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Cardiovascular disease (CVD) including coronary artery disease and stroke is a significant health problem in Japan regardless of well established health care and insurance system and various public campaigns and exhibitions in the contemporary Japanese society. Higher and increasing prevalence and incidence of well-known risk factor of CVD may contribute to increasing mortality and morbidity of CVD in the future. However, limited knowledge was available for understanding perceptions of risk for CVD among Japanese adults. This grounded theory study aimed to explore social psychological process in perception of risk for CVD among Japanese adults.There were a total of 26 individuals participated in this study. Participants consisted of 19 Japanese adults with at least one CVD risk factor and 7 Japanese health care providers residing or working in which a consistently high mortality rate of CVD in both men and women.The theory grounded from the data was a process to avoid serious physical, emotional, social, and financial suffering as a consequence of developing CVD or of leaving it untreated and a process to maintain a good relationship with risk for CVD among Japanese adults with CVD risk factors. This grounded theory was consisted of the central concept of perceived risk for CVD, which defined as fear, threats, sorrow, worries, and/or anxiety for possible adverse impacts on their life living with their family and suffering for loss of independence and quality of life consequent upon CVD. This central concept was followed by actions to avoid these adverse and excruciating consequences of CVD including changing behavior, taking measures to manage CVD risk, and continually evaluating their condition. Factors contributed to perception of risk for CVD among Japanese adults were seriousness and severity of consequences of CVD, susceptibility, proneness, and possibility to develop CVD, and Japanese specific contextual factors.This study may contribute to appropriately addressing perception of risk for CVD and behavior change among Japanese adults with risk factors for CVD within the unique social, cultural context of Japan. The results of this study could apply to better nursing practice for CVD risk management and health promotion in Japan.

Quality end-of-life care in the adult critical care remains a high priority for numerous professional agencies and organizations due to advanced technologies that sustain or extent life, regardless of life quality. The purpose of this study was to describe how family members of patients in adult critical care attain awareness that their loved one is dying or near death in the adult critical care setting. Two research questions were addressed: 1) What is the human-environment health process of knowing that end-of-life is imminent by family members of patients in the adult critical care area?, and 2) What factors influence the human-environment health process of knowing that end-of-life is imminent by family members in the adult critical care area? A Glaserian grounded theory design was utilized to conduct this retrospective study. Both primary (interviews) and secondary (poem, nursing art, song, media and film) data sources supported the emerging theory. The Process of Death Imminence Awareness by Family Members of Patients in Adult Critical Care contained six phases: Patient's Near Death Awareness, Dying Right in Front of Me, Turning Points in the Patient's Condition, No Longer the Person I Once Knew, Doing Right by Them, and Time to Let Go. Influencing factors associated with this process were discussed as process facilitators and hindrances. Supportive nursing behaviors and actions as well as family member's emotional, behavioral, and physical reactions to having a critically ill family member were also discussed. This substantive theory will guide nursing education, practice, and research in the creation of nursing interventions, instrumentation, protocols, and policies and procedures aimed at providing cost effective quality end-of-life care in this specialized area of care.

In breast cancer patients, symptoms of depression decrease quality of life and may have other serious consequences, such as increasing mortality. Few studies have focused on psychosocial issues and their relation to breast cancer in African-American women. Thus, only limited information has been published on the breast cancer experience of African American women. A grounded theory approach was used to explicate the social psychological and social structural processes of African American women with breast cancer experiencing depressive symptoms. The sample included nine African American women with breast cancer who experienced depressive symptoms. Unstructured interviews were conducted with each participant.Data were analyzed using the constant comparison method. The data indicated that African American women used the basic social process of Transcending the now to manage the basic social problem of having breast cancer and experiencing depressive symptoms. The five phases of the basic social psychological (BSP) process Transcending the Now that emerged during data analysis were Relying on Faith, Being Strong, Seeking Support, Dealing with Life Too, and Enduring Breast Cancer. The findings of this study provide nurses with new knowledge regarding the experience of depressive symptoms in African American women with breast cancer and provide a theory of transcending that can be used in building a research-based practice.

