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Dissertations / Theses on the topic 'Chronically mentally ill'
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1
West, Tousha Terrell. "An evaluation study of the homeless chronically mentally ill program." DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 1997. http://digitalcommons.auctr.edu/dissertations/573.
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This is an summative evaluation of the Homeless Chronically Mentally Ill program which examined the impact of case management and the outcome of the program on participant's substance abuse usage. Twenty-six participants' participated in the study. Participants were evaluated by two scales, the Client Satisfaction Questionnaire and the Reid-Gundlach Social Service Satisfaction Scale. Participants were sampled from those who were admitted into the HCMI program. The result of the study revealed that the majority (73.1) of those surveyed were satisfied overall with the program and 73.1 percent felt they could count on their social worker in times of trouble. This indicates that the HCMI program is meeting its goal to serve those veterans who are homeless and chronically mentally ill in order to help them reconnect into society.
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Pellack, David. "The chronically homeless mentally ill characteristics that predict program compliance /." [Bloomington, Ind.] : Indiana University, 2007. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3297096.
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Thesis (Ph.D.)--Indiana University, Dept. of Counseling Psychology, 2007.Title from dissertation home page (viewed Sept. 25, 2008). Source: Dissertation Abstracts International, Volume: 69-02, Section: A, page: 0519. Adviser: Michael L. Tracy.
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McIlroy, Charles R. "Aftercare for the chronically mentally ill utilizing church resources in the community /." Theological Research Exchange Network (TREN), 1985. http://www.tren.com.
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Newman, Andrea Ardele. "The healing nature of dwelling." Thesis, Montana State University, 2008. http://etd.lib.montana.edu/etd/2008/newman/NewmanA0508.pdf.
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My thesis will discuss the historical pattern of mistreatment and misunderstanding of the chronically mentally ill and the continued struggle the population faces. I believe that architecture holds some of the answers for these issues concerning the "ill" and that environmental factors do play a large part in the effective treatment of this population. It is my intention to design a facility where the chronically mentally ill can live and communicate freely without the stigma that has plagued them for so long. I will use the tools that social theory, philosophers such as Heidegger and the concepts of phenomenology have given me to explore the question: how can architecture help heal the chronically mentally ill.
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Thames, Robert Milton 1955. "The chronically mentally-ill served by the public fiduciary of Pima County, Arizona." Thesis, The University of Arizona, 1987. http://hdl.handle.net/10150/276536.
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This study was a survey of the chronically mentally ill cases served by the Public Fiduciary of Pima County, Arizona made to determine differences between and among these cases in numbers, finances, living arrangements, and the nature of their involvement with the Public Fiduciary according to age, sex, ethnic group, and mental disorder. Information was collected on 89 chronically mentally ill cases. Summaries and statistical analyses were made of the collected information. Schizophrenia in its various forms was found to be the dominant illness. Over half of the cases lived in unsupervised settings. Almost half of the cases received supplemental security income. Three-fourths of the cases received a total income of less than 350 dollars per month. The percentage of Hispanic people in the sample was higher than in the percentage of this group in the general population of Pima county. (Abstract shortened with permission of author.)
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Larivière, Nadine. "Adjustment to community residential settings among severely and chronically mentally ill older adults." Thesis, McGill University, 2001. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=31253.
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Little is known about the impact of deinstitutionalization on severely and chronically mentally ill older adults. The primary purpose of this study was to describe the adjustment process of 33 adults, aged 65 years and over, with severe and chronic psychiatric disorders, who were transferred from a psychiatric hospital to community housing facilities between 1995 and 1998. Data was collected at five periods in times, twice prior to discharge and three times following relocation. Global functioning, social behaviors, functioning in activities of daily living, cognitive status, perceived quality of life, housing conditions and rehospitalizations rates were assessed. Results showed that participants remained stable over time in general functioning, regardless of baseline functioning. Only five subjects were readmitted for short hospitalizations. Eighty-nine percent preferred to live in the community. Relocating these participants to a smaller supervised community facility did not lead to significant deterioration in their functioning and improved their quality of life.
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Milner, James Allen Sr. "The intervention and assistance to the chronically mentally ill who are experiencing homelessness." DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 2006. http://digitalcommons.auctr.edu/dissertations/560.
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The writing of this dissertation was an effort to address the issue of providing assistance to those persons who have been diagnosed with a chronic mental illness and were also experiencing homelessness. The author addresses several questions surrounding this issue. Ultimately, it was the desire of this writer to develop a Safe Haven program for this population that would create a residential service center. At this writing, there is not such a program in the State of Georgia. Among the many questions surrounding this issue that this writer addressed was: What is the history behind this problem? How did so many people in this targeted population become homeless? Is there a possible solution? What does the bible have to say regarding this issue and what if anything can the Faith community do to intervene and render assistance to this population? The questions were challenging. The intent of this dissertation was to provide some answers and design a program that could be replicated by any congregation that believed they were called to such a mission.
The project consisted often men who were homeless and had a diagnosis of achronic mental illness. The period of time these men were observed was a minimum of six months. The staff consisted of a director of counseling who is a licensed master of social work degree holder who specialized in psychotherapy; there were case managers; peer specialist; residential support staff; night managers and a dietician.The program was designed to include volunteerism from the members of the sponsoring congregation. Funding was sought through the support of the sponsoring church as well as other churches and individuals. The bulk of the funding however was provided by government sources. The overall hypothesis was that if given adequate support and assistance, those persons targeted by this effort could become stabilized, non-symptomatic and able to live in permanent housing with the necessary supportive services
8
Stanek, Richard James. "Residential Options for the Institutionalized Chronically Mentally Ill: The Impact of Psychosis on Choice." PDXScholar, 1993. https://pdxscholar.library.pdx.edu/open_access_etds/4631.
