published_or_final_version / Social Work / Master / Master of Social Work

The effects of a monetary reward and self-monitoring on reducing interdialytic weight gain (IWG) were compared for 6 hemodialysis patients in an outpatient setting. A single-subject experimental design (A-B-BC-B-BC) was used to examine each variable individually and in combination, with alternating phases to control for possible sequencing effects. Monetary reward (50 cents - $3) was administered in a titrated manner according to standardized criteria, ranging from 3 % and 4% of patients' dry weight on weekdays and weekends, respectively, to 3.5% and 4.5% for weekdays and weekends. Self-monitoring involved recording daily fluid and diet intake. Results indicated that by the end of the treatment program, the 6 participants averaged a 14% reduction in weekday IWG and a 15.45% reduction in weekend IWG; however, due to significant variability, it cannot be concluded that the reductions are treatment effects. Four out of 6 participants reduced their average IWG for both weekends and weekdays by .75 kg (1.65 lb.). The average weekend reduction for these 4 participants was .85 kg (1.87 lbs.) while the average weekday reduction was .65 kg (1.43 lb.). All 6 participants showed reductions in weekday IWG that averaged .53 kg (1.17 lb.). However, only 2 participants demonstrated IWG reductions that could be attributable to either of the 2 treatment variables. The standardized dry weight criterion for assessing fluid adherence may have posed excessively stringent demands on participants, as only 1 of the 6 participants actually met the criterion. Future research should address the role of nonspecific treatment factors, as well as patient characteristics and responsivity to particular treatment components in an effort to identify those factors responsible for behavior change in this population.

Research has begun to explore the presence and role of health-related injustice perceptions in samples of individuals who experience chronic pain associated with traumatic injury. Existing studies indicate that higher level of injustice perception is associated with poorer physical and psychosocial outcomes. However, to date, few clinical populations have been addressed. The aim of the current study was to explore injustice perceptions in a sample of individuals who have sustained a spinal cord injury (SCI), as research suggests that such individuals are likely to experience cognitive elements characteristic of injustice perception (e.g., perceptions of irreparable loss, blame, and unfairness). The study explored the relationship between participants’ level of perceived injustice and several variables associated with outcomes following SCI (depression, pain, and disability) at initial admission to a rehabilitation unit and at three months following discharge. The Injustice Experience Questionnaire was used to measure injustice perceptions. IEQ was found to significantly contribute to depression and anger at baseline. IEQ significantly contributed to depression, present pain intensity, and anger at follow-up. The implication of these preliminary findings may be beneficial for development of future interventions, as many individuals in the United States experience the lifelong physical and psychological consequences of SCI at a high personal and public cost.

M.A. / Modern health-care services in general hospital settings are often characterised by mUltidisciplinary and interdisciplinary approaches to patient care. The underlying rationale of these approaches lies in the potential pooling of specialised medical resources from a variety of medical fields. Consequently there is usually an increase in the diagnostic procedures available, theoretically offering a more comprehensive health service. Whilst the above approach is seen to be effective when the health-car~ team specialists subscribe to one encompassing paradigm, it is hypothesised that the existence of other alternative paradigms may affect the efficacy of team work. Using the interface between the Psychology and Renal units of J.G. Strijdom Hospital as an example, this study describes the effect of paradigmatic differences within a team approach on the conceptualisation of problems and treatment choices. The traditional medical approach is contrasted against a systems based psychological approach. The existence of the two approaches within a single team encounters difficulty in the gaining of consensus regarding the level of focus.

