Thesis (Ph. D.)--Ohio State University, 2006. / Title from first page of PDF file. Includes bibliographical references (p. 210-229).

The overall aim of this thesis is to gain a better understanding how people with dementia and their spouses experience dementia over time, especially the impact it has on their inter-personal relationships and patterns of everyday life. Data were collected using separate semi-structured interviews with 20 persons with dementia and their spouses of 6 monthly intervals over an 18-months period (132 interviews in total), and analysed using constructivist grounded theory. Analysis suggested that whilst spouses are aware of and acknowledge the diagnosis of dementia, they do not routinely talk about it but rather the focus of their combined efforts is on making life as meaningful as possible. To do this couples, rather than individuals, actively ‘work together’ to create a ‘nurturative relational context’ in order to sustain the quality of their relationship, and maintain the self-image and sense of agency of the person with dementia. In order to create a ‘nurturative relational context’ couples continued to ‘do things together’ for as long as possible by understanding complementary roles underpinned by a mutual appreciation of each others contribution in a way that builds upon the remaining strengths of the person with dementia. Their focus is therefore on ‘couplehood’ as much as ‘personhood’. An analysis of the complete data set identified three temporally sequenced but overlapping phases of the experience of couplehood termed ‘sustaining couplehood’, ‘maintaining involvement’, and ‘becoming alone’. ‘Sustaining couplehood’ had the primary goal of ensuring that the spuses’ ‘work’. This involved four interrelated sets of activities: talking things through, in order to ensure good communication and acknowledge and value differences; being affectionate and appreciative by demonstrating continued attractiveness to their spouse; making the most of things by enjoying everyday pleasures, looking for positive interpretations of events and focussing on the present (living for today); and finally, keeping the peace by being aware of potential points of friction and not responding to difficult behaviour. Both the person with dementia and the non-affected spouse were active strategies in the above process. In addition both spouses worked to ‘maintain the involvement’ of the person with dementia by ensuring that they had an active role to play. However, despite their efforts, eventually the non-affected spouse took on an increasing role and this occurred in a number of ways, either by the person with dementia consciously ‘handing over’ responsibility or more passively ‘letting go’, or by the non-affected spouse ‘taking over’. ‘Sustaining couplehood’ and ‘maintaining involvement’ often occurred simultaneously but the relative emphasis changed over time as ‘sustaining couplehood’ became more difficult and increasing effort was expended in ‘maintaining involvement’. As this occurred the data suggested that the non-affected spouse became increasingly ‘alone’ as the dementia progressed. This process has yet to be fully explored, however, it is clear that for spouses a complete understanding of the dementia experience is not possible without consideration of ‘couplehood’.

Uppsatsen syftar till att skapa en större förståelse för hur omorganisationer påverkar de anställdas inställning och engagemang till sitt arbete. Studien utfördes inom en del av industrin som hade varit inbegripna i ett projekt vars övergripande syfte var att höja de anställdas arbetsengagemang för att på det sättet uppnå en högre produktivitet. Studien utfördes genom kvalitativa intervjuer vilka analyserades och tolkades genom en metodik som inledningsvis var inspirerad av Grounded Theory. Studien har också kompletterats med en teoretisk referensram utifrån det empiriska materialet. Den bärande teoretiska ramen utgår ifrån Max Webers rationalitet som till viss del kompletteras med Karl Marx`alienationsteori. Resultatet från studien visar att det undersökta ALF- projektet inte upplevdes ha påverkat de anställdas arbetssituation i någon högre grad. Studien belyser olika faktorer som bidragit till den upplevelsen. Studien påvisar att företagets och de anställdas skilda målsättningar tillsammans med ett likartat rationellt handlande bidrar till att engagemanget och inställningen till förändringsarbetet varierar hos de anställda.

The aim of this study was to investigate how a workplace should be formed to promote health according to the employees. The study was made in IKEA handla hemma in Älmhult, Sweden. The aim of the study was to find out why people experience health at their workplace environment, from a salutogenetic point of view. The study is based on 12 strategically selected interviews and where analysed according to Grounded Theory. This resulted in a model where the core category was “The prevailing spirit of the organisation” and the five main categories was “That the organisation creates favourable conditions to promote health”, “That there is a god atmosphere amongst the colleagues and the bosses”, “The personal point of view about health”, “The relationship to goals and responsibility” and “The personal point of view about their surroundings”. The result shows that it’s important to look upon health in its entirety. Health isn’t stronger than its weakest point. The findings should work as a guide in the on going work with the employees at IKEA handla hemma. For the future it would be interesting to do a study in a workplace with worse health and then compare them with each other.

