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In North America, hysterectomy is the most common major surgery for benign non-obstetric reasons (e.g., uterine fibroids, endometriosis, abnormal bleeding) in premenopausal women. Many of these conditions may result in pelvic pain, sexual and psychological difficulties. However, the capacity of hysterectomy to relieve these problems has not been adequately evaluated. Recently, there has been controversy as to whether less invasive surgeries such as subtotal hysterectomy, in which the uterus is removed and the cervix is left intact, are less detrimental than total hysterectomy, in which both the uterus and the cervix are excised. / The first part of this thesis consists of a comprehensive review of the literature on the psychosocial outcomes of hysterectomy published within the past 30 years. Controversial theories, empirical studies, and review articles are discussed with regard to sexual, pain, and psychological outcomes. Findings suggest that while hysterectomy results in reduced pain, there are no strong effects on sexual or psychological functioning. Nevertheless, many studies reported adverse psychosocial outcomes in a subgroup of 10-20% of women post-hysterectomy. / The second part of this thesis presents findings from a randomized controlled trial investigating the psychosocial outcomes of total versus subtotal hysterectomy. Premenopausal patients with benign gynecological conditions were randomly assigned to either total hysterectomy, i.e., laparoscopic assisted vaginal hysterectomy (N=32), or subtotal hysterectomy, i.e., supra-cervical laparoscopic hysterectomy (N=31). In addition, two control groups of premenopausal women undergoing minor gynecological surgery (N=30) and healthy women undergoing no surgery (N=40) were recruited. For the two hysterectomy groups, abdominal pain was significantly reduced post-surgery. There was some evidence for positive effects of hysterectomy on sexual functioning, while psychological functioning did not significantly change. The study indicated that total and subtotal hysterectomy produced equally beneficial outcomes. Although 3-16% of women reported various adverse effects in psychosocial functioning post-hysterectomy, similar percentages of the two control groups reported such changes.

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This thesis explored possible underlying processes of bulimic behaviours by conducting a naturalistic examination into binge antecedents and consequences. Main hypotheses were derived from contemporary theories of binge-eating behaviour, which postulate that dietary restraint, negative affect, and dissociative phenomena (i.e., lapses in self-awareness) may precipitate and maintain bulimic symptoms. A secondary aspect of this study was to determine whether or not personality variations influence individuals' sensitivity to processes that may precipitate binge eating or that may shape binge consequences. A sample of 39 women with bulimia-spectrum eating disorders provided "on line" self-reports on eating episodes, urge to binge, behavioural and cognitive dietary restraint, negative and positive affect, and dissociation, with samplings obtained in response to random prompts, and before and after every eating episode. Across participants, recording with the daily diaries spanned 7- to 29-day intervals and resulted in a total of 3,204 recordings. Multilevel modelling analyses indicated that increases in behavioural dietary restraint preceded stronger urges to binge. Affect was also poor prior to actual binge episodes and seemed to worsen after bingeing. In addition, dissociation was likely to be present prior to and after bingeing. These results suggest that processes linked to dietary restraint, affect, and dissociation potentiate, trigger, and/or maintain bulimic behaviours. In contrast, the results did not consistently support the role of personality traits as moderators of binge antecedents or consequences. The present findings suggest that binge eating is a multiply determined behaviour that is linked to diverse cognitive, behavioural, and affective processes. Recommendations for future research and clinical implications are discussed.

Thesis (Ph. D.)--University of Hawaii at Manoa, 1990. / Includes bibliographical references (leaves 145-158) / Microfiche. / viii, 158 leaves, bound 29 cm

The increased intensity and complexity of cancer treatment has an impact on the lives of the adolescents undergoing such treatments. Living with cancer is a distinct experience for them which include physical, psychological, spiritual and social dimensions. The cancer experience comprises more than the measurement of symptom occurrence, frequency, duration and severity, or the ratings of quality oflife. The meanings of the lived experience from the adolescent's perspective and self-report can give a more accurate, holistic picture of the nature and scope of the experience. Practitioners need to know and understand the meaning of the experience from the adolescent's perspective in order to design appropriate interventions to prevent or relieve distress in these patients. The purpose of this study was to describe the meanings of the lived experience ofhaving cancer for adolescents undergoing treatment. Phenomenology was the qualitative research methodology used. As outlined by Patricia Munhall, this methodology seeks to understand the meaning of lived experiences. Seven adolescents, 14 to 18 years of age, in treatment for cancer were interviewed. Six males and one female participated in this study. Six were receiving treatment for acute lymphocytic leukemia and one for a solid tumor. All participants were of Pacific Island origin; two live in Hawaii and five were temporary residents. The audio taped interviews were transcribed and analyzed to understand the meaning of the cancer experience. The essence of the experience for the individual adolescent was described and a composite interpretation of the meaning derived. Recommendations to healthcare providers for improving communication with adolescents in treatment for cancer are provided, including discussing death and dying early in the illness trajectory. The interdisciplinary concept of care is stressed, as well as the importance of a thorough physical examination. The importance of social support and techniques to potentially strengthen and increase this support are outlined. Solutions to the problems of school reintegration are introduced.

