Thesis (Ph. D.)--Oregon State University, 1995. / Typescript (photocopy). Includes bibliographical references (leaves 58-66). Also available on the World Wide Web.

Thesis (M.S.)--University of Michigan, 1999. / Includes bibliographical references (leaves 27-29).

Thesis (M.S.)--University of Michigan, 1983.

Thesis (Ph.D)--Brandeis University, 2010. / "UMI:3391164." Includes bibliographical references

Thesis (Ph. D. (Education))--Rhodes University, 2006.

Thesis (M.A.)--Northern Kentucky University, 2006. / Made available through ProQuest. Publication number: AAT 1435896. ProQuest document ID: 1136092801. Includes bibliographical references (p. 28-29)

Made available in DSpace on 2016-03-15T19:40:26Z (GMT). No. of bitstreams: 1 Paulo Roberto Ferreira.pdf: 529852 bytes, checksum: ecce2ffc57c1f52236add8a313c0702c (MD5) Previous issue date: 2007-08-06 / Fundo Mackenzie de Pesquisa / This work sought to understand how the family of chronically ill patients deals with them and how this care affects family structure. The main objective was to study changes in family relations due to caring for chronically disabled people 5 families responsible for severely mentally handicapped children, recruited in a specialized institution in Espírito Santo State. Data were obtained via adapted Crichton Geriatric Scale (DLA) that assesses the functional capacity of the patient and has the advantage of knowing the evolution of capacities and limitations of the patient through frequent registration; Smilkstein s Family APGAR was adapted to assess the level of the patient s family integration. Results showed an evolution in some of the severely mentally handicapped patients. Concerning the degree of dependence, in the beginning all the five patients were totally dependant and nowadays two are still totally dependant and three are partially dependant. It also could be observed that from the starting of illness to the moment, families are integrated in the helping relation, in their members participation in decision making situations, in freedom of family members concerning financial matters, in affective relations and in time that family members dedicate to the patient. It was observed that family interactions have not suffered damage due to the chronically illness of their members, and that they succeeded in different stages of adaptation to the illness. This study could show the family carers viewpoint, as they add to a reality that enriches the comprehension of family relation of severely handicapped patients and their family universe. / Este trabalho buscou compreender como a família de pacientes crônicos lida com o cuidado a estes pacientes e como este cuidado afeta a estrutura familiar. O objetivo principal, portanto, foi estudar as modificações nas relações familiares decorrentes do cuidado a pessoas com transtornos crônicos. Participaram desta pesquisa 5 famílias, responsáveis pelo cuidado de crianças com deficiência mental severa, recrutadas em uma instituição de atendimento a pessoas deficientes numa cidade do interior do Espírito Santo. Os dados foram obtidos através de respostas a questionário da escala geriátrica de Crichton (AVD), adaptada, que avalia a capacidade funcional do paciente e tem a vantagem de permitir conhecer a evolução das capacidades e limitações do paciente através do registro periódico; para avaliação do grau de integração do paciente utilizou-se a adaptação do APGAR Familiar de Smilkstein. Os resultados mostraram uma evolução em alguns dos deficientes mentais severos. Em relação ao grau de dependência, inicialmente todos os cinco pesquisados eram totalmente dependentes e atualmente, dois continuam totalmente dependentes e três encontram-se parcialmente dependentes. Observa-se também que desde início do surgimento da doença até o momento, as famílias encontram-se integradas na relação de ajuda, na participação de seus membros na tomada de decisões, na liberdade dos membros da família nas questões financeiras, na relação afetiva e no tempo que os membros da família dão ao paciente crônico. Observa-se que as interações familiares não sofreram prejuízo devido à doença crônica de seus membros e que elas foram bem sucedidas nas diferentes fases de adaptação a doença. Este estudo pode proporcionar uma visão dos familiares cuidadores, uma vez que eles agregam uma realidade que enriquece a compreensão da relação familiar das pessoas com deficiência mental severa e seu universo familiar.

