Over the last 50 years technical and other advances have resulted in more than 90% of children born with congenital heart disease (CHD) surviving and reaching adulthood. This new patient population has been largely overlooked in recent policy and practice developments in health and social care. Evidence available at the start of the study confirmed increased survival and suggested the need for life long follow up. There was found to be limited research exploring the view of what was required by adults with CHD or into psychosocial aspects of living with a heart condition. The purpose of this phenomenological study was to discover the adults' experience of living with CHD. Twenty-eight people, over the age of 20 years, who had undergone surgery for their heart condition, participated in semi-structured interviews during which they recounted their experience of growing up and living with CHD. Five people, who epitomised being well, contributed to second interviews during which they told stories that demonstrated what being well meant for them. Thematic analysis revealed participants had a positive view of themselves and were highly motivated to maintain their health. Their heart condition was an integral part of who they were, but did not dominate their life. Three main areas influenced the positive view held by participants. These were: first the perceptions of wider society, second when the CHD impacted on available choices, and third when hospital attendance occurred. Second interviews revealed `being well' developed through participants' ability to make their own decisions, which was done in a responsible manner, resulting in informants being able to get on with life, engaging in activities of their choosing. The study findings inform proposals for services to develop in ways that can enhance opportunities for adults with CHD to achieve their full potential. Developing skills relevant to `non-patient' activities and managing the misconceptions of wider society are key factors in adults with CHD being able to participate in meaningful activities of their choice. It is essential for health and social care to be delivered in ways that promote patient autonomy and self-management. Areas for further research emerge from the findings. Hearing the way living with CHD is experienced during childhood and adolescence can contribute to transition processes. Hearing the experience of other groups including parents, partners and health professionals, as well as people surviving with other chronic childhood conditions, can add to the findings presented here.

This research project is designed to determine a plan of assessment and intervention, which can be used by nurses in the community to help elderly patients cope with painful conditions. A theoretical model is developed, in which coping is defined in terms of the degree of control experienced over pain and other stressors. This model identifies emotional state as the indicator of coping at any particular time. A study is described, in which subjects were 190 retired patients, who were being visited by a district nurse, and who identified that they had persistent or recurrent pain. Data on pain and coping was collected using semi-structured interview. Mood state was measured as the dependent variable. Independent variables for quantitative analysis included pain intensity ratings, pain duration, disability, health, personal and financial problems, age and locus of control. Qualitative data were collected to validate the quantitative findings. Questionnaire data were collected from nurses for purposes of verification and comparison. Nonparametric correlations, and multiple regression analysis, identified that the variables which directly determined coping were feeling the pain to be under control, being occupied, feeling informed about the painful condition, having regrets and non pain-related personal problems (notably bereavement loss). Those who used active occupational and pain-relieving strategies coped better than those who adopted passive coping strategies. Patients generally valued supportive aspects of nursing care, particularly the provision of encouragement and confidence. Nurses systematically underestimated patients' worst pain and overestimated anxiety. There was a significant association between patients' pain complaints and perceived pain exaggeration. Few nurses used a pain assessment protocol, or had received formal education in the management of chronic pain. These results are used to produce guidelines for the nursing management of elderly patients with pain in the community, with particular reference to assessment and intervention, based upon the nursing process

This study examines the role of psycho-social factors in contributing to chronic illness, in particular Coronary Heart Disease (CHD) and cancer. Research conducted over the last 50 years indicates a modest role for psycho-social factors as risk factors for these conditions. The research suggests that in combination with other modest risk factors, psycho-social factors play an equally important role. Grossarth-Maticek & Eysenck (1990) gained notoriety by reporting research results which seriously question current wisdom. Grossarth-Maticek & Eysenck (1990) conducted what must be considered the largest long term prospective psychological health study. They followed around 20,000 probands for 15 years in order to determine the relative contributions to health outcomes (primarily cancer and CHD) of standard medical and psycho-social risk factors. They reported an 81% accuracy of prediction of death by cancer or CHD with the use of a psychometric test. Further, answers to the test were reported to be six times more predictive of cancer or CHD than were any of the standard medical risk factors, either taken on their own or together. Being far in excess of claims made by any other researchers, the treatment/prevention implications of Grossarth-Maticek’s study are far reaching. It is an important endeavor to examine possible influencing factors in these results. While scientific fraud can never be excluded, in the absence of any incriminating evidence, this assertion is considered to be non-empirical. Amelang (1991) wonders whether unknown, favourable and non replicable conditions were present in Grossarth-Maticek’s samples or methodology which influenced the results. The current research program represents an attempt to ascertain what some of those factors may have been. It is suggested here that Grossarth-Maticek’s probands learnt of their cancer or CHD proneness in the course of the interview which formed the basis of the data collected in their study. Focusing on this aspect of Grossarth-Maticek’s data collection methodology, the possibility of a large scale treatment effect emerges. The most psychologically vulnerable of his probands, having been stimulated by the interview process, may have ruminated and ‘catastrophized’ over their health prospects during the ensuing years, thereby making themselves physiologically more vulnerable to the feared conditions. The possibility of probands being adversely influenced by the interview is tested in the current study with subjects being measured for changes in cancer/CHD risk perception and anxiety levels as a result of participation in the ‘Grossarth-Maticek interview’ format. In order to test this hypothesis, two studies were undertaken in which Grossarth-Maticek’s data collection method was replicated with 105 subjects. Subjects were assessed on a range of self report items prior to the ‘Grossarth-Maticek’ interview, and again post to this interview. They were assessed as to their beliefs about vulnerability to cancer and CHD; and their levels of anxiety in relation to contracting these conditions. Subject’s responses to learning of their ‘health prediction’ according to Grossarth-Maticek’s assessment tool were also measured via a heart rate monitor. Changes in subject’s self report measures and heart rate responses were noted and associations to the type of health prediction which they were given at the end of the interview was assessed. In the second study, the relative effects of family history, Neuroticism and time on disease risk perception and anxiety were studied via statistical analyses of self report measures. The results of this study do not support the notion of the interview having any adverse influence. Problems with the methodology and sample selection may have influenced the outcome. It is concluded that for these reasons, the current study did not represent a thorough test of the current hypothesis. Recommendations for a superior test of this hypothesis are made.

