Examining the Influence of the Patient Declaration of Values on Hospital Policies and Practices

The purpose of this study was to explore how a leading Ontario hospital operationalizes their Patient Declaration of Values (PDoV) in policy and in practice. This was a single case study, which took place in a leading patient-centred Ontario hospital. The study included 18 individual interviews with employees and patient experience advisors, as well as, document analysis of strategic planning reports (n=10). Five themes emerged: (1) setting the stage, (2) inspiring change, (3) organizational structures, (4) organizational and environmental barriers, and (5) reflection and improvement. This study has highlighted the role of the PDoV within a leading Ontario hospital. It lends itself to providing a process with core strategies for creating change in an acute health care organization; to embed a culture of patient and family centred care.

Exploring the experiences of parents with children who have communication delays, as a population at risk for the development of behavioural concerns

Existing research identifies preschoolers with communication delays as a population at risk for the development of behavioural concerns. This risk increases when additional environmental factors such as parental stress and family conflict are also present. Research has also shown that behavioural concerns can be stable over time when they develop early. However, early intervention has been shown to be effective in addressing these concerns. The effectiveness of early intervention in addressing both child and family outcomes increases when interventions are delivered in a family-centred approach. This research project made use of data related to child behaviour and parenting, gathered through the Family Resource Project which explored the parenting experiences and resource access and allocation decisions of families who have preschool children with and without communication delays. Cluster analysis was used to explore whether there were identifiable clusters of children and families within each sample. Interview data fi"om each identified family cluster was then explored further, to identify how parents described their child's behaviour and their experience of parenting. Results show that, within this sample, parents of preschoolers with communication delays described their child's behaviour and their experience of parenting differently than did parents of children without communication delays. Results also showed that within this sample parents experiencing parental stress and/or family conflict described their child's behaviour and their experience of parenting differently than did parents from other clusters. Results suggest support for early intervention and the use of family-centred intervention, particularly for families of children with communication delays.

Athletic injury care training in high school coaches

The purpose of this qualitative study was to understand the client and occupational therapist experiences of a mental health group. A secondary aim was to explore the extent to which this group seemed to have reflected a client-centred approach. The topic emerged from personal and professional issues related to the therapist as teacher and to inconsistencies in practice with the profession's client-centred philosophy. This philosophy, the study's frame of reference, was established in terms of themes related to the client-therapist relationship and to client values. Typical practice was illustrated through an extensive literature review. Structured didacticexperiential methods aiming toward skill development were predominant. The interpretive sciences and, to a lesser extent, the critical sciences directed the methodology. An ongoing support group at a community mental health clinic was selected as the focus of the study; the occupational therapist leader and three members became the key participants. A series of conversational interviews, the . core method of data collection, was supplemented by observation, document review, further interviews, and fieldnotes. Transcriptions of conversations were returned to participants for verification and for further reflection Analysis primarily consisted of coding and organizing data according to emerging themes. The participants' experiences of group, presented as narrative stories within a group session vignette, were also returned to participants. There was a common understanding of the group's structure and the importance of having "air time" within the group; however, differences in perceptions of such things as the importance of the group in members' lives were noted. All members valued the therapeutic aspects of group, the role of group as weekly activity and, to a lesser extent, the learning that came from group. The researcher's perspective provided a critique of the group experience from a client-centred perspective. Some areas of consistency with client-centred practice were noted (e.g., therapist attitudes); however the group seemed to function far from a client-centred ideal. Members held little authority in a -relationship dominated by the leaders, and leader agendas rather than member values controlled the session. Possible reasons for this discrepancy ranging from past health care encounters through to co-leader discord emerged. The actual and potential significance of this study was discussed according to many areas of implications: to OT practice, especially client-centred group practice, to theory development, to further areas of research and methodology considerations, to people involved in the group and to my personal growth and development.

