No / People with dementia need increasingly specialised support as they approach the end of life, and so too do their families and the professionals working with them. This book describes not only what can be done to ensure maximum quality of life for those in the final stages of the illness, but also how best to support those involved in caring for them. Emphasising the importance of being attuned to the experiences and needs of the person with dementia, the authors explain why and how they should be included in decisions relating to their end of life care. Practical strategies for ensuring physical and emotional wellbeing are provided, drawing on useful examples from practice and providing solutions to potential challenges that carers and family members will face. Dilemmas surrounding end of life care are explored in detail, including the moral dilemma of medical intervention, and the authors suggest ways of supporting family members through the process in terms of providing information, helping them adjust to change and loss, and involving them in their relative's care, and at how care staff can be supported through appropriate education and training, team building and information-giving.

Aims: Acquired Brain Injury (ABI) is often researched from a reductionist perspective, focusing on pathology and dysfunction (Olney & Kim, 2001). More recently there has been a call towards taking a person-centred, global approach; questioning old ‘assumptions’ about what is currently known, and incorporating the views of the patient (Hill, 1999). This qualitative research study aimed to make a further contribution to the evidence-base by investigating the experience of adjusting to life after ABI. Method: Six participants, (two female, four male) aged 26-49, who had experienced a severe ABI an average of 31 months previously, were interviewed using a semistructured schedule. Interpretative Phenomenological Analysis (IPA) was employed to analyse the transcripts. Results: Five master themes emerged from the participants’ accounts: Experiencing a loss of control; Observed changes as a threat to identity; Being displaced by the injury: Feeling unchanged in a changed world; Attempts at managing a threatened identity, and Enable me don’t disable me: The role of support in recovery. Implications: Clinical implications were considered within Bronfenbrenner’s (1979, 2004) Ecological Systems Theoretical Framework. Within the Microsystems (the individual’s immediate systems such as their body, home and work) participants described a struggle to make sense of their perceived loss of control of their body and brain. They described the importance of making sense of these changes. Clinically there is a potential role for professionals to facilitate how people make sense of their experiences, perhaps moving away from reductionist explanations, which appeared to prevent participants from having hope to influence change. From a Macrosystemic level (the individual’s social, cultural and political systems) the participants felt they were less valued and as a result, judged by society and by political systems. Participants’ accounts suggested that they wanted to continue to contribute and be valuable in society. An implication therefore is for professionals involved to take more a political stance in influencing how we currently conceptualise people after brain injury, focusing on enablement rather than disablement.

Univerzita Karlova v Praze 1. léka ská fakulta Studijní program: Specializace v léka ství Studijní obor: Adiktologie Bc. Kate ina Sklená ová Francová ístup zam ený na lov ka (PCA) v psychoterapii závislostí: teoretická východiska, aplika ní možnosti a kompatibilita se sou asným systémem ambulantní pé e a jeho praxí. Person centred approach in psychotherapy of addiction: theoretical background, application possibilities and compatibility with the current system of outpatient care and practice. Diplomová práce Vedoucí práce: PhDr. Monika Nevoralová Praha, 2013 Abstrakt diplomové práce: Východiska: Mezi základní charakteristiky p ístupu zam eného na lov ka (PCA) ve vztahu klient- terapeut pat í mimo jiné pojmy bezpodmíne né p ijetí, empatie a autenticita. V minulosti se tento psychoterapeutický sm r nazýval nedirektivním. Dnes je tento název p ekonán pro jeho redukující edur ení, nicmén pojem nedirektivita by se dal ozna it jako další z jeho p ízna ných rys . Sou asný systém lé by a rehabilitace závislých v psychiatrických lé ebnách, terapeutických komunitách i ambulantních typech lé by je založen na kontrole, režimu, vedení, tvorb terapeutického plánu a jiných, zejména kognitivn -behaviorálních metod, které jsou v sou asné adiktologii "dominantní". Nabízí se proto otázka, zda PCA m že najít v adiktologii...

