Thesis advisor: Callista Roy / The purpose of this secondary analysis was to understand the coping and adaptation processes of reservist soldiers and one family member throughout the first year following deployment to Iraq. A directed content analysis based on the Roy (2009, 2011) conceptualization of coping and adaptation was accomplished on 75 interviews from 20 Army Reserve and family participants. Research questions were; which contextual stimuli affected the coping capacity for dealing with focal stimuli; military deployment and reintegration. Second, whether resourceful and focused coping at Wave 1 positively influenced the adaptation level at 52 weeks. Third, whether physical and fixed coping at Wave 1 negatively affected the adaptation level at 52 weeks. Fourth, whether coping capacity varied during the reintegration year. Findings confirmed primary study outcomes (MacDermid, 2006) where participants described individualized reintegration. Informants' depictions were different from the previously published, "New Emotional Cycles of Deployment." Contextual stimuli were complicating or protective and exerted substantial influence on managing the deployment and reintegration. Cognitive-emotional processing the meaning and repercussions of the deployment is part of the reintegration process. Resourceful and focused coping positively affected the adaptation level at 52 weeks. Insufficient reports of physical and fixed coping precluded determining its effect. Coping efforts were a discrete measure of coping extrapolated from narratives, and were found to fluctuate throughout the year. When demands intensified, participants accelerated their coping efforts as predicted by the Roy adaptation model (2009). Coping strategies were effective or ineffective. Concepts of transcendence, transformation, and hope were understood in new ways within the Roy model. Transcendence in individuals and groups was further explicated. Spirit was another concept from Roy's work that was observed in the participants. Implications for policy, theory, nursing practice, education and research are discussed. Keywords: adaptation, adaptation level, coping, coping efforts, Roy adaptation model, spirit, transcendence, transformation, hope, military deployment, post-deployment, reintegration, Reservist, military family, deployment cycle, directed content analysis / Thesis (PhD) — Boston College, 2012. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Thesis advisor: Barbara E. Wolfe / Despite the chronicity and less than optimal outcomes of inpatient treatment (IPT) for anorexia nervosa (AN), treatment guidelines continue to reflect the common notion of one-size-fits-all and the process of weight restoration continues to be poorly understood. Weight restoration, a primary goal of IPT for AN, does not occur in isolation but rather reflects an adaptation process within internal and external environments. It is unknown whether or not there are unique patterns of change in body weight that are associated with factors identified in the existing literature as being predictors of weight gain. The purpose of this study was to explore the extent to which patterns of change in body weight existed among individuals during IPT for AN, and the relationship with factors identified in the existing literature as being predictors of weight gain (i.e., age at time of admission, admission caloric intake, percent of ideal body weight [IBW] at time of admission, body weight at time of discharge, body mass index [BMI] at time of discharge). Individuals who were diagnosed with AN and admitted to the inpatient unit of an eating disorder treatment facility in the Northeast between January 1, 2012 to December 31, 2015 were included in this retrospective, exploratory study (N = 500). Group-based trajectory modeling (GBTM) was used to identify distinct trajectories of change in body weight, and to determine the risk of being in a particular trajectory. Four distinct trajectories were identified: weight gain (n = 197), weight loss (n = 177), weight plateau (n = 82), and weight fluctuate (n = 44) groups. Significant predictors of trajectories were age, history of prior IPT for AN, admission caloric intake, body weight at time of admission and discharge, and length of stay. Results from this study suggest that a further understanding of patterns of change in body weight among individuals with AN, will help guide assessment and treatment interventions and consequently influence outcomes. Additionally, there is an opportunity to update treatment guidelines and recommendations for AN. / Thesis (PhD) — Boston College, 2016. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Thesis advisor: Callista Roy / <bold>Problem</bold>: Cancer patients lack information and support needed to make the transition to survivorship. This problem was addressed by testing a psycho-educational group intervention, the Mid-Life Directions Workshop, for its effect on hope and quality of life in midlife cancer survivors. <bold>Participants</bold>: Twenty-six midlife adults (23 women, 3 men, mean age = 54.3 years, range 40-65) with breast cancer (n = 19), colorectal cancer (n = 4), lung cancer (n = 2), and malignant melanoma (n = 1) stages I, II and III were recruited from two hospital-affiliated Cancer Centers in the Northeastern United States. Mean time since completion of active primary treatment was 11.5 months (SD = 6.67, range, 0-28 months). Most participants were