Occupational therapist and client experiences of a mental health group

The purpose of this qualitative study was to understand the client and occupational therapist experiences of a mental health group. A secondary aim was to explore the extent to which this group seemed to have reflected a client-centred approach. The topic emerged from personal and professional issues related to the therapist as teacher and to inconsistencies in practice with the profession's client-centred philosophy. This philosophy, the study's frame of reference, was established in terms of themes related to the client-therapist relationship and to client values. Typical practice was illustrated through an extensive literature review. Structured didacticexperiential methods aiming toward skill development were predominant. The interpretive sciences and, to a lesser extent, the critical sciences directed the methodology. An ongoing support group at a community mental health clinic was selected as the focus of the study; the occupational therapist leader and three members became the key participants. A series of conversational interviews, the . core method of data collection, was supplemented by observation, document review, further interviews, and fieldnotes. Transcriptions of conversations were returned to participants for verification and for further reflection. Analysis primarily consisted of coding and organizing data according to emerging themes. The participants' experiences of group, presented as narrative stories within a group session vignette, were also returned to participants. There was a common understanding of the group's structure and the importance of having "air time" within the group; however, differences in perceptions of such things as the importance of the group in members' lives were noted. All members valued the therapeutic aspects of group, the role of group as weekly activity and, to a lesser extent, the learning that came from group. The researcher's perspective provided a critique of the group experience from a client-centred perspective. Some areas of consistency with client-centred practice were noted (e.g., therapist attitudes); however the group seemed to function far from a client-centred ideal. Members held little authority in a relationship dominated by the leaders, and leader agendas rather than member values controlled the session. Possible reasons for this discrepancy ranging from past health care encounters through to co-leader discord emerged. The actual and potential significance of this study was discussed according to many areas of implications: to OT practice, especially client-centred group practice, to theory development, to further areas of research and methodology considerations, to people involved in the group and to my personal growth and development.

Families of the traumatically brian-injured : a case study approach to perceptions of quality of service, degree of satisfaction, and family needs /

The purpose of this qualitative research study was to foster an understanding of the rehabilitation counselling practice offamilies of the brain-injured. Specifically, the study explores the perceptions of stakeholders in regards to the degree of satisfaction with the quality of service received. Questionnaires were administered, and semi-structured, openended interviews were conducted, with six participating families (n=8). Preliminary data were collected via two instruments: (i) the Family Participant Questionnaire, consisting of participants' sample characteristics, information pertaining to the history of the family, details of the injury, and information relating to the type, use, and need offamily services utilized; and (ii) the Community Integration Questionnaire, a measurement of the degree of social displacementllevel of community integration of the injured family member. Utilizing the procedural steps outlined by Colaizzi's (1978) method of protocol analysis, recommendations for a future program based on related and current family needs are discussed in detail. Substantiating and supporting information are offered to rehabilitation practitioners, educational planners, and policymakers alike, concerning the degree of satisfaction with rehabilitative service, and the means of improving upon the overall quality of health care to families of the brain-injured. Implications for clinical practice and research are also raised for discussion.

Changes in education and student-centred learning as related to senior secondary school English

The main purpose of this thesis is to t r ace broadly the educational changes in the past two decades showing a shift of emphasis from a teacher-directed, content-centred philosophy of teaching to a self-directed, student-centred mode of learning. The major justification for an Independent or an Individualized Learning programme with emphasis on "the response to literature approach" is 2 to produce the independent learner. Comprehensive r eading and t he use of t he ERIC system reveal widespread educational thought and practice related t o Individualization and Independent Study as a really democratic way of learning with freedom, independence and responsibility.

Letting go : a self-study utilizing critical literacy as method in improving my practice /

This is a Self-study about my role as a teacher, driven by the question: "How do I improve my practice?" (Whitehead, 1989)? In this study, I explored the discomfort that I had with the way that I had been teaching. Specifically, I worked to uncover the reasons behind my obsessive (mis)management of my students. I wrote of how I came to give my Self permission for this critique: how I came to know that all knowledge is a construction, and that my practice, too, is a construction. I grounded this journey within my experiences. I constructed these experiences in narrative fomi in order to reach a greater understanding of how I came to be the teacher I initially was. I explored metaphors that impacted my practice, re-constructed them, and saw more clearly the assumptions and influences that have guided my teaching. I centred my inquiry into my teaching within an Action Reflection methodology, bon-owing Jack Whitehead's (1989) term to describe my version of Action Research. I relied upon the embedded cyclical pattern of Action Reflection to understand my teaching Self: beginning from a critical moment, reflecting upon it, and then taking appropriate action, and continuing in this way, working to improve my practice. To understand these critical moments, I developed a personal definition of critical literacy. I then tumed this definition inward. In treating my practice as a textual production, I applied critical literacy as a framework in coming to know and understand the construction that is my teaching. I grounded my thesis journey within my Self, positioning my study within my experiences of being a grade 1 teacher struggling to teach critical literacy. I then repositioned my journey to that of a grade 1 teacher struggling to use critical literacy to improve my practice. This journey, then, is about the transition from critical literacyit as-subject to critical literacy-as-instmctional-method in improving my practice. I joumeyed inwards, using a critical moment to build new understandings, leading me to the next critical moment, and continued in this cyclical way. I worked in this meandering yet deliberate way to reach a new place in my teaching: one that is more inclusive of all the voices in my room. I concluded my journey with a beginning: a beginning of re-visioning my practice. In telling the stories of my journey, of my teaching, of my experiences, I changed into the teacher that I am more comfortable with. I've come to the frightening conclusion that I am the decisive element in the classroom. It's my personal approach that creates the climate. It's my daily mood that makes the weather As a teacher, I possess a tremendous power to make a person's life miserable or joyous. I can be a tool of torture or an instrument of inspiration. I can humiliate or humour, hurt or heal. In all situations, it is my response that decides whether a crisis will be escalated or de-escalated and a person humanized or de-humanized. (Ginott, as cited in Buscaglia, 2002, p. 22)

