Aim: The overall aim of this thesis was to evaluate the experiences of nurses and families participated in Family Health Conversations (FamHC) and the effects of this intervention on those families with a family member living in a residential home for older people. Methods: This thesis comprises four studies. The FamHC were structured as three conversations held at two-week intervals and a closing letter. In two of the studies (I and II), group interviews with family members were interpreted using qualitative content analysis. A mixed-method research design was used in study three (III). Data were collected through group interviews with families and by using the instruments FHI and SWED-QUAL completed by the family members. The qualitative and quantitative data were analyzed and then integrated. In the fourth study (IV), registered nurses who had performed the FamHC participated in individual interviews after they had completed four conversation series each. The RNs also wrote diary notes about what they experienced directly after conducting each conversation. The interviews and diary notes were interpreted with qualitative content analyses. Result: The findings from study I one month after participating in the conversations showed that the families felt alleviated from guilty consciences. The FamHC gave the family members confirmation that they were, indeed, good enough. Study II showed that, six months after participating in the conversations, the families had experienced the FamHC as healing because the sharing and reflections through dialogue within the conversations mediated confirmation, which made the families feel consoled. Study III revealed that the families’ emotional wellbeing had increased six months after participating in the FamHC. The families also showed an improved ability to work together. In study IV, the nurses reported that the FamHC was a useful care action in their work with families. Conclusion: The overall conclusion from the findings is that the families were consoled by participating in the FamHC. The conversations offered an arena for families to listen to each other’s narration which provided a better relationship and cooperation within the family and a greater sense of well-being for the family members. / Bakgrund: Att ha en sjuk närstående som bor på ett särskilt boende för äldre påverkar hela familjen. Familjemedlemmarna kan uppleva känslor av saknad, skuld, maktlöshet och sorg. Det finns därför ett behov av att utvidga omvårdnaden till att innefatta hela familjen som ett system för att minska ohälsa hos familjer. Detta kan ske genom familjecentrerade interventioner. Ett exempel på en familjecentrerad intervention är hälsostödjande familjesamtal (FamHC). Det är en vårdhandling med focus på familjens styrkor, resurser och relationer inom familjen. Det finns begränsad kunskap om dessa familjeinterventioner i kontexten vård och omsorg av äldre. Syftet: Syftet med avhandlingen är att ur ett familje- och sjuksköterskeperspektiv studera upplevelser, responser och effekter av sjuksköterskeledda hälsostödjande familjesamtal med närstående som har en familjemedlem boende på ett särskilt boende för äldre. Metoder: Denna avhandling är baserad på en intervention med FamHC genomförd vid tre särskilda boenden för äldre i norra Sverige. Samtalens struktur är tre på varandra följande samtal varannan vecka med skilda fokus och avslutas med ett avslutande brev. Avhandlingen består av fyra delstudier. I studie I-II användes semistrukturerade gruppintervjuer med närstående som analyserades med kvalitativ innehållsanalys. I studie III användes mixad metod. Kvalitativa resultat från intervjuer och kvantitativa resultat från instrumenten SWED-QUAL och FHI, analyserades parallellt samt integrerades därefter. I Studie IV intervjuades tre sjuksköterskor med semistrukturerade individuella intervjuer. Sjuksköterskorna skrev även dagboksanteckningar. Intervjuerna och dagböckerna analyserades med kvalitativ innehållsanalys. iv Resultat: Resultaten från studie I visar att de närstående en månad efter deltagandet i FamHC upplevde en lindring av sitt dåliga samvete då de krav som familjerna ställer på sig själva minskat. Vid samtalen fick de närstående bekräftelse på att de gjorde så gott de kunde. Genom att dela sina föreställningar med varandra genom berättelser skapades en ökad förståelse för hela familjens upplevelse av situationen. Studie II visar att sex månader efter samtalsseriens avslutande upplevde familjen deltagandet i FamHC som ett delande i en dialog med en läkande kraft. Delandet upplevdes bekräftande vilket gjorde att de närstående upplevde samtalen som trösterika. Studie III visar att de närståendes emotionella välbefinnande hade förbättrats sex månader efter att ha deltagit i FamHC. Studien visar på förbättrad kommunikation och relationer samt förbättrat samarbete inom familjen. Studie IV visar att sjuksköterskorna upplevde att FamHC var en tillämpbar omvårdnadsåtgärd i arbetet med familjer. Det gav en förbättrad förståelse av familjens situation och förbättrade relationen med närstående. Konklusion: Den övergripande slutsatsen från resultaten i delstudierna är att genom att delta i FamHC blev familjerna tröstade. Samtalen skapade en arena för de närstående att berätta samt att lyssna till varandras berättelser. Det gavs utrymme att gråta och sörja över sin situation över att ha en sjuk familjemedlem på ett särskilt boende. Samtalen medförde reviderade föreställningar bland närstående och sjuksköterskorna samt en ökad förståelse och ett bättre samarbete inom familjen och en ökad känsla av välbefinnande hos de närstående. Hälsostödjande familjesamtal kan därmed föreslås vara ett användbart verktyg för sjuksköterskor i deras arbete med närstående inom kontexten särskilda boenden för äldre personer.