Syftet med studien är att undersöka vilka faktorer som inverkar på personalens relation till brukarna på ett korttidshem för flerfunktionshindrade ungdomar och unga vuxna, samt att granska hur dessa faktorer influerar varandra. Data har insamlats i huvudsak genom djupintervjuer men också utifrån ett självetnografiskt förhållningssätt. Analysmetoden som använts är Grounded Theory. Resultatet av studien visar att vårdpersonalens relation till brukarna kan kopplas till den nivå av relationell trygghet som upplevs gentemot brukarna på korttidshemmet. Den relationella tryggheten påverkas i sin tur av vårdgivarens personlighet, det upplevda relationella djupet mellan vårdgivaren och brukaren, samt graden av upplevd arbetsrelaterad stabilitet. Ju fler av dessa komponenter som uppnår tillfredställande nivåer, desto högre upplevs den relationella tryggheten, vilket påverkar den arbetsrelaterade motivationen samt graden av engagemang riktad mot brukaren positivt. De fynd som framkommer genom resultatanalysen sammanfattas i två modeller. Den ena tillhandahåller en allmängiltig förklaringsmodell för hur arbetsrelaterade relationer kan förstås utifrån deras givna kontexter – så kallad relationell motivation. Denna modell beskriver hur individers arbetssätt, anknytning och upplevda trygghet på arbetsplatsen påverkar den riktning som de arbetsrelaterade relationerna tar. Modellen utgör en grund för förståelsen av den andra, specifikt mot korttidshemmet, riktade modellen, vilken förklarar vårdpersonalens relation till brukarna. Studiens konklusion är att korttidshemmet bör sträva efter att maximera vårdpersonalens möjligheter till högkvalitativa kontakttillfällen med brukarna. För att detta ska vara möjligt, och för att höga nivåer av relationell trygghet ska kunna uppnås bland vårdgivarna, bör uppkomsten av störande yttre faktorer minimeras på arbetsplatsen.

Recreational shopping has long been of interest to business academics and practitioners, but research on it has been underdeveloped in the leisure field. Although the leisure literature and business literature represent distinct perspectives, there appears to be many significant parallels between recreational shopping and leisure. The purpose of this study was to examine the intrinsic meanings of shopping; to explore the experiential aspects of the recreational shopping experience (including the influences of the retail environment on individuals who regularly engage in recreational shopping). This study took place in Toronto, Ontario. The sample included five female self-proclaimed recreational shoppers. The researcher accompanied each participant on a shopping excursion which took place at a shopping mall selected by the participant. Data were collected through three qualitative methods. First, participant observation involved the researcher walking alongside the participant as she shopped. Following the shopping session, the researcher conducted an in-depth face-to-face interview with each participant; the interview was guided by a set of open-ended questions. In addition, this study utilized photo-elicitation in which the participants were asked to photograph ‘anything’ that made an impression during their visit to the mall. The photographs offered tangible illustrations of shopping experiences and were used as a catalyst for discussion during the interviews. The data was analyzed using Grounded Theory coding which lead to the identification of two main themes and six respective subthemes. The emergent themes are all connected to the key idea that shoppers are motivated by their expectations and desires when they partake in the recreational shopping activity. Shopping offers numerous opportunities that provide immediate hedonic pleasure as well as intrinsic rewards. Such opportunities often include, the ‘before and after’ phases of experiences of acquisition and unexpected discoveries, the positive interactions which occur both inside and outside a retail environment, and lastly, the individual’s use of shopping as a means of self-expression and a tool to manage their self image. Satisfaction, spontaneity, familiarity, mastery, accomplishment, and feelings of escape were all present in these shopping experiences. The findings also described the role of shopping malls as a leisure space and as facilitators of recreational shopping activities. Furthermore, this study demonstrated that shopping can offer a profound leisure experience for many people and the activity should not only be researched in terms of just ‘recreational shopping’ or ‘utilitarian shopping.’ Rather, the findings indicate several overlaps between the two types of shopping and further research is needed to more fully understand the complexities of the activity.

Mothers play a vital role in providing healthy food choices for their preschool children. This role has become more complex in the present obesity-producing environment that has contributed to the increasing prevalence of childhood overweight and obesity in Canada. Childhood overweight and obesity is a significant public health issue in Nova Scotia where the percentage is higher than the national average. The purpose of this study was to generate a theoretical understanding of the process in which 18 mothers living within the Cape Breton Regional Municipality engaged while making food choices for their preschool children. Constructivist grounded theory methodology informed by sensitising constructs from symbolic interaction and the socio-environmental health promotion perspective facilitated a multilevel exploration of the factors that affect mothers’ food choice practices for their preschoolers. Data collection took place over 16 months. Thirty-five interviews were completed. Grounded theory methods were used to analyze the data and a substantive theory of how mothers made food choices for their preschool children was co-constructed with the participants. The substantive theory, Persistent Optimizing, consists of three main integrated conceptual categories. In the first conceptual category, Acknowledging Contextual Constraints, mothers acknowledged various individual, interpersonal, and socio-environmental contextual factors that hindered their ability to make intended, healthier food choices for their children. In the second conceptual category, Stretching Boundaries, mothers developed and enacted moderating strategies to lessen the impact of contextual constraints, thereby increasing the number of food choices available to them. In the third conceptual category, Strategic Positioning, mothers developed and enacted a variety of optimizing strategies to get them closer to making the optimal food choice for their children in a given situation. Mothers in this study struggled continuously with varying degrees of success to provide the foods they believed their children needed. The findings suggest that in practice, policy, research, and education, community health nurses must work independently and collaboratively at all levels of influence to facilitate, mediate, and advocate for social, economic, and physical environments that improve mothers’ ability to make food choices that promote their children’s health and reduce their risk of becoming overweight and obese.

