No description available.

There is no abstract available for this dissertation. / Department of Educational Leadership

There is a paucity of research on the effects of passive relaxation training on the anxiety of patients going through physical rehabilitation. The fourteen participants of this study were Caucasian and between the ages of 45 and 82 years of age. Participants reported levels of anxiety through the use of a self-report instrument called the State-Trait Anxiety Inventory. Measurements were made at four different time periods; on intake, prior to relaxation training, following relaxation training, and at discharge. A two-way Analysis of variance was implemented with time and gender being the independent variables. The results of the study revealed no statistically significant differences. Qualitative reports of the participants feedback and Post-hoc analysis of the data for Pearson's r and Pairwise Comparisons indicate further research is needed to fully determine the effects of passive relaxation training on participant's anxiety. / Department of Counseling Psychology and Guidance Services

An individual who is diagnosed with an inherited bleeding disorder is expected to manage his or her condition on a daily basis. This chronic situation can totally disrupt psychosocial functioning and make it more difficult to adjust to the illness. Other researchers have studied this phenomenon in various other chronic illnesses; however, not in individuals with inherited bleeding disorders (Akkasilpa, et al, 2000, Pollack, 1989a, 1989b). Psychosocial problems are not restricted to individuals with one chronic illness and clinically, it is noted that some individuals adjust to chronic diseases better than others. Individuals living with inherited bleeding disorders may also have other chronic illnesses such as hypertension, asthma, diabetes mellitus (DM), congestive heart failure (CHF), arthritis, and hepatitis A, B, C and/or HN. The aims of this study are to describe health stressors, health related hardiness, perception of illness impact, self perception of health status and psychosocial adjustment to illness in individuals living with an inherited bleeding disorder; to determine relationships between demographic and illness variables, health stressors, health related hardiness, perception of illness impact, self­ perception of health status and psychosocial adjustment to illness; and to determine if perception of illness impact has a direct and/or mediating effect on the relationship between health stressors, health related hardiness, and self-perception ofhealth status and psychosocial adjustment to illness. A cross sectional survey design was used in this study. Sixty individuals of predominantly Asian Pacific Islander ethnicity diagnosed with hemophilia, von Willebrand's Disease, Factor V or as hemophilia carriers comprised the sample which was drawn from the Hemophilia Treatment Center of Hawaii. All participants were asked to complete five questionnaires: Demographic form and illness information, health related hardiness scale (Pollock, 1990), perception of illness impact scale, self-perception of health status and psychosocial adjustment to illness scale (Derogatis, 1990). Higher health stressors were associated with higher perception of illness impact, lower perception of health status and poorer psychosocial adjustment to illness. Individuals with higher hardiness were better adjusted to their illness. Higher perception of illness impact was associated with lower self-perception of health status and poorer psychosocial adjustment to illness. Higher self-perception of health status was associated with better psychosocial adjustment to illness. Perception of illness impact did mediate the relationship between health related hardiness and psychosocial adjustment to illness. Perception of illness impact did not mediate the relationship between health stressors and psychosocial adjustment to illness, between health stressors and self-perception of health status, and between health related hardiness and self-perception of health status. The knowledge generated from this study has the potential to impact the existing practices in improving evidence-based nursing practice in caring for individuals with inherited bleeding disorders. Future research is indicated with a large sample to determine differences between diagnosed individuals and carriers, between various Asian Pacific Islander cultural groups, and to determine replicability of the findings from this smaller study sample.

M.Cur. (Intensive General Nursing) / The incidence of coronary heart disease is still rising due to man's stressful way of life. Angioplasty is a relatively new procedure used to dilate coronary arteries which have been narrowed by sclerosis. This is seen as the 'instant solution' for a select group of patients with coronary artery sclerosis. It fits in well in the fast paced society. Angioplasty is painful and causes anxiety as the patient is awake during the whole procedure. The goal of the study is to determine the patient's experience during angioplasty and to set guidelines for nurses for the preparation of other patients for angioplasty. The Phenomenological method of interviewing was used for data-collection. Interviews were conducted with 9 participants who had had their first experience of angioplasty. Data was subjected to Phenomenological analysis and verified with suitable literature. The conclusions that were reached were used to set guidelines and make suggestions for the counselling of patients for angioplasty.

