A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Objective: To compare findings of emergency echocardiography (rescue echo) in the intra‐ operative period to findings of rescue echo in the ICU setting. Design: We queried a database of perioperative echo for all rescue echo studies done over a two year period. We compared the frequency of left ventricular (LV) and right ventricular (RV) systolic dysfunction, LV diastolic dysfunction, LV segmental wall motion abnormalities, and hypovolemia of the intraoperative and ICU studies. Results: LV and RV systolic dysfunction were more prevalent in ICU rescue echo studies compared to intra‐op rescue studies (22% vs. 10%, and 34% vs. 13%, respectively, p<0.05 for each). LV diastolic dysfunction was more prevalent in ICU rescue echo studies compared to intra‐op rescue studies (60% vs. 48%, p<0.05). Segmental wall motion abnormalities (SWMA) were more prevalent in the ICU compared to intra‐op setting (38% vs. 19%, p<0.05). Conclusion: In an observational study of real‐world rescue echo, the incidence of LV and RV systolic dysfunction, LV diastolic dysfunction, and LV SWMA were all more common in the ICU compared to the intra‐op studies. This could reflect the differences in patient population, differences in reasons clinicians perform rescue echo in the OR and in the ICU, or the hemodynamic effects of anesthesia.

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This study explores perspectives of feminist therapists on working with adolescent girls. The participants in this study were three feminist therapists, two of whom were pursuing doctoral studies in counseling psychology and one of whom was an experienced therapist, trained in social work. The research data were collected through in-depth, semi-structured interviews, as well as through questionnaires. Triangulation of the data (Creswell & Plano Clark, 2007) and interview coding formed the basis of the analysis. The results indicated that participants held well-defined ideas as to the meaning which they gave to feminist therapy and the methods which they used to implement it, in the form of principles, objectives, techniques, and characteristics of the therapeutic relationship, both with adolescents and with adults. In addition, participants revealed their thoughts regarding the appropriateness and relevance of feminist therapy for working with adolescent girls. Furthermore, several challenges to practicing feminist therapy were discussed.

The research examined the relationship between counsellor awareness of client-identified helpful events and session and event level outcome. Furthermore, counselling participants' experiences of the change processes in high and low counsellor awareness were also examined. Quantitative and qualitative methods were used to analyze ratings and word responses of clients' and counsellors' perspectives about how therapeutic change came about in helpful therapy events. Results of the quantitative study indicated no association between counsellor awareness and session and event level outcome. Results of the qualitative study indicated that in helpful events that therapists were most aware of, clients described the process as particularly more helpful than events where therapists were least aware. Descriptions from the high awareness events indicated that therapists tended to be most aware of client selected helpful events characterized by an interpersonal therapeutic focus, with clients expressing and exploring negative feelings toward significant others. Descriptions from the low awareness events indicated that therapists were least aware of client selected helpful events where clients were working toward identifying their feelings and understanding unwanted aspects of themselves.

Across a number of theoretical orientations, the manifestation and working through of clients' central relationship patterns is considered to be an important aspect of psychotherapy process. The Core Conflictual Relationship Theme (CCRT) method was developed as an operationalization of transference, or the transfer of an individual's core relational schemas across relationships. Studies of therapeutic transference using pathological client samples have shown that there is some overlap between clients' relationship patterns with others and those that emerge with the therapist. The main objectives of the present research was to extend the study of therapeutic transference to therapies with high-functioning clients and to improve the methodology used in transference research by exploring an alternate method of collecting client narratives about their relationship with the therapist. / The first study explored the manifestation of transference with high-functioning clients in early sessions. Factor analyses of Wish (W), Response of Other (RO) and Response of Self (RS) components of the CCRT were conducted to examine the relationship between client relational themes with significant others and client relational themes with the therapist. Findings within the Wish (W) and Response of Other (RO) components indicated a complementary pattern of relating in which the therapist was idealized and others were devalued, and findings within the RS component indicated a concordant relational transfer, in which clients had a negative response to both the therapist and others. Additionally, control issues emerged in the W component for significant others and in the RS component for the therapist. / The second study addressed methodological limitations found in previous studies by drawing therapist narratives from a Participant Critical Event (PCE) interview rather than from psychotherapy sessions. In the PCE interview, client narratives about the therapist are not constrained by the presence of the therapist, resulting in a greater availability of potentially more candid descriptions of the therapeutic relationship. Factor analyses for the W and RO components indicated a complementary pattern of relating, in which the therapist was devalued and others were idealized, and findings for the RS component indicate a concordant relational transfer, in which clients felt bad with both the therapist and others. Additionally, the factor structure of the W and RO components suggests that as clients experience control issues with significant others, they wish to adopt a submissive stance toward the therapist. / Although both studies yielded a similar overall pattern of complementary and concordant transference, there was an inversion in the valence of the complementary transference; in the first study, therapists were idealized and significant others were devalued while in the second study, therapists were devalued and others were idealized. Since the source of therapist narratives was the single greatest methodological difference between the two studies, the inversion in the findings could reasonably be attributed to the source of therapist narratives. Taken together, the results of these two studies suggest that the source of relational narratives is an important consideration in the study of relationship patterns. Clinical and research implications are discussed.

