Environmental sustainability in buildings is an important part of preserving the environment and reducing climate change. The increasing amount of physical infrastructure systems in Malawi has not been accompanied by policy-makers clearly understanding perceptions and attitudinal behaviors of building designers to promote environmental sustainability. Some building designers in Malawi might not be practicing sustainability innovations adequately, requiring more research to understand their perceptions and behaviors. The purpose of this mixed methods sequential and explanatory study was to explore how building designers' behaviors relate to the implementation of sustainability innovations in Malawi. Ajzen's theory of planned behavior explaining how attitudinal behaviors relate to individual's actions, served as the conceptual framework. The central research question investigated perceptions and attitudinal behaviors building designers hold about sustainability, and how these behaviors connect with practicing sustainability innovations. Data collection used a Likert scale questionnaire to capture behavior items. A sample of 99 individuals working in building organizations completed the questionnaire. Multiple linear regression analysis showed attitude behavior influenced practicing sustainability more than the subjective and perceived control behaviors. Interviews with 24 participants supported the analytical finding. Government and policy-makers were the target audience. Knowledge about behaviors toward sustainability innovations enables government and policy-makers strategize and change stakeholders' mindset to increase sustainability practices thereby impacting societal change in the construction communities.

Children with Autism Spectrum Disorder (ASD) are known to experience performance and participation challenges, with early diagnosis being critical for improved outcomes. Children from ethnic minority backgrounds tend to receive their diagnoses later, even when symptomatology is similar. This mixed methods study explored symptom severity, functional difficulties, and age at diagnosis for ASD and to describe the functional challenges encountered by preschool-aged children with ASD of African American descent. The International Classification of Functioning, Disability, and Health along with the Model of Human Occupation were the theories used for this study to conceptualize functional challenges and other potential factors. Research questions addressed symptom severity, degree of functional challenges, and age of diagnosis, and to gather family perspectives regarding functional challenges for preschool-aged children of African American descent. Data consisted of subpopulation responses from the 2009-2010 National Survey for Children with Special Healthcare Needs (N = 224) and locally-conducted interviews with parents (N = 3). No significant relationships were found using general linear model between age at diagnosis and symptom severity or degree of functional challenges. Qualitative themes included the diagnosis process, routines and transitions, communication, family and home environment, and school and community environments. Educators and health care providers need to enhance screening for early signs of ASD and consider racial and cultural implications related to performance and participation challenges. Social change implications include the development of effective and targeted awareness campaigns and improved diagnostic and intervention services for children with ASD from minority backgrounds and their families.

Purpose. To systematically develop and field test an intervention to engage families and healthcare teams in the decision-making process about life support for critically ill patients in the Intensive Care Unit (ICU). Setting. Adult medical-surgical ICU at a Canadian academic teaching hospital. Methods. The International Patient Decision Aid Standards (IPDAS) criteria and the Interprofessional Shared Decision Making (SDM) model guided the study of families facing decisions about life support for their relative in ICU that involved:1) systematic review; 2) qualitative descriptive study; 3) mixed methods field test of a novel patient decision aid (DA). Systematic review findings. Of 3162 citations, four trials evaluated interventions to improve communication between health professionals and patients/families. One intervention met eight of nine criteria for SDM but did not evaluate its effect on the benefit to communication. Qualitative study findings. Six family members and nine health professionals identified two options (life support or comfort care) and values associated with these options. Values included maintaining quality of life, surviving critical illness, minimizing pain and suffering, not being attached to machines, giving the family enough time to adapt emotionally to the patient’s health situation, and the judicious use of healthcare resources. Families were unlikely to become engaged without healthcare professionals making the decision explicit and minimizing other barriers across the decision-making process. Field test findings. Family members and health professionals for eight patients indicated that the DA was feasible to use, acceptable to users, had the potential to do what was intended, and did not seem to present adverse consequences to users. An enhanced delivery strategy is needed for future evaluation of its effect on facilitating patient/family involvement in decisions. Conclusions. Limited involvement of families in the process of decision-making about life support in the ICU reinforced the need for effective interventions to facilitate SDM. These studies validated the operationalization of the IPDAS criteria, as part of a systematic process for developing and field testing DAs. However, IPDAS criteria stop short of elements necessary to consider when implementing the DA in the processes of care.

