Breast cancer is the most common cancer diagnosis of women, with an estimated 232,670 new cases in 2014. With 89.2% of breast cancer patients surviving five years or longer, studies are needed to investigate the long-term impact of breast cancer on women and families (National Cancer Institute, 2014). The purpose of this study was to examine, using a mixed methods approach, the impact of chemotherapy on mothering occupations for patients diagnosed with breast cancer. Thirty-one women (mean age=39.6, SD=5.79), with breast cancer of any stage, who were currently undergoing chemotherapy and had at least one child under the age of 18 living in the home, were recruited from a comprehensive breast cancer care center. These participants completed the Fatigue Symptom Inventory Then Test, the Parent Disability Inventory, the FACT-G quality of life inventory, and a demographic questionnaire. Of these 30 participants, ten participants were selected using purposeful sampling to participate in semi-structured interviews focusing on the impact of chemotherapy on mothering occupations. Qualitative data were analyzed using a grounded theory approach (Corbin & Strauss, 2008) and quantitative data were analyzed using SPSS version 22 to determine descriptive statistics and correlations among variables. After analysis, the central category that emerged from the data was “Keeping life the same while weathering cancer treatments,” which was developed from categories of learning, adapting, accepting support, growing and normalcy. Quantitative analyses found a correlation between fatigue and parent disability (Spearman rho correlation = -0.476, p < 0.05), quality of life and fatigue interference (-0.481, p < 0.001) and parent disability and quality of life (0.745, p<0.001). Implications for future occupational therapy practice are discussed.

Collaboration has been proposed as an inclusive forum for bringing together state and non-state stakeholders to deliberate and negotiate solutions to complex environmental problems. A key aspect of collaborative approaches is the potential to help stakeholders share and integrate expert science and local knowledge with their beliefs and values. This process creates a vernacular knowledge that is necessary to address the quasi-scientific characteristics of complex environmental problems. Stakeholder networks have an important role in collaborative processes, and the creation and sharing of knowledge. The manner in which stakeholder networks form, function, and contribute to the creation and sharing of knowledge, both internally and externally, is not well understood from both a theoretical and empirical perspective. The purpose of this research is to provide insight concerning this gap in the literature by addressing three research objectives: (1) to develop a conceptual framework for evaluating the creation and sharing of vernacular knowledge by a stakeholder network within collaborative problem-solving processes; (2) to use the conceptual framework to evaluate the contribution of stakeholder networks to the creation and sharing of vernacular knowledge in an actual example of a collaborative problem-solving processes; and (3) to develop recommendations for the design of collaborative problem-solving processes in order to facilitate the creation and sharing of vernacular knowledge using stakeholder networks. A case study was used to evaluate a multi-stakeholder problem-solving process that has involved stakeholder network representatives at the watershed and provincial scales in Ontario, Canada. This was undertaken through an extensive literature review, and the analysis of data collected through participant observation, survey questionnaire, and a review of publicly available documents using a mixed methods research approach. The research focused on the evaluation of the formation and function of an agri-environmental network composed of representatives from key provincial farm organizations and the provincial agricultural ministry. This research seeks to provide insight concerning the role of stakeholder networks in the creation and sharing of vernacular knowledge within collaborative problem-solving processes, and provide insights for both theoretical and practical applications of collaborative approaches to problem-solving. This addresses questions in the literature regarding the effectiveness of stakeholder networks to contribute knowledge to problem-solving within forums that are intended to be collaborative in nature, but may also include elements of a regulatory approach. Further, this agri-environmental network has supported the development and function of a diverse group of farm community representatives involved in a prescribed environmental problem-solving process. The research demonstrates that this network has been effective in contributing to the creation and sharing of vernacular knowledge in a coordinated fashion at the local and provincial scale. This responds to questions in the literature concerning how stakeholder networks communicate and cooperate across different scales and administrative, physiographic and political boundaries. The study also provides recommendations for practice concerning the selection of community representatives, the creation of vernacular knowledge, and the promotion of stakeholder network involvement as part of collaborative approaches to problem-solving. Although the research results are situated in an Ontario context, the results of the study can be applied in other jurisdictions where stakeholder networks exist or may emerge to participate in collaborative approaches to environmental problem-solving.

