In this Practice Inquiry, Mexican American parents' perceptions of cultural influences on grieving the death of their child were described. Findings were used to inform a continuing education module for nurses involved in the care of Mexican American parents who have experienced the death of their child. This line of inquiry is important as the needs of grieving Mexican American parents are not always recognized by those providing care. Ethnographic methodology was used to explore the narratives of three Mexican American fathers and three Mexican American mothers who had experienced the death of their child. A purposive sample was recruited from a faith based community health center in Tucson, AZ. In depth interviews were conducted primarily in the participants' homes by the researcher. All interviews were conducted in Spanish language. Data sources included participant interviews, participant observation, field notes and measures for demographic data and acculturation (ARSMA-II).The overarching cultural theme that represents the participants' perspectives is El Dolor de los Padres: Pain in the Parent. The three major themes that support the overarching cultural theme include: (a) Enduring Great Pain, (b) Voices of Mexican American Parents, and (c) Cultural Death Traditions. The fourth major theme, Going Forward: For the Provider specifically addresses data gathered to educate nurses for supporting Mexican American parents grieving the death of a child. The findings of the study are interpreted within the context of the Mexican cultural concepts of familismo, machismo, marianismo, fatalismo, spiritualidad, respeto, confianza and personalismo and the concept of vulnerability.The study's significance for the practice of nursing is upheld in the findings that are specific to understanding and preventing disparities in the care of Mexican American parents who have experienced the death of a child. Increasing nursing knowledge of the cultural context of grieving, especially spiritualidad and continuing memories, offering culturally competent nursing interventions at this time of deep emotional pain are elucidated in this Practice Inquiry.

This article offers a perspective on adolescents' experiences of aggression in a secondary school, with a focus on the manifestation, contributing factors, consequences, and learners' opinions on aggression. An inductive qualitative research approach was chosen, where learners wrote about their experiences and participated in focused semi-structured interviews. Central themes were derived by means of thematic content analysis. The results revealed that a substantial number of learners experienced negative feelings about aggression at school and that aggression was related to individual characteristics, the adolescent's developmental stage, socialisation, status, competition, home environment, prior experiences, learnt behaviour and the effect of the media and music. Aggression was present among all genders. ages and cultures in school. It seemed to have a higher prevalence among boys, but was also significantly present among girls. Physical and emotional bullying had a high prevalence. which showed that bullying is problematic at schools. Passive aggression was mostly present in the form of oppositional behaviour towards authorities at school and educators are often verbally abused and ignored by learners, but their classrooms are also damaged. Individual characteristics, interpersonal relationships, multicultural interaction and a lack of sufficient social skills contributed towards many acts of aggression. Aggression was prominent in the reciprocal relationships between adolescents and their social environment. Being part of a group and forming a social identity are very important. Confiding in groups may expose learners to peer pressure, which may lead to activities and behaviour that are aggressive in nature. There were reports of discrimination and it seemed that learners get along better with others who share an equal status. This may possibly explain why aggression seemed less between white English-speaking and black English-learners, while it was more common between white Afrikaans and white/black English-speaking learners. Increased social contact between members of different social groups could reduce prejudice if these persons have an equal status. Exposure to aggression had emotional consequences, and some learners were prone to feelings of anger, fear, depression, being controlled and a loss of self-content. Behavioural responses included retaliation, pacifism, vandalism and suicide. Exposure to aggression (directly and indirectly) provoked several responses. These responses may be emotional or behavioural in nature. Emotions such as fear and anger and feeling overwhelmed, depressed and helpless may be elicited in response to aggression. Some learners may retaliate towards an aggressive incident through physical or verbal behaviour; others may withdraw and avoid social interactions. Learners may direct their aggression towards others (people and objects) or themselves. In the case of the latter, it may lead to depression, self-harm or even suicide. No single factor propels an adolescent to act aggressively. Instead, the causes of such behaviour are complex and multifaceted. Most participants in this research experienced aggression at school as unhealthy. Aggression may have emotional and behavioural consequences such as disruption, discomfort and disturbance of normal functioning. Although aggression seemed relatively under control at this particular school, there are signs of an increase in aggression and in the severity of some of the incidents, and of the possibility of desensitisation towards aggression, with the agonising possibility that aggression is serving as a form of entertainment for some learners. The need for learner involvement, school guidance programmes and life-skill training was prominent, accompanied by the need for school counsellors to assist in the management of aggression. Teachers must have better knowledge of the adolescent developmental phase so that they could understand and identify behavioural problems among learners. / Thesis (M.Sc. (Clinical Psychology))--North-West University, Potchefstroom Campus, 2007

Patients admitted to the Intensive Care Unit (ICU) are critically ill and often at extremely high risk of death. These patients receive aggressive interventions to prolong their lives. Despite these measures, many patients still succumb to their illness. Although ICU physicians are good at predicting which patients have a high risk of mortality, they are still offering interventions that do not prolong life, but potentially cause more suffering at the end of life. This is because there is a lack of high quality and early communication to discuss prognosis and establish patients' goals of care. This gap in communication is even more profound when patients are transferring from rural hospitals to busy tertiary care centers. This dissertation discusses the utilization of tele-video conferencing to enhance early communication with family members/loved ones of critically ill patients prior to their transfer from a rural hospital to a tertiary care center. It begins with a description of telemedicine and its uses in the ICU to date. Chapter 2 discusses the poor prognoses of patients receiving high intensity interventions such as cardiopulmonary resuscitation (CPR). The extremely dismal outcomes underscore the importance of early, thorough discussions regarding prognosis and goals of care in these patients. The next chapter describes a pilot study utilizing telemedicine to conduct formal unstructured telemedicine conferences with family members prior to transfer. This study demonstrated that palliative care consultations can be provided via telemedicine for critically ill patients and that adequate preparation and technical expertise are essential. Although this study is limited by the nature of the retrospective review, it is evident that more research is needed to further assess its applicability, utility and acceptability. Chapter 4 describes an investigation into the barriers and facilitators of conducting conferences via telemedicine and the perceptions of clinicians regarding the use of telemedicine for this purpose. This chapter identified unique barriers and facilitators to the use of telemedicine that will need to be addressed when designing a telemedicine intervention for conducting family conferences. This thesis describes the importance and process of implementation of telemedicine for the novel purpose of enhancing early communication among physicians and family members of critically ill loved ones. Further studies are needed to refine and investigate patient and family centered clinical outcomes utilizing this intervention.

The purpose of the study was to explore juvenile offenders' perceptions of the counseling relationship. Eight juvenile offenders who were on probation under the jurisdiction of a juvenile court participated in the study. Using a phenomenological methodology, two interviews with each participant were conducted in order to obtain participants' full descriptions of the phenomenon of the counseling relationship. The main research question was: What are juvenile offenders' perceptions of the counseling relationship? Sub-questions were: (a) What are the themes and qualities that account for how feelings and thoughts connected to the counseling relationship are aroused?, (b) What are the underlying conditions that account for juvenile offenders' perceptions of the counseling relationship?, (c) What are the universal structures (e.g. time, space, bodily concerns, physical substance, causality, relation to self or others ) that precipitate feelings and thoughts about the experience of the counseling relationship?, and (d) What are the unique qualities of the experience that facilitate a description of the "counseling relationship" as it is experienced by juvenile offenders? Participants' descriptions provided a range of descriptions that were summarized in three thematic categories: Themes Related to Participants, Themes Related to Counselors, and Themes Related to the Process of Counseling Relationships. In addition, a composite textural-structural description of participants' experiences provided a holistic description of the phenomenon as lived by participants. Participants' experiences provided a greater depth of understanding of the counseling relationship with this challenging population from the perspective of juvenile offenders. Implications for juvenile offender counselors and counselor educators are discussed. Implications for phenomenological methodology are also discussed.