As relações interpessoais são discutidas em vários campos da enfermagem; na saúde mental e na psiquiátrica elas se desenvolvem como relações terapêuticas sendo abordadas como relação de ajuda ou relacionamento interpessoal. Na Abordagem Centrada na Pessoa as atitudes de consideração positiva incondicional, atitude empática e congruência são imprescindíveis para se desenvolver relações interpessoais terapêuticas promovendo nelas um clima de facilitação do crescimento e desenvolvimento do sujeito no cuidado. Na literatura brasileira de enfermagem não foram encontradas medidas de avaliação de tais atitudes embora se acredite que serão necessárias tanto no campo do cuidado quanto da educação. Através deste estudo, buscou-se desenvolver um instrumento de avaliação das relações interpessoais, abrangendo as três atitudes facilitadoras: consideração positiva incondicional, atitude empática e congruência e realizar a análise exploratória quanto à dimensionalidade e a fidedignidade do instrumento. O polo teórico envolveu a explicação dos construtos, a elaboração dos itens e as análises empíricas; o polo empírico relacionou-se a fase de experimentação do instrumento. Trata-se da escala de observação da interação enfermeiro-cliente constituída de itens positivos e reversos, tipo likert com cinco pontos. A consideração positiva incondicional ficou com 22 itens (15 reversos); a atitude empática compôs-se de 18 itens (2 reversos) e a congruência totalizou em 8 itens (2 reversos). Tais itens expressam o componente comportamental, verbal e motor de cada construto e foram indicados para o uso em situações de observação durante o cuidado. Optou-se pela filmagem das relações interpessoais desenvolvidas por 10 enfermeiros com 92 pessoas diagnosticadas com transtornos mentais durante consultas de enfermagem realizadas nas Estratégias de Saúde da Família de uma cidade do interior de Minas Gerais. No polo analítico, utilizou-se da análise fatorial (AF) e a consistência interna (coeficiente alfa de Cronbach) segundo referencial teórico-metodológico utilizado. O instrumento foi avaliado segundo modelo teórico apresentando alfa da escala global de 0,82, do atributo um (consideração positiva incondicional) 0,68, do atributo dois (atitude empática) 0,76 e do atributo três (congruência) 0,49. Devido à baixa consistência interna do atributo três em conformidade com os resultados das cargas fatoriais, analisou-se um modelo sugerido pela AF de 36 itens, o que se mostrou frágil em relação aos conceitos constitutivos e a operacionalização. Os melhores resultados apontaram para um instrumento composto de três subescalas. A escala global de consideração positiva incondicional apresentou alfa de 0,687, a escala de atitude empática teve escore global de 0,769 e a terceira de 0,517. Itens com cargas fatorais abaixo de 0,40 foram eliminados. Todos os coeficientes foram significativos com valor-p <0,01 e correlação significativa observada pelo coeficiente de Spearman. Consideram- se necessários ajustes no construto/atributo três, devido à fragilidade dos resultados, embora estejam dentro dos parâmetros considerados aceitáveis. O instrumento construído pode ser utilizado por profissionais que desejam avaliar as relações interpessoais no cuidado de enfermagem que tenha a finalidade de pesquisa ou didática. / The interpersonal relations are discussed in many nursing fields and in mental health or psychiatric nursing they develop themselves as therapeutic relations that are approached as help relations or interpersonal relationship. In the Person-Centred Approach, unconditional positive consideration attitudes, empathetic attitudes and congruence are indispensable to develop therapeutic interpersonal relations and to promote an environment of growing and development facilitation for the subject on care. In Brazilian nursing literature, evaluation measures for these attitudes were not found although one believes that they will be necessary so far as in care and education fields. Through this study, one had as an objective to develop an interpersonal relationship evaluation instrument that enfolds the three facilitating attitudes, unconditional positive consideration attitudes, empathetic attitudes and congruence, and to perform the exploratory analysis concerning the dimensionality and reliability of such an instrument. The theoretic pole involved the explanation of the constructs, elaboration of the items and empirical analysis; the empirical pole related to the experimentation phase of the instrument. It is a matter of nurse-customer interaction observation scale constituted of positive and reverse items like a Likert-scale with five points. The unconditional positive consideration stayed with 22 items (15 reverse); the empathetic attitude was composed of 18 items (2 reverse) and the congruence counted for 8 items (2 reverse). Such items express the behavioral, oral and motor component of each construct and were indicated for using in conditions of observation during care. One chose for recording the interpersonal relations developed by 10 nurses involving 92 subjects with mental-impaired patients during nursing inquiries performed in Family Health Strategies in an inland city of Minas Gerais. In the analytical pole one made use of the factorial analysis (FA) and the internal consistency (Cronbach\'s alpha-coefficient) according the used theoretic-methodological referential. The instrument evaluated concerning to the theoretical model presented an alpha-scale global outcome of 0.82, being 0.68 for attribute one (unconditional positive consideration), 0.76 for attribute two (empathetic attitude) and 0.49 for attribute three (congruence). Due to the low internal consistency of attribute three in relation to the factorial load results, one analyzed a model of 36 items suggested by FA that showed itself fragile in relation to constitutive concepts and operationalization. The best outcomes indicate a three-subscale instrument. The unconditional positive consideration global scale presented an alpha of 0.687, the empathetic attitude scale got a global score of 0.769, and congruence featured 0.517. Items with factorial load below 0.40 were eliminated. All coefficients were significant for p<0.01 and significant correlation confirmed by Spearman coefficient. Some adjustments are necessary for the third construct/item due to the fragility of the results, although they are within acceptable parameters. The instrument so developed can be used by professionals who wish to evaluate the interpersonal relations in nursing care with research or didactic purpose.

