published_or_final_version / Nursing Studies / Master / Master of Nursing

This qualitative study is an attempt to explore the adaptive experiences of elderly Chinese caregivers who have to take care of their spousal partners who are suffering from Alzheimer’s disease (AD). As the illness is known to be chronic and degenerative in nature, caregivers are thus faced with many stressful situations and adjustments are necessary. The purpose of this study is to examine how these caregivers in AD situations are interpreting the factors that might have influenced their adjustments. The sample consists of 26 participants aged 60 and above that have been a primary caregiver for not less than a year. Three in-depth interviews were conducted with each participant during the study period, which lasted for about two years. Findings show that most of them had to adjust to stressful situations in various aspects of life. They also developed many strategies for life adaption, which can be summarized in the following six adjustment themes. First, after hearing the AD diagnosis, they initially experienced a series of shocks and false hopes, and subsequent adjustments include eliminating uncertainty, establishing reasonable expectations toward both the disease and treatment, learning to take on the caregiver role, and finally, separating the disease from their partner’s personality. Second, these elderly caregivers gradually learned to attain inner peace through converting to various religions, searching for meanings within their stressful situations, and reconstructing rational explanations for their negative emotions. Third, in the area of spousal interaction, adaptive strategies included staying connected with their sick partners, reinforcing their caregiving motivations, completing the “familiar-strange-familiar” cycle, and re-establishing daily routines. Fourth, in situations involving other family members, such as adult children, the adjustment strategies included sharing economic burdens, re-allocating housework chores, delegating care responsibilities, and emotionally supporting one another. Fifth, in terms of social network, the main support that caregivers received usually came from informal sources; formal support is extremely limited. Findings further show a connection between the input and output of social support and personal capacity. Sixth, elderly spousal caregivers often possessed the ability to re-position and re-construct their self-confidence while adjusting to their new life rhythm. They were also able to achieve a balance between their private lives and their care responsibilities, which helps to maintain their well-being and neutralize their distresses. In summary, participants of the study often utilized more than one strategy in adjusting to their situations. The six aspects of adjustments are thus put together in this study as an integrated model of life adaptation and survival tactics adopted by elderly Chinese AD spousal caregivers. Also, whether these caregivers are successful in adapting depends on their abilities to accept changes in themselves and their environment, and achieve a compromise between the two. Based on the above findings, a culturally sensitive perspective is thus put forward to enhance the understanding of studied phenomenon within the contemporary Chinese context. Recommendations are also made regarding the needed policy changes and the revisions of social work practices in support of the elderly suffering from AD and their caregiving spouses. / published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

No description available.

The purpose of this qualitative research is to provide an in-depth exploration of the impact that a diagnosis of a terminal illness has on family functioning. The goal is to gain insight into adult children's personal experience when a parent is diagnosed with a terminal form of cancer. This study explores how families respond, adapt and cope when this specific family member is diagnosed with a terminal illness. It also explores any significant changes in relationships within the family and any shifts in the roles of the members and how they adjusted to such shifts. / The study is informed by a phenomenological paradigm and used an explorative, qualitative design, which included semi-structured interviews. Participant text and "found poetry" is used in order to present a more accurate account of the participants' experiences. Found poetry provides an opportunity to hear the participant's voices by taking direct quotes from their transcripts and forming them into a poem. Themes of denial, anger, helplessness, hope and anticipatory grief/mourning are portrayed in the findings of this study. The difficult emotional dilemmas and tensions that people have to work through when faced with a family member dying are discussed. The realization of the loss of future relationships will be identified as one of the greatest impacts of the illness. This study shows the lack of professional supports and resources that are available for each participant's family in being faced with the diagnosis of a terminal illness, and will address a needed consideration for social work practice.

