Thesis advisor: Dorothy Jones / The importance of the nurse-patient relationship to the overall well- being of the person has been explored extensively by nurses. What is largely missing from this knowledge developed to date is the patient's perspective. The purpose of this study was to develop a reliable and valid measure of patients' perceptions of feeling known by their nurses during an acute, surgical, hospital admission. The development of the PPFKN Scale was guided by Newman's theoretical framework of Health as Expanding Consciousness (1994) and data from a qualitative descriptive study conducted in 2003 (Somerville). The current investigation focused on the development and psychometric testing of the PPFKN Scale. The four themes that emerged from the earlier qualitative study were used to guide the development of the 85-item scale. This scale was exposed to a panel of nurse experts to establish inter-rater agreement and content validity, item understandability and readability. The revised scale was piloted with five participants who had experienced an inpatient, surgical admission to determine content validity, item readability and understandability. The revised 77-item scale was then administered to 327 surgical inpatients across seven general care units at a large academic urban medical center. A sample size of 296 completed surveys was analyzed. A four-component solution was devised using Principal Components Analysis with Varimax rotation. This four-component solution accounted for 63.3% variance, with a total scale Cronbach's alpha coefficient of 0.99. A component loading cut-off was set at 0.3 and items not loading at this value on the expected component were dropped. This process resulted in a reliable and valid 48 item PPFKN Scale with four components and a total scale Cronbach's alpha coefficient of 0.98. / Thesis (PhD) — Boston College, 2009. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

This mixed-methods study was situated within one Florida county and investigated the impact of a newly initiated end-of-course Civics examination upon middle school teachers’ instruction and student learning. High-stakes testing is often a polarizing issue regarding the perceived benefits and challenges for both students and teachers. Participating teachers completed surveys comprised of Likert-type items and short-answer questions inquiring about their instructional choices and resulting student learning with and without the presence of the Civics EOC examination. A subset of department instructional leaders were interviewed providing additional qualitative data with a wider scope due to their dual positioning as teachers and as links between the social studies teachers at their school and the School District of Sunshine County. The analysis of the data reveals that while civics teachers value the increased prestige brought to the subject area with the introduction of the end-of-course examination, the heightened importance of standards has a resulted in a focus on breadth of content coverage rather than depth of learning, leading to content-centered rather than student-centered classroom environments and subsequent loss of voice and choice in curricular decisions for teachers and students. Teachers feel intense pressure to cover the curriculum, raise test scores and engage in test preparation; they question the soundness of the examination to adequately assess the learning of all students and to capture the essence of civics education: active engagement. Teachers’ perspectives on the effect of the examination on teacher practice and student learning were framed within contextual factors that emerged in the analysis: the abandonment of the policy to introduce foundational content at the elementary level; a lack of communication among stakeholders, but particularly between state-level decision makers and local educators; and an absence of the ongoing scaffolding required to create a strong foundation of knowledge and skills to foster continued growth. Consequently, the recommendations of this study of educators’ voices on the policies that impact their profession are directed primarily at state level policy makers and future researchers regarding the flow of communication, inclusion of teacher feedback, continued teacher development, addition of a participatory component, and curricular alignment. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2018. / FAU Electronic Theses and Dissertations Collection