Despite nursing’s espoused professional values of caring and social justice, some patients are stigmatized and receive discriminatory nursing care. There is a gap in existing literature about how nurses deal with the tension they experience when personal and professional values collide. The purpose of this study was to generate a substantive theory of the process that nurses use when faced with values tension in clinical practice and how this affects their behaviour. Using constructivist grounded theory methodology informed by symbolic interactionism and critical social theory, the theory of Juggling a Way of Being was co-constructed with data obtained through interviews with registered nurses (n=8) who provide frontline care in an emergency department in Atlantic Canada. The study’s findings revealed a process fraught with tension as nurse participants assimilated internal and external stressors, adjusted the patient-centered/nurse-centered lens according to their interpretation of the situation, and achieved a point of action or inaction. Implications for nursing practice and administration, education and research are discussed.

Sport in Canada is struggling to demonstrate that it is accountable, value-based, and socially responsible. Simultaneously, there is a growing consciousness among elite athletes to use the power and appeal of sport to affect meaningful social change. Through in-depth interviews, I sought to understand which values and experiences motivated 15 elite Canadian athletes to become involved in social and political activities. I employed a grounded theory approach to analyze interview data and to develop the Athlete Social Responsibility (ASR) framework. My results show that ASR is grounded in identity and existential development. The research participants indicated that, early in their careers, sport provided discipline, direction, and purpose, but through the maturation process, they indicated that becoming socially and politically active was instrumental to their personal development, performance, and continued participation in elite sport. They voiced frustration that the current sport system does little to encourage such engagement and offered a number of innovative ways in which the current system could adopt an ASR perspective. These ideas included: developing a resource to help athletes find their cause and link with related organizations, companies, or charities; helping athletes find ways to connect to their local communities; and restructuring the Canadian Athlete Assistance Program to include both performance and ASR criteria.

This thesis examines the impact of governance process development on engagements between onshore and offshore subsidiaries of multinational IT services organisations. Offshoring is a significant global phenomenon. Over the last decade, there has been substantial growth in the number of organisations setting up ‘captive’ (wholly owned subsidiaries) centres in offshore locations. The desired benefits of greater coordination, leveraging and sharing of knowledge have, in many instances, failed to materialise for these IT services organisations. These failures arise from a variety of causes including a lack of intra-organisational processes to coordinate and manage work, weak alignment between the parent organisation’s strategic objectives and those of the subsidiary, and the inability to navigate cross-organisational and cultural barriers. This thesis comprises three interrelated projects. The first established that organisations develop offshore subsidiaries in order to obtain one or more of a number of complex and interrelated set of strategic objectives. The second project, through the use of grounded theory, demonstrates that within one IT services organisation, imposed governance processes do not facilitate communication and engagement between the onshore and offshore subsidiaries. Cross-cultural and organisational differences inhibited the engagement between the subsidiaries, thus contributing to the failure to achieve the desired benefits of offshoring. Organisations engaged in captive offshoring are faced with two apparently contradictory sets of issues: a set of highly desirable and interrelated strategic benefits and a variety of operational challenges that arise from the imposed nature of the governance processes. The third project, a case study of a similar IT services organisation, examines how these apparently contradictory issues were resolved. The results show that it is the co-development and implementation of governance processes based on the informal working practices of both the onshore and offshore teams that enable the operational challenges established in the second project to be resolved and thus provide reconciliation between these and the achievement of the strategic benefits that drive offshoring. This thesis concludes that co-developed and implemented governance processes are a key factor in the mitigation of the deleterious effects of cross-organizational and cultural working and adds the notion of co-development and implementation of governance processes to the academic literature on the governance of outsourcing.