Dissertations / Theses on the topic 'Life events; Experiences; Morbidity'

This thesis presents a program of work designed to explore and describe what the experience of caring for a child who has an Acute Life Threatening Event (ALTE) is like for the nurses. An ALTE may include a cardiac arrest, respiratory arrest or unplanned admission for a ward to the Paediatric Intensive Care unit. Using the MRC framework for the development of complex interventions, this information was then coupled with theory to develop the PREPARE and SUPPORT interventions. Given the wide-ranging and exploratory nature of this research, a pragmatic, mixed design approach was used to address the aims and objectives of the thesis. The mixed design approach included: a systematic literature review; international survey of practice; interviews with nurses and doctors using Interpretative Phenomenological Analysis; development, refinement and evaluation of interventions during a feasibility study. Two studies were identified through the systematic review which aimed to evaluate the effectiveness of debriefing. The studies did not provide evidence to support the use of these interventions within healthcare. The international survey of practice demonstrated hospitals were using interventions to both prepare and support nurses for these events. The preparatory interventions were clinically focused and the majority of the supportive interventions included a debrief. The interventions were not being evaluated for effectiveness. The interviews conducted with nurses and doctors provided insight into what that experience was like for the participants. Using the MRC framework, this evidence was coupled with theory to develop the PREPARE and SUPPORT interventions. A multidisciplinary working party used an iterative process to refine and evaluate the interventions and study procedures were explored through a feasibility study. The pragmatic, mixed design approach demonstrated how the empirical evidence was coupled with theory and clinical expertise to develop interventions for use within the healthcare environment.

Evidências científicas trazem importantes associações entre a vivência de eventos estressores por gestantes e prejuízos a saúde mental materna. Identifica ainda que tal exposição possa estar relacionada ao aumento de consumo de álcool e tabaco por mulheres. Visto os prejuízos para a saúde materna relacionada a esta vivência, este estudo teve por objetivo analisar a relação entre a ocorrência de eventos estressores, morbidade psiquiátrica e consumo de álcool e tabaco em mulheres no terceiro trimestre gestacional. Trata-se de um estudo epidemiológico clínico, observacional, transversal, sobre amostra de 449 gestantes de uma maternidade pública na cidade de Ribeirão Preto-SP. Os instrumentos de coleta foram: um questionário para obtenção de dados sócio-demográficos, relato de uso de tabaco, Questionário de Morbidade Psiquiátrica de Adultos (QMPA) e entrevista para eventos recentes de vida (IRLE). Para avaliação do consumo de álcool foi utilizado o instrumento T-ACE (Tolerance, Annoyed, Cut-down, Eye-Opener) e um questionário para avaliação segundo critérios de pesquisa da CID-10 para uso nocivo ou síndrome de dependência. Os eventos estressores receberam três tipos de análises: isolados, agrupados em categorias e através da somatória total. Os resultados demonstraram que todas as participantes reportaram ter vivenciado algum evento estressor durante o período avaliado (µ = 5; dp = 2,2; min = 1, máx = 14) com destaque para a categoria saúde (99,1%). Quanto aos eventos estressores específicos, a gravidez indesejada (60,5%; n = 272) e dificuldade financeira média (31,8%; n = 143) foram os mais freqüentes. O primeiro evento estressor recebeu elevado impacto de estresse, 97 gestantes referiram estresse alto ou acentuado, 128 estresse baixo ou moderado e apenas 47 nenhum estresse. A somatória total de eventos estressores (p< 0,001) e as categorias Educação, Finanças, Aspectos legais, Migração e Trabalho apresentaram correlação estatística significante em relação à morbidade psiquiátrica (p< 0,001). Os eventos dificuldade financeira média ou grande e brigas com familiares foram cerca de 3,5 vezes maior em gestantes com suspeição de transtorno psiquiátrico (p< 0,001; 95%IC:2,16-3,84). Em relação ao consumo de álcool, o número total de eventos e a categoria Finanças apresentaram correlação estatística significante com o consumo de risco e uso nocivo ou dependência. O uso de tabaco foi associado à categoria finanças (p< 0,05) e aos eventos gravidez indesejada (p< 0,001; 95%IC:1,4-4,9) e brigas com o marido (p< 0,05; 95%IC:0,8-3,1). Os dados apontam alta vivência materna de eventos estressores durante o período gestacional e associação entre eventos estressores (isolados ou em categorias), sintomas psiquiátricos, consumo de álcool e tabaco. A avaliação dos eventos estressores por profissionais de saúde torna-se, portanto útil para o tratamento, educação e promoção da saúde pública visto que pode ajudar as mulheres a reforçar os seus estilos de enfrentamento ao estresse e prevenir o consumo de substâncias lícitas e danos à saúde mental materna.<br>Scientific evidences provide important associations between the experience of stressful events by pregnant women and harm to mental health. It identifies that such exposure may be related to increased consumption of alcohol and tobacco by women. Considering the damage to maternal health related to this experience, this study aimed to analyze the relationship between the occurrence of stressful events, psychiatric morbidity and alcohol and smoking consumption in pregnant women. This is a clinical epidemiological study, observational, cross-sectional sample of 449 pregnant women at a public maternity hospital in Ribeirão Preto. The instruments used to collect the data were a questionnaire to obtain socio-demographic data, history of tobacco use, Psychiatric Morbidity Questionnaire for Adults (QMPA) and interview for recent life events (IRLE). To assess alcohol consumption it was used the instrument T-ACE (Tolerance, Annoyed, Cut down, Eye-Opener) and a second questionnaire to evaluate the search criteria of CID-10 criteria for harmful use or dependence syndrome. The stressful events were three types of analysis: individual, grouped into categories and through the total sum. The results showed that all participants reported having experienced some stressful event during the period study ( = 5, SD = 2.2, min = 1, max = 14) with emphasis on the category \"health\" (99.1%). Considering the specific stressful events, the \"unwanted pregnancy\" (60.5%, n = 272) and \"average financial difficulty\" (31.8%, n = 143) were the most frequent. The first stressor received high impact stress, 97 pregnant women reported high stress or severe, 128 moderate stress and only low or no stress 47. The total sum of stressful events (p < 0.001) and the categories of \"education\", \"finance\", \"legal aspects\", \"migration\" and \"work\" showed statistically significant correlation in relation to psychiatric morbidity of patients (p < 0.001) . The events \"mean and great financial difficulty\" and \"fights with family members\" were about 3.5 times higher in women with suspected psychiatric disorder (p < 0.001, 95% IC : 2,16-3, 84 ). In relation to alcohol consumption, the total number of events and the category \"Finances\" showed statistically significant correlation with the risk and consumption of alcohol abuse or dependence. Tobacco use was associated with the category \"Finances\" (p < 0.05) and events \"unwanted pregnancy\" (p <0.001, 95% IC :1,4-4, 9) and \"fights with her husband\" ( p < 0.05, 95% IC :0,8-3, 1). The data indicate high maternal experiences of stressful events during pregnancy and association between stressful events (singly or in categories), psychiatric symptoms, alcohol and tobacco. The evaluation of stressful events by health professionals it is therefore useful for treatment, education and promotion of public health, because it can help women strengthen their coping styles with stress and prevent the consumption of licit and damage to mental health.

