Abstract: My inquiry, involving participant-observation and self-study, explores the stories of four older women through verbal and visual narratives. Showing how two specific types of visual narratives—sandpictures and collages—stimulate experiential story-telling and promote understanding about life experiences, I also illustrate how engagement with images extends learning and meaning-making. Effective in carrying life stories and integrating experience, the visual narratives also reveal archetypal imagery that is sustained and sustaining. Considering how visual narratives may be understood independently, I describe multiple strategies that worked for me for entering deeply into the images. I also elaborate on the relationship of visual narratives to accompanying verbal narratives, describing how tacit knowing may evolve. Through this process, I offer a framework for a curricular approach to visual narratives that involves feeling and seeing aesthetically and associatively and that provides a space for learners to express their individual stories and make meaning of significant life events. Salient narrative themes include confrontation with life-death issues, the experience of “creating a new life,” an avid early interest in books and learning, and a vital connection to the natural world. New professions after mid-life, creative expression, and volunteerism provide fulfillment and challenge as life changes promote attempts to marry relationships with self and others to work and service. My therapy practice room was the setting for five sessions, including an introduction, three experiential sandplay sessions, and a conclusion. Data derive from transcripts from free-flowing conversations, written narratives, photographs of sandpictures, and field notes written throughout the various phases of my doctoral process. This study of older women, with its emphasis on lifelong learning, visual narratives, and development of tacit knowing, will contribute to the field of narrative inquiry already strongly grounded in verbal narrative and teacher education/development. It may also promote in-depth investigations of male learners at a life stage of making meaning of, and integrating, their life experiences. New inquirers may note what I did and how it worked for me, and find their unique ways of extending the study of visual narratives while venturing into the broad field of diverse narrative forms.

The decrease in hospital recovery time created a transition to more care being performed in the home. There is a need to balance care needs from both demand and supply characteristics. This research sets out to address how the presence or absence of informal caregiver(s) impacts on resource allocation decisions made by home and community care case managers. This research used a mixed methodologies approach employing both semi-structured interviews with frontline workers and secondary data analysis of the Central and Toronto Central LIHN Resident Assessment Instrument for Home Care (RAI-HC). Overall total average hours of formal services did not differ between care recipients depending on the presence or absence of a caregiver. It is evident from the responses provided by the participants that street-level bureaucracy plays a large role in service allocation decisions. That is, decisions are being made based on diverse idiosyncratic observations, opinions and feelings.

The decrease in hospital recovery time created a transition to more care being performed in the home. There is a need to balance care needs from both demand and supply characteristics. This research sets out to address how the presence or absence of informal caregiver(s) impacts on resource allocation decisions made by home and community care case managers. This research used a mixed methodologies approach employing both semi-structured interviews with frontline workers and secondary data analysis of the Central and Toronto Central LIHN Resident Assessment Instrument for Home Care (RAI-HC). Overall total average hours of formal services did not differ between care recipients depending on the presence or absence of a caregiver. It is evident from the responses provided by the participants that street-level bureaucracy plays a large role in service allocation decisions. That is, decisions are being made based on diverse idiosyncratic observations, opinions and feelings.

Abstract: My inquiry, involving participant-observation and self-study, explores the stories of four older women through verbal and visual narratives. Showing how two specific types of visual narratives—sandpictures and collages—stimulate experiential story-telling and promote understanding about life experiences, I also illustrate how engagement with images extends learning and meaning-making. Effective in carrying life stories and integrating experience, the visual narratives also reveal archetypal imagery that is sustained and sustaining. Considering how visual narratives may be understood independently, I describe multiple strategies that worked for me for entering deeply into the images. I also elaborate on the relationship of visual narratives to accompanying verbal narratives, describing how tacit knowing may evolve. Through this process, I offer a framework for a curricular approach to visual narratives that involves feeling and seeing aesthetically and associatively and that provides a space for learners to express their individual stories and make meaning of significant life events. Salient narrative themes include confrontation with life-death issues, the experience of “creating a new life,” an avid early interest in books and learning, and a vital connection to the natural world. New professions after mid-life, creative expression, and volunteerism provide fulfillment and challenge as life changes promote attempts to marry relationships with self and others to work and service. My therapy practice room was the setting for five sessions, including an introduction, three experiential sandplay sessions, and a conclusion. Data derive from transcripts from free-flowing conversations, written narratives, photographs of sandpictures, and field notes written throughout the various phases of my doctoral process. This study of older women, with its emphasis on lifelong learning, visual narratives, and development of tacit knowing, will contribute to the field of narrative inquiry already strongly grounded in verbal narrative and teacher education/development. It may also promote in-depth investigations of male learners at a life stage of making meaning of, and integrating, their life experiences. New inquirers may note what I did and how it worked for me, and find their unique ways of extending the study of visual narratives while venturing into the broad field of diverse narrative forms.

Doctor of Philosophy / Department of Hospitality Management and Dietetics / Rebecca A. Gould / Congregate meal programs under Older Americans Act Title IIIC provide hot meals for individuals 65 and older in a community setting during lunch time. The program focuses on preventing the problems associated with malnutrition and social isolation. From 1980 to 2002, the number of congregate meals served decreased by 18% while home-delivered meals increased almost 290%. To further understand reasons for declining program participation factors that impact participation were examined. The Theory of Planned Behavior (TPB) was used in this study to explain participation intention of community-dwelling elderly who lived in the Kansas North Central-Flint Hill region. A two-phased elicitation study including: 1) focus groups and 2) salient beliefs study was administered to uncover participation beliefs and identify and clarify salient belief items. Based on the results of an elicitation study and a literature review, a valid questionnaire was developed. Data were collected at a senior fair, senior centers, senior living facilities, senior exercise classes, and a monthly meeting of retired seniors yielding a total of 238 samples. Descriptive statistical analysis was used to summarize the respondent’s demographic characteristics. A two-step modeling approach including confirmatory factor analysis and structural equation modeling was performed to assess measurement model fit and checked causal relationships between factors. Five advantages that respondents believe influence participation include: convenience, social interaction, low-price, nutritious and balanced meals, and less waste. Family members, friends, neighbors, cooks at the meal site, and heath professionals were important referents who affected seniors’ program participation intention. The salient facilitators of program participation were activities at senior centers, the availability of transportation, the inclusive culture of senior centers, the lack of motivation and ability to cook, and poor weather. Results show the data fits the TPB moderately well: all predictor variables (attitude, subjective norm, perceived behavior control (PBC), and past behavior) had a significant positive effect on participation intention. Among the four factors, PBC had the greatest predictive power on intention. Attitude had the least impact on participation intention. Seniors provide thoughtful and insightful opinions about meal program. Results suggest program provider should focus on remove participation barriers and implement effective strategies to increase congregate meal program participation. The ultimate goal is to encourage the elderly to participate, improving their nutritional intake and thus, their quality of life.

Master of Science / Department of Family Studies and Human Services / Candyce S. Russell / As the number of Americans aged 60 and over increases substantially in the coming years, so is the incidence of depression among this age group. The purpose of this report is to explore the mental health needs of older Americans, the ways in which they are undiagnosed or under-diagnosed for depression, the clinical challenges associated with treating depression in the elderly, and the barriers that are in place due to social, psychological, financial and governmental factors. With the “Baby Boom” generation (those born between 1946-1964) entering their senior years, there will be an increased need for Marriage and Family Therapists to be cognizant of the rise in depression and familiar with the treatment options and limitations. Marriage and Family Therapists adhere to the Systems Theory and thus are uniquely qualified to act as a bridge between the medical and mental health communities. This report will promote the collaborative approach to healthcare and the way in which Marriage and Family Therapists can contribute to the treatment of depression in the aged.

Master of Arts / Department of Sociology, Anthropology, and Social Work / Laszlo Kulcsar / This study provided an exploratory qualitative analysis of printed brochures to evaluate the conceptualization of successful aging. Data was collected from a sample of 39 printed brochures derived from Kansas Department on Aging Directory (KDAD) of Adult Care Homes 2009. Content analysis methodology was employed to investigate how these brochures reflect the core elements of successful aging as constructed in the gerontological literature (Rowe and Kahn’s and Baltes and Baltes), as well as compare across the ‘traditional’ and ‘culture-change’ models. Other variables of ‘licensure classification’, ‘residency cost’ and ‘gender’ were explored. An overall perspective indicated several brochures met the core elements of successful aging delineated by the literature. In most cases, these elements showed no significance difference for brochures representing facilities by model types, licensure classifications, residency cost and by the demographic of gender.