This study explored the experiences of stepmothers of non-residential stepchildren, using a phenomenological approach and qualitative exploratory design. Participants were recruited in the Gauteng area through purposive sampling. Thematic analysis was used to analyse the information. The findings of this study indicate the following: the participants, in their role as stepmothers of non-residential stepchildren, experienced various challenges that were very stressful, especially during the early stages of stepfamily formation. The lack of acknowledgement of the stepmothers’ dedication to their stepchildren, as well as conflicting rules concerning how to care for the children, caused distress for the participants. Support from their partners, as well as improved stepfamily relationships over time, were acknowledged as contributing factors to the participants’ continued commitment to their stepfamilies. Further research on stepmothers of non-residential stepchildren is recommended / Psychology / M. A. (Clinical Psychology)

This dissertation concerns the family context of self-determination in adults with intellectual disabilities (ID) during life transitions. Although self-determination is interpreted in different ways in different disciplines, the construct is frequently used to describe the attitudes and behaviours that allow people to feel autonomous and causal in their lives. Research on self-determination in adolescents and adults with ID has commonly occurred in community and special education sectors, with an emphasis on arranging supports for people with ID to develop component self-determination skills, like choice making, problem solving, and goal setting. From the perspective of organismic-dialectical theories, people develop and express self-determination through relationships and person-environment interactions at multiple system levels. Further research on the way family interactions and supports influence the self-determination of adults with ID is important. To address this need, this dissertation includes a qualitative study presented in two manuscripts and a quantitative study presented in one manuscript. The qualitative study explored processes and challenges in the family system during significant life transitions with an adult family member with ID. Families participated in semi-structured interviews and ethnographic observations of daily activities every three to four months for one year. Manuscript 1 concerns the influence of family processes on the self-determination of two young adults with ID as they attained adult roles in the community. Parents were observed to model goal setting, encourage choice making, and scaffold new skills, which helped the young adults with ID to experience autonomous motivation in their transitions. Parents reported feeling unsure of the best way to promote their adult child’s independence while ensuring his or her safety. They tried to resolve this dilemma with open and honest communication. Most interestingly, families collaborated in choice making to the extent that every family member perceived autonomy in transition planning and implementation. Manuscript 2 concerns the influence of transition processes and challenges on the quality of life and resilience of four families with an adult family member with ID. Although families reported different transition types, they progressed through similar transition stages. They invested in quality of life and self-determination as a foundation, considered future support needs, pre-planned and actively planned transitions, implemented transitions, adjusted to new roles and routines, and reflected upon their growth. Although all families experienced challenges during their transitions, two families entered a state of crisis when they did not receive mental health and residential supports. Findings highlight that transitions are lifelong processes in the family system, and risk and protective factors at multiple system levels affect resilience and self-determination. The quantitative study, presented in Manuscript 3, considers that the family system functions within broader socioecological environments that include formal services for adults with ID. Community participation supports provide opportunities to develop self-determination in recreational, educational, and vocational activities. In a cohort of families requesting community participation supports, the vast majority of parents endorsed the expectation that this service would improve choice-making outcomes for their adult child with ID. Preliminary results suggest that the gender and prior choice-making experience of the adult with ID may be associated with the odds of parents endorsing this expectation. The General Discussion integrates the primary findings from each manuscript within a conceptual framework informed by self-determination theory, family systems theory, and family resilience models. This dissertation has theoretical implications for the way the self-determination construct is understood and applied in research with families with a family member with ID. Further, this dissertation reveals practical implications for supporting families with a family member with ID during important life transitions.

