This thesis presents research to build and evaluate embedding of a textual form of state machines into high-level programming languages. The work entailed adding state machine syntax and code generation to the Umple model-oriented programming technology. The added concepts include states, transitions, actions, and composite states as found in the Unified Modeling Language (UML). This approach allows software developers to take advantage of the modeling abstractions in their textual environments, without sacrificing the value added of visual modeling. Our efforts in developing state machines in Umple followed a test-driven approach to ensure high quality and usability of the technology. We have also developed a syntax-directed editor for Umple, similar to those available to other high-level programming languages. We conducted a grounded theory study of Umple users and used the findings iteratively to guide our experimental development. Finally, we conducted a controlled experiment to evaluate the effectiveness of our approach. By enhancing the code to be almost as expressive as the model, we further support model-code duality; the notion that both model and code are two faces for the same coin. Systems can be and should be equally-well specified textually and diagrammatically. Such duality will benefit both modelers and coders alike. Our work suggests that code enhanced with state machine modeling abstractions is semantically equivalent to visual state machine models. The flow of the thesis is as follows; the research hypothesis and questions are presented in “Chapter 1: Introduction”. The background is explored in “Chapter 2: Background”. “Chapter 3: Syntax and semantics of simple state machines” and “Chapter 4: Syntax and semantics of composite state machines” investigate simple and composite state machines in Umple, respectively. “Chapter 5: Implementation of composite state machines” presents the approach we adopt for the implementation of composite state machines that avoids explosion of the amount of generated code. From this point on, the thesis presents empirical work. A grounded theory study is presented in “Chapter 6: A Grounded theory study of Umple”, followed by a controlled experiment in “Chapter 7: Experimentation”. These two chapters constitute our validation and evaluation of Umple research. Related and future work is presented in “Chapter 8: Related work”.

The purpose of this study was to develop a theory to explain how nurses experience and respond to uncertainty arising from patient care-related situations and the influence of uncertainty on their information behaviour. Strauss and Corbin’s (1998) grounded theory approach guided the study. Semi-structured face-to-face interviews were conducted with 14 staff nurses working in an adult medical-surgical intensive care unit (MSICU) at one of two participating hospitals. The grounded theory recognizing and responding to uncertainty was developed from constant comparison analysis of transcribed interview data. The theory explicates recognizing, managing, and learning from uncertainty in patient care-related situations. Recognizing uncertainty involved a complex recursive process of assessing, reflecting, questioning and/or predicting, occurring concomitantly with facing uncertain aspects of patient care situations. Together, antecedent conditions and the process of recognizing uncertainty shaped the experience of uncertainty. Two main responses to uncertainty were physiological/affective responses and strategies used to manage uncertainty. Resolved uncertainty, unresolved uncertainty, and learning from uncertainty experiences were three consequences of managing uncertainty. The ten main categories of antecedent, actions and interactions, and consequences that comprised the theory were interrelated and connected through temporal and causal statements of relationship. Nurse, patient, and contextual factors were linked through patterns of conditions and intervening relational statements. Together, these conceptual relationships formed an explanatory theory of how MSICU nurses experienced and responded to uncertainty in their practice. This theory provides understanding of how nurses think through, act and interact in patient situations for which they are uncertain, and provides insight into the nature of the processes involved in recognizing and responding to uncertainty. Study implications for practice, nursing education, and further theory development and research are discussed.

The evidence that treatment of life-threatening arrhythmia (LTA) with an Implantable Cardioverter Defibrillator (ICD) can prolong life is convincing. Living with a lifelong heart disease will gradually influence the everyday life and encompasses some or all aspects of life. In order to influence health outcomes, the impact of the ICD must be considered in a broader context including not only the physical, but also the psychological and social functioning of the individual. The general aim of this thesis was to describe everyday life in recipients living with an ICD in a longterm perspective. The aim in Paper I was to describe changes in the life situation of recipients’ with an ICD over a period of 1 year. The aim in Paper II was to describe quality of life (QOL) and uncertainty in recipients who have an ICD and to predict QOL at long-term follow-up. Fifty-six recipients participated (I) and 35 of these recipients, who had survived at least five years, were further included (II). The Quality of Life Index-Cardiac version (I, II), Mishel Uncertainty in Illness Scale-Community version (I, II), Patient ICD Questionnaire (I) and multiple regression analysis (II) were used. Higher scores indicate higher QOL and uncertainty. The questionnaires were completed before implantation, three and twelve months after implantation (I) and also five years after implantation i.e. long-term follow up (II). At the long-term follow up, the average ICD recipient had lived with an ICD for six years and nine months (6.9 years). The results showed the overall QOL and QOL in the health/functioning domain were unchanged over time. QOL in the socio-economic (p= .002) and psychological/spiritual domains (p= .012) decreased in the first year. From baseline to long-term follow up, the QOL in the family domain (p= .011) and overall uncertainty (p= .002) decreased. Uncertainty related to the information decreased at year 1 in relation to baseline (p= .001). The aim in Paper III was to illuminate the main concern of recipients living with an ICD and how they handle this in their daily life. Sixteen recipients who had lived with an ICD between six to twenty-four months were interviewed. Data was collected and analysed in a simultaneous process according to guidelines for classical grounded theory. In the analysis, a substantive theory was generated explaining the main concern of ICD recipients and how they handle this in their daily life. The core category, labelled “Striving to resume command”, illuminates the main concern of ICD recipients. To manage this main concern, the recipients used the following strategies: Economizing resources, Distracting oneself, Submitting to one’s fate and Re-evaluating life. The aim in Paper IV was to explore relationships between OQL, coping strategies, anxiety, depression and perceived control in recipients living with an ICD and to compare those having received an ICD less or more than one year ago and those with a primary or secondary preventive indication. A cross-sectional, correlational, multicenter design was used, and 147 recipients who had lived with an ICD between six to twenty-four months completed Quality of Life Index-Cardiac version, Jalowiec Coping Scale, Hospital Anxiety and Depression Scale and Control Attitude Scale. The results showed that anxiety, depression and perceived control were predictors of QOL. Anxiety was also a predictor of coping with optimistic coping being the most used coping strategy. There was no relationship between QOL and coping. No differences were found in QOL, coping, anxiety, depression and perceived control between recipients implanted either on a primary or secondary preventive indication or having the device less or more than one year. In this thesis, it was concluded that the ICD recipients strived to resume command over their life (III) and the more control the recipients perceived the more satisfied they were with their QOL (IV) and the more symptoms of anxiety, depression and uncertainty they experienced the less satisfied they were with their QOL (II, IV). Coping strategies were used more frequently by ICD recipient perceiving more anxiety (IV). QOL was fairly good 6,9 years after implantation and ICD recipients felt less uncertain once they had passed the first year of their illness.

