Central Appalachia experiences disproportionate rates of poverty. Historical exploitation has resulted in a lack of trust in others. Appalachia Service Project (ASP) utilizes interpersonal interactions as a way to market their free home repair services to a hesitant region. This study is an extension of a qualitative project about the link between housing repairs and health. The purpose is to highlight the impact that positive interaction with ASP has on willingness to receive assistance through service organizations in rural East Tennessee. Twenty-eight phone interviews were recorded through Zoom and thematic analysis was done using NVivo software. Twenty-four (86%) of those interviewed increased in their willingness to receive assistance based on their positive experience. Themes included being treated with dignity and respect, quality time, the intergenerational interface, reciprocity, and being spiritually uplifted. Further research is suggested regarding the affect religious communities, honor culture, rurality, and industrial ties have on willingness to receive assistance.

Background: Child development in developing countries is often evaluated using assessment tools created for 'Western' settings. Recent work has demonstrated that, for certain developmental milestones, 'Western' tools may be inaccurate as they include items unfamiliar to children of different cultural settings. Methods: We used qualitative methods to gather information about normal development in an African setting. Ten village and two professional focus group discussions (FGDs) were conducted. We used purposive sampling methods to recruit groups of mothers, grandmothers and men in four areas of Southern Malawi for village FGDs. Separate FGDs were carried out with professionals working in areas relating to child development. A thematic content analysis established main patterns and themes and dissemination of results and continued feedback allowed for respondent validation and reflection of results. The information then gathered was used to create questions for a revised Malawian developmental assessment tool. Results: Social and gross motor milestones were the main focus of interest for village and professional FGDs with the latter creating new language and fine motor concepts. Social milestones highlighted included 'duties and chores', 'sharing' and 'taking up leadership roles'. Language milestones included 'reporting events' and 'shrugging to indicate no' and fine motor milestones included 'peeling bananas', 'sorting maize' and 'making patterns with bottle tops'. Intelligence was described in relation to social and community integrity rather than 'Western' concepts of numeracy and literacy. Conclusions: Concepts, ideas and language relating to normal development in a sub-Saharan African setting have been gathered in this study. These have been used to create items for a more culturally appropriate developmental assessment tool.

Although Canada is a bilingual country, official language minority community patients struggle to access quality care in their language. This reality has been of concern for Francophone minority communities in Ontario, but has seldom been examined in a nursing context. This research sought to examine the lived experiences of registered nurses and nursing students providing care to French-speaking patients in Ontario, as well as the realities of Francophone patients seeking French language health care services in Ontario. The conceptual frameworks guiding the study were the “Four Levels of Change for Improving Quality” model and the “Four-Level Model of the Health Care System.” Using qualitative phenomenological inquiry, as influenced by Martin Heidegger and Max van Manen, 31 semi-structured interviews were conducted with three subsets (n=10 Francophone patients; n=10 nursing students; n=11 registered nurses) throughout Ontario who had experience with the phenomenon being investigated. Data collection took place over a year (2018-2019) and was analysed thematically. Significant findings were identified across the three groups. Participants revealed the patchwork of individual actions taking place to remedy the existing gaps regarding care for Francophone minority populations. This included navigating a health care system where good enough care was the unfortunate standard for Francophone patients, and discussing how Francophone patients and nursing care providers implement strategies individually to manage the lack of resources for Francophone patient populations in Ontario. This thesis asserts that official language minority communities and their nursing care providers remain faced with difficulties providing and receiving care in Ontario. While numerous structures and resources exist to remediate the problems, these interventions and resources are not always implemented systemically, leading to a disproportionate burden on individuals, significant risks for safety for patient populations, and ethical dilemmas for nursing care providers. Recommendations are provided to bridge the gaps and ensure considerations of the needs of linguistic minorities throughout the health care system.

