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Syrén, Susanne. "Det outsagda och ohörsammade lidandet : Tillvaron för personer med långvarig psykossjukdom och deras närstående." Doctoral thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap, HV, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:vxu:diva-7360.
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Syrén, Susanne (2010). Det outsagda och ohörsammade lidandet. Tillvaron för personer med långvarig psykossjukdom och deras närstående (Being in the world with long term psychotic illness – the unspoken and unheard suffering), Linnaeus University Dissertations No 6/2010. ISBN: 978-91-86491-07-9. Written in Swedish with a summary in English. Aim: The overall aim of the thesis was to describe the lived experience of being in the world with long term psychotic illness. This is described from three perspectives; the perspective of persons diagnosed with long term psychotic disorder; the perspective of their relatives; and a family perspective. Method: Three studies were conducted guided by a reflective lifeworld approach grounded in phenomenology. The data were generated through individual, group, and family interviews. Data were analyzed for essential meanings of being in the world. Results: Persons with long term psychotic illness live in a borderland of paradoxes between the usual and unusual. For the ill persons the existence is incomprehensible and defenceless with feelings of not being at home in the body and in the world. They search for themselves in a care context that is contradictory, simultaneously good and hostile. These experiences are mostly unspoken, a struggle with doubts about having health or illness, what is good or evil, and about being usual or unusual. The relatives exist in a dilemma of the possible and impossible, a continual infinite struggle. Co-existing with their ill family member is a communion and a longing for togetherness is prominent. Relatives struggle with responsibilities for themselves and for their ill family member. In these unheard struggles the relatives yearn for participation in the formal care context. Family interviews with persons with long term psychotic illness and their relatives revealed a co-existence hovering between chaos and boredom while striving for a peaceful and quiet life. Thefamilies search for constancy and predictability in the presence of incomprehensible and threatening dangers. The experience of being a We balances the unshared meanings of being in the world and the loss of being able to experience and do things together. The experience of being a We keeps their individual existence and co- existence from falling apart.Conclusion: Persons with long term psychotic illness and their relatives have to withstand extensive existential suffering, which is unspoken and unheard. Formal caring should be existential caring, supporting the ill person’s comprehensibility and understanding of life, and feelings and experiences of being at home. Further, relatives should be acknowledged both as persons and carers and invited to participate in formal care. These results also point to the importance of strengthening feelings of togetherness and of being a We through systemic oriented existential conversations, where the ill person, their relative and a formal carer converse together.
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Tang, Yee-man, and 鄧綺汶. "Determinants of long-term outcome in psychotic disorders: a 13-year prospective study." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B49617771.
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Motivations
The growing interest in the investigation of longitudinal course and outcome of psychotic disorders grew from the Kraepelinian view of schizophrenia, which was considered a disease with progressive downhill course. With emerging evidence-based findings suggesting outcome heterogeneity, prospective studies have strived to identify factors influencing the course and outcome. The paucity of prospective long-term studies has prevented us from knowing the enduring impacts of predictors.
Using a prospective cohort of 153 psychosis patients, the study aimed to determine the outcome of global functioning, remission, functional recovery, and recovery at 13 years following the first-episode psychosis. Prognostic values of a range of baseline and early outcome predictors were examined. Specific research interests included the explorations of the enduring impact of duration of untreated psychosis (DUP), the longitudinal relationship between neurocognition and functional outcome, and the added predictive ability of early outcome predictors.
Methods
This study attempted to follow up the 153 patients at 13 years following their first episode onset of psychosis. Prior investigations collected a comprehensive profile of demographics, premorbid adjustment, clinical symptoms, and neurcognition at baseline. Early outcomes at 3 years including remission, relapse, primary negative symptoms, and unemployment were also ascertained. In this current investigation, living subjects were invited to an interview in order to assess their outcomes of global functioning, remission, functional recovery, and recovery at 13 years. Appropriate regression models were applied to identify predictors of long-term outcomes. Standardized mortality ratios (SMRs) for all-cause mortality and suicide were also determined.
Results
Ninety-six patients were successfully interviewed. Their mean (s.d.) score of global functioning was 64.3 (16.5). Considerable proportions of patients fulfilled criteria for remission (47%), functional recovery (33%), and recovery (16%) at 13 years. Higher level of global functioning was predicted by a married status at study entry and being in remission and employed at 3 years. Remission was predicted by a shorter DUP and better premorbid social adjustment. Functional recovery was predicted by better premorbid social adjustment, better baseline visual memory, and being employed at 3 years. No baseline and early outcome predictors of recovery could be identified. Addition of early outcome predictors significantly increased the variance explained for global functioning and improved model discrimination between patients who had functional recovery and those who had not. SMRs for all-cause mortality and suicide were 6.07 and 24.80, respectively.
Discussion
A prolonged DUP may intensify the progression of negative symptoms and lead to less likelihood of remission. The study has confirmed the enduring adverse impact of DUP but its reversibility is still in doubt. As the significance of visual memory in functional outcome has not received consistent support from literature, more prospective long-term studies are in need to re-examine the relationship. Early outcome predictors appear to be more relevant to functional outcome than clinical outcome.
Discussion
A prolonged DUP may intensify the progression of negative symptoms and lead to less likelihood of remission. The study has confirmed the enduring adverse impact of DUP but its reversibility is still in doubt. As the significance of visual memory in functional outcome has not received consistent support from literature, more prospective long-term studies are in need to re-examine the relationship. Early outcome predictors appear to be more relevant to functional outcome than clinical outcome.published_or_final_version
Psychiatry
Doctoral
Doctor of Philosophy
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Brassington, Linsay. "Better living with illness : transdiagnostic approaches to psychological interventions for people with chronic illness." Thesis, University of Edinburgh, 2015. http://hdl.handle.net/1842/20955.
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Objective: Chronic physical health problems are on the rise. Psychological interventions can play a role in helping people cope with the challenges that long term physical conditions brings. This thesis systematically reviewed the literature for group psychological interventions. Following this, an Acceptance and Commitment Therapy group intervention for people living with a range of long term physical conditions was designed and evaluated. Methods: Key databases were searched for relevant randomized-controlled studies. Papers that met inclusion criteria were quality assessed, and a meta-analysis was conducted. Participants with chronic physical health conditions were invited to an Acceptance and Commitment Therapy group (n=53). Measures were completed at assessment, pre, post and 3-month follow-up. These assessed anxiety and depression symptoms, health perceptions, values-based living and psychological flexibility. Assessment to pre-intervention served as a within-participant control. Results: 22 relevant studies were retrieved, with 18 rated as acceptable or high quality and 14 included in a meta-analysis. The majority of studies reported interventions as efficacious at reducing mental health problems, though effect sizes were weaker when compared to active controls such as education. In the Acceptance and Commitment therapy group, depression and anxiety symptoms reduced significantly from pre to post, compared to control period. Conclusions: Group psychological interventions may be beneficial for people with physical health problems. In particular, group-based ACT interventions may be effective with this population and can be delivered transdiagnostically for a range of physical conditions.
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Carter, Michael FitzGerald. "The self-reported needs of people with a long-term mental illness." Thesis, Bangor University, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.342575.
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Jarbin, Håkan. "Long-term Outcome, Suicidal behaviour, Quality of Life and Expressed Emotion in Adolescent Onset Psychotic Disorders." Doctoral thesis, Uppsala University, Department of Neuroscience, 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3341.
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This study investigated a consecutive cohort of 88 youngsters with onset of a psychotic disorder at age 15.7 (sd 1.5) years and followed-up 10.6 (sd 3.6) years after first admission at the age of 26.5 (sd 3.7) years. A subsample of 15 subjects were assessed with the Five Minute Speech Sample for measuring Expressed Emotion and subsequent recording of relapses during a two year period.
A diagnostic split between schizophrenia spectrum psychosis and affective psychotic disorder was usually stable over time. The main diagnostic shift was an influx to schizophrenia spectrum disorder of subjects with a better premorbid function and less insidious onset as compared to those with a stable schizophrenia diagnosis.
Early onset schizophrenia spectrum disorder usually had a poor functional outcome. Most subjects needed support in the form of a disability pension. Early onset affective psychotic disorder usually had a good functional outcome. Most subjects worked and enjoyed regular friendships. The functional level before onset of illness was the best predictor of future functional level in psychotic disorders. A family history of non-affective psychosis predicted a worse function in schizophrenia. Frequent episodes and low intelligence predicted a worse function in affective disorders.
Four men (4.5% of the sample) committed suicide. The risk of suicide was increased about 30 times. Almost a third of subjects attempted suicide. Females made more attempts. Suicide attempts were related to more depressive symptoms but less negative symptoms at first episode, to readmissions and to dependence on nicotine.
Subjects with schizophrenia spectrum psychoses were less satisfied with life than those with affective psychotic disorder. Subjective satisfaction in schizophrenia was strongly associated to depressive mood while in affective disorders it was associated to degree of employment.
Adolescents with psychosis in families rated high or borderline high in Expressed Emotion either during first episode or after discharge had an increased risk of relapse.
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Jarbin, Håkan. "Long-term outcome, suicidal behaviour, quality of life and expressed emotion in adolescent onset psychotic disorders /." Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3341.