Introduction: Psychotic-like experiences are commonly found in the general population; this raises the question as to why some individuals are in ‘need for care’ whilst others are not adversely impacted by such experiences. Cognitive models of psychosis highlight appraisals as key to moving people along the psychosis continuum. Victimisation has also been implicated in both clinical and non-clinical populations. The role of appraisals in providing a cognitive route between victimisation and psychosis is investigated more fully in the current study. Method: Appraisals of two experimentally-induced anomalous experiences (the Cards Task and Telepath Task) and number of victimisation experiences (interpersonal trauma and perceived discrimination) of individuals currently endorsing psychotic-like experiences in ‘need for care’ (N = 25) and ‘not in need for care’ (N = 25) were compared. The relationship between victimisation and appraisal type (maladaptive versus adaptive) was also explored across groups. Results: The ‘need for care’ group endorsed significantly higher ratings on maladaptive appraisals on both experimental tasks. The ‘non-need for care’ group endorsed significantly higher ratings on adaptive appraisals on the Telepath task. There were no significant differences in number of lifetime victimisation experiences between groups; however the ‘need for care’ group reported higher rates of adulthood discrimination. A significant relationship between victimisation and appraisals was not evident. Nevertheless there were some tentative links between adaptive, but not maladaptive, appraisals and impact and powerlessness in relation to victimisation experiences. Conclusions: Results are consistent with cognitive models of psychosis. Similar rates of total victimisation experiences across the lifespan in both groups suggest that victimisation may be implicated in the formation of anomalous experiences, but not in determining ‘need for care’ status. Factors such as social support and on-going impact and powerlessness in relation to the victimisation experiences, may be more relevant to the transition to ‘need for care’.

