Introduction In recent years the concept of ‘recovery’ has become increasingly prevalent in both government and health service policy, and in the terminology used by mental health service users. The current study examines the experiences of recovery as described by service users living in a rural / semi-rural population. This is in contrast to the majority of similar studies, which have tended to focus on urban centres where population characteristics, and the services available to service users, differ in many ways. As such, the aim of the current study was to add to the growing theory regarding what constitutes recovery from the viewpoint of service users living in a relatively remote area of the UK. Methodology Eight adult participants, all of whom defined themselves as either recovering or having recovered from significant mental health problems, were interviewed about their experiences using a semi-structured interview. Interviews were audio-recorded, transcribed and analysed for emerging themes using a social constructionist version of Grounded Theory. Data Analysis & Discussion Analysis revealed a consistent set of themes emerging from the participant interviews. These are encapsulated in the concept of reflection and integration, and the dynamic nature of these phenomena over time. Participants made reference to the nature of their problems and the impact they had on relationships, the treatment they had sought and received, and the effects of their experiences on their notions of themselves as individuals. Conclusions The findings of the current study are discussed in the light of existing relevant literature and in relation to current policy initiatives. Comparisons to the emerging theory regarding recovery are drawn, and distinctions made between the existing theory and the findings which appear to be particularly pertinent to the sample population. Suggestions for clinical applications are made. Limitations of the study are also addressed, and areas for potential further research are outlined.

With the corporatization of healthcare, combined with rapid advances in medical technology, frontline health care workers, especially nurses, are facing an increase in daily ethical dilemmas, with potential increases in moral distress. The contributing factors and negative effects of moral distress are well researched, in particular as they impact nurses in specialty areas. However, understanding how nurses navigate moral distress, specifically in general medical and surgical units, is not as well understood. The purpose of this study was to understand and articulate the processes that nurses carry out when navigating moral distress, by exploring their interactions with the health care environment. Using grounded theory methodology, a substantive theory was developed to explain the process. The participants in this study were all registered nurses from an acute care academic hospital, who worked on non-specialty medical and/or surgical units. Data collection consisted of audio-recorded face-to-face interviews that were transcribed post interview. All the events and situations that resulted in the experience of moral distress were primarily rooted in organizational structures, which often blindsided the nurses in this study, and led to a sense of feeling ill-equipped and unsupported to respond in the moment. Furthermore, the participants expressed their inability to be agents of change due to the established organizational expectations. The basic social process for navigating moral distress was “Just getting through the shift”. This theory is comprised of the categories of Experiencing Moral Distress, Making Sense of the Situation, and Finding the Way. In working through these processes, the participants engaged in navigating moral distress. Making sense of the situation was an ongoing process that nurses engaged in whereby they sought out knowledge in various ways, such as exploring internal resources, and building relationships with their peers, their patients, and patients’ families. Throughout this iterative process of making sense of the situation, the nurses were then able to find their way. Participants discussed positive outcomes such as reflecting and learning from the experience. However, despite this response, there was a feeling of powerlessness to make a difference. Therefore, they focused on providing the best care they could and getting on with their shift without experiencing closure. / Graduate