Over the last several years, there has been an increased awareness regarding consensual sexual relationships (CSRs) between professors and students. Specifically, there has been a growing movement for academic institutions to develop policies addressing, discouraging, and/or prohibiting these relationships due to the potential for sexual harassment cases. Even though the appropriateness of such relationships has been widely debated among the university community, a limited amount of empirical work has examined this issue with the majority focusing on attitudinal studies. The current exploratory study consists of a content analysis of 278 faculty and student responses to the question, “If there is a difference between consensual sexual relationships and sexual harassment, what is it?” Responses indicate that there are several overlapping themes for both faculty and students in how they view these differences, with a large number of responses specifically indicating themes such as “CSR is consensual” while “sexual harassment is one sided.” There are also some unique perspectives given by faculty regarding the complexities and acceptability of CSRs, who are generally more specific and nuanced in their answers. Considering the complexities of this issue, it is the recommendation of the current study that much more research fully exploring the attitudes of faculty and students is needed to develop a well-rounded and comprehensive policy.

Background The trajectory of recovery after sepsis varies. Survivors may have considerable ongoing limitations, requiring a caregiver for a prolonged period. Objectives To learn about experiences, quality of life, coping, resilience, and social support of caregiver caring for survivors of sepsis. Methods We conducted a convergent mixed-methods study, recruiting informal caregivers of patients who had survived sepsis in the past year and were readmitted to the intensive care unit with sepsis. Individual face-to-face, semistructured interviews and validated surveys on quality of life, coping, caregiver burden, resilience, and social support were administered to caregivers. Interview transcripts were analyzed using content analysis. Surveys were scored and summarized using descriptive statistics. Results Caregivers were primarily middle-aged, White, and female. Half were spouses of their care recipient. Caregivers reported some deficits in mobility, pain, and anxiety/depression. Coping styles varied, with engaged coping being more prevalent. Most caregivers reported mild to moderate burden, all reported either normal or high resilience levels, and types of social support were similar. However, interviews and survey findings were not always consistent. Major themes that emerged from the analysis included (1) advocating for and protecting their loved one, (2) coping with caregiving, (3) uncertain future, (4) rewards of caregiving, and (5) need to optimize communication with family. Discussion Caregivers of sepsis survivors are protective of their care recipient and use a variety of strategies to advocate for their loved one and to cope with the uncertainty involved in a new intensive care unit admission. More advocacy and support are needed for this population.

In this study, I explored marriage and family therapist interns' growth experiences, both personal and professional, and the interplay between them. Participants discussed, using Internet discussion board and chat room formats, different kinds of personal experiences that influenced their clinical growth (as well as the reverse) and how these growth processes came about. Family systems theory provided the theoretical framework and Constructivism theory guided the manner in which the study was conducted. Thirteen marriage and family therapist interns from ten accredited MFT programs participated in the discussion board portion of the study. During the chat room interview, which took place at the end of the study, four participants elaborated upon their growth experiences and the reciprocal influence between their personal and professional lives. This study highlighted numerous personal, clinical, and professional growth experiences that played significant roles in the participants' lives. Participants identified experiences that were categorized as either "sources of growth" (what led to growth?) or "kinds of growth" (how did they grow?). For example, personal therapy and work experiences were noted as influential sources of growth for their clinical work. Family Systems Theory, whether discussed in a classroom setting or implemented in the clinic room, was considered influential on their personal lives. Participants' mentioned various kinds of personal and clinical growth experiences such as self-awareness, perspective-taking, and open-mindedness. To conceptualize and illustrate therapist interns' recursive growth processes, a theoretical model was developed. / Master of Science

Magister Pharmaceuticae - MPharm / Diabetes mellitus is a complex chronic condition and has become a major public health concern worldwide. Many diabetic patients are accessing primary health care (PHC) clinics for diabetes care. Diabetic patients who are considered stable are referred to chronic diseases of lifestyle club at the PHC facility. Effective management of this chronic condition requires a multidisciplinary team approach to diabetes care. Pharmacists are not often included in a multidisciplinary team and would consist of doctors, nurses and dieticians. Teams may be expanded and require specialist healthcare members’ expertise who can assist in the management of this disease, for example, ophthalmologists and podiatrists. Adherence to standard treatment guidelines (STGs) for the management of diabetes by healthcare professionals at a primary care level can improve glycemic control, decrease health costs and reduce the development of long-term diabetic complications.

