published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Nursing Studies / Master / Master of Nursing

In mainland China, around 20,000 infants with non-syndromic cleft lip and/or palate are born every year. There is a great clinical need for the rigorous investigation of the speech problems in this population. This thesis aimed to investigate the consonant misarticulations in native Putonghua speakers with repaired cleft palate based on a research project comprised of four studies. Misarticulations associated with cleft palate are well established for English and several other Indo-European languages. However, few research articles describing the articulation of Putonghua (standard Mandarin Chinese) speakers with cleft palate have been published in English language journals. Study One reviewed relevant studies published over the past 30 years in Chinese language journals. Thirty-seven articles were analyzed and coded on a number of methodological variables. This critical review identified many methodological issues. These design flaws made it difficult to draw reliable conclusions about characteristic articulation errors. Seeing the methodological shortcomings found in Study One, a cross-sectional approach was used in Study Two to identify common consonant error patterns. Thirty-two speakers with repaired cleft palate were allocated to four groups dependent on age and the type of cleft. Articulation was evaluated based on the Putonghua Segmental Phonology Test and the Deep Test for Cleft Palate Speakers in Putonghua. The data were transcribed using International Phonetic Alphabet conventions by two experienced examiners. Several ‘language universal’ findings were identified. In addition, distinctive features in Putonghua phonology appeared to contribute to the observed language specific error patterns. The following two studies focused on the particularly vulnerable manner of articulation: affricates. The results from Study Three showed that distorted affricates from speakers with repaired cleft palate exhibited distinctive spectral features compared to typical articulation. These spectral findings added objective evidence to support the articulation deviation noted in Study Two. Study Four examined the relationship between spectral moments and perceptual judgment of accuracy for the place of affricate and to explore whether listeners relied on different spectral moments to perceive place of articulation. Both typical and distorted affricates were played to twelve listeners to make a judgment of articulation accuracy using visual analog scaling. Results showed that the third spectral moment (L3) was significantly correlated with perceptual rating of accuracy of place information from typical speakers. For affricates produced by speakers with cleft palate, the first moment (M1) showed a significantly correlation with perceptual judgment of the accuracy of alveolar affricates. Recommendations concerning methodological issues in the perceptual investigation of cleft palate speech were given in the systematic review. For the first time, the speech error study demonstrated the influence of language-specific features on Putonghua cleft palate speech. The spectral study contributed to our understanding of the differences in affricate production between speakers with cleft and their typical speaking peers. The investigation of the relationship between spectral features and the perception of alveolar and retroflex affricates provided specific clinical directions for establishing the correct place of articulation. Further research is needed to explore the contribution of other variables (e.g., age of palatoplasty) to the error patterns identified in the present study. / published_or_final_version / Speech and Hearing Sciences / Doctoral / Doctor of Philosophy

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Loss of control is a well-documented human response to hospitalization. The purpose of this study was to construct and test a theoretical model of perceived territorial control among hospitalized adults. Territorial control was defined as the freedom or choice one has in regulating or influencing the objects, activities, and social intereactions within a particular space claimed or identified as one's own. The space of concern in this study was the patient's hospital room. The study focused not on the negative aspects of a loss of control but on the positive outcomes of having a sense of control. A three-stage, multivariate, causal-modeling design was used to estimate the impact of perceived territorial control on state anxiety and satisfaction with care in a convenience sample of 80 Hispanic and Anglo-American males and females between the ages of 18 and 79 who were in the hospital for short-term orthopedic care. Attitudinal, self-report measures were used predominantly. Instruments were constructed to index centrality of territory and territorial control perceptions. Correlational and multiple regression statistical techniques were used to estimate the theoretical model. Tests for violations of the statistical and causal assumptions were performed. Centrality of territory, assistance needs, and the powerful others locus of control significantly influenced patient territorial control perceptions. Temporal duration, internal locus of control, and chance locus of control made no significant impact on perceived territorial control. Patient territorial control perceptions significantly decreased state anxiety and significantly increased satisfaction with care. Perceived territorial control explained 24 percent of the variance in patient state anxiety and 21 percent of the variance in satisfaction with care. An unstaged, empirical test of the model increased the explained variance to 32 percent for state anxiety and 40 percent for satisfaction with care. There was a positive relationship (r = .41) between age and centrality of territory and a negative relationship (r = -.31) between age and state anxiety. The implications were related primarily to continued theory-building and the development of nursing practice theories.

