This thesis is comprised of four studies and concerns haemodialysis patients’ confidence in being able to manage fluid intake between treatment sessions, and whether the fluid intake is influenced by certain modifiable characteristics of the persons in question. The overall aim was to study aspects of excessive fluid overload and haemodialysis patients’ self-regulation of fluid allotment from a bio-psychosocial and behavioural medicine perspective. The extent of non-adherence to fluid allotment was described in Study I. National registry data were used. Three out of ten Swedish haemodialysis patients had excessive fluid overload and one out of five was at risk for treatment related complications due to too rapid ultrafiltration rate. The objective in Study II was to develop and psychometrically evaluate a self-administered scale to measure situation-specific self-efficacy to low fluid intake. The measure (the Fluid Intake Appraisal Inventory) was found to be reliable and valid in haemodialysis settings. Subgroups based on individual profiles of self-efficacy, attentional style and depressive symptoms were explored in Study III using a cluster analytic approach. Three distinct subgroups were found and the subgroup structure was validated for clinical relevance. The individuals’ profile concerning self-efficacy, attentional style and depressive symptoms has to be taken into account in nursing interventions designed to reduce haemodialysis patients’ fluid intake. In Study IV, an intervention designed to reduce haemodialysis patients’ fluid intake was introduced and its acceptability, feasibility and efficacy were evaluated and discussed. Acceptability of such an intervention was confirmed. Addressing beliefs, behaviours, emotions and physical feelings is clinically feasible and may reduce haemodialysis patient’s excessive fluid overload. This thesis indicates that there is a potential for improvement in the fluid management care of haemodialysis patients. Behavioural nursing strategies that aim to assist patients to achieve fluid control should be applied more extensively. Cognitive profiles of the patients should be taken into account when targeted nursing intervention aiming to encourage and maintain the patient’s fluid control is introduced.

Made available in DSpace on 2010-04-20T20:15:15Z (GMT). No. of bitstreams: 1 61070100611.pdf: 844754 bytes, checksum: 3b9f50710eaf7ac36ed163b18c947fba (MD5) Previous issue date: 2009-04-01T00:00:00Z / O distanciamento identificado entre as teorias do campo de estratégia e organização e a prática das empresas motivou o desenvolvimento de uma abordagem de pesquisa comumente denominada 'estratégia como prática'. Neste trabalho buscamos contribuir com essa nova abordagem explorando a prática de planejamento estratégico. A pesquisa se baseou num estudo de caso único exploratório em uma empresa organizada por projetos que identificou os processos de mudança na prática de planejamento estratégico do caso. Esses processos foram analisados por meio uma abordagem inspirada na teoria da estruturação de Giddens (1984), indicando que o nível adequado de formalização da prática de planejamento estratégico deve ser dado por sua estruturação na dinâmica social da organização que, por sua vez, é permeada por 'lutas' entre indivíduos pela definição da noção de planejamento estratégico na empresa e, no caso estudado, sofreu a influência de dois fatores principais: (i) adoção de um discurso da 'excelência', e (ii) o papel de práticas e procedimentos de planejamento em uso. / A gap identified between the theories created in field of strategy and organization and the practice of the enterprises motivated the development of a research approach commonly called 'strategy-as-practice'. The present work seeks to contribute with this new approach exploring the practice of strategic planning. Our research is based on an exploratory single case study in a project-based organization in which we identified the change processes in the practice of strategic planning. These processes were analyzed through an approach inspired by structuration theory (GIDDENS, 1984) which indicated that the adequate level of strategic planning formalization is given by the organizational social dynamics which is permeated by 'struggles' between the individuals for the organizational definition of strategic planning and was influenced in our case by two key factors: (i) the adoption of a discourse of 'excellence', and (ii) the role of planning practices and procedures in use.

