The major focus of this thesis is the role of feelings and emotions in moral thinking/knowing, ethical conduct and, in particular, moral distress in nursing. Research has consistently found that the moral decisions nurses must make can sometimes lead to distress. However, such experiences are overly individualised in the literature. An alternative view of the person, drawing on the philosophy of Alfred North Whitehead (e.g. 1927-8/1978) and the recent work of Paul Stenner (e.g. 2008), sees human subjectivity or mind as processual and always embodied and in-the-world. The emphasis upon the body draws attention to the role of felt experiences this thesis views feelings as integral to both sense-making knowing and thinking and sensibility or emotionality. The emphasis in-the-world highlights that subjectivity is embedded within social contexts, which include relations of power and organisations of material and symbolic capital aligned with those relations. Influenced by deep empiricism (e.g. Stenner, 2011a), this thesis develops a novel bricolage methodology based on a metaphor of diffraction to explore nurses experiences of moral distress. Nurses feelings of discomfort, a particular form of feelings of knowing , appear to be the seeds of moral distress. Various situations seem to be important antecedents for these seeds to bloom into full moral distress, including certain clinical issues, ethical conflict with colleagues, and issues of competency. Nurses also experience some aspects of their job as systemic barriers to high standards of care, which can also be morally distressing. Such distress sometimes affects nurses relationships, their physical health, and their mental health. Participants have found several strategies useful in coping with their distress. It is argued that these strategies are about altering one s feelings through changing one s activities and/or environment. Additionally, past distress may remain a dormant part of a person s subjectivity and re-emerge or become (re)enacted in the narrations of those past distressing experiences. It is suggested that subjectivity entails an organisation of past experiences in the present, for present purposes and in anticipation of the future. Six dominant thematic patternings, which recurred throughout the analyses, are discussed: (i) the centrality of feelings; (ii) the relationality of felt experiences; (iii) the complexity of morality, moral conduct, and moral distress moral/ethical issues become entangled with identity, power, professional competency, and social relations; (iv) the prominence of power and interest; (v) nurses' lives as afflicted by moral distress; and (vi) life-as-process. Discussion of these motifs leads to a rethinking of moral distress. Implications for nursing practice, moral distress research and the study of feelings, emotions, and affect are discussed.

Studien undersökte sambandet mellan stress mindset (individens övertygelser om stress) och upplevd stress hos gymnasieungdomar. 122 deltagare i åldrarna 16-19 år deltog i studien genom att svara på ett elektroniskt formulär. Frågorna bestod av Perceived Stress Scale (PSS-14), som undersökte upplevd stress, och Stress Mindset Measure (SMM), som undersökte deltagarnas mindset om stress. Resultatet visade en signifikant negativ korrelation mellan stress mindset och upplevd stress. Detta gav stöd till forskningshypotesen att övertygelsen att stress är skadligt har ett signifikant samband med hög upplevd stress hos gymnasieungdomar. Praktiska implikationer och framtida forskning diskuteras.

The main purpose of this study was to determine the impact of depression and anxiety on mortality, CHD incidence, and quality-of-life in patients hospitalised for an acute myocardial infarction (MI). Questionnaires, including the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory were completed during hospitalisation by 288 MI patients, and four months and 12 months after discharge among survivors. Quality-of-life was assessed at both follow-up points using the Dartmouth COOP charts. Twenty-five (8.7%) patients died, 22 of cardiac causes, during the four month follow-up. Six further fatalities occurred between four and 12 months following MI. Symptoms of depression and anxiety did not predict either cardiac or all-cause mortality, or CHD incidence at either follow-up point. Indices of disease severity predicted both four month and 12 month mortality and CHD incidence. In a subset of seven patients who died prior to discharge, depressive symptoms did predict mortality, but the association did not withstand correction for severity of infarction. Multiple regression analyses revealed that baseline depression and state anxiety, as well as severity of infarction, predicted both four and 12 month quality-of-life. In addition, partner status and living alone also predicted four and 12 month quality-of-life, respectively. Attendance at rehabilitation was positively associated with quality-of-life at both four and 12 months, and negatively associated with 12 month CHD morbidity. In conclusion, depression and anxiety were not significant predictors of mortality, or CHD incidence, during the first year following MI but they were predictive of four and 12 month quality-of-life among survivors.

