Background: This thesis examines the impact of dream or wish fulfilment on seriously ill children and their families. Dream or wish fulfilment is operationalised as the actualisation of a seriously ill child’s wish by a charity that provides desired experiences. Anecdotal reports suggest that the experience of having a dream or a wish fulfilled can provide seriously ill children and their families with a sense of hope and time away from illness. However, little empirical research has been conducted in this area. This thesis reports the impact of dream fulfilment on the psychosocial well-being of ill children and their families. The research questions are: what is the experience of having a dream fulfilled for the child? What is the impact of dream fulfilment on the family? Methods: A constructivist grounded theory methodology was adopted, using theoretical sampling to recruit families from across the UK. Twenty-one families were interviewed, including 15 dream recipients, 8 siblings, and 24 parents. Analysis followed the grounded theory methodology of simultaneous data collection and development of theory, resulting in analytic interpretations of participants’ worlds. Results and Conclusions: This thesis reports for the first time a theory and accompanying theoretical model, that explain the impact of dream fulfilment on families’ lives. The generated theory suggests that dream fulfilment was conceptualised as an alternative milestone in seriously ill children and their families’ lives. Additionally, the dream experience shifted perceptions of illness by providing instances and experiences where illness did not underscore family life. Findings additionally suggest that the dream fulfilment process provided families with ill children, who often felt excluded and stigmatised from services, with a period of much needed support. Findings also highlight the unintended negative consequences of dream fulfilment. Implications for Dreams Come True, and other dream and wish fulfilment organisations are discussed.

Growth in the elderly population and restraint in the health sector have led to decision makers placing an increasing priority on home care services. In Canada, there are three models of home care: a preventive and maintenance model which is designed to reduce the rate of deterioration for persons with relatively low level care needs; an acute care substitution model where home care substitutes for hospital care; and a long term care substitution model which uses home care as a substitute for facility care. This study focuses on the long term care substitution model. The research question is: In the British Columbia continuing care sector, is home care for the elderly a cost-effective alternative for government funders to care in long term care facilities, by level of care? To answer this question, data were obtained on three cohorts of clients for one year prior to initial assessment and three years post-assessment. The cohorts were new admissions to the British Columbia continuing care system in the 1987/88, 1990/91 and 1993/94 fiscal years. Costs to government for home care services, residential services, pharmaceuticals, fee-for-service physician services and hospital services were analyzed. The central finding of this study was that, on average, the overall health care costs to government for clients in home care are about one half to three quarters of the costs for clients in facility care, by level of care. A related finding was that costs differ by the type of client. The lowest home care costs were for individuals who were stable in their type and level of care. For clients who died the costs for home care were higher, compared to clients in long term care facilities. It was also found that some one half of the overall health care costs for home care clients were attributable to their use of acute care hospital services and that a significant portion of the health costs for home care clients occur at transition points, that is, when there is a change in the client's type, and/or level, of care. These findings are compared to the American literature which indicates that home care is not a cost-effective substitute for residential care. Possible reasons for the differences in findings are discussed. The study concludes with a discussion of the implications of the findings for a series of potential, future, policy agendas regarding: the organization and management of continuing care services; legislation and administrative policy; service delivery; resource allocation; information systems; and research. / Graduate

The relationship between Public Administration and the people is one that requires legitimacy and compromise in order to solve complex problems. Individuals with intellectual and developmental disabilities (IDD) and their families during the last fifty years have put forth an agenda that calls for the advancement of rights for the disabled and more integration into the larger society. In this arena, government, with post civil rights legislation like the 1990 Americans with Disabilities Act (ADA), plays a huge role in promoting social awareness and bringing down barriers of stigmatization, understanding, and access. This struggle is fought on many fronts. A significant part of the effort focuses on moving the locus of long-term care of the disabled, including the IDD population, from an institutional setting to the least restrictive setting that will foster social ties and integration. Since the early 1980s as part of this effort to deinstitutionalize the disabled, legislation at both the federal and state level has supported and incentivized the creation of Home and Community Based Service (HCBS) programs. HCBS waivers, as they are typically called, are also promoted as a means of containing government expenditures for long-term care. However, the effectiveness of these waivers is poorly understood. The critical questions being - Do HCBS waivers promote and create an environment that increases awareness of the needs of IDD individuals? Do the programs help reduce stigmatization, promote understanding, and increase access to services and activities that foster social interaction? Or, do HCBS waivers create a new "iron cage" where the intellectually or developmentally disabled are once again relegated to existing as second class citizens? In this research, programs are mapped and then evaluated to paint a better picture of how HCBS waivers change long-term care. / This research combines qualitative and quantitative approaches to triangulate on these phenoamea as a means to investigate when and how HCBS waiver programs facilitate, promote, or stifle the social integration of those with IDD. How does social integration manifest itself in the quality long-term care of those who often cannot take care of themselves? / by Enrique M. Perez. / Thesis (Ph.D.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.