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Discharge planning for hospitalized chronically mentally ill usually involves only verbal descriptions of community residential options. Psychosis often impairs ability to conceptualize abstract information, and quality of the choice process may be poor without describing options in concrete form, i.e., using written descriptions and photographs. A random sample (N= 90) of Dammasch State Hospital (Wilsonville, Oregon) patient population, comprising persons diagnosed schizophrenic, schizoaffective, organic mental disorder, and bipolar, were assigned to three treatment groups, asked to rank six community residential options suited for them when they were ready to leave the hospital. The three treatment groups were presented the same set of residential options, but the manner of presentation of options was manipulated: first group received verbal descriptions, second group received verbal descriptions with placards containing printed highlights of descriptions, third group received verbal descriptions, printed descriptions, and five photographs of each type of residential option. After ranking the options, respondents were asked how difficult it was to make their choices: very difficult, kind of difficult, not very difficult. Finally, an open-ended question was asked, "What guided you in making your choices?" Respondents' social workers were asked to rank same six residential options for each respondent. Chisquare and Kruskal-Wallis tests were computed for treatment groups-by-respondents' choices for first through sixth choice with no significance found. "Difficulty of Choice"by- treatment group analyses found no significance using Kruskal-Wallis test, and trend toward significance using chi-square. Content analysis of open-ended question, "What guided you ..• " yielded seven categories of answers, and chi-square of "What guided you"-by-respondents' first choice of residential setting was significant. "Experience" and "Privacy and Independence" were most influential factors from content analysis, but only trends toward significance were found in chi-square, cross-tabulating them by treatment group. Since cross-tabulation of respondents'-by-social workers' choices showed no significance, six rankings were collapsed into three and significance was found for supported housing option (respondents and social workers choosing it in common third or fourth) for total sample. Other significance was found in verbal treatment group for homeless shelter (chosen in common fifth or sixth), and for supported housing (chosen in common third or fourth). Rank correlations of respondents' and social workers' choices for total sample found significant negative relationship for room and board option. Rank correlations of choices by treatment group found significant negative relationship for room and board in the verbal treatment group; found significant positive relationship for residential care facility in the verbal/written treatment group; found significant negative relationship for room and board option in the verbal/written/visual treatment group. Abstraction deficits evidently do no affect the way chronically mentally ill persons choose residential options. The chronically mentally ill also do not find choosing a residential placement any more or less difficult given the presentation of written and visual descriptions in addition to verbal description. Given excess of "not very difficult" answers to "difficulty" question, validity of "difficulty" question to detect quality of choice process is questionable. Better outcome question may have been, "How satisfied are you with you choices?". Given distribution of respondents' and social workers' choices, compromise between independent living and residential care facility is suggested in choice of supported housing program.
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Mireau, Margaret Ruth. "The experience of women who are caregivers to their chronically mentally ill adult children." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp03/MQ54734.pdf.
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THOMPSON, MARK DAVID. "THE EFFECTS OF A PSYCHO-EDUCATIONAL GROUP ON PARENTS OF THE CHRONICALLY MENTALLY ILL." Diss., The University of Arizona, 1987. http://hdl.handle.net/10150/184102.
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The purpose of this study was to examine the effect of a psycho-educational group on parents of the chronically mentally ill. The perceived quality of the parent's marital relationships, family environment, reported psychological symptoms, and knowledge of the etiology, treatment, and phenomena regarding chronic mental illness were measured for members of the treatment and comparison groups. A non-randomized comparison pretest-posttest design was employed to study the impact of participation in a psycho-educational group on the dependent variables. The treatment group (n = 18) and comparison group (n = 20) were matched on a number of demographic variables. The Dyadic Adjustment Scale, comprised of four subscales, measured the perceived quality of the parents' marital relationship. Eight of the ten subscales of the Family Environmental Scale were used to assess the family atmosphere while selected subscales of the Symptom Checklist 90-Revised assessed the parents' reported psychological symptoms. The Mental Illness Questionnaire served as an indicator of parents' knowledge of various aspects of chronic mental illness. Data were analyzed using a two-factor repeated measures analysis of variance (ANOVA). T tests were conducted at the pretest point to ensure the comparability of the groups. Interviews were conducted at the follow-up point to obtain subjective comments regarding the impact of chronic mental illness on the family as well as an evaluation of the psycho-educational group. Findings indicated that families do increase and retain knowledge regarding chronic mental illness as a result of participating in a psycho-educational group. Some improvement was noted in the perceived quality of marital relationships for members of the treatment group. There were no identified changes in the family environment or reported psychological symptoms based solely on group participation. The individual interviews conducted at the four-week follow-up supported the belief that chronic mental illness typically has a detrimental effect on the variables studied, and that participation in a psycho-educational group serves as a valuable resource to address the family's concerns.
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Sam, Noluthando. "Experiences of professional nurses related to caring for chronic mentally ill patients at rural primary healthcare clinics." Thesis, Nelson Mandela Metropolitan University, 2014.