Prostate cancer is the most commonly diagnosed cancer and second leading cause of death in American men. Patients with localized prostate cancer may experience unique and multidimensional symptoms that are distressful from treatment and thereafter. This cross-sectional correlational study aimed to investigate the relationships among stress, symptoms, symptom distress, and symptom self-management and identify the effective strategies of symptom self-management in men with localized prostate cancer following prostatectomy or radiation therapy.Eight saliva samples and 3 questionnaires (Perceived Stress Scale, Symptom Indexes, and Strategy and Effectiveness of Symptom Self-Management) were obtained from each participant between 1 and 3 months following their first prostate cancer treatment. The sample consisted of 53 men with localized prostate cancer. Mean salivary cortisol concentrations for the entire sample ranged from 0.3 to 0.08 ug/dL. Cortisol was secreted in a circadian rhythm with heightened activity in the early morning and lowered activity late in the day. The circadian pattern of cortisol secretion was similar in both the prostatectomy and radiation therapy groups, although the values were slightly different. Two areas Under the Curve (AUC) of salivary cortisol were calculated. Three cortisol circadian rhythms were identified, but the majority of the sample had a typical negative consistent circadian rhythm.Patients with localized prostate cancer who underwent radical prostatectomy or radiation therapy had low perceived stress. Perceived stress was positively correlated with AUCg, noon salivary cortisol concentrations, and afternoon salivary cortisol concentrations. Subjects reported a moderate degree of symptoms and symptom distress on urinary, bowel, and sexual dysfunction 1-3 months following treatments. The most effective strategies of urinary symptom management were pad and kegel exercise; the most effective strategy of bowel symptom management was rest or endure; the most effective strategies of sexual dysfunction management included express their feelings or find alternative ways to express their affection. The symptom self-management strategies were significantly and positively correlated with symptom self-management effectiveness.Symptom distress and AUCg were significant and strong predictors of symptom self-management. Findings can help health care providers develop effective strategies for symptom self-management that enhance health related quality of life among men with localized prostate cancer.

Premenstrual symptoms are a universal event during a woman's reproductive life but little is known about the experience of emerging adulthood women aged 18-25 years. The purpose of this study was to determine feasibility of daily symptom data collection via an electronic diary and to examine the relationship between premenstrual symptom perception, severity and distress with academic stress. This sample consisted of 50 women with a mean age of 20(±.9) years living in campus housing of a private undergraduate rural college. Results determined it is feasible to utilize an electronic diary for daily prospective symptom and academic demand data collection. Surprisingly, in this sample of healthy undergraduate women, there were significantly higher numbers of symptoms perceived (7.16±3.8 follicular and 6.18±3.3 luteal, p=.001 and higher distress (.39±.3 follicular and .31±.3 luteal, p=.003) in the follicular phase than in the luteal phase. Academic stress findings indicated mild stress as measured by the Student-life Stress Inventory (Gadzella, 1991) and students overall perceived stress levels fell in the minimal to mild range. The academic demand component of academic stress measured daily frequency and distress associated with assignments, papers, projects/presentation and time studying. Within the follicular phase number of assignments due was significantly correlated to symptom perception and distress (.31, .37, respectively) and the number of projects/presentations due was correlated to symptom distress (.25) at p<.05. There were significant correlations between follicular phase symptom perception and distress, and luteal phase symptom distress with academic demand distress for assignments, papers, projects/presentations and time studying, indicating a relationship between distress components of symptom experience and some components of academic stress. These premier results about the relationship between symptom distress and academic stress warrants further exploration and development of a clearer conceptual definition of academic stress and clear and consistent operationalization of this phenomena.

No description available.

