There is limited research examining the experiences of nurse leaders in the sustainability of change. The current literature found that nurse leaders have focused on the role of creating/leading a change in practice, and the strategies and solutions necessary for the creation of the given change (Buonocore, 2004; Morjikian, Kimball, & Joynt, 2007). Scattered amongst the literature are insights and empirical research that looks into why there is not sustainability in a change/innovation. The purpose of this qualitative, descriptive study was to develop an understanding of nurse leaders’ roles, experiences, successes, and failures in the sustainability of change. Roger’s (2003) Diffusion of Innovation Theory provided the conceptual framework for the study. The experiences of eight nurse leaders, from a variety of roles representing positions of formal and informal power, were explored. The findings of this study revealed nurse leaders’ perceptions of strategies required to maintain changes in nursing practice; and provides valuable insight into the roles, experiences, and perspectives of nurse leaders in the sustainability of change.

This qualitative study utilized the action-project theory and method to investigate the close, long-term friendships (two to ten years in duration) of female, early adolescent dyads. Ten early adolescent girls between the ages of 11 and 13 were studied. The purpose of this study was twofold; first, to determine the characteristics of best friendship projects and how they manifested within early adolescent friendship conversations and; second, to investigate the nature of self-representations (descriptions of the self) made by the participants. The processes (cognitive, affective, and behavioural) and meaning (goals) of friendship jointly expressed within the conversations were identified. As well, self-representations were analyzed from the perspective of whether they functioned to advance friendship projects. In addition to the friendship conversations, collages explicating the girls’ meanings and processes around their close friendships were also explored through an individual interview with each participant. The participants engaged in five friendship projects within their friendship conversations. First, an overriding project to preserve and maintain the friendship was demonstrated. Other sub-projects demonstrated within the conversations were the desire to have fun, to provide support to each other, and to connect with each other. Simultaneously, while jointly enacting other friendship projects, the participants also demonstrated through action, the project of exploring and discovering aspects of their identities. Multiple functional steps (the means) to achieve these projects were utilized. Gossip, fictional and factual storytelling, teasing, joking, problem solving, asking for advice, and displaying physical affection are examples of these means. Self-representations from the conversations were not always consistent with those revealed during self-confrontation interviews, at times in the service of achieving friendship goals. Self-representations between the collage interviews and the friendship conversations were very consistent, suggesting the complementary nature of the data sources. Meanings and processes gleaned from the friendship conversations were also very consistent with those found within the friendship collages. Implications of these findings for parents, educators, and counsellors are discussed.

Doctor of Philosophy (PhD) / Recent sociological literature on family life focuses on the apparently increasing scope for individual choice in forming meaningful, intimate relationships. One important arena for the exercise of such choice is adoption, which is increasingly taking place across national boundaries, taking the form of intercountry adoption. Little attention, however, has been paid to this aspect of contemporary family life by these broader accounts of family change. The research which deals specifically with intercountry adoption focuses on the development and trends of the practice as well as outcome studies, often undertaken in the fields of social work and psychology, and there is little research which investigates the interaction between the general trends in family structure and intercountry adoption. This study responds to these gaps in the literature by examining the experiences of individuals choosing to form families through intercountry adoption in the Australian social policy environment. Documentary evidence was used to understand the development of Australian intercountry adoption and provide the historical and social policy context for the qualitative component of the study. Semi-structured in-depth interviews were conducted to develop an understanding of the choice participants made to form their family through intercountry adoption, and to examine how the state manages this area of social policy. My study found that individuals choose to form families through intercountry adoption because children are a crucial means by which they can add meaning to their lives and intimate relationships by providing another human being to love and nurture. This child focus was seen as ‘natural’ and, for some, as an inevitable extension of their relationship. The research also generated findings about the nature of relationships within intercountry adoptive families and the factors which influence how these families are different from biological families. The complex policy environment in Australia creates difficulties for individuals negotiating the system and diversity in legislation and practice among states results in an unclear policy orientation. The movement of children across international boundaries, while not new, has been influenced by a number of global forces including improved transport, enactment of international treaties, media coverage and the introduction of the internet. These advances have resulted in increased knowledge and access to information about intercountry adoption and a more developed understanding of how the process operates in other countries, which impacts on the experience of the process in Australia. The sociological account of family formation involving intercountry adoption in Australia that I have developed in this thesis confirms that relationships of choice are being formed in postmodern society, despite messages from a variety of authorities regarding family life which are often mixed, contradictory and dominated by particular family types, rather than by the concept of choice. My study differs from existing studies on intercountry adoption in its achievement of an account of the personal experiences of the intercountry adoption process and family life that links the two together, to show both how broader issues in postmodern family formation structure intercountry adoption, and how intercountry adoption constitutes a vital element of contemporary family formation.

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.

Doctor of Philosophy (PhD) / Recent sociological literature on family life focuses on the apparently increasing scope for individual choice in forming meaningful, intimate relationships. One important arena for the exercise of such choice is adoption, which is increasingly taking place across national boundaries, taking the form of intercountry adoption. Little attention, however, has been paid to this aspect of contemporary family life by these broader accounts of family change. The research which deals specifically with intercountry adoption focuses on the development and trends of the practice as well as outcome studies, often undertaken in the fields of social work and psychology, and there is little research which investigates the interaction between the general trends in family structure and intercountry adoption. This study responds to these gaps in the literature by examining the experiences of individuals choosing to form families through intercountry adoption in the Australian social policy environment. Documentary evidence was used to understand the development of Australian intercountry adoption and provide the historical and social policy context for the qualitative component of the study. Semi-structured in-depth interviews were conducted to develop an understanding of the choice participants made to form their family through intercountry adoption, and to examine how the state manages this area of social policy. My study found that individuals choose to form families through intercountry adoption because children are a crucial means by which they can add meaning to their lives and intimate relationships by providing another human being to love and nurture. This child focus was seen as ‘natural’ and, for some, as an inevitable extension of their relationship. The research also generated findings about the nature of relationships within intercountry adoptive families and the factors which influence how these families are different from biological families. The complex policy environment in Australia creates difficulties for individuals negotiating the system and diversity in legislation and practice among states results in an unclear policy orientation. The movement of children across international boundaries, while not new, has been influenced by a number of global forces including improved transport, enactment of international treaties, media coverage and the introduction of the internet. These advances have resulted in increased knowledge and access to information about intercountry adoption and a more developed understanding of how the process operates in other countries, which impacts on the experience of the process in Australia. The sociological account of family formation involving intercountry adoption in Australia that I have developed in this thesis confirms that relationships of choice are being formed in postmodern society, despite messages from a variety of authorities regarding family life which are often mixed, contradictory and dominated by particular family types, rather than by the concept of choice. My study differs from existing studies on intercountry adoption in its achievement of an account of the personal experiences of the intercountry adoption process and family life that links the two together, to show both how broader issues in postmodern family formation structure intercountry adoption, and how intercountry adoption constitutes a vital element of contemporary family formation.

Thesis (M.A.)--York University, 2006. Graduate Programme in Psychology. / Typescript. Includes bibliographical references (leaves 199-211). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pqdiss&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:MR29570

Thesis (Ph.D. in Nursing) -- University of Colorado at Denver and Health Sciences Center, 2006. / Typescript. Includes bibliographical references (leaves 144-159). Free to UCDHSC affiliates. Online version available via ProQuest Digital Dissertations;

Thesis (Ph.D.)--Indiana University, 2009. / Title from screen (viewed on November 4, 2009). School of Nursing, Indiana University-Purdue University Indianapolis (IUPUI). Advisor(s): Sharon Sims, Carrie Foote, Joan Austin, Melinda Swenson. Includes vita. Includes bibliographical references (leaves 104-110).

Thesis (M.S.)--Ohio University, June, 2009. / Title from PDF t.p. Includes bibliographical references.

Thesis (Ph. D.)--Ohio State University, 2005. / Available online via OhioLINK's ETD Center; full text release delayed at author's request until 2006 Aug 15.