Introduction The process of decision making has been widely studied within different academic paradigms. Many theories and models have been developed from this research activity. However, there is a lack of in-depth research on individuals’ experience of decision making. The present research explores this topic with Clinical Psychologists. This group of professionals are trained to be expert in a specific discipline, which emphasises the need for making informed judgements and for justifying decisions. Objectives To provide an in-depth account of how Clinical Psychologists experience decision making in the context of clinical practice. To relate the analysis to theories and models of decision making and to research on factors thought to influence judgement and decision making. Method Semi-structured interviews were conducted with seven Clinical Psychologists. These were transcribed and analysed using Interpretative Phenomenological Analysis (IPA) methodology. Outcomes Elements of the decision making environment such as managing one’s conflicting beliefs and difficult emotions, responding to uncertainty and changeable scenarios and normative versus unique elements of one’s practice were elucidated in the analyses. The contribution of this work to research in decision making and the development of clinical practice are discussed.

Introduction: Young people recovering from first episode psychosis experience a high degree of emotional distress and co-morbidity. Depression and social anxiety are highly prevalent following first episode psychosis and have been associated with poorer outcome, increased risk of suicide and lower quality of life. However, there is little research examining how these emotional difficulties relate to the course of psychotic symptoms and subsequent adaptation and recovery. The primary aim of this research was to establish a grounded theory of the experience of mood and anxiety related difficulties in young people who experience a first episode psychosis. Secondly, the research aimed to establish the underlying psychological factors contributing to the relationship between psychosis and affective dysfunction. Method: The study used a mixed-methods design with primacy given to the qualitative component (QUAL+quan). Young people (n=10) who had experienced a first-episode of psychosis were interviewed and completed measures of depression, social anxiety and recovery. Interviews were transcribed and analysed using a social constructivist version of grounded theory. Quantitative measures were integrated with the qualitative data, providing a framework for re-examining inferences made in the qualitative analysis. Results: The overarching theme to emerge was the experience of a developmental trajectory of psychosis. Seven key categories were identified: The build up; coping; breaking point; facing diagnosis; impact of illness; getting stuck and; moving on. Isolation, low mood and anxiety were universal outcomes and appeared to be mediated by maladaptive forms of coping and mood regulation in addition to psychological appraisals and negative illnessrelated experiences. Conclusions: The findings suggest that depression and social anxiety are not co-morbid features of psychosis but are intrinsically linked to the underlying processes involved in coping with and adapting to psychosis. Strengths and limitations of the research are discussed and implications for clinical practice and further research are reviewed.

The case study as a scientific method is, and has been for a long time, a subject of heavy discussion in the scientific community. Some scientists disregard the study completely and argue that it’s nothing more than story-telling, while others claim that the case study is the most relevant research method there is. As with all scientific methods case studies have both advantages and disadvantages and the aim of this study is to present and discuss these.

Patients admitted to the Intensive Care Unit (ICU) are critically ill and often at extremely high risk of death. These patients receive aggressive interventions to prolong their lives. Despite these measures, many patients still succumb to their illness. Although ICU physicians are good at predicting which patients have a high risk of mortality, they are still offering interventions that do not prolong life, but potentially cause more suffering at the end of life. This is because there is a lack of high quality and early communication to discuss prognosis and establish patients' goals of care. This gap in communication is even more profound when patients are transferring from rural hospitals to busy tertiary care centers. This dissertation discusses the utilization of tele-video conferencing to enhance early communication with family members/loved ones of critically ill patients prior to their transfer from a rural hospital to a tertiary care center. It begins with a description of telemedicine and its uses in the ICU to date. Chapter 2 discusses the poor prognoses of patients receiving high intensity interventions such as cardiopulmonary resuscitation (CPR). The extremely dismal outcomes underscore the importance of early, thorough discussions regarding prognosis and goals of care in these patients. The next chapter describes a pilot study utilizing telemedicine to conduct formal unstructured telemedicine conferences with family members prior to transfer. This study demonstrated that palliative care consultations can be provided via telemedicine for critically ill patients and that adequate preparation and technical expertise are essential. Although this study is limited by the nature of the retrospective review, it is evident that more research is needed to further assess its applicability, utility and acceptability. Chapter 4 describes an investigation into the barriers and facilitators of conducting conferences via telemedicine and the perceptions of clinicians regarding the use of telemedicine for this purpose. This chapter identified unique barriers and facilitators to the use of telemedicine that will need to be addressed when designing a telemedicine intervention for conducting family conferences. This thesis describes the importance and process of implementation of telemedicine for the novel purpose of enhancing early communication among physicians and family members of critically ill loved ones. Further studies are needed to refine and investigate patient and family centered clinical outcomes utilizing this intervention.