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Since the deinstitutionalisation of chronic mentally ill patients, there has been an increase in the number of relapsed chronic mentally ill patients who become acutely mentally ill and need to be re-admitted for acute care in psychiatric institutions. Professional nurses working at rural primary healthcare clinics find it difficult to care for these individuals because they lack the necessary knowledge and skills. Chronic mentally ill patients who have been admitted to acute care facilities are stabilised by rendering care, treatment and rehabilitation and then released into the care of the professional nurses working at rural primary healthcare clinics. These patients live in the community and have to make use of the primary healthcare clinics nearest to their homes to provide them with their prescribed medication and care. Furthermore the patients’ mental conditions do not always remain stable, possibly because of a knowledge deficit, at times about their mental status. Patients may become non-compliant, resulting in the recurrence of symptoms, and thus need to be re-admitted to the acute care facility. However, the problem leading to re-admission is not clear for all admissions. It may be that patients do not make use of the primary healthcare clinics. It also seems that the professional nurses in the primary healthcare clinics are unfamiliar in dealing with chronic mentally ill patients living in rural communities. The aim of this study was therefore, to explore and describe the experiences of these professional nurses in caring for chronic mentally ill patients living in a rural community. The researcher used qualitative, explorative, descriptive, and contextual research design. The research population consisted of professional nurses working at primary healthcare clinics. Non-probability purposive sampling was used to identify participants for inclusion in the study. Data collection was conducted using one-on-one, semi structured interviews, observations and field notes and interviews were tape-recorded and transcribed. Data analysis was conducted using Tesh’s method of content analysis to identify themes and sub-themes. A literature control was done to compare the findings to the current published research. Trustworthiness was ensured by using Gubas’s model (1985) of trustworthiness. A pilot study, conducted by interviewing a small sample prior to the start of the main study, determined whether the sampling and interviewing techniques of the researcher as well as the research questions were adequate for data collection. The researcher ensured that the study was of a high ethical standard by taking into consideration values that guide the principles of autonomy, beneficence, non-maleficence and justice. The findings of the study was categorised into three main themes and 13 sub-themes. The main themes were as follow: Professional nurses experience problems when they have to take care of psychiatric patients attending rural primary healthcare clinics. This theme had six sub-themes which were discussed in details in chapter three. The second theme was that professional nurses experience that psychiatric patients in rural communities experience problems which affected their well-being. This second theme has got five sub-themes which were discussed further in chapter three. The last theme was that professional nurses have positive experiences when caring for psychiatric patients in rural communities. This theme has got two sub-themes as well discussed further in chapter three.
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Cunningham, Daniel Morton. "The impact of aggressive case management service in reducing the frequencies of acute episodes of the chronically mentally ill." CSUSB ScholarWorks, 1996. https://scholarworks.lib.csusb.edu/etd-project/1287.
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Patterson, Nona L. "Providing behavioral data to physicians for enhancing medication treatment for chronically mentally disabled individuals." Scholarly Commons, 1987. https://scholarlycommons.pacific.edu/uop_etds/2140.
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Physicians are often unaware of mentally disabled outpatients' symptomatic behaviors that are relevant to their medication prescriptions. Such information is available to the clients' residential care providers . The present study trained clients' residential care providers in data collection and provided these data to physicians. It was predicted that these data would improve medication treatment for these clients and consequently lead to a decrease in client's symptomatic behaviors . The results did not confirm the predictions; the data provided to physicians on clients' between- visit behaviors had no measured effect on the physicians' treatment of these clients, although the physicians reported positive attitudes about the helpfulness and utility of ·the system .
14
Loomis, Sandra Ann 1953. "Siblings of the chronically mentally ill: How are they affected and what variables may alter the effects?" Thesis, The University of Arizona, 1989. http://hdl.handle.net/10150/291636.
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Seventeen well siblings of chronically mentally ill (CMI) individuals were studied to examine effects associated with having a CMI sibling and factors associated with variations in effects. The respondents were largely better-educated, white, middle class, and age 21 years or older, recruited through a local family support group, and an acute care mental health facility. A self-report questionnaire was developed for use in this study utilizing a Likert scale for standardization. Areas of focus were self-esteem, relationships, and emotional and financial burden. All areas except self-esteem showed some negative effects. The main concerns identified were a "Don't Talk" attitude about mental illness, active mourning, fear of having a CMI offspring, and future financial responsibility. Differences in effects were observed between groups by gender, birth-order, likeness (same sex/opposite sex), and proximity. Diagnosis and level of functioning also appeared to be associated with variations in effects.
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Portillo, Carmen Julieta 1955. "RESOURCES AND OBSTACLES TO MENTAL HEALTH SERVICE UTILIZATION: INTERVIEWS WITH CHRONICALLY MENTALLY ILL MEXICAN AMERICAN CLIENTS AND SIGNIFICANT FAMILY MEMBERS." Thesis, The University of Arizona, 1986. http://hdl.handle.net/10150/291716.
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The intent of this study was to examine the perceived resources and obstacles which were related to the utilization of mental health services by chronically mentally ill Mexican American clients. Specifically, the study identified resources and obstacles encountered by six chronically mentally ill clients and six family members as they accessed various mental health services. The study was conducted in the fall of 1985 from clients currently receiving services from La Frontera Center, Inc., Tucson, Arizona. Data were interpreted through content analysis to conceptualize and categorize client and family member responses. Chronically mentally ill clients relied heavily on individuals such as friends, therapist and priest as resources for mental health service support. In contrast, family members focused primarily on institutions for resource support. Financial resources, institutional policies, denial, and the lack of personal direction were listed as obstacles to seeking mental health services by clients and family members. Study results suggested that the perceptions of traditional and nontraditional obstacles and resources by Mexican American clients and family members continue to strongly influence utilization of mental health services In particular, the issue of "stigma" and the personal
qualities and abilities of the therapist emerged as significant descriptors in client and family member self statements.
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MARSHALL, CATHERINE ANN. "STRESS REDUCTION THROUGH SKILLS TRAINING IN FAMILIES OF THE SEVERELY PSYCHIATRICALLY DISABLED: A REHABILITATION PSYCHOLOGY APPROACH (CHRONICALLY MENTALLY ILL)." Diss., The University of Arizona, 1985. http://hdl.handle.net/10150/187912.