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McCutcheon, Helen H. I. "The long term effects of attendance at child care on childhood respiratory illness /." Title page, table of contents and summary only, 1993. http://web4.library.adelaide.edu.au/theses/09MPM/09mpmm133.pdf.
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Walker, Matthew S. "Exploring stigmatizing attitudes toward mental illness in a midwestern long-term care facility." Thesis, Blessing-Rieman College of Nursing, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=1561036.
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The purpose of this study is to assess the attitudes towards individuals with mental illness among the healthcare providers of a long-term care facility. It takes a quantitative, non-experimental, cross-sectional, descriptive approach to view relationships. Minimal research exists in this subject matter, and literature reviews suggest that negative attitudes toward mental illness exist among healthcare providers (Ahmead et al., 2010; Aydin et al., 2003; Bjorkman et al., 2008; Rao et al., 2008; Reed & Fitzgerald, 2005; Ucok, 2008; Ross & Goldner, 2009; Smith et al., 2011; Zolnierek & Clingerman, 2012). The Community Attitudes toward the Mentally Ill (CAMI) questionnaire was given to a sample of 51 long-term care employees. Data was analyzed by using the IBM Statistical Package for the Social Sciences (SPSS) version 20.0, focusing on significant results concerning t-test, chi-square, and correlations in order to answer the research questions. Findings suggest a majority of the employee's attitudes in this long-term care facility were nonauthoritarian, nonsocial restrictive, and nonbenevolent. While there was no significant empirical support for differences in attitudes among RNs, LPNs, and CNAs, certain questions on the CAMI did provide significant results. Related to this there was also no empirical evidence for differences among the attitudes of departments, except when individual analysis of each question was complete. Correlational analysis showed relationships between various variables: education and seeking treatment for oneself, race and previous work experience, department and previous work experience, authoritarian views and gender, authoritarian views and education, nonsocial restrictive view and age, community mental health ideology and age, and community mental health ideology and department. Implications on future research and a discussion of recommendations to further decrease stigma in the long-term care environment are completed.
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Howarth, Anastassia. "Development and evaluation of a brief mindfulness-based intervention for long-term illness." Thesis, St George's, University of London, 2018. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.754062.
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BACKGROUND: According to the World Health Organization, long-term illness will account for almost three-quarters of global deaths by 2020. Evidence supports the use of both self-management and mindfulness-based interventions (MBIs) for those who live with long-term illness. While this research is promising, a major barrier with traditional MBIs is the amount of time they require (eight weeks) and the necessity of a trained specialist. OBJECTIVE: The aim of this thesis is to develop and evaluate a brief MBI for those with long-term illness, through a literature review, a qualitative study and a pilot study. METHODS: A systematic review of studies using brief MBIs for health-related outcomes was the initial stage. This provided a basis for a qualitative study, which was conducted to assess views of long-term illness patients (i.e., persistent pain, chronic obstructive pulmonary disease, cardiovascular disease) on the acceptability of a brief (10 minute) MBI, to define population suitability and to refine delivery and assessment. A pilot randomised controlled trial (RCT), informed by results from the first study, was then conducted with persistent pain patients. A brief mindfulness body scan audio was compared to an active control and immediate effects of the intervention were assessed with brief measures for perceived pain severity, distress and distraction. Feasibility of a definitive RCT was assessed in relation to recruitment and retention rates. At baseline, one week and one month, assessments included: mindfulness, anxiety, depression, health-related quality of life, pain catastrophizing, pain self-efficacy, activities of daily living limitations, and ratings o f‘usefulness’ and ‘likelihood to recommend’ the intervention. RESULTS: The review identified 71 eligible studies of brief MBIs, including 70 RCTs. Sixty-seven studies observed a positive effect on at least one health related outcome. There was high heterogeneity for both types of MBI and health-related outcomes and low use of clinical populations. Results from the qualitative study, with 14 patients, suggested that a brief MBI audio was acceptable and was most suited to a persistent pain population. Patients tended to prefer an MBI of 15 minutes rather than 10 minutes. In the pilot study of a 15 minute MBI audio, of 220 patients referred, 147 were randomised and 71 completed all assessments. There were no significant immediate effects of the MBI, although there was a tendency for a marked improvement in both groups. Significant effects were found for ‘usefulness’ at one week and self-efficacy at one month in the MBI group compared with the control. Levels of recruitment were acceptable and attrition rates were high. CONCLUSIONS: The findings of the systematic review demonstrate that brief MBIs can have a positive impact on a range of health-related outcomes and that further studies are required, especially with clinical populations. Qualitative findings confirm the acceptability of a brief MBI, particularly for a persistent pain population. In the pilot study, lack of immediate effects could be due to the potency of the control and a less engaging control needs to be considered. A definitive trial is required in which retention of patients is optimized, for example, by delivering the MBI alongside existing rehabilitative programmes.
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Snell, Marissa. "The Impact of Drop-in Centers on the Long Term Mentally Ill." NSUWorks, 2016. http://nsuworks.nova.edu/cps_stuetd/108.
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Drop-in centers for individuals with serious and persistent mental illness offer a unique and perhaps under-recognized environment option for adjunct treatment. The current study examines and evaluates components thought to be a part of an enriched drop-in center experience that contribute to positive member outcomes through the effects of empowerment. These components include self-help, peer support, and creative expression. Outcomes were evaluated based on quality of life, self-worth, and symptom reduction. Such data are necessary in promoting the growth and development of drop-in centers and identification of components that contribute to positive member outcomes. Participants (n=101) were administered a series of measures including The Multidimensional Scale of Perceived Social Support, The Empowerment Scale, The Rosenberg Self-Esteem Scale, The World Health Organization Quality of Life-BREF, The BASIS-32™, and a series of questions created for the purposes of the current study regarding creative expression and self-help. The psychometric properties of each measure were evaluated and reviewed. Additionally, mean differences between normative data and participant means were examined and demographic data were analyzed. It was hypothesized from the literature that self-help, peer support, and creative expression would have significant indirect effects on all of the proposed outcome variables through the effects of empowerment. Results revealed significant indirect relationships between peer support and all of the outcome variables through the effects of empowerment and between self-help and all of the outcome variables through the effects of empowerment. No significant relationships were found between creative expression and any of the outcome variables through the effects of empowerment. These findings suggest that peer support and self-help may be instrumental in achieving positive outcomes through the effects of empowerment. Centers that offer experiences to enhance self-help and peer support will subsequently enhance feelings of empowerment in members, which relates to higher levels of self-worth, higher levels of quality of life, and lower levels of psychiatric symptomatology. Further implications of such findings and suggestions for continuation of this research are discussed in detail.
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Allbutt, Helen Mary. "The experience of illness and employment among young adults with a long-term condition." Thesis, University of Edinburgh, 2008. http://hdl.handle.net/1842/29242.
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There is little research on how individuals with chronic illness from childhood fare in the labour market as an adult and the perceptions of these groups towards work and career prospects. A qualitative study was undertaken using grounded theory to explore these issues among adults from three disease categories. In total, 30 respondents were interviewed aged between 20-32 years; 10 with cystic fibrosis, 10 with Type 1 diabetes and 10 with arthritis with gender represented equally across the three groups. Respondents had varying degrees of disease severity. There was, however, a consensus among these young adults in how symptoms were experienced and managed. Respondents viewed themselves as competent individuals and their approach to care reflected this standpoint. Management of illness was largely taken-for-granted and perceived only as intrusive by those with deteriorating health. There was some discrepancy between the apparent advice given by health care professionals and decisions made by individuals about illness which were located in the social fabric of day-to-day activities. No specialist careers guidance had been available to these young adults. Career choice was hindered by lack of educational attainment in some cases and restricted employment opportunities in others. Most respondents were not familiar with welfare to work initiatives. At the point of interview, 20 were in full-time jobs, 2 worked part-time, 3 attended higher educational institutions and 5 were out of work receiving full disability-related benefits. Disclosure of health status in employment emerged as a key issue. Half the sample reported having to make some sort of adjustment to manage working lives. The majority of these involved self-care strategies such as buying special adaptations, getting up extra early on work days and making great efforts to accommodate meals into busy schedules. These types of adjustments were seemingly acknowledged by employers.
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Brooks, Helen. "Patient perceptions, experiences and expectations of recovery and prognosis in long-term conditions." Thesis, University of Manchester, 2013. https://www.research.manchester.ac.uk/portal/en/theses/patient-perceptions-experiences-and-expectations-of-recovery-and-prognosis-in-longterm-conditions(ffd083bc-ad64-4fc3-9d22-9050aef29cb4).html.
