Stress within healthcare environments can be the result of uncertainty, illness, or the environment itself. In order to promote better health outcomes for dialysis users, scientific literature advocates stress reduction within healthcare environments. Dialysis patients are subject to numerous stressors, including the threat of potential losses and lifestyle change. Studies have revealed that patients who suffer from chronic illness perceive different levels of quality of life than those who are considered healthy and because of these lifestyle changes they employ various coping mechanisms when dealing with stress. There is a rising movement to mitigate stress through the use of holistic healing, an approach that addresses a person’s mental, emotional, physical, and spiritual elements to create a total healing environment. In accordance with this growing movement, the intent of this practicum is to create an outpatient centre for Manitoba’s dialysis patients that increases their perceived quality of life. The inquiry process began by questioning dialysis patients and conducting observational research at the Winnipeg Health Sciences Centre. Literature and precedent reviews were conducted, and the design programme was developed. The result of this research-based design proposal is an outpatient hemodialysis centre located within the Winnipeg Health Sciences Centre that helps mitigate stress while patients attempt to cope with lifestyle changes. The resulting design is one that is warm, welcoming, home-like and comfortable, which is supported by the theories explained in the literature review. This environment provides a greater sense of control, creates positive distractions and allows spiritually evoking opportunities to take place for all users of this new facility.

The purpose of this study was to explore social work practitioner familiarity with and interpretation of the 2005 Canadian Association of Social Workers (CASW) Code of Ethics (“Code”) to determine whether specific sections of the existing Code enable social work practitioners to deliver ethical service in uniquely-situated geographical locations in northern Manitoba. A qualitative research style with exploratory methodology was employed in this study. In-person interviews were conducted with six social workers who have practiced in a northern Manitoba setting for at least three years post- graduation. Once given the opportunity to read and interpret the 2005 Code, five of six respondents reported that the intent of the Code is reflective of their practice, an apparent contradiction between how they described their understanding of the intent of the Code versus their practice realities. All reported that dual roles and potential conflicts of interest are very difficult to avoid when practicing social work in the North. Other key findings indicate that the study participants believe that social workers in the North: are not familiar with the 2005 Code; have a lack of education, knowledge, discussion and accessibility in this Code, and find there is a lack of application of this Code in practice environments. The emergence of the Manitoba College of Social Workers (MCSW), through legislation, will require that all practicing social workers adhere to the 2005 Code of Ethics. All six participants reported factors in northern, rural, remote and isolated environments that affect his/her ability to adhere to the 2005 Code. When social workers are required to register to use the title of Social Worker, the MCSW will be in a position to recognize the environmental factors of practicing in northern, rural, remote and isolated environments. MCSW may choose to consider that, where social workers are required to adhere to the 2005 Code, it may not be feasible in northern, rural, remote and isolated practice areas due to specific factors that have been identified throughout this study. In future studies, consideration and flexibility on behalf of the Psychology/Sociology Research Ethics Board (PSREB) may be necessary in order to ensure that research subjects are protected versus the need to understand, through research, the realities of social work practice. Secondly, researchers interested in expanding or replicating the findings of this study may choose to consider the disclosure and provision of the interview questions prior to the actual interviews. Additionally, future research to review ethical practice in the social work profession would facilitate a broader understanding of whether all social workers practice under existing requirements set out in current MIRSW by-laws and, in the future, provincial legislation that is applicable to every social worker in Manitoba. This study was limited to six participants. Broader research to more fully investigate the practical realities of applying the 2005 Code in northern environments could inform how the new legislation is implemented.

The purpose of the critical review is understood to be a critical reflection and comment on the work presented in the papers. The critical review is centred on the papers, as they form the substance of the submission, and the wider tobacco control literature. This review has not attempted to re-analyse the findings of the studies but attempts to draw wider lessons from the studies and to contribute to the future implementation of tobacco control policy and programmes. It will be claimed that the contribution to the research studies, the publications and the critical review represents a significant body of work and contribution to the advancement of knowledge in tobacco control. The aim of the thesis is to present and critically review six publications on the social de-normalisation of tobacco use, as it relates to public and private smoke-free environments and professional engagement in Scotland. The publications are treated as a coherent body of tobacco control research and draw upon three studies conducted over the period 1999-2007. Breathing Space Study 1: 1999-2002 evaluated an intervention which aimed to produce a significant shift in community norms towards non-smoking in a lowincome area. A process evaluation, as part of a quasi-experimental design, was undertaken in the intervention area, using a range of qualitative methods, including observation, in-depth interviews and focus groups. Papers 1 and 2 explore the context of health promotion professional practice in the development and implementation of tobacco control interventions in one disadvantaged community. The Qualitative Community Study 2: 2005-2007 aimed to explore the impact of the Scottish smoke-free legislation on attitudes and behaviour, at both individual and community levels, in four socio-economically contrasting localities in Scotland. A longitudinal qualitative evaluation was conducted using observation, in-depth interviews with smokers and ex-smokers, key stakeholders and focus groups. Papers 3 and 4 explore qualitative differences in the experience of smoke-free legislation in advantaged and disadvantaged communities, with particular consideration of the unintended consequences of the legislation for some smokers. The Smoke-free Homes Study 3: 2006-2007 aimed to describe changes in smoking behaviour and attitudes to smoking following implementation of the smoke-free legislation. It sought to identify the potential enablers and barriers to reducing SHS exposure in the home. A cross-sectional study was conducted using qualitative interviews. Papers 5 and 6 explore the changing discourses about second-hand smoke exposure, and the development of smoking restrictions in the home, with a particular focus on motivation to protect children. In addition, insight into the changing culture of professional practice in creating smoke-free homes was gained. Key findings A synthesis of key findings from these publications supports the identification of three major themes: the experience of power at each stage of the process of the social de-normalisation of tobacco use; the experience of stigmatisation of smoking as a consequence of policy; and health promotion practice as both barrier to and enabler of the implementation of smoke-free environments in the community and the home. The thesis also highlights the benefits and challenges of two research methodologies, process evaluation and qualitative longitudinal research (QLLR), in capturing both intended and unanticipated aspects of policy and practice implementation. This synthesis of the key findings that cut across the three studies has generated four research questions that are explored in this critical review: 1. How can policy be evaluated in community settings and in the home? 2. How do smokers, particularly disadvantaged smokers, engage with tobacco control policies and interventions? 3. Is professional practice a barrier or facilitator to understanding the impact of tobacco control policies and interventions? 4. What are some of the key unintended consequences of recent tobacco control policies? Conclusion This thesis contributes to knowledge through a critical account of the reshaping of smoking as a collective lifestyle, in both public and private domains. The social de-normalisation of tobacco use is experienced differently in advantaged and disadvantaged social contexts. Population tobacco control strategies may benefit from contextual adjustments, particularly for those smokers who live in areas of disadvantage and thus experience dual stigmatisation. Additionally, the effectiveness of future interventions would be enhanced by a more nuanced understanding of smoking behaviour, as a collective social practice, embedded in specific spaces, places and times.

