Over 5 million older adults with diabetes are hospitalized each year. Though typically not the index condition that leads to hospitalization, diabetes control often decompensates during the course of an admission and necessitates changes in home self-management plans. The specific transitional care needs of older adults with diabetes have been largely unstudied. Transition theory provided the guiding framework for this research and proposes that each transition is a complex process created by the continuous interaction of personal, community, and societal-level conditions that facilitate or inhibit the health of a transition. Hospitalization has been described as a series of three successive, interrelated transitions. The aims of this study were to determine whether personal and community transition conditions impacted the early and intermediate post-discharge outcomes in a sample of older adults with diabetes. A simultaneous quantitative/qualitative mixed method design was used to identify factors that impacted the home recovery transition experiences in a sample of 96 older adults with a mean age of 75 years. A supplementary content analysis of free-response data gathered during administration of the Post-Discharge Coping Difficulty Scale (PDCDS) clarified difficulties encountered by elders and caregivers during in the first 30 days following discharge. Four overarching themes emerged: "the daily stuff is difficult"; "engineering care at home is difficult"; "life is stressful" and "difficulty managing complex health problems". Difficulties managing a complex medication regimen, regulating blood glucose, and managing a non-diabetes chronic health problem such as hypertension and chronic lung disease were subthemes that emerged during qualitative data analyses. These subthemes were transposed into discrete nominal level variables and served as additional indicators of post-discharge coping difficulty in the descriptive correlational core component of the research project. Participants in this study who experienced an event of recidivism had lower pre-discharge assessments of readiness on the Readiness for Hospital Discharge Scale (RHDS) (t = 2.274, df = 48, p =.028). Higher PDCDS scores were observed in patients who experienced an event of recidivism within 30 days of discharge (t = -3.363, df=24.7, p = .003) and also in respondents who described difficulties with managing medications, controlling diabetes, and managing a chronic illness. Binary logistic regression was used to identify factors that may predict recidivism risk. No condition-specific predictor variables were identified. A statistically significant three-variable model (X2 = 26.737, df = 3, p < .001) revealed that PDCDS scores at 7 days (Wald X2 =3.671, df = 1, p =.050), PDCDS scores at 30 days (Wald X2 = 6.723, df = 1, p =.010), and difficulty managing a chronic health condition (Wald X2 = 8.200, df = 1, p =.004) were predictive of an event of recidivism within 30 days of discharge. Difficulty managing a chronic health problem other than diabetes was particularly predictive of recidivism. The nurse's skill in delivering discharge education was a factor in limiting early postdischarge difficulties. Elders with residual information needs on the day of discharge as measured by scores the Quality of Discharge Teaching Scale (QDTS) reported a lower readiness for discharge (r = -.314, p = .003) and experienced greater difficulties with early post-discharge coping (r =. 288, p = .023). Greater satisfaction with the post-discharge transition was noted in participants with higher QDTS scores (r = .444, p < .001). Outcomes of the hospital-to-home transition experience were impacted by a variety of personal, hospital, and community factors. Findings of this study suggest that there is a need to better understand the sequential nature of the home recovery transition and the fluid needs of older adults during this high-risk phase of care. The environments in which older adults receive post-discharge care are complex and need to be thoroughly considered when planning the postdischarge transition. Metrics of institutional performance of transitional care practices need to extend beyond events to recidivism and include evaluations of post-discharge coping and transition satisfaction. The nurse as the primary provider of discharge education has the potential to significantly promote positive transition outcomes for older adults and their family care providers.

Since the 1970s we have witnessed a flourishing of transitional justice efforts around the globe. Yet, the actual impact of transitional justice is in question. This study assesses the impact of transitional justice with a single-case study of South Korea, the May 18 Democratic Movement (5.18) case in particular. In addition to the impact assessment, my dissertation provides an explanation on how transitional justice mechanisms exert their impact. To assess the impact of transitional justice, the study examines three dimensions - civil-military relations, historical narratives and institutional safeguards against human rights violations – which are essential in deterring further human rights violations by states. After process tracing the evolution of each dimension for the last 36 years, the study finds that transitional justice in South Korea has had a positive impact on deterring human rights violations since the democratic transition: the impact on civil-military relations and historical narratives is strong and positive, and the impact on institutional safeguards is positive, but somewhat limited due to South Korea’s unique security circumstances. Although the implementation of transitional justice mechanisms was imperfect and their impact is limited in some domains, on balance, the benefits of pursuing transitional justice in the South Korean case outweighed any possible costs – benefits in terms of (1) strengthening civilian control over the military, (2) creating a new historical narrative that delegitimated human rights abuses, and (3) creating institutional safeguards against human rights violations. Despite the possible negative consequences, the South Korean experience suggests that if transitional justice is pushed by strong public demand and properly implemented (sequence, timing, etc.), it can actually be more profitable and fruitful in establishing a society in which human rights are well respected and protected. The study also finds that transitional justice is a long and non-linear process, and not only the outcome but also the process itself produces a positive impact. / 2025-11-30T00:00:00Z