In light of the increasing prevalence of obesity in the UK, health professionals working within general practice are urged to initiate discussion about weight with overweight and obese patients. Despite such appeals, evidence suggests that only a minority of health professionals routinely talk to patients about weight loss. To understand more about the barriers to raising the topic of weight in general practice, three empirical studies guided by qualitative research design were carried out. The first two studies draw on psychological theory to identify barriers to raising the topic of weight. Semi-structured interviews were conducted with 17 GPs and 17 primary care nurses. The third study conducted with 20 GPs is underpinned by discourse analysis and uses trigger film interviews to capture and critically analyse the discursive production of, and macro-discourses shaping, barriers. In study 1 and 2, three main themes summarise barriers identified from GP and primary care nurse perspectives: limited understanding about obesity care, concern about negative consequences and limited time to raise a sensitive topic. In study 3, four discursive frameworks were identified as underpinning constructions about the barriers to broaching discussion about obesity: medical-reductionist, medical-holistic, moral and ethical. Findings extend understanding about the ways in which obesity is constructed as both a medical and non-medical issue. The findings have implications for health professional education, policy and research including the need to expose and challenge dominant understandings of obesity as a behavioural problem, to address barriers operating at the socio-cultural as well as the individual-level, and to enhance understanding about the socially embedded and pernicious effects of obesity stigma in the consultation and beyond.

It has been well established that self-harm is a key healthcare issue facing young people (Health and Social Information Centre, 2015). Consequently, many self-harmers preferentially seek support from friends (Evans, Hawton, & Rodham, 2005). Despite their unique position, friends’ experiences have been marginalised. Historically, friends have only been considered when they feature in the lives of the person who self-harms, when they are identified as “gate-keepers” to self-harming young people (Klingman & Hochdorf, 1993, p. 123), or when they themselves go on to self-harm (e.g. Hawton, Rodham, Evans, & Weatherall, 2002). Bearing in mind the friends’ unique, yet highly vulnerable status, there is a notable lack of research exploring how friends come to understand their experiences, and the subsequent impact this has on their friendships with the self-harmer. Through this qualitatively approached thesis I aimed to explore how the impact of self-harm on friendship is understood. Data was collected through a series of interviews and focus groups with friends of self-harmers, and those who supported them. Using a qualitative methodology, I conducted three studies. In Study One, I explored how counsellors made sense of the impact of self-harm on friendship. Studies Two and Three focussed on how friends, whilst maintaining a friendship with a self-harmer, came to understand themselves, their friendship with the self-harmer, and their relationships with others. The results indicated that friends struggled to integrate self-harm into their friendships and their understanding of themselves, took on excessive responsibility for the self-harmer, and felt constrained by secret-keeping. Additionally, as the friends in Study Three felt that information available to them was either absent, or lacking, I developed a prototype support tool tailored specifically to the needs of the friends.

Orientador: Antonio de Pádua Pithon Cyrino / Banca: Águeda Beatriz Pires Rizatto / Banca: Lilia Blima Schraiber / Resumo: A Faculdade de Medicina de Botucatu-Unesp há 40 anos desenvolve práticas de ensino de graduação médica na comunidade, no âmbito da atenção primária à saúde. Essa experiência se fez sob distintas influências, dentre as quais se podem destacar os movimentos de reforma médica da Medicina Integral e da Medicina Comunitária, nas décadas de 1960 e 1970. Já nos anos 1990 o ensino foi influenciado pelo Programa UNI e, na última década, exerceram papéis relevantes as Diretrizes Curriculares Nacionais para os cursos de medicina e o papel indutor do Ministério da Saúde, por meio dos programas de incentivo às mudanças curriculares: Promed e Pró-Saúde. Nesse contexto, em 2003, a Faculdade Medicina de Botucatu implanta experiência de ensino na comunidade para alunos do 1º ao 3º ano de graduação - o Programa de Interação Universidade, Serviço e Comunidade (IUSC), que é orientado pelos princípios da integralidade e humanização e por inovações pedagógicas. Este estudo tem por objetivo compreender os significados e percepções de alunos que cursaram o IUSC e caracterizar sua proposta pedagógica à luz dos movimentos mais recentes de reforma na educação médica. Para tanto, realizou-se estudo de natureza qualitativa com a primeira turma de alunos que cursaram o IUSC, quando já estavam no 6º ano médico, por meio de três grupos focais, e pesquisa documental a respeito do projeto e operacionalização do IUSC. Os conteúdos obtidos nos grupos focais foram transcritos e submetidos a análise temática. O estudo documental do IUSC mostrou sua criação sob influência de políticas públicas de indução de reorientação da educação médica no país, as quais viabilizaram, em parte, a sustentação financeira e política do programa. Sua operacionalização fez-se adotando-se como modelo pedagógico a problematização. Os resultados obtidos mostram que, para ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: For 40 years the Medical School of Botucatu-Unesp has been developing teaching practices of medical graduation in the community concerning the primary health care. This experience has been influenced by different factors such as the movements of medical renovation of Comprehensive Medicine and Community Medicine, in the 60s and 70s. UNI Program influenced this practice in the 90s; in the last decade two programs played an important role in the medical courses: the National Curriculum Directions and the inducing role of the Health Ministry, through programs which motivated curricula changes like Promed and Pro-Saúde. In such context, in 2003, the Medical School of Botucatu implemented the experience of community teaching for students of the first and third years of graduation - the Program Interaction University, Service and Community (IUSC), guided by the principals of comprehensiveness and humanization and by pedagogical innovations. This study aimed to understand meanings and perceptions of students who studied the IUSC and to characterize its pedagogical proposal regarding recent movements of medical education renovation. This is a qualitative study with the first group of students who have done the IUSC, when they were in the sixth year, through three focus groups and documental research regarding the IUSC project and operation. The narrative obtained in the focus groups were transcribed and submitted to thematic analysis of content. The documental study of UISC showed its development under influences of public policies of induction of medical education reorientation in the country what provided the partial financial and political support of the program. Its operation adopted the problematization as the pedagogical model. The results show that, for the students, the familiar visit was the most significant practical activity experienced during the course; however, there ... (Complete abstract click electronic access below) / Mestre

This thesis reports on an empirical investigation into manufacturing strategy (MS) formation in practice. The broad objective is to advance the understanding of MS processes through constructing consistent patterns in decision-making and action-taking relating to the manufacturing structure and infrastructure of the organisations studied. Using a combined "Grounded Theory - Case Study" approach, nine organisations within the metal products, machinery and equipment manufacturing sectors in Australia were studied, in order to address the following research questions: How are competitive priorities arrived at and translated into decisions and actions regarding the manufacturing structure and infrastructure? What are the consistent patterns of manufacturing strategy formation within specific organisational contexts and why those patterns exist that way? Qualitative data gathered through interviews conducted with the management staff - based on the sequences of events, actions and decisions, as well as other broader aspects of MS - were analysed by means of progressive coding. The themes, relationships and conceptual schemas emerged through the coding process are presented using narratives and graphical displays. The overall findings are presented in aggregate terms using a conceptual model, supplemented by several theoretical propositions. Deeper structures in MS processes represent linear and parallel, converging and diverging and sequential and iterative progression of strategic initiatives across four major phases identified as initiation, progression, commitment and realisation. The multiple modes of initiation, alternative paths of consolidation and differing forms of commitment and realisation are explained by the nature of strategic initiatives, the causal links between the modes themselves and the influence of certain organisational contextual factors. When enfolded in extant literature, these findings make two major contributions. First, apart from corroborating the complex and dynamic nature of MS formation in practice, they explicate the underlying patterns and alternative forms of MS formation. Second, they demonstrate some causal relationships between alternative forms of MS formation and certain contextual factors. These insights would inform future research, leading towards the development of a plausible mid-range theory of MS processes. They would also help practitioners to better understand the dynamics of MS formation and to nurture appropriate forms of MS formation within specific organisational settings.

