Past research advocates the need for long-term care (LTC) facilities to adopt a person-centred model of care to optimize residents quality of life. The construct of quality of life in LTC has been defined by satisfaction with a set of domains identified by Kane and colleagues (2003). One goal of this study was to determine which domain is the most predictive of overall well-being among LTC residents in a rural setting. Based on past research and on Deci and Ryans (1985; 1991) self-determination theory, satisfaction with autonomy was predicted to emerge as most predictive of overall well-being. The present study also examined the relation between resident quality of life and well-being, and the degree of routinization (i.e., adherence to a rigid, inflexible daily schedule) within the LTC environment. Routinization is conceptually at odds with a person-centred model of care, yet its relation to the well-being of care recipients had not been examined prior. One hundred and ninety-eight residents from 15 LTC facilities in rural Saskatchewan participated in individual interviews to measure their satisfaction with 11 quality of life domains (Kane et al., 2003), and their overall well-being (using the Memorial University of Newfoundland Scale of Happiness; MUNSH; Kozma & Stones, 1980). One hundred and thirty-one staff from the 15 facilities completed a questionnaire designed to assess routinization within the LTC environment. Contrary to predictions, autonomy failed to emerge as a significant predictor of overall well-being among sample residents. The domain of meaningful activity received residents lowest satisfaction rating of the 11 domains, and also accounted for the most unique variance in overall well-being. Routinization was negatively related to resident quality of life, with staff rating routinization higher in facilities which residents reported lower satisfaction with quality of life. Results provide focus for improving the quality of life of LTC residents, and point to areas for further study.

The purpose of this dissertation was to explore the experience of long term grief following a perinatal loss. In particular, the processes of meaning reconstruction and self-changes stemming from perinatal loss were explored by listening to parents in-depth narratives of their experiences of loss and grief. A narrative methodology was used, based on a constructivist epistemology that suggests that people are storytellers by nature and we attempt to organize and make sense of our life experiences by constructing coherent narratives. Participants were 4 couples and 8 individuals whose losses occurred 1 to 35 years before the interview. Interviews followed a reflexive-dyadic interview model. Analysis of the narratives was approached in two ways: First, a voice-centered relational approach was used for initial interpretation and identification of prevalent voices in the stories. Second, five of the stories were written as evocative narratives, which served as a way of incorporating the authors personal experience of perinatal loss, as well as to evoke an empathic understanding of the experience of perinatal loss. The interpretation and discussion of the stories focused on meaning-making that was evident on both an individual level as well as across the larger group of participants. In particular, meaning-making influences and strategies were identified, including influences of the medical establishment and social networks which either served to disenfranchise parents losses or to comfort and ease parents in their grief. The impact of meaning-making on long-term grief was considered, as well as parents reports of positive and negative self-changes that emerged from their struggle with grief. The unique contribution of this project lies in its elaboration of the meaning reconstruction process in the context of perinatal loss; its demonstration of both positive and negative self-changes in a group of perinatally-bereaved parents; its exploration of grief several years to decades following a perinatal loss; its inclusion of the researchers self as both an additional source of data and as a validity check on the presentation and interpretation of participants stories; and the use of evocative narratives to evoke an empathic understanding of a historically disenfranchised form of loss.

Oral health has dramatically improved in most industrialized countries over the latter half of the 20th century. However, profound oral health disparities still exist especially for those most at risk of developing oral diseases and associated systemic consequences such as populations residing in long-term care facilities. Despite the growing body of literature that supports the link between oral microflora and the importance of oral hygiene in limiting the risk of pneumonia development, there are still gaps in our knowledge to effectively manage this risk. The research included in this dissertation sought to further our understanding of oral health and oral care in the context of pneumonia pathogenesis (chapter 3) and, by exploring the perspective of various stakeholders in oral health, we sought to further understand the factors that influence care provision (chapter 5). Additionally, a novel knowledge translation approach was tested to challenge traditional oral care interventions in order to promote improvements in front-line oral care practices (chapter 6). The relationship between oral microflora, oral care and pneumonia was found to be complex. It directs us to consider converging risk factors including a patient’s health status, health behaviours and access to oral care services. Different professional groups were found to possess different definitions of oral health, which influenced both their motivation to provide care as well as their focus of care. Definitions of oral health could also potentially influence the saliency of different types of oral care information to different targeted groups; therefore, this should be considered in developing education and training initiatives aimed at improving the provision of oral care. An appreciative knowledge translation approach was found to be effective in bridging the gap between oral care knowledge and the provision of care. Regardless of the type of intervention chosen, organizations were reported to play a crucial role in promoting oral health and supporting the successful implementation of oral care programs.