Designed financial distress prediction model is intended directly for the farmer (decision-maker) in order to diagnose the farm’s financial condition and predict the likelihood of financial distress, by using financial information of his farm. There are identified family farm characteristics in which family farms have higher risks to run in financial distress and are guidelines for the family farms that intend to more carefully monitor and control their financial condition. The aim of the research: after analysing the conception of financial distress and identifying the factors determining the financial condition as well as related indicators and prediction models, to methodologically justify and design financial distress prediction model of family farms. / Parengtas finansinio išsekimo prognozavimo modelis tiesiogiai skirtas ūkininkui, kuris panaudodamas savo ūkio finansinę informaciją, galėtų diagnozuoti ūkio finansinę būklę ir iš anksto numatyti finansinio išsekimo grėsmę. Disertacijoje nustatytos ir įvardintos ūkininkų ūkių charakteristikos, kurioms esant ūkiai turi didesnes grėsmes finansiškai išsekti, yra gairės ūkininkų ūkiams, kurie ketina atidžiau stebėti savo veiklą ir kontroliuoti finansinę būklę. Tyrimo tikslas – ištyrus finansinio išsekimo sampratą, identifikavus finansinę būklę sąlygojančius veiksnius, indikatorius ir prognozavimo modelius, metodologiškai pagrįsti ir parengti ūkininkų ūkių finansinio išsekimo prognozavimo modelį.

Class of 2012 Abstract / Specific Aims: The objective of this study is to evaluate and compare clinical outcomes and economic impact involved with the use of beractant (B) compared to poractant (P) for the treatment of respiratory distress syndrome (RDS) in premature neonates admitted to a neonatal intensive care unit. Methods: Patients were included if they were less than 35 weeks gestational age at birth, survived at least 48 hours, and admitted to the neonatal intensive care unit and treated with P or B for RDS. The primary outcome of this study is the change in the fraction of inspired oxygen (FiO2) over the first 48 hours after surfactant administration. Secondary outcomes were the change in oxygen saturation, time spent on mechanical ventilation and continuous positive airway pressure (CPAP), complication occurrence and mortality of the neonates. Main Results: There were a total of 40 neonates whose charts were reviewed (n= 13 and n=27 in the P and B groups respectively). The mean gestational age of the neonates were 29.2+/-2.9 and 28.8+/-2.9 weeks in the P and B groups respectively. The FiO2 was found to not be lower between the P and B groups (35.5+/-22.2 and 42.4+/-24.2, respectively; p=0.379), as well as the O2 saturation (94.6+/-4.6 and 92.3+/-6.1; p=0.194). Significance was also not found for the other clinical or economic outcomes assessed in this study. Conclusions: There was not a significant difference between poractant and beractant in FiO2, O2 saturation, or in the other clinical outcomes evaluated in this study.

Published literature has focused on understanding moral distress from a descriptive standpoint. Missing from the literature is an exploration of the role a nurse can play in his/her/own moral distress.A qualitative study with an interpretive design incorporated Clandinin and Connelly' narrative methodology. Results highlighted assumptions were made by participants in the absence of resources, which led them to" know the right action to take" from their own perspective.

Clinicians and researchers know that women experience distress related to the diagnosis of and treatment for ovarian cancer. A review of the literature revealed that while there is interest in the topic, distress is inconsistently defined and measured. Women have been reported to have a variety of distress experiences including the challenges of late diagnosis and the treatment regimen, communication difficulties with healthcare providers, and concern about the effect of their diagnosis on their loved ones. Without information directly from women, assumptions predominate about what the experience is like and what they would find helpful from support persons. Women’s perceptions about distress was identified as a gap in the knowledge leading to the present study which asked “What do women with ovarian cancer want their spouse/significant other, family, friends, and healthcare providers to know about their experience of distress during diagnosis and treatment?” A qualitative method, Grounded Theory as outlined by Glaser and Strauss in 1967 was chosen to guide this IRB approved study. Twelve women participated in audiotaped interviews contributing data for analysis using the constant comparative method. Six common themes or subcategories emerged across all the interviews and resulted in a conceptualization of the experience as an “existential assault.” Though individual experience differed, abstraction and conceptualization of the data revealed the common themes as (a) “out of the blue like lightning”; (b) “no stone left unturned”; (c)“knowing what I don’t want to know and not knowing what I want to know”; (d) “watching you, watching me- we are both afraid”; (e) “talking yet not talking, about death”; and (f) “now I have to take care of me.” Participants expressed the need for professional support people who contribute their efforts to cure, but who also listen to the participant’s need to manage and control their own experience and to live in ways that give their life meaning and purpose. The experience of distress for the participants was intensified by the needs of those in their social network (spouse/significant other, family, friends, and healthcare providers) who also experienced distress, at times requiring participants to provide support for those who would be expected to be providing support.