In Ontario, the population of older adults is increasing. While the provincial government is taking action to address increasing demand on health systems, older adults are still suffering the consequences of a health system that is not able to meet their complex care needs. Older adults face barriers to continuity of care including difficulties with memory, reliance on informal caregivers, frailty, and difficulties scheduling appointments. These barriers also exist within the long-term care setting. Long-term care facilities are making efforts to provide more effective care, including designing care approaches aimed to meet the complex care needs of older adults. Aspects of a goal-oriented approach suggest that it has the potential to reduce fragmentation and positively impacting continuity of care. However, the impact of goal-oriented care on continuity of care in a long-term care setting has yet to be explored. This thesis uses an exploratory case study methodology to describe how a goal-oriented care approach influenced continuity of care in a long-term care setting, as perceived by residents, staff, and administrators. The case study setting is the Perley & Rideau Veterans Health Centre in Ottawa, Ontario, where the SeeMe program, a frailty-informed approach with a goal-oriented component, was recently introduced. Factors associated with the SeeMe program and other organizational factors perceived to facilitate and inhibit informational, relational and management continuity were identified. Aspects of the SeeMe program that facilitated informational continuity were: goals-of-care meetings with residents, their care team and family; care conferences that helped residents understand their care options; and, procedures that ensured consistency in where resident’s goal information is stored. Aspects that facilitated relational continuity were: understanding residents’ values and preferences; staff increasing awareness of the program for families; and, integration of the family perspective into a resident’s care. Program aspects that facilitated management continuity were: discussions that led to informed decision-making; use of assessments as a reference tool in the case of an acute health event; discussions that empowered residents to talk to external care providers; and, creation of a structure that facilitated consistencies in care. These factors can be targeted when designing care approaches aimed to improve continuity in long-term care settings.

The objective of this research was to investigate the relationship between self-concept and goal attainment for assertive training groups. To determine if self-concept is related to the extent to which one's goals are attained was of major interest. Another purpose was to determine if self-concept measures increase as a result of participation in group assertive training. Subjects were 67 volunteers, students from Utah State University, and Cache Valley, Utah, community members. Subjects were administered as pretests and posttests the Tennessee Self Concept Scale and the Goal Attainment Scaling procedures including the Behavioral Monitoring Progress Record. Three groups were formed: 1) AT I, a self-directed assertive training group, 2) AT II, a directed, goal-oriented assertive training group, and 3) a no-treatment control group. Four assertive training sessions were conducted and posttesting was completed. Two correlations were computed: 1) the pretest TSCS scores were correlated with the GAS scores, and 2) the posttest TSCS scores were correlated with the GAS scores. A test of significance between correlation coefficients was applied to the two correlation coefficients obtained. The two correlations were not significantly different at the .05 significance level suggesting that the extent to which goals are attained is not related to self-concept for the two assertive training groups. Increases from the TSCS pretest to posttest for each assertive training group were significant as indicated by the analysis of variance for repeated measures. The experience of participating in both assertive training groups was suggested as effecting positive changes in self-concept.

The purpose for this study was to develop guidelines for the implementation of Goal Attainment Sealing (a mental health measurement technique) in the medical care setting. As a graduate student of social work, I have become involved in the delivery of medical care and am interested in the dynamics of psycho-social variables as they affect the structure, delivery, and outcome of medical services.

Indiana University-Purdue University Indianapolis (IUPUI) / Many advanced cancer patients receive intensive treatment near the end of life (EOL). Intensive treatment near the EOL is often associated with worse outcomes, such as worse quality of life (QOL), greater distress in patients and caregivers, and higher health care costs. For cancers typically unresponsive to chemotherapy such as lung and gastro-intestinal (GI), the side effects of intensive treatment are endured without increasing survival time. To date, research on EOL care in advanced cancer patients has focused on patient prognostic understanding, physician communication, and patient distress. These factors do not fully explain why many patients receive intensive treatment near the EOL when there is no hope for cure. Hence, there is a need to better understand the factors that influence EOL treatment in order to improve patient and caregiver outcomes. Self-Regulation Theory (SRT) provides a framework that may help explain motivations and care decisions in this population. This study had two aims: 1) to examine the associations between EOL clinical encounters (i.e., EOL conversations with a physician) and treatment intensity in advanced cancer patients near the EOL; and 2) to examine the associations between important SRT constructs (i.e., goal flexibility, hope, and optimism) and treatment intensity in advanced cancer patients near the EOL. A sample of 76 advanced lung and GI cancer patients was recruited from Indiana University Simon Cancer Center. Hope predicted receiving chemotherapy closer to death (β = -.41, t (66) = -2.31, p = .025), indicating more intensive treatment near EOL. Other predictor variables were not significantly associated with intensive treatment. Implications and methodological limitations are discussed.

