School-age children with Cystic Fibrosis (CF) possess valuable knowledge about themselves. They have experience and ability to offer insight about living with CF. Previous studies, exploring the perceptions of CF children, give little attention to eliciting and listening to their voices. Also, traditional data collection methods limit children from participating in research. The purpose of this study was to explore and describe how school-age children with CF see themselves in the world they live. The study utilized qualitative description methodology. Symbolic Interactionism served as the researcher’s philosophical lens. It is a perspective that seeks to understand the social world of others, as they perceive it. Photo elicitation was used as the primary data collection method. Each participant was asked to take photographs about “What it is like to be you”. Photographs were then used to stimulate and guide an audio-recorded interview and make a photo book for the child to keep. Data were analyzed using Boyatzis method of inductive thematic content analysis. Sixteen children with CF between the ages of 8 to 11 were purposively recruited from the Southeastern United States. Data saturation was achieved after 13 interviews. Rigor was maintained by a variety of ways including bracketing, peer evaluation, and member checking. Five themes emerged from the data Me Being Me, My Medicine and Treatments, My Family, My Friends and Other Key Relationships, and My World. Findings revealed that life does not revolve around CF, but instead centers on “me being me” and living a normal life. Additionally, photo elicitation empowered participants to be authors of their own stories, and promoted communication between them and the researcher. In knowing the reality of children, nurses and other multidisciplinary CF team members are better equipped to design and plan interventions that are meaningful, beneficial, and satisfying to the child and his or her parent. The results of this study demonstrate children can be active participants in research and provides opportunities to transform nursing care by developing and evaluating strategies for the delivery of care to children with CF. Recommendations for future research include expanding this study to other CF centers and including the perceptions of parents, nurses, and other CF health care providers. Additionally, because perceptions a person holds about them selves and the world change overtime, a follow-up study when participants reach adolescence and adulthood is suggested.