This interpretive descriptive study explored the meaning and lived experience of breast cancer for 5 mothers and their 5 adolescent daughters, and for these mother-daughter relationships. Mothers had been diagnosed with breast cancer between 2 and 6 years ago, and their daughters were between 11 and 13 years old at the time of the diagnosis. A series of six in-depth interviews with mothers and daughters, conducted both jointly and separately, afforded a view of aspects of experience that were shared and privately held. Interview data were supplemented with participants' drawings of their experience, and the researcher's observations. The interpretive descriptive framework employed was augmented with the lens of portraiture in the conduct of study, data analysis, and composition of the product of inquiry. Portraiture utilizes five essential features: voice, relationship, context, emergent themes, and aesthetic whole. Individual and relational experience and meaning were described in four themes: (a) Inhabiting Another Landscape, (b) Intending and Acting, (c) Acquiring Wisdom, and (d) Enduring Mother-Daughter Relationships. The theme of Inhabiting Another Landscape described a trajectory of experience and meaning that began with diagnosis, persisted through prolonged effects of treatment, and continued in the present and into imagined futures. Mothers and daughters had privately held concerns about the mothers' breast cancer and the possibility that breast cancer might one day visit daughters as well. The most prominent reminder of vulnerability was recurrence among friends in the social networks of breast cancer. The theme of Intending and Acting described the mutual caring and protectiveness of these mothers and daughters. Mothers and daughters described actions and strategies to minimize the threat of breast cancer for themselves and for the other person. Actions included attempts by both persons to create and maintain a sense of normalcy. Conversations between mothers and daughters on the experience of breast cancer were limited, in particular around prognosis and the possibility of death. The theme of Acquiring Wisdom described personal growth and change after the diagnosis of breast cancer. For both persons, realizations of mortality brought a new perspective on what was important in life. Mothers passed on the wisdom gained from their experience either directly in what was said to daughters or indirectly in the attitudes and behaviours they modelled. The theme of Enduring Mother-Daughter Relationships described the quality of mother-daughter relationships and the import of breast cancer for these relationships. Mothers and daughters described their relationships as close. Daughters described their relationships as closer than most, in part because of their experience with breast cancer. Parenting and being parented was in some cases complicated by breast cancer. Friction between mothers and daughters was described as par for the course during the teen years, but one source of friction was the unexpected and prolonged effects of treatment. The findings in this study indicate the value in attending to the voices of teenage daughters, which remain largely absent in the literature. Mothers and daughters have needs for information and support that are not being met. The emotional landscape of breast cancer, which entails prolonged uncertainty for both mothers and daughters, deserves further study. Personal growth described by both mothers and daughters provides an alternative view of the largely problem-focused perspective in the literature of the meaning and experience of breast cancer.

The need for a family therapeutic counselling programme in the management of HIV/AIDS was established by the researcher in 2001 (den Hollander 2001). The focus of this study was to develop the training programme model in family therapeutic counselling for church leaders and lay counsellors. This was accomplished using a variety of samples and research instruments, by firstly exploring the issues and problems facing people and families living with HIV/AIDS and then how best churches could respond as faith-based community organizations. At a theoretical level, this study sought to compare the paradigms of contextual and narrative family therapy with the theory and practice of social work and practical narrative theology, in order to integrate these paradigms into an incorporated response to the HIV/AIDS pandemic. The main research methodology was the Intervention Research Model as adapted from De Vos (2001). This model consists of six phases, consisting of problem analysis and project planning, information gathering and synthesis, design, early development and pilot testing, evaluation and advanced development, and dissemination of the training model. During the analysis phase an extensive literature research, as well as several field studies, both quantitative and qualitative were conducted. During the development phase, three pilot studies were designed and performed, in attempt to accommodate the context specific problems of different families and communities. The results of these two phases indicated a need for pastoral training in family therapeutic counselling, specifically in the areas of mental health, trauma and bereavement and child participation. Importantly, the need to intervene meaningfully to alleviate structural problems such as poverty and food insecurity were clearly indicated, with the study recommendation being for active networking across all stakeholders so that therapeutic counselling may work in tandem with these community based efforts. Recommendations in respect of offering such training are to provide a comprehensive structure of training, supervision and counselling practice. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2009.