Antipsychotic use is an important issue in long-term care (LTC) homes due to their widespread use, the potential for serious adverse events and limited evidence about their efficacy in treating behavioural and psychological symptoms of dementia. Rates of antipsychotic use vary across LTC homes, but little is known about the contribution of physicians to this variation. This study documented the characteristics of physicians who regularly treated residents in Ontario LTC homes and examined variation in antipsychotic prescribing across physicians. In a population-based retrospective cohort of LTC residents, 637 (52.8%) of 1,207 LTC physicians cared for 46,365 (90.4%) of all residents. Overall, 27.3% of residents received antipsychotic therapy, but extremely high prescribers prescribed antipsychotics to 42.8% of their patients. Variation in physician antipsychotic prescribing persisted after controlling for clinical and behavioural resident characteristics. This variation was reduced by 47.1% when LTC homes were accounted for in multilevel cross-classification logistic regression models.

Objective: To assess the efficacy of personal support worker (PSW) mouth care education to improve the oral health of residents of long term care homes. Methodology: Experimental PSWs received mouth care education at baseline before taking the knowledge test. PSWs‟ mouth care knowledge was measured using a 20-item knowledge test at baseline, post-test (supervised); 6-months (un-supervised). Residents‟ oral health outcomes assessed at baseline and 6-months using the modified Plaque Index and modified Gingival Index. Results: Experimental PSWs‟ post-test knowledge (n=32;M=17.59;SD=1.43) significantly increased from pre-test (M=15.34;SD=2.10), F(2,72)=4.90;p<.05. 39 control residents and 41 experimental residents participated. Experimental residents‟ PI significantly decreased at 6-months compared to baseline, F(1,156)=5.52;p<.05, there was no significant difference in their GI between baseline and 6-months, F(1,156)=3.29;p=.07. Conclusion: PSWs‟ mouth care knowledge significantly increased after receiving mouth care education and was sustained over six months. Only experimental residents‟ PI significantly improved after 6 months.

This thesis aimed to test the relationship between resident satisfaction and staff satisfaction. Using a cross-sectional design, administrators, staff and residents from 24 LTC homes were surveyed. Logistic regression models predicting high resident satisfaction were developed with a primary focus on the relationship to direct care staff satisfaction, while controlling for facility, staff and resident characteristics (and facility-level clustering). Regression models were developed for overall staff satisfaction and three other domains of job satisfaction. The odds of high overall resident satisfaction decreased by 27% and 31% for each 1-unit increase in overall job satisfaction and satisfaction with workload, respectively. In contrast, the odds of high overall resident satisfaction increased by 5.56 times for each 1-unit increase in mean staff satisfaction with work content. LTC homes may be able to improve staff and resident experiences concurrently by encouraging direct care staff to enter into meaningful relationships with residents.

Objective: To assess the efficacy of personal support worker (PSW) mouth care education to improve the oral health of residents of long term care homes. Methodology: Experimental PSWs received mouth care education at baseline before taking the knowledge test. PSWs‟ mouth care knowledge was measured using a 20-item knowledge test at baseline, post-test (supervised); 6-months (un-supervised). Residents‟ oral health outcomes assessed at baseline and 6-months using the modified Plaque Index and modified Gingival Index. Results: Experimental PSWs‟ post-test knowledge (n=32;M=17.59;SD=1.43) significantly increased from pre-test (M=15.34;SD=2.10), F(2,72)=4.90;p<.05. 39 control residents and 41 experimental residents participated. Experimental residents‟ PI significantly decreased at 6-months compared to baseline, F(1,156)=5.52;p<.05, there was no significant difference in their GI between baseline and 6-months, F(1,156)=3.29;p=.07. Conclusion: PSWs‟ mouth care knowledge significantly increased after receiving mouth care education and was sustained over six months. Only experimental residents‟ PI significantly improved after 6 months.