The Stress and Coping Cyclical Amplification Model of Perfectionism in Illness posits, that in the context of a chronic illness, both perfectionistic strivings and concerns contribute to poor health outcomes. Similarly, person-centred models, such as the tripartite model of perfectionism, claim that high levels of both perfectionism concerns and strivings reflect an “unhealthy” perfectionism that takes a toll on well-being. To date there are few comparative tests of these models for physical and mental health outcomes in healthy versus chronically ill individuals. The aim of the current study was to investigate the implications of perfectionism for health by testing how within-person combinations of perfectionism varied in relation to health outcomes, and between fibromyalgia patients (n = 89) and healthy controls (n = 123). Supporting both models, within-person combinations of high perfectionistic strivings and concerns were associated with high stress and poor mental and physical health compared to other within-person combinations. These links were more robust for fibromyalgia patients compared to controls, and stress mediated the association with physical health outcomes only for the fibromyalgia patients. Findings support the value of taking a person-centred approach for understanding how perfectionistic strivings contributes to poor health in the context of chronic illness.

As relações interpessoais são discutidas em vários campos da enfermagem; na saúde mental e na psiquiátrica elas se desenvolvem como relações terapêuticas sendo abordadas como relação de ajuda ou relacionamento interpessoal. Na Abordagem Centrada na Pessoa as atitudes de consideração positiva incondicional, atitude empática e congruência são imprescindíveis para se desenvolver relações interpessoais terapêuticas promovendo nelas um clima de facilitação do crescimento e desenvolvimento do sujeito no cuidado. Na literatura brasileira de enfermagem não foram encontradas medidas de avaliação de tais atitudes embora se acredite que serão necessárias tanto no campo do cuidado quanto da educação. Através deste estudo, buscou-se desenvolver um instrumento de avaliação das relações interpessoais, abrangendo as três atitudes facilitadoras: consideração positiva incondicional, atitude empática e congruência e realizar a análise exploratória quanto à dimensionalidade e a fidedignidade do instrumento. O polo teórico envolveu a explicação dos construtos, a elaboração dos itens e as análises empíricas; o polo empírico relacionou-se a fase de experimentação do instrumento. Trata-se da escala de observação da interação enfermeiro-cliente constituída de itens positivos e reversos, tipo likert com cinco pontos. A consideração positiva incondicional ficou com 22 itens (15 reversos); a atitude empática compôs-se de 18 itens (2 reversos) e a congruência totalizou em 8 itens (2 reversos). Tais itens expressam o componente comportamental, verbal e motor de cada construto e foram indicados para o uso em situações de observação durante o cuidado. Optou-se pela filmagem das relações interpessoais desenvolvidas por 10 enfermeiros com 92 pessoas diagnosticadas com transtornos mentais durante consultas de enfermagem realizadas nas Estratégias de Saúde da Família de uma cidade do interior de Minas Gerais. No polo analítico, utilizou-se da análise fatorial (AF) e a consistência interna (coeficiente alfa de Cronbach) segundo referencial teórico-metodológico utilizado. O instrumento foi avaliado segundo modelo teórico apresentando alfa da escala global de 0,82, do atributo um (consideração positiva incondicional) 0,68, do atributo dois (atitude empática) 0,76 e do atributo três (congruência) 0,49. Devido à baixa consistência interna do atributo três em conformidade com os resultados das cargas fatoriais, analisou-se um modelo sugerido pela AF de 36 itens, o que se mostrou frágil em relação aos conceitos constitutivos e a operacionalização. Os melhores resultados apontaram para um instrumento composto