The interest towards managing structural change successfully through downsizing activities has increased as a result of globalization and the recent economic, technological and demographic changes occurring across Europe. As a result of downsizing activities companies often break a Psychological Contract that an employee has established with the organization when starting the employment contract. This results in employees experiencing negative feelings, lack of motivation, inability to re-motivate oneself after the downsizings and uncertainty about one’s future within the organization. If an employee is unable to rebuild the psychological contract, one might decide to resign from the organization as a consequence. Since employees are companies most valuable asset for companies and the key asset to remain competitive, companies should focus on preventing the violation of the psychological contract. The purpose of this study is to understand why some downsizing survivors decide to voluntarily resign during the post-downsizing era. A collective case study was conducted in a form of interviews from two cases. The results from the primary and secondary data illustrated that employees who are unable to rebuild the psychological contract are more likely to voluntarily resign.

Purpose The purpose of this enquiry is to explore the symptom experience and the health-related quality of life (HRQL) of children who have survived a brain tumour. Design An emergent, mixed-method study design was used with three phases of inquiry. 1) A systematic review was undertaken of previous research on the HRQL outcomes and symptom experience of children who have survived a brain tumour. 2) A quantitative study of the relationship between symptom experience and HRQL in 50 children who have survived a pediatric brain tumour was completed. This study was followed by a qualitative study of 12 children that used an interpretive descriptive methodology to understand the perceived relationship between symptom experience, coping and quality of life. 3) The results of phases 1 and 2 were translated into an evidence-informed clinical practice framework. Results 1) Pediatric brain tumour survivors had poorer HRQL outcomes than other cancer survivors or healthy peers. Only two previous studies had explored the relationship between symptoms and HRQL. 2) Pediatric brain tumour survivors experience many symptoms following the completion of treatment. The most distressing symptoms were pain, headaches, fatigue and sleep problems. Survivors of pediatric brain tumours described multiple symptoms that affect their life; yet overall they described their quality of life as good. Survivors used a variety of coping strategies to help mitigate the negative effects of these symptoms. 3) The results of the above studies informed the development of a clinical practice framework (the Queen’s-Macartney Multidisciplinary Action Plan for Oncology Survivors - Q-MapS), that requires further testing. It is intended to optimize clinical practice, to encourage education and to stimulate further research. Conclusions Child survivors of brain tumours experience various symptoms that can affect their HRQL. Nurses play a pivotal role in the systematic assessment and management of the multidimensional symptom experience of children following treatment for a brain tumour. Q-MapS can empower patients and their families by increasing their awareness of potential or actual problems related to their symptom experience and HRQL. More research is needed to better understand the relationship between symptoms and HRQL in children surviving brain tumours. / Thesis (Ph.D, Nursing) -- Queen's University, 2013-05-01 21:12:57.809

Suicid är en avsiktlig, självdestruktiv handling som leder till döden. Varje år begås närmare 800 000 suicid runt om i världen och av dessa uppskattas cirka 1100 suicid begås i Sverige. I genomsnitt sörjer sex personer för varje fullbordat suicid, vilket innebär att sjuksköterskor i stor utsträckning kommer att möta dessa anhöriga inom vården. Syftet med studien var således att belysa anhörigas upplevelser av att mista en familjemedlem till följd av suicid. Föreliggande studie är en litteraturbaserad studie baserat på kvalitativa artiklar. Studien behandlade begrepp som hälsa och lidande, vilket vidare relaterades till suicid och de efterlevandes upplevelser. En sammanställning av totalt nio vetenskapliga artiklar användes som grund i utformningen av resultatet. Resultatet redovisade att de efterlevande i hög omfattning upplevde känslor av skuld och skam, relaterat till att bli dömd av andra och att döma sig själv. Att bli dömd av omgivningen framgick bero på att denna sortens handling inte var accepterat i samhället, det beskrevs vara ett tabubelagt ämne. Stöd beskrevs upplevas som antingen tillfredsställt eller bristande. Att genomgå sorg innefattade ett känslomässigt kaos och de efterlevande hade ett stort behov av att få sörja. Att därefter gå vidare i livet gjordes med hjälp av olika metoder, bland annat ritualer för att bevara minnen av den avlidne men även att uppnå acceptans för att förmå att leva vidare. Dessa efterlevande upplevde ofta både psykiskt och fysiskt lidande, genomgående i kris- och sorgeprocessen. Det beskrevs att de efterlevande upplevde stort behov av stöd, men att flertalet inte erhöll tillgodosedda stödinsatser. Sjuksköterskors förmåga till utveckling av vårdkvaliteten för att förmå att minska lidande och förebygga ohälsa hos dessa anhöriga beskrevs därför som viktig. Sjuksköterskor bör således även ha en grund i vårdvetenskap för att kunna bidra till kunskapsutveckling inom detta område. / Background: Suicide is defined as a deliberate and self-destructive act that leads to death. It’s considered as a extensive health problem and each year, nearly 800 000 people die as a result of suicide around the world. Six people in each case estimates to be affected about the suicide. Sufficient support is considered important for these people. Aim: The aim of this study was to illuminate relative’s experience of losing a family member as a result of suicide. Method: A literature-based study including qualitative studies was chosen, according to Friberg (2006), in order to illuminate the relative’s experience of losing a family member as a result of suicide. The results of a total of nine scientific articles were compiled. Results: The results are presented in four themes, and a total of eight subthemes. The presented themes where grief, to be judged by others and to judge themselves, need of support and to continue living. Conclusion: The relatives often experience great suffering, but the results in this study shows that most suicide survivors don’t receive sufficient support. The care of these survivors thus requires a big commitment from the nurses. A guidance to relevant support measures is therefore of great importance, because sufficient support relieve illness, suffering and depression. The nurse should have a reflective approach and a scientific base in the care of these suicide survivors.

