published_or_final_version / Social Work / Master / Master of Social Sciences

Mode of access: World Wide Web. / Thesis (Ph. D.)--University of Hawaii at Manoa, 2005. / Evidence suggests that routine screening of primary care patients for exposure to traumatic life events, and particularly assaultive trauma, may yield both clinical and cost benefits for healthcare systems (e.g., Green, Epstein, Krupnick, & Rowland, 1997; Lecrubier, 2004). However, although advocated by authorities, such screening has yet to be widely adopted. A sample of female university healthcare patients (N = 339) was assessed for exposure to trauma in order to examine several unaddressed issues that may diminish the clinical utility of screening for trauma in primary care patients. First, because the length of the traditional trauma history assessment makes it less acceptable for use in time-pressured primary care settings, the discriminative validity of a brief, self-administered screening question about exposure to trauma, the Structured Clinical Interview for DSM-IV (SCID) posttraumatic stress disorder (PTSD) module's screening question (First, Spitzer, Williams & Gibbon, 1997) was compared to a longer, inventory method of assessment, the Traumatic Life Events Questionnaire (TLEQ, Kubany et al., 2000). Second, because it is unclear whether patients who have experienced assaultive trauma will disclose these experiences when asked in a primary care setting, the relative predictive efficacy of informing respondents that their responses would, or would not be, disclosed to health center personnel was evaluated. Two versions of the brief screening question were assessed across two instructional sets regarding disclosure, to determine each condition's relative classification accuracy for identifying respondents who reported experiences of sexual or physical assault, and/or symptoms of PTSD. The brief screen identified more than three-quarters of the survivors of traumatic assault; and more importantly, identified almost all of the women who reported significant PTSD symptomatology: the inventory method identified only 2 additional women of the 47 who met criteria for PTSD. Although survivors of sexual assault were significantly less likely to disclose their history to their provider, no differences were found for those assault survivors who also reported symptoms of PTSD. Results suggest that a brief screening question about traumatic life events may be an acceptable option in settings where more time-consuming assessment procedures are not practical. / Includes bibliographical references (leaves 83-98). / Electronic reproduction. / Also available by subscription via World Wide Web / x, 98 leaves, bound 29 cm

[Truncated abstract] Physical healthcare uses a suite of tools for measuring response to treatment. However, reliable systems of regular patient monitoring are rare in mental healthcare. Mental health services often measure a treatment response from pre- to post- therapy, yet measurement between those occasions is less common. This omission is problematic since arguably there is a need for an alarm system in psychotherapy (Andrews & Page, 2005). A substantial minority of patients do not experience reliable change following treatment, and a small proportion deteriorates (Hansen, Lambert, & Forman, 2002; Newnham, Harwood, & Page, 2007). Without monitoring, it is not always possible to know which patients are progressing poorly. Since the publication of Howard and colleagues' (1996) proposal that patient progress be monitored routinely during therapy and the results fed back to clinicians to direct treatment, this monitoring regime has garnered attention in the United States and Europe (Lambert, 2007; Lutz, et al., 2006). Findings in outpatient psychotherapy have demonstrated that providing real-time feedback on patient progress to clinicians and patients significantly improves clinical outcomes for those patients demonstrating a negative response to treatment (Harmon et al., 2007; Lambert et al., 2001; Lambert et al., 2002). What is not yet apparent is how these processes would generalize to inpatient and day patient (i.e. patients attending hospital for a whole day of treatment) psychiatric care. Inpatients often present with greater severity and are treated in an intensive setting. ... Deviations from this expected pattern would highlight possible differences between inpatient and outpatient care. To develop an appropriate system for monitoring patient progress, it was important to first define clinically significant recovery in inpatient psychiatric care, and provide criteria for clinicians to judge outcome in routine practice (Newnham, Harwood, & Page, 2007). Second, a quick and easy-to-administer system of progress monitoring and real-time feedback was developed to enhance treatment decision making (Newnham, Hooke, & Page, 2009). Third, the system was evaluated to determine clinical effectiveness. Using the World Health Organization’s Wellbeing Index, a program for monitoring patient progress and providing feedback to clinicians and patients was established at Western Australia's largest private psychiatric service. The sample consisted of 1308 consecutive inpatients and day patients whose primary diagnoses were predominantly depressive (67.7%) and anxiety (25.9%) disorders. Feedback to patients and clinicians was effective in reducing depressive symptoms (F (1,649) = 6.29, p<.05) for those patients at risk of poor outcome, but not effective in improving wellbeing (F (1,569) = 1.14, p>.05). The findings support the use of progress monitoring and feedback in psychiatric care to improve symptom outcomes, but raise questions about changes in wellbeing during psychotherapy. The effectiveness study was conducted as a historical cohort trial, consistent with quality improvement efforts, and replication with a randomized controlled design is warranted. Feedback of progress information appears to be an important process within psychotherapy, and further investigation of the means by which clinicians and patients use that information is necessary.

