<p>Alternate Level of Care, or ALC, is a designation assigned to a patient during an acute care hospital stay when that patient is occupying a bed but no longer requires that intensity of service. A high proportion of beds occupied by patients requiring ALC results in problems in the healthcare system related to patient flow, access, and efficiency. The purpose of this study was to better understand the experience of older patients and family caregivers while the patient is designated as requiring ALC. This study employed the Three-Dimensional Narrative Inquiry Space method of Clandinin and Connelly (2000) to examine the experiences of five patients and four family caregivers. The primary data source for this study was a series of semi-structured interviews with individual participants over time while they were in the midst of the experience of ALC. Data analysis involved a twofold process of restorying all interview transcriptions for a given participant into a single story summarizing his or her experience, and analyzing the content across stories to identify common themes. The major finding of this study was that uncertainty was a significant part of the experience of ALC. This uncertainty was manifest in relation to self-concept, waiting for placement, not knowing about information, not being included in planning, lack of mobility, and lack of meaningful activity. The study findings have implications for strategies to manage uncertainty in the areas of practice, policy, education, and research in order to improve the experience of older patients and their family caregivers.</p> / Master of Science (MSc)

This study includes an analysis of the autobiographies of William A. Owens, a contemporary writer, educator, and Texas folklorist; a discussion of Owens' educational experiences and attitudes; an explanation of Readers Theatre requirements; and a fifty to fifty-five minute Readers Theatre script, "Lighting the Lamp: William A. Owens' School Days in Pin Hook." The script portrays Owens as a Texas schoolboy and country schoolteacher and it conveys some of Owens' attitudes about education. The script was adapted from Owens' two autobiographies, This Stubborn Soil and A Season of Weathering, to be performed by junior and senior high school students.

Because of the lasting impact that traumatic family events can have on psychological well-being, students who present for services at college counseling centers may be experiencing problems and symptoms associated with earlier trauma. Many college counseling centers utilize the Counseling Concerns Survey developed by the Research Consortium of Counseling and Psychological Services in Higher Education (1991) and the Outcome Questionnaire-45 (OQ-45; Lambert et al., 1996) as intake instruments to assess students who present for counseling. The major components of the Counseling Concerns Survey are the 18-item Family Experiences Questionnaire, which identifies history of family trauma, and the 42-item Presenting Problems List, which assesses students' major areas of distress. The OQ-45 measures symptom severity. While it is generally assumed that family trauma during childhood and adolescence can negatively impact future mental health and well-being, it has been unclear how specific traumatic family experiences reported on the Family Experiences Questionnaire are related to specific presenting problems as listed on the Presenting Problems List or symptom severity as measured by the OQ-45. The purpose of this study was to examine this relationship and to ascertain discernible patterns. Data from the intake instruments of 20,495 students who sought counseling services at a large western U.S. university from 1997 to 2007 was analyzed. Logistic regression of each of the 18 traumatic family history experiences was performed, using the initial OQ-45 score, the 42 Presenting Problems List items, and five Presenting Problems List factors (Draper, Jennings, & Baron, 2003) as "predictors" of the types of trauma the students might have experienced. Results showed that although family trauma of a variety of types was associated with symptom severity and various presenting problems, there did not seem to be an overall discernible pattern. The results suggest that trauma seems to have a diffuse association with presenting problems and symptom severity. However, some family traumas are associated with a greater number of presenting problems, and these traumas were identified.

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