951 resultados para Need for intervention


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The birth of a preterm infant is in most cases unexpected and can be a distressing experience for parents. Parents of premature babies report more stress, experience more adjustment difficulties and need for support during the first year after delivery compared to parents of infants born at term. It has been documented that parents may experience posttraumatic stress reactions, anxiety and depression following the premature birth of their baby, which subsequently may impact on the mother-baby-interactions, their attachment relationship and the cognitive, social and behavioural development of the baby. In this pilot study, we offered an expressive writing intervention to women who recently had a premature baby to alleviate their psychological distress and to improve their physical health. During the expressive writing intervention, women were asked to write down their deepest thoughts and feelings about the most traumatic aspect of their experience of having a premature baby for 15 min over three consecutive days. The aims of the study were as follows: (1) To evaluate the effect of expressive writing on psychological and physical health in women who recently had a premature baby. (2) To evaluate the effect of expressive writing on the use of healthcare services and medication in this population. (3) To evaluate the acceptability and feasibility of this intervention for this population. Forty participants were randomly allocated to either the expressive writing intervention group or a wait list control group. Pre- and post questionnaires to evaluate the effectiveness of the expressive writing intervention, as well as their acceptability and feasibility were completed. The intervention took place when the baby was 3 months of corrected age. Post-measures were completed at 1 and 3 months following the intervention. Results and their clinical implications will be discussed with regards to the implementation of this safe and cost-effective method as a preventative measure in the routine care of women who recently gave birth to a premature baby

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BACKGROUND: The burden of asthma on patients and healthcare systems is substantial. Interventions have been developed to overcome difficulties in asthma management. These include chronic disease management programmes, which are more than simple patient education, encompassing a set of coherent interventions that centre on the patients' needs, encouraging the co-ordination and integration of health services provided by a variety of healthcare professionals, and emphasising patient self-management as well as patient education. OBJECTIVES: To evaluate the effectiveness of chronic disease management programmes for adults with asthma. SEARCH METHODS: Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register, MEDLINE (MEDLINE In-Process and Other Non-Indexed Citations), EMBASE, CINAHL, and PsycINFO were searched up to June 2014. We also handsearched selected journals from 2000 to 2012 and scanned reference lists of relevant reviews. SELECTION CRITERIA: We included individual or cluster-randomised controlled trials, non-randomised controlled trials, and controlled before-after studies comparing chronic disease management programmes with usual care in adults over 16 years of age with a diagnosis of asthma. The chronic disease management programmes had to satisfy at least the following five criteria: an organisational component targeting patients; an organisational component targeting healthcare professionals or the healthcare system, or both; patient education or self-management support, or both; active involvement of two or more healthcare professionals in patient care; a minimum duration of three months. DATA COLLECTION AND ANALYSIS: After an initial screen of the titles, two review authors working independently assessed the studies for eligibility and study quality; they also extracted the data. We contacted authors to obtain missing information and additional data, where necessary. We pooled results using the random-effects model and reported the pooled mean or standardised mean differences (SMDs). MAIN RESULTS: A total of 20 studies including 81,746 patients (median 129.5) were included in this review, with a follow-up ranging from 3 to more than 12 months. Patients' mean age was 42.5 years, 60% were female, and their asthma was mostly rated as moderate to severe. Overall the studies were of moderate to low methodological quality, because of limitations in their design and the wide confidence intervals for certain results.Compared with usual care, chronic disease management programmes resulted in improvements in asthma-specific quality of life (SMD 0.22, 95% confidence interval (CI) 0.08 to 0.37), asthma severity scores (SMD 0.18, 95% CI 0.05 to 0.30), and lung function tests (SMD 0.19, 95% CI 0.09 to 0.30). The data for improvement in self-efficacy scores were inconclusive (SMD 0.51, 95% CI -0.08 to 1.11). Results on hospitalisations and emergency department or unscheduled visits could not be combined in a meta-analysis because the data were too heterogeneous; results from the individual studies were inconclusive overall. Only a few studies reported results on asthma exacerbations, days off work or school, use of an action plan, and patient satisfaction. Meta-analyses could not be performed for these outcomes. AUTHORS' CONCLUSIONS: There is moderate to low quality evidence that chronic disease management programmes for adults with asthma can improve asthma-specific quality of life, asthma severity, and lung function tests. Overall, these results provide encouraging evidence of the potential effectiveness of these programmes in adults with asthma when compared with usual care. However, the optimal composition of asthma chronic disease management programmes and their added value, compared with education or self-management alone that is usually offered to patients with asthma, need further investigation.

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Background Little is known about the types of ‘sit less, move more’ strategies that appeal to office employees, or what factors influence their use. This study assessed the uptake of strategies in Spanish university office employees engaged in an intervention, and those factors that enabled or limited strategy uptake. Methods The study used a mixed method design. Semi-structured interviews were conducted with academics and administrators (n = 12; 44 ± 12 mean SD age; 6 women) at three points across the five-month intervention, and data used to identify factors that influenced the uptake of strategies. Employees who finished the intervention then completed a survey rating (n = 88; 42 ± 8 mean SD age; 51 women) the extent to which strategies were used [never (1) to usually (4)]; additional survey items (generated from interviewee data) rated the impact of factors that enabled or limited strategy uptake [no influence (1) to very strong influence (4)]. Survey score distributions and averages were calculated and findings triangulated with interview data. Results Relative to baseline, 67% of the sample increased step counts post intervention (n = 59); 60% decreased occupational sitting (n = 53). ‘Active work tasks’ and ‘increases in walking intensity’ were the strategies most frequently used by employees (89% and 94% sometimes or usually utilised these strategies); ‘walk-talk meetings’ and ‘lunchtime walking groups’ were the least used (80% and 96% hardly ever or never utilised these strategies). ‘Sitting time and step count logging’ was the most important enabler of behaviour change (mean survey score of 3.1 ± 0.8); interviewees highlighted the motivational value of being able to view logged data through visual graphics in a dedicated website, and gain feedback on progress against set goals. ‘Screen based work’ (mean survey score of 3.2 ± 0.8) was the most significant barrier limiting the uptake of strategies. Inherent time pressures and cultural norms that dictated sedentary work practices limited the adoption of ‘walk-talk meetings’ and ‘lunch time walking groups’. Conclusions The findings provide practical insights into which strategies and influences practitioners need to target to maximise the impact of ‘sit less, move more’ occupational intervention strategies.

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INTRODUCTION: Malnutrition is multifactorial and may be modified by nutritional intervention. We aimed to assess the impact of an intervention on the nutritional status of malnourished hemodialysis patients and their acceptance of a non-industrialized nutritional supplement. METHODS: 18 patients were studied, they were selected from a previous nutritional assessment where nutritional risk was defined as: subjective global assessment > 15 plus one criterion for malnutrition. The following variables were assessed: anthropometric parameters, subjective global assessment, dietary intake, six-minute walking test, quality of life (SF-36), and biochemical tests. Patients were randomized to either Control or Intervention Groups. The Intervention Group received a dietetic supplement during dialysis containing 355 kcal, prepared from simple ingredients. After three months, subjects from the Control Group and other patients also considered at nutritional risk underwent the same intervention. The study groups were compared after three months, and all patients were analyzed before and after the intervention. RESULTS: Fifteen men and three women, aged 56.4 ± 15.6 years-old, nine in each group, were studied. The Intervention Group showed an improvement in the subjective global assessment (p = 0.04). There were differences in role physical and bodily pain domains of SF-36, with improvement in the Intervention Group and worsening in the Control Group (p = 0.034 and p = 0.021). Comparisons before and after intervention for all patients showed improvement in the subjective global assessment (16.18 ± 4.27 versus 14.37 ± 4.20, p = 0.04), and in the six-minute walking test (496.60 ± 132.59 versus 547.80 ± 132.48 m; p = 0.036). The nutritional supplement was well tolerated by all patients, and it did not cause side effects. CONCLUSIONS: The nutritional intervention improved the subjective global assessment and quality of life of hemodialysis patients at short-term. A global intervention by a dietitian produced specific and nonspecific positive effects in the whole group. Nutritional supplementation was feasible, palatable, and had low cost. Its clinical impact and effectiveness need to be further assessed in a larger group of patients at long-term.

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Physical inactivity poses a huge burden on Canada's health care system and is detrimental to the health of Canadians (Katzmarzyk & Janssen, 2004). Walking is a viable option for individuals to become physically active on a daily basis and is in fact the most commonly reported leisure time physical activity. It has been associated with many health benefits including weight loss/weight control, reduced risk of coronary artery disease and diabetes, lowered blood pressure, and improved psychological wellbeing (Brisson & Tudor-Locke, 2004). Specifically, individuals' stage of change, selfefficacy and health related quality of life (HRQL) are three psychological constructs that can be greatly improved with increased physical activity (Dishman, 1991; Penedo & Dahn, 2005; Poag & McAuley, 1992). Public health physical activity recommendations exist but many individuals find these difficult to meet due to overly busy lifestyles (Public Health Agency of Canada, 2003). Pedometers are inexpensive devices that can monitor individual bouts of walking so that the incorporation of physical activity into one's daily life is more plausible. They are also excellent tools for motivation, goalsetting, and immediate feedback (Brisson & Tudor-Locke, 2004). Since many people spend a large proportion of their time at their places of employment, workplaces have begun to be a common site for the development of physical activity interventions. These programs have been growing in popUlarity and have shown numerous benefits for both employees and employers (Voit, 2001). The purpose of the current study was to implement and evaluate the use of a pedometer-based physical activity intervention incorporating goal-setting and physical activity logs in a workplace setting, and to examine the relationship between different types of self-efficacy (task, barrier, and scheduling) and different phases of the intervention. Twenty male participants from a local steel manufacturing plant who exhibited health risk factors (e.g. hypertension, diabetes, etc.) were assigned to one of two groups (group A or group B). All participants were asked to wear pedometers on their waists, record their daily steps, set goals that were outlined on a step-tracking sheet (detennined by their baseline number of steps), and keep track of their work days, wakelbed time, sedentary time, and time spent doing other physical activity. Group A began the intervention immediately following the baseline measures, whereas group B continued with their regular routine for 4 weeks before beginning. Physiological measures (height, weight, blood pressure, relative body fat, waist and hip circumference, and body mass index) were taken and a battery of questionnaires that assessed barrier, task and scheduling self-efficacy, HRQL, and stage of change administered at baseline, week 5 (end of intervention for group A), week 9 (end of intervention for group B; follow-up for group A) and week 13 (follow-up for both groups). Results showed that this workplace physical activity intervention was successful at increasing the participants' daily steps, that task self-efficacy is a significant predictor of participants' exercise adherence during the initial stages of participation (intervention phase), and that the participants felt that this intervention was effective. Finally, further exploratory analyses showed that this intervention was effective for all participants, but most valuable for participants most in need of improvement - that is, those who were most sedentary prior to the intervention. This intervention is an inexpensive use of simple and effective tools (e.g. pedometers), has the potential to attract a wide variety of participants and become a pennanent part of any health promotion initiative.

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Forty-five 12- and 13-year-old females attending Grade 7 in North York, Ontario were randomly selected from a group of 100 females who had volunteered to participate in a oneday hands-on workshop called It's Your Choice at Seneca College. The goals of this intervention were to broaden the career horizons of these students and to help them realize the need to continue mathematics and science through high school in order to keep occupational options unlimited. The young women were given a pre- and post-attitude survey to provide background information. In the month following participation in the workshop the students were interviewed in small groups (S students per group) to discover their perceptions of the impact of the workshop. The interviews revealed that participants felt that after the workshop their feelings of self-confidence increased, specifically with respect to working with their hands. Participants felt more aware of the usefulness and importance of the study of mathematics, science and technology, They also felt that It's Your Choice increased their interest in careers in these domains and helped them to see that these careers are viable choices for females. The interviews also revealed that many of the participants felt that in this society their roles and their choices were influenced and probably limited by the fact that they are female.