This study examines the role of psycho-social factors in contributing to chronic illness, in particular Coronary Heart Disease (CHD) and cancer. Research conducted over the last 50 years indicates a modest role for psycho-social factors as risk factors for these conditions. The research suggests that in combination with other modest risk factors, psycho-social factors play an equally important role. Grossarth-Maticek & Eysenck (1990) gained notoriety by reporting research results which seriously question current wisdom. Grossarth-Maticek & Eysenck (1990) conducted what must be considered the largest long term prospective psychological health study. They followed around 20,000 probands for 15 years in order to determine the relative contributions to health outcomes (primarily cancer and CHD) of standard medical and psycho-social risk factors. They reported an 81% accuracy of prediction of death by cancer or CHD with the use of a psychometric test. Further, answers to the test were reported to be six times more predictive of cancer or CHD than were any of the standard medical risk factors, either taken on their own or together. Being far in excess of claims made by any other researchers, the treatment/prevention implications of Grossarth-Maticek’s study are far reaching. It is an important endeavor to examine possible influencing factors in these results. While scientific fraud can never be excluded, in the absence of any incriminating evidence, this assertion is considered to be non-empirical. Amelang (1991) wonders whether unknown, favourable and non replicable conditions were present in Grossarth-Maticek’s samples or methodology which influenced the results. The current research program represents an attempt to ascertain what some of those factors may have been. It is suggested here that Grossarth-Maticek’s probands learnt of their cancer or CHD proneness in the course of the interview which formed the basis of the data collected in their study. Focusing on this aspect of Grossarth-Maticek’s data collection methodology, the possibility of a large scale treatment effect emerges. The most psychologically vulnerable of his probands, having been stimulated by the interview process, may have ruminated and ‘catastrophized’ over their health prospects during the ensuing years, thereby making themselves physiologically more vulnerable to the feared conditions. The possibility of probands being adversely influenced by the interview is tested in the current study with subjects being measured for changes in cancer/CHD risk perception and anxiety levels as a result of participation in the ‘Grossarth-Maticek interview’ format. In order to test this hypothesis, two studies were undertaken in which Grossarth-Maticek’s data collection method was replicated with 105 subjects. Subjects were assessed on a range of self report items prior to the ‘Grossarth-Maticek’ interview, and again post to this interview. They were assessed as to their beliefs about vulnerability to cancer and CHD; and their levels of anxiety in relation to contracting these conditions. Subject’s responses to learning of their ‘health prediction’ according to Grossarth-Maticek’s assessment tool were also measured via a heart rate monitor. Changes in subject’s self report measures and heart rate responses were noted and associations to the type of health prediction which they were given at the end of the interview was assessed. In the second study, the relative effects of family history, Neuroticism and time on disease risk perception and anxiety were studied via statistical analyses of self report measures. The results of this study do not support the notion of the interview having any adverse influence. Problems with the methodology and sample selection may have influenced the outcome. It is concluded that for these reasons, the current study did not represent a thorough test of the current hypothesis. Recommendations for a superior test of this hypothesis are made.

Thesis (Ph. D.)--Washington State University, May 2009. / Title from PDF title page (viewed on June 17, 2009). "Murrow College of Communication." Includes bibliographical references (p. 103-118).

