The number of patients who suffer from colorectal cancer in Thailand has increased during the last three decades as a result of the change to a Westem-style diet. Due to many patients presenting at a late stage and the location of tumours in the rectum, patients have a higher probability of needing a colostomy. This study explores the experiences, coping strategies and the factors that influence coping strategies over a sixmonth period in a group of Thai colorectal cancer patients who have a colostomy. The conceptual framework used in this study was based on the Moos and Schaefer conceptual model of the stress and coping process. A case study methodology was employed to collect both quantitative and qualitative data from eleven participants at three points in time: within one month after the operation to create a colostomy, three months and six months after the operation. Data were collected from structured interviews, which followed the Coping Responses Inventory (CRI), the Ostomy Adjustment Scale (OAS), the Personal Resources Questionnaire 2000 (PRQ 2000), the Life Orientation Test-Revised (LOT-R), and the Functional Assessment Cancer Therapy- Colon (FACT-C). These data provided information on the participants' levels of coping strategies, adjustment to a colostomy, social support, optimism and quality of life. Indepth interviews with open-ended questions provided a deeper understanding of the participants' experiences in relation to their colostomy. Findings from quantitative data showed statistically significant changes in the participants' quality of life over time, particularly in their physical and functional wellbeing. An examination of the coping focus used (approach and avoidance) indicated that participants utilised both approach and avoidance coping at the same time, although approach coping was more common. Changes in the most frequently and the least frequently used coping subtypes at six months after the operation were observed. Correlation tests showed various relationships between the levels of quality of life domains and coping subtypes as time passed. Multidimensional scaling procedures uncovered a consistent pattern of coping which involved 'problem solving' and 'seeking guidance and support'. Six major qualitative themes emerged through content analysis of the in-depth interview data. The themes described how participants' psychological and emotional concerns changed over time; the steady improvements in physical health after the operation; the difficulties of adjusting to life with a stoma; facing up to the reality of the new circumstances; the spiritual aspects of their lives; and the level of social support experienced. Religious beliefs such as the 'Law of Kanna', as well as a variety of religious rituals and other practices such as Buddhist chanting and "making merit" played important roles in coping. The findings from the quantitative and qualitative data were used in a complementary and confirmatory manner to provide a richer understanding of the participants' experiences as they coped with this life changing event. The findings of the study are significant as they provide important indicators for improvements in nursing service, particularly the development of nursing procedures to enhance the psychological aspects of care. In addition, they offer important indicators for improvement of the nursing curriculum and directions for further research in Thai culture and the health care system.

Det finns tidigare studier som visat att sexuallivet påverkats efter förvärvade hjärnskador. I denna studie avsågs att lyfta personernas individuella perspektiv. Intervjustudien omfattar nio personer som förvärvat en hjärnskada för mer än ett år sedan, och som deltagit i hjärnskaderehabilitering vid Skånes universitetssjukhus. Åldern på deltagarna varierade mellan 25 och 64 år, och ålder vid skadetillfälle eller insjuknande var 16-55 år. Frågeställningar i uppsatsen var huruvida personerna i studien upplevt förändringar i sexuallivet efter att ha förvärvat en hjärnskada, och hur personerna hanterat detta, samt om det förekom skillnader i mäns och kvinnors upplevelse. I resultatet framkom att förändringar skett inom flera områden relaterade till sexualitet. Tydligast var förändringar som påverkats av trötthet, förändringar i erektion, lubrikation samt orgasmförmåga. Förändringarna påverkade även sexualiteten på det interpersonella planet. Dessa förändringar tolkades och hanterades olika av deltagarna. I analysen har scriptteorin använts, samt resonemang om copingprocesser. Slutsatsen är att sexualitet är en viktig del i rehabiliteringsprocessen, och att program som omfattar detta bör utvecklas / Sexuality is a central part of life among people in general. What happens to sexuality when a person suddenly acquires a brain injury as a result of severe illness or an accident? The focus at primary rehabilitation concerns more obvious functions which are aimed to make the person more independent in daily life. Questions about the personal experience of how the brain injury has affected identity as a male or female, and questions about sexuality can therefore be neglected. A review of earlier studies shows that sexuality is affected among persons who have acquired a brain injury. Sexuality can be seen as constructed both on intra psychic and interpersonal level, and script theory can be used to analyze changes in experiences of sexuality. AIMS: The aim of the current study was to illuminate the personal perspective of sexual changes among persons who had acquired a brain injury. Has the brain injury resulted in changes of the experienced sexual life, and if so how did the person manage these? Methods: In the current study nine people, both women and men were interviewed. The participants aged between 25 and 64 years had acquired a brain injury at the age between 16 and 55. All participants had acquired the brain injury for more than one year ago, and all had participated in a rehabilitation program at Skåne University Hospital. Results: Changes in sexuality was seen in relation to common consequences of brain injury such as fatigue and difficulties concerning concentration. Changes also appeared in relation to the ability to achieve erection, lubrication and orgasm (the intrapsychic level). There were also changes at the interpersonal level for example role changes in the relationship. All changes were managed in different ways by the participants including different coping strategies. Not all coping strategies were efficient for the person.Conclusions: Sexuality can be seen as a vital part of the rehabilitation process and therefore rehabilitation programs including sexuality should be developed. Partners’ perspective should also be considered.