The present study implemented an experimental design to investigate the impact of psychotherapists' transient affective states (mood) on the formulation of client problem and on treatment recommendations. Moderating influence of personality traits and situational factors was also explored. / Thirty-two counseling interns participated in a between-subject experiment which compared the impact of 20 minutes of positive or negative mood inductions (achieved by exposure to a humorous or a conflictive film segment) upon their assessment of stimulus material consisting of a 20-minute segment of an initial counseling interview. Three measures were obtained prior to mood induction: (a) background information consisting of demographic data, theoretical orientation, and clinical experience, (b) the Life Events Report (LER) measuring level of satisfaction in various life areas and self-reported actual mood, and (c) the Eysenck Personality Inventory (EPI) to define levels of Extraversion and Neuroticism. Immediately following mood induction a double mood check was obtained through rating of the film just watched, and the Profile of Mood States (POMS). Finally, the Client Assessment Form (CAF) was administered immediately after exposure to the stimulus material in order to obtain an assessment of the client and ensuing treatment recommendations. / Although a series of univariate analyses of variance failed to reveal between-group differences, multivariate statistical tests showed significant differences relative to client assessment. Results indicated that mood and current life events accounted for a substantial percentage of the variance for the assessment variables considered. Findings suggest that negative mood (distressed) clinicians assess global severity in less serious terms than positive mood (nondistressed) clinicians. Clinicians reporting current negative life events (stressed clinicians) assess client problems in less serious terms than clinicians reporting current positive life events (nonstressed clinicians). Additionally, a post-hoc exploratory series of two-way univariate analyses of variance showed unexpected biasing effects of mood on the assessment produced by psychodynamicists relative to their humanist counterparts. Findings of this study support the main hypotheses in that they show significant differences in assessment ability attributable to clinicians' mood and current life events. In addition, post-hoc data analyses suggest that clinicians with certain theoretical approaches may be more sensitive to the biasing effects of mood than others.

This research study aimed at determining the relationships between nurse staffing and nurse sensitive outcomes (urinary tract infection, pressure ulcers, pneumonia, missed dose, wrong dose, and wrong drug) in the University Central Teaching Hospital of Kigali. A retrospective, descriptive design guided the study. A purposive sampling method was used to select the unit of study. Patient files were selected (n =797) and reviewed from the medical and surgical wards in February and March 2006. A checklist format was used to collect the data. The first instrument for data collection on staffing included the shifts, the categories of nurses, the total number of nurses and the patient census. The second instrument on adverse events included all events under study. Data collection was done by the researcher. A quantitative method was used to analyze data. The results indicated a statistically significant relationship between pressure ulcers, pneumonia, and phlebitis and number of registered nurses. Risk of wound infection was statistically significant between both increased numbers of enrolled nurse and registered nurses as well as nurse: patient ratio. The findings also revealed a statistically significant protective relationship between pneumonia, missed dose, and phlebitis with increased nurse: patient ratio. The findings of this study revealed no statistically significant relationship were found between urinary tract infection, pneumonia, phlebitis, and missed medication dose and the mean number of enrolled nurses. There was no statistically significant relationship between urinary tract infection and missed medication dose and the mean number of registered nurses. The result of this study suggests that there is an impact of nursing workload and expertise on patient outcomes. / Thesis (M.A.)-University of KwaZulu-Natal, 2006.