Health regions in Canada are primarily associated with the rationalization of conventional, historically expensive provincial health care systems. At the same time, it is unclear what contribution health regions make to advancing health system reform, particularly health-promoting activities. This work sets out to understand the relationships between regionalization and health-promoting activity by studying two health regions in Canadian provinces that have different approaches to regionalization (British Columbia and Ontario). I use a constructivist grounded theory methodology (Charmaz, 2006) to analyse data from nineteen key informant interviews with senior management working in the two regional health authorities and in provincial health organizations. The iterative analysis of the empirical data and the review of corporate documents from both regional organizations result in the identification of three core themes grounded in the data. The dominant theme emerging from the analysis is identified as place-making referring to a region’s ability to facilitate health-promoting activity by making the region a place with special meaning and resonance for the populations served. The other two themes are creating space within organizations for health-promoting activity and developing networks. The former refers to a region’s willingness and ability to operationally support health-promoting activity and the latter refers to efforts undertaken to establish relationships with other organizations in the health-promotion and healthcare networks. I conclude that these three themes characterize critical components of a therapeutic region. A therapeutic region suggests a conceptualization of regional health authorities (RHAs) in which priority is given to health-promoting activities, alongside an entrenched curative healthcare agenda (the medical model). A therapeutic region is conceived of as a region that implements policies and develops structures aimed at achieving improvements in the overall health status of the population it serves. In this research I develop a four-cell matrix to frame the theory of therapeutic regions. One axis represents a continuum of place-making, while the second axis reflects a continuum depicting how regions develop the two other themes -- one extreme represents a piecemeal or patchwork approach, and the other an integrated strategic approach. The implications of this research relate to practice and policy. The practice of improving the health of the population served requires regions to open pathways, and remove longstanding barriers by making place-making core to all community engagement and develop health-promoting activity within their organizations and their networks. Policy-makers need to bring clarity to the regions’ role in health-promoting activity. This research indicates that health-promoting activity, innovation and progress occur when a region has the ability to manage both conventional, curative health care and health-promoting activities. Whether that is through direct governance or new ways to bring together decision-making, service co-ordination and evaluation is a subject for future work. / Graduate

In the 21st century, transdisciplinary approaches to research and problem solving rooted in complexity theory and complex systems methodologies offer hope for understanding and solving previously intractable problems. However, in the face of daunting modern challenges like a broken health care system, growing social and economic inequity, and climate change, the knowledge and skills required to understand and ultimately solve problems across interdependent complex systems are distinctly lacking in our collective practice. The underlying premise of this study is that if modern society is to deal effectively with interconnected challenges across ecological, social, political, and economic systems, our education system must prepare students to grapple with complexity. This research expands upon previously identified core complex systems knowledge, skills, and dispositions to contribute rich description to a working definition of the term systems literacy, develop a theory of how one becomes systems literate, and offer access points for educators entering the world of complexity. The study employed complexity-informed grounded theory methods including data from semi-structured interviews with complex systems scholars and educators across a wide range of academic disciplines. Additional data was gleaned from texts and online resources produced by systems educators and complexity scholars. The three resulting journal articles were designed to consolidate much of what is known about complex systems into a package that is useful for educators, school leaders, and other stakeholders. Together, these articles contribute to an understanding of how curricula and instruction might better emphasize the dynamic nature of interdependent complex systems and the agency of individuals and collectives to innovate, engage in authentic problem solving, and participate in actively preserving and reshaping the world in which we live.

Literature related to fathers and child physical abuse and neglect is lacking (Guterman & Lee, 2005; Lee, Bellamy, & Guterman, 2009). The purpose of this study was to better understand several pertinent aspects of fathering related to maltreatment. Three research questions were examined: 1.What are the attitudes, behaviors and contexts of fathers who have abused or neglected a child that relate to maltreatment? 2. What are the resources and capacities of these fathers which could be capitalized on? 3. How does goodness-of-fit or a poor fit between the father and child impact the parenting relationships of these fathers? Fifteen fathers in a parenting program for parents who are at high risk or who have abused or neglected a child participated in the study. In order to answer these questions, a traditional grounded theory methodology was used. Data analysis consisted of thematic analysis and constant comparative analysis. Based on data collected, a substantive theory entitled Fathering in a Context of Challenge and Complexity was developed. Results suggest that these fathers experience many challenges, but also have important strengths. Becoming a father was an important turning point for many of the fathers in this study. Fathers’ relationships with his children’s mothers, the need for social support, and the theme of change were all relevant. Implications for practice, policy, and research are discussed.

