• Title/Summary/Keyword: illness appraisal

Search Result 18, Processing Time 0.024 seconds

Testing the Mediating Effect of Appraisal in the Model of Uncertainty in Illness

  • Kang, Younhee
    • Journal of Korean Academy of Nursing
    • /
    • v.33 no.8
    • /
    • pp.1127-1134
    • /
    • 2003
  • Background. Although there have been a great number of research studies based on the model of uncertainty in illness, few studies have considered the appraisal portion of model. Purpose. The purpose of this study was to test the mediating effect of appraisal in the model of uncertainty in illness. Additionally, this study aimed to examine the relationships among uncertainty, symptom severity, appraisal, and anxiety in patients newly diagnosed with atrial fibrillation. Methods. This study employed a descriptive correlational and cross-sectional survey design using a face-to-face interview method. Patients diagnosed with atrial fibrillation within the previous 6 months prior to data collection were interviewed by Mishel Uncertainty in Illness Scale-Community Form, appraisal scale, Symptom Checklist-Severity V.3, and State Anxiety Inventory. Results. A total of 81 patients with atrial fibrillation were recruited from two large urban medical centers in Cleveland, Ohio, U.S.A.. Symptom severity was the significant variable in explaining uncertainty ($\beta$=0.34). Individuals with greater symptom severity perceived more uncertainty. Uncertainty was appraised as a danger rather than opportunity, and those with greater uncertainty appraised a greater danger (p<.0l). While the appraisal of opportunity had the negative relationship with anxiety (r=-0.25), the appraisal of danger was positively associated with anxiety (r=0.78). The measure of goodness of fit (Q) of the model was .7863, and the significant test (X$^2$) for the Q was statistically significant (df =3, p<.00l). Accordingly, the overall mediating model of uncertainty in illness was proven not to be fit to the empirical data of patients with atrial fibrillation. Consequently, the mediating effect of appraisal was not supported by the empirical data of this study. Conclusion. The findings of this study were discussed in terms of their relevance compared with those of previous studies or theoretical framework and the plausible explanations on study findings. Lastly, in order to expand the present body of knowledge on uncertainty in illness model, recommendations for the future nursing studies were included.

A Study on Factors Influencing the Appraisal of Uncertainty in Patients having Rheumatoid Arthritis (류마티스 관절염 환자의 불확실성 인지에 영향을 주는 요인 탐색)

  • Yoo, Kyoung-Hee
    • Journal of muscle and joint health
    • /
    • v.4 no.2
    • /
    • pp.277-296
    • /
    • 1997
  • This study was conducted to investigate the influencing factors on the appraisal of uncertainty in patients having rheumatoid arthritis. Subjects of the study constituted 528 patients who visited outpatient clinics of two university hospitals and one general hospital in Seoul. Self report questionnaires were used to measure the variables influencing the appraisal of uncertainty. Reliability coefficients of these instruments were found Cronbach's Alpha=$.70{\sim}.96$. In data analysis, SPSS PC 6.0 program was utilized for descriptive statistics, Pearson's correlation, logistic and multiple regression analysis. The results of logistic and multiple regression analysis were as follows 1) Among the independent variables, significant factors to explain the appraisal of uncertainty in patients were uncertainty(p<.001), severity of illness(p<.05), educational level (p<.05) and age (p<.05). 2) When patients appraised uncertainty as "Danger", significant factors to explain the appraisal of uncertainty were uncertainty(p<.0001), age(p<.0005), severity of illness(p<.001), educational level (p<.05). 3) When patients appraised uncertainty as "Opportunity", significant factors to predict the appraisal of uncertainty were uncertainty(p<.0005), social support(p<.0005), severity of illness(p<.005), credible authority(p<.05), age(p<.05) and educational level (p<.05).