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Families are now often the primary caretakers of severely psychiatrically disabled relatives, also referred to as the chronically mentally ill (CMI). As a result, families report experiencing stressors such as a lack of psychosocial resources, disturbance in family routine, and increased financial problems--in addition to feelings of guilt and embarrassment. Research has indicated that the families need education, support, and training in coping skills. La Frontera Center, Inc. (LFC), a comprehensive community mental health agency in Tucson, Arizona, provided both education and support to families of the severely psychiatrically disabled. The education essentially involved providing families with knowledge regarding schizophrenia; support was available through a task-oriented self-help group. The purpose of the present research was to develop a complementary coping skills training program, and investigate its effectiveness. The research was conducted through two separate studies. The first study compared subjects who received the skills training, and education, with subjects who received education only. The second study utilized members from the LFC support/advocacy group who had previously attended the education class. One-half of these subjects received the skills training, while continuing involvement with the support group, and were compared to subjects who were involved with support only. In each study, subjects were randomly assigned to either the treatment or comparison group. Both designs involved repeated measures, with data analyzed according to an analysis of covariance statistical procedure. Though the hypotheses were not supported statistically in the first study, a number of results were statistically significant in the second study, and did support the hypotheses, including treatment subjects experiencing decreased anxiety, decreased depression, decreased conflict within the family, and increased social functioning and use of community resources.
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Hyde, Emily. "Perception of healthcare professionals and use of formal-informal resources by families with son with chronic mental/physical illness." Virtual Press, 1995. http://liblink.bsu.edu/uhtbin/catkey/1020157.
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The purpose of this secondary analysis of Malone's (1993) study was to identify formal and informal resources used by families with an adult son with chronic mental or physical illness. It also explored the identified perceptions of health care providers by the families in this study. This study was guided by the Resiliency Model of Family Stress, Adjustment and Adaptation (McCubbin & McCubbin, 1993).The sample population was patients who were receiving outpatient care from Valley Mental Health Center and University Hospital Neurology Clinic in Salt Lake City, Utah, and families which met certain criteria. The data of 42 respondents of the original 68 in Malone's (1993) study were perused for trends and themes about the use of formal and informal resources and perceptions of health care professionals using the process of secondary analysis.Findings revealed that the outpatients and families used six formal resources and seven informal resources. Family resources accounted for 44 percent of the total utilization of informal resources by the respondents. Hospital/clinics accounted for 24.3 percent of the total formal resources used by the respondents. Findings also revealed that perceptions of health care professionals by the respondents was negative.With the increase of chronic illnesses, the recommendations and implications for nursing identify that patient education in the future will undoubtedly be the most vital and crucial component to an individual's success/failure to adjust to the chronic illness. With the additional knowledge base, prevention of unnecessary anxiety related to the chronic illness would promote a more positive environment for the patient. In addition, both the patient and family could make that smooth transition into the adaptation phase and function effectively with the chronic mental or physical illness.School of Nursing
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Hrabe, David Paul. "Relationship development among chronically ill women in a computer-mediated environment." Diss., The University of Arizona, 2001. http://hdl.handle.net/10150/280117.
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The purpose of this study was to determine the stages and processes of relationship development in a computer-mediated support group. Using grounded theory methodology, a secondary data analysis was conducted of 22 weeks of textual message exchanges among 15 chronically ill women. The study's outcome is a new middle range theory, Connecting in Cyberspace. This theoretical framework is the first attempt to describe the processes and phases of a computer-mediated support group and is intended as a beginning guide for nursing practice in an electronic environment. Orienting is defined as the start-up period in which members experience techno-uncertainty and unsettled impressions of fellow group members. The next stage, Intensifying, evolves from orienting and represents overcoming the uncertainty of phase one. It is heralded by high messaging activity fueled by the novelty of communicating in a new environment and the ability to connect with others in similar situations. As Intensifying's excitement fades, the group enters a settling and blending period termed Integrating. Integration's focus is the group's work to support one another, share life events and suggest coping alternatives. In the Concluding phase, the group's task is to transition away from the official group experience and to determine what contact they will have with one another afterward. Six relationship processes were identified in the data. Maintaining is the process by which participants sustained functioning of the group. Committing, an affiliative process, involves giving back to the group, entrusting the group with significant personal information, providing explanations or updates about one's participation or situation and extending oneself to group members. Maintaining and Committing followed similar trajectories as they peaked in weeks three through six, then gradually declined until the group's termination. The secondary processes support functioning of the primary processes and remained constant throughout the operation of the group. Initiating is the process by which participants commence messages to each other while Responding processes are communication that reply to previous messages. Grouping is the participants' identification with the group. Terminating comments are expressions of appreciation and saying goodbye that function to transition members away from the group.
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Jenkinson, Crispin. "Social and psychological factors affecting the impact of painful chronic illness upon mental health." Thesis, University of Oxford, 1989. http://ora.ox.ac.uk/objects/uuid:2c6e33c7-4931-435c-bd60-d3958866087a.
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This thesis is a report of a study on patients suffering one of two painful chronic illnesses (rheumatoid arthritis (RA) or migraine), and attempts to discover possible determinants of psychological reactions to long term painful illness. One hundred and sixty chronically ill individuals were interviewed, (80 migraine and 80 RA sufferers). In keeping with other evidence, the extent of psychological disturbance was found to be higher for chronically ill individuals than for general population samples. There were no zero order correlations between reported pain and psychological distress. Age and length of suffering have often been cited as possible factors influencing mood state, but no evidence was found for this in the data gained in this survey. The results provide no evidence for the use of coping strategies as a method of adapting to the demands of the painful chronic illnesses studied here. Beliefs in control over illness have been posited as possible factors that may influence psychological state, and were measured in this research using a health locus of control scale. However locus of control scores were not found to be associated with mood state, although, in keeping with other research, scores were found to be associated with age and social class, with both lower social class and older sufferers scoring higher on externality than those from higher social classes, or whom were younger. The strongest association was found between aspects of subjective health status and mood state. The major finding of this study is that patients assessment of their own health state, in both illnesses, is the major factor associated with psychological state.
