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No description available.

This qualitative study investigates patients' awareness of the relational work done by nurses. Relational work, a component of many women's jobs, is the work involved in dealing with, and managing, feelings and emotions. It is said to be invisible because it is unnoticed, undervalued, or taken for granted. Patients expect relational care but few classify it as work. They value it personally but do not see how it contributes to medical or technical work in the hospital. Patients attribute the skill involved in doing this work to personality, link the motivation for doing it to altruism, and overlook the constraints which determine how nurses provide emotional care. This research provides a comparison to studies which examine relational work done by women in other roles and raises questions about how work is defined.

These studies investigated relationships between the working alliance, client good moments, therapist verbal response modes, and client experiencing. Correlations between increased levels of the working alliance and increased occurrence of good moments were only between the bond aspect of the alliance and good moments of provision of significant information. The best fitting models of the working alliance, therapist verbal response modes, and client good moments indicated that a 3-way interaction was a good fit in the provision of significant information modality. Two-way interactions between the working alliance and therapist response modes revealed that low structure response modes, Particularly reflection/restatement occurred more frequently than expected at moderate alliance levels, and high structure interventions, particularly direct guidance/advice, occurred more frequently than expected at low and high affiance levels. It was suggested that the context of collaboration and liking (high alliance), and the context of struggle (low alliance), may be having an influence that prompts therapists to structure their interventions. The interactions between the working alliance and good moments in the exploratory and affective/expressive modalities showed that the high proportions of good moments occurred in the high and low working alliance sessions. The lowest proportions of good moments occurred in the moderate alliance sessions suggesting that different processes may be in operation at different alliance levels. The best fitting models of interactions of client experiencing, therapist verbal response modes, and client good moments in indicated that 2-way interactions best explained the data. In general, as experiencing levels rose, there were increases in the frequency of occurrence of client good moment. The interactions between therapist verbal response modes and experiencing indicated that specific levels of experiencing seem to be associated with specific c

Providing chronically ill patients with informational support is crucial for successful disease management. The effectiveness of educational interventions was examined utilizing three questionnaires which assessed glaucoma patients' health beliefs, disease knowledge and medication compliance. 60 chronic open-angle glaucoma patients either: watched a glaucoma film, read glaucoma information pamphlets, received instruction verbally from their ophthalmologist or proceeded with their regular check-up. Measures were taken pre-intervention, then 2 and 30 days later. A 3 x 4 mixed ANOVA found a significant interaction between time and intervention in the film group. The relationship between the degree of patient's visual field loss and measures on compliance, health beliefs, and knowledge was also assessed. The positive correlations indicate that patients with modest visual field losses are also those with the highest scores on the three dependent measures. Patients, who have less visual field loss, may possess the behavioral, affective and cognitive components required to successfully manage their illness regimens.

This qualitative, quasi-phenomenological study presents strategies and methods hospital-based mental health social workers utilize to promote social justice and advocate for their clients. Three frontline mental health social workers and one mental health department head were interviewed. The findings of this research demonstrated that the participating social workers utilized a variety of creative and flexible approaches to promote social justice and successfully advocate for their clients. These approaches included: the use of appropriate language, using the system against itself, developing written standards and regulations for their tasks, and forming a network of allies.

Bowlby's notion that client secure attachment to the therapist leads to deeper client exploration, is considered an important corner stone of the therapeutic process. Psychotherapy researchers have neglected the study of therapist contributions and observer perspectives when studying this important therapeutic phenomenon. Studies of therapeutic secure base have shown that there is a relationship between client general attachment patterns and those with therapist, as well as that this secure attachment to therapist relates to deeper sessions. The main objectives of the present research was to extend the study of secure base in therapy to include consideration of therapist attachment processes and to improve the methodology used in attachment research by adding the expert observer perspective to operationalize session exploration. The first study explored the secure base hypothesis, the transference hypothesis and the role of therapist attachment in the process. Sixty-seven clients and therapists in-training, in short term therapy, completed the Experiences in Close Relationship Scale (ECRS), the Client Attachment to Therapist Scale (CATS), Working Alliance Inventory (WAI), and a measure of session depth; the Session Evaluation Questionnaire-Depth subscale. In line with Bowlby's (1988) secure base hypothesis, secure attachment to therapist was significantly associated with session depth. Therapist insecure adult attachment was negatively associated with client secure attachment to therapist. / The second study addressed methodological limitations found in previous studies by using both client and expert observer perspectives in the operationalization of session exploration. Thirty-one clients assessed depth in the middle sessions of their short-term therapies and rated their attachment to their therapists. Raters assessed experiencing in the same sessions using the Experiencing Scale. Secure attachment to therapist was positively and significantly associated with experiencing levels. However, the two perspectives on session exploration did not converge, suggesting that each taps a distinct aspect of session exploration and underlining the importance of rater perspective in the operationalization of this construct. Taken together, the results of these two studies offer a strong support for the secure base hypothesis. Clinical and research implications are discussed.

This project aimed to explore the nature of psychological distress experienced by patients at the initial medical consultation prior to bone marrow transplant (BMT). BMT patients (n=20) completed standardized measures of physical and emotional distress related to their illness, the impact the illness was having on their life, anxiety and depression. Patient satisfaction with the doctor was assessed, as were doctor impressions of patient distress and behaviour during the consult. Results indicated that patient distress was best represented by the physical and emotional impact it was having on the patient's life. Overall, doctors had difficulty accurately assessing distress levels in their patients. Interpretation of multiple regression analysis revealed that doctor perception of patient behaviour was predicted more highly by patient distress levels than patient satisfaction. Due to the continual restrictions in doctors accurately assessing distress during medical consultations this research suggests that further studies are needed, in particular regarding the use of direct questioning or brief screening measures to assist doctors with the identification of distress. / Thesis (MPsychology)--University of South Australia, 2006.