Thesis (Ph. D.)--University of Missouri--Columbia, 2001. / Typescript. Vita. Includes bibliographical references (leaves 228-243). Also available on the Internet.

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Thesis (M.S.)--University of Michigan, 1991.

Thesis (M.S.)--University of Michigan, 1985.

Thesis (M.S.)--University of Michigan, 1985.

Thesis (M.S.)--University of Michigan, 1991.

During later years, the primary care services are experiencing a heavier strain in terms of increasing expenses and higher demand for medical services. An increased awareness about pharmaceutical adverse effects and the global concern of antibiotic resistance has given self-care and active surveillance a stronger position within the primary care services. The management strategy for minor illnesses is important because care-seekers tend to repeat successful strategies from past events, and past experience with self-care drives future self-care practices. The overall aim of this thesis was to explore people’s experiences and needs when practicing self-care and receiving self-care advice for minor illnesses. This was achieved by studying people’s experiences with and knowledge of minor illnesses, self-care interventions and channels of information used when providing self-care for minor illness. Needs for confidence in self-care were studied, as well as supporting and obstructing factors in the practice of self-care. Satisfaction with telephone nursing and people’s experiences of reassurance in relation to the decision-making process in self-care for minor illness was explored. The results showed that experience correlated with self-rated knowledge of the condition, and the least common conditions most often generated a health care services consultation. To confidently practice self-care people needed good knowledge and understanding about obtaining symptom relief. Younger persons more often reported the need of having family or friends to talk to. Easy access to care was most often reported as a support in self-care, and a lack of knowledge about illnesses was most often reported as obstructing self-care. Care-seekers receiving self-care advice were less satisfied with the telephone nursing than care-seekers referred to medical care, and feeling reassured after the call was the most important factor influencing satisfaction. Self-care advice had a constricting influence on healthcare utilization, with 66.1% of the cases resulting in a lower level of care than first intended. The course of action that persons in self-care decided on was found to relate to uncertainty and perception of risk. Reassurance had the potential to allay doubts and fears to confidence, thereby influencing self-care and consultation behavior. In conclusion, symptoms of minor illness can cause uncertainty and concern, and reassurance is an important factor influencing people’s course of action when afflicted with minor illness. The nurse constitutes a calming force, and the encounter between the nurse and the care-seeker holds a unique possibility of reassurance and confidence that minor illness is self-limiting to its nature and that effective interventions can provide relief and comfort. Just as health is more than the absence of disease, self-care is more than the absence of medical care.

Studies have revealed that nursing students experience greater amounts of stress and anxiety than the average college student. Nursing students attribute increased stress levels to the twin demands of their classroom and clinical workloads. Higher stress levels frequently result in students reporting symptoms of poor health and lack of psychological well-being. It is important to note that some nursing students are also actively working in clinical settings and contending with the added stress of the recent COVID-19 pandemic. Mindfulness meditation is a natural measure that can help alleviate the feelings of perceived stress and anxiety and improve levels of mindfulness and self-compassion. An experimental two group pretest-posttest randomized controlled design was used to evaluate the effect of a virtual mindfulness meditation intervention on levels of perceived stress, anxiety, self-compassion, and mindfulness of nursing students. Study participants were randomly assigned to either an intervention or control group and received recordings prepared by the study authors. The intervention group received a 10-minute mindfulness meditation recording each week and the control group simultaneously received five 10-minute separate recordings on nursing news and information. Both groups were instructed to listen to the recordings at least three days per week for four weeks. The instruments used in this study were the Perceived Stress Scale (PSS), the Generalized Anxiety Disorder subscale (GAD-7), the Self-Compassion Scale (SCS), and the Mindfulness Attention Awareness Scale (MAAS). These surveys were provided at baseline and at a 4-week follow-up. The study presented in this dissertation is part of a larger study that was a collaboration between this author, Debra Heinrich, and Shohini Holden. Other instruments in the original study that are not discussed here are the Depression, Anxiety, and Stress Scale (DASS) and the Five Factor Mindfulness Questionnaire (FFMQ). This dissertation consists of three articles. The first article provides an analysis of the effect of a mindfulness meditation intervention on the stress and anxiety levels of nursing students. A two-way mixed ANOVA revealed a significant interaction between group assignment and timing of test on participants’ stress levels and on their anxiety levels. Follow-up simple main effects tests involving independent-samples t tests revealed that the intervention group, receiving the online mindfulness meditation recordings, experienced lower levels of stress and anxiety on the posttest surveys than the control group. The second article reports on a study of the effect of the intervention on mindfulness and self-compassion levels. The findings of a two-way mixed ANOVA and independent t tests demonstrated that mindfulness meditation can increase levels of mindfulness and self-compassion in nursing students. The third article compares two instruments used to self-report feelings of anxiety, reports on the demographic variables related to anxiety among nursing students, and explores the correlation between levels of mindfulness and levels of anxiety in this study. There were no significant relationships found between any demographic variable and anxiety scores. The GAD-7 instrument was found to be more sensitive to mild and moderate anxiety then the DASS instrument, and it is, therefore, the recommended instrument for use in nursing programs. There was a significant inverse relationship between levels of mindfulness and anxiety for students in this study. The findings of this study demonstrate that mindfulness meditation can reduce stress and anxiety, while increasing mindfulness and self-compassion levels in nursing students. This could be useful for nurse educators assisting students to manage the stress and anxiety often experienced in nursing education. Nursing programs could screen students to evaluate their levels of stress, anxiety, and mindfulness. Stress relief techniques, such as mindfulness meditation, could be incorporated into nursing programs as part of a wellness program or curricular offering. Mindfulness meditation could also be part of orientation programs in clinical sites for new nurses and offered to all nursing staff as part of continuing education. Further research, using rigorous scientific methods, will be needed to study the most effective methods to evaluate and manage stress and anxiety. This could ultimately decrease the stress and anxiety levels and improve well-being for student nurses and nurses, which could in turn positively impact patient care and outcomes.