Introduction. There is clear evidence that children raised in families affected by parental drug use are at high risk for a wide range of adverse outcomes, including; early cognitive and language delay (van Baar & de Graaff, 1994); poor school attendance and educational under-achievement (Hogan & Higgins, 2001; Steinhausen, Blattmann, & Pfund, 2007); substance abuse and psychological problems (Keller, Catalano, Haggerty, & Fleming, 2002; Kilpatrick, Acierno, Saunders, Resnick, Best, & Schnurr, 2000; Kolar, 1994; Lagasse, Hammond, Liu, Lester, Shankaran, Bada et al., 2006; Merikangas, Dierker, & Szatmari, 1998; Moss, Vanyukov, Majumder, Kirisci, & Tarter, 1995; Nunes, Weissman, Goldstein, McAvay, Beckford, Seracini et al., 2000; Nunes, Weissman, Goldstein, McAvay, Seracini, Verdeli et al., 1998; Stanger, Higgins, Bickel, Elk, Grabowski, Schmitz et al., 1999). Careful examination of the impact of parental drug use on children and the developmental mechanisms associated with risk and resilience is central to the establishment of appropriate intervention. Children born to mothers who are drug dependent and enrolled in methadone maintenance treatment during pregnancy face the “double jeopardy” of prenatal drug exposure and post-natal environmental disadvantage (Zuckerman & Brown, 1993). This research aimed to identify early developmental difficulties or differences in communicative and cognitive development, and in particular the joint attention skills, of young children born to mothers engaged in methadone maintenance treatment. Of particular interest was the way in which pre- and postnatal factors combined to influence developmental outcome at age 2 years. This prospective, longitudinal study offered the opportunity to indentify early indicators of developmental differences in this group and thus, contribute to a better understanding of the long-term mechanisms of risk. Research Methods. Sixty children born to mothers engaged in methadone maintenance treatment and 60 randomly-selected, non-exposed comparison children were followed prospectively from birth to age 2 years. During the third trimester of pregnancy, mothers completed a comprehensive maternal interview. At 18 months, children were visited at home and evaluations of the social background, family and childrearing context were completed. At age 2 years, all children underwent a developmental assessment that included the Early Social Communication Scales (ESCS) (Mundy, Hogan, & Doehring, 1996). The ESCS consists of a semi-structured series of activities, which assess the joint attention abilities, social skills and interactive behaviour of infants aged 8 to 30 months. The focus of this study was on children’s use of two types of communicative behaviour – requesting and affect-sharing communications. Alongside the ESCS, the Mental Development Index (MDI) and language items from the Bayley Scales of Infant Development (BSID-II) (Bayley, 1993) and the Communication and Symbolic Behaviour Scales– Developmental Profile (CSBS-DP) (Wetherby & Prizant, 1998), were used to assess concurrent cognitive and language skills. Results. The results of this study indicated that children born to mothers engaged in methadone maintenance treatment were typically growing up in single-parent families (p=<.0001) and in welfare-dependent households (p=<.0001). Methadone-exposed children were also more likely to be living in out-of-home care placements at age 18months than comparison group children (p=<.0001). Their caregivers were less likely to be accepting of (p=<.01) and responsive to their needs (p=.008) compared to parents of comparison children. At home, methadone-exposed children had fewer learning opportunities (p=<.0001) and were more likely to live in houses where the television was on for longer, compared to non-exposed children (p=<.001). Caregivers of methadone-exposed toddlers reported more depression (p=<.0001), more illicit substance use (p=<.0001) and more family stress (p=.004) than comparison caregivers. They were also more often victims of psychological aggression (p=.002) and violence from others (p=<.0001), but they also reported that they were more likely to use psychological aggression (p=<.001) and physical punishment (p=<.03) in managing their children’s behaviour than comparison caregivers. The developmental assessment at age 2 years suggested that methadone-exposed children were significantly more likely to engage in communicative behaviour, which expressed a request, than non-exposed, comparison children (p=.03). On the other hand, analysis suggested that whilst methadone-exposed children were less likely than comparison children to engage in communication, which had the goal of affect sharing, this difference did not reach significance (p=.27). Previous research links greater use of requesting behaviours with later behaviour problems (Sheinkopf, Mundy, Claussen, & Willoughby, 2004). The MDI, BSID language measure and CSBS results further indicated significant delay in both cognitive (p =<.0001) and language development (p =<.0001) in the methadone-exposed group, compared to the comparison group. Between group differences were attenuated by control for confounding social background and prenatal factors, including maternal education, gestational age, other drug exposures during pregnancy and gender, but significant differences remained. Further analysis suggested that parenting practices and family environment factors were important intervening influences on the relationship between being born to a mother engaged in methadone maintenance treatment and poorer outcomes. More specifically, the association between methadone-exposure and differences in joint attention behaviours, were explained by caregiver use of psychological aggression (p=.01), caregiver disruption (p=.07) and caregiver stress (p=.01). On the other hand, poorer cognitive and language outcomes were explained by family contextual factors, including a less child-centered home environment (p=.008), caregiver disruption (p=.001), increased use of background TV (p=.02) and fewer stimulating activities (p=.06) Discussion. The family circumstances of children born to mothers engaged in methadone maintenance treatment during pregnancy, when compared with a group of randomly-selected comparison children, showed pervasive differences and multiple disadvantage. Findings suggest that these differences in family disruption, family functioning and parenting practices explain the negative outcomes of methadone-exposed children in early cognitive and communication skills at age 2 years. These results raise concerns for the later functioning of methadone-exposed children and emphasise the key importance of early intervention for children and families affected by parental drug use.