This study was based on the premise that most people made funeral arrangements only after a death had occurred and within a setting of emotional turmoil. The desire of the study was to make available material, and instruction which would help to prepare the practical materials, providing information for the survivors of the deceased listing the desires of the deceased for his or her bodily disposal. When this material had been completed it was found that over seventy percent of those who used the material, made their actual funeral arrangements or consciously made known their desires for their funeral arrangements, either in writing or verbally, before any time of trauma or crisis, and made others significantly more alert to the planners real desires for such a time. The over sixty-five (65+) age group is closer in years to the time of death when time is considered in the biological development of life. This age group will naturally have a larger percentage of deaths per thousand of population than any other age group in America. Florida contains the largest number of persons within this age group of any state. Our ministry location presents added problems in death crisis times because of location and problems of relationships to other geographic locations. Age, also, opens a door to the awareness of the need for pre-preparation that is usually ignored at other times of life. This same 'age' provides for the opportunity for an unusual ministry of pre-preparation. It is this ministry which was planned for and evolved from this study project. The average age and health conditions of the membership of the congregation to which the study was directed, provided a sense of urgency and emphasized the need for this act of ministry. This program resulted in financial outlay decrease. Emotional upset was seemingly eased for each participant. The study reflects information that could be available to any group that shows elements of interest for such a ministry. Although the study deals with an emotionally sensitive area, it also helps to remove the concept of morbidity which is found ingrained into the minds of many of the people who are approached on this subject. This study is, above all, a report of what is (in age and death) and what can or should be accomplished through a ministry of pre-preparation. Chapter VI stands alone as the focus of this study. It contains the goals toward which and from which the act of ministry evolved.

Although older Canadians constitute a large portion of patients in hospital, many receive less-than-optimal drug care. Most registered nurses (RNs) and other health care professionals who provide older adults (OAs) with drug therapy lack pre-professional education about that practice. Concurrently, there is little research available about how RNs learn about drug therapy for OAs. Using a qualitative method, this thesis explores hospital RNs’ insights about their knowledge about drug therapy for OAs, their associated learning needs and strategies, and contextual influences on their learning. The findings illuminated RNs’ extensive knowledge, their learning needs and varied learning strategies, and constraints and facilitators of their learning. Drug therapy for OAs is a complex activity. RNs play a pivotal role in that care and have ample knowledge. RNs’ learning is holistic, ongoing, mostly informal, and reflective of many adult-learning theories. By learning, RNs build and transform their repertoires of knowledge to stay current with the quickly changing landscapes of health care, gerontological know-how, and drugs and drug practices. As a result, sometimes RNs protect not only OAs but also other hospital stakeholders from the negative effects of uninformed practice. Nurse educators should teach students about drug therapy for OAs and broaden their own views about RNs’ knowledge and learning strategies for that care. Nurse leaders should maximize chances for RNs to learn and prepare them to influence other stakeholders in ways that support learning. Hospital administrators and other stakeholders should recognize RNs’ pivotal role in drug care and support their learning through organizational changes. Communities should design strategies that ease RNs’ learning. Policymakers should replace corporatism with innovations that champion learning. Researchers and RNs should collaborate on novel projects that bolster RNs’ learning.

Although older Canadians constitute a large portion of patients in hospital, many receive less-than-optimal drug care. Most registered nurses (RNs) and other health care professionals who provide older adults (OAs) with drug therapy lack pre-professional education about that practice. Concurrently, there is little research available about how RNs learn about drug therapy for OAs. Using a qualitative method, this thesis explores hospital RNs’ insights about their knowledge about drug therapy for OAs, their associated learning needs and strategies, and contextual influences on their learning. The findings illuminated RNs’ extensive knowledge, their learning needs and varied learning strategies, and constraints and facilitators of their learning. Drug therapy for OAs is a complex activity. RNs play a pivotal role in that care and have ample knowledge. RNs’ learning is holistic, ongoing, mostly informal, and reflective of many adult-learning theories. By learning, RNs build and transform their repertoires of knowledge to stay current with the quickly changing landscapes of health care, gerontological know-how, and drugs and drug practices. As a result, sometimes RNs protect not only OAs but also other hospital stakeholders from the negative effects of uninformed practice. Nurse educators should teach students about drug therapy for OAs and broaden their own views about RNs’ knowledge and learning strategies for that care. Nurse leaders should maximize chances for RNs to learn and prepare them to influence other stakeholders in ways that support learning. Hospital administrators and other stakeholders should recognize RNs’ pivotal role in drug care and support their learning through organizational changes. Communities should design strategies that ease RNs’ learning. Policymakers should replace corporatism with innovations that champion learning. Researchers and RNs should collaborate on novel projects that bolster RNs’ learning.