Bakgrund: Bröstcancer är en av de vanligaste cancersjukdomarna hos kvinnor i världen. Trots att förekomsten av bröstcancer uppskattas öka årligen har mortaliteten minimerats på grund av rutinmässiga mammografikontroller som kan upptäcka indikationer på bröstcancer i ett tidigare skede. Bröstcancer uppkommer när cancerceller förökar sig okontrollerat och bildar en tumör. Beroende på tumörens storlek och spridning krävs olika behandlingsmetoder. Varje enskild kvinna upplever sjukdomstillståndet individuellt, livsvärlden och hälsan kan påverkas negativt. Sjuksköterskan har i sin yrkesroll ett ansvar att vårda dessa patienter utifrån ett helhetsperspektiv. Syfte: Syftet med denna studie är att beskriva kvinnors upplevda erfarenheter av att leva med bröstcancer. Metod: En litteraturöversikt utfördes utifrån Fribergs metod. Databaserna som användes var CINAHL Complete och Medline vilket genererade i nio kvalitativa artiklar samt en artikel som utgjorde en mixad metod där främst den kvalitativa datan användes. Författarna sökte artikelurvalet utifrån helikopterperspektivet vilket kännetecknas av ett öppet och kritiskt tänkande. Resultat: I resultatet identifierades tre huvudteman: Vikten av att få information och rådgivning från vårdpersonal, att handskas med sin bröstcancer samt påverkan på det dagliga livet. Det sistnämnda temat gestaltar tre subteman: Kroppslig och psykisk påverkan, betydelsen av att få stöd från närstående samt perspektiv på livet och andra existentiella frågor. Diskussion: Resultatet har diskuterats utifrån Katie Erikssons Caritativa teori vars syfte är att förstå och lindra lidande. Bröstcancer kan frambringa olika former av unika lidande som sjuksköterskan bör ta hänsyn till i vårdandet.<br>Background: Breast cancer is one of the most common cancer diseases affecting women in the world. Despite the existence of breast cancer is increasing yearly the mortality has decreased due to routine mammography checkups that are able to discover early signs of breast cancer. Breast cancer occurs when cancer cells multiply uncontrollably and form a tumor. Depending on the tumors size and proliferation there are different types of treatments. Each individual woman experiences the disease state individually, life-world and health can be affected negatively. In its professional role, the nurse has a responsibility to care for these patients from a holistic perspective. Aim: The aim of this study is to describe women’s lived experiences of living with breast cancer. Method: A literature review was conducted based on Friberg´s method. The databases that were used were CINAHL Complete and Medline which generated in nine qualitative articles and one mixed method where main the qualitive part was used. The authors sought articles with help from the helicopter perspective, which is characterized by open and critical thinking. Results: The result identified three main themes: The importance of receiving information and counseling from health care professionals, handle their breast cancer and the disease affecting daily life. The latter theme embodies three subthemes: Bodily and mental impact, the meaning of receiving support from close friends and different perspectives on life and other existential questions. Discussion: The result has been discussed in the basis of Katie Eriksson´s Caritative theory, which aims to understand and relieving suffering. Breast cancer can produce carious forms of unique suffering that the nurse should consider in the care.

There appears to be a growing body of literature focusing on PTSD and HIV-related PTSD (the diagnosis of HIV being the significant traumatic event) amongst HIV-positive samples, but only a few African studies that attempt to estimate the prevalence of PTSD amongst HIV-positive people, and even fewer that attempt to estimate the prevalence of HIV-related PTSD. The systemic review presented in this study is currently fully inclusive and is the most up-to-date available. Estimates of the prevalence of PTSD and HIV-related PTSD in South Africa range from 0.7 to 54.1% and, 4.2 to 40% respectively. The current cross-sectional study made use of a mixed-method approach to investigate traumatic life events, PTSD and HIV-related PTSD within a primary health-care centre in KwaZulu-Natal. The quantitative sample consisted of 159 adults (18-50 years) who were compliant on ARV medication. Using the CIDI-PTSD module, the adapted CIDI-PTSD module for HIV, and IES-R, findings indicated that 62% had reported some kind of traumatic event in their lifetime, with 29.6% of participants meeting the criteria for lifetime PTSD, and 40.9% meeting the criteria for lifetime HIV-related PTSD. Altogether, 57.9% of individuals met the criteria for some form of PTSD (either regular PTSD or HIV-related PTSD), and 12.6% met the criteria for both PTSD and HIV-related PTSD. Of the different categories of traumatic events, interpersonal violence has the highest rate of PTSD, followed by a diagnosis of and living with HIV, and then disaster. Furthermore, the IES-R was compared for its usefulness as a screening measure for PTSD against both the CIDI, but results suggest that it is an inferior screening measure to the PDS. The qualitative study consisted of six participants who were examined using IPA methodology informed by the Ehlers and Clark (2000) Model of trauma. Their experiences revealed experiences of stigma, a number of negative appraisals, negative emotions and coping behaviours. Some of the latter might serve as compensatory mechanisms to avoid negative judgements. Hypervigilance seems to be a feature of ARV-compliance that might confer added vulnerability to PTSD and other anxiety disorders.

Bakgrund: En amputation innebär ett avlägsnade av en kroppsdel. De flesta amputationer utförs i de nedre extremiteterna. I Sverige sker årligen ungefär 2250 amputationer i de nedre extremiteterna. Orsaken till amputation kan vara kärlsjukdomar, diabetes samt trauma. Sjuksköterskan har i sin profession en betydande roll i mötet med patienten. Syfte: Syftet var att beskriva patienters upplevelser efter amputation av nedre extremitet. Metod: En litteraturöversikt genomfördes utifrån Fribergs metodbeskrivning. Tio kvalitativa originalartiklar inhämtades via databaserna PubMed och Cinahl Complete. Primära sökord som användes var amputation, nedre extremitet och livsförändrade händelser med begränsningar såsom engelska och peer reviewed. Resultat: Fyra teman identifierades: Upplevelsen av psykiska och fysiska förändringar, Att uppleva rollförändring och förlust av självständighet, Förändrad kroppsuppfattning och känslan av sårbarhet samt Vägen tillbaka efter amputation. Resultatet visade att patienterna upplevde en förlust av självständighet vilket gav upphov till en känsla av att vara en börda för sin familj. Den fysiska förmågan försämrades vilket bidrog till att de inte kunde ta sig utanför hemmet. Detta resulterade i att de kände sig ensamma och isolerade. Slutsats: Patienter upplevde känslomässig chock och rädsla inför framtiden. Att inte kunna prestera till fullo, bidrog till en känsla av förlust av identitet och självständighet. Vikten av stöd från familj, vänner och vårdpersonal har en central betydelse för återhämtning efter amputation. Amputation innebär att patienten genomgår en övergång till en ny fas i livet, en transition.<br>Background: An amputation implies a removal of a body part. Most amputations transact at the lower extremities. In Sweden approximately 2250 lower extremity amputations are made a year. The causes of amputation may be vascular diseases, diabetes or trauma. The profession of a nurse has a major role in the relation to the patient. Aim: The aim was to investigate patients’ experiences after an amputation of lower extremity. Method: To approach the aim a literature review was performed by the method of Friberg. Ten qualitative original articles were collected by the databases PubMed and Cinahl Complete. Primary keywords were amputation, lower extremity and life change events. Limitations were English and peer reviewed. Results: Four themes were identified: Experience of psychological and physical changes, To experience changes of identity and loss of independents, Changes of self-perceptions and the feeling of being vulnerable and How to recover after an amputation. The result showed that the patients’ experienced a loss of independence which resulted in a feeling of being a burden. The physical ability was impaired and contributed to a feeling of being isolated and lonely. Conclusion: The patients’ experienced emotional shock and a fear for the future. Not being able to perform to the fullest produced a loss of identity and independence. Support from family, friends and healthcare professionals has a central value for the recovery. To be amputated results in a transitioning and a new phase in life.