This mixed-method case study examined effects of high school musicians' participation in the jam session, a student-directed, extracurricular music activity. The single case study site was a rural British Columbia high school exceptional for its support of jamming. Forty-four subjects, including 21 who fully met stated criteria for jammers, and 13 non-jamming subjects, were studied over a period of four months. The general research question was: Does participation in a band room jam session benefit students cognitively and motivationally? Specific research questions were: Do students who informally jam on various forms of music enhance their music skills in the perception and meaningful manipulation of music elements, and if so, how? In what ways does Csikszentmihalyi's flow theory explain the continued participation of students in the jam session? Three quantitative instruments were administered to 13 jammers capable of playing a Bb Concert scale on a melody instrument as well as to a comparable group of 13 non-jammers. These instruments included Gordon's Advanced Measures of Music Audiation (AMMA), Froseth's Test of Melodic Ear-to-Hand Coordination (TMEHC), and a researcher-developed test of ear-to-hand coordination (SOR). An ANOVA test showed no significant difference between jammer and non-jammer groups on AMMA scores (p<0.05). ANOVA showed a notable but not significant difference (p<0.056) between groups on the TMEHC, while a Repeated Measures Analysis of pre/post test TMEHC scores showed no effect of jamming over a period of 10 weeks. ANOVA showed a very clear difference between groups on the SOR (p<0.001). Qualitative data collected via journaling, interviews, observation, and participant-observer tasks indicated that jammers were perceiving and manipulating music elements in meaningful ways, and also supported Csikszentmihalyi's flow theory as an explanation for jam session participation. In particular, flow characteristics including transformation of time, loss of self-consciousness, and challenge/skill balance were both observed and reported. The role of the teacher, the presence of a music subculture, and the pseudo-curricular nature of jamming were noted as possible topics for further research.

The survival rate and life expectancy of infants with complex health needs have increased overthe last decades, and this increases the number of families who have to care for such infants at home. These families seek support in the community setting, and supporting them has a positive impact on the well-being of both the parents and the infant. In South Africa the needs of these parents are not known, and this fact makes it difficult to adequately support them in the community. The aim of this study was to explore and describe the needs of parents of infants with complex health needs in the community setting. Two objectives were set to reach the aim mentioned above: 1) to critically appraise and synthesise the best available evidence on the support needs of parents of infants with complex health needs and 2) to explore and describe parents’ emic perspective on their support needs as parents of infants with complex health needs in a South African context. A sequential mixed method approach was utilised in two phases, here discussed in five chapters. In an attempt to meet objective one, the support needs of parents of infants with complex health needs were determined by means of an integrative literature review from studies obtained through computerised searches of several electronic databases, supplemented by checking reference lists and consultation with experts. This was followed by individual face-to-face interviews with the stated parents in three different settings. The latter addressed the second objective of the study, namely to provide an emic perspective on the support needs of parents of infants with complex health needs in a South African context. The integrative literature review described five main themes on the support needs of parents of infants with complex health needs: need for information, need for parent-to-parent support, need for professional support, need for self-confidence in the care of the infant and need for social support. All of these themes were confirmed in the South African context through the interviews with parents. However, South African parents added an additional theme: the need for normality. The final chapter offers an evaluation of the study and discusses study limitations and recommendations for nursing practice, education and research. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

The survival rate and life expectancy of infants with complex health needs have increased overthe last decades, and this increases the number of families who have to care for such infants at home. These families seek support in the community setting, and supporting them has a positive impact on the well-being of both the parents and the infant. In South Africa the needs of these parents are not known, and this fact makes it difficult to adequately support them in the community. The aim of this study was to explore and describe the needs of parents of infants with complex health needs in the community setting. Two objectives were set to reach the aim mentioned above: 1) to critically appraise and synthesise the best available evidence on the support needs of parents of infants with complex health needs and 2) to explore and describe parents’ emic perspective on their support needs as parents of infants with complex health needs in a South African context. A sequential mixed method approach was utilised in two phases, here discussed in five chapters. In an attempt to meet objective one, the support needs of parents of infants with complex health needs were determined by means of an integrative literature review from studies obtained through computerised searches of several electronic databases, supplemented by checking reference lists and consultation with experts. This was followed by individual face-to-face interviews with the stated parents in three different settings. The latter addressed the second objective of the study, namely to provide an emic perspective on the support needs of parents of infants with complex health needs in a South African context. The integrative literature review described five main themes on the support needs of parents of infants with complex health needs: need for information, need for parent-to-parent support, need for professional support, need for self-confidence in the care of the infant and need for social support. All of these themes were confirmed in the South African context through the interviews with parents. However, South African parents added an additional theme: the need for normality. The final chapter offers an evaluation of the study and discusses study limitations and recommendations for nursing practice, education and research. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