Multidisciplinary cancer conferences (MCCs) provide an opportunity for health professionals to discuss diagnosis and treatment options with the goal of providing optimal patient management. No prior studies have explored the experiences of adopting and implementing MCCs in Canada. Methods: Using a grounded theory approach, interviews, participant-observation, and document analysis were triangulated to explore the experiences of implementing MCCs at four hospitals in Ontario, Canada. Constant comparative analysis was used to identify themes and assimilate them into a theoretical understanding of policy, administrative/organizational, and participant contributions to implementing MCCs. Results: Thirty-seven MCCs, in three hospitals, were observed, and 48 interviews were conducted. The core conceptual category was a perceived value for time balance, which was influenced by policy and administrative factors, and themes related to MCC structure and participant interaction. Conclusions: MCC implementation in Ontario is inconsistent. Future efforts should concentrate on a systematic implementation plan involving clinicians and administrators.

Syftet med denna studie är att försöka ta reda på vad ett dramapedagogiskt förhållningssätt är  samt att sprida det till andra som arbetar med drama utan att vara utbildade. Dessutom vill  författaren hitta tydliga exempel från barnlitteraturen för att konkretisera det abstrakta som ett  förhållningssätt innebär.     Frågeställningarna är:  Vad är ett dramapedagogiskt förhållningssätt?  Hur kan man konkretisera det för att göra det mer gripbart och förståeligt?    Det är en kvalitativ undersökning gjord enligt grounded theory och med tankar från symbolisk  interaktionism. Metoden är fokussamtal kombinerat med intervju via e-post. Informanter är  dramapedagogutbildarna på Västerbergs folkhögskola samt verksamma dramapedagoger som har  genomgått utbildningen. Det empiriska materialet har bearbetats enligt grounded theory och har  lett fram till 10 nycklar som alla representerar olika delar av det dramapedagogiska  förhållningssättet. Dessa nycklar presenteras i resultatet samt med barnboksfigurer som aktörer.

A grounded theory methodology, justified by the logic of methodical hermeneutics, was employed to guide both the collection and analysis of data produced from interviews with 11 psychotherapy clients who reported having unsuccessful experiences. Ultimately, I put forth the Clients Helical Path as a theoretical model grounded in clients' unsuccessful therapy experiences. The theory subsumes four subcategories: three cyclically-related subcategory processes (Embarking, Evaluating, and Ending), and a fourth category (Familiarity) that provides a temporal/experiential dimension. Clients embark upon a course of therapy with certain expectations; they later evaluate their experience on the basis of these expectations, and then end therapy when they adjudicate it as not sufficiently successful. Clients' familiarity with the enterprise of therapy is enhanced with each successive therapy experience, and this familiarity implicates clients' subsequent expectations, evaluations, and endings. The theory contextualizes clients experiences of unsuccessful therapy at the level of the individual, rather at the level of the course of therapy, thereby providing an understanding for how past therapy experiences influence future ones. This feature of the theory represents a significant departure from and contribution to the existing psychotherapy research literature. I discuss the unique nature and utility of the theory, its overlap with existing empirical findings, as well as its limitations. I suggest directions for future research, and I provide multiple credibility checks.