  • PDF

Adaptation Model for Family Caregiver of Cancer Patient (암환자 가족 중 주간호제공자의 적응모형구축)

  • Shin, Gye-Young
    • Asian Oncology Nursing
    • /
    • v.2 no.1
    • /
    • pp.5-16
    • /
    • 2002
  • Purpose: This study was to develop a stress-adaptation model for family caregivers of cancer patients that could provide the basis of planning nursing intervention. Method: A hypothetical model was developed using the family adaptation model proposed by Haley et al. (1987). In the literature, the stressor was identified as patient's characteristics, caregiver's characteristics, duration of illness, and family life events. It affected stress appraisal, family resources, family coping and finally caregiver's adaptation. In this model, 18 paths were constructed. Data were collected from 241 caregivers, whose family members were in treatment between June and August 2000, at 3 university hospitals and were analyzed by SPSS and LISREL programs. Results: 1) The overall fitness indices of the hypothetical model were x 2=267.78 (P= .0), GFI= .92, AGFI= .87, NFI= .93, NNFI= .93, PNFI= .64, PGFI= .55, and RMR= .43. Ten of the eighteen paths proved to be significant. 2) To improve the model fitness, the hypothetical model was modified considering modification indices and the paths proved not significant. Final model excluded 3 paths demonstrated to be improved by x2=161.96 (P= .00), GFI= .95, AGFI= .91, NFI= .96, NNFI= .96, and RMR= .23. Twelve of fifteen paths proved to be significant. 3) Stress appraisal was influenced by disease related characteristics and duration of illness and was explained 22% of the variance. Family resources were influenced by stress appraisal and was explained 57% of variance. Family coping was influenced by disease related characteristics, caregiver's characteristics, duration of illness, family life event, and stress appraisal and was explained 57% of variance. Family caregiver adaptation was influenced by disease related characteristics, caregiver's characteristics, stress appraisal, and family coping and was explained 31% of variance. Twelve of fifteen paths were significant. Conclusion: Based on this study, to help family caregivers to adapt, individual intervention is necessary with consideration of disease related and caregiver's characteristics and duration of illness. The intervention should include efforts to raise the family resources and to identify positively the stress they encounter, and there is a need to establish an adaptation model that considers emotional aspects of family caregivers. Since there is a difference in emotional status depending on the disease stage, a study needs to be done to analyze the differences among the disease stages (diagnosis, treatment, recurrence, and terminal stages).

  • PDF

Factors Influencing Stress Appraisal of Cancer Patients' Primary Caregivers (암환자의 일차간호제공가족의 스트레스 인지평가 영향 요인 분석)

  • Shin, Gye-Young;Kim, Mae-Ja
    • Korean Journal of Adult Nursing
    • /
    • v.14 no.1
    • /
    • pp.125-134
    • /
    • 2002
  • Purpose: The objectives for this study were to identify the factors that correlate with appraisal of illness and to explore what variables are predictive of cancer patients primary caregivers' cognitive appraisal for stress. Method: The subjects were selected by convenient sampling and 130 caregivers who completed a questionnaire. Measures used in this study included the Family Inventory of Resources for Management, Social Support Index, Family Crisis Oriented Personal Evaluation Scales and Family Coping Coherence Index. Pearson correlation was used to identify the relationship among factors and multiple regression was used to determine the individual and cumulative effect of potential predictors on the caregivers' appraisal. Results: Patient's level of activity, severity of the disease, quality of relation between patient and caregiver, caregiver's subjective health status, economic status, family resources and coping were significantly correlated. Among the variables, coping, family resources, economic status and quality of relation between caregiver and patient predicted 49.2 percent of the variance in appraisal of caregivers' stress condition. Conclusion: These findings suggest that coping mechanisms and family resources are important for positive appraisal. Nurses should provide adequate nursing care for the primary caregiver about professional care information and supportive counseling.

  • PDF

Impact of Uncertainty on the Anxiety of Hospitalized Pregnant Women Diagnosed with Preterm Labor: Focusing on Mediating Effect of Uncertainty Appraisal and Coping Style (입원한 조기진통 임부의 불확실성이 불안에 미치는 영향: 불확실성 평가와 대처양상의 매개효과를 중심으로)