Background: An emergency department (ED) should offer timely care for acutely ill or injured persons that require the attention of specialized nurses and physicians. This study was aimed at exploring what is actually going on at an ED. Methods: Qualitative data was collected 2009 to 2011 at one Swedish ED (ED1) with 53.000 yearly visits serving a population of 251.000. Constant comparative analysis according to classic grounded theory was applied to both focus group interviews with ED1 staff, participant observation data, and literature data. Quantitative data from ED1 and two other Swedish EDs were later analyzed and compared with the qualitative data. Results: The main driver of the ED staff in this study was to reduce non-acceptable waiting. Signs of non-acceptable waiting are physical densification, contact seeking, and the emergence of critical situations. The staff reacts with frustration, shame, and eventually resignation when they cannot reduce non-acceptable waiting. Waiting management resolves the problems and is done either by reducing actual waiting time by increasing throughput of patient flow through structure pushing and shuffling around patients, or by changing the experience of waiting by calming patients and feinting maneuvers to cover up. Conclusion: To manage non-acceptable waiting is a driving force behind much of the staff behavior at an ED. Waiting management is done either by increasing throughput of patient flow or by changing the waiting experience.

Food distribution (FD) is a part of the public social and care service in Sweden aiming to prevent improper food intake for persons that they are unable to do their own shopping, and prepare their own meals, and in that way ensure reasonable standard of living. Before a person can be granted the FD service, from any municipality, an assessment of their individual requirements has to be made by a public home care officer. The aim of this study was to explore how public home care officers reason when they make a needs assessment for homebound elderly people. The data was collected through individual interviews (n=18). The transcribed interview material was analysed by means of the grounded theory method. The findings showed that the public home care officers were confronted with many challenges when making an assessment of a person’s individual needs. They are influenced by their subjective feelings related to their personal views as to what should be the right solution for the individual. However, they remained aware that they needed to be guided by the legal requirements.  Further, they described that the level of an individual’s living standard is a leading concept in the governing laws that they need to interpret. Interpretation of this concept is very subjective with the possible consequence that an assessment result may lead to inefficient support. In conclusion, the concept of a reasonable standard of living needs to be clearly defined, decision regarding FD should not take long time, need assessment and decision should be based on the whole picture behind each individual case and there are needs to develop general guidelines for making needs assessment. The findings in this study have implications for public administration, nursing and gerontology.

Rheumatic diseases are often chronic and involve a lifetime of suffering. The focus of rheumatology care is to support patients to manage their lives and master their disease. Healthcare providers and patients have different views on the consequences of living with rheumatic diseases and patients are reporting unmet healthcare needs. There is a need to integrate providers' perspective to develop the quality of rheumatology care. The aim was to explore healthcare providers' experiences of their interaction with patients in their management of RA. Interviews with 18 providers from different clinical settings were analysed in accordance with the grounded theory method. A core category; Delivering knowledge and advice was found to be the most important task and involved providing the patient with information about the disease and appropriate forms of treatment. Healthcare providers' attitudes and patients' responses influenced the outcome of the delivery of knowledge and advice and three dimensions emerged; completed delivery, adjusted delivery and failed delivery. There were differences in the providers' experiences in their interaction with patients as well as in reflections on their role as the delivering part. There could be difficulties in the interaction when patients' expectations and preferences were not taken into account when giving advice. These findings highlight the importance of developing rheumatology care, as no provider or patient benefits if the delivery of knowledge and advice becomes a failed delivery. The healthcare organization must acknowledge the difficulties involved in the interaction with patients in their management of RA and find methods to develop a more person-centred approach to care.