Background: Patients with mental illness often experience stigma and marginalization, which affects the quality of their healthcare. In most settings, end of life decisions, including goals of care, must be discussed with all patients upon hospital admission. This includes determining cardiopulmonary resuscitation preferences, in the event of a medical emergency. Despite this requirement, category status conversations do not routinely occur in psychiatry. It is common for psychiatric inpatients, including those at high risk for cardiac or respiratory arrest, to be admitted, cared for, and discharged without their category status known or documented. By default, patients become a ‘full code status’, which mandates life-sustaining interventions, including CPR. Unwanted interventions are often unsuccessful and inappropriate. They might also cause harm through increased pain and suffering or have no medical benefit. Aim: To explore how and why category status conversations occur, or do not occur, for patients admitted to psychiatry. Methods: This was a descriptive qualitative study, with data collected through two semi-structured focus groups. Nine nurses working in psychiatry, representing two campuses of a larger tertiary care academic hospital in Ottawa, Ontario participated. Elo and Kyngäs’s approach to inductive content analysis was used to analyze the verbatim transcripts of the focus group discussions. Findings: Findings reveal the shared experiences of nurses initiating and engaging in category status conversations with patients admitted to psychiatry. Four overarching categories were identified: ‘The Psychiatric Culture’, ‘Being a Psychiatric Patient’, ‘Physical Health Status’, and ‘Suggestions and Recommendations’. Participants spoke about important considerations for the advancement of knowledge regarding category status conversations in psychiatry, including the nurse’s role in category status determination, the challenges of implementing a ‘one-size fits all’ approach to category status policies, and the ways in which HCPs perceptions of patients who are receiving care for depression or suicidal ideation influence these conversations in psychiatry. Conclusion: Nurses working in psychiatry care for patients with complex medical and psychiatric comorbidities, who are also sometimes older and frail. Category status determination for these patients is complicated and often the documented status is based on clinician presumption rather than consultation with the patient. Although the importance of completing category status conversations with patients admitted to psychiatry is known, they seldomly occur, and there is ambiguity about the nursing role within the psychiatric context. Efforts are needed to improve nurses’ contributions to category status determination for patients admitted to psychiatry, to ensure that patients’ preferences are known and upheld. Further, there are illness-related factors that complicate typical processes used to discuss and identify patient preferences, such as suicidal ideation and minimal family support. These considerations must be accounted for in hospital policy if meaningful practice change is expected.

This study utilized life history as a methodological tool to explore the identity formation of Mary, a woman in her eighties who is diagnosed with Alzheimer's disease. The results of this study showed that Mary's sense of self was greatly influenced by her childhood experiences. Five predominate themes emerged in the interview process: Mary's admiration for her father, her willingness to share wisdom, her career as a beautician, her role as a mother, and her devotion as a wife. The Dynamical Identity Model was constructed to help further illustrate Mary's identity development and the model served as a basis to describe possible outcomes in Mary's life, as a woman diagnosed with Alzheimer's disease. Her story reveals that Mary has a wonderful disposition about life and, even though she was diagnosed with this disease, she does not perceive the disease as threatening. / Master of Science

Poor software quality leads to lost profits and even loss of life. U.S. organizations lose billions of dollars annually because of poor software quality. The purpose of this multiple case study was to explore the strategies that quality assurance (QA) leaders in small software development organizations used for successful software quality assurance (SQA) processes. A case study provided the best research design to allow for the exploration of organizational and managerial processes. The target population group was the QA leaders of 3 small software development organizations who successfully implemented SQA processes, located in Saint John, New Brunswick, Canada. The conceptual framework that grounded this study was total quality management (TQM) established by Deming in 1980. Face-to-face semistructured interviews with 2 QA leaders from each organization and documentation including process and training materials provided all the data for analysis. NVivo software aided a qualitative analysis of all collected data using a process of disassembling the data into common codes, reassembling the data into themes, interpreting the meaning, and concluding the data. The resulting major themes were Agile practices, documentation, testing, and lost profits. The results were in contrast to the main themes discovered in the literature review, although there was some overlap. The implications for positive social change include the potential to provide QA leaders with the strategies to improve SQA processes, thereby allowing for improved profits, contributing to the organizations' longevity in business, and strengthening the local economy.