This study was designed to investigate the sibling's view of living in a family where another child was being treated for cancer. Specifically, the purpose of the study was to conceptualize the sibling's perception of day to day living when another child in the family is being treated for cancer. Eight children belonging to two families participated in the study. Two conversation sessions were held with each child, either individually or in a group, during which the interviewer elicicted descriptions of daily life. Using the constant comparative process associated with grounded theory, concepts identified as emerging from the data were the special status of the ill child, and a new normality. The process of redefining normality was identified as the central variable which accounted for the majority of the variation in behavior. This redefinition of normality appeared to make it possible for siblings to process problems in such a way as to make life viable (Glaser 1978, p. 57). The results of this study support other research which indicates that the child's view of the world is different than the adult's. Relating the findings of this study to the literature has resulted in specific suggestions for nursing research for elucidating the sibling's view. The implications for nursing practice are discussed within the framework of Orem's general theory of nursing. / Applied Science, Faculty of / Nursing, School of / Graduate

Recent research in gerontology and geriatrics has identified that one factor repeatedly associated with depression in the elderly is the presence of physical illness. The increasing numbers of elderly persons in the population and their high rate of chronic physical illness make it important to identify critical disease and individual characteristics that play a role in the association of depression and physical illness. In order to investigate and clarify these relationships and concerns, a panel survey of 133 middle aged and elderly persons with recent exacerbations of various physical illnesses was completed. Subjects were referred by medical offices and agencies in the Portland metropolitan area. Two in-depth interviews were completed approximately three months apart. The data were analyzed using descriptive statistics, correlational analysis, analysis of variance, multiple regression, and dynamic (change focused) correlational analysis. Results indicated a slight but consistent decrease in level of depression with increasing age. Increased levels of income, social support, religiosity, subjective health, internal locus of control for health, and life expectancy were associated with decreased levels of depression. Conversely, increased levels of pain, physical dependency, progressiveness of the disease, death anxiety, external locus of control for health, and worry about medical resources were associated with increased levels of depression. While the residential setting of urban, suburban, or rural had a significant effect on income and a slight effect on size of support system, it had no significant impact on level of depression. The four best predictors of level of depression at Time 1 were subjective health, pain, death anxiety, and income. Analysis of change over time revealed moderate stability in levels of depression. The best predictor of level of depression at Time 2 was level at Time 1. Only change in pain added significantly to the prediction of depression at Time 2. The results of this study will help to identify physically ill middle aged and elderly persons at risk for the development of depression. Analysis of change over time suggests causal relationships for further investigation.

The psychological well-being of surgical patients is important to the smoothness of recovery. Effective psychological preparation which reduces pre- and post-surgical anxiety should reduce the patient's perception of pain and reduce the stress associated with hospitalization. Within the context of total patient care, there is also concern for the effect the spouse has on the patient. Techniques to improve the care of patients must be both appropriate and feasible given the shortage of staff in hospitals. This reality underscores the need to involve the patient and spouse as active participants in the health care system. The efficacy of teaching surgical patients a cognitive coping strategy designed to distance the patient from the stressful situation was examined in this study. It was hypothesized that regular utilization of self-generated emotive imagery should decrease the patients' state of anxiety and attenuate the pain experience. The second hypothesis examined whether actively involving the patient's spouse in the emotive imagery treatment would enhance the effects of the coping strategy. Twenty-four married, male patients who were scheduled for their first laminectomy were contacted the afternoon prior to surgery. They were divided into three groups (attention-placebo, therapist-assisted intervention, and spouse-assisted intervention) of eight which were matched for type of surgery, surgeon, and duration of back pain. Two treatment sessions were conducted; the first, pre-surgically, was done under the direction of the experimenter; the second, post-surgically, under the direction of either experimenter or spouse. Using state anxiety, self-report pain measures, behavioral pain measures, and several medication indices as dependent measures, analyses of variance comparing the three groups were performed. No significant main effects or interactions that supported the use of emotive imagery as a presurgical intervention on the utilization of the spouse as a partner in the intervention were found. Reasons for this outcome were explored and suggestions for further research were made. A model for clinical intervention was also suggested. / Ph. D.

No description available.

No description available.

The psychosocial adjustment of nine adolescents with end-stage renal disease (ESRD) was described by two standard psychologic tests; Piers-Harris Self-Concept Scale and Nowicki-Strickland Locus of Control. Life Events were recorded to evaluate the effect of stress at the time of testing. The mean self-concept scores were higher (p = .009) for the ESRD adolescents than the normative sample. However, the individual's scores did not differ significantly. The Life Events were comparable to the healthy population for age. The family members were assessd on the Family Assessment Measure (FAM) to assess the influence of family functioning on adolescent psychosocial adjustment. The standardized FAM scores were comparable to a normative sample. Cluster analysis of the ESRD adolescents revealed three groups differing significantly on: self-concept, locus of control, FAM self-rating and number of years from diagnosis to dialysis. Significant differences were maintained across the family members on FAM General Scale and FAM Self-Rating Scale. The adequate psychosocial adjustment of the adolescents with ESRD is consistent with recent studies suggesting that chronically ill children and adolescents do not differ from healthy children. However, the results also suggest that within the study group, a number of individuals may be experiencing problems of adjustment. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

The present study evaluated a commitment-based intervention to improve adherence with a 10-day antibiotic regimen. Subjects were 48 undergraduate students receiving treatment from the Student Health Services at Virginia Polytechnic Institute and State University. Adherence was assessed by pill counts obtained in unannounced home visits 7 to 10 days after the regimen was prescribed and by subjects’ self-reports. Pre- and posttest measures of self- efficacy and outcome expectancy were completed by subjects. Significantly more subjects in the intervention group were adherent (85%) than in the control group (64%) when adherence was defined as at least 80% of medication taken and nonadherence defined as less than 80% or more than 110% of medication taken. Self-efficacy and outcome expectancy scores, when multiplied together for a predictive index, were significantly correlated with self-reported adherence at pre- and posttest, but were not correlated with pill count adherence. Self-efficacy at pre- and posttest and outcome expectancy at pretest were significantly correlated with self-reported adherence. Self-efficacy at posttest was significantly correlated with pill count adherence. An intervention designed to increase commitment to medical regimen resulted in greater adherence with a short-term regimen. Self-efficacy and outcome expectancy predicted self-reports of adherence behavior, but were poor predictors of objective measures of adherence. At best, self-efficacy appeared to reflect recent behavior. / Master of Science

Not available / text

No description available.

Increases in the number of users of the medical delivery system, along with an ever-increasing variety of available services, makes it desirable to identify those individuals who will benefit most from its services. With the growing reliance on third party payment, economic limitations no longer effectively restrict the use of the system's resources to those individuals who are truly ill. A framework is needed whereby individuals who are medically ill can be separated from those whose needs might be more effectively addressed by other services. A variety of means, including locus of control, has been used in the attempt to make such discriminations. In conclusion, it was observed that the low magnitude of obtained relationships presents opportunities for future research, but disallows meaningful prediction at the present time.