Aim: To generate a theoretical model how patients experience their management of rheumatoid arthritis (RA) in everyday life.Method: An explorative design with the grounded theory approach was used by interviewing 16 informants with RA.Results: The generated theoretical model emerged in a core category- Striving for a good life with two categories; making use of personal resources and grasping for support from others, which formed the base of managing RA. When relating these categories together, four dimensions emerged which characterised patients’ different ways of managing RA: mastering, relying, struggling and being resigned.Discussion: The management of RA incorporated the use of personal resources and the grasping for support from others. Both self-management strategies and patients’ need of support were highlighted as aspects that were of importance when managing RA. Patients’ experiences of their need of support to manage RA give extended knowledge that is of importance for nurses and other healthcare providers. The relationship between patients and healthcare providers is always the key to a good encounter. Interventions to increase self-management in RA have to incorporate this knowledge when trying to increase patients’ self-efficacy and with their experience of support

Using a grounded theory approach to investigate the multidimensional reflections of two Reading Recovery teachers, this inquiry responds to calls for research on reflection and provides information for the field of education in understanding the nature of teachers’ reflections and how they inform teaching practices. Reading Recovery is a progressive intervention program which brings the lowest performing readers and writers to average levels of achievement in twelve to twenty weeks through daily, thirty minute one-on-one tutoring sessions that follow the same lesson pattern daily. Reading Recovery teachers are carefully trained to use reflection to design, implement, and observe children’s reading and writing practices to accelerate their reading and writing skills. To investigate the nature of participants’ reflections and how those reflections informed their teaching practices the data sources, collected over eight weeks, for each participant included field notes from seventeen observations, two semi-structured interview transcripts, thirty-six course documents, and two member checks transcripts. Open coding, memoing, and axial coding were used to examine all data sources. Further, each of the three dimensions of reflection, time, type, and context, were accounted for to fully explore participants’ reflections. Three interrelated major themes connected to the nature of Reading Recovery teachers’ reflectivity and practice were identified: (1) participants’ reflections are situated within the contextual framework of Reading Recovery and inform practices by serving as a roadmap to scaffold individualized instruction and examine personal philosophies of teaching and instructional assumptions; (2) Teacher identity as a reflective practitioner is a natural outcome participants and fosters the interconnectedness of practice and automaticity in their reflective practices; and (3) Systematic observations of the child during instruction focus on actions of the child and themselves as a teacher and serve as a trigger for reflection in a data-driven response sequence linking theory to practice. This study offers insight into how reflective practices of teachers of reading may be fostered through teacher education and into their own teacher development by linking their theoretical perspectives to their teaching practices.

The rate of development for large-scale wind energy in the Canadian province of Saskatchewan is a complex issue such that the various actors of the surrounding policy community (decision-makers, influential stakeholders, and the attentive public) cannot reach consensus. Inaction on resource and environmental issues like this one is often the result of complexity, either the inherent complexity of the problem being targeted or the complexity of the communicated information surrounding the problem. Inherent complexity is managed chiefly by central decision-makers and influential stakeholders of the policy community, while information complexity must be dealt with primarily by the attentive public of the policy community. This thesis uses a case study of large-scale wind energy development in Saskatchewan to explore complexity as a root cause of environmental inaction. In manuscript style, this thesis investigates two types of environmental complexity and two segments of the wind energy policy community. Through an exploration of barriers to wind energy expansion in Saskatchewan, the first manuscript focuses on the complexity of environmental problems themselves as dealt with by decision-makers and other influential policy actors. Interviews were conducted with a range of experts and stakeholders where participants were asked to describe barriers to development in each of six categories: agreement, knowledge, technology, economic, social, and political barriers. A number of key issues are identified: disagreement regarding the balance between environment and economy, contradictory knowledge about the benefits of wind energy, conflicting faith in technology to accommodate high levels of wind energy, unquantified non-economic benefits of wind energy, lack of social interest in and support for wind energy, and lagging provincial political leadership on the issue of wind energy. Perhaps more importantly, the interviews reveal that experts disagreed on many facets of the wind energy issue, which demonstrates that the complexity of the issue makes consensus and any resulting action difficult to accomplish. Intuitive solutions for managing complexity through the more effective reconciliation of disagreement are also suggested. The second manuscript focuses on the complexity of environmental information by examining policy information regarding wind energy implementation in Saskatchewan for complications that might reduce understanding about and participation in the issue by the attentive public. Through a review of publicly available reports, articles, and documents, four complexity-related problems are uncovered: non-intuitive information, misreported information, obsolete information, and absent information. Such occurrences may well be problematic for environmental policy information in general, so intuitive solutions involving clarification and elaboration are suggested for managing each one. Together, the two manuscripts illustrate that both inherent and information complexity can be problems for environmental issues, especially when one causes or feeds back into the other. Results from this thesis provide a way of thinking about environmental complexity and understanding environmental inaction as managed by policy communities.