Thesis (M.S.)--University of Wisconsin-Madison, 1993. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 36-38).

The purpose of this study was, first, to further our understanding of the experience of dying in a long-term care (LTC) facility from the perspective of family members and second, to identify the relationships between the various factors which may influence satisfaction with end-of-life care. Using a sequential mixed methods design, a convenience sample of 87 family members completed a survey interview using a modified version of the Toolkit of Instruments to Measure End-of-life Care (TIME) Nursing Home Version in the first phase of the study. Findings from the parametric and non-parametric analyses indicated that family satisfaction with end-of-life care was best predicted by contact and communication with nursing staff, feeling that care provided at the end of life met expectations, staff providing consistent care, feeling that the health care aide listened to their concerns about care and that respondents felt they had received enough emotional support. Being transferred to hospital in the last month of life, dying in a place other than the LTC facility, and respondent age and employment status were all associated with significant mean differences in satisfaction scores. In the second phase, three focus groups were conducted to further explore areas of satisfaction and dissatisfaction with end-of-life care. Focus groups provided confirmation of the findings of the first phase of the study and were instrumental in developing a list of ten recommendations for improvements in end-of-life care delivery. Recommendations for future research are made based on the study results. / October 2007

Objective: Chronic physical health problems are on the rise. Psychological interventions can play a role in helping people cope with the challenges that long term physical conditions brings. This thesis systematically reviewed the literature for group psychological interventions. Following this, an Acceptance and Commitment Therapy group intervention for people living with a range of long term physical conditions was designed and evaluated. Methods: Key databases were searched for relevant randomized-controlled studies. Papers that met inclusion criteria were quality assessed, and a meta-analysis was conducted. Participants with chronic physical health conditions were invited to an Acceptance and Commitment Therapy group (n=53). Measures were completed at assessment, pre, post and 3-month follow-up. These assessed anxiety and depression symptoms, health perceptions, values-based living and psychological flexibility. Assessment to pre-intervention served as a within-participant control. Results: 22 relevant studies were retrieved, with 18 rated as acceptable or high quality and 14 included in a meta-analysis. The majority of studies reported interventions as efficacious at reducing mental health problems, though effect sizes were weaker when compared to active controls such as education. In the Acceptance and Commitment therapy group, depression and anxiety symptoms reduced significantly from pre to post, compared to control period. Conclusions: Group psychological interventions may be beneficial for people with physical health problems. In particular, group-based ACT interventions may be effective with this population and can be delivered transdiagnostically for a range of physical conditions.

Recent years have seen a significant increase in the number of ventilator-dependent children being discharged from the hospital. There is a wealth of literature describing the issues surrounding the complex discharge process required for these children however there has been limited exploration of the experiences of parents during their child’s admission to hospital. Interpretive phenomenology based on Heideggerian research philosophy was used to explore the lived experiences of hospital for parents of children commenced on invasive long-term ventilation (I-LTV). Purposive sampling was utilised to select parents of children who had been cared for at one NHS hospital trust. Eight in-depth, unstructured qualitative interviews involving sixteen parents (eight couples) were conducted over a six month period during 2014 to gather data about the parent’s recollections of the time spent with their child in hospital. Most children were cared for on both the paediatric intensive care (PIC) and high dependency units (HDU) with the majority having been discharged from hospital at the time of the interviews. All interviews were transcribed verbatim, and analysed using a modified van Manen (1990) approach. Thematic analysis provided an insight in to the lived world of the parents caring for their technology-dependent child, with two over-arching concepts of uncertainty and transitions characterising the parents’ journeys. The findings revealed multiple transitions in a world of complexity and uncertainty with four main themes emerging from the data; 1) Going in to the Unknown, 2) This wasn’t what we wanted, 3) Safer at Home, and 4) Clawing every little bit back. Parents were required to develop coping strategies to deal with the transitions and uncertainties experienced and establish new roles and identities as they became experts in caring for their technology-dependent child. As a result of the findings a new framework combining the concepts of uncertainty and transitions was derived identifying areas for consideration including: health-illness, psycho-social, situational and developmental transitions together with existential, biographical, environmental, relational and temporal uncertainties. Strategies for facilitating coping and adaptation towards healthier outcomes were identified and a strong argument emerged for the development of more effective management of transitions and uncertainty delivered within an environment more conducive to family-centred care.

Drop-in centers for individuals with serious and persistent mental illness offer a unique and perhaps under-recognized environment option for adjunct treatment. The current study examines and evaluates components thought to be a part of an enriched drop-in center experience that contribute to positive member outcomes through the effects of empowerment. These components include self-help, peer support, and creative expression. Outcomes were evaluated based on quality of life, self-worth, and symptom reduction. Such data are necessary in promoting the growth and development of drop-in centers and identification of components that contribute to positive member outcomes. Participants (n=101) were administered a series of measures including The Multidimensional Scale of Perceived Social Support, The Empowerment Scale, The Rosenberg Self-Esteem Scale, The World Health Organization Quality of Life-BREF, The BASIS-32™, and a series of questions created for the purposes of the current study regarding creative expression and self-help. The psychometric properties of each measure were evaluated and reviewed. Additionally, mean differences between normative data and participant means were examined and demographic data were analyzed. It was hypothesized from the literature that self-help, peer support, and creative expression would have significant indirect effects on all of the proposed outcome variables through the effects of empowerment. Results revealed significant indirect relationships between peer support and all of the outcome variables through the effects of empowerment and between self-help and all of the outcome variables through the effects of empowerment. No significant relationships were found between creative expression and any of the outcome variables through the effects of empowerment. These findings suggest that peer support and self-help may be instrumental in achieving positive outcomes through the effects of empowerment. Centers that offer experiences to enhance self-help and peer support will subsequently enhance feelings of empowerment in members, which relates to higher levels of self-worth, higher levels of quality of life, and lower levels of psychiatric symptomatology. Further implications of such findings and suggestions for continuation of this research are discussed in detail.

Sport for development programs are becoming increasingly popular to address a variety of social issues such as poverty, lack of education, gender equality, and conflict within marginalized communities. Within Canada, many sport for development programs are created for Aboriginal peoples, as they are considered marginalized communities. However, there is a dearth of research on what the actual impacts of sport for development programs are on the recipients of the program, as well as on those who provide the program. My thesis, which is written in the publishable paper format, is comprised of two papers. Using a case study approach in paper one, I explore the impacts that Alberta’s Future Leaders Program’s (AFL) youth leadership retreat has had on its participants (Aboriginal youth). Similarly, using a case study approach in paper two, I explore if/how working for AFL had lasting impacts on the former employees, known as youth workers and arts mentors. Together, the two papers in this thesis show the need for a deeper look into the actual impacts sport for development programs yield, provide insights into some of the lasting impacts AFL has had on its participants, and address the importance of long-term evaluation for sport for development programs.

The salinity distribution in an inverse estuary (where the sea water is concentrated by the estuary water) possesses its own uniqueness due to excessive net freshwater loss and restricted circulation. The study of long-term balance of salinity can contribute to a better understanding of the mixing and transport properties in such a distinct type of water body (i.e., inverse estuary water), and can provide valuable information for sound water management and environmental assessment. The Persian Gulf is chosen to be the study region, as it is a typical large-scale inverse estuary with severe shortages of freshwater resources and has been of significant research interest during the past several decades. For basin-wide examinations of a large-scale inverse estuary, analytical solutions are typically unavailable and field measurements are expensive, so numerical modeling as well as validation with available data is the main focus in this thesis. Firstly, the salinity distribution in the Persian Gulf is simulated with 8 different schemes, and the obtained results are compared with the World Ocean Atlas 2013 (WOA13) data. The comparisons can validate the utilization of the numerical model in predicting the salinity distribution in a large-scale inverse estuary. Given that results are affected by the choice of the numerical scheme, a performance analysis of candidate schemes is performed. The most appropriate scheme for the Persian Gulf is figured out in this stage. Secondly, the validated scheme is used for the prediction with respect to the long-term salinity response of the Persian Gulf to the climate change and anthropogenic activities. The results show that without mitigation measures taken, the salinity in the Persian Gulf will continually increase with time. The long-term and basin-wide simulations that will be presented in this thesis are expected to be more useful than previous studies (which were generally limited in time from hours to a few months) in terms of inspecting long-term characteristics. The performance of various numerical schemes has been assessed for the first time through a practical case study, which can contribute to a better understanding of the applications and characteristics of these schemes. Besides, the long-term salinity variations in the Persian Gulf are predicted for the next half-century, and this is the first numerical prediction of the long-term salinity response of the Persian Gulf to climate changes and anthropogenic activities.

Abstract Early sport specialization is a phenomenon that continues to be practiced in today’s youth sports environment. The purpose of this study was to explore practices around early specialization within the minor hockey context in Eastern Ontario. More specifically, the goal of this thesis was to better understand parental perspectives on specialization versus diversification relative to their child’s experience in the sport of ice hockey. Additionally, this study aimed to uncover the rates of specialization in Minor Peewee AA ice hockey players in Eastern Ontario and the factors that influence those who specialize. A concurrent embedded mixed-methods procedure was employed for this study; a total of 114 survey responses and 15 semi-structured interviews formed the study sample. Findings in the study reveal a large majority of parents foster specialization in their child as 87% (n=114) of survey participants identified as having a child who specializes in the sport of ice hockey. However, interview data revealed that parents favor development through diversification. Individual influences such as parents and coaching staff were found to be contributing factors to the phenomenon of specialization. Further, the availability of resources within the hockey context was additionally found to influence specialization. Finally, Hockey Canada’s current position was cogitated with the results to reveal a strong inclination towards elite development. Results indicate a need for parent and coach education regarding their role in early specialization and their support for diversification of sport experiences. It is of particular importance during the transitioning years in particular where stakeholders (parents, coaches, administration) foster the sense of well-rounded development of a participating child not just for the preparation for the elite stages of sport but for overall wellness of the individual.

0 / SPK / specialcollections@tulane.edu

Each year, hospitalizations from long-term care (LTC) settings occur, in part, due to underdeveloped nursing assessment skills, ineffective communication with primary care providers (PCPs), and delayed intervention. Through staff development nursing education, the quality and timeliness of care can be improved. The practice question that guided this doctoral project focused on whether evidence-based research information would assist in decreasing LTC-to-hospital admission rates through improved nursing assessment skills and better communication with PCPs. Using the logic model, the effectiveness of a program was evaluated and the impact of interventions on a predicted outcome was determined. Sources of evidence included obtaining best practice research information from scholarly nursing journals and official nursing websites. Analytical strategies included a review of the literature to examine data from nursing journals, websites, and other publication sources in addition to the use of a synthesis matrix that classified different ideas rated by the Cochrane Consumer Network. The findings of this project might contribute to positive social change by fostering improved patient assessments, enhanced communication with PCPs, early intervention, and decreased LTC-to-hospital admission rates through the improvement of nursing practice policy.