Wellness and balance: perceptions amongst female health care professionals negotiating career, family, and continuing education /

The purpose ofthis study was to explore the perceptions of wellness and bidance amongst female health care professionals negotiating career, family aiul continuing education commitments. Five women who met the criteria of having a family (with children), holding a full-time professional career in health care, and who were presently pursuing continuing education were interviewed. This paper begins with the introduction to the topic of research and the questions to be answered. The review of literature explores the theory and research A^ch precede this study and addresses the surrounding areas of: wellness, balance, multiple roles, stress and continuing education. < This study has assumed a qualitative, phenomenological approach. The data collected through the use of individual interviews were analyzed using a two-part process. Analysis using both (a) methodological interpretation and (b) The Listening Guide method has allowed for the uncovering of major themes, and the portrayal of each participant's unique experience. Some of the major themes which emerged from this research include: wellness as multidimensional and fluctuating, making personal sacrifices, the presence of stress, professional as a vital role, and continuing education as something for me. Perhaps the most significant finding this research has identified is the positive role continuing education can hold in the lives of women already negotiating multiple commitments. The notion that continuing education can act as a means of enhancing perceptions of wellness and balance holds a number of implications in theory, practice, and for future research.

Examining the influence of family support on diabetes education behavioural outcomes

The purpose of this study was to examine the influence of family support on diabetes education behavioural outcomes, specifically in relation to diet, exercise, and blood glucose monitoring in adult individuals with Type 2 diabetes. Fifty-three individuals attending diabetes education for the first time were followed approximately 1 month. The findings for the influence of family support were mixed. Family attending diabetes class with participants had a positive influence with respect to diet. This is consistent with Carl Rogers (1969) who espouses setting a positive climate for learning and that learning new attitudes or information comes when external barriers are at a minimum. However family attending class with participants had no influence with respect to exercise or blood glucose monitoring. The family support action of encouraging with respect to diet overall did not influence healthy eating behaviours except for decreased skipped meals and scheduled snacks. In fact, in the areas of family willing to make healthy choices along with participant, the less the family was involved in encouraging, the better the participant did. Exercise on the other hand was influenced positively by family encouragement. This is consistent with Bandura's theory that enhancement of self-confidence and self-efficacy can lead to desired behaviour changes. Family encouragement however did not appear to influence blood glucose monitoring behaviours. This study has implications for practice in that diabetes education programs can encourage family to attend classes or get involved in encouraging the person with diabetes, so that it may help to increase healthy eating behaviours and exercise. As time is necessary to implement changes in behaviour, future research can look at the influence of family support over a 6-month, I-year, or greater period.

Early childhood pedagogical practice within a cultural kaleidoscope

Please consult the paper edition of this thesis to read. It is available on the 5th Floor of the Library at Call Number: Z 9999 E38 K39 2006

Exploring the Family Context Among Children Adopted From China: Perceptions of Pre-Adoption Factors, Post-Adoption Experiences, and the Quality of Parent-Child Relationships

Within the context of international adoption, previous research has focused on parentchild attachment relationships and various aspects of the adoption process. However, less is known about other aspects of parent-child relationships (e.g., cohesion, conflict) within internationally adoptive families. Additionally, there is a need for research that explores both parent and child perceptions of the process of adoption - including pre- and post-adoptive factors - and its connection to the quality of parent-child relationships. This research utilized a qualitatively-oriented methodology to conduct separate, in-depth interviews with 10 adoptive Canadian mothers and their adopted Chinese children (aged 9 to 11 years). Results highlight parent and child reports of mainly strong, positive relationships. Several pre-adoption experiences are examined, including institutionalization, age at the time of adoption, and parental stress/expectations. A key finding concerns the link that adoptive parents perceive between the quality of their child's pre-adoptive care (i.e., mainly early institutionalized care) and the quality of their relationship. Interestingly, this link is perceived in two different ways - either as a challenge for the parent-child relationship or as a means to strengthen it. Post-adoption experiences are also explored, including cultural socialization, creating a transracial family, discussing adoption, parental stress, and sibling involvement. A key finding involves parent and child reports that cultural socialization efforts (i.e., familiarizing children with Chinese culture) are linked to more positive parent-child relationships. The implications of these findings are discussed in relation to theory and practice within the context of international adoption.