  • Kim, Eun Mi;Hong, Sehoon
    • Journal of Korean Academy of Nursing
    • /
    • v.48 no.4
    • /
    • pp.485-496
    • /
    • 2018
  • Purpose: This study aimed to test the mediating effect of uncertainty appraisal and coping style in the relation between uncertainty and anxiety in hospitalized pregnant women diagnosed with preterm labor. Methods: The participants were 105 pregnant women diagnosed with preterm labor in hospitals in Korea. Data were collected from July to October 2017. The measurements included the Uncertainty in Illness Scale, Uncertainty Appraisal Scale, Coping Style Scale, and State Anxiety Inventory. Data were analyzed using descriptive statistics, an independent t-test, correlation, and multiple regression following the Baron and Kenny method and Sobel test for mediation. Results: The mean score for anxiety was 2.29 out of 4.00 points and for uncertainty it was 2.46 out of 5.00 points. There were significant correlations among uncertainty, uncertainty danger appraisal, uncertainty opportunity appraisal, problem-focused coping, emotion-focused coping, and anxiety. Uncertainty danger appraisal (${\beta}=.64$, p<.001) had a complete mediating effect in the relation between uncertainty and anxiety (Z=4.54, p<.001). Uncertainty opportunity appraisal (${\beta}=-.45$, p<.001) had a complete mediating effect in the relation between uncertainty and anxiety (Z=3.28, p<.001). Emotion-focused coping (${\beta}=-.23$, p=.021) had a partial mediating effect in the relation between uncertainty and anxiety (Z=2.02, p=.044). Conclusion: Nursing intervention programs focusing on managing uncertainty appraisal and improving emotion-focused coping are highly recommended to decrease anxiety in hospitalized pregnant women diagnosed with preterm labor.

The Prediction Model of Adaptation in Patients with Rheumatoid Arthritis - Propositional Synthesis of Roy's and Lazarus & Folkman's Theory - (류마티스 관절염 환자의 적응 예측모형 -Roy이론과 Lazarus 및 Folkman 이론의 명제 합성-)

  • Kim, In-Ja;Suh, Moon-Ja
    • Journal of muscle and joint health
    • /
    • v.4 no.2
    • /
    • pp.197-220
    • /
    • 1997
  • The lack of a comprehensive theory describing the mechanism of adaptation scientifically has been one of the limiting factors for the development of nursing intervention of patients with chronic illness. Since Roy's theory provides the general conceptual framework depicting adaptation process with structural stimuli and control mechanism, it is appropriate to understand the process of adaptation. But in Roy's theory, the propositions about cognator and regulator as control mechanisms are not clearly defined. For this reason, most of the previous researches applying the Roy's theory have disregarded the study of cognator and regulator. For the patients with chronic illness such as rheumatoid arthritis, it was reported that adaptation states were different for the same stimuli due to the difference of the control mechanism. Moreover in nursing it is important to identify the control mechanism which can be and must be intervened by nurses. It was the Lazarus and Folkman's theory that proposed the control mechanism. They suggested that individual differences in the reaction against the perceived stress are due to the difference in appraisal and coping. Therefore, the synthesis of Roy's and Lazarus and Folkman's propositions might help to clearly understand the mechanism of adaptation. From this point, a theoretical framework has been developed and tested. The subjects were the 297 patients who had been diagnosed rheumatoid arthritis and attended the outpatient clinic. A hypothetical prediction model of adaptation was tested by the covariance structure analysis with PC-LISREL 7.13. As a result, the overall fit was good($x^2$=78.83, p=0.00 ; GFI=0.96 : AGFI=0.90 ; RMR=0.04) for the hypothetical model. In the final model added GA(5, 1), the overall fit was increased ($x^2$=57.82, p=0.003 ; GFI=0.97 ; AGFI=0.93 : RMR=0.036). Except the fact that illness symptoms affected physical adaptation directly, it was supported that focal and contextual stimuli affected physical and psychosocial adaptation through appraisal and coping. Therefore, it was asserted that the synthesis of two theory's propositions was appropriate. So this model would be useful for the theoretical framework in the nursing practice. And this study synthesizing and testing the theory might contribute to establish nursing's scientific base.

  • PDF

Development of a Family Pattern Appraisal to Guide a Rogerian Nursing Practice (Rogers 이론에 근거한 가족양상 사정지침개발)

