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- Creators: Arizona State University
- Creators: Fleury, Julie
Description
Nurses are using health information technology during patient care activities in acute care at an unprecedented rate. Previous literature has presented nurses' response to technology obstacles as a work-around, a negative behavior. Using a narrative inquiry in one hospital unit, this dissertation examines nurses' interactions when they encounter technology obstacles from a complexity science perspective. In this alternative view, outcomes are understood to emerge from tensions in the environment through nonlinear and self-organizing interactions. Innovation is a process of changing interaction patterns to bring about transformation in practices or products that have the potential to contribute to social wellbeing, such as better care. Innovation was found when nurses responded to health information technology obstacles with self-organizing interactions, sensitivity to initial conditions, multidirectionality, and their actions were influenced by a plethora of sets of rules. Nurses self-organized with co-workers to find a better way to deliver care to patients when using technology. Nurses rarely told others outside their work-group of the obstacles that occurred in their everyday interactions, including hospital-wide process improvement committees. Managers were infrequently consulted when nurses encountered technology obstacles, and often nurses did not find solutions to their obstacles when they contacted the Help Desk. Opportunities exist to facilitate interactions among nurses and other members of the organization to realize better use of health information technology that improves quality and safety while decreasing cost in the patient experience.
ContributorsLalley, Catherine (Author) / Malloch, Kathy (Thesis advisor) / Fleury, Julie (Committee member) / Danzig, Arnold (Committee member) / Arizona State University (Publisher)
Created2013
Description
In the United States, under the provisions set forth by a policy known as community benefit, nonprofit hospitals receive special tax exemptions from government in exchange for providing a wide range of health care services to the communities in which they are located. In recent years, nonprofit hospitals have claimed billions of dollars as community benefit justifying their tax-exempt status. However, growing criticism by numerous stakeholders has questioned the extent to which the level of community benefit claimed by nonprofit hospitals reflects the exemptions they receive. In addition, a dearth of research exists to understand the relationship between community benefit claims and the impact they have on improving the health of communities. In an effort to better understand the relationship between community benefit claims, tax status, and community health outcomes this study examines the community benefit policies of a nonprofit healthcare system representing hospitals in California, Nevada, and Arizona. It does so by reviewing materials produced by the system, her hospitals, vested stakeholders, and government that have shaped the development, implementation, and assessment of community benefit policy processes. Findings of the study suggest that the majority of nonprofit hospital community benefit claims are consumed by shortfalls reported between costs associated with providing care to Medicare and Medicaid patients and the compensation nonprofit hospitals receive from government. Results of the study also demonstrate that community benefit policies do positively impact the health of communities. However, future community benefit policies need to be refined to include measures that capture the magnitude of community health improvement if the relationship between policy and health outcomes is to be fully realized.
ContributorsMartz, Mark Patrick (Author) / Cayer, Joseph (Thesis advisor) / Glaser, Mark (Committee member) / Corley, Elizabeth (Committee member) / Arizona State University (Publisher)
Created2013
Description
Family caregivers are a quickly growing population in American society and are potentially vulnerable to a number of risks to well-being. High stress and little support can combine to cause difficulties in personal and professional relationships, physical health, and emotional health. Siblings are, however, a possible source of protection for the at-risk caregiver. This study examines the relational and health outcomes of gratitude exchange between caregivers and their siblings as they attend to the issue of caring for aging parents. Dyadic data was collected through an online survey and was analyzed using a series of Actor-Partner Interdependence Models. Intimacy and care conflict both closely relate to gratitude exchange, but the most significant variable influencing gratitude was role. Specifically, caregivers are neither experiencing nor expressing gratitude on the same level as their siblings. Expressed gratitude did not relate strongly or consistently to well-being variables, though it did relate to diminished negative affect. Implications for theory, the caregiver, the sibling, the elder, the practitioner, and the researcher are addressed in the discussion.
