Utilizing a collective case study design, I examined and described the filial therapy (FT) process and adaptations discovered to be necessary and unnecessary in working with families who have a child with a life-threatening illness in the hospital setting. Data from a total of 7 parents was utilized, including those who terminated early, in order to gain a greater understanding of adapting FT for families who have a child with a life-threatening illness and their participation patterns. The parents attended 10 one- to two-hour FT sessions. The data was analyzed to examine for themes, patterns and relationships intrinsically with each case participant, as well as across cases. Analysis indicated that parents with a child with a life-threatening illness had great difficulty committing to attend FT; and a high rate of attrition occurred for those who did commit. A theme regarding flexibility was found to be of eminent importance in a variety of manifestations including therapeutic methods, session format, location and time of sessions, and intense vs traditional FT. Therapeutic adaptations in flexibility found to be important including openness to cathartic and personal parenting sessions, tolerance of forgetfulness, and lowering typical therapeutic concerns of dependency in the relationship. An inability for parents in this situation to benefit from intense FT methods was also noted. Changes noted in the child of focus included increased confidence, increased cooperation in the medical setting, increased communication with the parent and with medical staff regarding medical issues, and increased communication with the parent regarding personal feelings and issues. Changes noted in the parents included increased confidence in parenting skills, increased awareness of the child's perceptions of the environment, increased tolerance in allowing the child to struggle in and out of the medical setting, with both emotional and physical pain in order to gain coping skills, increased ability to allow the child to empower self, and increased abilities in limit setting.

No description available.

No / Ambulance service demand is increasing in the United Kingdom. A common speculative view makes a link between this rise in demand, deprivation, and certain medical conditions. This study explored factors infl uencing English ambulance service demand in two areas of differing socioeconomic status. Adopting a causal comparative design, the study compared the numbers of life-threatening calls that Yorkshire Ambulance Service receives and serves in two geographical areas within the Hull and East Riding area. The area of lower socioeconomic status generated signifi cantly more life-threatening calls than the area of higher socioeconomic status; these calls often supported younger patients (mean age 59 years versus 71 years) for breathing diffi culties (29% versus 14.5%) more commonly. Tackling inequality will require a whole-systems approach, effective leadership, and recognition of the benefi ts of understanding difference. A key relationship will entail engaging with seldom heard communities.

[Truncated abstract] The malleefowl (Leipoa ocellata) is a large, ground-dwelling bird that is listed as threatened in all states of Australia in which it occurs. Its range encompasses much of southern Australia; however, much of it has been cleared for agriculture. Malleefowl are thought to have suffered substantial decline owing to multiple threats that include habitat loss, predation from exotic predators, grazing of habitat by introduced herbivores and fire - common threats in the decline of many Australian vertebrate species. The malleefowl has an unmistakeable appearance, unique biology, and widespread distribution across Australia. Consequently, it has been the focus of much scientific and community interest. In the Western Australian wheatbelt, community groups are working to conserve the species and have been actively collecting data on its distribution for over 15 years. The vast majority of these data are presence-only and have been collected in an opportunistic manner but, combined with long-term data from government agencies and museums spanning over 150 years, they present a significant opportunity to inform ecological questions relevant to the conservation of the species. The purpose of this study was to answer key ecological questions regarding the distribution, status and habitat preferences of malleefowl using unstructured occurrence records supplemented by reliable absences derived from Bird Atlas data sets and targeted surveys. Malleefowl in the Western Australian wheatbelt were used as a case study to illustrate: 1) how the decline of a species can be quantified and causes of that decline identified; and 2) how threats can be identified and responses to threats explored. I used bioclimatic modelling to define and explore variation within the climatic niche of the Malleefowl across Australia. '...' This thesis provides substantial additional knowledge about the ecology, distribution and status of malleefowl in Western Australia. It also illustrates how opportunistic and unstructured data can be augmented to investigate key aspects of a species' ecology. Despite the limitations of these data, which primarily relate to variation in observer effort across time and space, they can provide important outcomes that may not be achieved using standard survey and data collection techniques. The utility of opportunistic data is greatest in situations where the species: is recognisable and easily observed; is relatively sedentary; and occurs within a landscape containing consistent land use and habitat types. The approaches used in this study could be applied by researchers to situations where community interest exists for species with these attributes. At a national scale, the malleefowl is predicted to decline by at least 20% over the next three generations. The findings of this thesis suggest that the future for the species in the Western Australian wheatbelt may not be as dire as predicted elsewhere within its range, owing largely to the easing and cessation of threatening processes (e.g. land clearing, grazing of habitat by livestock) and the ability of the species to occupy a variety of habitat types. Despite this perceived security, some caution must be exercised until there is a more complete knowledge of the impact of fox predation and reduced rainfall due to climate change on malleefowl populations. Furthermore, the status of the species beyond the agricultural landscapes in Western Australia requires closer examination.

