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Understanding spirituality from the perspectives of Jordanian people diagnosed with end stage renal failure : a phenomenological studyTamimi, Abdelrhman Mohammad January 2015 (has links)
Spirituality has been increasingly acknowledged in nursing literature as an important element of holistic care provision. The literature to date has investigated the meaning of spirituality in Western cultures, predominantly through positivist methodologies. Spirituality in Middle Eastern countries remains under-researched, and this study aims to address this gap and to better understand this concept. The main aim was to understand and interpret patients’ perceptions, experiences, beliefs and practices associated with spirituality by exploring how spirituality is manifest in the lives of Jordanian End Stage Renal Failure (ESRF) patients. A hermeneutic phenomenological approach was adopted informed by the philosophy of Martin Heidegger (Heidegger, 1962). Participants (n=27) were recruited from four different dialysis units: in a public hospital, a private hospital, an educational hospital and a refugees’ hospital in Jordan. Data was collected through in-depth unstructured interviews. Analysis was guided by the tenets of hermeneutic phenomenology, namely: gaining an immediate sense of what was said both during and after each interview, transcribing data verbatim, translating interviews into the English language, intensive reading and re-reading, seeking meaning units by line-to-line coding, developing situated structures (how spirituality was manifest in each text) and developing a general structure from the individual situated structures (how the phenomenon ‘spirituality’ comes into being). The findings uncovered the phenomenon of spirituality and how the Jordanian ESRF patients experienced it during their illness. The nature of this phenomenon appeared to be complex and multifaceted. The three superordinate themes that emerged from analysis and interpretation of the participants’ accounts clustered around Religion, Relationships and Desperation. The study findings show how language, religion and culture were important elements and cannot be ignored in understanding Jordanian ESRF spirituality. The findings reveal that cultural issues such as losing employability, social stigma, social isolation and being tagged negatively are results of suffering from ESRF and are related to the meaningful way in which Jordanian ESRF patients viewed their spirituality. This has important implications for health care professionals. Should they use spirituality in care, there is a need to address wider issues such as stigma that patients face in society which impacts negatively upon individuals’ spirituality. In addition, findings show a specific and crucial characteristic of spirituality was the conflict between acceptance and rejection of the illness, and a sense of patients feeling that they are human and that life has not stopped. It is also evident that spirituality has played an important role in Nafs (inner self). It was part of the transforming process of Nafs from being Nafs Ammarah (evil inside) to Nafs Lawamah (blaming) to ultimately reach tranquil Nafs (peace and comfort). These were the core spiritual needs of participants, who expected that health care providers, family and community should have the essential skills to address these needs. The role of nurses within the dialysis team is essential in enhancing patients’ spirituality through spiritual and religious engagements. However, few participants highlighted the challenges in nurse-patient relationships, for example being in a busy unit, cultural boundaries, nurses’ characteristics, lack of knowledge, lack of awareness, unbalanced power in such relationships, lack of support, lack of respect, and a lack of attention and psychological care. All these elements may affect a nurse’s role in providing spiritual care. This research prompts us to look at the important role pre-dialysis nurses can play in improving and addressing spiritual needs, increasing awareness, and educating patients, family and the public about ESRF in its early stages. It also highlights the important role for religious leaders, Imams, and psychologists in enhancing an individual’s spirituality. The study argues that a “secular” concept of spirituality had no meaning for the participants in the study in the absence of religion. Spirituality is fundamentally part of religion and vice versa. The findings may have consequences for the use of spirituality in multi-cultural settings in Western countries. Additionally, findings highlight an important emphasis on the practice of spirituality, often underestimated in previous literature for Arab-Muslim Jordanian patients. The study findings contribute to the existing gap in knowledge regarding how Arab-Muslim Jordanian ESRF patients experience spirituality during their illness. It provides valuable insights into the importance of spirituality for this patient group and suggests how nurses, educators and policy makers might help address ESRF patients’ spirituality and spiritual needs in order to provide appropriate spiritual care. The study suggests the findings may have relevance beyond the Jordanian context in educating nurses on the importance of appreciating the religious dimension of spirituality. The study recommends further research in order to understand spirituality from the healthcare providers’ perspective.
