Faculty Of Health Science The Mark Liveris Health Science

Evaluating an Internet Therapy Service: Therapeutic Alliance and OutcomesPresented by: Ben Mullings, School of Psychology and Speech PathologyCourse:Doctor of PhilosophySupervisors: A/Prof. Jan Grant, Dr. Clare Rees, Dr. Bob KaneHealth practitioners are increasingly using the Internet to deliver web-based services, but to date,most of the research has focused on self-guided approaches where interactions between the clientand therapist are minimal. This research explores the potential for Internet communication todeliver psychological services, by directly comparing the processes and therapeutic outcomes oftherapy delivered either face-to-face or over Internet chat communication.A team of 20 therapists provided psychological services to clients who self-selected either face-tofaceor Internet chat therapy. Measures of the alliance and symptom severity were obtained andinterviews with both clients and therapists were conducted to explore the experiences of peopleusing Internet chat for therapy.Strong main effects were found for improvement across the first 3 sessions in both treatmentgroups, but differences between treatment groups were not statistically significant on most of thekey variables. Therapist-rated symptom severity did not show significant levels of improvementover the first 3 sessions and clients receiving face-to-face therapy rated the alliance significantlyhigher. Qualitative data generated from interviews at the conclusion of Internet therapy showed theimportance of therapeutic distance for people who select this form of treatment. Participants alsodescribed the formation of mental images of the other party and the role this had in terms ofconstructing a sense of interaction with the other person. Although this had an impact on the qualityof the working alliance that developed, both clients and therapists were generally satisfied with thetherapeutic relationship overall. Given that meta-analytic reviews show larger treatment effects areassociated with web-based interventions where there is greater therapist involvement, the presentstudy raises questions about whether Internet chat could be better utilised.A Mother’s Knowledge and Understanding of her Child’s Care at the Time ofCardiac SurgeryPresented by: Mary Tallon, School of Nursing and MidwiferyCourse: Master of Science (Nursing)Supervisors: Dr. Garth Kendall, Dr. Paul SniderThe earliest years of a child’s life are the most crucial for life-long health and wellbeing. The child’smain carer, usually the mother, is most influential in helping her child regulate early developmentalprocesses. When a young child requires heart surgery the stress and anxiety associated with therisks of the operation to health and long-term development can make it very difficult for mothers toremember important information about the appropriate care of their child. Nurses could do a greatdeal more to help parents to learn about these special care requirements.This quantitative cross sectional study aimed to validate an instrument to measure maternalknowledge and understanding (KU) at the time of surgery and explore the impact of stress, anxiety,depression and social support on KU. Mothers attending the Children’s Cardiac Centre at PrincessMargaret Hospital between Aug 2008 and April 2010 were invited to complete a questionnaire.Validated instruments were used to measure levels of maternal stress, anxiety, depression andsocial support, while a consensual instrument was developed to measure KU. Descriptive,bivariate and multiple regression analyses were completed.The response rate was 61%. The KU instrument demonstrated high internal consistency(Cronbach’s Alpha .78). Significant stress was experienced by 29% of mothers, anxiety by 28%and depression by 22%. In bivariate analyses, family financial strain was associated withincreased anxiety and the severity of the child’s heart problem was associated with greaterlikelihood of depression. In a multiple regression model mother’s increased anxiety, dissatisfactionwith partner support, and insufficient support from relatives were all independently associated withlower KU scores.This study calls for further research to validate an instrument to measure Maternal KU forapplication across the paediatric setting. This work highlights the need for nurses to work within afamily-centred care framework that includes diligent attention to early child development, maternalmental health, empowerment theory, and partnership development.