The purpose of this study was to increase awareness and understanding of parental caregivers’ current support needs in order to provide direction in the development of a theory-based hope intervention. The intervention is intended to improve psychosocial and bereavement support for parental caregivers of children with life limiting (LLI) or life threatening illnesses (LTI). The number of parents who have children living with a LLI/LTI is increasing. The impact of these illnesses on parents is significant as they travel alongside their child and experience emotional, physical, and spiritual upheaval. Current empirical research reveals that this journey challenges parents’ understanding of life, faith, and certainty in the future. Many studies demonstrated that parents’ needs are not consistently met and parents often reported the need for psychosocial support. Hope has been found to be an important psychosocial concept for parents and has been shown to provide support when facing difficult circumstances. For this reason, the concept of hope provided the conceptual framework for this research. In order to develop a theory-based psychosocial hope intervention for parental caregivers, a large scale privately funded project that included a metasynthesis of current research, a Delphi survey, and focus groups was conducted. All three components of this project were developed by a research team of two doctorate nurse researchers, one pediatric palliative care specialist, one pediatric oncologist, one community member, and a graduate student. The study presented here is based on the Delphi survey only and serves as the graduate student’s master of nursing thesis. A Delphi survey consisting of three rounds of questions and controlled feedback to experts was employed. Sixty-eight experts were recruited including parental caregivers who have children diagnosed with LLIs or LTIs and those who care for them such as community members, nurses, social workers, and physicians. Based on Bally et al.’s (2013) grounded theory of Keeping Hope Possible, the survey focused on four subprocesses that were identified as essential for parental hope. Experts suggested strategies or activities for each subprocess. Answers were summarized and ranked in order of highest to lowest according to feasibility and effectiveness. The final round revealed a consensus and eight major themes emerged: organize basic needs; connect with others; prioritize self-care; obtain meaningful information; take things day by day; advocate for parental participation; manifest positivity; and celebrate milestones. The survey took place via email to allow easy access to experts and parents globally. This study identified needs of parents of children with LLIs or LTIs in order to develop a theory-based psychosocial hope intervention. Results have the potential to provide direction for a newly developing pediatric palliative care program in Western Canada.

Syfte: Studiens syfte var att ur ett etiskt perspektiv belysa hur psykiatrisjuksköterskan skapar en relation med patienten i en hotfull situation. Metod: En empirisk studie med kvalitativ ansats. Öppna intervjuer med fyra psykiatrisjuksköterskor låg till grund för innehållsanalys enligt Graneheim och Lundman (2004). Resultat: Analysen resulterade i fyra teman vilka är Sjuksköterskan som professionell vårdare, Sjuksköterskan som patientens advokat, Det hotfulla mötet och Det motsättningsfulla mötet. Slutsats: Psykiatrisjuksköterskan skapar en relation med patienten i en hotfull situation, förklarad med hjälp av Lévinas etik, genom att bli djupt påverkad av medlidande och sorg över patientens öde, genom att med sitt bestående ansvar ta initiativ att närma sig patienten i lyssnande och tillit, genom att i detta lyssnande få stöd av arbetsgruppen, för att utvidga ansvarstagandet i relation till patienten, den Andre och genom att, när tvång används, vara övertygad om att det är för patientens bästa. Sjuksköterskan handlar dels enligt generella mönster, dels visar hon djup förståelse för den Andres annanhet, vilket uttrycks i begreppet andlighet: det Oändliga enligt Lévinas. / Objective:The purpose of this study was that from an ethical perspective illuminate how the psychiatric nurse creates a relationship with the patient in a threatening situation. Method: An empirical study with a qualitative approach. Open interviews with four psychiatric nurses formed the basis for content analysis in accordance with Graneheim and Lundman (2004). Findings: Four themes emerged, i.e. the nurse as a professional caregiver, the nurse as the patient's advocate, the threatening encounter and the ambiguous encounter. Conclusion: The psychiatric nurse creates a relationship with the patient in a threatening situation, explained by Lévinas ethics, by experiencing feelings of compassion and sorrow for the patient's fate, by taking a permanent responsibility approaching the patient in listening and trust, by having support of colleagues in this listening, expanding the responsibility for the patient, the Other and by, when coercion is used, be convinced that it is the patient's best interests. On the one hand the nurse acts in accordance with general patterns, on the other she shows her deep understanding of the Other's otherness, which is expressed in the concept of spirituality: the Infinite according to Lévinas.