The impact of Internet technology on critical thinking is of growing interest among researchers. However, there still remains much to explore in terms of how critical thinking can be fostered through online environments for higher education. Ten years ago, Garrison, Anderson, and Archer (2000) published an article describing the Community of Inquiry (CoI) framework which provided an outline of three core elements that were able to describe and measure a collaborative and positive educational experience in an online learning environment, namely teaching presence (design, facilitation, and direct instruction), social presence (the ability of learners to project themselves socially and emotionally), and cognitive presence (the extent to which learners are able to construct and confirm meaning through sustained reflection and discourse). This dissertation extends the body of research surrounding the CoI framework and also the literature on developing critical thinking in online environments by examining and exploring the extent to which teaching and social presence contribute to cognitive presence. The researcher was able to do this by offering 189 learners enrolled in 10 research methods courses and educational research courses an opportunity to use an innovative online resource (Research Design Learning Resource – RDLR) to assist them in learning about educational research and developing research proposals. By exploring how participants used this resource the researcher was able to gain insight into what factors contributed to a successful online learning experience and fostered cognitive presence. Quantitative and qualitative research approaches (mixed methods) were used in this study. The quantitative results indicated that both social and teaching presence had a strong positive relationship with cognitive presence and that learners generally perceived to have a positive learning experience using the RDLR. The qualitative findings helped elaborate the significant quantitative results and were organised into the following themes: making connections, multiple perspectives, resource design, being a self-directed learner, learning strategies, learning preferences, and barriers to cognitive presence. Future directions for critical thinking in online environments are discussed.

Leadership is important to quality improvement initiatives in healthcare. However, few studies have evaluated leadership interventions to enhance nurses’ use of guideline recommendations in the field of knowledge translation. Purpose: To develop and evaluate an intervention designed to operationalize a leadership strategy composed of relations, change, and task-orientated leadership behaviours, and to examine its influence on nurses’ use of guideline recommendations in home-care nursing. Design: Sequential mixed methods pilot study with post-only cluster randomized controlled trial. Methods Phase I: Intervention Development 1. A participatory approach was used at a community healthcare organization with 23 units across the province of Ontario, Canada. The guideline selected was developed by the Registered Nurses’ Association of Ontario for the assessment and management of foot ulcers for people with diabetes. 2. Integrative literature review, qualitative interviews, and baseline chart audits were conducted. 3. Four units were randomized to control or experimental groups. 4. Clinical and management leadership teams participated in a 12-week intervention consisting of printed materials, interactive workshop, and teleconferences. Participants received summarized chart audit data, identified priority indicators for change, and created a team leadership action plan to address barriers and influence guideline use. Phase II: Evaluation 5. Chart audits compared differences in nursing process and patient outcomes. Primary outcome: eight-item nursing assessment score. 6. Qualitative interviews evaluated the intervention and leadership behaviours. Results: No significant difference was found in the primary outcome. A significant difference was observed in nurses’ documentation of five priority indicators chosen by the experimental groups (p=.02). Gaps in care included: 53%, 76%, and 94% of patients not assessed for ulcer depth, foot circulation, or neuropathy (respectively); 75% and 93% did not receive wound debridement or hydrogel dressings. Receiving data to identify priority indicators for change and developing a leadership action plan were reported as useful to guideline implementation. The experimental group described using more relations-oriented leadership behaviours conducting audit and feedback, and sending reminders. Conclusion: Findings from this pilot study suggest that leadership is a team process involving relations, change, and task-oriented behaviours enacted by managers and clinical leaders. A leadership model is proposed as a beginning taxonomy to inform future leadership intervention studies.

This thesis will discuss the results of a two-year 90 game study to consider the role violence and aggression plays in competitive minor hockey and its role as a mechanism for injury. The second objective of this thesis was to determine the contextual factors that lead to injury on the ice. Using a mixed methods approach, the study followed three minor hockey teams from the Ottawa-Gatineau region over two sporting seasons. The study found that players are not being injured due to aggressive or violent play but rather players are being hurt within the rules of the game. The contextual factors that were shown to lead to injury included: (1) body-checking, (2) time of the game, (3) player’s body mass, (4) position played and (5) legal plays. Injuries were also broken down by anatomical site (head/neck, upper body and lower body); the upper body was affected by injury most.

Studies have shown that girls’ attitudes toward math are not as positive as that of boys (Fennema, & Sherman, 1977; Eccles, & Blumenfeld, 1985; Guimond, & Roussel, 2001). Crucially, research has also shown that this gender imbalance is a learned trait, female students in high school are more likely to have negative perceptions of Mathematics, than female students in elementary school (Spears Brown, & Bigler, 2004; Maritnot, 2012). This mixed methods research study examined the perceptions of gender bias in Grade 8 mathematics at West Rock Middle School, surveying 45 participants, (20 male, 25 female). A modified Fennema-Sherman Mathematics Attitude Scale, in combination with a Forgasz and Leder Who and Mathematics Scale, was used to uncover a slight variability in achievement and attitudinal scores between genders in a middle school mathematics class. A follow-up semi-structured interview with six students (two male, four female) determined that that variance seemed not to be due to a student perception of gender bias, but, rather, a multitude of attitudinal concerns. / Graduate / 0280 / 0727 / 0525 / icooper@uvic.ca