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Background: Whilst the experience of chronic physical conditions is well documented and has been recognised as relevant for health policy and practice little is known about notions of recovery and prognosis from the point of view of those with long-term physical health conditions. The extent to which people consider the future outcomes of their conditions is relevant to health policy which seeks to engage people in shared decision making, care plans, and self-management. This gap in knowledge about lay perceptions of recovery and prognosis becomes more pronounced when compared with literature from the mental health field in which recovery is one of the dominant foci, is comparatively well researched and in recent years has fed into policy and management approaches.Aims: The aim of the thesis is to explore perceptions of recovery and prognosis with people with long-term physical health conditions and to compare these with perspectives on recovery and prognosis apparent in the mental health field.Methodology: Using qualitative methods, a two phased approach to data collection and analysis was undertaken. Phase 1 used secondary data analysis with two existing datasets to examine whether notions of recovery and prognosis were implicit in narratives about the experience of illness. Phase 2 built on the findings from phase 1 and utilised longitudinal, primary data collection in the form of narrative interviews undertaken at two time points (baseline and 12 month follow-up). The analysis in both phases involved a cross case thematic analysis to look for commonalities and differences across individuals. Data from phase 2 were also subject to a narrative emplotment of individual stories which were used to capture the longitudinal changes in patient perspectives over time.Results: There were similarities with findings from the mental health field (recovery as a complex, nonlinear journey, the input from friends and family, notions of burden and the impact of condition on sense of self). However, there were nuanced differences in relation to physical health conditions which related to expectations about mortality, the experience of time, the extent to which narratives were future oriented and the experience of stigma. The dual focus on mental and physical health recovery proved useful for understanding those experiences of multiple morbidities. The results were used to develop a model of recovery narratives based on two dimensions (expectations and responsibility) which gave rise to four typologies of narratives. The aim of this model was to further highlight and summarise the themes arising from the data analysis.Discussion: The results of this study highlight the importance of understanding notions of recovery and prognosis in order to better understand the experience of illness and self-management. The thesis challenges the blanket use of health promotion strategies for those with and without chronic health conditions and supports a shift in policy focus from improved choice and autonomy to what Mol (2009) refers to as ‘enhanced care’.
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Marshall, Alan. "Developing a methodology for the local estimation and projection of limiting long term illness and disability." Thesis, University of Manchester, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.511749.
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McWilliams, David Joseph. "The role of rehabilitation in improving short and long term outcomes for survivors of critical illness." Thesis, Manchester Metropolitan University, 2018. http://e-space.mmu.ac.uk/621024/.
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This thesis aims to evaluate the role of rehabilitation in improving outcomes for patients admitted to critical care. Patients admitted to critical care experience significant muscle weakness, which when present is associated with prolonged stays in both ICU and hospital and higher mortality levels. Although overall survival rates from critical illness are improving, survivors are often left with significant and ongoing physical, functional and psychological dysfunction. Preventing the physical consequences of critical illness and supporting recovery from intensive care therefore remains a high priority area for critical care practice and research. This thesis presents and critiques 11 peer reviewed publications and 2 national guidelines to demonstrate the role of rehabilitation in improving outcomes. The first 5 papers presented investigate the impact of a novel post ICU rehabilitation programme to improve long term outcomes. This begins with the initial feasibility testing of the programme and demonstrates development of the analysis into a more robust multi-centre trial. The impact of exercise based rehabilitation is evaluated with regards to physical, psychological and quality of life measures. The next 6 papers presented investigate the potential for early rehabilitation which commences in ICU to reduce the negative impact of critical illness and improve patient outcomes. Specifically they evaluate the impact of a structured approach to rehabilitation within critical care, identifying the key components required and potential barriers to implementation. The findings of the papers included in this thesis provide valuable insights to inform future research opportunities and challenges in order to continue to develop the evidence for critical illness rehabilitation and recovery.
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Pinfold, Vanessa Anne. "Community connections : geographies of rehabilitation amongst people with long term and enduring mental health problems in Nottingham." Thesis, University of Nottingham, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.324061.
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Bäckström, Ingegärd. "Att skilja agnarna från vetet : om arbetsrehabilitering av långvarigt sjukskrivna kvinnor och män." Doctoral thesis, Umeå universitet, Institutionen för socialt arbete, 1997. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-65881.
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The subject of the thesis is work-oriented rehabilitation of people on long-term sick-leave. The overall aim of my thesis is to: - analyse work-oriented rehabilitation as a gender theoretical phenomenon. - analyse how this phenomenon is expressed, maintained and changed on a societal, authority and individual level. The specific aims of the different reports were: I) to analyse the collaboration between the different authorities taking part in local rehabilitation groups, the results from these groups, as well as how the clients experienced the groups II) to analyse the situation of these clients some years after completed rehabilitation. III) to analyse gender related differences in rehabilitation. IV) to analyse factors in the rehabilitation process of importance for gender related differences in rehabilitation as well as the attitudes to gender constructions among clients and rehabilitation administrative staff. V) to give a broader context to the study of rehabilitation as gender theoretical, in which work rehabilitation as well as gender are constructed. Both quantitative and qualitative methods were used in the first and second study. Study number three and four used qualitative methods. The fifth study consisted of a literature review on womens work and gender related to illness. The studies of local rehabilitation groups (I, II) revealed that it was more common for male social services workers to formulate concrete decisions regarding work or training for male clients, which can be interpreted as long-term ill men are the first chosen to be helped. The results of the third investigation. Rehabilitation for men?y highlighted the gender related differences in long-term illness and rehabilitation. The rehabilitation staff seemed to adopt a gender-neutral or equality-based position in relation to themselves, their clients and the world around. In spite of that, women were sometimes considered more difficult to rehabilitate because of their responsibility for unpaid work and care in their homes. In the study, "Women's private burden the conceptions of the clients' and rehabilitation staff of the meaning of gender in relation to long-term illness and rehabilitation were divided into three groups. I chose to call the first group androgynous since the interviewees, only men held the position that gender was meaningless. In the second group the meaning of gender was related to the primary responsibility for paid and unpaid work and the division of labour was according to gender. The third group is represented by rehabilitation staff who held the position that gender had meaning on a structural level, in the labour market and in rehabilitation, and the system worked in such a way that women were unfairly treated. The shaping of social insurance is gender-neutral - there are neither men nor women but rather "the insured". But gender neutrality produces paradoxical results since it overlooks the fact that men and women do not live in an equal society. The lack of conformity between ideals and reality is found in, amongst other contexts, services provided for rehabilitation and long-term illness.digitalisering@umu
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Ray, Maureen Georgina. "Continuity and change : sustaining long-term marriage relationships in the context of emerging chronic illness and disability." Thesis, Keele University, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.325863.
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Murphy, Elizabeth T. (Elizabeth Therese). "Between asylum and independence : toward a system of community care for people with long-term mental illness." Thesis, Massachusetts Institute of Technology, 1988. http://hdl.handle.net/1721.1/76004.
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Ullah, Nafeesa. "A 360-degree appraisal of the barriers to medication adherence in paediatric patients with long-term illness." Thesis, University of Brighton, 2017. https://research.brighton.ac.uk/en/studentTheses/4d67ece2-e3a6-4e2c-8eae-5265a65aa0bf.
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Research indicates that paediatric medication adherence in long-term conditions is often sub-optimal and can be affected by a range of developmental, social and family factors. However, little is known about children’s medication-taking experience. The aim of this research was to identify the most common barriers to adherence from the perspective of three different groups: the medicine-taker, the medicine giver and the healthcare professional (HCP). A further aim was to evaluate the role of community pharmacists in supporting paediatric patients with long-term medication needs. Study one conducted a systematic review of seven databases from January 1995 to 2016, yielding 18 studies that used self-report methods to identify barriers to medication adherence in children and adolescent, aged 5-18 years with long-term conditions. The common barriers were a lack of caregiver and healthcare support, medication regimen complexity, forgetfulness, medication side-effects and concerns about medication need and efficacy. Stigma was the only condition-specific adherence barrier for children and adolescents with HIV, all other barriers were uniform across conditions. Study two used a Delphi method with paediatric healthcare professionals (N=23) to prioritise adherence barriers in current clinical practice. Agreement was rated on a 5-point scale, the mean and standard deviation was used to determine consensus between participants to each adherence barrier. The main observed barriers to adherence were the need for constant reminders from caregivers to ensure medication was taken, medicationtaking fatigue, medication taste and increased responsibility for medication-taking. The results indicated that there is a variation between the barriers identified through paediatric self-reports and what is observed by healthcare professionals in practice. Study three used a retrospective questionnaire to identify caregivers (N=52) barriers to medication administration and their opinions of community pharmacists. Common barriers identified were their child’s heavy reliance on them to ensure medication was taken, frustration and fatigue from having to take regular medication and their child’s increased responsibility for medication-taking. Caregivers were generally positive about the support they received from the pharmacist to care for their child with long-term medication needs and would welcome medication reviews and information sessions with the pharmacist to help with their child’s adherence.
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Barnett, Sarah Anne Louise. "An application of multilevel modelling techniques to the study of geographical variations in health outcome measures." Thesis, University of Southampton, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.327258.
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Alkhalaf, Ahmed. "Harsh parenting and encouragement from parents during childhood : long-term effects on well-being, mental health, and major illness." Thesis, University of Plymouth, 2011. http://hdl.handle.net/10026.1/544.