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Traditional chemical looping technologies utilize solid oxygen carriers and has some disadvantages, especially when solid fuels like coal are used. In this work, a novel chemical looping process using gaseous metal oxide as oxygen carrier was proposed. The reaction of activated charcoal with gas-phase MoO3 was studied for the first time. The experiments were conducted isothermally at different temperatures in a fixed-bed reactor. The apparent activation energy of the reaction was calculated and suitable kinetic models were determined. The results and analysis showed that the proposed concept has potential in both coal chemical looping combustion and gasification process. To further investigate the mechanism of carbon oxidation by gas-phase MoO3, the adsorption of a gaseous (MoO3)3 cluster on a graphene ribbon and subsequent generation of COx was studied by density functional theory (DFT) method and compared with experimental results. The (MoO3)n -graphene complexes show interesting magnetic properties and potentials for nanodevices. A comprehensive analysis of plausible reaction mechanisms of CO and CO2 generation was conducted. Multiple routes to CO and CO2 formation were identified. The (MoO3)3 cluster shows negative catalytic effect for CO formation but does not increase the energy barrier for CO2 formation, indicating CO2 is the primary product. Mechanism of the homogenous MoO3 - CO reaction was studied and showed relatively low energy barriers. The DFT result accounts for key experimental observations of activation energy and product selectivity. The combined theoretical and experimental approach contributes to the understanding of the mechanism of reactions between carbon and metal oxide clusters. To gain a better understanding of the MoO2 oxidation process, the adsorption and dissociation of O2 on MoO2 surface were studied by DFT method. The results show that O2 molecules prefer to be adsorbed on the five-coordinated Mo top sites. Density of states analysis shows strong hybridization of Mo 4d orbitals and O 2p orbitals in the Mo-O bond. Clean MoO2 slab and slabs with O2 adsorption are metallic conductors, while the surface with high O atom coverage is reconstructed and becomes a semiconductor. Surface Mo atoms without adsorbed O or O2 are spin-polarized. The oxygen adsorption shows ability to reduce the spin of surface Mo atoms. The adsorption energy of O2 and O atoms decreases as coverage increases. The transition states of O2 dissociation were located. The energy barriers for O2 dissociation on five-coordinated and four-coordinated Mo top sites are 0.227 eV and 0.281 eV, respectively.

The purpose of this mixed methods study was to understand how context may shapemultiple goal negotiation. Prior research has focused on identifying variables that influence goal pursuit in general, but little attention has been given to how these principles operate in different circumstances. This study adopted the Dynamic Systems Model of Role- Identity and studied context through an identity lens. The context of the L2 teacher was selected as the focus of investigation, specifically the L2 teacher’s pursuit of speaking in the second language for 90% of instructional time while forming meaningful relationships with students. Fifty six L2 teachers participated. The study was carried out over five phases. In the first phase, data were collected in an online survey targeting teachers’ contextual variables, goal commitment, goal expectancy, self-accordance, job satisfaction, and perception of goal conflict. In the second phase, teachers were divided into groups based on their perception of conflict between the two goals: misaligned, no effect, and aligned. Chi-square analysis and Fischer exact tests were conducted and the only significant difference between groups was the amount of L2 spoken. A MANOVA, followed by univariate analysis found that the groups differed significantly regarding their level of commitment to the L2 goal, and their goal expectancy for forming relationships. In the third phase, a content analysis of the open-ended responses found that context influenced the goal navigation process, that the most frequent approach to resolving conflict was abandoning the L2 goal, that multifinality is contingent on one’s role-identity, and that tension may be conscious or unconscious. In the fourth phase, 14 L2 teachers completed semi-structured interviews, which were used to further explore how role-identity informs goal navigation. Analysis of the transcripts revealed that role- identity has a powerful influence on how teachers manage and construal their goals. In the fifth and final phase, all the data were synthesized, resulting in the implications for researchers, administrators, and teachers. / Educational Psychology