Thesis (Ph. D.)--University of Missouri-Columbia, 2004. / Typescript. Vita. Includes bibliographical references (leaves 119-129). Also available on the Internet.

Thesis (M.A.)--University of Missouri-Columbia, 2008. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file (viewed on August 19, 2009) Includes bibliographical references.

Thesis (Ph. D.)--University of Washington, 1996. / Vita. Includes bibliographical references (leaves [56]-59).

Thesis (M. A.)--University of British Columbia, 2006. / Includes bibliographical references (leaves 101-104). Also available online (PDF file) by a subscription to the set or by purchasing the individual file.

Please read the abstract in the section 00front of this document / Dissertation (MEd (Educational Psychology))--University of Pretoria, 2005. / Educational Psychology / unrestricted

In the health psychology literature there has been a proliferation of research linking forms of self-attention to psychological distress, especially to depression. The broad conclusion that self-attention is harmful, however, challenges the central premise of self-regulation theory - a theory detailing the role of self-attention as the engine of an adaptive regulating system that enables people to achieve their goals. In an attempt to reconcile these perspectives, I conducted two studies to distinguish the forms and states of self-attention that serve an adaptive self-regulation function from those that create a vulnerability to depression. Both studies included a pretest and a daily diary component. Participants were pretested on trait self-attention, trait negative affectivity (Study 1), depression (Study 2), and a goal inventory. Study 2 included a follow-up session where participants again completed the depression inventory. For the diary component, participants described and rated the most negative event they experienced during the rating period (twice daily for 2 weeks in Study 1; once daily for 4 weeks in Study 2). Diary self-report measures of self-attention included: level of rumination (Study 1), initial self-analysis (Study 2), and multi-day-protracted attention (Study 2). After the diaries were completed, participants' event descriptions were coded for goal-relevance and level of self-focused attention (SFA). Consistent with self-regulation theory, participants' goal-related events elicited stronger self-attentional responses (higher levels of SFA, rumination, initial self-analysis, and protracted attention) than did their goal-unrelated events. These within-person effects were not moderated by the pretest measures, nor did they predict levels of emotional distress. Thus, in daily life it appears to be typical and not harmful for people to respond to goal-setbacks by engaging in elevated levels of introspection, self-analysis, and even negative, symptom-focused rumination. With respect to individual differences, people higher in pretest rumination and in chronic daily rumination, initial self-analysis and protracted attention experienced higher levels of emotional distress. Chronic daily levels of initial self-analysis and rumination predicted emotional distress after controlling for pretest levels of distress. Thus, self-attention appears to create a vulnerability to depression only when people have chronic difficulty containing initial levels of self-analysis and rumination in response to negative events. / Arts, Faculty of / Psychology, Department of / Graduate

While self-determination researchers emphasize the importance of pursuing internally motivated goals for self-regulation, cybernetic theorists instead highlight the structural features of goal systems and the manner in which such structural features should facilitate controlled behavior in daily life. However, it was our intuition that a consideration of both these literatures might best explain self-regulatory processes in daily life. Along these lines, we conducted two studies in which we measured the degree to which a person's goals are organized in hierarchical manner with respect to their intrinsic versus extrinsic properties. In Study 1, we found that individuals with hierarchical goal structures were less likely to experience increased motivation to quit following frustrating events. Consistent with this pattern, in Study 2 we found that negative feedback concerning goal progress adversely affected only those without hierarchical goal structures. Implications of these findings for perspectives on self-regulation are discussed, as well as potential new directions for testing cybernetic concepts within human functioning.