Study 1 - Individual - The purpose was to determine whether a 12-week behavioural risk reduction intervention caused self-reported MVPA to increase and to identify associated Theory of Planned Behaviour (TPB) constructs. Three hundred twenty-four physically inactive (<150 minutes/week moderate-vigorous PA) participants were included. Intervention participants were significantly more likely to meet PA guidelines at 12-weeks (OR=3.54, 95% CI 2.22-5.63, p<.001), which was significantly correlated with increases in TPB constructs. // Study 2 - Family - Semi-structured interviews were conducted with 36 participants to elicit perceptions of factors that influence PA. Interviews were audiotaped, transcribed, coded and analyzed. Spouses were more likely to engage in PA with their spouse after the CHD event; however this may be limited by their partners’ capabilities. The data suggests awareness of an increased susceptibility to CHD is not stimulating participants to increase their own PA to prevent future risk, particularly among offspring, but they may take other actions. The shared family environment can promote PA, although intensity may be limited. // Study 3 - Neighbourhood - Self-reported PA from a prospective behavioural risk reduction intervention was explored in the context of objectively measured Walk Scores and neighbourhood walkability in Ottawa, Canada. Participants in the intervention arm had significantly higher odds of meeting PA guidelines at 12-weeks compared to the standard care control group. This was not influenced by Walk Scores or walkability. This individual-level intervention was effective in assisting participants to overcome potential structural barriers presented by their neighbourhood to meet PA guidelines at 12-weeks.

Text in English / Two consecutive referrals of early onset (symptom onset at 11 years) anorexia nervosa (restricting sub-type) to an inpatient eating disorders unit in a psychiatric hospital, will be described. Within both cases, there was a history of sequential mother-daughter dieting prior to the daughter's onset of anorexic symptoms. This pattern will be viewed from the perspective of systemic theory, with reference to the cybernetic processes implicated in the onset and maintenance of symptoms. Structural systemic interpretations, in terms of exchangeable senses of self within the mother-daughter pairs, will also be considered. A brief comment will be made about the symmetry which underlies the choreography of anorexia nervosa when viewed from the perspective of communication theory. The implications for intervention will be addressed. In conclusion, the nature of the intergenerational transmission of disordered eating behaviours, will be considered with reference to the nature-nurture debate. / Clinical Psychology / M.A. (Clinical Psychology)

Magister Artium - MA / Adolescent substance abuse is a widely researched area both internationally and nationally. It has been known to affect many problems which are prevalent in most low socioeconomic communities such as crime, school truancy and family fragmentation. It is of particular concern in low socioeconomic communities within the Cape Flats District which continues to be plagued with social ills such as gangsterism, adolescent criminal behaviour, and high rates of school dropout. The problem of adolescent substance abuse cannot be explored in isolation, but rather, in conjunction with all other spheres which it affects such as family relationships, dynamics and functioning. Parents fulfil an important role in managing their adolescent's addiction problem. These parents often feel helpless, hopeless, guilty, and angry, and are inclined to blame themselves for their child's delinquent behaviour. In some cases spouses blame one another for their being too permissive or too stern. However, there is a dearth in research of parents' lived experiences and the ways in which they attribute meaning to their situations. The aim of this study was to explore parents' lived experiences of their adolescent's substance abuse. More specifically the study explored parents' perceptions of the ways in which one family member's substance abuse affects the dynamics and the functioning of the family. At a theoretical level, this study aligned with Bowen's Family Systems theory, as it allowed the researcher to explore the ways in which family roles, dynamics and functioning are affected by a relative's substance addiction. The current study was conducted within the qualitative methodological framework, as the aim was to gain an in-depth understanding of parent's lived experiences of managing their adolescent's substance abuse. Furthermore, this study was positioned within the phenomenological epistemological framework as it aligns well with the aims of this study, which is to acquire an understanding of parents' lived experiences of their adolescent's substance abuse.

