The purpose of this study was to examine the relationship among Healthy Work Environments (HWEs), nurse caring behaviors, and nursing-sensitive patient outcomes, specifically catheter-associated urinary tract infections (CAUTIs), patient falls with injury, and hospital-associated pressure injuries (HAPIs) Stage 2 and above in Magnet hospitals. A descriptive, cross-sectional, quantitative, study was conducted between January 1, 2018, and February 28, 2018, in seven Magnet-designated hospitals in a large faith-based system in the United States. A convenience, non-probability, purposive sample of permanently employed, direct-care RNs assigned to inpatient adult medical-surgical, telemetry, progressive care, stepdown, and critical care units were eligible to participate in the study. Three hundred and thirty-nine of 2632 eligible direct-care RNs participated in the study resulting in an overall response rate of 13.0% with a range of 5.5%–38.1% across hospitals. Nurse participants completed the AACN Healthy Work Environment Assessment Tool and the Nurse Caring Behaviors Inventory–24. Nursing-sensitive patient outcome data were obtained from patients cared for in the units during the study period. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2019. / FAU Electronic Theses and Dissertations Collection

Numerous researchers have explored the benefit of creative activities for the aging population diagnosed with dementia. However, there is a lack of data available to community administrators and organizers of senior residences about how successful aging may be enhanced, in the relatively healthy older adults, through their participation in creative art-making. Activities that provide mental stimulation, facilitate expression of emotions, and that are related to overall psychological well-being can provide a foundation for healthy aging. Accordingly, the purpose of this study was to explore older adults' subjective experience of engaging in creative artwork. The conceptual framework that guided this phenomenological study was based on Lazarus's cognitive-emotional-relational theory of emotions. The focus of the research questions was on the subjective experience of 10 older adults who participated in 7 weekly art sessions offered at a senior residence. Audiotaped interviews that were held after the last art-making session, together with participants' artwork and field notes, were analyzed, coded, and then categorized into themes. Results indicated the participants learned they can be creative, and that their images became a visual inroad to meaningful expression of emotions, insight, and motivation. The results point to evident social change when community organizers and administrators of senior residences increase activities for residents, especially meaningful activities designed to facilitate expression of emotions and insight during later life. Creative image-making activities can lead to continued learning, heightened social interactions, increased mental fitness, reduced depression, and enhanced healthy aging.

Over a quarter of children and two thirds of adults in Australia are overweight, with these estimates reflecting global trends. The literature review in Chapter 1 highlights that treatment of childhood overweight is an important part of the public health approach required to address the obesity epidemic. Energy moderation, behaviour modification and family support are the cornerstones of treatment of childhood overweight. However the evidence to guide best practice is limited, with a call being made for well designed studies to inform age-appropriate effective, long term child weight management. Studies are needed in a range of populations and to assess a range of health outcomes. This thesis tested the hypothesis that, pre-pubertal children whose parents participate in a parent-led, family-focused child weight management intervention comprising parent skills training and intensive lifestyle education will have adiposity, metabolic profiles and indicators of physical and psychosocial functioning after 12 months that are a) improved compared to children wait listed for intervention and b) no different to children whose parents participate in parenting skills training alone (without intensive lifestyle education). Methods of the randomised controlled trial undertaken with 111 overweight, pre-pubertal 6-9 year olds to test this hypothesis are detailed in Chapter 2. Parents were defined as the agents of change, responsible for attending intervention sessions and implementing family-focused lifestyle change to support child weight management. Two interventions, both utilising parenting skills training, but differing in the presence or absence of intensive lifestyle eduction were compared to a group waitlisted for intervention with a brief pamphlet. Program effectiveness was defined in terms of adiposity together with broader health and evaluation outcomes. Chapter 3 describes the study population, their flow through the study, the primary outcome BMI z score and waist circumference z score. With parenting plus intensive lifestyle education there was a 10% reduction in BMI z score over 12 months. However this was not statistically different to the 5% reduction observed with parenting alone or intervention waitlisting. There was a significant reduction in waist circumference between baseline and 12 months with parenting alone and parenting plus lifestyle education, but not waitlisting. There was a group, time and gender interaction, with boys receiving intervention having greater reductions in adiposity. In determining intervention effectiveness, growth, metabolic profile and psychosocial outcomes are presented in Chapter 4. While there were limited improvements in metabolic profile and body dissatisfaction, significant improvements were observed in parent-perceived HR-QOL relating to psychosocial and family functioning. Improvements were confined to the intervention groups, parenting plus lifestyle education more than parenting alone. Chapter 5 presents the study process and impact evaluation. Parents were satisfied with the program and reported that it provided the type of help they wanted. Personal, rather than program factors such as work and family commitments limited intervention attendance to 60%. Child health behaviours and parental weight status show positive change in all groups, but favour intervention. Chapter 6 highlights key findings, study strengths/limitations and areas for further research. In conclusion, a parent-led family-focused intervention utilising parenting skills training and healthy family lifestyle is a promising intervention for young overweight children.