M.A. / Please refer to full text to view abstract

Do atendimento a cardiopatas internados, criou-se a categoria vivência de perdas, desencadeada por evento(s) significativo(s) que implica no processo do luto. Segundo Freud (1916), o luto é um trabalho psíquico que requer um tempo para elaboração da perda e de transformação da realidade psíquica, desestruturada pela falta do objeto perdido. Entende-se que o luto é o correlato psicodinâmico da reação manifesta de depressão. Com estes fundamentos, esta pesquisa teve por objetivo geral: investigar vivência de perdas, estados de luto e de depressão. Foram avaliados 44 pacientes com os diagnósticos médicos de infarto agudo do miocárdio e angina, de 33 a 65 anos, 50% mulheres e 50% homens. Utilizados três instrumentos: entrevista semi-estruturada, para avaliação do luto; Inventário de Depressão de Beck, para depressão; Escala de Avaliação e Reajustamento Social de Holmes e Rahe, que avalia porcentagem de probabilidade de apresentar problemas de saúde. Os resultados foram relacionados através do programa Statistical Package for Social Sciences, versão 11.0. Apresenta estado de luto 65,9%, sendo significativas as relações entre: luto e depressão (p<0,05); luto e gênero (p=0,000); presente em 90,9% das mulheres; depressão e gênero (p<0,05). Os eventos significativos relatados com maior freqüência foram: morte de familiares, 47% ou de pessoa próxima, 13%. Também é significativa a relação estatística entre luto e quantidade de mortes relatadas por participante como evento significativo (p<0,05). Sugere vivência de perdas como indicativo de risco psicológico para doença arterial coronariana, apontando para a associação entre luto e depressão / Since the attendance of hospitalized cardiac patients was created the category experience of losses caused by significative(s) event(s) that implicated in the mourning process. According to Freud (1916), mourning is a psychic process that requires time for the loss elaboration and changing of the psychic reality, shaped by the lost object missing. Mourning is understood as a psychodynamic correlation of the manifested depression reaction. On this basis, this research aimed: investigate experience of losses, mourning and depression. 44 patients with medical diagnosis of severe heart attack and angina were evaluated, from 33 to 65 years old, 50% women and 50 % men. Three instruments were used: semi-structured interview for mourning evaluation; Beck Depression Inventory, for depression; Holmes and Rahe Social Readjustment Rating Scale, which evaluates the probability of presenting health problems. The results were treated by the software Statistical Package for Social Sciences version 11.0 . 65,9% presented state of mourning and the association between : mourning and depression were significative (p<0,05); mourning and gender (p=0,000), presented in 90,9% of the women; depression and gender (p<0,05). The significative events more frequently reported were: death of a relative 47%, or closer person 13%. It is also significative the statistical relation between mourning and deaths related by the participants as significative event (p<0,05). Experience of losses is suggested as indicative of psychological risk for coronary artery disease, highlighting the association with mourning and depression