This two-part study evaluates a government sponsored Long Term Care Aide/ESL Program taken by a group of immigrant women. The purpose of the first part of the study was to assess how effective a B.C. government sponsored Long Term Care Aide/ESL program was in preparing a group of immigrant women for the workplace. A questionnaire was used to determine demographics and employment status. Also, it obtained perceptions on the strengths and weaknesses of the program. The purpose of the second part of this study was to hear the women's personal insights and voices about their experiences while taking the program and after the program. Semi-structured interviews were used to obtain these stories. Results from the quantitative questionnaire indicated that 94% of the immigrant women who had taken this course were employed as care aides. Three years after the completion this program, the women felt that the course had provided them with both a vocational skill and more English language skills. Results from the qualitative portion of this paper focused on how the women felt about their experiences in this Long Term Care Aide/ESL program in their own words. The data were analyzed and put into themes. Theme 1 was "The pain of renewal". It presented their collective stories of being an immigrant and struggling to begin again. Theme 2 was "The costs and the benefits". This theme presented the women's insights on working as care aides. Most of the women liked their jobs but found trying to secure a full time job difficult. Theme 3 was "The need to learn the language of care". All the women interviewed wanted to have more "caring" language, the "everyday" language to relate to their clients. Theme 4 was "Advice to other immigrant women". This theme revealed how some women felt about the work they did. The last theme, Theme 5, was "Hopes and dreams". Half of the women interviewed had aspirations to continue their education and these women were already enrolled in other health care courses. The results of the study are discussed and implications are drawn for research and pedagogy.

Thesis (M.A.)--Carleton University, 2008. / Includes bibliographical references (p. 118-130). Also available in electronic format on the Internet.

This two-part study evaluates a government sponsored Long Term Care Aide/ESL Program taken by a group of immigrant women. The purpose of the first part of the study was to assess how effective a B.C. government sponsored Long Term Care Aide/ESL program was in preparing a group of immigrant women for the workplace. A questionnaire was used to determine demographics and employment status. Also, it obtained perceptions on the strengths and weaknesses of the program. The purpose of the second part of this study was to hear the women's personal insights and voices about their experiences while taking the program and after the program. Semi-structured interviews were used to obtain these stories. Results from the quantitative questionnaire indicated that 94% of the immigrant women who had taken this course were employed as care aides. Three years after the completion this program, the women felt that the course had provided them with both a vocational skill and more English language skills. Results from the qualitative portion of this paper focused on how the women felt about their experiences in this Long Term Care Aide/ESL program in their own words. The data were analyzed and put into themes. Theme 1 was "The pain of renewal". It presented their collective stories of being an immigrant and struggling to begin again. Theme 2 was "The costs and the benefits". This theme presented the women's insights on working as care aides. Most of the women liked their jobs but found trying to secure a full time job difficult. Theme 3 was "The need to learn the language of care". All the women interviewed wanted to have more "caring" language, the "everyday" language to relate to their clients. Theme 4 was "Advice to other immigrant women". This theme revealed how some women felt about the work they did. The last theme, Theme 5, was "Hopes and dreams". Half of the women interviewed had aspirations to continue their education and these women were already enrolled in other health care courses. The results of the study are discussed and implications are drawn for research and pedagogy. / Education, Faculty of / Language and Literacy Education (LLED), Department of / Graduate