This study assessed the psychological problems associated with hemodialysis and included an investigation of the differences and similarities between (1) dialysis patients' and medical staff's perceptions of patients' problems, and (2) the problems of hemodialysis patients and spinal cord injury patients. Data were collected from 31 adult hemodialysis patients, 34 dialysis medical staff and 32 spinal cord injury patients at the Miami, Florida Veterans Administration Medical Center. The scaling technique of magnitude estimation was used to measure patients' and staff's perceptions of the relative seriousness of various illness-related problems. Depression and anxiety in hemodialysis patients and spinal cord injury patients were measured by standardized self-report inventories. Among the most significant findings were that: (1) Dialysis patients judged problems concerning lifestyle changes (e.g., inability to travel and work) and loss of body function (e.g., reduced levels of physical activity) to be more serious or emotionally distressing than other problems they experienced. (2) Dialysis patients and medical staff differed significantly in their perceptions of the seriousness of most problems associated with hemodialysis; moreover, there was less agreement between patients and physicians than between patients and other types of staff (e.g., nurses and technicians). (3) There were no significant differences between dialysis patients and spinal cord injury patients in their scaled problem judgments. (4) Depression in hemodialysis patients and spinal cord injury patients was greater than for the general population, with the majority of both patient groups meeting criteria for diagnosis of clinical depression. In addition, although dialysis patients and spinal cord injury patients did not differ significantly in their total mean depression scores, dialysis patients endorsed somatic components of depression more frequently and/or with greater intensity than spinal cord injury patients did. (5) Anxiety in dialysis patients was not greater than for the general population and was significantly less than for spinal cord injury patients. (6) Depression and anxiety were positively related to most problems for hemodialysis patients, while anxiety, but not depression, was significantly associated with most problems for spinal cord injury patients. A major contribution of this study is the comparison, for the first time, of patients' and medical staff's scaled problem judgments.

It was proposed that the optimal matching of psychotherapy approach to selected patient characteristics results in improved treatment outcome. Three patient dimensions were identified as contributing specific predictive power in determining the effectiveness of several types of treatment: symptom complexity, style of psychological defense, and reactance potential. Symptom complexity level was held relatively constant by studying a sample of psychiatric inpatients, who were admitted to a teaching hospital for short-term care and treated in individual psychotherapy by psychiatric residents and psychology interns. Patient defensive style was assessed in terms of an internalization/externalization ratio, derived from patient MMPI scores, and was hypothesized to differentially affect outcome depending on the degree of patient-therapist match in terms of an internalized versus externalized focus of therapeutic approach. Patient reactance potential was assessed by the Control Wanted subscale of the FIRO-B, and was hypothesized to be optimally matched by varying levels of therapy directiveness. Therapeutic approach was assessed by scores on the Theoretical Orientation Questionnaire. Outcome was assessed by three independent sources: therapist discharge ratings of global improvement, pre- and posttreatment patient ratings on a standardized symptom index, and nurses' ratings of ward behavior at the beginning and end of treatment. These measures constituted the dependent variables in a series of multiple regression analyses, which also included a number of patient background and collateral treatment variables as potential predictors. Results indicated that, after accounting for pretreatment levels of disturbance, the match between patient defensive style and internal/external focus of therapeutic approach was a significant predictor of treatment outcome. The degree of patient-therapist match on this dimension accounted for 9% and 8% of the variability in posttreatment measures of patient symptomatology and ward behavior, respectively. Matching with respect to patient reactance potential and therapy directiveness was not seen to affect outcome, and no effects due to matching were observed for therapists' ratings. Results are discussed in terms of validity and reliability of the ratings, problems in assessment from the different vantage points of patient/therapist/observer, and biases deriving from the use of self-report instruments.

This study examined changes in adult learning, adaptation, and anxiety that occurred as the result of the adult cancer education program "I Can Cope." The study utilized a repeated measures descriptive design. A volunteer sample of 19 subjects participated in this study. Changes in each person's pre-mid-post-test scores were measured against their pre-mid-post-test scores on three instruments: (a) Course Inquiry Test; (b) Purpose in Life Test; and (c) A-State Anxiety Inventory. A comparison of scores measured whether any short-term adult learning, adaptation and change in anxiety occurred as a result of the "I Can Cope" Program. The study did demonstrate that an organized adult patient education program could foster and enhance adult learning and adaptation as well as influence anxiety of participants.

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No description available.