A grounded theory methodology, justified by the logic of methodical hermeneutics, was employed to guide both the collection and analysis of data produced from interviews with 11 psychotherapy clients who reported having unsuccessful experiences. Ultimately, I put forth the Clients Helical Path as a theoretical model grounded in clients' unsuccessful therapy experiences. The theory subsumes four subcategories: three cyclically-related subcategory processes (Embarking, Evaluating, and Ending), and a fourth category (Familiarity) that provides a temporal/experiential dimension. Clients embark upon a course of therapy with certain expectations; they later evaluate their experience on the basis of these expectations, and then end therapy when they adjudicate it as not sufficiently successful. Clients' familiarity with the enterprise of therapy is enhanced with each successive therapy experience, and this familiarity implicates clients' subsequent expectations, evaluations, and endings. The theory contextualizes clients experiences of unsuccessful therapy at the level of the individual, rather at the level of the course of therapy, thereby providing an understanding for how past therapy experiences influence future ones. This feature of the theory represents a significant departure from and contribution to the existing psychotherapy research literature. I discuss the unique nature and utility of the theory, its overlap with existing empirical findings, as well as its limitations. I suggest directions for future research, and I provide multiple credibility checks.

Multidisciplinary cancer conferences (MCCs) provide an opportunity for health professionals to discuss diagnosis and treatment options with the goal of providing optimal patient management. No prior studies have explored the experiences of adopting and implementing MCCs in Canada. Methods: Using a grounded theory approach, interviews, participant-observation, and document analysis were triangulated to explore the experiences of implementing MCCs at four hospitals in Ontario, Canada. Constant comparative analysis was used to identify themes and assimilate them into a theoretical understanding of policy, administrative/organizational, and participant contributions to implementing MCCs. Results: Thirty-seven MCCs, in three hospitals, were observed, and 48 interviews were conducted. The core conceptual category was a perceived value for time balance, which was influenced by policy and administrative factors, and themes related to MCC structure and participant interaction. Conclusions: MCC implementation in Ontario is inconsistent. Future efforts should concentrate on a systematic implementation plan involving clinicians and administrators.

This thesis is involved with exploration of key changes drivers and market phenomena in the Southeast Asia and the development of new conceptual frameworks for business environmental analysis of airlines. The research is constructed under the phenomenology paradigm which adopts a coherentism approach and mainly takes airline industry’s publications, statistics, and executives as units of analysis. Hermeneutic phenomenology, a single-embedded case study, concurrent triangulation mixed method, and grounded theory are all used as methodologies. Methods using document reviews, interviews, and questionnaires are applied to surface the key changes drivers, market phenomena and the perceptions of the importance of changes factors. The collected data are analysed by content analysis, thematic analysis, cognitive mapping analysis, constant comparative analysis and descriptive analysis to classify, generalise and develop into proper forms. The research reveals that ‘market’, ‘competition/strategy’, ‘regulation/policy’, ‘infrastructure/resource’, ‘cooperation’, ‘distribution’, ‘technology, and ‘broad’ factors are discovered as key change drivers. Their different importance levels are measured by occurrences, density, centrality, and tail occurrences as root causes of changes. The characteristics of their interrelationships are based on directional and influential dimensions. There are 16 emerged changes/market phenomena and 11 generalised conceptual frameworks and 3 newly developed frameworks for analysing the airline business environment. The quantitative findings from content analysis are evaluated by inter-coder analysis which achieves kappa coefficient = 0.87 indicating high reliability of the analysis. The qualitative findings are qualified through ten criteria assessment of research quality. The deliverables provide both theoretical and methodological contributions. The research limitations are found in some sources of collected data and findings which are caused by scarce data availability and three types of biases. The recommendations for future research into financial performance, changes’ leading indicators and comparative in-depth study in other ASEAN countries and regions are made.

The purpose of this study was to develop a theory to explain how nurses experience and respond to uncertainty arising from patient care-related situations and the influence of uncertainty on their information behaviour. Strauss and Corbin’s (1998) grounded theory approach guided the study. Semi-structured face-to-face interviews were conducted with 14 staff nurses working in an adult medical-surgical intensive care unit (MSICU) at one of two participating hospitals. The grounded theory recognizing and responding to uncertainty was developed from constant comparison analysis of transcribed interview data. The theory explicates recognizing, managing, and learning from uncertainty in patient care-related situations. Recognizing uncertainty involved a complex recursive process of assessing, reflecting, questioning and/or predicting, occurring concomitantly with facing uncertain aspects of patient care situations. Together, antecedent conditions and the process of recognizing uncertainty shaped the experience of uncertainty. Two main responses to uncertainty were physiological/affective responses and strategies used to manage uncertainty. Resolved uncertainty, unresolved uncertainty, and learning from uncertainty experiences were three consequences of managing uncertainty. The ten main categories of antecedent, actions and interactions, and consequences that comprised the theory were interrelated and connected through temporal and causal statements of relationship. Nurse, patient, and contextual factors were linked through patterns of conditions and intervening relational statements. Together, these conceptual relationships formed an explanatory theory of how MSICU nurses experienced and responded to uncertainty in their practice. This theory provides understanding of how nurses think through, act and interact in patient situations for which they are uncertain, and provides insight into the nature of the processes involved in recognizing and responding to uncertainty. Study implications for practice, nursing education, and further theory development and research are discussed.