The study was developed after research with older women suffering urinary symptoms showed that many had tolerated social, psychological and hygiene effects on their lives for some time. There is evidence that some symptoms in later life may originate from pregnancy and childbirth. However, whist there is evidence that pelvic floor muscle exercises can be effective in the short term, there is a paucity of research on the reasons why women tolerate symptoms in the postnatal period rather than seek help. It was also unclear what significance the interactions with health professionals had in aiding or suppressing help-seeking. The aim of this qualitative study was to use grounded theory methodology to describe women’s experiences and knowledge of urinary symptoms in the postnatal period and the perceptions of health professionals. Fifteen women were interviewed in the postnatal period, and one woman was interviewed twice. From the interviews and observations of antenatal clinics and postnatal groups three categories emerged; messages women receive, seeking and understanding information and responding to the messages. Views and knowledge of health professionals were obtained through two focus groups of five. From the analysis of the findings the following five categories emerged; clarifying pathways of care, clarifying education, improving communication, understanding actions and serious issues. The core category arising from this; overcoming barriers to facilitate empowerment, revealed barriers that women and health professionals must overcome in order to approach the issue of urinary incontinence collaboratively. This study identified that there can be problems with communication at all levels between women and health professionals, resulting in poor communication regarding urinary symptoms and accessing treatment. Furthermore, superficial education regarding pelvic floor muscle exercises and dysfunction, both in the antenatal and postnatal periods, coupled with difficulties with disclosure on a sensitive subject could be disempowering for women and health professionals. In particular, women found the possibility of an examination so soon after delivery worrying. Normalisation was a negative but powerful influence on women, encouraged by friends and family. It is suggested that, by developing interventions that enable women and health professionals to overcome the barriers of communication and knowledge exchange, women could be empowered in relation to their physical health after childbirth to manage their urinary symptoms. Empowerment for women, therefore, with regard to postnatal urinary symptoms means being able to believe that looking after the pelvic floor is normal rather than accepting urinary symptoms after childbirth as inevitable.

Patient participation is a central theme in health care policy in the United Kingdom (U.K.). Indeed, there is a trend in health care policy and practice towards encouraging patients to participate actively in their care, treatment and the services they use (Department of Health, 1989, 2003; 2004; 2005; 2006; 2008; 2009; 2010; 2011; 2012). Despite the current popularity surrounding such an approach to care, the concept remains elusive. Patient participation in nursing care specifically has not been examined adequately and remains one of the least understood ideas in clinical practice. The contribution that nurses make to this important activity has also not been explored. Furthermore, only a few studies have examined the nature of patient participation in nursing care from the frame of reference of the acute surgical patient (Henderson, 1997; Sahlston et al., 2008 and Larsson et al., 2011). Most studies have targeted clinically distinct patient groups and discrete aspects of patient participation within the context of chronic illness or medical and primary care practice. They are therefore limited by their precision and narrow focus (Cassileth et al., 1980; Haug & Levin, 1981; Vertinsky et al., 1984; Caress et al., 2005; Entwhistle et al., 2004; Collins et al., 2007; S. Parsons et al., 2010). Most have also drawn on positivist epistemologies and derived data from self-completed fixed choice questionnaires. An empirically grounded theory that explains the process of patient participation in surgical nursing care within the empirical world has yet to be published. The purpose of this grounded theory study was to explore the nature of patient participation in nursing care within the context of the acute surgical care setting. Ultimately the aim was to generate a substantive theory that could account for, and explain, the process by which patients’ participate in their surgical nursing care. A qualitative, inductive design, based on the classic grounded theory approach to data collection and data analysis (Glaser & Strauss, 1967; Glaser, 1978) was employed to examine the complex nature or natural history of patient participation within the context of contemporary surgical nursing practice. The informants of the research were patients and nurses on three acute surgical wards in an NHS Trust Hospital. Data were collected through 61 unstructured, audiotaped interviews (47 patients and 14 nurses) and 72 hours of participant observation. The interview and observational data were analysed using the constant comparative method of analysis (Glaser & Strauss, 1967; Glaser, 1978). The analytic process generated a substantive theory, labelled Engaging in Nursing Care. The theory explains how patient participation in nursing care within the acute surgical setting is established, developed, maintained or inhibited. It reveals an evolutionary context-sensitive process, which describes the complex and challenging nature of patient participation in nursing care as experienced by patients and nurses in the pre and post-operative period. Three dynamic phases: Establishing Readiness, Shaping Work and Incurring Rewards and Costs describe how patients engage in their nursing care prior to and after surgery. The phase Establishing Readiness describes the structural, organisational and environmental antecedents of patient participation within the context of the surgical care setting. Shaping Work describes the range and variation in participatory behaviour and the levels at which patients participate in their own nursing care throughout their surgical experience. The phase Incurring Rewards and Costs explains the varied effects of patient participation in surgical nursing care on the individual patient, the nurse and surgical ward performance and resources. A number of recommendations are made to enable nurses, educationalists, health care managers and policy makers to develop substantiated strategies and initiatives for the effective implementation of patient participation in modern surgical nursing practice.