by Ho Mun-Wan, Audrey. / Thesis (Ph.D.)--Chinese University of Hong Kong, 1991. / Includes bibliographical references. / Title Page --- p.i / Thesis Committee --- p.ii / Table of Contents --- p.iii / Abstract --- p.ix / List of Figures --- p.xii / List of Tables --- p.xiv / List of Appendices --- p.xviii / Acknowledgements --- p.xxi / Statement of Originality --- p.xxiii / Chapter CHAPTER I --- INTRODUCTION: STATEMENT OF RESEARCH PROBLEM --- p.1-11 / Chapter 1.1 --- Introduction --- p.2 / Chapter 1.2 --- Death and Quality of Life --- p.3 / Chapter 1.3 --- Pain and Quality of Life --- p.6 / Chapter 1.4 --- Measuring Quality of Life in Chinese Population --- p.8 / Chapter 1.5 --- The Research Problem and Sample --- p.10 / Chapter CHAPTER II --- LITERATURE REVIEW AND CONCEPTUAL FRAMEWORK --- p.12-62 / Chapter 2.1 --- Introduction --- p.13 / Chapter Part A: --- The Concept of Quality of Life / Chapter 2.2 --- Definitions of Quality of Life --- p.14 / Chapter 2.3 --- Towards a Structural Definition of Quality of Life --- p.19 / Chapter 2.4 --- Quality of Life: Subjective or Objective? --- p.22 / Chapter 2.5 --- Quality of Life and Social Cultural Context --- p.28 / Chapter Part B: --- Ideology and Psychology of Death and Dying / Chapter 2.6 --- Chinese Ideas on Death and Dying --- p.31 / Chapter 2.7 --- Western Religions in Hong Kong --- p.38 / Chapter 2.8 --- Local Folk Beliefs on Death and Dying --- p.41 / Chapter 2.9 --- Psychology of Death and Dying --- p.42 / Chapter Part C: --- Measuring the Quality of Life of Terminally I11 Patients / Chapter 2.10 --- Quality of Life of End Stage Cancer Patients of the West --- p.48 / Chapter 2.11 --- Factors Affecting Quality of Life of Terminally I11 Patients --- p.51 / Chapter 2.12 --- Existing Measures on Quality of Life and Pain --- p.55 / Chapter 2.13 --- Summary --- p.61 / Chapter CHAPTER III --- TOWARDS CONSTRUCTING A CHINESE QUALITY OF LIFE QUESTIONNAIRE FOR THE THE TERMINALLY ILL PATIENTS --- p.64-107 / Chapter 3.1 --- Introduction: The Need for a Chinese Quality of Life Questionnaire (CQLQ) --- p.65 / Chapter 3.2 --- Preparatory Survey I: Identification of the Needs of Patients by Medical and Health Professionals --- p.67 / Chapter 3.3 --- Preparatory Survey II: Identification of the Needs of Patients by Severely I11 Patients --- p.75 / Chapter 3.4 --- Design of the Chinese Quality of Life Questionnaire (CQLQ) --- p.84 / Chapter 3.5 --- Preparatory Survey III: First Validation of the Chinese Quality of Life Questionnaire --- p.87 / Chapter 3.6 --- Preparatory Survey IV: Second Validation of the Chinese Quality of Life Questionnaire --- p.104 / Chapter 3.7 --- Summary --- p.107 / Chapter CHAPTER IV --- THE DEVELOPMENT OF A CHINESE PAIN QUESTIONNAIRE FROM THE McGILL PAIN QUESTIONNAIRE --- p.108-128 / Chapter 4.1 --- Introduction --- p.109 / Chapter 4.2 --- Preparatory Survey I: Collection of Cantonese Pain Descriptors --- p.110 / Chapter 4.3 --- Preparatory Survey II: Pilot Test of the Preliminary Pain Descriptors --- p.112 / Chapter 4.4 --- Modification of the Cantonese Pain Questionnaire --- p.115 / Chapter 4.5 --- Preparatory Survey III: Pilot Test of the Modified Pain Descriptors --- p.122 / Chapter 4.6 --- Preparatory Survey The Development of A Scoring System --- p.122 / Chapter 4.7 --- Preparatory Survey V: Pilot Test of the Final Draft of the Chinese Pain Questionnaire (CPQ) --- p.126 / Chapter 4.8 --- Summary --- p.128 / Chapter CHAPTER V --- EXPLORING THE VALIDITY OF TWO NEWLY DEVELOPED QUESTIONNAIRES: CQLQ AND CPQ - A FEASIBILITY STUDY --- p.129-161 / Chapter 5.1 --- Introduction --- p.130 / Chapter 5.2 --- The Study Design and Methodology --- p.130 / Chapter 5.3 --- "The Demographic, Social, Economic, and Illness Status of Subjects" --- p.145 / Chapter 5.4 --- Summary --- p.161 / Chapter CHAPTER VI --- THE VALIDATION FINDINGS --- p.162-241 / Chapter 6.1 --- Introduction --- p.163 / Part A / Chapter 6.2 --- Reporting on the Concurrent Validity in a Patient Sample --- p.163 / Chapter 6.3 --- Reporting on the CQLQ Validation Findings --- p.177 / Chapter 6.4 --- Reporting on the CQLQ Reliability --- p.211 / Chapter 6.5 --- Age and Quality of Life --- p.214 / Part B / Chapter 6.6 --- Reporting on the Validation of the CPQ Findings --- p.223 / Chapter 6.7 --- Summary of CPQ Findings --- p.241 / Chapter CHAPTER VII --- "STRUCTURAL, PAIN-ILLNESS, AND PSYCHOLOGICAL DETERMINANTS OF OVERALL QUALITY OF LIFE" --- p.242-286 / Chapter 7.1 --- Introduction --- p.243 / Chapter 7.2 --- Structural Model of Quality of Life --- p.243 / Chapter 7.3 --- Pain-Illness Model of Quality of Life --- p.264 / Chapter 7.4 --- Psychological Model of Quality of Life --- p.282 / Chapter 7.5 --- Summary --- p.286 / Chapter CHAPTER VIII --- CONCLUSION AND FUTURE DIRECTIONS / Chapter 8.1 --- Introduction --- p.288 / Chapter 8.2 --- The Chinese Quality of Life Questionnaire --- p.288 / Chapter 8.3 --- The Validity of the Chinese Quality of Life Questionnaire --- p.291 / Chapter 8.4 --- The Chinese Pain Questionnaire --- p.300 / Chapter 8.5 --- Liimitations and Implications --- p.304 / REFERENCES --- p.306-314 / APPENDICES --- p.315-408