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This study probed for an answer to the question, "How do you identify as early as possible those students who are at risk of failing or dropping out of college so that intervention can take place?" by field testing two diagnostic instruments with a group of first semester Seneca College Computer Studies students. In some respects, the research approach was such as might be taken in a pilot study. Because of the complexity of the issue, this study did not attempt to go beyond discovery, understanding and description. Although some inferences may be drawn from the results of the study, no attempt was made to establish any causal relationship between or among the factors or variables represented here. Both quantitative and qualitative data were gathered during. four resea~ch phases: background, early identification, intervention, and evaluation. To gain a better understanding of the problem of student attrition within the School of Computer Studies at Seneca College, several methods were used, including retrospective analysis of enrollment statistics, faculty and student interviews and questionnaires, and tracking of the sample population. The significance of the problem was confirmed by the results of this study. The findings further confirmed the importance of the role of faculty in student retention and support the need to improve the quality of teacher/student interaction. As well, the need __f or ~~ills as~e:ss_~ent foll,,-~ed }JY supportiv e_c_ounsell~_I'l9_ ~~d_ __ placement was supported by the findings from this study. strategies for reducing student attrition were identified by faculty and students. As part of this study, a project referred to as "A Student Alert project" (ASAP) was undertaken at the School of Computer Studies at Seneca College. Two commercial diagnostic instruments, the Noel/Levitz College Student Inventory (CSI) and the Learning and Study Strategies Inventory (LASSI), provided quantitative data which were subsequently analyzed in Phase 4 in order to assess their usefulness as early identification tools. The findings show some support for using these instruments in a two-stage approach to early identification and intervention: the CSI as an early identification instrument and the LASSI as a counselling tool for those students who have been identified as being at risk. The findings from the preliminary attempts at intervention confirmed the need for a structured student advisement program where faculty are selected, trained, and recognized for their advisor role. Based on the finding that very few students acted on the diagnostic results and recommendations, the need for institutional intervention by way of intrusive measures was confirmed.

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This study probed for an answer to the question, "How do you identify as early as possible those students who are at risk of failing or dropping out of college so that intervention can take place?" by field testing two diagnostic instruments with a group of first semester Seneca College Computer ,Studies students. In some respects, the research approach was such as might be taken in a pilot study_ Because of the complexity of the issue, this study did not attempt to go beyond discovery, understanding and description. Although some inferences may be drawn from the results of the study, no attempt was made to establish any causal relationship between or among the factors or variables represented here. Both quantitative and qualitative data were gathered during four resea~ch phases: background, early identification, intervention, and evaluation. To gain a better understanding of the problem of student attrition within the School of Computer Studies at Seneca College, several methods were used, including retrospective analysis of enrollment statistics, faculty and student interviews and questionnaires, and tracking of the sample population. The significance of the problem was confirmed by the results of this study. The findings further confirmed the importance of the role of faculty in student retention and support the need to improve the quality of teacher/student interaction. As well, the need for skills assessmen~-followed by supportive counselling, and placement was supported by the findings from this study. strategies for reducing student attrition were identified by faculty and students. As part of this study, a project referred to as "A Student Alert Project" (ASAP) was undertaken at the School of Computer Studies at Seneca college. Two commercial diagnostic instruments, the Noel/Levitz College Student Inventory (CSI) and the Learning and Study Strategies Inventory (LASSI), provided quantitative data which were subsequently analyzed in Phase 4 in order to assess their usefulness as early identification tools. The findings show some support for using these instruments in a two-stage approach to early identification and intervention: the CSI as an early identification instrument and the LASSI as a counselling tool for those students who have been identified as being at risk. The findings from the preliminary attempts at intervention confirmed the need for a structured student advisement program where faculty are selected, trained, and recognized for their advisor role. Based on the finding that very few students acted on the diagnostic results and recommendations, the need for institutional intervention by way of intrusive measures was confirmed.

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Research points clearly to the need for all concerned stakeholders to adopt a preventative approach while intervening with children who are at-risk for future reading disabilities. Research has indicated also that a particular sub-group of children at-risk for reading impairments include preschool children with language impairments (Catts, 1993). Preschool children with language impairments may have difficulties with emergent literacy skills - important prerequisite skills necessary for successful formal reading. Only in the past decade have researchers begun to study the effects of emergent literacy intervention on preschool children with language impairments. As such, the current study continues this investigation of how to effectively implement an emergent literacy therapy aimed at supporting preschool children with language impairments. In addition to this, the current study explores emergent literacy intervention within an applied clinical setting. The setting, presents a host of methodological and theoretical challenges - challenges that will advance the field of understanding children within naturalistic settings. This exploratory study included thirty-eight participants who were recruited from Speech Services Niagara, a local preschool speech and language program. Using a between-group pre- and posttest design, this study compared two intervention approaches - an experimental emergent literacy intervention and a traditional language intervention. The experimental intervention was adopted from Read It Again! (Justice, McGinty, Beckman, & Kilday, 2006) and the traditional language intervention was based on the traditional models of language therapy typically used in preschool speech and language models across Ontario. 5 Results indicated that the emergent literacy intervention was superior to the ,t..3>~, ~\., ;./h traditional language therapy in improving the children's alphabet knowledge, print and word awareness and phonological awareness. Moreover, results revealed that children with more severe language impairments require greater support and more explicit instruction than children with moderate language impairments. Another important finding indicated that the effects of the preschool emergent literacy intervention used in this study may not be sustainable as children enter grade one. The implications of this study point to the need to support preschool children with language impairments with intensive emergent literacy intervention that extends beyond preschool into formal educational settings.

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This qualitative study investigated senior level staff (Senior Therapists), front-line staff (Instructor Therapists), and parent perspectives on parent-therapist collaboration within Intensive Behavioural Intervention settings. Two senior staff interviews, two parent interviews, and a focus group with therapists were conducted to examine how parents and therapists currently interact within IBI settings, parent and therapist expectations of each other, factors that promote and barriers that impede parent-therapist collaboration, and how parent-therapist collaboration might be improved. A constant comparative analysis by question within and across cases revealed five prominent themes of 'Role Definition', 'Perspective-taking/Empathy', 'Trust', 'Open Communication', and 'Consistency'. Additional similarities and differences were discovered between parent and therapist perspectives such as the need for clear parentprofessional boundaries, the importance of maintaining client privacy, and respect. Implications of the findings and suggestions for future research are discussed.

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This is a study exploring teenaged girls’ understanding and experiences of cyberbullying as a contemporary social phenomenon. Participants included 4 Grade 11 and 12 girls from a medium-sized independent school in southwestern Ontario, Canada. The girls participated in 9 extracurricular study sessions from January to April 2013. During the sessions, they engaged with Drama for Social Intervention (Clark, 2009; Conrad, 2004; Lepp, 2011) activities with the intended goal of producing a collective creation. Qualitative data were collected throughout the sessions using fieldnotes, participant journals, interviews, and participant artefacts. The findings are presented as an ethnodrama (Campbell & Conrad, 2006; Denzin, 2003; Saldaña, 1999) with each thematic statement forming a title of a scene in the script (Rogers, Frellick, & Babinski, 2002). The study found that girl identity online consists of many disconnected avatars. It also suggested that distancing (Eriksson, 2011) techniques, used to engender safety in Drama for Social Intervention, might have contributed to participant disengagement with the study’s content. Implications for further research included the utility of arts-based methods to promote participants’ feelings of growth and reflection, and a reevaluation of cyberbullying discourses to better reflect girls’ multiple avatar identities. Implications for teachers and administrators encompassed a need for preventative approaches to cyberbullying education, incorporating affective empathy-building (Ang & Goh, 2010) and addressing girls’ feelings of safety in perceived anonymity online.

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"Thèse présentée à la Faculté des études supérieures de l'Université de Montréal en vue de l'obtention du grade de Docteur en droit (LL.D.) et à l'Université Panthéon-Assas (Paris II) Droit-économie-Sciences Sociales en vue de l'obtention du grade de Docteur en droit (Arrêté du 30 mars 1992 modifié par l'arrêté du 25 avril 2002)"