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The traumatic effect of homicide in mentally disordered offenders and implications for treatmentBromley, Alison January 2016 (has links)
This thesis provides a broad and diverse investigation into the field of traumatic responses in mentally disordered perpetrators of homicide and group treatment for such offenders. A range of methods including a systematic review, a single case study and a primary phenomenological investigation were used to explore issues in the field. Following an introduction in Chapter 1, Chapter 2 reviews trauma responses in homicide offenders. The results indicate that trauma reactions among homicide offenders as a direct result of the offence are highly prevalent which has implications for potential interventions. The existing literature is obstructed by weak studies using suboptimal scientific designs and future research is recommended. In Chapter 3 a single case study explores a homicide offender’s progress in a group treatment. The group therapy under investigation adopts a recovery oriented approach, addressing both criminogenic need and the well-being of the offender. The impact of the treatment is determined using a range of psychometric measures. The results indicate improvements in the targeted areas with clinically significant change demonstrated. Chapter 4 explores the lived experience of a group treatment for homicide using the principles of Interpretive Phenomenological Analysis. Three areas were discussed: (1) the Group (2) Recovery and (3) Risk. Recurrent themes reflected the importance of shifting narratives and hope for the future in both domains of recovery and risk, lending support to the utilisation of narrative approaches in Index Offence work. The results have implications for clinical practice and are discussed in the context of directions for further research. Chapter 5 evaluates the Inventory of Complicated Grief which was used as an assessment measure in Chapter 3. Finally, Chapter 6 provides a discussion and close to the thesis drawing together the implications of the research.
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A clinical study of psychogenic pain in childrenLima, Denio January 1995 (has links)
No description available.
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Experiences of family members of adult children in forensic services and their interactions with mental health professionalsFinlay-Carruthers, Gemma January 2016 (has links)
The importance of family caregiver involvement in (secure) mental health services has been increasingly recognised and there is a wide consensus that family caregivers should be seen by clinicians as partners in the care of patients (Harvey & Ramsay, 2004). Mental health carers however, especially those caring for relatives who are subject to compulsory care and treatment, often feel overlooked and marginalised, caring in complex circumstances with little or no support. This thesis focuses specifically on the views and experiences of parents of adult children in forensic mental health services. A structured review and synthesis of qualitative studies was undertaken to develop insight into the perceived level of involvement in care, from the perspective of family members of mental health service users. The review also examines family carers’ relationships and engagement with mental health professionals. This highlighted that the practices of some professionals contribute to the distress experienced by caregivers in this marginalised group. The empirical research study, employed a qualitative design conducted within the framework of IPA, and explored what it is like for parents with an adult son or daughter with mental illness and offending background detained in a regional medium secure unit. Findings indicated that parents’ experiences were characterised by a strained relationship with mental health services, accompanied by practical difficulties in getting help in the first place, and conflicting emotions felt in response to their unwell family member’s continued detention in the forensic care setting. Following on from this, a case study describes brief family psycho-education in secure care and illustrates how staff in forensic services can collaborate with parents more empathetically and effectively. Afterwards, the Family Relations Test, an instrument that assesses affective relations from the child’s perspective is critically reviewed. The utility of this tool in clinical practice is remarked upon. In the concluding chapter, the ways in which service delivery and research can be influenced by ‘giving a voice’ to parents of forensic clients is explored, and implications of the findings are discussed with reference to the current recognition of family and social inclusion.