Why do some allies restructure their existing alliance relationships which they once favored, but some do not? In what ways do allies restructure their alliances? Historically interstate military alliances change their original agreements more than they remain the same, and the average duration of bilateral alliances is less than a decade. Theoretically, previous works have paid great attention mostly to the formation and duration of alliances. Answers to the above basic questions have been largely indeterminate, despite the fact that when allies change their original agreements, it reshapes the behaviors of both allies and non-allies. This study argues that when a state grows more powerful relative to its neighbors and external powers; and experiences a domestic regime change, the state is likely to restructure its exiting alliance relationship. These external and internal changes since the alliance formation cause the state’s original preference on the arms-and-allies balance to shift, and the state has greater incentive to restructure the existing alliance by way of dealignment, expiration, or renewal. In order to test the argument, this study first provides the quantitative results by testing 142 post-WWII alliances formed from 1946 to 2000, and identifies the statistically significant and substantial effects of three factors, capabilities increase, regime change (democratization and authoritarianization), and government change (both leadership and supporting coalition change), on the state’s alliance restructuring. Then this study qualitatively tests the quantitative findings and traces the causal process through case studies for three U.S. alliances in East Asia (the Philippines, South Korea, and Japan). The Philippine alliance restructuring in 1992 is examined as a typical case demonstrating that the argument empirically works. Then this study investigates why South Korea did not restructure the alliance with the U.S. in the 1990s even though the external and internal factors suggest that it would restructure. Lastly, the U.S.-Japan alliance case in 2009-2010 is examined to assess the explanatory power of the argument beyond the data population. An alliance restructuring can significantly affect an individual state’s security positively or negatively, therefore state leaders must continue to pay a close attention to the management of alliances.

Cognitive difficulties can persist for months and years after stroke and adversely impact confidence, mood and functional recovery. Stroke survivors, carers and healthcare professionals collectively agree that improving cognition is the number one research priority for life after stroke. Future research should include measurements of outcome that service users deem important. Patient reported outcome measures (PROMs) are a means of gaining patient perspectives that can be standardised for use in a trial. PROMs should be developed with service users to incorporate their priorities but people with cognitive difficulties are often systematically excluded from the development and use of PROMs. Study 1 used qualitative interviews (N=16) to explore stroke survivor perspectives on the important and measureable impacts of persisting cognitive problems. The results of this study generated requirements for a PROM that related to conceptual underpinning and face validity of a measurement tool. Study 2 was a systematic review of existing PROMs related to cognition. 20 Identified PROMs were critically appraised against the requirements generated in the qualitative study. No existing PROMs were identified that met all of the qualitative study review criteria. The next stage described in chapter 3, was to develop a new PROM that: utilised the strengths of existing tools; met qualitative study requirements; and was refined through consultation with different stakeholders, prioritising feedback of stroke survivors with cognitive difficulties. The result of this work was the Patient Reported Evaluation of Cognitive State (PRECiS) scale. Study 3 was a psychometric study with stroke survivors (N=164) to test PRECiS in a large sample. Quantitative and qualitative data were collected on acceptability, feasibility and other psychometric properties of validity and reliability. PRECiS demonstrated good acceptability to stroke survivors and performed well psychometrically. Future validation work required for PRECiS is described in discussion chapter 4. Subject to further validation work, PRECiS may be particularly useful for pragmatic trials of cognitive rehabilitation after stroke.

Do investment portfolios meet the needs and preferences of investors? Can the portfolio selection process be improved? Traditionally, investor preferences have been identified using risk tolerance questionnaires. These questionnaires have recently attracted a fair deal of criticism. However, there has been little focus as to whether the questionnaires are useful in predicting investors' risk-taking behaviour. In this thesis, an explanatory sequential mixed methods approach was employed to find answers to the primary research question: what factors determine risk-taking behaviour in investment decisions? This thesis looked at the risk-taking behaviour of investors in Canada (N=192) and the risk-taking advice provided by financial advisers in Canada (N=155), collectively risk-taking decisions. The results suggested that return expectations and demographic variables were important predictors of risk-taking decisions, whereas risk tolerance questionnaires were not. Further investigation suggested that investment literacy impacted risk-taking decisions while investment experience impacted both return expectations and risk-taking decisions. In a novel contribution by this thesis, additional perspective was provided by qualitative analysis using semi-structured interviews with investors and advisers. From the results of the qualitative analysis, the author suggests that discovery and self-discovery, a consistent approach and a focus on process versus outcome are key attributes valued by both investors and advisers. The thesis concluded with implications and recommendations for stakeholders, including a greater focus on return expectations, more training in discovery for advisers, simulating investment experience for prospective investors and including investment literacy in school curricula.

