This candidate's essay initially describes addiction problems in Sweden. The Swedish National Board of Health and Welfare proposes methods to handle the problem. Standalone self-help groups such as Anonymous Alcoholics and Narcotics Anonymous (u.å.c; 2018) provide the 12-step program as an alternative to government recommendations. This essay aims to study this alternative method using a qualitative and inductive approach in order to interpret determinants which benefits the program as well as formulate a theory that can understand the process. The authors researched the 12-step program’s history and describes the actual places which were observed as well as their pre-understanding of the program. In accordance with studies on human life situations ethical principles have been reported and used recurrently. To increase understanding of the phenomenon, previous studies on the program has been researched; knowledge bases regarding classifications; psychological; sociological approaches and qualitative methods. Thereafter, an explanation of the usage of relevant concepts in the work. Data collection is done exclusively with micro-ethnographic methods, respondents who volunteered have experienced the 12-step program of one of the two selected self-help groups. Furthermore, Grounded theory and Narrative analysis was used to interpret collected data, a detailed description was constructed in order to enhance the study’s transferability. Generated codes resulted in a conceptualization of a triangular effect between the concepts of motivation; spirituality and the group. Trinity was analyzed and two additional determinants, receptiveness and structure, were formulated. This study concludes that introduction of the 12-step program is defined by an initial personal receptiveness and an adequate structure, these phenomena interact recurrently when the individual meets the other determinants of the program. Which are described as an internal process of reflection (spirituality); external physical action (motivation) and collective social development (the group). Together, the five determinants constitute the success of the 12-step program which the authors try to verify theoretically by problematizing the content.

This multiple case study focused on the lives and experiences of four women who participated in an adult literacy program. This case study approach used critical ethnography as an analytic tool employing grounded theory leading to the development of a substantive theory. In-depth, semi-structured interviews and researcher's reflective journal were employed to collect data for this study that critically examined the impact of the transformative process of its participants and its influence on their socio-cultural context. Results revealed that participants did not necessarily experience a disorienting dilemma as contended by Mezirow (1978, 1991, and 2000). Rather participants experienced a series of integrating circumstances that led to the transformative experience. Moreover, the study indicated that unlike Mezirow's assumption that individuals need to have a high cognitive or educational level to experience a transformation these participants with little or no education experienced a transformation. Overall, the purpose of this study was to generate grounded theory on the impact of the transformative experience on the participants and their socio-cultural context. From the findings of the study, a substantive theory emerged revealing profound changes: a metamorphosis. Thus, the substantive theory is: Metamorphosis: Given the opportunity to shift frames of reference, one has the innate capacity to alter one's life and impact one's socio-cultural context creating possibilities for self and others. In light of this, all participants related experiences that reflect the core elements of transformative learning as first posited by Mezirow. These elements included exploration of new roles or actions, self-confidence in new roles, development of a plan of action and reintegration into life based on their new frames of reference. Major themes that emerged from the data are self-esteem and assertiveness, discovery of self, great personal sacrifice, development of sense of possibility for self and family, beliefs and values, increased spirituality, self-sufficiency, role model, opportunity for social action. As the women became empowered, the changes affected their socio-cultural context resulting in changes with their children, family and community. Finally, this study has far-reaching implications for policy-makers and practitioners in particular for strategic improvement of life for low-income families and family relationships. These findings can serve as the impetus to improve the disintegration of family values triggering a positive impact on entire communities.

