http://hdl.handle.net/1974/172 2013-05-26T07:58:20Z 2013-05-26T07:58:20Z English, Christine http://hdl.handle.net/1974/8037 2013-05-24T05:09:36Z 2013-05-23T04:00:00Z

Title: Ontario’s Home First Approach, Care Transitions, and the Provision of Care: The Perspectives of Home First Clients and Their Family Caregivers Authors: English, Christine Abstract: Home First is an Ontario transition management approach that attempts to reduce the pressure on hospital and Long Term Care (LTC) beds through early discharge planning, the provision of timely and appropriate home care, and the delay of LTC placement. The purpose of this qualitative descriptive study was to obtain descriptions from South Eastern Ontario Home First clients and their family caregivers of their experiences with and thoughts about care transitions, the provision of care, and the Home First approach. The goal was to enable insight into the Home First approach, care transitions, and the provision of care through access to the perspectives of study participants. Nine semi structured interviews (and one or more follow-up calls for each interview) with Home First clients discharged from hospitals in South East Ontario and their family caregivers were conducted and their content analyzed. All participating Home First clients were pleased to be home from hospital and did not consider LTC placement a positive option. All had family involved with their care and used a mix of formal and informal services to meet their care needs. Four general themes were identified: (a) maintaining independence while responding (or not) to risks, (b) constraints on care provision, (c) communication is key, and (d) relationship matters. Although all Home First clients participating in the study were discharged home successfully, a sense of partnership between health care providers, families, and clients was often lacking. The Home First approach may be successfully addressing hospital alternative level of care issues and getting people home where they want to be, but it is also putting increasing demands on formal and informal community caregivers. There is room for improvement in how well their needs and those of care recipients are being met. Health professionals and policy makers must ask caregivers and recipients about their concerns and provide them with appropriate resources and information if they want them to become true partners on the care team. Description: Thesis (Master, Rehabilitation Science) -- Queen's University, 2013-05-23 16:10:53.323

2013-05-23T04:00:00Z Cameron Duarte, Jasmin Joan http://hdl.handle.net/1974/7876 2013-04-15T20:51:51Z 2013-04-15T04:00:00Z

Title: 'Expert Patient' in Health Professional Education: Experience of OT Students Authors: Cameron Duarte, Jasmin Joan Abstract: Patient-centred care is the gold standard of health care, yet in practice, problems prevail. The use of the ‘expert patient’ in health professional education is one form of learning patient-centred care. A gap in the literature regarding how the use of ‘expert patient’ in health professional education promotes patient-centred care was acknowledged in current research. With Queen’s University Health Sciences & Affiliated Teaching Hospitals Research Ethics Board approval, a sample of Queen’s University MScOT students participated in a qualitative study with the following research question: “How does the students’ experience of interacting with the ‘expert patient' (‘XP’) relate to learning regarding client-centred practice (CCP)?” Three objectives were proposed: 1. Describe the OT students’ experience of interacting with the ‘expert patient’, 2. Describe the students’ learning regarding client-centered practice, 3. Identify the conditions particular to the ‘expert patient’ experience that led to learning regarding client-centered practice. In-depth interviews were conducted with the students subsequent to their ‘expert patient’ experience. Analysis revealed three conditions that together provided the foundation for student experiential learning regarding client-centred practice: interaction with particular persons with stable disability known as ‘expert patients’; students’ requirement to evaluate them and thus ‘experience power’; and explicit opportunities for ‘directed reflection and discussion’. Questions were raised for researchers, health care professional educators and health care professionals regarding the potentially transformative nature of engaging in unfamiliar contexts with openness to learning. The thesis allowed insight into the lived experience of OT students learning with ‘expert patients’; and the admiration, discomfort, humility and gratefulness they experienced while gaining a sense of the meaning of collaboration, respect for autonomy and recognition of expertise. Implications of the research impact all stakeholders in health professional education. Description: Thesis (Master, Rehabilitation Science) -- Queen's University, 2013-04-15 08:39:19.094

2013-04-15T04:00:00Z White, CATHERINE http://hdl.handle.net/1974/7839 2013-03-05T06:06:41Z 2013-03-04T05:00:00Z

