BACKGROUND: Prolonged mechanical ventilation for acute medical conditions increases the risk of chronic critical illness (CCI). Close family members are confronted with the life-threatening condition of the CCI patients and are prone to develop posttraumatic stress disorder affecting their health-related quality of life (HRQL). Main aim of the present study was to investigate patient- and family-related risk factors for posttraumatic stress and decreased HRQL in family members of CCI patients. METHODS: In a cross-sectional design nested within a prospective longitudinal cohort study, posttraumatic stress symptoms and quality of life were assessed in family members of CCI patients (n = 83, aged between 18 and 72 years) up to 6 months after transfer from ICU at acute care hospital to post-acute rehabilitation. Patients admitted a large rehabilitation hospital for ventilator weaning. The Posttraumatic Stress Scale-10 and the Euro-Quality of life-5D-3L were applied in both patients and their family members via telephone interview. RESULTS: A significant proportion of CCI patients and their family members (14.5 and 15.7 %, respectively) showed clinically relevant scores of posttraumatic stress. Both CCI patients and family members reported poorer HRQL than a normative sample. Factors independently associated with posttraumatic stress in family members were the time following ICU discharge (β = .256, 95 % confidence interval .053-.470) and the patients\' diagnosis of PTSD (β = .264, 95 % confidence interval .045-.453). Perceived satisfaction with the relationship turned out to be a protective factor for posttraumatic stress in family members of CCI patients (β = -.231, 95 % confidence interval -.423 to -.015). Regarding HRQL in family members, patients\' acute posttraumatic stress at ICU (β = -.290, 95 % confidence interval -.360 to -.088) and their own posttraumatic stress 3 to 6 months post-transfer (β = -.622, 95 % confidence interval -.640 to -.358) turned out to be significant predictors. CONCLUSIONS: Posttraumatic stress and HRQL should be routinely assessed in family members of CCI patients at regular intervals starting early at ICU. Preventive family-centered interventions are needed to improve posttraumatic stress and HRQL in both patients and their family members.

BACKGROUND: Prolonged mechanical ventilation for acute medical conditions increases the risk of chronic critical illness (CCI). Close family members are confronted with the life-threatening condition of the CCI patients and are prone to develop posttraumatic stress disorder affecting their health-related quality of life (HRQL). Main aim of the present study was to investigate patient- and family-related risk factors for posttraumatic stress and decreased HRQL in family members of CCI patients. METHODS: In a cross-sectional design nested within a prospective longitudinal cohort study, posttraumatic stress symptoms and quality of life were assessed in family members of CCI patients (n = 83, aged between 18 and 72 years) up to 6 months after transfer from ICU at acute care hospital to post-acute rehabilitation. Patients admitted a large rehabilitation hospital for ventilator weaning. The Posttraumatic Stress Scale-10 and the Euro-Quality of life-5D-3L were applied in both patients and their family members via telephone interview. RESULTS: A significant proportion of CCI patients and their family members (14.5 and 15.7 %, respectively) showed clinically relevant scores of posttraumatic stress. Both CCI patients and family members reported poorer HRQL than a normative sample. Factors independently associated with posttraumatic stress in family members were the time following ICU discharge (β = .256, 95 % confidence interval .053-.470) and the patients\' diagnosis of PTSD (β = .264, 95 % confidence interval .045-.453). Perceived satisfaction with the relationship turned out to be a protective factor for posttraumatic stress in family members of CCI patients (β = -.231, 95 % confidence interval -.423 to -.015). Regarding HRQL in family members, patients\' acute posttraumatic stress at ICU (β = -.290, 95 % confidence interval -.360 to -.088) and their own posttraumatic stress 3 to 6 months post-transfer (β = -.622, 95 % confidence interval -.640 to -.358) turned out to be significant predictors. CONCLUSIONS: Posttraumatic stress and HRQL should be routinely assessed in family members of CCI patients at regular intervals starting early at ICU. Preventive family-centered interventions are needed to improve posttraumatic stress and HRQL in both patients and their family members.