  • 이광옥;한영란;김희정
    • Journal of Korean Academy of Nursing
    • /
    • v.25 no.4
    • /
    • pp.751-773
    • /
    • 1995
  • We, clinical nurse specialists practising and guiding student practice in a Community health nursing clinic, wanted to develop a family pattern appraisal consistent with Rogers' conceptual system, the nursing model guiding our practice. We use Rogers' model because it is harmonious with the traditional Korean view of the one human, natural and cosmic world. The purpose of our research was to contribute to science - based nursing practice, not only, one helpful model, but also a model of how to use, in guiding practice, a conceptual system which reflects nurse practitioners' philosophy of nursing, is intellectually satisfying, and enriches meaning in daily nursing life. The research objectives were to review the literature on Rogers' model and analyse it according to Kim's five - level analytical framework, to explore Rogers' definition of family, to review appraisals based on Rogers' model, and to develop a family appraisal which is culturally appropriate for use in our community. This work including the use of the appraisal and its refinement with families in our practice which was done during 1994 and 1995, in Seoul, in the Capital of the Republic of Korea. At the highest level of analysis, Rogers conceptual system emphasizes acausality and multidimentional meaning ; the world view is characterized by process, movement and wholeness. The epistemology Is one of holism and the knowledge base includes all forms of experience, from sensory to mystical, objective, and subjective. At the metaparadigm level, nursing focuses on the unitary human being and the environment. At the level of nursing philosophy, the model identifies human being, nursing, nurse, and illness and health. At the paradigm level the model assumes the irriducibility of the human to parts, noncausality and continual change. Rogers' practice methodology consists of pattern manifestation appraisal and deliberative mutual patterning. Under-standing patterns and patterning of people is the key to helping them achieve their potential. At the theory level, the basic assumptions, key concepts, and homeodynamic principles were identified. Rogers states the family energy field is an undividable, four-dimensional negentropic energy field which is in a larger envircinmental field show-ing such characteristics as cannot be predicted by knowledge of individual family members. Based on the word of Rogers scholars, we chose Rogers' correlates of patterning to understand the family unit as a whole-frequency, rhythms, motion, time perception, sleeping-waking beyond waking, pragmatic -imaginative-visionary to develop the appraisal. We, also used some of Barrel's (1988) criteria including interpersonal network and professional health care access and use, and Cordon's (1982) criteria including self perception - self concept modified to fit the family. Our family Pattern appraisal included 1. Influencirg data, 2. Professional health care access and use, 3. Family self perception-self concept, 4. Family interpersonal network, 5. Sleep-wake-be-yond waking, 6. Pragmatic-imaginary-visionary, 7. Family frequency and rhythm, 8. Family motion, 9. Family time perception. The appraisal was used with four families and modified to eliminate overlap and to make it possible for the family member to express themselves more easily. We plan to gain more experience with the appraisal toward further development of the tool.

  • PDF

A Critical Review of Literature: Mid-Range Nursing Theory of Uncertainty in Illness (중간범위 간호이론인 Mishel의 질병에서의 불확실감에 관한 문헌고찰)

  • Kang, Younhee
    • Korean Journal of Adult Nursing
    • /
    • v.15 no.1
    • /
    • pp.146-153
    • /
    • 2003
  • 연구목적: 본 연구는 대표적인 중간범위 간호이론인 Mishel의 Uncertainty in Illness모델에 관한 연구문헌 고찰이다. 기존의 간호이론에 근거해서 새로운 간호연구가 시행되고 있으며, 이러한 연구들의 결과는 또한, 근거이론을 지지 및 수정보완을 통해서 간호이론의 타당성과 유용성을 강화해왔다. Mishel의 모델에 근거한 불확실감에 관한 연구의 수행에 앞서, 근거이론에 관한 현지식의 상태와 부족한 영역을 탐구하여, 이에 기여할 수 있는 연구계획을 수립하는데 문헌고찰의 주요한 목적이 있다. 연구방법: 본 문헌고찰은 중간범위 간호이론인 Mishel's Uncertainty in Illness에서의 주요 개념간의 관계에 대해서 선행연구 결과를 토대로 분석하였다. 연구결과: 불확실감의 선행요소들(antecedents)과 불확실감, 불확실감의 평가(appraisal of uncertainty), 불확실감 모델내에서 건강 통제위(health locus of control)의 역할, 및 불확실감의 결과, 적응(adaptation)에 관하여 고찰하였다. 결론: 문헌고찰 결과로서, 불확실감 이론에 관한 현지식의 상태를 확인하였고 이 이론의 타당성과 유용성을 확인하기 위한 추후연구에 대한 방향도 제언되었다.