Thesis (Ph.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / To describe the structural strains and cultural conflicts that take place when two social systems confront each other, the concept of Transitional Role was used to analyze the sociological adaptation in the social system, and the concept of Perceptual Distortion of Transitional Roles by different groups was usee to analyze the strain and conflict that continued. In order to locate, describe and analyze Transitional Roles in Ghana, Nigeria and Sierra Leone, the social science reserach in five categories of Husbands and Wives, Buyers and Sellers, Priests and Pastors, Administrators and Agitators and Servants and Masters was examined. In order to evaluate the Perceptual Distortion of the Transitional Roles described, the available social science reserach was compared with two samples of novels (those by West Africans and those by Europeans) about West Africa. The following were the findings: (1) Social strain and culture conflict affect both groups, West African and European. (2) Social strains exist in all the above aspects of colonial life. (3) Despite severe dual systemic strain, the colonial social system operated as one viable social system. (4) Not all social strains are resolved immediately by the creation of Transitional Roles and therefore, the historical development of Transitional Roles indicates that they continue to change. (5) Social circles formed around transitional roles and as these social circles proliferated, the basis of a new society was established. Thus a positive resolution of social strain has been located and described in the development of Transitional Roles. The findings of this study resulting from the application of Levels of Transition to culture conflict indicate that: (1) the European novelists see culture conflict as maladjustment existing with the individual African either in the form of reversion to an earlier evolutionary stage or in the form of poor imitation of British culture; and they do not see their own involvement in culture conflict; (2) the African novelists, in contrast, locate culture conflict between the various Levels of Transition or within social relationships between the numerous West African social circles, and secondarily between British and West African Transitional Roles. The findings of this study resulting from the evaluation of Perceptual Distortion suggest that (1) Transitional Role incumbents are more accurate observers than are stabilized role incumbents. (2) Perceivers observe members of their own social system of origin more accurately than they perceive a foreign social system. (3) Segregation, "Time Lag" and ideology distort perception. This analysis substantiates the proposition that novels are of limited value as sources of sociological insights unless they are compared with social science research and unless the orientation in terms of social membership of the novelist is known. The reading public in the est, to the extent that it has depended upon European novels as its source of information about West Africa, is inadequately informed. Americans who rely on this fictional material have looked at West Africa primarily through European eyes. / 2031-01-01

Many post-conflict societies, even those which have been free from active conflict for decades, continue to be heavily divided along the same lines on which the conflict was once fought. While active conflict might be a distant memory, the legacy of conflict ensures the group identities which either caused or were borne out of the conflict remain strong. Achieving a situation where a society truly lets go of the anger and resentment that fuels its divisions has proven to be an allusive prospect, however, it’s a goal many post-conflict states continue to reach for. The effort a state uses to try to deconstruct these potentially harmful social identities and to deal with the conflict-related grievances which strengthen them can be loosely understood as post-transitional justice. Part of the reason why effective reconciliation has proven so difficult is that post-transitional justice typically requires societies to reopen old wounds and publicly address challenging memories. Thus, in the context of divided post-conflict societies, post-transitional justice, if not properly implemented, can itself be a divisive procedure and one that risks heightening tensions rather than reducing them. Despite this clear risk, little research has been conducted to understand what factors are likely to make the difficult process of introducing post-transitional justice more or less successful. This thesis addresses this research gap. It uses a social identity approach to examine how socio-political context influences group identification and inter-group behaviour in divided societies and how these behaviours subsequently impact how those groups perceive post-transitional justice mechanisms. This thesis draws on the timely case of Northern Ireland, which is in the process of introducing a wide-reaching post-transitional justice mechanism at a time when the socio-political context has been markedly challenged by Brexit and other socio-political events. Through a mixed methods approach which used both questionnaires and key informant interviews, this thesis demonstrates how the recent socio-political context in Northern Ireland has significantly heightened nationalist and unionist identification with their groups and has concurrently heightened tensions between the two groups. This thesis shows how this environment has subsequently made these groups less likely to accept the terms of the post-transitional justice mechanism, thus limiting its ability to reach its goal of creating an enabling environment for reconciliation, trust, and peacebuilding.

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Background: Transitions out of hospital result in poor outcomes for older people. Research investigating transitions for care home residents living with dementia is limited, even though such residents often have multi-morbidities and frequently use hospital services. Nurses are key care providers. Yet their perspectives on optimising care for people living with dementia transferring back to their care home remains under explored. Aims: This qualitative descriptive study explores hospital and care home nurses’ perspectives on how they optimise care for people living with dementia who transfer from hospital back to their care home, and the alignment of this care with best practice. Methods: Thirty-three nurses participated in either semi structured interviews or focus groups. Data were analysed using qualitative content analysis. Results: Nurses described four roles: 1) exchanging information, 2) assessing and meeting needs, 3) working with families and 4) checking and organising medication. They described care home residents with dementia as having distinct needs and variation in how they provided care. Nurses described interdependent roles, but care home nurses were often excluded from involvement in planning resident’s care on return and were not fully recognised as members of wider healthcare teams. Facilitators for optimising care include: nurses understanding the principles of dementia care, nurse leadership and autonomy, having positive relationships between hospital and care home nurses and opportunities for joint working. The care practices nurses described broadly aligned with best practice. Implications: Hospital and care home nurses require joint working opportunities to understand their roles and build relationships. Care home nurses’ status needs to be addressed with action to support their integration into the wider healthcare system. / Alzheimer’s Society (UK)

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