Stress within healthcare environments can be the result of uncertainty, illness, or the environment itself. In order to promote better health outcomes for dialysis users, scientific literature advocates stress reduction within healthcare environments. Dialysis patients are subject to numerous stressors, including the threat of potential losses and lifestyle change. Studies have revealed that patients who suffer from chronic illness perceive different levels of quality of life than those who are considered healthy and because of these lifestyle changes they employ various coping mechanisms when dealing with stress. There is a rising movement to mitigate stress through the use of holistic healing, an approach that addresses a person’s mental, emotional, physical, and spiritual elements to create a total healing environment. In accordance with this growing movement, the intent of this practicum is to create an outpatient centre for Manitoba’s dialysis patients that increases their perceived quality of life. The inquiry process began by questioning dialysis patients and conducting observational research at the Winnipeg Health Sciences Centre. Literature and precedent reviews were conducted, and the design programme was developed. The result of this research-based design proposal is an outpatient hemodialysis centre located within the Winnipeg Health Sciences Centre that helps mitigate stress while patients attempt to cope with lifestyle changes. The resulting design is one that is warm, welcoming, home-like and comfortable, which is supported by the theories explained in the literature review. This environment provides a greater sense of control, creates positive distractions and allows spiritually evoking opportunities to take place for all users of this new facility.

The purpose of this study was to explore social work practitioner familiarity with and interpretation of the 2005 Canadian Association of Social Workers (CASW) Code of Ethics (“Code”) to determine whether specific sections of the existing Code enable social work practitioners to deliver ethical service in uniquely-situated geographical locations in northern Manitoba. A qualitative research style with exploratory methodology was employed in this study. In-person interviews were conducted with six social workers who have practiced in a northern Manitoba setting for at least three years post- graduation. Once given the opportunity to read and interpret the 2005 Code, five of six respondents reported that the intent of the Code is reflective of their practice, an apparent contradiction between how they described their understanding of the intent of the Code versus their practice realities. All reported that dual roles and potential conflicts of interest are very difficult to avoid when practicing social work in the North. Other key findings indicate that the study participants believe that social workers in the North: are not familiar with the 2005 Code; have a lack of education, knowledge, discussion and accessibility in this Code, and find there is a lack of application of this Code in practice environments. The emergence of the Manitoba College of Social Workers (MCSW), through legislation, will require that all practicing social workers adhere to the 2005 Code of Ethics. All six participants reported factors in northern, rural, remote and isolated environments that affect his/her ability to adhere to the 2005 Code. When social workers are required to register to use the title of Social Worker, the MCSW will be in a position to recognize the environmental factors of practicing in northern, rural, remote and isolated environments. MCSW may choose to consider that, where social workers are required to adhere to the 2005 Code, it may not be feasible in northern, rural, remote and isolated practice areas due to specific factors that have been identified throughout this study. In future studies, consideration and flexibility on behalf of the Psychology/Sociology Research Ethics Board (PSREB) may be necessary in order to ensure that research subjects are protected versus the need to understand, through research, the realities of social work practice. Secondly, researchers interested in expanding or replicating the findings of this study may choose to consider the disclosure and provision of the interview questions prior to the actual interviews. Additionally, future research to review ethical practice in the social work profession would facilitate a broader understanding of whether all social workers practice under existing requirements set out in current MIRSW by-laws and, in the future, provincial legislation that is applicable to every social worker in Manitoba. This study was limited to six participants. Broader research to more fully investigate the practical realities of applying the 2005 Code in northern environments could inform how the new legislation is implemented.