This study examines the experience of individuals who participated or did not participate in the caregiving process for a family member who died within approximately the past three years of an AIDS-related illness. The focus of this study is on the adjustment of the caregivers and non-caregivers after the death of the PWA. It was hypothesized that due to their direct involvement in the caregiving process, caregivers would differ significantly from non-caregivers on a number of measures designed to evaluate adjustment. It was hypothesized that caregivers would report better overall adjustment than non-caregivers.Participants completed the Symptom Checklist 90 (SCL-90; Derogatis, Lipman, & Covi, 1973), as well as a semi-structured interview about their experiences. A two-tailed t-test revealed no significant differences between groups. However, effect sizes computed for these variables revealed moderate to large diff ererences between caregivers and non-caregivers on the somatization and interpersonal subscales of the SCL-90. Comparisons to a standardization sample showed that caregivers differed significantly on all subscales from that standardization sample: Non-caregivers differed only on the depression and interpersonal sensitivity subscales. Analysis of the interview data revealed a significant difference in reported stress, with caregivers reporting significantly more stress during the illness of the PWA than non-caregivers. Effect sizes were computed for nine other interview categories; these suggested that caregiversreported substantially less social withdrawal, fewer feelings of guilt, fewer problems resolving issues with the PWA, substantially more physical illness, and more life affirming statements than their non-caregiver counterparts. Several other noteworthy trends that emerged in the interview portion of the study are discussed.Small sample size and pre-existing characteristics of the participants are explored as possible factors affecting the outcome of the study. More controlled studies exploring the adjustment of caregivers and non-caregivers are needed in order to better understand the possible differences that may exist between caregivers and non-caregivers in terms of adjustment after the death of their loved one from an AIDS-related illness. / Department of Psychological Science

The purpose of this study was to investigate the influence of gender, time since diagnosis, and the family environment on the psychosocial adaptation of cancer patients. This study was important because there is a deficit in the literature investigating the effects of the family environment on psychosocial adaptation in male and female cancer patients with diverse diagnoses. This study measured psychosocial adaptation by the patient's ability to adjust to cancer-related stressors in the areas of social relationships, involvement in health care, psychological well-being, household and work related duties, and family relationships. The family environment was measured by the patient's perceived level of cohesion, expressiveness, and conflict in the family.The study's sample consisted of 149 stage I or II cancer patients over the age of 50 with no prior cancer diagnosis, recurrence, or metastases. Participants completed a set of questionnaires, including the Psychosocial Adjustment to Illness Scale and the Family Relationship Index. The combination of gender, time since diagnosis, and the family environment, with demographic variables held constant, was significant and accounted for nearly one-third (27 %) of the variance in cancer patients' psychosocial adaptation. Results showed that the family environment is a significant predictor of psychosocial adaptation in cancer patients. Gender and time since diagnosis were not significantly related to psychosocial adaptation. Implications from this study are offered. / Department of Counseling Psychology and Guidance Services

There is no abstract available for this dissertation. / Department of Counseling Psychology and Guidance Services

Given the limited empirical evidence to guide support for romantic functioning in Autism Spectrum Disorder (ASD), this research aims to explore how closeness is managed in romantic relationships when one member is diagnosed with ASD. 8 participants, 3 couples and 2 individuals aged between 26 and 80 took part in the study. Of these 5 (3 male and 2 female) were autistic and 3 (1 male and 2 females were non-autistic). Participants were recruited using a specialist nationwide organization and they were interviewed individually or conjointly, as well as observed during a 15- minute interaction. Constructivist grounded theory was used to analyse the data and a framework was produced to describe processes of managing closeness in ASD. The core concept to emerge from the analysis was entitled “reaching towards the unknown”. It consisted of three categories, termed “encountering the other”, “reaching for understanding” and “managing uncertainty”. The framework captured processes of joining with and adapting to someone very different, of stretching beyond familiar bounds in order to understand the other and manage uncertainty. This research offers an inter-subjective perspective of ASD. It frames socio-emotional reciprocity and adaptability within romantic relationships as relational phenomena, which are contingent upon factors outlined within the framework. The model considers pre-existing theories about romantic closeness in order to assist counselling psychologists in accommodating ASD within their couple therapy practice.