This study focuses on how diabetic patients manage to handle their disease,what has facilitated and what has impaired that process. The approach was to use a qualitative method as to enable the researcher to fathom the patients' point of view and to highlight their own experiences.Thus, the study is observational, describing processes, and does not aspire to give verification of the processes described. The study is based on interviews with 48 insulin dependent diabetic patients including newly diagnosed patients, patients who were regarded as well adapted with long duration of the disease but with no complications, and patients who had developed vascular complications. They were chosen in that way as to give a broad range of experiences representing different faces of the illness. It was found that the self-management of diabetes is an intricate matter, embodying categories that could be expressed as; Walking a fine line, Managing oneself physically, Managing oneself emotionally, Mastering life, Evading the problem of managing and Managing the health care system. Walking a fine line elucidates much of the behavioural variation in the data. It captures the patient's need to balance his emotional and physiological state, as well as his interactions with the health care system. Patients who manage the balancing act may enjoy good health but they are walking a fine line between maintaining this state and falling below par. It seemed that the ideal situation of interaction between the health care system and the patient was not applied in the context of the diabetic patients' everyday life. Patients had to invest considerable effort to cope, not just with their own condition, which is complex enough, but with the system officially charged to help them. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1990, härtill 5 uppsatser.</p> / digitalisering@umu

När människor drabbas av en traumatisk kris som raserar deras vardag tvingas de till att försöka bygga upp sin tillvaro igen. Vissa gör detta genom att blogga om sina tankar och känslor rörande krisen. Vad kommer det sig att så många väljer att visa upp sitt lidande i ett offentligt forum? Med hjälp av grundad teori undersöker vi de mest centrala aspekterna av och omkring krisbloggande för att skapa en större förståelse för detta nutida fenomen. Genom intervjuer och studier av bloggar framkommer det att personer som bloggar får möjlighet att på egna villkor göra sin röst hörd, sprida sin berättelse och reflektera över sin egen resa. Detta, samt det stöd som de får genom återkoppling från läsarna, gör att de upplever ett ökat välmående. Med hjälp av utvalda delar från Giddens teori om det senmoderna samhället placerar vi fenomenet krisbloggar i en nutida kontext och genom Franks teorier om narrativ förklarar vi hur viktigt det är att få skapa och dela sin berättelse för människor som drabbats av någon form av kris. / When people suffer from a traumatic crisis that destroys their lives, they are forced to try and rebuild their everyday lives again. Some do this by writing blogs about their thoughts and feelings regarding the crisis. Why is it that so many people choose to display their suffering in a public forum? With the help of grounded theory, we investigate the most central aspects of blogging about traumatic crises in order to create a greater understanding of this contemporary phenomenon. Through interviews and the study of blogs, it is revealed that the people behind the blogs are able to make their voices heard on their own terms, to spread their story and to reflect on their own journey. This, alongside the support they recieve through the feedback from their readers, make them experience increased well-being. With the help of selected parts from Giddens' theory on modernity, we place the phenomenon of cirisis blogs in a comtemporary context and through Frank's theories regarding narratives, we explain how important it is to create and share stories for people affected by some form of crisis.

This investigation explores the meanings primary school teachers who apply outdoor learning and teaching methods associate withthe places that encompass their teaching practices. A symbolic interactionist framework coupled with a social constructionistorientation was employed to analyze data collected from semi-structured interviews and photo elicitation techniques. The findingsillustrated that meaning ascribed to place derived from the interactional processes between the study’s respondents and thephysical setting within which educational interventions occurred. The nature of these interactions also appeared to be highlyinfluenced by the social worlds in which informants participated and their featured social processes. The results elucidated that theattribution of meaning to learning landscapes was impacted by school administrational factors, institutionalized school practices,the respondents’ university education and the perspectives they held about outdoor teaching and learning. Findings from thisenquiry make progress towards gaining an insight into the social construction of meanings ascribed to outdoor learningenvironments. Additionally, they contribute to a theoretical discussion regarding the impact of social contexts encompassingteaching and learning interventions on the educational potential of outdoor places.

Tėvystės tyrimai, apimantys socialinės lyties aspekto nagrinėjimą, Lietuvoje vis dar fragmentiški. Vyriškumo aspektas tėvystės tyrimuose svarbus, nes dažnai paaiškina tėvystės praktikas, grįstas galios santykiais tarp vyrų ir moterų šeimoje bei vyrų santykio su vaikais pobūdį. Šeimos modelio pokyčiai nuo tradicinės link modernios šeimos Lietuvoje demografų pastebimi po 1990 m. Nepriklausomybės atkūrimo. Vienas iš modernios šeimos bruožų – įvairėjančios šeimos formos, sąlygojančios tėvystės praktikų įvairovę. Disertacijoje nagrinėjamos skirtingo socialinio statuso bei skirtingų šeimos formų vyrų tėvystės patirtys bei gilinamasi į jų tėvo vaidmens sampratą. Disertacijos tikslas - sukurti grindžiamąją teoriją, atskleidžiančią vyrų, turinčių mažų vaikų tėvystės patirtis ir praktikas. Tam pasitelkta A. Strausso ir J. Corbin (1996) grindžiamosios teorijos versija. Tyrimo rezultatai interpretuojami pasitelkiant teorines darbo prielaidas - R. Connell (1987) hegemoninio vyriškumo teoriją, T. Coleso (2008) mozaikinio vyriškumo interpretaciją, H. Novotny (1981) emocinio kapitalo sampratą, L. Adkins (2004) ir P. Bourdieu (1977) kritinio refleksyvumo koncepcijas. Sukurtoje grindžiamojoje teorijoje išryškėja, kad šiuolaikinis tėvas vis labiau verčiamas būti sąmoningu ryšyje su vaikais ir vaikų motina. Jo sąmoningumą skatina tiek išorinės struktūrinės aplinkybės: išsilavinimas ar darbas susijęs su ugdymo klausimais, prieinama ekspertinė literatūra vaikų ugdymo klausimais, šeimos santykių... [toliau žr. visą tekstą] / Researches of fatherhood involving gender dimension, are still fragmentary in Lithuania. The aspect of masculinity in fatherhood researches is important, because it often explains fathering practices based on power relations between men and women in the family and the relationship nature of men with their children. Demographers observe family model changes from traditional to modern family in Lithuania since the restoration of Independence in 1990. An increasingly diverse family forms is one of the modern family attributes allowing a variety of fathering practices. The dissertation examines fathering experiences of men with different social status and diverse types of family as well as looks into the men’s conception of the father role. Objective of the thesis - to create a Grounded theory, revealing men with young children fathering experiences and practices according to A. Strauss and J. Corbin (1996) Grounded theory version. The results are interpreted by means of theoretical assumptions - R. Connell (1987) theory of hegemonic masculinity, T. Coles (2008) interpretation of the mosaic masculinity, H. Novotny (1981) concept of emotional capital, L. Adkins (2004) and P. Bourdieu (1977) concepts of critical reflexivity. The results of Grounded theory reveal that the contemporary father is progressively enforced to be conscious in relations with the child and the mother. His awareness is stimulated both by external structural factors, such as education or work associated to the... [to full text]

Environmental racism has recently entered the realm of academic inquiry and although it currently sits in a marginalized category, Indigenous and environmental communities and scholars have acknowledged it as an important subject of critical inquiry. With roots in southern Americana history, environmental racism has had a limited scope of study within Canadian universities. Few Canadian scholars have presented the rippling effects of this critical phenomenon to Aboriginal and non-Aboriginal students and the challenge to bring this discourse to the universities of Canada remains significant. Mainstream educators and environmentalists dismiss discourses of environmental racism, ecological destruction and the correlating demise of Indigenous peoples’ knowledges, cultures and wellness as an insignificant and sometimes radical propaganda. In opposition, Indigenous peoples globally are countering this dismissal by telling their stories to ensure all have access to the discourses of environmental racism found within the ecological destructions of traditional lands and the cultural genocides of their peoples. The stories of their histories and the subsequent activism define the resistances found within Indigenous communities. These same stories show the resiliencies of Aboriginal peoples in their quest for self-determination. Using an Indigenous research methodological framework, this study seeks to provide an understanding of the complexities associated with incidences of environmental racism found within Canadian Aboriginal communities. It further seeks to find, analyze and report the depth of resistance and resilience found within the storywork of Aboriginal women. The researcher attempts to gain perspective from eight Aboriginal women of four distinct Nations by focusing on the context of their lives in relationship to their leadership decisions and actions from a worldview of Indigenous knowledge, eco-justice and peace. The lived experiences of Aboriginal women from the traditional lands of the Cree, the Denesuline, the Inuit and the Métis are critical to an analysis of how environmental racism is dismantled and wellness sought. The storywork of these participants provides answers as to how these Aboriginal women have come to resist environmental racism and why they currently lead others in the protection and sustainability of traditional lands, Aboriginal knowledge, culture and kinship wellness. Framed within Indigenous research methodology, all researcher actions within the study, including the collection, analysis and reporting of multiple data sources, followed the ceremonial tradition and protocols of respect and reciprocity found among Aboriginal peoples. Data from semi-structured qualitative interviews and written questionnaires was analyzed from the supportive western method of grounded theory. Findings revealed the strength of Storywork through the primary themes of Woman as Land and Woman as Healer. These are discussed through the Sisters’ embodiment of resistance, reflection, re-emergence and re-vitalization. The ways in which these Indigenous women have redeemed their knowledges and resurged as leaders is integral to the findings. The study concludes with an emphasis on the criticality of collective witnessing as transformation.

The overall aim of this thesis was to investigate patient safety in the emergency department (ED) and to determine whether this varies according to patient safety culture, waiting, and outcomes of efficiency and quality variables. I: Patient safety culture was described in the EDs of two different hospitals before and after a quality improvement project. The questionnaire “Hospital Survey on Patient Safety Culture” was used to investigate the patient safety culture. The main finding was that the staff at both hospitals scored more positively in the dimension Team-work within hospital after implementing a new work model aimed at improving patient flow and patient safety in the ED. Otherwise, we found only modest improvements. II: Grounded theory was used to explore what happens in the ED from the staff perspective. Their main concern was reducing patients’ non-acceptable waiting time. Management of waiting was improved either by increasing the throughput of patient flow by structure pushing and by shuffling patients, or by changing the experience of waiting by calming patients and by feinting to cover up. III: Three Swedish EDs with different triage models were compared in terms of efficiency and quality. The median length of stay was 158 minutes for physician-led team triage compared with 243 and 197 minutes for nurse–emergency physician and nurse–junior physician triage, respectively. Quality indicators (i.e., patients leaving before treatment was completed, the rate of unscheduled return within 24 and 72 hours, and mortality rate within 7 and 30 days) improved under the physician-led team triage. IV: Efficiency and quality variables were compared from before (2008) to after (2012) a reorganization with a shift of triage model at a single ED. Time from registration to physician decreased by 47 minutes, and the length of stay decreased by 34 minutes. Several quality measures differed between the two years, in favour of 2012. Patients leaving before treatment was completed, unscheduled return within 24 and 72 hours, and mortality rate within 7 and 30 days all improved despite the reduced admission rate. In conclusion, the studies underscore the need to improve patient safety in the ED. It is important to the patient safety culture to reduce patient waiting because it dynamically affects both patients and staff. Physician-led team triage may be a suitable model for reducing patient waiting time and increasing patient safety.

