Thesis (M.S.)--University of Michigan, 1982.

Thesis (M.S.)--University of Michigan, 1978.

Thesis (Ph. D.)--University of Texas at Austin, 2005. / Vita. Includes bibliographical references.

Thesis (Ph.D.)--Duquesne University, 2006. / Title from document title page. Abstract included in electronic submission form. Includes bibliographical references (p.156-185) and index.

The purpose of this descriptive exploratory study was to describe specific self-care behaviours related to the provision of eye care and performance of daily living activities, of postsurgical cataract patients during their first few weeks at home following cataract extraction. The twenty subjects who comprised the study sample were all over sixty years of age, were English speaking, had a best corrected visual acuity in the unoperated eye of 20/50 or less, and had undergone uncomplicated unilateral standard cataract surgery without lens implant. Subjects were interviewed in their homes on two occasions. Difficulties that were experienced and concerns that were expressed by subjects and family members in the performance of eye care procedures, and management of daily living routines were recorded; and factors which influenced the ability of subjects to manage their care at home were identified. Observations were made of the instillation of eyedrops, the application of a protective eye shield, and the status of the operated eye. The findings suggest a high degree of adherence to the prescribed medication regime, and to the precautionary measures that were to be followed. Difficulties were reported or observed in several areas such as administering eyedrops, applying the eye shield, reading instructions, opening eyedrop containers, and obtaining prescriptions or supplies. The majority of concerns expressed were related to the performance of eye care procedures, and to the prospective visual outcome of the surgery. Examples of factors identified as affecting home self-care were: the availability of direct assistance and emotional support from family and community resources; the understanding of the surgical procedure and recovery process; the knowledge, and the timing of the receipt of knowledge, of expected behaviours; and the possession of adequate manual skills to perform the eye care procedures with competence and confidence. Implications for nursing, medical, and pharmacist's practice are discussed, and areas for further research are identified. / Applied Science, Faculty of / Nursing, School of / Graduate

This study involves the investigation of the basis and validity of considering health information as therapeutic, the definition of Information Therapy, and whether the therapeutic nature of information can be measured empirically. The purpose of the study is to determine if there are any significant differences in the therapeutic effect of Information Therapy through the different delivery modes of support groups communicating face-to-face and those utilizing computer-mediated communication on the Internet. The comparison of these groups revealed no significant differences on three measures of health: physical, mental, and social support. Because one communication medium is not found to be advantageous over the other, the use of the computer can extend the benefits of Information Therapy to the home-bound, to those in remote areas, to people with time restraints, and those who may be shy. The validity of the therapeutic nature of information was verified by participant report of the effect of a health information search. Results demonstrated that the primary source for information is the physician, followed by the Internet, and 77% of participants reported a positive or therapeutic effect when health information was found. These results are significant because individuals who are in positions to deliver Information Therapy can better meet needs by identification of the sources to which people look for information and can have a major impact on patient care and the general health of the population. Providing people with information can empower them to take an active role in their health, can increase confidence in self-care, and should provide coping and disease management skills thus decreasing the utilization of healthcare resources and preventing costly acute and chronic health complications.