Bakgrund: Inflammatorisk tarmsjukdom (IBD) är ett samlingsnamn för de kroniska tarmsjukdomarna Crohns sjukdom (CD) och Ulcerös kolit (UK). Det gemensamma för de två sjukdomarna är att de löper i skov med försämringsperioder och långa besvärsfria perioder samt att de drabbar relativt unga personer. Det är viktigt att sjuksköterskan kan stödja dessa individer genom evidensbaserad och personcentrerad vård för att kunna ge en så god omvårdnad som möjligt.  Syfte: Beskriva individers upplevelse av att leva med inflammatorisk tarmsjukdom Metod: En litteraturöversikt valdes som metod. Artikelsökningen genomfördes i databaserna CINAHL Complete och PubMed. De begränsningar som gjordes i databassökningarna var vetenskapliga originalartiklar, skrivna på engelska, genomgått peer-review och publicerade mellan 2009-2019. Totalt inkluderades elva artiklar i resultatet, av dessa var tio artiklar kvalitativa och en var kvantitativ. Resultat: Resultatet visade att individerna upplevde att sjukdomen påverkade deras arbetsliv, sociala liv, känslor och identitet. Deras möte med hälso- och sjukvården påverkade personernas förtroende för vården samt deras vilja att söka vård framöver. Det visades även att personer med inflammatorisk tarmsjukdom genomgick en transitionsperiod efter deras diagnos. Hur personerna upplevde att leva med IBD påverkades av om de för tillfället befann sig i ett skov eller nyligen fått diagnosen. De personer som befann sig i ett skov eller nyligen fått diagnosen hade en övervägande negativ syn.  Diskussion: Resultatet diskuterades utifrån Katie Erikssons teori om lidande och hälsa. Författarna resonerade om individernas negativa påverkan kunde kopplas till stigman av sjukdomen. De diskuterade även angående den långsiktiga påverkan av frånvaron från arbetet och sociala sammanhang. Författarna fann i resultatet att individer med IBD upplevde sjukdomen olika i sin vardag beroende på hur länge de haft sjukdomen och vilken inställning de har gentemot sin IBD. Därmed bör vården anpassas efter de individuella behoven för att säkerställa att insatserna främjar hälsan.<br>Background: Inflammatory bowel disease (IBD) is a chronic illness that includes Crohn´s disease (CD) and ulcerative colitis (UK). Both diseases have in common that they have relapse and periods with improvement. The diseases effects relatively young people. It is important that the nurse can support these individuals through evidence based and person-centred care in order to provide the best possible care. Aim: Describe individuals experiences of living with inflammatory bowel disease  Method: A literature review was chosen as the method. The article search was carried out in the databases CINAHL complete and PubMed. The limitations made in the database searches were scientific original articles, written in English, peer-reviewed and published over the last ten years. A total of eleven articles was included in the result, of which ten were of qualitative design and one was quantitative design. Results: The results showed that the individuals experienced that the disease affected their working life, social life, feelings and identity. Their meeting with healthcare services affected their trust in the care and their willingness to seek care in the future. It was also shown that people with inflammatory bowel disease underwent a transition period after the diagnosis. How the individuals experienced living with IBD was affected by whether they were relapsing or in remission. People currently in a relapse had a more negative view of the disease.  Discussion: The result was discussed based on Katie Eriksson´s theory of suffering and health. The authors reasoned if the negative impact of the individuals could be linked to the stigma and shame of the disease. They also discussed the long-term impact of the absence from work and social activities. The authors found in the results that individuals with IBD experienced the disease differently in their daily lives depending on how long they had the disease and what attitude they had towards their IBD. The care should be adapted to the individual needs to ensure that the efforts promotes health.