Attacks on public administration are commonplace in today’s anti-bureaucratic approach to government. The legitimacy of public administration has long been questioned. Public administration is not one of the three branches of government explicitly formed by the Constitution. Further, public administrators are not elected by the people. Numerous attempts have been made to develop an idea of legitimacy that is grounded in the Constitution and that renders public administration consistent with the representative character of American government. A recent attempt presents public administration as an institution of governance that is derived from, and grounded in, the Agency Perspective. This perspective provides a new foundation stone for the legitimacy of public administration. Central to the perspective is public administration’s ability to evoke dialogue in a way that takes into account the public interest and brings about communities of shared meaning. This literature, however, does not provide a specific enough perspective, i.e., a perspective that has been given a practical specification. Simply exhorting public administrators to evoke dialogue is not sufficient. Public administrators who are encouraged in this general manner will have no choice but to look to what they know: interest group liberalism. Public administration needs a more specific alternative to interest group liberalism and a new methodology from which public administrators can work. In the research at hand, a new methodology is developed and demonstrated. The outline of the new methodology can be seen through the lens of principled negotiation. This literature maintains that negotiation from the positions of the various parties involved in a conflict, as is characteristic of interest group liberalism, is inefficient. Principled negotiation, on the other hand, recognizes that vital interests, not positions, are the key to creating consensus and achieving collaboration. The difficulty with this approach is that people, either as individuals or as role occupants in organizations, typically are unaware of their vital interests. Therefore, it is the task of the negotiator or, in this case, the public administrator to help surface these deeper interests. The new methodology is grounded in the literature of structuralism. Structuralism is a social theory and a method of inquiry (Gibson, 1984:2) that provides a means of looking beneath the surface of events or issues to identify patterns of meaning that are not evident at the surface. The work of linguist Ferdinand de Saussure served as the basis for modern structuralism (Sturrock, 1988:6). Working from Saussure’s writings, Claude Levi-Strauss "treats all forms of cultural expression as language and he assumes that like language it is all [structured] by unconscious laws that constitute a grammar for each" (White, 1983:12). In a similar vein, the structuralist undertaking in this research views the vital interests of the related groups and role occupants as the "underlying grammar" that structures the various approaches to policy formulation. This research employs a case study design to which the theory of structuralism and the technique of structural analysis have been applied. The case study is that of national long-term care policy. Role occupants from 23 national organizations involved in long-term care policy were interviewed. The role occupants are key people involved in long-term care policy formulation for the organizations for which they work. The organizations' long-term care position papers were obtained. Using a process of structural analysis, the position papers and interview transcripts were analyzed to identify vital interests. An analysis of linguistic elements such as metaphors and other figures of speech, justifications, preferred meanings, and recurrent terms was conducted. In addition, content analysis was carried out with the aid of a computer program. The vital interests identified through these analyses served as the basis for the development of a strategy to shape the national long-term care policy debate. / Ph. D.

This study is a Time 4 (T4) follow-up interview of ninety-three caregivers of persons who experienced a first stroke between 2 to 4 years (mean = 36 months) prior to the T4 interview. The first wave of data collection occurred within two months after the stroke. The second and third waves occurred six and twelve months, respectively, after the first interview. The caregivers were identified by the person with stroke as being the person closest to him/her who would be responsible for care after the stroke. Data were gathered at all four interviews using reliable and valid measures for depressive symptomatology (CES-D; Radloff, 1977), psychological well-being (IPWB; Berkman, 1971), and caregiver burden (Zarit, 1980). The contribution of social support to caregiver well-being was also investigated. Additional areas of investigation at T4 included coping strategies (F-Copes; McCubbin, Larsen, and Olson, 1981), caregiver adjustment, and the respondents' perception of themselves as "caregivers". The mean scores of depressive symptomatology, perceived burden, negative well-being, and positive well-being did not change significantly over the four points in time. However, the percentage of the sample having CES-D levels of 16 and above (indicating potential diagnosis of clinical depression) decreased by ten percent between T1 and T4. About ten percent of the respondents who were at risk for clinical depression at T4 reported high levels of depressive symptoms at all four interviews. Respondents who specifically thought of themselves as "caregivers" (sixty-two percent) were significantly more likely to report high levels of depressive symptoms, to experience high levels of strain and caregiver burden, and to be caring for persons who were more severely impaired by the stroke than those who did not. Caregiver characteristics contributed more to the variance in depressive symptoms and psychological well-being than did characteristics of the stroke. However, depressive symptomatology and perceived burden were significantly associated with both the functional capacity of the person with stroke and with an index of stroke severity comprised of communication impairments and negative personality/behavior changes since the stroke. The findings from this study have implications for stroke management programs, caregiver intervention planning, and health care policy.

Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2007. / Source: Masters Abstracts International, Volume: 46-01, page: 0311. Adviser: Osama Mikhail. Includes bibliographical references.

Thesis (M.Sc.)--Memorial University of Newfoundland, 2004. / Includes bibliographical references.