M.A. (Clinical Social Work) / The focus of this study is to understand patients’ experience of the long-term hospitalization from drug resistant tuberculosis (DR-TB). Tuberculosis (TB) has been prevalent in many societies over a long period with significant effects, and the World Health Organisation (WHO) has declared TB a global emergency. The eventual emergence of DR-TB globally has added to the TB burden. DR-TB is highly infectious and difficult to treat, with less chance of cure, more complications of the disease and more side effects of treatment. It is also more expensive to treat. The treatment and management of DR-TB requires a protracted course of medication (18-24 months), requiring long-term hospitalization, which is often involuntary. Hospitalization involves complete withdrawal of patients from their regular social environment. When DR-TB patients are hospitalized, it means that they can no longer perform their normal roles. Prolonged hospitalization brings sudden changes and interrupts the patients’ lives and compounds all kinds of losses. The isolation of DR-TB patients in the hospital, away from the social environment, to receive medical treatment and management of the disease, can have a complex biopsychosocial impact on the patient. DR-TB is complex and requires a multidisciplinary approach, not just medical treatment. The key to DR-TB control and management requires biopsychosocial intervention to ensure holistic care and treatment of those infected. Social work care and support is imperative and plays a very significant role. My premise is that DR-TB patients, who are hospitalized for a long time experience and confront overwhelming existential problems which they are unable to understand and address – questions of mortality, purpose and meaning, hope, belonging and identity. Yalom (1980) states that the givens of existence are important and will happen to each person during life. Unless they are discovered, one’s existence will be frustrated, leading to pain and great confusion as well as an inauthentic existence. The existential issues are very painful, with devastating and complex effects on their lives, and require adequate and relevant social work care and support. The existential framework is vital, as different people attach different meanings to their daily life experiences of being hospitalized for DR-TB. This will enable the social worker to explore, understand and raise patient awareness of his/her existence and help the patient deal effectively with these issues. This study seeks to answer the question: What is the experience of long term hospitalization like for DR-TB patients? This study adopted a qualitative, exploratory-descriptive approach to understand in-depth the patients’ experience of being hospitalized for a long time due to DR-TB.A phenomenological research design was used in this study to describe and reduce the participants’ experiences to a central meaning or essence of experience. This study was conducted at a DR-TB hospital in Gauteng with three adult participants, who were living with DR-TB and had been in hospital for at least 12 months. Unstructured interviews were used to explore the participants’ existential experience of long term hospitalization due to DR-TB. The history of existentialism, what it is, philosophy and clinical practice is outlined, and followed by a discussion on Yalom’s existential framework on how to understand and use it to identify and deal with the patients’ existential problems. It is observed in this study that the participants experienced existential concerns emanating from their long term hospitalization due to DR-TB which they could not understand and did not know how to deal with. They were as a result distressed, overwhelmed, frustrated and confused, with constant emotional chronic pain. Such participants’ experiences are understandable since human beings at one point of their life are faced with problems which arise from an individual person’s concerns about existence (Yalom, 1980). Six themes emerge that are consistent with literature for this study: anxiety, hospitalization and death; time; isolation; loss; stigma (social pain) and loss of perspective (living with endless uncertainty). The study findings may broaden insight on the hospitalization experience of DR-TB patients, and on the psychosocial impact of prolonged hospitalization. The study concludes that the participants experience existential problems during their long term hospitalization, which they are not able to deal with on their own. Therapy based on the existential approach plays a very critical role and is helpful in exploring and dealing effectively with these existential concerns. Therapeutic intervention, with necessary care and support, will help the patients become aware and understand their situation, including own behaviour and emotions and help them confront and manage their situation effectively achieving change and wholeness. The medical social worker plays an important role in this regard.

The purpose of this study was to understand the meaning of transformation in surviving terminal cancer. An existential-phenomenological approach was used to interview five participants who had lived at least five years beyond the diagnosis of widely metastatic or terminal cancer. Review of the literature which addressed the issue of transformation suggested that life-threatening illness is an opportunity for growth. There are many cross-cultural accounts of transformation, and many studies of survivorship qualities, but little research into the transformation process as it is experienced by cancer survivors. Participants told the story of their recovery from cancer and how it changed their lives. Cochran's (1986) dramaturgical approach provided the model for capturing the meaning of this experience in story form. Each interview lasted from 2½to 5 hours. Interviews were audio-recorded and transcribed. Analysis of the interviews followed Colaizzi's (1978) method. Significant statements were extracted from the protocols, themes were formulated, and a description of the experience was written. Other sources of data were used in addition to interviews. An autobiography and a series of articles were collected from two participants. This written material was analyzed in the same way as the interviews. The experience of the researcher also served as data, and was analyzed through reflective and descriptive methods. Conducting interviews, soliciting written descriptions and including the researcher's experience allowed the data to be more broadly supported. Results of the study were validated by the participants in a second interview. They confirmed that the 38 themes and the common pattern of transformation derived from the five participants accurately reflected their own experience. The results indicated that psychological transformation in survivors of terminal cancer is a spiritual journey. In allowing a life-threatening disease to become an opportunity for personal awareness and growth, people can transform their illness into a spiritual teaching. Serious illness can teach people about the meaning of life., and give their own lives purpose and direction. Through this affirmation of life, and by following their purpose and path, healing can occur. This healing not only moves people toward wholeness, but it holds the potential for transforming and healing the problems of others. This pattern of transformation has practical implications for the nature of support useful for people experiencing a health crisis, and has implications for the designing of effective psychosocial support for cancer patients. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