<p> The research literature suggests that contingency management protocols are a useful approach in suboxone/buprenorphine treatment. However, there is a lack of data on its rate of use amongst service providers in Massachusetts. This study sought to survey the practices of service providers of suboxone/buprenorphine clients in Massachusetts. An online survey, questioning providers on their demographics, criteria for adherence to their treatment program, views and use of rewards, and views and use of punishments was developed and distributed to service providers. Fifty-four participants provided sufficient data to analyze. Descriptive statistics revealed that most participants were in the medical field, with a large number of participants having nursing degrees and nursing positions. Three criteria for treatment adherence were popular amongst service providers: &ldquo;Adherence to a suboxone/buprenorphine prescription, attendance at mandatory meetings, and abstinence&rdquo; (37%), followed by &ldquo;Adherence to a suboxone/buprenorphine prescription&mdash;decrease in substance use&rdquo; (24.1%), and &ldquo;Adherence to a suboxone/buprenorphine prescription and attendance at mandatory meetings&mdash;decrease in substance use&rdquo; (14.8%). Less than half of participants utilized rewards (38.9%). The most popular rewards used were &ldquo;<i>Reduction in frequency of supervision</i>&rdquo; (66.7%) and &ldquo;<i>Reduction in frequency of dispensing</i>&rdquo; (61.9%). Punishment use was more popular amongst participants (63%), and was viewed as significantly more effective than rewards. The most popular punishments were &ldquo;<i>Referral for additional services </i>&rdquo; (91.2%), &ldquo;<i>Increase in frequency of supervision </i>&rdquo; (85.3%), and &ldquo;<i>Discharge from the program</i>&rdquo; (70.6%). The most frequently cited factors that influenced the use of reward and punishment systems involved treatment engagement and use of illicit drugs. Future research in the field should focus on developing a standard approach towards contingency management use in suboxone/buprenorphine programs. For studies seeking to emulate the current research, drawing a larger population of participants will help develop greater likelihood of detecting significant relationships amongst variables.</p><p>

This descriptive comparative, correlational study examined nurses' knowledge and attitudes towards patients with sickle cell disease (SCD). The literature suggests that SCD patients are inadequately managed by nurses, resulting in unnecessary suffering, delayed treatment, and prolonged hospitalization. The study was conducted on a convenience sample of 109 registered nurses (RNs) working in southeast Florida. The data, collected via self-administered questionnaires using the Nurses Knowledge Base Inventory (Lorenzi, 1993) and the Sickle Cell Disease Attitude Questionnaire, were analyzed by descriptive and inferential statistics. Knowledge was not found to be correlated with attitude. A perplexing finding was the inverse relationship between education level and attitude (r= .23, p= .015). Ethnicity was not a differentiating factor in nurses SCD attitude scores, however, there was a strong trend showing that Blacks were the least positive in SCD attitude among the four ethnic groups studied. Formal education alone may not be sufficient in gaining better knowledge and understanding about SCD. Appropriate interventions might be achieved when nurses are knowledgeable about SCD and possess a positive attitudes toward patients with SCD.

Therapeutic touch has been shown to help reduce pain in several ailments. Cancer patients experience considerable pain during their illness. The purpose of this study is to evaluate the effect of therapeutic touch on pain experienced by cancer patients. The study uses a quasi-experimental design. A sample of sixteen hospitalized cancer patients was selected. The patients were randomly assigned to two groups: the experimental and the placebo control group. The patients assigned to the experimental group received a therapeutic touch treatment on two consecutive days, each day the treatment lasted for a period of 20 to 30 minutes. The patients in the placebo control group received mimicked therapeutic touch for 20 - 30 minutes.. A Visual Analogue Scale (VAS) was used to measure pain before and after the therapeutic touch treatment. At the end of the second day of the study, a Patient Touch Questionnaire (PTQ) was administered to measure the subjects' responses to the therapeutic touch treatment. The hypothesis that Therapeutic vi Touch would significantly decrease pain in cancer patients is supported by the observations made in this study.

The number of people waiting for organ transplantation continues to outnumber the number of donors by far. Nurses who are the primary caregivers for the organ donor, must be aware of the needs of the donor’s family members during that time. This study attempts to determine whether there is a difference between the actual needs of family members of organ donors and nurses’ perceptions of those needs. A comparative survey was used to describe and compare the responses of family members and of nurses. None of the variables were manipulated, and the approach used was descriptive. The results of the study indicated that nurses, overall, are aware of family needs during the organ donation process. Despite the overall result, the study did find areas in which the scores of nurses and family members were significantly different (P

A numerical study has been conducted to understand the gas flows in a De-Laval micronozzles using 2D continuum axisymmetric model, which solves the governing equations by control volume method. The numerical model was validated with existing experimental data employing slip and no-slip boundary conditions at the wall. The numerical results showed good agreement with experimental data on exit thrust values except at low Reynolds number. Parametric studies included the effect of geometric scaling via scaling down of throat diameter for various throat Reynolds numbers and the effect of chemical propellants on the integrated performance of the nozzle. On the effect of geometric scaling, the nozzle throat diameter was scaled from 10 mm to 0.1 mm and the throat Reynolds number was varied from 5 to 100. A correlation was developed and presented to predict the specific Impulse for any given throat diameter and throat Reynolds number. To understand the effect of chemical propellants on nozzle performance, propellants like helium, nitrogen, argon and carbon dioxide were selected and simulations were conducted for throat diameter equal to 0.1, 1 and 10 mm respectively for Rethroat varying from 5 to 2000.