Thesis (Ph. D.)--University of Washington, 1994. / Vita. Includes bibliographical references (leaves [161]-172).

Quality of life and well-being of patients living in chronic care (CC) are determined to a considerable extent by the relationships these patients have with nursing personnel caring for them. Given the importance of these relationships, there is an absence of empirical research and measurement tools to assess these relationships from a patient’s perspective. The purpose of this study was to develop and test valid and reliable instruments to determine what qualities of the humanistic relationships between cognitively competent patients and nursing personnel in CC settings were most important to patients and what they experience most. A conceptual framework based on the Humanistic Nursing Theory by Paterson and Zderad (1976) served as a foundation to develop two scales; the Humanistic Relationship Importance Scale (HRIS) assessed what attributes of the relationship are most important, and the Humanistic Relationship Experience Scale (HRES) assessed what attributes of the relationship are experienced. Sixty-nine content relevant items based on six dimensions of the Paterson and Zderad theory were developed and tested for content validity resulting in the deletion of 20 items. Forty patients completed the now 49-item scales to establish their initial internal consistency reliability, test-retest reliability and construct validity. Another 25 items were deleted in the process. The 24-item scales were completed by 249 patients in five CC facilities and the results subjected to a iii principal axis analysis (PAA). An oblique rotation resulted in a five factor solution labeled: relational availability, promoting quality of daily life, recognizing and supporting choice, forming connections, and supporting human uniqueness. This was a simplification of the original six dimensions of the Paterson and Zderad theory. A PAA of the 24-item HRES resulted in a one factor solution labeled humanistic connection. Reliability testing of the factors resulted in the deletion of one more item and an HRIS with a Cronbach′s alpha of .87 indicating strong internal reliability and an HRES with a Cronbach′s alpha of .98 suggesting some redundancy of items. Relational availability was rated as the most important factor in the nurse-patient relationship although all factors were important to patients. The mean score of the HRES indicated that patients experience a moderate level of humanistic connection in terms of frequency and intensity with nurses who generally care for them. Findings of this study have contributed to a better understanding of the nurse-patient relationship, and support the care, research, and theoretical knowledge of nurses and patients in these environments.

Quality of life and well-being of patients living in chronic care (CC) are determined to a considerable extent by the relationships these patients have with nursing personnel caring for them. Given the importance of these relationships, there is an absence of empirical research and measurement tools to assess these relationships from a patient’s perspective. The purpose of this study was to develop and test valid and reliable instruments to determine what qualities of the humanistic relationships between cognitively competent patients and nursing personnel in CC settings were most important to patients and what they experience most. A conceptual framework based on the Humanistic Nursing Theory by Paterson and Zderad (1976) served as a foundation to develop two scales; the Humanistic Relationship Importance Scale (HRIS) assessed what attributes of the relationship are most important, and the Humanistic Relationship Experience Scale (HRES) assessed what attributes of the relationship are experienced. Sixty-nine content relevant items based on six dimensions of the Paterson and Zderad theory were developed and tested for content validity resulting in the deletion of 20 items. Forty patients completed the now 49-item scales to establish their initial internal consistency reliability, test-retest reliability and construct validity. Another 25 items were deleted in the process. The 24-item scales were completed by 249 patients in five CC facilities and the results subjected to a iii principal axis analysis (PAA). An oblique rotation resulted in a five factor solution labeled: relational availability, promoting quality of daily life, recognizing and supporting choice, forming connections, and supporting human uniqueness. This was a simplification of the original six dimensions of the Paterson and Zderad theory. A PAA of the 24-item HRES resulted in a one factor solution labeled humanistic connection. Reliability testing of the factors resulted in the deletion of one more item and an HRIS with a Cronbach′s alpha of .87 indicating strong internal reliability and an HRES with a Cronbach′s alpha of .98 suggesting some redundancy of items. Relational availability was rated as the most important factor in the nurse-patient relationship although all factors were important to patients. The mean score of the HRES indicated that patients experience a moderate level of humanistic connection in terms of frequency and intensity with nurses who generally care for them. Findings of this study have contributed to a better understanding of the nurse-patient relationship, and support the care, research, and theoretical knowledge of nurses and patients in these environments.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A incerteza à a inabilidade da pessoa em determinar o significado dos eventos relacionados à doenÃa. Trata-se de um estudo com delineamento metodolÃgico que teve por objetivos traduzir, adaptar culturalmente para a lÃngua portuguesa e validar a Mishel Uncertainty in Illness Scale for Family Members em familiares de pessoas com lesÃo medular com dÃficit motor tipo paraplegia e ainda, verificar a confiabilidade e validade da Mishel Uncertainty in Illness Scale for Family Members (PPUS-MF). A amosta envolveu 152 familiares dos pacientes internados com lesÃo medular. Os dados foram coletados em um hospital pÃblico referÃncia em trauma situado em Fortaleza-CE, no perÃodo de janeiro a julho de 2012 por meio de entrevista utilizando um formulÃrio para obtenÃÃo dos dados sociodemogrÃficos e a seguir com a aplicaÃÃo da versÃo final em portuguÃs da escala PPUS-MF. O formulÃrio da escala à apresentado no formato de Escala de Likert: discordo totalmente (1), discordo (2), indeciso (3), concordo (4) e concordo totalmente (5). O processo de adaptaÃÃo seguiu as etapas preconizadas pela literatura. A PPUS-FM permite medir o nÃvel de incerteza dos membros da famÃlia cujo parente està doente. A escala à auto-aplicada, tem 31 itens sendo a pontuaÃÃo calculada somando-se as respostas com maior escore indicando nÃveis mais elevados de incerteza e sua pontuaÃÃo varia entre 31-155. Quanto maior o escore, maior a incerteza do familiar em relaÃÃo à doenÃa. Os 31 itens sÃo distribuÃdos em quatro domÃnios, AmbigÃidade, Falta de Clareza, Falta de InformaÃÃo e Imprevisibilidade. As propriedades psicomÃtricas analisadas foram: a validade de conteÃdo (comità de juÃzes); a validade de construto (anÃlise fatorial confirmatÃria e a comparaÃÃo das mÃdias dos fatores e dos escores totais segundo as variÃveis sociodemogrÃficas dos familiares do estudo); a confiabilidade (teste-reteste e alfa de Cronbach). Os aspectos Ãticos e legais foram contemplados. Os resultados revelaram que, a maioria dos participantes era do sexo feminino 85 (55,9%), com mÃdia de idade de 42,8 anos, com grau de parentesco entre IrmÃo (a) 45 (29,8%), seguido por MÃe 27 (17,9%) e Esposa 26 (17,2%). Destes 84 (55,3%) do Interior, 116 (76,3%) possuem companheiro e 68 (44,7%) tiveram 4 a 8 anos de estudo com uma mÃdia de 8,78 anos e com 104 (68,4%) exercendo atividades laborais. Na avaliaÃÃo das propriedades psicomÃtricas, destaca-se que na anÃlise fatorial confirmatÃria, foram feitos ajustes excluindo-se os itens 4, 9, 14, 24,25 e 27. Destes os itens 4, 24 e 25 pertencentes ao domÃnio AmbigÃidade, os itens 9 e 14 integrantes do domÃnio Falta de Clareza e o item 27 do domÃnio Imprevisibilidade. Enfatiza-se que mesmo com a exclusÃo dos itens houve um super ajustamento de dados para se ter a convergÃncia. A versÃo traduzida da PPUS-MF apresentou coeficientes muito baixos do alfa de Cronbach em seus domÃnios: AmbigÃidade (0,54), Falta de Clareza (0,41), Falta de InformaÃÃo (0,40) e Imprevisibilidade (0,29). Houve um ajustamento dos dados na anÃlise fatorial confirmatÃria para a obtenÃÃo da convergÃncia revelando que a escala EMID-MF Ã, aceitÃvel e està ajustada parcimoniosamente ao modelo original. Os coeficientes para os domÃnios foram baixos, tais resultados permitiram inferir que os itens parecem representar fenÃmenos que nÃo podem ser reduzidos a medidas mais sintÃticas, especialmente quando se mede um construto psicolÃgico. Concluiu-se, portanto que se obteve um instrumento confiÃvel e vÃlido capaz de ser aplicado com familiares de pacientes internados com lesÃo medular pontuando as caracterÃsticas e domÃnios de suas incertezas.

Over the past decade, Integral Theory has been an emerging focus of academic scholarship in nursing and other fields. At this nascent period, it is evident that nursing scholars are using Integral Theory in ways that depart from an approach seen in some other disciplines, where Integral Theory is used as a metatheoretical framework for organizing disciplinary knowledge to inform professional practice. The purpose of this paper-based dissertation is to clarify how Integral Theory is being used by the discipline and profession of nursing in relation to the metatheoretical approach used by other disciplines, and to conduct research that contributes a practice-based perspective on Integral Theory in nursing. This has been achieved using the following three approaches, which are presented in three separate papers in this dissertation: 1. The first paper introduces Integral Theory to the nursing community as a metatheory, capable of providing an integrated, coherent view of multiple disciplinary perspectives within nursing and, using a case example, demonstrates Integral Theory’s application in nursing practice. 2. The second paper examines Dossey’s Theory of Integral Nursing from Integral Theory’s metatheoretical perspective. Although aspects of Integral Theory are incorporated into the Theory of Integral Nursing, this paper demonstrates how Dossey’s approach differs from the metatheoretical intent of Integral Theory. 3. The third paper reports on research findings from a qualitative study conducted using an Interpretive Descriptive Research Methodology to investigate how nurses use Integral Theory in their professional work. Findings indicate that nurses in this study used Integral Theory as a map that gave structure to an inquiry process in their nursing practice, while also identifying factors that constrained their use of Integral Theory. The presentation of this dissertation is organized in the following manner. The introductory chapter includes a description of Integral Theory in academic scholarship, its potential usefulness in nursing as a metatheory, and a review of literature on Integral Theory in the professional practice fields of nursing and psychology. The three papers are then presented in three separate chapters, followed by a final chapter outlining implications of this dissertation for the practice discipline of nursing. / Graduate / 0569 / lshea@uvic.ca

CoordenaÃÃo de AperfeiÃoamento de NÃvel Superior / A paralisia cerebral à uma patologia crÃnica, irreversÃvel, nÃo progressiva, que ocorre durante o desenvolvimento fetal do cÃrebro, ocasionando alteraÃÃes sensÃrio-motoras que limitam o desempenho da crianÃa na realizaÃÃo das atividades de vida diÃria. Essas alteraÃÃes afetam a crianÃa, e refletem diretamente na qualidade de vida da famÃlia envolvida. O momento do diagnÃstico de paralisia cerebral à rodeada de muita dor, medo e incertezas. Ao considerar esse contexto, mais atenÃÃo deve ser dada à mÃe, pois, à ela a detentora dos cuidados domÃsticos e dos filhos. Assim posto, esse estudo tem como objetivo analisar na percepÃÃo das mÃes, a incerteza na doenÃa de seus filhos com paralisia cerebral com base nos pressupostos da Teoria da Incerteza na DoenÃa, de Mishel. Esta teoria trata das incertezas, anseios e dÃvidas, provocando estresse por parte de quem sofre, por nÃo saber o que pode lhe acontecer no futuro. Trata-se de um estudo descritivo na perspectiva da investigaÃÃo qualitativa, realizado no NÃcleo de Tratamento e EstimulaÃÃo Precoce â NUTEP e no Hospital Infantil Albert Sabin durante os meses de julho e agosto de 2009. Participaram do mesmo 12 mÃes de crianÃas com o diagnÃstico de paralisia cerebral atendidas nos serviÃos supracitados. Os instrumentos para a coleta dos dados foram um formulÃrio com contemplando as variÃveis sociodemogrÃficas das mÃes e um roteiro de entrevista semi-estruturado, composto de dados relacionados à Teoria de Mishel na versÃo pais/ filhos. Os dados foram analisados por meio da AnÃlise de ConteÃdo proposta por Bardin. Nos achados desvelou-se doze categorias temÃticas, a saber: o conhecimento da mÃe sobre o diagnÃstico do filho, bem como sobre a gravidade da doenÃa, momento do diagnÃstico e suas implicaÃÃes futuras, planos para o futuro, ajuda nos cuidados ao filho, melhoria com o tratamento e medicaÃÃes, recebimento de explicaÃÃes sobre a doenÃa, conhecimento sobre o propÃsito dos profissionais, presenÃa de dÃvidas, previsÃes e alteraÃÃes no quadro de saÃde do filho. Diante dos discursos, constatamos que as mÃes apresentam ainda muitos sentimentos de incerteza quanto à patologia da crianÃa, principalmente em relaÃÃo ao futuro. Tais incertezas podem vir a ser reduzidas mediante o apoio dos profissionais de saÃde, oportunizando um melhor manejo com as mÃes, tirando suas dÃvidas, dando explicaÃÃes sobre a patologia e todo o processo de tratamento e, ainda, oferecendo oportunidade para um feedback quanto à evoluÃÃo da crianÃa. Estes aspectos servirÃo como ferramenta para reduzir suas dÃvidas e, conseqÃentemente, suas incertezas. O estudo à mais uma contribuiÃÃo do saber no cenÃrio da enfermagem neurolÃgica, visto que se ancora nas questÃes da promoÃÃo da saÃde visando a melhoria da qualidade de vida destas crianÃas e de seus familiares. / Cerebral palsy is a cronic, irreversible, non-progressive patology that occurs during the fetal development of the brain, provoking motor-sensorial changes which limit the development of a child when accomplishing daily tasks. These changes affect not only the childâs life quality, but also the whole family envolved. The moment a child is diagnosed as having brain paralysis is a painful one and is always surrounded by fear and uncertainties. Considering this context, greater attention should be devoted to the mother since, sheâs the one who is responsible for childcare and household tasks. Therefore, this study has as a main goal, to analyse, from the motherâs perception, the uncertainty in her brain paralysis affected child, based on Uncertainty During Desease Theory, of Mishel. Such theory deals with the uncertainties, anxiety and questionings, provoking stress in those envolved, since they donât know about their childâs future. It is a descriptive study, based on a qualitative, investigative perspective, accomplished at the NÃcleo de Tratamento e EstimulaÃÃo Precoce â NUTEP and at the childrenâs hospital Albert Sabin between July and August 2009.Twelve mothers took part in the study about brain paralysis affected children who were under care in the services mentioned above. The gathering of data was made through forms filled with social and demographics information about the mothers and also through a semi-structured interview composed by data related to Mishelâs Theory according to a parents/children version. Data was analysed based on the Content Analysis proposed by Bardin. Among the studies, twelve thematic categories have been highlighted as follows: The awereness of the mother about her childâs diagnosis as well as its severity, the moment of the diagnosis and its future implications, future plans, help during childcare, improvemnt of explanation about the illness, knowledge about the professionalâs proposes, presence of questionings, previews and changes in the chidâs health situation. During the research we have noticed that the mothers lack information and show feelings of uncertainty about their childrenâs patology, mainly about the future. Such uncertainties may be reduced by the professionals of health, promoting a better relationship with the mothers, clarifying their questions, as well as aquiring information about the patology and all the process of treatment and even giving opportunities for a feedback about the childâs evolution. These aspects will work as a tool to reduce their questions and, consequently their uncertainties. The study is a contribution of knowing in the scene of the neurological nursing, since anchored in the questions of the promotion of the health aiming the improvement of the quality of life of these children and his family.

Book Summary: Perspectives on Nursing Theory is a comprehensive anthology of important articles addressing diverse theoretical and philosophical perspectives on the nature of theory and knowledge development in nursing. This informative and contemporary resource features some of the most widely read and cited articles that facilitates thought and discussion among nurses, researchers, students, and teachers.Features 52 of the most widely read and frequently cited articles reflecting seminal, modern, and futuristic perspectives on nursing theory. Includes new articles reflecting current, cutting-edge views of nursing theory and trends. Includes biographical information about each author that provides insight into the author's perspective.

The authors propose connecting the dots among theory, practice, and research by adopting an expanded conceptual-theoretical-empirical structure of nursing knowledge and matrix process to guide the placement of nursing knowledge in a contextual whole. An overview of the theoretical journey of nursing knowledge development is contrasted with the journey from practice resulting in a theory-practice disconnect. Both approaches are united to present an integrated view of the dimensions of the knowledge development of nursing as a professional discipline.

Thesis advisor: Jane M. Flanagan / Purpose: The purpose of this study was to explore nurses’ experiences of Watson’s Theory of Human Caring Caritas Process Three: Cultivation of One’s Own Spiritual Practices and Transpersonal Self, Beyond Ego-Self. Background: There is currently an inadequacy of spiritual care provided to patients and families in the ICU despite a significant articulated need. Nurses report discomfort with and a lack of preparation in providing spiritual care competently. Nurses with strong personal spiritual development are more likely to report comfort with spiritual caregiving and provide spiritual care. Watson’s Theory of Human Caring Caritas Process Three; Cultivation of One’s Own Spiritual Practice and Transpersonal Self, Going Beyond Ego-Self makes explicit the primacy of relationship between nurse spiritual development and transpersonal spiritual nursing care. However, the nature of spiritual development of nurses in the ICU remains unknown. Methods: A qualitative descriptive methodology with directed content analysis applying Watson’s Caritas Process Three was used to analyze data for this study. Results: Ten ICU Nurses provided evidence of the experience of Caritas Process Three. Five themes were identified in the analysis of data: Caritas nurses vary in their ability to move beyond ego-self, Personal spiritual practices serve as a barrier and/or facilitator to nurses’ ability to provide spiritual care, Critical illness as experienced by patients and families provided the opportunity for nurses to explore spirituality with other, The care environment serves as a barrier and/or facilitator to nurses’ personal spiritual growth, and Cultivation of spiritual practice and spiritual identity is integral to a life-long process of consciousness evolution. Conclusions: The findings of this study extend and inform Caritas Process Three of Watson’s Theory of Human Caring. Nurses in this study provide evidence for the primacy of personal spiritual development for the delivery of spiritual and transpersonal care for patients in the ICU. / Thesis (PhD) — Boston College, 2019. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

The death of one�s parents, irrespective of the age at which it occurs, is generally regarded as a life experience of considerable significance. The last few years of an elderly person�s life are often characterized by increasing frailty, declining health and loss of independence. Responsibility for the spiritual and physical care of parents during that period is undertaken by many adult children. Current research in this area is generally informed by the requirements of social policy, which, by identifying and addressing the inherent difficulties in this so-called informal caring, is designed to support carers in the community. The research reported in this thesis represents a departure from this mode of inquiry and seeks, rather, to explore the existential aspects of caring in this particular situation, from the carer�s perspective. To achieve this objective, an existential phenomenological approach informed principally by the philosophies of Heidegger and Merleau-Ponty, and the adaptation of these philosophies by Schutz, Giorgi and van Manen to social science research, was developed to suit the particular requirements of the topic. In addition to the author�s autobiographic material, primary sources include conversations with five people who had been principal carers for their parents during their final illnesses. In all cases caring had ended with the parent�s death at least one year before the conversations took place. The principal secondary sources are Simone de Beauvoir�s memoir, A Very Easy Death, and Philip Roth�s account of his father�s illness and death, Patrimony: A True Story. In addition, the argument is supported throughout by reference to other literary works. From these sources a number of major existential themes, including temporality, hope, suffering, and knowing the body, have been explored in depth, in conjunction with relevant existential theories. Synthesis of these topics suggests that in this particular circumstance, for the people involved in the study, the phenomenon of caring can be understood as an unconditional engagement with the life and concerns of their parent at the end of life, and can be interpreted within an existential framework as representing an authentic way of Being.