Doctor of Philosophy (PhD) / Healthcare services and health research aim to improve the physical and psychosocial well being of consumers, and to offer responsive services needed and valued by them. Research in chronic kidney disease (CKD) has predominantly focused on investigating biomedical aspects and evaluating technological or pharmacological treatment interventions to improve medical management. While research into assessing patients’ and caregivers’ quality of life, and symptom burden, is growing minimal attention has been given to gaining a broad and in-depth understanding about the experiences, psychosocial issues and needs of patients and their caregivers. These need to be considered when planning and delivering patient-centred care and health research across the whole trajectory of CKD. The studies that form the major part of this thesis explore the perspectives, needs and experiences of CKD patients and their caregivers, within a broad and multidimensional framework encompassing aspects of the nature of the health and illness experiences and consumer perspectives. In Chapter 2, to understand what is known about parental experiences of caring for a child with CKD, the relevant qualitative literature was systematically reviewed and synthesized. Three inter-related clusters were identified: intrapersonal, interpersonal and external experiences. In Chapter 3, to gain a more detailed and broader understanding of this topic, in-depth interviews were conducted with parents of 20 children with CKD and 4 major themes were identified: absorbing the clinical environment, medicalising parenting, disrupting family norms, and coping strategies and support structures. In Chapter 4, to assess the effectiveness of support interventions for caregivers of patients with CKD, a systematic review was conducted which identified only three eligible studies that assessed only the effect of educational material on caregiver knowledge, not other domains. In Chapter 5, to describe and compare the broad range and depth of experiences and perspectives from predialysis, dialysis and transplantation patients, data from patient focus groups were analysed. The 5 themes that emerged from this data were: personal meaning of CKD, managing and monitoring health, lifestyle consequences, family impact, and informal structures. In Chapter 6, the focus groups were also used to elicit research priorities and identify reasons that patients used to develop their research priorities. A patient focused research agenda was elicited for CKD and 5 reasons that patients used to develop their research priorities were identified: normalisation of life, altruism, economic efficiency, personal concerns and clinical outcomes. During the focus groups, participants repeatedly expressed frustration about the poor public profile, and lack of community-based information on CKD prevention. So in Chapter 7, to assess how Australian news media covered prevention and early detection of CKD, I analysed television and newspaper stories that referred to CKD prevention or early detection. Kidney disease in general, and particularly the prevention and early detection of CKD, received virtually no media attention. When mentioned, it was mainly in the context of transplantation and donor stories, and seldom prevention or early detection, which appears largely unnewsworthy in its current form. At best, CKD received peripheral mention as a secondary concern in diabetes and obesity news stories which focused on lifestyle solutions. In Chapter 8, to develop a checklist for explicit and comprehensive reporting of qualitative studies (in-depth interviews and focus groups), I performed a comprehensive search in relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: 1) research team and reflexivity, 2) study design, and 3) data analysis and reporting. The overarching purpose of these studies was to gain a better understanding about the needs, experiences and perspectives of CKD patients and their caregivers. The findings describe the permanent, profound and pervasive impact of CKD on the lives of patients and caregivers across the whole illness trajectory. A more detailed and broader understanding about patient and caregiver perspectives, as presented in this thesis, can support a move towards advancing patient-centred healthcare and research in CKD.

Corporate governance has become an increasingly topical issue in recent years. This has been fuelled by such corporate collapses as Enron, Worldcom, Parmalat, One.Tel and HIH. The role and responsibility of the board and directors has emerged as an important issue in examining the cause of these collapses. This has created much debate on what the role of the directors is in 'directing', 'monitoring' or 'advising' a company. Research indicates that investors are prepared to a pay a premium for good governance. This raises a number of questions. What is governance? How do we determine what is good governance? What role do directors have in this? Does the company's performance improve by adopting good governance practices? There are numerous approaches to examining what makes a good board. Quantitative techniques have included the use of such measurable concepts as the number of executive and non-executive directors, directors' skill base (for example, accountancy, marketing etc) and frequency of meetings attended. Researchers have also attempted to measure board performance and effectiveness by using indicators such as share values and shareholder returns. There is a lack of qualitative research in board behaviour and effectiveness. This exploratory study adopts a qualitative approach in order to provide richer data. It uses interviews to evaluate directors' views on some aspects of corporate governance, specifically in relation to the executive and non-executive director debate. The interviews were conducted with 11 directors from a variety of organizations in the forprofit and not-for-profit sectors. Two major themes have emerged from the analysis of the interviews. Firstly, directors are traditionally considered to be responsible for maximising shareholder wealth. However, directors are now expected to broaden their responsibilities to include other stakeholders and to consider social and environmental issues in making their decisions. The findings indicate that it is now more demanding to be a director due to increased workloads arising from the regulatory and legal requirements. This has also impacted on director and board evaluations, multiple directorships and directors remuneration levels. The second major theme that emerged from this study is that directors' personal experiences did not necessarily concur with governance principles and guidelines. For example, the widely recommended method of achieving 'best practice' by having a majority of non-executive directors on a board is considered too simplistic. Further studies are required on the behavioural and personality traits, technical skills of the directors, board structure, composition and type of organization which make the best contribution to achieving boardroom effectiveness.