Thesis (Ph. D.)--University of California, San Diego and San Diego State University, 2008. / Includes bibliographical references (p. 90-98).

Thesis (Ph. D.)--University of California, San Diego and San Diego State University, 1998. / Vita. Includes bibliographical references (leaves 152-164).

Thesis (Ph. D.)--University of Texas at Austin, 2007. / Vita. Includes bibliographical references.

Shared characteristics and predictors of psychological distress are beginning to be identified in research on women seeking genetic testing for BRCA1 and BRCA2 gene mutations. This study further explored patterns of psychological distress for 51 community women waiting to receive such genetic test results. There was no significant relationship between psychological distress and family cancer history, personal cancer history, social support networks, and family environment. Women in this sample tended to rely more on females and relatives for support than males and friends. Social support satisfaction was not related to gender or number of relatives providing support. Thirty-four of the 36 women classified on the family environment type were from Personal Growth-Oriented families. Comparisons with normal and distressed family means revealed increased cohesion and expressiveness with decreased conflict, indicative of supportive family environments. Limitations and implications are discussed.

Mode of access: World Wide Web. / Thesis (Ph. D.)--University of Hawaii at Manoa, 2005. / Evidence suggests that routine screening of primary care patients for exposure to traumatic life events, and particularly assaultive trauma, may yield both clinical and cost benefits for healthcare systems (e.g., Green, Epstein, Krupnick, & Rowland, 1997; Lecrubier, 2004). However, although advocated by authorities, such screening has yet to be widely adopted. A sample of female university healthcare patients (N = 339) was assessed for exposure to trauma in order to examine several unaddressed issues that may diminish the clinical utility of screening for trauma in primary care patients. First, because the length of the traditional trauma history assessment makes it less acceptable for use in time-pressured primary care settings, the discriminative validity of a brief, self-administered screening question about exposure to trauma, the Structured Clinical Interview for DSM-IV (SCID) posttraumatic stress disorder (PTSD) module's screening question (First, Spitzer, Williams & Gibbon, 1997) was compared to a longer, inventory method of assessment, the Traumatic Life Events Questionnaire (TLEQ, Kubany et al., 2000). Second, because it is unclear whether patients who have experienced assaultive trauma will disclose these experiences when asked in a primary care setting, the relative predictive efficacy of informing respondents that their responses would, or would not be, disclosed to health center personnel was evaluated. Two versions of the brief screening question were assessed across two instructional sets regarding disclosure, to determine each condition's relative classification accuracy for identifying respondents who reported experiences of sexual or physical assault, and/or symptoms of PTSD. The brief screen identified more than three-quarters of the survivors of traumatic assault; and more importantly, identified almost all of the women who reported significant PTSD symptomatology: the inventory method identified only 2 additional women of the 47 who met criteria for PTSD. Although survivors of sexual assault were significantly less likely to disclose their history to their provider, no differences were found for those assault survivors who also reported symptoms of PTSD. Results suggest that a brief screening question about traumatic life events may be an acceptable option in settings where more time-consuming assessment procedures are not practical. / Includes bibliographical references (leaves 83-98). / Electronic reproduction. / Also available by subscription via World Wide Web / x, 98 leaves, bound 29 cm