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George, Marisa M. "The impact of spirituality and group therapy on counseling a client presenting with symptoms of depression and chronic pain." Theological Research Exchange Network (TREN), 2005. http://www.tren.com/search.cfm?p074-0057.
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Lindholm, Michelle Marie. "Chronic childhood disease and child abuse." CSUSB ScholarWorks, 1998. https://scholarworks.lib.csusb.edu/etd-project/1559.
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The purpose of the present research is to investigate whether or not chronically ill children are victims of child abuse more frequently than healthy children. The gender of the child and of the parent will also be examined for differences in the treatment children receive.
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Heimbigner, Rachel Michelle. "A study of the predisposing factors for depression in in-center chronic hemodialysis patients." CSUSB ScholarWorks, 1997. https://scholarworks.lib.csusb.edu/etd-project/1310.
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Sánchez, Ortega Mª Aurelia. "Efectividad de un programa de intervención psicosocial enfermera para potenciar la agencia de autocuidado y la salud mental positiva en personas con problemas crónicos de salud." Doctoral thesis, Universitat de Barcelona, 2015. http://hdl.handle.net/10803/387116.
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INTRODUCCIÓN:
El sistema sanitario está apostando por un cambio de paradigma que se orienta hacia la implicación activa de los pacientes en su proceso de salud y; se propone poner énfasis en los pacientes con enfermedades crónicas, grandes consumidores de servicios sanitarios. Por otro lado, la situación actual obliga a repartir los recursos disponibles y, por tanto, es necesario un cambio en el modelo de actuación fomentando la participación de la población y, en este sentido, el ciudadano puede aportar mucho en su autocuidado. Procurar una salud mental positiva se incluye en las acciones saludables y pensamos que el contexto de las consultas de enfermería puede ser un espacio idóneo para ello.
Este trabajo se postula en base a las posibilidades de intervención psicosocial de enfermería con pacientes con problemas crónicos y en la relación entre los constructos Agencia de Autocuidado y Salud Mental Positiva. Se planteó una investigación estructurada en dos fases.
OBJETIVOS:
Fase I: Describir las características sociodemográficas y las condiciones de salud física en pacientes con problemas crónicos de salud y explorar los niveles de Agencia de Autocuidado y de Salud Mental positiva y la correlación entre ambos constructos.
Fase II: Evaluar la efectividad de un programa de intervenciones psicosociales de enfermería para potenciar la agencia de autocuidado y la salud mental positiva en personas adultas con problemas crónicos de salud física e identificar la utilidad del programa y la satisfacción del mismo.
METODOLOGÍA:
Fase I se planteó un estudio transversal, descriptivo, y correlacional.
Fase II quasi-experimental, pretest-posttest, con grupo de intervención y grupo control.
La muestra estuvo configurada en la Fase I por n=259 y en la Fase II por n= 44 grupos: de intervención (n=22) y control (n=22).
En la Fase I se realizó un análisis descriptivo, de todas las variables. Los datos se analizaron con el paquete estadístico PASW-18, con una significación p-valor de <0.05. En la Fase II, para la comparación entre las variables categóricas se utilizó el test exacto de Fisher y para las variables cuantitativas la U de Mann-Whitney. Para determinar si la intervención era significativa se realizó un análisis multivariante (MANOVA) con las diferencias pretest-posttest entre el grupo de intervención y el grupo de control.
RESULTADOS:
Los instrumentos utilizados, Escala de Agencia de Autocuidado (ASA) y Cuestionario de Salud Mental Positiva (CSM+) obtuvieron una α de Cronbach de 0.73 y 0.91 respectivamente. La correlación entre ambos constructos la correlación fue muy significativa y bidireccional. En el programa de intervención psicosocial de enfermería se comprobó la efectividad del mismo con un aumento significativo en la agencia de autocuidado (ASA) y en la salud mental positiva (CSM+) (F [7,36]=28,51, p<0,0001).
CONCLUSIONES:
El perfil es el de una mujer de 66-75 años, con una capacidad de agencia de autocuidado medio y una salud mental positiva moderada-alta.
Existe una relación bidireccional estadísticamente significativa entre los constructos: agencia de autocuidado y salud mental positiva.
El programa de intervención fue efectivo generando un incremento de la agencia de autocuidado y de la salud mental positiva en el grupo de intervenciónINTRODUCTION: The health system is committed to a paradigm shift towards the active involvement of patients in their process of health, and the strong emphasis is placed in patients with chronic diseases, who are the large consumers of health services. Conversely, the current situation requires distributing the available resources and consequently a change is necessary in the performance model. Thus, encouraging population participation can be a pathway to achieve this goal, and in this sense, citizens can contribute much to their self-care. Ensure a positive mental health is included in wholesome actions. The hypothesis of this project is based on the possibilities of psychosocial nursing interventions in patients with chronic physical health problems, and the relationship between of Self-Care Agency and Positive Mental Health. A research structured in two phases was designed. OBJECTIVES: In Phase I objectives were: To describe the sociodemographic characteristics and physical health conditions in patients with chronic health problems and explore the levels of the Self-Care Agency and Positive Mental Health, and the positive correlation between the two constructs. In Phase II the objectives were: Evaluate the effectiveness of a program of psychosocial nursing interventions to enhance the Self-Care Agency and positive mental health in adults with chronic physical health problems and identify the program's usefulness and satisfaction. METHODS: For Phase I sectional, descriptive, correlational study and for Phase II quasi-experimental, pretest-posttest studies were proposed, with intervention group and control group. The sample in Phase I included 259 people with chronic health problems; Phase II included 44 people, divided between the intervention (n = 22) and control (n = 22) groups. In Phase I was conducted a descriptive analysis of all variables. Data were analyzed with SPSS-18 statistical package, with a significant p-value of <0.05. In Phase II, Fisher's exact test was used for comparison between categorical variables, and the Mann-Whitney U test for quantitative variables. To determine whether the intervention was significant, multivariate analysis (MANOVA) with pretest-posttest differences between the intervention group and the control group was performed. RESULTS: The instruments used, Appraisal of Self-Care Agency Scale (ASA) and Positive Mental Health Questionnaire (CSM +) obtained a Cronbach α of 0.73 and 0.91 respectively. Analyzing the correlation between both constructs, the correlation was highly significant and bidirectional. The effectiveness of nursing psychosocial intervention program demonstrated a significant increase in self-care agency (ASA) and positive mental health (CSM +) (F [7,36] = 28.51, p <0 , 0001). CONCLUSIONS: The following conclusions were obtained: The profile of the sample studied is that of a woman of 66-75 years, with a moderate capacity in the self-care agency and a moderate medium-high positive mental health. There is a statistically significant two-way relationship between the constructs: self-care agency and positive mental health , so that the more efficient self-care a higher level of positive mental health. The nursing psychosocial intervention program was effective in generating an increase in self-care agency and positive mental health in the intervention group. The usefulness of exercises carried out and participant satisfaction were very high.