The literature contains few examples examining how the opening of a grocery store in a food desert affects the experience of food security of those living in that food environment. Station 20 West (S20W) is a community enterprise centre that opened in Fall 2012 in Saskatoon’s inner city, significantly changing the foodscape of a former food desert. S20W includes the Good Food Junction grocery store (GFJ), community kitchen space, a café, community meeting space, and community organization, health region and university offices. This project investigates the experience of food security for participants in a collective kitchen (CK) at S20W. Using semi-participant observation and responsive interviews, data was collected using phenomenology to learn about participants’ food procurement experiences, their involvement in CKs, and their interaction with S20W organizations and other health-based organizations. This research illuminates the complexity of food [in]security; participants’ lived experiences of food [in]security were intertwined with their health and that of their families. Several participants came to the CK seeking socialization and friendship rather than increased food security. Most participants interviewed were not inner city residents, so their foodscapes were not changed by the opening of the GFJ. However, the S20W CK is a potential gateway to other organizations and services at S20W, and cross-promotion of programs, services, and the GFJ could increase their impact. Further research should explore the changes over time in the foodways of those who interact with S20W, to understand the longer-term effects of a food store opening in a former food desert.

No description available.

The aim of this research is to examine the changing nature of risks that face journalists and media workers in the world's difficult, remote and hostile environments, and consider the 'adequacy' of managing hostile environment safety courses that some media organizations require prior to foreign assignments. The study utilizes several creative works and contributions to this area of analysis, which includes a documentary film production, course contributions, an emergency reference handbook, security and incident management reviews and a template for evacuation and contingency planning. The research acknowledges that employers have a 'duty of care' to personnel working in these environments, identifies the necessity for pre-deployment training and support, and provides a solution for organizations that wish to initiate a comprehensive framework to advise, monitor, protect and respond to incidents. Finally, it explores the possible development of a unique and holistic service to facilitate proactive and responsive support, in the form of a new profession of 'Editorial Logistics Officer' or 'Editorial Safety Officer' within media organizations. This area of research is vitally important to the profession, and the intended contribution is to introduce a simple and cost-efficient framework for media organizations that desire to implement pre-deployment training and field-support – as these programs save lives. The complete proactive and responsive services may be several years from implementation. However, this study demonstrates that the facilitation of Managing Hostile Environment (MHE) courses should be the minimum professional standard. These courses have saved lives in the past and they provide journalists with the tools to "cover the story, and not become the story."

This study investigates the listening environments of hearing aid users by employing the data logging capacity of their hearing aids. The idea that a hearing aid user's listening environments are important in prescribing desired hearing aid features has been discussed in the literature, however, investigation of listening environments has been limited in the past as it has relied mainly on subjective recordings. Data logging, the capacity of a hearing aid to continuously store information regarding time spent in different programs, listening environments, and microphone modes, is now available in a number of hearing aid models, and therefore provides an objective tool for studying a hearing aid user's listening environments. The data logging information from fifty-seven new hearing aid wearers, including 50 males and 7 females (mean age = 68 years, SD = 11.3), was obtained during the first routine clinic follow-up session for each individual. Measures of time spent in different listening environments, microphone modes, and overall sound levels, were analyzed. Hearing aid usage time was found to be highest in "Speech Only" situations (44.8%), followed by "Quiet" (26.7%), "Noise Only" (16.3%) and "Speech in Noise" (12.3%) situations. The majority of the hearing aid users' time was spent in "Surround" microphone mode (74.3%), followed in order by "Split" (22.3%) and "Full" (3.5%) directional modes. Results of two separate two-way ANOVAs revealed no significant age effect either on time spent in different listening environments [F(3,49) = 0.7, p= 0.5] or on time spent in different microphone modes [F(3,20) = 0.6, p= 0.6]. These findings provide empirical evidence regarding the general listening pattern of hearing aid users, which can be used as a starting point when troubleshooting problems experienced by hearing aid clients, or assessing a user's need for various hearing aid features.