Many patients are affected by chronic obstructive pulmonary disease (COPD), a progressive lung disease that obstructs air flow, resulting in dyspnea and inability to carry out daily activities. Despite optimal pharmacological management, COPD patients make frequent emergency room visits and are hospitalized due to exacerbations of COPD. Literature has suggested that pulmonary rehabilitation (PR), a nonpharmacological treatment, could help to decrease the symptoms that lead to illness exacerbation, hospital readmissions, and decreased quality of life in patients with COPD. The purpose of the project was to increase the quality of life and reduce admission rates for patients diagnosed with COPD through the development and implementation of patient education material that would increase PR awareness, increase patient motivation, and promote participation. The ACE star model was used to guide the project development, and the theoretical framework of the health belief model was used to enhance patients' perceptions and desires to participate in a PR program. Evaluation of the pretests and posttests revealed significant improvement in various variables, reduction of dyspnea, improved exercise tolerance, and increased knowledge. The evaluation of health-related quality of life using the short form 36 showed significant improvement in some subscales namely: general health, role emotional, with slight significance in bodily pain. There were no readmissions among the participants. The implementation of comprehensive PR has implications for positive social change because it helps patients with COPD to be more knowledgeable about their disease and allows for more independence and a higher quality of life.

Previous literature has shown that childhood trauma and adverse experiences are related to a wide range of negative outcomes that can span into adulthood (e.g., low self-worth, poor physical health, and increased likelihood of co-morbid psychological symptoms). However, a gap remains in the existing literature regarding early interventions that may target complicated outcomes (i.e., self-esteem and self-worth) while the survivor is still in childhood. This paper attempts to elucidate the impact that traumatic childhood experiences may have on self-worth, and the importance of implementing targeted intervention before the child reaches adulthood. Therefore, an extensive review was first conducted to gain further insight in regards to how specific variables, namely locus of control and health-related quality of life, may predict childhood development of self-worth. The present study then explored the influence of each factor on a child and adolescent community sample that experienced various types of trauma 61 children and adolescents who were survivors of varying types of trauma were recruited from a local mental health clinic (M=11.89; SD=2.49; 31 males, 30 females). Measures pertaining to locus of control, health-related quality of life, and self- worth were administered at their therapeutic baseline by a randomly assigned therapist. A measure of resiliency was also administered as a secondary exploratory analysis. Results highlighted pediatric quality of life and trauma type as meaningful predictors of self-worth outcomes. Additionally, resiliency as a construct with a significant correlational relationship with self-worth. All findings were interpreted for purposes of intervention, and treatment proposals were delineated.

Indiana University-Purdue University Indianapolis (IUPUI) / Taxane-induced musculoskeletal pain (TIMP) is musculoskeletal pain that includes myalgia (i.e., diffuse muscle pain, usually accompanied by malaise) and/or arthralgia (i.e., joint pain) that occurs following treatment with taxane-based chemotherapy. TIMP is a symptom that is clinically reported as negatively affecting most cancer survivors receiving taxane-based chemotherapy; however, TIMP is not comprehensively understood. The purpose of this dissertation was to conduct a cross sectional, descriptive, correlational pilot study to describe TIMP in women with ovarian cancer who were being or had been treated with paclitaxel-containing regimens. Specific aims were to: (1) describe the TIMP symptom experience (intensity, distress, duration, location, quality, temporal pattern, aggravating and alleviating factors, and pain management); (2) describe the associations between TIMP (intensity, distress) and co occurring symptoms (pain [general], peripheral neuropathy, impaired sleep, fatigue, emotional distress, and/or hot flashes); and (3) identify associations between TIMP (intensity, distress) and patient-reported outcomes (interference with daily activities, physical functioning, and health-related quality of life). Primary data collection was performed on a convenience sample of 15 women with ovarian cancer. Participants were recruited from an outpatient cancer clinic, local cancer support communities, and a national cancer survivors’ research registry. Descriptive statistics and Spearman’s correlations were used. Findings showed TIMP is moderate to severe in intensity on average, constant, affecting a large area of the body, and aggravated by everyday walking. Greater TIMP intensity or distress was associated with greater intensity and interference of most co-occurring symptoms and was associated with greater interference with daily activities, worse physical functioning, and worse health-related quality of life. Nurses are encouraged to comprehensively assess TIMP using structured, validated tools for pain to better intervene on aggravating and alleviating factors and pain management regimens. Prospective, longitudinal studies with larger sample sizes are needed to further understand TIMP and its impact on cancer survivors.

Indiana University-Purdue University Indianapolis (IUPUI) / Schizophrenia is a serious mental illness that significantly lessens health-related quality of life (HRQoL). A better understanding of HRQoL is needed to inform holistic and patient-centered treatments for schizophrenia. The purpose of this dissertation is to conduct an in-depth exploration of HRQoL in people with schizophrenia. The dissertation includes three components. The first component is an integrative literature review aimed at identifying factors associated with physical quality of life (QoL) in people with schizophrenia. The review reveals that symptoms of schizophrenia, depression, obesity or body mass index, and physical activity are associated with physical QoL in this population. The second and third components are based on illness narratives of 20 people with schizophrenia who had participated in a larger study of individuals diagnosed with serious mental illness. The second component of the dissertation is a qualitative descriptive study conducted to describe common HRQoL concerns in people with schizophrenia. The results indicate that these concerns were related to social relationships, psychiatric symptoms, psychiatric care, and employment. The third component of the dissertation is a parallel convergent mixed-methods study conducted to explore whether computerized lexical analysis (CLA) of illness narratives of people with schizophrenia can reveal their HRQoL concerns. CLA is an automatized process that counts words in text data and sorts them into pre-defined word categories. The results provide preliminary support for the potential use of CLA to efficiently assess HRQoL in people with schizophrenia as the CLA identified some of the HRQoL concerns that had been identified in the prior qualitative descriptive study. The results of the three studies reveal the complexity of the phenomenon of HRQoL in people with schizophrenia and can inform the development of strategies to identify and promote HRQoL in this population.

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