Non-communicable diseases are on the increase worldwide, causing more than 36 million deaths each year. Evidence of the link between the role of nutrition and reducing non-communicable diseases is predominant in the literature. The factors influencing intervention strategies/policies and activities, however, need attention. AIM: The study aims to examine the factors that influence nutrition interventions within the United Arab Emirates’ healthcare system. METHOD: This research adapts an interdisciplinary approach where a triangulation mixed methodology is applied. Both qualitative and quantitative methods are used, through the analysis of ten interviews with policy makers, four case studies and 161 questionnaires. Furthermore, the research framework, which emerged from the literature search and qualitative analysis, is tested and validated by rigorous quantitative analysis using SPSS. The statistical analysis, using factor analysis, MANCOVA and ranking analysis aims to provide solid support for the resulting factors. MAIN FINDING: The study identifies five factors that influence nutrition interventions in a healthcare system, and could enhance the effectiveness of nutrition interventions. The factors are 1) quality and processes, 2) training and use of technology, 3) senior management involvement and responsibility, 4) patient diversity, and 5) multidisciplinary teams. CONCLUSION: This study contributes to the emerging literature on management in nutrition interventions and the theory and importance of preventative measures in relation to nutrition. This study provides a roadmap for policy makers to adopt in order to enhance the role of nutrition interventions in healthcare settings.

Doctor of Philosophy / Curriculum and Instruction Programs / Jacqueline Spears / The purpose of this study is to explore the classroom configurations and technologies used to mediate instruction to female students in gender-separated classrooms at Qassim University and Alfaisal University in Saudi Arabia. The study describes the methods used, evaluates and compares the effectiveness of the approaches, and describes the issues and challenges that female students and their male professors face in gender-separated classrooms. The study was conducted using a sequential exploratory mixed-methods design and contains two phases, a qualitative phase and a quantitative phase. Two theoretical frameworks, Community of Inquiry and Technology Acceptance model, were used to guide the data collection in the qualitative component of the study. The results of the qualitative component were then used to develop a survey instrument that was used to collect data from a larger sample of the population. The qualitative phase focused on identifying the approaches used to mediate instruction to female students and explored the experiences of female students and male professors in gender-separated classrooms. A multiple case study design was used for collecting and analyzing the qualitative data. It included observations of five gender-separated classrooms that are equipped with different technologies and classroom configurations in Qassim and Alfaisal universities, focus groups made up of female students, and interviews with the male professors who taught those classes. Based on the themes and findings from the qualitative study, a survey instrument was developed and distributed to a sample of female students and male faculty members who teach female classrooms at Qassim University. The quantitative data enabled the researcher to report findings reflective of a larger and more diverse sample of female students and male professors at Qassim University. In conclusion, the qualitative phase of this study identified five different classroom configurations used in gender-separated classrooms: VCR, CCTV, and VC at Qassim University and Double deck and Partition at Alfaisal University. VCR was found to be the least effective classroom configuration due to the numerous technical problems associated with its use and limited instructional capabilities. CCTV was found to have fewer technical problems but also had limited instructional capabilities. VC also had fewer technical problems and advanced instructional capabilities, making it the most effective classroom configuration observed at Qassim University. At Alfaisal University, Partition classrooms appeared to be the most effective due to the enhanced educational experience provided by face-to-face instruction in the small sized classrooms. Double deck classrooms were found to be less effective. Students reported feeling isolated and disconnected in the classroom.

Philosophiae Doctor - PhD / Have South African women's lives become happier since the transition to democracy? If they are, could this be linked to gender equality? This is the central question of this study. This study explored a group of women’s subjective experiences of gender equality, by which I mean equality on the basis of gender; and happiness, which refers to women’s life satisfaction and their affective state. It further explores whether gender equality and happiness are linked. The study assumed that everything being equal, endeavours to liberate women from patriarchy and towards gender equality enhance women’s happiness. 1994 ushered in a democratic South Africa and numerous legislative and policy changes were introduced that affect women. Considerable gains have been made at the constitutional and political levels for women’s equality and gender justice. This is reflected in the rankings of South Africa on many different indices. Yet, we see numerous challenges facing women including poverty and gender-based violence. This study examined whether the presence of a range of policies as well as affirmative and protective measures for women have impacted on how they experience their lives. In particular, do they feel that they are happy and do they see happiness as linked to gender equality efforts? Given the research question, this study was grounded within a feminist framework. A mixed methods approach utilising both qualitative and quantitative methods was employed.