This article reports the findings of a grounded theory study of the processes involved in adherence and treatment seeking delay for febrile neutropenia in chemotherapy patients. Interviews were conducted with 12 patients. Six theoretical constructs were generated, namely ‘Recall of Treatment Advice’, ‘Impact of Emotions’, ‘Influence of Social Networks’, ‘Symptom Monitoring Behaviour’, ‘Symptom Interpretation’, and ‘Preparation and Journey Time’. A model was developed to reflect the complex interplay between these theoretical constructs. Data extracts are presented to illustrate the grounding of the model in patients’ accounts, and the model is discussed with reference to previous theory and research.

Background: Primary care providers, family physicians and nurse practitioners provide most mental health services in Canada. However, primary care providers lack knowledge, skills, and time to provide these services. Access to onsite mental health consultation or collaborative mental health care, affords primary care providers support to offer patients increased access to mental health services. Researchers suggest that interprofessional collaborative relationships are foundational to the success of collaborative mental health care. However, there is little understanding of how to build these relationships. Purpose: The purpose of this grounded theory study was to develop an understanding of how primary care and mental health care providers collaborate to deliver mental health care in primary care settings. Methods: Counsellors, family physicians, psychiatrists, nurse practitioners, and program leaders were recruited (N=40). Data were collected using individual (19) and focus group (7) semi-structured interviews. Interviews were audio recorded, transcribed and open coded. After open coding the first seven interviews, memos were written on each participant and focus group. These memos were sorted, compared to previous memos and then used to create a coding table. This iterative process of open coding, memo writing and then adding emergent codes to the coding table was repeated for all transcripts. Similar codes were grouped then collapsed to create the preliminary categories. Preliminary categories were sent to the participants after the primary care provider interviews and again after the provider focus groups to create the final categories. The final categories were compared to examine their relationships to one another. Findings: The main finding of this study is a theoretical rendering of the participants’ experiences and ascribed meaning of interprofessional collaboration to deliver mental health services in primary care. Specifically, a collaborative relationship building model with four developmental stages: 1) Primary Care Providers Need for Collaboration, 2) Initiating Co-location, 3) Fitting-in, and 4) Growing Reciprocity is offered. Conclusions: The findings underscore that collaborative care requires an understood need for collaboration, organizational support, contextually effective modes of communication, and a perception that collaboration improves patient care. Further research may explore the applicability of this model to other health care contexts. / February 2017

Patient-centred care positions patients as active participants, collaborators, and experts in their healthcare and healthcare relationships - a role that adults with High Functioning Autism Spectrum Disorder (HFASD) may find challenging. The purpose of this study was to better understand the perspective and experiences of adults with HFASD in healthcare and healthcare relationships. Twenty-eight North American adults with HFASD responded to four open-ended long-answer questions online, which were analyzed using constant comparison methods within the grounded theory framework. Participants’ positive and negative experiences in healthcare were determined by their interactions with healthcare professionals who were portrayed as knowledgeable and empowering allies, or unknowledgeable and overpowering adversaries. Ultimately, these findings highlight the need for more education and knowledge about HFASD among healthcare professionals, and how it impacts these adults, as well as the need to develop evidence based interventions and tools to support adults with HFASD communication in healthcare. / October 2016