The overarching aim of this thesis was to describe how family members experienced everyday life with life-threatening illness close to death, with focus on self-image and identity. The thesis comprises four papers, each with a specific aim to illuminate various aspects of the phenomenon under study. The study population consisted of 29 participants; ten family caregivers and five families, including five patients with life threatening illness and their family members. Data were based on retrospective single interviews (paper I), prospective individual, couple and group interviews with the families over six to eighteen month (papers II-III). Interpretive description approach (papers I, II, IV), narrative method (paper III) and secondary analysis (paper IV) were used to analyze data. The findings show how living close to death influences everyday life at home, at several levels (papers I-IV). From the perspective of the dying person, narrations of daily situations was described by four themes related to identity and everyday life; inside and outside of me, searching for togetherness, my place in space and my death and my time. The changing body, pain, fatigue, decreased physical capacity and changed appearance, appeared to influence the dying person’s need for altered knowledge and community, and as a result the patterns of interaction within the families changed. The strive for knowledge and community took place at home, an arena for identity work and the conscious search for meaning, knowledge and community; it was limited by time and inevitable death (paper III). For the family member, life close to death can mean sharing life with a changing person in a changing relationship (paper II). It may mean that everyday life needs to be modified in order for it to work (papers I-IV). New patterns of dependence and an asymmetrical relationship affect all involved (papers III-IV). Daily life close to death is about finding the space to promote the individual self-image, me-ness, at the same time as finding new ways of being a family; we-ness (paper II). Regardless of being the ill person or not, the family members we interviewed had to face impending death, which challenged earlier ways of living together (papers I-IV). From the perspective of the relatives, the everyday life of caring for the dying family member was characterized by challenged ideals, stretched limits and interdependency (paper I). Situations that challenged the caregivers’ self-image were connected to intimacy, decreasing personal space and experiences such as “forbidden thoughts”. The findings suggest that the bodily changes were of importance for the self-image, and that the former approach to the own body was important in the process of experiencing the body. The person living close to death was in transition to something new; being dead in the near future. One way of handling the struggles of everyday life was to seek togetherness, strive to find other persons with similar experiences while sharing thoughts and feelings. Togetherness was sought within the family, in the health care system and on the internet; a sense of togetherness was also sought with those who had already died. The other family members were also in transition as the future meant living on without the ill family member and changing their status to for example being a widow or being motherless. Identity work close to death denotes creating an access ramp into something new; a transition into the unknown. From a clinical perspective, this study emphasizes the significance of creating a climate that allows caregivers to express thoughts and feelings.

This thesis deals with first aid knowledge among the general public. The theoretical part focuses on the basic aspects of first aid. The practical part is a survey of the results of the research, which are then evaluated and commented upon in the discussion. The research group consisted of people of working age. To obtain the data used quantitative research, carried out by polling, through a questionnaire. Based on its evaluation were confirmed or refuted in advance the hypothesis. These hypotheses were statistically verified. Research suggests that the level of knowledge of the general public is not sufficient.