ContributorsAmaro, Lauren M (Author) / Miller, Katherine I. (Thesis advisor) / Alberts, Janet K. (Thesis advisor) / Updegraff, Kimberly (Committee member) / Arizona State University (Publisher)
Created2014
Description
Some disabled users of assistive technologies (AT) have expressed concerns that their use of those AT devices brings particular attention to their disability and, in doing so, stigmatizes them in the eyes of their peers. This research studies how a wide range of design factors, influence how positively or negatively users of wearable technologies are perceived, by others. These factors are studied by asking survey respondents to estimate the degree to which they perceive disabilities in users of various products. The survey was given to 34 undergraduate Product Design students, and employed 40 pictures, each of which showed one person using a product. Some of these products were assistive technology devices, and some were not. Respondents used a five-bubble Likert scale to indicate the level of disability that they perceived in this person. Data analysis was done using SPSS software. The results showed that the gender of the respondent was not a significant factor in the respondent's estimation of the level of disability. However, the cultural background of the respondent was found to be significant in the respondent's estimates of disability for seven of the 40 pictures. The results also indicated that the size of AT, its familiarity to the mainstream population, its wearable location on the user's body, the perceived power of the user, the degree to which the AT device seemed to empower the user, the degree to which the AT device was seen as a vehicle for assertion of the user's individuality, and the successfulness of attempts to disguise the AT as some mainstream product reduced the perceived disability of the user. In contrast, symbols or stereotypes of disability, obstructing visibility of the face, an awkward complex design, a mismatch between the product's design and its context of use, and covering of the head were factors that focused attention on, and increased the perception of, the user's disability. These factors are summarized in a set of guidelines to help AT designers develop products that minimize the perceived disability and the resulting stigmatization of the user.
ContributorsValamanesh, Ronak (Author) / Velasquez, Joseph (Thesis advisor) / Black, John (Committee member) / Herring, Donald (Committee member) / Arizona State University (Publisher)
Created2014
Description
This research is particularly concerned with organizations’ advocacy of value-based change aimed at improving consumers’ well-being. This work contributes to the Transformative Services Research area and presents a conceptualization of the value-laden service organization (VLSO), which I define as organizations that advocate for specific value-based behaviors from consumers both within and beyond the particular service setting.
In a VLSO, consumers are expected to act in accordance with the values of the organization. If the consumer’s pre-existing value system is not aligned with the values of the service organization, the consumer may experience a sense of psychological disequilibrium, which can lead to unintended decrease in well-being. This research explores how value conflicts are managed by both the organization and by the consumers.
This work emerges out of an interpretive study of a Catholic-based homeless shelter for pregnant women. From it, I identify the practices of consumers and the service organization and explored their interactions. This has resulted in a theoretical conceptualization of a Rescue Institution, which combines aspects of both a Total Institution and a Reinventive Institution in a unique way. Further, I conceptualize a cycle of agency and authenticity that maps the dynamics of the consumer in a VLSO as they negotiate the structure/agency duality.
In gathering data, I used an interpretive approach over the course of three years’ of direct involvement with a service organization, St. Mary’s House. My methods included participant observation, collection of artifacts, and one-on-one in-depth interviews. I interviewed a total of 30 participants, whose transcribed interviews resulted in over 1500 pages of text. Analysis of themes and concepts occurred as a result of repeated examinations of both existing theory and data.
My findings reveal key organizational and consumer practices that negotiate the tension between structure and agency. Organizational practices include rules and social norms, as well as two forms of hierarchy. Consumer practices, often in response to organizational practices, include a cycle of agency and authenticity and participation in a shadow structure. These practices collectively influence consumer’s interpretive drift, which is their adoption of the organization’s values that creates internalized change. I conclude with implications for theory and service organization management. First, value priorities mean that tradeoffs must be made, which can cause unexpected and painful conflict. The experience of change, from both the consumer and service provider perspective, can be very messy. This process includes a dynamic and individual negotiation of authenticity and agency, which will be of interest in future studies. The service providers must be open to this process, carefully navigating their responses to the consumer’s dynamic authenticity, agency and values. Service providers should expect and acknowledge the conflict in consumers’ experience in order to foster their long-term perspective and perseverance.