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Sinnen, K. Leila. "The head nurses’ perceptions of the impact of deinstitutionalization on the chronically mentally ill." Thesis, 1993. http://hdl.handle.net/2429/1739.
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This study describes head nurses' perceptions of the impact of deinstitutionalization on persons with chronic mental illness. A phenomenological approach is the methodology used in this study. Data were collected by use of an in-depth semi-structured interview. The participants in the study were seven head nurses from a large psychiatric institution in Western Canada.
Themes derived from the data were abstracted into three content categories. The content categories are contributing factors, impact on the individual and facilitating factors. Major themes under each of the content categories are described. The findings reveal that head nurses perceive that deinstitutionalization has negative and positive effects on the chronic mentally ill. The negative effects are stigma, homelessness and the revolving door syndrome. Positive effects of deinstitutionalization can be a better quality of life with adequate communication, patient preparation, education and resources/facilities in the community. The findings also show that head nurses perceive that some persons with chronic mental illness may require care in a psychiatric institution for most of their lives. The implications that deinstitutionalization has for nursing practice, education, administration and research are presented.
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Lan, Yu-li, and 藍毓莉. "The Life Style Associated with Body Weight and Blood Pressure of Chronically Mentally Ill Inpatients." Thesis, 2006. http://ndltd.ncl.edu.tw/handle/89061316800228436005.
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博士慈濟大學
醫學研究所
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Objective: This study investigated the prevalence of hypertension and overweight, defined as BMI≧24kg/m2, and their associated life styles in chronic mentally ill inpatients. Methods: This cross-sectional study included 1,086 inpatients in a psychiatric hospital in eastern Taiwan. Data were collected from medical records, questionnaire, and measurement of participants’ blood pressure, height and weight. Social demographic data, disease history, use of atypical anti-psychotics, diet, smoking, regular exercise, BMI and BP were analyzed. Results: 1. The hypertension and high normal blood pressure prevalence rates were 35.1% and 20% respectively. 2. The prevalence rate of overweight was 66%. 3. The variables of sex, age, race, ward category, social function, disease history, use of medication to reduce blood pressure, diet category, beverage category, smoking behavior, length of smoking history, and smoking frequency were significantly different among patients with hypertension, high normal blood pressure, and optimal blood pressure. 4. The intake of food quantity and the beverage category beyond regular food and drinks supplied by the hospital were negatively associated with Systolic Blood Pressure (SBP). The length of smoking history and BMI were positively associated with SBP. The intake of food quantity beyond the regular food supplied by the hospital was negatively associated with Diastolic Blood Pressure (DBP). The variable of BMI was positive associated with DBP. 5. The variables of races, diet category, exercise duration, and exercise intensity were significantly associated with Patients’ BMI. 6. The significant predictors of the BMI≧24kg/m2 by logistic regression were diet category, diet quantity, exercise frequency, exercise duration, and exercise intensity. 7. The smoking quantity and BMI were significant predictors of SBP when the variables of social demographic variables, disease history, and the use of medication were under control. In the same statistic analysis model, this study showed that BMI was a significant predictor of DBP. Conclusion: This study showed that the prevalence of hypertension, high normal blood pressure and overweight in chronic mentally ill inpatients were much higher than in the general population in Taiwan. The life styles of study participants were significantly associated with their BMI and blood pressure. The findings of this study suggest the necessity of further researches to identify the impacts of healthy life style on the BMI and blood pressure in chronic mentally ill inpatients.
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Dimirsky, Mark A. "The quality of life of the chronically mentally ill living in community : an investigation of the Oregon quality of life theory." 1992. http://hdl.handle.net/1993/18020.
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Burke, Kevin John. "Health, mental health, and spirituality in chronically ill elders /." 1999. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pqdiss&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:9951768.
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Noël, La Tonya Mayon 1974. "Causal beliefs and treatment preferences for the symptoms of depression among chronically ill African Americans, Latino, and White patients." Thesis, 2007. http://hdl.handle.net/2152/3768.