  • PDF

Active Coping Strategy Model for Chronic Arthritis : Appling Internal Model of World and Coping Resource (내적모형과 대응자원을 이용한 만성관절염 환자의 적극적 대응전략모형)

  • Mun, Mi-Sook;Lim, Nan-Young
    • Journal of muscle and joint health
    • /
    • v.6 no.1
    • /
    • pp.100-135
    • /
    • 1999
  • Typical symptoms of rheumatic disease affect overall daily living and cause severe stress. Individuals afflicted with rheumatic disease have many illness-related stresses. Pain was the predominantly perceived stress followed by limitation in mobility, difficulties in carrying out activities of daily living. helplessness, dependency on others, threat to self-esteem, interference in social activity, interference in family relationships. difficulties performing at work, and discomfort of the treatment. Patients with chronic arthritis are subjected to long periods of continuous stress, which may require the management by the health care provider. In these cases, the purpose of the nursing is helping to promote health through supporting patient's coping. Therefore, for the nursing intervention to be effective, it is critical to build a theoretical framework that describes stress-coping for chronic arthritis. Thus, the purpose of this dissertation is to present a theoretical framework which describes the stress-coping processes and to empirically test pathos of this framework for the people with chronic arthritis. The foundation upon which this framework is built in the Erickson, Tomlin, and Swain(1983) theory of Modeling and role-Modeling. The subjects were 275 patients with rheumatoid arthritis or osteoarthritis who visited the outpatient clinic. A hypothetical model of stress-coping was tested by covariance structure analysis with PC-LISREL 8.12 program. As a result, the overall fit was good(Chi-square=94.49, P=0.00, RMR=0.067, GFI=0.95, AGFI=0.91, NNFI=0.93, NFI=0.91) for the hypothetical model. The results of hypothesis testing were as follows : Basic need satisfaction had a statistically significant influence on illness-related experience, emotional stress and coping resources. Internal health locus of control had a statistically significant influence on coping resources. However, independent variables(basic need satisfaction, internal health locus of control, illness-related experience, emotional stress and coping resource) did not have significantly influence on coping. And then, the hypothetical model was modified by considering both the theoretical implication and statistical significance of the parameter estimates. The revised model had a better fit to the data(Chi-square=83.11(P=0.00), RMR=0.061, GFI=0.96, AGFI=0.92, NNFI=0.95, NFI=0.92). Hypothesis emerged from the revised model was tested. The results of hypothesis testing were as follows : Basic need satisfaction had a statistically significant influence on illness-related experience, emotional stress and coping resources. Internal health locus of control had a statistically significant influence on illness-related experience and coping resources. Internal health locus of control, illness-related experience, emotional stress and coping resources had a significantly influence on coping. According to the results of this dissertation, basic need satisfaction and internal health locus of control play a central role in appraisal of illness-related experience and coping resources. And illness related-experience, emotional stress, and coping resources affect on coping activities. In summary, nursing interventions to enhance basic need satisfaction and internal health locus of control will decrease illness related experience and emotional stress and increase coping resources. Increased coping resources will prompt coping activities.

  • PDF

Factors Related to Workload of Intensive Care Unit Nurses: Systematic Review and Meta-Analysis (중환자실 간호사의 업무부담 관련 요인: 체계적 문헌고찰 및 메타분석)

  • Jeong, Ah In;Shin, Sujin;Hong, Eunmin
    • Journal of Korean Clinical Nursing Research
    • /
    • v.29 no.3
    • /
    • pp.296-311
    • /
    • 2023
  • Purpose: This study aimed to identify factors related to the workload of intensive care unit nurses through a systematic literature review and meta-analysis to provide basic data to explore the direction of development of nursing staffing standards. Methods: This study involved quantitative studies about nurses working in intensive care units related to nursing workload published in English or Korean since 2000. Search terms included 'intensive care unit', 'nursing workload', and their variations. Databases such as RISS, DBpia, MEDLINE(PubMed), CINAHL, PsycINFO, and Web of Science were utilized. Quality assessment was conducted using the Joanna Briggs Institute's Critical Appraisal Checklist for Analytical Cross-Sectional Studies. JAMOVI software facilitated the analysis of effect sizes, employing a meta-analysis approach for 7 studies with correlational or regression data. Results: From 16 studies on the workload of intensive care unit nurses, a total of 20 patient and nurse-related factors were identified. Patient-related factors included severity of illness, length of stay, and age. Meta-analysis was conducted for three patient-related factors: age, severity of illness measured by SAPS 3, and length of stay. Only severity of illness measured by SAPS 3 was significantly associated with nurse workload (Zr=0.16, p<.001, 95% CI=0.09-0.24). Conclusion: In previous studies, the characteristics of intensive care units and patients varied across studies, and a variety of scales for measuring workload and severity of illness were also used. Sustained research reflecting domestic intensive care unit work environments and assessing the workload of intensive care unit nurses should be imperative.