Bakgrund: Diabetes typ 2 har utvecklats till en global folksjukdom och utgör cirka 90 % av all diabetes. Kända orsaker till att insjukna i T2D är ärftlighet, ålder och dåliga levnadsvanor. En stor del av behandlingen består av egenvård och patienten har eget ansvar över sin sjukdom. För att kunna utföra egenvård på rätt sätt krävs det att patienter har kunskap om hur kost, motion och andra faktorer påverkar deras blodsockernivåer. Utmaningar och svårigheter som patienter upplever vid utförande av egenvård kommer att styra deras behov av kunskap samt stöd och därför är det viktigt att som sjuksköterska ha en förståelse om detta.   Syfte: Denna studies syfte var att beskriva patienter med diabetes typ 2 upplevelser av sin egenvård.  Metod: Systematisk litteraturöversikt som utgick från 14 vetenskapliga studier med kvalitativ ansats. Den analysmetod som användes var innehållsanalys. Resultat: Tre kategorier och 7 subkategorier kunde synliggöras. De tre kategorierna var Upplevelser av inre faktorer som hindrar genomförandet av egenvård, Upplevelser av inre faktorer som främjar genomförandet av egenvård samt Upplevelser av yttre faktorer som påverkar genomförandet av egenvård.  Konklusion: För att kunna erbjuda personcentrerad vård måste sjuksköterskan ha en förståelse för de hinder som patienter upplever vid utförandet av egenvård. Resultatet i denna studie visade att många patienter saknade kunskap om kosthållning och motion vilket inverkade negativt på deras sjukdomshantering. Patienter upplevde även utmaningar i att hantera de känslor som var vanligt förekommande samt de utökade krav som sjukdomen bidrog till. Faktorer som främjade genomförandet av egenvård var motivation, självinsikt samt acceptans och patienter upplevde att omgivningen hade en stor påverkan på deras förmåga att göra livsstilsförändringar. I och med komplexiteten på sjukdomen är det viktigt att behandlingen utformas och anpassas efter varje patients individuella behov och önskemål.<br>Background: Type 2 diabetes has developed into a global public disease and may account for about 90 percent for all diagnosed cases of diabetes. Known causes of T2D disease are heredity, older age and unhealthy lifestyle behaviors. Self-management is an important part of diabetes treatment and the patients have a responsibility over their illness. To be able to manage self-care in the right way requires that patients have knowledge about how diet, exercise and other factors affect their blood sugar levels. The challenges and difficulties that patients experience while managing self-care will control their need for knowledge and support and that is why it is important for nurses to have an understanding of these issues. Aim: The aim of this study was to describe how patients with type 2 diabetes experience their self-management.  Method: Systematic literature review based on 14 scientific studies with a qualitative approach. The analysis method used was content analysis. Result: Three categories and seven subcategories were identified and presented in this study. The three categories were Experiences of internal factors that hinder the implementation of self-care, Experiences of internal factors that promote the implementation of self-care and Experiences of external factors that affect the implementation of self-care.   Conclusion: To be able to offer patient centered care nurses need an understanding of the obstacles that patients experience when practicing self-care. The result of this study showed that a lot of patients lacked knowledge about nutrition and physical exercise which had a negative effect on their self-management behaviors. Patients also experienced challenges in dealing with common emotions and the increase of requirements that came along with the disease. Supporting factors that promoted self-care were motivation, self-perception and acceptance and patients experienced that the social environment had a major impact on their ability to make lifestyle changes. As a result of the complexity of the disease it is important that treatment is designed and adapted to every patient’s individual needs and wishes.

This study examines the effects of hope and mindfulness on the relationship between life experiences and resilience, as well as the direct relationships among these constructs. Participants were 537 undergraduates who were taking online courses at Texas A&M University. Most participants were traditionally-aged and female. Quantitative self-report measures for each construct were administered online via SurveyMonkey. The small, positive relationship between life events and resilience approached, but did not reach, statistical significance, and hope but not mindfulness was found to moderate this relationship. Correlations were significant, positive, and linear between resilience and hope (r = .57, p < .01), resilience and mindfulness (r = .50, p less than .01), and hope and mindfulness (r = .44, p less than .01). Suggestions for clinical interventions aimed at increasing resilience by increasing hope and mindfulness are provided

M.Cur.<br>Who am I? What am I doing here? What is the purpose of life? What is real? Individuals are intent on trying to find an answer to their questions about life, yet many may find that they remain in a quagmire of confusion and vacillating inner torment. In their own lives many individuals deal with pain, guilt and death, each having their own share of suffering where they may either withdraw into their own world or attempt to take from it whatever bit of happiness and pleasure they can, which often leaves them with a feeling of emptiness, futility and despair. What is it aU for? What is life about? According to what Waltos and Waltos (2002:16) have termed "a conscious revolution", individuals have entered an age of responsibility and empowerment. In both human life and healthcare this translates to individuals being more willing to take charge of their lives as well as responsibility for their overall health. Frankl (1984:15) posits mental health and stability to be dependent upon an individual's ability to perceive meaning. This quest for meaning is one of the greatest challenges facing individuals, families and nations (Wong & Fry, 1998:406). At certain points in life, everyone has questioned what sustains their being and what makes life worth living. With a focus on the family, the researcher to this study noticed that the first crack in many famUy structures developed during pregnancy, birth and parenthood due to an inability of the parents to communicate their differing views and perspectives of their reality. Consequently, this resulted in self-expression becoming compromised and inhibited, resulting in inner confusion and turmoil. Parenthood also brings about personal challenges of coping and making meaning out of life circumstances. This breakdown in relationships impacts on individuals' and families' ability to develop and grow holistically, with consequent negative ripple effects on family dynamics and structure. Such discord and disharmony further cascades out to include community and the work environment.