non-Hispanic (96.2%) and white (100%) with some college or a college degree (88.5%). <bold>Method</bold>: A multimethod experimental design randomly assigned 17 participants to the treatment group, receiving the workshop in six 2-hour sessions, and 9 participants to the control group, receiving a nutrition program in six 1-hour sessions. Hope was measured pre- and post-intervention using the Herth Hope Index as was quality of life using the Quality of Life Instrument, Patient/Cancer Survivor Version. Written reflections were created by treatment group participants post-intervention. <bold>Findings</bold>: The quantitative measures revealed a significant increase in hope (p = .047) for the control group. The treatment group reported positive effects on hope and quality of life by means of written reflections. Six themes emerged: 1) examining what is, 2) feeling connected, 3) accepting what is, even the painful, 4) embracing one's life experiences, 5) exploring new possibilities, and 6) moving forward with enthusiasm. <bold>Implications</bold>: The Mid-Life Directions Workshop demonstrated positive effects on hope and quality of life for this group of midlife cancer survivors. The richness of the qualitative findings highlights the importance of multimethod design for future studies. The Nutrition Program also merits further study. This study provides an increased understanding of interventions that may support hope in midlife cancer survivors following active primary treatment. / Thesis (PhD) — Boston College, 2012. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Krūties vėžys jau daugelį metų yra dažniausia moterų onkologinė liga bei opiausia ir aktualiausia jų sveikatos problema. Problemos aktualumą lemia vis didėjantys susirgimo mastai bei nepaliaujamas sergamumo krūties vėžiu augimas. Atlikus darbą bus išsiaiškinta su kokiais adaptacijos poreikiais susiduria sergančios moterys 1- 4 parą po operacijos (ankstyvuoju pooperaciniu laikotarpiu) ir išvykusios į namus (vėlyvuoju pooperaciniu laikotarpiu). Išsiaiškinus adaptacijos poreikius, būtų galima greičiau bei efektyviau padėti pacientėms susidoroti su iškilusiomis adaptacijos problemomis. Darbo tikslas - įvertinti ir palyginti moterų, sergančių krūties vėžiu, adaptacijos poreikius ankstyvuoju ir vėlyvuoju pooperaciniu laikotarpiu. Šiam tikslui pasiekti buvo naudojami 3 uždaviniai: 1. Palyginti moterų, sergančių krūties vėžiu fizinės adaptacijos poreikius ankstyvuoju bei vėlyvuoju pooperaciniu laikotarpiu remiantis C. Roy adaptacijos modeliu. 2. Palyginti moterų, sergančių krūties vėžiu vaidmens poreikius ankstyvuoju bei vėlyvuoju pooperaciniu laikotarpiu remiantis C. Roy adaptacijos modeliu. 3. Palyginti moterų, sergančių krūties vėžiu tarpusavio ryšio poreikius ankstyvuoju bei vėlyvuoju pooperaciniu laikotarpiu remiantis C. Roy adaptacijos modeliu. 4. Palyginti moterų, sergančių krūties vėžiu asmens tapatumo poreikius ankstyvuoju bei vėlyvuoju pooperaciniu laikotarpiu remiantis C. Roy adaptacijos modeliu. Tyrimo objektas - 25 – 55 metų amžiaus pacientės, sergančios I – II... [toliau žr. visą tekstą] / A breast cancer is the most common malignant disease of women and the most serious and relevant problem of their health. The actuality of this problem depends on the extent of this disease and continuous growth of the incidence of breast cancer. Following the work will clarify what are the adaptation needs for women after 1 – 4 day from surgery (early postoperative period), and during the period of backing home (the late postoperative period). Clarifying the adaptation needs leads the faster and more efficient way to help patients cope with adaptation problems. The objective of the work is to assess and compare the adaptation needs in the early and late postoperative period of the women with breast cancer. To accomplish the object of work was used three tasks: 1. Compare physiological adaptation needs in the early and late postoperative period based on C. Roy adaptation model for women with breast cancer. 2. Compare the self-concept function of early and late postoperative period based on C. Roy adaptation model for women with breast cancer. 3. Compare the needs of interrelation in the early and late postoperative period based on C. Roy adaptation model for women with breast cancer. 4. Compare personal interdependence needs in early and late postoperative period based on C. Roy adaptation model for women with breast cancer. The object of investigation - 25 - 55 year-old patients, suffering from I - II-stage breast cancer, which has been operated and treated at the LSMU KK... [to full text]

Résumé : La schizophrénie est un trouble mental grave qui affecte toutes les facettes de la vie de la personne. En outre, le manque de soutien social est un problème important qui contribue à l’aggravation de la maladie, notamment en influençant négativement la capacité d’adaptation. Chez les personnes atteintes de schizophrénie, la capacité à utiliser des stratégies d’adaptation adéquates et efficaces est essentielle afin d’améliorer la santé, le bien-être et la prévention des rechutes. Cette recherche utilise la conception de l’adaptation de Roy (2009). De nombreuses études confirment la présence de difficultés d’adaptation chez ces personnes. De plus, le processus d’adaptation lui-même reste mal connu. La question de recherche était : Quel est le processus d’adaptation des personnes vivant avec la schizophrénie lorsque leur soutien social est