As of 2021, nearly 538 million adults and children live with diabetes mellitus worldwide, with projections for 2045 estimated at 645 million adults globally. In the United States, there are 34 million adults with diabetes and an additional 88 million with prediabetes. The economic costs are staggering, primarily due to management of acute or chronic complications. As a chronic condition requiring daily self-care, the psychosocial burden of diabetes is significant. Therefore, diabetes self-management education is recommended as a standard of care for all people with diabetes. The Association of Diabetes Care and Education Specialists (ADCES) has created a framework of education incorporating seven self-care behaviors, each with several knowledge, skill, and barrier resolution outcome measures. However, research has suggested that diabetes self-management and support services are not utilized sufficiently. YouTube™ with a reach of over 2 billion users is a potential medium to reach more people with diabetes. At the present time, there is a paucity of research describing the source and content of the most widely viewed videos on diabetes selfcare. This study aimed to help fill that gap. Specific aims of the study included: (a) describe characteristics of widely viewed YouTube™ videos on Diabetes Self-Care concerning length, date posted, source, speaker(s), format, and number of views; (b) describe the content of the most widely viewed YouTube™ videos on diabetes self-management education and support, categorized by the ADCES7 Self-Care™ behaviors; and (c) examine the source of videos in relation to number of views. The researcher used a YouTube™ Application Programming Interface to retrieve video URLs along with meta data such as source, duration, date posted, and view counts. Data were sorted by URL and view count, duplicates removed, and screened for inclusion and exclusion criteria. The top 100 videos by view count were used as the sample in the study. A codebook developed for this study categorized the upload source, speaker, format, and seven content categories. Descriptive analyses were conducted to understand the most viewed sources and the content categories likely and not likely to be mentioned. Collectively, these 100 videos were viewed 146,405,133 times, with an average duration of 12.2 minutes. Most of the videos (N = 77) were uploaded between 2017 and 2021. Results indicated that the two most popular sources for videos were Professionals and Corporations together uploading 72 videos and garnering 77% of cumulative views. In contrast, government agencies uploaded 1 video (<1% of cumulative views). Professionals was the most common protagonist (N = 42) when a speaker could be identified. Talk by professional received 34.09% of cumulative views, almost as much as Animation with voice (35.95%). The content areas most mentioned were Background on Diabetes, focusing on factors affecting blood sugar and ADCES7 Self-Care BehaviorsTM, especially Healthy Eating. Reversal of Diabetes was broached in 18 videos with 23.13% of cumulative views. Prevention Strategies for Communities was not mentioned at all, and Prevention Strategies for Individuals garnered less than 4% of cumulative views. YouTube™ is a popular source of online information for people with diabetes. As such, it presents an excellent avenue to raise awareness of prediabetes and dissemination of diabetes self-management education. Significant opportunity exists for government and advocacy agencies to increase their presence on YouTube™ in terms of viewership, while presenting meaningful and credible information. Recommendations for population and public health initiatives as well as future research and practice were presented to utilize the power of YouTube™ as a medium to expand the reach of diabetes self-management education and support.

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This thesis describes a three year study which explored perceptions and experiences of being involved in self care and perceptions of control and self-efficacy over time amongst patients receiving a six month course of chemotherapy treatment for colorectal cancer. The study was underpinned by Leventhal’s Self Regulation Model and aimed to explore how patients undergoing chemotherapy for colorectal cancer perceived the meaning of self care, what they did as part of their self care in managing the effects of their treatment and whether this changed between the beginning and end of their six month course of chemotherapy. The study also set out to explore the relationship between patients’ perceptions of control and self efficacy and their involvement in self care. The study adopted a patient focussed, mixed method, longitudinal approach for complementarity and expansion purposes in which the qualitative findings formed the focus of the investigation, supplemented by the quantitative findings. This was important to provide a greater breadth and range to the study and to obtain a realistic understanding of patients’ perceptions and experiences of being involved in self care during their six month course of chemotherapy treatment and the influence of their perceptions of control and self efficacy on their involvement in self care. Thirty one patients participated in the study and data were collected using qualitative semi structured interviews (with a subsample of patients who participated in the study) and quantitative questionnaires (Illness Perception Questionnaire-revised and the Strategies Used by People to Promote Health) and prospective self care diaries with the full study sample. Data were collected at several time points over the course of patients’ chemotherapy treatment (beginning, middle and end of treatment) and were analysed and integrated in accordance with Tashakkori and Teddlie (1998)’s guidance for integrating qualitative and quantitative findings in a mixed methods study. The study findings revealed that the use of a mixed method, longitudinal study design was a valuable approach for understanding patients’ involvement in self care during chemotherapy for colorectal cancer and the influence of factors, such as their perceptions of control, on their subsequent involvement in their self care. In particular, the principal findings suggested that self care held a range of meanings to the patients in this study. Principally, patients’ self care consisted of two components; physical self care, carried out to manage the physical impact of undergoing treatment, and emotional self care, carried out to manage their emotional response to being diagnosed with, and undergoing treatment for, cancer. The findings suggested that there was no association between patients’ perceptions of control and the degree of self care that they carried out identified in the quantitative analysis. However, in the qualitative analysis, it was revealed that patients’ perceptions of control were likely to influence their attitudes towards their active involvement in self care and the importance with which they viewed this role. In particular, patients who considered themselves to have a high degree of control during their treatment were more likely to believe that they could limit the impact of the treatment through their own actions, that being actively involved in their self care was important and were interested in taking on this role, and that they would use a greater range of self care strategies in helping to manage the impact of their treatment. Conversely patients who considered themselves to have a lower degree of control during their treatment were less likely to believe that they could limit the impact of the treatment through their own actions, that their active involvement in self care was important and were less likely to expect to take on an active role, preferring to leave the management of treatment-related effects to health professionals, whom they regarded as being the “experts”. The findings from this study have implications for nursing practice because they reinforce the importance of the listening to the patient’s experience and how this approach can contribute to a fuller and more accurate understanding of how patients become involved in their self care and the factors that influence this. This is important so that nurses can provide holistic care, tailored to meet their patients’ self care needs and preferences, and to encourage partnership working between patients, nurses, allied health professionals and other agencies in promoting involvement in self care. The findings also have implications for theories relating to self care in emphasising the importance of patient centred models of care and for Leventhal’s Self Regulation Model in adding further support for the components of the model yet also offering a greater understanding of how the model fits with patients’ emotional responses to the effects of illness and its’ treatments. Finally, the study findings have implications for future research, calling for further research to focus on the meaning of constructs such as self care and control from the patients’ perspective and to further explore the use of the mixed methodology in researching and understanding patients’ involvement in self care and the factors that influence this.