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This thesis examines long-term, negative consequences of various behaviours characteristic of negative parenting styles, specifically verbal maltreatment (insulting children), physical maltreatment (beating or hitting children), and lack of encouragement. Psychological scales were employed to explore the relationship of each of these factors to mental and physical health in adults. As a part of this research, a new questionnaire, the Arabic Parenting Style Questionnaire (APSQ), was developed and compared with existing measures. Seven separate studies were conducted with Saudi Arabian participants in order to investigate the questions put forth in this thesis. To explore the impact of harsh parenting and emotional discouragement, the relationships of these variables to mental and physical health were examined in both non-clinical and clinical samples including both men and women and a broad range of ages (19 to 60 years). Findings indicate that parents’ discouraging their children from expressing thoughts and feelings, and parents’ being verbally and physically harsh towards their children, are both powerful risk factors for a broad array of long-term health outcomes in both clinical and non-clinical samples. Various aspects of the individuals’ childhood relationships with their parents, as measured using the new APSQ, are significantly correlated with the following health- and wellness-related variables in adulthood: quality of life as assessed on the Global Quality of Life Scale (GQLS), health complaints as assessed using the Minor Health Complaints Questionnaire (MHCQ), well-being mood state, life satisfaction as assessed with the Life Satisfaction Scale (SLS), depression, Chronic Fatigue Syndrome, Borderline Personality Disorder, and specific physical diseases (asthma, cancer, heart disease).
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Byng, Richard Norman. "The evaluation of Mental Health Link, an intervention to develop shared care for patients with long-term mental illness." Thesis, King's College London (University of London), 2005. https://kclpure.kcl.ac.uk/portal/en/theses/the-evaluation-of-mental-health-link-an-intervention-to-develop-shared-care-for-patients-with-longterm-mental-illness(7278b3ca-eba5-4148-8c2d-2e9c71f2c781).html.
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Nygren, Zotterman Anna. "Encounters in primary healthcare from the perspectives of people with long-term illness, their close relatives and district nurses." Doctoral thesis, Luleå tekniska universitet, Institutionen för hälsovetenskap, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-60984.
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People with a long-term illness and their close relatives regard encounters as the foundation of their relationshipwith the district nurses within the primary healthcare setting. The overall aim of this doctoral thesis was todescribe and elucidate the experiences of encounters for people with long-term illness, their close relatives anddistrict nurses within a primary healthcare setting. From the overall aim, specific aims were formulated asfollows: to describe district nurses’ views on quality of healthcare encounters in primary healthcare (I), toelucidate meanings of encounters for patients with long-term illness within the primary healthcare setting (II), toelucidate meanings of encounters for close relatives of people with a long-term illness within a primaryhealthcare setting (III) and to describe the experiences of dignity encounters from the perspective of people withlong-term illness and their close relatives within a primary healthcare setting (IV). Data were collected fromfocus group interviews (I), narrative interviews (II, III), and semi-structured interviews (IV). The interviewswere analysed using thematic content analysis (I, IV) and phenomenological hermeneutics (II, III). The findingsshow that encounters are given great importance among people who have a long-term illness, their closerelatives, and district nurses in the setting of primary healthcare. The manner in which the encounter wasexperienced in the relationship with healthcare personnel was, at many times, crucial for the whole careexperience to be viewed as beneficial or not. The findings show that district nurses described that the encountersformed the basis of their work as an important aspect and that many times they were difficult because of stressand lack of time. The first meeting with the patient was important since it was unique and unrepeatable. Districtnurses considered themselves as being the patients ‘advocate’ who helped them and protected their interests.They indicated the importance of confirming the patient as a person deserving of respect, and if a meeting turnedout poorly, it was their duty to give the patient an apology (I). The findings also show that patients with a longtermillness experienced that good encounters had health-promoting effects on their health and recovery. Patientsfelt well when they were welcomed as a person with respect, interest, and attention by the healthcare personnel.They wanted to participate in their own care by receiving regular information and follow-up dialogues abouttheir status with the healthcare personnel. Continuity with the healthcare personnel laid the foundation for apersonal and a trustful relationship (II). Close relatives of people with a long-term illness wanted to beencountered as part of the ill person’s family as they accompanied him or her to the healthcare centre. To beconfirmed as a family was important, as it gave meaning to their lives and strengthened their well-being. A goodencounter was characterised by aspects of being involved in the care of the ill person and being respected as avaluable person (III). The findings show that people with a long-term illness and their close relatives experienceddignity in the encounter when they had access to care. They experienced that it was important to be encounteredwith dignity, as it meant receiving help with their needs from the healthcare personnel. To be confirmed by beingseen and listened to was important. When the couples experienced dignity in the encounter, they felt satisfiedwith the care they received. To be encountered with dignity made they feel valuable; this facilitated their healthand well-being, and it contributed to a good impression of the healthcare personnel within primary healthcare(IV). In conclusion, the findings of this thesis show that healthcare encounters are more than just meetings; theyalso mean being confirmed as a human being by being treated with respect, engagement and dignity. Healthcarepersonnel should promote encounters for people with long-term illness and their close relatives in order tosupport their feelings of being regarded as persons and to feel that they are welcomed to primary healthcare withtheir needs, which can empower their health and well-being.
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Tyler, Katherine. "Levers and barriers to patient-centred care with school-age children living with long-term illness in multi-cultural settings." Thesis, City University London, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.509117.
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Spataro, Josie 1973. "Gender differences in child sexual abuse characteristics and long-term outcomes of mental illness, suicide, and fatal overdose : a prospective investigation." Monash University, Dept. of Psychological Medicine, 2002. http://arrow.monash.edu.au/hdl/1959.1/8111.
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Rasmusson, Tannis. "Factors that affect quality of life for older persons with life limiting illness in long term care homes : a literature review." Thesis, Sophiahemmet Högskola, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-2285.
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Dying is a normal life process. Palliative care is the means in which health care professionals care for individuals with either life limiting or terminal illness at or near the end of life. It is important to deliver palliative care across all health care contexts - from acute care to residential care. Nurses within the specialty of palliative care or who have had palliative care education consider all aspects of caring for individuals - physical, psychological, social, and spiritual. Quality of life (QoL) is important at all stages of life. Older persons with life limiting illness residing in long term care homes may have different factors that influence their QoL than younger persons in good health. The purpose of this study was to describe factors affecting quality of life for older persons with life limiting illness who reside in long term care (LTC) homes. It was also of interest to discover what nursing strategies are used to promote quality of life for this population. A literature review of sixteen articles was carried out. Articles which were relevant to the literature review’s aim were retrieved from CINAHL and PubMed databases. Twelve articles were retrieved from the databases and four articles were found using a manual search. A systematic process of reviewing each article, reading and re-reading them to analyze the method and results was undertaken. Deductive reasoning was used to develop themes with inspiration from the World Health Organization’s domains of quality of life. Results were categorized into categories of sociodemographic characteristics, psychological/spiritual, physical health/independence, environment, and nursing strategies. It was found that being female and married positively affected one’s quality of life. Visits from family and friends positively affected QoL. Of interest was that having a higher education negatively affected one’s quality of life. Having a lower cognitive function and more comorbidities negatively affected one’s quality of life. Living in a smaller long term care home and also long term care homes with more leisure activities positively affected one’s quality of life. Nursing strategies to positively affect quality of life in long term care homes included education of staff in palliative care by a palliative care consult team, and assessment and treatment of older persons’ pain. In conclusion, QoL must be emphasized in LTC homes since the world’s population is aging and more complex symptoms within an increase in co-morbidities require expert nursing. QoL is affected by social factors such as visits from family and friends. It is affected by nurses’ attention to pain management and their caring nature in supporting residents’ dignity. QoL is also affected by demographic characteristics which staff and managers must be aware of in order to support the resident in optimizing QoL in a LTC home. Nurses, nurse specialists and managers at LTC homes need to prioritize their work in order to positively affect QoL for older persons with life limiting illness.
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Briney, Glenna Denise. "Long term effects of day treatment programs for adults with severe and persistent mental illness: Effectiveness measured in rates of recidivism." CSUSB ScholarWorks, 2005. https://scholarworks.lib.csusb.edu/etd-project/2731.
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The purpose of this study was to compare and measure the long term effectiveness of the rehabilitative day treatment program at San Bernardino County's Department of Mental Health. This current study was completed in 2005 and is a follow up study tracking the long term effectiveness of the program.
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Manning, Joseph. "Stories of survival : exploring long-term psychosocial well-being in childhood survivors of acute life threatening critical illness : a multiple-case study." Thesis, University of Nottingham, 2015. http://eprints.nottingham.ac.uk/29334/.
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Background: Childhood critical illness is characterised by a rapid and potentially catastrophic loss of physiological reserve caused by a wide variety of illnesses and injuries. In the Western world, death from childhood critical illness is rare due to advances in paediatric intensive care (PIC) provision, medicine, technology and public health. However, surviving PIC can expose children and their families to a complex array of physical, psychological and social problems. Physical disability, chronic illness, delirium, and stress symptoms have been reported to manifest in the immediate to short-term (
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Morris, Rebecca. "Evolving 'self'-management : a qualitative study of the role of social networks for chronic illness management in primary care." Thesis, University of Manchester, 2011. https://www.research.manchester.ac.uk/portal/en/theses/evolving-selfmanagement-a-qualitative-study-of-the-role-of-social-networks-for-chronic-illness-management-in-primary-care(4cb673aa-009c-4962-af1b-05f909482221).html.