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The focus of the research study is to explore chronically ill African American, Latino, and White patients' causal attributions of symptoms of depression and factors that predict depression care treatment preferences among these groups. Research has demonstrated that perception of illness impacts what treatments a person will deem appropriate for their mental health problems and from whom they will seek treatment. Research also indicates that certain ethnic groups are more likely to seek treatment for their symptoms of depression in the primary care setting. Yet, it is unclear how they actually perceive their symptoms and what best predicts the treatments that they are likely to consider acceptable. A convenient sample of 109 HIV+ adults, 79 diabetic adults, and 3 adults with both conditions were recruited for this study. Participants had to be receiving services for either HIV, diabetes, or both conditions in one of the three central Austin facilities and be a representative from one of three racial/ethnic groups: African Americans, Latino, and White. Differences were found across ethnicity with regard to causal beliefs and treatment preferences for the symptoms of depression both among the HIV and the diabetic subgroups. Latinos in both groups were more likely than Whites to prefer counseling or a single form of treatment over combined treatment methods. Diabetic Latinos were more likely to prefer counseling for symptoms of depression. HIV seropositive individuals who reported the least number of symptoms of physical illness were more likely to attribute their symptoms of depression to stressful life events, whereas those who reported the greatest number of symptoms of physical illness were more likely to attribute their symptoms of depression to their medical illness. Additionally among the HIV subgroup, individuals who reported high stress tended to predict the preferences for treatment provided by a psychiatrist/psychologist and Whites scored highest on this factor. Finally, differences in depression scores across race/ethnicity were also revealed. The utility of assessing a patient's understanding of symptoms of depression in order to determine how personal illness models impact treatment preferences and knowledge of patient's causal attributions can aid medical social workers and physicians in collaborative management of chronic illness and depression are discussed.
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Esposito, Jessica. "Understanding Unpredictable Chronic Illness and its Links to Posttraumatic Stress and Growth: The Case of Multiple Sclerosis." Thesis, 2016. https://doi.org/10.7916/D8JM29WB.
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The present study was conducted to help understand the impact of living with multiple sclerosis (MS), an unpredictable, chronic illness that is widely known to have a large influence on psychosocial functioning, mental health, and life satisfaction (Motl & Gosney, 2007; Weiner, 2004). Recent research has begun to position certain chronic illnesses, such as MS, as traumatic events that influence mental health in both beneficial and detrimental ways. Thus, the present study investigated the positive and negative consequences of centralizing one’s identity within their MS experiences as related to trauma, growth, and psychosocial influences via a path model with 616 individuals with MS. The results indicate strong support for the hypothesized paths between the variables of interest—centrality of MS, posttraumatic stress, posttraumatic growth, social support, personal mastery, depression, and life satisfaction. Specifically, results indicate that posttraumatic stress and posttraumatic growth partially mediated the relations between centrality of MS with depression and life satisfaction. Moderation analyses indicated that social support and personal mastery did not moderate any relations between centrality of MS with depression and life satisfaction. Rather, additional analyses suggest social support and personal mastery may be viewed as additional mediators between centrality and posttraumatic stress and posttraumatic growth. The results of the present study is the first known study to extend trauma literature to the population of MS in order to provide an approach to help understand the high rates of depression and inconsistent findings on quality of life for this population. Implications for practice, theory and research are discussed.
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Carstens, Lillian Elizabeth. "Teachers' experience of teaching in a hospital school." Thesis, 2008. http://hdl.handle.net/10210/711.
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This essay deals with the experiences of hospital school teachers, when teaching terminally and chronically ill children. Teachers form part of a multidisciplinary team of doctors, nurses, therapists, social workers and other caregivers. As a team they all share the same goal of assisting the child to better health with the minimum disruption to normal development and education. The effects on teachers personally; coping with emotional stresses of children being seriously ill and sometimes, unfortunately dying and professionally; by constantly adapting learning and teaching styles to suit the needs of these learners, are numerous when working in these conditions and often results in burnout. This essay explores these effects by inquiring into the lives of four teachers at one particular hospital school. This phenomenological study comes to a conclusion that hospital teachers need specific and distinctive characteristics to deal with issues out of the norm. They have to own extraordinary commitment and acknowledge the true value of teacher collaboration. Finally teachers needed ongoing support on a personal level; counseling, and on a professional level; teacher training and development in order to remain healthy, personally intact and at the spearhead of developments in the teaching profession. The essay ends with recommendations for hospital school teachers and hospital schools.Dr. M.P. van der Merwe
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Zheng, Katherine. "Developmental Assets in Adolescents with Chronic Illness and Co-Morbid Depression." Thesis, 2020. https://doi.org/10.7916/d8-4qkx-p811.
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This dissertation aims to elucidate the relationships between chronic illness, depression, and developmental assets among adolescents with chronic illness and co-morbid depression. Chapter One describes the current state of evidence on the intersections between chronic illness, depression, and adolescent development, and introduces Positive Youth Development theory and the Developmental Assets Framework. Chapter Two describes an integrative review synthesizing findings from 11 cohort studies examining relationships between depression or depressive symptoms and chronic illness-related disease control, self-management behaviors, illness-related morbidity, and quality of life among adolescents. Chapter Three describes a cross-sectional study comparing the number and types of developmental assets between adolescents with differing health statuses and examining relationships between assets and co-morbid depression using data from the 2016 National Survey of Children’s Health. Chapter Four describes a qualitative study exploring ways that developmental assets were discussed by 16 adolescents and young adults who lived with chronic illness and co-morbid depression during adolescence and uploaded videos to YouTube, a public video-sharing platform. Chapter Five summarizes key findings of this dissertation, outlines strengths and limitations, and discusses implications for future research, policy, and practice.
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Kramer, Barbara. "Mental health issues for families served by a care manager under a managed care Medicaid project : b report of a research experience : submitted in partial fulfillment ... for the degree of Master of Science in Nursing ... / c Barbara Kramer." 1995. http://catalog.hathitrust.org/api/volumes/oclc/68798771.html.
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Bilazarian, Ani. "Primary Care Practice Structural Capabilities and Emergency Department Utilization Among High-Need High-Cost Patients." Thesis, 2021. https://doi.org/10.7916/d8-fx47-ja94.