Despite efforts to ensure patient safety in the United States, patients are being harmed by preventable errors. There is a gap in the literature from the nurse's perspective as to why medical errors continue to occur despite having evidence-based safety strategies available. The purpose of this constructivist grounded theory study was to develop a theory explaining nurses' perception of their role in patient safety and why medical errors are still occurring despite implementation of evidence-based safety strategies. The systems engineering initiative for patient safety (SEIPS) model provided the conceptual framework for the study. Data collection included interviews with 11 nurses who worked in a Magnet designated hospital. Data were sorted and analyzed using the constant comparative method. Three themes emerged: technology, work environment, and human factors. These themes aligned with components of the SEIPS model. An emphasis on how technology adds to the nurses' workload compounded with a busy work environment was noted as a contributing factor for bypassing safety systems. The bypass model theory was derived from the themes to describe the conditions that nurses work in that result in bypassing safety systems. Further research needs to go beyond engaging nurses with the implementation of health IT system by examining long-term impacts on workflow as changes are being made. Addressing the reasons why safety measures are bypassed can affect positive social change which will improve the quality and safety of patient care outcomes.

Hope is meaningful and very important for people – even for people at the last days of their lives. Health professionals can sometimes describe hope in terms of hope for a cure, which may lead to feelings of hopelessness or empty hope for a patient with an incurable disease. In research, there is very little written about hope in the palliative home care context, even more so from the patient’s perspective. The aim of this project was to study how hope changes over time in cancer patients at the palliative phase, and to study the strategies used to cope with these changes. This was studied from the patients’ own perspective and in a home care context, but with the ambition of developing the results into a model or theory. Grounded Theory was the chosen research approach. Two sets of tape-recorded interviews were made with 11 patients in specialized palliative home care – a total of 20 interviews. The patients were also asked to write diaries about changes in their everyday feelings of hope within a 4-week period. Measurements of hope (HHI-S) and symptoms (ESAS) were also made at three occasions. Constant comparison of data was made during the analysis. The results showed that patients’ hope changed over time. Hope was described as a process involving a glimmering core of hope untouched by external circumstances (Study I). Hope was described in different processes, creation of a convinced hope, creation of simulated hope, collection and maintaining moments of hope and gradually extinct hope. The dying patient’s hope can be described as a gradual and successive adaptation process. Strategies for maintaining life were expressed to preserve the meaning in life, to communicate with others about life and death, to involve "fellow travelers" and to change focus. The strategy of preparing for death involved; taking responsibility for the future and seeing possibilities of living on even after death (Study II). The strategies were parallel to, and dependent on each other. It is important that health professionals understand the patient’s own strategies for maintaining life/hope, as well as the patient’s own preparations for death, so that hope is never taken away despite preparations at the end of life. In summary, hope can be interpreted as a changing process over time – a process that can change quickly, but is based on an inviolable core that is not easily moved by external circumstances. It is important that the health care personnel realize that patients simultaneously prepare for their deaths even as they try to maintain hope. Deeper understanding of what hope can mean for a patient can decrease the risk of hope being taken away during one’s final days. / Hopp har stor betydelse för människor, även för människor i livets slutskede. Av vårdpersonal beskrivs ibland hopp som bot, vilket kan leda till att inget hopp alls eller att ett meningslöst hopp förmedlas till en patient med en obotlig sjukdom. Forskningsmässigt förekommer hopp sparsamt beskrivet i den palliativa kontexten, särskilt från patientens perspektiv. Syftet med avhandlingen var att studera hur hopp kan förändras över tid hos patienter med cancer i ett palliativt skede, liksom vilka strategier de använder för att hantera dessa förändringar. Detta har studerats utifrån patientens eget perspektiv i en palliativ hemsjukvårdskontext, men ska sedan utvecklas vidare till en modell/teori. I denna avhandling har Grounded Theory valts som forskningsansats. Bandinspelade intervjuer gjordes vid två tillfällen med elva patienter i specialiserad palliativ hemsjukvård. Det blev totalt 20 intervjuer. Patienterna skrev också dagböcker om de förändringar av deras hopp, som uppstod i vardagen under en period av fyra veckor. Även mätning av hopp (HHIS) och symtom (ESAS) genomfördes vid tre tillfällen. Analysen skedde med den konstant komparativa metoden. Resultatet visade att patientens hopp förändrades över tid och beskrevs i en process med en inre glödande kärna av hopp, som inte påverkades så mycket av yttre omständigheter, men som kunde falna eller flamma upp (studie I). Hopp beskrivs i olika processer som att skapa ett övertygat hopp, ett simultant hopp, som att samla och uppehålla hopp och som ett hopp, som håller på att rinna ut. Den döende patientens hopp kan skildras som en successiv anpassningsprocess. Strategier som upprätthåller liv beskrivs vara att upprätthålla sin egen mening, att samtala om liv och död, att skaffa medresenärer och att byta fokus (studie II). Strategier, som förberedde döden, var att ta ansvar för framtiden och att se möjligheter att leva vidare även efter döden. Dessa tillvägagångssätt var parallella och beroende av varandra. Kunskap hos vårdpersonal om patientens egna strategier att upprätthålla liv/hopp och förbereda död är viktigt, för att inte ta ifrån patienten dennes hopp vid samtidig förberedelse för döden. Sammanfattningsvis ska hopp ses som en föränderlig process över tid och som snabbt kan förändras, men som har en inre glöd, som är mer oantastlig och inte så lätt påverkas av yttre omständigheter. Det är viktigt för vårdpersonal, som arbetar med döende patienter, att känna till att patienter har parallella strategier, som upprätthåller hopp. Ökad kunskap om vad hopp innebär för den enskilde patienten kan minska risken för att hopp fråntas patienten i livets sista tid. / The Glimmering Embers - experiences of hope among cancer patients in palliative home care / Maintaining hope when close to death: insight from cancer patients in palliaitve home care

