Thesis (Ph. D.)--Columbia University, 1934. / Bibliography: p. 81-91.

Thesis (M.S.)--University of Wisconsin. School of Nursing, 1975. / eContent provider-neutral record in process. Description based on print version record.

Thesis (M.S.)--University of Wisconsin, School of Nursing. / eContent provider-neutral record in process. Description based on print version record.

Thesis (M.A.)--Rowan University, 2005. / Typescript. Includes bibliographical references.

Thesis (Psy. D.)--Wheaton College Graduate School, Wheaton, IL, 2002. / Abstract. Includes bibliographical references (leaves 79-82).

Thesis (M.A.)--York University, 2005. Graduate Programme in Psychology. / Typescript. Includes bibliographical references (leaves 235-272). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url%5Fver=Z39.88-2004&res%5Fdat=xri:pqdiss &rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:MR11800

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This feminist postmodern praxis oriented research investigates the journey and discourses of women living with breast cancer. This study explores the ways in which discourses and health care practices are implicated in relations of power, and how these discourses and practices inter-relate and inform each other. Alternative possibilities for creating new discourses and practices for women living with breast cancer are also examined in the study. Seventeen women in various stages of being diagnosed and treated for breast cancer participated in two years of individual interviews, group discussions, and informal conversations with the researcher. Participants also read and responded to the emerging construction of the dissertation and contributed pieces of original writing that they had created over the course of their journey with breast cancer. This research uncovers and illuminates the ways in which participants interpret biomedical discourse and position themselves in biomedical and other discourses. It also fosters an understanding about the ways in which women's discourses, sense of agency, power, and identity are impacted as they traverse their journey with breast cancer. In fore-grounding women's discourses, the differences between a woman's personal illness story and her journey with breast cancer and the biomedical emphases on the disease diagnosis and treatment trajectory are highlighted. An examination of women's discourses also illuminates the various ways that women may be positioned by biomedical discourse, position themselves and others, and as well, resist and reposition themselves in relationships. These understandings direct our attention to the strengths and capacities of women and the manner in which they exercise personal and collective agency. This research is unique in it's emphases on illuminating women's discourses about living with breast cancer and on the professional, social, historical and institutional discourses that shape experiences for women. Highlighting a woman's journey with breast cancer, her own discourses, exercise of agency and development of transformative knowledge provides health care professionals with an insider's view. Knowledge of health care practices and relationships in the care of women with breast cancer are useful in envisioning ways of practicing to support and strengthen women's construction of a cogent illness journey and ability to participate in their care in meaningful ways. / Graduate