This thesis is located within the field of Information Systems implementation. More specifically it focuses within Information Systems at the issues associated with implementation of business proves-based change. There is much evidence, both theoretical and empirical, to suggest that there are a high percentage of Information Systems and Business Process implementation failures (Meredith 1981, Lucas 1981, Walsham 1993, Land et al 1989). The aim of this thesis is twofold. Firstly to analyse the reasons behind the failures in process-based change implementations and secondly to provide a solution that will enable companies to overcome some of the problems and thus reduce the number of these failures. This research is based on a joint project between IBM PSS and the University if Plymouth. The research focuses specifically on the implementation of process-based change occurring in IBM Product Support Services (PSS). PSS is primarily responsible for the maintenance of IBM and non-IBM hardware and software and the selling of services associated with them. In order to understand what happens during implementation the researcher participated in three action research projects. All three projects were part of an IBM world-wide Business Process Re-engineering project called Customer Relationship Management. To ensure the validity of this action research process the researcher has closely followed the guidance compiled by Eden and Huxham. This research will present a framework that has been developed to improve the management of implementation projects. The framework is based on a synthesis of theoretical evidence and empirical findings. The empirical findings have been developed from investigating the reasons for failure in the three action research projects. All findings were analysed using the ‘Grounded Theory’ approach. The framework consists of five dominant themes, which are senior management commitment, analysis of problem situation, project planning and management, proves focus and user involvement. In the researchers view the problem of unsuccessful implementation is a complex one which may only begin to be improved when all the themes are addressed together as a whole. In order to test the themes of the framework a process for application was required. The process developed for using the framework involves applying a focus group at project initiation and questionnaires throughout the course of the project. The purpose of the focus group is to understand the themes of the themes of the framework within the context of the particular problem situation being investigated. The questionnaire is used to audit each theme of the framework to identify potential areas of implementation weakness. T-test analysis is carries out on the questionnaire results to measure whether any changes between questionnaires results are statistically significant. The framework was successfully applied to a fourth project. The T-test results indicated that applying the framework to the project throughout the course of the implementation had significantly improved the implementation. The originality of this research is in the framework and its application. This thesis will describe the history of implementation successes and failures at IBM, survey appropriate implementation theory and describe the synthesis and testing of the framework.

Despite a historical pessimism about the possibility of helping people with schizophrenia using psychological therapies, a great deal of progress has been made recently using cognitive-behavioural therapy (CBT) approaches. These treatments have been developed from changing understandings of schizophrenia, and focus on reducing the distress of psychotic symptoms through coping strategies and altering distressing beliefs. There is increasing evidence that suggests CBT may be helpful for a significant portion of people with psychosis. Limited information on the factors implicated in differing outcomes is available. The present study investigated factors differentiating individuals with good and poor outcomes on the basis of accounts of CBT for psychosis from eight therapist/client dyads. Four therapists and eight of their clients (two associated with each therapist) were interviewed about their experiences of CBT. Topics covered included, effect of the therapy, elements felt to be helpful and the therapeutic relationship. Interview data was analysed using a qualitative, "grounded theory", methodology. The analysis produced a number of major categories which differentiated clients who progressed and did not progress in CBT. These included ability to let go of distressing beliefs, logical thought, holding therapy, and presence of a shared goal. Overall, clients who progressed were better able to understand, hold and engage with ideas put forward by the therapist. Additionally, clients' views of CBT were positive and therapists and clients felt that non-specific benefits accrued from the therapy even when CBT specific progress did not occur. The results were consistent with previous studies suggesting that ability to consider disengaging from distressing beliefs are important in therapeutic progression. However further research is required to clarify the role of logical thought, holding therapy and therapeutic alliance in progress and in predicting outcome. Reasons considered for the inability to progress include, emotional investment in psychotic beliefs and information processing factors.