This paper is drawn from oral history interviews from elderly residents who survived the Hurricane Katrina disaster in 2005. The aged faced similar challenges as their younger counterparts in the evacuation, aftermath, and rebuilding phases of the storm; however, their responses are limited by a number of factors that make the impact on their lives more intense. The majority of storm casualties in New Orleans were elderly. Those elderly who did survive the flooding experienced life-threatening physical and emotional stress. Life-altering changes, such as relocation from familiar neighborhoods to nursing homes in unfamiliar cities or a dependent life with family members, have often meant a loss of independence, a loss of community, and a loss of their sense of history. As natural storytellers, many elderly New Orleanians have important accounts to relate and oral history offers a method to preserve their narratives.

ABSTRACT South Africa has a high incidence of violence and death due to unnatural causes. Gunshot and/or multiple stab wounds to the trunk are consequently injuries commonly seen in South African hospitals. Penetrating injuries often necessitate explorative surgical intervention to identify and treat injuries to the internal organs. Patients are managed in the intensive care unit and frequently return to theatre for abdominal lavage prior to eventual wound closure. Critical illness with prolonged mechanical ventilation and immobilization results in some degree of muscle dysfunction. Survivors of critical illness suffer from poor functional capabilities and decreased quality of life. No formal rehabilitation programmes exist in South Africa for these patients following discharge. Purpose: To determine if patients that survived penetrating trunk trauma recover adequately spontaneously following critical illness over the first six months following discharge from the hospital. Methods: A prospective, observational study was conducted. Patients with penetrating trunk trauma were recruited from four intensive care units in Johannesburg. Patients who received mechanical ventilation < 5 days were placed in Group 1 and those who received mechanical ventilation 5 days were placed in Group 2. Lung function tests, dynamometry, quality of life, six-minute walk distance and oxygen uptake tests were performed over six months following discharge from the hospital. The obtained results for dynamometry, exercise capacity and quality of life were compared between groups and to that measured for a healthy (age and sex-matched) control group. Results and Discussion: No pulmonary function abnormalities were detected for subjects in Groups 1 or 2. Distance walked during 6MWD test was significantly reduced for subjects in Group 2 compared to the control group [one-month (p = 0.00), three-months (p = 0.00)]. Morbidity correlated significantly with distance walked by subjects in Group 2 during 6MWD test [three-months (p = 0.03), six-months (p = 0.02)]. No statistically significant differences were found between subjects during the VO2peak test although subjects in Group 1 performed better clinically than those in Group 2. At one-month there was a significant reduction in upper and lower limb strength for subjects in Group 2 compared to those in Group 1 and the controls (p = 0.00 – 0.04). Similar results were detected at the three- and six-month assessments. ICU and hospital length of stay did demonstrate a significant relationship with muscle strength at one and three months following discharge for subjects in Group 2. Severity of illness and morbidity in ICU did not have a significant relation to muscle strength for subjects in Groups 1 or 2 at any of the assessments. Subjects in Group 1 had a significant reduction in right deltoid and triceps strength compared to the controls at one-month (p = 0.00 respectively) only. No significant differences in upper and lower limb muscle strength were detected between the control group and subjects in Group 1 three and six months after discharge. Subjects in both groups had similar limitations in physical and mental aspects of quality of life one-month after discharge. Subjects in Group 1 reported a quality of life comparable to the control group by three-months. Subjects in Group 2 had significant limitations in the physical components of quality of life at three- and six-months compared to those in Group 1 and the controls [p = 0.00 – 0.02]. Conclusion: Subjects in Group 1 recovered adequately on their own within three months after discharge from hospital with regard to muscle strength, exercise capacity and all aspects of quality of life. Subjects in Group 2 presented with significant limitations in exercise capacity, muscle strength and the physical aspects of quality of life even at six months after discharge. Impaired function was related to the duration of critical illness and immobility. A physiotherapist-led rehabilitation programme may be indicated for survivors of penetrating trunk trauma that received prolonged mechanical ventilation to address cardiovascular endurance and peripheral muscle strength retraining between one and three months after discharge to address the physical disabilities observed in these subjects.