碩士<br>國立臺北護理健康大學<br>生死與健康心理諮商系<br>103<br>Qualitative Research of Cancer Patients’ Life Experiences Regarding the Impacts of Cancer Events--An example for Colorectal Cancer Mei-Yu Chan Abstract Background: Colorectal cancer, which is increasing every year, has accounted for the largest number of cancer cases. According to Taiwan Cancer Registry Annual Report in 2012, colorectal cancer contributed 15.48% of all cancer cases, and accounted for 11.75% of total cancer deaths. Meanwhile, it is the third cause of death among men and women. Patients with cancer, aside from dealing with physical pain and stress during treatment, also grapple with latent issues like threat of death, fear for death, meaning of life and existential choices. Therefore, they may be burdened with psychological and spiritual worries, which results in emotional disturbances like depression, anxiety or even suicidal ideation in the process of treatment and course of illness. This study aims to understand patients’ change regarding attitudes towards death, meaning of life and existential concerns in the trajectory of cancer. Method：This study was conducted with in-depth interviews and hermeneutic phenomenological analysis. The data resources of this study came from the cancer experiences of four colorectal cancer patients. Findings: (1) Cancer surgery caused damage to their body functions, lifestyle and eating habits that must be adjusted. Early cancer diagnosis brings emotional impact to face the choice of treatment of diseases, and great help from case managers is important. The patents suffer from chemotherapy pain, frequency, uncertainty and a strong wish to die, but they just want to escape the pain of the body instead of end their lives in reality. (2)Cancer experiences awake the awareness of death and begin to pay attention to realize the impermanence of life. Death is a natural life process, but the individual's religion certainly provide comfort. (3)After the patient feel life is limited, cherishing life become important, and the meaning of life is more significant. Family, friends, love and care, as well as personal life are the support power during illness. Conclusion: The experience of cancer patients is ongoing and multi-faceted nature, meaning patients have to learn to receive reality and change their minds to create a new life through service to others to feel life value and meaning of their own existence. Care of cancer patients to explore life and death problems are important issues. Keyword：Attitude of death, cancer patients, colorectal cancer, hermeneutic phenomenology, life experiences, meaning of life

The purpose of this study was to explore the life experiences of multiparous teenage mothers at selected communities in the Eastern Cape Province. The population for this study was pregnant teenage mothers aged 12-18 years having at least one previous pregnancy, living in the catchment areas of the provincial hospital of Bizana in the Alfred Nzo District of the Eastern Cape Province. Data were collected through 12 semi-structured individual interviews using a selfdeveloped interview schedule. The transcribed interviews were analysed by means of thematic analysis, using the five stages according to Terre Blanche, et al. (2006), namely familiarisation, inducing themes, coding, elaboration, and checking. Subcategories were grouped into 12 categories and five main themes. Findings on the life experiences of the multiparous teenage mothers are described according to the main themes, namely the everyday life of the teenage mothers, cultural practices leading to pregnancies, factors contributing to pregnancies, challenges experienced by teenage mothers, and messages from the teenage mothers. Recommendations focus on the role of social services to engage the multidisciplinary team and the community to assist in the empowerment of young mothers to break the cycle of multiparous teenage pregnancies and the negative impact thereof on the lives of young mothers.<br>Health Studies<br>M. P. H.

