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A descriptive study of the perceptions of young adults with asthma : their health problems, associated… Richardson, Heather Margaret 1985

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A D E S C R I P T I V E S T U D Y OF T H E P E R C E P T I O N S O F Y O U N G A D U L T S W I T H A S T H M A : T H E I R H E A L T H P R O B L E M S , A S S O C I A T E D L E A R N I N G N E E D S , A N D R E L A T I O N S H I P S B E T W E E N S E L E C T E D D E M O G R A P H I C AND P E R S O N A L V A R I A B L E S , AND P E R C E I V E D L E A R N I N G N E E D S B y H E A T H E R M A R G A R E T R I C H A R D S O N B . S . N . , T h e U n i v e r s i t y o f B r i t i s h C o l u m b i a , 1 9 8 1 A T H E S I S S U B M I T T E D I N P A R T I A L F U L F I L L M E N T OF T H E R E Q U I R E M E N T S F O R T H E D E G R E E OF M A S T E R OF S C I E N C E I N N U R S I N G i n T H E F A C U L T Y OF G R A D U A T E S T U D I E S S c h o o l o f N u r s i n g We a c c e p t t h i s t h e s i s as c o n f o r m i n g t o t h e r e q u i r e d s t a n d a r d T H E U N I V E R S I T Y OF B R I T I S H C O L U M B I A D e c e m b e r , 1 9 8 5 H e a t h e r M a r g a r e t R i c h a r d s o n , 1 9 8 5 In p resen t ing this thesis in partial fu l f i lment of the requ i rements for an a d v a n c e d d e g r e e at the Univers i ty of Brit ish C o l u m b i a , I agree that t h e Library shall m a k e it freely avai lable fo r re fe rence a n d s tudy . I further agree that pe rm iss ion for ex tens ive c o p y i n g of this thesis fo r scho lar ly p u r p o s e s may b e g ranted by the h e a d of m y d e p a r t m e n t o r by his o r her representat ives . It is u n d e r s t o o d that c o p y i n g o r p u b l i c a t i o n of this thesis fo r f inancia l gain shall no t b e a l l o w e d w i t h o u t m y wr i t ten p e r m i s s i o n . D e p a r t m e n t T h e Un ivers i ty o f Brit ish C o l u m b i a 1956 M a i n M a l l V a n c o u v e r , C a n a d a V 6 T 1Y3 DE-6(3 /81) ABSTRACT The I n c e n t i v e f o r d o i n g t h i s r e s e a r c h o r i g i n a t e d from a c o n c e r n f o r the p r o v i s i o n of r e l e v a n t h e a l t h e d u c a t i o n f o r young a d u l t s w i t h b r o n c h i a l asthma of the e x t r i n s i c t y p e . The stud y d e s c r i b e s the p e r c e p t i o n s of young a d u l t s w i t h asthma i n r e s p e c t to t h e i r h e a l t h problems r e l a t e d to asthma, t h e i r a s s o c i a t e d l e a r n i n g n eeds, and d e t e r m i n e s r e l a t i o n s h i p s between s e l e c t e d demographic and p e r s o n a l v a r i a b l e s and p e r c e i v e d l e a r n i n g needs. Survey methodology was use d . Twenty young a d u l t p a r t i c i p a n t s , between the ages of 20 - 45 and who had e x t r i n s i c asthma, were i n t e r v i e w e d . The U.B.C. Model  f o r N u r s i n g (1980) f a c i l i t a t e d the a t t a i n m e n t and o r g a n i z a t i o n of p a r t i c i p a n t p e r c e p t i o n s . S t a t i s t i c a l a n a l y s i s was done u s i n g F i s h e r ' s E x a c t T e s t to d e t e r m i n e r e l a t i o n s h i p s between s e l e c t e d demographic and p e r s o n a l v a r i a b l e s , and p e r c e i v e d l e a r n i n g needs. The f i n d i n g s r e v e a l e d t h a t the common h e a l t h problems of young a d u l t s w i t h asthma were: l i f e s t y l e , symptom c o n t r o l , s e l f - e s t e e m , s o c i a l i s o l a t i o n , a d j u s t m e n t , p s y c h o l o g i c a l and i n t e r v e n t i o n p r o b l e m s . Common l e a r n i n g needs were a s s o c i a t e d w i t h symptom c o n t r o l ( t h e m a j o r i t y of the l e a r n i n g needs i i i i d e n t i f i e d ) , l i f e s t y l e , and i n t e r a c t i o n p r o b l e m s . The l e a r n i n g needs d e s c r i b e d d i d not however a d d r e s s the m u l t i p l e h e a l t h problems which had been i d e n t i f i e d by the sample. L a s t l y , r e l a t i o n s h i p s e x i s t e d between two p e r s o n a l v a r i a b l e s ( l e n g t h of time d i a g n o s e d and how f r e q u e n t l y p r o f e s s i o n a l h e a l t h c a r e due to asthma was s o u g h t ) , and one demographic v a r i a b l e ( h a v i n g d ependents — c h i l d r e n ) and p e r c e i v e d l e a r n i n g n eeds. These f i n d i n g s s u g g e s t e d the f o l l o w i n g c o n c l u s i o n s : t h a t the h e a l t h problems and l e a r n i n g needs of young a d u l t s w i t h asthma of the e x t r i n s i c type were m u l t i p l e , p e r v a s i v e and d i v e r s e ( t h i s f i n d i n g i s congruous w i t h what has been e s t a b l i s h e d i n the a l l i e d h e a l t h l i t e r a t u r e ) ; t h a t the d i v e r s i t y i n p e r c e i v e d l e a r n i n g needs, among the p a r t i c i p a n t s , were s t a t i s t i c a l l y r e l a t e d to p e r s o n a l or demographic v a r i a b l e s ; and f i n a l l y t h a t t h e r e was some i n c o n g r u e n c e between the h e a l t h problems e x p e r i e n c e d by the p a r t i c i p a n t s and t h e i r a s s o c i a t e d l e a r n i n g needs. i v T A B L E OF C O N T E N T S P a g e A B S T R A C T i i L I S T OF T A B L E S v i i i A C K N O W L E D G E M E N T S x C H A P T E R ONE B a c k g r o u n d t o t h e P r o b l e m . . . < > . < > • » . • • . • • • . . o . . o . e 3 P u r p o s e 7 P r o b l e m S t a t e m e n t 7 D e f i n i t i o n o f T e r m s 8 A s s u m p t i o n s 9 L i m i t a t i o n s 10 C H A P T E R TWO R e v i e w o f L i t e r a t u r e 11 O v e r v i e w 11 P r o b l e m s o f I n d i v i d u a l s w i t h A s t h m a a n d o r C h r o n i c O b s t r u c t i v e P u l m o n a r y D i s e a s e a s D o c u m e n t e d b y A l l i e d H e a l t h P r o f e s s i o n a l s 11 L e a r n i n g N e e d s o f P a t i e n t s , a s I d e n t i f i e d f r o m t h e P a t i e n t s ' P e r s p e c t i v e 16 R e l a t i o n s h i p s B e t w e e n S e l e c t e d D e m o g r a p h i c a n d P e r s o n a l V a r i a b l e s a n d P e r c e p t i o n s o f L e a r n i n g N e e d s A m o n g P a t i e n t s 20 V C u r r e n t H e a l t h E d u c a t i o n F o c u s b y N u r s e s f o r P e r s o n s w i t h A s t h m a a n d / o r C h r o n i c O b s t r u c t i v e P u l m o n a r y D i s e a s e 23 S u m m a r y 27 C H A P T E R T H R E E M e t h o d o l o g y . . 29 O v e r v i e w 29 I n s t r u m e n t C o n s t r u c t i o n 29 C r i t e r i a f o r S e l e c t i o n o f P a r t i c i p a n t s 32 P o p u l a t i o n a n d S a m p l e S e l e c t i o n P r o c e d u r e . . . . 32 D a t a C o l l e c t i o n 34 D a t a A n a l y s i s 36 E t h i c a l C o n s i d e r a t i o n 37 A . I n f o r m e d C o n s e n t a n d R i s k B e n e f i t 37 B . P r i v a c y 38 C . C o n f i d e n t i a l i t y 38 S u m m a r y • 39 C H A P T E R F O U R P r e s e n t a t i o n a n d A n a l y s i s o f F i n d i n g s 40 O v e r v i e w 40 D e m o g r a p h i c a n d P e r s o n a l I n f o r m a t i o n 41 H e a l t h P r o b l e m s o f Y o u n g A d u l t s 47 H e a l t h P r o b l e m s R e l a t e d t o t h e N e e d F o r S a f e t y a n d S e c u r i t y 47 H e a l t h P r o b l e m s R e l a t e d t o t h e N e e d F o r B a l a n c e B e t w e e n P r o d u c t i o n a n d U t i l i z a t i o n o f E n e r g y 51 v i Page Health Problems Related to the Need For Mastery 53 Health Problems Related to the Need For Respect of Self, By Self and Others.... 57 Health Problems Related to the Need For Love, Belongingness and Dependence 62 Health Problems Related to the Need For Intake of Food and F l u i d : Nourishment.. 64 Health Problems Related to the Need For Intake of Oxygen 66 Health Problems Related to the Need For Stimulation of the Senses 67 Health Problems Related to the Need For C o l l e c t i o n and Removal of Accumulated Waste 69 Summary 80 Learning Needs of Young Adults with Asthma... 80 Overview 80 Learning Needs Related to the Need For Safety and Security 81 Learning Needs Related to the Need For Balance Between Production and U t i l i z a t i o n of Energy.... 83 Learning Needs Related to the Need For Mastery 84— Learning Needs Related to the Need For Intake of Food, F l u i d : Nourishment..... 85 Learning Need Related to the Need For Love, Belongingness and Dependence 87 Learning Need Related to the Need For Intake of Oxygen 88 Summary 93 v i i Page Relationship Between Selected Demographic and Personal Variables 95 Overview 95 Summary 100 CHAPTER FIVE Summary, Conclusions, Implications and Recommendations . • .. 101 Overview 101 Summary and Conclusions 101 Implications for Nursing Practice 105 Implications for Nursing Education 109 Recommendations for Further Research 110 Summary I l l REFERENCES 112 APPENDICES A - Demographic and Personal Interview Schedule 117 B - Interview Schedule 119 C - Letter to the Physician 120 D - Physician Consent 122 E - Cover Letter to Participants 123 F - Participant Consent 125 v i i i L I S T OF T A B L E S T a b l e P a g e 1 P e r c e n t a g e a n d F r e q u e n c y D i s t r i b u t i o n i n R e l a t i o n t o D e m o g r a p h i c a n d P e r s o n a l V a r i a b l e s 42 2 P e r c e n t a g e a n d F r e q u e n c y D i s t r i b u t i o n o f H e a l t h P r o b l e m s R e l a t e d t o t h e N e e d F o r S a f e t y a n d S e c u r i t y 48 3 P e r c e n t a g e a n d F r e q u e n c y D i s t r i b u t i o n o f H e a l t h P r o b l e m s R e l a t e d t o t h e N e e d F o r B a l a n c e B e t w e e n P r o d u c t i o n a n d U t i l i z a t i o n o f E n e r g y 52 4 P e r c e n t a g e a n d F r e q u e n c y D i s t r i b u t i o n o f H e a l t h P r o b l e m s R e l a t e d t o t h e N e e d F o r M a s t e r y 54 5 P e r c e n t a g e a n d F r e q u e n c y D i s t r i b u t i o n o f H e a l t h P r o b l e m s R e l a t e d t o t h e N e e d F o r R e s p e c t o f S e l f , B y S e l f a n d O t h e r s 58 6 P e r c e n t a g e a n d F r e q u e n c y D i s t r i b u t i o n o f H e a l t h P r o b l e m s R e l a t e d t o t h e N e e d F o r L o v e , B e l o n g i n g n e s s a n d D e p e n d e n c e . . . 62 7 P e r c e n t a g e a n d F r e q u e n c y D i s t r i b u t i o n o f H e a l t h P r o b l e m s R e l a t e d t o t h e N e e d F o r I n t a k e o f F o o d a n d F l u i d : N o u r i s h m e n t 64 8 P e r c e n t a g e a n d F r e q u e n c y D i s t r i b u t i o n o f H e a l t h P r o b l e m s R e l a t e d t o t h e N e e d — F o r I n t a k e o f O x y g e n 67 9 P e r c e n t a g e a n d F r e q u e n c y D i s t r i b u t i o n o f H e a l t h P r o b l e m s R e l a t e d t o t h e N e e d F o r S t i m u l a t i o n o f t h e S e n s e s 68 10 P e r c e n t a g e a n d F r e q u e n c y D i s t r i b u t i o n o f H e a l t h P r o b l e m s R e l a t e d t o t h e N e e d F o r C o l l e c t i o n a n d R e m o v a l o f A c c u m u l a t e d W a s t e 70 11 P e r c e n t a g e a n d F r e q u e n c y D i s t r i b u t i o n o f L e a r n i n g N e e d s R e l a t e d t o t h e N e e d F o r S a f e t y a n d S e c u r i t y 81 ix Page 12 Percentage and Frequency D i s t r i b u t i o n of Learning Needs Related to the Need For Balance Between Production and U t i l i z a t i o n of Energy 84 13 Percentage and Frequency D i s t r i b u t i o n of Learning Needs Related to the Need For Mastery 85 14 Percentage and Frequency D i s t r i b u t i o n of Learning Needs Related to the Need For Intake of Food, F l u i d : Nourishment... 86 15 Percentage and Frequency D i s t r i b u t i o n of Learning Needs Related to the Need For Love, Belongingness and Dependence... 87 16 Percentage and Frequency D i s t r i b u t i o n of Learning Needs Related to the Need For Intake of Oxygen 88 17 Relationship Between Length of Time Diagnosed and the Learning Need Pathophysiology of Asthma 96 18 Relationship Between Length of Time Diagnosed and the Learning Need Perceptions of Others with Asthma and Their Coping Strategies 97 19 Relationship Between How Often Professional Health Care Due to Asthma is Sought and the Learning Need Long-Term Prognosis of Asthma 98 20 Relationship Between Having Dependents (Children) and the Learning Need Hereditary Factors in Asthma 99 X ACKNOWLEDGEMENTS I extend my s i n c e r e a p p r e c i a t i o n to the members of my t h e s i s committee, Dr. Kathleen Simpson, c h a i r p e r s o n , and Jo Ann Pe r r y , M.S.N., f o r t h e i r guidance, c h a l l e n g e s and support. I a l s o wish to extend my g r a t i t u d e to the twenty p a r t i c i p a n t s who so w i l l i n g l y gave of t h e i r time, and shared t h e i r p e r c e p t i o n s f o r the purpose of c o n t r i b u t i n g to t h i s r e s e a r c h study. F i n a l l y , I am e s p e c i a l l y g r a t e f u l to my f a m i l y and f r i e n d s f o r t h e i r c o n s i s t e n t encouragement throughout the w r i t i n g of t h i s t h e s i s . 1 C H A P T E R ONE B r o n c h i a l a s t h m a i s a c h r o n i c i l l n e s s c l a s s i f i e d a s o n e o f t h e t h r e e c h r o n i c r e s p i r a t o r y p r o b l e m s r e f e r r e d t o a s C h r o n i c O b s t r u c t i v e P u l m o n a r y D i s e a s e ( L u c k m a n n & S o r e n s e n , 1 9 8 0 ; S e x t o n , 1 9 8 1 ) . I n 1 9 8 3 , t h e p r e v a l e n c e o f a s t h m a a m o n g C a n a d i a n s was 2 . 1 p e r c e n t ( A b e l s o n , P a d d o n & S t r a s h m e n g e r , 1 9 8 3 ) , a n d i n 1 9 8 2 , t h e m o r t a l i t y r a t e d u e t o a s t h m a was 4 7 4 p e r 1 0 0 , 0 0 0 p o p u l a t i o n ( S t a t s . C a n . , M a r . 1 9 8 4 ) . S i n c e a s t h m a i s a c h r o n i c I l l n e s s , i t h a s s p e c i f i c i m p l i c a t i o n s f i r s t , f o r t h o s e e x p e r i e n c i n g i t , a n d s e c o n d , f o r n u r s e s p r o v i d i n g h e a l t h e d u c a t i o n f o r i n d i v i d u a l s w i t h a s t h m a . T h e l i f e - l o n g o r l o n g - t e r m n a t u r e o f a s t h m a c h a r a c t e r i s t i c a l l y c r e a t e s m u l t i p l e a n d c o m p l e x p r o b l e m s a s s o c i a t e d w i t h a s t h m a w h i c h may d i s r u p t e s t a b l i s h e d d a i l y l i v i n g p a t t e r n s . I t t h e r e f o r e b e c o m e s e s s e n t i a l f o r p e r s o n s w i t h a s t h m a t o l e a r n h o w t o c a r e f o r t h e m s e l v e s o n a d a i l y b a s i s . S t r a u s s a n d G l a s e r ( 1 9 7 5 ) s p e c i f i c a l l y e m p h a s i z e d t h a t t h o s e w i t h a c h r o n i c i l l n e s s r e q u i r e i n - d e p t h h e a l t h e d u c a t i o n t o l e a r n how t o c o m p e t e n t l y m a n a g e t h e i r p r o b l e m s a s s o c i a t e d w i t h c h r o n i c i l l n e s s . F o r e x a m p l e , m a s t e r y o f n e w s e l f - c a r e s k i l l s , a n d o f new d a i l y l i v i n g 2 p a t t e r n s i s f r e q u e n t l y r e q u i s i t e b e f o r e asthma can be s u c c e s s f u l l y a s s i m i l a t e d i n t o d a i l y l i v i n g , and an o p t i m a l l e v e l of h e a l t h m a i n t a i n e d . U l t i m a t e l y , those w i t h asthma need to l e a r n how to become the p r i m a r y d e c i s i o n - m a k e r s r e g a r d i n g t h e i r h e a l t h c a r e (The Commission on C h r o n i c I l l n e s s , 1959; S t r a u s s & G l a s e r , 1975; Van Dam Anderson & Bauwens, 1981; Dimond & J o n e s , 1983; M i l l e r , 1983). Nurse e d u c a t o r s such as Redman ( 1 9 8 1 ) , B i l l e ( 1 9 8 2 ) , Rankin and D u f f y ( 1 9 8 3 ) , and Squyres ( 1 9 8 0 ) , have contended t h a t nurses can a s s i s t i n d i v i d u a l s to cope s u c c e s s f u l l y w i t h t h e i r problems i n the p r o v i s i o n of h e a l t h e d u c a t i o n . I n d i v i d u a l s f r e q u e n t l y depend on n urses to a s s i s t them w i t h t h e i r h e a l t h problems; moreover, s e v e r a l i n f l u e n t i a l n u r s i n g e d u c a t o r s h o l d t h a t h e a l t h e d u c a t i o n i s one of the p r i m a r y f u n c t i o n s of n urses ( B i l l e , 1982; Redman, 1980). T h e r e f o r e , p r o f e s s i o n a l n urses need to be e x p e r t h e a l t h e d u c a t i o n t e a c h e r s b e f o r e a c c o u n t a b i l i t y and r e s p o n s i b i l i t y i n c l i n i c a l p r a c t i c e may be a s s u r e d . S p e c i f i c a l l y , In t e a c h i n g persons w i t h asthma how to care f o r themselves on a d a i l y b a s i s , i t i s e s s e n t i a l t h a t n u r s e s have a comprehensive knowledge of the problems e x p e r i e n c e d i n a s s o c i a t i o n w i t h asthma, and of the unique l e a r n i n g needs of i n d i v i d u a l s w i t h asthma. 3 B a c k g r o u n d T o T h e P r o b l e m C o m m o n p r o b l e m s o f i n d i v i d u a l s w i t h a s t h m a f r e q u e n t l y m a y i n c l u d e e n v i r o n m e n t a l c o n t r o l t o r e d u c e a l l e r g e n a n d i r r i t a n t c o n t a c t s ; c h a n g e s i n i n t i m a t e a n d s o c i a l r e l a t i o n s h i p s ; c h a n g e s i n l i f e s t y l e a n d c u s t o m a r y r o l e s ; a n d p r o b l e m s w i t h a d h e r e n c e t o m e d i c a t i o n r e g i m e n s ( L u c k m a n & S o r e n s e n , 1 9 8 1 ; S e x t o n , 1 9 8 1 ) . H o w e v e r , t o p r o v i d e h e a l t h e d u c a t i o n w h i c h h a s d i s t i n c t v a l u e a n d u s e f u l n e s s i n a s s i s t i n g p e r s o n s w i t h a s t h m a t o c o p e w i t h t h e i r p r o b l e m s , n u r s e s m u s t m a k e c e r t a i n t h e i r t e a c h i n g i s f o u n d e d o n a c o m p r e h e n s i v e u n d e r s t a n d i n g o f t h e s p e c i f i c h e a l t h p r o b l e m s e x p e r i e n c e d b y p e r s o n s a n d t h e i r l e a r n i n g n e e d s ( R a n k i n & D u f f y , 1 9 8 3 ; R e d m a n , 1 9 7 6 ; B i l l e , 1 9 8 2 ; S q u y r e s , 1 9 8 0 ) . S e v e r a l n u r s e e d u c a t o r s , s u c h a s R a n k i n a n d D u f f y ( 1 9 8 3 ) ; R e d m a n ( 1 9 7 6 , 1 9 8 1 ) ; B a r r y ( 1 9 8 2 ) ; a n d B i l l e ( 1 9 8 2 ) h a v e c o n t e n d e d , h o w e v e r , t h a t t h e c o n t e n t i n h e a l t h e d u c a t i o n p r e p a r e d b y n u r s e s i s f r e q u e n t l y p l a n n e d a c c o r d i n g t o n u r s e s ' p e r c e p t i o n s o f t h e l e a r n i n g n e e d s o f i n d i v i d u a l s , r a t h e r t h a n o n i n d i v i d u a l s ' p e r c e p t i o n s o f w h a t i s m o s t c r i t i c a l f o r t h e m t o l e a r n . T h i s may h a v e s i g n i f i c a n t b e a r i n g o n t h e u s e f u l n e s s o f h e a l t h e d u c a t i o n p r o v i d e d b y n u r s e s . 4 F o r e x a m p l e , B a r r y ( 1 9 8 2 ) a n d L a u e r , M u r p h y , a n d P o w e r s ( 1 9 8 2 ) c l a i m e d t h a t n u r s e s o f t e n p r e p a r e h e a l t h e d u c a t i o n w h i c h i s s t a n d a r d i z e d a n d p r e s c r i p t i v e . S u b s e q u e n t l y , t e a c h i n g p r o v i d e d b y n u r s e s f r e q u e n t l y e m p h a s i z e s d i s e a s e p r o c e s s e s a n d t r e a t m e n t s m o d a l i t i e s r a t h e r t h a n d i r e c t i n g a p p r o p r i a t e a t t e n t i o n t o f o s t e r i n g n e w c o p i n g b e h a v i o r s w h i c h a r e m o s t n e e d e d t o a s s i s t i n d i v i d u a l s w i t h t h e a c t u a l h e a l t h p r o b l e m s t h e y e x p e r i e n c e . H e n c e , t h e h e a l t h e d u c a t i o n p r o v i d e d m a y n o t a d d r e s s t h e m o s t c r u c i a l p r o b l e m s a n d l e a r n i n g n e e d s o f p e r s o n s a s t h e y p e r c e i v e t h e m . S o c i o l o g i s t s s u c h a s S t r a u s s a n d G l a s e r ( 1 9 7 5 ) c o n c e d e d t h a t e a c h c h r o n i c i l l n e s s p r e s e n t s c o m m o n t y p e s o f p r o b l e m s ; i t m a y t h e r e f o r e b e a s s u m e d t h a t c o m m o n t y p e s o f p r o b l e m s e x i s t a m o n g t h o s e w i t h a s t h m a . F u r t h e r , m e d i c a l s o c i o l o g i s t s , o t h e r s o c i o l o g i s t s , a n d i n d i v i d u a l s i n t h e d i s c i p l i n e o f m e d i c i n e , m a i n t a i n t h a t i l l n e s s i s p e r c e i v e d a n d e x p e r i e n c e d w i t h i n t h e c o n t e x t o f s i t u a t i o n a l f a c t o r s p r e s e n t i n t h e p e r s o n ' s l i f e . A n e x p l a n a t i o n f o r d i v e r s e p e r c e p t i o n s ( c o g n i t i v e a p p r a i s a l ) i n t h e i l l n e s s e x p e r i e n c e w a s p r o p o s e d b y M o o s , who s t a t e d , T h i s c o g n i t i v e a p p r a i s a l , t h e p e r c e p t i o n o f t a s k s i n v o l v e d , a n d t h e s e l e c t i o n o f r e l e v a n t c o p i n g s k i l l s a r e i n f l u e n c e d b y t h r e e s e t s o f f a c t o r s : b a c k g r o u n d a n d p e r s o n a l c h a r a c t e r i s t i c s , i l l n e s s - r e l a t e d f a c t o r s , a n d f e a t u r e s o f t h e p h y s i c a l a n d s o c i o c u l t u r a l e n v i r o n m e n t . ( 1 9 7 7 , p . 8 ) 5 I n v i e w o f t h i s e x p l a n a t i o n , i t m a y b e a s s u m e d t h a t p e r s o n a l c h a r a c t e r i s t i c s , a s w e l l a s i l l n e s s -r e l a t e d f a c t o r s , m a y i n f l u e n c e t h e p e r c e p t i o n s o f p e r s o n s w i t h a s t h m a . T h e r e f o r e , a m o n g p e r s o n s w i t h a s t h m a , p e r c e p t i o n s r e l a t e d t o t h e i r i l l n e s s m a y v a r y a c c o r d i n g t o s e v e r a l i n f l u e n t i a l f a c t o r s . T h i s m a y h a v e s p e c i f i c s i g n i f i c a n c e f o r n u r s e s c o n c e r n e d w i t h p l a n n i n g m e a n i n g f u l h e a l t h e d u c a t i o n w h i c h b e s t a d d r e s s e s p e r s o n s ' h e a l t h p r o b l e m s a n d l e a r n i n g n e e d s . A l t h o u g h S t r a u s s a n d G l a s e r c o n c e d e d t h a t n u r s e s a n d o t h e r h e a l t h c a r e p r o f e s s i o n a l s h a v e c o n s i d e r a b l e k n o w l e d g e o f t h e p r o b l e m s a s s o c i a t e d w i t h c h r o n i c i l l n e s s , t h e y n e v e r t h e l e s s m a i n t a i n e d t h a t . . . t o u n d e r s t a n d h o w a g i v e n d i s e a s e a f f e c t s t h e d a i l y e x p e r i e n c e s o f t h e a f f l i c t e d p e r s o n s , o n e i s l i k e l y t o f i n d b e t t e r i n f o r m a t i o n i n t h e o c c a s i o n a l a u t o b i o g r a p h i e s w r i t t e n b y p a t i e n t s t h a n i n t h e s t a n d a r d l i t e r a t u r e a b o u t t h e i r d i s e a s e s . ( 1 9 7 5 , p . 7 ) F i n a l l y , B i l l e ( 1 9 8 2 ) s t r e s s e d t h a t i n d i v i d u a l s k n o w t h e i r e n v i r o n m e n t b e t t e r t h a n a n y o n e ; t h e r e f o r e , t h e y m a y b e s t i d e n t i f y t h e i r l e a r n i n g n e e d s . T h e c o g n i t i v e - f i e l d t h e o r y o f l e a r n i n g , a m a j o r c o m t e m p o r a r y l e a r n i n g t h e o r y , c o n t e n d s t h a t f o r t e a c h i n g t o b e m e a n i n g f u l , i t m u s t b e p l a n n e d i n 6 a c c o r d a n c e w i t h l e a r n e r p e r c e p t i o n s o f t h e i r s i t u a t i o n . C o g n i t i v e - f i e l d l e a r n i n g t h e o r i s t s s p e c i f i c a l l y h o l d t h a t o b t a i n i n g t h i s i n f o r m a t i o n i s c r u c i a l t o p l a n n i n g t e a c h i n g w h i c h i s r e l e v a n t t o t h e l e a r n e r s s i t u a t i o n , b e c a u s e t h e t e a c h i n g w o u l d b e c o n g r u e n t w i t h t h e l e a r n e r ' s p e r c e p t i o n o f t h e i r n e e d s , g o a l s , a b i l i t i t e s a n d s i t u a t i o n a l f o r c e s ( B i g g e , 1 9 8 2 ) . T h e s e l e a r n i n g t h e o r i s t s a l s o p r e m i s e , a s d o s e v e r a l m e d i c a l s o c i o l o g i s t s , t h a t p e r c e p t i o n s a r e d i r e c t l y a s s o c i a t e d w i t h v a r i a b l e s i n p e r s o n s ' s i t u a t i o n s . C o g n i t i v e - f i e l d l e a r n i n g t h e o r i s t s a r e l e a r n e r -c e n t r e d , a n d a d d i t i o n a l l y s t r e s s t h a t i n t h e t e a c h i n g a n d l e a r n i n g p r o c e s s , p e r s o n s n e e d t o b e a c t i v e p a r t i c i p a n t s b a s e d o n t h e p r e m i s e t h a t l e a r n e r s a r e a c t i v e p r o b l e m - s o l v e r s a n d i n s i g h t f u l t h i n k e r s c a p a b l e o f d e t e r m i n i n g t h e i r s i t u a t i o n ( O r n s t e i n , 1 9 7 7 ; S w a n s o n , 1 9 8 0 ; H i l g a r d & B o w e r , 1 9 7 5 ) . I t m a y b e a s s u m e d i n t h i s s t u d y t h a t i n d i v i d u a l s w i t h a s t h m a c a n p e r c e i v e t h e i r h e a l t h p r o b l e m s a s s o c i a t e d w i t h a s t h m a a n d t h e i r l e a r n i n g n e e d s i n a c c o r d w i t h t h e i r p e r c e p t i o n s o f t h e i r s i t u a t i o n . I n s u m m a r y , w h a t h a s b e e n d o c u m e n t e d b y s o m e s o c i o l o g i s t s , m e d i c a l s o c i o l o g i s t s , n u r s e e d u c a t o r s , a n d c o g n i t i v e - f i e l d l e a r n i n g t h e o r i s t s , p r o v i d e s t h e 7 r a t i o n a l e t h a t i n t h e p r o v i s i o n o f m e a n i n g f u l h e a l t h e d u c a t i o n n u r s e s n e e d t o o b t a i n k n o w l e d g e o f p e r s o n s ' p e r c e p t i o n s o f t h e i r h e a l t h p r o b l e m s , l e a r n i n g n e e d s , a n d v a r i a b l e s w h i c h m a y b e I n f l u e n t i a l t o l e a r n i n g n e e d p e r c e p t i o n s . T h i s s t u d y w a s d e s i g n e d t o e x p l o r e t h e p e r c e p t i o n s o f y o u n g a d u l t s w i t h a s t h m a . T h e y o u n g a d u l t a g e g r o u p w a s s e l e c t e d b y t h e I n v e s t i g a t o r b e c a u s e b r o n c h i a l a s t h m a i s o n e o f t h e m o s t c o m m o n c h r o n i c h e a l t h p r o b l e m s a m o n g y o u n g a d u l t s ( S e x t o n , 1 9 8 1 ) . P u r p o s e o f t h e R e s e a r c h S t u d y T h e p u r p o s e o f t h i s r e s e a r c h s t u d y w a s t o f o c u s o n y o u n g a d u l t s w i t h a s t h m a a n d t o i d e n t i f y a n d d e s c r i b e f i r s t , y o u n g a d u l t p e r c e p t i o n s o f t h e i r h e a l t h p r o b l e m s r e l a t e d t o a s t h m a ; s e c o n d , t h e i r p e r c e p t i o n s o f t h e i r l e a r n i n g n e e d s ; a n d t h i r d , t o d e t e r m i n e r e l a t i o n s h i p s b e t w e e n s e l e c t e d d e m o g r a p h i c a n d p e r s o n a l v a r i a b l e s a n d p e r c e i v e d l e a r n i n g n e e d s . P r o b l e m S t a t e m e n t I n t h e p r o v i s i o n o f r e l e v a n t h e a l t h e d u c a t i o n f o r y o u n g a d u l t s w i t h a s t h m a , i t i s e s s e n t i a l t h a t t h e t e a c h i n g p r o v i d e d b y n u r s e s i s f o u n d e d o n a t h o r o u g h u n d e r s t a n d i n g o f how t h i s c l i e n t g r o u p p e r c e i v e s t h e i r h e a l t h p r o b l e m s a n d l e a r n i n g n e e d s . 8 Thi s study was conducted to o b t a i n knowledge of the p e r c e p t i o n s of young a d u l t s with asthma i n r e s p e c t to t h e i r h e a l t h problems a s s o c i a t e d with asthma, t h e i r l e a r n i n g needs, and to i d e n t i f y r e l a t i o n s h i p s between l e a r n i n g needs and s e l e c t e d demographic and personal v a r i a b l e s . The d e f i n i t i o n of terms, assumptions and l i m i t a t i o n s p e r t a i n i n g to the study are as f o l l o w s : D e f i n i t i o n of Terms B r o n c h i a l Asthma: Is a d i s e a s e c h a r a c t e r i z e d by an i n c r e a s e d responsiveness of the trachea and bronchi to va r i o u s s t i m u l i ( o f t e n a l l e r g e n s ) and manifested by widespread airway narrowing that changes i n s e v e r i t y , e i t h e r spontaneously or as a r e s u l t of therapy; presents as e p i s o d i c dyspnea, cough, and wheezing. ( B l a k i s t o n , 1979, p. 128) E x t r i n s i c Asthma: Is a s p e c i f i c type of asthma caused by i n h a l a n t s , food, or drugs. ( B l a k i s t o n , 1979) Young A d u l t : Is an ad u l t between the ages of 20-45. B a s i c Human Needs: Are i n n a t e , and have been determined as needs f o r : mastery; l o v e , belongingness and dependence; r e s p e c t f o r s e l f , by s e l f and othe r s ; e l i m i n a t i o n ; nourishment; s a f e t y and s e c u r i t y ; balance between r e s t and a c t i v i t y ; i n t a k e of oxygen; s t i m u l a t i o n of the senses. (The U.B.C. Model Committee, 1980) 9 H e a l t h P r o b l e m s : Are what persons p e r c e i v e as t h e i r d i f f i c u l t i e s a n d / o r concerns i n d a i l y l i v i n g , due to the impact of asthma, and i n a s s o c i a t i o n w i t h b a s i c human n e e d s . L e a r n i n g Needs : Are what persons p e r c e i v e that they need to know and do to enable them to cope w i t h an a s s o c i a t e d h e a l t h p r o b l e m . H e a l t h E d u c a t i o n : Is a s y s t e m a t i c a l l y planned l e a r n i n g e x p e r i e n c e which i s d e s i g n e d on the b a s i s of an assessment of p e r s o n s ' p e r c e p t i o n s of t h e i r h e a l t h problems and l e a r n i n g n e e d s , and c h a r a c t e r i s t i c s of the g r o u p . Demographic and P e r s o n a l V a r i a b l e s (Appendix A ) : Are p o t e n t i a l i n t e r v e n i n g f o r c e s which may i n f l u e n c e p e r s o n s ' p e r c e p t i o n s . Demographic v a r i a b l e s are sex , d e p e n d e n t s , age, o c c u p a t i o n , e d u c a t i o n and h a v i n g c o n f i d a n t s ( such as a s p o u s e , f r i e n d s and r e l a t i v e s ) . P e r s o n a l v a r i a b l e s are i l l n e s s - r e l a t e d f o r c e s . Assumptions 1. I t i s assumed that young a d u l t s who have asthma can p e r c e i v e t h e i r h e a l t h problems r e l a t e d to asthma, and communicate them to o t h e r s . 2. I t i s assumed that young a d u l t s who have asthma can p e r c e i v e t h e i r l e a r n i n g needs i n r e l a t i o n to p e r c e i v e d h e a l t h p r o b l e m s , and can communicate them to o t h e r s . 10 L i m i t a t i o n s 1. The g e n e r a l i z a b i l i t y o f t h e f i n d i n g s may be l i m i t e d by a s m a l l s a m p l e s i z e , and a n o n - p r o b a b i l i t y c o n v e n i e n c e s a m p l e . 11 C H A P T E R TWO R e v i e w o f L i t e r a t u r e O v e r v i e w T h e p u r p o s e o f t h e f o l l o w i n g l i t e r a t u r e r e v i e w i s t o p r o v i d e a f r a m e o f r e f e r e n c e f o r t h e r e s e a r c h p r o b l e m s i n t h i s s t u d y . I t i s o r g a n i z e d i n t o f o u r s e c t i o n s , a n d s u m m a r i z e s t h e i m p a c t o f a s t h m a a n d / o r c h r o n i c o b s t r u c t i v e p u l m o n a r y d i s e a s e o n i n d i v i d u a l s a s d o c u m e n t e d b y a l l i e d h e a l t h p r o f e s s i o n a l s ; c u r r e n t r e s e a r c h w h i c h i n v e s t i g a t e d c h r o n i c a l l y i l l p a t i e n t s ' p e r c e p t i o n s o f t h e i r l e a r n i n g n e e d s ; r e s e a r c h s t u d i e s w h i c h h a v e i n v e s t i g a t e d t h e r e l a t i o n s h i p s b e t w e e n s e l e c t e d d e m o g r a p h i c a n d p e r s o n a l v a r i a b l e s a n d t h e p e r c e i v e d l e a r n i n g n e e d s o f p a t i e n t s ; a n d f i n a l l y , t h e c u r r e n t h e a l t h e d u c a t i o n f o c u s p r o v i d e d b y n u r s e s f o r t h o s e w i t h a s t h m a a n d / o r c h r o n i c o b s t r u c t i v e l u n g d i s e a s e . P r o b l e m s o f I n d i v i d u a l s w i t h A s t h m a a n d / o r C h r o n i c O b s t r u c t i v e P u l m o n a r y D i s e a s e , a s D o c u m e n t e d b y A l l i e d H e a l t h P r o f e s s i o n a l s I t a p p e a r s t h a t t h e p r o b l e m s o f i n d i v i d u a l s w i t h a s t h m a a n d / o r c h r o n i c o b s t r u c t i v e p u l m o n a r y d i s e a s e h a v e b e e n i d e n t i f i e d b y a l l i e d h e a l t h p r o f e s s i o n a l s , 12 e i t h e r w i t h i n t h e c o n t e x t o f p a t h o p h y s i c a l , p s y c h o l o g i c a l o r s o c i a l s y m p t o m a t o l o g y , o r w i t h i n t h e c o n t e x t o f t h e i m p a c t o f a s t h m a o n a s p e c t s o f d a i l y l i v i n g . W h a t f o l l o w s s u m m a r i z e s t h e p r o b l e m s o f i n d i v i d u a l s w i t h a s t h m a a n d / o r c h r o n i c o b s t r u c t i v e l u n g d i s e a s e , a s t h e y h a v e b e e n d e s c r i b e d w i t h i n t h e s e c o n t e x t s . H o w e , D i c k a s o n , J o n e s , a n d S n i d e r ( 1 9 8 4 ) i d e n t i f i e d s e v e r a l o f t h e p h y s i c a l s y m p t o m s e x p e r i e n c e d i n a s t h m a . T h e y w e r e : n a s a l c o n g e s t i o n a n d s n e e z i n g , s h o r t n e s s o f b r e a t h , w h e e z i n g a c c o m p a n i e d b y a n x i e t y a n d r e s t l e s s n e s s , a l t e r e d v i t a l s i g n s s u c h a s a n i n c r e a s e d h e a r t a n d r e s p i r a t o r y r a t e , n o t i c e a b l e s w e a t i n g a n d p e r s p i r a t i o n , c o u g h i n g , a p r o d u c t i v e c o u g h w i t h m u c u s , n a s a l f l a r i n g , u s e o f e x c e s s o r y m u s c l e s o f r e s p i r a t i o n , p a l e a n d b l u i s h a p p e a r a n c e t o t h e s k i n , a n d f a t i g u e . I n a c a s e s t u d y p r e s e n t a t i o n , S m i t h ( 1 9 8 2 ) d e s c r i b e d t h e p r o b l e m s o f a 25 y e a r o l d d u r i n g a n a s t h m a a t t a c k . I n s u m m a r y , t h e p r o b l e m s d i a g n o s e d w e r e : b r e a t h l e s s n e s s , f e a r a n d a n x i e t y , e x h a u s t i o n , i n a b i l i t y t o t a l k , i n a b i l i t y t o r e - p o s i t i o n o n e s e l f , n a u s e a a n d p o o r a p p e t i t e , d e h y d r a t i o n , a l l e r g y t o f e a t h e r s , r i s k o f p n e u m o t h o r a x a n d / o r c a r d i a c a r r e s t , a n d p o s s i b l e c h e s t i n f e c t i o n . 13 G e r s h w i n ( 1 9 8 1 ) , S t e r n ( 1 9 8 1 ) , Y o u n g ( 1 9 8 0 ) , a n d Hume ( 1 9 7 0 ) h a v e c l a i m e d t h a t t h e p a t h o p h y s i o l o g i c a l p r o b l e m s a s s o c i a t e d w i t h a s t h m a c a n i n d u c e p r o b l e m s o f a p s y c h o l o g i c a l n a t u r e . H u d g e l a n d M a d s e n ( 1 9 8 0 ) , S e x t o n ( 1 9 8 1 ) , G e r s h w i n ( 1 9 8 1 ) , B u r n s ( 1 9 8 2 ) , a n d C r e e r , ( 1 9 7 9 ) h a v e i d e n t i f i e d t h e p s y c h o l o g i c a l p r o b l e m s a n d t h e s o c i a l p r o b l e m s m a n i f e s t e d i n p e r s o n s who h a v e a s t h m a . T h e p r o b l e m s i d e n t i f i e d w e r e a s f o l l o w s : a n x i e t y a n d a g i t a t i o n , f e e l i n g s o f f r i g h t , p a n i c , h e l p l e s s n e s s , i r r i t a b i l i t y , r e s t l e s s n e s s a n d e x c e s s i v e w o r r y i n g , d e p r e s s i o n , r e d u c e d s e l f - e s t e e m , s o c i a l i s o l a t i o n a n d s t i g m a . C r e e r ( 1 9 7 9 ) c l a i m e d t h a t f e e l i n g s o f d e p r e s s i o n , a n d d e c r e a s e d s e l f - e s t e e m may b e l i n k e d t o t h e p a i n f u l l o s s e s e x p e r i e n c e d b y t h o s e w h o h a v e a c h r o n i c o b s t r u c t i v e p u l m o n a r y d i s e a s e . F o r i n s t a n c e , t h e y m a y b e a s s o c i a t e d w i t h t h e l o s s o f f a m i l i a r r o l e s a n d c u s t o m a r y p a t t e r n s o f d a i l y l i v i n g . C r e e r ( 1 9 7 9 ) p r o p o s e d t h a t t h e e x p e r i e n c e o f s o c i a l i s o l a t i o n may b e a s s o c i a t e d w i t h t h e n e e d t o r e s t r i c t p h y s i c a l a n d s o c i a l a c t i v i t y d u r i n g a n e x a c e r b a t i o n o f a s t h m a s y m p t o m s . I n a d d i t i o n , C r e e r ( 1 9 7 9 ) s u g g e s t e d t h a t t h e s o c i a l s t i g m a o f t e n c o n n e c t e d w i t h a s t h m a may h a v e e v o l v e d i n s o c i e t y b e c a u s e o f t h e b e l i e f b y s o m e t h a t p s y c h o l o g i c a l f a c t o r s a r e t h e p r i m a r y t r i g g e r i n g f a c t o r s i n a s t h m a . C r e e r ( 1 9 7 9 ) 14 a l s o s p e c u l a t e d t h a t a s t h m a s y m p t o m s c a n b e u s e d f o r p e r s o n a l g a i n I n s o m e s i t u a t i o n s . A s a r e s u l t , a s t h m a m a y e v o k e f e e l i n g s o f f r u s t r a t i o n a n d h o s t i l i t y i n t h o s e c l o s e t o p e r s o n s w i t h a s t h m a . C h a l m e r ' s ( 1 9 8 4 ) r e s e a r c h s t u d y d e t e r m i n e d t h a t t h e m a j o r p r o b l e m s o f p e r s o n s w i t h a s t h m a , c h r o n i c b r o n c h i t i s a n d e m p h y s e m a a r e b r e a t h l e s s n e s s a n d t h e i n e v i t a b l e d e c r e a s e i n e n e r g y . T h i s s t u d y i l l u s t r a t e d t h a t b r e a t h l e s s n e s s a n d d e c r e a s e d e n e r g y c a n a f f e c t a l l a s p e c t s o f d a i l y l i v i n g , f o r e x a m p l e , t h e a b i l i t y t o w o r k , t o d o h o u s e h o l d t a s k s , a n d t o t r a v e l . I n a d d i t i o n , C h a l m e r s c l a i m e d t h a t b r e a t h l e s s n e s s a n d d e c r e a s e d e n e r g y m a y i n t e r f e r e w i t h t h e i n d i v i d u a l s ' a b i l i t y t o c o m m u n i c a t e . T h e r e s e a r c h f i n d i n g s a d d i t i o n a l l y i n d i c a t e d t h a t p e r s o n s w i t h a c h r o n i c o b s t r u c t i v e p u l m o n a r y d i s e a s e f r e q u e n t l y e x p e r i e n c e d c h a n g e d i n t e r p e r s o n a l r e l a t i o n s h i p s w i t h t h e i r s p o u s e a n d / o r s i g n i f i c a n t o t h e r s , a n d c h a n g e d s o c i a l r e l a t i o n s h i p s . I t w a s a d d i t i o n a l l y f o u n d t h a t a p r i m a r y c o n c e r n o f t h o s e w i t h a c h r o n i c o b s t r u c t i v e p u l m o n a r y d i s e a s e w a s t h a t t h e y m a i n t a i n t h e i r c u s t o m a r y r o l e w i t h i n t h e i r f a m i l y a n d s o c i a l r e a l m . S t r a u s s a n d G l a s e r ( 1 9 7 5 ) s u g g e s t e d a s y s t e m a t i c m e a n s f o r c o n c e p t u a l i z i n g t h e c o m m o n p r o b l e m s g e n e r a l l y e x p e r i e n c e d b y t h e c h r o n i c a l l y i l l 15 i n t h e i r d a i l y l i v e s . The common p r o b l e m s w h i c h were i d e n t i f i e d i n c l u d e d the f o l l o w i n g : 1. The p r e v e n t i o n o f m e d i c a l c r i s e s and t h e i r management once t h e y o c c u r . 2. The c o n t r o l of symptoms. 3. The c a r r y i n g out of p r e s c r i b e d r e g i m e n s and t h e management of p r o b l e m s a t t e n d a n t upon c a r r y i n g out the r e g i m e n . 4. The p r e v e n t i o n o f , or l i v i n g w i t h , s o c i a l i s o l a t i o n c a u s e d by l e s s e n e d c o n t a c t w i t h o t h e r s . 5. The a d j u s t m e n t to changes i n the c o u r s e of the d i s e a s e , w hether i t moves downward or has r e m i s s i o n s . 6. The a t t e m p t s at n o r m a l i z i n g b o t h i n t e r a c t i o n w i t h o t h e r s and s t y l e of l i f e . 7. F u n d i n g — f i n d i n g the n e c e s s a r y m o n e y — t o pay f o r t r e a t m e n t s or to s u r v i v e d e s p i t e p a r t i a l or c o m p l e t e l o s s of employment. (1975, p. 7) In summary, a r e v i e w o f the l i t e r a t u r e of the p r o b l e m s of p e r s o n s w i t h asthma a n d / o r c h r o n i c o b s t u c t i v e p u l m o n a r y d i s e a s e s r e v e a l e d t h a t p r i m a r y c o n c e r n s o f i n d i v i d u a l s w i t h asthma a n d / o r c h r o n i c o b s t r u c t i v e p u l m o n a r y d i s e a s e were c o n c e r n s i n r e s p e c t t o t h e i r c u s t o m a r y p a t t e r n s of l i v i n g and i n t e r p e r s o n a l r e l a t i o n s h i p s w i t h i n t h e i r f a m i l i e s and s o c i a l m i l i e u x . T hese f i n d i n g s a r e c o n s i s t e n t w i t h some of the key p r o b l e m s of t h e c h r o n i c a l l y i l l i n d a i l y l i v i n g , as 16 presented by Strauss and Glaser (1975). The i d e n t i f i c a t i o n of problems within a pathophysiological, psychological, and s o c i a l symptomatology context does provide some knowledge of the impact of asthma; i t nevertheless has some li m i t a t i o n s as a means of developing a comprehensive knowledge of the problems of persons with asthma. A more in-depth understanding of their problems may be gained by obtaining their perceptions of their problems associated with asthma. The autobiographical approach may provide more knowledge of their problems, experienced on a daily basis, and as described within their context of understanding. Learning Needs of Patients, as Id e n t i f i e d from  Patients' Perspectives There appears to be a paucity of information regarding the learning needs of patients with asthma, as i d e n t i f i e d from their perspective. Some research has focused on various patient populations and attempted to i d e n t i f y patient learning needs for health education from their unique perspective. These studies offe r a frame of reference for this study and are summarized in what follows. Forsyth, Delaney and Gresham (1984) Investigated the learning needs of patients who were experiencing 17 chronic i l l n e s s , from their perspective. Data were collected by using unstructured interviews. The study's findings i l l u s t r a t e d that patients i d e n t i f i e d the following learning needs: how to maintain themselves in challenging situations; what home remedies can work for them; and what their bodies w i l l tolerate in terms of diet, drugs, treatment and a c t i v i t y . Patients a d d i t i o n a l l y expressed a desire for pa r t i c u l a r types of information. For example, they sought information . . . which had direct u t i l i t y in solving what they perceived as problematic . . . patients were not receptive to standard patient education formats. Rather, they appreciated readings and information on self-help groups, the opportunity to talk to other h o s p i t a l i z e d patients. (Forsyth et a l . , 1984, p. 187) Barry (1982) designed a factor searching study to investigate the learning need perceptions of adults with epilepsy. A needs assessment served as a basis for an interview consisting of 24 structured questions which were grouped Into the following four sections: coping, seizures, medications, and community resources. Other questions were constructed to e l i c i t information about the patients' knowledge le v e l of their health problems, and several semi-structured questions were also designed to s p e c i f i c a l l y obtain 18 p a t i e n t s ' p e r c e p t i o n s o f t h e i r l e a r n i n g n e e d s . T h e f o l l o w i n g a r e e x a m p l e s o f t h e t y p e o f s e m i - s t r u c t u r e d q u e s t i o n s a s k e d : " W h a t p r o b l e m s , c o n c e r n s , w o r r i e s , o r q u e s t i o n s d o y o u h a v e w i t h r e g a r d t o y o u r s e i z u r e s ? I n y o u r o p i n i o n , w h a t i n f o r m a t i o n s h o u l d p e o p l e w i t h e p i l e p s y k n o w a b o u t ? " ( B a r r y , 1 9 8 2 , p . 3 1 ) . T h e f i n d i n g s o f t h i s s t u d y i n d i c a t e d t h a t p a t i e n t s p e r c e i v e d t h a t t h e i r m a j o r l e a r n i n g n e e d w a s t o o b t a i n i n f o r m a t i o n o n how t o a l t e r t h e i r l i f e s t y l e , s o t h a t t h e y m i g h t b e b e t t e r a b l e t o c o p e w i t h t h e i r h e a l t h p r o b l e m s . T h e r e s e a r c h s t u d i e s o f G e r a r d a n d P e t e r s o n ( 1 9 8 4 ) a n d C a s e y , O ' C o n n e l l a n d P r i c e ( 1 9 8 3 ) w e r e d e s i g n e d t o d e t e r m i n e h o w n u r s e s ' p e r c e p t i o n s o f p a t i e n t s ' l e a r n i n g n e e d s c o m p a r e d t o p a t i e n t s ' p e r c e p t i o n s . G e r a r d a n d P e t e r s o n ( 1 9 8 4 ) e x a m i n e d n u r s e s ' a n d p a t i e n t s ' p e r c e p t i o n s o f t h e l e a r n i n g n e e d s o f c a r d i a c p a t i e n t s , d u r i n g t h e i r r e c o v e r y f r o m a m y o c a r d i a l i n f a r c t i o n i n t h e c o r o n a r y c a r e u n i t a n d a f t e r t h e i r d i s c h a r g e f r o m t h e u n i t . N u r s e s a n d p a t i e n t s r a n k e d t h e i m p o r t a n c e o f i n f o r m a t i o n i t e m s i n a c c o r d a n c e w i t h t h e i r p e r c e p t i o n s o f n e e d s f o r s p e c i f i c t y p e s o f i n f o r m a t i o n . T h e f i n d i n g s i l l u s t r a t e d t h a t i n t h e c o r o n a r y c a r e u n i t t h e m o s t i m p o r t a n t l e a r n i n g n e e d c a t e g o r i e s i d e n t i f i e d b y p a t i e n t s w e r e : r i s k f a c t o r s , 19 m e d i c a t i o n s , p s y c h o l o g i c a l f a c t o r s , a c t i v i t y , m i s c e l l a n e o u s n e e d s , t h e c o r o n a r y c a r e u n i t , a n d a n a t o m y a n d p h y s i o l o g y . C a s e y e t a l . ( 1 9 8 3 ) c o m p a r e d n u r s e s ' , p a t i e n t s ' , a n d p h y s i c i a n s ' p e r c e p t i o n s o f t h e l e a r n i n g n e e d s o f p a t i e n t s a f t e r a m y o c a r d i a l i n f a r c t i o n . T h e m e t h o d o l o g y u s e d w a s s i m i l a r t o t h a t o f G e r a r d a n d P e t e r s o n ' s ( 1 9 8 4 ) s t u d y . T h e i n f o r m a t i o n i t e m s w e r e t a b u l a t e d i n a c c o r d w i t h t h e f o l l o w i n g l e a r n i n g n e e d c o n t e n t c a t e g o r i e s : n u t r i t i o n ; r e c o g n i t i o n a n d c h a n g i n g o f r i s k f a c t o r s ; m e d i c a t i o n s ; r e c r e a t i o n a l ( w o r k a c t i v i t i e s ) ; e t i o l o g y o f h e a r t a t t a c k s ; a n d d e a l i n g w i t h f e e l i n g s , t e n s i o n , a n d s t r e s s . T h e p a t i e n t s t h e m s e l v e s b e l i e v e d t h a t how t o d e a l w i t h t h e i r f e e l i n g s , t e n s i o n , a n d s t r e s s w a s t h e i r m o s t i m p o r t a n t l e a r n i n g n e e d . P a t i e n t s a d d i t i o n a l l y i d e n t i f i e d t h e f o l l o w i n g a s o t h e r i m p o r t a n t l e a r n i n g n e e d s : i n f o r m a t i o n r e l a t e d t o t h e s i g n s a n d s y m p t o m s o f a h e a r t a t t a c k ; h o w t o m o d i f y c o n t r i b u t a r y p e r s o n a l f a c t o r s ; a n d i n f o r m a t i o n r e l a t e d t o t h e n a m e s , d o s a g e , a n d s i d e e f f e c t s o f m e d i c a t i o n s . I n s u m m a r y , i t a p p e a r s t h a t t h e l e a r n i n g n e e d s i d e n t i f i e d b y p a t i e n t s f o c u s e d o n w h a t t h e y p e r c e i v e d t h a t t h e y n e e d e d t o l e a r n t o e n a b l e t h e m t o c o p e , o n a d a i l y b a s i s , w i t h t h e m u l t i f a c e t e d p r o b l e m s a s s o c i a t e d 20 with t h e i r p a r t i c u l a r i l l n e s s . Research s t u d i e s which were designed to determine the l e a r n i n g needs of persons with asthma, as i d e n t i f i e d from t h e i r p e r s p e c t i v e , may provide some i n s i g h t i n t o the l e a r n i n g needs of t h i s s p e c i f i c c h r o n i c a l l y i l l p a t i e n t group. R e l a t i o n s h i p s Between S e l e c t e d Demographic and P e r s o n a l  V a r i a b l e s and P e r c e p t i o n s of L e a r n i n g Needs Among  P a t i e n t s What f o l l o w s p r o v i d e s a b r i e f summary of the demographic and pe r s o n a l v a r i a b l e s that have been s e l e c t e d to o b t a i n i n f o r m a t i o n about the p o p u l a t i o n s i n r e s e a r c h s t u d i e s which i n v e s t i g a t e d p a t i e n t s ' p e r c e p t i o n s of t h e i r l e a r n i n g needs. In a d d i t i o n , t h i s s e c t i o n w i l l summarize the f i n d i n g s i n cu r r e n t s t u d i e s which have i n v e s t i g a t e d r e l a t i o n s h i p s between s e l e c t e d demographic and pe r s o n a l v a r i a b l e s , and pe r c e i v e d l e a r n i n g needs of p a t i e n t s . Barry (1982) i n v e s t i g a t e d the p e r c e i v e d h e a l t h e d u c a t i o n l e a r n i n g needs of persons with e p i l e p s y . The demographic and pers o n a l v a r i a b l e s s e l e c t e d to o b t a i n i n f o r m a t i o n about the sample i n c l u d e d the f o l l o w i n g : age, sex, m a r i t a l s t a t u s , employment, e d u c a t i o n , the number of years the c l i e n t has been diagnosed with e p i l e p s y , the frequency of s e i z u r e s , the len g t h of time 21 c a r e h a d b e e n p r o v i d e d b y a s e i z u r e c l i n i c , a n d t h e n u m b e r o f h o s p i t a l i z a t i o n s i n t h e i n - p a t i e n t e p i l e p s y u n i t t h e c l i e n t h a d r e q u i r e d . D o d g e i n v e s t i g a t e d r e l a t i o n s h i p s b e t w e e n s e l e c t e d d e m o g r a p h i c a n d p e r s o n a l v a r i a b l e s , a n d p e r c e i v e d l e a r n i n g n e e d s o f p a t i e n t s . T h e s e l e c t e d d e m o g r a p h i c a n d p e r s o n a l v a r i a b l e s i n c l u d e d : s e x , e d u c a t i o n , a g e , t h e n a t u r e o f t h e i l l n e s s a n d t h e l e n g t h o f t i m e i n v o l v e d w i t h t h e i l l n e s s , f o r e x a m p l e , w h e t h e r t h e p a t i e n t s ' i l l n e s s w a s o f l o n g o r s h o r t t e r m d u r a t i o n . T h e f i n d i n g s d e m o n s t r a t e d t h a t s e v e r a l s i g n i f i c a n t d i f f e r e n c e s e x i s t e d b e t w e e n t h e s e l e c t e d v a r i a b l e s a n d p a t i e n t s ' p e r c e p t i o n s o f t h e i r l e a r n i n g n e e d s w i t h i n a l l o f t h e s e l e c t e d v a r i a b l e c a t e g o r i e s . F o r i n s t a n c e , r e g a r d i n g d i f f e r e n c e s r e l a t e d t o a g e , D o d g e r e p o r t e d t h a t y o u n g a d u l t p a t i e n t s w e r e m o r e c o n c e r n e d t h a n o l d e r o n e s w i t h k n o w i n g how w e l l t h e y w e r e r e c o v e r i n g a n d w h e n t h e y w o u l d r e a c h v a r i o u s s u b g o a l s i n t h e r e c o v e r y p r o c e s s . C a s e y e t a l . ( 1 9 8 3 ) s t u d i e d t h e p e r c e p t i o n s o f h e a l t h e d u c a t i o n l e a r n i n g n e e d s o f p a t i e n t s a f t e r a m y o c a r d i a l i n f a r c t i o n . A c h i - s q u a r e a n a l y s i s w a s d o n e t o d e t e r m i n e i f r e l a t i o n s h i p s e x i s t e d b e t w e e n p a t i e n t s ' p e r c e p t i o n s o f t h e i r l e a r n i n g n e e d s , a n d s e x , a g e , a n d t h e n u m b e r o f m y o c a r d i a l I n f a r c t i o n s w h i c h t h e p a t i e n t s 22 the number of myocardial i n f a r c t i o n s which the patients had experienced. One s i g n i f i c a n t difference was found between men and women: men believed that i t was more important to know the locations, structure, and function of the heart than women did. F i n a l l y , three s i g n i f i c a n t differences were determined between the perceived learning needs of f i r s t time myocardial i n f a r c t i o n patients, compared to those who were recovering from their second or third myocardial i n f a r c t i o n . In summary, this review of studies which investigated relationships between selected demographic and personal ( i l l n e s s - r e l a t e d ) variables, and perceived learning needs demonstrates that selected variables may have an impact on patients' perceptions of their learning needs. These findings lend some support to the assumptions held by medical s o c i o l o g i s t s and cognitive learning t h e o r i s t s , who espoused that s i t u a t i o n a l forces can influence persons' perceptions. The variables selected for r e l a t i o n s h i p comparisons In these studies offered d i r e c t i o n for the selection of demographic and personal variables for relat i o n s h i p comparisons in this study. 23 Current Health Education Focus by Nurses for Persons  with Asthma and/or Chronic Obstructive Pulmonary  Disease Rifas (1983) examined the problems of persons with asthma and proposed a health education teaching plan which included the following: how to use a bronchodilator inhaler; how to prevent another attack; how to manage environmental control (how to keep the home environment dust and mold free, how to keep c i r c u l a t i n g pollen to a minimum, what fumes and i r r i t a t i n g chemicals to avoid as a consumer), i d e n t i f i c a t i o n of common products, such as a s p i r i n and tartrazine food colouring, which may trigger an attack; and how to recognize the signs and symptoms of chest i n f e c t i o n . Hudgel and Madsen (1980) maintained that health education for persons with chronic asthma should include the basic pathophysiology of an asthma attack, and the p r i n c i p l e s of medication management, such as what side effects to look for, and how and when to use medication. Hudgel and Madsen (1980) claimed that the most s i g n i f i c a n t part of health education rests in teaching patients how to recognize when to seek medical attention for unabated bronchoconstriction. They also 24 pointed out that in conjunction with these recommendations for teaching, additional services such as: "immunotherapy, physical therapy, dietary services and psychosupportive help" (1980, p. 1795) could also be included. K i r i l l o f f and Tibbals (1983) developed a comprehensive guide for nurses which summarized pharmaceutical information pertaining to the major drugs groups used to either prevent or control asthma. This a r t i c l e recommended health education content which could be of benefit to persons on medication regimens. K i r i l l o f f and Tibbals (1983) proposed that health education should include information on the following: drug side e f f e c t s , explanations to patients as to why they are taking a pa r t i c u l a r medicati on, the expected benefit, proper dosage, route, the time schedule for medication taking, special foods or f l u i d s which are either recommended to eat or to avoid in combination with p a r t i c u l a r medications, as well as information on s p e c i f i c c r i t e r i a to follow when shortness of breath is not r e l i e v e d . Kaufman and Woody (1980) claimed that patients with a chronic obstructive pulmonary disease can l i v e at a higher l e v e l of wellness through health teaching. 25 H e n c e , t h e y d e s i g n e d a h e a l t h e d u c a t i o n p r o g r a m s p e c i f i c a l l y f o r c h r o n i c o b s t r u c t i v e p u l m o n a r y d i s e a s e p a t i e n t s w h i c h i n c l u d e d t h e f o l l o w i n g c o n t e n t a r e a s : b r o n c h i o d i l a t o r t h e r a p y , p u l m o n a r y p r o t o c o l ( s t e a m i n h a l a t i o n , p o s t u r a l d r a i n a g e w i t h p e r c u s s i o n , e f f e c t i v e c o u g h i n g t e c h n i q u e , d i a p h r a g m a t i c b r e a t h i n g e x e r c i s e s ) , h y d r a t i o n m a n a g e m e n t , e n v i r o n m e n t a l c o n t r o l m a n a g e m e n t , r e l a x e d b r e a t h i n g p o s i t i o n s . D ' A g o s t i n o ' s ( 1 9 8 4 ) h e a l t h e d u c a t i o n p r o g r a m f o r p e r s o n s w i t h c h r o n i c o b s t r u c t i v e p u l m o n a r y d i s e a s e e m p h a s i z e d p r e v e n t a t i v e m a n a g e m e n t . S h e p r o p o s e d t h a t t e a c h i n g s h o u l d b e d i r e c t e d t o w a r d t h e f o l l o w i n g : h o w t o h o u s e c l e a n s o t h a t i r r i t a n t s a n d a l l e r g e n s may be r e m o v e d , s p e c i f i c s u g g e s t i o n s o n h o w t o c l e a n p a r t i c u l a r r o o m s s u c h a s t h e b e d r o o m , i n f o r m a t i o n o n t h e a p p r o p r i a t e h o u s e t e m p e r a t u r e , h u m i d i t y , a n d s p e c i f i c i r r i t a n t s w h i c h m u s t be a v o i d e d . M a r t i n d a l e ' s ( 1 9 8 4 ) r e s e a r c h s t u d y p r o p o s e d t o e v a l u a t e a n a s t h m a h e a l t h e d u c a t i o n p r o g r a m , w h i c h was c u r r e n t l y t a k i n g p l a c e i n New Z e a l a n d . T h e r a t i o n a l e f o r t h e s t u d y w a s t h a t i m p r o v e m e n t i n t h e h e a l t h e d u c a t i o n a v a i l a b l e t o p e r s o n s w i t h a s t h m a w a s n e e d e d . I t s p e c i f i c a l l y i n c l u d e d t h e f o l l o w i n g t o p i c a r e a s : t h e a n a t o m y a n d p h y s i o l o g y o f t h e r e s p i r a t o r y s y s t e m , a 26 s i m p l i f i e d explanation of the pathophysiology of asthma, signs and symptoms of an acute attack, assessment of the severity of an attack, medication-taking knowledge, c r i s i s management, technique for use of inhaler and peak flow meter, diaphragmatic breathing, relaxation positions, postural drainage, forced expiration, the benefits of sports and exercise, a discussion of trigger f actors, and prevention of asthma. Also included in this health education programme were any other asthma related topics which participants stated they wished to discuss. F i n a l l y , Muzzuca investigated the value of health education for those experiencing a chronic i l l n e s s problem. The findings of this study indicated that "patients need to know less about the pathophysiology of their disease, and more about integrating new demands into their d a i l y routine" (1982, p. 528). In summary, the health education focus for those with asthma and chronic obstructive pulmonary diseases implies that the health education content planned by nurses may be standardized, "pre-packaged," and medicocentric, and demonstrates a lack of focus on learning needs related to their s o c i a l and 27 psychological health problems. For instance, current health education c h a r a c t e r i s t i c a l l y focuses on explanations of the pathophysiology of asthma, information of treatment regimens such as how to take medications, and how to manage environmental control. Summary A review of the l i t e r a t u r e revealed the following. F i r s t , the problems of individuals with asthma and/or chronic obstructive pulmonary disease are multiple and pervasive, and they have been described within various contexts of understanding by a l l i e d health professionals. However, a more comprehensive knowledge of the problems of persons with asthma may be gained by obtaining their perceptions of their problems. Second, i t implied that the primary learning needs of patients with a chronic i l l n e s s focused on what they perceived that they needed to learn to cope with problems experienced in association with their p a r t i c u l a r chronic i l l n e s s . Third, research studies i l l u s t r a t e d that relationships may exist between selected demographic and personal variables, and the perceived learning needs of patients. Fourth the health education focus provided by nurses may not be directed toward the most c r u c i a l learning needs of persons with asthma. S p e c i f i c a l l y , the h e a l t h education focus does not appear to address the p s y c h o l o g i c a l and s o c i a l problems which may be experienced by those with asthma. 29 CHAPTER THREE Methodology Overview A descriptive research design using survey methodology was used to address the research problem. P o l i t and Hungler maintained that a descriptive design i s appropriate when the reseacher wishes to "summarize the status of some phenomena of interest as they currently e x i s t " (1983, p. 184). This chapter summarizes the following: instrument construction; c r i t e r i a for the selection of participants; population and sample selection procedure; data c o l l e c t i o n ; data analysis; and f i n a l l y , e t h i c a l considerations in this study. Instrument Construction Two questionnaires were used in the survey. The f i r s t questionnaire (Appendix A), consisted of an interview schedule which was constructed to c o l l e c t demographic and personal ( i l l n e s s - r e l a t e d ) information. Current research which has investigated relationships between selected demographic and personal variables, and perceived learning needs of patients; 30 the investigator's nursing knowledge of i l l n e s s - r e l a t e d factors which may have an influence on the impact of asthma on persons; and in collaboration with a respiratory c l i n i c a l nurse s p e c i a l i s t , were instrumental in constructing the demographic and personal interview schedule for this study. Selected demographic variables were: (1) sex, (2) having dependents, (children) (3) age, (4) occupation (5) highest education attained, (6) having confidants, and (7) selected i l l n e s s - r e l a t e d personal variables (Appendix A, 7-19 i n c l u s i v e ) . The second questionnaire, a semi-structured interview schedule (Appendix B), consisted of open-ended questions to obtain data on the perceptions of young adults with asthma. P o l i t and Hungler (1983) maintained that open-ended questions are an appropriate means to obtain personal acccounts and the perceptions of others. In this study, The U.B.C. Model for Nursing (1980) was selected by the investigator to obtain the perceptions of young adults with asthma. This nursing model was used to f a c i l i t a t e the construction of the second questionnaire for the purposes of obtaining the perceptions of young adults in this study. This p a r t i c u l a r nursing conceptual framework was chosen because i t provides a systematic and comprehensive data 31 c o l l e c t i o n tool for assessing individuals and obtaining their perceptions, within the context of the "whole" integrated person, and a behavioral system. In addition, many of Its key concepts, in respect to explaining human behavior, are congruent with the major constructs within the cognitive f i e l d theory of learning. The s p e c i f i c key concepts within The U.B.C. Model  for Nursing (1980) which f a c i l i t a t e d the construction of this interview schedule were the following: 1. An i n d i v i d u a l has nine basic human needs, each represented by a subsystem. 2. Needs, need-related goals, a b i l i t i e s , s o c i o c u l t u r a l , impersonal and personal forces, within each subsystem influence i n d i v i d u a l perceptions of need s a t i s f a c t i o n . 3. A l l subsystems, each representing one basic human need, are interdependent and i n t e r a c t i n g . 4. An in d i v i d u a l responds as a behavioral system. These assumptions directed the investigator to construct questions which addressed the impact of asthma on young adults in association with the nine basic human needs premised within The U.B.C. Model for Nursing (1980). Therefore, in constructing a questionnaire which takes into account basic human 32 needs, within the context of other s p e c i f i c key assumptions i n The U.B.C. Model for Nursing (1980), i t was assumed that this questionnaire would ensure a comprehensive and systematic means of obtaining the perceptions of young adults with asthma. C r i t e r i a for Selection of Participants The c r i t e r i a for selection of participants in this study included: 1. Persons must speak English. 2* Young adults diagnosed with e x t r i n s i c asthma, and between the ages of 20 - 45 years. 3. Young adults who have asthma, but are without other major i l l n e s s e s . Population and Sample Selection Procedure Participants were selected from an out-patient population at a respiratory unit in a major teaching hospital in Vancouver, B r i t i s h Columbia. Twenty participants meeting the c r i t e r i a were recruited using the following procedure. 1. The investigator i n i t i a l l y explained the purpose of the study and selection c r i t e r i a to three r e s p i r o l o g i s t s (physicians), as well as to respiratory technologists and re c e p t i o n i s t s , 33 e m p l o y e d a t t h e r e s p i r o l o g y u n i t . T h e i n v e s t i g a t o r g a v e e a c h o f t h e s e i n d i v i d u a l s , a c o p y o f t h e " c o v e r l e t t e r t o p h y s i c i a n s " ( A p p e n d i x C ) , w h i c h e x p l a i n e d t h e p u r p o s e o f t h e s t u d y a n d t h e s e l e c t i o n c r i t e r i a . T h e i n v e s t i g a t o r t h e n s o u g h t t h e p e r m i s s i o n a n d s i g n e d c o n s e n t ( A p p e n d i x D ) f r o m t h e t h r e e r e s p i r o l o g i s t s , f o r t h e i n v e s t i g a t o r t o r e c r u i t p a t i e n t s f r o m t h e i r p r a c t i c e . I t w a s e s t a b l i s h e d t h a t r e c r u i t m e n t w o u l d o c c u r w h e n p r o s p e c t i v e p a r t i c i p a n t s c a m e i n t o t h e u n i t t o k e e p p r e - b o o k e d a p p o i n t m e n t s w i t h e i t h e r t h e r e s p i r o l o g i s t s o r r e s p i r a t o r y t e c h n o l o g i s t s . T h e p u r p o s e o f t h e s t u d y w a s t o b e e x p l a i n e d , b y p h y s i c i a n s o r r e s p i r a t o r y t e c h n o l o g i s t s , t o p o t e n t i a l p a r t i c i p a n t s who m e t t h e s a m p l i n g c r i t e r i a . I n a d d i t i o n t o t h i s , p o t e n t i a l p a r t i c i p a n t s w e r e g i v e n a b r i e f v e r b a l d e s c r i p t i o n o f w h a t w o u l d be r e q u i r e d o f t h e m s h o u l d t h e y a g r e e t o p a r t i c i p a t e i n t h e s t u d y . T h i s w a s e x p l a i n e d i n m o r e d e t a i l i n a c o v e r . l e t t e r ( A p p e n d i x E ) w h i c h w a s g i v e n t o p o t e n t i a l p a r t i c i p a n t s b y a p h y s i c i a n o r r e s p i r a t o r y t e c h n o l o g i s t . T h e c o v e r l e t t e r m a d e e x p l i c i t t o p e r s o n s t h a t t h e y w e r e i n no w a y o b l i g a t e d t o p a r t i c i p a t e i n t h e s t u d y , a n d t h a t 34 n o n - p a r t i c i p a t i o n would not j e o p a r d i z e the h e a l t h care they were r e c e i v i n g i n any way. The i n v e s t i g a t o r ' s t e lephone number was p r o v i d e d i n the cover l e t t e r (Appendix E ) , to a l l o w the p o t e n t i a l p a r t i c i p a n t s c o n t a c t w i t h the i n v e s t i g a t o r i f they wished f u r t h e r c l a r i f i c a t i o n of the s t u d y . 5. Those i n t e r e s t e d i n p a r t i c i p a t i n g i n the s tudy s u b m i t t e d t h e i r name and t e l e p h o n e number to the p h y s i c i a n or r e s p i r a t o r y t e c h n o l o g i s t r e c r u i t o r s who i n t u r n gave the names and t e l e p h o n e numbers of p o t e n t i a l p a r t i c i p a n t s to the i n v e s t i g a t o r . 6 . A f t e r a one or two day i n t e r v a l , the i n v e s t i g a t o r c o n t a c t e d p o t e n t i a l p a r t i c i p a n t s by t e l e p h o n e to d i s c u s s t h e i r p a r t i c i p a t i o n i n t e n t . If p o t e n t i a l p a r t i c i p a n t s s t i l l wished to p a r t i c i p a t e i n t h i s s t u d y , a t i m e , d a t e , and p l a c e f o r an i n t e r v i e w which was c o n v e n i e n t to the p a r t i c i p a n t was e s t a b l i s h e d . Data C o l l e c t i o n I n i t i a l l y p a r t i c i p a n t s were g i v e n an e x p l a n a t i o n of the purpose of the s t u d y , how data were to be c o l l e c t e d , and were p r o v i d e d w i t h a b r i e f i n g of t h e i r e t h i c a l and human r i g h t s i n r e s e a r c h . P a r t i c i p a n t s then s i g n e d consent (Appendix F) f o r p a r t i c i p a t i o n i n t h i s s t u d y . 35 Data were collected by Interviewing participants during one session only. Interviews occurred at the homes of participants; however, three exceptions to this occurred when participants came to the home of the investigator, because this arrangement was more convenient for them. The interviews took place in a private place, in the dining or kitchen area, where the participant and investigator could s i t around a table. It appeared to the investigator that the participants were most at ease in these l o c a t i o n s . F i r s t , the demographic and personal interview schedule (Appendix A) was used to c o l l e c t demographic and personal data. Responses were documented by the investigator and were la t e r validated by the participant to be correct as read. Second, using the semi-structured, open-ended interview schedule, (Appendix B) participants were interviewed by the investigator to obtain young adults perceptions of their health problems related to asthma, and their learning needs for health education. These interviews were audio-taped by using a portable tape recorder. The investigator took a l l necessary equipment for audio-taping to each interview. A code number only was v i s i b l e on the audio tapes. Participants were given the opportunity to explore 36 their perceptions of their health problems related to asthma, and their learning needs for health education. S e n s i t i v i t y toward the participants necessitated f l e x i b i l i t y in questioning. The interviews continued u n t i l the question areas had been explored or the participant wished to end the interview. Data Analysis The audio-tapes of the open-ended, semi-structured interview schedule (Appendix B) were transcribed for categorization after each interview. The nine basic human needs premised within The U.B.C. Model of Nursing (1980) f a c i l i t a t e d the sub-categorization of the perceptions of young adults of their health problems related to asthma, and their learning needs for health education (The U.B.C. Model Committee, 1980). Frequency d i s t r i b u t i o n s were used to describe and answer the research questions. The health problems and learning needs were then categorized according to existing commonalities within and across the need categories . Fisher's Exact Test was used to determine relationships between selected demographic and personal variables and the perceived learning needs of young adults with asthma of the e x t r i n s i c type (Zar, 1984). 37 A p r o b a b i l i t y l e v e l of .05 was used. E t h i c a l C o n s i d e r a t i o n s This study was conducted with the approval of the U n i v e r s i t y of B r i t i s h Columbia's Screening Committee f o r Research I n v o l v i n g Human S u b j e c t s . The human r i g h t s of the p a r t i c i p a n t s were safeguarded i n the f o l l o w i n g ways: A. Informed Consent and R i s k / B e n e f i t 1. The i n i t i a l v e r b a l e x p l a n a t i o n s gave the c l e a r o p t i o n of p a r t i c i p a t i o n or n o n - p a r t i c i p a t i o n without p r e j u d i c e . 2. The cover l e t t e r (Appendix E) s t a t e d that withdrawal from the study could occur at any time. 3. The cover l e t t e r informed p a r t i c i p a n t s that they could r e f u s e to answer any q u e s t i o n s , at any time, i f they wished. 4. P o t e n t i a l b e n e f i t s were o u t l i n e d i n the cover l e t t e r . 5. The cover l e t t e r s t a t e d that the i n v e s t i g a t o r was a v a i l a b l e to d i s c u s s the study with p o t e n t i a l p a r t i c i p a n t s to c l a r i f y any questions which they might have before making t h e i r d e c i s i o n about p a r t i c i p a t i o n . 38 6. I f during the i n t e r v i e w p a r t i c i p a n t s demonstrated behavior which was or p o t e n t i a l l y could be hazardous to t h e i r h e a l t h , the i n v e s t i g a t o r suggested r e f e r r a l to a p p r o p r i a t e h e a l t h care profes s i o n a l s . 7. Upon completion, the t h e s i s was made a v a i l a b l e to p a r t i c i p a n t s , through the l i b r a r i e s of the U n i v e r s i t y of B r i t i s h Columbia. B. P r i v a c y 1. P r i v a c y was in s u r e d d u r i n g the i n t e r v i e w s . Interviews occurred i n the home of the p a r t i c i p a n t or that of the i n v e s t i g a t o r . C. C o n f i d e n t i a l i t y 1. Access to the data was l i m i t e d to the i n v e s t i g a t o r and her a d v i s o r y committee. 2. Data was held i n confidence and kept anonymous by the use of a coding system known only to the r e s e a r c h e r . 3. Data was destroyed at the completion of the study. Summary Th i s chapter has presented the methodology of the study and summarized the f o l l o w i n g : the instrument c o n s t r u c t i o n , the c r i t e r i a f o r the s e l e c t i o n of p a r t i c i p a n t s ; p o p u l a t i o n and sample s e l e c t i o n procedure; data c o l l e c t i o n ; data a n a l y s i s ; and concluded with a summary of e t h i c a l c o n s i d e r a t i o n s the study. 40 C H A P T E R F O U R P r e s e n t a t i o n A n d A n a l y s i s O f F i n d i n g s O v e r v i e w T h e p u r p o s e o f t h i s c h a p t e r i s t o p r e s e n t a n d a n a l y s e t h e f i n d i n g s o f t h i s s t u d y . I t i s d i v i d e d i n t o f o u r s e c t i o n s w h i c h s u m m a r i z e t h e f o l l o w i n g : d e m o g r a p h i c a n d p e r s o n a l i n f o r m a t i o n p e r t a i n i n g t o t h e y o u n g a d u l t s a m p l e p o p u l a t i o n i n t h i s s t u d y ; y o u n g a d u l t s ' p e r c e p t i o n s o f t h e i r h e a l t h p r o b l e m s r e l a t e d t o a s t h m a ; t h e i r p e r c e i v e d l e a r n i n g n e e d s ; a n d t h e r e s u l t s o f t h e s t a t i s t i c a l r e l a t i o n s h i p s b e t w e e n s e l e c t e d d e m o g r a p h i c a n d p e r s o n a l v a r i a b l e s a n d p e r c e i v e d l e a r n i n g n e e d s . T a b l e s w e r e u s e d t o i l l u s t r a t e q u a l i t a t i v e i n f o r m a t i o n , d e s c r i p t i v e s t a t i s t i c s , a n d s t a t i s t i c a l a n a l y s i s r e s u l t s . A n a n a l y s i s o f t h e f i n d i n g s o c c u r s a t t h e e n d o f e a c h s e c t i o n . T h e b a s i c h u m a n n e e d s p r e m i s e d w i t h i n T h e U . B . C .  M o d e l f o r N u r s i n g ( 1 9 8 0 ) p r o v i d e d n e e d c a t e g o r i e s f o r t h e s u b - c a t e g o r i z a t i o n o f r e l a t e d h e a l t h p r o b l e m s a n d l e a r n i n g n e e d s w h i c h f a c i l i t a t e d t h e p r e s e n t a t i o n a n d 41 analysis of the findings. It should be pointed out that within this nursing conceptual model, a l l nine subsystems each representing one basic human need are considered i n t e r r e l a t e d and interdependent. Hence, i t did not necessarily provide a mutually exclusive approach to data analysis. Demographic and Personal Information  Overview Twenty young adults who met the sampling c r i t e r i a participated in this study. A l l participants in this study had asthma of the e x t r i n s i c type; therefore, the sample was homogeneous in this respect. The demographic and personal data collected were collapsed into two c l a s s i f i c a t i o n ranges. This organization of the data was necessary prior to investigating relationships between selected demographic and personal variables and perceived learning needs. Table 1 summarizes percentage and frequency d i s t r i b u t i o n s related to demographic and personal data pertaining to the young adult population in this study. 42 T a b l e 1 P e r c e n t a g e a n d F r e q u e n c y D i s t r i b u t i o n I n R e l a t i o n t o  D e m o g r a p h i c a n d P e r s o n a l V a r i a b l e s D e m o g r a p h i c a n d P e r s o n a l V a r i a b l e S a m p l e P e r c e n t a g e N=20 D e m o g r a p h i c V a r i a b l e 1 . S e x M a l e s F e m a l e s 2 . H a s d e p e n d e n t s Y e s No 3 . A g e 20 - 30 y e a r s 31 - 45 y e a r s 4 . O c c u p a t i o n P r o f e s s i o n a l N o n - P r o f e s s i o n a l 25 75 55 45 50 45 20 80 5 15 11 9 10 9 4 16 T a b l e 1 c o n t i n u e d . 43 Sample Demographic and Personal Variable Percentage % N=20 n Highest Education Attained P a r t i a l secondary school education or completed same 40 P a r t i a l college or university education or completed same 60 Has confidants Yes 80 No 20 12 16 4 Personal Variables 7. Length of time diagnosed with asthma Less than 1 year to 5 years 35 Six years to 30 years 65 8. Seasonally-related p r e c i p i t a t i o n of asthma Occasionally or Yes 50 No 50 7 13 10 10 Table 1 continued . . 44 S a m p l e D e m o g r a p h i c a n d P e r s o n a l V a r i a b l e P e r c e n t a g e % N=20 n 9 . I n t e r f e r e n c e o f a s t h m a i n d a i l y a c t i v i t i e s S e l d o m o r m i l d l y M o d e r a t e l y o r s e v e r e l y 1 0 . H o s p i t a l i z a t i o n b e c a u s e o f a s t h m a Y e s No 1 1 . F r e q u e n c y o f h o s p i t a l i z a t i o n O c c a s i o n a l l y S e v e r a l t i m e s 1 2 . N u m b e r o f m e d i c a t i o n s t a k e n f o r a s t h m a 0 - 2 3 - 6 55 45 65 35 25 40 60 40 11 9 13 7 5 8 12 8 T a b l e 1 c o n t i n u e d . 45 Sample Demographic and Percentage % N=20 Personal Variable n 13. Asthma medications prescribed Have not been prescribed, or when asthma symptoms exacerbate 20 4 When asthma symptoms exacerbate and daily on a regular basis 80 16 14. Number of allergens or i r r i t a n t s i d e n t i f i e d 0 - 4 50 10 5 - 8 50 10 15. Treatment prescribed other than medications for asthma Yes 10 2 No 90 18 Table 1 continued 46 S a m p l e D e m o g r a p h i c a n d P e r s o n a l V a r i a b l e P e r c e n t a g e % N=20 1 6 . F r e q u e n c y h e a l t h c a r e b y p h y s i c i a n d u e t o a s t h m a i s s o u g h t O c c a s i o n a l l y , o r 1 t o 2 t i m e s p e r y e a r T h r e e t o 4 t i m e s p e r y e a r 1 7 . S m o k i n g h a b i t Y e s No 1 8 . E x e r c i s e h a b i t s D a i l y t o 3 t i m e s p e r w e e k O c c a s i o n a l l y o r n o t a t a l l 1 9 . R e c e i v e d h e a l t h e d u c a t i o n ~~ r e l a t e d t o a s t h m a Y e s No 55 45 10 90 60 40 11 9 2 18 12 8 15 85 3 17 47 Table 1 I l l u s t r a t e s that the majority of the participants were female and non-professional; had a confident; took medications for asthma when symptoms exacerbated, and on a dai l y basis; followed no treatment for asthma other than medication-taking; were non smokers; and had no formal health education related to asthma. Health Problems of Young Adults Related to Asthma  Overview What follows describes health problems as they have been sub-categorized in r e l a t i o n to the nine basic human needs premised within The U.B.C. Model For  Nursing (1980) . Health Problems Related to the Need For Safety and  Security A t o t a l of ten health problems were i d e n t i f i e d as related to the need for safety and security. The cumulative frequency of responses which have been i d e n t i f i e d within this need category was 62. Table 2 tabulates the health problems related to this need and i l l u s t r a t e s percentages and frequency d i s t r i b u t i o n s . 48 T a b l e 2 P e r c e n t a g e a n d F r e q u e n c y D i s t r i b u t i o n o f H e a l t h  P r o b l e m s R e l a t e d t o t h e N e e d F o r S a f e t y a n d S e c u r i t y H e a l t h P r o b l e m S a m p l e P e r c e n t a g e % N=20 n 12 11 2 . 1 E n v i r o n m e n t a l a l l e r g e n a n d i r r i t a n t c o n t r o l 60 2 . 2 U p p e r r e s p i r a t o r y i n f e c t i o n s c o n t r o l 55 2 . 3 E s t a b l i s h m e n t a n d a d h e r e n c e t o m e d i c a t i o n s c h e d u l e t o c o n t r o l s y m p t o m s 45 2 . 4 C o n c e r n f o r m e d i c a t i o n s i d e - e f f e c t s 45 2 . 5 C o n c e r n f o r a d d i c t i o n t o a s t h m a m e d i c a t i o n s 40 2 . 6 E x p e r i e n c e u n p l e a s a n t p s y c h o l o g i c a l r e s p o n s e s 20 2 . 7 L i f e e x p e c t a n c y c o n c e r n s 15 2 . 8 H e r e d i t y f a c t o r c o n c e r n s 10 2 . 9 F i n a n c i a l c o n c e r n s 10 4 3 2 2 T a b l e 2 c o n t i n u e d 49 Sample Percentage % N=20 Health Problem ja 2.10 Concern for the effects of asthma and medications during pregnancy 10 2 A frequently perceived health problem which has been i d e n t i f i e d , within the need category for safety and security, was the d i f f i c u l t y experienced by 60% (n=12) of the participants in c o n t r o l l i n g allergens and i r r i t a n t s in the environment. One interviewee summarized her p a r t i c u l a r d i f f i c u l t i e s in c o n t r o l l i n g allergens in her environment and in dealing with the prospects of developing more a l l e r g i c responses. She stated, So you do tend I suppose to p u l l back, you know, and probably don't r e a l i z e i t u n t i l you s i t down and examine i t . Occasionally, when something new ( r e f e r r i n g to the i d e n t i f i c a t i o n of a new allergen) crops up, I get f e eling that the world i s closing in on me and I wonder what is going to happen next. Am I going to end up in a p l a s t i c bubble or something? It is sort of scary, i t seems l i k e another l i t t l e chunk of "normal l i f e " i s gone. 50 Other frequently mentioned health problems were the following. Some stated that they were susceptibile to contracting head colds and upper respiratory i n f e c t i o n s , and needed to take special precautions in cold, damp weather. Fo r t y - f i v e percent (n=9) found that establishing and adhering to a medication schedule to prevent or control their symptoms was d i f f i c u l t . S p e c i f i c a l l y , some participants stated that organization prior to a c t i v i t i e s such as sports or travel was not easy for them. Several stated that d i f f i c u l t i e s arose in making certain their medications were readily a v a i l a b l e , and in administering preventative doses of medication before sports a c t i v i t i e s . Further, thoughtful planning was often necessary before travel to ensure that medication supplies would be s u f f i c i e n t , during the time away from home . Another 45% (n=9) expressed concerns associated with the side-effects of some asthma medications they administered to control or prevent asthma symptoms. Several stated that medication side-effects such as tachycardia, shakiness, drowsiness, hyperactivity, increased moodiness, and depression frightened them. Some (n=3) mentioned that elevated doses of certain medications made them fe e l emotionally unstable. One 51 stated, "I thought I was going crazy." Another interviewee expressed her personal anguish regarding the side-effects of medications. She stated, Sometimes I think I should just creep into a corner and wheeze in peace and not take anything because the side-effects of the drugs are often a lot worse than the actual asthma. Another health problem frequently perceived was that the necessity of d a i l y medication schedules i n i t i a t e d f e e lings, in some, that they were becoming addicted to their asthma medications. For example, some stated that they f e l t anxious i f their medications were not close at hand, esp e c i a l l y when they were short of breath, or i f their medication pr e s c r i p t i o n mistakenly had not been r e f i l l e d . A few in fact stated that they f e l t l i k e "junkies." Twenty percent (n = 4) experienced unpleasant psychological responses of fear, panic and anxiety during periods when they are short of breath. Other less frequently perceived health problems In this need category are tabulated in Table 2 (2.7 to 2.10 i n c l u s i v e ) . Health Problems Related to the Need For Balance Between  Production and U t i l i z a t i o n of Energy Four health problems were sub-categorized in r e l a t i o n to - the need for balance between production and 52 u t i l i z a t i o n of energy. The cumulative frequency of responses which have been i d e n t i f i e d within this need category was 41. Table 3 itemizes the health problems and i l l u s t r a t e s the percentages and frequency d i s t r i b u t i o n s . Table 3 Percentage and Frequency D i s t r i b u t i o n of Health  Problems Related to the Need For Balance Between  Production and U t i l i z a t i o n of Energy Sample Percentage % N=20 Health Problem ri 3.1 Restricts sport p a r t i c i p a t i o n 80 16 3.2 Fatigue due to dyspnea and/or i n a b i l i t y to maintain regular sleep patterns during dyspnea 70 14 3.3 Dyspnea frequently interrupts d a i l y a c t i v i t i e s 35 7 3.4 Exacerbation of symptoms during travel and holidays 20 4 53 T h e m o s t f r e q u e n t l y c i t e d h e a l t h p r o b l e m w i t h i n t h i s n e e d c a t e g o r y , a m o n g 80% ( n = 1 6 ) o f t h e s a m p l e , w a s t h a t a s t h m a s y m p t o m s o f t e n n e c e s s i t a t e d r e s t r i c t i o n s i n s p o r t s p a r t i c i p a t i o n a n d t h a t t h i s w a s t h e c r u x o f m a n y o f t h e i r f r u s t r a t i o n s . O n e o f t h e i n t e r v i e w e e s m a i n t a i n e d , T h e e x e r c i s e i s o n e t h i n g I r e a l l y m i s s b e i n g a b l e t o d o a s e a s i l y a s I w o u l d l i k e t o . I w a s e x t r e m e l y f i t a n d i t i s k i n d o f d i s h e a r t e n i n g I g u e s s i s t h e w o r d , t o l o o k a t m y s e l f n o w i n r e l a t i o n t o t h e n a n d r e a l i z e t h a t I c a n ' t g o o u t a n d c y c l e w i t h t h e g u y s a s e a s i l y a s I w o u l d h a v e i n t h e p a s t . O f t h e f o u r who d i d n o t i d e n t i f y t h i s a s a h e a l t h p r o b l e m , t h r e e d i d n o t e n j o y s p o r t s a n d p r e f e r r e d t o r e m a i n s e d e n t a r y , a n d o n e p a r t i c i p a n t w a s c u r r e n t l y a c t i v e i n s p o r t s a n d a s t h m a s e l d o m i n t e r f e r e d w i t h t h i s . A s p o r t s e v e r a l s t a t e d t h e y c o u l d n o l o n g e r t a k e p a r t i n w a s s k i i n g . A n o t h e r f r e q u e n t l y i d e n t i f i e d h e a l t h p r o b l e m , i n t h i s n e e d c a t e g o r y , w a s f a t i g u e d u e t o d y s p n e a a n d / o r i r r e g u l a r s l e e p p a t t e r n s d u r i n g d y s p n e i c p e r i o d s . O t h e r h e a l t h p r o b l e m s p e r c e i v e d l e s s f r e q u e n t l y w e r e t a b u l a t e d i n T a b l e 3 ( 3 . 3 t o 3 . 4 i n c l u s i v e ) . H e a l t h P r o b l e m s R e l a t e d t o t h e N e e d F o r M a s t e r y A t o t a l o f s i x h e a l t h p r o b l e m s w e r e s u b -c a t e g o r i z e d a s r e l a t e d t o t h e n e e d f o r m a s t e r y . T h e 54 c u m u l a t i v e f r e q u e n c y o f r e s p o n s e s w h i c h h a v e b e e n i d e n t i f i e d w i t h i n t h i s n e e d c a t e g o r y w a s 3 2 . T a b l e 4 i t e m i z e s t h e h e a l t h p r o b l e m s r e l a t e d t o t h i s n e e d a n d i l l u s t r a t e s p e r c e n t a g e s a n d f r e q u e n c y d i s t r i b u t i o n s . T a b l e 4 P e r c e n t a g e a n d F r e q u e n c y D i s t r i b u t i o n o f H e a l t h  P r o b l e m s R e l a t e d t o t h e N e e d F o r M a s t e r y H e a l t h P r o b l e m s S a m p l e P e r c e n t a g e N=20 4 . 1 E m p l o y m e n t a n d c a r e e r g o a l s t h r e a t e n e d 4 . 2 T r i a l a n d e r r o r l e a r n i n g n o t a n e f f i c i e n t w a y t o l e a r n how t o c o p e w i t h h e a l t h p r o b l e m s 4 . 3 D i f f i c u l t y w i t h h o u s e h o l d t a s k s 4 . 4 I g n o r i n g s i t u a t i o n s w h i c h c a n p r e c i p i t a t e a s t h m a i n o r d e r t o s a t i s f y i m p o r t a n t g o a l s 70 4 5 25 14 20 55 Seventy percent (n=14) s t a t e d that asthma threatened t h e i r employment or career g o a l s . This was so e s p e c i a l l y i f a l l e r g e n s or i r r i t a n t s were commonly found at the place of work. One i n t e r v i e w e e s t a t e d , I have to choose c a r e f u l l y what r e s t a u r a n t s I work i n . The customers' smoke can f i l l the whole room i n f i v e minutes and i f the r e s t a u r a n t doesn't have a i r c o n d i t i o n i n g I'd be having asthma a t t a c k s a l l through work. Another respondent claimed, As a salesman when I go i n t o an i n d u s t r i a l p l a n t I would be aware of pai n t and things l i k e that which may i n h i b i t me i n making a s a l e s c a l l or whatever. Another i n t e r v i e w e e , a r e g i s t e r e d nurse, was s e v e r e l y a l l e r g i c to Metamucil powder, a drug she commonly admin i s t e r e d to p a t i e n t s . As a r e s u l t she had been unable to work f o r the l a s t s i x months, because of severe asthma symptoms. Two p a r t i c i p a n t s had concerns that p r o s p e c t i v e employers may q u e s t i o n whether they are capable of performing w e l l at work i f t h e i r d i a g n o s i s of asthma was known to the p o t e n t i a l employer. Six professed that they f e e l f r u s t r a t e d when they cannot p a r t i c i p a t e i n some a c t i v i t i e s , f u r t h e r t h e i r career g o a l s , or compete with others as much as they wished because of asthma. One d e s c r i b e d her 56 degree of f r u s t r a t i o n in these words, I can handle the discomfort or pain or whatever; what drives me mad is not being able to do what I want to do. Fort y - f i v e percent (n=9) stated that after the diagnosis of asthma had been made, they experienced d i f f i c u l t i e s in learning about the i l l n e s s i t s e l f , and how to master and cope with the problems i t presents. They pointed out that what they had learned about asthma and how to cope with i t was largely due to their own t r i a l and error methods, or was related to information they had been able to glean from r e l a t i v e s or friends who had asthma. Several claimed that there is l i t t l e access to health education, and maintained that the lack of educational resources was fr u s t r a t i n g and stress provoking. One interviewee said, "I would have like d to be given the knowledge that i t took me so long to obtain myself." In addition, 10% (n=2) pointed out that they would favor health education which focused on s i m p l i s t i c explanations rather than in-depth medical explanations. Other less frequently cited health problems within this need category were itemized in Table 4 ( 4 . 3 to 4.4 i n c l u s i v e ) . Some interviewees perceived d i f f i c u l t i e s in performing certain customary household tasks. One 57 d e s c r i b e d h e r d i f f i c u l t i e s a s s o c i a t e d w i t h c a r r y i n g o u t h o u s e h o l d t a s k s i n t h i s w a y . J u s t g o i n g d o w n t o t h e b a s e m e n t t o t h e l a u n d r y a n d c o m i n g u p t h e l a u n d r y s t a i r s , t h i n g s l i k e t h a t i s s o m e t i m e s h a r d w o r k . A n d w h a t e l s e ? C a r r y i n g g r o c e r i e s , b a g s o f g r o c e r i e s u p t h e s t e p s i s d i f f i c u l t . V a c u u m i n g a n d d u s t i n g w e r e p a r t i c u l a r l y t r o u b l e s o m e t a s k s f o r s o m e , e s p e c i a l l y w h e n t h e y w e r e w h e e z y o r s h o r t o f b r e a t h . O t h e r s s t a t e d t h a t t h e s e t a s k s c o u l d , i n f a c t , p r e c i p i t a t e a s t h m a s y m p t o m s b e c a u s e t h e c o m m o n l y m a r k e t e d h o u s e h o l d c l e a n i n g a g e n t s , e s p e c i a l l y a g e n t s s o l d i n s p r a y d i s p e n s e r s , a n d c l e a n i n g a g e n t s s u c h a s a m m o n i a o r b l e a c h c o u l d i n i t i a t e a s t h m a s y m p t o m s . O f t h e 25% ( n = 5 ) w h o a c k n o w l e d g e d d i f f i c u l t y i n a c c o m p l i s h i n g s o m e o f t h e i r h o u s e h o l d t a s k s , t w o w e r e n o t e m p l o y e d o u t s i d e t h e i r h o m e . O n l y o n e m e n t i o n e d t h a t t h e i r m a t e o r h u s b a n d h a d t a k e n r e s p o n s i b i l i t y f o r s o m e o f t h e t a s k s w h i c h w e r e p a r t i c u l a r l y t r o u b l e s o m e . H e a l t h P r o b l e m s R e l a t e d t o t h e N e e d F o r R e s p e c t o f  S e l f , B y S e l f a n d O t h e r s A t o t a l o f f i v e h e a l t h p r o b l e m s w e r e s u b -c a t e g o r i z e d a s r e l a t e d t o t h e n e e d f o r r e s p e c t o f s e l f , b y s e l f , a n d o t h e r s . T h e c u m u l a t i v e f r e q u e n c y o f r e s p o n s e s w h i c h h a v e b e e n i d e n t i f i e d w i t h i n t h i s n e e d 58 c a t e g o r y w a s 2 9 . T a b l e 5 i t e m i z e s t h e s e h e a l t h p r o b l e m s a n d i l l u s t r a t e s p e r c e n t a g e s a n d f r e q u e n c y d i s t r i b u t i o n s . T a b l e 5 P e r c e n t a g e a n d F r e q u e n c y D i s t r i b u t i o n o f H e a l t h  P r o b l e m s R e l a t e d t o t h e N e e d F o r R e s p e c t o f S e l f , B y S e l f a n d O t h e r s S a m p l e P e r c e n t a g e % N = 2 0 H e a l t h P r o b l e m ri 5 . 1 A s t h m a s y m p t o m s c a n p r e c i p i t a t e 50 10 d e p r e s s i o n 5 . 2 Some i n s o c i e t y i n c l u d i n g m e m b e r s o f t h e h e a l t h p r o f e s s i o n s a r e p r e j u d i c e d t o w a r d i n d i v i d u a l s w i t h a s t h m a 30 6 5 . 3 E m b a r r a s s e d b y a s t h m a s y m p t o m s a n d o f m e d i c a t i o n - t a k i n g i n p u b l i c 30 6 5 . 4 L a c k o f s t a m i n a c o m p a r e d t o p e e r s 2 0 4 5 . 5 D i f f i c u l t y i n a c c e p t a n c e o f a s t h m a d i a g n o s i s a n d o f p e r c e i v i n g s e l f a s c h r o n i c a l l y i l l 15 3 59 A f r e q u e n t l y p e r c e i v e d h e a l t h p r o b l e m w h i c h was i d e n t i f i e d i n t h i s need c a t e g o r y was d e p r e s s i o n . S e v e r a l s t a t e d t h e i r f e e l i n g s of d e p r e s s i o n were r e l a t e d to t h e f a c t t h a t asthma symptoms can f r e q u e n t l y p r e c l u d e p o s i t i v e a t t i t u d e s r e g a r d i n g t h e i r p h y s i c a l a p p e a r a n c e , and can a f f e c t t h e i r g e n e r a l f e e l i n g s of p h y s i c a l w e l l - b e i n g . One 26 y e a r o l d i n t e r v i e w e e s t a t e d , The o n l y t i m e t h a t i t ( a s t h m a ) r e a l l y a f f e c t s me i s when I have to t a k e the m e d i c a t i o n . I t makes me shake or i t makes me r e a l l y t i r e d and I g e t b l a c k c i r c l e s u n d e r my eyes and you j u s t f e e l " b l a h " a l l o v e r . You d o n ' t r e a l l y f e e l l i k e d o i n g a n y t h i n g or g o i n g any where you j u s t want to go to bed. T h i r t y p e r c e n t (n=6) p e r c e i v e d t h a t many i n s o c i e t y a r e p r e j u d i c e d toward t h o s e w i t h asthma. P a r t i c i p a n t s b e l i e v e d t h a t t h e r e a r e i n d i v i d u a l s i n s o c i e t y who l a r g e l y a t t r i b u t e d p s y c h o l o g i c a l c a u s e s w i t h asthma, or h o l d t h a t p e r s o n s w i t h asthma can use t h e i r symptoms f o r p e r s o n a l g a i n . One i n t e r v i e w e e a s s e r t e d , " I d o n ' t t h i n k o t h e r s u n d e r s t a n d the e f f e c t s o f asthma b e c a u s e i t i s not s o m e t h i n g t a n g i b l e to them." A n o t h e r p a r t i c i p a n t a c k n o w l e d g e d , I s o r t of have k e p t i t i n the c l o s e t r e a l l y ( h a v i n g a s t h m a ) , b e c a u s e p e o p l e who d o n ' t u n d e r s t a n d what i t i s and j u s t p e r c e i v e i t as a w e a k n e s s — a p s y c h o l o g i c a l weakness, so I d o n ' t admit to o t h e r p e o p l e t h a t I have i t . 60 I t was a l s o emphasized t h a t some p h y s i c i a n s g e n e r a l l y c o u l d be more Informed about asthma and more adept at d i a g n o s i n g i t . Some s t a t e d t h a t they s u f f e r e d p r o l o n g e d mental a n g u i s h because t h e i r asthma had not been di a g n o s e d b e f o r e a s u b s t a n t i a l amount of time had l a p s e d a f t e r the onset of symptoms. One i n t e r v i e w e e c l a i m e d , I went to s e v e r a l d o c t o r s and d e s c r i b e d the symptoms, and they thought t h a t I had some "mental problems." The d i a g n o s t i c problem went on p r o b a b l y f o r a y e a r . I t was r e p o r t e d by o t h e r s t h a t they f e l t embarrassed or s e l f - c o n s c i o u s when they sensed t h a t t h e i r asthma symptoms were e a s i l y observed by o t h e r s i n s o c i a l or p u b l i c s i t u a t i o n s . One i n t e r v i e w e e c o n s c i e n t i o u s l y t r i e d to mask her symptoms from o t h e r s . She acknowledged, I f i n d one of my main problems w i t h asthma i s a t t e m p t i n g to c o n c e a l t h a t I have i t . I don't know why, but I have always had t h i s a b s o l u t e h o r r o r of anyone knowing I have i t . Two i n t e r v i e w e e s s t a t e d t h a t they d i d not f e e l at ease t a k i n g m e d i c a t i o n s such as t h e i r i n h a l e d b r o n c h o d i l a t o r i n the presence of o t h e r s . They t h e r e f o r e found i t n e c e s s a r y to t r y to f i n d a p r i v a t e p l a c e to a d m i n i s t e r t h e i r m e d i c a t i o n s . 61 Twenty percent (n=4) were distressed because they lacked the physical stamina they believed that others of their age group possess. Some stated they f e l t much older than their actual years when their asthma symptoms were severe. For example, one interviewee confessed "sometimes I f e e l l i k e I am 90 years old." Generally participants f e l t they should be better able to perform physically r e l a t i v e to their chronological age. Among those who professed that i t was d i f f i c u l t for them to accept the fact that they had asthma, some acknowledged that a few years had passed before they could f u l l y accept the r e a l i t y of being an individual with a chronic i l l n e s s , having to learn how to cope with i t , and having to adhere to a treatment regimen. One interviewee described his experience in this way, I r e a l l y ignored i t for a while. It was a bit of shock r e a l i z i n g that I would have i t for the rest of my l i f e , that i t won't go away. You always think those things happen to other people not to yourself. When he (the physician) f i r s t told me I had asthma, i t was l i k e having an accident, i t always happens to someone else, not to yourself. Another interviewee stated, It i s hard to accept being an asthmatic, i t r e a l l y i s hard, when you haven't been sick before in your l i f e , and have been healthy and active prior to t h i s . Then, a l l of a sudden you discover you can't run up the street or walk up a h i l l without problems, you think what is happening to me! 62 Health Problems Related to the Need For Love,  Belongingness and Dependence Five health problems were sub-categorized as unmet needs related to the basic human need for love, belongingness, and dependence. The cumulative frequency of responses which have been i d e n t i f i e d within this category, was 21. Table 6 tabulates these health problems and i l l u s t r a t e s percentages and frequency d i s t r i b u t i o n s . Table 6 Percentage and Frequency D i s t r i b u t i o n of Health  Problems Related to the Need For Love, Belongingness  and Dependence Sample Health Problem Percentage N=20 n 6 . 1 Restricts s o c i a l a c t i v i t i e s with family and friends 35 7 6 .2 Si g n i f i c a n t others and friends have l i t t l e understanding of their problems 30 6 6 .3 Tension in relationships with family 20 4 6 .4 Inhibits sexual intercourse 15 3 6 .5 Loneliness during nocturnal dyspnea 5 1 63' T h i r t y - f i v e p e r c e n t (n=7) found t h a t t h e i r asthma symptoms can c u r t a i l t h e i r s o c i a l e v e n ts and a c t i v i t i e s w i t h f a m i l y and f r i e n d s . T h i s f r e q u e n t l y was n e c e s s a r y when asthma symptoms were p a r t i c u l a r l y t r o u b l e s o m e , or when i t was n e c e s s a r y to a v o i d a l l e r g e n c o n t a c t s which c o u l d be p r e s e n t i n the s o c i a l e n v i r o n m e n t . One i n t e r v i e w e e s t a t e d , S o c i a l l y i t (asthma) i s v e r y i n h i b i t i n g , e x t r e m e l y i n h i b i t i n g . When I am i n v i t e d to someone's p l a c e , I t h i n k to m y s e l f , do they smoke? I can c o n t r o l my own s i t u a t i o n i n my own home but you can't when you go o u t , and I a l s o have a problem i n r e s t a u r a n t s . Some acknowledged t h a t the s o c i a l r e s t r i c t i o n can a l s o p r e d i s p o s e f e e l i n g s of l o n e l i n e s s . I n r e f e r e n c e to t h i s , one i n t e r v i e w e e s t a t e d , "You know, i t s o r t of makes you f e e l l i k e an odd man ou t . " T h i s same i n t e r v i e w e e a l s o s t r e s s e d t h a t h a v i n g asthma was p a r t i c u l a r l y annoying when i t i n t e r f e r e d w i t h a c t i v i t i e s w i t h her c h i l d r e n . She found i t e s p e c i a l l y u p s e t t i n g to hear her c h i l d say, "Mummy can't go because she has asthma." Other l e s s f r e q u e n t l y p e r c e i v e d h e a l t h problems are i t e m i z e d i n Table 6 (6.3 to 6.5 i n c l u s i v e ) . Four p e r c e i v e d t h a t the symptoms of asthma made them: i r r i t a b l e , c r a b b y , l a c k i n g i n p a t i e n c e , demanding, and 64 depressed." One interviewee stated, "It changed my whole personality, I'm not what I used to be, and I hate being l i k e t h i s . " Subsequently, these persons pointed out that mood changes placed a s t r a i n on close r e l a t i o n s h i p s . Health Problems Related to the Need For Intake of  Food and F l u i d : Nourishment Four health problems were sub-categorized in r e l a t i o n to the need for intake of food and f l u i d : nourishment. The cumulative frequency of responses which have been i d e n t i f i e d within this need category was 20. Table 7 tabulates these health problems and i l l u s t r a t e s percentages and frequency d i s t r i b u t i o n s . Table 7 Percentage and Frequency D i s t r i b u t i o n of Health  Problems Related to the Need For Intake of Food and  F l u i d : Nourishment Sample Health Problem Percentage N=20 _n 7.1 Food and f l u i d allergen control 40 8 Table 7 continued. . 65 S a m p l e H e a l t h P r o b l e m P e r c e n t a g e N=20 n 7 . 2 G a s t r o i n t e s t i n a l u p s e t d u e t o a s t h m a m e d i c a t i o n s 30 6 7 . 3 P o o r n u t r i t i o n a l h a b i t s c a n e x a c e r b a t e a s t h m a s y m p t o m s 15 3 7 . 4 D e c r e a s e d e x e r c i s e t o l e r a n c e c a u s e s w e i g h t g a i n 15 3 T h e m o s t f r e q u e n t l y c i t e d h e a l t h p r o b l e m w i t h i n t h i s n e e d c a t e g o r y w a s t h a t c e r t a i n f o o d a n d f l u i d a l l e r g e n s h a d t o b e c o n s c i e n t i o u s l y a v o i d e d . T h i s w a s t r o u b l e s o m e , i n m o s t c a s e s , e i t h e r b e c a u s e t h e f o o d s a n d f l u i d s t h a t h a d t o b e a v o i d e d w e r e f a v o r i t e c o m m o d i t i e s , o r b e c a u s e t h e r e s t r i c t i o n s m a d e i t d i f f i c u l t t o f o l l o w i n g t h e c u s t o m a r y m e a l t i m e h a b i t s o f o t h e r s . F o r e x a m p l e , o n e i n t e r v i e w e e s t a t e d , T h e r e i s l i t e r a l l y n o t h i n g t h a t I c a n h a v e f o r b r e a k f a s t . A n y t h i n g t h a t a " n o r m a l " p e r s o n w o u l d h a v e f o r b r e a k f a s t l i k e c e r e a l , t o a s t o r e g g s i s a l l o u t f o r me b e c a u s e I am n o w a l l e r g i c t o a l l t h o s e t h i n g s . 66 Several contended that having food and f l u i d allergens was e s p e c i a l l y inconvenient and could produce awkward moments while dining out at a friends* home, or in a restaurant. Others who were a l l e r g i c to some chemicals, preservatives, and additives in food and f l u i d s such as metabisulphate, frequently found that i t was d i f f i c u l t to absolutely avoid these agents. The second-most frequently perceived health problem was that medications, prescribed to control or prevent asthma, may produce g a s t r o i n t e s t i n a l upset such as indi g e s t i o n . Other less frequently i d e n t i f i e d health problems are itemized in Table 7 (7.3 to 7.4 i n c l u s i v e ) . Health Problems Related to the Need For Intake of  Oxygen Two health problems were sub-categorized in r e l a t i o n to the need for intake of oxygen. The cumulative frequency of responses which have been i d e n t i f i e d within this need category was 10. Table 8 itemizes these health problems and i l l u s t r a t e s percentages and frequency d i s t r i b u t i o n s . 67 Table 8 Percentage and Frequency D i s t r i b u t i o n of Health  Problems Related to the Need For Intake of Oxygen Sample Health Problem Percentage N=20 n 8.1 Emotions and stress can pre c i p i t a t e dyspnea 40 8 8.2 Enjoy smoking and continue to do so but i t can preci p i t a t e asthma symptoms 10 2 Forty percent (n=8) stated that emotions and stress can pre c i p i t a t e dyspnea. Several pointed out that they frequently needed to conscientiously make an ef f o r t to remain calm and relaxed. This was p a r t i c u l a r l y d i f f i c u l t when situations at work, or at home, were es p e c i a l l y t r y i n g . Health Problems Related to the Need For Stimulation  of the Senses Four health problems were sub-categorized in r e l a t i o n to the need for stimulation of the senses. 68 The cumulative frequency of responses which have been i d e n t i f i e d within this need category was 10. Table 9 itemizes these health problems and i l l u s t r a t e s percentages and frequency d i s t r i b u t i o n s . Table 9 Percentage and Frequency D i s t r i b u t i o n of Health  Problems Related to the Need For Stimulation of the Senses Sample Health Problem Percentage N=20 n 9 . 1 Decreased sense of taste 25 5 9 .2 Decreased sense of smell 10 2 9 .3 Sense of smell for allergen odours has increased 10 2 9 .4 Eyes puffy and i r r i t a t e d 5 1 Twenty-five percent (n=5) stated that asthma symptoms could contribute to a diminished sense o f — taste. Some found this f r u s t r a t i n g because i t had implications for the enjoyment of meals, and i t also necessitated that they find others to season food for them. 69 Other less frequently perceived health problems were itemized in Table 9 (9.2 - 9.4 i n c l u s i v e ) . Of those who experienced a diminished sense of smell, one interviewee stated this was a concern for her because she worried that she would not be able to quickly detect a housefire at her residence i f one occurred. Others believed their sense of smell for some i r r i t a n t s and allergens had become more acute. This was described as an unpleasant experience, and one interviewee said he became nauseated when exposed to the smell of certain substances he is a l l e r g i c to. Health Problems Related to the Need For C o l l e c t i o n and  Removal of Accumulated Waste One health problem was sub-categorized in r e l a t i o n to the need for c o l l e c t i o n and removal of accumulated waste. The cumulative frequency of responses which have been i d e n t i f i e d within this need category was 6. Table 10 tabulates this health problem and i l l u s t r a t e s percentages and frequency d i s t r i b u t i o n s . 70 Table 10 Percentage and Frequency D i s t r i b u t i o n of Health  Problems Related to the Need For C o l l e c t i o n and Removal of Accumlated Waste Sample Health Problem Percentage N=20 n 10.1 D i f f i c u l t y in clearing chest of mucus in A.M. 30 6 Those who experienced d i f f i c u l t y in clearing their chest upon awakening in the morning found i t necessary to set aside time in their morning routine for pulmonary hygiene. Thus far in this section the multiple health problems related to asthma, as perceived by the participants in this study, have been singularly described in d e t a i l . What follows presents an a n a l y t i c a l summary of the health problems which were i d e n t i f i e d most frequently among the sample. The health problems have been c l a s s i f i e d as they occur 71 w i t h i n and a c r o s s t h e n i n e n e e d s c a t e g o r i e s i n t e r m s o f c o m m o n a l i t i e s t h a t e x i s t i n t h e g e n e r a l t y p e o f d i f f i c u l t y a n d / o r c o n c e r n e x p e r i e n c e d . By g r o u p i n g t h e h e a l t h p r o b l e m s i n t h i s m a n n e r , common g e n e r a l c a t e g o r i e s o f h e a l t h p r o b l e m s w e r e g e n e r a t e d f r o m t h e a r r a y o f s p e c i f i c h e a l t h p r o b l e m s p e r c e i v e d . Of t h e s e v e n h e a l t h p r o b l e m c a t e g o r i e s g e n e r a t e d , f i v e w e r e c l a s s i f i e d a c c o r d i n g t o S t r a u s s and G l a s e r ' s ( 1 9 7 5 ) s u g g e s t e d s y s t e m f o r c o n c e p t u a l i z i n g t h e common t y p e o f h e a l t h p r o b l e m s e x p e r i e n c e d by t h e c h r o n i c a l l y i l l . The r e m a i n i n g two common c a t e g o r i e s o f h e a l t h p r o b l e m s w e r e g e n e r a t e d on t h e b a s i s o f t h e i n v e s t i g a t o r s * i n t e r p r e t a t i o n o f t h e d a t a and i n v i e w o f wha t has b e e n d o c u m e n t e d i n t h e a l l i e d h e a l t h l i t e r a t u r e s p e c i f i c a l l y p e r t a i n i n g t o t h e p r o b l e m s e x p e r i e n c e d by t h o s e w i t h as t h m a . To b e g i n , t h e f i r s t c a t e g o r y o f h e a l t h p r o b l e m s w e r e c l a s s i f i e d as s i m i l a r i n t y p e b e c a u s e t h e y c r e a t e d i f f i c u l t i e s i n c u s t o m a r y l i f e s t y l e p a t t e r n s . The f o l l o w i n g h e a l t h p r o b l e m s b e l o n g t o t h i s g e n e r a l c a t e g o r y a l t h o u g h t h e y do v a r y i n r e s p e c t t o t h e s p e c i f i c l i f e s t y l e p r o b l e m e x p e r i e n c e d . F o r e x a m p l e , 80% (n=16) o f t h e p a r t i c i p a n t s s t a t e d t h a t a s t h m a r e s t r i c t e d s p o r t s p a r t i c i p a t i o n . Among i n d i v i d u a l s o f 72 t h i s y o u n g a g e g r o u p t h i s i s a n u n d e r s t a n d a b l e f i n d i n g , a n d e s p e c i a l l y i n v i e w o f t h e c u r r e n t e m p h a s i s i n t h e 1 9 8 0 ' s o n p h y s i c a l f i t n e s s . O n t h e o t h e r h a n d , 70% ( n = 1 4 ) p r o f e s s e d t h a t t h e y e x p e r i e n c e d f a t i g u e d u e t o s h o r t n e s s o f b r e a t h a n d / o r i n a b i l i t y t o m a i n t a i n r e g u l a r s l e e p p a t t e r n s d u r i n g p e r i o d s o f d y s p n e a , w h i l e 70% ( n = 1 4 ) a c k n o w l e d g e d t h a t h a v i n g a s t h m a p r e s e n t e d a t h r e a t t o t h e i r e m p l o y m e n t o r c a r e e r g o a l s . I t h a s b e e n e x t e n s i v e l y d o c u m e n t e d i n t h e l i t e r a t u r e , b y s e v e r a l s o c i a l s c i e n c e t h e o r i s t s , t h a t " b e c o m i n g e s t a b l i s h e d i n a v o c a t i o n o r p r o f e s s i o n t h a t p r o v i d e s p e r s o n a l s a t i s f a c t i o n , e c o n o m i c I n d e p e n d e n c e , a n d a f e e l i n g o f m a k i n g a w o r t h w h i l e c o n t r i b u t i o n t o s o c i e t y " i s o n e o f t h e d e v e l o p m e n t a l t a s k s o f y o u n g a d u l t s ( M u r r a y & Z e n t n e r , 1 9 7 9 ) . I t i s t h e r e f o r e r e a s o n a b l e t h a t t h i s p r o b l e m w o u l d b e o f c o n c e r n t o t h e y o u n g a d u l t p a r t i c i p a n t s i n t h i s s t u d y . I n s u m m a r y , t h e s e h e a l t h p r o b l e m s , a l t h o u g h u n i q u e i n t h e m s e l v e s a n d r e f l e c t i v e o f i n d i v i d u a l d i f f e r e n c e s i n p e r c e p t i o n , c a n b e g e n e r a l l y c l a s s i f i e d a s d i f f i c u l t i e s i n c u s t o m a r y l i v i n g p a t t e r n s ; h e n c e t h e y w e r e c a t e g o r i z e d a s l i f e s t y l e p r o b l e m s . S t r a u s s a n d G l a s e r ( 1 9 7 5 ) s u g g e s t e d t h a t t h e c o m m o n p r o b l e m s e x p e r i e n c e d i n d a i l y l i v i n g b y t h e c h r o n i c a l l y i l l w e r e p r o b l e m s r e l a t e d t o t h e c u s t o m a r y s t y l e o f l i f e o f 73 i n d i v i d u a l s . The f i n d i n g s i n t h i s study then are c o n s i s t e n t with some of what has been p r e v i o u s l y documented i n respe c t to the common types of problems experienced i n ch r o n i c i l l n e s s . The second category of h e a l t h problems may be considered a common type because they pose d i f f i c u l t i e s f o r i n d i v i d u a l s i n c o n t r o l l i n g asthma symptoms. The f o l l o w i n g are h e a l t h problems of t h i s type and are i l l u s t r a t i v e of the d i v e r s i t y i n i n d i v i d u a l p e r c e p t i o n s of s p e c i f i c problems which can be c l a s s i f i e d w i t h i n t h i s common category. S i x t y percent (n=12) of the sample i d e n t i f i e d that the need to avoid and c o n t r o l environmental a l l e r g e n s and I r r i t a n t s was a h e a l t h problem. This p a r t i c u l a r f i n d i n g i s s i g n i f i c a n t l y j u s t i f i a b l e i n view of the knowledge that a l l p a r t i c i p a n t s i n t h i s study had asthma of the e x t r i n s i c type, that 50% (n=10) of the sample v e r i f i e d that t h e i r asthma was s e a s o n a l l y - r e l a t e d or at l e a s t o c c a s i o n a l l y so, and that 50% (n=10) c i t e d 5 to 8 a l l e r g e n s or I r r i t a n t s which p r e c i p i t a t e d t h e i r asthma. Another 55% ( n = l l ) r e p o r t e d that they were s u s c e p t i b l e to upper r e s p i r a t o r y i n f e c t i o n s . This h e a l t h problem r e q u i r e d the adherence to p r e v e n t a t i v e p r a c t i c e s to avoid c h a r a c t e r i s t i c upper r e s p i r a t o r y i n f e c t i o n symptoms. F o r t y - f i v e percent (n=9) of p a r t i c i p a n t s professed that 74 establishing and adhering to their prescribed medication schedule, as a means to control their asthma symptoms, was problematic. Other health problems perceived by 40% (n=8) were d i f i c u l t i e s in c o n t r o l l i n g food and f l u i d allergens and, by 30% (n=6), in clearing their lungs of mucus upon a r i s i n g . In summary, these health problems have been categorized as problems related to c o n t r o l l i n g the symptoms of asthma, and hence they may be referred to as symptom control problems. Strauss and Glaser (1975) also determined that this common type of problem was frequently experienced by the chronically i l l . The third common category of health problems have been i d e n t i f i e d as problems of a similar type because they create d i f f i c u l t i e s in the maintenance of a positive self-esteem. The following may be categorized as s p e c i f i c health problems of this type, and demonstrate the d i v e r s i t y in in d i v i d u a l perception which may exist within this common health problem category. F i f t y percent (n=10) of the participants conceded that asthma symptoms, and commonly related responses, can pr e c i p i t a t e depression. Hudgel and Madsen, 1980; Sexton, 1981; Gershwin, 1981; Burns, 1982; Creer, 1979 also i d e n t i f i e d that depression is common among individuals with asthma. Although Creer 75 (1979) claimed that feelings of depression may be associated with the losses experienced by those with chronic obstructive pulmonary disease, however, the participants in this study linked their depression with lack of physical well-being and changes in their physical attractiveness and appearance due to the nature of symptoms in asthma. Another health problem which may have an impact on the self-esteem of this c l i e n t group, as i d e n t i f i e d by 30% (n=6) of the part i c i p a n t s , was the b e l i e f that some in the general society and in the health professions appeared to be prejudiced toward persons with asthma. Creer (1979) also asserted that those with asthma may experience s o c i a l stigma and suggested this may be due to the assumption that asthma symptoms are i n i t i a t e d by psychological f a c t o r s . F i n a l l y , another 30% (n=6) professed that they experienced embarrassment when their asthma symptoms and medication-taking were obvious to others in public s i t u a t i o n s . Although s p e c i f i c health problems varied within this category, they may be categorized as of a common type because they may reduce the self-esteem of persons with asthma. Therefore, they may be referred to as self-esteem problems. The i d e n t i f i c a t i o n of this problem is consistent with what has been written in the current a l l i e d health l i t e r a t u r e . For example, 76 Creer (1979) maintained that this p a r t i c u l a r c l i e n t group may experience decreased self-esteem. The fourth category of health problems may be considered a common type because they create experiences of so c i a l i s o l a t i o n among individuals with asthma. The following have been categorized as s p e c i f i c health problems of this type and are i l l u s t r a t i v e of the in d i v i d u a l differences in perception. T h i r t y - f i v e percent (n=6) of the participants perceived that having asthma i n h i b i t s s o c i a l a c t i v i t i e s with their family and friends. Creer (1979) held that the experience of s o c i a l i s o l a t i o n may be linked to r e s t r i c t i o n s in s o c i a l a c t i v i t y . Hence, the s o c i a l i n h i b i t i n g factor associated with asthma i d e n t i f i e d in this study is consistent with current l i t e r a t u r e . Another 30% (n=6) reported that s i g n i f i c a n t others and friends have l i t t l e understanding of the problems they experience with asthma. One explanation for this could be related to the s o c i a l stigma that exists toward those with asthma. As suggested by Creer (1979) asthma may evoke feelings of f r u s t r a t i o n and h o s t i l i t y in s i g n i f i c a n t others. In summary, these health problems may be categorized as problems of s o c i a l i s o l a t i o n . This 77 finding i s consistent with the Strauss and Glaser (1979) framework of common problems experienced by the chronically i l l . The f i f t h category of health problems may be c l a s s i f i e d as a common type because they may be instrumental in presenting d i f f i c u l t i e s for individuals in adjusting to l i v i n g with asthma. The following demonstrate the d i v e r s i t y of adjustment problems which exist within this common category. Forty-five percent (n=9) of the participants reported that the t r i a l and error, s e l f - i n s t r u c t e d learning process that they experienced, due to the lack of appropriate community resources, was not an e f f e c t i v e way to learn how to cope with asthma. It is l o g i c a l to suggest that this d i f f i c u l t y may have s i g n i f i c a n t implications for creating a multitude of other health problems. Another 25% (n=5) stated they experienced a decreased sense of taste, and therefore they frequently needed to e l i c i t the assistance of others in food preparation to season the food as necessary. Some also reported that this decreased their enjoyment of their meals. F i n a l l y , 20% (n=4) professed they at times ignored situations which can pre c i p i t a t e asthma in order to s a t i s f y goals important to them. 78 These health problems may be Identified as adjustment problems related to asthma. Strauss and Glaser (1975) also suggested that adjustment problems were common among those l i v i n g with a chronic i l l n e s s . The sixth category of health problems share a commonality in that they may be grouped as d i f f i c u l t i e s and/or concerns which create a broad spectrum of unpleasant psychological f e e l i n g s . The following r e f l e c t the d i v e r s i t y in health problems within this common category. Twenty percent (n=4) of the participants conceded that they experienced marked shortness of breath. Two of these interviewees also reported that emotions and stress could, in fact, p r e c i p i t a t e or exacerbate their asthma symptoms. This health problem was sub-categorized as a d i f f i c u l t y related to the need fo r : intake of oxygen. Hence, perceived health problems related to the need for safety and security could influence the emergence of a health problem related to another basic human need. This finding may be explained and supported by the assumption in The U.B.C. Model for Nursing (1980) that a l l need subsystems are interdependent and i n t e r r e l a t e d . The psychological feelings i d e n t i f i e d by the participants in this study are consistent with what has been documented in the l i t e r a t u r e . Gershwin 79 (1981), Stein (1981), Young (1980), and Hume (1970) maintained that the pathophysiological problems in asthma can induce problems of a psychological nature. It has also been suggested by Hudgel and Madsen, 1980; Sexton, 1981; Gershwin, 1981; Burns, 1982; and Creer, 1979, that anxiety, fear, panic, and excessive worrying are common in those with asthma. Several health problems i d e n t i f i e d as concerns in r e l a t i o n to the need for safety and security created worries for several. The most frequently cited worry experienced by 45% (n=9) was related to the side-effects of taking asthma medications. Some of the nine participants stated that the physical symptoms they experienced were worrisome, while others were gravely concerned regarding feelings of mental i n s t a b i l i t y experienced while taking certain medications. Other concerns were i d e n t i f i e d among the sample but they were perceived by fewer participants in this study as being problematic. To summarize, these health problems may be categorized as psychological problems. The seventh and last category suggests the d i f f i c u l t y experienced by some participants in int e r a c t i n g with others. Twenty percent (n=4) among the sample reported that having asthma could produce tensions in relationships with their family members. This i s consistent with Chalmer's (1984) research 80 findings who i d e n t i f i e d that individuals with chronic obstructive pulmonary disease frequently experienced changed interpersonal relationships with their spouse and s i g n i f i c a n t others. In summary, this health problem may be referred to as a s o c i a l i n t e r a c t i o n problem. Strauss and Glaser's (1975) framework for i d e n t i f y i n g the problems of the chron i c a l l y i l l also suggested that i n t e r a c t i o n a l problems were common. Summary The common health problems experienced by young adults with asthma in this study were categorized as follows: l i f e s t y l e , symptom control, self-esteem, s o c i a l - i s o l a t i o n , adjustment, psychological, and int e r a c t i o n problems. It has been i l l u s t r a t e d that the health problems, within the general categories, varied markedly among the particpants although common types of health problems were experienced. Learning Needs of Young Adults with Asthma  Overvi ew What follows describes the learning needs perceived by the young adult participants as they have been sub-categorized in r e l a t i o n to the nine basic 81 human needs premised within The U.B.C. Model for Nursing ( 1980) . Learning Needs Related to the Need For Safety and  Securi ty A t o t a l of nine learning needs were sub-categorized in r e l a t i o n to the need for safety and security. The cumulative frequency of responses which have been i d e n t i f i e d within this need category was 45. Table 11 tabulates these learning needs and indicates percentages and frequency d i s t r i b u t i o n s . Table 11 Percentage and Frequency D i s t r i b u t i o n of Learning Needs  Related to the Need For Safety and Security Sample Percentage % N=20 Learning Needs n 11.1 Relaxation techniques 40 8 11.2 Functions and side-effects of asthma medications 40 8 11.3 Causal factors in asthma 40 8 11.4 Environmental control 35 7 Table 11 continued . . . 82 Sample Learning Needs Percentage^ N=20 n 11.5 Hereditary factors in asthma 25 5 11.6 Long-term prognosis of asthma 20 4 11.7 When to take asthma medications 15 3 11.8 Special precautions during pregnancy 5 1 11.9 Emergency measures for asthma attack 5 1 The learning needs perceived most frequently, within this need category, were the following: how to do relaxation techniques, the functions and side-effects of asthma medications, the causal or trig g e r i n g factors related to asthma (of those who wished to learn more about the causal factors in asthma, f i v e had been diagnosed recently), and how to control the environment to minimize allergen and i r r i t a n t contacts. Other learning needs less frequently mentioned are 83 i l l u s t r a t e d in Table 11 (11.5 to 11.9 i n c l u s i v e ) . Of those who wished to learn of the implications of heredity factors in asthma, a l l had children. Furthermore, of those who were interested in obtaining information about the long-terra prognosis of asthma, two stated that asthma severely Interferred with their d a i l y needs and a c t i v i t i e s . The need to gain information about special care for persons with asthma, during pregnancy, was suggested by an interviewee who had recently delivered her f i r s t c h i l d , and was intending to have more children. Learning Needs Related to the Need For Balance  Between Production and U t i l i z a t i o n of Energy Two learning needs were sub-categorized in r e l a t i o n to the need for balance between production and u t i l i z a t i o n of energy. The cumulative frequency of responses which have been i d e n t i f i e d within this need category was 11. Table 12 i l l u s t r a t e s these learning needs, percentages and frequency d i s t r i b u t i o n s . 84 Table 12 Percentage and Frequency D i s t r i b u t i o n of Learning Needs  Related to the Need For Balance Between Production and  U t i l i z a t i o n of Energy Sample Percentage % N=20 Learning Needs ti 12.1 Pacing techniques in sports 40 8 12.2 B e n e f i c i a l and appropriate sports 15 3 Forty percent (n=8) i d e n t i f i e d that they wished to obtain information about how to go about pacing themselves in sports. The purpose of this was to learn how to increase their a c t i v i t y tolerance, endurance, and to set r e a l i s t i c sports goals in the provision of maintaining sports involvement. Others stated they wished to learn what sports are the most appropriate and b e n e f i c i a l for persons with asthma. Learning Needs Related to the Need For Mastery Two learning needs were sub-categorized in r e l a t i o n to the need for mastery. The cumulative 85 frequency of responses which have been i d e n t i f i e d within this need category was 11. Table 13 tabulates these learning needs. Table 13 Percentage and Frequency D i s t r i b u t i o n of Learning Needs  Related to the Need For Mastery Sample Learning Needs Percentage % N=20 n 13.1 Asthma pathophysiology 30 6 13.2 Perceptions of others with asthma and the coping strategies used by them 25 5 Thirty percent (n=6) pointed out that they desired to learn the s p e c i f i c anatomy and physiology connected with asthma symptomatology. Twenty-five percent (n=5) also stated they wished to learn how others with asthma perceived themselves and how they coped with their health problems. Learning Needs Related to the Need For Intake of  Food, F l u i d : Nourishment Two learning needs were sub-categorized in r e l a t i o n to the need for intake of food, f l u i d : 86 nourishment. The cumulative frequency of responses which have been i d e n t i f i e d within this need category was 10. Table 14 itemizes these learning needs. Table 14 Percentage and Frequency D i s t r i b u t i o n of Learning Needs  Related to the Need For Intake of Food, F l u i d : Nourishment Sample Percentage % N=20 Learning Needs n 14.1 Diet t a i l o r e d to indivi d u a l s with asthma 35 7 14.2 Maintenance or weight loss diet 15 3 T h i r t y - f i v e percent (n=7) i d e n t i f i e d that they wished to obtain information about foods and n u t r i t i o n which may be most b e n e f i c i a l and appropriate for in d i v i d u a l s with asthma because they contended that there is a l i n k between maintenance of good n u t r i t i o n and the prevention and control of asthma symptoms. Of 87 those who wished to obtain knowledge about an appropriate diet to maintain or lose weight, a l l stressed they had a tendency toward weight gain in conjunction with l i m i t a t i o n s in a c t i v i t y related to as thma. Learning Need Related to the Need For Love,  Belongingness and Dependence One learning need was sub-categorized in the r e l a t i o n to the need for love, belongingness and dependence. The cumulative frequency of responses which have been i d e n t i f i e d within this need category was 3. Table 15 i l l u s t r a t e s the learning need in this category. Table 15 Percentage and Frequency D i s t r i b u t i o n of Learning Needs  Related to the Need For Love, Belongingness and  Dependence Sample Percentage % N=20 Learning Needs n 15.1 Maintenance of relationships with s i g n i f i c a n t others 15 3 88 How to e f f e c t i v e l y cope with relationships with signficant others when tensions arise due to the impact of asthma was the one perceived learning need sub-categorized within this need category. Learning Need Related to the Need For Intake of Oxygen One learning need was sub-categorized in r e l a t i o n to the need for intake of oxygen. The cumulative frequency of responses which have been i d e n t i f i e d within this need category was 2. Table 16 i l l u s t r a t e s this learning need. Table 16 Percentage and Frequency D i s t r i b u t i o n of Learning Need  Related to the Need For Intake of Oxygen Sample Percentage % N=20 Learning Need ii 16.1 Coughing technique 10 2 89 How t o e f f e c t i v e l y c l e a r l u n g a i r w a y s o f m u c u s w a s t h e o n e p e r c e i v e d l e a r n i n g n e e d s u b - c a t e g o r i z e d w i t h i n t h i s n e e d c a t e g o r y . I n t h i s s e c t i o n t h e l e a r n i n g n e e d s , a s p e r c e i v e d b y y o u n g a d u l t s i n t h i s s t u d y , h a v e b e e n d e s c r i b e d i n d i v i d u a l l y a n d I n d e t a i l i n r e l a t i o n t o n e e d c a t e g o r i e s . W h a t f o l l o w s i s a s u m m a r y o f t h e l e a r n i n g n e e d s , w h i c h w e r e i d e n t i f i e d m o s t f r e q u e n t l y a m o n g t h e s a m p l e , a n d r e p r e s e n t s a s y s t e m a t i c a n a l y s i s o f t h e d a t a a c c o r d i n g t o s i m i l a r g e n e r a l c h a r a c t e r i s t i c s w h i c h a r e i n h e r e n t i n t h e l e a r n i n g n e e d s d e s c r i b e d . T h i s a n a l y s i s o c c u r s i n a s i m i l a r m a n n e r t o w h i c h t h e c o m m o n c a t e g o r i e s o f h e a l t h p r o b l e m s w e r e g e n e r a t e d . T h e l e a r n i n g n e e d s w e r e c l a s s i f i e d a c c o r d i n g t o t h e i n v e s t i g a t o r ' s i n t e r p r e t a t i o n o f e x i s t i n g c o m m o n a l i t i e s i n l e a r n i n g n e e d s w h i c h a d d r e s s e d t h e a s s o c i a t e d h e a l t h p r o b l e m s d e s c r i b e d . I n t h i s m a n n e r t h e n a m e s o f c o m m o n l e a r n i n g n e e d c a t e g o r i e s w e r e k e p t c o n s i s t e n t w i t h t h e n a m e s o f t h e c o m m o n h e a l t h p r o b l e m c a t e g o r i e s . T h e m a j o r i t y o f l e a r n i n g n e e d s h a v e b e e n s u b - c a t e g o r i z e d i n r e l a t i o n t o t h e n e e d f o r s a f e t y a n d s e c u r i t y . T h e s e l e a r n i n g n e e d s may b e c o n s i d e r e d o f a c o m m o n t y p e b e c a u s e t h e y m a y b e c l a s s i f i e d a s l e a r n i n g 90 needs associated with symptom control problems, nevertheless they i l l u s t r a t e the vast d i v e r s i t y in learning needs among the participants in this study. For instance, 40% (n=8) reported that learning how to do relaxation techniques to control stress and emotions would be b e n e f i c i a l . Casey et a l . 1s ( 1983) research, which investigated the learning needs of patients after a myocardial i n f a r c t i o n , also revealed that patients reported that learning how to deal with their emotions and stress was one of their learning needs; in fact, i t was their most important one. Obtaining knowledge of the functions and side-effects of asthma medications was a learning need i d e n t i f i e d by another 40% (n=8) of this sample. This finding is also similar to the findings in Casey et a l . ' s ( 1983) study which determined that patients wished to gain knowledge of medication s i d e - e f f e c t s . Given some of the unpleasant and unfortunate experiences that some participants in this study experienced due to the side-effects of medications, the i d e n t i f i c a t i o n of this learning need i s not a surprising f i n d i n g . Forty percent (n=8) of the participants stated they wished knowledge of the causal factors in asthma, another 35% (n=7) maintained that learning how to control their environments was a s p e c i f i c need; while 25% (n=5) reported they wanted 91 more knowledge of the heredity factors in asthma. F i n a l l y , another 20% (n=4) pointed out that they needed to learn more in respect to the long-term prognosis of asthma. These findings are similar to the findings in Gerrard and Peterson's (1984) and Casey et al.'s (1983) studies which i l l u s t r a t e d that cardiac patients perceived that they needed knowledge of ri s k factors, and the etiology of myocardial i n f a r c t i o n s . Two learning needs which were sub-categorized in r e l a t i o n to the need for mastery may be i n d i r e c t l y c l a s s i f i e d as learning needs associated with needed problems because i t Is assumed that related pathophysiology knowledge and knowledge of how others with asthma cope with their health problems may as s i s t ind i v i d u a l s with their symptom control problems. These i d e n t i f i e d learning needs are as follows and demonstrate the differences in learning needs c l a s s i f i e d within this common learning need category. Thirty percent (n=6) stated they required knowledge of asthma pathophysiology, another 25% (n=5) reported that they wished to learn of how others with asthma perceive themselves, and to learn from these individuals how they cope with their problems. This last finding is similar to what was found in Forsyth et a l . 1 s study, which investigated the learning needs of chronically 92 i l l patients; that i s , patients appreciated the opportunity to learn from other patients in a similar s i t u a t i o n to their own. In summary, these learning needs may be categorized as learning needs associated with symptom control problems. The second category of learning needs may be c l a s s i f i e d in terms of commonalities that exist in association with l i f e s t y l e problems. The following are learning needs of this type although i n d i v i d u a l differences in perception vary in r e l a t i o n to this common learning need category. Pacing techniques in sports, which was sub-categorized in r e l a t i o n to the need for balance between production and u t i l i z a t i o n of energy, was reported by 40% (n=8) and may be generally c l a s s i f i e d as a learning need necessary to cope with r e s t r i c t i o n s in sports a c t i v i t i e s . Diets t a i l o r e d to individuals with asthma, sub-categorized in r e l a t i o n to the need for intake of food, f l u i d : nourishment, may be referred to as what participants needed knowledge "of to maintain healthy eating patterns. These findings are consistent with what Forsyth et a l . ( 1984) found, that i s , c h r o n i c a l l y i l l patients desired information related to recreational a c t i v i t i e s and d i e t . To summarize, the learning needs just described 93 may be categorized as of a common type. They may be commonly conceptualized as learning needs associated with l i f e s t y l e problems. One l a s t learning need may be generally c l a s s i f i e d as a learning need associated with s o c i a l i n t e r a c t i o n problems. Maintenance of relationships with s i g n i f i c a n t others, which has been sub-categorized within the need for love, belongingness and dependence, was i d e n t i f i e d as a learning need by 15% (n=3) of the p a r t i c i p a n t s . Casey et a l . 1 s (1983) research study also i l l u s t r a t e d that cardiac patients perceived they required information on how to modify personal factors. To summarize, one learning need perceived by participants in this study may be categorized as a learning need to enable them to cope with their associated s o c i a l i nteraction problems. Summary The learning needs perceived by the young adults with asthma who participated in this study were as follows: learning needs associated with symptom control problems, learning needs associated with l i f e s t y l e problems, and learning needs associated with s o c i a l i n t e r a c t i o n problems. It has been demonstrated that p a r t i c i p a n t s ' perceptions of s p e c i f i c learning 94 needs di f f e r e d although common types of learning needs were experienced. It is apparent that the learning needs perceived by this sample population c l e a r l y placed an emphasis on learning how to control symptoms, how to manage their l i f e s t y l e and s o c i a l i n t e r a c t i o n s . However, there appears to be a lack of consistency in the number and type of perceived health problems which included: self-esteem, s o c i a l i s o l a t i o n , psychological, l i f e s t y l e s and adjustment problems compared to the number and type of learning needs that were subsequently perceived. Several reasons for this may be suggested. F i r s t , during interviews, participants received l i t t l e guidance from the investigator in the problem-solving process of defining learning needs in association with perceptions of their problems. It is possible that individuals require some assistance with the cognitive process involved in problem-solving and in determining learning needs, p a r t i c u l a r l y when the learning needs relate to requirements for health education. Second, some interviewees may have believed that, although they experienced a p a r t i c u l a r health problem related to asthma, they were nevertheless coping s u f f i c i e n t l y with i t , and therefore did not 95 require further information. Third, the investigator speculated that a lack of knowledge among the interviewees of the current extended role of the nurse may be a factor. Hence, the interviewees may envisage nurses in the role of a s s i s t i n g them with their learning needs associated with symptom control problems, more so than with a s s i s t i n g them with their psychological and s o c i a l problems. F i n a l l y , the investigator found that the basic human needs premised within The U.B.C. Model for  Nursing (1980) provided a useful means to sub-categorize the health problems and learning needs in r e l a t i o n to need sub-categories. Nonetheless, i t did not provide an e f f e c t i v e means to categorize the learning needs and health problems in terms of broad commonalities that e x i s t , because common types of health problems and learning needs exist across the needs categories. Relationships Between Selected Demographic and  Personal Variables and Perceived Learning Needs Overview The perceived learning needs of young adults with asthma were related to selected demographic and 96 personal variables, and Fisher's Exact Test was used to determine the s t a t i s t i c a l significance of the r e l a t i o n s h i p s . A probabilty l e v e l of .05 was set for judgements of s t a t i s t i c a l s i g n i f i c a n c e . A re l a t i o n s h i p was found between time since diagnosis and the learning need of pathophysiology of asthma. More participants in this study, diagnosed less than 1 year to 5 years, perceived pathophysiology of asthma as a learning need. Table 17 i l l u s t r a t e s the variable frequency d i s t r i b u t i o n among the sample in r e l a t i o n to the perceived learning need. Table 17 Relationship Between Length of Time Diagnosed and the  Learning Need Pathophysiology of Asthma Pathophysiology of asthma Length of time diagnosed Yes No Less than 1 year to 5 years 5 2 Five years to 30 years 1 12 ** F = 5, p <.01, Fisher's Exact Test It was also determined that time since diagnosis was related to wanting to learn of the perceptions of other persons with asthma and their coping strategies. 97 More young adults in this study, diagnosed less than 1 year to 5 years, i d e n t i f i e d the perceptions of others with asthma and their coping strategies as a learning need. Table 18 shows the variable frequency d i s t r i b u t i o n among the sample in r e l a t i o n to the perceived learning need. Table 18 Relationship Between Length of Time Diagnosed and the  Learning Need Perceptions of Others With Asthma and  Their Coping Strategies Perception of others with asthma and their coping strategies Length of time diagnosed Yes No Less than 1 year to 5 years 4 3 Five years to 30 years 1 12 * F = 4, p <.05, Fisher's Exact Test The frequency with which professional health care, due to asthma, is sought was related to the learning need, long-term prognosis of asthma. More participants who sought out professional health care due to asthma 3 to 4 times per year perceived the long-term prognosis of asthma as a learning need. Table 19 shows the 98 variable frequency d i s t r i b u t i o n among the sample in re l a t i o n to the perceived learning need. Table 19 Relationship Between How Often Professional Health Care  Due To Asthma Is Sought and the Learning Need Long-Term  Prognosis of Asthma Long-term prognosis of Frequency professional asthma health care, due to asthma, is sought Yes No Occassionally or 1 to 2 times 0 11 per year Three to 4 times per year 4 5 * F = 4, p <.05, Fisher's Exact Test F i n a l l y , whether or not the participants had dependents (children) was a demographic variable related to the learning need hereditary factors in asthma. More young adults in this study who had dependents (children) perceived hereditary factors in asthma as a learning need. Table 20 i l l u s t r a t e s the variable frequency d i s t r i b u t i o n among the sample in r e l a t i o n to the perceived learning need. 99 Table 20 Relationship Between Having Dependents (Children) and  the Learning Need Hereditary Factors in Asthma. Hereditary factors in asthma Dependents (children) Yes No Yes 5 6 No 0 9 * F = 0, p <.05, Fisher's Exact Test The four s t a t i s t i c a l relationships described above are understandable from a c l i n i c a l perspective. For example, those recently diagnosed with asthma are more l i k e l y to be in the process of learning about the nature of asthma, of learning how other persons with asthma perceive their problems, and how they cope with them, compared to those who have had asthma for many years. It is understandable that those who sought professional health care more frequently than other participants with asthma wished to learn of the prognosis of asthma. These individuals perhaps perceived they were suffering more from asthma, were 1 0 0 s i c k e r than the o t h e r s , and wished to become we l l again. Hence, understandably they sought a s s i s t a n c e from t h e i r p h y s i c i a n f r e q u e n t l y and were more concerned with the long-term prognosis of asthma. F i n a l l y , i t i s understandable from a c l i n i c a l p e r s p e c t i v e to f i n d that i n d i v i d u a l s with c h i l d r e n were concerned about t h e i r c h i l d r e n developing asthma and t h e r e f o r e wished to l e a r n of the h e r e d i t a r y f a c t o r s i n asthma compared to persons with asthma who had no c h i l d r e n . Summary The s t a t i s t i c a l a n a l y s i s determined that two of the personal v a r i a b l e s and one of the demographic v a r i a b l e s were r e l a t e d to p e r c e i v e d l e a r n i n g needs. S p e c i f i c a l l y , i t was determined that l e n g t h of time, diagnosed, how o f t e n p r o f e s s i o n a l h e a l t h care due to asthma i s sought, and having dependents ( c h i l d r e n ) were r e l a t e d to s p e c i f i c p e r c e i v e d l e a r n i n g needs. 101 CHAPTER FIVE Summary, Conclusions, Implications, and Recommendations Overview This chapter presents a summary of the study, conclusions to be drawn from the findings, implications of the findings for nursing practice and nursing education, and recommendations for further research. Summary The impetus for doing this research was founded on concern for the meaningfulness and relevancy of health education, provided by nurses, for young adults with asthma of the e x t r i n s i c type. The study's purpose was to describe the perceptions of young adults with asthma. F i r s t , their perceptions of their health problems related to asthma; second, their perceptions of their associated learning needs, and third to determine relationships between selected demographic and personal variables, and perceived learning needs. The rationale for the study was derived from assumptions held by some s o c i o l o g i s t s , medical s o c i o l o g i s t s , nurse educators, and cognitive f i e l d learning t h e o r i s t s . 102 Current a l l i e d health l i t e r a t u r e , which was relevant to this study, was summarized as the following. F i r s t , the problems of indivi d u a l s with asthma and/or chronic obstructive pulmonary disease are multiple, and they have been described within various contexts by a l l i e d health professionals. Second, i t appears that the learning needs of patients with a chronic i l l n e s s , as i d e n t i f i e d from their perspective, primarily focus on what they perceived they needed to learn to cope with their problems experienced i n chronic i l l n e s s . Third, research studies i l l u s t r a t e d that relationships may exist between selected demographic and personal variables, and the perceived learning needs of patients. Fourth, the health education focus provided by nurses may not address the most c r u c i a l learning needs of patients because l i t t l e attention appears to be directed toward patients psychological and s o c i a l problems. Instead, emphasis has been directed toward a s s i s t i n g patients with coping s k i l l s to control the pathophysiological symptoms associated with asthma. A descriptive research design using- survey methodology was used to address the research problem. Twenty young adults, between the ages of 20-45 who had asthma of the e x t r i n s i c type, participated in this 103 study. Data were collected using two questionnaires: a demographic and personal closed-ended interview schedule (Appendix A), and a semi-structured open-ended interview schedule (Appendix B). The semi-structured interview schedule was used to obtain the perceptions of young adults of their health problems, due to asthma, and of their associated learning needs. Key concepts i n The U.B.C. Model for Nursing (1980) were instrumental in the construction of this schedule. Data analysis was f a c i l i t a t e d by the nine basic human needs categories provided by The U.B.C. Model for Nursing (1980). Data were f i r s t sub-categorized in r e l a t i o n to the need categories. Second, common categories of health problems and learning needs were generated by determining s i m i l a r i t i e s both in the perceived health problems and associated learning needs found within and across need categories. S t a t i s t i c a l analysis was done using Fisher's Exact Test to determine relationships between selected demographic and personal variables, and perceived learning needs. A probability l e v e l of .05 was set for judgements of s t a t i s t i c a l s i g n i f i c a n c e . The findings revealed that the common health problems of young adults with asthma were: l i f e s t y l e , symptom control, self-esteem, s o c i a l i s o l a t i o n , 1 0 4 adjustment, psychological and int e r a c t i o n problems. Common learning needs were associated with symptom control (the majority of the learning needs i d e n t i f i e d ) , l i f e s t y l e , and inte r a c t i o n problems. The learning needs described did not however address the multiple health problems which had been i d e n t i f i e d by the sample. In addition, relationships existed between two personal variables (length of time diagnosed and how frequently professional health care due to asthma was sought), and one demographic variable (having dependents—children) and perceived learning needs. Conclusions The following may be concluded from this study. Among the young adults with asthma who participated in this study, common types of health problems and learning needs e x i s t . These findings suggest i t may be concluded that among this sample, the health problems experienced and associated learning needs were multiple and pervasive. This finding i s congruous with what has been established previously in the published a l l i e d health l i t e r a t u r e . It i s also apparent in the findings that a broad spectrum of d i v e r s i t y in perceptions of s p e c i f i c health problems and learning needs exist among the participants, and that three demographic or personal variables were s t a t i s t i c a l l y related to 105 perceived learning needs. It may be concluded, on the basis of these findings, that d i v e r s i t y in associated learning needs among the sample is related in some instances to demographic and personal v a r i a b l e s . F i n a l l y , the learning needs of young adults with asthma did not consistently address the multiple s o c i a l and psychological health problems which they experienced, but focused on symptom control, l i f e s t y l e and int e r a c t i o n problems. Hence i t may be concluded that there is incongruence between the health problems perceived and the associated learning needs of the sample. The above conclusions were based on the responses of a small convenience sample of 20 young adults with e x t r i n s i c asthma. The investigator does not claim that the sample is representative of a l l young adults with asthma of the e x t r i n s i c type, and therefore cannot conclude that the findings are generalizable to other sample populations of similar c h a r a c t e r i s t i c s . Implications for Nursing Practice The findings drawn from this study suggest several implications for nursing practice and in pa r t i c u l a r for health education provided by nurses. Most of them are not new or unique but are a r e i t e r a t i o n of what has previously been professed in nursing l i t e r a t u r e . 106 To begin, the h e a l t h problems and l e a r n i n g needs d e s c r i b e d i n t h i s study, from the p e r s p e c t i v e of young a d u l t s with asthma, were m u l t i f a c e t e d , d i v e r s e , and p e r v a s i v e . A l s o , the f i n d i n g that r e l a t i o n s h i p s may e x i s t between demographic and p e r s o n a l v a r i a b l e s suggest that the h e a l t h problems and l e a r n i n g needs of i n d i v i d u a l s with asthma cannot be comprehensively i d e n t i f i e d without c o n s i d e r a t i o n f o r the i n d i v i d u a l ' s understanding of h e r / h i s h e a l t h problems and l e a r n i n g needs. T h e r e f o r e , any form of h e a l t h education which does not address the i n d i v i d u a l , has grave l i m i t a t i o n s as a means to provide h e a l t h education which e f f e c t i v e l y a s s i s t s i n d i v i d u a l s with t h e i r h e a l t h problems and l e a r n i n g needs given what i s probl e m a t i c f o r them i n terms of t h e i r experience with asthma. Hence, i n the i n i t i a l assessment phase of planning h e a l t h education, nurses need to o b t a i n i n f o r m a t i o n r e g a r d i n g the h e a l t h problems and l e a r n i n g needs of young a d u l t s with asthma from t h e i r frame of r e f e r e n c e . This w i l l serve to broaden and supplement nurses' knowledge of the h e a l t h problems and l e a r n i n g needs of i n d i v i d u a l s with asthma, and w i l l f a c i l i t a t e i n the s e l e c t i o n of teaching content which o s t e n s i b l y attempts to address the d i f f i c u l t i e s s p e c i f i c to t h i s unique c l i e n t group. The h e a l t h problems and a s s o c i a t e d l e a r n i n g needs 107 as described in this study, from the perspective of young adults with asthma, may f a c i l i t a t e in the development of a more comprehensive understanding of the experience of l i v i n g with asthma and how i t can affe c t a l l basic human needs and a l l facets of daily l i v i n g . This h o l i s t i c understanding of the impact of asthma is representative of a departure from the more t r a d i t i o n a l way of describing the experience of asthma and i t s associated problems, within the context of the medical model, which focuses on the disease and i t s ' symptomatology. Examination of the health problems and learning needs described from young adults' perceptions may also indicate areas in which nurses may need to broaden their c l i n i c a l knowledge and expertise, so that they can more e f f e c t i v e l y a s s i s t individuals with asthma both through health education and in general c l i n i c a l practice. For instance, nurses may need to consult with other health professionals such as n u t r i t i o n i s t s , and sports medicine experts to most e f f e c t i v e l y a s s i s t individuals in coping with some of their l i f e s t y l e problems. The study determined that the learning needs of young adults with asthma are associated with symptom control, l i f e s t y l e and s o c i a l interaction problems, and concluded that the learning needs i d e n t i f i e d did not consistently address the multiple s o c i a l and 108 p s y c h o l o g i c a l h e a l t h problems which had been as d e s c r i b e d i n t h i s study, from the p e r s p e c t i v e of d e s c r i b e d . This c o n c l u s i o n has i m p l i c a t i o n s f o r nurses i n the p r o v i s i o n of h e a l t h e d u c a t i o n . I t i n f e r s that i n d i v i d u a l s may r e q u i r e more a s s i s t a n c e from nurses i n d e f i n i n g t h e i r l e a r n i n g needs than the p a r t i c i p a n t s i n t h i s study r e c e i v e d from the i n v e s t i g a t o r . It a l s o i m p l i e s that although nurses purport t h e i r f u n c t i o n i s to a s s i s t i n d i v i d u a l s with t h e i r s o c i a l and p s y c h o l o g i c a l needs, perhaps i n d i v i d u a l s are not cognizant that nurses can be an a p p r o p r i a t e resource i n t h i s regard. I f t h i s i s so, nurses w i l l need to make ev i d e n t , through t h e i r p r a c t i c e , that they have the knowledge and e x p e r t i s e to e f f e c t i v e l y d eal with the s o c i a l and p s y c h o l o g i c a l needs of i n d i v i d u a l s . In summary, the c o n c l u s i o n s i n t h i s study suggest that i n p r a c t i c e , s p e c i f i c a l l y i n te a c h i n g h e a l t h education, nurses need to o b t a i n the p e r c e p t i o n s of i n d i v i d u a l s with asthma r e g a r d i n g t h e i r h e a l t h problems and a s s o c i a t e d l e a r n i n g needs because p e r c e p t i o n s can vary markedly ac c o r d i n g to persons' i l l n e s s e x p e r i e n c e s . Rankin and Duffy (1983) suggested that i n d i v i d u a l s ' p e r c e p t i o n s of t h e i r l e a r n i n g needs may be obtained i n a comprehensive and syst e m a t i c way by using a n u r s i n g conceptual model i n p r a c t i c e , i n c o n j u n c t i o n with the nur s i n g p r o c e s s . They e x p l i c i t l y s t r e s s e d 109 that nurses may o b t a i n l e a r n e r p e r c e p t i o n s of t h e i r l e a r n i n g needs i n the f o l l o w i n g way, Learning needs are d e f i n e d when a nurse assesses the p a t i e n t , the assessment f o r p a t i e n t education does not have to be separate from other patient-assessment a c t i v i t i e s . Information about the l e a r n i n g needs of the p a t i e n t and h i s f a m i l y i s gathered with other data about the p a t i e n t ' s c o n d i t i o n . (1983, p. 114) T h e r e f o r e , nurses concerned with p r e p a r i n g h e a l t h e d u c a t i o n , which has meaning and r e l e v a n c e f o r i n d i v i d u a l s with asthma, may f a c i l i t a t e the h e a l t h e d u c a t i o n planning process by becoming s k i l l f u l at a p p l y i n g a nursing conceptual framework and the n u r s i n g process to the h e a l t h education p r o c e s s . I m p l i c a t i o n s f o r Nursing E d u c a t i o n This study concluded that the h e a l t h problems and l e a r n i n g needs of young a d u l t s with asthma are m u l t i p l e , d i v e r s e and p e r v a s i v e . This lends support to the b e l i e f that student nurses r e q u i r e a thorough knowledge base i n the b i o l o g i c a l and s o c i a l s c i e n c e s , i n the teaching and l e a r n i n g p r o c e s s , as well as adeptness i n u t i l i z i n g a systematic n u r s i n g conceptual framework p r e p a r a t o r y to the p r o v i s i o n of meaningful h e a l t h education f o r i n d i v i d u a l s such as those with asthma. 110 Recommendations f o r F u r t h e r Study Proposals f o r f u r t h e r r e s e a r c h to i n v e s t i g a t e the h e a l t h problems and l e a r n i n g needs of i n d i v i d u a l s with asthma from t h e i r p e r s p e c t i v e , and to determine r e l a t i o n s h i p s between s e l e c t e d demographic and personal v a r i a b l e s and p e r c e i v e d l e a r n i n g needs are as f o l l o w s : 1 . R e p l i c a t i o n s of t h i s study to determine the p e r c e i v e d h e a l t h problems and l e a r n i n g needs of young a d u l t s with asthma of the e x t r i n s i c type. A r e p l i c a t i o n may serve to v a l i d a t e the f i n d i n g s and c o n c l u s i o n s i n t h i s study. 2. Research s t u d i e s to determine how persons with asthma cope with t h e i r h e a l t h problems may be i n s t r u m e n t a l i n a s s i s t i n g nurses to gain an i n depth knowledge of how to most e f f e c t i v e l y a s s i s t persons with asthma through h e a l t h e d u c a t i o n . 3. Research s t u d i e s to i n v e s t i g a t e the p e r c e i v e d h e a l t h problems and l e a r n i n g needs of a d o l e s c e n t s , middle-aged and e l d e r l y a d u l t s with asthma of the e x t r i n s i c type. Studies such as these could determine s i m i l a r i t i e s and d i f f e r e n c e s i n p e r c e p t i o n s during v a r i o u s ages and development stages. 4 . Studies using p r e - s t r u c t u r e d q u e s t i o n n a i r e s to determine the h e a l t h problems and l e a r n i n g I l l needs of young a d u l t s with asthma, f o c u s i n g on t h e i r p e r s p e c t i v e , and to i n v e s t i g a t e r e l a t i o n s h i p s between s e l e c t e d demographic and personal v a r i a b l e s and p e r c e i v e d l e a r n i n g needs. F i n d i n g s from the proposed s t u d i e s using a d i f f e r e n t methodology could be f u n c t i o n a l f o r comparison purposes with the f i n d i n g s i n t h i s study. Summary In summary, the i n v e s t i g a t o r holds that o b t a i n i n g the personal accounts of how young a d u l t s with asthma p e r c e i v e t h e i r h e a l t h problems and a s s o c i a t e d l e a r n i n g needs i s a v i t a l l e a r n e r - c e n t e r e d approach which can a s s i s t nurses i n planning h e a l t h education which could most s a t i s f y the needs of t h i s c l i e n t group. A thorough knowledge of what i n d i v i d u a l s i d e n t i f y as t h e i r c r i t i c a l h e a l t h problems and l e a r n i n g needs, may f a c i l i t a t e nurses i n a s s u r i n g r e s p o n s i b i l i t y and a c c o u n t a b i l i t y i n t h e i r p r a c t i c e , s p e c i f i c a l l y , i n the h e a l t h education they p r o v i d e . 112 R E F E R E N C E S A b l e s o n J . , P a d d o n , P . & S t r o h m e n g e r , C . ( 1 9 8 3 ) . P e r s p e c t i v e s o n H e a l t h . M i n i s t e r o f S u p p l y a n d S e r v i c e s C a n a d a , O t t a w a . A m e r i c a n P s y c h o l o g i c a l A s s o c i a t i o n . ( 1 9 8 3 ) . P u b l i c a t i o n M a n u a l o f t h e A m e r i c a n P s y c h o l o g i c a l  A s s o c i a t i o n . ( 3 r d e d . ) . W a s h i n g t o n : A m e r i c a n P s y c h o l o g i c a l A s s o c i a t i o n . B a r r y , K . ( 1 9 8 2 ) . T h e H e a l t h E d u c a t i o n N e e d s o f t h e A d u l t w i t h E p i l e p s y . R e h a b i l i t a t i o n N u r s i n g , 1 ( 3 ) , 3 0 - 3 3 . B i g g e , M . ( 1 9 8 2 ) . T h e o r i e s f o r T e a c h e r s . New Y o r k : H a r p e r & R o w . B i l l e , D . ( 1 9 8 2 ) . P r a c t i c a l A p p r o a c h e s t o P a t i e n t  T e a c h i n g . B o s t o n : L i t t l e , B r o w n . B l a k i s t o n . ( 1 9 7 9 ) . G o u l d M e d i c a l D i c t i o n a r y ( 4 t h e d . ) . S t . L o u i s : M c G r a w - H i l l B o o k C o . B u r n s , K . ( 1 9 8 2 ) . B e h a v i o r a l h e a l t h c a r e i n a s t h m a . P u b l i c H e a l t h R e v i e w . X ( 3 - 4 ) 3 3 9 - 3 8 0 . C a s e y , E . , O ' C o n n e l l , J . , & P r i c e , J . ( 1 9 8 3 ) . P e r c e p t i o n s o f E d u c a t i o n a l N e e d s f o r P a t i e n t s A f t e r M y o c a r d i a l I n f a r c t i o n . P a t i e n t E d u c a t i o n a n d  C o u n s e l i n g , 6 / 2 ) , 7 7 - 8 2 . C h a l m e r s , K . ( 1 9 8 4 ) . A C l o s e r L o o k a t How P e o p l e C o p e w i t h C h r o n i c A i r f l o w O b s t r u c t i o n . C a n a d i a n N u r s e , 8 _ 0 ( 2 ) , 3 5 - 8 . C o m m i s s i o n o n C h r o n i c I l l n e s s . C h r o n i c I l l n e s s i n t h e  U n i t e d S t a t e s . P r e v e n t i o n o f C h r o n i c I l l n e s s . C a m b r i d g e : H a r v a r d U n i v e r s i t y P r e s s . _1_. C r e e r , T . ( 1 9 7 9 ) . A s t h m a T h e r a p y . N e w Y o r k : S t r i n g e r . D ' A g o s t i n o , J . ( 1 9 8 4 ) . T e a c h i n g T i p s f o r L i v i n g w i t h C O P D a t H o m e , N u r s i n g 8 4 , J_4 ( 2 ) , 5 7 . D i m o n d , M . , & J o n e s , S . ( 1 9 8 3 ) . C h r o n i c I l l n e s s  A c r o s s t h e L i f e S p a n . N o r w a l k , C o n n . : A p p l e t o n - C e n t u r y - G r o f t s . 113 D i r k s , J . , & B r o w n , E . ( 1 9 8 2 ) . T h e B a t t e r y o f A s t h m a I l l n e s s B e h a v i o r , I I : I n d e p e n d e n c e f r o m A i r w a y s H y p e r a c t i v i t y . J o u r n a l o f A s t h m a , 1_9_( 2 ) , 7 9 - 8 3 . D o d g e , J . ( 1 9 6 9 ) . F a c t o r s r e l a t e d t o p a t i e n t s p e r c e p t i o n s o f t h e i r c o g n i t i v e n e e d s . N u r s i n g  R e s e a r c h , 1 8 , 5 0 2 - 5 1 2 . E i s e n b e r g , L . , & K l e i n m a n , A . ( e d s . ) , ( 1 9 8 1 ) . T h e R e l e v a n c e o f S o c i a l S c i e n c e f o r M e d i c i n e . B o s t o n : R e i d e l P u b . C o . F o r s y t h , G . , D e l a n e y , K . , & G r e s h a m , M . ( 1 9 8 4 ) . V y i n g f o r a W i n n i n g P o s i t i o n : M a n a g e m e n t S t y l e o f t h e C h r o n i c a l l y 1 1 1 . R e s e a r c h i n N u r s i n g a n d H e a l t h , 7_, 1 8 1 - 1 8 8 . G e r a r d , P . , & P e t e r s o n , L . ( 1 9 8 4 ) . L e a r n i n g N e e d s o f C a r d i a c P a t i e n t s . C a r d i o V a s c u l a r N u r s i n g , 2 0 ( 2 ) , 7 - 1 1 . G e r s h w i n , M . ( 1 9 8 1 ) . B r o n c h i a l A s t h m a , P r i n c i p l e s o f  D i a g n o s i s a n d T r e a t m e n t . New Y o r k : G r u n e & S t r a t t o n . H i l g a r d , E . , & B o w e r , G . ( 1 9 7 5 ) . T h e o r i e s o f L e a r n i n g ( 4 t h e d . ) . E n g l e w o o d C l i f f s , New J e r s e y : P r e n t i c e H a l l . H o w e , J . , D i c k a s o n , E . , J o n e s , D . , & S n i d e r , M . ( e d s . ) . ( 1 9 8 4 ) . T h e H a n d b o o k o f N u r s i n g . New Y o r k : J o h n W i l e y & S o n s . H u d g e l , D . , & M a d s e n , L . ( 1 9 8 0 ) . A c u t e a n d C h r o n i c A s t h m a a G u i d e t o I n t e r v e n t i o n . A m e r i c a n J o u r n a l o f  N u r s i n g . 8 0 ( 1 0 ) , 1 7 9 1 - 1 7 9 5 . H u m e , K . ( 1 9 7 0 ) . A s t h m a ; a G u i d e f o r P a t i e n t s . L o n d o n : H e a l t h H o r i z o n . J o s p e , M . , W i e b e r d i n g , J . , & C o h e n , B . ( 1 9 8 0 ) . P s y c h o l o g i c a l F a c t o r s i n H e a l t h C a r e . L e x i n g t o n , M a s s . : L e x i n g t o n B o o k s . K a u f m a n , J . , & W o o d y , J . ( 1 9 8 0 ) . F o r P a t i e n t s w i t h C O P D : B e t t e r L i v i n g t h r o u g h T e a c h i n g . N u r s i n g 8 0 , j _ 0 ( 3 ) , 5 7 - 6 1 . K e s t e n b a u m , V . ( 1 9 8 2 ) . T h e H u m a n i t y o f t h e 1 1 1  P h e n o m e n o l o g i c a l P e r s p e c t i v e s . 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Chronic I l l n e s s , Overcoming  Powerlessness. Philadelphia: F.A. Davis. Moos, R. (Ed.). (1977). Coping with Physical  I l l n e s s . New York: Plenum Medical Book Co. Murray, R., & Zentner, J . (1979). Nursing Assessment  and Health Promotion Through the L i f e Span (2nd ed.). Englewood C l i f f s , New Jersey: Prentice-Hall, Inc. Muzzuca, S. (1982). Does patient education in chronic disease have therapeutic value? Journal of Chronic  Diseases . 35 , 521-529. Ornstein, A. (1977). An Introduction to the Foundations of Education. Chicago: Rand McNally. P o l i t , D., & Hungler, B. (1983). Nursing Research (2nd ed.) . Philadelphia: J.B. Lippincott Co. Rankin, S. & Duffy, K. (1983). Patient Education:  Issues, P r i n c i p l e s , and Guidelines. Philadelphia: J.B. Lippincott Co. 115 R e d m a n , B . ( 1 9 7 6 ) . T h e P r o c e s s o f P a t i e n t T e a c h i n g ( 3 r d e d . ) . S t . L o u i s : T h e C V . M o s b y C o . R e d m a n , B . ( 1 9 8 0 ) . T h e P r o c e s s o f P a t i e n t T e a c h i n g ( 4 t h e d . ) . S t . L o u i s : T h e C V . M o s b y C o . R e d m a n , B . ( 1 9 8 1 ) . I s s u e s a n d C o n c e p t s i n P a t i e n t  T e a c h i n g . New Y o r k : A p p l e t o n - C e n t u r y - C r o f t s . R i f a s , E . ( 1 9 8 3 ) . T e a c h i n g P a t i e n t s t o M a n a g e A c u t e A s t h m a t h e F u t u r e i s N o w . N u r s i n g 8 3 , J u l y , 1 1 - 1 4 . S e x t o n , D . ( 1 9 8 1 ) . C h r o n i c O b s t r u c t i v e P u l m o n a r y  D i s e a s e . S t . L o u i s : C V . M o s b y . S m i t h , J . ( 1 9 8 2 ) . A s t h m a : P l a n o f A c t i o n . N u r s i n g  M i r r o r , 1 5 4 ( 1 9 ) , 6 0 - 6 2 . S q u y r e s , W. ( 1 9 8 0 ) . P a t i e n t E d u c a t i o n : A n I n q u i r y  I n t o t h e S t a t e o f A r t . New Y o r k : S p r i n g e r . S t a t i s t i c s C a n a d a . ( M a r c h , 1 9 8 4 ) . M o r t a l i t y : S u m m a r y L i s t O f C a u s e s V i t a l S t a t i s t i c s . V o l I I I , 1 9 8 2 . O t t a w a : M i n i s t e r o f S u p p l y & S e r v i c e s . S t a t i s t i c s C a n a d a . ( J u l y , 1 9 8 4 ) . H o s p i t a l M o r b i d i t y  1 9 7 9 - 1 9 8 0 , 1 9 8 0 - 1 9 8 1 . O t t a w a : M i n i s t e r o f S u p p l y & S e r v i c e s . S t e r n , A . ( 1 9 8 1 ) . A s t h m a a n d E m o t i o n . New Y o r k : G a r d n e r P r e s s . S t r a u s s , A . & G l a s e r , B . ( 1 9 7 5 ) . C h r o n i c I l l n e s s a n d  t h e Q u a l i t y o f L i f e . S t . L o u i s : T h e C V . M o s b y C o . S w e n s o n , L . C ( 1 9 8 0 ) . T h e o r i e s o f L e a r n i n g . B e l m o n t : W a d s w o r t h . U n i v e r s i t y o f B r i t i s h C o l u m b i a M o d e l C o m m i t t e e . ( 1 9 8 0 ) . T h e U n i v e r s i t y o f B r i t i s h C o l u m b i a M o d e l  f o r N u r s i n g . S c h o o l o f N u r s i n g , U n i v e r s i t y o f B r i t i s h C o l u m b i a , V a n c o u v e r , B r i t i s h C o l u m b i a . V a n Dam A n d e r s o n , S . , & B a u w e n s , E . ( 1 9 8 1 ) . C h r o n i c  H e a l t h P r o b l e m s . S t . L o u i s : T h e C V . M o s b y C o . Y o u n g , P . ( 1 9 8 0 ) . A s t h m a A l l e r g i e s : A n O p t i m i s t i c F u t u r e . W a s h i n g t o n : U . S . D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s . Z a r , J . ( 1 9 8 4 ) . B i o s t a t i s t i c a l A n a l y s i s . E n g l e w o o d C l i f f s , New J e r s e y : P r e n t i c e H a l l I n c . 116 APPENDICES 117 Appendix A Demographic and P e r s o n a l I n t e r v i e w Schedule Code Number 1. Sex? 2. Dependents ( c h i l d r e n ) ? 3. Age? 4 . Occupation? 5. H i g h e s t e d u c a t i o n a t t a i n e d ? 6. C o n f i d a n t ? 7. How l o n g have you had asthma? 8. A p p r o x i m a t e l y when do you have asthma a t t a c k s ( s e a s o n a l l y -r e l a t e d ) ? 9. How much does asthma i n t e r f e r e w i t h your d a i l y needs and a c t i v i t i e s ? 10. Have you ever been h o s p i t a l i z e d because of asthma? 11. I f y e s , how many times? 12. How many m e d i c a t i o n s do you take f o r asthma? ( ) Female ( ) Male Who? ( ) Seldom ( ) M i l d l y ( ) M o d e r a t e l y ( ) E x t e n s i v e l y 13. I f y e s , how o f t e n do you take them? 14. A l l e r g e n s and i r r i t a n t s which can p r e c i p i t a t e asthma? 15. What m e d i c a l treatment i s p r e s c r i b e d f o r you, o t h e r than m e d i c a t i o n s f o r asthma? 1 1 8 1 6 . How o f t e n do y o u s e e k p r o f e s s i o n a l h e a l t h c a r e d u e t o a s t h m a ? 1 7 . Do y o u s m o k e ? 1 8 . How m a n y t i m e s p e r w e e k d o y o u e x e r c i s e , a n d w h a t t y p e o f e x e r c i s e ? 1 9 . H a v e y o u e v e r h a d h e a l t h e d u c a t i o n r e l a t e d t o h o w t o m a n a g e a s t h m a ? F r o m whom? 119 Appendix B Interview Schedule 1. What impact has asthma had on you? 2. Has asthma caused you any problems i n your d a i l y a c t i v i t i e s , or changed your l i f e s t y l e pattern? 3. Can you thin k of any other concerns you have i n r e l a t i o n to the impact that asthma has had on you? 4. I f the p a r t i c i p a n t does not address a l l of the nine needs i n the The U.B.C. Model f o r Nursing (1980),* the i n t e r v i e w e r w i l l ask the p a r t i c i p a n t i f she/he has experienced any problems i n r e l a t i o n to the remaining s p e c i f i c needs. For example, i n r e l a t i o n to the need f o r respect of s e l f , by s e l f and ot h e r s , the i n t e r v i e w e r w i l l ask: has asthma i n f l u e n c e d the way you f e e l about y o u r s e l f and others? 5. What kinds of things do you want to know more about that could help you manage the impact of asthma? 6. What questions do you have about asthma, i t s management, or about how you can cope b e t t e r with i t ? U.B.C. Model Committee. (1980). The U.B.C. Model  f o r N u r s i n g . F a c u l t y of Nursing, U n i v e r s i t y of B r i t i s h Columbia, Vancouver, B.C. 120 Appendix C 'Letter to the Physician Dear I am a Master's student in nursing at the University of B r i t i s h Columbia. The unique health problems, and needs for health education of young adults who have asthma are a major concern of mine. I believe that a better knowledge and understanding of this c l i e n t group w i l l f a c i l i t a t e nurses and other health professionals in planning health education that is t a i l o r e d to the s p e c i f i c needs of the young adult with asthma. For these reasons, I would l i k e to learn more about this c l i e n t group. Therefore, I have planned a research study to focus on young adults with asthma to ident i f y and describe f i r s t , young adult perceptions of their health problems related to asthma; second, their perceptions of their learning needs; and t h i r d , to determine relationships between selected demographic and personal variables and perceived learning needs. I w i l l need to interview approximately twenty sample participants between the ages of 20-45 years. Would you be w i l l i n g for potential participants to be recruited from your practice? Recruitment could occur in the following way. Clients who meet the c r i t e r i a for the research could be recruited as they come in to keep an appointment time at the c l i n i c or unit. They could be informed of the purpose of the reseach, and what would be involved i f they decide to p a r t i c i p a t e . This is explained in d e t a i l in a cover l e t t e r that may be given to prospective subjects. Those interested in p a r t i c i p a t i n g could leave their name and phone number with someone at the c l i n i c . I could then contact them at a l a t e r date to set a convenient interview time. The selection c r i t e r i a are as follows: 1. The i n d i v i d u a l must speak English. 2. Young adults diagnosed with e x t r i n s i c asthma, and are between the ages of 20-45 years. 3. Young adults with asthma, but are without other major health problems. 122 Appendix D P h y s i c i a n Consent I, the undersigned, give p e r m i s s i o n to Heather Richardson, R.N., B.S.N., (M.S.N. Candidate) to contact consenting young a d u l t s with asthma from my p r a c t i c e f o r the purpose of her r e s e a r c h study. P h y s i c i a n s ' Signature Researcher's Signature Dated at , t h i s day of . 1985 . 123 A p p e n d i x E C o v e r L e t t e r t o P a r t i c i p a n t s D e a r P a r t i c i p a n t : I am a g r a d u a t e s t u d e n t i n t h e S c h o o l o f N u r s i n g a t t h e U n i v e r s i t y o f B r i t i s h C o l u m b i a . The h e a l t h p r o b l e m s , c o n c e r n s , and n e e d s f o r h e a l t h e d u c a t i o n o f y o u n g a d u l t p e r s o n s who h a v e a s t h m a a r e a m a j o r c o n c e r n o f m i n e . Y o u r u n i q u e e x p e r i e n c e w i t h a s t h m a w o u l d g i v e v a l u a b l e i n f o r m a t i o n t h a t w o u l d u l t i m a t e l y h e l p o t h e r p e r s o n s w i t h a s t h m a . I t w o u l d g i v e n u r s e s a b e t t e r u n d e r s t a n d i n g o f t h e p r o b l e m s and n e e d s o f p e r s o n s s u c h as y o u r s e l f . I t w o u l d a l s o h e l p n u r s e s i n p l a n n i n g h e a l t h t e a c h i n g t h a t w o u l d a s s i s t t h o s e who have a s t h m a i n m a i n t a i n i n g f e e l i n g s o f h e a l t h and w e l l - b e i n g . T h e r e f o r e , I h a v e p l a n n e d a r e s e a r c h s t u d y , and I am i n v i t i n g y o u t o p a r t i c i p a t e i n i t . A n y i n f o r m a t i o n t h a t y o u a r e w i l l i n g t o s h a r e o f y o u r u n i q u e h e a l t h p r o b l e m s r e l a t e d t o a s t h m a , and o f y o u r n e e d s f o r h e a l t h e d u c a t i o n t h a t c o u l d h e l p y o u w i t h y o u r p r o b l e m s , w i l l be o f g r e a t v a l u e . Y o u r p a r t i c i p a t i o n w o u l d i n v o l v e an i n t e r v i e w w i t h me , a t a t i m e c o n v e n i e n t t o y o u . The i n t e r v i e w w i l l be r e c o r d e d on an a u d i o t a p e . The t a p e w i l l be i d e n t i f i e d by a n u m b e r , and y o u r name w i l l n o t be a s s o c i a t e d w i t h t h e r e c o r d e d i n f o r m a t i o n . O n l y m y s e l f and my t h e s i s c o m m i t t e e ( t w o n u r s i n g f a c u l t y m e m b e r s ) w i l l h a v e a c c e s s t o t h e t a p e s . A t t h e end o f t h e s t u d y , t h e t a p e s w i l l be e r a s e d . Y o u h a v e t h e r i g h t t o r e f u s e to p a r t i c i p a t e i n t h i s r e s e a r c h s t u d y and y o u a r e f r e e t o w i t h d r a w a t any t i m e , w i t h o u t j e o p a r d i z i n g t h e h e a l t h c a r e y o u a r e r e c e i v i n g . Y o u may h a v e t h e o p t i o n o f n o t a n s w e r i n g some o f t h e q u e s t i o n s i f y o u w i s h . Upon c o m p l e t i o n , t h i s s t u d y w i l l be d o c u m e n t e d i n a t h e s i s . I t w i l l be a v a i l a b l e t o y o u , i f y o u w i s h , t h r o u g h t h e U . B . C . l i b r a r i e s . 125 Appendix F Participant Consent I, the undersigned, understand the nature of Heather Richardson's research study as described in the cover l e t t e r and give my consent to participate in her research. Participant's Signature Researcher's Signature Dated at day of , this 1985. > 

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