M.Cur. (Intensive General Nursing Science) / "Patient experiences in a critical contextual, qualitative research phenomenological method to obtain and objectives of the study are: care unit" is a study using the analyse data. The - to establish and describe how myocardial infarction patients experience the critical care unit (CeU) environment, and - to propose guidelines for optimal nursing care. The Nursing for the Whole Person Theory forms the paradigmatic framework of the study. The central proposition states that the myocardial infarction patient's experience of the CCU as his external environment, will have direct impact upon his quest for health. Five participants were interviewed. The interviews were coded by the researcher and an independent nursing specialist, using the Kerlinger method of content analysis. The findings were compared to relevant available literature. Data obtained revealed that certain aspects of the CCU environment generate anxiety and therefore impede the quest for health in myocardial infarction patients! Guidelines for optimal nursing care of myocardial infarction patients were proposed.

Behavior analysts who study verbal behavior theorize that people derive relationships between stimuli - forming stimulus classes such that psychological functions transfer among stimuli and therefore affect behavior. Verbal processes are thought to play a role in cancer patients' behavioral flexibility. The current study examined if an analogue intervention produced changes in relations between health-relevant stimuli from pre- to post-test in patient and student samples. A matching-to-sample (MTS) task required participants to form three 4-member classes that included health, treatment, or neutral terms. Participants next listened to either an acceptance-based or a control-based rationale and therapy exercise, or a distracter task. Then, they were re-exposed to the MTS task. Latencies and accuracies for learning each class as well as between condition differences were examined. Finally, changes in ratings of stimuli from pre to post analogues were measured. Differences in stimuli ratings were seen in the student sample, reflecting transfer of function and some reduction in responsiveness to stimuli following intervention, but overall no learning performances are found. Discussion explores the consistency of the findings with acceptance and commitment therapy (ACT) theory in light of the seemingly lack of findings.

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

COPD is the third leading cause of death in the United States and is the sixth leading cause of death for low-to middle income countries (Downs & Appel, 2006; GOLD, 2011). COPD is a largely preventable disease due to the lifestyle factors that heavily contribute to disease onset and severity. Although traditionally COPD research has focused on health outcomes related to risk factors, compliance, comorbid psychological and physical conditions, and treatment interventions, a growing body of research suggests religious and spiritual factors may play an equally important role in health outcomes for several medical conditions, including pulmonary disease. However, studies of this kind have not specifically examined COPD nor have they examined the role of religious and spiritual beliefs in COPD management among ethnic minority patients. As such, the current study aimed to examine whether spiritual ethnic minority patients with COPD hold religious fatalistic attitudes and less active religious problem solving . A sample of 35 ethnic minority patients from the Louis. B. Stokes Cleveland VA Medical Center (LSCVAMC) Outpatient Pulmonary Clinic in Cleveland, OH. were recruited to participate in the study. Due to the acknowledgeable limitations of the present study, results are preliminary but convey associations between religious health fatalistic beliefs and religious problem solving approaches. Implications and areas of future study are discussed.

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Both popular clinical folklore and the findings of empirical research have suggested a relationship between cognitive rigidity and suicidal behavior. Specifically, it has been hypothesized that individuals deficient in the capacity for flexible thought become increasingly hopelessness and suicidal in the face of high levels of environmental stress. That is, these persons are thought to be cognitively unprepared to deal with negative life events. The present study sought to evaluate this model with hospitalized psychiatric patients placed on suicidal precautions status by hospital staff. Suicidal and non-suicidal control subjects completed measures of life stress, depression, cognitive rigidity, hopelessness, and suicidal intent. In addition, these subject also completed two measures of interpersonal problem-solving. Suicidal subjects were found to report higher levels of negative life stress in the previous year than members of the control group. Suicidal subjects were also significantly more cognitively rigid and the rigidity appears to have been reflected in their performance on the interpersonal problem-solving measures. Overall, suicidal subjects were observed to be poorer problem-solvers than the non-suicidal control group members on both measures of interpersonal problem-solving skills. More specific analyses showed that these subjects were not able to generate as many potential solutions to interpersonal problems from their own lives and when asked to evaluate these solutions, the suicidal subjects tended to rate them more negatively than did the control subjects. Suicidal subjects were also less likely than control subjects to employ these alternatives when subsequently attempting to solve the presented problem. Additionally, the suicidal subjects tended more often to implement irrelevant solutions. Although the suicidal subjects were significantly more hopeless than the non-suicidal subjects, it appears that this variable contributed independently to the level of suicide intent, rather than resulting from cognitive rigidity and interpersonal problem-solving deficits. Results are interpreted as supporting Beck's (1979) viewpoint that both deficits in problem-solving skills and hopelessness need to be addressed in the treatment of suicidal patients. / Ph. D.

Upper limb (UL) impairments are common after stroke and can lead to loss of independence and long-term disability. Motor learning interventions for individuals with stroke can improve UL function and engagement in daily activities. Self-controlled practice (SCP) involves allowing choice during motor skill practice and has been shown to improve motor learning in healthy adults as well as individuals with Parkinson's disease. Additionally, SCP may impact psychological outcomes, including intrinsic motivation, self-efficacy, and positive affect. Although SCP has been incorporated into complex stroke rehabilitation interventions, little is known about its specific impact on motor learning for individuals with stroke. The purpose of this study is to investigate the effect of SCP on motor learning and psychological outcomes for adults with chronic UL impairment after stroke. Sixteen participants with chronic UL impairment due to stroke were paired and randomized into two groups. All participants practiced a standardized motor task with both their more affected and less affected hands for two consecutive days. During each day of practice, participants completed 50 30-second trials (10 blocks of 5 trials each) with their more affected hand and 20 30-second trials (10 blocks of 2 trials each) with their less affected hand. The experimental group was given control over their practice schedule and chose the order they practiced blocks of trials. Participants in the control group followed a pre-determined practice schedule based on the choices made by the participant they were paired with in the experimental group. Outcome measures were assessed on Day 1 before practice (Pre-Test), Day 2 after practice (Post-Test), and Day 3 (Follow-up). Motor learning outcomes included 24-hour retention of the trained motor task and immediate (10-minute) and delayed (24-hour) transfer of learning to an untrained motor task. Psychological outcomes including intrinsic motivation, self-efficacy, and positive affect were also assessed. Both groups demonstrated significant improvements from baseline on both the trained task and the untrained task at the Day 3 follow-up assessment. There were no significant between-group differences on any motor learning or psychological outcome measures. However, there was a significant association between perceived choice that was assessed on Day 2 following practice and amount of change on the untrained transfer task at Day 3. This suggests that perception of choice may be a relevant factor for motor learning after stroke. However, more research with larger sample sizes is needed to further investigate this finding.

徐文艷. / Thesis (doctoral)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (p. 259-278). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in Chinese and English. / Xu Wenyan.

This quasi-experimental study investigates neuropsychological functioning differences between 63 active duty soldiers who were placed into three groups (MTBI, PTSD, control) to provide better information for differentiating PTSD and MTBI. The ANAM and MicroCog were utilized to measure psychomotor speed, memory, and attention. Participants with PTSD performed worse on most measures of psychomotor speed and attention, and endorsed more symptoms of depression and anxiety when compared to MTBI and control participants. Further, attention appears to be the best cognitive domain for differentiating PTSD from MTBI, whereas memory variables did not differentiate these groups. Clinical and research implications of these findings are discussed.

published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy