Advance directives (ADs) convey consumers' wishes about accepting or refusing future treatment if they become incompetent. The issue of making a particular AD, more commonly referred to as a living will, is the focus of this thesis. The typical direction of the living will is that life-sustaining activities such as the provision of mechanical ventilation should be withheld so that a person may die what is hoped to be a 'peaceful death'. Clearly the whole basis of the thinking behind the recognition of ADs is that patients' wishes should prevail. ADs have been championed by some as a means of preserving both dignity and autonomy at the end of life in the face of increasing medical advances in technology to preserve life indefinitely. ADs are seen as a means of promoting peace of mind in will-makers, of allowing carers and family to honour the person's wishes and of stimulating communication between all involved parties.While at present there is no statutory right for people in New Zealand to make ADs, it is considered they have rights to do so in common law as consumers of health and disability services in this country. Little is known about the views of New Zealanders making ADs or their justification for doing so. This small qualitative study, using a discourse analysis approach after Potter and Wetherell (1987), aimed to investigate how the participants justified making ADs. Six people were interviewed and the transcriptions were analysed identifying three dominant interpretative repertoires and three corresponding subject positions.The findings indicated that the participants positioned themselves: as independent self-determining individuals who knew when they were ready to make ADs after witnessing undesirable deaths of close family members; as judges of knowing when inappropriate treatments lead to undignified deaths; and as concerned parents who want to relieve their families of uncertainty in the future when making surrogate end-of-life decisions for them. Witnessing a prolonged family member's death in the past was a contributing factor to the participants making ADs. The participants' recall of these events led them to make their wishes known in advance so that their families, in turn, would not have to go through a similar experience at the terminal stages of their lives. The overarching motivations for formalising ADs was to avoid having life artificially prolonged by receiving life-sustaining treatments as well as the desire to die a dignified death.This study highlights the need for healthcare professionals to value the importance of advance planning with well adults before they lose the capacity to give informed choices at the end of life. The taking of a values history as part of this advance planning may inform family and healthcare professionals about peoples' general values and at the same time confirm and record end-of-life choices for future reference.

本研究旨在探討前導組織(advance organizer)教學對國中生英文聽力理解的影響。關於前導組織的實證研究為數眾多，其中不少分別針對圖像類(pictorial)及文字類(verbal)前導組織對聽力促進、閱讀習得之效用做探討，未見有研究將兩類前導組織的效用一起比較。因此，本實驗採用此兩類前導組織，經量化研究方法，探究「圖像語境線索」(Pictorial Contextual Cues)及「文字語境關鍵」(Verbal Contextual Keys) 對國中生觀看無字幕英語發音影片時聽力理解的影響。 研究對象為台灣北部一所國立高中之國中部三年級三個班的八十七位學生，三個班級皆採常態分班，經隨機指定為兩實驗組及一對照組。實驗歷時四個禮拜，實驗前對三組受試者施以前測—GEPT中級聽力測驗—以得知受試者個別的英文聽力程度。實驗後讓受試者填寫一態度問卷，以得知受試者對前導組織的看法及感想。實驗時，觀看教學影片前，兩個實驗組及一個對照組分別接受「圖像語境線索」(Pictorial Contextual Cues)、「文字語境關鍵」(Verbal Contextual Keys)及「無實驗處理」(No treatment)，前導組織教學後隨即觀看一個約五分鐘長的無字幕英語教學影片(instructional video)。影片觀看後，三組受試者隨即接受研究者根據影片聽力內容自編的測驗，以得知受試者的理解程度。如此的實驗過程重複三次，四個禮拜後，根據三個聽後測驗的結果進行統計分析，本研究主要發現 如下：(1)整體而言，「圖像語境線索」與「文字語境關鍵」分別對國中生觀看無字幕英文教學影片的聽力理解是有幫助的；(2)整體而言，「圖像語境線索」與「文字語境關鍵」對國中生觀看無字幕英文教學影片的聽力理解，兩者間的效用並無顯著差異；(3)大部分受試者對前導組織教學在英文聽力理解的幫助持正向態度，認為前導組織有助於英文聽力理解；(4)相較於「圖像語境線索」，較多受試者願意再接受「文字語境關鍵」前導組織教學的幫助。最後，研究者認為雖額外準備教材需花費許多時間、精力，但能讓學生經由前導組織的幫助，在影片教學中習得“真實語言(real language)”，不僅能藉此促進學生的學習動機，也能讓英文聽力訓練更加有趣、多變。 / This study is to investigate the effects of the two advance organizers—pictorial contextual cues and verbal contextual keys—on students’ English listening comprehension. There were many empirical studies examining the effects of pictorial or verbal advance organizers respectively. However, based on the researcher’s literature review, effects of these two distinct types of advance organizers have not been compared. Hence, the researcher intended to find out if the two advance organizers—pictorial contextual cues and verbal contextual keys—facilitate students’ English listening comprehension on watching video clips without captions. There were 87 9th-grade participants, divided into two experimental groups and one control group, receiving pictorial contextual cues, verbal contextual keys, and no treatment. In the beginning, all participants received a test, i.e. the listening comprehension section of General English Proficiency Test (GEPT) intermediate level. Then, the three groups received their respective treatments in three consecutive weeks. Each time after the treatments, participants watched a 5-minute video clip and took a listening test on the content they just heard. After viewing the three video clips, on the fourth week, participants filled out an attitude questionnaire to express their perceptions of advance organizers. Analyzing the results of the three listening tests and the questionnaire, the researcher found that both groups receiving advance organizers significantly outscored the control group. However, there was no significant difference between the two advance organizers. As for students’ attitude, more than half of all the participants agreed on the effectiveness of the two advance organizers. Yet, more students in the Verbal Contextual Keys group held positive attitude on receiving the advance organizer again. Though designing or preparing advance organizers and selecting suitable authentic/instructional video materials may take teachers much extra time and energy, students could be motivated when they learned the “real language.” Moreover, English listening training could be more interesting and diverse.

