Eleven participants living with non-insulin-requiring Type 2 Diabetes (T2DM) discussed their self-monitoring blood glucose (SMBG) experience. All had been recently diagnosed (< 2 years) and treated for diabetes with a self-regulating SMBG guideline for primary care practice. Their digitally-recorded interviews and photographed logbooks were analyzed thematically and interpreted through the lens of numeracy literature to answer 2 questions: 1. What is the meaning of SMBG among people with non-insulinrequiring T2DM? 2. How do people with non-insulin-requiring T2DM perceive the function of SMBG in diabetes self-management? The meanings of SMBG were patient competence, "It is easy, just a little pin prick"; patient control, "I can control it. It doesn't control me"; and patient security, "It is not that way anymore." Three periods of lived time were observed: Diagnosis "The numbers say I have diabetes"; "I just can't figure out why it does that"; and Routine "I make my numbers." Prominent numeracy functions emerged by time period. During Diagnosis primary numeracy functions included comparing SMBG results to target values. Participants expressed this experience as, "I am some kind of O.K." During applied numeracy functions included taking medication correctly. SMBG readings were experienced as a clue to the diabetes mystery, sometimes confusing the participants, "I just don't know why it does what it does," or answering questions, "Now there is no question marks." Numbers motivated some people for action "The numbers get me out a walking" or restraint "If I didn't have the numbers, I would be tempted to cheat." During Routine interpretive numeracy functioned to aid the evaluation of the efficacy of participant's health behavior change. Numbers had taken on meaning helping a person to "know where I am at." Clinical implications are suggested including adjustments to the selfregulating SMBG guideline for primary care practice. Findings are discussed in relation to personal knowledge processes (Sweeny, 1994) and related SMBG research. Participants concluded that routine SMBG is essential to maintaining and restraining health behavior. This study provides a model for use of SMBG in diabetes selfmanagement and patient perspectives on SMBG during the 2 years following T2DM diagnosis.

Despite the developmental and clinical importance of body image during the pre-adolescent and adolescent years, there remains a dearth of information on the body image experiences of immigrant children and adolescents. This thesis represents a purposeful attempt to examine body image experiences among immigrant and ethnic minority children and adolescents in Canada and the United States (US). Specifically, the thesis integrates multiple methods (scoping reviews, qualitative interpretive description, quantitative multi-level modeling) and samples (clinical and population-based samples) to systematically contribute to the academic literature focusing on body image experiences among immigrant and ethnic minority children and adolescents in Canada and the US. Consisting of four conceptually related studies, this thesis makes the following methodological and conceptual contributions to epidemiological and clinical research and practice. First, the results from all four studies point to the need to develop standardized approaches for identifying and classifying immigrant and ethnic-minority children and adolescents. This will substantially increase the field’s ability to systematically characterize the nature and magnitude of body image dissatisfaction, body image distortion, and their associated outcomes among immigrant and ethnic minority children and adolescents. In addition, this systematic classification has the potential to inform the development or adaptation of universal and targeted preventative intervention strategies. Second, Study’s 1 and 2 demonstrate a clear need to further examine the constructs and experiences of acculturation and acculturative stress in relation to the body image experiences of immigrant and ethnic minority children and adolescents. The literature is unclear with respect to whether or not immigrant adolescents’ adoption of the values, behaviours and ideals of the Canadian or US culture increases their risk for body image concerns. On the other hand, we are also unclear as to whether or not immigrant adolescents’ retaining of the values, behaviours and ideals of their culture of origin may offer protection from poor body image experiences. Similarly, we are unclear about whether—and to what extent—stress as a result of adolescents’ acculturative experiences (i.e. acculturative stress) influence the onset or pervasiveness of body image concerns. Greater understanding about these constructs and processes and the extent to which they are implicated in the body image experiences among immigrant children and adolescents has the potential to inform culturally competent and targeted intervention approaches. Results from Study 3 indicate that immigrant adolescents have body image and appearance-related concerns that extend beyond what has typically been found among non-immigrant adolescents. More specifically, immigrant adolescents are concerned about the appearance of their skin (texture, complexion), their hair, their teeth, as well as other bodily features. It would be prudent for future researchers and clinicians to consider this information in relation to measuring, classifying and addressing body image dissatisfaction among immigrant adolescents. Finally, Study 4 demonstrates that females and first generation immigrants with body image dissatisfaction are at significantly elevated risk for body image distortion. This suggests that the assessment and intervention for body image dissatisfaction—particularly among females—soon after the migratory experience may play an important role in reducing body image distortion experiences. Taken together, the findings of this thesis strengthen the body image field by demonstrating that there are several unique aspects about being an immigrant that can influence adolescents’ body image experiences; and therefore, should be considered from a conceptual and methodological standpoint in future research and implementation of body image interventions. / Dissertation / Doctor of Philosophy (PhD) / Body image dissatisfaction and body image distortion have been linked to serious psychological outcomes, including depression and eating disorders. Yet, we know very little about the nature of these experiences among immigrant and ethnic minority children and adolescents. This thesis uses qualitative and quantitative methods, as well as general population and clinical samples to investigate body image dissatisfaction and body image distortion among immigrant and ethnic minority children and adolescents in Canada and the United States. Results provide important information that can inform the development of preventative interventions targeting body image dissatisfaction and body image distortion among immigrant and non-immigrant children and adolescents.