Title: RECOVERY AS A GUIDE FOR ENVIRONMENTAL ENHANCEMENT IN GROUP HOMES FOR PEOPLE WITH A MENTAL ILLNESS: A SOCIAL-ECOLOGICAL APPROACH Authors: White, CATHERINE Abstract: Background: As the paradigm underlying mental health care slowly shifts from an approach primarily institutional and medical in its orientation toward one more community-based and recovery-oriented, housing needs have come to the forefront. Many people with persistent mental illness accept group home living situations that do not necessarily meet their needs, and do not align with the recovery vision. Research focused on recovery for residents of group homes is all but absent in the literature. Purpose: The purpose of this study was to identify the challenges and opportunities for enabling group homes to increase their capacity to serve as an environment that integrates the recovery vision. Method: Using ethnographic methods, this case study examined the cultural milieu of a group home, how recovery is understood within the setting, and the impact of policies and practices on enacting the recovery vision. By converging multiple strategies for data collection (participant observation, key informant interviews, and document analysis), a multi-level perspective was achieved. The use of the social-ecological model, with its attention to multiple levels of influence, emerged as a highly relevant perspective, without which the recovery vision cannot be realized. Findings: The culture within the home revealed a comfortable atmosphere, basic needs being met, access to planned and unplanned activity, and caring relationships with staff, which contribute to a place attachment that could be difficult to loosen. There is a lack of awareness of recovery-enabling practice at multiple levels, which emerged as a key challenge to its implementation. Although some policies at the government level support self-sufficiency as an important objective, others make progress towards this ideal difficult, if not impossible, such as those related to funding. The focus on enhancing well-being in the day-to-day setting subsumes the growth goals associated with recovery. Conclusion: Integrating the recovery vision within group home could benefit from confronting well-established approaches, embracing advocacy roles, and addressing mechanisms for change at multiple levels. Only then will people with mental illness living in group homes reap the benefits of social justice, social inclusion and full citizenship that come with recovery. Description: Thesis (Ph.D, Rehabilitation Science) -- Queen's University, 2013-02-27 23:27:44.925

2013-03-04T05:00:00Z Graydon, Maclean http://hdl.handle.net/1974/7745 2013-01-15T06:05:22Z 2013-01-14T05:00:00Z

Title: Ground Reaction Forces in Feet with Morton's Syndrome Authors: Graydon, Maclean Abstract: Morton’s syndrome is a foot condition where the 1st metatarsal does not protrude as far distally as the 2nd metatarsal. Clinicians believe that short 1st metatarsal protrusion affects foot mechanics and leads to painful conditions of the foot. Normal protrusion ratio of the 1st and 2nd metatarsal has not been delineated in scientific literature, and little is known about the mechanics of feet with short 1st metatarsal protrusion beyond anecdotal clinical evidence. In the first part of this two-part study, a novel tool was developed to guide metatarsal measurement and reduce measurement error so values for normal metatarsal protrusion ratios could be established. In the second part, subjects were divided into those with shorter and longer than average 1st metatarsal protrusion ratio and we measured if there were any differences in the foot-floor forces between the two groups. In Part 1, the feet of 65 healthy subjects were measured with a novel measurement tool and it was determined that the average ratio (1st metatarsal/2nd metatarsal) was 0.902, suggesting a 1st metatarsal that does not protrude as far distally as the 2nd metatarsal. For Part 2, participants were divided into two groups: the short 1st metatarsal group had a ratio of more than one standard deviation below the mean (0.866 or lower) while the control group had a metatarsal ratio of more than one standard deviation above the mean (0.938 or higher). We hypothesized that short 1st metatarsal protrusion would cause an imbalance across the forefoot because the 1st metatarsal would not be able to carry the required load on the medial side of the foot; however, the results of the gait study did not show this as only forces in the walking direction near toe-off correlated with metatarsal protrusion ratio. We can only speculate as to the relationship between the metatarsal protrusion ratio and increased shear force in the walking direction, but it is possible that to compensate for the diminished stabilizing capacity of the shorter 1st metatarsal, the foot must push off with more force to propel the body forward. Description: Thesis (Master, Rehabilitation Science) -- Queen's University, 2013-01-14 14:38:55.255

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