limité ? Cette question sous-tendait deux objectifs : 1) décrire le processus d’adaptation des personnes atteintes de schizophrénie dans un contexte de soutien social limité et 2) contribuer au développement du modèle de Roy dans le contexte des troubles mentaux graves. Le devis de recherche était la théorisation ancrée constructiviste, auprès de 30 personnes vivant avec la schizophrénie. Les données étaient composées d’entrevues et de résultats de trois questionnaires qui ont contribué à décrire de façon plus détaillée le profil des participants. Les résultats sont une modélisation du processus d’adaptation nommée « les filtres dans le processus d’adaptation des personnes vivant avec la schizophrénie ». Cette modélisation met en lumière le fait que le potentiel d’adaptation des personnes vivant avec la schizophrénie est affecté à la fois par des éléments de l’environnement social et des éléments inhérents à la maladie elle-même. Ces éléments altèrent la possibilité et la capacité à utiliser des stratégies d’adaptation adéquates et efficaces. Ces résultats de recherche pourraient permettre d’améliorer l’évaluation des personnes atteintes de schizophrénie et de diminuer les « inconnues » dans l’effet des interventions, tout comme de favoriser les actions visant à lutter contre les conditions sociales qui nuisent à l’adaptation. / Abstract : Schizophrenia is a severe mental disorder that affects all human facets of life. In addition, the lack of social support is an important problem that contributes to the worsening of the disease by negatively influencing the capacity to adapt. For people with schizophrenia, ability to use appropriate and effective coping strategies is essential to improve health, well-being and preventing relapse. This research uses Roy’s adaptation model (2009). Numerous studies confirm the presence of adaptation problems for those persons. Furthermore, the adaptation process itself remains unclear. The research question was: what is the adaptation process of people with schizophrenia when social support is limited? This question underpinned two objectives: 1) describe the adaptation process of people with schizophrenia in a limited social support context and 2) contribute to the development of Roy’s adaptation model in severe mental disorders context. The research design was a constructivist grounded theory, with 30 people with schizophrenia. The data were consisted of interviews and results of three questionnaires that were helping to detail the participants profile. The results show a construct of an adaptation process called "the filters in the adaptation process of someone living with schizophrenia". This construct highlights the fact that the adaptation potential of people with schizophrenia is affected both by elements of the social environment and elements that are inherent to the disease itself. These elements affect the possibility and the ability to use appropriate and effective coping strategies. The research findings could facilitate the assessment of people with schizophrenia and reduce the unknowns in the impact of interventions, as well as fighting against social conditions that can interfere with their capacity to adapt.

Thesis advisor: Sr. Callista Roy / Social Cognition and the Impact of Race and Ethnicity on Clinical Decision Making Most literature reflects the persistent existence of unequal treatment in the care provided to ethnic and racial minorities. Comparatively little about ethnic bias in the literature goes beyond the retrospective study as the most frequently encountered method of inquiry. Access to providers and the ability to pay only provide partial explanation in the known data. A more controversial hypothesis is the one offered in this dissertation. This qualitative research explored the cognitive processes of ethnic bias as a phenomenon in clinical decision making. The method was a simulation that captured events as they occurred with a sample of nurse participants. The racial and ethnically related cognitive content of participants was evoked through the interactive process of playing a board game. Immediately following that activity, a video vignette of an ambiguous pain management situation involving an African American male was viewed by each nurse who was then asked to make a "treat" or "not treat" clinical decision. The dialogues during playing of the board game in addition to the rationale for the treatment decision provided data for analysis. Content analysis is the primary approach for using the data to answer the research question. Themes of latent and manifest content were described for those who made the decision to treat and those who decided not to treat. / Thesis (PhD) — Boston College, 2012. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Bakgrund: Idag drabbas många av cancersjukdom men tack vare tidig upptäckt botas många. Under sjukdomstiden påverkas även patientens maka/make/partner av cancersjukdomen. Anhöriga som stöttar sin partner kan ha en ökad risk att drabbas av egna hälsorelaterade problem.  Syfte: Syftet var att belysa anhörigas upplevelser av att stötta en partner i kurativt skede av cancersjukdom.  Metod: Resultatet består av tolv vetenskapliga artiklar som analyserades och delades in i sju teman. Roys Adaptationsmodell har använts för att diskutera resultatet. Artiklarna samlades in via databaserna CINAHL och PUBMED med urvalet 2007-2017.   Resultat: Resultatet visade på att anhörigas behov blev åsidosatta under partnerns sjukdomstid.  