Thesis (M.S.)--University of Michigan, 1990.

Thesis (Ph.D.)--Aberdeen University, 2008. / Title from web page (viewed on Apr. 21, 2009). Includes bibliographical references.

Thesis (M.A.)--Catholic Theological Union at Chicago, 2005. / Vita. "April 2005." Includes bibliographical references (leaves 22-23).

Thesis (M.A.)--Catholic Theological Union at Chicago, 2005. / Vita. "April 2005." Includes bibliographical references (leaves 22-23).

Thesis (Ed.D.)--University of West Florida, 2005. / Title from title page of source document. Document formatted into pages; contains 208 pages. Includes bibliographical references.

Thesis (H. Sc. D.)--University of Sydney, 2008. / Title from title screen (viewed Nov. 13, 2008) Submitted in fulfilment of the requirements for the degree of Doctor of Health Sciences to the Faculty of Health Sciences. Includes bibliographical references. Also available in print form.

Background: This thesis examines the impact of dream or wish fulfilment on seriously ill children and their families. Dream or wish fulfilment is operationalised as the actualisation of a seriously ill child’s wish by a charity that provides desired experiences. Anecdotal reports suggest that the experience of having a dream or a wish fulfilled can provide seriously ill children and their families with a sense of hope and time away from illness. However, little empirical research has been conducted in this area. This thesis reports the impact of dream fulfilment on the psychosocial well-being of ill children and their families. The research questions are: what is the experience of having a dream fulfilled for the child? What is the impact of dream fulfilment on the family? Methods: A constructivist grounded theory methodology was adopted, using theoretical sampling to recruit families from across the UK. Twenty-one families were interviewed, including 15 dream recipients, 8 siblings, and 24 parents. Analysis followed the grounded theory methodology of simultaneous data collection and development of theory, resulting in analytic interpretations of participants’ worlds. Results and Conclusions: This thesis reports for the first time a theory and accompanying theoretical model, that explain the impact of dream fulfilment on families’ lives. The generated theory suggests that dream fulfilment was conceptualised as an alternative milestone in seriously ill children and their families’ lives. Additionally, the dream experience shifted perceptions of illness by providing instances and experiences where illness did not underscore family life. Findings additionally suggest that the dream fulfilment process provided families with ill children, who often felt excluded and stigmatised from services, with a period of much needed support. Findings also highlight the unintended negative consequences of dream fulfilment. Implications for Dreams Come True, and other dream and wish fulfilment organisations are discussed.

Growth in the elderly population and restraint in the health sector have led to decision makers placing an increasing priority on home care services. In Canada, there are three models of home care: a preventive and maintenance model which is designed to reduce the rate of deterioration for persons with relatively low level care needs; an acute care substitution model where home care substitutes for hospital care; and a long term care substitution model which uses home care as a substitute for facility care. This study focuses on the long term care substitution model. The research question is: In the British Columbia continuing care sector, is home care for the elderly a cost-effective alternative for government funders to care in long term care facilities, by level of care? To answer this question, data were obtained on three cohorts of clients for one year prior to initial assessment and three years post-assessment. The cohorts were new admissions to the British Columbia continuing care system in the 1987/88, 1990/91 and 1993/94 fiscal years. Costs to government for home care services, residential services, pharmaceuticals, fee-for-service physician services and hospital services were analyzed. The central finding of this study was that, on average, the overall health care costs to government for clients in home care are about one half to three quarters of the costs for clients in facility care, by level of care. A related finding was that costs differ by the type of client. The lowest home care costs were for individuals who were stable in their type and level of care. For clients who died the costs for home care were higher, compared to clients in long term care facilities. It was also found that some one half of the overall health care costs for home care clients were attributable to their use of acute care hospital services and that a significant portion of the health costs for home care clients occur at transition points, that is, when there is a change in the client's type, and/or level, of care. These findings are compared to the American literature which indicates that home care is not a cost-effective substitute for residential care. Possible reasons for the differences in findings are discussed. The study concludes with a discussion of the implications of the findings for a series of potential, future, policy agendas regarding: the organization and management of continuing care services; legislation and administrative policy; service delivery; resource allocation; information systems; and research. / Graduate

There is presently an increasing trend towards deinstitutionalization of several different populations, including physically disabled adults. Although a variety of staffed resources provide for alternative care, 'home' and 'family' remain the primary resource in the community based care system. Given that the family of the 1980's has a decreased capacity to care due to such factors as increased mobility and loss of extended family networks we must be concerned with the continued viability of this resource. And, given that 'family’ is often a euphemism for 'nearest female relative' and that women's role in society has changed markedly in recent years the issue of women as caregivers is one of particularly urgent concern. This study is based on extensive interviews with eight women caring for disabled husbands. The interview schedule and methodology facilitated descriptive data regarding caregiving tasks as well as a comprehensive exploration of what was problematic about the day to day reality of caregiving for these women. The data analysis identified struggling with the 'role' of wife-caregiver, isolation and a changed marital dynamic as primary themes in the process of caregiving. This study provides some insight into what is problematic about caregiving for these wives and some suggestions for improving social work practice and providing more effective services in relation to this population. / Arts, Faculty of / Social Work, School of / Graduate

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