de três subescalas. A escala global de consideração positiva incondicional apresentou alfa de 0,687, a escala de atitude empática teve escore global de 0,769 e a terceira de 0,517. Itens com cargas fatorais abaixo de 0,40 foram eliminados. Todos os coeficientes foram significativos com valor-p <0,01 e correlação significativa observada pelo coeficiente de Spearman. Consideram- se necessários ajustes no construto/atributo três, devido à fragilidade dos resultados, embora estejam dentro dos parâmetros considerados aceitáveis. O instrumento construído pode ser utilizado por profissionais que desejam avaliar as relações interpessoais no cuidado de enfermagem que tenha a finalidade de pesquisa ou didática. / The interpersonal relations are discussed in many nursing fields and in mental health or psychiatric nursing they develop themselves as therapeutic relations that are approached as help relations or interpersonal relationship. In the Person-Centred Approach, unconditional positive consideration attitudes, empathetic attitudes and congruence are indispensable to develop therapeutic interpersonal relations and to promote an environment of growing and development facilitation for the subject on care. In Brazilian nursing literature, evaluation measures for these attitudes were not found although one believes that they will be necessary so far as in care and education fields. Through this study, one had as an objective to develop an interpersonal relationship evaluation instrument that enfolds the three facilitating attitudes, unconditional positive consideration attitudes, empathetic attitudes and congruence, and to perform the exploratory analysis concerning the dimensionality and reliability of such an instrument. The theoretic pole involved the explanation of the constructs, elaboration of the items and empirical analysis; the empirical pole related to the experimentation phase of the instrument. It is a matter of nurse-customer interaction observation scale constituted of positive and reverse items like a Likert-scale with five points. The unconditional positive consideration stayed with 22 items (15 reverse); the empathetic attitude was composed of 18 items (2 reverse) and the congruence counted for 8 items (2 reverse). Such items express the behavioral, oral and motor component of each construct and were indicated for using in conditions of observation during care. One chose for recording the interpersonal relations developed by 10 nurses involving 92 subjects with mental-impaired patients during nursing inquiries performed in Family Health Strategies in an inland city of Minas Gerais. In the analytical pole one made use of the factorial analysis (FA) and the internal consistency (Cronbach\'s alpha-coefficient) according the used theoretic-methodological referential. The instrument evaluated concerning to the theoretical model presented an alpha-scale global outcome of 0.82, being 0.68 for attribute one (unconditional positive consideration), 0.76 for attribute two (empathetic attitude) and 0.49 for attribute three (congruence). Due to the low internal consistency of attribute three in relation to the factorial load results, one analyzed a model of 36 items suggested by FA that showed itself fragile in relation to constitutive concepts and operationalization. The best outcomes indicate a three-subscale instrument. The unconditional positive consideration global scale presented an alpha of 0.687, the empathetic attitude scale got a global score of 0.769, and congruence featured 0.517. Items with factorial load below 0.40 were eliminated. All coefficients were significant for p<0.01 and significant correlation confirmed by Spearman coefficient. Some adjustments are necessary for the third construct/item due to the fragility of the results, although they are within acceptable parameters. The instrument so developed can be used by professionals who wish to evaluate the interpersonal relations in nursing care with research or didactic purpose.