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The forensic relevance of sexual fantasy : internal mental models, self-representation and personalitySowemimo, S. January 2016 (has links)
Practitioners working within forensic environments will be acutely aware of the diverse risks, complex treatment needs and unique responsivity issues found within the multifaceted marginal group of sexual offenders. Deviant sexual fantasy (DSF) is considered to be important in the assessment and treatment of sexual offenders. Despite the recent growth in research, conclusions remain inconsistent on the significance of fantasy in offending behaviour. Furthermore, the underlying structural components of fantasy remain relatively unexplored. The aim of this thesis was to explore the forensic relevance of the fantasy phenomenon predominantly related to sexual offending populations. This was done by investigating the cognitive components of fantasy in regards to the intersection between fantasy, cognition, personality and self-representation (the latter constructs being considered as reflections of individual internal mental models). Chapter one provided a context to the thesis by presenting an argument that fantasy is forensically relevant in terms of implicit beliefs (offence supportive), cognitions (cognitive distortions, offence supportive beliefs) and personality organisation and functioning (e.g. coping mechanisms). Chapter two detailed a literature review following a systematic approach, exploring the role of fantasy within sexual offending behaviour. Sixteen studies were included in the review. An associative relationship was found between offence supportive fantasy and sex offending behaviour. Personality (among others) was identified as one of the moderating factors within this relationship. However, key methodological limitations with the included studies were discussed. Chapter three utilised a case study approach to consider the complexities of assessment and treatment for a medium risk internet sexual offender (ST). This chapter explored ST’s vulnerabilities in depth (low self-esteem, interpersonal difficulties, emotional dysregulation, rigid cognitive style) and provided a comprehensive assessment and formulation of risk (fantasy experiences reinforce offence supportive attitudes and cognitive distortions). Results suggested that fantasy could be mapped onto personality, organisation and functioning. ST’s fantasy life was considered a latent variable that only became an acute and dynamic risk factor when combined with his distorted attitudes. Chapter four detailed a critique of the MCMI-III. Specific emphasis was placed on assessing the utility of the measure within forensic settings and how this could supplement assessment of fantasy experiences. The tool was found to be psychometrically stable, however it was suggested that use with a sex offender population is approached with caution. Chapter five investigated associations between personality, fantasy proneness and sexual fantasies, in addition to exploring the function and structural components of sexual fantasy. An anonymous electronic questionnaire (containing several psychometric questionnaires e.g. IPIP-50, WSFQ, CEQ) was presented online for a period of 12 weeks. 259 males participated in the study. Links to fantasy proneness, certain personality markers (e.g. agreeableness, intellect/imagination) and early abusive experiences were found. Static fantasy experiences were associated with conscientiousness. Behavioural expression of fantasy was associated with extraversion. ‘Vividness’ of sexual fantasy was explained by the following themes: 1) Boundaries of imagination 2) Context 3) Structure of fantasy and, 4) Fantasy-Reality distinction. Finally, chapter six provides a conclusion to the thesis by summarising the main findings, with particular emphasis on how findings relate more directly to the fantasy phenomenon. The main suppositions and recommendations are as follows: • Fantasies prime self-other associations. Thus, indirect measures of fantasy may be useful and allow the cognitive mapping of fantasy. • A tiered definition of offence related fantasy is recommended pertaining to frequency, vividness, level of intrusion and the risk relevance. • Control (and disintegration of), coping and cognitive capabilities are implicated as important concepts for fantasy prone individuals. To a certain point, offence related fantasy may act as a protective factor for some individuals, until the fantasy can no longer satiate their needs. • The temporal ordering of fantasy function is important in determining risk relevance pertaining to protective factors (emotional regulation), risk inducing factors (priming offender identity) and high risk situations. • Fantasy generation is a skill; the more involvement an individual has with their internal world the more adept they will be at generating complex fantasy experiences and, in turn, the more enmeshed fantasy and reality can become. • Grounding techniques and acceptance commitment therapy may be a useful treatment recommendation for individuals that experience offence related fantasy. Discussion is augmented within contemporary theoretical perspectives in order to consider clinical implications. Limitations of the current thesis and recommendations for future research are also outlined.
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Anger dysfunction and its treatment among offendersSammut Henwood, Kevin January 2016 (has links)
This thesis sought to explore the effectiveness of CBT based anger management interventions with offenders. This was achieved in part through a random control trial on a sample of 24 community based male offenders, screened for dysfunctional anger. Statistical analysis revealed significant post-intervention reductions for both Groups in the reported anger symptoms and a substantial overall treatment effect noted (r = .89). The intervention used in the RCT was adapted to provide treatment for a female offender (N=1). An in-depth formulation of the case study facilitated the adaptation of the programme for the female offender. The case study was assessed at baseline, after the intervention and after a period of follow-up. The results obtained indicated clinically significant changes which seemed to justify the formal adaption of the programme. A psychometric critique also delved in the suitability of using the Anger Disorder Scales (Di Giuseppe & Tafrate, 2004) as the main measure of anger in the research and case study. Its reliability and validity and its strengths in terms of developing in-depth formulation of offenders’ anger dysfunction were discussed. The research and case study used psychometric measures to assess the efficacy of interventions. Thus, to compensate for the reliance on self-reported measures, the systematic review and meta-analysis explored the effectiveness of CBT based interventions by analysing long-term behavioural changes of interventions as measured through general and violent recidivism. All the included studies (n=14) were submitted to a quality assessment prior to extracting the required information. An overall risk reduction of 23% was estimated for general recidivism (k = 7; n = 1836; RR = .77; 95% CI .61 to .96) and 28% for violent recidivism (k = 7; n = 1888; RR = .72; 95% CI .55 to .93) following treatment. Furthermore the risk reduction for general recidivism increased to 42% (k = 6; n = 703; RR = .58; 95% CI .39 to .87) and increased to 56% for violent recidivism (k = 6; n = 1029; RR = .44; 95% CI .27 to .71) for those offenders completing treatment compared to treatment drop-outs. The magnitude of effect in the included studies also compared lower intensity programmes such as anger management with more intensive violence prevention programmes. Conclusions of this meta-analysis were discussed in terms of the economic viability of interventions and magnitude of treatment effects.