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Background: Much social network analysis in health related research has focused on the impact of social networks in the genesis of long term conditions and associated inequalities. However, there has been little research on the role of social networks in the management of such conditions. This is significant at a time when increasing policy emphasis is placed on individual self-care and assumptions are often made about social support, and familial support in particular. The management of chronic illness is complex involving the interplay of personal and contextual factors and comprised of a number of daily activities which include the ongoing negotiation of management into existing roles and the degree of individual engagement with self-management. Little is known about how these aspects interact to shape and influence management, what constitutes a social network for individuals with long term conditions and whether this changes over time.Methods: This study was embedded within the Whole Systems Informing Self-management Engagement (WISE) randomised control trial. It used a longitudinal qualitative design with initial face to face in-depth interviews, telephone follow-ups over a year and final face-to-face interviews where sociograms were also used to elicit network structure.Results: The findings suggest that who is in the social network, and the types of relationships which are present, influence how management practices are framed and the extent to which they are engaged with. Resources available to an individual through the network support, or undermine, engagement and changed over time. Networks included family, friends, GP, nurses and companion animals. The amalgamation of the different types of relationships that constitute the social networks are characterised by three typologies; the family focused network, the friend focused network and the health care professional focused network. These network types reflected where support was sought in times of crisis. In the absence of 'typical' sources accounts highlighted the substitutability of network members which was often narrowly sought from key individuals. Changes in illness management, either positive or negative, were framed around critical moments as they challenged existing norms of practice and involved significant network members. Further, co-morbid conditions placed an additional complexity to management and priorities were shaped by the recursive relationship with health services which seemingly influences patients' orientation in becoming either active assessors of health care or less engaged through being overwhelmed. Conclusions: This thesis challenges the notion of 'self'-management as an individual construct as many of the practices of illness management involved the support and/or negotiation of roles with others. Critical moments are a key point where normalised management practices are challenged and have particular relevance for future interventions which could foster these critical points to facilitate such changes in routines. Interventions and education need to reflect this wider setting in which chronic illness management occurs for the practices of management to become normalised into everyday routines.
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Leijon, Pia, and Maria Johansson. "Patienters erfarenheter av undervisning vid långvarig sjukdom - en litteraturöversikt." Thesis, Högskolan i Skövde, Institutionen för vård och natur, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:his:diva-8260.
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Bakgrund: För patienter med långvarig sjukdom är kunskap om sjukdom och behandling av stor betydelse för att kunna hantera sitt dagliga liv. En väg till ökade kunskaper är via patientundervisning. Syftet: Syftet med denna studie var att beskriva patienters erfarenhet av undervisning vid långvarig sjukdom. Metod: Studien bygger på tolv vetenskapliga artiklar som har analyserats med kvalitativ metod. Resultat: Patienter erfar att en relation med känsla av förståelse och respekt samt en relation som bygger på en öppen dialog har grundläggande betydelse för deras lärande. När kunskap erhölls ökade självförtroendet och patienter vågade ställa frågor vilket skapade trygghet. Kunskap behövdes för att patienten skulle kunna ta ansvar och fatta beslut. Kunskap hade en positiv inverkan på hälsa och välbefinnande. Konklusion: Studien visar att undervisning är av stor betydelse för patienter med långvarig sjukdom hälsa och välbefinnande samt för deras möjlighet till delaktighet i vården. Sjuksköterskan har en viktig roll i att skapa en relation som bygger på öppenhet, förståelse och respekt.Background: For patients with long-term illness education is of great importance to be able to self-care their disease in daily life. Aim: The aim of this study is to describe patients experience of education during long-term illness. Method: The study is a qualitative literature- based study. Based on twelve scientific articles. Results: Patients experiencing a relationship whit a sense of understanding and respect. Relationship based on open dialogue is essential to patient learning. When knowledge was transferred to patients, their confidence increased which resulted courage to ask questions and that made patients feel more safe. For patients to be able to take responsibility for making their own decisions a lot of knowledge was needed. Knowledge did have a positive impact on the patients health and well being. Conclusion: Education is of great importance for patients with long-term illness. The nurse has an important role of transferring knowledge, which leads to the patient feeling more safe. A relationship with an open dialog that includes sense of understanding and respect increased the patient’s participation.
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Smirl, Julie E. "QUALITY-OF-LIFE INDICATORS IMPACTING OLDER ADULTS." OpenSIUC, 2015. https://opensiuc.lib.siu.edu/dissertations/1044.
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Radical changes in the senior citizen population have been triggered by the addition of the baby-boomer generation, which drastically increased the growth of this cohort group. A determination of needs for this diverse group of people is necessary for clinical professionals to employ evidence-based practices in the daily provision of services. Purpose: The focus of this study was to measure quality-of-life indicators by concentrating on the association of chronic illness and mental well-being in predicting long-term relationship satisfaction. A sample of older adults were studied in relationship with health and wellness concerns guided by previous research conducted by the Centers for Disease Control and Prevention (CDC, 2011a), and the World Health Organization (1991). Methods: The population selected for this study was older adults participating in outpatient mental health services. A representative sample of 111 participants was used in the statistical analysis of this project. The utilization of the Revised Dyadic Adjustment Scale (Busby, Crane, Larson, & Christensen, 1995) established relationship satisfaction scores among this varied population. Correlation analysis was used to determine the association between seven variables. The factors of interest were: chronic health, chronic pain, mental health acute or chronic, and scores on mental health screenings routinely used in the outpatient mental health clinics included in this study. These variables were broken down in a hierarchical multiple regression model to find out if any factors predicted overall relationship satisfaction. Results: Hierarchical multiple regression analysis delineated an inverse relationship between mental health status (acute or chronic) and degree of overall relationship satisfaction. Chronic health conditions and pain ratings were positively related, however, did not associate negatively with overall relationship satisfaction as hypothesized. Positive relationships were found among the following variables: anxiety ratings and pain-related impairment, increased reports of anxiety with chronic mental health status, and pain ratings with higher risk for suicide. Low correlation coefficient values found throughout the statistical analysis make these findings tentative. Conclusions: The indications of this study confirmed a negative association between chronic mental illness and overall relationship satisfaction scores. This highlights the importance of addressing long-term psychiatric issues as an integral part of working with older adults. Age-related decline creates a functional need for reliance on others complicating satisfaction in intimate partnerships. Mental health practitioners need to be aware of the struggles found among the growing population of older adults to address their treatment and case management needs. Additional research is necessary to determine the indicators of relationship satisfaction impacting quality-of-life among older adults. Key words: quality-of-life, older adults, generational status, chronic illness, chronic pain, mental health, revised dyadic adjustment scale.
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Andersson, Elin, and Sofie Engebratt. "Sjuksköterskors upplevelser av att vårda patienter med kroniska sjukdomar : En kvalitativ litteraturstudie." Thesis, Högskolan i Skövde, Institutionen för hälsovetenskaper, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:his:diva-19268.
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Bakgrund: Antal patienter med kroniska sjukdomar ökar. Detta orsakar lidande och förändrad livsvärld hos patienter. Att drabbas av kronisk sjukdom kan innebära ökade antal tillfällen som kräver vård. Sjuksköterskans ansvar är att ge en personcentrerad vård och lindra lidande trots komplexa vårdsituationer. Syfte: Belysa sjuksköterskors upplevelser av att vårda patienter med kroniska sjukdomar. Metod: Studien är en kvalitativ litteraturöversikt. Resultat: Resultatet visar att förståelse för patienten kunde uppnås genom öppenhet och lyssnande. En vårdande relation gynnar den personcentrerade vården och genom att stärka patientens självbestämmande ökade engagemanget. Stöttning för både patienter och sjuksköterskor ansågs vara viktigt, genom reflektion kunde stöttning utvecklas. Bristande följsamhet hos patienten hanterades på olika sätt av sjuksköterskorna. Tiden var en viktig faktor som kunde påverka den vårdande relationen och informationen som framkom genom samtal. Slutsats: Sjuksköterskor upplever att patienter med kroniska sjukdomar är komplexa och kräver långa vårdtillfällen och regelbunden vårdkontakt. Genom att vara öppen och lyssna ökade förståelsen för patienten vilket gynnar vårdrelationen och således den personcentrerade vården. För att göra vården mer patientsäker upplevde sjuksköterskorna tiden, koordinering, interprofessionellt arbete, stöttning och hanteringen av bristande följsamhet som viktiga faktorer.Background: The number of patients with chronic diseases is increasing and causing suffering and a changed life situation for patients. Suffering from a chronic illness can mean an increased number of occasions that require care. The nurse's responsibility is to provide person-centered care and alleviate suffering despite complex care situations. Aim: To research nurses' experiences of caring for patients with chronic diseases. Method: The study is a qualitative literature review. Results: Understanding could be achieved through openness and listening. A caring relationship benefits the person-centered care and by strengthening the patient's selfdetermination, the commitment increased. Support for both patients and nurses was considered important, through reflection support could be developed. Lack of patient compliance was handled in different ways. Time was an important factor that could affect the caring relationship and the information that could emerge through conversations. Conclusion: Nurses experience that chronically ill patients are complex, require long-care sessions and regular care contact. By being open and listening, the understanding increased, which benefits the care relationship and thus the person-centered care. To make care more patient-safe, the nurses experienced time, coordination, interprofessional work, support and management of lack of compliance as important factors.