A Research Report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements of the PhD degree. Johannesburg 2014<br>The current study investigates the relationship between stressful life events, personality profile, dissociative experiences, attachment styles and the types of crimes committed among 100 mentally ill offenders and 100 criminal offenders in the South African context. It is motivated by the fact that there are no studies in South Africa comparing forensic patients and criminal offenders and the various factors that may lead to criminal behaviour, and how these may present in terms of the type and/or nature of offences committed. Instead, there is a growing emphasis on observation of patients and assessments for fitness and competence to stand trial with very little focus on understanding the mentally ill offenders and criminal offenders. This study aims to improve the understanding and knowledge with regards to the presentation of each of these groups under study and also to investigate possible differences in the types of crimes committed. It aims to assess possible correlations between the variables of the study (stressful life events, personality profiles, dissociative experiences, attachment styles and the types of crimes). It further aims to inform future treatment interventions in the forensic setting and to offer possible prevention models for the community setting. The study hypothesises that there are no differences between the mentally ill offenders and criminal offenders with regards to stressful life events, personality profile, dissociative experiences, attachment styles and the types of crimes committed. Ethical clearance was obtained from the Committee for Research on Human Subjects of the University of Witwatersrand‟s medical school. The sample size of this study consists of 200 participants (156 males and 54 females). Convenience sampling was used, where 100 mentally ill offenders admitted at the Sterkfontein Psychiatric Hospital and 100 criminal offenders, incarcerated at the Johannesburg Correctional Services in the Johannesburg area at the time of data collection, were involved in the study. The mentally ill offenders from Sterkfontein Psychiatric Hospital were interviewed at the hospital and the criminal offenders from Correctional Services were interviewed in their respective prisons without the presence of a prison guard. Participants‟ ages ranged from 18 years to 60 years. Those people who were not willing to participate were not included in the study. The Biographical details questionnaire, Social Readjustment Rating Scale (SRRS), Stressful Life Events Screening Questionnaire (SLESQ), Multiphasic Minnesota Personality Inventory – II (MMPI-II), Dissociative Experience Scale (DES) and Attachment Styles Questionnaire (ASQ) were administered to the participants of the study as a means of gathering information regarding the variables under study. The types of crimes and diagnoses were obtained from the records. The study attempted to ascertain whether there were any associations, and whether predictions could be made for possible future assessments and treatment strategies. It is a quasi-experimental design with “diagnosis” as the between-participants factor. Independent variables of the study were the type of offender, i.e. mentally ill/clinical/forensic patient offender and criminal offenders, as well as the types of crimes, i.e. violent or non-violent crime. The dependent variables were stressful life events. These variables were measured in terms of low risk to illness, moderate risk and high risk to illness; personality profile; dissociative experiences, measured as either low levels or high levels of dissociation and attachment styles (secure, fearful avoidant, ambivalent and preoccupied attachment styles). The confounding variables were substance abuse, medication and comorbid diagnoses. Descriptive statistics and the discriminant function analysis were performed. Box M was also performed to test the null hypothesis that the covariance matrices did not differ between groups formed by the dependent variables. The Chi Square test for independence was also used to determine whether associations existed between two nominally categorical variables. The results of the study indicated that there were only four female participants in the clinical offender group. A high number of research participants were single in both the criminal (72%) and clinical (80%) offender groups. Furthermore, the majority of the participants in the study were Black, where 93% in the criminal offender group and 75% in the clinical offender group. 65% of the participants in the criminal offender group and 85% in the clinical offender group had no tertiary education. There was evidence that clinical offenders tended to commit more violent crimes (83%), while criminal offenders committed more non-violent (61%) and “other” crimes (21%). 91% of criminal offenders reported homelessness compared to clinical offenders (22%). The Dissociative Experience Scale was statistically significant, suggesting that dissociative experiences were a strong determinant of whether one is deemed a criminal or clinical offender. High levels of stress were correlated with higher incidents of criminal behaviour. In contrast to the literature review, past childhood trauma was not statistically significant in the current study. Clinical offenders reported more psychological problems. When ANOVA‟s were performed, psychological difficulties such as depression, anger, antisocial practices, low self-esteem, psychasthenia and family problems were statistically significant, suggesting that these variables were strong determinants for the likelihood of criminal offending. Dismissive and Fearful attachment styles were statistically significant. In conclusion, dissociative experiences, social re-adjustment, psychological pathology and both dismissive and fearful attachment styles were strong determinants of offending behaviour.

No<br>Despite advances in technology and medicine, death itself remains an immutable certainty. Indeed, the acceptance and understanding of our mortality are among the enduring metaphysical challenges that have confronted human beings from the beginning of time. How have we sought to cope with the inevitability of our mortality? How do various cultural and social representations of mortality shape and influence the way in which we understand and approach death? To what extent do personal beliefs and convictions about the meaning of life or the notion of an afterlife affect how we perceive and experience the process of death and dying? Steve Paulson, executive producer and host of To the Best of Our Knowledge, moderated a discussion on death, dying, and what lies beyond that included psychologist Lani Leary, professor of philosophy and religion Jeffrey J. Kripal, and sociologist Allan Kellehear. The following is an edited transcript of the discussion that occurred February 5, 7:00-8:30 pm, at the New York Academy of Sciences in New York City.

Variables predicting the effects of surgery in patients with low back pain Abstract The theoretical part of the thesis summarizes the knowledge about pain and its types, especially chronic pain. Than we focus on low back pain and currently used approaches in the treatment of this syndrome. In this work we summarize the influence of central sensitization and adverse life experineces and posttraumatic stress disorder on pain (especially low back pain). In the practical part, we investigated the effect of central sensitization and adverse life events and posttraumatic stress disroder on the effect of spinal surgery in low back region. The results were obtained using Central Sensitization Inventory (CSI), PTSD Cecklist dor DSM-5 (PCL- 5) a Life Event Checklist (LEC-5 Standard), Short Form 36 Helth Survey Questionnaire (SF- 36), NASS Lumbar Spine Questionnaire. The obtained data were statistically evaluated and processed. Higher scores of CSI and LEC-5 (more adverse life events) were both statistically significantly correlated with worse low back surgery outcomes. At the same time, a statistically significant relationship between PCL-5 (checklist of PTSD symptoms) and CSI was confirmed. Keywords Pain, central sensitization, adverse life experiences, adverse life events, PTSD, posttraumatic stress disorder,...