Sexualitet är ett komplext och mångdimensionellt område som inte är alldeles lätt att bemöta. Det är många sjukdomar, funktionsnedsättningar och läkemedelsbehandlingar som påverkar patienters sexualitet. En av sjuksköterskans uppgift i omvårdnad är att ge information och rådgivning. Syftet med litteraturstudien var att beskriva faktorer som kan hämma sjuksköterskan att samtala med patienter om sexualitet. Metoden som användes var en litteraturstudie som utgick från Polit och Beck (2012) nio-stegsmodell. Databaserna CINAHL och PubMed användes för att få fram de elva artiklarna som ingick i studien. De elva artiklarna kvalitetsgranskades och efter dataanalys och bearbetning framträdde tre kategorier. Resultatets kategorier var kunskapsbrist, föreställningar och vårdmiljö. Kategorierna beskriver faktorer som hämmar sjuksköterskor att samtala om sexualitet. Slutsats Sjuksköterskor behöver mer kunskap och utbildning i ämnet. Sjuksköterskor måste bearbeta sina egna attityder och förhållningsätt till sexualitet för att kunna bemöta patienter på ett professionellt sätt. Även vårdmiljön kan förbättras för att skapa bättre förutsättning till samtal om sexualitet.

This research examined the relationship between client emotional expression and the level of working alliance between therapist and client. The data were collected from 24 psychotherapy sessions conducted by exemplary psychotherapists of different theoretical orientations. The results of the quantitative analysis indicated that there was no significant linear relationship between the level of intensity of client emotional expression and the level of working alliance. Client emotional expression occurred independently of the level of the working alliance. Using a qualitative method, the study restricted its sample to 5 episodes each from the high and low working alliance sessions in order to examine therapeutic processes surrounding client emotional expression more closely. It was found that the nature of emotional expression and the interaction between therapist and client were quite different in episodes taken from the high and the low alliance sessions. In the high alliance sessions, clients expressed their troubling feelings as they examined their problems. Client emotional expressions were signs of productive therapeutic process. On the other hand, in the low alliance sessions, clients expressed anger and frustration toward their therapists for certain breaches of their relationship. Independently of the differing theoretical orientations, the therapeutic process appeared to converge particularly in the low alliance sessions, showing a similar pattern of therapist and client transactions. In addition to the findings, the study proposed a qualitative method suited for examining a wide variety of questions arising from clinical practice.

A balance testing methodology was developed, based on a posture control model which defines relative stability by the degree to which a transient postural perturbation would cause the centre-of-pressure on the feet to approach the limits of the base-of-support. To minimize anticipatory adaptations and to ensure subject safety, the balance test used a small-amplitude continuous random or pseudorandom perturbation. The data were used to identify an input-output model, which was then used to predict large-amplitude transient response. The test perturbation was an anterior-posterior acceleration of a platform on which the subject stood. Pilot experiments were performed to determine appropriate perturbation parameters. Testing of sixty-four normal subjects demonstrated highly significant ageing-related decreases in predicted stability. No significant sex-related differences were found. Predicted stability increased when the subjects were blindfolded. In using the balance test to identify balance-impaired individuals, the blindfolded results and the eyes-open/blindfolded ratio provided higher success rates than the eyes-open results. Depending on the modelling method used, the balance test was able to identify up to three of five vestibular patients and five of five elderly fallers, at a false positive rate of 25% in the normal subjects. Correlations between the balance test results and measures of spontaneous postural sway were weak, except in the normal young adult subjects. Comparison with transient tests showed the balance test to yield reasonably accurate predictions of small-amplitude transient response, but to overestimate the large-amplitude response; however, the transient test results may have been confounded by adaptive effects. It was concluded that the balance test provides a sensitive functional measure of the changes in postural control that are known to occur in ageing. Although it shows promise as a tool for identifying balance impairments, larger numbers of balance-impaired subjects must be tested.