This study addresses the importance of studies of human psychoneuroimmunology in understanding the role of psychological factors in cancer. Research trends in psychosocial aspects of cancer are reviewed, exploring the role of distress and the support group as an intervention which potentially reduces distress through enhancing interpersonal relationships, emotional adjustment and communication with health professionals, in these ways helping the patient to cope with the symptoms of treatment. In South Africa, most hospitals which treat cancer patients medically do not simultaneously have support groups for the newly diagnosed patient to join in order to discuss immediate fears and acquire more knowledge about their particular disease. Following an experimental cancer support group involving patients who had recently undergone a bone marrow transplant (some considerable time after their first cancer diagnosis) in Cape Town's Groote Schuur Hospital, the researcher, as one of the participants in the fortnightly meetings convened to dicuss psychosocial issues related to each patient's experience of the cancer and transplant process, transferred the themes, concepts and questions that arose in that scenario, to a cancer clinic in Pretoria where recently diagnosed patients were asked to volunteer to participate in such a group. It was felt that these patients would derive some benefit early in their treatment programme. Psychosocial concerns are left to the individual patient to seek therapy should it be required. Presently, it is reported in the body of knowledge about cancer, that interventions aimed at alleviating the psychosocial distress of cancer patients highlight hypnosis, guided imagery and relaxation therapy. It is contended that a more appropriate intervention for the majority of people with cancer in South Africa would entail a fellow-patient support group meeting on a regular basis. / Psychology / (M.A. (Psychology)

Please read the abstract in the section 00front of this document / Dissertation (DPhil (Psychology))--University of Pretoria, 2005. / Psychology / unrestricted

The study purposes were to identify changes in resilience, satisfaction with life (SWL), depression, spirituality, and functional independence (FI) and to examine the relationship between these variables, during the inpatient rehabilitation for a spinal cord injury (SCI). The sample included 42 individuals with a SCI, 33 males and 9 females, who were inpatients with a mean stay of 52 days (SD = 15.78). A repeated measures design was employed with questionnaires completed at three times during rehabilitation. Results indicated that there were significant changes in depression, satisfaction with life, spirituality, and FI during inpatient rehabilitation. Findings also indicated significant correlations between resilience, SWL, spirituality, and depression. Future studies developing interventions, and examining factors that predict resilience could help build resilience and may improve rehabilitation outcomes.

With the increase in survival for children with cancer, part of the focus of current research is aimed towards evaluating how these children are adapting psychosocially. Neurocognitive deficits have been well established. However, there are multiple facets encompassing quality of life, including general mental health, lifestyles and health behaviors, and academic and cognitive functioning. The relationship between neurocognitive and psychosocial functioning has yet to be thoroughly evaluated. The purpose of this study was to investigate the relationship between neurocognitive and psychosocial functioning in survivors of brain tumors and acute lymphoblastic leukemia. Data was collected from existing archival database comprised of patients of the at Cook Children's Medical Center in Texas. The sample consisted of 177 patients between the ages of 3 and 12 who were at least two years post-diagnosis. Measures used included the NEPSY and the Behavioral Assessment for Children. Statistical analyses included a several one-way analysis of variances, an independent samples t-test, a univariate analysis of variance, a hierarchical multiple regression, and odds ratio analyses. Results indicated survivors treated with neurosurgery alone appear to be less at risk for developing behavior problems than other treatment modalities. Also, brain tumor survivors demonstrate more problematic behaviors than survivors of acute lymphoblastic leukemia. Visuospatial functioning, diagnosis, and type of treatment were found to be predictive variables of behavior problems. Attention, and perhaps language, deficits may predispose children to more problems in their behavior. It is concluded that there are other factors affecting behavior in this population that were not accounted for in this analysis. It is recommended for future studies to research the individual clinical scales of the Behavior Assessment System for Children, obtain information from multiple informants, study this relationship longitudinally, and research additional factors that may be influencing the relationship between neurocognitive and psychosocial functioning. This provides evidence of risk factors that should be monitored as the child returns home and to school.

