The Child Welfare System is faced with an increasing number of children in foster care with a decreasing number of foster homes available for placement. By interviewing adults who were former foster children, this study examines the significance of one caring adult in the life of a foster child. Erik Erikson states that in the first stage of psychosocial development a child learns trust vs. mistrust. For many children entering foster care, this first stage of development has not been achieved, given their experiences in their biological families. In order to protect themselves during this time of mistrust, children exhibit behaviors designed to keep adults at a distance. This poses a problem for foster parents who must try to develop trust with their foster children in an effort to change their behavior. What if anything can be done to help these children learn to trust? The participants were asked to focus on specific behaviors at least one caring adult demonstrated that helped them as foster children, move through their past experiences of mistrust to a place of trusting that caring adult. The concept of attachment theory provided a foundation for the study. / Master of Science

Indiana University-Purdue University Indianapolis (IUPUI) / Pregnant and postpartum women with substance use disorders (SUDs) are likely to experience adverse health care encounters that contribute to poor health outcomes for them and their infants. The purpose of this dissertation is to describe the health care encounters of pregnant and postpartum women with SUDs. This dissertation includes two studies. The first study is a metasynthesis of published qualitative studies using a metasummary approach to classify the types of health care encounters experienced by pregnant and postpartum women with SUDs. A taxonomy of health care encounters was developed. Five types of adverse encounters were identified and labeled as (a) judgmental, (b) disparaging, (c) scrutinizing, (d) disempowering, and (e) deficient care. Three types of beneficial encounters were identified and labeled as (a) recovery-based, (b) accepting, and (c) effective care. The second study was a qualitative descriptive study conducted to describe factors that influence the formation of trusting relationships between maternity nurses and pregnant and postpartum women with SUDs. Interviews with 15 maternity nurses and 10 pregnant and postpartum women with SUDs were conducted. Content analysis of the participant narratives revealed a number of characteristics of maternity nurses and pregnant and postpartum women with SUDs that helped or hindered trusting relationships. Six characteristics of maternity nurses were identified and labeled as (a) rapport-building with women, (b) demeanor toward women, (c) provision of care, (d) provision of information, (e) attitude toward substance use, and (f) addiction expertise. Five characteristics of the women were identified and labeled as (a) engagement with nurses, (b) demeanor toward nurses, (c) acceptance of care, (d) investment in recovery, and (e) bonding with infant. Adverse encounters were often associated with provider stigma related to substance use during pregnancy and limited provider knowledge related to addiction. The findings will contribute to the development of strategies to improve the health care encounters of this population by promoting stigma awareness and communication skills training.

Background: It is a well-known phenomenon that nurses and other oncology staff have a tendency to ascribe patients with cancer more problems and suffering than the patients themselves report. Aim: The overall aim of the present thesis was therefore to gain increased knowledge and understanding of dis/agreement between patients with cancer and nurses regarding their perception of patients’ situation and of the importance of patient-nurse dis/agreement in clinical practice. Methods: A prospective comparative design was used. Data were collected from a sample of 90 consecutively recruited patient-nurse pairs. Each pair consisted of a patient with cancer, newly admitted to a ward, and a nurse responsible for that patient’s care. Data were collected from the pairs with corresponding self-administrated questionnaires on two occasions: directly after the admission interview and on the patient’s third day on the ward. Results: At the group level, a distinct pattern was shown in which nurses ascribed the patients more emotional distress, less coping resources and a lower quality of life than the patients themselves reported. In short, the results revealed the following clinical importance of patient-nurse dis/agreement. With respect to how nurses act in relation to their perceptions of patients’ emotional distress, patient-nurse dis/agreement did not seem to be important; with few exceptions, nurses’ implemented care did not differ when it was directed at more as compared to less distressed patients. Further, nurses’ general tendency to overestimate cancer patients’ problems and suffering had no influence on patients’ satisfaction with received care and nurses’ satisfaction with provided care. However, patients cared for by nurses who underestimated their level of depression were less satisfied with those nurses’ care. In addition, the more frequently the nurse had implemented care characterized by a trusting relationship, the higher patients’ and nurses’ satisfaction with received/provided care. Conclusions: Initial patient-nurse dis/agreement concerning patients’ situation appears to be of little significance to nurses’ caring behaviour and to patients’ and nurses’ subsequent evaluation of received and provided care.