This study considers the contested meaning of public education through a qualitative investigation of Patrick Henry School of Science and Arts, a charter elementary school in Richmond, Virginia. The central research question that guides this study is “How do parents construct the idea of public schools as they explain their choice of Patrick Henry Charter School?” To answer this question I conducted a constructivist inquiry that involved a series of 16 semi-structured interviews with a maximum variation sample of Patrick Henry parents concerning their ideas about the school and about public education. The analysis of these interviews led to a grounded theory of the parents’ ideas as well as a case report constructed from the categorized units of data that explores the core themes of the theory. This study also addresses two sub-questions: (1) “How do the parents’ ideas about public schools reflect the logics embedded in the larger policy discourses concerning charters and the reinvention of public education?” and (2) “How do the parents’ ideas about public schools reflect the local public discourse around the public-ness of the school?” To answer the first sub-question I use my review of literature to develop an understanding of the reform debates around charter schools and their relationship to the contested ideas of public education. To answer sub question two, I present an adapted constructivist qualitative analysis of the public discourse that surrounded the school from April 2007 – when the idea of the school was first proposed at a school board meeting – until December 2011 – a year and a half after the school opened its doors. To capture the public discourse I collected and analyzed articles, editorials and letters from six local print publications (newspapers, weekly magazines) as well as the public comment portion of the minutes from Richmond School Board meetings. This analysis resulted in the construction of two competing narratives about the school, the juxtaposition of which shed light on the how idea of public-ness was constructed in the public discourse.

Background: Malignant cerebral glioma is a rare cancer but has a devastating impact on patients and their families. In Scotland each year, around 450 people are diagnosed with glioma. Prognosis is generally poor and treatment is essentially palliative. There is a growing recognition that non-clinical aspects of care for both patients and their families need to be acknowledged and integrated into health care provision in line with a patient-focused ethos of care. Currently, there is relatively little research exploring the psychosocial issues and needs of this patient group. Aims: To give patients being investigated for malignant cerebral glioma and their families the opportunity to describe their shared experiences of their illness journey and voice their concerns and unmet needs. To examine how these experiences and needs change over time as the patient progresses through the illness journey. To ascertain the extent to which these needs are recognised and supported, taking into accounts professionals’ views and making suggestions for steps forward in improving patients’ psychosocial care. Methods: A total of 80 qualitative prospective longitudinal interviews (30 paired and 50 separate) were conducted with 26 people with a suspected or confirmed diagnosis of malignant cerebral glioma being treated at a regional hospital and 24 primary relative/informal carers. Patients and carers were interviewed at the following five times: leading up to diagnosis; following a formal diagnosis; around the end of initial treatment (radiotherapy); at a designated six-month follow-up stage; and bereavement interviews with carers. One-off interviews were carried out with 66 health professionals (19 case-linked GPs and 47 other health, health-related and social care professionals involved in patients' care). Interviews were recorded and transcribed verbatim and analysed using the constant comparative method from a grounded theory approach assisted by QSR NVivo Version 7. Findings: Distress, anxiety and shock were overwhelming reactions in the period leading up to a diagnosis of glioma, making it difficult for participants to make sense of their experience. Over time, participants employed a range of strategies in order to cope with their diagnosis. Social and emotional support from professionals and friends, family and other patients were vital in many cases but support often felt inadequate. The role of information and the manner in which it was communicated was closely linked to participants’ ability to cope. Information needs were variable but on the whole patients and carers did not feel well informed. Dealing with cognitive and physical symptoms of their illness and side effects of treatment inhibited patients’ ability to resume their everyday activities. The lives of relatives were also affected as they struggled to care for their loved ones. People with a diagnosis of glioma were faced with the possibility of death from an early point in their illness trajectory and awareness of this, coupled with ability to make sense of existential issues, varied across participants. Issues around support, communication, information and palliative care were considered to be important among health professionals involved in the care of people with a diagnosis of glioma but provision fell short. Conclusions: Concerns regarding information, communication and support reported elsewhere in the literature are enduring in glioma patients and their relatives. Reporting of unmet psychosocial and supportive care issues by patients and recognition by professionals of the need to improve these dimensions of care for people affected by glioma emphasises previous recommendations yet to be fully implemented into patient care.

Doctor of Philosophy / Department of Sociology, Anthropology, and Social Work / Dana M. Britton / Historically, relationships between police and residents in minority communities have often been contentious. However most of the literature on race, place, and policing has focused on the policing of Blacks and their interactions with the police in urban settings. Building on this work, this study aims to capture similar processes of racialized policing as they occur in the suburbs. This project expands our understanding by exploring policing as it is carried out in a marginalized Black enclave located in a predominately white middle class suburb. Specifically, I focus on Meacham Park, which is a segregated enclave annexed to the nearby white community of Kirkwood, Missouri. Drawing on interviews with thirty African-American residents of Meacham Park, I explore how residents experience policing and their attitudes toward the police. The interviews reveal a contentious history of relations between residents and the police, and I discuss respondents’ accounts of specific experiences with police surveillance, harassment, and (in some cases) misconduct. However, though many respondents reported extremely negative attitudes toward the police, the great majority also reported at least some positive interactions and experiences. This study extends research on the policing of minority communities into a segregated suburban context and offers implications for improving relations between the police and minority communities.