Abstract The purpose of this study was to describe and predict the quality of counseling of chronically ill adults in hospital. The aim of the first study was to describe the elements of the counseling of chronically ill adults using an integrated literature review (n=31). The aim of the second and third study was to describe and determine the factors predicting the quality of patient counseling. The data was collected with the CQI measurement from chronically ill adults (n=106) and analyzed using statistical methods. The aim of the fourth study was to describe the implementation of the quality of counseling based on documentation. The data were collected from patient records (n=150) and analyzed with deductive-inductive content analysis. There were three typical elements of counseling in the literature review: the counseling needs of chronically ill adults, the implementation of counseling and the impact of counseling. The counseling needs of the chronically ill included knowledge of the disease, emotions and social support. The implementation of counseling concerned need-based counseling interaction and counseling atmosphere. The impact of counseling included compliance with disease treatment and emotional well-being. Based on the survey, the content of counseling was sufficient, but there was lack of counseling about social support and disease prediction. Social support was the strongest predictor of the content of counseling. Half of the respondents received planned counseling and the interaction was good. There was lack of patient-centered counseling and counseling about disease prediction. Preplanned counseling was the strongest predictor for the implementation of counseling. The impact of counseling was the effect of attitudes and treatment, and the effects of disease treatment predicted the impact of counseling. There was little documentation of counseling in the patient records. In particular, there was a lack of counseling on chronically ill adults’ feelings during their hospital visit. They showed that counseling focused on the disease and its treatment and everyday life support. The implementation of counseling was related to the activity of the patient and evaluation of counseling as well as disease treatment and needs of emotional support. According to documentation, the benefits of counseling were seen as competence in self-care and handling symptoms. The information generated by the study may be utilized in counseling of chronically ill adults as well as in basic and continued nursing education. / Tiivistelmä Tutkimuksen tarkoituksena oli kuvailla ja ennustaa pitkäaikaissairaiden aikuispotilaiden ohjauksen laatua sairaalassa. Ensimmäinen osatutkimus kuvaili pitkäaikaissairaiden aikuisten ohjauksen tunnuspiirteitä integroidulla kirjallisuuskatsauksella (n=31). Toinen ja kolmas osatutkimus kuvaili ja ennusti ohjauksen laatua pitkäaikaissairaiden aikuisten arvioimana. Aineisto kerättiin Ohjauksen laatu -kyselylomakkeella pitkäaikaissairailta (n=106) ja analysoitiin tilastollisin menetelmin. Neljäs osatutkimus kuvaili pitkäaikaissairaiden aikuisten ohjauksen laatua kirjaamisen perusteella. Aineisto kerättiin potilasasiakirjoista (n=150) ja analysoitiin deduktiivis-induktiivisella sisällönanalyysillä. Kirjallisuuskatsauksen mukaan ohjauksen tunnuspiirteitä olivat ohjaustarpeet, ohjauksen toteutus ja hyödyt. Pitkäaikaissairaiden ohjaustarve liittyi tietoon sairaudesta, tunteisiin ja sosiaaliseen tukeen. Ohjauksen toteutus ilmeni yksilöllisten ohjaustarpeiden, vuorovaikutuksen ja ilmapiirin huomioimisena. Ohjauksen hyödyt olivat hoitoon sitoutuminen ja emotionaalinen hyvinvointi. Kyselyaineiston perusteella ohjaus oli sisällöllisesti riittävää, mutta sosiaalinen tuki ja tutkimustulosten ohjaus oli heikkoa. Ohjauksen sisällön laatua voimakkaimmin ennusti saatu ohjaus sosiaalisesta tuesta. Vastaajista puolet piti ohjauksen toteutusta suunnitelmallisena ja vuorovaikutusta hyvänä. Potilaslähtöisyydessä ja sairauden ennusteen ohjauksessa oli parannettavaa. Ohjauksen toteutuksen laatua voimakkaimmin ennusti ohjauksen suunnitelmallisuus. Ohjauksen hyötyjä olivat vaikutus asenteisiin ja sairauden hoitoon, ja ohjauksen hyötyä ennusti vaikutus sairauden hoitoon. Ohjausmenetelmiä ja -materiaaleja pidettiin hyvinä. Potilasasiakirjoihin ohjausta kirjattiin niukasti. Erityisesti ohjaus sairauden aiheuttamista tunteista oli vähäistä. Ohjaus oli sairauden ja sen hoidon sekä arkielämän tukea. Ohjauksen toteutus muodostui pitkäaikaissairaiden aktiivisuudesta ohjaustilanteissa ja ohjauksen arvioinnista sekä sairauteen ja emotionaaliseen tukeen liittyvistä ohjaustarpeista. Ohjauksen hyötyjä kuvattiin itsehoidon osaamisena ja sairauden oireiden hallintana. Tutkimuksen tuottamaa tietoa voidaan hyödyntää pitkäaikaissairaiden ohjauksen kehittämisessä sekä hoitotyön perus- ja täydennyskoulutuksessa.