This thesis aimed to test the relationship between resident satisfaction and staff satisfaction. Using a cross-sectional design, administrators, staff and residents from 24 LTC homes were surveyed. Logistic regression models predicting high resident satisfaction were developed with a primary focus on the relationship to direct care staff satisfaction, while controlling for facility, staff and resident characteristics (and facility-level clustering). Regression models were developed for overall staff satisfaction and three other domains of job satisfaction. The odds of high overall resident satisfaction decreased by 27% and 31% for each 1-unit increase in overall job satisfaction and satisfaction with workload, respectively. In contrast, the odds of high overall resident satisfaction increased by 5.56 times for each 1-unit increase in mean staff satisfaction with work content. LTC homes may be able to improve staff and resident experiences concurrently by encouraging direct care staff to enter into meaningful relationships with residents.

The method of characteristics (MOC) is a deterministic transport method that has been applied to large-scale problems including those in reactor physics and radiative transfer. Long characteristics, (LC) methods, have been used extensively to discretize and solve transport problems in the spatial domain. There is a need for an equally adequate time-dependent discretization for these transport problems. The new contributions from this research include the development of a space-time long characteristic (STLC) method with various source approximations including several that employ a piece-wise linear (PWL) approximation spatially. In the prism-PWL (PPWL) method the coefficient of each PWL spatial function is linear in time in each space-time cell. Along with STLC, a PWL-LC method is developed for steady-state problems in (x, y) and (x, y, z). The methods developed in this work use least-squares projections to determine the coefficients of their source approximations. This work presents a detailed asymptotic analysis of the PWL-LC and STLC methods in the thick diffusion limit, which is of special interest in radiative transfer problems. This is the first such analysis reported for LC methods and these new methods are the first that are expected to perform well in this limit. Results from test problems executed with a modified version of the Parallel Deterministic Transport code, PDT, show the PWL-LC and STLC methods are more accurate than current methods for streaming problems. From asymptotic analysis and test problems, it is found that the steady-state PWL-LC method is accurate in the thick diffusion limit with solutions similar to those of analogous discontinuous finite element method, DFEM, solutions. Similarly, the PPWL-STLC method is found to be accurate in time-dependent thick diffusive problems. STLC is also a promising method for massively parallel applications because it permits the use of track-based sweeping, which appears to have significant advantages over cell-based sweeping. This is a key topic recommended for further research.

This study uses a grounded theory approach (Charmaz, 2006) in a small case study to examine if drama as praxis influences long-term care residents when presented as a recreational activity. When used as “praxis” (Taylor, 2000), drama focuses solely on the learning and personal growth of the participants. The growth of long-term care underscores the value of recreational programming for quality of life in these institutions; drama as praxis has not been widely used in this context. Elements of the literature review were used to identify areas where dramatic activities have demonstrated influence in educational contexts: • Engagement / Participation • Self-Confidence / Sense of Efficacy • Social Skills / Empathy • Creativity / Imagination • Cognitive Skill Development / Understanding These became sensitizing concepts for the creation of “drama as praxis” activities, presented in six sessions to a small group of residents at a long-term care residence in the Toronto area. Data collection was based on the researcher’s observations and participant interviews. Drama was found to have a recreational benefit impacting quality of life, with Engagement, Social Skills,, and Self-Confidence, the predominant benefits observed. Creativity and Cognitive Skill Development were less frequent. A Theory of the Recreational Benefit of Drama as Praxis was then developed to help the researcher understand why these benefits might be caused by drama. Based on theoretical sampling from recent research in gerontology and brain science, the theory highlights four beneficial components of drama as praxis: 1. Kinesthetics – Fosters engagement and memory retrieval 2. Play and Endorphinal Release – Triggers cognitive work without fear or fatigue 3. Imagination and Perspective-taking – Helps individuals retrieve emotional memories, develop different perspectives, and joyfully create 4. Narrative - Helps participants access and process events in their lives, past and present The study ends with a discussion of possible implications for the use of drama in long-term care but emphasizes that, due to the size of the sample, the results of the research cannot necessarily be assumed to apply in other contexts. Suggestions for further research are made that might address this and help to clarify the findings of the study.