The provision of ultra-safe healthcare relies upon investment in robust systems of work. The transition of care between healthcare providers has been shown to contribute significant risk to patients, so much so that the improvement in handover was listed as one of the top five priorities for the World Health Organisation in 2014. Current handover practices have been evaluated in medicine using numerous techniques on the qualitative – quantitative continuum. The systematic evaluation of published literature revealed a paucity of evidence in relation to the optimal transfer of patient care. As a consequence, the post-operative handover was evaluated by first undertaking semi-structured interviews of anaesthetic, recovery and surgical staff. Differences of opinion were discovered between professional groups involved in the post-operative handover. These differences have the potential to fuel inter-professional conflict. The handover process was seen as being vulnerable to the effects of outside agencies, with time pressure being most to blame. The post-operative handover was observed and a novel handover intervention was introduced, with the primary objective of reducing multi-tasking and improving information accuracy. The intervention combined education of handover error alongside standardisation of the process. The introduction of a bed-side aide memoire to separate the transfer of equipment from standardised information transfer was introduced with staff involvement. Prior to the introduction of the handover intervention, core information points such as the patient’s name and allergies were frequently omitted and the process was often beset with distraction from concomitant activities. Both of these factors improved following the introduction of the intervention. These findings support previous revelations in handover that transitions are frequently not optimised to reduce risk in the patient pathway. However, it is feasible to ameliorate this risk by introducing a low cost quality improvement intervention which aims to standardise what can otherwise be haphazard working practice.

This dissertation advances previous research on the journalistic interpretive community by placing news at the center of a community's construction of place. By focusing on the construction of Iowa City, Iowa's "Southeast Side" - neighborhoods home to predominantly newly arrived black residents from Chicago and other urban areas - this study identifies dominant news characterizations of the Southeast Side that mark the place as a "ghetto" or "inner city." Beyond providing information about community issues and social conditions from southeastern neighborhoods, the term Southeast Side performed a singular ideological purpose: to identify and maintain dominant community values throughout the rest of Iowa City. Racialized and stereotyped news narratives of urban people, places, and problems in a place called the Southeast Side created an ideological boundary between those in and outside the Southeast Side. Such a boundary subjugated the Southeast Side's cultural diversity and its people, presenting them as being counter to Midwestern values and a threat to notions of a safe, white and historically homogeneous community. Indeed, the creation of Southeast Side was just as much about creating an "inner city" as it was about constructing notions of Iowa City itself. Through mental mapping, this project then compares dominant news characterizations to those made by Southeast Side residents, journalists, and public officials. In the end, this study explores cultural meanings that emerged from examining the similarities or differences between the place-making of residents, journalists, and news sources. This study reveals place-making as a fundamental role of the journalistic community and identifies another ideological function of the press in that they assign power and meanings by describing news by where it happens. Journalists and media scholars have long talked about the press as improving community journalism to meet the notion of the public sphere. Yet, this dissertation is not another such study that only encourages journalists to alter how they report on local news and communities. Instead, this study suggests that journalists and scholars recognize the cultural power of journalistic place-making and the challenge to their authority to do so by residents from a particular place.

Drawing upon two forms of qualitative data—interviews with trustees and national trade association publication archival documents—and employing an abductive theory building strategy based on my analysis of higher education governance in the present day and historically, I perform an organizational etiology of U.S. higher education governing boards and governance. Studying governance in higher education lends itself to theory building, as governance lacks a strong basis of comparability, distinguishable from firm-based or other non-profit enterprise governance. Further, while governing boards are principal parties of authority, the shared governance framework almost universally privileges participation by a host of stakeholder parties. Further, the targets of governance, colleges and universities, are comparatively complex and ambiguous in terms of goals, priorities, purposes, products, and strategic interests, as well as in terms of operational, professional, hierarchical, and financial models of sustainability and advancement. I deconstruct governing boards, governance, and governing at several levels of consideration to find that explicit and ubiquitously understood organizational and work objectives and practices of governance conceal a state of organizing that necessitates considerable attention, deliberation, strategic action, and investment of resources by governing boards. It is the state of organizing itself that is a consummate and pervasive focus of attention and consideration. Governance and governing is an ongoing process or state of organizing characterized by a readiness to examine, address, and act upon boundaries of organization, profession, and work practices. As much as governing boards govern institutions, boards govern boundaries, and multiple kinds of boundaries at multiple levels of consideration at that. While boundary work implies work at the periphery, the boundary work of governance and governing boards is itself core to the organization and work performed. I dissect cognitive and practice-based dimensions of governing, ordering perceptions and explanations of the form of work being done by boards as professional organizations, and by tracing the broader culture and history of the field of governance, and show how boundaries and boundary work are a consuming strategic focus. Boards are enduring institutions with paradoxically unenduring boundaries. I find and describe how these boundaries share a set of traits and propensities indicative of a form of organizing without theoretical match or explanation: organizational amorphousness. I build the case for amorphousness throughout and, in the conclusion, explain how governing boards, the field of governance, and the work and practices of governing represent extreme cases of an evolved organizing predicated on dexterity and contingency. This form of organizing seemingly contradicts basic assumptions of organizing and begs the question as to what functions boards actually serve, as well as to what effect.