Purpose: The purpose of this research was examine potential barriers and facilitators to the implementation of healthy public policy related to aging, specifically in municipal planning and transportation departments, in the suburban context. Research Questions: What are the factors which influence successful implementation of healthy public policy in municipal and, specifically, suburban contexts? How do suburban planning and transportation policies interface with policies aimed at physical environmental changes to shape the built environment in ways that are theorized to affect seniors health? Methods and Results: A qualitative case study approach was used to examine Strathcona Countys Older Adults Plan (2009a). Strathcona County is a municipality bordering Edmonton, Alberta, Canada. Data was collected through document reviews and 19 semi-structured interviews with 21 individuals involved in the development of the plan or potentially affected by its implementation. Results were triangulated in a final analysis of policy implementation capacity in Strathcona County.

Studies have shown that the rising rate of adverse physical, social and mental conditions are tightly related to a lack of physical activity, poor eating habits, and the lack of social interaction. Unlike health problems centuries ago which were often caused by lethal diseases, the contemporary health problems in the United States relate to peoples' lifestyles and built environments. Vehicle-oriented community design has caused limited physical activity and unhealthful eating habits that increase obesity and other related health problems. Modern built environments often unintentionally discourage social interactions and present unintended obstacles to physical activities which causes social and mental health problems. This thesis is an attempt to address some of the issues related to improving community design for better community health outcomes via a better design on the built environment. Specifically, this thesis is a case study in the Burlington neighborhood, a low income urban area in Knoxville, Tennessee. I test how design may the issues mentioned above. Following the WHO's definition of health, which is ``a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.'' This thesis therefore addresses the issue of human health by focusing upon two things. The first thing is to improve the physical health. This includes providing access for pedestrians and bicyclists, access to healthy food and places to exercise. The second focus is to improve social and mental health by providing recreation areas for socialization and refreshing mental health. Unlike the traditional public health approach that relies upon medical interventions, this thesis posits the preventive efforts by utilizing spaces close to people's dwelling places.

Older adults represent a growing part of the population of the United States. Due to decreased physical activity, dietary changes, and alterations in metabolic rate this population is susceptible to an increased rate of diseases. The generation entering older adulthood is one which welcomed fast food and meal replacement foods allowing them to adapt to a more sedentary lifestyle and to need programs of preventative health. The Nutrition and Life Satisfaction Survey was used to investigate gardening as a preventative health intervention for older adults. This instrument was used to compare older (age 50+) gardeners and nongardeners on their perceptions of personal life satisfaction, nutrition, health, and gardening habits. The instrument was posted online at the Aggie Horticulture website in spring 2005. Respondents differentiated themselves as gardeners or nongardeners by responding positively or negatively to the question “Do you garden?” Then, they completed the questionnaire about their quality of life andhealth status and, for gardeners, their gardening habits. Results indicated that gardeners had more desirable responses: Overall quality of life scores were higher for gardeners compared to nongardeners, and four individual quality of life statements yielded more positive answers by gardeners. Additionally, gardeners reported a higher consumption of total fruits and vegetables, including herbs, and of vegetables only including herbs. Personal reports of physical activity and of perceived health were higher among gardeners. Females were more likely than males to garden and spend a higher percentage of their budget on fruits and vegetables. Higher consumption of fruits and vegetables and higher levels of physical activity result in healthier lifestyles and, in turn, can increase quality of life.

Despite widespread health promotion and nutrition education efforts, gaps between official healthy eating messages and people’s actual eating practices persist. There is increasing recognition that emphasizing individual responsibility for eating may have limited applicability in improving people’s health. Many experts advocate that future research on healthy eating should involve exploration of how food practices are shaped by social structures (or determinants) and individual agency. The purpose of this study was to explore the ways in which people engage with food structures to construct everyday notions of healthy eating. ‘Food structures’ draws on the concept of ‘structure,’ described by the social theorist Anthony Giddens, to refer to the range of food rules and resources people draw on. The research was conducted as part of a qualitative study on family food decision-making that included 144 participants from 13 African Nova Scotian, 10 European Nova Scotian, 12 Punjabi British Columbian and 11 European British Columbian families. These groups were chosen for their potential differences in perspectives based on place, ethnocultural background and histories of immigration to Canada. Data collection consisted of individual interviews with three or more family members aged 13 and older, and, with each family, observation of a grocery shopping trip and a family meal. Analysis followed common qualitative procedures including coding, memoing and thematic analysis. Together, the analyses support views that the gaps between official healthy eating messages and people’s eating practices may not be closed by further education about how to eat. Drawing on the theoretical concepts of Anthony Giddens and Michael Foucault, the findings suggest that one way to understand why people eat the way they do and how changes in eating habits occur is to think about the constant exposure to change through everyday, taken-for-granted practices. The findings also suggest that further healthy eating discourses may require more reflection with respect to the roles of nutrition educators and the social roles/autonomy of people in goals for health and well-being. Dietary goals for the population cannot be considered as isolated scientific objectives without taking into consideration how healthy eating discourses provide social standards beyond messages about healthy eating.