L’objectif de cette thèse est de d’écrire l’évolution du produit dans les trois dimensions (spatiale, temporelle et spatio-temporelle). Dans le contexte industriel actuel, les modèles produit sont considérés uniquement du point de vue spatial pendant la phase de conception et du point de vue temporel pendant la phase d’assemblage. Le manque de lien entre le produit et le process mène à des incompréhensions de définition de produit et entraine de mauvaises interprétations en conception. Cependant, le produit ´évolue à travers le temps et subit des changements tout au long des phases de conception et d’assemblage. L’aspect dynamique des activités de conception nécessite de lier ces deux dimensions afin de pouvoir représenter l’évolution du produit et avoir une cohérence des informations. Par conséquent, la dimension spatio-temporelle (i.e. permettant de lier l’espace et le temps) a besoin d’être ajoutée et les relations entre la modélisation du produit et sa séquence d’assemblage ont besoin d’être particulièrement étudiées. Cette thèse en mécanique et conception s’est inspirée de divers domaines comme la gestion des connaissances, les systèmes d’information géographique et la philosophie. Ici le produit est considéré d’un point de vue perdurantiste. Le perdurantisme considère l’objet comme étant compose de tranches temporelles et gardant toujours la même identité quelque soit le changement subi. D’après les précédentes déclarations, cette thèse introduit une nouvelle description du couple produit-process afin d’assurer la compréhension des intentions de conception aux acteurs projet. Dans le but d’atteindre cet objectif, une théorie mereotopologique, permettant de d´écrire le produit comme perçu dans la réalité, et de développée et implémentée dans un modèle ontologique pour être formalisée. La théorie JANUS d´écrit qualitativement l’évolution du produit à travers le temps dans un contexte de conception orientée assemblage, permettant l’intégration de la séquence d’assemblage d`es le début du processus de conception. La théorie permet la description formelle des relations liant les informations et connaissances du couple produit-process. Ces efforts ont pour but d’apporter une base concrète pour la description des changements d’entités spatiales (telles que les composants) et leurs relations `a travers l’espace et le temps. Cette théorie basée sur les régions lie les dimensions spatiale, temporelle et spatio-temporelle et apporte donc une vision perdurantiste en conception de produit. Ensuite, PRONOIA2 – une ontologie formelle basée sur la précédente théorie –développée. De ce fait, les informations liées à l’assemblage sont rendues accessibles et exploitables par des systèmes de gestion d’information et les outils de XAO afin de supporter les activités de l’architecte produit et du concepteur. En effet, les informations et connaissances liées à la conception de produit, ainsi que la séquence d’assemblage associée, ont besoin d’une fondation sémantique et logique afin d’être gérées de manière cohérente et proactive. Suite au développement de la théorie JANUS et de l’ontologie PRONOIA2, l’approche proposée permet d’associer les informations spatiales (gérées par le PDM) et les informations temporelles (gérées par le MPM) à travers des relations mereotopologiques spatio-temporelles. Par conséquent, de nouvelles entités doivent être gérées dans le PLM, en utilisant notamment l’ontologie et un système hub, afin d’assurer un maintien des principes d’ingénierie proactives et améliorer la compréhension de l’architecte produit et du concepteur concernant l’ évolution du produit. / The major goal of this research is to describe product evolution in the three dimensions (i.e. spatial, temporal andspatiotemporal). In the current industrial context, product models are only considered from a purely spatial point ofview during the design stage and from a purely temporal point of view during the assembly stage. The lack of linkbetween product and process leads to misunderstanding in engineering definition and causes wrong designinterpretation. However, the product undergoes changes throughout the design and assembly phases. The dynamicaspect of design activities requires linking both dimensions in order to be able to represent product evolution andhave consistent information. As such, spatiotemporal dimension (i.e. linking space and time) needs to be added andrelationships between product modelling and assembly sequences need to be particularly studied.This PhD thesis in mechanical design draws inspiration from several domains such as mathematics, geographicinformation systems and philosophy. Here the product is considered from a perdurantist point of view. Perdurantismregards the object as being composed of temporal slices and always keeping the same identity whatever changesundergone. Based on this statement, this PhD thesis introduces a novel product-process description so as to ensureproduct architect's and designer's understanding of design intents at the early design stages. In order to achieve thisobjective, a mereotopological theory, enabling the product description as it is perceived in the real world, has beendeveloped and implemented in an ontology model to be formalized.The JANUS theory qualitatively describes product evolution over time in the context of AOD, integrating assemblysequence planning in the early product design stages. The theory enables the formal relationships description ofproduct-process design information and knowledge. The proposed efforts aim at providing a concrete basis fordescribing changes of spatial entities (i.e. product parts) and their relationships over time and space. This regionbasedtheory links together spatial, temporal and spatiotemporal dimensions, therefore leading to a perdurantistphilosophy in product design.Then, PRONOIA2 - a formal ontology based on the previous mereotopological theory - is developed. Assemblyinformation is accessible and exploitable by information management systems and computer-aided X tools in orderto support product architects and designer's activities. Indeed product design information and knowledge as well asthe related assembly sequence require a semantic and logical foundation in order to be managed consistently andprocessed proactively.Based on JANUS theory and PRONOIA2 ontology, the MERCURY approach enables associating spatial information(managed by PDM) and temporal information (managed by MPM) through spatiotemporal mereotopologicalrelationships. Therefore, new entities are managed through PLM, using ontology and hub system, so as to ensureproactive engineering and improve product architects' and designers' understanding of product evolution.

Information technologies are making their way into health care. While they have been primarily in the domain of the health care providers, applications are being created for use by patients. This qualitative study looks at the usability of an electronic tool with a broader view of patient-as-user; the research question asks how this tool stands up to an assessment of the tool’s usability. Usability seeks to find out how easy a system is to use, whether the system is acceptable, and whether the system is enjoyable to use. Qualitative description techniques were employed for a broader perspective on the usability results. Key findings indicate that patients need to be in control of the process of using self-reporting tools; patients want to be able to use these applications at home; computer technologies do not replace the need for human contact in the health care setting; self-reporting assessment tools can give a voice to patients who are otherwise silent; privacy concerns must be handled. Few studies have attempted to look at patients as they use electronic applications, but if we want patients to use them, tools need to be designed with the patient-as-user in mind, considering diverse levels of functioning among patients.