No description available.

La mort d'un enfant est considérée comme l'une des expériences les plus difficiles à laquelle une personne puisse faire face. Les cliniciens, les hôpitaux et plusieurs organismes ont pour objectif d’aider les parents endeuillés, mais leurs efforts sont compliqués par un manque de recherche dans le domaine du deuil parental. Cette thèse est composée de trois articles, soit deux revues de littérature et une étude empirique, qui tentent de combler cette lacune et d’informer les services en soins palliatifs pédiatriques et les services de soutien au deuil en particulier. Le premier article porte sur les besoins des patients recevant des soins palliatifs pédiatriques et de leurs familles. Par le biais d’un méta-résumé de la recherche descriptive et qualitative récente, 10 domaines de besoins ont été identifiés qui correspondent aux lignes directrices actuelles en soins palliatifs pédiatriques et de fin de vie. Ces besoins sont présentés de manière à être facilement applicables à la pratique. Cependant, les résultats mettent aussi en évidence plusieurs aspects des soins identifiés comme déficitaires ou problématiques qui mériteraient une attention particulière dans le cadre de politiques futures. Dans le deuxième article, l'objectif était de résumer une vaste littérature d'une manière utile aux cliniciens. À cette fin, une synthèse narrative a permis d’intégrer la recherche quantitative et qualitative dans le domaine du deuil parental. Les résultats mettent en évidence les éléments susceptibles de favoriser l’adaptation des parents au deuil, éléments qui suggèrent par le fait même des avenues possibles de soutien et d'intervention. Cette synthèse a cependant cerné dans la littérature certaines failles méthodologiques qui rendent l'applicabilité clinique des résultats difficile. L'objectif du troisième article était d'informer les services de suivi et de soutien au deuil auprès des parents en se renseignant directement auprès de parents endeuillés. À cette fin, 21 parents (dont 8 couples) et 7 membres du personnel impliqués dans des activités de suivi de deuil de 2 hôpitaux pédiatriques ont été interrogés dans le cadre d’une description interprétative, et l'application clinique des résultats a été vérifiée par le biais de réunions avec des collaborateurs de recherche et les décideurs des centres hospitaliers. Les résultats décrivent comment les parents ont fait face à leur détresse dans la phase précoce de leur deuil, ainsi que leurs points de vue sur la façon dont les divers services de suivi de deuil ont été aidants. Les résultats suggèrent que les parents gèrent leurs sentiments intenses de douleur par une alternance de stratégies axées soit sur leur deuil ou sur leur quotidien et que dans plusieurs cas leurs relations avec autrui les ont aidé. Cette étude a également permis d'élucider la façon dont divers services de soutien aide les parents à aborder leur deuil. Les implications cliniques de ces résultats sont discutées ainsi que des recommandations à l’intention de ceux qui sont impliqués dans la provision des services en deuil. / The death of a child is considered one of the most stressful and difficult experiences a person can face. Clinicians, hospitals, and other organizations want to help and support bereaved parents through their grief, but their efforts are hampered by a lack of research in the area of parental bereavement. This dissertation is comprised of two literature reviews and one empirical study that attempt to address this gap and inform services in paediatric palliative care in general, and in bereavement support in particular. The first article consists of an examination of the needs of patients receiving paediatric palliative care and their families. By metasummarizing the descriptive and qualitative research in the area, 10 need domains were found. The results were generally in agreement with current guidelines in paediatric palliative and end-of-life care; however, there were several aspects of care that were