Preserving and improving the health and well-being of older people is a significant public health issue of the 21st century. The increased attention to the promotion of health in old age has given rise to an extensive body of literature on the subject of “healthy aging” – a discourse dedicated to understanding the multidimensional factors associated with aging and health and the application of this knowledge. Adopting a place-based, qualitative approach, this dissertation addresses key gaps in the healthy aging literature. The public life of older people aging in place was examined to understand how neighbourhoods, as important physical and social places of aging, contribute to the well-being and healthy aging of older people. This dissertation employed a critical geographical gerontology research framework and a methodology called ‘friendly visiting’ which combines ethnography, narrative and case study research and utilizes participant observation, visual methods and interview techniques. The qualitative data were analyzed using grounded theory and an adapted coding strategy that integrated the textual, visual, and auditory data. The analysis process highlighted theoretically-informed themes that characterized participant’s perceptions and experiences of their neighbourhoods. Findings reveal neighbourhoods are important places of aging that impact the well-being of older people aging in place. This dissertation provides insight into the micro-territorial functioning of neighbourhoods for older people. Embedded within these environments are key sites for informal public life called third places (e.g., parks, streets and coffee shops). Third places are important material and social places for older populations. Preparing for, journeying to, and engaging in these public sites promotes healthy aging by providing opportunities for engagement in life and facilitating social networks. Results advance healthy aging and aging and place research, contribute to gerontological and geographical methodologies, and have implications for policy and practice in areas such as health promotion and age-friendly community initiatives.

A qualitative research study was conducted with people who had participated as healthy subjects in phase I drug trials at commercial research facilities, in order to develop a better understanding of their perspective regarding research participation. The participants were recruited using online advertisements posted on the University of Toronto student website (www.my.utoronto.ca) and NOW Magazine online. Thirty-one subjects were interviewed. The audiotaped interviews were transcribed and analyzed using grounded theory methods. A grounded theory was developed that describes the process of participation and the main factors affecting the experience of participation, from the perspective of healthy subjects. The theory, called Making Participation Work, explains how healthy subjects frame participation as an income earning opportunity, and how this framing shapes their behaviour with regard to participation. Participants expressed a range of attitudes about the experience of participation, from very positive to very negative. The main factor affecting the experience is the perceived net burden, which is in turn affected by the degree to which subjects find personal control over their participation. Net burden and finding personal control were both affected by the degree to which subjects felt valued by research staff, and by whether subjects had trust in the research enterprise. Although subjects framed participation as work, the relationship with the study doctors and nurses was viewed as clinical. Most subjects are generally trusting that participation in phase I drug trials is safe. These findings suggest that models of research participation assuming participation motivated by altruism or potential therapeutic benefit cannot accommodate the attitudes and behaviours of healthy subjects in phase I drug trials. New models must be developed which account for the framing of participation as work, while being sensitive to the trust that healthy subjects place in the research enterprise.

While it has been long known that the behaviour of others can influence individual behaviour, norms (the views and behaviours of others) are not generally reported as strong motivators of physical activity. Using the theory of normative social behaviour as a guiding framework, the purpose of this research was to examine if descriptive norms (the perceived prevalence of others behaviour) would be more important in predicting activity than previously suspected. A secondary purpose was to extend this examination to another health behaviour, healthy eating. Three independent studies were conducted. The first two studies examined what individuals thought motivated their physical activity (Study 1) and eating (Study 2) as well as the relationship between descriptive norms and participants own activity behaviour and healthy eating intentions. Results revealed that, despite being rated by participants as less motivating, descriptive norms were stronger predictors of activity behaviour and healthy eating intentions than other well-established non-normative reasons. It also was found that descriptive norm perceptions about a group proposed to be high in group identity (i.e., friends) was most related to physical activity behaviour and healthy eating intentions. To extend these results, a third study manipulated normative and non-normative messages to examine effects on physical activity. Participants were grouped into one of four conditions (descriptive norm, health, appearance, and control) and received motivation-based email messages specific to their condition encouraging them to be active. It was hypothesized that participants in the descriptive norm condition would experience the greatest increase in physical activity but results did not support this hypothesis, as participants across all conditions significantly increased total physical activity after receiving the messages. A secondary hypothesis examining the focal nature of the targeted behaviours was supported in that responses to normative messages were greatest with the most focal behaviour (using the stairs). Taken together, the results of the first two studies provide preliminary evidence to suggest that the relationships between both descriptive norms and physical activity and descriptive norms and healthy eating may be going undetected. In light of the results of the third study, however, future studies are needed.