本研究旨在探討於青少年時期曾經驗父（母）親過世的成人，面對其父（母）親過世的失落事件個人之因應方式，以及失落事件對個人造成的影響和意義是什麼？ 研究採現象學取向的深度訪談方式為研究方法，邀請五位成年人，進行回溯性資料蒐集，並以中心主題及個人描敘文加以分析資料。主要的研究發現如下： 一、失落事件與自我之間存在一個互為背景與圖像的關係。以此一觀點引申，發現失落具有四個內涵：失落感覺的產生來自情境的引發、失落是經驗主體的主動感知、失落是循環不止的質變過程、失落其實是部份自我的失落。 二、失落事件的發生對個人最主要的影響在於，經驗失落的主體之自我概念的改變。其中改變的向度包括自我認同、家庭動力、人際互動及生命觀等四個層面。 三、成功的因應失落來自於經驗主體其自我概念的成功重建。 四、失落的意義在於，個人因與過世父（母）親的關係的中斷，促使經驗失落的主體得以發展新的眼光來看待過去關係中的「自我」。 五、以時間序列的縱觀角度探討失落的因應歷程時，發現個人因應失落的歷程有極高的個殊性，無法歸納出相同的步驟、階段。但在失落感受發生的片刻之間，發現個人在面對其失落感受及現實生活挑戰時，具有極為相似的心理歷程。 最後依據以上的研究發現，提出有關對諮商人員、父母及教育工作者及對未來研究的建議。 / The purpose of this study was to understand coping process, the influence, and the meaning of adults when they were adolescent following parental death. Five interviewees participated this study. Phenomenological deep interview was adopted to collect data. Central themes and essential descriptions were chosen to analyze. The main finding were as follow: 1. The relationship of loss and self was just like figure and ground. There were four implications from this concept such as: 1) loss was induced by the environment 2)loss was an active feeling 3)the meaning of loss was changeable.4) loss came from part of self loss. 2. Facing the event of loss, the most critical influence towards interviewees was the change to his/hers self-concept. Changed aspects included self-indentity, family dynamics, interpersonal dynamics, and vision to life. 3. Successful coping skills mean the self-concept had been successfully reconstructed. 4. The meaning of loss was what could get a new self-concept ideal by the interrupted parental relationship. 5. There were no typical loss coping process among these interviewees. But when loss appears in daily life, there was a similar psychological process. The discussion and suggestion about the develoment of loss counseling were raised at the end the article.

This thesis investigates the interdependence of religiosity and a life situation changed by cancer, focusing especially on the coping process. This implies analyses of a number of identified expressions of religiosity regarding prerequisites and functions in the coping process. In order to synthesize the results from the studies, the aim has been operationalized into three comprehensive research questions that were posed to each of the empirical studies of the thesis: 1) What are the functions of the analysed expressions of religiosity during the coping process? 2) What prerequisites for the influence of religiosity on the coping process can be identified?  3) How is religiosity influenced by a life situation changed by cancer? The empirical studies are presented in four separate articles. Each of the studies has its own specific research questions that are related to the comprehensive research questions. The method was qualitative and explorative. The research material was gathered with qualitative interviews of 20 Swedish informants of varying gender, age, congregational affiliation and diagnosis. The informants defined themselves as Christians and practised their Christian faith and had or had had a cancer disease. There is longitudinal data from half of the group. The theoretical framework was based on the coping theories developed by Kenneth Pargament and Ruard Ganzevoort and complemented by, among other things, the object-relations theoretical concept of transitional objects. The results show that most of the analysed expressions of religiosity function as a preserving coping method but some of them also function as a reconstructing coping method. In some cases, the expressions of religiosity also function as methods of attributing control, either to God or to the individual. Two main groups of prerequisites for the expressions of religiosity were identified in conjunction with the coping process: contextual and psychological. The former could in turn be divided into religious and medical contexts; the latter into several different kinds, such as perceptual psychological factors, the need to create and use transitional objects, locus of control, and personality traits. Reconstructing coping methods imply varying degrees of changes in the informants’ religiosity, both regarding the analysed expression of religiosity and other expressions of religiosity. In addition to gaining insights into the interdependence of religion and coping for Christians living with cancer, the study contributes to the development of the psychology of religion coping theory by adding to the theory: 1) suggested specifications to the current concepts of Pargament’s coping theory; 2) the concept coping tool; 3) the distinction between functional and relational regarding the concepts of coping mechanism and coping method; 4) the coping mechanism attributing, and 5) the distinction between unilateral and bilateral deferring coping styles. The results indicate that the coping process can include a creative element in the form of a search for, or creation of, functional coping methods and/or coping tools which enhance the functionality of the coping process.