Cette thèse propose une exploration du lien entre le capital social familial et les dimensionscognitive et relationnelle du capital social organisationnel de l'entreprise familiale (EF). La rechercheconduite allie fondamentaux théoriques de l'EF et théories de la sociologie, psychosociologie etpsychanalyse. En considérant que la famille, via sa culture, fournit un socle de lectures partagées dela réalité et influence les schèmes d'action et de pensée de ses membres, la question se pose del'impact sur le construit socio-culturel de l'EF, de l’entrechoquement ou de la superposition de cesschèmes (entre générations, membres d’une fratrie, ou membres de la famille et salariés exogènes).Pour aborder les ambivalences animant ces synergies famille-individu-entreprise, nous adaptons leconcept de PIH (Patrimoines Individuels d'Habitudes) développé par Kaufmann (2001) aux dirigeantsfamiliaux (DF), dans le cadre d'un cas unique (EF sous contrôle familial depuis le 19e siècle) précédéd'un cas exploratoire, et en enrichissant ce concept des dimensions émotions-psyché-affects. Unmodèle de cube dialectique est exploité pour une analyse et une mise en perspective inter ettransgénérationnelle conduisant à l'identification d'un "processus de gestion des PIH" des DF.L'analyse des risques attachés à ce processus offre un double axe de réflexion et d'action aux DF,l'un relatif au capital social interne de l'organisation, l'autre à la gouvernance. Le design de larecherche, abductif, de nature qualitative et interprétative, combine techniques de récits de vie,cartes cognitives, questionnaires, matrices processuelles, génogrammes, analyses des risques etélaboration de plans d'action. / The objective of this thesis is to explore the link between family social capital and the cognitive andrelational dimensions of the family firm (FF) social capital. At the crossroads of managementsciences, sociology and psychoanalysis, this work contributes to a better knowledge of the FF, whichintermingles, because of its very nature, emotions and affects in a very specific and ambivalent way.We consider that the family, through its culture, provides a shared framework to tackle reality andinfluences therefore the patterns of action and thought of its members. Thus, the question arises ofthe impact of the confrontation or superposition of these patterns (between generations, betweenbrothers and sisters, or family members and non-family employees) on the organizational culture ofthe FF. To address the ambivalences animating these family-individual-business synergies, we adaptthe concept of ICH (Individual Capitals of Habits) developed by Kaufmann (2001) to family-membermanagers (FMM), throughout a single case (preceded by an exploratory case), and we enriched itwith emotion-psyche-affect dimensions. Thus we use a dialectical cube model as a framework ofanalysis to shed light, from the inter and transgenerational angle, on a ICH management process.The analysis of the risks induced by this transversal process provides FMM with means to improveinternal organizational social capital and FF governance. The design of the research is abductive,based on a qualitative and interpretative approach. It combines FMM life stories, cognitive maps,semi directive interviews (non-family-member managers), matrices of process analysis, genograms,and risk analysis.

Att avsiktligt skära, bränna eller på annat sätt skada sig själv illa är förenat med ett stort lidande och väcker ofta starka reaktioner hos de anhöriga. Problematiken är omfattande och självskadebeteende förefaller vara en stark prediktor för självmordsförsök och fullbordade självmord. Globalt är självmord den näst vanligaste dödsorsaken bland ungdomar. Efterfrågan på effektiva behandlingsmodeller för denna målgrupp är stor. I Sverige, närmare bestämt i Uppsala har behandlingsmodellen IKB – Intensiv Kontextuell Behandling utvecklats för ungdomar med självskadebeteende och/eller suicidala beteenden och deras familjer. Modellen är en integrerad individ- och familjeterapeutisk behandlingsmodell. Föreliggande studie syftade till att undersöka behandlingsmodellen IKB:s effektivitet i förhållande till minskat självskadebeteende hos ungdomarna och minskade nivåer av Expressed emotion hos föräldrarna. Sammanlagt har 34 familjer deltagit i studien och de har samtliga genomgått behandling inom ramen för IKB-modellen. Resultatet visade på en effektivitet i behandlingsmodellen IKB avseende att minska självskadebeteende hos ungdomarna samt att minska nivåerna av Expressed emotion hos föräldrarna. Utfallet av studien diskuteras utifrån tidigare forskning och metodologiska frågor. / To intentionally cut, burn or hurt oneself severely is associated with great suffering and often arouse strong reactions within the family context. The problem is extensive and self-harm appears to be a strong predictor of suicide attempts and completed suicides. Globally, suicide is the second leading cause of death among young people. Effective treatment models for this group is urgent. In Sweden, (Uppsala) the model IKB - Intensive Contextual Treatment was developed for adolescents with self-harm and / or suicidal behavior, and their families in order to provide support. IKB is an integrated individual and family therapeutic model. The aim of the study were to evaluate the effectiveness of IKB in relation to frequency of self-harm and levels of Expressed emotion. A total of 34 families participated in the study and they all received treatment in the context of the IKB-model. The families completed the self-assessment forms for data collection before treatment, after treatment and follow-up. Results showed efficiency to reduce self-harm among adolescents and to decrease levels of Expressed emotion. The outcome of the study are discussed based on previous research and methodological issues. / <p>27</p>