This thesis examined the relationship of behavioural self-blame and psychological adjustment to chronic illness and addressed some of the conceptual and methodological inconsistencies found in the existing literature on self-blame by studying different groups of chronically ill patients. Study One comprised a questionnaire study and was designed to mainly examine 1) differences in the levels of self-blame in three different patient groups (i.e. diabetes, heart disease and breast cancer patients), 2) the relationship between perceptions of behavioural risk factors contributing to the patients' illness and level of self-blame and 3) the relationship between self-blame, self-efficacy and psychological adjustment. Findings showed that there are significant differences in the levels of self-blame across the three groups with breast cancer patients showing the least self-blame. These differences were explained in terms of the different levels of perceived lifestyle factors contributing to the cause of illness and its subsequent management in the three groups. Also, self-blame was higher when patients were asked to consider a specific negative event relevant to their illness than when they considered their illness in general. For all three groups, self-blame was correlated to the number of behavioural risk factors patients reported as having contributed to their illness. No relationship was found between self-blame and self-efficacy or psychological adjustment. Study Two looked at the predictors of behavioural self-blame in heart disease patients by testing a theoretical model derived from evidence in the literature. The model included certain person (i.e. gender, age, characterological self-blame, and prior risk) and illness- related characteristics (i.e. type of diagnosis, time since diagnosis, perceived illness consequences, controllability of health behaviours) that had either direct paths to behavioural self-blame or indirect paths through their effect on behavioural causal attributions. The final model -showing gender and characterological self-blame as having both direct and indirect paths to self-blame, and prior risk, diagnosis and consequences as having only indirect paths- fit the data well. Also, behavioural attributions predicted improved health behaviour after the illness. No relationship between behavioural self-blame or causal attributions and psychological adjustment was found. Studies Three and Four addressed criticisms regarding the inconsistent conceptualisation and operation definitions of self-blame, which caution against unfounded generalisations such as the interchangeable use of the terms causality, responsibility and blame or the generalisation of results across different populations. This was done by 1) examining the degree to which self-blame is contingent upon the actual experience of illness, and 2) by comparing 14 negative events rated on dimensions relevant to blame and controllability. Specifically, in Study Three, non-patients were compared to patient counterparts from the previous study to look at differences in levels of self-blame for heart disease. Non-patients were found to have higher levels of self-blame than non-patients and showed no relationship between self-blame and behavioral risk suggesting a different understanding and utility of the concept. In Study Four, non-patients rated 14 negative events on the dimensions of blame, responsibility, control and avoidability. Two dimensional plots showed that while there were many similarities in the way the examined dimensions were applied to the 14 events, illnesses were represented separately from other negative events. Overall, these studies suggest a strong cognitive component in self-blaming patients as opposed to the motivational elements suggested in the literature. Possible explanations and ways to theoretically link the contradictory findings are discussed in the last chapter of the thesis and include the consideration of self-regulation processes and of changes that the self is subject to throughout the course of an illness.

The nature of, indications for, and aims of amputation and prosthetic rehabilitation are described. The influence of those procedures on patients' physical, psychological and social states are examined over time. Psychological theories of the coping techniques of surgical patients are used to develop an understanding of the influence of patients' pre-surgical characteristics on their post-operative rehabilitation. The Roehampton Functional Assessment Scale has been developed and validated on three separate samples of primary lower-limb amputees. The developmental sample consisted of 121 patients, the reliability sample of 50 amputees and the validity sample of 25 patients. The 10-point Body Barrier Test, Family Environment Scale, General Health Questionnaire, Multidimensional Health Locus of Control, Minnesota Multiphasic Personality Inventory, State-Trait Anxiety Inventory and the Roehampton Functional Assessment Scale were used to assess patients' pre- and post-operative physical, psychological and social parameters. 109 patients were assessed before their amputation, whom were re-assessed six months after amputation, and 27 followed-up at eighteen months or more after their operation. The results indicated that patients' psychological profiles differed at each assessment stage, and the changes observed were not always in the same direction. Patients appeared to suffer from worse physical symptoms, sleep disturbances, State Anxiety and body-image before their amputation than after, while still functioning independently from their family environment. At the first post-operative assessment, amputees wore found to fare better than at any other assessment stage. Nevertheless, inter-personal difficulties, indicated by reduced Individuality scores, became evident at this stage. At the final stage, amputees appeared to continue physically and psychologically functioning on levels similar to the previous stage, except for significantly increased Trait Anxiety scores. The three pre-operative variables accounting for most of the variance in the first post-operative assessment variables were Trait Anxiety, Anxiety and Dysphoria and Sleep Disturbances [the later two are subscales of the General Health Questionnaire (GHQ)]; while for the second post-operative assessment the variables were State Anxiety, Somatic Symptoms (a subscale of the GHQ) and Chance Locus of Control. Male and non-vascular patients and those with below-the-knee amputations achieved the best physical rehabilitation and lowest levels of psychopathological disturbances at both re-assessment stages. Additionally, younger patients were found to do better that older amputees at the first post-operative assessment. This clear age difference was not maintained at their second post-operative assessment. Explanations of the possible relationships of the results obtained and a comparison with the results of previous research studies are provided. Clinical applications and recommendations for future research are also included.