The concept of patient empowerment, although acknowledged by the medical community as important, is rarely understood and seldom given priority in the illness trajectory of the cancer patient. A pilot study of a Shared Care Model amongst haematological cancer patients highlighted the fact that some patients spoke of a sense of empowerment and an overall sense of greater control when more fully included in the treatment and management of their condition. The research which forms the basis of this thesis focused on the role of empowerment in the wellbeing of cancer patients. There were three objectives to be met by completing this research. Firstly, to demonstrate that empowerment is a uniquely identifiable concept and can be measured separately from other quality of life indicators. Secondly, the study sought to explore that concept that empowerment takes into account the way in which patients act upon their prognosis and optimise the outcomes of treatment. Thus it is believed that accessing tailored resources and support structures benefit cancer patients and those who are caring for them such as close family members and friends by helping the patient achieve an individual level of empowerment. Finally, the research sought to explore the concept that empowerment improves psychological outcome in patients. The benefits are increased empowerment and an active use of coping strategies amongst patients in order to regain a measure of control over their illness. The Patient Empowerment Scale was developed to measure empowerment as an individual construct. '...' The Patient Empowerment Scale (15 items) was shown to be a reliable measure of empowerment and fitted the model well. A qualitative methodological approach sought to address and explore the second and third concepts. In addition, the concept of empowerment as it relates to motivation and self-efficacy was investigated qualitatively using in-depth interviewing technique. A phenomenological methodology was used to explore the 'lived experience of cancer patients' in regard to regaining control of their illness and the management thereof. Participants were interviewed using concepts identified for the Patient Empowerment Scale such as support strategies and use of resources. A series of interviews with breast cancer patients were conducted whereby patients responded to a number of questions. The questions explored areas such as support mechanisms in relation to cancer, their relationships with health professionals and significant others and their attitude toward and use of other resources and support systems such as support groups, spirituality, complementary therapies. In addition their views on acceptance and adaptation to their altered health status were explored. Results The research confirmed that it is feasible to measure empowerment as a separate quality of life indicator. Furthermore, that empowerment is linked to motivation and self-efficacy beliefs. The research also demonstrated that there are a number of core areas which are fundamental to regaining control and increasing empowerment for patients. These core areas are linked to support mechanisms, willingness to adapt and to access resources tailored to meet their needs. Patient empowerment emerged as a key aspect of enhanced quality of life regardless of prognosis and improved psychological outlook.

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice