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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  DESCRIPTIVE OF  THEIR AND  HEALTH  YOUNG  OF  ADULTS  PROBLEMS,  RELATIONSHIPS  PERSONAL  STUDY  WITH  PERCEPTIONS ASTHMA:  ASSOCIATED  BETWEEN  VARIABLES,  THE  AND  LEARNING  SELECTED PERCEIVED  NEEDS,  DEMOGRAPHIC LEARNING  AND  NEEDS  By HEATHER B . S . N . ,  A  The  THESIS  MARGARET  University  SUBMITTED  THE  of  IN  REQUIREMENTS MASTER  OF  RICHARDSON B r i t i s h  Columbia,  PARTIAL  FULFILLMENT  FOR  DEGREE  SCIENCE  THE IN  OF  NURSING  in THE  FACULTY  OF  School  We  accept to  THE  this the  GRADUATE of  Nursing  thesis  required  UNIVERSITY  OF  Margaret  as  conforming  standard  BRITISH  December,  Heather  STUDIES  COLUMBIA  1985  Richardson,  1985  1981  OF  In  presenting  degree freely  at  this  the  available  copying  of  department publication  of  in  partial  fulfilment  of  the  University  of  British  Columbia,  I  agree  for  this or  thesis  reference  thesis by  this  for  his thesis  and  scholarly  or for  her  Department  DE-6(3/81)  Columbia  I further  purposes  gain  be  It  is  shall  that  agree  may  representatives.  financial  permission.  T h e U n i v e r s i t y o f British 1956 M a i n M a l l Vancouver, Canada V 6 T 1Y3  study.  requirements  not  that  the  Library  permission  granted  by  understood be  for  allowed  an  advanced  shall for  the that  without  make  it  extensive  head  of  my  copying  or  my  written  ABSTRACT  The from  a  Incentive  concern  f o r doing  f o r the p r o v i s i o n  education  f o r young  extrinsic  type.  young  adults  problems needs,  with  asthma  with  research  bronchial  i n respect their  methodology  participants, extrinsic  between  asthma,  Nursing  to t h e i r  and  used.  the ages  were  (1980)  was  Twenty  selected  interviewed.  facilitated  T h e U.B.C.  the a t t a i n m e n t  done  was  determine  using  Fisher's  r e l a t i o n s h i p s between  personal  variables,  findings  revealed  problems  o f young  adults  control,  adjustment,  that  self-esteem,  social  (the majority  were  of the l e a r n i n g  and  to  learning  were:  needs.  health lifestyle,  isolation,  and i n t e r v e n t i o n associated  Model  demographic  t h e common  asthma  needs  adult  Statistical  Test  selected  with  psychological  learning  Exact  and p e r c e i v e d  The  young  o f 20 - 45 and who had  analysis  control  learning  perceived  of p a r t i c i p a n t p e r c e p t i o n s .  Common  of  health  associated  variables  of the  the p e r c e p t i o n s  organization  symptom  asthma  r e l a t i o n s h i p s between  and p e r s o n a l  health  needs.  Survey  and  originated  of r e l e v a n t  describes  to asthma,  and d e t e r m i n e s  learning  for  adults  The s t u d y  related  demographic  this  with needs  problems. symptom  iii  identified),  lifestyle,  learning  needs  multiple  health  the  sample.  personal  described  sought),  Lastly,  (length  professional  findings  conclusions:  that  of young  congruous health  with  needs,  statistically variables; between  what  the h e a l t h  related  the h e a l t h  problems  and t h e i r  and  (this  was  needs.  learning  or was  type  finding i s  i n the  in  allied  perceived  were  demographic some i n c o n g r u e n c e  experienced  associated  how  of the e x t r i n s i c  the p a r t i c i p a n t s ,  there  two  following  the d i v e r s i t y  that  and  to asthma  established  to p e r s o n a l  by  (having  problems  asthma  the  between  learning  and d i v e r s e  that  and f i n a l l y  participants  with  has been  among  due  variable  The  identified  diagnosed  care  the  address  existed  and p e r c e i v e d  pervasive  literature);  learning  health  suggested  adults  multiple,  had b e e n  of time  and one d e m o g r a p h i c  These  were  which  relationships  dependents — c h i l d r e n )  needs  d i d not however  problems  variables  frequently  and i n t e r a c t i o n p r o b l e m s .  by t h e  learning  needs.  iv  TABLE  OF  CONTENTS  Page ABSTRACT LIST  OF  i i TABLES  v i i i  ACKNOWLEDGEMENTS CHAPTER  x  ONE  Background  to  the  Problem...<>.<>•».••.•••..o..o.e  Purpose  3 7  Problem  Statement  D e f i n i t i o n  of  7  Terms  8  Assumptions  9  Limitations  10  CHAPTER Review  TWO of  Literature  11  Overview  11  Problems of Individuals with Asthma and Chronic Obstructive Pulmonary Disease as Documented by A l l i e d Health  or  Professionals Learning from  Needs  the  and  of  Patients,  Patients'  Relationships Personal  Learning  11  Between  Selected  Variables  Needs  as  Identified  Perspective  Among  and  16 Demographic  Perceptions  Patients  of 20  V  Current for  Health  Persons  Education with  Obstructive  Focus  Asthma  Pulmonary  by  and/or  Nurses Chronic  Disease  23  Summary  CHAPTER  27  THREE  Methodology.  .  Overview  29 29  Instrument C r i t e r i a  Construction  for  Population  Selection  and  Sample  29 of  Participants  Selection  P r o c e d u r e . . . .  32 32  Data  C o l l e c t i o n  34  Data  Analysis  36  E t h i c a l A.  Consideration  Informed  Consent  37 and  Risk  Benefit  B. Privacy C. C o n f i d e n t i a l i t y Summary  CHAPTER  •  38 38 39  FOUR  Presentation  and  Analysis  of  Findings  Overview  Health  and  Problems  Health  40 40  Demographic  For  37  Personal  Information  41  of  Adults  47  Problems  Safety  and  Young Related  to  the  Security  Health Problems Related to the For Balance Between Production U t i l i z a t i o n  of  Need  Energy  47 Need and 51  vi Page H e a l t h Problems Related For Mastery  to the Need 53  H e a l t h Problems Related to the Need For Respect of S e l f , By S e l f and Others....  57  H e a l t h Problems Related For Love, Belongingness  62  to the Need and Dependence  H e a l t h Problems Related to the Need For Intake of Food and F l u i d : Nourishment..  64  H e a l t h Problems Related For Intake of Oxygen  66  to the Need  H e a l t h Problems Related to the Need For S t i m u l a t i o n of the Senses  67  H e a l t h Problems Related to the Need For C o l l e c t i o n and Removal of Accumulated Waste  69  Summary  80  L e a r n i n g Needs of Young A d u l t s with Asthma...  80  Overview  80  L e a r n i n g Needs Related to the Need For S a f e t y and S e c u r i t y  81  L e a r n i n g Needs Related to the Need For Balance Between P r o d u c t i o n and U t i l i z a t i o n of Energy....  83  L e a r n i n g Needs Related For Mastery  to the Need 84—  L e a r n i n g Needs Related  to the Need  For Intake  of Food, F l u i d : Nourishment.....  L e a r n i n g Need Related to the Need For Love, Belongingness and Dependence L e a r n i n g Need Related to the Need For Intake of Oxygen Summary  85 87 88 93  vii Page R e l a t i o n s h i p Between S e l e c t e d Demographic and  Personal Variables  95  Overview  95  Summary  100  CHAPTER FIVE Summary, C o n c l u s i o n s , I m p l i c a t i o n s and Recommendations  .  • ..  101  Overview  101  Summary and C o n c l u s i o n s  101  Implications  f o r Nursing  Practice  105  Implications  f o r Nursing  Education  109  Recommendations  f o r F u r t h e r Research  110  Summary  Ill  REFERENCES  112  APPENDICES A - Demographic and P e r s o n a l  Interview  Schedule  117  B - I n t e r v i e w Schedule  119  C - L e t t e r to the P h y s i c i a n  120  D - P h y s i c i a n Consent  122  E - Cover L e t t e r to P a r t i c i p a n t s  123  F - Participant  125  Consent  v i i i  LIST  OF  TABLES  Table 1  Page Percentage and in Relation to Personal  2  of  3  4  5  Variables  Percentage For  Frequency D i s t r i b u t i o n Demographic and  Health  and  Frequency  Problems  Safety  and  42 D i s t r i b u t i o n  Related  to  the  Need  Security  48  Percentage and F r e q u e n c y D i s t r i b u t i o n of H e a l t h Problems Related to the Need For Balance Between Production and U t i l i z a t i o n of Energy  52  Percentage and F r e q u e n c y D i s t r i b u t i o n of H e a l t h Problems Related to the Need For Mastery  54  Percentage and F r e q u e n c y D i s t r i b u t i o n of H e a l t h Problems Related to the Need For Respect of Self, By S e l f and Others  6  Percentage and F r e q u e n c y D i s t r i b u t i o n of H e a l t h Problems R e l a t e d to the Need For  7  8 —  10  Love,  Belongingness  Dependence...  62  64  Percentage and F r e q u e n c y D i s t r i b u t i o n of H e a l t h Problems Related to the Need Intake  of  Oxygen  Percentage and F r e q u e n c y D i s t r i b u t i o n of H e a l t h Problems Related to the Need For S t i m u l a t i o n of the Senses  67  68  Percentage and F r e q u e n c y D i s t r i b u t i o n of H e a l t h Problems Related to the Need F o r C o l l e c t i o n and Removal of Accumulated  11  and  Percentage and F r e q u e n c y D i s t r i b u t i o n of H e a l t h Problems Related to the Need For Intake of Food and F l u i d : Nourishment  For 9  58  Waste  70  Percentage and F r e q u e n c y D i s t r i b u t i o n of L e a r n i n g Needs R e l a t e d to the Need For  Safety  and  Security  81  ix Page 12  13  14  15  16  17  18  19  20  Percentage of L e a r n i n g For Balance Utilization  and Frequency D i s t r i b u t i o n Needs Related to the Need Between P r o d u c t i o n and of Energy  84  Percentage and Frequency D i s t r i b u t i o n of L e a r n i n g Needs Related to the Need For Mastery  85  Percentage and Frequency D i s t r i b u t i o n of L e a r n i n g Needs Related to the Need For Intake of Food, F l u i d : Nourishment...  86  Percentage and Frequency D i s t r i b u t i o n of L e a r n i n g Needs Related to the Need For Love, Belongingness and Dependence...  87  Percentage and Frequency D i s t r i b u t i o n of L e a r n i n g Needs Related to the Need For Intake of Oxygen  88  R e l a t i o n s h i p Between Length of Time Diagnosed and the L e a r n i n g Need Pathophysiology of Asthma  96  R e l a t i o n s h i p Between Length of Time Diagnosed and the L e a r n i n g Need P e r c e p t i o n s of Others with Asthma and T h e i r Coping S t r a t e g i e s  97  R e l a t i o n s h i p Between How Often 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 the L e a r n i n g Need Long-Term Prognosis of Asthma  98  R e l a t i o n s h i p Between Having Dependents ( C h i l d r e n ) and the L e a r n i n g Need H e r e d i t a r y F a c t o r s i n Asthma  99  X  ACKNOWLEDGEMENTS  I extend my t h e s i s and  my s i n c e r e  committee,  Jo Ann P e r r y ,  challenges  appreciation  Dr. Kathleen  M.S.N., f o r t h e i r  wish  to e x t e n d  who so w i l l i n g l y  shared  perceptions  their  contributing  to t h i s  Finally,  research  consistent  of t h i s  gave  to the t w e n t y  of t h e i r  t i m e , and  f o r the p u r p o s e of  I am e s p e c i a l l y  for their  writing  chairperson,  guidance,  my g r a t i t u d e  participants  the  Simpson,  and s u p p o r t .  I also  friends  to t h e members o f  thesis.  study. grateful  to my f a m i l y and  encouragement  throughout  1  C H A P T E R ONE  Bronchial as  one  of  referred  to  (Luckmann the  the  asthma three  as  1982,  asthma  & Sorensen,  mortality  a  for  f i r s t , nurses with  1981).  daily  becomes  essential  to  for  how t o  new s e l f - c a r e  asthma  was  has  health  1983,  2.1  1983), was  and  474  i n  per Since  s p e c i f i c  experiencing  long-term  creates with  i t ,  education  for  on  a  chronic s k i l l s ,  with  daily  and for  manage i l l n e s s .  basis.  and  of  to  learn  Strauss  that  health  For  disrupt  therefore  asthma  their  asthma  complex  may  It  emphasized  in-depth  of  and  which  patterns.  persons  require  nature  multiple  asthma  l i v i n g  competently  with  i t  those  s p e c i f i c a l l y  i l l n e s s  associated  or  themselves  (1975)  to  In  C a n . , Mar. 1984).  I l l n e s s , for  Canadians  Disease  asthma.  associated  established  due  providing  l i f e - l o n g  problems  rate  (Stats.  chronic  c h a r a c t e r i s t i c a l l y  of  Sexton,  & Strashmenger,  The  learn  1980;  Pulmonary  Paddon  individuals  chronic  Obstructive  c l a s s i f i e d  problems  (Abelson,  implications  Glaser  respiratory  among  is  care  i l l n e s s  asthma  population  second,  chronic  of  the  100,000  a  chronic  Chronic  prevalence  percent  is  those  education  how and  with to  problems example,  new d a i l y  mastery  l i v i n g  a  2  patterns  i s frequently  successfully optimal with  r e q u i s i t e before  assimilated  level  of h e a l t h  a s t h m a need  decision-makers  into daily  living,  maintained.  t o l e a r n how regarding  t o become the  their  health  1975;  Van  A n d e r s o n & B a u w e n s , 1981;  1983;  Miller,  ( 1 9 8 2 ) , R a n k i n and have c o n t e n d e d  s u c h as  Duffy  that  education.  moreover, s e v e r a l  of n u r s e s  their  (Bille,  their  i s one  1982;  of  the  t o be  a c c o u n t a b i l i t y and be  teaching  persons with  a s t h m a how  assured.  the  a s t h m a , and  i n d i v i d u a l s with  of  hold  Therefore, health  education  Specifically, to  care  for  nurses  in In  themselves have a  problems experienced the  asthma.  on  functions  responsibility  b a s i s , i t i s e s s e n t i a l that  c o m p r e h e n s i v e k n o w l e d g e of  depend  educators  primary  expert  p r a c t i c e may  n e e d s of  provision  problems;  Redman, 1 9 8 0 ) .  n u r s e s need  with  i n the  health  nursing  clinical  association  (1980),  Individuals frequently  before  a daily  Bille  a s s i s t i n d i v i d u a l s to  teachers  on  Glaser,  Dimond & J o n e s ,  Squyres  problems  influential  education  professional  &  Redman ( 1 9 8 1 ) ,  can  to a s s i s t them w i t h  health  those  (The  Strauss  ( 1 9 8 3 ) , and  nurses  cope s u c c e s s f u l l y w i t h  that  an  1983).  Nurse educators  nurses  1959;  be  primary  care  Chronic I l l n e s s ,  of h e a l t h  and  Ultimately,  C o m m i s s i o n on Dam  a s t h m a can  unique  learning  in  3  Background  Common frequently allergen social  may i n c l u d e  roles;  1981).  and  regimens  However,  d i s t i n c t  value  to  certain  cope  their  Duffy,  of  by  1983;  & Sorensen, health  the  i n  s p e c i f i c  persons  and  Redman,  1976;  health  their  to  1981;  which  has  must  with  make  comprehensive  problems  learning  B i l l e ,  Sexton,  persons  nurses a  and  and  education  on  reduce  intimate  assisting  founded  to  adherence  problems,  is  in  l i f e s t y l e  with  and u s e f u l n e s s their  asthma  control  changes  i n  problems  teaching  understanding experienced  changes  provide  with  with  environmental  (Luckman  to  Problem  individuals  contacts;  r e l a t i o n s h i p s ;  medication  &  of  and i r r i t a n t  customary  asthma  problems  To The  needs  1982;  (Rankin  Squyres,  1980) . Several (1983);  nurse  Redman  (1976,  (1982)  have  health  education  planned learning  them the  to  1981);  contended,  needs  of  to  usefulness  by  of  Rankin  (1982); the is  rather  what  is  and  Duffy  B i l l e  content  of  than  most  s i g n i f i c a n t  education  and  i n  frequently  perceptions  may h a v e  health  as  that  nurses  i n d i v i d u a l s ,  This of  Barry  nurses'  perceptions  learn.  such  however,  prepared  according  i n d i v i d u a l s '  educators,  the on  c r i t i c a l bearing  provided  by  for on  nurses.  4  For  example,  (1982)  Barry  claimed  education  emphasizes rather  fostering  teaching  needs  of  Hence,  as  Sociologists conceded  that  types  problems;  of  common  types  asthma.  of  medicine,  i t  present  i n  diverse  perceptions  i l l n e s s  experience  the  person's  context  be  l i f e .  proposed  the is  of  to they  p r o v i d e d may  and  learning  (1975) common  assumed  those  s o c i o l o g i s t s ,  (cognitive was  problems  presents  among  i l l n e s s  needed  and G l a s e r  i l l n e s s  in  to  them.  Strauss  exist  modalities  most  education  problems  and i n d i v i d u a l s that  are  health  may t h e r e f o r e  medical  within the  as  frequently  attention  perceive  chronic  maintain  experienced  c r u c i a l they  health  by n u r s e s  actual  Powers  p r e s c r i p t i v e .  which  health  problems  Further,  s o c i o l o g i s t s ,  the  such  each  the  and  and treatments  behaviors  most  persons  prepare  appropriate  with  Murphy,  and  provided  processes  individuals  the  often  standardized  new c o p i n g  address  and L a u e r ,  nurses  d i r e c t i n g  experience. not  is  disease  than  assist  that  which  Subsequently,  (1982)  that  with  other  d i s c i p l i n e  perceived situational  An e x p l a n a t i o n appraisal) by M o o s ,  i n who  of  and factors for the stated,  This cognitive appraisal, the p e r c e p t i o n of tasks involved, and the s e l e c t i o n of relevant coping s k i l l s a r e i n f l u e n c e d by t h r e e sets of factors: background and p e r s o n a l characteristics, i l l n e s s - r e l a t e d factors, and features of the p h y s i c a l and s o c i o c u l t u r a l environment. (1977, p . 8)  5  In that  view  of  personal  this  characteristics,  related  factors,  persons  with  asthma,  perceptions  according have  may  to  several  meaningful  addresses  persons'  other  Strauss  health  knowledge i l l n e s s ,  care  of  the  they  for  health health  and  with  may  This  have  with  best  learning  that  vary may  concerned  and  conceded  of  persons  which  needs.  nurses  and  considerable  associated  nevertheless  i l l n e s s -  factors.  problems  problems  assumed  i l l n e s s  nurses  professionals  as  among  education  Glaser  be  perceptions  their  i n f l u e n t i a l  significance  planning  to  may  well  the  Therefore, related  it  as  influence  asthma.  s p e c i f i c  Although  explanation,  with  maintained  chronic  that  . . . t o u n d e r s t a n d how a g i v e n disease affects the daily experiences of the a f f l i c t e d persons, one i s l i k e l y to find better i n f o r m a t i o n i n the occasional autobiographies written by p a t i e n t s than in the standard literature about their diseases. (1975, p. 7)  F i n a l l y , their may  B i l l e  (1982)  environment  best The  i d e n t i f y  better their  c o g n i t i v e - f i e l d  comtemporary teaching  stressed  to  learning be  than  that  anyone;  learning theory  theory,  meaningful,  it  individuals  know  therefore,  they  needs. of  learning,  contends must  be  that  a  major  for  planned  in  6  accordance  with  s i t u a t i o n .  to  learners  goals,  hold  that  planning  with  the  a b i l i t i t e s  1982).  These  several  medical  d i r e c t l y  obtaining  the  learner's  theorists  with  is  information  is  relevant  the  perception  s o c i o l o g i s t s ,  associated  theorists  teaching  situational  learning  their  this  which  because  and  of  learning  teaching  s i t u a t i o n ,  congruent  perceptions  C o g n i t i v e - f i e l d  s p e c i f i c a l l y crucial  learner  would of  forces also  that  variables  to be  their  (Bigge,  premise,  as  perceptions i n  needs,  do  are  persons'  s i tuat ions. C o g n i t i v e - f i e l d centred, and  and  learning  participants active of  persons  based  the  their  1980; in  perceive  perceptions  study health  learning of  their  summary,  s o c i o l o g i s t s ,  to  that  in  in  active are  thinkers  (Ornstein, 1975).  capable  1977;  It  may  with  associated  accord  teaching  learners  individuals  problems  learner-  the  be  that  i n s i g h t f u l  & Bower,  are  be  asthma  with  with  can  asthma  their  s i t u a t i o n .  what  medical  c o g n i t i v e - f i e l d  premise  and  needs  that  need  situation  Hilgard  this  their  their  In  on  theorists  stress  process,  determining  assumed  and  a d d i t i o n a l l y  problem-solvers  Swanson,  and  learning  has  been  documented  s o c i o l o g i s t s ,  learning  nurse  theorists,  by  some  educators,  provides  the  7  rationale  that  education  nurses  perceptions and  of  variables  perceptions age  the need  their which  perceptions.  adult  in  This of  provision  of  to  knowledge  obtain  health may  be  study  problems,  was  designed  adults  with  was  selected  by  because  bronchial  chronic  health  problems  among  of  Research  Study  1981)  is  to to  one  of  explore The  need the  young  Investigator the  young  needs,  learning  asthma. the  persons'  most  adults  common (Sexton,  .  Purpose The on  asthma  of  health  learning  I n f l u e n t i a l  young  group  meaningful  the  purpose  young  of  this  adults  with  describe  f i r s t ,  young  problems  related  of  learning  their  to  asthma adult  asthma;  needs;  relationships  between  variables  perceived  Problem  the  provision  adults  teaching  with  provided  understanding health  and  study  to  was  i d e n t i f y  perceptions second,  and  third,  selected  of  and health  perceptions  determine  demographic  learning  focus  their  their to  to  and  personal  needs.  Statement  In young  and  research  of  problems  of  asthma, by how  and  relevant it  nurses this  is is  essential founded  client  learning  health  group  needs.  on  education that a  for  the  thorough  perceives  their  8  This the to  study  was c o n d u c t e d  perceptions their  of young  health  to o b t a i n  adults  with  problems a s s o c i a t e d  learning  n e e d s , and to i d e n t i f y  learning  needs  and s e l e c t e d  knowledge of  asthma with  i n respect  asthma,  relationships  d e m o g r a p h i c and  their  between  personal  variables. The  definition  limitations  Definition Bronchial  o f t e r m s , a s s u m p t i o n s and  pertaining  to the study  a r e as f o l l o w s :  o f Terms Asthma:  I s 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 t h e t r a c h e a and b r o n c h i to v a 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 m a n i f e s t e d by w i d e s p r e a d a i r w a y n a r r o w i n g t h a t changes i n s e v e r i t y , e i t h e r s p o n t a n e o u s l y or as a r e s u l t o f t h e r a p y ; p r e s e n t s as e p i s o d i c d y s p n e a , c o u g h , and wheezing. ( B l a k i s t o n , 1979, p . 128) Extrinsic  Asthma:  Is a s p e c i f i c t y p e o f asthma c a u s e d f o o d , or d r u g s . ( B l a k i s t o n , 1979) Young  Adult: Is  Basic  by i n h a l a n t s ,  an a d u l t  Human  between  t h e ages  of 20-45.  Needs:  Are i n n a t e , and have been d e t e r m i n e d as needs f o r : m a s t e r y ; l o v e , b e l o n g i n g n e s s and d e p e n d e n c e ; r e s p e c t f o r s e l f , by s e l f and o t h e r s ; e l i m i n a t i o n ; n o u r i s h m e n t ; s a f e t y and s e c u r i t y ; b a l a n c e 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 t h e s e n s e s . ( T h e U.B.C. M o d e l C o m m i t t e e , 1980)  9 Health  Problems:  A r e what p e r s o n s 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 c o n c e r n s i n d a i l y l i v i n g , due to the i m p a c t of a s t h m a , and i n a s s o c i a t i o n w i t h b a s i c human needs. Learning  Needs:  Are what p e r s o n s and do to e n a b l e health problem.  p e r c e i v e t h a t t h e y need to know them to cope w i t h an a s s o c i a t e d  Health Education: Is a s y s t e m a t i c a l l y p l a n n e d l e a r n i n g e x p e r i e n c e w h i c h i s d e s i g n e d on the b a s i s of an a s s e s s m e n t 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 p r o b l e m s 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  Variables  (Appendix A ) :  A r e 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 w h i c h may influence persons' perceptions. 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 ( s u c h 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 illness-related forces.  Assumptions 1.  It  is  assumed  asthma  can  related  to  that  perceive asthma,  young a d u l t s their  health  who have problems  and communicate  them  to  others . 2.  It  is  asthma  assumed can  relation  to  communicate  that  perceive  young a d u l t s their  perceived them to  who have  l e a r n i n g needs  health  others.  problems,  in  and  can  10  Limitations 1.  The  generalizability  limited  by  a  small  non-probability  of  the  sample  findings  size,  convenience  and  sample.  may a  be  11  CHAPTER  Review  of  TWO  Literature  Overview The to  purpose  provide  problems  in  sections, chronic  a  this  the of  summarizes  by  perceptions have  selected  current  investigated  of  their  health  with  and  needs  education  asthma  and/or  the  for  the  of  disease  review  into  asthma on  needs;  i l l  provided  studies  between  variables and  as  patients'  research  patients;  chronic  and/or  current  relationships  focus  four  individuals  professionals; chronically  is  research  organized  personal of  literature  impact  learning  investigated  learning  is  the  health  demographic  perceived  It  pulmonary  a l l i e d  which  following  reference  study.  obstructive  research  those  frame  and  documented  which  of  and  the  f i n a l l y ,  by  nurses  obstructive  the for  lung  disease.  Problems Chronic by  of  Obstructive  A l l i e d It  asthma have  Individuals  Health  appears and/or  been  with  Asthma  Pulmonary  and/or  Disease,  as  Documented  Professionals that  chronic  i d e n t i f i e d  the  problems  obstructive by  a l l i e d  of  individuals  pulmonary  health  with  disease  professionals,  12  either  within  the  psychological context  of  l i v i n g .  or  the  What  context social  impact  asthma  on  summarizes  individuals  with  asthma  disease,  they  have  as  pathophysical,  symptomatology,  of  follows  of  and/or  been  or  within  aspects  the  of  daily  problems  chronic  described  the  of  obstructive  within  lung  these  context s. Howe,  Dickason,  i d e n t i f i e d in  several  asthma.  shortness and  They of  sweating with  breath,  heart  physical  nasal  symptoms  signs  and r e s p i r a t o r y  rate,  pale  coughing, use  and b l u i s h  of  experienced  and  accompanied  v i t a l  f l a r i n g ,  (1984)  congestion  wheezing  altered  nasal  r e s p i r a t i o n ,  sneezing,  by  such  anxiety  as  an  noticeable a  productive  excessory  appearance  to  cough  muscles the  of  skin,  fatigue. In  a  described  case the  study  attack.  were:  breathlessness  i n a b i l i t y nausea  to  risk  possible  In  talk,  and poor  feathers,  presentation,  problems  asthma  and  the  and S n i d e r  and p e r s p i r a t i o n ,  mucus,  and  of  were:  restlessness,  increased  Jones,  of  summary, ,  fear  chest  25 the  year  to  problems  i n f e c t i o n .  and/or  an  diagnosed exhaustion,  r e - p o s i t i o n  dehydration,  pneumothorax  (1982)  old during  and a n x i e t y ,  i n a b i l i t y  appetite, of  a  Smith  oneself,  allergy cardiac  to arrest,  13  Gershwin Hume  (1970)  problems a  (1981),  have  (1981),  Creer,  (1979)  and Madsen  Gershwin  (1981),  who  have  asthma.  follows:  anxiety  i s o l a t i o n of  have  a  familiar  they roles  primary  of  by  customary  proposed may be and  that  may h a v e  some  that  triggering  (1979)  with  patterns the  associated  social  the  in  factors  in  claimed  by  of  may  those  loss  the  l i v i n g . of  need  during  Creer  often  connected  because are  Creer  to  an  addition,  factors  For  of  daily  society  asthma.  that  disease.  the  stigma  psychological  and  self-esteem  with  In  social  evolved  f r i g h t ,  experience  a c t i v i t y  symptoms.  as  self-esteem,  pulmonary  that  persons  were  experienced  associated  asthma  suggested  asthma  belief  and  physical  exacerbation  with  may be  (1979)  Creer  obstructive  i n  of  reduced  losses  and  restlessness  and d e c r e a s e d  painful  i s o l a t i o n  restrict  (1979)  the  (1980),  manifested  i r r i t a b i l i t y ,  stigma.  of  psychological  feelings  depression,  problems  (1982),  i d e n t i f i e d  agitation,  and  chronic  Creer  problems  depression,  to  instance,  social  and  induce  Burns  the  The problems  worrying,  linked  who  s o c i a l  helplessness,  feelings be  the  i d e n t i f i e d  and  pathophysiological  Hudgel  have  with  the  (1980),  nature.  and  social  that  Young  can  problems  excessive  (1981),  asthma  psychological  panic,  claimed  associated  Sexton  Stern  of  the (1979)  the  14  also  speculated  personal may  gain  evoke  those  In  close  to  major  asthma  some  feelings  Chalmer's the  that  s i t u a t i o n s .  of  (1984)  with  persons  bronchitis  and emphysema  inevitable  decrease  that a l l to  i n  breathlessness aspects  work,  to  do  household  addition,  Chalmers  decreased  energy  a b i l i t y  to  obstructive  and/or  pulmonary  s i g n i f i c a n t  that  others, was  primary  of  those  disease  customary  role  systematic problems  was  within  for  generally  to  the  a b i l i t y  i n d i v i d u a l s '  findings  with  with  chronic  experienced their  found  maintain  conceptualizing the  spouse  that  the  a  obstructive their  and s o c i a l  suggested  by  a  s o c i a l  chronic  family  experienced  the  and  and changed  (1975)  affect  breathlessness  frequently  they  i l l u s t r a t e d  In  with  a  the  t r a v e l .  persons  with  their  and G l a s e r  means  and  that  and  can  example,  a d d i t i o n a l l y  that  in  chronic  study  energy  relationships  It  pulmonary  asthma,  The r e s e a r c h  r e l a t i o n s h i p s .  Strauss  that  disease  interpersonal  concern  for  may i n t e r f e r e  indicated  for asthma  determined  This  tasks,  claimed  result,  breathlessness  l i v i n g ,  communicate.  additionally  changed  are  with  and decreased  daily  used  and h o s t i l i t y  study  energy.  of  be  asthma.  research  of  can  As a  frustration  persons  problems  symptoms  realm.  a common  chronically i l l  15  in  their  daily  identified  lives.  included  The  the  common  problems  which  following:  1.  The p r e v e n t i o n o f m e d i c a l crises and t h e i r management once t h e y occur.  2.  The  3.  The c a r r y i n g out of p r e s c r i b e d and t h e management o f p r o b l e m s upon c a r r y i n g out the regimen.  4.  The p r e v e n t i o n o f , o r l i v i n g i s o l a t i o n c a u s e d by l e s s e n e d others.  5.  The a d j u s t m e n t to c h a n g e s i n t h e of the d i s e a s e , w h e t h e r i t moves o r has remissions.  6.  The a t t e m p t s at n o r m a l i z i n g i n t e r a c t i o n w i t h o t h e r s and lif e.  7.  control  of  symptoms. regimens attendant  with, social contact with  course downward  both style  of  F u n d i n g — f i n d i n g the n e c e s s a r y money—to 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 complete l o s s of employment.  (1975,  In problems  summary, of  obstuctive concerns  of  obstructive to  their  a  of  with  pulmonary  pulmonary  the  the  asthma  with  their are  literature and/or  and/or  were  concerns  living  families  consistent  chronically  i l l  in  of  that  asthma  of  p.  7)  the  chronic  revealed  disease  patterns  within  findings  of  diseases  individuals  customary  These  review  persons  relationships  problems  were  and  and with daily  primary chronic in  respect  interpersonal  social some  milieux.  of  living,  the as  key  16  presented  by  Strauss  identification  developing  has  The  social  symptomatology  context  does  some l i m i t a t i o n s  as a means of  a comprehensive knowledge of the problems of  persons with  asthma.  problems may  perceptions The  (1975).  some knowledge of the impact of asthma; i t  nevertheless  their  Glaser  of problems w i t h i n a p a t h o p h y s i o l o g i c a l ,  p s y c h o l o g i c a l , and provide  and  be gained  of t h e i r  autobiographical  knowledge of t h e i r b a s i s , and  A more in-depth  understanding  by o b t a i n i n g  their  problems a s s o c i a t e d with approach may  provide  problems, experienced  as d e s c r i b e d w i t h i n t h e i r  of  asthma.  more on  a daily  context  of  understanding.  Learning  Needs of P a t i e n t s , as I d e n t i f i e d  Patients'  Perspectives  There appears to be regarding  the  as i d e n t i f i e d has  focused  a p a u c i t y of  information  l e a r n i n g needs of p a t i e n t s with from t h e i r  on v a r i o u s  perspective.  patient populations  to i d e n t i f y  education  from t h e i r unique p e r s p e c t i v e . for this  These  study  and  studies  are  i n what f o l l o w s .  F o r s y t h , Delaney and the  and  p a t i e n t l e a r n i n g needs for h e a l t h  a frame of r e f e r e n c e  summarized  asthma,  Some r e s e a r c h  attempted  offer  from  Gresham (1984) I n v e s t i g a t e d  l e a r n i n g needs of p a t i e n t s who  were  experiencing  17  chronic  illness,  collected  from t h e i r  perspective.  by using u n s t r u c t u r e d  study's f i n d i n g s i l l u s t r a t e d  interviews.  how  to  identified  maintain  s i t u a t i o n s ; what home  remedies can work f o r them; and what t h e i r tolerate  The  that p a t i e n t s  the f o l l o w i n g l e a r n i n g needs: themselves i n c h a l l e n g i n g  Data were  bodies  will  i n terms of d i e t , drugs, treatment and  activity.  P a t i e n t s a d d i t i o n a l l y expressed a d e s i r e f o r  particular  types of i n f o r m a t i o n .  sought i n f o r m a t i o n  For example, they  . . .  which had d i r e c t u t i l i t y i n s o l v i n g what they p e r c e i v e d as problematic . . . p a t i e n t s were not r e c e p t i v e to standard p a t i e n t education formats. Rather, they a p p r e c i a t e d readings and i n f o r m a t i o n on s e l f - h e l p groups, the o p p o r t u n i t y to t a l k to other h o s p i t a l i z e d patients. ( F o r s y t h et a l . , 1984, p. 187) Barry  (1982) designed a f a c t o r s e a r c h i n g  investigate with for  the l e a r n i n g need p e r c e p t i o n s  epilepsy. an i n t e r v i e w  A needs assessment  of adults as a basis  c o n s i s t i n g of 24 s t r u c t u r e d  which were grouped Into coping,  served  the f o l l o w i n g four  s e i z u r e s , medications,  study to  questions  sections:  and community  resources.  Other questions  were c o n s t r u c t e d  information  about the p a t i e n t s ' knowledge l e v e l of  t h e i r h e a l t h problems, and s e v e r a l questions  were a l s o designed  to e l i c i t  semi-structured  to s p e c i f i c a l l y  obtain  18  patients'  perceptions  following  are  questions  asked:  questions  do  your  examples  The  know  that  information might  be  type  problems, regard  information  of  their  on  learning  the  with  about?"  findings  perceived  they  what  their  of  "What  you have  opinion,  epilepsy  of  how t o better  their  worries,  people p.  or  seizures?  In  with  31).  indicated  learning  alter  your  1982,  study  major  concerns, to  The  semi-structured  should  (Barry, this  of  needs.  obtain  l i f e s t y l e ,  so  that  with  health  to  cope  studies  of  Gerard  was  patients  to  able  need  that  their  problems. The and  research  Casey,  determine needs  O'Connell how n u r s e s '  compared Gerard  to  and P e t e r s o n  perceptions  patients,  during  i n f a r c t i o n discharge  i n from  importance  their  of  their  the the of  perceptions  the  The f i n d i n g s  coronary  unit  categories  the  i d e n t i f i e d  most  to  learning  for  nurses'  needs  of  from  a  unit  and a f t e r  Nurses  information  information. care  learning  care  needs  designed  patients'  examined  recovery  u n i t .  of  were  (1984)  perceptions.  (1984)  coronary  of  (1983)  perceptions  patients'  patients'  the  and P r i c e  and Peterson  in  i l l u s t r a t e d  by p a t i e n t s  their ranked  accordance  s p e c i f i c  important  cardiac  myocardial  and p a t i e n t s  items  and  types that  were:  risk  of  in  learning  with  the need  factors,  19  medications,  psychological  miscellaneous anatomy  and  Casey and  et  a l .  after  methodology  content  a  was  i n  of  accord  r i s k  with  patients their  needs:  with  following  how t o  of  summary,  i t  that daily  they  basis,  with  to  heart and  that  of  Gerard  and were  learning  need  and  recreational  attacks;  how t o  and  was  The  deal  with  their  most  a d d i t i o n a l l y  other the  important  learning  signs  symptoms  and  contributary  related  of  items  stress.  stress  to  needs  The  recognition  Patients as  p a t i e n t s ' ,  to  the  of  personal  names,  dosage,  medications. appears  patients  needed  of  modify  effects  by  that  following  and  related  and  i d e n t i f i e d  and  learning  medications;  need.  and i n f o r m a t i o n  In  the  believed  factors; side  to  tension,  tension,  attack;  the  i n f a r c t i o n .  etiology  information  heart  unit,  The i n f o r m a t i o n  factors;  learning the  of  similar  feelings,  feelings,  i d e n t i f i e d  nurses',  n u t r i t i o n ;  themselves  important  compared  study.  a c t i v i t i e s ) ;  dealing  care  myocardial  categories:  changing (work  (1983)  (1984)  tabulated  coronary  perceptions  used  Peterson's  the  a c t i v i t y ,  physiology.  physicians'  patients  a  needs,  factors,  focused  learn  the  that  to  the  learning  on what  enable  multifaceted  they  them  to  problems  needs  perceived cope,  on  a  associated  20  with  their  particular illness.  w h i c h were d e s i g n e d persons  with  may p r o v i d e  of t h i s  specific  Relationships Variables  to determine  Between  some  from  insight  and P e r c e p t i o n s  the l e a r n i n g  patient  Demographic  of L e a r n i n g  needs o f  their  into  chronically i l l  Selected  studies  the l e a r n i n g  asthma, as i d e n t i f i e d  perspective, needs  Research  group.  and P e r s o n a l  Needs  Among  Patients What  follows  demographic  provides  and p e r s o n a l  selected  to o b t a i n  research  studies  perceptions section which  have  learning  Barry  learning  been in  patients' In a d d i t i o n , i n current  relationships variables,  needs  information  about  sex, m a r i t a l  epilepsy,  have  the p o p u l a t i o n s  needs.  (1982) i n v e s t i g a t e d  of years  about  of t h e  studies  between  and  this  selected  perceived  of p a t i e n t s .  and p e r s o n a l  number  that  the f i n d i n g s  and p e r s o n a l  demographic  age,  summary  investigated  learning  summarize  needs  education  which  investigated  demographic  variables  information  of t h e i r  will  a brief  of persons variables  t h e sample status,  the c l i e n t  the f r e q u e n c y  the p e r c e i v e d with  health  epilepsy.  selected  to  obtain  included  the f o l l o w i n g :  employment,  e d u c a t i o n , the  has been d i a g n o s e d  of s e i z u r e s ,  The  with  the l e n g t h  of time  21  care  had  number unit  been  of  the  client  and  needs  and  personal  the  nature  the  i l l n e s s ,  the  and  ones  when  with  they  recovery  et  number  that  reach  length  short  of  whether term  duration.  variables needs  categories.  For  age,  more  well  and  within instance,  Dodge  reported  concerned  than  they  various  the  s i g n i f i c a n t  selected  to  age,  time  learning  were how  demographic  education,  several  the  selected  perceived  example,  their  patients  and  sex,  or  related  a l .  (1983)  studied  learning  needs  i n f a r c t i o n .  determine  perceptions the  of  knowing  education  myocardial to  epilepsy  between  selected  the  for  variable  would  the  were  subgoals  recovering in  the  process.  Casey health  and  between  differences adult  The  long  demonstrated  selected  young  older  of  perceptions  regarding that  was  existed  and  in-patient  included:  with  patients' of  patients.  i l l n e s s  differences  the  variables,  the  i l l n e s s  in  c l i n i c ,  relationships  personal of  seizure  required.  variables  findings  a l l  a  of  patients' The  had  investigated  demographic  involved  by  hospitalizations  Dodge  learning  provided  if of  of  A  learning  myocardial  of  existed needs,  Infarctions  perceptions  patients  chi-square  relationships their  the  after  analysis between and  sex,  which  of  the  was  a done  patients' age,  and  patients  22  the  number of myocardial i n f a r c t i o n s which the p a t i e n t s  had  experienced.  One s i g n i f i c a n t d i f f e r e n c e  between men and women: men b e l i e v e d important  to know the l o c a t i o n s ,  function  of the heart  significant perceived  recovering  F i n a l l y , three  were determined  needs of f i r s t  infarction patients,  compared  i t was more  s t r u c t u r e , and  than women d i d .  differences  learning  that  was found  between the  time myocardial  to those who were  from t h e i r second or t h i r d  myocardial  infarction. In summary, t h i s review of s t u d i e s  which  investigated  r e l a t i o n s h i p s between s e l e c t e d  and  ( i l l n e s s - r e l a t e d ) v a r i a b l e s , and perceived  personal  learning  needs demonstrates that  selected  have an impact on p a t i e n t s ' p e r c e p t i o n s learning the  needs.  assumptions held  cognitive  learning  situational The In  These f i n d i n g s  forces  variables  by medical  can i n f l u e n c e  s o c i o l o g i s t s and  persons'  that perceptions.  comparisons  d i r e c t i o n f o r the s e l e c t i o n of  demographic and p e r s o n a l v a r i a b l e s comparisons i n t h i s  some support to  for r e l a t i o n s h i p  offered  v a r i a b l e s may  of t h e i r  t h e o r i s t s , who espoused  selected  these s t u d i e s  lend  demographic  study.  for relationship  23  Current H e a l t h Education Focus by Nurses f o r Persons with Asthma and/or Chronic O b s t r u c t i v e Pulmonary Disease Rifas  (1983) examined the problems of persons  asthma and  proposed a h e a l t h education  which i n c l u d e d the f o l l o w i n g :  how  to use  b r o n c h o d i l a t o r i n h a l e r ; how  to prevent  how  control  to manage environmental  home environment dust circulating irritating  pollen  tartrazine and  how  another  to keep  mold f r e e , how  to keep  the  and  to avoid as a consumer), such  c o l o u r i n g , which may  to recognize  attack;  (how  of common p r o d u c t s ,  food  plan  a  to a minimum, what fumes  chemicals  identification  and  teaching  with  the signs and  as a s p i r i n  trigger  and  an a t t a c k ;  symptoms of chest  infection. Hudgel and education include and  Madsen (1980) maintained  f o r persons  with c h r o n i c asthma  the b a s i c pathophysiology  the p r i n c i p l e s  what side e f f e c t s medication.  of medication  should  of an asthma a t t a c k , management, such  to look f o r , and  how  and  when to  Hudgel and Madsen (1980) claimed  most s i g n i f i c a n t  part of h e a l t h education  t e a c h i n g p a t i e n t s how attention  that h e a l t h  that  as use the  rests in  to recognize when to seek  f o r unabated b r o n c h o c o n s t r i c t i o n .  medical  They a l s o  24  pointed  out that i n c o n j u n c t i o n with  these  recommendations f o r t e a c h i n g , a d d i t i o n a l as:  "immunotherapy, p h y s i c a l  and  psychosupportive  s e r v i c e s such  therapy, d i e t a r y s e r v i c e s  h e l p " (1980, p. 1795) could  also  be i n c l u d e d . Kirilloff  and T i b b a l s (1983) developed  comprehensive guide pharmaceutical  could  summarized  prevent  to the major  or c o n t r o l  recommended h e a l t h education to persons  which  regimens.  that h e a l t h  i n c l u d e i n f o r m a t i o n on the f o l l o w i n g :  s i d e e f f e c t s , e x p l a n a t i o n s to p a t i e n t s as to why  they are t a k i n g a p a r t i c u l a r m e d i c a t i on, b e n e f i t , proper dosage, r o u t e , the time medication either  taking, special  recommended  foods  specific  criteria  the expected schedule f o r  or f l u i d s which are  to eat or to avoid i n combination  with p a r t i c u l a r m e d i c a t i o n s ,  not  asthma.  content  on medication  and T i b b a l s (1983) proposed  education should drug  to e i t h e r  be of b e n e f i t  Kirilloff  which  information pertaining  drugs groups used This a r t i c l e  f o r nurses  a  as w e l l as i n f o r m a t i o n on  to f o l l o w when shortness of breath i s  relieved. Kaufman and Woody (1980) claimed  that p a t i e n t s  w i t h a c h r o n i c o b s t r u c t i v e pulmonary disease can l i v e at  a higher l e v e l  of wellness  through  health teaching.  25  Hence,  they  designed  specifically patients  for  which  effective  chronic  postural  coughing  relaxed  D'Agostino's  emphasized teaching to  houseclean  removed,  so  rooms  appropriate  specific  such house  irritants  Martindale's evaluate  an  currently for  the  study  education It the  taking  that  anatomy  and  to  She the  and  on  be  research  New  included  the  physiology  of  how  may  be  information  on  study  clean  and  in  with  proposed  program,  Zealand.  The the  asthma  following the  following:  avoided.  improvement persons  that  humidity,  education  in  proposed  to  bedroom,  for  disease  allergens  how  temperature, must  control  program  pulmonary  toward  the  health  available  specifically  as  (1984)  place  was  education  irritants  which  asthma  environmental  management.  suggestions  breathing  positions.  health  directed  that  specific  particular the  be  (steam  diaphragmatic  obstructive  preventative  areas:  percussion,  management,  (1984)  disease  content  protocol  with  breathing  chronic  should  pulmonary  program  pulmonary  following  technique,  management,  with  the  drainage  hydration  education  obstructive  therapy,  exercises),  persons  health  included  bronchiodilator inhalation,  a  to  which  was  rationale  health was  topic  respiratory  needed.  areas: system,  a  26  simplified  explanation  of the pathophysiology  asthma, signs and symptoms of an acute  of  attack,  assessment of the s e v e r i t y of an a t t a c k , medication-taking technique  knowledge, c r i s i s  f o r use of i n h a l e r and peak flow meter,  diaphragmatic drainage,  breathing,  relaxation positions, postural  f o r c e d e x p i r a t i o n , the b e n e f i t s of sports and  e x e r c i s e , a d i s c u s s i o n of t r i g g e r prevention education  management,  of asthma.  Also  f a c t o r s , and  included  programme were any other  t o p i c s which p a r t i c i p a n t s s t a t e d  in this  health  asthma r e l a t e d  they wished to  discuss. F i n a l l y , Muzzuca i n v e s t i g a t e d the value education  f o r those  experiencing  problem.  The f i n d i n g s of t h i s  a chronic  study  " p a t i e n t s need to know l e s s about  of h e a l t h  illness  i n d i c a t e d that  the  pathophysiology  of t h e i r d i s e a s e , and more about i n t e g r a t i n g new demands i n t o t h e i r d a i l y  r o u t i n e " (1982, p. 528).  In summary, the h e a l t h education with  focus  f o r those  asthma and c h r o n i c o b s t r u c t i v e pulmonary  implies  that the h e a l t h education  nurses may be s t a n d a r d i z e d , medicocentric, learning  content  diseases  planned by  "pre-packaged," and  and demonstrates a l a c k of focus on  needs r e l a t e d to t h e i r  s o c i a l and  27  p s y c h o l o g i c a l h e a l t h problems.  For i n s t a n c e , c u r r e n t  h e a l t h education c h a r a c t e r i s t i c a l l y  focuses  e x p l a n a t i o n s of the pathophysiology  of asthma,  i n f o r m a t i o n of treatment medications,  and  how  on  regimens such as how  to  to manage environmental  take  control.  Summary A review following.  of the l i t e r a t u r e  First,  revealed  the  the problems of i n d i v i d u a l s  with  asthma and/or c h r o n i c o b s t r u c t i v e pulmonary d i s e a s e are multiple  and  p e r v a s i v e , and  they have been d e s c r i b e d  w i t h i n v a r i o u s contexts of understanding health professionals.  by o b t a i n i n g t h e i r  problems.  allied  However, a more comprehensive  knowledge of the problems of persons gained  by  with asthma may  p e r c e p t i o n s of  their  Second, i t i m p l i e d that the primary  needs of p a t i e n t s with a c h r o n i c i l l n e s s  learning  focused  on  what they p e r c e i v e d that they needed to l e a r n  to cope  with problems experienced  their  i n a s s o c i a t i o n with  p a r t i c u l a r chronic i l l n e s s . illustrated selected perceived  Third, research studies  that r e l a t i o n s h i p s may  demographic and  exist  between  p e r s o n a l v a r i a b l e s , and  l e a r n i n g needs of p a t i e n t s .  Fourth  the  the  h e a l t h education focus provided by nurses  may  directed  needs of  toward  the most c r u c i a l  learning  be  not  be  persons  with  education  asthma.  focus  psychological experienced  by  does  and  Specifically, not a p p e a r  social  those  with  the  health  to a d d r e s s  p r o b l e m s w h i c h may asthma.  the be  29  CHAPTER THREE  Methodology  Overview A d e s c r i p t i v e r e s e a r c h design using methodology was used Polit is  to address  and Hungler maintained  the r e s e a r c h  wishes to "summarize  the s t a t u s of some phenomena of i n t e r e s t (1983, p. 184). This  summarizes the f o l l o w i n g : instrument criteria and  as they  chapter  construction;  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 ;  sample s e l e c t i o n procedure;  analysis;  and f i n a l l y ,  problem.  that a d e s c r i p t i v e design  a p p r o p r i a t e when the reseacher  currently exist"  survey  ethical  data  population  collection;  data  considerations in this  study.  Instrument  Construction  Two q u e s t i o n n a i r e s were used first  i n the survey.  The  q u e s t i o n n a i r e (Appendix A ) , c o n s i s t e d of an  i n t e r v i e w schedule  which was c o n s t r u c t e d  demographic and personal information.  Current  to c o l l e c t  (illness-related)  r e s e a r c h which has 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 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 of p a t i e n t s ;  30  the  i n v e s t i g a t o r ' s nursing  knowledge of i l l n e s s - r e l a t e d  f a c t o r s which may have an i n f l u e n c e on the impact of asthma on persons; and i n c o l l a b o r a t i o n with a respiratory  clinical  instrumental personal  nurse s p e c i a l i s t , were  in constructing  the demographic and  i n t e r v i e w schedule f o r t h i s  study.  Selected  demographic v a r i a b l e s were: (1) sex, (2) having dependents, ( c h i l d r e n ) (3) age, (4) occupation highest  education  a t t a i n e d , (6) having  (7) s e l e c t e d i l l n e s s - r e l a t e d (Appendix A, 7-19 The  personal  c o n f i d a n t s , and variables  inclusive).  second q u e s t i o n n a i r e ,  interview  (5)  a  semi-structured  schedule (Appendix B ) , c o n s i s t e d of  open-ended questions  to o b t a i n data  on the p e r c e p t i o n s  of young a d u l t s with  asthma.  and Hungler  maintained  that open-ended questions  means to o b t a i n of o t h e r s .  Polit  personal  In t h i s  are an  (1983)  appropriate  acccounts and the p e r c e p t i o n s  study, The U.B.C. Model f o r Nursing  (1980) was s e l e c t e d by the i n v e s t i g a t o r to o b t a i n the perceptions  of young a d u l t s with  model was used  to f a c i l i t a t e  second q u e s t i o n n a i r e perceptions particular  because i t provides  This  nursing  the c o n s t r u c t i o n of the  f o r the purposes of o b t a i n i n g the  of young a d u l t s nursing  asthma.  in this  conceptual  study.  This  framework was chosen  a systematic  and comprehensive  data  31  collection their  tool  for assessing  perceptions,  integrated  within  i n d i v i d u a l s and o b t a i n i n g  the context  person, and a b e h a v i o r a l  of the "whole"  system.  In  a d d i t i o n , many of I t s key concepts, i n respect to e x p l a i n i n g human behavior, constructs  within  are congruent with  the c o g n i t i v e f i e l d  the major  theory of  learning. The for  Nursing  of t h i s 1.  s p e c i f i c key concepts w i t h i n The U.B.C. Model (1980) which f a c i l i t a t e d  i n t e r v i e w schedule were the f o l l o w i n g :  An i n d i v i d u a l has nine represented  2.  the c o n s t r u c t i o n  b a s i c human needs, each  by a subsystem.  Needs, n e e d - r e l a t e d  goals,  abilities,  s o c i o c u l t u r a l , impersonal and personal  forces,  w i t h i n each subsystem i n f l u e n c e i n d i v i d u a l perceptions 3.  of need  satisfaction.  A l l subsystems, each r e p r e s e n t i n g need, are interdependent  4.  one b a s i c human  and i n t e r a c t i n g .  An i n d i v i d u a l responds as a b e h a v i o r a l  system.  These assumptions d i r e c t e d the i n v e s t i g a t o r to construct  questions  which addressed  asthma on young a d u l t s  the impact of  i n a s s o c i a t i o n with  the nine  b a s i c human needs premised w i t h i n The U.B.C. Model f o r Nursing  (1980).  questionnaire  Therefore,  i n constructing a  which takes i n t o account b a s i c human  32  needs, w i t h i n  the context of other s p e c i f i c key  assumptions i n The U.B.C. Model f o r Nursing was assumed that  (1980), i t  t h i s q u e s t i o n n a i r e would ensure a  comprehensive and s y s t e m a t i c means of o b t a i n i n g p e r c e p t i o n s of young adults  Criteria The study  for Selection criteria  the  with asthma.  of P a r t i c i p a n t s  for selection  of p a r t i c i p a n t s  in this  included:  1.  Persons must speak  2*  Young a d u l t s  English.  diagnosed with e x t r i n s i c asthma, and  between the ages of 20 - 45 y e a r s . 3.  Young adults  who have asthma, but are  without other major i l l n e s s e s .  P o p u l a t i o n and Sample S e l e c t i o n Participants  were s e l e c t e d  p o p u l a t i o n at a r e s p i r a t o r y hospital  from an  unit  meeting the c r i t e r i a  the  following  1.  The i n v e s t i g a t o r  out-patient  i n a major  i n Vancouver, B r i t i s h Columbia.  participants  the  Procedure  teaching  Twenty  were r e c r u i t e d  using  procedure. initially  explained  study and s e l e c t i o n c r i t e r i a  respirologists respiratory  (physicians),  technologists  the purpose of  to three  as w e l l  as to  and r e c e p t i o n i s t s ,  33  employed gave  at  each  "cover  of  to  the  selection  respirology  these  letter  explained  The  the  purpose  was  from  then  for  when  prospective  keep  pre-booked  The  the  physicians  of or  were  what  would  to  participate d e t a i l to  be  in  obligated  to to  in a  study  came with  was  which  the  and  three to  recruit  the  into  to  met  a  brief of  be  verbal  in  The were  the  to  description  should was  participants  they  by  sampling  by  E) a  cover in  study,  they  agree  explained  (Appendix  technologist.  to  the  explained,  This  cover.letter  unit  potential  them  study.  participate  the  either  the  t h i s ,  that  occur  technologists.  to  required  would  technologists,  who  given  persons  the  recruitment  respiratory  potential  respiratory  e x p l i c i t  that  addition  of  or  C),  and  investigator  respiratory  In  participants  given  the  practice.  participants  c r i t e r i a .  was  of  permission  from  appointments or  purpose  D)  the  participants  r e s p i r o l o g i s t s  more  copy  study  sought  the  their  established  potential  a  investigator  (Appendix  the  (Appendix  r e s p i r o l o g i s t s ,  It  of  The  c r i t e r i a .  consent  patients  individuals,  physicians"  investigator  signed  u n i t .  which  physician letter  no  in  way  and  that  made  34  non-participation care  they  jeopardize  receiving  i n any way.  investigator's  telephone  number was  letter  (Appendix E ) ,  participants wished  contact  further  submitted  their  physician  or  discuss  or  potential  their  participants study,  still  the  participants  date,  convenient  to  i n the  the  they  study  number  to  the  recruitors  the  numbers  of  investigator  by t e l e p h o n e  intent.  If  for  an  to  potential  participate  and p l a c e to  if  investigator.  interval,  wished  potential  and t e l e p h o n e  participation  a time,  w h i c h was  to  the  study.  technologist  names  two day  The provided in  the  and t e l e p h o n e  participants  A f t e r a one contacted  the  health  investigator  in p a r t i c i p a t i n g name  the  a l l o w the  w i t h the  respiratory  who i n t u r n gave potential  to  c l a r i f i c a t i o n of  Those i n t e r e s t e d  6.  not  were  cover  5.  would  in  this  interview  participant  was  established.  Data C o l l e c t i o n Initially of  the  p u r p o s e of  collected, ethical  participants the  and were  study,  signed  this  study.  consent  given  how d a t a  an were  explanation to  provided with a b r i e f i n g  and human r i g h t s  then  were  in research.  ( A p p e n d i x F)  for  be of  their  Participants participation  in  35  Data were c o l l e c t e d during one  by I n t e r v i e w i n g p a r t i c i p a n t s  session only.  homes of p a r t i c i p a n t s ;  Interviews  however, three  occurred  at  exceptions  the to  t h i s occurred when p a r t i c i p a n t s came to the home of i n v e s t i g a t o r , because t h i s convenient private  f o r them.  arrangement was  The  the  more  i n t e r v i e w s took place i n a  p l a c e , i n the d i n i n g or k i t c h e n area, where the  participant  and  It  to the i n v e s t i g a t o r that the p a r t i c i p a n t s  appeared  i n v e s t i g a t o r could s i t around a t a b l e .  were most at ease i n these l o c a t i o n s . First, schedule and  the demographic and  (Appendix A) was  personal data.  investigator participant  and  personal  used to c o l l e c t  demographic  Responses were documented by  were l a t e r v a l i d a t e d by  to be  interview  c o r r e c t as  Second, using  the  i n t e r v i e w schedule,  the  the  read.  semi-structured,  open-ended  (Appendix B) p a r t i c i p a n t s were  interviewed  by the i n v e s t i g a t o r to o b t a i n young a d u l t s  perceptions  of t h e i r  and  their  h e a l t h problems r e l a t e d  l e a r n i n g needs f o r h e a l t h e d u c a t i o n .  i n t e r v i e w s were audio-taped recorder.  to asthma,  The  by using  a portable  These tape  i n v e s t i g a t o r took a l l necessary  equipment f o r a u d i o - t a p i n g  to each i n t e r v i e w .  number only was  the audio  visible  P a r t i c i p a n t s were given  on  A code  tapes.  the o p p o r t u n i t y  to  explore  36  their  perceptions  asthma, and t h e i r  of t h e i r  h e a l t h problems r e l a t e d to  l e a r n i n g needs f o r h e a l t h  education.  Sensitivity  toward the p a r t i c i p a n t s n e c e s s i t a t e d  flexibility  i n questioning.  until  the q u e s t i o n  participant  wished  The i n t e r v i e w s  areas had been explored  continued or the  to end the i n t e r v i e w .  Data A n a l y s i s The  audio-tapes of the open-ended,  interview  semi-structured  schedule (Appendix B) were t r a n s c r i b e d f o r  c a t e g o r i z a t i o n a f t e r each i n t e r v i e w .  The nine  basic  human needs premised w i t h i n The U.B.C. Model of Nursing (1980) f a c i l i t a t e d perceptions related  the s u b - c a t e g o r i z a t i o n  of young a d u l t s of t h e i r h e a l t h  to asthma, and t h e i r  education  problems  l e a r n i n g needs f o r h e a l t h  (The U.B.C. Model Committee, 1980).  Frequency d i s t r i b u t i o n s were used answer the r e s e a r c h  questions.  to d e s c r i b e and  The h e a l t h  l e a r n i n g needs were then c a t e g o r i z e d existing  of the  problems and  according to  commonalities w i t h i n and across  the need  categories . F i s h e r ' s Exact relationships  Test was used  between s e l e c t e d demographic and personal  v a r i a b l e s and the p e r c e i v e d a d u l t s with  to determine  l e a r n i n g needs of young  asthma of the e x t r i n s i c  type (Zar,  1984).  37  A probability  Ethical  study  University  I n v o l v i n g Human  Informed  1.  The i n i t i a l option  4.  Consent  Screening  of t h e  Committee  The human  safeguarded  i n the  and R i s k / B e n e f i t  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  or n o n - p a r t i c i p a t i o n  prejudice.  The c o v e r  letter  withdrawal  from  the s t u d y  The c o v e r  letter  informed  if  the a p p r o v a l  Subjects.  were  of p a r t i c i p a t i o n  without  could  with  ways:  A.  3.  used.  Columbia's  of the p a r t i c i p a n t s  following  2.  was c o n d u c t e d  of B r i t i s h  Research  rights  of .05 was  Considerations  This  for  level  (Appendix  r e f u s e to answer  they  E) s t a t e d could  that  occur  a t any t i m e .  participants  that  they  any q u e s t i o n s , a t any t i m e ,  wished.  Potential  benefits  were o u t l i n e d  i n the c o v e r  letter. 5.  The c o v e r  letter  available  to d i s c u s s t h e s t u d y  participants might  stated  to c l a r i f y  have b e f o r e making  participation.  that  the i n v e s t i g a t o r with  potential  any q u e s t i o n s their  was  which  decision  they  about  38  6.  I f during behavior  the i n t e r v i e w p a r t i c i p a n t s w h i c h was or p o t e n t i a l l y  demonstrated  c o u l d 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  referral  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 c o m p l e t i o n , participants, University  the t h e s i s  through  of B r i t i s h  the l i b r a r i e s  Privacy  1.  P r i v a c y was i n s u r e d d u r i n g  or  that  occurred  Confidentiality  1.  Access  2.  to the data  her a d v i s o r y  D a t a was h e l d the  the i n t e r v i e w s .  i n t h e home of t h e p a r t i c i p a n t  of the i n v e s t i g a t o r .  C.  and  of t h e  Columbia.  B.  Interviews  was made a v a i l a b l e t o  was l i m i t e d  t o the i n v e s t i g a t o r  committee.  i n confidence  use of a c o d i n g  system  and k e p t known  only  anonymous by to the  researcher.  3.  D a t a was d e s t r o y e d  at the c o m p l e t i o n  of t h e s t u d y .  Summary This study  chapter  has p r e s e n t e d  and summarized  the m e t h o d o l o g y  the f o l l o w i n g :  of the  the instrument  construction,  the  participants;  p o p u l a t i o n and  procedure; concluded the  study.  data  criteria  f o r the sample  c o l l e c t i o n ; data  w i t h a summary  of  selection  of  selection  analysis;  and  ethical considerations  40  CHAPTER  Presentation Of  FOUR  And  Analysis  Findings  Overview The analyse four  purpose the  of  findings  sections  which  demographic  and  young  sample  adult  asthma;  their  learning  summarize  of  and  information,  s t a t i s t i c a l  analysis  The Model the  for  occurs basic  at  learning  needs  end  needs  (1980)  sub-categorization which  It  of  of  health  and  and to  to  the  related the  perceived i l l u s t r a t e  s t a t i s t i c s , of  and  the  section.  premised  within  need  U.B.C.  categories  health the  The  to  results  selected  analysis  each  f a c i l i t a t e d  into  young  problems  between  An  related  divided  study;  needs;  used  provided  is  and  pertaining  this  descriptive  results.  the  human  Nursing  in  present  following:  variables were  qualitative  findings  the  relationships  Tables  to  study.  learning  personal  needs.  is  information  their  perceived  s t a t i s t i c a l  demographic  this  population  perceptions  the  of  chapter  personal  adults'  of  this  for  problems  and  presentation  and  41  a n a l y s i s of the f i n d i n g s .  I t should  be pointed out  that w i t h i n t h i s n u r s i n g conceptual model, a l l nine subsystems each r e p r e s e n t i n g one b a s i c human need are considered did  interrelated  and i n t e r d e p e n d e n t .  Hence, i t  not n e c e s s a r i l y provide a mutually e x c l u s i v e  approach to data  analysis.  Demographic and P e r s o n a l  Information  Overview Twenty young a d u l t s who participated  i n t h i s study.  met  A l l participants  study had asthma of the e x t r i n s i c sample was  the sampling  homogeneous i n t h i s  respect.  the data was necessary r e l a t i o n s h i p s between  ranges. prior  related  The were c o l l a p s e d  This o r g a n i z a t i o n of  to i n v e s t i g a t i n g  selected  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 summarizes  in this  type; t h e r e f o r e , the  demographic and p e r s o n a l data c o l l e c t e d i n t o two c l a s s i f i c a t i o n  criteria  needs.  percentage and frequency  Table 1  distributions  to demographic and p e r s o n a l data  to the young a d u l t p o p u l a t i o n i n t h i s  pertaining  study.  42  Table  1  Percentage  and  Demographic  Frequency  and  Personal  D i s t r i b u t i o n  In  Relation  to  Variables  Sample  Demographic Personal  Demographic 1 .  2.  3.  4.  and  Percentage  N=20  Variable  Variable  Sex Males  25  5  Females  75  15  Yes  55  11  No  45  9  Has  dependents  Age 20  -  30  years  50  10  31  -  45  years  45  9  Professional  20  4  Non-Professional  80  16  Occupation  Table  1  continued  .  43  Sample  Demographic and  Percentage  %  N=20  Personal Variable  n  Highest Education A t t a i n e d Partial  secondary  school  e d u c a t i o n or completed Partial  same  40  c o l l e g e or u n i v e r s i t y  e d u c a t i o n or completed  60  12  Yes  80  16  No  20  4  35  7  65  13  O c c a s i o n a l l y or Yes  50  10  No  50  10  Has  same  confidants  Personal Variables 7.  Length  of time  diagnosed  with asthma Less  than  1 year  to 5 years  Six years to 30 years 8.  Seasonally-related precipitation of asthma  Table  1 continued  . .  44  Sample  Demographic Personal  9.  or  asthma  in  mildly  11  45  9  Yes  65  13  No  35  7  Occasionally  25  5  Several  40  8  0 - 2  60  12  3 - 6  40  8  or  H o s p i t a l i z a t i o n as  12.  of  n  55  Moderately  11.  N=20  a c t i v i t i e s  Seldom  10.  %  Variable  Interference daily  Percentage  and  severely because  of  thma  Frequency  Number for  of  of  h o s p i t a l i z a t i o n  times medications  taken  asthma  Table  1  continued  .  45  Sample  Demographic and Personal  13.  Percentage %  Variable  Asthma medications  N=20 n  prescribed  Have not been p r e s c r i b e d , or when asthma symptoms exacerbate  20  4  80  16  0-4  50  10  5-8  50  10  Yes  10  2  No  90  18  When asthma symptoms exacerbate and 14.  daily  on a r e g u l a r  basis  Number of a l l e r g e n s or i r r i t a n t s identified  15.  Treatment p r e s c r i b e d  other  than  medications f o r asthma  Table  1 continued  46  Sample  Demographic Personal  16.  health  care  physician  due  asthma  to  times  per  or  1  to  2  year  11  45  9  Yes  10  2  No  90  18  60  12  40  8  Yes  15  3  No  85  17  Smoking  to  4  times  related  year  habits to  3  times  Occasionally Received  per  habit  Exercise Daily  ~~  by  55  Three  19.  N=20  sought Occasionally,  18.  %  Variable  Frequency  is  17.  Percentage  and  health to  or  per not  week at  a l l  education  asthma  47  Table  1 Illustrates  that the m a j o r i t y of the  p a r t i c i p a n t s were female and n o n - p r o f e s s i o n a l ; had a confident;  took medications  exacerbated, treatment  f o r asthma when symptoms  and on a d a i l y b a s i s ; f o l l o w e d no  f o r asthma other  than m e d i c a t i o n - t a k i n g ;  non smokers; and had no formal h e a l t h education  were  related  to asthma.  H e a l t h Problems of Young A d u l t s Related  to Asthma  Overview What f o l l o w s d e s c r i b e s h e a l t h problems as they have been s u b - c a t e g o r i z e d human needs premised Nursing  in r e l a t i o n  to the nine b a s i c  w i t h i n The U.B.C. Model For  (1980) .  Health Problems Related  to the Need For S a f e t y and  Security A total related  of ten h e a l t h problems were  identified  to the need f o r s a f e t y and s e c u r i t y .  cumulative  frequency  identified  w i t h i n t h i s need category was  tabulates  of responses  percentages  The  which have been  the h e a l t h problems r e l a t e d  illustrates  as  and frequency  62.  Table 2  to t h i s need and distributions.  48  Table  2  Percentage Problems  and  Frequency  Related  to  D i s t r i b u t i o n  the  Need  For  of  Safety  Health and  Security  Sample  Percentage Health  2.1  2.2  Problem  Environmental i r r i t a n t Upper  allergen  and  control  respiratory  Establishment medication  and  Concern  adherence  Concern  schedule  to  55  11  control 45  for  medication  for  45 addiction  to  asthma  medications 2.6  12  to  side-effects 2.5  60 infections  symptoms 2.4  N=20 n  control 2.3  %  Experience  40 unpleasant  psychological 2.7  Life  2.8  Heredity  2.9  F i n a n c i a l  20  4  concerns  15  3  concerns  10  2  10  2  responses  expectancy factor  concerns Table  2  continued  49  Sample  Percentage  %  N=20  H e a l t h Problem  2.10  Concern of  f o r the  asthma and  ja  effects  medications  d u r i n g pregnancy  10  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 problem  2  which  has  been i d e n t i f i e d , w i t h i n the need category f o r s a f e t y and  s e c u r i t y , was  the d i f f i c u l t y  (n=12) of the p a r t i c i p a n t s irritants  allergens  in controlling  i n the environment.  summarized her p a r t i c u l a r  experienced  One  and  60%  allergens  and  interviewee  difficulties  i n her environment  by  in controlling  i n d e a l i n g with  prospects of developing more a l l e r g i c  the  responses.  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 . O c c a s i o n a l l y , 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 a l l e r g e n ) crops up, I get f e e l i n g that the world i s c l o s i n g i n on me and I wonder what i s going to happen next. Am I going to end up i n a p l a s t i c bubble or something? I t i s sort of s c a r y , i t seems l i k e another l i t t l e chunk of "normal l i f e " i s gone.  She  50  Other f r e q u e n t l y mentioned h e a l t h the  following.  to c o n t r a c t i n g infections,  Some s t a t e d head colds  that  they were s u s c e p t i b i l e  and upper r e s p i r a t o r y  and needed to take s p e c i a l p r e c a u t i o n s i n  c o l d , damp weather.  F o r t y - f i v e percent  that e s t a b l i s h i n g and adhering to prevent  problems were  or c o n t r o l t h e i r  Specifically, organization  to a medication  schedule  symptoms was d i f f i c u l t .  some p a r t i c i p a n t s s t a t e d p r i o r to a c t i v i t i e s  t r a v e l was not easy f o r them. difficulties  (n=9) found  that  such as sports or  Several  stated  arose i n making c e r t a i n t h e i r  that  medications  were r e a d i l y a v a i l a b l e , and i n a d m i n i s t e r i n g preventative  doses of medication before  activities.  Further,  necessary before  thoughtful  planning  t r a v e l to ensure that  s u p p l i e s would be s u f f i c i e n t ,  sports  during  was o f t e n  medication  the time away from  home . Another 45% (n=9) expressed  concerns  associated  with the s i d e - e f f e c t s of some asthma medications administered Several  to c o n t r o l or prevent  stated  tachycardia, increased  they  asthma symptoms.  that medication s i d e - e f f e c t s such as  shakiness,  drowsiness, h y p e r a c t i v i t y ,  moodiness, and depression  Some (n=3) mentioned  that  medications made them f e e l  elevated  frightened  them.  doses of c e r t a i n  emotionally  unstable.  One  51  s t a t e d , "I thought  I was going c r a z y . "  i n t e r v i e w e e expressed  Another  her p e r s o n a l anguish r e g a r d i n g  the s i d e - e f f e c t s of m e d i c a t i o n s .  She s t a t e d ,  Sometimes I think I should j u s t creep i n t o a corner and wheeze i n peace and not take anything because the s i d e - e f f e c t s of the drugs are o f t e n a l o t worse than the a c t u a l asthma. Another h e a l t h problem f r e q u e n t l y p e r c e i v e d was that  the n e c e s s i t y of d a i l y medication  initiated addicted  f e e l i n g s , i n some, that to t h e i r  some s t a t e d  that  they were becoming  asthma m e d i c a t i o n s . they f e l t  anxious  schedules  For example,  i f their  medications  were not c l o s e at hand, e s p e c i a l l y when they were short of  b r e a t h , or i f t h e i r medication  m i s t a k e n l y had not been r e f i l l e d . that  they f e l t  during less  A few i n f a c t  stated  like "junkies."  Twenty percent psychological  prescription  (n = 4)  responses  experienced  unpleasant  of f e a r , panic and a n x i e t y  periods when they are short of b r e a t h .  Other  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 In t h i s need  category are t a b u l a t e d i n Table 2 (2.7 to 2.10 inclusive).  H e a l t h Problems Related to the Need For Balance P r o d u c t i o n and U t i l i z a t i o n  Between  of Energy  Four h e a l t h problems were s u b - c a t e g o r i z e d i n relation  to the need f o r balance between p r o d u c t i o n and -  52  utilization responses category and  of energy.  The  cumulative  which have been i d e n t i f i e d was  41.  illustrates  Table  frequency  within this  of need  3 i t e m i z e s the h e a l t h problems  the percentages  and  frequency  distributions. Table 3 Percentage  and  Frequency D i s t r i b u t i o n of H e a l t h  Problems Related to the Need For Balance P r o d u c t i o n and  Utilization  Between  of Energy  Sample  Percentage H e a l t h Problem  Restricts  3.2  F a t i g u e due  sport p a r t i c i p a t i o n  16  to maintain  70  14  35  7  20  4  regular  Dyspnea f r e q u e n t l y i n t e r r u p t s daily  3.4  80  to dyspnea and/or  sleep p a t t e r n s during dyspnea 3.3  N=20 ri  3.1  inability  %  activities  Exacerbation during  travel  of symptoms and  holidays  53  The  most  this  need  that  asthma  sports of  frequently  category,  among  symptoms  80%  often  p a r t i c i p a t i o n  their  cited  and  f r u s t r a t i o n s .  health (n=16)  problem of  the  necessitated  that One  this  of  sample,  was  restrictions  was  the  within  the  crux  of  in many  interviewees  maintained,  The  exercise  is  one  thing  I  r e a l l y  miss  being  able t o do as easily as I would like to. I was e x t r e m e l y f i t and i t is kind of disheartening I guess is the word, to look at myself now i n r e l a t i o n to then and realize that I can't go o u t and c y c l e w i t h the guys as easily as I would have i n the past.  Of  the  problem,  four  three  did  remain  sedentary,  active  in  t h i s .  A  part  in  health to  sport  dyspnea  less  not  and/or  frequently  sports  seldom  stated  Another  Other  were  was  could  category,  health  tabulated  no  health to  with  longer  take  i d e n t i f i e d was  patterns  problems in  a  currently  interfered  they  sleep  as  preferred  frequently  need  irregular  this  and  participant  asthma  this  periods.  i d e n t i f y  enjoy  several  in  not  one  and  skiing.  problem,  did  and  sports  was  dyspneic  who  Table  fatigue  due  during perceived  3  (3.3  to  3.4  i n c l u s i v e ) .  Health A  Problems  Related  total  six  categorized  of as  to  health  related  to  the  Need  problems the  need  For  Mastery  were for  sub-  mastery.  The  54  cumulative  frequency  i d e n t i f i e d  within  itemizes  the  i l l u s t r a t e s Table  of  this  health  responses need  category  problems  percentages  and  which  related frequency  have  was to  32. this  been Table need  4  and  d i s t r i b u t i o n s .  4  Percentage Problems  and  Frequency  Related  to  the  D i s t r i b u t i o n Need  For  of  Health  Mastery  Sample  Health  4.1  Employment goals  4.2  4.3  T r i a l  Percentage  Problems  and  career  threatened and  error  70 learning  an  e f f i c i e n t  way  to  cope  health  with  D i f f i c u l t y  with  to  learn  Ignoring can in  important  how 45  household 25  situations  precipitate order  not  problems  tasks 4.4  to  which  asthma  satisfy goals  N=20  20  14  55  Seventy threatened so  percent  their  especially  found  at  the  (n=14) s t a t e d  employment  or  i f allergens place  of  or  work.  that  career  asthma  goals.  irritants One  This  were  was  commonly  interviewee  stated,  I have to c h o o s e 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 c u s t o m e r s ' smoke can f i l l the whole room i n f i v e m i n u t e s and i f the r e s t a u r a n t d o e s n ' t have a i r c o n d i t i o n i n g I'd be h a v i n g asthma a t t a c k s a l l t h r o u g h work.  Another  respondent  claimed,  As a s a l e s m a n 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 p a i n t and things l i k e t h a t w h i c h may i n h i b i t me i n making a s a l e s c a l l or w h a t e v e r . Another  interviewee,  allergic  to M e t a m u c i l  administered  to  to work f o r  severe  asthma  are  diagnosis employer. they their they  of  of  career wished  As  last  employers  performing  she  a result  severely  commonly  she  had  p a r t i c i p a n t s had  may well  known  professed  was  been  s i x months, b e c a u s e  Two  asthma was  Six  cannot  the  symptoms.  prospective capable  powder, a d r u g  patients.  unable  that  a r e g i s t e r e d nurse,  that  question at to  concerns  whether  work i f  of  they  their  the p o t e n t i a l  they  feel  f r u s t r a t e d when  p a r t i c i p a t e i n some a c t i v i t i e s , goals,  or  compete  with  because  of  asthma.  One  others  further as  described  much her  as  56  degree of f r u s t r a t i o n  i n these  words,  I can handle the d i s c o m f o r t or pain or whatever; what d r i v e s me mad i s not being able to do what I want to do. Forty-five  percent  (n=9) s t a t e d that a f t e r the  d i a g n o s i s of asthma had been made, they difficulties  experienced  i n l e a r n i n g about the i l l n e s s  how to master and cope with  i t s e l f , and  the problems i t p r e s e n t s .  They pointed out that what they had learned about asthma and how to cope with own t r i a l  i t was l a r g e l y  due to t h e i r  and e r r o r methods, or was r e l a t e d to  i n f o r m a t i o n they had been able to glean from or f r i e n d s who had asthma. is  little  that and  access  have l i k e d  out  to h e a l t h e d u c a t i o n ,  the l a c k of e d u c a t i o n a l resources stress  long  S e v e r a l claimed  there  was  frustrating  provoking.  One i n t e r v i e w e e  to be given  the knowledge that i t took me so  to o b t a i n myself."  focused  on s i m p l i s t i c  medical  explanations.  s a i d , "I would  In a d d i t i o n , 10% (n=2) pointed  explanations  Other l e s s f r e q u e n t l y c i t e d need category  inclusive). in  that  and maintained  that they would favor h e a l t h education  this  relatives  performing  which  r a t h e r than  in-depth  h e a l t h problems w i t h i n  were i t e m i z e d i n Table 4 ( 4 . 3 to 4.4  Some i n t e r v i e w e e s certain  perceived  customary household  difficulties tasks.  One  57  described out  her  d i f f i c u l t i e s  household  Just  tasks  going  laundry things And  down  and  to  that  else?  groceries  this  up  up  is  steps  and  tasks  for  some,  especially  short  of  breath.  Others  fact,  such  marketed  sold  as  in  Of  accomplishing  were  not  mentioned  that  p a r t i c u l a r l y  Health Self, A  categorized by  s e l f ,  responses  and  bags  of  d i f f i c u l t .  p a r t i c u l a r l y when  stated  troublesome  they  were  wheezy  that  these  or  tasks  could,  cleaning  agents,  especially  dispensers,  bleach  could  (n=5)  some  of  their  outside mate  some  who  of  cleaning  i n i t i a t e  acknowledged  home.  husband  the  tasks  the  Need  agents  asthma  household  their or  and  d i f f i c u l t y  tasks,  Only had  two  one  taken  which  were  troublesome.  Self  total  is  household  for  Problems By  work.  the  their  r e s p o n s i b i l i t y  hard  groceries,  because  25%  employed  the stairs,  symptoms  or  the  carrying  asthma  spray  ammonia  symptoms. in  were  precipitate  commonly agents  dusting  to  laundry  sometimes  Vacuuming  in  basement the  Carrying  the  with  way.  the  coming  like  what  in  associated  Related  and of  as  For  Respect  of  Others  five  health  related  others.  which  to  have  to The  been  problems  the  need  were  for  sub-  respect  of  cumulative  frequency  of  i d e n t i f i e d  within  this  self,  need  58  category  was  29.  Table  5  problems  and  illustrates  i t e m i zes  these  percentages  health  and  frequency  distributions. Table  5  Percentage Problems Self  and  Frequency  Related  and  to  the  Distribution Need  For  of  Respect  Health of  Self,  By  Others  Sample  Percentage Health  5.1  Problem  Asthma  %  N=20 ri  symptoms  can  precipitate  50  10  30  6  30  6  20  4  15  3  depression 5.2  Some of  in  the  society health  prejudiced with 5.3  professions  toward  are  individuals  by  asthma  medication-taking  5.4  Lack  5.5  Difficulty  of  asthma self  members  asthma  Embarrassed of  including  as  stamina in  symptoms in  public  compared  to  acceptance  of  diagnosis  and  chronically  of i l l  and  peers  perceiving  59  A  frequently  identified  in  perceived  this  need  Several  stated  their  related  to  fact  preclude  the  positive  appearance, physical  and  health  category  feelings that  attitudes  can  affect  well-being.  One  was  of  asthma  problem  depression symptoms  their  were  can  their  general  year  was  depression.  regarding  26  which  old  frequently physical  feelings  of  interviewee  stated, The only time that i t (asthma) r e a l l y affects me i s when I have t o t a k e t h e m e d i c a t i o n . It m a k e s me s h a k e o r i t m a k e s me r e a l l y tired a n d I g e t b l a c k c i r c l e s u n d e r my e y e s a n d you j u s t f e e l "blah" a l l over. You don't really f e e l l i k e d o i n g a n y t h i n g o r g o i n g any w h e r e y o u j u s t w a n t t o go t o bed.  Thirty society  are  Participants society with  who  prejudiced believed  or  symptoms  for  "I  of  because  them."  don't  Another  perceived  toward that  those  there  attributed  hold  asserted, asthma  (n=6)  largely  asthma,  their  percent  that  think i t is  not  participant  with  asthma.  with One  in  causes  asthma  can  use  interviewee  understand  something  in  individuals  psychological  gain.  others  many  are  persons  personal  that  the  tangible  effects to  acknowledged,  I s o r t of have kept i t i n the c l o s e t really ( 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 don't understand w h a t 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 w e a k n e s s , so I d o n ' t admit to o t h e r p e o p l e that I have i t .  60  It  was  could  a l s o emphasized  that  be more I n f o r m e d  diagnosing prolonged  a b o u t a s t h m a and  i t . Some s t a t e d mental anguish  been d i a g n o s e d lapsed  some p h y s i c i a n s  after  before  the  that  because  they  generally  more a d e p t  suffered  their  a s t h m a had  a s u b s t a n t i a l amount of  o n s e t of  symptoms.  at  One  not  time  had  interviewee  claimed, I went t o s e v e r a l d o c t o r s and d e s c r i b e d t h e symptoms, and t h e y t h o u g h t t h a t I had some "mental problems." The d i a g n o s t i c p r o b l e m went on p r o b a b l y f o r a y e a r . It  was  embarrassed their  reported or  by  others  that  s e l f - c o n s c i o u s when t h e y  a s t h m a symptoms were e a s i l y  social  or p u b l i c s i t u a t i o n s .  conscientiously others.  She  they  tried  One  t o mask her  felt sensed  observed  by  that others  in  interviewee symptoms  from  acknowledged,  I f i n d one of my main p r o b l e m s w i t h a s t h m a 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 d o n ' t know why, but I have a l w a y s had t h i s a b s o l u t e h o r r o r of anyone k n o w i n g I h a v e i t . Two  interviewees  stated  that  taking  medications  s u c h as  in  p r e s e n c e of  others.  the  necessary their  to  t r y to f i n d  medications.  they  their  d i d not inhaled  feel  ease  bronchodilator  They t h e r e f o r e  a p r i v a t e place  at  to  found i t administer  61  Twenty percent lacked of  (n=4) were d i s t r e s s e d  the p h y s i c a l stamina  their  they  age group possess.  o l d e r than  their  b e l i e v e d that  Some s t a t e d they  a c t u a l years when t h e i r  symptoms were severe.  "sometimes I f e e l  like  Generally  participants  they should  perform  physically  they  others felt  much  asthma  For example, one i n t e r v i e w e e  confessed  to  because  felt  relative  I am 90 years o l d . " be b e t t e r able  to t h e i r c h r o n o l o g i c a l  age. Among for  those who professed  them to accept  the f a c t  fully  accept  the r e a l i t y  with a c h r o n i c i l l n e s s , with  i t , and having  difficult  that they had asthma, some  acknowledged that a few years could  that i t was  having  had passed of being  before  they  an i n d i v i d u a l  to l e a r n how to cope  to adhere to a treatment  One i n t e r v i e w e e d e s c r i b e d h i s experience  regimen.  i n t h i s way,  I r e a l l y ignored i t f o r a w h i l e . It was a b i t of shock r e a l i z i n g that I would have i t f o r the r e s t of my l i f e , that i t won't go away. You always t h i n k those things happen to other people not to y o u r s e l f . When he (the p h y s i c i a n ) f i r s t t o l d me I had asthma, i t was l i k e having an a c c i d e n t , i t always happens to someone e l s e , not to y o u r s e l f . Another i n t e r v i e w e e s t a t e d , 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 s i c k before i n your l i f e , and have been healthy and a c t i v e p r i o r to t h i s . Then, a l l of a sudden you d i s c o v e r you can't run up the s t r e e t or walk up a h i l l without problems, you think what i s happening to me!  62 H e a l t h Problems Related to the Need For Love, Belongingness  and Dependence  F i v e h e a l t h problems were s u b - c a t e g o r i z e d as unmet needs r e l a t e d  to the b a s i c human need f o r l o v e ,  belongingness, frequency within  and dependence.  The  of responses which have been  this  category, was  21.  identified  Table 6 t a b u l a t e s these  h e a l t h problems and i l l u s t r a t e s frequency  cumulative  percentages  and  distributions.  Table 6 Percentage and Frequency D i s t r i b u t i o n of H e a l t h Problems Related to the Need For Love,  Belongingness  and Dependence Sample H e a l t h Problem  6. 1  Restricts with  social  N=20 n  activities 35  7  30  6  with f a m i l y  20  4  6 .4  Inhibits  15  3  6 .5  L o n e l i n e s s during n o c t u r n a l 5  1  6 .2  f a m i l y and  Percentage  Significant  friends  others and  f r i e n d s have understanding  little of t h e i r  problems 6 .3  Tension  dyspnea  in relationships  sexual i n t e r c o u r s e  63'  Thirty-five  percent  (n=7) f o u n d  symptoms c a n c u r t a i l t h e i r with  f a m i l y and f r i e n d s .  social This  that  events  could  be p r e s e n t  interviewee  to avoid  i n the s o c i a l  asthma  and a c t i v i t i e s  f r e q u e n t l y was n e c e s s a r y  when a s t h m a symptoms were p a r t i c u l a r l y when i t was n e c e s s a r y  their  troublesome, or  allergen contacts environment.  which  One  stated,  S o c i a l l y i t (asthma) i s very i n h i b i t i n g , extremely i n h i b i t i n g . When I am i n v i t e d t o someone's p l a c e , I t h i n k t o m y s e l f , do t h e y smoke? I c a n c o n t r o l my own s i t u a t i o n i n my own home b u t y o u c a n ' t when y o u go o u t , and I a l s o have a p r o b l e m i n r e s t a u r a n t s . Some a c k n o w l e d g e d predispose this,  that  makes you f e e l interviewee  like  also  particularly  upsetting  restriction  f e e l i n g s of l o n e l i n e s s .  one i n t e r v i e w e e  activities  the s o c i a l  can a l s o  In reference  to  s t a t e d , "You know, i t s o r t o f  an odd man o u t . "  stressed  that  having  This  same  a s t h m a was  a n n o y i n g when i t i n t e r f e r e d w i t h  with  her c h i l d r e n .  to hear her c h i l d  She f o u n d  i t especially  s a y , "Mummy c a n ' t go  b e c a u s e she has a s t h m a . " Other are  less frequently  itemized  perceived irritable,  perceived  health  problems  i n T a b l e 6 ( 6 . 3 t o 6.5 i n c l u s i v e ) .  that  Four  t h e symptoms o f a s t h m a made them:  crabby, l a c k i n g i n patience,  d e m a n d i n g , and  64  depressed."  One  interviewee  whole p e r s o n a l i t y , I'm hate  being  like  pointed out  s t a t e d , " I t changed  not what I used  this."  Subsequently,  to be, these  my  and  I  persons  that mood changes placed a s t r a i n on c l o s e  relationships.  H e a l t h Problems Related Food and  Fluid:  to the Need For Intake  of  Nourishment  Four h e a l t h problems were s u b - c a t e g o r i z e d i n relation  to the need f o r i n t a k e of food  nourishment.  The  cumulative  which have been i d e n t i f i e d was  20.  frequency  percentages  of  fluid: responses  w i t h i n t h i s need  Table 7 t a b u l a t e s these  illustrates  and  and  category  h e a l t h problems  frequency  and  distributions.  Table 7 Percentage  and  Frequency D i s t r i b u t i o n of H e a l t h  Problems Related Fluid:  to the Need For Intake  of Food  and  Nourishment Sample H e a l t h Problem  Percentage  N=20 _n  7.1  Food and control  fluid  allergen 40 Table 7 c o n t i n u e d .  8 .  65  Sample  Health  Percentage  Problem  N=20 n  7 .2  Gastrointestinal due  7 .3  to  Poor  asthma  Decreased causes  The this  need  frequently  troublesome, fluids  to in  that  be  had  to  or  d i f f i c u l t  following  others.  For  There for br person toast now a l  that  cases,  commodities, to  cited  health  certain  be  because  example,  15  3  15  3  avoided  the the  one  either  problem  food  conscientiously  most  6  tolerance  gain  was  30  can  symptoms  exercise  category had  habits  asthma  weight  most  allergens  and  medications  n u t r i t i o n a l  exacerbate 7 .4  upset  and  avoided. because  were  interviewee  is l i t e r a l l y nothing that eakfast. Anything that a would have for breakfast or eggs is a l l out f o r me l e r g i c to a l l those thing  f l u i d This  the  was  foods  favorite  restrictions customary  within  made  mealtime  it habits  stated,  I can have "normal" like cereal, because I am s.  of  66  S e v e r a l contended was  especially  that having  i n c o n v e n i e n t and  moments while d i n i n g restaurant.  was  Others who  allergens  could produce  were a l l e r g i c  such as metabisulphate,  difficult  fluid  out at a f r i e n d s *  c h e m i c a l s , p r e s e r v a t i v e s , and fluids  food and  awkward  home, or i n a to some  additives  i n food  f r e q u e n t l y found  that i t  to a b s o l u t e l y avoid these agents.  second-most 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 problem that m e d i c a t i o n s , p r e s c r i b e d to c o n t r o l asthma, may  and  produce  gastrointestinal  The was  or prevent  upset  such  as  indigestion. Other  less frequently i d e n t i f i e d  are itemized i n Table 7 (7.3 to 7.4  h e a l t h problems  inclusive).  Health Problems Related to the Need For Intake of Oxygen Two relation  h e a l t h problems were s u b - c a t e g o r i z e d i n to the need f o r i n t a k e of oxygen.  cumulative  frequency  identified  w i t h i n t h i s need category was  itemizes  of responses  these h e a l t h problems and  percentages  and  frequency  The  which have been 10.  illustrates  distributions.  Table 8  67  Table 8 Percentage and Frequency D i s t r i b u t i o n  of H e a l t h  Problems Related to the Need For Intake of Oxygen Sample H e a l t h Problem  8.1  N=20 n  Emotions and s t r e s s can precipitate  8.2  Percentage  dyspnea  Enjoy smoking  40  8  10  2  and continue  to do so but i t can precipitate  asthma  F o r t y percent stress that  symptoms  (n=8) s t a t e d  can p r e c i p i t a t e dyspnea.  they f r e q u e n t l y needed  effort  that  Several pointed out  to c o n s c i e n t i o u s l y make an  to remain calm and r e l a x e d .  particularly  difficult  home, were e s p e c i a l l y  emotions and  This was  when s i t u a t i o n s  at work, or at  trying.  H e a l t h Problems Related to the Need For S t i m u l a t i o n of the Senses Four h e a l t h problems were s u b - c a t e g o r i z e d i n relation  to the need  for stimulation  of the senses.  68  The  cumulative frequency of responses  identified itemizes  which have been  w i t h i n t h i s need category was 10.  Table 9  these h e a l t h problems and i l l u s t r a t e s  percentages  and frequency  distributions.  Table 9 Percentage  and Frequency  D i s t r i b u t i o n of H e a l t h  Problems Related to the Need For S t i m u l a t i o n of the Senses Sample Health  Percentage  Problem  N=20 n  9. 1  Decreased  sense  of t a s t e  25  5  9 .2  Decreased  sense of smell  10  2  9 .3  Sense of smell f o r a l l e r g e n 10  2  5  1  odours 9 .4  Eyes  has i n c r e a s e d  puffy and i r r i t a t e d  Twenty-five percent (n=5) s t a t e d symptoms could c o n t r i b u t e taste.  Some found  this  that  to a d i m i n i s h e d sense o f —  frustrating  because  implications  f o r the enjoyment of meals,  necessitated  that  them.  asthma  they f i n d  i t had  and i t a l s o  others to season  food f o r  69  Other l e s s were i t e m i z e d those  who  f r e q u e n t l y perceived  i n Table 9 (9.2  experienced  a diminished  interviewee  s t a t e d t h i s was  she worried  that she  Others b e l i e v e d t h e i r a l l e r g e n s had  described  the  said  be  Of  sense of s m e l l ,  able  residence  f o r her  because  to q u i c k l y  i f one  become more acute.  occurred.  experience,  This  was  and  one  he became nauseated when exposed  smell of c e r t a i n  one  sense of smell f o r some i r r i t a n t s  as an unpleasant  interviewee  inclusive).  a concern  would not  detect a h o u s e f i r e at her  and  - 9.4  h e a l t h problems  substances  H e a l t h Problems Related  he  to  i s a l l e r g i c to.  to the Need For C o l l e c t i o n  and  Removal of Accumulated Waste One to  h e a l t h problem was  the need f o r c o l l e c t i o n  waste.  The  cumulative  sub-categorized and  removal of  frequency  in r e l a t i o n  accumulated  of responses which  have been i d e n t i f i e d w i t h i n t h i s need category Table  10 t a b u l a t e s t h i s h e a l t h problem and  percentages  and  frequency  distributions.  was  6.  illustrates  70  Table  10  Percentage and Frequency D i s t r i b u t i o n of Problems Related  Health  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  Difficulty chest  of mucus i n A.M.  Those who chest  in clearing  experienced  upon awakening  to set aside pulmonary Thus  30  difficulty  i n the morning  time i n t h e i r morning  in clearing their  found  i t necessary  routine for  hygiene. far in this  s e c t i o n the m u l t i p l e  problems r e l a t e d to asthma, as perceived participants described  6  in this  in d e t a i l .  health  by the  study, have been s i n g u l a r l y What f o l l o w s  presents  an  analytical  summary of the h e a l t h problems which were  identified  most f r e q u e n t l y among the sample.  The h e a l t h problems have been c l a s s i f i e d  as they  occur  71  within  and  across  commonalities difficulty health  and/or  categories  of  array  of  seven  health  suggested  were  in  exist  this  health  according  problems  remaining  for  needs  in  categories general  problems  problems  from  perceived.  Of  to  and  the  the  basis  interpretation  of  the  data  documented  in  the  allied  pertaining  to  the  problems  of  the  and  in  health  the  the the  were  (1975)  common t y p e  of  chronically i l l .  common c a t e g o r i e s  on  five  Glaser's  c o n c e p t u a l i z i n g the  generated  of  generated  generated,  by  of  general  categories Strauss  terms  By g r o u p i n g  common  were  in  type  experienced.  experienced  two  the  manner,  health  problem  system  nine  concern  specific  classified  The  that  problems  health  the  of  health  problems  investigators* view  of  what  literature  experienced  by  has  been  specifically those  with  as t h m a . To were  begin,  the  classified  difficulties following  in  as  health  problems  although  specific  lifestyle  (n=16)  restricted  of  the  sports  category  similar  customary  category  80%  first  they  do  in  of  type  health  because  problems they  lifestyle  patterns.  belong  this  vary  in  to  participants  stated  participation.  to For  that  Among  The  general  respect  problem experienced.  create  the example,  asthma  i n d i v i d u a l s of  72  this and  young  age  group  especially  i n view  1980's  on  (n=14)  professed  shortness regular 70%  physical  of  (n=14)  threat been  to  personal a  adults  is  (Murray  In  in  perception,  d i f f i c u l t i e s  and  i n  experienced problems  as  daily  related  to  this  l i v i n g the  It  a  has by  "becoming that  provides  be  contribution tasks is  of  of  to  young  therefore  of  problems,  concern  to  the  although  unique  individual  differences  c l a s s i f i e d  as  patterns;  problems.  that by  while  study.  l i v i n g  suggested  to  presented  l i t e r a t u r e ,  It  would  style  due  Independence,  generally  l i f e  70%  dyspnea,  goals.  profession  health  the  maintain  of  that  1979).  i n  customary  (1975) i n  be  the  worthwhile  and r e f l e c t i v e  categorized Glaser  or  problem  these  can  career  i n  hand,  asthma  developmental  & Zentner,  summary,  themselves  were  a  participants  in  or  economic  the  this  having  in  fatigue  to  periods  theorists,  making of  that  adult  that  finding,  emphasis  other  i n a b i l i t y  vocation  of  one  On t h e  documented  a  current  during  s a t i s f a c t i o n ,  reasonable young  i n  feeling  society"  and/or  science  understandable  experienced  employment  social  an  the  they  acknowledged  established  and  that  extensively  several  of  patterns  their  is  f i t n e s s .  breath  sleep  this  the  the  customary  hence Strauss  common  problems  chronically style  they  of  l i f e  i l l of  were  73  individuals.  The f i n d i n g s  consistent  with  documented  i n respect  experienced The considered for  specific  this  sample  environmental  problems  they  type, asthma  that  that  percent  t h e need  o f the knowledge  in this  study  type  which  precipitated that  and a r e  adherence  characteristic  This  to p r e v e n t a t i v e upper  percent  perceptions within  and c o n t r o l  was a h e a l t h  of the e x t r i n s i c  verified  or at l e a s t  that  their  occasionally  5 t o 8 a l l e r g e n s or their  t h e y were  infections.  The  that a l l  had asthma  50% (n=10) c i t e d  reported  Forty-five  symptoms.  is significantly  50% (n=10) o f the sample  respiratory  difficulties  (n=12) o f t h e  and I r r i t a n t s  was s e a s o n a l l y - r e l a t e d  Irritants  pose  to avoid  particular finding  i n view  and t h a t  (n=ll)  of t h i s  may be  can be c l a s s i f i e d  Sixty  allergens  This  participants  the  because  which  category.  justifiable  of problems  of the d i v e r s i t y i n i n d i v i d u a l  identified  problem.  previously  types  of h e a l t h  problems  problems  common  then are  illness.  type  are health  illustrative  so,  has been  to t h e common  category  a common  study  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  following  of  some of what  i n chronic  second  in this  asthma.  susceptible health  to upper  problem  practices  respiratory  A n o t h e r 55%  to a v o i d  infection  (n=9) o f p a r t i c i p a n t s  required  symptoms.  professed  that  74  establishing medication  and adhering  to t h e i r p r e s c r i b e d  schedule, as a means to c o n t r o l  symptoms, was p r o b l e m a t i c . perceived  asthma  h e a l t h problems  by 40% (n=8) were d i f i c u l t i e s  food and f l u i d their  Other  their  in controlling  a l l e r g e n s and, by 30% (n=6), i n c l e a r i n g  lungs of mucus upon  arising.  In summary, these h e a l t h problems have been categorized  as problems r e l a t e d  to c o n t r o l l i n g the  symptoms of asthma, and hence they may be r e f e r r e d to as symptom c o n t r o l problems. a l s o determined  that t h i s  f r e q u e n t l y experienced The  third  Strauss and G l a s e r  common type of problem was  by the c h r o n i c a l l y  common category  have been i d e n t i f i e d  categorized and  as problems of a s i m i l a r  as s p e c i f i c  h e a l t h problems of t h i s  Fifty  percent  common h e a l t h problem  (n=10) of the p a r t i c i p a n t s  can p r e c i p i t a t e d e p r e s s i o n .  Madsen, 1980; Sexton,  type,  in individual perception  that asthma symptoms, and commonly  responses,  1982;  i n the maintenance of  The f o l l o w i n g may be  which may e x i s t w i t h i n t h i s  conceded  type  self-esteem.  demonstrate the d i v e r s i t y  category.  ill.  of h e a l t h problems  because they create d i f f i c u l t i e s a positive  (1975)  related  Hudgel and  1981; Gershwin, 1981; Burns,  C r e e r , 1979 a l s o i d e n t i f i e d  that d e p r e s s i o n i s  common among i n d i v i d u a l s with asthma.  Although  Creer  75  (1979) claimed that  feelings  of d e p r e s s i o n may  a s s o c i a t e d with the l o s s e s experienced  be  by those with  c h r o n i c o b s t r u c t i v e pulmonary d i s e a s e , however, the participants  in this  study l i n k e d  l a c k of p h y s i c a l w e l l - b e i n g and physical attractiveness  and  client  have an impact  group,  s o c i e t y and prejudiced  toward  stigma  assumption  their  health  problem  by 30%  the b e l i e f  (n=6)  this  of the  that some i n the g e n e r a l  that  persons  with asthma.  Creer  those with asthma may suggested  t h i s may  to be (1979)  experience  be due  to the  asthma symptoms are i n i t i a t e d by  factors.  Finally,  they experienced  another  30%  (n=6)  embarrassment when  asthma symptoms and m e d i c a t i o n - t a k i n g were  obvious  to others i n p u b l i c  Although this  and  that  psychological professed  Another  to the  i n the h e a l t h p r o f e s s i o n s appeared  a l s o a s s e r t e d that social  changes i n t h e i r  on the s e l f - e s t e e m of  as i d e n t i f i e d  p a r t i c i p a n t s , was  d e p r e s s i o n with  appearance due  nature of symptoms i n asthma. which may  their  specific  h e a l t h problems v a r i e d w i t h i n  category, they may  type because they may with asthma.  is consistent  current a l l i e d  be c a t e g o r i z e d as of a common  reduce  the s e l f - e s t e e m of  T h e r e f o r e , they may  s e l f - e s t e e m problems. problem  situations.  The  be r e f e r r e d  identification  with what has  health l i t e r a t u r e .  of  persons  to as this  been w r i t t e n i n the For example,  76  Creer (1979) maintained  that  this  group may experience decreased  particular  client  self-esteem.  The f o u r t h category of h e a l t h problems may be considered a common type because they c r e a t e experiences of s o c i a l  isolation  among i n d i v i d u a l s  asthma.  The f o l l o w i n g  specific  h e a l t h problems of t h i s  have been c a t e g o r i z e d as type and are  illustrative  of the i n d i v i d u a l  perception.  Thirty-five  participants  p e r c e i v e d that having  social  be l i n k e d the s o c i a l  inhibiting  identified  in this  significant  in social  factor  study  inhibits  f a m i l y and f r i e n d s .  activity.  i s consistent  others and f r i e n d s  stigma  that e x i s t s  As suggested  feelings  of f r u s t r a t i o n  Hence, asthma  have  little with  could be r e l a t e d  to  toward those with  by Creer (1979) asthma may evoke and h o s t i l i t y  in significant  others. summary, these h e a l t h problems may be  categorized  may  with c u r r e n t  of the problems they experience  asthma.  In  Creer  isolation  a s s o c i a t e d with  One e x p l a n a t i o n f o r t h i s  the s o c i a l  asthma  Another 30% (n=6) r e p o r t e d that  understanding asthma.  (n=6) of the  the experience of s o c i a l  to r e s t r i c t i o n s  literature.  differences in  percent  a c t i v i t i e s with t h e i r  (1979) held that  with  as problems of s o c i a l  isolation.  This  77  finding  i s c o n s i s t e n t with  the Strauss and G l a s e r  (1979) framework of common problems experienced  by the  chronically i l l . The  fifth  classified  category of h e a l t h problems may be  as a common type because they may be  instrumental i n presenting d i f f i c u l t i e s in  a d j u s t i n g to l i v i n g with asthma.  demonstrate the d i v e r s i t y exist  within this  (n=9)  of the p a r t i c i p a n t s  error,  self-instructed  The f o l l o w i n g  of adjustment  common category.  for individuals  problems which  Forty-five  percent  reported that the t r i a l and  learning  process  that  they  e x p e r i e n c e d , due to the l a c k of a p p r o p r i a t e community r e s o u r c e s , was not an e f f e c t i v e way to l e a r n how to cope with asthma.  It i s l o g i c a l  d i f f i c u l t y may have s i g n i f i c a n t  to suggest  that  this  implications for  c r e a t i n g a multitude of other h e a l t h problems. Another 25% (n=5) s t a t e d they experienced  a decreased  sense  of t a s t e , and t h e r e f o r e they f r e q u e n t l y needed to  elicit  the a s s i s t a n c e of others i n food p r e p a r a t i o n to  season  the food as necessary.  t h i s decreased Finally,  enjoyment of t h e i r  meals.  20% (n=4) p r o f e s s e d they at times  situations satisfy  their  Some a l s o reported that  which can p r e c i p i t a t e  goals important  to them.  ignored  asthma i n order to  78  These h e a l t h problems may be I d e n t i f i e d as adjustment problems r e l a t e d to asthma. Glaser  (1975) a l s o suggested  that adjustment  were common among those l i v i n g The  s i x t h category  Strauss and problems  with a c h r o n i c  of h e a l t h  illness.  problems share a  commonality i n that they may be grouped as d i f f i c u l t i e s and/or concerns which create unpleasant reflect  psychological feelings.  the d i v e r s i t y  common category. participants shortness reported  a broad spectrum of  i n h e a l t h problems w i t h i n  Twenty percent  conceded  of b r e a t h .  that  they experienced  for  marked  Two of these i n t e r v i e w e e s  or exacerbate t h e i r  to the need f o r : intake  also  in fact,  asthma symptoms.  h e a l t h problem was s u b - c a t e g o r i z e d  perceived  this  (n=4) of the  that emotions and s t r e s s could,  precipitate  related  The f o l l o w i n g  This  as a d i f f i c u l t y  of oxygen.  Hence,  h e a l t h problems r e l a t e d to the need  s a f e t y and s e c u r i t y could  i n f l u e n c e the emergence  of a h e a l t h problem r e l a t e d to another b a s i c human need. the  This  f i n d i n g may be explained  assumption  and supported by  i n The U.B.C. Model f o r Nursing  that a l l need subsystems are interdependent interrelated.  and  The p s y c h o l o g i c a l f e e l i n g s i d e n t i f i e d by  the p a r t i c i p a n t s i n t h i s has  (1980)  study are c o n s i s t e n t with  been documented i n the l i t e r a t u r e .  Gershwin  what  79  (1981),  Stein  maintained  (1981), Young (1980),  that the p a t h o p h y s i o l o g i c a l problems i n  asthma can induce  problems of a p s y c h o l o g i c a l n a t u r e .  It has a l s o been suggested Sexton, 1979,  and Hume (1970)  by Hudgel and Madsen, 1980;  1981; Gershwin, 1981; Burns, 1982; and C r e e r ,  that a n x i e t y , f e a r , p a n i c , and e x c e s s i v e  are common i n those with asthma. problems i d e n t i f i e d  as concerns  need f o r s a f e t y and s e c u r i t y several.  asthma m e d i c a t i o n s . stated  Several health in relation  worry  while  feelings  concerned  Other  experienced concerns  were  in this  study as being  problematic.  summarize, these h e a l t h problems may be  categorized The  were  among the sample but they were p e r c e i v e d by  fewer p a r t i c i p a n t s To  participants  of mental i n s t a b i l i t y  taking c e r t a i n medications.  identified  of taking  symptoms they experienced  worrisome, while others were g r a v e l y regarding  experienced  to the s i d e - e f f e c t s  Some of the nine  that the p h y s i c a l  to the  created worries f o r  The most f r e q u e n t l y c i t e d  by 45% (n=9) was r e l a t e d  worrying  as p s y c h o l o g i c a l problems.  seventh  difficulty  and l a s t  experienced  category  suggests the  by some p a r t i c i p a n t s i n  i n t e r a c t i n g with o t h e r s .  Twenty percent  the sample reported that having t e n s i o n s i n r e l a t i o n s h i p s with  (n=4) among  asthma could produce their  f a m i l y members.  This i s c o n s i s t e n t with Chalmer's (1984) r e s e a r c h  80  f i n d i n g s who obstructive changed  identified  that  i n d i v i d u a l s with  pulmonary d i s e a s e  interpersonal  frequently  chronic  experienced  r e l a t i o n s h i p s with t h e i r spouse  and s i g n i f i c a n t o t h e r s . In summary, t h i s h e a l t h as a s o c i a l  i n t e r a c t i o n problem.  (1975) framework chronically  problem may  ill  be r e f e r r e d to  Strauss  and  Glaser's  f o r i d e n t i f y i n g the problems of the a l s o suggested  that i n t e r a c t i o n a l  problems were common.  Summary The common h e a l t h adults  with asthma  follows:  symptom c o n t r o l ,  the general  markedly among the p a r t i c p a n t s health  and  I t has been i l l u s t r a t e d  problems, w i t h i n  as  self-esteem,  adjustment, p s y c h o l o g i c a l ,  i n t e r a c t i o n problems. health  by young  i n t h i s study were c a t e g o r i z e d  lifestyle,  social-isolation,  problems experienced  categories,  that  the  varied  although common types of  problems were e x p e r i e n c e d .  Learning Needs of Young A d u l t s  with Asthma  Overvi ew What f o l l o w s perceived  describes  by the young  been sub-categorized  adult  the l e a r n i n g  needs  p a r t i c i p a n t s as they  i n r e l a t i o n to the nine  basic  have  81  human needs premised Nursing  w i t h i n The U.B.C. Model f o r  ( 1980) .  L e a r n i n g Needs Related to the Need For S a f e t y and S e c u r i ty A t o t a l of nine l e a r n i n g sub-categorized security.  in relation  The cumulative  needs were  to the need f o r s a f e t y and  frequency  of responses  which  have been i d e n t i f i e d w i t h i n t h i s need category was 45. Table  11 t a b u l a t e s these l e a r n i n g  percentages  and frequency  needs and i n d i c a t e s  distributions.  Table 11 Percentage  and Frequency D i s t r i b u t i o n of Learning  Needs  R e l a t e d to the Need For S a f e t y and S e c u r i t y  Sample  Percentage  %  L e a r n i n g Needs  N=20 n  11.1  R e l a x a t i o n techniques  40  8  11.2  Functions and s i d e - e f f e c t s of asthma medications  40  8  11.3  Causal  40  8  11.4  Environmental  35  7  factors  i n asthma control Table  11 continued  . . .  82  Sample  L e a r n i n g Needs  Percentage^  N=20 n  11.5  Hereditary  11.6  factors  i n asthma  25  5  Long-term prognosis of asthma  20  4  11.7  When to take asthma medications  15  3  11.8  Special precautions  5  1  5  1  during  pregnancy 11.9  Emergency measures f o r asthma attack  The l e a r n i n g needs perceived most  frequently,  w i t h i n t h i s need c a t e g o r y , were the f o l l o w i n g : do r e l a x a t i o n side-effects triggering wished  techniques, the f u n c t i o n s and of asthma m e d i c a t i o n s , the causal or  factors  related  to asthma ( o f those who  to l e a r n more about the causal  asthma, f i v e had been diagnosed control irritant  how to  factors i n  recently),  and how to  the environment to minimize a l l e r g e n and contacts.  Other l e a r n i n g needs l e s s  f r e q u e n t l y mentioned are  83  illustrated  i n Table  those who  wished  heredity  factors  Furthermore,  stated  i n asthma, a l l had  of those who  special  recently delivered  The  need  care f o r persons  suggested her f i r s t  with  their  with asthma,  by an i n t e r v i e w e e child,  and  who  was  to have more c h i l d r e n .  Between P r o d u c t i o n and U t i l i z a t i o n  of  Balance Energy  l e a r n i n g needs were s u b - c a t e g o r i z e d i n to the need f o r balance between p r o d u c t i o n and  utilization responses  in obtaining  to gain  Learning Needs Related to the Need For  relation  of  the long-terra prognosis of asthma,  d u r i n g pregnancy, was  Two  Of  children.  were i n t e r e s t e d  activities.  i n f o r m a t i o n about  intending  inclusive).  that asthma s e v e r e l y I n t e r f e r r e d  d a i l y needs and  had  to 11.9  to l e a r n of the i m p l i c a t i o n s  i n f o r m a t i o n about two  11 (11.5  of energy.  The  cumulative  which have been i d e n t i f i e d  category was  11.  needs, percentages  within this  Table 12 i l l u s t r a t e s and  frequency  frequency  these  of need  learning  distributions.  84  Table  12  Percentage and Frequency D i s t r i b u t i o n Related  of L e a r n i n g  Needs  to the Need For Balance Between P r o d u c t i o n and  Utilization  of Energy  Sample  Percentage % Learning  12.1  Pacing  12.2  Beneficial  Needs  techniques  ti  i n sports  F o r t y percent  (n=8) i d e n t i f i e d  i n f o r m a t i o n about how  themselves i n s p o r t s .  to set r e a l i s t i c  maintaining wished and  15  3  that they wished to  to go about  activity  pacing  t o l e r a n c e , endurance,  sports goals  s p o r t s involvement.  i n the p r o v i s i o n of Others s t a t e d  to l e a r n what sports are the most  beneficial  8  The purpose of t h i s was to l e a r n  how to i n c r e a s e t h e i r and  40  and a p p r o p r i a t e  sports  obtain  N=20  they  appropriate  f o r persons with asthma.  L e a r n i n g Needs Related  to the Need For Mastery  Two l e a r n i n g needs were s u b - c a t e g o r i z e d i n relation  to the need f o r mastery.  The  cumulative  85  frequency within  of responses  this  need category was  these  l e a r n i n g needs.  Table  13  Percentage  which have been  and  11.  identified  Table  13 t a b u l a t e s  Frequency D i s t r i b u t i o n of L e a r n i n g Needs  Related to the Need For Mastery Sample Percentage %  L e a r n i n g Needs 13.1  Asthma  pathophysiology  13.2  Perceptions asthma and  of others the  to l e a r n  (n=6)  the s p e c i f i c  pointed  anatomy and  out  25  5  themselves and  how  that they d e s i r e d  physiology  Twenty-five  a l s o s t a t e d they wished to l e a r n how  health  6  coping  with asthma symptomatology.  perceived  30 with  s t r a t e g i e s used by them  T h i r t y percent  they  connected  percent  others with  coped with  L e a r n i n g Needs Related to the Need For Intake  Two relation  of  Nourishment  l e a r n i n g needs were s u b - c a t e g o r i z e d to the need for intake of food,  (n=5) asthma  their  problems.  Food, F l u i d :  N=20 n  in  fluid:  86  nourishment.  The  cumulative  frequency  of  responses  which have been i d e n t i f i e d w i t h i n t h i s need was  10.  Table  Table 14 i t e m i z e s these l e a r n i n g  category  needs.  14  Percentage  and Frequency  Distribution  of L e a r n i n g Needs  Related to the Need For Intake of Food, F l u i d : Nourishment  Sample  Percentage  %  N=20  L e a r n i n g Needs  14.1  Diet  tailored  n  to  i n d i v i d u a l s with asthma 14.2  Maintenance or loss  wished  percent  (n=7)  15  3  identified  to o b t a i n i n f o r m a t i o n about  which may  7  weight  diet  Thirty-five  35  be most b e n e f i c i a l  and  that  foods and  nutrition  appropriate for  i n d i v i d u a l s with asthma because they contended there i s a l i n k between maintenance of good and  the p r e v e n t i o n and  control  they  that  nutrition  of asthma symptoms.  Of  87  those who  wished  appropriate diet stressed  they had  to o b t a i n knowledge about  an  to maintain or l o s e weight, a l l a tendency  toward weight gain i n  c o n j u n c t i o n 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 One  and  Dependence  l e a r n i n g need was  relation  to the need f o r l o v e , belongingness  dependence.  The  cumulative  which have been i d e n t i f i e d was  3.  s u b - c a t e g o r i z e d i n the  Table  frequency within this  15 i l l u s t r a t e s  of  and  responses  need  the l e a r n i n g  category  need i n t h i s  category. Table  15  Percentage Related  and  Frequency D i s t r i b u t i o n  of L e a r n i n g Needs  to the Need For Love, Belongingness  and  Dependence Sample Percentage  L e a r n i n g Needs 15.1  Maintenance of  %  N=20 n  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  signficant  cope with r e l a t i o n s h i p s  others when tensions a r i s e due to the  of asthma was  the one p e r c e i v e d l e a r n i n g  s u b - c a t e g o r i z e d w i t h i n t h i s need  l e a r n i n g need was  category.  sub-categorized  to the need f o r intake of oxygen. frequency within this  Table  of responses  learning  of Oxygen  in relation  The  cumulative  which have been  identified  t h i s need category was  impact  need  L e a r n i n g Need Related to the Need For Intake One  with  2. Table  16  illustrates  need.  16  Percentage Related  and Frequency D i s t r i b u t i o n  to the Need For Intake  of L e a r n i n g Need  of Oxygen  Sample  Percentage L e a r n i n g Need  16.1  Coughing  technique  %  N=20 ii  10  2  89  How the  one  this  e f f e c t i v e l y  perceived  need In  by  to  learning  need  section  adults  in  the  this  categories.  What  follows  needs,  were  i d e n t i f i e d  which  are  and  inherent  learning  to  in  of  within  needs  which  need  names  the  common  sub-categorized  type  this  These  health  of  in  learning  because  they  the  needs  to  needs may  which  be  the  the may  the commonalities  associated  the  common  The  to  existing  which  This  generated.  problem  relation  to  the  the  described.  kept  learning  of  characteristics  manner  were  among  analysis  according of  learning  frequently  addressed  categories  majority  security.  In  described  the  were  interpretation  been  of  manner  c l a s s i f i e d  learning  common  was  perceived  summary  needs  similar  as  need  general  were  described.  The  mucus  to  systematic  learning a  problems  of  of  relation  most  problems  needs  learning  in  needs,  have  a  health  investigator's in  a  in is  similar  the  occurs  categories  detail  represents  according  analysis  In  study,  and  data  airways  sub-categorized  learning  i n d i v i d u a l l y  sample,  lung  category.  this  young  clear  names  consistent  of  health common  with  the  categories. have need be  been for  safety  considered  c l a s s i f i e d  as  and of  a  learning  90  needs a s s o c i a t e d  with symptom c o n t r o l problems,  n e v e r t h e l e s s they i l l u s t r a t e learning For  40% (n=8) reported  do r e l a x a t i o n  which i n v e s t i g a t e d a myocardial  stress  learning  revealed  sample.  findings  O b t a i n i n g knowledge of medications  need i d e n t i f i e d by another 40% (n=8) of This  f i n d i n g i s also  s i m i l a r to the  i n Casey et a l . ' s ( 1983) study which  determined  that  patients  medication s i d e - e f f e c t s .  wished to gain  knowledge of  Given some of the unpleasant  and u n f o r t u n a t e experiences that this  patients  needs; i n f a c t , i t  and s i d e - e f f e c t s of asthma  was a l e a r n i n g this  one.  that  some p a r t i c i p a n t s i n  study experienced due to the s i d e - e f f e c t s of  m e d i c a t i o n s , the i d e n t i f i c a t i o n of t h i s l e a r n i n g i s not a s u r p r i s i n g f i n d i n g . the  participants  causal that  after  with t h e i r emotions  and s t r e s s was one of t h e i r l e a r n i n g  functions  research,  needs of p a t i e n t s  how to deal  was t h e i r most important  how to  and emotions  1  the l e a r n i n g  study.  learning  Casey et a l . s ( 1983)  i n f a r c t i o n , also  that  in this  that  techniques to c o n t r o l  would be b e n e f i c i a l .  the  diversity in  needs among the p a r t i c i p a n t s  instance,  reported  the vast  factors  learning  specific  stated  Forty  percent  need  (n=8) of  they wished knowledge  of the  i n asthma, another 35% (n=7) maintained how to c o n t r o l  t h e i r environments was a  need; while 25% (n=5) reported  they  wanted  91  more knowledge of the h e r e d i t y Finally,  factors  another 20% (n=4) pointed  to l e a r n more i n respect asthma.  These f i n d i n g s  i n asthma.  out that  they needed  to the long-term prognosis of are s i m i l a r to the f i n d i n g s i n  Gerrard  and Peterson's (1984) and Casey et a l . ' s (1983)  studies  which i l l u s t r a t e d  perceived and  that  relation  cardiac  of myocardial i n f a r c t i o n s .  learning  needs which were s u b - c a t e g o r i z e d i n  to the need f o r mastery may  classified  patients  they needed knowledge of r i s k f a c t o r s ,  the e t i o l o g y Two  that  as l e a r n i n g  be i n d i r e c t l y  needs a s s o c i a t e d  problems because i t Is assumed  that  with needed  related  pathophysiology knowledge and knowledge of how with asthma cope with t h e i r h e a l t h  problems may  i n d i v i d u a l s with t h e i r symptom c o n t r o l identified  learning  classified  within  in learning  t h i s common l e a r n i n g  T h i r t y percent (n=6) s t a t e d  assist  problems.  needs are as f o l l o w s  demonstrate the d i f f e r e n c e s  others  These  and needs  need  they r e q u i r e d  category.  knowledge of  asthma p a t h o p h y s i o l o g y , another 25% (n=5) reported they wished to l e a r n of how  others with asthma  themselves, and to l e a r n from these i n d i v i d u a l s they cope with t h e i r problems. similar  to what was  which i n v e s t i g a t e d  found  This  i n Forsyth  the l e a r n i n g  last  that  perceive how  finding is  et a l . s study, 1  needs of c h r o n i c a l l y  92  ill  patients;  that  i s , patients  appreciated  o p p o r t u n i t y to l e a r n from other p a t i e n t s situation  to t h e i r  control The  as l e a r n i n g  be  needs a s s o c i a t e d  second category of l e a r n i n g  with  with l i f e s t y l e  needs of  differences  that  exist in  The  following  problems.  Pacing  sub-categorized  techniques i n  i n r e l a t i o n to  need f o r balance between p r o d u c t i o n and energy, was classified  reported  by 40%  as a l e a r n i n g  restrictions  i n sports  (n=8)  and  may  need necessary  activities.  need f o r intake referred  of  be  to maintain healthy e a t i n g are that  consistent  i s , chronically i l l  related To  to r e c r e a t i o n a l summarize, the  i n r e l a t i o n to  These  activities  may  findings  et a l . ( 1984)  patients  learning  t a i l o r e d to  needed knowledge "of  patterns.  with what F o r s y t h  generally  nourishment,  to as what p a r t i c i p a n t s  of  to cope with  Diets  food, f l u i d :  the  utilization  i n d i v i d u a l s with asthma, s u b - c a t e g o r i z e d  be  are  vary i n r e l a t i o n to t h i s  need c a t e g o r y .  which was  be  t h i s type although i n d i v i d u a l  in perception  common l e a r n i n g  the  symptom  needs may  i n terms of commonalities  association  sports,  needs may  problems.  classified  learning  in a s i m i l a r  own.  In summary, these l e a r n i n g categorized  the  desired and  found,  information  diet.  needs j u s t  described  93  may  be  categorized  as of a common type.  commonly c o n c e p t u a l i z e d with l i f e s t y l e One  last  as  l e a r n i n g needs  was  associated  l e a r n i n g need may  be g e n e r a l l y  with s o c i a l i n t e r a c t i o n  o t h e r s , which has  been  sub-categorized  the need f o r l o v e , belongingness and  identified  participants.  as a l e a r n i n g need by  To  that  cardiac on how  summarize, one  learning  (n=3)  1  information  participants  15%  in this  patients  social  of  to modify personal  be  categorized  they  factors.  l e a r n i n g need perceived  study may  the  study  perceived  need to enable them to cope with  associated  dependence,  Casey et a l . s (1983) r e s e a r c h  also i l l u s t r a t e d required  classified  Maintenance of r e l a t i o n s h i p s with  significant within  be  problems.  as a l e a r n i n g need a s s o c i a t e d problems.  They may  by as a  their  i n t e r a c t i o n problems.  Summary The  l e a r n i n g needs perceived  with asthma who follows:  by  p a r t i c i p a t e d in this  l e a r n i n g needs a s s o c i a t e d  the  young  study were as with  symptom  c o n t r o l problems, l e a r n i n g needs a s s o c i a t e d lifestyle social that  problems, and  adults  with  l e a r n i n g needs a s s o c i a t e d  i n t e r a c t i o n problems.  p a r t i c i p a n t s ' perceptions  It has  with  been demonstrated  of s p e c i f i c  learning  94  needs d i f f e r e d were  although  common types  of l e a r n i n g needs  experienced. It  i s apparent  by t h i s  that the l e a r n i n g needs  sample p o p u l a t i o n  l e a r n i n g how lifestyle  clearly  placed  to c o n t r o l symptoms, how  and s o c i a l  interactions.  perceived  an emphasis on  to manage t h e i r  However, there  appears to be a l a c k of c o n s i s t e n c y i n the number and type of p e r c e i v e d self-esteem, lifestyles  h e a l t h problems which i n c l u d e d :  social  isolation, psychological,  and adjustment  problems compared  to the  number and type of l e a r n i n g needs that were subsequently  perceived.  be suggested. received  F i r s t , during  little  process  a s s o c i a t i o n with  perceptions  the c o g n i t i v e process  of t h e i r  problem r e l a t e d  problems.  i n v o l v e d i n problem-solving  to requirements  they experienced  with  and  when the  for health may  have b e l i e v e d  a particular  to asthma, they were  sufficiently  It i s  r e q u i r e some a s s i s t a n c e with  Second, some i n t e r v i e w e e s  t h a t , although  coping  interviews, participants  l e a r n i n g needs, p a r t i c u l a r l y  l e a r n i n g needs r e l a t e education.  may  of d e f i n i n g l e a r n i n g needs i n  that i n d i v i d u a l s  i n determining  for this  guidance from the i n v e s t i g a t o r i n the  problem-solving  possible  S e v e r a l reasons  health  nevertheless  i t , and t h e r e f o r e d i d not  95  require  further information.  speculated  that a l a c k of knowledge among the  interviewees may  T h i r d , the i n v e s t i g a t o r  of the current  be a f a c t o r .  extended r o l e of the nurse  Hence, the interviewees  nurses i n the r o l e of a s s i s t i n g them with l e a r n i n g needs a s s o c i a t e d  with symptom  may  envisage  their  control  problems, more so than with a s s i s t i n g them with psychological Finally,  their  and s o c i a l problems. the i n v e s t i g a t o r found  that  the b a s i c  human needs premised w i t h i n The U.B.C. Model f o r Nursing  (1980) provided  sub-categorize in relation did  a u s e f u l means to  the h e a l t h problems and l e a r n i n g needs  to need s u b - c a t e g o r i e s .  not provide  an e f f e c t i v e means to c a t e g o r i z e  l e a r n i n g needs and h e a l t h commonalities health needs  Nonetheless, i t the  problems i n terms of broad  that e x i s t , because common types of  problems and l e a r n i n g needs e x i s t across  the  categories.  Relationships Personal  Between  Variables  Selected  Demographic and  and Perceived  Learning  Needs  Overview The p e r c e i v e d  l e a r n i n g needs of young a d u l t s  asthma were r e l a t e d to s e l e c t e d  demographic and  with  96  p e r s o n a l v a r i a b l e s , and F i s h e r ' s Exact Test was determine  the s t a t i s t i c a l  relationships.  A probabilty  judgements of s t a t i s t i c a l A r e l a t i o n s h i p was d i a g n o s i s and asthma. less  significance level  found  of the  of .05 was  set f o r  between time s i n c e  the l e a r n i n g need of pathophysiology  More p a r t i c i p a n t s  in this  study,  of  diagnosed  than 1 year to 5 y e a r s , p e r c e i v e d pathophysiology Table  v a r i a b l e frequency d i s t r i b u t i o n relation Table  17 i l l u s t r a t e s  the  among the sample i n  to the p e r c e i v e d l e a r n i n g  need.  17  R e l a t i o n s h i p Between Length  of Time Diagnosed  L e a r n i n g Need Pathophysiology  Length  No  5  2  1  12  F i v e years to 30 years  ** F = 5, p <.01,  related  F i s h e r ' s Exact Test  a l s o determined to wanting  other persons  of asthma  Yes  1 year to 5 years  It was  the  of time  diagnosed  than  and  of Asthma  Pathophysiology  was  to  significance.  of asthma as a l e a r n i n g need.  Less  used  that  time  since diagnosis  to l e a r n of the p e r c e p t i o n s of  with asthma and  their  coping  strategies.  97  More young a d u l t s i n t h i s  study, diagnosed  year to 5 years, i d e n t i f i e d with asthma and need.  Table  distribution perceived Table  their  than 1  the p e r c e p t i o n s of others  coping  strategies  18 shows the v a r i a b l e  as a l e a r n i n g  frequency  among the sample i n r e l a t i o n  learning  less  to the  need.  18  R e l a t i o n s h i p Between Length  of Time Diagnosed  Learning Need P e r c e p t i o n s of Others  and  the  With Asthma and  T h e i r Coping S t r a t e g i e s  P e r c e p t i o n of others asthma and  their  with  coping  strategies Length  of time  diagnosed  Less  than  1 year to 5 years  F i v e years to 30 years  * F = 4, p <.05, The due  frequency  No  4  3  1  12  Test  with which p r o f e s s i o n a l  to asthma, i s sought  need, long-term who  F i s h e r ' s Exact  Yes  was  related  prognosis of asthma.  h e a l t h care,  to the  learning  More p a r t i c i p a n t s  sought  out p r o f e s s i o n a l h e a l t h care due  to asthma 3  to 4 times  per year p e r c e i v e d the long-term  prognosis  of  asthma as a l e a r n i n g need.  Table  19 shows the  98  variable  frequency d i s t r i b u t i o n  relation  to the perceived  among the sample i n  learning  need.  Table 19 Relationship  Between How Often P r o f e s s i o n a l  H e a l t h Care  Due To Asthma Is Sought and the L e a r n i n g Need Long-Term Prognosis of Asthma  Long-term prognosis of Frequency health  professional  care,  asthma  due to  asthma, i s sought  Occassionally per  or 1 to 2 times  Yes  No  0  11  4  5  year  Three to 4 times per year  * F = 4, p <.05, F i s h e r ' s  Exact  Test  F i n a l l y , whether or not the p a r t i c i p a n t s had dependents ( c h i l d r e n ) was a demographic  variable  related  factors in  asthma.  to the l e a r n i n g  need h e r e d i t a r y  More young a d u l t s  in this  dependents ( c h i l d r e n ) p e r c e i v e d asthma as a l e a r n i n g  need.  study who had  hereditary  factors in  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  relation  to the perceived  among the sample i n  learning  need.  99  Table  20  R e l a t i o n s h i p Between Having  Dependents ( C h i l d r e n ) and  the L e a r n i n g Need H e r e d i t a r y F a c t o r s i n Asthma.  Hereditary in  Dependents ( c h i l d r e n )  No  Yes  5  6  No  0  9  F i s h e r ' s Exact  The four s t a t i s t i c a l are understandable  from  Test  relationships  a clinical  example, those r e c e n t l y diagnosed to be i n the process  asthma p e r c e i v e t h e i r them, compared  I t i s understandable  about the  other persons  have had asthma f o r many that those who  p a r t i c i p a n t s with asthma wished  perceived  they were  with  they cope with  sought  p r o f e s s i o n a l h e a l t h care more f r e q u e n t l y than  prognosis of asthma.  For  with asthma are more  problems, and how  to those who  d e s c r i b e d above  perspective.  of l e a r n i n g  nature of asthma, of l e a r n i n g how  years.  asthma  Yes  * F = 0, p <.05,  likely  factors  other  to l e a r n of the  These i n d i v i d u a l s s u f f e r i n g more from  perhaps asthma, were  100  sicker  than  again.  the  others,  and  wished  Hence, u n d e r s t a n d a b l y  from  their  with  the  physician  long-term  understandable individuals  from  with  they  frequently  prognosis  of  a clinical  children  developing  learn  the  hereditary  factors  with  asthma who  had  of  persons  become  sought  and  and  no  well  assistance  were more  asthma.  concerned  Finally,  perspective  c h i l d r e n were asthma  to  to  find  concerned  about  therefore  wished  i n asthma  i t is that  their to  compared  to  children.  Summary The the  statistical  personal  variables  variables  were r e l a t e d  Specifically, diagnosed, asthma related  how  i t was  to  one  of  the  perceived that  professional  and  specific  and  determined  determined  often  i s sought, to  analysis  having  perceived  that  two  of  demographic  learning length  health  dependents learning  needs. of  care  time, due  (children) needs.  to were  101  CHAPTER FIVE  Summary, C o n c l u s i o n s ,  I m p l i c a t i o n s , and Recommendations  Overview This chapter conclusions  presents  a summary of the study,  to be drawn from the f i n d i n g s , i m p l i c a t i o n s  of the f i n d i n g s f o r n u r s i n g p r a c t i c e and n u r s i n g education,  and recommendations  for further research.  Summary The concern  impetus f o r doing  f o r the meaningfulness and r e l e v a n c y  education,  provided  by nurses,  asthma of the e x t r i n s i c  type.  to d e s c r i b e the p e r c e p t i o n s asthma.  First,  problems r e l a t e d of t h e i r  t h i s r e s e a r c h was founded on  their  of h e a l t h  f o r young a d u l t s The study's  purpose was  of young a d u l t s  perceptions  of t h e i r  to asthma; second, t h e i r  with  with health  perceptions  a s s o c i a t e d l e a r n i n g needs, and t h i r d 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  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 The  r a t i o n a l e f o r the study  was d e r i v e d  assumptions held by some s o c i o l o g i s t s , s o c i o l o g i s t s , nurse educators, learning  theorists.  l e a r n i n g needs. from  medical  and c o g n i t i v e f i e l d  102  Current a l l i e d relevant  health  to t h i s study, was  following.  First,  multiple,  appears that  health  as the  pulmonary d i s e a s e are within  professionals.  the l e a r n i n g  illness,  primarily  Second, i t  needs of p a t i e n t s  as i d e n t i f i e d from t h e i r  focus on what they perceived  various  with a perspective,  they needed to  to cope with t h e i r problems experienced i n  chronic that  obstructive  and they have been d e s c r i b e d  contexts by a l l i e d  learn  summarized  was  the problems of i n d i v i d u a l s with  asthma and/or c h r o n i c  chronic  l i t e r a t u r e , which  illness.  Third,  r e l a t i o n s h i p s may  research  studies  e x i s t between  illustrated  selected  demographic and personal v a r i a b l e s , and the learning  needs of p a t i e n t s .  education  focus provided  most c r u c i a l l e a r n i n g attention  F o u r t h , the  by nurses may  needs of p a t i e n t s  appears to be d i r e c t e d  psychological  toward  and s o c i a l problems.  health  not address the because  Instead,  toward a s s i s t i n g p a t i e n t s  skills  the p a t h o p h y s i o l o g i c a l  associated  with  with  coping  symptoms  design using- survey  used to address the research  Twenty young a d u l t s , asthma  emphasis  asthma.  A d e s c r i p t i v e research methodology was  little  patients  has been d i r e c t e d to c o n t r o l  perceived  between  problem.  the ages of 20-45 who  of the e x t r i n s i c type, p a r t i c i p a t e d  in this  had  103  study.  Data were c o l l e c t e d using  a demographic and personal  two q u e s t i o n n a i r e s :  closed-ended  interview  schedule (Appendix A ) , and a s e m i - s t r u c t u r e d i n t e r v i e w schedule (Appendix B ) . interview  The  open-ended  semi-structured  schedule was used to o b t a i n  the perceptions  of young a d u l t s of t h e i r h e a l t h problems, due to asthma, and of t h e i r  associated  l e a r n i n g needs.  concepts i n The U.B.C. Model f o r Nursing instrumental  provided  Nursing  Data were f i r s t  (1980).  sub-categorized i n Second, common  of h e a l t h problems and l e a r n i n g needs were  generated by determining perceived  b a s i c human  by The U.B.C. Model f o r  to the need c a t e g o r i e s .  categories  schedule.  by the nine  needs c a t e g o r i e s  relation  (1980) were  i n the c o n s t r u c t i o n of t h i s  Data a n a l y s i s was f a c i l i t a t e d  Key  similarities  both i n the  h e a l t h problems and a s s o c i a t e d  found w i t h i n and across  need c a t e g o r i e s .  a n a l y s i s was done using  F i s h e r ' s Exact  determine r e l a t i o n s h i p s between and personal  A probability level  Statistical  Test to  selected  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  demographic  l e a r n i n g needs.  of .05 was set f o r judgements of  statistical significance. The f i n d i n g s revealed  that  the common  problems of young a d u l t s with  asthma were:  symptom c o n t r o l , s e l f - e s t e e m ,  social  health lifestyle,  isolation,  104  adjustment, p s y c h o l o g i c a l Common l e a r n i n g control  needs were a s s o c i a t e d  (the m a j o r i t y  of the l e a r n i n g  identified), lifestyle, needs described  multiple  health  needs The  d i d not however address the  problems which had been i d e n t i f i e d by  the  sample.  In a d d i t i o n ,  two  personal v a r i a b l e s  how f r e q u e n t l y  with symptom  and i n t e r a c t i o n problems.  learning  was  and i n t e r a c t i o n problems.  relationships  (length  professional  existed  between  of time diagnosed and  health  care due to asthma  sought), and one demographic v a r i a b l e  d e p e n d e n t s — c h i l d r e n ) and perceived  (having  learning  needs.  Conclusions The  following  may be concluded  Among the young adults this  concluded  needs e x i s t . that  been e s t a b l i s h e d  that  This  learning  i t may be problems  needs were  multiple  f i n d i n g i s congruous with what has  previously  literature.  i n the published  I t i s a l s o apparent  allied  i n the f i n d i n g s  a broad spectrum of d i v e r s i t y i n p e r c e p t i o n s of  s p e c i f i c health the  suggest  among t h i s sample, the h e a l t h  pervasive.  health  problems and  These f i n d i n g s  experienced and a s s o c i a t e d and  study.  with asthma who p a r t i c i p a t e d i n  study, common types of h e a l t h  learning  from t h i s  problems and l e a r n i n g  p a r t i c i p a n t s , and that  personal v a r i a b l e s  needs e x i s t among  three demographic or  were s t a t i s t i c a l l y  r e l a t e d to  105  perceived  l e a r n i n g needs.  I t may  be concluded, on the  b a s i s of these f i n d i n g s , that d i v e r s i t y i n a s s o c i a t e d l e a r n i n g needs among the sample i s r e l a t e d i n some instances Finally,  to demographic and p e r s o n a l  variables.  the l e a r n i n g needs of young a d u l t s with  did not c o n s i s t e n t l y address the m u l t i p l e psychological but  focused  s o c i a l and  problems which they experienced,  on symptom c o n t r o l , l i f e s t y l e  interaction there  health  asthma  problems.  Hence  i t may  and  be concluded  that  i s incongruence between the h e a l t h problems  perceived  and the a s s o c i a t e d  l e a r n i n g needs of the  sample. The above c o n c l u s i o n s of a small extrinsic the  were based  convenience sample of 20 young adults asthma.  asthma of the e x t r i n s i c conclude that  type,  of a l l young a d u l t s and t h e r e f o r e  the f i n d i n g s are g e n e r a l i z a b l e  sample populations  Implications  not  new  with  cannot to other  f o r Nursing P r a c t i c e  f o r nursing  education  provided  study suggest  been professed  several  p r a c t i c e and i n p a r t i c u l a r f o r by nurses.  Most of them are  or unique but are a r e i t e r a t i o n  previously  that  of s i m i l a r c h a r a c t e r i s t i c s .  The f i n d i n g s drawn from t h i s implications  with  The i n v e s t i g a t o r does not c l a i m  sample i s r e p r e s e n t a t i v e  health  on the responses  i n nursing  of what  literature.  has  106  To  begin,  described adults  in this  with  Also,  between  suggest  that  individuals identified  does as  any  assists  learning  of t h e i r  i n the i n i t i a l  health  education,  reference. nurses' needs in  with This  asthma  of i n d i v i d u a l s w i t h  unique  client  The  their is with of  to o b t a i n and  and  health problematic asthma.  information needs  of  frame of  to b r o a d e n  and  problems  supplement  and  and w i l l  the d i f f i c u l t i e s  which  planning  learning  content  learning  which  phase  asthma,  the s e l e c t i o n o f t e a c h i n g  of  grave l i m i t a t i o n s  what  from t h e i r  serve  needs  education  experience  of the h e a l t h  to a d d r e s s  has  given  problems  will  knowledge  attempts  problems  education  need  may  f o r the i n d i v i d u a l ' s  assessment  nurses  the h e a l t h  adults  needs  and  variables  learning  form of h e a l t h  health  young  comprehensively  i n d i v i d u a l s with  Hence,  young  and  the i n d i v i d u a l ,  them i n terms  regarding  health  of  diverse,  personal  consideration  to p r o v i d e  and  and  needs  relationships  c a n n o t be  of h e r / h i s  not a d d r e s s  learning  the p e r s p e c t i v e  problems  asthma  Therefore,  problems for  demographic  with  effectively  from  and  the f i n d i n g t h a t  without  a means  problems  were m u l t i f a c e t e d ,  the h e a l t h  understanding needs.  study,  asthma,  pervasive. exist  the h e a l t h  which  learning  facilitate ostensibly  specific  to  this  group.  health  problems  and  associated  learning  needs  107  as d e s c r i b e d i n t h i s  study, from  young a d u l t s with asthma, may  the p e r s p e c t i v e of  facilitate  i n the  development of a more comprehensive understanding the experience of l i v i n g affect  with asthma and  a l l basic human needs and  living.  This h o l i s t i c  understanding  and  of d e s c r i b i n g  i t s a s s o c i a t e d problems,  i t can  a l l f a c e t s of  daily  of the impact  asthma i s r e p r e s e n t a t i v e of a departure t r a d i t i o n a l way  how  of  from  of  the more  the experience of asthma w i t h i n the context of the  medical model, which focuses on the d i s e a s e and i t s ' symptomatology.  Examination  of 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 from young a d u l t s ' p e r c e p t i o n s may  also indicate  broaden t h e i r  areas i n which nurses may  c l i n i c a l knowledge and  they can more e f f e c t i v e l y  assist  need to  e x p e r t i s e , so  individuals  with  asthma both through  h e a l t h education and  in general  clinical  For i n s t a n c e , nurses  may  practice.  c o n s u l t with other h e a l t h p r o f e s s i o n a l s nutritionists,  and  effectively assist their  lifestyle The  s p o r t s medicine individuals  such  that  need to as  experts to most  i n coping with some of  problems.  study determined  that  the l e a r n i n g  needs of  young a d u l t s with asthma are a s s o c i a t e d with symptom control, l i f e s t y l e concluded  that  and  social  interaction  problems,  the l e a r n i n g needs i d e n t i f i e d  c o n s i s t e n t l y address  the m u l t i p l e s o c i a l  and  d i d not  and  108  psychological as  described  described. in  problems which  in this This  study,  defining this  may  their  study  implies  assist  that  regard.  evident,  social  need  with  asthma  vary  markedly  experiences. individuals' obtained a nursing with  of  conceptual  the n u r s i n g  process.  have the w i t h the  suggest  health  their  health  of  problems  perceptions  can  illness  (1983) suggested  of t h e i r  model  to make  the p e r c e p t i o n s  to p e r s o n s '  i n a comprehensive  resource i n  study  i n teaching  regarding  and D u f f y  deal  in this  to o b t a i n  perceptions  function i s  individuals.  l e a r n i n g needs b e c a u s e  Rankin  It also  need  they  to e f f e c t i v e l y  according  nurses i n  and  will  p r a c t i c e , that  the c o n c l u s i o n s  nurses  associated  their  social  i s so, nurses  their  that  i n d i v i d u a l s are not  in practice, specifically  individuals  from  can be an a p p r o p r i a t e  If this  summary,  It infers  the p a r t i c i p a n t s i n  purport  their  perhaps  and e x p e r t i s e  education,  and  than  and p s y c h o l o g i c a l needs  In that  nurses  nurses  through  knowledge  education.  the i n v e s t i g a t o r .  i n d i v i d u a l s with  cognizant  the p e r s p e c t i v e of  more a s s i s t a n c e  from  needs,  had been  has i m p l i c a t i o n s f o r n u r s e s  l e a r n i n g needs  although  psychological  this  require  received  that  from  conclusion  the p r o v i s i o n of h e a l t h  individuals  to  health  that  l e a r n i n g needs may be  and s y s t e m a t i c  way  by  using  in practice, i n conjunction They  explicitly  stressed  109  that  nurses  learning  may  needs  obtain learner perceptions i n the  following  of  their  way,  L e a r n i n g needs a r e d e f i n e d when a n u r s e a s s e s s e s the p a t i e n t , the a s s e s s m e n t f o r p a t i e n t e d u c a t i o n does not have to be s e p a r a t e from o t h e r p a t i e n t - a s s e s s m e n t activities. I n f o r m a t i o n 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 g a t h e r e d w i t h o t h e r d a t a about the p a t i e n t ' s condition. ( 1 9 8 3 , p. 114)  Therefore,  nurses  education,  which  individuals education applying process  with  to  the  multiple, belief  knowledge in  the  process  needs  of  d i v e r s e and that  asthma.  relevance  for  facilitate  by  becoming  i n the and  education  and  at  the  nursing  process.  the  health  adults with  pervasive. nurses  This  and  the  lends  such  of as  support  to  sciences,  well  nursing  provision  for individuals  as  are  thorough  social  process,  a systematic  problems  asthma  require a  biological  to  health  skillful  framework  that  learning  in u t i l i z i n g  the  Education  young  student  framework p r e p a r a t o r y health  and  conceptual  concluded  teaching  adeptness  health  meaning  for Nursing  base  preparing  health education  study  learning  with  a s t h m a , may  a nursing  This  the  has  planning  Implications  and  concerned  as  conceptual  meaningful those  with  110  Recommendations Proposals  for Further  for further research  health  problems  asthma  from  and  their  l e a r n i n g needs  perspective,  relationships  between  variables  perceived  1.  and  perceived young  type.  2.  A  this  health  to  determine  study  problems  cope w i t h  instrumental  with  follows: the  l e a r n i n g needs  of  serve  conclusions  as  the  extrinsic  to v a l i d a t e  in this how  their  p r o b l e m s may  in assisting  knowledge  persons with  of  nurses  how  persons  to g a i n  to most  asthma  the  study.  to d e t e r m i n e health  the  personal  determine  and  may  and  are  to  replication  studies  assist  individuals  asthma  Research  depth  of  adults with  and  in  investigate  l e a r n i n g needs  findings  asthma  and  to  s e l e c t e d demographic  R e p l i c a t i o n s of  of  Study  with be an  effectively  through  health  education. 3.  Research health  studies  problems  adolescents, with  these  differences and 4.  and  the could  using  to d e t e r m i n e  l e a r n i n g needs and  extrinsic determine  in perceptions  development  Studies  i n v e s t i g a t e the  middle-aged  asthma of  s u c h as  to  of  elderly type.  adults Studies  similarities  during  various  and ages  stages.  pre-structured the  perceived  health  questionnaires  problems  and  learning  Ill  needs  of young  their  perspective,  relationships personal needs. using  adults  Findings a different  functional findings  selected  focusing  on  d e m o g r a p h i c and  and p e r c e i v e d  from  learning  the p r o p o s e d  methodology  f o r comparison  in this  asthma,  and to i n v e s t i g a t e  between  variables  with  studies  could  purposes  be with  the  study.  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B i o s t a t i s t i c a l C l i f f s , New J e r s e y : Prentice  Analysis. Hall Inc.  Englewood  116  APPENDICES  117 Appendix A D e m o g r a p h i c 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  3.  Age?  4.  Occupation?  5.  Highest  6.  Confidant?  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 related ) ?  9.  How much does asthma i n t e r f e r e w i t h y o u r d a i l y needs and activities?  ( (  ) Female ) Male  (children)?  education attained? Who?  10.  Have you e v e r been h o s p i t a l i z e d b e c a u s e o f asthma?  11.  I f y e s , how many  12.  How many m e d i c a t i o n s t a k e f o r asthma?  13.  I f y e s , how o f t e n do you t a k e them?  14.  A l l e r g e n s and i r r i t a n t s w h i c h can p r e c i p i t a t e asthma?  15.  What m e d i c a l t r e a t m e n t i s p r e s c r i b e d f o r you, other m e d i c a t i o n s f o r asthma?  times? do you  than  ( ( ( (  ) ) ) )  Seldom Mildly Moderately Extensively  118  16.  How o f t e n do y o u s e e k professional h e a l t h c a r e due to asthma?  17.  Do  18.  How many t i m e s p e r exercise, and what exercise?  19.  Have you e v e r had related t o how t o F r o m whom?  you  smoke? week type  health manage  do of  you  education asthma?  119  Appendix B Interview  1.  What  impact  2.  Has asthma  caused  activities,  3.  the  to t h e i m p a c t  concerns  that  asthma  interviewer  remaining  you have i n  a l l of the n i n e  f o r Nursing  ask the p a r t i c i p a n t  needs.  f o r respect  the i n t e r v i e w e r  influenced  pattern?  any p r o b l e m s i n r e l a t i o n  specific  the need  others,  will  the way  F o r example,  of s e l f , will  you f e e l  daily  has had on you?  does not a d d r e s s  i n the The U.B.C. Model  has e x p e r i e n c e d  to  your l i f e s t y l e  o f any o t h e r  I f the p a r t i c i p a n t needs  had on you?  you any p r o b l e m s i n y o u r  or changed  Can you t h i n k relation  4.  has asthma  Schedule  (1980),* i f she/he to the  in relation  by s e l f and  a s k : has asthma about  y o u r s e l f and  others?  5.  6.  What k i n d s  of t h i n g s  that  could  help  What  questions  do you want  you manage  do you have  management, or about how  to know more about  the i m p a c t  of asthma?  about asthma, i t s  you can cope b e t t e r  with  it?  U.B.C. Model C o m m i t t e e . (1980). The U.B.C. M o d e l for Nursing. F a c u l t y o f N u r s i n g , 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 , V a n c o u v e r , B.C.  120 Appendix C 'Letter to the  Physician  Dear I am a Master's student i n nursing at the U n i v e r s i t y of B r i t i s h Columbia. The unique h e a l t h problems, and needs f o r h e a l t h education of young a d u l t s who have asthma are a major concern of mine. I b e l i e v e that a b e t t e r knowledge and understanding of t h i s c l i e n t group w i l l f a c i l i t a t e nurses and other h e a l t h p r o f e s s i o n a l s i n planning h e a l t h education that i s 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 l e a r n more about t h i s c l i e n t group. Therefore, I have planned a r e s e a r c h study to focus on young adults with asthma to i d e n t i f y and d e s c r i b e f i r s t , young adult p e r c e p t i o n s of t h e i r h e a l t h problems r e l a t e d to asthma; second, t h e i r perceptions of t h e i r l e a r n i n g needs; and t h i r d , 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. I w i l l need to i n t e r v i e w approximately twenty sample p a r t i c i p a n t s between the ages of 20-45 y e a r s . Would you be w i l l i n g f o r p o t e n t i a l p a r t i c i p a n t s to be r e c r u i t e d from your practice? Recruitment could occur i n the f o l l o w i n g way. C l i e n t s who meet the c r i t e r i a f o r the r e s e a r c h could be r e c r u i t e d as they come in to keep an appointment time at the c l i n i c or u n i t . They could be informed of the purpose of the reseach, and what would be i n v o l v e d i f they decide to participate. This i s explained i n d e t a i l i n a cover l e t t e r that may be given to p r o s p e c t i v e s u b j e c t s . 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 could leave t h e i r 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 i n t e r v i e w time. The  selection criteria  are as  follows:  1.  The  2.  Young a d u l t s diagnosed with e x t r i n s i c are between the ages of 20-45 y e a r s .  3.  Young adults with asthma, but major h e a l t h problems.  i n d i v i d u a l must speak E n g l i s h . asthma,  are without  and  other  122  Appendix D Physician  I,  the undersigned,  Richardson, consenting for  R.N., young  the p u r p o s e  Physicians'  Researcher's  Dated day  B.S.N.,  Consent  give  permission  (M.S.N. C a n d i d a t e )  adults with  asthma  of her r e s e a r c h  from  study.  Signature  Signature  at  of  to Heather  , this .  1985 .  my  to contact practice  123  Appendix E Cover  Dear  Letter  to  Participants  Participant:  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 at 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 . 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 of m i n e . Your unique e x p e r i e n c e w i t h asthma would g i v e v a l u a b l e i n f o r m a t i o n that would u l t i m a t e l y help other persons with asthma. I t would g i v e nurses 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 such as y o u r s e l f . I t would a l s o help nurses 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 h a v e 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 . Any i n f o r m a t i o n t h a t you are w i l l i n g to share of your 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 you w i t h your 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, at a t i m e c o n v e n i e n t to 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 a n a u d i o t a p e . T h e 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 , a n d 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 the 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 a n d my t h e s i s c o m m i t t e e (two n u r s i n g f a c u l t y members) w i l l have a c c e s s to the t a p e s . A t t h e end o f t h e s t u d y , the t a p e s w i l l be e r a s e d . You have the r i g h t to 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 to w i t h d r a w at any t i m e , w i t h o u t j e o p a r d i z i n g the health care you are 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 . U p o n 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 thesis. 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 the U . B . C . l i b r a r i e s .  125  Appendix F Participant  Consent  I, the undersigned, understand Heather  Richardson's  cover l e t t e r  the nature of  r e s e a r c h study as d e s c r i b e d i n the  and give my  consent  to p a r t i c i p a t e  i n her  research.  Participant's  Researcher's  Dated day of  at  Signature  Signature  , this  1985.  >  

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