Deras identitet påverkades då de anpassade tillvaron för att kunna fokusera på sin partners vård. Rollfördelningen i parrelationen förändrades och anhöriga fick ta mer ansvar. En för stor börda på de anhöriga kunde ha stor påverkan på deras hälsa men många anhöriga upplevde att de kom sin partner närmare under sjukdomstiden.                    Diskussion: De fyra anpassningslägena i Roys modell påverkar varandra och är svåra att separera. Detta visar på att det är viktigt att ha en helhetssyn på människan. Vi anser att det är viktigt att vården uppmärksammar anhörigas behov och situation och erbjuder stöd för att undvika framtida ohälsa. / Background: A large number of individuals are affected by cancer disease every year, but due to improved treatment and early discovery many are cured. The illness, also affect the patient´s significant other and may increase their risk of own health-related problems. Aim: The aim was to describe significant others´ experiences when supporting a partner in curative phase of cancer disease. Method: The results are based on twelve scientific articles and categorized in seven themes. The Roy Adaptation model was used to discuss the result. Data were collected from the CINAHL and PUBMED databases, including articles from the years 2007-2017. Results: The results show that significant others´ own needs were put aside during their partner´s illness. Their identities were affected as they were adapting their everyday life to be able to support their partner. A partner´s illness also changed the couple’s roles as the couples responsibility changed within the relationship. If the significant other experienced the support as burdensome their health could be negatively affected. Significant others´ experienced their relationship to their partner to improve during the illness. Discussion: The four adaptation modes by Roy are related to each other and are hard to distinguish and the holistic view of each person is important. We conclude that it is important that the health care system also acknowledges the significant other´s needs and situations and thereby provide support needed to elude future health issues.

The purpose of this study was to determine how pain in PLHIV on community home based care programme was managed using the Roy adaptation model (RAM) as the theoretical framework. This study used a descriptive mixed method research design which allowed for the research topic to be investigated and described in terms of both narrative qualitative accounts and descriptive statistics. A sequential exploratory approach was adopted in which qualitative data collection was conducted in the initial phase followed by quantitative data collection. Ten qualitative interviews, guided by the components of the RAM were conducted in the initial phase and a structured interview schedule (questionnaire) partially based on the result of the qualitative phase and (which was also structured in accordance with the RAM) was administered to 120 respondents who met the inclusion criteria of being on CHBC. Convenience sampling was used to select study participants and respondents in both phases of the study. Peripheral neuropathy was the most common pain syndrome experienced by patients. More females suffered numbness/tingling sensation of toes, followed by chest pains than their male counterparts. Pain experienced was moderate to severe which was not treated effectively. The study findings could assist health care providers, policy makers and researchers to invest into improving pain management for PLHIV, strengthen education of patients and their primary caregivers on the causes of pain and modalities to employ for pain relief and implement palliative care guidelines for PLHIV. / Health Studies / D. Litt. et Phil. (Health Studies)

The purpose of this study was to determine how pain in PLHIV on community home based care programme was managed using the Roy adaptation model (RAM) as the theoretical framework. This study used a descriptive mixed method research design which allowed for the research topic to be investigated and described in terms of both narrative qualitative accounts and descriptive statistics. A sequential exploratory approach was adopted in which qualitative data collection was conducted in the initial phase followed by quantitative data collection. Ten qualitative interviews, guided by the components of the RAM were conducted in the initial phase and a structured interview schedule (questionnaire) partially based on the result of the qualitative phase and (which was also structured in accordance with the RAM) was administered to 120 respondents who met the inclusion criteria of being on CHBC. Convenience sampling was used to select study participants and respondents in both phases of the study. Peripheral neuropathy was the most common pain syndrome experienced by patients. More females suffered numbness/tingling sensation of toes, followed by chest pains than their male counterparts. Pain experienced was moderate to severe which was not treated effectively. The study findings could assist health care providers, policy makers and researchers to invest into improving pain management for PLHIV, strengthen education of patients and their primary caregivers on the causes of pain and modalities to employ for pain relief and implement palliative care guidelines for PLHIV. / Health Studies / D. Litt. et Phil. (Health Studies)