Cette recherche ancrée principalement sur une approche systémique, propose d’évaluer l’impact de la déficience intellectuelle d’un enfant sur son environnement familial et en particulier sur ses frères et sœurs. Le handicap d’un enfant ne touche pas uniquement celui qui en est atteint, mais constitue une information signifiante pour le système familial qui va modifier ses interactions en fonction d’elle. Nous nous intéressons, dans cette étude, au vécu subjectif des frères et sœurs, âgés entre 6 et 12 ans, d’enfants porteurs de déficience intellectuelle. Nous avons réalisé une étude comparative entre un groupe expérimental composé de 27 familles et 34 frères et sœurs confrontés à la déficience intellectuelle et un groupe témoin composé de 19 familles et de 24 frères et sœurs sur la nature de la relation fraternelle (proximité, conflits, rivalité), la fonctionnalité de la typologie familiale (« équilibrée », « moyennement équilibrée » ou « extrême »), le sentiment d’intégration sociale (en famille, dans les collectivités et parmi les pairs) et le degré de dépression. La variable indépendante est la présence ou non d’un enfant porteur d’une déficience intellectuelle dans la famille. Nous souhaitons ainsi montrer l’impact de la présence d’un enfant porteur d’une déficience intellectuelle dans la famille. Nous avons également procédé à une étude corrélationnelle entre les variables retenues (nature de la relation fraternelle, fonctionnalité de la typologie familiale, sentiment d’intégration sociale et degré de dépression) afin d’identifier les facteurs de risques et de protection pour ces fratries. Les résultats obtenus indiquent que peu de différences existent entre ces familles sur les variables retenues. Seules deux modalités de la relation fraternelle sont significativement différentes entre les deux groupes. Les frères et sœurs d’enfants atteints de déficience intellectuelle évaluent leurs relations comme moins proches et également moins conflictuelles avec l’enfant déficient intellectuel .D’autre part, l’étude corrélationnelle montre que la typologie familiale et la proximité fraternelle ne sont corrélées à aucune autre variable. Le sentiment d’intégration sociale dans les trois domaines de la collectivité, de la famille et des pairs est, quant à lui, corrélé négativement, pour les deux groupes, à la rivalité dans la relation fraternelle ainsi qu’au degré de dépression. Une corrélation positive significative est établie uniquement pour le groupe témoin entre le degré de dépression et les conflits dans la fratrie. Ainsi, l’étude comparative permet de montrer que les fratries et les familles confrontées à la déficience intellectuelle ne sont pas différentes des autres sauf sur la nature de la relation fraternelle. D’autre part, le modèle explicatif établi par l’étude corrélationnelle permet d’identifier l’importance de la rivalité fraternelle et du sentiment d’intégration sociale pour le bien-être des frères et sœurs. Enfin, ces constats permettent de contribuer à une réflexion sur les applications cliniques de cette recherche. / The present study, predominantly using a family systems approach, aimed to estimate the impact of a child's intellectual disability on the family environment, and specifically on brothers and sisters. A child's disability does not simply affect himself, but is also a significant factor for the family system, where interactions will be altered in response to this information.This study explored the subjective experience of brothers and sisters, aged between 6 and 12 years old, of intellectually disabled children.A comparative study was conducted of an experimental group made up of 27 families and 34 brothers and sisters faced with the intellectual disability of a sibling, and a control group made up of 19 families and 24 brothers and sisters, on the kind of sibling relationships (closeness, conflict, rivalry), typology of family functioning, (« balanced », « moderate » or « extreme »), feeling of social integration (in the family, in the community and within peer groups) and degree of depression. The independant variable was the presence or absence of an intellectually disabled child in the family. This study, therefore, sought to illustrate the impact of having a intellectually disabled child in the family. A correlational study was conjointly carried out on the different variables (kind of sibling relationships, typology of family functioning, feeling of social integration, degree of depression) in order to pinpoint risk and protection factors for siblings. Results indicated little difference between the families on these variables. Only two kinds of sibling relationships were significantly different in the two groups. Brothers and sisters of intellectually disabled children evaluated their relationships as being less close and also less conflictual with their intellectually disabled sibling. Furthermore, the correlational study also showed that family typology and sibling closeness were not correlated with any other variable. As for children's feeling of social integration for the three areas of community, family and peers, this was found to be negatively correlated for both groups with rivalry in sibling relationships as well as with the degree of depression. A significant positive correlation was established only for the control group, between the degree of depression and sibling conflicts. Thus, the comparative study illustrates that siblings and families faced with the intellectual disability of a child are no different from others except for the kind of sibling relationships. Furthermore the explicative model established by the correlational study illustrates the importance of sibling rivalry and of the feeling of social integration for the psychological well-being of brothers and sisters. These findings help to generate further discussion of the clinical applications of this research.