A growing body of research recognizes spirituality as a key element in well-being, but the agency of individual spirituality remains unclear. This study explores the role of embodied knowledge in reality construction and its effect on illness by considering how spirituality as embodied existence shapes reality. Spirituality, as a form of embodied knowing, is shown to reach deeply into the fundamental relatedness of existence. The study argues for a mindbody- spirit unity, making no distinction between self and spirit, emotions and subjective experiences situated in the spirit. As the medium between body and self, spirituality gives form to the felt reality of embodied knowledge and meaning, shaping language, cognition, thought and action towards lived reality. New ways of thinking about eating disorders were stimulated by innovative discoveries through investigating the lived reality of the illness within an epistemology that included subjective experiences as part of reality. While acknowledging the influence of social discourse, the study calls for a recognition of vulnerability in the human condition giving rise to the embodiment of a wounded self or disenabling spirituality, manifested in the development of an eating disorder. It uncovers the anti-spiritual properties involved in the lived reality of people struggling with anorexia/bulimia, evident in social withdrawal and/or self-injury. Behavioural patterns of obsession and repetition underscore similarities to addiction and ritual. The study synthesised pastoral therapy and research. A postmodern approach to illness and a qualitative design with interpretive phenomenology were used. Three young women struggling with anorexia/bulimia participated in semi-structured research interviews. Their narrative accounts provided a chronology of developing, living with and healing from anorexia /bulimia. Emphasis shifted from an approach aimed at fixing the body to focusing on individual experiences of the illness; what she brought to the encounter in her own resources and potential to heal. Healing is envisaged as the ongoing development of a renewed sense of self, an inherently spiritual process orchestrated from within. Previous disassociation of body and self is replaced with reconnection between body, self and other, care of the spirit became care of the body, expressed in harmony and wholeness of being. / Practical Theology / D.Div. (Pastoral therapy)

A growing body of research recognizes spirituality as a key element in well-being, but the agency of individual spirituality remains unclear. This study explores the role of embodied knowledge in reality construction and its effect on illness by considering how spirituality as embodied existence shapes reality. Spirituality, as a form of embodied knowing, is shown to reach deeply into the fundamental relatedness of existence. The study argues for a mindbody- spirit unity, making no distinction between self and spirit, emotions and subjective experiences situated in the spirit. As the medium between body and self, spirituality gives form to the felt reality of embodied knowledge and meaning, shaping language, cognition, thought and action towards lived reality. New ways of thinking about eating disorders were stimulated by innovative discoveries through investigating the lived reality of the illness within an epistemology that included subjective experiences as part of reality. While acknowledging the influence of social discourse, the study calls for a recognition of vulnerability in the human condition giving rise to the embodiment of a wounded self or disenabling spirituality, manifested in the development of an eating disorder. It uncovers the anti-spiritual properties involved in the lived reality of people struggling with anorexia/bulimia, evident in social withdrawal and/or self-injury. Behavioural patterns of obsession and repetition underscore similarities to addiction and ritual. The study synthesised pastoral therapy and research. A postmodern approach to illness and a qualitative design with interpretive phenomenology were used. Three young women struggling with anorexia/bulimia participated in semi-structured research interviews. Their narrative accounts provided a chronology of developing, living with and healing from anorexia /bulimia. Emphasis shifted from an approach aimed at fixing the body to focusing on individual experiences of the illness; what she brought to the encounter in her own resources and potential to heal. Healing is envisaged as the ongoing development of a renewed sense of self, an inherently spiritual process orchestrated from within. Previous disassociation of body and self is replaced with reconnection between body, self and other, care of the spirit became care of the body, expressed in harmony and wholeness of being. / Philosophy, Practical and Systematic Theology / Th. D. (Pastoral therapy)

The abstract on the file is incorrect, use the the one in the system as it summerizes the full text. / This attempted to describe factors contributing to sleep deprivation in the a multidisciplinary intensive care unit in KwaZulu-Natal Province. A quantitative, descriptive research design was adopted and structured interviews were conducted with 34 adult patients. Most factors contributing to these patients' sleep deprivation are basic physiological needs. Much can be done to enhance patients' abilities to sleep if noise (from alarms, monitors, televisions, telephones and footsteps) could be controlled, patients' pain would be managed effectively, doctors would visit the patients regularly, doctors and nurses use lay terms when talking to patients. Visible clocks and windows will help patients to maintain time orientation. Friendly, approachable and respectful nurses who introduce themselves to the patients help' to reduce patients' stress levels and improve their abilities to sleep. / Health Sciences / M.A. (Health Studies)