M.A. / When a person is diagnosed with a chronic illness, the family as a whole is affected. The family members as caregivers to the patient become the clients. During the course of their care-giving, family members encounter various situations that require them to give ethical and value-ridden decisions that are related to the care and wellbeing of their patients. Many of the issues and dilemmas facing family members as caregivers place them in a double-bind situation. The decision to act or not to act is emotionally painful and guilt-provoking. These impacts on the family members warrant that they be assisted by a social worker, to adjust to a new situation as caregivers and also to preserve the normal family functioning system. The goal of this study is to investigate the emotional and social impact chronic illness has on the patient's family, with the purpose of formulating recommendations for the improvement of current family interventions as part of chronically ill patients rehabilitation programme. The study was conducted at Emseni Chronic Care center, which is a hospital for the chronically ill patients in Hillbrow. There are about 240 patients of which more than 60% are dislocated from their families. Purposive sampling was used in this study and 26 patient's families were interviewed. The qualitative approach is adopted in this study. The qualitative approach has advantages that it is a highly effective means of obtaining the information required for further understanding and exploration of a topic, Cresswell (1994). A qualitative interview was used with one main question, to gather data for the study. The data was also analyzed qualitatively and conclusions are drawn from the results. The study presents the guidelines as recommendations to be considered when working with families of chronically ill patients. The researcher is of the opinion that if practiced properly, the guidelines can be a valuable asset as a tool for social workers working with the family members as part of rehabilitation programme for the chronically ill patients. / Dr. W. Roestenburg

No description available.

Much of the prior research on the psychosocial aspects of end stage renal disease (ESRD) has focused solely on the individual, without considering the family's role in patient adjustment. Little research has been conducted on the contextual elements of the patient's adjustment to renal failure and dialysis. It was the purpose of this study to assess the effect of family relationships on a patient's health locus of control as a measure of adjustment to ESRD. Health locus of control was hypothesized to be dependent on the family relationship variables of cohesiveness, adaptability and independence; as well as a communications variable measuring incongruent communications. From the general context of the double bind a path model was constructed to estimate the associations among the variables. Data was collected and analyzed on 91 ESRD patients from four dialysis treatment centers and a sample of Continuous Ambulatory Perotineal Dialysis patients. The results of this research suggest that the double bind theory may be an excellent explanatory paradigm for patient adjustment to chronic illness. It was found that the greater the perceived paradox in family communications the more likely the patient was to subscribe to an externally oriented health locus of control. The family relationship variables were found to be indirect predictors of health locus of control, acting through the family communications process. / Ph. D.

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

The purpose of this qualitative research is to provide an in-depth exploration of the impact that a diagnosis of a terminal illness has on family functioning. The goal is to gain insight into adult children's personal experience when a parent is diagnosed with a terminal form of cancer. This study explores how families respond, adapt and cope when this specific family member is diagnosed with a terminal illness. It also explores any significant changes in relationships within the family and any shifts in the roles of the members and how they adjusted to such shifts. / The study is informed by a phenomenological paradigm and used an explorative, qualitative design, which included semi-structured interviews. Participant text and "found poetry" is used in order to present a more accurate account of the participants' experiences. Found poetry provides an opportunity to hear the participant's voices by taking direct quotes from their transcripts and forming them into a poem. Themes of denial, anger, helplessness, hope and anticipatory grief/mourning are portrayed in the findings of this study. The difficult emotional dilemmas and tensions that people have to work through when faced with a family member dying are discussed. The realization of the loss of future relationships will be identified as one of the greatest impacts of the illness. This study shows the lack of professional supports and resources that are available for each participant's family in being faced with the diagnosis of a terminal illness, and will address a needed consideration for social work practice.

No description available.

Most prior research on stress and hemodialysis has focused on physical, psychological and staff-patient dimensions. Little research has been conducted on the correlates of stress experienced by dialysis patients in th~ context of the family. The purposes of this investigation were to operationalize 12 propositions from a model synthesizing 50 years of family stress research and to determine the applicability of the propositions for a population of in-center dialysis patients. The two dependent variables were family vulnerability to stress and family regenerative power. The independent variables were selected on the basis of the relative absence in the dialysis literature, and the applicability to dialysis patients and their families. A 41-item closed-ended interview schedule was designed by the investigator, analyzed for validity and reliability by a panel of experts, and pretested on a small group of dialysis patients. Six dialysis centers in Western Virginia participated in the investigation and 207 of a possible 215 patient interviews were completed. Pearson product-moment correlation coefficients were calculated for each of the relationships within the hypotheses. Four hypotheses received strong support: the greater the amount of crisis, the greater the vulnerability; the greater the family positional influence, the less the vulnerability; the greater the personal influence, the greater the vulnerability; and, the greater the marital adjustment, the greater the regenerative power. Four hypotheses received moderate support: the greater the positional influence, the lower the family regenerative power; the greater the anticipation socialization, the less the vulnerability; the greater the extended familism, the greater the regenerative power; and, the greater the regenerative power, the greater the family level of reorganization. Several additional correlations were reported which helped explain the findings related to the hypothesis testing. Methodological, theoretical and practical implications were discussed and recommendations for future research were made. / Ph. D.