Man-made objects are an expression of both the social organisation in which they were produced and the communicative context in which they appear and are used. In this respect, they represent easily accessible material, which is highly suitable for and useful in reconstructing the social structures in organisations and opening up latent structures of meaning for analysis. Nevertheless the analysis of physical materials has tended to live a shadow existence. This paper presents a hermeneutic method of analysing artefacts in organisations. The basic concept centres on the reconstructing of the processes of meaning and organising in social systems. After providing a brief introduction to the methodological principles, the paper goes on to discuss this method in greater detail. Concrete examples of the study of specific materials in an organisational analysis context are used to ground the interpretation of artefacts in the overall organisational analysis context. The paper closes with a discussion of the possibilities and limitations of this kind of analysis. (authors' abstract) / Series: ["p_series_typename_S48" not defined]

Little is known about the perceived changes in identity and sense of self in individuals with aphasia. Seminal research using qualitative methods and personal narratives has been conducted in England regarding the experience of living with aphasia (see for instance Parr, Byng, Gilpin & Ireland, 1999; Parr, Duchan & Pound, 2003; Byng, Pound & Hewitt, 2004), but the use of such methodologies is still emergent in the United States. In addition, despite the great achievements of the disabilities movement in countries such as the U.S. and the U.K., individuals with aphasia have remained largely at the margins due to the very nature of their impairment (Pound & Hewitt, 2004). How can one reflect upon and adjust to the changes brought about by a disability when one is devoid of words? According to Brumfitt (1993), individuals with aphasia, especially during the acute stages of recovery, have the tendency to idealize their "prior self." However are these identities transformed in relation to the acquired disability as individuals enter the chronic stages? If so, are these changes perceived in the same manner by survivors and caregivers? The purpose of the present study was to investigate these perceptual changes in identity using a qualitative ethnographic methodology. Seven individuals with aphasia and five caregivers participated in in-depth ethnographic interviews addressing perceived changes in sense of self after the onset of aphasia. Interview analysis resulted in ethnographic narratives in which participants and caregivers reflected on their perceptions of change and adaptation to disability. Common themes included the discovery of new identities, the gradual compromise between rehabilitation and adaptation, divergent perceptions of change, and the role of support groups during the rehabilitation process. The study was concluded with reflections from the investigator and the participants on how the results from this research could be used in our clinical practice.

This thesis explores the impact of hepatitis C on women’s childbearing decisions and experiences of motherhood. A partial grounded theory approach was used, in which 34 women living with hepatitis C participated in semi-structured interviews to determine the direct and indirect effects of hepatitis C on their own personal decisions regarding childbearing and to describe their lived experiences of motherhood. The qualitative interview data were analysed thematically, in which common themes were identified and explored.¶ Three key areas are explored: women’s social experience of hepatitis C; hepatitis C and childbearing decisions; and the meaning of motherhood for women with hepatitis C.¶ The interviews revealed that living with hepatitis C had direct effects on the childbearing decisions of women. The direct effects of the virus which impacted on women’s childbearing decisions included poor physical and emotional hepatitis C related health, the perceived risk of vertical transmission of hepatitis C, concerns their future hepatitis C related health might impact upon their mothering abilities, and childbearing can conflict with treatment for hepatitis C. However, of greater importance to these women, appeared to be the indirect effects of living with a virus which is so highly stigmatised within our society. In particular, hepatitis C is closely associated with injecting drug use, which means these women are often assumed to possess the stereotypical characteristics associated with injecting drug users. As a result, they experience widespread medical discrimination and social rejection. Hepatitis C also impacts indirectly upon a wide range of factors that most women in contemporary society take into consideration in their childbearing decisions, for example, available social support, financial security and age.¶ The experiences reported by these women are discussed in terms of their concordance or discord with prevailing theories of deviance, stigma and the social construction of motherhood. The interview data, considered in light of such theories reveal that possibly the greatest impact that hepatitis C can have upon women is to prevent them from achieving a legitimate adult female status through childbearing and becoming a ‘good mother’.¶ The implications of these findings are discussed in terms of public health and social policy.