This research was a pilot study at improving the medical, psychiatric and addiction care provided to women detainees at the jail. Few studies have been completed with women atjail intake, yet the population is suspected of having a multitude of medical, psychiatric and addiction in jail treatment and community reentry needs. Utilizing a descriptive, cross-sectional survey design, the following aims were completed for this pilot study: documented the creation of a nursing research infrastructure within a large jail; compared the results of the traditional 16- item paper and pencil Intake Service Center Screen with the 8-item paperless Brief Jail Mental Health Screen obtained via Audio Computer Assisted Self Interviewing (ACASI) technology; compared Addiction Severity Index scores and addiction treatment motivation and readiness scores obtained via ACASI technology with normative data; assessed the frequency of HIV risk behaviors and the medical, psychiatric and addiction treatment needs obtained via ACASI technology; while assessing the frequency and the average length of time for screening by providers at the jail via medical chart review. The results showed that the ACASI technology proved to be more effective than paper and pencil methods. This technology not only assessed detainee treatment needs, but simultaneously created reentry/discharge plans. The study demonstrated that HIV risk behaviors and the prevalence of past suicide attempts were high among the participants. The Addiction Severity Index scores and the Circumstance Motivation and Readiness scores demonstrated that methamphetamine addiction, and mental health severity is high among this population however motivation and readiness for treatment arc low. Therefore, recommendations for the most suitable jail psychiatric Advanced Practice Registered Nurse candidates could be given as a result of the study. This study was the first phase at improving the medical, psychiatric and addiction care provided to detainees at the jail. In future phases of this study more valid and reliable assessment tools and treatment planning aimed at reduced recidivism rates will be established. Future phases will build on the lessons learned here about working with security staff, collaborating with experienced researchers in the community, and seeking advice from the Department of Justice recognized experts.

Remorse continues to play an important role in the legal system and in offender rehabilitation; yet, it remains an understudied concept. Research related to remorse at the phenomenological level is sparse and studies that focus on youthful offenders are nearly non-existent. The purpose of this study was to describe the essence of the lived experience of male, adolescent offenders, who have experienced the phenomenon of remorse in the context of their crimes. Colaizzi‟s descriptive, phenomenological approach to inquiry and analysis guided this qualitative study. Narratives from in-depth, semi-structured interviews with 13 male, African American and European American, ages 16-18 year-old offenders placed in privately owned Residential Treatment Programs served as data. Eight clusters of themes and 18 themes emerged from the data and provided rich descriptions of the remorse experience among this population. Findings supported the positive and negative aspects of remorse noted in the literature. Implications for future nursing research, nursing practice, and policy were provided.

<p>We live in a society that continually reinforces the connection between femininity and maternity and for the majority of women, attempts to experience motherhood are successful. However, for others the world of motherhood is not so easy to enter. To date, research regarding the needs and life satisfaction of women who are unsuccessful in becoming mothers, is fairly limited. The purpose of this study was to explore the transitional phase women endure from potential motherhood to non-motherhood and to highlight some of the complexities underpinning infertility and its impact on the lives of women in South Africa. The main objective was to gain deeper insight into how women incorporated this experience into their lives and relationships and how they began to create a future life without their own biological children. A secondary aim of this study was to investigate whether the women viewed aspects such as age and finances as having had an effect on their decision to discontinue treatment for infertility. Feminist standpoint theory served as a theoretical framework for the study that recognized that each individual voice be heard. This study was a qualitative exploration, utilizing a short demographic questionnaire and an in-depth semi-structured interview. Five interviews were conducted with women from diverse backgrounds. These interviews were recorded / transcribed verbatim and thematic analysis of the data was conducted.</p>

Despite the efforts of researchers, mass hysteria is difficult to predict and challenges management. Outbreaks often causes large financial losses, usually represented by the waste of study or work hours, the involvement of emergency personnel, hospitalisation of those involved, and disruption of routine. Very few psychological studies have been produced to date, and some of the issues raised were the methodological difficulties in defining and limiting the phenomena as an object of scientific inquiry. An analysis of psychological variables utilising case study methodology and the historical method indicates that these variables are present in episodes of mass hysteria, and that they are likely to play a key role in triggering the outbreak, in spreading symptoms, maintaining the mass hysteric's behaviour, and ending the episodes. This is an exploratory study, and further research remains to be done on all aspects of the role of psychological variables in these outbreaks. Computer simulation of mass hysteria may help understand these phenomena, which often catch people by surprise, greatly limiting data recording and analysis of its natural occurrence.