reported as lacking or problematic that are not addressed in these guidelines and that should be considered in future guideline and policy creation. In the second article, parents’ adaptation to their grief and elements found to influence their adaptation were examined. The aim was to synthesize the relevant literature in a way that could be useful to clinicians; to this end, a narrative synthesis method was employed in order to synthesize both quantitative and qualitative research in the area of parental bereavement. The results suggest important elements to keep in mind when assessing how parents adapt to their grief. The results also suggest aspects related to better adaptation, which could serve as potential avenues for support and intervention. However, this review also demonstrated certain methodological issues in the literature that hinder the synthesis and clinical applicability of the findings. The objective of the third article was to inform bereavement follow-up and support services through the use of an interpretive description methodology. To this end, 21 bereaved parents (including 5 parental couples) and 7 hospital staff involved in bereavement follow-up activities at two paediatric hospitals were interviewed, and the clinical applicability of the results verified through various meetings with project collaborators and service/program providers. The results of the study describe how parents coped with their grief in the early phase of their bereavement, as well as their perspectives on how various bereavement follow-up services helped them cope. We found that parents regulate their intense feelings of grief through either loss-oriented or restoration-oriented strategies, including attempts to reorganize their self-identity and connection to their deceased child; often parents’ relationships with others help them cope in these ways. The insights we gained from the respondents also allowed us to elucidate how various bereavement support and follow-up services were helpful. These results are discussed along with the clinical implications and how these findings can inform bereavement service providers.

The purpose of this thesis is to explore the diverse experiences of accessing health and social services when living with a neurological condition in Manitoba. Using a qualitative research design, I conducted 15 in-depth semi-structured interviews with adults living with a neurological condition in Manitoba. Findings demonstrated how characteristics of patients, and their service providers/systems, either predisposed them to a lack of service coordination or enabled them to successfully navigate health and social services. In the event that those factors contributed to a need or desire for coordination, participants employed strategies to improve their experience accessing services by i. pursuing knowledge to improve access, ii. actively engaging in behaviours to improve services, or iii. mentally coping with inadequate services. To conclude, practical recommendations on possible initiatives to improve the daily experiences of individuals living with neurological conditions are also provided. / October 2015

Registered nurses and registered psychiatric nurses are members of multidisciplinary mental health teams that address the assessment and treatment of vulnerable youth. The phenomenon of interest for this study is nursing's distinct contribution to a multidisciplinary team in this clinical domain. An interpretive description drawing on the perspectives of seven nurses and seven clinicians from the professions of psychiatry, psychology, social work, child and youth care, and registered clinical counselling provides insight into understanding nursing's distinct contribution (NDC) to multidisciplinary mental health teams that serve vulnerable youth (MMHTSVY). Six major themes and multiple subthemes were inductively derived. The findings make explicit nursing’s contribution to MMHTSVY in ways that are meaningful to the clinical practice. / Graduate