The Edmonton Drug Treatment and Community Restoration Court (EDTC) diverts substance-addicted offenders from the criminal justice system and provides intensive court supervision, case management, and links to social, employment and education support. This thesis aimed to generate a grounded theory of the process of participant engagement with the EDTC, drawing on staff and participant interviews and observation of EDTC operations. Criteria of engagement included meeting expectations, communicating openly and honestly, and forming bonds. Internal engagement was described as feeling hopeful and willing, and perceiving expectations as helpful rather than controlling. Perceptions underlying internal engagement involved motivation and openness to socialization and trust; feeling engaged resulting in the act of confronting issues rather than avoiding them. The process of engagement was a positive cycle, instigated and perpetuated through interaction with expectations and discipline, realizing and experiencing specific reasons to change, forming trust and accessing internal and external resources to address barriers.

Despite widespread health promotion and nutrition education efforts, gaps between official healthy eating messages and people’s actual eating practices persist. There is increasing recognition that emphasizing individual responsibility for eating may have limited applicability in improving people’s health. Many experts advocate that future research on healthy eating should involve exploration of how food practices are shaped by social structures (or determinants) and individual agency. The purpose of this study was to explore the ways in which people engage with food structures to construct everyday notions of healthy eating. ‘Food structures’ draws on the concept of ‘structure,’ described by the social theorist Anthony Giddens, to refer to the range of food rules and resources people draw on. The research was conducted as part of a qualitative study on family food decision-making that included 144 participants from 13 African Nova Scotian, 10 European Nova Scotian, 12 Punjabi British Columbian and 11 European British Columbian families. These groups were chosen for their potential differences in perspectives based on place, ethnocultural background and histories of immigration to Canada. Data collection consisted of individual interviews with three or more family members aged 13 and older, and, with each family, observation of a grocery shopping trip and a family meal. Analysis followed common qualitative procedures including coding, memoing and thematic analysis. Together, the analyses support views that the gaps between official healthy eating messages and people’s eating practices may not be closed by further education about how to eat. Drawing on the theoretical concepts of Anthony Giddens and Michael Foucault, the findings suggest that one way to understand why people eat the way they do and how changes in eating habits occur is to think about the constant exposure to change through everyday, taken-for-granted practices. The findings also suggest that further healthy eating discourses may require more reflection with respect to the roles of nutrition educators and the social roles/autonomy of people in goals for health and well-being. Dietary goals for the population cannot be considered as isolated scientific objectives without taking into consideration how healthy eating discourses provide social standards beyond messages about healthy eating.

Health policy making is fraught with difficult decisions that result from conflicts between people’s values. Citizens are important stakeholders in this process, and it is through methods of public engagement that they can be involved in developing health policy. Deliberative forms, in particular, have the ability to improve decision quality and promote greater acceptance of decisions. This study used the Toronto Health Policy Citizens Council to examine citizens’ values on 7 specific health policy questions asked over a two-year period. A thematic analysis was performed on the transcript content derived from the audiotaped deliberations from Council meetings. Nineteen values were identified. The results suggest that it may be a combination of factors of the health policy topic discussed that shapes the values elicitation seen in this kind of public engagement. In conclusion, citizens councils appear effective at eliciting citizens’ values, and are a good way to actively educate participants about health care.

Health policy making is fraught with difficult decisions that result from conflicts between people’s values. Citizens are important stakeholders in this process, and it is through methods of public engagement that they can be involved in developing health policy. Deliberative forms, in particular, have the ability to improve decision quality and promote greater acceptance of decisions. This study used the Toronto Health Policy Citizens Council to examine citizens’ values on 7 specific health policy questions asked over a two-year period. A thematic analysis was performed on the transcript content derived from the audiotaped deliberations from Council meetings. Nineteen values were identified. The results suggest that it may be a combination of factors of the health policy topic discussed that shapes the values elicitation seen in this kind of public engagement. In conclusion, citizens councils appear effective at eliciting citizens’ values, and are a good way to actively educate participants about health care.