Doctor of Education / Department of Educational Leadership / Sarah Jane Fishback / This qualitative case study sought to understand in what formative ways instructors in one teaching department of the U.S. Army Command and General Staff College (CGSC) used common summative assessments and what similar practices instructors used as a result of common summative assessments. This research analyzed data from semi-structured interviews with purposefully selected participants, instructors in the Department of Army Tactics at CGSC, a representative mixture of civilian and active duty. This research confirmed that the formative use of summative assessments was typical among Department of Army tactics instructors and that continued or expanded formative use of summative assessments will increase student learning. Because so much of assessment is context dependent, this research will add to the body of knowledge in a particular area that the current literature did not fully address; the formative use of common summative assessments in higher education. Four conclusions were drawn from analysis of this research. First, the formative use of common summative assessments, especially feedback given to students, was typical of the Department of Army Tactics instructor, essentially a normal part of the assessment process. Second, DTAC instructors did not have a common understanding of the difference between summative and formative assessment, how they used the information gathered was more important than what the instrument was labeled. Third, “teaching to the curriculum” instead of “teaching the test” was typical in DTAC, an indication that the instructors saw their role beyond just preparing students for upcoming assessments. Fourth, the stratification of students during the grading process was typical, with the unintended consequence of students not being judged on quality of work alone.

The purpose of the study was to explore juvenile offenders' perceptions of the counseling relationship. Eight juvenile offenders who were on probation under the jurisdiction of a juvenile court participated in the study. Using a phenomenological methodology, two interviews with each participant were conducted in order to obtain participants' full descriptions of the phenomenon of the counseling relationship. The main research question was: What are juvenile offenders' perceptions of the counseling relationship? Sub-questions were: (a) What are the themes and qualities that account for how feelings and thoughts connected to the counseling relationship are aroused?, (b) What are the underlying conditions that account for juvenile offenders' perceptions of the counseling relationship?, (c) What are the universal structures (e.g. time, space, bodily concerns, physical substance, causality, relation to self or others ) that precipitate feelings and thoughts about the experience of the counseling relationship?, and (d) What are the unique qualities of the experience that facilitate a description of the "counseling relationship" as it is experienced by juvenile offenders? Participants' descriptions provided a range of descriptions that were summarized in three thematic categories: Themes Related to Participants, Themes Related to Counselors, and Themes Related to the Process of Counseling Relationships. In addition, a composite textural-structural description of participants' experiences provided a holistic description of the phenomenon as lived by participants. Participants' experiences provided a greater depth of understanding of the counseling relationship with this challenging population from the perspective of juvenile offenders. Implications for juvenile offender counselors and counselor educators are discussed. Implications for phenomenological methodology are also discussed.

Thesis advisor: Marilyn Cochran-Smith / In recent years, the theme of social justice in teacher education programs has been the subject of considerable controversy, as it has become at once more popular and more vulnerable to criticism. More and more teacher education programs claim to prepare teachers to teach for social justice. Yet we know little about the experience of teacher candidates learning to teach in programs with explicit social justice agendas, and we know little about the impact of this agenda on teachers, and in turn, on the students they teach. This dissertation aims to increase our understanding of what it means for teacher candidates/graduates to be prepared in a teacher education program with a stated commitment to social justice. By focusing in depth on two cases studies with very different outcomes, my study examines the impact of this agenda on teachers and the students they teach over a relatively long period of time. A qualitative case study design was employed to collect and analyze data for two master's level teacher candidates/graduates over three years. Data included extensive interviews and observations, teacher candidates' coursework, the assignments the teachers created, and their students work in response to these assignments. In addition, interviews were conducted with teacher education faculty, as well as with cooperating teachers, mentors, supervisors, and principals. Based on a sociocultural framework, and drawing on Bakhtin's theories of discourse and ideological becoming, this dissertation argues that learning to teach in a program with a stated social justice agenda was a complex process of negotiating several different and, at times, competing discourses of social justice. These discourses represented a range of ideas, interpretations, and practices that the teachers had to investigate and adapt as they developed their own authentic perspective. Furthermore, the development of an authentic perspective as teachers for social justice required embracing tensions within and among these discourses, and recognizing that these tensions were essential to their development as educators for social justice. Finally, this dissertation argues that the case study teachers' relative success or failure engaging in this ideological struggle was influenced by the contexts in which their learning took place, the support they had to negotiate the challenges and tensions associated with learning to teach for social justice, and their own personal capacity to handle the conflicts they encountered. / Thesis (PhD) — Boston College, 2009. / Submitted to: Boston College. Lynch School of Education. / Discipline: Teacher Education, Special Education, Curriculum and Instruction.