Cancer-related fatigue (CRF) is a persistent and debilitating problem for many breast cancer survivors. Although many CRF measurement tools are available, no consensus exists on the most appropriate tool to use for breast cancer survivors. The purpose of this project was to identify the best method of assessing CRF in breast cancer survivors. The practice-focused question inquired about the most appropriate way to assess fatigue in breast cancer survivors. The central concepts of the project were CRF and cancer survivorship. This project was informed by the theory of health as expanding consciousness and Mishel's theory of uncertainty in illness. The sources of evidence included multi-database searches and literature from professional organizations. Results were tracked using preferred reporting items for systematic reviews and metasystems and a literature review matrix. The search identified 14 sources, which were assessed for quality using the grading of recommendations, assessment, development, and evaluation process. The results of this systematic review did not support the use of any particular assessment tool; however, 2 clinical practice guidelines recommended screening using a numerical severity scale followed by detailed assessment of clinically significant fatigue using available assessment tools. Screening can be implemented into the survivorship clinic, allowing nurses to identify potentially clinically significant fatigue so that further workup is done and interventions are implemented. Identifying, assessing, and intervening for clinically significant fatigue can improve the quality of life for breast cancer survivors, contributing to positive social change.

This phenomenological study explores the needs of community dwelling Holocaust survivors and proposes a framework for social work practice with this population. Data from qualitative interviews with Holocaust survivors and family caregivers of Holocaust survivors suggest that there are at least two different cohorts of Holocaust survivors in this study. These cohorts, referred to as classic and contemporary survivors in this dissertation, differ with regard to their age as well as the extent to which they are affected by numerous barriers relating to their health and physical ability as well as to language, education, and work background. A small number of respondents demonstrated characteristics belonging to both of the cohorts. A continuum, with classic survivors on one end of the scale and contemporary survivors on the other is therefore suggested as the best way to understand the differences between the two cohorts of Holocaust survivors in this study. Research findings compare and contrast these two ends of the continuum, as well as the cases which fit somewhere in the middle, and suggest the following five themes: 1. There are important similarities and differences between classic and contemporary survivors, 2. Individual Holocaust survivors, their family members and the larger community have all been affected by the Holocaust, 3. Identities and values have been impacted by the trauma associated with the Holocaust, 4. Survivor characteristics can be classified as characteristics of resiliency and/or vulnerability, (The sub-themes uncovered in this study relating to resiliency include fierce independence, a “never give up” mentality and a strong social conscience. The sub-themes relating to vulnerability include guarded trust, a “going without” mentality, increased vulnerability to loss, and loss of secure identity), and 5. The needs of the study population can be better understood by considering resiliency and vulnerability characteristics. The life course framework and individual and community trauma theories are applied to understand these research findings which inform the proposed framework for social work practice.

This phenomenological study explores the needs of community dwelling Holocaust survivors and proposes a framework for social work practice with this population. Data from qualitative interviews with Holocaust survivors and family caregivers of Holocaust survivors suggest that there are at least two different cohorts of Holocaust survivors in this study. These cohorts, referred to as classic and contemporary survivors in this dissertation, differ with regard to their age as well as the extent to which they are affected by numerous barriers relating to their health and physical ability as well as to language, education, and work background. A small number of respondents demonstrated characteristics belonging to both of the cohorts. A continuum, with classic survivors on one end of the scale and contemporary survivors on the other is therefore suggested as the best way to understand the differences between the two cohorts of Holocaust survivors in this study. Research findings compare and contrast these two ends of the continuum, as well as the cases which fit somewhere in the middle, and suggest the following five themes: 1. There are important similarities and differences between classic and contemporary survivors, 2. Individual Holocaust survivors, their family members and the larger community have all been affected by the Holocaust, 3. Identities and values have been impacted by the trauma associated with the Holocaust, 4. Survivor characteristics can be classified as characteristics of resiliency and/or vulnerability, (The sub-themes uncovered in this study relating to resiliency include fierce independence, a “never give up” mentality and a strong social conscience. The sub-themes relating to vulnerability include guarded trust, a “going without” mentality, increased vulnerability to loss, and loss of secure identity), and 5. The needs of the study population can be better understood by considering resiliency and vulnerability characteristics. The life course framework and individual and community trauma theories are applied to understand these research findings which inform the proposed framework for social work practice.

No description available.

Thesis (Ph. D.)--University of Wisconsin--Madison, 2002. / Includes bibliographical references (leaves 145-165). Also available on the Internet.