive temperament, were investigated in relation to children’s ability to regulate emotions. The association between maternal and child emotional regulation and children’s functional outcomes was also explored. Mothers completed questionnaires assessing children’s somatisation, their own difficulties with having a child with persisting pain and an empathy scale. Mothers also completed a semi-structured interview by Katz and Gottman (1991) the Meta-Emotion Interview which discusses mothers’ awareness of their own and their child’s emotions, mothers acceptance of their own and their child’s emotions, the regulation of their own and their child’s emotions and coaching of their child’s emotions. Children and adolescents completed quesionnaires measuring anxiety, depression, emotional involvement, somatisation and pain sensitive temperament. The results indicated low maternal emotional regulation was significantly associated with children's depression, anxiety and somatisation scores, whilst children’s emotional regulation was associated with children’s anxiety and depression, but not with somatisation scores. Maternal emotional distress was associated with children's pain sensitive temperament, emotional distress and reduced physical functioning. Furthermore, emotional regulation in children was associated with children's pain sensitive temperaments. It is proposed that young people with chronic pain may have a biological vulnerability to respond to stress and traumatic events as pain, and pain related symptoms. This biological sensitivity may be associated with children’s threshold of pain, whereby children’s perceptual sensitivity may be associated with reporting of somatic complaints. Thus, maternal emotions and social factors may be associated with children’s somatosensory processing and the chronic pain experience.

The focus of this research is the stress placed on a child when a sibling in the family has a chronic illness or disability, and analysis of what factors may buffer this stress and be associated with well child resilience in the face of family illness. Several major studies from other countries (Cadman, Boyle, & Offord, 1988; Houtzager, Grootenhuis, Caron & Last, 2005; Laufersweiler-Plass, Rudnik-Schoneborn, Zerres, Backes, Lehmkuhl & von Gontart, 2003; Sharpe & Rossiter, 2002; Williams, Williams, Graff, Hanson et al., 2002) suggest that there may be deleterious outcomes for well children in such families, for example higher rates of anxiety, depression, aggressive behaviour and rule breaking behaviour. However there is a lack of clarity about the processes which lead to these negative outcomes. The current study had two major research aims. The first was to describe social, family and personal characteristics of a group of well children with siblings who have a chronic illness or disability. The second aim was to examine relationships between adjustment problems in these well children and factors relating to the family (income, number of children in family, respite availability and utilisation), parents (stress, parenting style, maternal education, access to support) and children (ill child behaviour, amount of care required, well child age, well and ill child participation in social activities). Adjustment in well-children (n=102) was assessed using child self report, child projective and parent rating measures. Parents rated well children with ill siblings as significantly higher in externalising and internalising behaviour than age and gender matched population norms. Children did not rate their behaviour problems higher than norms but did indicate quite high rates of emotional problems on a projective (drawing) test. Parent-rated behaviours of well children were associated with parental, family and ill child variables, including (high) parental stress (daily hassles), (low) family income and (high) ill child internalising and externalising behaviours. Relationships between the well child's perception of having a sibling with a chronic illness or disability and various parent, child and family variables were also explored. Well children who listed more negative (than positive) attributes about having a sibling with a chronic illness were more aggressive and rule breaking in their behaviour. Well children with emotional problems, as assessed by the child family drawings, did not differ significantly from children without emotional problems in any of the parent, child or family variables however both the emotional problems index and the use of scribble drawings were associated with several measures of well child maladjustment. The results were discussed in terms of family systems and resilience theory. Implications for well children and their families including practical applications for existing interventions which target well children, ill siblings and parents were discussed and ideas for future directions for interventions to improve outcomes for well siblings were presented.