Die gesin is die sentrum waarbinne die kind se vorming tot volwaardige volwassenheid plaasvind. Indien een van die ouers met 'n chroniese fisieke siektetoestand gediagnoseer word, mag dit moontlike implikasies inhou vir die ouer, die kind, maar ook ander gesinslede. Die chroniese siektetoestand en die implikasies wat dit vir die siek persoon inhou is bestudeer. Daarbenewens is die dinamiek van die gesin, waarbinne die ouer en die kind met mekaar in interaksie is, ontleed. Om te bepaal wat die effek van die chroniese fisieke siektetoestand van die ouer op die kind is, is 'n literatuurstudie onderneem. Dit is daarna geverifieer met gevallestudies wat ondemeem is. Die gevallestudies het die bevindinge van die literatuurstudie bevestig. Dit blyk dat die chroniese siektetoestand van die ouer 'n invloed op die wording van die kind het. Die siektetoestand is 'n voortdurende stressor binne die gesin, wat veroorsaak dat kind(ers) affektiewe-, kognitiewe-, gedrags- en sosiale probleme manifesteer. Daar moet aanpassings gemaak word om die stres binne die gesin te minimaliseer. Riglyne is saamgestel om die terapeut, wat hierdie kind(ers) en gesinne begelei, te help. / The family is the system within which the child develops and eventually attains maturity. When a patient is diagnosed with chronic disease, it has certain implications not only for the parent, but also for children and other members of that family. A liteature study was undertaken to determine the impact of the chronically ill parent on the child. This study was then verified with specific case studies done by the author. These case studies confinned the findings of the literature study. It would seem that the chronic illness of a parent has a definite impact on the development of a child. The parent's illness is a constant stressor within the family, causing children to manifest affective, cognitive, behavioral as well as social problems. Certain adjustments have to be made to minimize stress within such a family. Guidelines are provided to assist the therapist in dealing with these children and families. / Psychology of Education / M. Ed. (Voorligting)

The purpose of the present cross-sectional study was to examine the effects of ambiguity of loss and type of caregiver-to-patient relationship on anticipatory grief, negative physical and psychological outcomes associated with grief, and boundary ambiguity in family caregivers of chronically ill patients. Questionnaires were completed by 23 parents of ill children and 30 spouses of ill mates. Using an original and a revised concept for level of ambiguity, partial support was found for the prediction that parents and spouses in high ambiguity of loss circumstances would report more anticipatory grief than those in low ambiguity ones. Contrary to prediction, a slight but nonsignificant trend occurred for parents and spouses in low ambiguity situations to report more negative physical and psychological effects associated with grief as well. Level of ambiguity was not found to impact boundary ambiguity as had been hypothesized. Spouses reported more boundary ambiguity than parents, regardless of level of ambiguity of the loss. Contrary to prediction that parents would report less anticipatory grief and more negative physical and psychological outcomes than spouses, generally, no significant differences were found between the two groups. However, using the original concept of ambiguity, parents did tend to recall more past grief than spouses. The study highlighted several methodological concerns which impact research on loss and grief, particularly the difficulty involved in recruiting participants with subsequent occurrence of sampling bias, rudimentary status of available measurement tools, and a host of potentially confounding personal and sociodemographic variables. The present study supports a view of the loss which occurs in families dealing with chronic illness as a complex process whose impact on grief, distress, and family upheaval is influenced by multiple factors. Such factors include both the ambiguity of the loss and the type of family relationship involved. Complex research of a longitudinal nature using psychosocial models of illness is needed to better delineate the impact of factors such as these.

The purpose of this secondary analysis of Malone's (1993) study was to identify formal and informal resources used by families with an adult son with chronic mental or physical illness. It also explored the identified perceptions of health care providers by the families in this study. This study was guided by the Resiliency Model of Family Stress, Adjustment and Adaptation (McCubbin & McCubbin, 1993).The sample population was patients who were receiving outpatient care from Valley Mental Health Center and University Hospital Neurology Clinic in Salt Lake City, Utah, and families which met certain criteria. The data of 42 respondents of the original 68 in Malone's (1993) study were perused for trends and themes about the use of formal and informal resources and perceptions of health care professionals using the process of secondary analysis.Findings revealed that the outpatients and families used six formal resources and seven informal resources. Family resources accounted for 44 percent of the total utilization of informal resources by the respondents. Hospital/clinics accounted for 24.3 percent of the total formal resources used by the respondents. Findings also revealed that perceptions of health care professionals by the respondents was negative.With the increase of chronic illnesses, the recommendations and implications for nursing identify that patient education in the future will undoubtedly be the most vital and crucial component to an individual's success/failure to adjust to the chronic illness. With the additional knowledge base, prevention of unnecessary anxiety related to the chronic illness would promote a more positive environment for the patient. In addition, both the patient and family could make that smooth transition into the adaptation phase and function effectively with the chronic mental or physical illness. / School of Nursing