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This thesis examines the processes by which the self-concept is shaped by chronic illness in later life. This study contributes to our understanding of the development of the self in later life by examining patterns of continuity and change. Twenty-four women diagnosed with osteoarthritis (0A) were interviewed. The participants were community dwelling females, aged between 67 to 85 years. They were selected to reflect a range of OA, from mild to severe forms of the disease. A qualitative approach, more specifically, the grounded theory method was adopted for this study. The findings illustrate that OA in later life presents a source of change for the self concept. However, the influence of these processes of change vary considerably. In particular, the significance of change for the self-concept is shaped by the individual's perception of the impact of chronic illness for the self. These are shaped by several factors. The impact of OA on the self is influenced by the ways in which the person's multiple identities are affected. And, the person's perception of continuity and change for her "overall" or global sense of self must be considered. Finally, the type of process mechanisms that are drawn upon shape the person's perception of continuity and change. Such processes include: shifting and non-shifting prominence hierarchies, the ability to adjust and accommodate to one's limitations and the extent to which interactions and valued identities are modified, social comparison, reflected appraisal, and the dialogue between the past, the present, and the future self. The data show that older people do reflect some of the same issues that have previously been revealed by studies of chronic illness which do not focus on later life. However, experiences of chronic illness in later life also present unique variations. / Thesis / Master of Arts (MA)

The purpose of this study was to explore relationships between parents of children with exceptionalities and educational professionals. The guiding question of this study was: How do parents of children with exceptionalities describe their relationships with educational professionals? Bronfenbrenner's (1979) ecological theory and Crockett's (2002) star model for Special Education Planning provided the framework for this qualitative inquiry. Methods included a content analysis of four decades of journal abstracts depicting the past voices of parents of exceptional children. This historical review spanned articles about the following topics: a child's exceptionality being the result of physical or social heredity; educators as experts who train parents; the involvement of parents sought in certain instances; and, finally, professionals seeking out parental impressions and perspectives of educational practices. Current voices of 14 parents of children with exceptionalities were captured by individual and group interviews, as well as observations at an open parent meeting led by state officials. The constant comparative method was used to analyze the qualitative data. The study found current parental dissatisfaction, mainly concerning their relationships with general education professionals. The study's findings were grouped into four thematic categories: Communication, Caring, Competence, and Continuity. A model of parent-professional relationships depicting these categories was developed to inform both special and regular educators of parents' concerns, and, to assist in the establishment and maintenance of ongoing positive relationships. / Ph. D.

Yes / Avoidable harm associated with medicines is widespread – particularly at care transitions – and unintended discrepancies in patients’ medicines after discharge from hospital affect more than half of all patients. Patients with heart failure are frequent service users (including readmission to hospital), and susceptible to deficiencies in medicines management. Heart failure is responsible for approximately 5% of medical admissions and the readmission rate within 3 months of discharge may be as high as 50%.[1] The Improving Safety and Continuity of Medicines management at Transitions of care (ISCOMAT) study is an NIHR-funded programme of research in patients with heart failure. The first work package, described here, aimed to map and evaluate current medicines management pathways across care transitions, describing the core characteristics of best practice and effective systems at each stage. Mixed-methods research collecting data centred on patients’ journey out of hospital and back home exploring current practice relating on heart failure. NHS REC approval was obtained (16/NS/0018). Following a process of informed consent, data were collected from patients (n=16) in four health economies in England using semi-structured interviews conducted shortly after their discharge from hospital and again after two and six weeks and included video recording. Non-participant observation was conducted on cardiology wards in the four areas to understand predominant systems employed by the hospitals to deliver information to patients and to primary care. Interviews with staff in hospitals and primary care explored policy, practice and systems across the transition. Data were analysed using integrative ‘parallel mixed’ analysis. Several themes emerged that described the resilience of the system that manages patients’ medicines across the whole pathway. Spatial dimensions – including local working conditions – impacted on staff who managed transfers. Process efficiencies and effectiveness, including the degree of staff training and policy awareness, both enhanced and hindered communication with patients and health care professionals (HCPs) in primary care. The system did not allow staff to assess the impact of the management of medicines at discharge across the transition into primary care. Patients themselves were found to have different levels of knowledge and confidence in their medicines once back at home and, where their pathway included this, to value the care co-ordination functions of heart failure nurses. Primary care staff operated varying systems for managing discharge communication and implementing recommendations and some reported positive outcomes from integration of practice pharmacists into the system. To our knowledge this is the first UK study of medicines management along the patient’s journey from hospital into primary care for patients with heart failure. A whole pathway analysis has enabled a detailed understanding of resilience in each part of the healthcare system. These findings will be used in the co-design of an intervention to improve medicines management in the next phase of the research.

Yes / Background: medication-related problems occur frequently when older patients are discharged from hospital. Interventions to support medication use have been developed; however, their effectiveness in older populations are unknown. This review evaluates interventions that support successful transitions of care through enhanced medication continuity. Methods: a database search for randomised controlled trials was conducted. Selection criteria included mean participant age of 65 years and older, intervention delivered during hospital stay or following recent discharge and including activities that support medication continuity. Primary outcome of interest was hospital readmission. Secondary outcomes related to the safe use of medication and quality of life. Outcomes were pooled by random-effects meta-analysis where possible. Results: twenty-four studies (total participants=17,664) describing activities delivered at multiple time points were included. Interventions that bridged the transition for up to 90 days were more likely to support successful transitions. The meta-analysis, stratified by intervention component, demonstrated that self-management activities (RR 0.81 [0.74, 0.89]), telephone followup (RR 0.84 [0.73, 0.97]) and medication reconciliation (RR 0.88 [0.81, 0.96]) were statistically associated with reduced hospital readmissions. Conclusion: our results suggest that interventions that best support older patients’ medication continuity are those that bridge transitions; these also have the greatest impact on reducing hospital readmission. Interventions that included self management, telephone follow-up and medication reconciliation activities were most likely to be effective; however, further research needs to identify how to meaningfully engage with patients and caregivers to best support post-discharge medication continuity. Limitations included high subjectivity of intervention coding, study heterogeneity and resource restrictions. / National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant PB-PG-0317-20010).

Yes / Introduction A key priority for the UK National Health Service and patients is to ensure that medicines are used safely and effectively. However, medication changes are not always optimally communicated and implemented when patients transfer from hospital into community settings. Heart failure is a common reason for admission to hospital. Patients with heart failure have a high burden of morbidity, mortality and complex pharmacotherapeutic regimens. The Improving the Safety and Continuity Of Medicines management at Transitions of care programme comprises a cluster randomised controlled trial which will test the effectiveness of a complex behavioural intervention aimed at improving medications management at the interface between hospitals discharge and community care. We will conduct a rigorous process evaluation to inform interpretation of the trial findings, inform implementation of the intervention on a wider scale and aid dissemination of the intervention. Methods and analysis The process evaluation will be conducted in six purposively selected intervention sites (ie, hospital trusts and associated community pharmacies) using a mixed-methods design. Fidelity and barriers/enablers of implementation of the Medicines at Transitions Intervention (MaTI) will be explored using observation, interviews (20 patients, 40 healthcare professionals), surveys and routine trial data collection on adherence to MaTI. A parallel mixed analysis will be applied. Qualitative data will be thematically analysed using Framework analysis and survey data will be analysed descriptively. Data will be synthesised, triangulated and mapped to the Consolidated Framework for Implementation Research where appropriate. The process evaluation commenced on June 2018 and is due to end on February 2021. Ethics and dissemination Approved by Research Ethics Committee and the UK Health Research Authority REC: 18/YH/0017/IRAS: 231 431. Findings will be disseminated via academic and policy conferences, peer-reviewed publications and social media. Trial registration number ISRCTN66212970.