Purpose: The purposes of this study were: (a) to describe the physical and mental health status of Afghan immigrant women in one Canadian city; (b) to construct an Afghan cultural model of pain (experience and management) using interview data and available literature; (c) to explore the experience of chronic pain and its management among Afghan immigrant women, both culturally and individually; and (d) to identify potential barriers to chronic pain management for both Afghan immigrant women and their health care providers. Methods: This study has two parts; questionnaires were used in Part 1, and semi-structured interviews supplemented by three short questionnaires were used in Part 2. Interpretive description methodology using thematic analysis and conceptual mapping was used for analysis of interviews in Part 2. Results: SF-36 responses (n = 9) in Part 1 suggested that the physical health status of the Afghan women was better than their mental health status. Health sciences literature and interviews with 6 Afghan immigrant women and 1 healthcare professional were used to construct cultural models of pain experience and pain management. Findings indicated that Afghan immigrant women who experienced and managed their chronic pain within their cultural model did so holistically across multiple factors: environmental, spiritual, biological, and psychological. However, each individual internalized their cultural model of pain in varying amounts. Barriers in healthcare access that prevented Afghan immigrant women from managing their pain well included: (a) different cultural perspectives between Afghan immigrant women and healthcare professionals regarding how pain is experienced and managed; and (b) communication difficulties between healthcare professionals and Afghan immigrant women. Significance of Findings: Cultural perspectives on pain experience and pain management influence treatment expectations and pain management. Differences in cultural perspectives are a barrier in healthcare access that prevents Afghan immigrant women from managing their pain well. Addressing the differences in perspective identified in this study will increase understanding for healthcare professionals as they work together with Afghan immigrant women patients, thereby improve communication and reduce barriers to pain management.

The incidence rate of Chronic Kidney Disease¡]CKD¡^ in Taiwan is the highest among the world. This burden of disease is paralleled by enormous healthcare spending and society¡¦s pressure. Healthy People 2010 started to promote education program for the prevention of chronic kidney disease. A program has started in Taiwan since 2003 in order to control CKD progresses to end stage renal disease¡]ESRD¡^. However, few studies evaluated the effects of such program. This research will focus on the importance and outcome for the intervention of CKD education program and the impact on frequency for nephrology outpatient follow-up visit. Methods: 299 CKD patients were collected for their personal information, history of disease, and clinical values from hospitals in southern part of Taiwan. Results: The result indicated that early intervention for CKD had reduced the execration of clinical value. CKD patients with comorbidities have higher disease severity and inpatient utilization compare with those who without comorbidities. Although CKD education intervention has no significant difference on the change of clinical value, it is significant on the frequency of nephrology outpatient follow-up visit. Conclusion: Early intervention for patient with CKD has great impact on the progression of kidney failure. Effective CKD education program will increase nephrology follow-up visit so that patient could update the education plan and meet individual needs for the decrease of kidney function.

Thesis (Ph. D.)--University of Sydney, 2009. / Title from title screen (viewed Nov. 26, 2009) Includes tables and questionnaires. Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Kolling Institute of Medical Research, Faculty of Medicine. Degree awarded 2009; thesis submitted 2008. Includes bibliography. Also available in print form.

Thesis (MSc(Immunology))--University of Pretoria, 2008. / Includes bibliographical references.

Thesis (Ph. D.)--University of Oklahoma, 1994. / Includes bibliographical references.

Thesis (M.A.)--York University, 2008. Graduate Programme in Psychology. / Typescript. Includes bibliographical references (leaves 125-146). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pqdiss&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:MR38781

Chronic conditions negatively impact well-being, and the negative impact of a chronic condition can extend beyond the diagnosed person to his or her spouse. This association may be further influenced by gender, as gender can shape how individuals experience their own chronic conditions-- including what conditions they develop-- and how they react to the conditions and distress of their spouses. In my dissertation, I examine how one spouse’s chronic conditions are related to the other spouse's psychological distress over time. I address this using quantitative analysis of the Health and Retirement Study and qualitative analysis of in-depth interviews. In my quantitative analysis, I find that the association between one spouse’s chronic conditions and the other spouse’s distress differs by gender, number of conditions, whether one or both spouses have chronic conditions, and type of condition. Regarding number of conditions, a husband’s number of chronic conditions increases his wife’s distress more so than a wife’s number of chronic conditions increases her husband’s. These associations are mitigated by the chronically ill spouse’s own distress and functional limitations. Additionally, this gender difference is more pronounced if both spouses have chronic conditions compared to if only one has chronic conditions. Regarding type of condition, lung disease and stroke are the most negatively impactful for spouses’ distress, whereas high blood pressure, cancer, and arthritis are not related to spouses’ distress. All conditions, except for stroke, relate to husbands’ and wives’ distress similarly, but a husband's stroke increases a wife's distress initially whereas the wife's stroke increases the husband's distress over time. In my qualitative analysis, I find that when women are chronically ill, they continue to emotionally care for their husbands, which likely protects their husbands from psychological distress but exacerbates women’s own distress. My results point to the importance of promoting the psychological well-being of both spouses during periods of chronic conditions. This is especially critical for spouses of people with more than one condition, chronically ill women whose husbands are also chronically ill, and spouses of people experiencing stroke and lung disease. / text