Diabetes is a rapidly growing health concern in the developed world. Hypoglycaemia is a major risk factor in people with diabetes. Each year, about 7000 calls relating to hypoglycaemia are made to the Scottish Ambulance Service (SAS), including a considerable number of repeat callers. Very little is known about people’s experiences and explanations of recurrent hypoglycaemia; in particular, why some individuals manage their recurrent hypoglycaemic episodes independently, while others require more direct healthcare support. This thesis investigated participants’ experiences and individual explanations of recurrent hypoglycaemic episodes, in order to understand their health help-seeking behaviour. To do this, it compared the experiences of people who had called the emergency services within one month prior to recruitment (SAS participants), with those people who had not done so (non-SAS participants). The study employed a multiple methods longitudinal approach to prospectively capture participants’ experiences of hypoglycaemic episodes, using qualitative semi-structured interviews, hypoglycaemia and blood glucose diaries and follow-up telephone interviews over a six month period. Thirty participants were involved in the study, recruited through the Scottish Ambulance Service, Diabetes UK (Scotland), and the University of Stirling. All participants resided in the central belt of Scotland. Qualitative data was analysed using the framework method, and quantitative data was analysed using descriptive statistics. This study found that hypoglycaemic episodes had a wide ranging impact on people’s everyday life. It was not only the actual hypoglycaemic episode that affected participants’ everyday life, but also fears and worries about future hypoglycaemic episodes, the preparations that participants engaged in, and the process of recovery. Hypoglycaemia unawareness was found to be a major problem for many people living with diabetes. It appeared to be associated with the likelihood of needing external help. There were differences between participant groups with regard to management of hypoglycaemia unawareness. Non-SAS participants adopted strategies to prepare for future hypoglycaemic episodes, and appeared to be more knowledgeable about their diabetes and its management, resulting in needing less external help. SAS participants experienced more severe hypoglycaemic episodes. Consequently, they relied more on external help. Findings of this study call for a re-conceptualisation of the previously recognised ‘balancing act’ of managing diabetes and hypoglycaemic episodes. This study introduces the concept of a hypoglycaemic episode balancing continuum (HEBC) which enables a deeper understanding of the factors involved in this balancing act: it demonstrates that people balance the various risks differently, depending on whether they prioritised their fear of hypoglycaemia over fears of long-term complications. People’s position on the continuum directly affected their management strategies for hypoglycaemic episodes. Most hypoglycaemic episodes were managed by the individual without requiring any external help. However, participants’ ability to self-care differed and deficits occurred, resulting in participants being more likely to need involvement of others (family/friends). When the capacity of others to help broke down, participants’ were more likely to need SAS emergency care. In order to explain how hypoglycaemic episodes are managed, this thesis has developed a hypoglycaemic episode help-seeking network (HEHS network), which helps to identify the various agents involved in helping to manage hypoglycaemic episodes. Findings from this study have implications for clinical practice. For example, looking at hypoglycaemia unawareness, this study has shown that current understanding may fail to take account of participants’ real experiences, which show hypoglycaemia unawareness to be a fluid phenomenon that can affect people at various times. If blood glucose levels can fail to predict onset of hypoglycaemic episodes, healthcare professionals may need to broaden the range of blood glucose readings that might indicate a hypoglycaemic episode and tailor specific advice to individual patients. To reduce the use of emergency services, more attention must be paid to hypoglycaemia unawareness and better advice provided about this condition. Also, more education should be provided for family members/carers, given the crucial role they play in the management of diabetes and hypoglycaemic episodes, and being a link in the process leading to increased use of emergency services. The HEBC could be developed into a useful ‘screening tool’ to help healthcare professionals identify those at greater risk of hypoglycaemic episodes and those at greater risk of long-term complications, and to target advice more specifically to these patient groups. Further research could explore family member/carer knowledge in more detail to better understand their role in helping to manage hypoglycaemic episodes.

Traditionally, nurse anesthesia educators have utilized prior academic achievement to predict student success. However, research has indicated that prior academic achievement offers an inadequate assessment of student success in graduate healthcare programs with extensive clinical residencies. The educational literature has identified many non-cognitive factors, such as self-efficacy and locus of control, that may provide a more holistic prediction model of student success. An experimental study with pretest-posttest design and stratified random assignment was conducted to evaluate the effectiveness of an educational intervention to promote self-management, professional socialization, and academic achievement among first semester graduate nurse anesthesia students. Participants (N = 66) were demographically similar to the national graduate nurse anesthesia student body, though Hispanics and younger students were a little over-represented in the sample (56% female, 75.8% White, 15.2% Hispanic, 6% Other, 59% ≤ 30-years-old, 67% ≤ 3 years of ICU). The results showed that most graduate anesthesia students had strong self-management and professional socialization characteristics on admission. The results did not support the effectiveness of this educational intervention. Thus, ceiling effect may have accounted in part for statistically non-significant results regarding self-efficacy (p = .190, ω2 = .03), locus of control (p = .137, ω2 = .04), professional socialization (p = .819, ω2 = .001), and academic achievement (p = .689, ω2 = .003). Future researchers may need to expand the scope of the intervention, use a more powerful and sensitive instrument, and utilize a larger sample.

This thesis offers a rethinking of the role for education as critical workplace pedagogy in complex problems of health care. Taking the case of paediatric diabetes, the study explored how health-care professionals learn the work of supporting children, and their parents, to self-manage the condition. By reconceptualising work problems as sociomaterial learning struggles, this research contributes new understandings of informal professional learning in everyday health-care provision. Data were generated through fieldwork in an outpatient clinic. Particular challenges of supporting self-management in this case were the difficulties of balancing policy aspirations for empowerment with biomedical knowledge about risks to immediate and long-term health. Tracing the materialisation of learning as it unfolded in moments of health-care practice showed professionals handling multiple and contradictory flows of information. Particular challenges were posed by insulin-pump technologies, which have specific implications for professional roles and responsibilities, and introduce new risks. A key insight is that professionals were concerned primarily with the highly complicated perpetual discernment of safe parameters within which children and their parents might reasonably be allowed to contribute to self-management. Such discernment does not readily correspond to the notion of empowerment circulating in the policies and guidelines intended to enable professionals to accomplish this work. As a result, this thesis argues that the work of discernment is obscured. Learning strategies evolve, but could be supported and extended by explicit recognition of the important work of learning as it unfolds in everyday practices of supporting self-management in paediatric diabetes. Most importantly, workplace pedagogies could be developed in ways that attune to the profound challenges and uncertainties that are at stake in these practices.