Purpose. To systematically develop and field test an intervention to engage families and healthcare teams in the decision-making process about life support for critically ill patients in the Intensive Care Unit (ICU). Setting. Adult medical-surgical ICU at a Canadian academic teaching hospital. Methods. The International Patient Decision Aid Standards (IPDAS) criteria and the Interprofessional Shared Decision Making (SDM) model guided the study of families facing decisions about life support for their relative in ICU that involved:1) systematic review; 2) qualitative descriptive study; 3) mixed methods field test of a novel patient decision aid (DA). Systematic review findings. Of 3162 citations, four trials evaluated interventions to improve communication between health professionals and patients/families. One intervention met eight of nine criteria for SDM but did not evaluate its effect on the benefit to communication. Qualitative study findings. Six family members and nine health professionals identified two options (life support or comfort care) and values associated with these options. Values included maintaining quality of life, surviving critical illness, minimizing pain and suffering, not being attached to machines, giving the family enough time to adapt emotionally to the patient’s health situation, and the judicious use of healthcare resources. Families were unlikely to become engaged without healthcare professionals making the decision explicit and minimizing other barriers across the decision-making process. Field test findings. Family members and health professionals for eight patients indicated that the DA was feasible to use, acceptable to users, had the potential to do what was intended, and did not seem to present adverse consequences to users. An enhanced delivery strategy is needed for future evaluation of its effect on facilitating patient/family involvement in decisions. Conclusions. Limited involvement of families in the process of decision-making about life support in the ICU reinforced the need for effective interventions to facilitate SDM. These studies validated the operationalization of the IPDAS criteria, as part of a systematic process for developing and field testing DAs. However, IPDAS criteria stop short of elements necessary to consider when implementing the DA in the processes of care.

Lifelong Learning is a key concept in modern ‘knowledge-based’ society and it is viewed as a commodity, a personal drive or a social necessity. This thesis aims to unravel its many dimensions and the values that are ascribed to it by the teachers of Greek Model Experimental High Schools. A Model Experimental High School is a relatively new type of state school in Greece, which is highly differentiated from other schools in terms of curriculum, inter-school activities, staff and students and emerged in the Greek education system in 2011. For this reason, research on the effects of this differentiation in the aspects of Lifelong Learning is scarce. The mixed methods strategy was used in order to form a complete picture of the Lifelong Learning dimensions and the research was conducted in two parts. The first part was quantitative and aimed to categorize the elements that constitute Lifelong Learning for the teachers, the factors that encourage or discourage it and its positive and negative dimensions on a macro level as, through a questionnaire, and as a result responses were collected from the thirty-six Model Experimental High Schools in urban and semi-urban areas of Greece. The second part was qualitative and through semi-structured interviews, it explored more in-depth the issue of Lifelong Learning and the concept of vocational vitality which is related both to Lifelong Learning and a teacher’s professional life. Following the propositions of the Theory of Work Adjustment, the research revealed that through the various non-formal and informal activities that the demanding context of Model Experimental High Schools promotes, Lifelong Learning acts as a reinforcer and a means of sustaining the balance between the school and the teachers by increasing their satisfaction. Moreover, both the quantitative and the qualitative methods revealed that teachers consider Lifelong Learning firstly as a means of personal development and secondly as continuous professional development. Lifelong Learning as investment in the human capital was not found as important as the previous two. Furthermore, the vocational vitality of teachers was found to be thriving due to the importance that Lifelong Learning plays in their life a and despite the difficulties which arise from the work demands or the difficult socioeconomic context in Greece due to the economic crisis of the recent years.

This mixed-method case study examined effects of high school musicians' participation in the jam session, a student-directed, extracurricular music activity. The single case study site was a rural British Columbia high school exceptional for its support of jamming. Forty-four subjects, including 21 who fully met stated criteria for jammers, and 13 non-jamming subjects, were studied over a period of four months. The general research question was: Does participation in a band room jam session benefit students cognitively and motivationally? Specific research questions were: Do students who informally jam on various forms of music enhance their music skills in the perception and meaningful manipulation of music elements, and if so, how? In what ways does Csikszentmihalyi's flow theory explain the continued participation of students in the jam session? Three quantitative instruments were administered to 13 jammers capable of playing a Bb Concert scale on a melody instrument as well as to a comparable group of 13 non-jammers. These instruments included Gordon's Advanced Measures of Music Audiation (AMMA), Froseth's Test of Melodic Ear-to-Hand Coordination (TMEHC), and a researcher-developed test of ear-to-hand coordination (SOR). An ANOVA test showed no significant difference between jammer and non-jammer groups on AMMA scores (p<0.05). ANOVA showed a notable but not significant difference (p<0.056) between groups on the TMEHC, while a Repeated Measures Analysis of pre/post test TMEHC scores showed no effect of jamming over a period of 10 weeks. ANOVA showed a very clear difference between groups on the SOR (p<0.001). Qualitative data collected via journaling, interviews, observation, and participant-observer tasks indicated that jammers were perceiving and manipulating music elements in meaningful ways, and also supported Csikszentmihalyi's flow theory as an explanation for jam session participation. In particular, flow characteristics including transformation of time, loss of self-consciousness, and challenge/skill balance were both observed and reported. The role of the teacher, the presence of a music subculture, and the pseudo-curricular nature of jamming were noted as possible topics for further research.