The research is a small-scale study of the potential benefits of Child Psychotherapy assessment of Looked After Children in transition, for the child and for the professional network caring for the child where the child psychotherapist-researcher is part of the network working together to plan for the child’s long-term future. The assessments aim to bring specific understanding of the child’s emotional state and emotional needs, of his perception of what has happened in his life and of the ways in which his development has been influenced by these external events and perceptions. The assessments also explore the potential for the work to help the child make sense of his history and of himself and the assessments aim to be a distinct and essential part of the overarching assessment process which informs preparation of the children and their prospective carers for permanent alternative placement. Four latency-aged children in transition were assessed in an inner-city community-based Child and Adolescent Mental Health Service by the clinician-researcher. using Standard child psychotherapy techniques were used with some adaptations of technique to address the children’s transitional status. The assessment framework included in-depth interviews with social workers and foster carers and information from schools. Process recordings of the assessment sessions are the primary data in this enquiry and these are analysed using an adapted version of Grounded Theory methodology. The depth and complexity of the children’s experiences and their internal worlds is strikingly revealed by the assessments, in new and compelling detail. All of the assessments were highly significant in shaping short and long-term provision for the children. The outcome of the study strongly supports the inclusion of child psychotherapy assessment as part of an integrated, multi-disciplinary assessment process for all children in transition. The method of assessment and of analysis of data transfers well to a range of Looked After Children in transition in the study as well as providing an effective basis from which to communicate clearly and effectively across interdisciplinary boundaries: making possible a more truly representative, responsive and integrated map for the future.

Social Networks are broad set of actors or organizations and relations between them. The recent review of the literature shows that the research has been focused mainly on the effects of social networks on the entrepreneurial process but little attention is being paid to the process of development of social networks during an entrepreneurial process. The present studies highlight the aspects of process through analysing life cycle, teleology, dialectic and evolutionary views of process of development of social networks. This thesis presents ‘Becoming a Networked Entrepreneur’, a substantive theory of process of social network development in Entrepreneurship Literature constructed using Constructivist Grounded Theory approach to study the 13 entrepreneurs of Fast Growing Firms in Lahore, Pakistan. There are three main conceptual domains of this theory: sources of networks and actions of the entrepreneur and Developmental Patterns. The process of becoming a networked entrepreneur involves constant interaction of entrepreneur with the environment where sources of networks enable the entrepreneur to get connected to a network actor. Through studying the process of becoming a networked entrepreneur, the researchers can view the process in an integrated approach which involves the development of networks before starting the venture and interaction of entrepreneur with the environment where these networks are being developed. The process of becoming a networked entrepreneur presents a framework to study the networks and their development along the entrepreneurial venture.

Background: Interest in resilience has rapidly increased over recent years because of its potential impact on health, well-being and quality of life. However, despite the increasing prevalence of dementia, there is a lack of resilience research involving people diagnosed with this condition. Therefore, little is known about what it is that enables people to live well with dementia and continue to lead successful and meaningful lives. Even small delays in the onset and progression of dementia have the potential to significantly reduce its global burden. More specifically, studies have shown an association between social engagement and reduced risk of cognitive decline and incident dementia and consequently there is growing interest in the effect of increasing social interaction on cognition. Objectives: This thesis comprises two parts. Initially, a systematic literature review summarises and evaluates the current empirical evidence to establish whether interventions which aim to increase social interaction can improve cognition in older adults. Secondly, a qualitative study aims to develop a grounded theory of the concept of resilience in people diagnosed with mild to moderate dementia. Methods: For the systematic review, a comprehensive list of electronic databases was systematically searched, relevant authors in the field were contacted and a hand search of relevant journals was conducted. For the qualitative study, seven semi-structured interviews were conducted with people diagnosed with dementia, with a social constructivist version of grounded theory informing the collection and analysis of data. Results: 17 studies met eligibility criteria for the systematic review, mostly of moderate quality. Study heterogeneity and methodological variability made it difficult to determine the specific contribution of social interaction to cognitive improvements. There was, however, tentative support for improvement in semantic fluency. The results of the qualitative study propose a model which hypothesises resilience is a process of ‘overcoming dementia’. For participants this meant maintaining a sense of pre- and post-diagnostic continuity which was achieved through a complex interaction of their approach to life and acceptance of dementia in conjunction with spousal and other social support. Conclusions: Although the systematic review found some evidence increased social interaction can improve cognition in older adults, this finding is tentative and should be interpreted with caution, with further research warranted. The qualitative study proposes a model of resilience which explains the process of ‘overcoming dementia’. Resilience is conceptualised as comprising individual, social, community, societal and cultural aspects and opens up the possibility of promoting resilience in people with dementia through the development of psychosocial interventions. This study emphasises the strengths and abilities of people with dementia, as well as the importance of social support, but most importantly it is from the perspective of the person with dementia.