Background: The context for this study is the National High Secure Healthcare Service for Women (NHSHSW). This service opened in 2007 following the closure of all other high secure healthcare services for women. Consequently the NHSHSW is the UK’s only facility to provide assessment and treatment for women detained under the Mental Health Act and who are classified as posing a grave and immediate danger to others. Care delivered within the NHSHSW is grounded within the guiding principles of trauma informed environments. This philosophy of care understands that women patients in high secure forensic healthcare experience heightened and usually chronic levels of distress which can be communicated through violent and dangerous behaviour (McMillan & Aiyegbusi, 2009). This group of marginalised women are an important but small group of people with unique experiences. These women patients’ experiences have yet to be explored from the perspective of the women themselves. This is the first study to explore how women patients detained in the NHSHSW experience distress and the impact that distress has on their behaviour from the perspective of the women patients themselves and their care-givers. The care-givers referred to are named nurses whose perspective provides perceptual and interactional context to this study. Insight into the women patients’ experiences is important to ensure that the development of healthcare can respond effectively to need. The importance of service user involvement has been increasingly recognised in general mental health settings. However, user involvement in forensic research is less well developed. This has now been recognised and for the first time this study included the women patients as research facilitators. Method: Women patients were invited to attend discussion groups to identify a research project that would form a baseline evaluation for an evidence based development of the NHSHSW. A working party including the researcher and voluntary women patients was established to facilitate the research process. The number of women patients contributing to the working party ranged between eight and thirteen depending on availability. Feminist principles provided a framework for this enquiry (Lykke, 2010). The experiences identified for exploration were: How women patients in high secure healthcare understand their distress. How women patients in high secure healthcare communicate their distress. How nurses interpret the women patients’ distress. Multi-perspective Interpretative Phenomenological Analysis (IPA) was used to analyse semi-structured interviews (Loaring, Larkin, Shaw & Flowers 2015). Twenty three voluntary patient interviews, representing 57% of the overall patient population and thirteen voluntary named nurse interviews took place, representing 34% of the named nurse population. No participants dropped out or withdrew their contribution. Findings: Themes regarding the women patient participants’ understanding and communication were identified as: Observable behaviours and responses; Blocks to getting help; Change over time; An entity to be endured; An emotional experience; A physical experience; Being alone. The themes identified from the nurse interviews were: Perception of the distress experience. What influences my response and what is expected of me? The patient and the nurse interviews evidenced differences in understanding related to the women patients’ experience of distress. The women patients placed emphasis on the physiological/sensory aspect of their distress, whereas nurses placed emphasis on the emotional aspect of the women patients’ distress. The implication is that at times of heightened distress the women patients did not feel they were understood. The findings also highlighted areas of unmet need including family involvement in care and a perceived lack of support to enhance family contact. In addition loneliness was emphasised as a significant stressor for the women patients as was being perceived as an on-going risk of harm. All the findings were validated by the participants and subject to peer review. Conclusion: This study provides the first evidence base for healthcare practice specifically for women patients detained in the NHSHSW. This is also the first study to involve the women patients in the NHSHSW as co-facilitators of research. This experience was described as empowering by the women patients who took part and whose involvement ensured that the research subject was relevant and meaningful. The depth of the women patients’ involvement has set precedents for policy, procedure and practice development within the NHSHSW and evidenced the women patients’ ability to be co-producers of the services they use. The study was conducted for women by women and as such was guided by feminist principles seeking the right to provide services based on women patients’ needs and experiences. As a consequence this study has made a unique and significant contribution to available literature and the development and provision of services for women detained in high secure care. The study originally aimed to provide an evidence base for the development of the NHSHSW; however, continued interest from lesser secure services clearly demonstrates the applicability of the findings to services beyond the NHSHSW. Limitations There were limitations to this study which could have influenced the findings. The researcher was known to the patient and nurse participants. Established relationships between researchers and participants have the potential to bias an outcome; however it can also provide a baseline of trust. Service user involvement as both researcher and participant potentially allows participants to purposefully respond to questions with the aim to confirm their original pattern of thinking rather than exploring a concept to uncover new findings. The balance of findings in this research suggests that while some bias can be argued it did not invalidate the findings.

Breast cancer statistics in the United States are staggering. As the number of women diagnosed grows, so does the number of women who are writing about their experiences. This thesis is a multi-textual work which includes both the stories of women with breast cancer as well as the thesis author's personal journal entries. Women's experiences are used to examine and critique current institutional and cultural responses to breast cancer. Experience literature reveals that efforts against breast cancer in the United States are emerging from two distinct ideologies which are identified as Cure and Prevention in this work. This thesis address the most prevalent issues within Cure and Prevention, and analyzes how these mindsets are shaped by definitions and expectations of femininity. The following pages elucidate how engendered values and socialization play out through the Cure and Prevention paradigms. Ultimately, the Prevention model will be shown as the one that most resolutely addresses the issue of breast cancer. Women's experiences and expertise are critical for understanding the ramifications of Cure and Prevention responses to breast cancer; women are informing and bridging misunderstandings between Cure and Prevention thinking. / Graduation date: 1997

This study examined the applicability of Mishel's model of uncertainty in illness (1990) to the adaptation process of women diagnosed with fibromyalgia. The power of uncertainty and social support to predict an uncertainty appraisal and its corresponding coping strategy utilized in this population were examined.Structural equation modeling was employed to clarify the relationships among uncertainty, social support, the appraisal of uncertainty as either danger or opportunity, and coping as either emotion-focused or problem-focused. One hundred sixty-five participants completed the Mishel Uncertainty in Illness Scale (MUIS-A), the Appraisal of Uncertainty Scale (AUS), the Jalowiec Coping Scale (JCS), and the Social Provision Scale (SPS). After an analysis of several measures of goodness-of-fit, the original model was modified based on theory, the modification indices, and a review of the maximum likelihood estimates (mle) for structural paths. These modifications resulted in a competing model. Finally, a Chi-square test was performed comparing the goodness-of-fit indices of the competing models.Results indicated that Mishel's model is a useful model within which to conceptualize the issues faced by women diagnosed with fibromyalgia. Mishel's model performed adequately; however, the overall goodness-of-fit was significantly improved by modifications which placed greater emphasis on social support. Social support and uncertainty exerted approximately equal effect on a danger appraisal and in the revised model only social support predicted an opportunity appraisal. Results also suggested that uncertainty had a direct effect on emotion-focused coping regardless of the appraisal of the uncertainty as danger or opportunity. The current study did not unequivocally support Mishel's assertion that uncertainty may be evaluated as an opportunity. Although uncertainty demonstrated a significant inverse relationship with an opportunity appraisal in the original model, in the revised model, which considered the direct effects of social support on the appraisal process, uncertainty failed to have a significant effect. Given the depth of evidence and applicability of Mishel's original model, additional research is necessary to determine whether these results are specific to the experience of fibromyalgia or perhaps social support is an under-appreciated factor in Mishel's model. Implications for treatment and directions for future research are explored. / Department of Counseling Psychology and Guidance Services

Thesis (M.S.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Source: Masters Abstracts International, Volume: 46-06, page: 3258. Adviser: Dorothy K. Waller. Includes bibliographical references.

Thesis (Ph. D.)--University of Alabama at Birmingham, School of Education, 1998. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 103-109).