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La consommation des jeunes placés dans les centres jeunesse du Québec est bien documentée, mais leurs motivations à consommer, à changer ou à parler de leur consommation avec un intervenant demeurent inconnues. Par ailleurs, très peu de chercheurs se sont intéressés aux particularités du processus de changement à l’adolescence et encore moins à ce processus dans un contexte d’autorité. Pour ces raisons, la présente recherche donne la parole aux jeunes afin de mieux comprendre leur usage de substances psychoactives, leur désir éventuel de réduire ou d’arrêter leur consommation, leur ouverture à réfléchir ou à discuter de leur consommation et leur ouverture envers les interventions disponibles. Basés sur une collecte de données qualitatives composée de 27 entrevues avec les jeunes hébergés au Centre jeunesse de Montréal et de huit mois d’observations participantes dans les unités de vie, les résultats indiquent que la majorité des adolescents interviewés disent consommer diverses substances psychoactives pour lesquelles ils identifient différentes sources de motivation, autant à consommer qu’à changer leur consommation. De plus, ces sources de motivation identifiées sont plus ou moins associées au contexte d’autorité dans lequel les jeunes sont placés. Ainsi, si certains jeunes estiment que la possibilité de changement est facilitée par l’environnement contrôlé du Centre jeunesse, pour d’autres, les contraintes de ce milieu de vie ne semblent pas avoir d’impact sur leur motivation. Par ailleurs, les jeunes démontrent différents degrés d’ouverture envers les interventions disponibles et envers les éducateurs qui les côtoient. En général, les approches compréhensives et moins autoritaires semblent encourager un certain investissement de la relation entre jeunes et éducateurs et peuvent potentiellement faciliter l’établissement d’une relation d’aide et le changement de comportement. En utilisant le cadre théorique proposé, une combinaison du Modèle transthéortique du changement et de la Théorie de l’auto-détermination, il apparaît limité de considérer les jeunes en difficulté comme étant motivés ou non motivés à changer leur consommation. Les analyses démontrent que les perceptions de la nécessité ou des possibilités d’amorcer un processus de changement varient beaucoup d’un jeune à l’autre. Ainsi, l’approche choisie pour intervenir auprès des jeunes en difficulté devrait prendre en considération les nuances et la dynamique des motivations afin de mieux adapter les services offerts et de mieux comprendre les raisons associées au succès et à l’échec de certaines interventions et intervenants vis-à-vis de certains adolescents. En outre, afin de favoriser une perception positive du « placement » et pour que les jeunes le voient comme une « opportunité de changement », il apparaît important d’examiner la fréquence et l’intensité des interventions contraignantes appliquées dans les centres de réadaptation. Finalement, il importe de mentionner que les conclusions de cette étude exploratoire ne permettent d’établir des relations causales entre l’approche choisie par l’intervenant, la motivation à changer et l’ouverture des jeunes. Cependant, les données obtenues permettent d’analyser en profondeur les représentations que les jeunes ont des relations entre ces trois éléments.

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L’insuffisance cardiaque (IC) est une maladie chronique dont les symptômes sévères peuvent mener à des hospitalisations répétées. Pour gérer ces symptômes, le plan de traitement implique plusieurs auto-soins, par exemple une diète limitée en sel et en liquide, ce qui est parfois difficile à respecter. Le but de la présente étude pilote randomisée à deux groupes (n = 16 / groupe) était d’évaluer la faisabilité, l’acceptabilité et l’efficacité préliminaire d’une intervention infirmière favorisant la pratique des auto-soins des patients atteints d’IC. L’intervention est basée sur la théorie de l’autodétermination (TAD) qui promeut l’autonomie dans la pratique des auto-soins. L’autodétermination est favorisée par le sentiment de compétence perçue, d’autonomie et d’affiliation. Pour soutenir le besoin d’affiliation, un aidant principal participe à l’intervention qui consiste en cinq entrevues chez le groupe d’intervention (GI) dont deux durant l’hospitalisation et trois par un appel téléphonique suite au congé. Les interventions découlant de cette théorie incluent par exemple de proposer des choix plutôt que d’imposer des restrictions, d’éviter la critique, de favoriser l’empathie et le renforcement positif. Les entrevues ont servi également à guider les aidants principaux pour qu’ils soutiennent à leur tour l’autodétermination de leur parent atteint d’IC. Les résultats soutiennent la faisabilité et l’acceptabilité de l’intervention évaluée dans la présente étude et permettent d’améliorer la pratique des auto-soins avec des résultats favorables pour la majorité des hypothèses évaluées. Ces résultats prometteurs permettront de guider la pratique clinique et offrent des pistes de recherches futures.

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Rapport de stage présenté à la Faculté des sciences infirmières en vue de l’obtention du grade de Maître ès sciences (M. Sc.) en sciences infirmières option formation en sciences infirmières