We live in a society where the individual is prioritised over the collective. Newspaper articles abound lamenting adolescents' lack of personal responsibility and social commentators are increasingly highlighting the need to recapture and interweave an agenda of personal responsibility into the social fabric. Personal responsibility has been defined as being accountable to oneself and the needs and well-being of others (Ruyter, 2002). Doherty (1998) has argued that there is an increasing trend in society to refuse accountability and to blame others for one's situation. Despite these assertions, there is little empirical research that has attempted to define and examine personal responsibility. This dissertation is about the role of personal responsibility in the lives of adolescents. The research program was divided into three studies utilising quantitative and qualitative research methods to answer four research questions. Study 1: How do adolescents and teachers understand 'personal responsibility?' Study 2: Can a quantitative questionnaire define and measure an adolescent's level of personal responsibility? Study 3: Can a program aimed at enhancing the personal responsibility level of adolescents be taught in a high school and demonstrate measurable effect? Is there a relationship between personal responsibility, emotional intelligence and self-esteem? Study 1 used focus groups to address research question 1. Four focus groups with a total of 20 Year 11 students, and two focus groups with a total of 10 teachers were conducted. The results revealed that key components of the personal responsibility variable were choices and consequences, behavioural control, thoughts and feelings, and consideration for others. This finding complemented the definition derived from the literature review. Additionally, the focus group data served to inform Study 2, the development of the Personal Responsibility Questionnaire and Study 3, the creation, implementation and evaluation of the Personal Responsibility Program. Study 2 involved examining appropriate literature, focus group data from Study 1, and related measures to create a quantitative measure assessing personal responsibility in adolescents. A 100-item measure was created and tested on more than 500 adolescents. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were used to determine a final 30-item Personal Responsibility Questionnaire with two factors (factor 1 - 'self control of emotion and thoughts' and factor 2 - 'self control of behaviour'). This measure was to serve in the evaluation of the Personal Responsibility Program. A fundamental aim of the study was to determine whether a Personal Responsibility Program could be implemented in a high school and demonstrate measurable effect. Study 3 involved the creation of the Personal Responsibility Program through examining other values-based education programs and the focus group data obtained in Study 1. Once created, the five-lesson program was implemented twice in one high school, with approximately half of the Year 11 students undertaking the first implementation (the experimental group), and the remaining Year 11 students completing the program during its second implementation (the control group). To assess whether the program had generated any changes in the adolescents' levels of personal responsibility, the Personal Responsibility Questionnaire developed in Study 2 was administered pre- and post-intervention to both the experimental and control groups. Additionally, the well-established constructs of emotional intelligence and self-esteem were assessed using the Emotional Intelligence Scale (Schutte et al., 1998) and the Rosenberg Self-Esteem Scale (Rosenberg, 1965) to determine potential relationships between these variables and to provide additional construct validity for the measure. The results from Study 3 revealed no significant findings on any variable at any time (pre- or post-intervention). Despite this finding, certain data trends were apparent between males and females across the experimental and control groups. Overall, females demonstrated slightly higher mean scores on emotional intelligence and personal responsibility than males, while males had slightly higher mean scores than females on self-esteem. In order to gather additional feedback about the program and the students' learning, qualitative data were gathered from the students and the teachers by completion of a feedback sheet at the end of each lesson and a teacher focus group interview after the first implementation of the Personal Responsibility Program. In relation to student learning, the qualitative data offered by the students showed that learning in the key areas targeted had occurred, with students reflecting on their growth and changing understandings about personal responsibility. With reference to the program, the students commented that the program was fun, interesting, relevant, valuable, and enabled them to learn new things about themselves. Feedback from the teachers highlighted that the students appeared to engage with the program, and that teaching it was rewarding. This research program has contributed to the literature by providing a theoretically and empirically derived definition of personal responsibility. The focus group process highlighted that personal responsibility could be understood and considered by adolescents due to the cognitive and moral sophistication that develops early in this developmental timeframe. Study 2 generated a Personal Responsibility Questionnaire that can be used to assess personal responsibility in adolescents, and Study 3 contributed a Personal Responsibility Program which has been developed from conceptual and empirical literature. The program was designed to be "teacher friendly' and allowed the schools to gather qualitative and quantitative feedback on the success of the program's implementation. As school administrators and teachers often lament the lack of personal responsibility in their students (Lickona, 1992), this program could be used to address this concern and put the issue of personal responsibility firmly on the agenda in high schools.