The targeted transplant center's abdominal organ transplant unit had difficulty providing adequate education to patients prior to discharge, which had resulted in a 24% readmission rate within 30 days due to infections. Patients and caregivers were unavailable to receive education despite multiple attempts, which made it challenging for health care providers to complete this aspect of their job, resulting in a negative impact on patients' long-term outcomes. A more structured educational environment was needed to provide appropriate and effective patient and caregiver education to increase adherence and positive outcomes. The health promotion model served as a foundation for the development of the evidence-based educational process and materials. A panel of 6 experts was invited to review the evidence-based, theory-supported educational materials along with the staff and caregiver educational process developed for the unit. Five experts participated in the formative and summative evaluation of the educational process, materials, and the evaluation tool. Results of the evaluations demonstrated that a majority (83%) of the experts found the educational materials and process were essential, accurate, and provided a more structured environment that afforded health care providers the ability to maintain compliance with the targeted transplant center's education policy. The materials, process, and evaluation tool will be implemented at the site. Social change will result from increased patient engagement and confidence in self-care; improved caregiver ability to assist the patient; and reduced risk of noncompliance, readmissions, and poor outcomes.

Healthy work environments are critical in fostering occupational self-care for helping professionals, but information on the self-care and the work environment is limited among community college counselors in California. Self-care is essential for the counseling profession in California community colleges (CCC), as it promotes wellness, which is needed in order to provide optimal services to students/clients. The lack of self-care results in counselor impairment, leading to undesirable factors (i.e., burnout, health conditions, and decrease in productivity). In educational institutions, counselors often find it difficult to maintain their own self-care. However, work environments have been shown to affect self-care at work (professional self-care). Past studies have suggested that the work environment can help counselors increase their ability to practice self-care. In this quantitative statewide study on 324 CCC counselors, it was found that the work environment was related to and predicted CCC counselors' professional self-care, even when considering demographic variables. Additional findings from this research study indicated that CCC counselors’ workload had the highest relation with counselors’ daily balance. Differences in groups (e.g., demographic/contextual factors) are found among CCC counselors' work environment and professional self-care, with the greatest group difference on CCC counselors’ status (e.g., tenured, adjunct). Results also suggest that CCC counselors who worked overload (if full-time) strengthened the relationship between their professional development and a sense of community in the workplace. However, overload hours worked per week showed a negative association with their sense of community. These results may be useful to community college counselors and administrators for organizational planning, policy, and advocacy of self-care-promoting work environments for CCC counselors. A limitation of the study was that the majority of participants were female, White, and tenured faculty, which may not represent those outside of this population.