O abuso sexual infantil (ASI) é um problema de grande relevância social que pode trazer prejuízos como risco aumentado para psicopatologias, problemas sexuais e déficit nos relacionamentos interpessoais. A Psicoterapia Analítica Funcional (FAP) propõe um tratamento baseado na instalação de repertório de relacionamento interpessoal, modelado na relação terapêutica, em um ambiente seguro para o cliente e com baixa probabilidade de punição. O objetivo da pesquisa foi verificar os efeitos da FAP no tratamento de um menino de 11 anos de idade vítima de ASI, por meio da mensuração de comportamentos clinicamente relevantes (CCR) e comportamentos extrassessão. Foi realizado um delineamento experimental de caso único de reversão (A1-B1-A2-B2) em que a Fase A1 correspondeu a Terapia Analítico- Comportamental Infantil (TACI) enfocando análise dos comportamentos fora do setting terapêutico, a Fase B1 correspondeu a introdução sistemática da FAP e as fases A2-B2 corresponderam a replicação das condições anteriores com a retirada da FAP e sua reintrodução, respectivamente. Uma sessão de follow-up também foi realizada um mês após o término da psicoterapia. Cinco sessões de cada fase foram categorizadas pelo instrumento FAPRS. Utilizou-se o questionário CBCL e a Escala de Comportamentos Extrassessão, respondidos pela mãe da criança, afim de obter as medidas de comportamento externo, bem como o instrumento PedsQL para medir mudanças na autoavaliação da criança sobre a satisfação com a qualidade de vida e CAPS para as mudanças na autoavaliação de atribuições/percepções sobre a experiência de ASI. Os resultados apontaram aumento da porcentagem de CCR2 e queda da porcentagem de CCR1 durante as fases de inserção da FAP; queda dos CCR2 e aumento dos CCR1 quando a FAP foi retirada. As mudanças das porcentagens dos CCR2 foram mais contingentes à manipulação da variável independente. Não foi observada reversão dos CCR1, resultado do bloqueio de esquiva produzido pelo contexto terapêutico e por características específicas dos CCR1 da criança. O CBCL demonstrou melhora global na maioria de suas categorias, fazendo com que a criança saísse da faixa clínica dos problemas para a faixa considerada normal. As melhoras clínicas sugeridas nas categorias da Escala de Comportamentos Extrassessão que se relacionavam com os CCR da criança parecem ter sido produzidas pela introdução da FAP enquanto as pioras clínicas parecem ter sido produzidas pela retirada da FAP, o que sugere uma generalização (para o ambiente natural) dos ganhos terapêuticos obtidos em sessão. Tanto a CAPS quanto o PedsQL apontaram uma piora na avaliação do cliente. No entanto, discutiu-se que tal quadro é representativo de uma melhora no autoconhecimento da criança / Child sexual abuse (CSA) is a problem of great social relevance that can cause impairment as an increased risk for psychopathologies, sexual problems and interpersonal relationships. Functional Analytic Psychotherapy (FAP) proposes a treatment based on the installation of an interpersonal relationship repertoire, shaped by the therapeutic relationship, in a safe environment for the client and a low probability of punishment. The objective of this study was to ascertain the effects of FAP on the treatment of an 11-year-old boy victim of CSA by measuring clinically relevant behaviors (CCR) and out-of-session behaviors. A single-subject withdrawal experimental design (A1-B1-A2-B2) in which Phase A1 corresponded to Childrens Behavioral-Analytic Therapy (TACI) focusing on behavioral analysis outside the therapeutic setting, Phase B1 corresponded to the systematic introduction of FAP and the A2- B2 phases corresponded to the replication of the previous conditions with the withdrawal of FAP and its reintroduction, respectively. A follow-up session was also held one month after the end of psychotherapy. Five sessions of each phase were coded by the FAPRS system. The CBCL questionnaire and the Out-of-session Behavior Scale, answered by the child\'s mother, were used to obtain the external behavior measures, as well as the PedsQL instrument to measure changes in the child\'s self-assessment on quality of life satisfaction and CAPS for the changes in the self-assessment of attributions/perceptions about the CSA experience. The results indicated an increase in CCR2s percentage and a decrease in CCR1s percentage during the FAP insertion phases; reduction of CCR2 and increase of CCR1 when FAP was withdrawn. Changes in CCR2 percentages were more contingent on independent variable manipulation. No reversal of CCR1 was observed, because of the avoidance behavior blockade produced by the therapeutic context and by the specific characteristics of the childs CCR1. The CBCL showed overall improvement in most of its categories, causing the child to leave the clinical range of problems for the range considered normal. The clinical improvements suggested in the Out-of-session Behavior Scale categories that related to the child\'s CCRE appear to have been produced by the introduction of FAP while clinical worsening appears to have been produced by FAP withdrawal, suggesting a generalization (for the natural environment ) of the therapeutic gains obtained in session. Both CAPS and PedsQL pointed to a worsening client assessment. However, it was argued that such a picture is representative of an improvement in the childs self-knowledge