The practice of double-loaded corridors and circulation cores only serves to segregate spaces and develops no relationship between one space and another. In a contemporary society based on human interactions, should the conduit for delivering human-to-human connections be confined simply to notions of “horizontal circulation” and “vertical circulation”? Do we deserve better? This thesis proposes that a measure of continuity can unify disparate spaces. This continuous architecture can join these spaces in series resulting in an instant and direct relationship of one space to another. Continuity can facilitate not only the interaction of spaces but also the interaction between occupants. / Master of Architecture

Bakgrund: Kontinuerlig barnmorskeledd vårdmodell för kvinnor under graviditet, förlossning och eftervård tillämpas i flera länder runtom i världen. Modellen har visat sig positiv både ur medicinska och ekonomiska aspekter. Kvinnor i Sverige uttrycker en önskan om att kontinuiteten i vården kring graviditet, förlossning och eftervård ska öka. Trots detta tillämpas inte kontinuerlig barnmorskeledd vårdmodell i Sverige idag, bortsett från enstaka nyligen påbörjade projekt. Syfte: Att beskriva kvinnors upplevelser av kontinuerlig barnmorskeledd vårdmodell under graviditet, förlossning och eftervård. Metod: Kvalitativ metasyntes med metaetnografisk innehållsanalys. Femton (15) artiklar inkluderades i resultatet. Resultat: Tre huvudkategorier och sju underkategorier identifierades som centrala och övergripande teman för kvinnors upplevelser av kontinuerlig, barnmorskeledd vårdmodell. De tre huvudkategorierna var personcentrerad vård, relationen till barnmorskan och kommunikationen. Överlag var kvinnornas upplevelser av kontinuerlig, barnmorskeledd vårdmodell positiva. Slutsats: Kvinnor upplever kontinuerlig barnmorskeledd vårdmodell som stödjande, stärkande och personcentrerad. Kontinuerlig barnmorskeledd vårdmodell är en personcentrerad vårdform som stödjer och stärker kvinnorna genom graviditet, förlossning och eftervård. De positiva upplevelserna av kontinuerlig barnmorskeledd vårdmodell verkar minska när vården under graviditeten bedrivs i gruppform istället för individuellt. Klinisk tillämpbarhet: Resultatet av denna studie kan vara till stöd för att utveckla mödrahälsovården och förlossningsvården i Sverige. Den här studien kan inspirera till förändring för att uppnå personcentrerad vård för kvinnor under graviditet, förlossning och eftervård. / Background: Midwife-led continuity of care model for women during pregnancy, childbirth and postpartum care is applied in several countries around the world. The model has proved positive both from medical and economic aspects. Women in Sweden express the wish that the continuity of care regarding pregnancy, childbirth and aftercare should increase. Despite this, midwife-led continuity of care model is not applied in Sweden today, apart from single recently initiated projects. Aim: To describe women's experiences of midwife-led continuity of care model during pregnancy, childbirth and aftercare. Method: Qualitative meta-synthesis with etnographic content analysis. Fifteen (15) items were included in the result. Results: Three main categories and seven subcategories were identified as central and overarching themes for women's experiences of midwife-led continuity of care model. The three main categories were person-centered care, the relation to the midwife and the communication. Overall, women's experiences of midwife-led continuity of care model were positive. Conclusion: Women experience midwife-led continuity of care model as supportive, strengthening and person-centred. Midwife-led continuity of care model is a person-centered form of care that supports and strengthens the women through pregnancy, childbirth and postpartum care. The positive experiences of midwife-led continuity of care model seem to decrease when the care is given in group form during pregnancy instead of individually. Clinical implications: The result of this study can be of value for developing maternity care in Sweden. This study can inspire to create new ways to achieve person-centered care for women during pregnancy, childbirth and postpartum care.

The following study examines the impact that perceptions of organizational continuity (POC) have on organizational identification (OI) and organizational outcomes, including organizational citizenship behaviors (OCBs) and turnover intentions. It was proposed that POC would be an important factor in determining OI, OCBs, and turnover intentions. In order to test this proposition, a scale was developed that measured an individual’s POC within their organization with regards to the organization’s culture and history. A survey was distributed among working individuals that contained the new measure of POC and other established measures of an organization’s culture and values. The sample consisted of 394 participants. The results showed that the construct of POC consisted of perceiving the organization’s culture and values as continuous over time. Additionally, the measure predicted OCBs and turnover intentions. POC did not, however, predict these outcomes over and above OI. Mediation analyses showed that OI mediated the relationship between POC and OCBs/turnover, thus, providing evidence to show that POC is a contributing factor in the development of an individual’s identification with an organization. This investigation extends research in the area of OI from the social identity perspective by providing the basis for understanding and measuring one of the components that leads to identification with an organization.

Orientador: Arthur Magon Whitacker / Banca: Maria Encarnação Beltrão Spósito / Banca: Beatriz Ribeiro Soares / Resumo: Com a aceleração do processo de urbanização no país, várias cidades cresceram populacionalmente e se expandiram territorialmente de forma significativa nas últimas décadas. Nesse contexto, vários centros urbanos passaram por transformações importantes, tais como o fortalecimento dos papéis desempenhados na rede urbana, configuração de aglomerações territorialmente contínuas e intensificação das interações espaciais entre municípios diferentes. Cidades de menor porte também passam a apresentar configurações territoriais contínuas com intensas interações espaciais intermunicipais, constituindo aglomerações urbanas. A aglomeração é compreendida como o processo de junção de centros urbanos distintos, tanto pela intensificação das interações espaciais quanto pela configuração de áreas territorialmente contínuas ou com tendências neste sentido. A partir destas considerações, a presente pesquisa analisou a expansão territorial e a intensificação dos fluxos entre as cidades de Presidente Prudente, Álvares Machado e Regente Feijó, na perspectiva do processo de aglomeração urbana. Os dados coletados e organizados apontam para uma forte vinculação entre Álvares Machado e Presidente Prudente, tanto pelos fluxos quanto pela expansão territorial. Diante desses resultados, compreende-se que a aglomeração urbana, enquanto forma (materialização do processo) fica evidente apenas entre Presidente Prudente e Álvares Machado. Já Regente Feijó e Presidente Prudente apresentam, até o momento, apenas uma tendência à continuidade territorial e uma significativa intensificação dos fluxos, evidenciando um processo de aglomeração ainda em curso. Esta distinção entre forma e processo constitui-se em um ponto importante para a discussão. / Abstract: With the acceleration of the urbanization process in the country, many cities increased the populations and expanded your territory with significant way in the last decades. In that context, many urban centers were transformed, before the invigoration of the papers executed in the urban net, configuration of territorial continuous agglomeration and intensification of the space interactions between different municipal districts. Smaller cities also starts to demonstrate continuous territorial configurations with intense interactions space inter cities, constituting urban agglomerations. The agglomeration is understood as the process of junction of different urban centers, as the intensification of the space interactions as for the configuration of continuous areas or with tendencies in this way. Starting from these considerations, this search analyzed the territorial expansion and the intensification of the flows among the Presidente Prudente, Álvares Machado and Regent Feijó, in the perspective of the process of urban agglomeration. The collected and organized data show a strong link between Álvares Machado and Presidente Prudente, as the flows as for the territorial expansion. With these results, we understood that the urban agglomeration, while it forms (materialization of the process) is evident just between analyzed the territorial expansion and the intensification of the flows between the cities: Presidente Prudente and Álvares Machado. Already Regent Feijó and Presidente Prudente present until now, just a tendency to the territorial continuity and a significant intensification of the flows, evidencing an agglomeration process still in course. This distinction between form and process is an important point for the discussion. / Mestre