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Magnusson, Annabella. "Home care of persons with long-term mental illness : nurses and mental health care workers' experiences of how changes in the organisation of psychiatric services have changed their work." Doctoral thesis, Stockholm, 2003. http://diss.kib.ki.se/2003/91-7349-638-3/.
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Lindström, Caisa. "Burnout in parents of chronically ill children." Doctoral thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-47391.
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Parents of children with a chronic disease are usually highly involved in their child’s treatment and may be affected by the heavy demands and constant stress. This can increase the risk of developing burnout, which is an individual reaction to long-term stress consisting of symptoms associated with emotional exhaustion, as well as physical and cognitive fatigue. The overall aim was to estimate the prevalence of burnout in parents of children with Type 1 Diabetes Mellitus (T1DM) and inflammatory bowel disease (IBD) (paper I), identify the risk factors associated with parenting a child with T1DM (paper II), explore how mothers suffering from burnout describe their mothering of a child with diabetes, with special focus on their need for control and Performance-based self-esteem (PBSE) (paper IV), and to evaluate the effect of a group intervention aimed at reducing stress-related symptoms (paper III). A total of 251 parents of children with T1DM, 38 parents of children with IBD and 124 parents of healthy children participated in a population-based study (I, II). The validated Shirom-Melamed Burnout Questionnaire (SMBQ) was used to assess burnout. 16 parents (SMBQ ≥3.75) participated in a group intervention and were evaluated for changes in SMBQ and PBSE (III). A total of 21 mothers of children with T1DM who scored for clinical burnout (SMBQ) participated in a qualitative study. Semi-structured interviews were conducted and Inductive content analysis was used (IV). In the study group 36.0% parents of children with a chronic disease scored for clinical burnout (SMBQ ≥3.75) compared to 20.2% of the reference parents (p=0.001) with a preponderance of mothers compared to fathers, 42% vs. 20.5% (p=0.001), respectively (I). Less support from the social network, sleep disturbances and lack of personal leisure time and recovery seem to be important risk factors for clinical burnout in parents of children with T1DM, especially mothers (II). Mothers’ experiences of mothering a child with T1DM were interpreted as one theme; Mission impossible, illustrating the extremely difficult circumstances under which they bring up the child with diabetes to adulthood (IV). Parents’ subjective evaluation of the intervention group was mainly positive and SMBQ (p=0.01) and PBSE scale (p= 0.04) measurements were significantly reduced 6 months after completion of the intervention (III). It is important to pay attention to how parents and especially mothers experience their daily life in order to support those who are at risk of developing burnout.
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Hylander, Irene, and (fd Johansson) Karin Lindström. "Socialt stöd till ungdomar med långvariga och kroniska sjukdomar : En intervjustudie ur skolsköterskors perspektiv." Thesis, Umeå universitet, Institutionen för omvårdnad, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-118502.
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Syfte: Att beskriva skolsköterskors sociala stöd till ungdomar med långvariga och kroniska sjukdomar.Bakgrund: Ungdomar med långvariga och kroniska sjukdomar hade behov av socialt stöd för att klara av sin skolgång på ett tillfredsställande sätt. Skolsköterskor ska arbeta förebyggande och främjande och genom hälsofrämjande omvårdnad stötta elever och vårdnadshavare vid sjukdom gentemot skolans miljö och krav. Eleverna värdesatte att skolsköterskorna lyssnade på dem aktivt och ställde motfrågor. Vidare ansåg eleverna att förtroende, uppmärksamhet, respekt, äkthet, tillgänglighet och kontinuitet var betydelsefullt i kontakten med skolsköterskorna.Design: Kvalitativ design med induktiv ansats.Metod: Individuella intervjuer utfördes med en semistrukturerad intervjuguide. Totalt nio skolsköterskor intervjuades och intervjuerna analyserades med kvalitativ innehållsanalys.Resultat: Analysen resulterade i sex kategorier och 16 underkategorier. Studien visade att skolsköterskors sociala stöd till elever med långvariga och kroniska sjukdomar utgjordes av att finnas tillhands, vara lyhörd och stötta föräldrar i kontakten med vården. Skolsköterskorna upplevde det positivt att involvera föräldrarna i elevernas skolsituation. I interaktionen med elever och föräldrar var samtal ett betydelsefullt verktyg för skolsköterskorna. Tidsbrist bidrog till att det sociala stödet påverkades negativt och tillgängligheten för eleverna försämrades.Slutsats: Skolsköterskornas arbete var mångfacetterat, ställde krav på kompetens, flexibilitet och samarbetsförmåga. De hade en betydelsefull roll när det gällde att ge socialt stöd till ungdomar med långvariga och kroniska sjukdomar.Nyckelord: socialt stöd, skolsköterskor, elever, ungdomar, långvarig sjukdom, kronisk sjukdom, omvårdnadAim: To describe school nurses social support to adolescents with long-term and chronic illness. Background: Adolescents with long-term and chronic illness needed social support in order to cope with their schooling in a satisfactory manner. School health nurses work with health prevention and health promotion and should support students and their parents during illness towards the school environment and demands. Students appreciated that the school health nurses listened to them actively and asked counter-questions. Furthermore, the students felt that trust, attention, respect, genuineness, availability and continuity of contact with the school nurses were significant. Design: Qualitative design with inductive approach. Method: Individual interviews were conducted using a semi-structured interview guide. Nine nurses were interviewed and the interviews were analyzed using qualitative content analysis. Findings: The analysis resulted in six categories and 16 subcategories. The study showed that school health nurses’ social support to students with long-term and chronic illness were to be available, be responsive and to support parents in their contact with healthcare. The school health nurses experienced it positively to involve parents in students' school situation. In the interaction with students and parents the dialogue was a meaningful tool for the school health nurses. Social support was negatively affected by lack of time, and the availability for the students was deteriorated. Conclusion: School health nurses work was multifaceted, required expertise, flexibility and teamwork skills. They had a meaningful role in providing social support to adolescents with long-term and chronic illness.Keywords: social support, school health nurses, students, adolescents, long-term illness, chronic illness, nursing
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Ågstrand, Mikaela. "Långtidssjukskrivning för psykisk ohälsa : Kvinnors upplevelser av att vara sjukskrivna och återvända till arbetet." Thesis, Mälardalens högskola, Akademin för hälsa, vård och välfärd, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-40906.
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Idag är psykisk ohälsa den vanligaste orsaken till långtidssjukskrivning i Sverige. Denna studie syftade till att undersöka vad det innebär för kvinnor att vara långtidssjukskrivna för psykisk ohälsa och återvända till arbetet. Datainsamlingen bestod av semistrukturerade intervjuer. Totalt intervjuades åtta kvinnor som varit sjukskrivna i minst två månader. Kvinnorna var bosatta i Uppsala län, Västmanlands län och Västra Götalands län. Dataanalysen genomfördes i linje med de riktlinjer IPA-metoden förespråkar. Resultatet påvisar att det förekommer en del svårigheter med att vara långtidssjukskriven för psykisk ohälsa. Mest framträdande var en känsla av orkeslöshet och isolering. Arbetsåtergången var utformad på olika sätt, den vanligaste rehabiliteringsåtgärden var arbetsanpassning. Studiens resultat tyder på att arbetsplatser saknar tydliga rutiner för arbetsåtergång vid långtidssjukskrivning för psykisk ohälsa. Vidare framgick det att delaktighet och inflytande, lyhörda chefer och den egna viljan var viktiga utgångspunkter för en god arbetsåtergång. Socialt stöd betraktades som en viktig förutsättning under hela sjukskrivningsförloppet.
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Kemi, Päivi, and Sirpa Andersen. "Patienter med långvarig sjukdom : upplevelser av möten med vårdpersonal på hälsocentral." Thesis, Luleå tekniska universitet, Institutionen för hälsovetenskap, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-73078.
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Goda möten och trygga relationer mellan patienter och vårdpersonal är kärnan i all sjukvård.Syftet var att undersöka hur personer med långvarig sjukdom upplever möten med vårdpersonal på hälsocentral. Uppsatsen är genomfördmed kvalitativ design. I denna studie utgick vi från Graneheim och Lundmans metod för kvalitativ innehållsanalys med en manifest ansats.I analysen identifierades fyra kategoriersom är rubriker i resultatet, att inte bli betrodd, att sakna stöd och information om vård och egenvård, att önska få vara delaktig i sin egen vård,att känna tacksamhet över att få vård på rätt nivå. Resultatet visar att patienternahade svårt att bli betrodd av läkareoch att kännedom om dem som patienter var viktigt.I kontakt med hälsocentralen fick de själv efterfråga om hjälpinsatserochstöd saknades för enklare hälsofrågor. God relation och kommunikation med läkare var betydelsefullt i vårdmötet. Patienterna ville vara delaktiga i sin egen vård och ville möta professionell expertis.Erfarenhetsutbytemed andra med samma sjukdom beskrevs betydelsefullt.De negativa fynden visaratt patienter inte blir betrodd av sjukvårdenoch att tillgänglighetenär bristfälligt. Det som skapar trygghet respektive otrygghet finns ett starkt samband mellan hur patienter med långvarig sjukdom upplever besöket och blir bemött av vårdpersonalen på hälsocentralen. Fler studier behövs inom området hur möten med vårdgivare påverkar patienter med långvarig sjukdom
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Hedblad, Maria, and David Kilström. "Tillsammans skapar vi lärande : Om lärande i grupp hos personer med långvarig sjukdom med utgångspunkt i Dorothea Orems Teori om omvårdnadssystem." Thesis, Ersta Sköndal högskola, Institutionen för vårdvetenskap, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-2022.