Manitoba has the highest rate of type 2 diabetes in Canada, exceeding other provinces 12-fold. Current literature has suggested that social supports are critical to the promotion and adoption of healthy living in youth living with type 2 diabetes. As such, high quality social support has been perceived as positive and can enhance youths’ resilience against life stressors. Despite this suggestion, there is little evidence on how best to support this population. The purpose of this Masters thesis was to explore the meaning of social support among Manitoban youth living with type 2 diabetes. Guided by a constructivist grounded theory approach, youth identified the following avenues of social support: family, friends, health care professionals, school and programming. Future interventionists should be aware of the vast incongruence in patients’ and physician’s perceptions of health in type 2 diabetes and design interventions accordingly. / February 2017

Clinicians and researchers know that women experience distress related to the diagnosis of and treatment for ovarian cancer. A review of the literature revealed that while there is interest in the topic, distress is inconsistently defined and measured. Women have been reported to have a variety of distress experiences including the challenges of late diagnosis and the treatment regimen, communication difficulties with healthcare providers, and concern about the effect of their diagnosis on their loved ones. Without information directly from women, assumptions predominate about what the experience is like and what they would find helpful from support persons. Women’s perceptions about distress was identified as a gap in the knowledge leading to the present study which asked “What do women with ovarian cancer want their spouse/significant other, family, friends, and healthcare providers to know about their experience of distress during diagnosis and treatment?” A qualitative method, Grounded Theory as outlined by Glaser and Strauss in 1967 was chosen to guide this IRB approved study. Twelve women participated in audiotaped interviews contributing data for analysis using the constant comparative method. Six common themes or subcategories emerged across all the interviews and resulted in a conceptualization of the experience as an “existential assault.” Though individual experience differed, abstraction and conceptualization of the data revealed the common themes as (a) “out of the blue like lightning”; (b) “no stone left unturned”; (c)“knowing what I don’t want to know and not knowing what I want to know”; (d) “watching you, watching me- we are both afraid”; (e) “talking yet not talking, about death”; and (f) “now I have to take care of me.” Participants expressed the need for professional support people who contribute their efforts to cure, but who also listen to the participant’s need to manage and control their own experience and to live in ways that give their life meaning and purpose. The experience of distress for the participants was intensified by the needs of those in their social network (spouse/significant other, family, friends, and healthcare providers) who also experienced distress, at times requiring participants to provide support for those who would be expected to be providing support.

For most of us, thoughts about our own mortality are largely unconscious, an invisible backdrop to our daily living. However, when forced to face a potentially life threatening event, these otherwise underlying thoughts about human transience rise to consciousness. Given the seemingly inherent link between receiving a cancer diagnosis and developing an increased awareness of one’s own mortality, the present study sought to address the following research question, “What are the experiences and processes by which women with gynecologic cancer construct meaning and manage death anxiety in the face of their cancer diagnosis?” Based on an interpretive grounded theory paradigm, 10 women with gynecologic cancer were interviewed to gather rich, nuanced information about the phenomenology of death anxiety in this understudied cancer population. The primary ways in which participants managed the threat of mortality were to engage in certain socially-sanctioned behaviors related to religion, spirituality, family, identity, and social obligations. These activities served a dual purpose by (1) giving participants the opportunity to fight symbolically or literally against death and (2) allowing them to derive a sense of meaning and purpose in life. Findings from this study offer a unique conceptual understanding of the cancer experience. Implications for theory, research, and practice are discussed.

