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Canadians are living longer with multiple complex illnesses. In turn, older adults are often in need of complex medical attention in crisis situations in acute care hospital settings. Although acute care settings are equipped with a growing variety of life saving technologies, hospitals are still the setting in which most people die. Yet, almost half of the Canadians who have been admitted to acute care centres with chronic life-limiting illnesses have not had advance care planning (ACP) conversations with their substitute decision-maker (SDM) about the personal values that bring quality to their lives. In fact, only 8% of the general Canadian population are ACP ready. Consequently, many SDMs are unprepared to make end of life (EOL) treatment decisions for their loved ones. One way to promote patient-centred care and ease the burden of in-the-moment EOL treatment decisions made by SDMs, is for nurses to engage their patients in ACP. However, very few registered nurses regularly engage their patients in ACP. The purpose of this research is to better understand the organizational factors influencing nurses’ decisions related to ACP in their hospital-based work. This ethnographic study was conducted on three acute care wards in two hospital sites located in Northern Ontario. Data collection methods included observational fieldwork, semi-structured interviews with administrators and registered nurses (n=23), and the collection of documents pertinent to the study purpose (i.e., accreditation reports, practice guidelines, etc.). Findings reveal that the work of nurses in hospital settings is embedded within a context that prioritizes patient flow, and efficiency. Consequently, hospitals often function at overcapacity, and nurses have extremely heavy workloads caring for complex patients with diagnoses that do not match the medical specialty of the units. Although participants state that they value ACP, they maintain that nurses have very little capacity to engage patients in these conversations in their practice. Findings support that expectations for hospital nurses to fully engage in ACP with their patients may be unrealistic given the context within which they work. Alternative models for considering ACP in acute care could be explored to ensure that patients with life-limiting conditions receive care that is best matched to their needs, values, and wishes. / Graduate

<p>In the social sciences, the dominant approach to the study of character—people’s</p> <p>essential interactional dispositions, especially of a moral and durable nature—has been to</p> <p>treat it as a set of objective dispositions lodged within the individual. This dissertation</p> <p>challenges the objectivist orthodoxy in the study of character by examining it from a</p> <p>symbolic interactionist perspective (Mead 1934; Blumer 1969; Strauss 1993). Drawing on</p> <p>14 months of ethnographic research in two Protestant Christian seminaries as an</p> <p>empirical case, I find that character is ultimately a matter of audience definition, a selfother</p> <p>dispositional designation achieved in social interaction. Three empirical papers</p> <p>examine specific aspects of the character-making process. The first paper considers</p> <p>character as a contingency influencing people’s trajectories of involvement in group life.</p> <p>The second paper examines how ministry students define and experience character</p> <p>formation in the seminary. The third paper analyzes how character problems are</p> <p>identified and responded to in the seminary.</p> / Doctor of Philosophy (PhD)

My doctoral research begins from the standpoint of pregnant women and mothers living with HIV in Ontario, Canada and explores the concerns that women living with HIV have as they navigate healthcare during pregnancy, childbirth, and early postpartum. Moving beyond a description or abstracted theorization of women’s experiences, I have used institutional ethnography to explicate how women’s concerns are connected to and organized by ruling relations such as the ideological discourses that underpin the work practices of healthcare providers operating within healthcare institutions. This dissertation follows three “threads” that were discovered in the overall institutional ethnographic inquiry, and that form the basis of three manuscripts. The first thread (Chapter Three) focuses on HIV disclosure, which all women who participated in this research expressed as a concern, and uncovers how the issue of HIV disclosure is accounted for in healthcare providers’ work activities. In this analysis, I show how both the women’s and healthcare provider’s concerns about and actions related to HIV disclosure are connected to discourses such as “fear of contagion” and “AIDS hysteria” that continue to permeate public consciousness. The second thread (Chapter Four) focuses on the discourse of “risk” as organizing women’s experiences and healthcare providers’ work, which became visible through medications women were prescribed, the prenatal clinic appointment schedule women were expected to follow, and the medical interventions that were applied to women’s bodies during childbirth and early postpartum. In a third line of inquiry (Chapter Five), I outline how the current organization of “high-risk” maternity care that is delivered by specialists and is located in regional hospitals has particular implications for women’s pregnancy and motherhood experiences, especially for women who live at a distance from these services and/or find it challenging to attend appointments because of employment and familial responsibilities. This analysis shows how the discourses of “risk” and “safety” are differently known and enacted by women and their healthcare providers, and calls into question the classification of pregnancies of women living with HIV as “high-risk.” In following the three threads and tracking the territory of perinatal care for women living with HIV, I illuminate points of disjuncture between women’s and healthcare providers’ ways of knowing HIV in the context of pregnancy and childbirth, and identify possibilities for how healthcare practices can be augmented to respond to the concerns and challenge that women expressed. In the Conclusion chapter, I draw attention to the tensions between the meta-level ideological discourses of “HIV exceptionalism” and “HIV normalization” that run through Chapters Three, Four, and Five, and that are generalized across the HIV and maternity care services that women living with HIV encounter. I end this dissertation with my thoughts regarding implications for the organization of perinatal care for women living with HIV in Ontario. / Dissertation / Doctor of Philosophy (PhD) / In Ontario, the maternity care that women living with HIV receive during pregnancy, childbirth, and early postpartum (also known as the perinatal period) is located in “high-risk” clinical settings within regional, academic teaching hospitals. The organization of such care has important implications for women’s daily lives. This inquiry begins from the personal experiences of pregnant women and mothers living with HIV in Ontario and explores the concerns that women have as they navigate HIV and maternity care during the perinatal period. The inquiry shows how the troubles that women face are produced through institutional conditions and the routine practices of healthcare providers. This dissertation also examines how institutional arrangements related to reducing the risk of HIV to the fetus and infant, and lingering fears about HIV as “contagion,” shape women’s care experiences. Implications for the organization and delivery of perinatal care to women living with HIV is discussed.