I examined the effectiveness of child-centered play therapy (CCPT) and person-centered teacher consultation (PCTC) for elementary school children identified with clinical or borderline levels of ADHD behaviors on the Teacher Report Form and the Conners' Teacher Rating Scale Revised - Short Form. Additionally, I examined the impact of CCPT and PCTC on the levels of parenting and teaching stress. Due to the current trend to determine interventions that are evidence-based through between-group or single case designs, for this study, I utilized a single case design experiment for which the behaviors of five children were examined. Trained observers utilized the Direct Observation Form in observations of all five students three times per week. Additionally, parents and teachers completed behavioral rating scales and stress inventories at pre-, mid-, and post-intervention. To prevent biased observational ratings, observers were blind to the assignment of the five children. Three students participated in 24 sessions of twice-weekly 30-minute sessions of CCPT, and these students' teachers participated in six sessions of once-weekly 10-minute PCTC. Two students participated in twice-weekly 30-minute sessions of reading mentoring, after which they participated in 14 sessions of CCPT. Visual analysis of the data indicated mixed results. Three students demonstrated substantial improvement in the observed ADHD behaviors within the classroom. Results of the parent and teacher assessment data were inconsistent, but did indicate behavior change for some children and a reduction in teaching stress for one teacher. Parenting stress appeared unaffected. Implications for future research regarding the use of single case design, the measurement of student behavior change, and issues of comorbidity are indicated.

Parents of children with autism spectrum disorder (ASD) face many challenges which lead to low levels of psychological well-being, partly caused by inability to parent in accordance with one’s values. Child-directed play, a moment of being fully attentive and responsive to one’s child, has the potential to increase parental values. A non-concurrent multiple-baseline experimental design investigated whether daily exercises of child-directed play improved valued parenting and parental perspective-taking. Eight parents of children with diagnosed or suspected ASD were followed daily for six weeks. The intervention comprehended daily practice of child-directed play and video supervision. Child-directed play increased ratings of parental values for all but one participant (Hedges’ g* = 1.67) with effect maintained at follow-up, and increased ratings of parental perspective-taking. A gradual effect indicates the need for greater difference in baseline length between participants. No effects on children, nor on parental well-being were investigated in the present study.

Text in English / This qualitative psychobiographical study sets out to explore and describe the life of Sir Winston Churchill within the context of his lifelong experience with depression, his ‘Black Dog’. The aim of the research is to present a case for depressive realism with Churchill as the single case study. The reconstruction of Churchill’s life as a psychological narrative is contextualised within the theoretical framework of Alfred Adler’s Theory of Individual Psychology. Data was collated via biographical and life history material. Data was analysed by means of thematic analysis. Data trustworthiness and ethical considerations were adhered to. The findings of this study reveal that Churchill’s depression had positive gains of him striving to contribute to society, potentially demonstrating that depressive realism exists as a side-effect of depression. The significance of which, conceivably substantiates the idea that positive aspects of depression do exist, enabling a potentially more encouraging and constructive outlook for individuals suffering from depression. / Psychology / M.A. (Psychology)

This thesis presents a 31-day case study carried out with a 15 year old young man who has classical autism. The study involved introducing him to a number of new and challenging activities, in a variety of contexts, over 31 days, that were previously assumed to be outside of his range of capability. The case study found that the application of the concepts of choice, control, challenge and risk had an unexpectedly positive impact upon the young man’s performance. This study further attempts to explore the concept of narrative as a ‘pedagogical bridge’ between the ‘worlds’ of autism and neurotypicality, arguing that narrative may provide a ‘way in’ to the world of autism. ‘Narrative’, this study contends, may provide a tapestry across which the world of autism may be connected with the world that surrounds it; by revealing a multiplicity of selves in a multiplicity of contexts. Methods of data collection included field notes, interviews, photographs and film footage. Ultimately, the study found that the use of ‘performance texts’ (DVDs featuring the young man’s achievements) constituted a powerful means of celebrating his accomplishments within the school and its wider community. Research approaches were participatory and ethnographic in the data collection phases, while a more phenomenological approach was adopted in the data analysis phase. The overarching analytical framework was that of ‘narrative analysis’ in telling a story of bravery, courage, hope and optimism.