In this dissertation, I explore, through qualitative means, the perceptions of parents related to discourse (what is said and not said) within formalized and required processes of special education. These processes are federal requirements that parents of children with disabilities or suspected disabilities encounter as their children progress through the school system. The processes purportedly protect the rights of children with disabilities. The goal of the process is to help children with disabilities make academic gains by providing scaffolds that meet their individual needs. During this process, parents of children with disabilities become empowered or disempowered by discourses focused on eligibility for special education services and Individualized Education Plans. These discourses may serve to privilege, empower, disempower, alienate and marginalize, or unite and value. I critically examine instances of this discourse to support and empower parents concerning instances of negatively framed discourse and to assist administrators, professionals, and teachers. My goal is to help these individuals understand how parents perceive the discourse within this framework. I aim to lessen instances of alienation, marginalization, and power inequities that parents repeatedly encounter through education. This study involves 15 survey participants and 14 remaining case-study participants who have or have had children with disabilities go through the special education process from five separate school systems within the Western U.S. I utilize a survey covering perceptions and attitudes about formalized special education processes along with open-ended, semi-structured interviews for case-study analysis. Participants discussed inequities and inequalities such as a perceived lack of power and voice. They referred to lost dignity for themselves and their children with disabilities and high levels of frustration due to poor communication and follow-through. Participants perceived successful interactions from persistent effort, advocacy, and self-education on special education law, procedure, and the disabilities of their children. I provide participant summary perceptions and desires regarding the special education process. I present two models of special education discourse derived from grounded theory and discuss my results regarding models of disability, a school-equity-improvement model, an ethical framework, and I argue for a call to action to begin the groundwork for positive, lasting change.