The implementation of evidence-based clinical practice guidelines in primary health care can substantially improve health promotion, early disease detection and the reduction of the burden of chronic disease. However, the implementation of evidence into clinical practice is a highly complex endeavour that has been said to occur in a 'black box‘, defying easily reached explanations of how it happens in practice. The aim of this study is to explore the 'black box‘ of guideline implementation associated with primary health care nurses‘ use of a guideline that targets high health need populations in a region of New Zealand. The potential for improvement of cardiovascular health overall and the reduction of the marked disparities between Mäori (indigenous people of New Zealand) and non-Mäori drives the imperative to enact the recommendations of the Assessment and Management of Cardiovascular Risk guideline. Primary health care nurses are well positioned at the frontline of healthcare to implement the guideline and an investigation of the realities of their practice as they do so will help to illuminate the contents of this particular 'black box‘. The aim is achieved in two components by: 1. Exploring the complexities of primary health care nurses‘ use of the New Zealand Assessment and Management of Cardiovascular Risk guideline. 2. Employing the Promoting Action on Research Implementation in Health Services (PARiHS) framework to identify the enablers and barriers to guideline implementation in the primary health care setting. Method Both components of this study involve qualitative methods. The first component involves qualitative description utilising focus groups and interviews to explore the perceptions and experiences of a range of primary health care professionals involved in implementing the AMCVR guideline and thematic analysis of data. The second component utilises template analysis of the data, based on the Promoting Action of Research Implementation in Health Services (PARiHS) framework. There are three elements of the PARiHS framework: Evidence, Context and Facilitation. This second component of the study is a systematic analysis of the enablers and barriers encountered by nurses as they implement the AMCVR guideline. Results The first component of the study generated four themes, which together have provided a rich portrait of the realities for nurses as they implemented the guideline. The four themes are self-managing client, everyday nursing practice, developing new relationships in the health team, and impact on health care delivery. The template analysis revealed that there were several enablers and barriers to guideline implementation in relation to Evidence and Context and that Facilitation was not occurring in a planned way. Conclusion Successful guideline implementation demands multidisciplinary, transformational practice development to create an effective workplace culture. Practice development is a powerful approach well suited to supporting primary health care nurses to maximise their practice-based knowledge and skills, and for them to contribute to the development of systems that will meet the information and communication requirements of successful guideline implementation. The imperative to improve cardiovascular health overall and specifically to address Mäori health inequity mandates sustained effort and mobilisation of resources to ensure successful implementation of the AMCVR guideline.

The implementation of evidence-based clinical practice guidelines in primary health care can substantially improve health promotion, early disease detection and the reduction of the burden of chronic disease. However, the implementation of evidence into clinical practice is a highly complex endeavour that has been said to occur in a 'black box‘, defying easily reached explanations of how it happens in practice. The aim of this study is to explore the 'black box‘ of guideline implementation associated with primary health care nurses‘ use of a guideline that targets high health need populations in a region of New Zealand. The potential for improvement of cardiovascular health overall and the reduction of the marked disparities between Mäori (indigenous people of New Zealand) and non-Mäori drives the imperative to enact the recommendations of the Assessment and Management of Cardiovascular Risk guideline. Primary health care nurses are well positioned at the frontline of healthcare to implement the guideline and an investigation of the realities of their practice as they do so will help to illuminate the contents of this particular 'black box‘. The aim is achieved in two components by: 1. Exploring the complexities of primary health care nurses‘ use of the New Zealand Assessment and Management of Cardiovascular Risk guideline. 2. Employing the Promoting Action on Research Implementation in Health Services (PARiHS) framework to identify the enablers and barriers to guideline implementation in the primary health care setting. Method Both components of this study involve qualitative methods. The first component involves qualitative description utilising focus groups and interviews to explore the perceptions and experiences of a range of primary health care professionals involved in implementing the AMCVR guideline and thematic analysis of data. The second component utilises template analysis of the data, based on the Promoting Action of Research Implementation in Health Services (PARiHS) framework. There are three elements of the PARiHS framework: Evidence, Context and Facilitation. This second component of the study is a systematic analysis of the enablers and barriers encountered by nurses as they implement the AMCVR guideline. Results The first component of the study generated four themes, which together have provided a rich portrait of the realities for nurses as they implemented the guideline. The four themes are self-managing client, everyday nursing practice, developing new relationships in the health team, and impact on health care delivery. The template analysis revealed that there were several enablers and barriers to guideline implementation in relation to Evidence and Context and that Facilitation was not occurring in a planned way. Conclusion Successful guideline implementation demands multidisciplinary, transformational practice development to create an effective workplace culture. Practice development is a powerful approach well suited to supporting primary health care nurses to maximise their practice-based knowledge and skills, and for them to contribute to the development of systems that will meet the information and communication requirements of successful guideline implementation. The imperative to improve cardiovascular health overall and specifically to address Mäori health inequity mandates sustained effort and mobilisation of resources to ensure successful implementation of the AMCVR guideline.

The implementation of evidence-based clinical practice guidelines in primary health care can substantially improve health promotion, early disease detection and the reduction of the burden of chronic disease. However, the implementation of evidence into clinical practice is a highly complex endeavour that has been said to occur in a 'black box‘, defying easily reached explanations of how it happens in practice. The aim of this study is to explore the 'black box‘ of guideline implementation associated with primary health care nurses‘ use of a guideline that targets high health need populations in a region of New Zealand. The potential for improvement of cardiovascular health overall and the reduction of the marked disparities between Mäori (indigenous people of New Zealand) and non-Mäori drives the imperative to enact the recommendations of the Assessment and Management of Cardiovascular Risk guideline. Primary health care nurses are well positioned at the frontline of healthcare to implement the guideline and an investigation of the realities of their practice as they do so will help to illuminate the contents of this particular 'black box‘. The aim is achieved in two components by: 1. Exploring the complexities of primary health care nurses‘ use of the New Zealand Assessment and Management of Cardiovascular Risk guideline. 2. Employing the Promoting Action on Research Implementation in Health Services (PARiHS) framework to identify the enablers and barriers to guideline implementation in the primary health care setting. Method Both components of this study involve qualitative methods. The first component involves qualitative description utilising focus groups and interviews to explore the perceptions and experiences of a range of primary health care professionals involved in implementing the AMCVR guideline and thematic analysis of data. The second component utilises template analysis of the data, based on the Promoting Action of Research Implementation in Health Services (PARiHS) framework. There are three elements of the PARiHS framework: Evidence, Context and Facilitation. This second component of the study is a systematic analysis of the enablers and barriers encountered by nurses as they implement the AMCVR guideline. Results The first component of the study generated four themes, which together have provided a rich portrait of the realities for nurses as they implemented the guideline. The four themes are self-managing client, everyday nursing practice, developing new relationships in the health team, and impact on health care delivery. The template analysis revealed that there were several enablers and barriers to guideline implementation in relation to Evidence and Context and that Facilitation was not occurring in a planned way. Conclusion Successful guideline implementation demands multidisciplinary, transformational practice development to create an effective workplace culture. Practice development is a powerful approach well suited to supporting primary health care nurses to maximise their practice-based knowledge and skills, and for them to contribute to the development of systems that will meet the information and communication requirements of successful guideline implementation. The imperative to improve cardiovascular health overall and specifically to address Mäori health inequity mandates sustained effort and mobilisation of resources to ensure successful implementation of the AMCVR guideline.