Dissertação de mestrado integrado em Psicologia (área de especialização em Psicologia Clínica)<br>Uma revisão da investigação empírica no domínio da psicoterapia revela que o terapeuta exerce um efeito superior no processo terapêutico em comparação com os métodos terapêuticos (Wampold, 2001). No entanto, verifica-se uma quantidade menor de estudos sobre a pessoa do terapeuta comparativamente com os que se baseiam no processo terapêutico. Implicitamente, a profissão de psicoterapeuta implica o contacto e trabalho com clientes que tenham experimentado experiências potencialmente traumáticas. Apesar das investigações se centrarem no impacto negativo da psicoterapia no terapeuta, existem alguns indícios que as reacções do terapeuta perante histórias potenciais de trauma podem contribuir para o progresso terapêutico (Peebles-Kleiger, 1989, citado em Arnold et al., 2005). Ainda, a metáfora de curadorferido (Guy, 1987 citado por Farber, Manevich, Metzger & Saypol, 2005) é atribuída ao terapeuta e considera que indivíduos que escolhem esta profissão ultrapassaram experiências potencialmente traumáticas. O crescimento pós-traumático caracteriza-se como um processo que ocorre após a incidência de uma experiência potencialmente traumática, em que o indivíduo que experimentou esta qualidade de experiência percepciona alterações benéficas na sua vida. Este processo tem sido associado aos modelos pragmáticos da sabedoria. O estudo do conceito de sabedoria é relativamente recente no âmbito da psicologia. A conceptualização da sabedoria pessoal de Webster (2003) fundamenta-se no estudo de cinco qualidades ou dimensões: regulação emocional, reflexividade, abertura à experiência, humor e experiências críticas. O objectivo do estudo desta dissertação de mestrado consistiu em avaliar o impacto da experiência profissional e da exposição aos acontecimentos de vida potencialmente traumáticos na sabedoria pessoal dos psicoterapeutas. Portanto, neste estudo participaram 53 psicólogos que constituíram dois grupos que se distinguem ao nível da experiência profissional: um grupo sem experiência profissional, isto é, estagiários de psicologia e o grupo com experiência profissional, mais especificamente, psicoterapeutas com um nível de experiência profissional equivalente ou superior a dez anos. Os resultados indicam que existe uma relação estatisticamente significativa entre a sabedoria pessoal e a experiência profissional e exposição aos acontecimentos de vida. Mais especificamente verificou-se uma correlação com significado estatístico entre a experiência profissional e três dimensões da sabedoria pessoal: abertura à experiência, experiências críticas e regulação emocional. Verificou-se também uma correlação com significado estatístico entre a exposição aos acontecimentos de vida e duas dimensões da sabedoria pessoal: abertura à experiência e experiências críticas.<br>A review of the empirical investigation in the field of psychotherapy reveals that the therapist exerts a greater effect on the therapeutic process compared to the therapeutic methods (Wampold, 2001). However, there are relatively fewer studies based on the person of the therapist than those based on the therapeutic process. Implicitly, the profession of psychotherapist involves contact and work with clients that have experienced potentially traumatic experiences. Even though studies have focused on the negative impact of psychotherapy on the therapist, there is evidence that the reactions of the therapist to potentially traumatic stories can contribute to therapeutic progress (Peebles-Kleiger, 1989, cited in Arnold et al., 2005). Also, the metaphor of wounded healer is assigned to the therapist, which considers individuals that choose this profession as having overcome potentially traumatic experiences. Post traumatic growth is defined as a process that occurs after a potentially traumatic experience, in which the individual that overcomes this type of experience perceives positive changes in his/her life. This process has been associated with some conceptualizations of wisdom, namely pragmatic models of wisdom. In the field of psychology, the study of the concept of wisdom is relatively recent. The concept of personal wisdom according to Webster (2003) is based on the study of five qualities or dimensions: emotion regulation, reflexivity, openness to experience, humor and critical experiences. The goal of this study consisted in evaluating the impact of the professional experience in psychotherapy and the exposure to potentially traumatic life events on personal wisdom of psychotherapists. Thus, this study included 53 participants that comprised two groups that differed at the level of professional experience: one group without professional experience in psychotherapy, specifically, psychology interns and a second group of psychotherapists with 10 or more years of professional experience. The results indicate that there is a positive statistical relation between personal wisdom and professional experience and exposure to life events. Specifically, a significant relation was found between professional experience and three dimensions of personal wisdom: openness to experience, critical experiences and emotion regulation. Also, a significant relation was found between exposure to life events and two dimensions of personal wisdom: openness to experience and critical experiences.

HIV and AIDS related deaths have left numerous children heading households as the number of adults dying from this pandemic increased significantly. The goal of this study was to gain an in-depth understanding of the experiences, challenges and coping resources of AIDS-orphans heading households in an urban area in Free State using a qualitative study. The research revealed that the level of suffering faced by these children began with their parents’ illness. This was further worsened by the death of the parents. These children are in most instances not absorbed by their extended families as the traditional safety nets are stretched to their limits. Children heading households were forced to take up adult responsibilities prematurely and as such encounter challenges on daily basis. The study concluded that the child headed families are a reality in South Africa and need lots of support from the government and local communities.<br>Social Work<br>M.A. (Social Work)

Text in English<br>Even though the prevalence of HIV has declined, South Africa continues to have a large number of people who are infected with HIV. Most communities still have to deal with the effects of HIV and AIDS on orphans and vulnerable children. One way of mitigating the effects of HIV and AIDS is strengthening families and communities to provide stable care to orphans. However, most families do not have the capacity to provide sufficient care to orphans hence the need for external support from the community and civil society organisations, in this instance provided through the loveLife goGogetter programme. The findings proved that the goGogetters relied on the support they received through the relationships and networks established in the community to enable them to provide effective service to orphans. The study demonstrated the importance of community networks in providing for the basic needs of orphans.<br>Social Work<br>M.A. (Social Behaviour Studies in HIV/AIDS)