Thesis (M. Nurs.)--University of Hong Kong, 2006.

Thèse : Helsinki : 1987. / Finlande. Includes bibliography.

No description available.

No description available.

Almost everyone experiences an incident, illness, or concern that requires clinical advice or assistance. Most persons obtain the desired care and renew their daily activities. Some people, however, appear to be (medical) problem-prone, wellness-resistant or reinforced by illness sequelae. Individuals who maintained illness behaviors are often called, for example, chronic pain, asthma, or psychiatric patients by caregivers who focus on diagnoses. Some patients may be viewed as primarily chronic, with specific diagnoses considered secondary. Chronicity is here defined as a measure of individual, situation, exposure, and provider interaction outcomes. Independent of disease processes, chronicity-producing interactions often predict inappropriate and atypical medical utilization patterns. The assessment of chronicity, its precursors, and dynamics may identity high risk person, situation, provider, and environment combinations and permit more effective and relevant prevention and treatment strategies. The study patient chronicity, the Pre-Assistance Questionnaire (PAQ) was developed with 320 items on medical, personal, and situational topics. PAQ responses from 60 medical and 40 psychiatric VA outpatients were correlated with three estimators of patient chronicity: PAQ totals (from an empirically-derived key), clinicians' subjective ratings of patients' chronicity, and indices of subjects' 2 year use of VA medical center resources. PAQ totals correlated significantly with 240 items, medical usage with 119, and clinicians' ratings with 100. For replication, a 40 item short form was given to 120 medical and 80 psychiatric outpatients. Thirty-four items correlated significantly with two of the three measures, 26 with all three. The short form demonstrated high reliability (alpha = .91; test-retest reliability = .90; split-half reliability = .89). PAQ totals, chronicity ratings, and use indices showed no significant differences across from administrations although the psychiatric patients scored significantly higher (more chronic) on all measures. The findings support a general chronicity construct and suggest many applications from the screening of potential employees to the development of specific treatment plans matched to particular PAQ patterns. The major message, however, is that public health, medical, psychological, and sociological constructs may be integrated into a comprehensive model of medical utilization patterns that provides views of illness, wellness, and health care delivery and assessment.

This thesis is concerned with families and chronic illness in childhood. The specific focus of the study is the nursing contribution to support of the family. A longitudinal study of the experience of four families caring for a child with cystic fibrosis was carried out using the ethnographic approach. Analysis of the four case studies provides insight to the effect of cystic fibrosis on each family member and on family interaction. The psychosocial transition by which the families moved from seeing themselves as healthy families to accepting the reality of a long-term health problem is described. The complexity of the effect of the genetic aspects and the grim prognosis is explored. The importance of finding meaning in suffering, the experiences of crisis and the chronic burden of care during the long-term adaptive stage of the illness are described. The support networks used by the families, and the nurse's contribution to that support are analysed. The research arose from practice and raises issues for nursing - issues relating to the level of interpersonal skill and the emotional investment required. The theoretical underpinning of nursing interaction is elaborated and the utility of systems theory in the understanding of the nursing situation is discussed. The importance of synchrony in the parents' adaptation to the child's illness is an emergent theme. The implications of the findings for nursing practice, management and research are discussed. The case for the development of a concept of family nursing to meet contemporary health care needs is argued.

There is no abstract available for this dissertation. / Department of Educational Psychology

This thesis is a report of a study on patients suffering one of two painful chronic illnesses (rheumatoid arthritis (RA) or migraine), and attempts to discover possible determinants of psychological reactions to long term painful illness. One hundred and sixty chronically ill individuals were interviewed, (80 migraine and 80 RA sufferers). In keeping with other evidence, the extent of psychological disturbance was found to be higher for chronically ill individuals than for general population samples. There were no zero order correlations between reported pain and psychological distress. Age and length of suffering have often been cited as possible factors influencing mood state, but no evidence was found for this in the data gained in this survey. The results provide no evidence for the use of coping strategies as a method of adapting to the demands of the painful chronic illnesses studied here. Beliefs in control over illness have been posited as possible factors that may influence psychological state, and were measured in this research using a health locus of control scale. However locus of control scores were not found to be associated with mood state, although, in keeping with other research, scores were found to be associated with age and social class, with both lower social class and older sufferers scoring higher on externality than those from higher social classes, or whom were younger. The strongest association was found between aspects of subjective health status and mood state. The major finding of this study is that patients assessment of their own health state, in both illnesses, is the major factor associated with psychological state.

The purpose of this focused ethnographic study was to describe the patterns of a good death held by elderly Japanese Americans living in Hawaii. Eighteen "healthy active" elderly Japanese Americans were interviewed individually. In addition, supplementary data, such as interviews with experts and field observations were collected for triangulation of the data. Four themes were derived from 1224 keywords, 56 categories, and 13 patterns. These were: being a burden to the family, process of life and death, individual views on death, and Japanese culture in Hawaii. Being a burden to the family was the largest concern in the participants' idea of dying a good death. Having secure financial resources were key for adequate preparation. The elderly Japanese Americans believed that suffering at the end-of-life should be avoided in order to achieve a good death. Their concept of suffering included: unmanageable pain, being ill for a long time, and being bedridden. Several participants preferred a sudden type of death because they would not have to suffer and not be burdens their family. Contentment in life was also an important aspect of a good death. There was a common belief that the way a person lived was connected with the way he/she died. A number of the participants preferred to die in their own home. Hospitals and retirement homes were other alternatives for the place of death. Individual views on death contributed to establish the concept of good death among elderly Japanese American participants. They shared similar attitudes toward death which were a part of life and inevitable. These attitudes were influenced by religious beliefs and past experiences with death. Different generations of elderly Japanese Americans had different views. The Shin-Issei (first generation who immigrated after World War II) and the Nisei (second generation) held more Japanese views compared to the Sansei (third generation) who were more acculturated. Although the Japanese American parents and children might have different views on life and death, the importance of close family relations and family support was passed on to younger generations.

The purpose of this study was to evaluate Leventhal, Nerenz, and Steele’s (1984) self-regulation model of adaptation to chronic illness when applied to children with asthma and their parents. The self-regulation model posits that illness representations influence coping, and via coping, adaptive outcomes. In the adult literature, illness representations or perceptions of symptoms, cause, time-line, consequences and control of illness have been found to be important determinants of coping and adjustment. No study, however, has examined illness representations in relation to coping and adjustment in children with a chronic illness or their parents. A second goal was to examine the influence of parents on the coping processes of their children. One hundred and twenty-eight children (7-13 years) with asthma and their 120 primary caregivers (96% mothers) were individually interviewed regarding their illness representations, and completed self-report questionnaires of coping and psychological adjustment. For both children and parents, illness representations had a direct association with psychological adjustment that was not mediated by coping. Children and parents who considered the child’s asthma to be a serious condition with frequent symptoms and serious consequences reported poor psychological adjustment, over and above any effect of the clinical severity of the illness itself. Parental illness representations and adjustment were significantly related to these same variables for children. However, after controlling for relevant demographic/asthma variables in regression analyses, only children’s illness representations remained significantly associated with parental illness representations. Children who demonstrated more negative illness representations had parents who also held more negative beliefs about asthma. These findings suggest illness representations to be an important target for psychological interventions.