This grounded theory study investigated how registered nurses (RNs) managed problem-solving and decision-making in residential aged care facilities (nursing homes) in Western Australia. The outcome of the study was the substantive theory of situational positioning, the process used by the RN participants when they were trying to get things right .In-depth interviews were conducted with 25 purposefully selected registered nurses and nursing home management staff. The interviews were transcribed verbatim, and analysed using the constant comparative method. Other sources of data. guided by theoretical sampling. were selected documents such as government reports regarding aged care, and some field observations. Situational positioning was a process that involved physical. cognitive, emotional, and moral dimensions, and reflected how the RN participants acted and responded when dealing with situations at work. Situational positioning was conceptualised as occurring along two intersecting continua of behaviours, and these behaviours emerged from the data as four interrelated categories. Yielding and confronting represented the poles on a continuum of action-oriented behaviour, with being flexible and being rigid on a continuum that reflected more affective or attitudinal responses. The four categories that made up the positioning continua had both positive and negative meanings in relation to the actions and responses of the participants, depending on the particular situation. Yielding was a conceptual category that reflected participants' comments about stopping a particular action and trying something else or giving up completely and even leaving the situation. f he term confronting was used to describe participants' actions that were based on assertiveness that was seen as a constructive behaviour, or anger that tended to be non-productive. / Being flexible meant that the participants were responsive to changing situational variables, and this was usually seen as a desirable attribute of effective nursing practice in aged care. However, it could also mean being pliant and ready to compromise in order to get through situations when the participants realised that they would be unable to get things right. At the other end of the response axis, the term being rigid was defined as the opposite of being flexible, that is, having firmly fixed or set ways of responding. or a tendency to respond to situations in the same way in all circumstances. The basic psychosocial problem, being unable to get things right, had two properties. One property was temporal, in that the problem occurred when the participants were getting behind or running late because of having insufficient time. usually due to interruptions. The second property of the problem was more qualitative in that contextual and intervening conditions led the participants to feel that they were not doing things properly because of adverse conditions. Conditions that varied .situational positioning were those that led to the participants being unable to get things right, such as having insufficient time. working with unqualified carers. and trying to meet the differing expectations of various stakeholders. Situations that were easy for the participants to manage involved known routines and few, if any. interruptions. In those circumstances, si uational positioning was intuitive and the phases of recognising, prioritizing, and moving on were negotiated quickly. In more complex situations, or when significant interruptions occurred, the participants followed an alternative pathway, which involved recognising that something in the situation changed. then compromising. that is. choosing a new course of action. / Compromising required tolerance, as the participants adjusted their expectations of what could be achieved in the circumstances. Repositioning then occurred belore they moved on to the next task or to the end of their shifts. Moving on. the third phase in the process, involved persevering as they continued trying to get things right. The adverse conditions that prevailed in nursing homes during the time of this study impeded nursing practice and the delivery of consistently good standards of care for all residents. Situational positioning enabled the participants to persevere in their efforts to try to get things right, but their capacity to maintain the effort was eroded by the apparently unrelenting nature of the adverse conditions that existed in nursing homes. The main conclusion of this study was that the RN role in nursing homes in Western Australia was ill-defined, and inefficient in terms of best utilisation of nursing time. Recommendations included a review of the RN role in aged care and implementation of strategies that would enable aged care RNs to focus on their clinical roles.

This study explores the processes and conditions surrounding long-term care decision-making and care management after traumatic brain injury. Grounded theory methodology and methods were used. Semi-structured interviews were conducted with a total of 51 participants in New South Wales, Australia. A grounded theory of care management was developed through constant comparison of data and cases and identified a social problem, a core social process, strategies, conditions and consequences. The basic social problem was the need for ongoing care, a problem which the person with brain injury and others managed collectively. Together, they determined an appropriate care location or living situation, configuration of carers and level of care. This study provides a framework for understanding preferred ways of living with care after brain injury. Increased autonomy was a desired outcome. Living alone and spending time alone were associated with increased autonomy and increased risk. A series of strategies and processes are suggested that allow professionals and family carers to gradually increase risk, and share responsibility for risk management. The findings have implications for health professional and legal practice, education, research and policy. / Doctor of Philosophy (PhD)