Aims: Exercise and physical activity have been found to be beneficial in managing disabilities caused by multiple sclerosis (MS). Despite the known benefits, people with MS (pwMS) are inactive. Research has focused on structured exercise programmes, rarely considering a broader range of activities, which pwMS integrate into everyday life. The aims of this study were to gain in-depth understanding of the priorities and meanings of exercise and physical activity from the perspective of pwMS and to explore how these might inform clinical practice. Methods: a mixed methods approach using three interconnected studies was adopted: Study 1: A four-round Delphi questionnaire scoped and determined consensus of priorities for exercise and physical activity and the reasons why pwMS (n=101) engaged in these activities. Content and statistical analyses were utilised. Study 2: Sixteen face-to-face, semi-structured interviews were conducted with pwMS to explore the meanings ascribed to exercise and physical activity in relation to the Delphi study. Study 3: Three focus groups involving 14 physiotherapists explored perceptions about exercise and physical activity. Data were analysed for studies 2 and 3 using Framework Analysis and themes developed. Results: outcome from each phase 1. Study 1 revealed that the prioritised exercise and physical activity practices and the reasons why pwMS (n=70) undertook these activities were diverse. Consensus was found for the exercise and physical activity practices (W=0.744, p < 0.0001) and the reasons why pwMS engaged in these activities (W=0.723, p < 0.0001). 2. Study 2 demonstrated that the meanings pwMS ascribed to exercise and physical activity was beyond ‘movement’ reflecting how they lived with a variable and progressive condition. Contextual factors, specifically personal factors were dominant influences. 3. Study 3 highlighted that physiotherapists shared similar views in some aspects to pwMS, however physiotherapists perceptions of exercise and physical activity were predominately influenced by their theoretical knowledge. Conclusion: The priorities and meanings ascribed to exercise and physical activity were ‘a matter of perspective’ and context driven. Understanding the strategies used by pwMS for prioritisation might help clinicians support pwMS more effectively in their decision making about exercise and physical activity. Taking this approach creates the opportunity to deliver a more focused patient-centred approach in the management of MS. Recommendations for clinical practice and further research were identified.

Theory and evidence suggests that person-centred models may be especially relevant for elucidating the role of perfectionism in health and well-being in those with chronic health conditions. This may be particularly true for conditions, such as chronic fatigue syndrome (CFS), in which perfectionism is known to play a prominent role in health outcomes. Yet to date no research has taken a person-centred approach to examine how within-person combinations of perfectionistic strivings and perfectionistic concerns are linked to vulnerability for poor health in CFS. The current study compared matched samples of people with CFS and healthy controls (N = 163 each) on measures of stress, depression, and health problems. Consistent with the Stress and Coping Cyclical Amplification Model of Perfectionism in Illness and the tripartite model of perfectionism, within-person combinations of high perfectionistic concerns and strivings had the poorest health profile compared to other within-person combinations, but only among those with CFS. In addition, the perfectionism was indirectly associated with health through stress in those with CFS only. Findings add to a growing evidence base on the utility of person-centred models for understanding the health risks of perfectionism in the context of chronic illness.

The social work profession requires the accumulation of theory, knowledge, skills and their integration into practice. The department of social work at UNISA trains students according to the person-centred approach (PCA). The question thus arises whether the social workers trained in PCA at UNISA are able to integrate theory into practice in their different areas of employment. Exploring this would give the department of social work an opportunity to re-visit the teaching of PCA and make some improvements if necessary. The qualitative study was conducted with social workers employed in different welfare organizations in Pretoria. The following themes emerged from the analysis: the perceived significance of building relationship with clients, the organizational influence in counselling, unique experiences with regard to colleagues who graduated from other institutions, challenges in handling a conflict or crisis situation, and lastly the nature of statutory cases. The conclusions were drawn and recommendations were presented. / Social Science / M.A. (Mental Health)

The social work profession requires the accumulation of theory, knowledge, skills and their integration into practice. The department of social work at UNISA trains students according to the person-centred approach (PCA). The question thus arises whether the social workers trained in PCA at UNISA are able to integrate theory into practice in their different areas of employment. Exploring this would give the department of social work an opportunity to re-visit the teaching of PCA and make some improvements if necessary. The qualitative study was conducted with social workers employed in different welfare organizations in Pretoria. The following themes emerged from the analysis: the perceived significance of building relationship with clients, the organizational influence in counselling, unique experiences with regard to colleagues who graduated from other institutions, challenges in handling a conflict or crisis situation, and lastly the nature of statutory cases. The conclusions were drawn and recommendations were presented. / Social Science / M.A. (Mental Health)