Orientadores: Emílio Carlos Elias Baracat, André Moreno Morcillo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-19T05:38:31Z (GMT). No. of bitstreams: 1 Romaneli_MarianaTresoldidasNeves_M.pdf: 5685752 bytes, checksum: bb58b36a9e0f1344d34b1120bc8b2e0b (MD5) Previous issue date: 2011 / Resumo: Introdução: Os ALTEs (eventos com aparente risco de morte) são episódios súbitos de alteração da coloração da pele (cianose ou palidez), da freqüência respiratória (apnéia) e do tônus muscular (hipotonia), e podem ser a primeira manifestação de inúmeras doenças congênitas ou adquiridas. Embora a história natural dos ALTEs seja benigna, existe risco de mortalidade subseqüente. Objetivos: Avaliar as características clínicas, epidemiológicas e os fatores associados ao óbito de lactentes atendidos na Unidade de Emergência Referenciada (UER) Pediátrica do Hospital de Clínicas (HC) da Universidade Estadual de Campinas (UNICAMP) com história de ALTE. Casuística e Métodos: Estudo transversal retrospectivo descritivo e analítico. Foram incluídos lactentes menores de 12 meses que apresentaram evento súbito de cianose, palidez, hipotonia e/ou apnéia e que foram atendidos na UER Pediátrica. Os dados foram coletados a partir dos Boletins de Atendimento de Urgência (BAUs), através de uma ficha previamente elaborada. Os dados obtidos foram processados com o software SPSS, versão 16.0, utilizando-se o teste de Mann-Whitney para comparação das idades. Para avaliar a associação do óbito com as variáveis independentes, determinou-se os valores de odds ratio bruto por regressão logística. Foram selecionadas para inclusão no modelo logístico multivariado não condicional aquelas que apresentavam associação na análise bivariada. Adotou-se o nível de significância de 5%. Resultados e Conclusão: O ALTE foi mais freqüente na faixa etária entre 9 e 15 semanas de vida, afetando igualmente ambos os gêneros. A manifestação mais comum de ALTE foi cianose, acompanhada ou não de outros sinais e sintomas. Os eventos únicos e de curta duração foram mais freqüentes, a maioria com melhora espontânea. Metade dos pacientes permaneceu internada por mais de 72 horas, em observação clínica e investigação etiológica do evento. O diagnóstico da doença que provocou o ALTE não foi esclarecido em 35,2% dos lactentes. Os demais foram elucidados e a maioria relacionada a doenças do trato respiratório. Durante a internação, a mortalidade dos lactentes com ALTE foi de 7,6%. O maior risco de óbito esteve presente na faixa etária acima dos 6 meses e quando os episódios não tiveram resolução rápida e espontânea, principalmente quando ocorreram como primeira manifestação de doenças do sistema cardiocirculatório / Abstract: Introduction: ALTEs (apparent life-threatening events) are sudden episodes of color change (paleness or cyanosis), apnea and marked change in the muscle tone (limpness), which may be the first sign of an underlying disease (congenital or acquired). Although the ALTE?s natural course is usually benign, there is a risk of subsequent death. Objectives: The aim of this study was to evaluate clinical and epidemiological characteristics, as well as the risk factors associated with mortality of infants who had presented an ALTE and were taken to the Emergency Pediatric Unit from the Clinical Hospital of the State University of Campinas (HC UNICAMP). Casuistic and Methods: Retrospective, transversal, descriptive and analytical study, There were included every infant younger than 12 months old, who had been taken to the Emergency Pediatric Unit after experienced a sudden episode of cyanosis, paleness, limpness and/or apnea. The data was collected from the Emergency care bulletin of each infant, using a previously elaborated card. The data obtained was processed with the software SPSS 16.0. To compare the ages, Mann-Whitney test was used. To evaluate the association among death with the independent variables, logistic regression was used to establish the odds ratio. The multivariate analysis included those variables with positive association in the bivariate analysis. The significance value used was 5%. Results and Conclusion: ALTE occurred more frequently around the ages of 9 and 15 weeks, achieving equally male and female infants. The most common sign observed during the event was cyanosis, with or without other signs and symptoms. The isolated events, with short duration were more frequent, mostly with spontaneous recovery. About 50% of the infants were hospitalized for more than 72 hours in observation and investigation of the underlying disease that caused the ALTE. The diagnosis couldn?t be established in 35.2% of the patients, and in the others, respiratory diseases were the most frequent ones. During the hospitalized investigation, 7.6% of the infants died. The risk factors associated with subsequent mortality were the age greater than 6 months and episodes with slow recovery, especially if the underlying disease affected the cardio-circulatory system / Mestrado / Pediatria / Mestre em Ciências

This paper investigates the use and function of intertextuality in the television series Suits, and examines the interplay between intertextuality and politeness. Intertextuality allows a text to incorporate other texts and to draw upon connotations that belong to those texts. Politeness theory offers a tool to analyse the pragmatic use of language in social interaction. Analysing occurrences of intertextuality from the first episode of the television series, the paper explores in what ways the fictional characters use intertextuality and for what purposes. It explores if, and how, intertextuality can be used as a politeness strategy. Findings suggest that intertextuality is used for three main purposes, and functions as characterisation and as a means to establish and/or maintain social relations. Detailed analyses of instances of intertextuality propose that intertextuality can be used as a politeness theory, but only in certain ways. The paper discusses these findings and offers a possible explanation for why intertextuality is only used in this restricted way.