Since the deinstitutionalisation of chronic mentally ill patients, there has been an increase in the number of relapsed chronic mentally ill patients who become acutely mentally ill and need to be re-admitted for acute care in psychiatric institutions. Professional nurses working at rural primary healthcare clinics find it difficult to care for these individuals because they lack the necessary knowledge and skills. Chronic mentally ill patients who have been admitted to acute care facilities are stabilised by rendering care, treatment and rehabilitation and then released into the care of the professional nurses working at rural primary healthcare clinics. These patients live in the community and have to make use of the primary healthcare clinics nearest to their homes to provide them with their prescribed medication and care. Furthermore the patients’ mental conditions do not always remain stable, possibly because of a knowledge deficit, at times about their mental status. Patients may become non-compliant, resulting in the recurrence of symptoms, and thus need to be re-admitted to the acute care facility. However, the problem leading to re-admission is not clear for all admissions. It may be that patients do not make use of the primary healthcare clinics. It also seems that the professional nurses in the primary healthcare clinics are unfamiliar in dealing with chronic mentally ill patients living in rural communities. The aim of this study was therefore, to explore and describe the experiences of these professional nurses in caring for chronic mentally ill patients living in a rural community. The researcher used qualitative, explorative, descriptive, and contextual research design. The research population consisted of professional nurses working at primary healthcare clinics. Non-probability purposive sampling was used to identify participants for inclusion in the study. Data collection was conducted using one-on-one, semi structured interviews, observations and field notes and interviews were tape-recorded and transcribed. Data analysis was conducted using Tesh’s method of content analysis to identify themes and sub-themes. A literature control was done to compare the findings to the current published research. Trustworthiness was ensured by using Gubas’s model (1985) of trustworthiness. A pilot study, conducted by interviewing a small sample prior to the start of the main study, determined whether the sampling and interviewing techniques of the researcher as well as the research questions were adequate for data collection. The researcher ensured that the study was of a high ethical standard by taking into consideration values that guide the principles of autonomy, beneficence, non-maleficence and justice. The findings of the study was categorised into three main themes and 13 sub-themes. The main themes were as follow: Professional nurses experience problems when they have to take care of psychiatric patients attending rural primary healthcare clinics. This theme had six sub-themes which were discussed in details in chapter three. The second theme was that professional nurses experience that psychiatric patients in rural communities experience problems which affected their well-being. This second theme has got five sub-themes which were discussed further in chapter three. The last theme was that professional nurses have positive experiences when caring for psychiatric patients in rural communities. This theme has got two sub-themes as well discussed further in chapter three.

This essay deals with the experiences of hospital school teachers, when teaching terminally and chronically ill children. Teachers form part of a multidisciplinary team of doctors, nurses, therapists, social workers and other caregivers. As a team they all share the same goal of assisting the child to better health with the minimum disruption to normal development and education. The effects on teachers personally; coping with emotional stresses of children being seriously ill and sometimes, unfortunately dying and professionally; by constantly adapting learning and teaching styles to suit the needs of these learners, are numerous when working in these conditions and often results in burnout. This essay explores these effects by inquiring into the lives of four teachers at one particular hospital school. This phenomenological study comes to a conclusion that hospital teachers need specific and distinctive characteristics to deal with issues out of the norm. They have to own extraordinary commitment and acknowledge the true value of teacher collaboration. Finally teachers needed ongoing support on a personal level; counseling, and on a professional level; teacher training and development in order to remain healthy, personally intact and at the spearhead of developments in the teaching profession. The essay ends with recommendations for hospital school teachers and hospital schools. / Dr. M.P. van der Merwe