Alignment of information systems (IS) with business activities has been an important problem for practitioners for many years even though there has been considerable research in the area. A criticism of some past research into IS/business alignment is that it has ignored organisational complexity and context. This is partly due to the dominant paradigm in use within IS research. One result of this paradigm is that there are numerous prescriptions provided in the literature for improving alignment but little in the way of theory development that explains the behaviour of practitioners when confronted with the task of attaining alignment. To address these criticisms a grounded theory approach was adopted using a coding family that encouraged the discovery of systems of interaction between variables rather than assuming linear causality. Data was collected via three unstructured focus groups that limited the effect of prior reading of the literature, an important consideration when conducting a grounded theory study. These were followed by semi-structured individual interviews. The instruments for the latter were developed after the focus group interviews were analysed, so reducing the impact of a prior reading. Analysis of the focus group interviews found that the major concern of practitioners was aligning IS strategies to either business strategies documented in business plans or the business strategies in use. This is a similar result to earlier alignment research. As a result of analysis of the focus group interviews the research question stabilised. This research investigated how factors within an organisational setting impact the ability of senior IT managers to identify, then act upon, the business strategies in use. It confirmed many of the enablers and inhibitors to alignment identified in earlier research. However, it also identified two variables that are rarely given prominence in the literature: the mental models held by managers; and the motivation and measurement schemes applied to managers. It is believed that both these variables have a significant impact on the alignment of IS and business strategies. The theory developed here demonstrates that a system of variables will tend to encourage IT managers to either collaborate with their business peers, or retreat from the business and concentrate on providing a low cost reliable technical IT solution. In the former situation alignment of IT managers’ actions to those of their business peers is encouraged. In the latter situation there will be little alignment between business and IS strategies nor between the actions of business and IT managers. A feedback loop of actions by actors within the system tends to reinforce the situation making a change in response extremely problematic. This, then, helps explain the intractable nature of alignment that has been observed for many years.

The purpose of this research is to discover how university lecturers in management subjects respond to the mix of local and international students in their classes. The aim is to develop a substantive theory based on a conceptual understanding of the main concern of lecturers working in a changing Higher Education context. The aim of developing theory rather than providing rich description led to the choice of Orthodox Grounded Theory as the methodology. Grounded Theory is an inductive methodology that provides the methods to conceptually generate the patterns that explain the behaviours of participants in the substantive area. This was relevant for the current research as I commenced with no explicit hypotheses and there was limited literature on the responses of university lecturers to teaching diverse groups of students, particularly a mix of local and international students. Interviews and observations were conducted with lecturers from both traditional and newer universities in Melbourne, and data analysed using open coding, categorising, constant comparison, theoretical sampling and coding, and frequent memoing. The main concern of respondents emerged as balancing professional capability with the requirements of a heterogeneous student population. The Basic Social Process and Core Category that resolves this concern is Maintaining Competence. Maintaining Competence is both a causal-consequence model, and a typology model consisting of four strategies � Distancing, Adapting, Clarifying and Relating. The emergent Grounded Theory of Maintaining Competence contributes to the extant literature, in particular the literature on professional competence, and the literature on teacher centred and student centred approaches and on contextual and contingency models of teaching. It adds to the latter by demonstrating the importance of the interplay of moderating variables, specifically Forces in the Lecturer and Forces in the Environment. The thesis adds also to the Grounded Theory literature in its explicit presentation of Orthodox Grounded Theory methods and its discussion of the research journey of a novice grounded theorist.

There are increasing numbers of Australian nurses working in part-time employment. This is important in a background where contemporary nursing shortages are a considerable barrier to the provision of adequate nursing personnel to meet nursing service demands. An accurate understanding of the situation of part-time nursing is necessary to enable effective human resource management of this segment of the nursing workforce. However, a paucity of available knowledge related to Australian part-time nursing represented a serious gap in the information required for effective and efficient management. Therefore the aim of this study was to discover and describe phenomena and develop theory that explains the ‘realities’ of part-time nursing in regional Queensland. Strauss and Corbin’s (1998) version of the grounded theory approach and methods were used to conduct this study. A sample of 86 regional Queensland part-time nurses and 18 nurse managers and nurse educators provided data that permitted the discovery of a substantive theory of part-time nursing. This theory has contributed knowledge relevant to practitioners in the substantive area by discovering, describing and explaining the phenomenon of part-time nursing, the conditions that influence the phenomenon and the responses that are made to adapt and adjust to the associated challenges. The developed grounded theory represents a significant contribution to the meagre base of knowledge that previously existed by offering insight, enhancing understanding and providing a valuable guide to action.