This thesis is an investigation into migration, identity and labour among South Asian immigrant women in the Greater Toronto Area. It is an ethnographic exploration of how South Asian migrant’s relationship with precarity and how it informs the process of subjectification when faced with the realities of downward mobility. I focus on the practices and narrative repertoire that aid the relationship between labour and the making of the self. This inquiry has implications for the study of migration and expands on previous conceptualization in the literature on precarity. / Thesis / Master of Arts (MA)

As a graduate student in a university music department, I have devoted a lot of time to working in associated yet also disparate realms: as a performer, a Teacher's Assistant, and a student. During this time, I have also begun conducting research examining the music department’s social culture. I have observed my colleagues– meaning my fellow graduate students–sacrificing their mental health, physical health, and emotional wellbeing in order to meet ambiguous expectations that I will argue are often rooted in the coloniality of Western Art Music. I have observed and experienced conversations that neglect to acknowledge the ways in which speech and behavioral patterns that currently transpire in the music building support the perpetuation of anti-Blackness, situational color- and cultural- blindness, and white supremacy within the music department at this school, which I have chosen to anonymize as “New England State University (NESU).” Like the bourgeoise in Downtown Crossing, the members of this music department tend to outright ignore the systemic and social inequities that exist in this space, instead consciously or unconsciously choosing to operate with blinders that protect them from fully realizing “the frightening things about…” this music department’s “sense of reality.” Despite some well-meaning but largely superficial acknowledgments of the aforementioned issues, many members of this music department still engage in speech and behavioral patterns—both in public and in private—that I argue do not pursue a path toward these same people’s stated goals of racial justice and musician health and well-being.

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With the proliferation of standards and accountability systems in education, questions about how they function and intersect with broader patterns of institutional relations await investigation. The existing literature in social studies education is replete with studies that frame teachers' expertise for managing how instruction unfolds in the classroom and how sophisticated domains of knowledge contribute to the ways that teachers manage the complexities of their work. While valuable for better understanding what makes teachers effective, this dispositional and cognitive framing makes it difficult to capture the myriad negotiations at play when teachers plan instruction. Further, relations of power are often rendered invisible. To uncover the negotiations and interactions that shape the work of teaching and learning requires research questions and method that bring the institution into view. There are two broad questions guiding this investigation. How are instructional design and planning activities coordinated, organized, regulated, and/or standardized by broader extralocal relations of power that function beyond the daily experiences of teachers? How do discourses and activities in the institution replicate, constitute, and/or challenge those institutional relations? My study drew on tools from institutional ethnography and was embedded in everyday experiences of teachers. Four teachers partnered with me, allowing me to observe their work as they planned their lessons. However, the interactional framing of the study required a shift in gaze away from teachers and to the production of instruction. Through teachers' conversations, activities, and materials, I mapped instructional units and analyzed them for predictable patterns and threads of interaction that crossed contexts and reflected institutional relations that shaped their work. Textual analyses related to curriculum documents at the state level were paired with the everyday experiences of teachers to illuminate points of intersection and how they were discursively constituted during planning. Rather than isolate these intersections as a study of the impact of standards on teaching, I positioned them in a complex landscape of negotiation that connected the work of teaching and learning beyond the classroom walls. An intriguing glimpse into the production of the institution and the relations of power that contextualized the lived experiences of teachers was revealed. / Ph. D.