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Bakgrund: Att leva med långvarig sjukdom innebär förluster för individen och krav på anpassning. En viktig del i sjuksköterskans arbete med att stärka hälsa hos personer i behov av vård är att stötta lärande. En viktig del i lärande är interaktion och delaktighet. Som vårdvetenskaplig utgångspunkt har Dorothea Orems “Teori om omvårdnadssystem” använts och denna teori beskriver interaktionen mellan sjuksköterskan och de personer hon vårdar. Syfte: Syftet var att nå kunskap om hur sjuksköterskan kan arbeta med lärande i grupp hos personer med långvarig sjukdom utifrån Dorothea Orems ”Teori om omvårdnadssystem”. Metod: En litteraturöversikt har genomförts där tio kvantitativa studier har sammanställts genom analys med Dorothea Orems “Teori om omvårdnadssystem” som utgångspunkt. Resultat: Resultatet visar hur de olika programmen i studierna arbetat med lärande i grupp bland personer med långvarig sjukdom, där det framkommer skillnader och likheter i deltagarnas och sjuksköterskans roller. Likheter fanns i programmens fokus på interaktion mellan deltagarna såväl som på sjuksköterskans faciliterande roll. En viktig skillnad fanns i utsträckningen av deltagarnas påverkan på innehållet i gruppträffarna, där vissa program lät deltagarnas behov och intresse styra medan vissa program i förväg hade bestämt innehållet. Diskussion: I resultatdiskussionen argumenteras för att människans egenidentifierade lärandebehov bör styra lärandet. Lärandet bör främja utvecklandet av självstyrning hos personen. Resultatet visar att deltagarna i interaktionen mellan varandra har inneboende resurser som används för att främja individens och andras lärande. I metoddiskussionen uppmärksammas styrkor och svagheter kring val av metod för denna litteraturöversikt.Background: Living with long term illness means losses for the individual and demands for adaptation. An important part of the nurse's work on strengthening the health of people in need of care is to support learning. An important part of learning is interaction and participation. As a nursing-science basis Dorothea Orem’s "Theory of nursing system" has been used and this theory describes the interaction between the nurse and the person she cares for. Aim: The purpose was to gain knowledge about how nurses can work with learning in a group of persons with long-term illness with basis in Dorothea Orem’s "Theory of nursing systems." Method: A literature review was carried out where ten quantitative studies have been compiled through analysis with Dorothea Orem’s "theory of nursing system" as a basis. Results: The results how how the various programs of the studies worked with learning in a group among people with long-term illness, where similarities and differences in the roles of the participants and the nurses emerged. Similarities were found in the programs focus on the interaction between participants as well as on the facilitating role of the nurse. An important difference was revealed in the extent of participants' influence on the content of the group sessions, where some programs let participants' needs and interests guide while some programs previously had determined the content. Discussions: In the discussion of the results it is argued that man's self-identified learning needs should direct learning. Learning should encourage the development of the person’s self-direction. The results show that participants in the interaction between each other have inherent resources used to promote learning among themselves and others. Strengths and weaknesses regarding the chosen method for this literature review are highlighted in the method discussion.
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Nilsson, Josefine, and Frida Löfgren. "Tillbaka till arbetet : En kvalitativ studie som belyser återgång till arbete efteren långtidssjukskrivning med psykisk ohälsa." Thesis, Högskolan i Halmstad, Akademin för hälsa och välfärd, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-40068.
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Syftet med studien är att skapa en djupare förståelse för vilka faktorer som upplevs främja återgången till arbete efter en långtidssjukskrivning vid psykisk ohälsa, utifrån den sjukskrivnes perspektiv. Studien baseras på Karaseks och Theorells modell som består av krav och kontroll samt en teoriutveckling av socialt stöd i förhållande till krav och kontroll av Jeffery Johnson. Studien baseras även på teorin ”Känsla av sammanhang”, förkortat KASAM, som utvecklats av Aaron Antonovsky. För att få en djupare förståelse för vilka faktorer som upplevs främja återgången till arbete efter en långtidssjukskrivning vid psykisk ohälsa genomfördes samtalsintervjuer med fem personer. Resultatet i studien visar att stöd och kommunikation med arbetsgivare och kollegor är en framgångsfaktor vid återgången till arbetet. Det framkommer även i studien att arbetsträning är en framgångsfaktor men kan hämma återgången om den inte är verklighetsförankrad. Deltagare i studien menar att lägre krav och högre egenkontroll är främjande i återgångsprocessen. Slutligen framkommer det även att återgången underlättas när individen känner tillhörighet till arbetsplatsen och arbetsgruppen.The aim of the study is to create a deeper understanding of which factors perceived to promote the return to work after a long-term sickness in mental health, based on the perspective of the sick-listed. The study is based on Karaseks and Theorells model consisting of demand, control and a theory development of social support in relation to demand and control by Jeffery Johnson. The study is also based on the theory ”a Sense of Coherence”, abbreviated KASAM, developed by Aaron Antonovsky. In order to gain a deeper understanding of which factors perceived to promote the return to work after a long-term sickness in mental ill-health, five interviews were conducted. The results in this study shows that support and communication with employers and colleagues is a success factor when returning to work. It also appears in the study that job training is a success factor but can inhibit the return if it is not reality-based. Participants in this study argues that lower demands and higher self-control are promotions in the return process. Finally, it also emerges that the return is facilitated when the individual feel a sense of coherence to the workplace and the working group.
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Berglund, Mia. "Att ta rodret i sitt liv : Lärande utmaningar vid långvarig sjukdom." Doctoral thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV), 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-11536.
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A starting point for this thesis is that patients’ learning has not received sufficient attention and thus has not featured in the study programmes in the field of caring. Focus has instead been placed on patients being given information and advice about their illness and treatment, advice that they are then expected to comply with. Too little attention has been paid to the individual who lives with his/her illness and who should be considered to have significant experiences. The overall aim has been to analyze and describe the phenomenon of learning to live with long-term illness as well as to develop a didactic model that can help carers to support patients’ learning processes. The theoretical perspective in the thesis is lifeworld theory, which permeates ontological, epistemological and methodological standpoints and also the view on learning. The design and carrying out of the research is based on a reflective lifeworld approach. The empirical study consists of interviews with people who live with different types of long-term illnesses. The learning that follows life with a long-term illness is generated in such a way as to respond to the will to live the well-known everyday life. A greater understanding of the empirical results has been achieved by a lifeworld philosophical elucidation, with a particular focus on learning turning points and the importance of reflection. Based on the empirical results, the lifeworld philosophical elucidation and the caring science lifeworld didactics a didactic model has been formulated. This model is entitled: The challenge – to take charge of one’s life with long-term illness. The model contains four theses: 1) Confronting one’s life situation and challenging to make a change, 2) Positioning oneself at a distance when creating a new whole, 3) Developing self-consciousness and taking responsibility, 4) Making learning visible with the aim of providing development and balance in life. The results in the thesis show that a genuine learning is something that differs from the learning of information and that the learning must be supported at an existential level based on the sufferer’s situation and for a long period of time.
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Hallström, Ina. "Sårbarhetskedjan : En feministisk studie av hur utförsäkring förkroppsligas när välfärden brister." Thesis, Stockholms universitet, Institutionen för etnologi, religionshistoria och genusvetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-132186.
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The welfare state is ideally about guaranteeing citizens welfare and social security. This thesis describes how the embodied experience of austerity politics and reforms of national health insurance in Sweden is lived along the links of what I call “the chain of precarity”. In 2008 the duration of the entitlement to sickness benefit was limited to 2.5 years. The majority of people on sick leave and passing the benefit limit were women. Using qualitative in-depth interviews and drawing on feminist phenomenology, theories of recognition and crip perspectives, the analysis shows that the chain of precarity orients women with long-term illness towards increased vulnerability and risk. This (dis)orientation is the result of a lack of recognition and respect within the fields of social insurance, health care, work life, discourse and politics as well as close relations.
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Wikström, Filippa, and Agnes Möller. ""Ibland hjälper han mig mer än vad alla ni i personalen gör." : Hur djur i vården påverkar välbefinnandet hos personer med långvarig ohälsa. En litteraturstudie." Thesis, Ersta Sköndal högskola, Institutionen för vårdvetenskap, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-2599.
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Background: Animals have been shown to have a positive effect on people. The nursing science approach says that a person can experience well-being despite illness. The positive attributes of animals can be used in health care to help ill people experience well-being. An animal-assisted intervention can be a form of activity or therapy involving pets (AAA / AAT) or horses (EAT). Aim: The purpose of this study was to elucidate how animals in health care promote well-being for people with long-term illness. Methods: Literature review based on fourteen original scientific articles, with both qualitative and quantitative approach. Results: The compilation of the results led to four main categories with two subcategories respectively. These were: Physical aspects with subcategories Physical well-being and Bodily functions; Psychic aspects with subcategories Psychic well-being and Reduced psychiatric symptoms; Existential aspects with subcategories Quality of Life and Safety; Social Aspects with subcategories Social behavior and Relationships. Discussions: Review and discussion of the selected method. Discussion of the results with the selected theoretical framework: Antonovsky's theory of Sense of Coherence (SOC) and the salutogenic approach. The results were discussed based on the concepts of comprehensibility, manageability and meaningfulness.