Studies have revealed that nursing students experience greater amounts of stress and anxiety than the average college student. Nursing students attribute increased stress levels to the twin demands of their classroom and clinical workloads. Higher stress levels frequently result in students reporting symptoms of poor health and lack of psychological well-being. It is important to note that some nursing students are also actively working in clinical settings and contending with the added stress of the recent COVID-19 pandemic. Mindfulness meditation is a natural measure that can help alleviate the feelings of perceived stress and anxiety and improve levels of mindfulness and self-compassion. An experimental two group pretest-posttest randomized controlled design was used to evaluate the effect of a virtual mindfulness meditation intervention on levels of perceived stress, anxiety, self-compassion, and mindfulness of nursing students. Study participants were randomly assigned to either an intervention or control group and received recordings prepared by the study authors. The intervention group received a 10-minute mindfulness meditation recording each week and the control group simultaneously received five 10-minute separate recordings on nursing news and information. Both groups were instructed to listen to the recordings at least three days per week for four weeks. The instruments used in this study were the Perceived Stress Scale (PSS), the Generalized Anxiety Disorder subscale (GAD-7), the Self-Compassion Scale (SCS), and the Mindfulness Attention Awareness Scale (MAAS). These surveys were provided at baseline and at a 4-week follow-up. The study presented in this dissertation is part of a larger study that was a collaboration between this author, Debra Heinrich, and Shohini Holden. Other instruments in the original study that are not discussed here are the Depression, Anxiety, and Stress Scale (DASS) and the Five Factor Mindfulness Questionnaire (FFMQ). This dissertation consists of three articles. The first article provides an analysis of the effect of a mindfulness meditation intervention on the stress and anxiety levels of nursing students. A two-way mixed ANOVA revealed a significant interaction between group assignment and timing of test on participants’ stress levels and on their anxiety levels. Follow-up simple main effects tests involving independent-samples t tests revealed that the intervention group, receiving the online mindfulness meditation recordings, experienced lower levels of stress and anxiety on the posttest surveys than the control group. The second article reports on a study of the effect of the intervention on mindfulness and self-compassion levels. The findings of a two-way mixed ANOVA and independent t tests demonstrated that mindfulness meditation can increase levels of mindfulness and self-compassion in nursing students. The third article compares two instruments used to self-report feelings of anxiety, reports on the demographic variables related to anxiety among nursing students, and explores the correlation between levels of mindfulness and levels of anxiety in this study. There were no significant relationships found between any demographic variable and anxiety scores. The GAD-7 instrument was found to be more sensitive to mild and moderate anxiety then the DASS instrument, and it is, therefore, the recommended instrument for use in nursing programs. There was a significant inverse relationship between levels of mindfulness and anxiety for students in this study. The findings of this study demonstrate that mindfulness meditation can reduce stress and anxiety, while increasing mindfulness and self-compassion levels in nursing students. This could be useful for nurse educators assisting students to manage the stress and anxiety often experienced in nursing education. Nursing programs could screen students to evaluate their levels of stress, anxiety, and mindfulness. Stress relief techniques, such as mindfulness meditation, could be incorporated into nursing programs as part of a wellness program or curricular offering. Mindfulness meditation could also be part of orientation programs in clinical sites for new nurses and offered to all nursing staff as part of continuing education. Further research, using rigorous scientific methods, will be needed to study the most effective methods to evaluate and manage stress and anxiety. This could ultimately decrease the stress and anxiety levels and improve well-being for student nurses and nurses, which could in turn positively impact patient care and outcomes.