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Background
Primary care practices in the United States (US) are currently constrained in their ability to deliver high quality care due to population aging, insurance expansion, and an increasing prevalence of chronically ill patients. The nurse practitioner (NP) workforce plays a critical role in meeting the growing demands for primary care, particularly in rural and underserved areas. NPs are also more likely to deliver care to clinically and socially complex populations such as high-need high-cost (HNHC) patients. HNHC patients are adults who suffer from multiple chronic conditions and experience additional functional, behavioral, or socioeconomic needs. Despite comprising only 5% of the US population, HNHC patients account for nearly half of total health care expenditures and over 90% of Medicare expenditures. HNHC patients with behavioral health diagnoses such as depression or substance abuse face heightened challenges managing their conditions and consequentially have higher preventable spending and emergency department (ED) utilization compared to the overall HNHC population.
Significant policy attention has been placed on enhancing primary care practices as a strategy to improve outcomes and reduce costs in HNHC patients. Structural capabilities are features of primary care practices (e.g., after-hours care or care coordination) which are needed to deliver high quality primary care and chronic disease management. Yet, to date little research has been done on structural capabilities in primary care practices where NPs deliver care to HNHC patients. The overall purpose of this dissertation is to understand how to enhance primary care delivery and structural capabilities to improve outcomes for HNHC patients. We have achieved the following specific aims: (1) Establish a clear definition of HNHC patients, (2) Identify existing primary care and payment models used among HNHC patients and evaluate their impact on ED utilization and costs, (3) Evaluate structural capabilities in NP primary care practices located in Health Professional Shortage Areas (HPSAs), and (4) Analyze the association between NP practice structural capabilities and ED utilization among HNHC patients with behavioral health conditions.
Dissertation Chapters and Key Findings
Chapter One includes an introduction to the landscape of current primary care delivery, the role of the NP workforce in expanding access, and the unique challenges of delivering care to HNHC patients. This chapter also discusses the conceptual framework guiding the dissertation, the specific aims of each study, and how each study will fill a gap in the literature.
Chapter Two (Aim 1) consists of a concept analysis of HNHC patients using the Walker and Avant framework. Three subgroups of HNHC patients were identified: adults over the age of 65 who suffer from multiple chronic conditions with functional or behavioral health needs, the frail elderly, and patients under 65 years old with a serious mental health condition or disability. Antecedents that predispose an individual to becoming a HNHC patient include challenges accessing timely care, low socioeconomic status, or unmet needs. Persistent high spending occurs as a result of poorly managed chronic diseases leading to acute exacerbations, preventable health service utilization, and fragmented care between the acute and primary care settings.
Chapter Three (Aim 2) is a systematic review of studies conducted from 2000-2020 on primary care and payment models used with HNHC patients. About half of the primary care models evaluated in the systematic review (11 out of 21 studies) showed no significant difference in ED utilization among HNHC patients. Care coordination and care management (15 out of 21 studies) demonstrated both positive and negative associations with ED utilization and costs. Primary care models that demonstrated significant reductions in ED utilization had shared features, including frequent follow-up, multidisciplinary team-based care, enhanced access, and care coordination.
Chapter Four (Aim 3) includes a cross-sectional study of NP survey data from 2018-2019 on practice structural capabilities linked with data on primary care shortages (i.e., HPSA designation). Bivariate analyses and multivariable regression models were used to compare NP characteristics and structural capabilities in HSPA practices compared to non-HPSA practices. The majority of NPs in our sample (61%) delivered care in HPSA practices. NP practices located in HPSAs were significantly more likely to deliver care coordination compared to non-HPSA practices. We found no significant difference in prevalence of registries, after-hours care, or shared communication systems.
Chapter Five (Aim 4) is a study of cross-sectional NP survey data from 2018-2019 on practice structural capabilities linked with Medicare Part A and Part B claims to identify HNHC patients and ED utilization. Multivariable Poisson models were used to estimate the association between ED utilization and structural capabilities in practices serving HNHC patients with behavioral health conditions including depression, alcohol use, and substance use disorder. Care coordination was associated with decreased rates of ED utilization among the overall HNHC population and those with alcohol use, but not among HNHC patients with depression or substance use disorders. Shared communication systems were associated with decreased rates of all-cause and preventable ED utilization among HNHC patients with alcohol use and substance use disorders.
Chapter 6 is a summary of findings across studies in this dissertation and will present the strengths, limitations, and contributions to science. This chapter will also discuss implications for policy, practice, and directions for future research.
Conclusion
HNHC patients face complex and wide-ranging medical, social, and behavioral health needs resulting in poor clinical outcomes and high costs. Enhancing primary care is an urgent goal for policymakers to improve disease management while reducing overall costs of care. Findings from these studies demonstrate that NPs practice in underserved areas and are significantly more likely to deliver care coordination in HPSA practices and to HNHC patients with behavioral health conditions. Care coordination has the potential to increase effectiveness of primary care delivery by tailoring models to target specific HNHC patients. Shared communication systems also show promise for improving primary care delivery and reducing ED utilization among HNHC patients with alcohol use and substance use disorders. Future research should continue to explore how structural capabilities may enable NPs to deliver timely, high quality, cost-effective primary care for HNHC patients.
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Jones, Sylvia Lynn. "The interaction between paediatric asthma and family functioning." Diss., 2002. http://hdl.handle.net/10500/786.
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The present study explored the interaction between paediatric asthma and family functioning, within the context of family systems theory. Eight families, each with an asthmatic child between the ages of 8 and 15, were included in this study. In each case, the parents were interviewed and completed a quantitative measure, the Family Assessment Device, The results indicated that each family has a unique way of functioning and of integrating the child's asthma into its lifestyle. Factors found to be involved in the mutual impact of paediatric asthma and family functioning were the size of the family, the severity of the child's condition, the ways in which the family copes with the stress of asthma, communication patterns between parents, compliance with family rules and boundaries, and the affective responsiveness and involvement of family members.Psychology
M.A. (Psychology)