PhD (Nursing Science) / Department of Advanced Nursing Science / State patients are admitted to the psychiatric hospital after being declared as such by a court of law in South Africa. After successful rehabilitation of state patients at the psychiatric hospital, they need to be reintegrated into their families. Perceptions of family members of male state patients regarding reintegration including development of a model to support such reintegration, is not largely explored in the scientific body of knowledge. The aim of this study was to develop a model to support reintegration of state patients into their families in Limpopo Province, South Africa. A qualitative approach using descriptive, explorative, and contextual designs was adopted for this study. The study population was family members whose relatives are male state patients admitted and recorded in the admission register of Hayani Hospital, in Limpopo Province. The study was conducted in two phases of which phase one was a situational analysis, and phase two was the development of the model to reintegrate male state patients into their families. This study was conceptualized within the Social Ecological Model (SEM) of human behaviour (Stokols, 2013), the grounded theory for model development outlined in Dickoff et al. (1968), and the approaches outlined in Chinn and Kramer (2008); Walker and Avant (1995). Model evaluation was done by a group of health professionals, some of whom are advanced psychiatric nurses who are doing masters and doctoral studies, and one doctoral graduate who is also an advanced psychiatric nurse. Presentations were made to this group during peer review sessions who in turn gave critical comments regarding the developed model to support reintegration of male state patients until the final model was accepted. Non-probability purposive and convenient sampling were used to sample a hospital and 10 family members of Venda-speaking male state patients. In-depth individual interviews were used as the instrument to collect data which was pretested on one family member who did not form part of the study. Data was analysed using thematic analysis approach. Data was co-coded by an independent doctoral degree graduate to ensure trustworthiness. Conducting home visits by health professionals came up strongly during data analysis. Credibility, dependability, confirmability and transferability to ensure trustworthiness of the study, as well as ethical considerations were adhered to. The findings of the study yielded two themes, being perceptions of participants regarding reintegration of male state patients, and perceptions of participants regarding the support needed from family members to reintegrate male state patients. During phase one, the results indicated that family members accept reintegration and also that they indicated the kind of support needed, that lead to phase two of developing a model to reintegrate male state patients. The study was restricted to only one hospital in the Vhembe District out of the five districts of the Limpopo Province.The researcher acknowledges that this study was contextual and that only family members of male state patients were interviewed, the perceptions of family members of female state patients were not heard. The study concluded that there are perceptions that family members of male state patients have regarding reintegration of these patients into their families. Furthermore, family members of male state patients can describe the kind of support that they need in order to reintegrate male state patients into their families. This should be done using the developed model that should involve family members and the community. The study recommends that psychiatric hospitals should implement the model involving family members of male state patients. Furthermore, a longitudinal study should be conducted for a period of 3-5 years to check the effectiveness of the model. / NRF

Indiana University-Purdue University Indianapolis (IUPUI) / African Americans' tendency to choose life-prolonging treatments (LPT) over comfort focused care (CFC) at end-of-life is well documented but poorly understood. There is minimal knowledge about African American (AA) perceptions of decisions to continue or discontinue LPT. The purpose of this study was to examine AA family members' perceptions of factors that influenced end-of-life care decision-making for a relative who recently died from serious illness. A conceptual framework informed by the literature and the Ottawa Decision Support Framework was developed to guide this study. A retrospective, mixed methods design combined quantitative and qualitative descriptive approaches. Forty-nine bereaved AA family members of AA decedents with serious illness who died between 2 to 6 months prior to enrollment participated in a one-time telephone interview. Outcomes examined include end-of-life treatment decision, decision regret, and decisional conflict. Quantitative data were analyzed using descriptive statistics, independent-sample t-tests, Mann-Whitney U tests, chi-square tests, Spearman and Pearson correlations, and linear and logistic regressions. Qualitative data were analyzed using content analysis and qualitative descriptive methods. Family members' decisional conflict scores were negatively correlated with their quality of general communication (rs = -.503, p = .000) and end-of-life communication scores (rs = -.414, p = .003). There was a significant difference in decisional regret scores between family members of decedents who received CFC versus those who received LPT (p = .030). Family members' quality of general communication (p = .030) and end-of-life communication (p = .014) were significant predictors of family members' decisional conflict scores. Qualitative themes related to AA family members' experiences in end-of-life decision-making included understanding (e.g., feeling prepared or unprepared for death), relationships with healthcare providers (e.g., being shown care, distrust) and the quality of communication (e.g., being informed, openness, and inadequate information). Additional qualitative themes were related to perceptions of the decision to continue LPT (e.g., a lack of understanding, believe will benefit) or discontinue LPT (e.g., patient preferences, desire to prevent suffering). In conclusion, this study generated new knowledge of the factors that influenced AA bereaved family members' end-of-life decision-making for decedents with serious illnesses. Directions for future research were identified.