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An exploration of the impact of complex psychological trauma on violent malesGarcha, Enderdeep January 2016 (has links)
This thesis explores the role of complex psychological trauma (CPT) and violence within male adult offenders. It aims to investigate the impact of CPT in better understanding the trauma-violence relationship. Chapter 1 provides an introduction to the topic of CPT and violence. Chapter 2 is a systematic review that investigates the prevalence of CPT in violent males and reviews the existing evidence for the trauma-violence relationship. This review provides some evidence for the trauma-violence relationship, finding that CPT correlated with violent outcomes. Physical neglect correctly classified violent offenders by offence status, whilst physical abuse, emotional abuse and sexual abuse were also found to be associated with violent offending. The findings regarding CPT predicting violent offending were mixed, whilst a higher percentage of studies supported the trauma- violence notion, a minority number of studies did not. The evidence for CPT predicting violent behaviour in custody was more consistently shown across studies assessing this outcome. The role of mediating and moderating factors in the trauma-violence relationship were also investigated, finding that psychopathy, age, substance misuse, genetic factors, and positive criminal thinking styles and attitudes accounted for some variances. Following this review, Chapter 3 includes a Thematic Analysis (TA) investigating forensic nursing staff’s perceptions of the impact of CPT on forensic male offenders with a diagnosis of personality disorder, particularly with regards to violent behaviour whilst detained in a mental health high-secure hospital. Nursing staff’s experiences of managing patient distress and violence were also explored. The findings illustrate that nursing staff believed patient distress and violent behaviour were associated with CPT experiences, suggesting that the impact of CPT on attachment, biological, cognitive and affective aspects of functioning during development, served to account for the difficulties that patients faced in adulthood and increased the likelihood of violence. On-going prevention strategies were found to be most important and more effective than short-term risk management steps. The management of patient distress in the context of the therapeutic relationship was illustrated as a significant component for promoting recovery and successfully managing challenging behaviours. Aspects of the secure environment that imitated abuse experiences were also perceived to significantly contribute to the occurrence of violent behaviour. Change with regards to transitioning and progressing through the system was identified to evoke trauma-related fears of moving on. The fear of moving on and its association with trauma experiences was explored in a single case study of a male violent offender with personality disorder, which is presented in Chapter 4. This chapter aimed to identify and outline the offender’s fears about transitioning from a high-secure hospital to a medium-secure unit (MSU), and understanding the factors that contributed to and maintained the client’s fears. The client’s fears were found to relate to previous-trauma related experiences, although interpersonal violence and trauma experiences in the prison environment were found to be a deep rooted aspect of the client’s concerns about moving on. Whilst the client feared being vulnerable to abuse, threat and further ‘persecution’, the fear of being unable to manage his behaviour (e.g. aggression) in response to this and cope with such potential experiences outside of the high-secure environment and subsequent consequences of not being able to cope (arrest and transfer to prison), was perceived to be a more frightening prospect. Upon exploring fears of moving on, the client’s existing cognitive-behavioural relapse prevention (RP) plan was reviewed in assisting the client to revisit skills and coping strategies that can be used to prepare and avoid high-risk situations. This work contributed to understanding the ways to best support the client in making a successful transition to a MSU. Key considerations and recommendations are made at the end of the chapter with regards to the case. Following this, Chapter 5 outlines a critique of the Coping Inventory for Stressful Situations (CISS; Endler & Parker, 1999), which was used in Chapter 4 as it provides a measure of coping with stressful, distressing or painful situations. The CISS is examined with regards to its purpose, reliability and validity in terms of its research uses. Chapter 6 provides a discussion of the thesis findings, outlining the implications of the research and providing recommendations for future research.