Legal aid programs comprise a robust national infrastructure attempting to alleviate and reduce poverty. Since their proliferation as part of the War on Poverty, these organizations have provided individual civil legal assistance and engaged in collective legal and political strategies to advance systemic change. Starting in the 1980s, however, public policies have been enacted to cut funding and restrict the ability of federally funded legal aid programs to engage in collective and systemic advocacy. As a result, the ability of programs to work alongside low-income communities has been compromised. The histories and core commitments of legal aid and social work are linked. As a profession social work is concerned broadly with efforts to address poverty and specifically with the self-determination and empowerment of those experiencing poverty directly. In this study a constructivist grounded theory design was used to examine the process of collaboration between legal aid attorneys and client community members. The sample for the study included 28 attorneys, client community members, and other stakeholders affiliated with three legal aid programs. Based on 28 interviews and two focus groups with these participants, a conceptual framework entitled Collaborating for Justice in a Legal Aid Context was constructed. Findings suggest that both primary stakeholder groups were motivated to act by the unequal access to advantage in the world around them. Once affiliated with legal aid, they were constrained by scarcity of resources but nonetheless acted creatively to collaborate as well as to enhance collaborative capacity. Collaboration occurred in different timeframes, and this temporal element suggested ways that individuals and organizations can extend and deepen collaboration. Collective activities, informal interaction, and boards and advisory groups all played roles in facilitating collaboration between legal aid programs and their client communities. Through these actions, participants and their affiliated organizations were able to move from circumstances of scarcity to circumstances of generativity and development. Implications for education, practice, and policy are discussed.

Cette thèse s'inscrit dans le domaine de l’internationalisation de la distribution. Son objectif est d’expliquer les facteurs de succès ou d’échec de la filiale étrangère du distributeur international. L’analyse de la littérature met en évidence l’existence d’une large palette de perspectives théoriques divergentes. Afin de construire un cadre conceptuel cohérent, notre travail se fonde sur un modèle intégré d’origine industrielle combinant les approches SCP (« Structure-Conduct-Performance »), RBV (« Resource-Based-View ») et la théorie des capacités dynamiques de la firme, que nous adaptons aux spécificités de la distribution. Le modèle est construit et présenté à partir du concept central de « compétences-clés », appliqué au distributeur, il s’agit de comprendre de quelle manière les compétences clés de la filiale internationale de distribution influencent ses choix stratégiques et sa performance. Cette recherche nous conduit à clarifier une série de notions ayant un lien étroit avec les compétences-clés. Nous pouvons observer indirectement les « compétences-clés » du distributeur international au travers des activités et capacités distinctives de sa filiale dans un pays donné. Le terrain choisi est la Chine, qui, tant par sa taille que par sa vitesse de développement économique et commercial, représente un véritable laboratoire des transformations à l’oeuvre dans les pays émergents. En termes de méthodologie, nous avons retenu une approche qualitative basée sur la « Grounded Theory ». Les résultats, obtenus par l’analyse des entretiens de vingt un dirigeants de filiale étrangère font apparaître d’une part, que la typologie des compétences-clés de la filiale du distributeur international repose sur deux types de compétences: les compétences de base et les compétences architecturales, d’autre part, le modèle intégré emprunté au domaine industriel est validé dans le domaine de la distribution sachant que les facteurs environnementaux jouent dans ce dernier cas un rôle plus important. / The purpose of this dissertation is to explain the success and failure factors for the foreign subsidiary of an international retailer. However, the existing literature draws on a wide range of divergent theoretical perspectives. In order to build one coherent conceptual framework, our study is based on an integrated model combining the SCP and RBV perspectives and the dynamical capability theory, while indicating the central role of core competences. Since this model was derived from industrial fields, we adapted it into a retailing model in order to understand how the core competences of the international retailer’s foreign subsidiary could influence its strategic choices and performances. This framework was used in a Grounded Theory study aimed at 21 top managers of international retailers in China. Our findings showed that the foreign subsidiary’s core competences for the international retailer could be classified as: component competences and architectural competences. Results from the international retailing fields broadly support the theoretical model borrowed from industrial fields. However, the environmental factors play a more important role in the first field.