This study used a 2 (advance organizers: paragraph vs. item) ¡Ñ 2 (story structures: hierarchical vs. sequential) experimental design to explore the effects of advance organizers and story structures on fifth graders¡¦ reading comprehension. The results were listed as following: 1. No matter the hierarchical story structure or the sequential story structure, students receiving the paragraph advance organizer recalled better on the total number of words and the idea units than the students receiving the item advance organizer. 2. The different advance organizers had different effects on students recall. Students receiving the paragraph advance organizer had a better recall on the main ideas, comprehension level 1, Comprehension level 2, and causal chain than students receiving the item advance organizer. 3. For the hierarchical story structure, students who receiving the paragraph advance organizer had a better recall on the detailed ideas and sequential recall than students receiving the item advance organizer. For the paragraph advance organizer, students receiving the hierarchical story structure had a better recall on the detailed ideas and sequential recall than students receiving the sequential story structure. 4. For the recall on dead-ends information, on the hierarchical story structure, students receiving the paragraph advance organizer had better recall than students receiving the item advance organizer. Also, on the item advance organizer, students receiving the sequential story structure had better recall than students receiving the hierarchical story structure. 5. The different advance organizers and story structures had effects on students¡¦ inferential ability. On the hierarchical story structure, the paragraph advance organizer performance surpassed in the item advance organizer. On the item advance organizer, students receiving the sequential story structure had better performance on the inference than students receiving the hierarchical story structure. 6. The different advance organizers had different effects on the literal comprehension. Students receiving the item advance organizer had better performance on the literal comprehension than student receiving the paragraph advance organizer. The different advance organizers and story structures have different effects on students¡¦ reading comprehension. Thus, teachers should to choose different advance organizers to present the reading material depends on the structure of the reading materials. Also, teachers should choose the story structure of the reading material based on which ability that students need to be strengthened.

Advance directives (ADs) convey consumers' wishes about accepting or refusing future treatment if they become incompetent. The issue of making a particular AD, more commonly referred to as a living will, is the focus of this thesis. The typical direction of the living will is that life-sustaining activities such as the provision of mechanical ventilation should be withheld so that a person may die what is hoped to be a 'peaceful death'. Clearly the whole basis of the thinking behind the recognition of ADs is that patients' wishes should prevail. ADs have been championed by some as a means of preserving both dignity and autonomy at the end of life in the face of increasing medical advances in technology to preserve life indefinitely. ADs are seen as a means of promoting peace of mind in will-makers, of allowing carers and family to honour the person's wishes and of stimulating communication between all involved parties.While at present there is no statutory right for people in New Zealand to make ADs, it is considered they have rights to do so in common law as consumers of health and disability services in this country. Little is known about the views of New Zealanders making ADs or their justification for doing so. This small qualitative study, using a discourse analysis approach after Potter and Wetherell (1987), aimed to investigate how the participants justified making ADs. Six people were interviewed and the transcriptions were analysed identifying three dominant interpretative repertoires and three corresponding subject positions.The findings indicated that the participants positioned themselves: as independent self-determining individuals who knew when they were ready to make ADs after witnessing undesirable deaths of close family members; as judges of knowing when inappropriate treatments lead to undignified deaths; and as concerned parents who want to relieve their families of uncertainty in the future when making surrogate end-of-life decisions for them. Witnessing a prolonged family member's death in the past was a contributing factor to the participants making ADs. The participants' recall of these events led them to make their wishes known in advance so that their families, in turn, would not have to go through a similar experience at the terminal stages of their lives. The overarching motivations for formalising ADs was to avoid having life artificially prolonged by receiving life-sustaining treatments as well as the desire to die a dignified death.This study highlights the need for healthcare professionals to value the importance of advance planning with well adults before they lose the capacity to give informed choices at the end of life. The taking of a values history as part of this advance planning may inform family and healthcare professionals about peoples' general values and at the same time confirm and record end-of-life choices for future reference.