Class size has long been recognized as a factor affecting achievement in face-to-face contexts. However, few studies have examined the effects of class size in online courses, or the effects of dividing an online class into smaller discussion groups. The current study examined the relationship between class size and the use of grouping strategies on note reading, note writing, and collaborative discussions in online graduate-level courses. This mixed-methods study analyzed tracking logs from 25 graduate-level online courses using Web Knowledge Forum (25 instructors and 341 students) and interviews from 10 instructors and 12 graduate students with diverse backgrounds. The quantitative and qualitative data analyses were designed to complement each other. Findings suggested 13 to 15 as an optimal class size and four to five as an ideal subgroup size. Not surprisingly, the results revealed that, as class size increased, the total notes that participants read increased significantly. However, as class size increased, the percentage of course notes that students read decreased significantly (i.e., students were reading a smaller proportion of the course notes). In larger classes, participants were more likely to experience information overload and students were more selective in the notes that they read. A significant positive correlation was found between class size and total notes written. Students’ note size and grade-level score were negatively correlated with class size. The data also suggest that the overload effects of large classes can be minimized by dividing students into small groups for discussion purposes. Interviewees felt that the use of small groups in large classes benefited their collaborative discussions. The preceding results underscore the importance of using small discussion groups when class sizes are large. The research concludes with a list of pedagogical recommendations and suggests new software features that may help enhance learning in online courses.

Self-regulation capacity allows individuals to manage their thoughts, feelings, and actions to attain personal goals (e.g., well-being and performance), as well as adjust to their changing social and physical environment (Zimmerman, 2000). Self-regulation as a positive adaptive skill and process has not been examined in relation to well-being in the context of medicine. The purpose of the current study was to examine self-regulation with 37 medical students and 25 supervising physicians to determine whether or not it may enhance well-being and performance, and reduce stress and burnout. A mixed-methods design was used to collect and analyze the data, and findings from the quantitative and qualitative phases were presented in two separate articles. Self-regulation capacity appears to be an important skill that may help both physicians and medical students to meet the demands of the medical profession and maintain an adequate level of well-being and performance in their work and daily life.

This dissertation was a mixed methods triangulation design combining quantitative and qualitative components. The purpose of this study was twofold. First, it examined the association between the frequency and quality of students’ online interactions with instructors and the quality of student-instructor relationship. Second, this study explored the meanings of student-instructor interactions mediated by online tools. Quantitative data were collected via an online survey from 320 undergraduate students enrolled at a public research university. Qualitative data sources were in-depth interviews with six undergraduate students and six professors, observations of student-instructor interactions on Facebook, and artifacts of student-instructor interaction via email. Hierarchical regression analysis showed that approximately one third of the variance in student-instructor connectedness was explained by the frequency of and satisfaction with face-to-face, email, Blackboard, and Facebook; the grade obtained in the class; and demographic variables. Significant predictors of connectedness were grade, frequency of face-to-face student interest-driven communication, satisfaction with the face-to-face interactions, and satisfaction with the email communication. The qualitative findings revealed that instructors held expectations of formal communication for email interactions, while students had expectations for response from instructors within one-two business days. The email practices identified for instructors included responding to student email within two days; compensating for limited face-to-face time; engaging students in communication about the class content; and dealing with student disengagement. Students adopted two main practices related to email: avoiding “emergency” emails to contact instructors, and using email to avoid face-to-face contact in some situations. For Facebook interactions, instructors expected that students initiate connections, while students expected that instructors signal their availability for connection with students. Instructors’ Facebook practices pointed out different approaches for accepting student friend requests; and performing interactions. Students’ practices on Facebook highlighted two patterns: initiating connections with instructors during the semester versus at the beginning of the semester. In addition, preserving connections beyond the boundaries of a class was a practice common to students and instructors.

The Resident-Medical Student Shadowing Program is a novel program in which first-year medical students shadowed a first-year resident during their clinical duties. It was developed to enhance the preparedness of medical students for clinical training. To examine the program’s effectiveness, a randomized control trial was conducted within a concurrent triangulation mixed methods study. Student participants were compared to controls using validated questionnaires. Participants’ experiences were further explored using semi-structured interviews. Results indicate that participation gave students an understanding of the clinical environment and their role within it, and taught them the skills and knowledge needed to perform that role. Students’ learning was enhanced by the relationship developed with their resident, facilitated by the residents’ approachability and relatability and their dedication to teaching. Residents, in turn, gained expertise in teaching and learned about professionalism. Suggestions for implementing this program in the future as well as future directions for research are discussed. / Measurement, Evaluation and Cognition