The implementation of evidence-based clinical practice guidelines in primary health care can substantially improve health promotion, early disease detection and the reduction of the burden of chronic disease. However, the implementation of evidence into clinical practice is a highly complex endeavour that has been said to occur in a 'black box‘, defying easily reached explanations of how it happens in practice. The aim of this study is to explore the 'black box‘ of guideline implementation associated with primary health care nurses‘ use of a guideline that targets high health need populations in a region of New Zealand. The potential for improvement of cardiovascular health overall and the reduction of the marked disparities between Mäori (indigenous people of New Zealand) and non-Mäori drives the imperative to enact the recommendations of the Assessment and Management of Cardiovascular Risk guideline. Primary health care nurses are well positioned at the frontline of healthcare to implement the guideline and an investigation of the realities of their practice as they do so will help to illuminate the contents of this particular 'black box‘. The aim is achieved in two components by: 1. Exploring the complexities of primary health care nurses‘ use of the New Zealand Assessment and Management of Cardiovascular Risk guideline. 2. Employing the Promoting Action on Research Implementation in Health Services (PARiHS) framework to identify the enablers and barriers to guideline implementation in the primary health care setting. Method Both components of this study involve qualitative methods. The first component involves qualitative description utilising focus groups and interviews to explore the perceptions and experiences of a range of primary health care professionals involved in implementing the AMCVR guideline and thematic analysis of data. The second component utilises template analysis of the data, based on the Promoting Action of Research Implementation in Health Services (PARiHS) framework. There are three elements of the PARiHS framework: Evidence, Context and Facilitation. This second component of the study is a systematic analysis of the enablers and barriers encountered by nurses as they implement the AMCVR guideline. Results The first component of the study generated four themes, which together have provided a rich portrait of the realities for nurses as they implemented the guideline. The four themes are self-managing client, everyday nursing practice, developing new relationships in the health team, and impact on health care delivery. The template analysis revealed that there were several enablers and barriers to guideline implementation in relation to Evidence and Context and that Facilitation was not occurring in a planned way. Conclusion Successful guideline implementation demands multidisciplinary, transformational practice development to create an effective workplace culture. Practice development is a powerful approach well suited to supporting primary health care nurses to maximise their practice-based knowledge and skills, and for them to contribute to the development of systems that will meet the information and communication requirements of successful guideline implementation. The imperative to improve cardiovascular health overall and specifically to address Mäori health inequity mandates sustained effort and mobilisation of resources to ensure successful implementation of the AMCVR guideline.

Thesis (Ph.D.)--Indiana University, 2008. / Title from screen (viewed on April 23, 2008). School of Nursing, Indiana University-Purdue University Indianapolis (IUPUI). Advisor(s): Melinda M. Swenson, Joan K. Austin, Sharon L. Sims, John McGrew. Includes vitae. Includes bibliographical references (leaves 142-161).

Thesis (Ph.D.)--Indiana University, 2009. / Title from screen (viewed on August 28, 2009). School of Nursing, Indiana University-Purdue University Indianapolis (IUPUI). Advisor(s): Anna M. McDaniel (Chair), Mary L. Fisher, Patricia R. Ebright, Bradley N. Doebbeling. Includes vita. Includes bibliographical references (leaves 140-154).

Objectives: The objectives of this thesis were to: (i) understand the experiences of parents/caregivers of children with inherited metabolic diseases (IMDs), including perceptions of the health care system; and (ii) identify important patient/family-centred outcomes for measurement in future studies. Methods: A qualitative study used semi-structured interviews to gain in-depth insight into caregivers’ experiences. In an adapted meta-synthesis study, the qualitative findings were integrated with the results of related research to identify priority outcomes. Results: Twenty-one caregivers were interviewed. Participants described adjusting to the management of their child’s illness through specific coping strategies but reported stress related to social development. While generally satisfied with disease-specific care, participants described negative experiences with non IMD-specific health services. Health-related quality of life, parental coping, and specific experiences with health care emerged as high-priority outcomes. Conclusions: This project contributes to the limited published literature on caregiver experiences with pediatric IMD and informs future patient-centred research.