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Delusional thinking in violent offending : implications for risk assessment and treatmentHepburn, Eve E. January 2016 (has links)
The impact of delusional thinking on the violent behaviour of individuals with psychiatric diagnoses has been explored using a variety of investigative methods. The notion that delusions play a role in an individual’s violent offending has been broadly upheld within the work of this thesis. The nature or function of delusions in this process appears to be affected by a range of mediating and moderating factors. The complexity of these was illustrated during the conduction of a case study. Advances in the understanding of mental disorder as a continuum, alongside the developments of risk assessment and management approaches, seem to provide the potential for an optimum vantage point to formulate the true role of delusions in the cognitive process. Future research should avoid utilising the overarching themes of psychiatric diagnoses or sets of symptoms to explore violence and should focus on considering the functions of individual symptoms or characteristics, as many of these overlap with other clinical and nonclinical populations.
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The effectiveness of nicotine replacement therapy during pregnancy : investigating the role of nicotine substitution, nicotine metabolism and pregnant smokers' experiencesBowker, Katharine January 2016 (has links)
Nicotine replacement therapy (NRT) is effective in non-pregnant populations at assisting smoking cessation, but there is no evidence that NRT can help pregnant smokers to stop. Nicotine metabolism increases during pregnancy, and so the nicotine dose delivered by NRT could be insufficient for ameliorating withdrawal symptoms. However, little is known about the level of nicotine substitution provided by NRT or the pattern of nicotine metabolism during pregnancy. Also low adherence to NRT may explain why NRT does not appear to be effective. The overall aim of this thesis was to increase understanding as to why NRT does not appear to be effective during pregnancy. The thesis consists of three studies. The first study involved analysing data on 33 pregnant participants from the NRT arm of a randomised control trial who had stopped smoking and were still using 15mg/16hr nicotine patches 1 month after quitting. Salivary cotinine levels when smoking at baseline were compared with levels on NRT at 1 month. Cotinine levels were lower than those achieved from smoking (median 98.5ng/ml while smoking and 62.8ng/ml while using NRT and remaining abstinent, p = 0.045). The second study involved 101 pregnant smokers, who were asked to provide saliva samples to measure NMR at 8-14 weeks, 18-22 weeks , 32-36 weeks gestation, 4 weeks postpartum and 12 weeks postpartum . Compared with NMR at 12 weeks postpartum, NMR was significantly higher at 18-22 weeks (26% higher, 95% CI 12% to 38%) and 32-36 weeks (23% higher, 95% CI 9% to 35%). There was no difference between the 8-14 weeks gestation or 4 weeks postpartum NMR and 12 weeks postpartum. The third study was a qualitative study that involved semi-structured telephone interviews with 14 pregnant smokers who had recently been prescribed NRT, but self-reported low NRT adherence or discontinuing treatment prematurely. Thematic analysis was used to analyse data. Most smoked regularly while using NRT and many used NRT to cut down their cigarette intake rather than to quit abruptly. Some were concerned that using NRT instead of smoking could actually increase their nicotine dependency or cause greater harm to the fetus, and consequently often underutilised NRT. This thesis supports the hypothesis that NRT at standard doses may be ineffective in pregnancy due to increased metabolism. The effectiveness of NRT may be hindered by the way in which NRT is used in pregnancy.
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Conversational resources of two-person psychotherapyKatz, Bruce Allen January 1971 (has links)
The research reported here takes as its data tape-recordings and transcripts of a number of two-person psychiatric interviews, conducted by two psychiatrists with a number of patients of both sexes. The transcripts are analysed by reference to speech acts as units, and the emphasis is on properties common to all speech in natural language. An attempt is made to show (a) that by reference to such unit acts, psychiatric events can be made intelligible, and (b) that an analysis along these lines is in principle capable of "explaining" the interactional mechanisms of the psychiatric interview, without recourse to psychiatric theory as part of the analytic apparatus.
Among issues given special attention are (1) the opening of the psychiatric interview and its consequentiality for further developments, (2) the negotiated character of topics and the availability of interactional devices for controlling topical development, and (3) the accomplishment of "treatment" through "talk".
Findings are reported with respect to each of these issues, but the report should be read chiefly as an exercise in the application of a method of socio-linguistic analysis to a type of data usually reserved for substantive treatment in the area of social psychiatry. / Arts, Faculty of / Sociology, Department of / Graduate
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