INTRODUCTION AND AIM: The current shortage of nurses is a concern shared by the healthcare industry globally. Whilst the reasons for these shortages are varied and complex, a key factor among them seem to involve an unhealthy work environment. The demanding nature of the critical care environment presents a challenge to many nursing professionals and it carries the risk of a high turn over rate due to the stress and intensity of the critical care environment. The critical care nurse is responsible for caring for the most ill patients in hospitals and the acute shortage of critical care nurses contributes to the intensity and pressures of this environment. Little evidence exists of research conducted to explore and describe the practice environment of the critical care nurse in South Africa. The main aim of this research study was to construct a theory for positive practice environments in critical care units in South Africa, grounded in the views and perceptions of critical care nurses working in the private hospital context. In recognition of the fact that a positive practice environment is considered to be the foundation for the successful recruitment and retention of nurses, it was clear that issues related to staff shortages will not be resolved unless the unhealthy work environment of nurses is adequately addressed. RESEARCH DESIGN AND METHOD: A constructivist grounded theory design was selected to address the inquiry at hand. The study was divided into two phases and pragmatic plurality allowed the use of both quantitative and qualitative data collection methods to explore, describe and contextualise the data in order to achieve the overall aim of the study. In phase one, a checklist developed by the researcher was used to describe the demographic profile of the critical care units (n=31) that participated in the study. The perceptions of critical care nurses (n=298) regarding their current practice environment was explored and decribed by using a valid and reliable instrument, the Practice Environment Scale of the Nursing Work Index (PES-NWI). In phase two, the elements of a positive practice environment were explored and described by means of intensive interviews with critical care nurses (n=6) working in the critical care environment. Concepts related to the phenomenon under investigation were identified by means of an inductive analysis of the data through a coding process and memo-writing. One core conceptual category and six related categories emerged out of the data. In the final phase of the theoretical sampling of the literature, a set of conclusions relevant to the phenomenon under study was constructed. The conclusions deduced from the empirical findings in both phases of the research process were integrated with those derived from the literature review to provide the foundation from which the theory was constructed. FINDINGS: The findings from the first phase of the research process provided information about the context in which the participants operate and assisted in discovering concepts considered relevant to the phenomenon under investigation. A grounded theory depicting the core conceptual category of "being in controi" and its relation to the other six categories was constructed from the data in order to explain a positive practice environment for critical care units in the private healthcare sector in South Africa. / Thesis (Ph.D. (Nursing))--North-West University, Potchefstroom Campus, 2010.

Evidence indicates that regular physical activity (e.g., aerobic physical activity for 30 minutes most days of the week) reduces recurrent cardiac events and death rates in women with coronary heart disease (CHD). However, study findings consistently report higher rates of physical inactivity among rural versus urban women. In addition, rural women experience significant geographic disparities, health inequities, and limited access to health care services and providers, creating further self-care challenges such as engaging in recommended physical activity behaviors post-MI. To understand how rural Nova Scotia (NS) women engage in physical activity behaviors post MI, and factors that affect their physical activity in the post-MI period, constructivist grounded theory (CGT) and photovoice methodologies and methods were used in this research. Eighteen NS women from rural settings participated in two interviews and in the taking of personal photographs using provided disposable cameras. Findings from the narrative and visual data culminated in a substantive theory, “Seeking-Self Worth: A Theory of How Rural Women Engage in Physical Activity Behavior Post-MI.” What was most problematic for study participants was questioning self-worth as a rural woman post-MI. To manage this problem, study participants engaged in the process of seeking self-worth as a rural woman post-MI. The theory of seeking self-worth also involved the processes of assessing MI damage and physical activity, testing physical activity limits, and choosing physical activity priorities. All of these processes played out within a rural context where gender and contextual factors encouraged or hindered study participants’ seeking of self-worth post-MI and, subsequently, their engagement in physical activity behavior post-MI. This substantive theory has implications for nursing, particularly rural public health nurses and nurse practitioners, in the areas of practice, education, research, and policy development.

While much is known about the long-term effects of childhood sexual abuse (CSA) on women in adulthood, little is currently known about their self-care efforts. Given the paucity of research on self-care for survivors, particularly those who are also mothers, and the potential importance of self-care for both themselves and their children, the main goal of the present study was to explore these women’s perceptions and practices of self-care. A grounded theory approach was chosen for this exploration as it provided a sensitive and open-ended methodology which garnered an in-depth understanding of self-care for survivor mothers. The current study combined classic grounded theory (GT) research methods with photovoice methods to explore self-care from the perspective of CSA survivor mothers. Analyses of interview and photograph data from 14 survivor mothers resulted in an original basic social process for understanding how these women care for themselves, feel better, and engage in healing in the context of past violence and trauma. Complex interactive behavioural patterns were identified that recreated a whole self out of damaged fragments; these were conceptualized as “reconstituting a damaged self”. This basic social process was comprised of three main stages, including: emotional de-paining, safetying, and authenticating and returning to self. Several substages within each of these main stages were also identified. Findings were discussed in relation to four theoretical frameworks. Future research directions and clinical implications for this neglected population were suggested. Reconstituting a damaged self can be a long process for sexual abuse survivor mothers involving taking small safe steps, for the most part, on one’s own.

INTRODUCTION AND AIM: The current shortage of nurses is a concern shared by the healthcare industry globally. Whilst the reasons for these shortages are varied and complex, a key factor among them seem to involve an unhealthy work environment. The demanding nature of the critical care environment presents a challenge to many nursing professionals and it carries the risk of a high turn over rate due to the stress and intensity of the critical care environment. The critical care nurse is responsible for caring for the most ill patients in hospitals and the acute shortage of critical care nurses contributes to the intensity and pressures of this environment. Little evidence exists of research conducted to explore and describe the practice environment of the critical care nurse in South Africa. The main aim of this research study was to construct a theory for positive practice environments in critical care units in South Africa, grounded in the views and perceptions of critical care nurses working in the private hospital context. In recognition of the fact that a positive practice environment is considered to be the foundation for the successful recruitment and retention of nurses, it was clear that issues related to staff shortages will not be resolved unless the unhealthy work environment of nurses is adequately addressed. RESEARCH DESIGN AND METHOD: A constructivist grounded theory design was selected to address the inquiry at hand. The study was divided into two phases and pragmatic plurality allowed the use of both quantitative and qualitative data collection methods to explore, describe and contextualise the data in order to achieve the overall aim of the study. In phase one, a checklist developed by the researcher was used to describe the demographic profile of the critical care units (n=31) that participated in the study. The perceptions of critical care nurses (n=298) regarding their current practice environment was explored and decribed by using a valid and reliable instrument, the Practice Environment Scale of the Nursing Work Index (PES-NWI). In phase two, the elements of a positive practice environment were explored and described by means of intensive interviews with critical care nurses (n=6) working in the critical care environment. Concepts related to the phenomenon under investigation were identified by means of an inductive analysis of the data through a coding process and memo-writing. One core conceptual category and six related categories emerged out of the data. In the final phase of the theoretical sampling of the literature, a set of conclusions relevant to the phenomenon under study was constructed. The conclusions deduced from the empirical findings in both phases of the research process were integrated with those derived from the literature review to provide the foundation from which the theory was constructed. FINDINGS: The findings from the first phase of the research process provided information about the context in which the participants operate and assisted in discovering concepts considered relevant to the phenomenon under investigation. A grounded theory depicting the core conceptual category of "being in controi" and its relation to the other six categories was constructed from the data in order to explain a positive practice environment for critical care units in the private healthcare sector in South Africa. / Thesis (Ph.D. (Nursing))--North-West University, Potchefstroom Campus, 2010.