The purpose of this study was to describe the relationships among perceptions of privacy, powerlessness, and subjective sleep characteristics in hospitalized adults with coronary heart disease. Thirty subjects, 48 to 92 years old who were hospitalized for suspected or confirmed coronary heart disease, completed three questionnaires. Negative relationships were found between patient privacy and powerlessness (r = -.44) and between powerlessness and the subjective sleep characteristics of sleep effectiveness (r = -.30). Feelings of powerlessness were negatively related to total number of days of (r = -.50) and number of days in the Coronary Care Unit (CCU) (r = -.41). The number of days in the CCU was positively related to sleep disturbance (r =.30). Age was negatively related to patient privacy (r = -31) but positively related to powerlessness (r =.33) and sleep supplementation (r =.35). A better understanding of the hospital environment enhances the planning of nursing care for hospitalized patients.

This study examined the applicability of Mishel's model of uncertainty in illness (1990) to the adaptation process of women diagnosed with fibromyalgia. The power of uncertainty and social support to predict an uncertainty appraisal and its corresponding coping strategy utilized in this population were examined.Structural equation modeling was employed to clarify the relationships among uncertainty, social support, the appraisal of uncertainty as either danger or opportunity, and coping as either emotion-focused or problem-focused. One hundred sixty-five participants completed the Mishel Uncertainty in Illness Scale (MUIS-A), the Appraisal of Uncertainty Scale (AUS), the Jalowiec Coping Scale (JCS), and the Social Provision Scale (SPS). After an analysis of several measures of goodness-of-fit, the original model was modified based on theory, the modification indices, and a review of the maximum likelihood estimates (mle) for structural paths. These modifications resulted in a competing model. Finally, a Chi-square test was performed comparing the goodness-of-fit indices of the competing models.Results indicated that Mishel's model is a useful model within which to conceptualize the issues faced by women diagnosed with fibromyalgia. Mishel's model performed adequately; however, the overall goodness-of-fit was significantly improved by modifications which placed greater emphasis on social support. Social support and uncertainty exerted approximately equal effect on a danger appraisal and in the revised model only social support predicted an opportunity appraisal. Results also suggested that uncertainty had a direct effect on emotion-focused coping regardless of the appraisal of the uncertainty as danger or opportunity. The current study did not unequivocally support Mishel's assertion that uncertainty may be evaluated as an opportunity. Although uncertainty demonstrated a significant inverse relationship with an opportunity appraisal in the original model, in the revised model, which considered the direct effects of social support on the appraisal process, uncertainty failed to have a significant effect. Given the depth of evidence and applicability of Mishel's original model, additional research is necessary to determine whether these results are specific to the experience of fibromyalgia or perhaps social support is an under-appreciated factor in Mishel's model. Implications for treatment and directions for future research are explored. / Department of Counseling Psychology and Guidance Services

This study utilized the Medical Symptom Validity Test (MSVT) and a set of standard neuropsychological instruments to determine the underlying construct of the MSVT that accounts for effort in mild traumatic brain injury (mTBI) patients by comparing/contrasting mTBI with dementia and an analog simulation. The results indicate that a common underlying neurocognitive construct (memory) exists between mTBI and dementia patients, which may account for poor effort as measured by the MSVT. Other underlying factors emerged for both groups, though they did not point to a common construct. This finding suggests that the overall effect of brain injury in neurologically impaired groups also impacts effort performance as measured by the MSVT. Similarly impaired performance patterns also emerged between mTBI and dementia groups in sub-groups that failed effort measures. Thus, failed effort tests may be a function of more pronounced deficits in these groups, rather than a function of effort. Finally, although similar effort profiles were noted between mTBI and analog simulators, the analog group was unable to mimic the neurocognitive effects of mTBI.