For students with learning disabilities, positive academic achievement outcomes are a chief area of concern for educators across the country. This achievement emphasis has become particularly important over the last several years because of the No Child Left Behind legislation. The content area of mathematics, especially in the higher order thinking arena of algebra, has been of particular concern for student progress. While most educational research in algebra has been targeted towards remedial efforts at the high school level, early intervention in the foundational skills of algebraic thinking at the elementary level needs consideration for students who would benefit from early exposure to algebraic ideas. A key aspect of students' instruction with algebraic concepts at any level is the degree and type of preparation their teachers have received with this content. Using a mixed methods design, the current researcher investigated the usage of the Developing Algebraic Literacy (DAL) framework with preservice special education teacher candidates in an integrated practicum and coursework experience. Multiple survey measures were given at pre-, mid-, and post- junctures to assess teacher candidates' attitudes about mathematics, feelings of efficacy when teaching mathematics, and content knowledge surrounding mathematics. An instructional knowledge exam and fidelity checks were completed to evaluate teacher candidates' acquisition and application of algebraic instructional skills. Focus groups, case studies, and final project analyses were used to discern descriptive information about teacher candidates' experience while engaging in work with the DAL framework. Results indicated an increase in preservice teachers' attitudes towards mathematics instruction, feelings of efficacy in teaching mathematics, and in the content knowledge surrounding mathematics instruction. Instructional knowledge also increased across preservice teacher candidates, but abilities to apply this knowledge varied across teacher candidates', based on their number of sessions working with students within their practicum site. Further findings indicate the desire of preservice teachers to increase the length and number of student sessions within the DAL experience, as well as the need for increased levels of instructional support to enhance their own experience. This study provides preliminary support for utilizing the DAL instructional framework within preservice teacher preparation experiences for future special educators.

Emergency contraception is a safe and effective form of contraception that is 75%-89% effective in preventing pregnancies within 120 hours of unprotected intercourse. Emergency contraception is a type of hormonal contraception, containing high doses of estrogen and progestin (ethinyl estradiol plus levonorgestrel) or progestin only (levonorgestrel). Wider access to emergency contraception has the potential to decrease the number of unintended pregnancies and abortions in the U.S. The Food and Drug Administration (FDA) has previously denied any over-the-counter (OTC) access to emergency contraception and only recently approved it for OTC status for women 18 years old and over; therefore, pharmacists continue to play a critical role in providing access to emergency contraception. For example, pharmacists can answer women's questions, dispel misconceptions, advise medical colleagues, and provide important information about the medication to clients. Although emergency contraception is a safe and effective medication, many pharmacists and pharmacies throughout the U.S. have either refused to fill prescriptions of emergency contraception or have refused to carry and stock emergency contraception. Pharmacists' perceptions and practice affect whether women have access to this form of contraception and whether pharmacies carry this medication. In addition, pharmacists' behavior, professional conduct, and ethical practice and training have major implications for public health and access to care for women, children, and families. This study has two purposes: First, because the attitudes and dispensing practices among pharmacists may be related to their understanding of the medication, a review of pharmacy school curricula in the U.S. was conducted, and involved (a) an assessment of course content related to emergency contraception and (b) an analysis of how this content is perceived by pharmacy students. The second purpose of the study is to assess emergency contraception knowledge, attitudes, subjective norms, perceived behavioral control, and dispensing practices of pharmacists and to determine if pharmacists' emergency contraception knowledge, attitudes, subjective norms, and perceived behavioral control are predictive of their dispensing practices. To reach these ends, a mixed-methods study design was employed using mixed methods data analysis techniques including coding methods, univariate, bivariate, and logistic regression.