This thesis reports on an exploratory study of how professional immigrants from Hong Kong to Canada make sense of their immigration experiences and what this can tell us about why a substantial number leave in their first year in Canada. In particular, I focus on how Hong Kong Chinese immigrants make sense of workplace opportunities. The study involves in-depth interviews with 19 informants from the Hong Kong Chinese community in Canada. The study was framed by a critical sensemaking approach and Foucauldian discursive analysis in which the local and formative contexts of sensemaking are analyzed. An analysis of the interviews demonstrates that immigrants’ identities are grounded by contextual sensemaking elements. Data show that informants have accepted unchallenged assumptions: (1) that the government is providing help for them to ‘get in’ the workplace; and (2) that the ethnic service organizations are offering positive guidance to their workplace opportunities. At the organizational level, a master discourse emphasizing integration has mediated immigrants’ struggles. Within these frustrations, many have internalized a hidden discourse of inadequate or deficient selves and adopted a sacrificial position in order to maintain a positive sense of identity. There is no question that racism exists on systemic and personal levels. However, immigrants are unaware of the ways their assumptions may be informed by racism; hence they might accept unequal practices as “normal.” Although contextual elements are powerful, some immigrants have developed strategies at the micro-level to resist. I contend that a critical sensemaking approach allows greater insights into immigration processes than realist surveys and interviews, which tend to impose a pre-packaged sense of the immigrant experience. Through critical sensemaking, immigrants’ own sense (understanding) of process is given voice; this encourages them to rethink the current role of ethnic service organizations in the immigration system. This thesis ends with a conclusion emphasizing my contributions and the value of a critical sensemaking framework in studying complex issues among broader societal discourses. / 2013-Apr

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This thesis presents a qualitative multiple case study which examines the early implementation of the community matron policy in three primary care trusts in England. The community matron was a new role in nursing, introduced by the Department of Health in 2004, as part of its strategy for the management of long term conditions (DH, 2005e). There was a paucity of research literature underpinning the policy and the implementation of the community matron role in England. A descriptive multiple case study was used as it generates a richness of data using multiple data collection methods, ideally positioned to investigate phenomena in context and contemporaneously. In addition to documentary material, 49 participants were recruited across the three case study sites, from community matrons, active case managers, health and social care colleagues and patients. A total of 30 interviews, 33 observations and one focus group were undertaken between 2006 and 2008. Framework Analysis was used to interpret the data and critical sensemaking was applied as a heuristic to gain insight into the findings.This study explored the early role implementation from the perspective of the community matron. It found that the community matron role had been adopted with regard to the national model but there was variation in its implementation between case study sites, seen in service structures, eligibility criteria and caseload management. Practitioners had exercised professional discretion to flex local service models to fit their ways of practice and professional decision making, although this may not have been conscious behaviour. They also expanded the role to include psychosocial support, beyond the nationally defined functions. Advanced practice was integral to the role; whilst there appeared to be a medical influence on this aspect of role development; practitioners had adopted traditionally medical tasks and incorporated them into nursing practice, making such roles their own. Community matrons described experiencing resistance to the role initially from some district nurses and GPs, outlining how they adopted strategies to address these and promote acceptance of the role. As such, individual community matrons were the key change agents. They experienced dissonance between organisational values and professional values, which they addressed by reinterpreting collective targets such as reducing hospital admissions into individual patient outcomes related to improved quality of life. Critical sensemaking gives a unique perspective on the implementation of national policy, through the lens of the community matron, highlighting the experience of nursing role development at an individual and team level, and the ways in which variation can occur. Further research is needed into nursing policy implementation to better understand the processes at play nationally and organisationally. Critical sensemaking might be used to inform how implementation can be effective and sustainable.