Chronic illnesses and disabilities are the number one health problems in North America, and are the health challenges of this era. Many studies have investigated the illness experience for people with chronic conditions, but little is known about how people with chronic conditions experience feeling healthy. Recent studies indicate that people with chronic illnesses/disabilities perceive themselves to be predominantly healthy. What follows from these studies is the need to know more about how health is experienced by this client group. The purpose of this study was to investigate this phenomena of health within illness. Specifically, the research question was: What is the meaning of feeling healthy for people with chronic illnesses/disabilities. An interpretive phenomenological investigation was undertaken with eight participants living with a variety of different chronic conditions. The results of this study provide two important findings. First, the participants described their healing journey which brought them to the experience of feeling healthy, and seven essential themes emerged to describe this healing experience. These themes included; (a) In the Beginning, (b) Hitting the Wall, (c) Turning Around, (d) Letting Go, (e) Opening Up, (f) Letting In, and (g) The Gift. Second, the participants described their experience of feeling healthy and six themes emerged to describe this experience. These themes included; (a) Honouring the Self, (b) Seeking and Connecting with Others, (c) Creating Opportunities, (d) Celebrating Life, (e) Transcending the Self, and (f) Acquiring a State of Grace. The rigor of this study was considered to by attending to the auditability, credibility, applicability and confirmability of this research method and results. The results of this research were then compared to theories of growth and change as a result of crisis, theories of developing consciousness, self identity, social support, hardiness and resilience. Also, these results were compared with other definitions of health. Recommendations were made for further research and theory development regarding the conceptualization of health within illness. Finally, the implications of incorporating a health within illness perspective for clients, nurses, and the health care system were discussed. The reconceptualization to include the experience of health within illness would contribute to an expanded focus for client care, and to the promotion of health. / Graduate

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Much of the prior research on the psychosocial aspects of end stage renal disease (ESRD) has focused solely on the individual, without considering the family's role in patient adjustment. Little research has been conducted on the contextual elements of the patient's adjustment to renal failure and dialysis. It was the purpose of this study to assess the effect of family relationships on a patient's health locus of control as a measure of adjustment to ESRD. Health locus of control was hypothesized to be dependent on the family relationship variables of cohesiveness, adaptability and independence; as well as a communications variable measuring incongruent communications. From the general context of the double bind a path model was constructed to estimate the associations among the variables. Data was collected and analyzed on 91 ESRD patients from four dialysis treatment centers and a sample of Continuous Ambulatory Perotineal Dialysis patients. The results of this research suggest that the double bind theory may be an excellent explanatory paradigm for patient adjustment to chronic illness. It was found that the greater the perceived paradox in family communications the more likely the patient was to subscribe to an externally oriented health locus of control. The family relationship variables were found to be indirect predictors of health locus of control, acting through the family communications process. / Ph. D.

The purpose of the present cross-sectional study was to examine the effects of ambiguity of loss and type of caregiver-to-patient relationship on anticipatory grief, negative physical and psychological outcomes associated with grief, and boundary ambiguity in family caregivers of chronically ill patients. Questionnaires were completed by 23 parents of ill children and 30 spouses of ill mates. Using an original and a revised concept for level of ambiguity, partial support was found for the prediction that parents and spouses in high ambiguity of loss circumstances would report more anticipatory grief than those in low ambiguity ones. Contrary to prediction, a slight but nonsignificant trend occurred for parents and spouses in low ambiguity situations to report more negative physical and psychological effects associated with grief as well. Level of ambiguity was not found to impact boundary ambiguity as had been hypothesized. Spouses reported more boundary ambiguity than parents, regardless of level of ambiguity of the loss. Contrary to prediction that parents would report less anticipatory grief and more negative physical and psychological outcomes than spouses, generally, no significant differences were found between the two groups. However, using the original concept of ambiguity, parents did tend to recall more past grief than spouses. The study highlighted several methodological concerns which impact research on loss and grief, particularly the difficulty involved in recruiting participants with subsequent occurrence of sampling bias, rudimentary status of available measurement tools, and a host of potentially confounding personal and sociodemographic variables. The present study supports a view of the loss which occurs in families dealing with chronic illness as a complex process whose impact on grief, distress, and family upheaval is influenced by multiple factors. Such factors include both the ambiguity of the loss and the type of family relationship involved. Complex research of a longitudinal nature using psychosocial models of illness is needed to better delineate the impact of factors such as these.

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Thesis (M.S.)--Texas Woman's University, 1997. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis (Ph. D.)--University of Texas at Austin, 2004. / Supervisors: Larry Browning and Rajiv Rimal. Vita. Includes bibliographical references.

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