Thesis (M.S.)--University of Wisconsin--Madison, 1990. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 157-161).

Thesis (M.Nurs.)--Washington State University, August 2007. / Includes bibliographical references (p. 40-48).

Thesis (M. Nurs.)--University of Hong Kong, 2006.

Advance care planning for adults is a process of consideration, discussion and decisions about care at the end of life. There is evidence that advance care planning improves outcomes such as the achievement of preferred place of death and the quality of dying. However, the uptake of advance care planning is variable. There are calls for more research to understand what influences people to carry it out to plan services and improve the quality of life of patients and their families. This dissertation reports on a qualitative, video interview study of 15 adult hospice patients. The study was interpretative influenced by the narrative approach with data driven thematic analysis and a video aide memoir. Coding was carried out using the Computer Assisted Qualitative Data Software programme Transana. The rigour and credibility of the study was viewed through the lens of trustworthiness which included the development of a Continuous Conversation Framework. The aim of the study was to investigate what would influence hospice patients to discuss their advance care planning to develop future education programmes based upon the perspectives of people at the end of their life: 1. What influences hospice patients in their advance care planning? 2. What communication skills do hospice patients find helpful when clinicians discuss advance care planning? Three findings are reported. These suggest that the influences on advance care planning activity and conversations is the less reported relationship of the personal context of a person's life (as well as services, diagnosis and prognosis considerations). First, the findings highlight the relevance of how people with an incurable illness live with and talk about their dying within the individual context of their daily lives. Secondly, differences are illustrated between how people prepare (for themselves) and plan (for others) in their dying. Thirdly, clinician communication behaviours such as empathy (through mutual connection and visible behaviours), tailored conversations (through accessible and selective honesty) and the design and use of space empower people to carry out conversations which support them as they live with, prepare and plan for dying. The three findings contribute to the perspective which supports the complexity of advance care planning that should focus on the context of person's life as well as the paperwork, prognosis or diagnosis. A contribution to person-centred care is suggested through a model of relational advance care planning.

Older adults with dementia are at increased risk of becoming incapable of making their own decisions and may therefore benefit from planning for care at the end-of-life. Advance care planning (ACP) is a complex, multifaceted process by which people can express their wishes about care at the end-of-life in case they become incompetent to make decisions for themselves. However, we have little understanding of the ACP process among people with dementia and their families. This study addressed three questions: 1) when and how to cognitively impaired older adults and their families receive information about ACP; 2) in which aspects of the ACP process do families of cognitively impaired older adults engage, and why (and does this fit within the framework of the transtheoretical model of behaviour change [TTM]); and 3) how ACP relates to the way in which family members perceive the quality of death of their loved one. 22 family members of deceased older adults with dementia were interviewed and data was analyzed using interpretive description qualitative methods. Participants reported that information about ACP is provided in a haphazard and often incomplete manner, leading to difficulty engaging in the ACP process. Older adults were in various stages of readiness to engage in ACP behaviours, with most only engaging in a subset of ACP behaviours. Although ACP was viewed as beneficial by participants, several barriers were identified that prevented people with dementia from dying in a way that was aligned with previously-expressed wishes. Implications for the practice of clinical neuropsychology and implications for policy on ACP are discussed. / Graduate

Advance care planning (ACP) is a process of discussing the patient’s wishes and preferences for future health care. ACP allows for the patient to retain their autonomy and involves informing the patient about their illness, prognosis, and their health care options. Despite the known advantages of completion of ACP forms, ACP discussions are minimal during primary care visits. The purpose of this DNP project was to identify primary care providers (PCP) beliefs and attitudes regarding barriers to addressing ACP with patients with a chronic illness in the primary care setting at one family practice clinic in Tucson, Arizona, and to determine if providing educational information will increase the PCPs intent to address ACP within clinical practice. A pre-survey, educational handout, and post-survey containing Likert-type scale questions and one ranking format question was created and sent via email to potential participants within the family practice clinic. The pre-survey requested demographic characteristics, and both the pre and post surveys assessed the PCPs beliefs and attitudes towards barriers to addressing ACP. 42 potential PCPs were asked to participate in the online surveys, eight (19%) completed the pre-survey, and four (9.5%) completed the post-survey. The data obtain from the surveys indicate lack of time, discomfort with the subject, and communication barriers as the most frequently reported perceived barriers to addressing ACP in the primary care setting. The results from this project can be used to understand PCPs beliefs and attitudes towards addressing ACP in the primary care setting and how this can affect future care of the patient when a serious illness occurs.