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Matsson, Marie-Loise, and Elin Wikstrand. "De lyckade fallen : En studie om återgång i arbetet efter långtidssjukskrivning för psykisk ohälsa." Thesis, Högskolan i Gävle, Avdelningen för socialt arbete och psykologi, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-21642.
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The overall aim of this study was to illustrate the organizations importance to female staff within education, health and social care on return to work after long term sick leave due to mental illness. The aim of this study was also to identify improvement opportunities. A qualitative study was made with seven interviewees that had return to work after long term sick leave for mental illness. The material was analyzed with an inducitve thematic method. The main themes that emerged was: Information and consulting, Social support from managers and colleagues, Changed attitude and participation in the rehabilitation process and Improvement opportunities. The main result showed that the social support from managers and colleagues and the changed attitude towards the illness mattered the most to the interviewees for a successful return to work. The result also showed that the interviewees had a great need of information about the sick leave process. According to the interviewees the understanding and knowledge about mental illness has to increase.
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Kung, Te-Yi, and 孔德宜. "Being a Psychotic Patient: Narratives and Experiences of Three Long-term Residents of Mental Institution." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/33c56u.
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碩士國立東華大學
諮商與臨床心理學系
106
Drawing three chronic schizophrenics on their narratives and experiences, this thesis aims to depict of how did they become psychotic patients and further to understand their sufferings through experiences. The project intends to verify the "impenetrable" of schizophrenic experiences, clarify the subtle, yet profound dynamics between patients and the institution, and recognize their differentiation and uniqueness, thereby to comprehend their solitude, helplessness, and desperation. It then reveals how the chronic patients living in a mental hospital locate themselves properly, adjust and behave themselves in the "patienthood," confront the conflicts and contradictions of clinical institution, and finally maintain vulnerable privileges over regulations. The project synthesizes patients' personal accounts along with the psychopathological criteria and challenges the dualistic mode of reason vs. madness, normal vs. abnormal, and regular vs. irregular. The thesis concludes that the schizophrenics simultaneously encounter with psychopathological disciplines and an inner unspeakable desolation. Insane and normal worlds co-exist; each refers to its own reality. The boundary between two realities has never been lucid but vague and committed paradoxical. Neither has truth.
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Hsin-ChiehTseng and 曾信捷. "The Impact of Flood and Landslide Disaster on the Short Term and Long Term Outpatient Care of Mental Illness." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/939yk3.
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碩士國立成功大學
經濟學系
106
This study estimated the impact of flood and landslide disaster on the short term and long term outpatient care of mental illness. Specifically, we study the visits and expenditures of outpatient care for mental illness. The outpatient medical records data is collected from 2008 to 2011 from National Health Insurance Research Database and analyzed by the difference-in-differences (DID) fixed effect regression model. The results showed that floods increase the rate of visits for mental illness and the rate of expenditures for mental illness in both short-term and long-term. Second, landslide disasters have no significant effect on the rate of visits for mental illness and the rate of expenditures for mental illness. Third, when floods and landslide disasters occur in the same township, rate of visits for mental illness is reduced in the short-term, but there is no significant change in long-term. The rate of expenditures for mental illness has increased significantly in both long-term and short-term. To sum up, floods would affect mental illness. The landslide disasters have no significant impact on the rate of visits and expenditures for mental illness. Because the disasters caused by landslide disasters are very large but the impact range is much smaller than that of floods. When floods and landslide disasters occur in the same township, rate of visits for mental illness reduces in the short-term, but there is no significant change in long-term. The rate of expenditures for mental illness increases significantly in both long-term and short-term.
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Chen, Mao-chang, and 陳懋昌. "Factors Associated with the Quality of Life In long-term Inpatient with Chronic Mental Illness." Thesis, 2004. http://ndltd.ncl.edu.tw/handle/06234521948489645423.
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Riley, Heather L. "The predictive validity of index Schneiderian first rank symptoms a long-term follow-up of schizophrenic and nonschizophrenic psychotic patients /." 2002. http://wwwlib.umi.com/dissertations/fullcit/3045439.
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Amoroso, Bice. "Finding Meaning in Place: The Perspectives of People with Severe Mental Illness Living Long Term in a Psychiatric Hospital." Thesis, 2012. http://hdl.handle.net/1807/32517.
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This study explored the perspectives on place of eight people with severe mental illness living, for one year or longer, in an urban psychiatric hospital. The research questions were: how do people with severe mental illness view the psychiatric hospital as place?; and how do they make meaning of the experience of living in hospital. The research employed a phenomenological approach, as described by Giorgi (1985). Using purposive sampling, one time, semi-structured, individual interviews were conducted. The audio recorded interviews were transcribed and thematically coded using Giorgi’s (2005) method. The meanings of the participants’ experiences are captured by the meta-theme: this is not a home; it’s a hospital. Four additional major themes emerged; and each of the major themes also had sub-themes The findings of this study challenged commonly held assumptions on how people living long term in a psychiatric hospital view the hospital as place and on institutionalization.
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Cowling, Vicki. "What are the special characteristics of families who provide long term care for children of parents with mental illness?" 2003. http://repository.unimelb.edu.au/10187/1896.
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This project investigated characteristics relating to family functioning and attitudes to mental illness, and caregiving, which distinguish families choosing to care for children of parents with mental illness (CPMI) from families who choose not to but do care for other children (NCPMI), and from families not involved in the adoptive care system (COMM). Welfare agencies seeking long term home based care for children of parents with mental illness (among other groups of children) report that potential caregivers are concerned about the child’s genetic risk, and the requirement that they facilitate access visits with the birth parent. Consequently it is more difficult to recruit caregivers to care for children of parents with mental illness. Previous studies found that families who adopt children with special needs had family systems that were flexible and able to adapt to changing needs, and in which family members felt close to one another. It was not known if the functioning of families who care for children of parents with mental illness would differ from other family groups. Nor was it known if these families would differ in motivation to be caregivers and attitudes to mental illness from other family groups.Forty four families completed a questionnaire providing background information, and a family functioning questionnaire which included the FACES II measure (Family Adaptability and Cohesion Evaluation Scale) and questions assessing level of altruism, and tendency to respond in a socially desirable manner. Data from the FACES II measure was used to classify families according to the Circumplex Model of Marital and Family Systems. Q-methodology was used to assess participants’ attitudes to eight issues related to the research question: mental illness, children of parents with mental illness, parents having a mental illness, family environment, motivation to be caregivers, ongoing contact between child in care and parent, approval of others when deciding to be a caregiver, and flexibility in deciding to accept a certain child for placement. The Q-method required participants to rate 42 statements (a Q-set), concerning these issues, according to a fixed distribution, from statements with which they strongly agreed to statements with which they strongly disagreed.
Participants could also give open-ended responses to questions addressing the same issues in a semi-structured interview. The CPMI group were found to have a lower level of income and education than the other two groups, and were more likely to be full time caregivers. Both caregiver groups were unlikely to have children of their own. The profiles of the three groups on the cohesion and flexibility sub-scales of FACES II were similar. The classification of the family groups on the Circumplex model showed that the CPMI group were located in the balanced and mid-range levels of the model more so than the other two groups. Responses to the Q-sort and interview questions suggested that the CPMI families were more understanding of mental illness, and of the needs of the children and capacity of their parents. It is suggested that future studies increase the number of participants, and investigate in more detail the factors which motivate families who provide long term care for children of parents with mental illness.
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Tseng, I.-Shun, and 曾奕舜. "Medical Utilization of Major Severe Illness – Cancer, Chronic Renal Failure, Long-term Mechanical Ventilation, and Mental Disease." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/46623700537177298204.
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碩士國立陽明大學
醫務管理研究所
102
Objectives: To compare medical expenditures between patients with severe illness and general people, and to further explore the non-severe illness part of medical expenditures for patients with severe illness. Methods: The National Health Insurance Research Database in 2010 and 2011 was used. Patients with severe illness, covering cancer (14,996), chronic renal failure (2,210), long-term mechanical ventilation (346), and mental disease (10,919), and 879,509 general people were included. Our study used generalized linear model to estimate the adjusted medical expenditures for four groups of patients and general people. The statistics of major types of disease unrelated to the major severe illness were also calculated for further comparison. Results: After controlling for sex, age, comorbidity score, and accreditation level of hospital, the predicted medical expenditures for patients with different severe illness were from 3.8 to 27.4 times than that for general people. The expenditures unrelated to severe illness for these patients, ranging from 25,346 to 138,110 TWD, were still higher than that for their counterparts. This may be explained by not only the high number of visits for the treatment of chronic diseases, but also the high likelihood of the treatment for the diseases similar and related to the specified severe illness. Conclusions: After considering the covariates, both the expenditures directly from the major severe illness and from other diseases were higher than that for general people. Strategies to lower some expenditures from other diseases related to or induced by the major severe illness including the preventive health care are needed for the health authorities.