Ce travail doctoral s’intéresse aux choix du mode d’entrée des PME de service d’ingénierie souhaitant s’implanter sur les marchés émergents. Le contexte est à un double titre : un pays d’économie en transition, la Russie, et une PME du type Born Global de services à forte intensité de connaissances (SFIC), secteur parapétrolier. Notre recherche porte sur la détermination des facteurs qui permettent de franchir avec succès les barrières à l’entrée dans ce contexte. Nous avons procédé à la collecte des données empiriques primaires sur le terrain en conduisant une analyse qualitative exploratoire longitudinale d’étude de cas unique sur la période 2006-2013. L’étude de cas a été privilégiée afin de valider nos propositions de recherche issues des travaux scientifiques identifiés tel que les théories concernant les modes d’entrée, les PME Born Global, l’internationalisation des activités de services aux entreprises, les réseaux relationnels. Les résultats obtenus montrent que les PME SFIC du type Born Global se développe à l’international en suivant leurs clientèles, en s’appuyant sur le marketing relationnel et sur leur réseau comme un outil d’accès à une information fiable dans une espace volatile, à la différenciation de l’offre et à la rapidité de réaction pour exploiter une stratégie de niche. La nature d’activité des SFIC nécessite pour convaincre les clients, d’exploiter les capacités rhétoriques du personnel en contact, faire attention à l’image projetée et de gérer les relations et les interactions avec les clients centraux. Nos résultats font apparaître l’importance de l’étape pré-export pour la réussite du projet d’implantation dans ce contexte de marché. / This research work focuses on the entry mode choices that best fit the needs of SMEs of engineering services which set up their business into emerging markets. The context is twofold: a country with transition economy, Russia, and the so-called « Born Global » SME of knowledge intensive business services (KIBS), operating in the oilfield sector. Our study tries to identify factors that may help successfully overcome the entry barriers in this particular context. To conduct this research, we used an empirical approach of primary data collected directly from the field. Our exploratory qualitative analysis has been carried out longitudinally and involves data collection of single case study over the period 2006-2013. The method of single case study was privileged in order to validate our research proposals that emerged from the theoretical background related to the works about: entry mode, « Born Global » SME, the internationalization of professional business service, networks. Our descriptive results indicate that « Born Global » KIBS firms attempt to set up their business by following their clients, through relationship marketing and networks approach as a tool to get an access to reliable information in the turbulent environment, reinforced by the offer differentiation, reactivity and a niche strategy. The work and the outcomes of KIBS cannot be immediately evaluated, which require to convince customers through the management of rhetorical skills of contact persons, image production and interactions with central clients. Moreover, our results show the importance of pre-export phase to perform better the set up project in the context of emerging market.

Il presente lavoro di tesi si colloca all’interno della tradizione di ricerca nota come Empirically Supported Therapy Relationships, un modello d’indagine centrato sulla natura e sulla funzione della relazione al di là della contrapposizione tra ricerca sugli esiti e ricerca sul processo. I tre studi in cui si articola il lavoro assumono come focus d'indagine porzioni progressive del trattamento: la prima seduta, le prime due sedute, l’intero percorso. Nel primo studio sono messi a confronto differenti esiti terapeutici per verificare se le ricadute sul piano clinico del metodo interpretativo siano riconducibili ad un criterio di presenza/assenza o da ricercare nell’intreccio con altri fattori caratterizzanti il percorso di cura. Il secondo studio si propone di affrontare casi di interruzione prematura del trattamento, differenziati in funzione del raggiungimento o meno della stipulazione di un contratto terapeutico: l’obiettivo è quello di evidenziare le caratteristiche connesse alla diversa fase di abbandono del contesto di cura. Infine il terzo studio, nella forma del single-case study, è incentrato sui momenti di frattura dell’alleanza terapeutica lungo un intero processo terapeutico di quaranta sedute. / The present dissertation refers to the theoretical background known in the literature as Empirically Supported Therapy Relationships, a research tradition focused on the relationship and its nature, beyond the outcome and process research opposition. The three studies included in this work focused on different portions of treatment: respectively the initial intake session, the first two sessions, and the overall treatment. In the first study different outcomes were compared in order to examine if the effects of interpretations were connected to specific factors of psychotherapeutic process. The second study aimed to assess clinical cases of premature termination, differentiated on the basis of the contract attainment: the purpose was to depict specificities due to the different phase of dropping out. Finally, the third study was a single-case research examining alliance ruptures within an entire clinical process of forty sessions.

Text in English / This qualitative psychobiographical study sets out to explore and describe the life of Sir Winston Churchill within the context of his lifelong experience with depression, his ‘Black Dog’. The aim of the research is to present a case for depressive realism with Churchill as the single case study. The reconstruction of Churchill’s life as a psychological narrative is contextualised within the theoretical framework of Alfred Adler’s Theory of Individual Psychology. Data was collated via biographical and life history material. Data was analysed by means of thematic analysis. Data trustworthiness and ethical considerations were adhered to. The findings of this study reveal that Churchill’s depression had positive gains of him striving to contribute to society, potentially demonstrating that depressive realism exists as a side-effect of depression. The significance of which, conceivably substantiates the idea that positive aspects of depression do exist, enabling a potentially more encouraging and constructive outlook for individuals suffering from depression. / Psychology / M.A. (Psychology)