Pistorius (1996) was the first individual to introduce research on serial murder in the South African context with her psychodynamic approach to the phenomenon. Since then, others have followed, namely Labuschagne (1998, 2001) with his search for interactional and communication connections; Du Plessis (1998) from a grounded theory approach; and Hodgskiss (2001) with his assessment of South African offender characteristics and behaviours. Four more studies have been conducted, namely Hook’s post-structural deconstruction of narratives of a person who committed serial murder (2003); De Wet’s psychosocial perspective (2005); Barkhuizen’s intrapsychic object relations approach (2006); and Del Fabbro’s exploration of the phenomenon from a family systems paradigm (2006). To date, no attempt has been made to review these research endeavors. In this article, these studies are reviewed and their strengths and weaknesses with regard to theory, methodology and research findings debated. The author concludes with several recommendations for future research on the phenomenon of serial murder: greater communication between various disciplines (e.g. psychology, criminology, law) investigating serial murder; expansion of Hodgskiss’ research (2001) on offence characteristics for profiling purposes; and the relationship between psychopathology and serial murder. / Dissertation (MA (Clinical Psychology))--University of Pretoria, 2007. / Psychology / MA / unrestricted

Study 1 - Individual - The purpose was to determine whether a 12-week behavioural risk reduction intervention caused self-reported MVPA to increase and to identify associated Theory of Planned Behaviour (TPB) constructs. Three hundred twenty-four physically inactive (<150 minutes/week moderate-vigorous PA) participants were included. Intervention participants were significantly more likely to meet PA guidelines at 12-weeks (OR=3.54, 95% CI 2.22-5.63, p<.001), which was significantly correlated with increases in TPB constructs. // Study 2 - Family - Semi-structured interviews were conducted with 36 participants to elicit perceptions of factors that influence PA. Interviews were audiotaped, transcribed, coded and analyzed. Spouses were more likely to engage in PA with their spouse after the CHD event; however this may be limited by their partners’ capabilities. The data suggests awareness of an increased susceptibility to CHD is not stimulating participants to increase their own PA to prevent future risk, particularly among offspring, but they may take other actions. The shared family environment can promote PA, although intensity may be limited. // Study 3 - Neighbourhood - Self-reported PA from a prospective behavioural risk reduction intervention was explored in the context of objectively measured Walk Scores and neighbourhood walkability in Ottawa, Canada. Participants in the intervention arm had significantly higher odds of meeting PA guidelines at 12-weeks compared to the standard care control group. This was not influenced by Walk Scores or walkability. This individual-level intervention was effective in assisting participants to overcome potential structural barriers presented by their neighbourhood to meet PA guidelines at 12-weeks.

<div> <div> <div> <p>The current study examines the relationships between frequency of yoga practice and outcomes of self-compassion, couple satisfaction, and family functioning. Yoga and other forms of Eastern medicine have become increasingly popular in Western culture. Not only has yoga become more appealing to the general population, it has also become more widely accepted and has been more frequently integrated into various mental health treatments. Using a cross-sectional design, this study analyzed data from an online questionnaire regarding systemic outcomes of yoga participants (N = 115). A three-step hierarchical regression analysis was completed to test significance between predictor and outcome variables. The results showed a significant relationship between social reason for practicing yoga and family functioning. This study indicates that families who practice yoga together may have healthier family functioning. The results highlight the potential of yoga as a therapeutic intervention for clinicians working with families.<br> </p> </div> </div> </div>