In a VLSO, consumers are expected to act in accordance with the values of the organization. If the consumer’s pre-existing value system is not aligned with the values of the service organization, the consumer may experience a sense of psychological disequilibrium, which can lead to unintended decrease in well-being. This research explores how value conflicts are managed by both the organization and by the consumers.
This work emerges out of an interpretive study of a Catholic-based homeless shelter for pregnant women. From it, I identify the practices of consumers and the service organization and explored their interactions. This has resulted in a theoretical conceptualization of a Rescue Institution, which combines aspects of both a Total Institution and a Reinventive Institution in a unique way. Further, I conceptualize a cycle of agency and authenticity that maps the dynamics of the consumer in a VLSO as they negotiate the structure/agency duality.
In gathering data, I used an interpretive approach over the course of three years’ of direct involvement with a service organization, St. Mary’s House. My methods included participant observation, collection of artifacts, and one-on-one in-depth interviews. I interviewed a total of 30 participants, whose transcribed interviews resulted in over 1500 pages of text. Analysis of themes and concepts occurred as a result of repeated examinations of both existing theory and data.
My findings reveal key organizational and consumer practices that negotiate the tension between structure and agency. Organizational practices include rules and social norms, as well as two forms of hierarchy. Consumer practices, often in response to organizational practices, include a cycle of agency and authenticity and participation in a shadow structure. These practices collectively influence consumer’s interpretive drift, which is their adoption of the organization’s values that creates internalized change. I conclude with implications for theory and service organization management. First, value priorities mean that tradeoffs must be made, which can cause unexpected and painful conflict. The experience of change, from both the consumer and service provider perspective, can be very messy. This process includes a dynamic and individual negotiation of authenticity and agency, which will be of interest in future studies. The service providers must be open to this process, carefully navigating their responses to the consumer’s dynamic authenticity, agency and values. Service providers should expect and acknowledge the conflict in consumers’ experience in order to foster their long-term perspective and perseverance.
ContributorsRiker, Elise Briggs (Author) / Anderson, Laurel (Thesis advisor) / Ostrom, Amy (Committee member) / Dobscha, Susan (Committee member) / Arizona State University (Publisher)
Created2015
Description
The relationship between parent and child acculturation gaps and the child's well-being for Asian American families, with the child's perceived family conflict as a potential mediating variable were examined in this study. In addition to linear relationships of acculturation gaps, curvilinear relationships were also examined. The sample consisted of 165 first or second generation Asian Americans, aged between 18 to 22. Results indicated that native culture gap is predictive of participants' self-report of depression, and family conflict did function as a mediator to the relationship between native culture gap and depression. The curvilinear relationship between acculturation gaps and well-being was not supported by the results of the study. Further implications and future directions are discussed.
ContributorsShi, Yue (Author) / Tracey, Terence (Thesis advisor) / Homer, Judith (Committee member) / Atkinson, Robert (Committee member) / Arizona State University (Publisher)
Created2015
Description
Due to the history of colonization, disruption of Indigenous life ways, and encroachment of external Western ideals and practices upon tribal peoples in New Mexico, the protection and preservation of tribal customs, values, traditions, and ways of thinking are critical to the continued existence of the tribes. It has taken many years for tribal communities, such as the 19 Pueblos of New Mexico, to get to where they find themselves today: In a paradoxical situation stemming from the fact that Pueblo people are told to pursue the iconic American Dream, which was not actually designed or intended for tribal peoples and that always seems to be just out of reach for many community members. Yet many of them do their best to emulate the capitalistic consumption and the Western way of life. What is troubling about this is that perhaps many of these people are starting to forget that it was the strength of their ancestors and their dreams that allowed Pueblo people to be here today. So, how do Pueblo people address this paradox? How do they begin to give newer generations, such as the youth, the tools to question and to assess future programs and the future of the tribal communities? Furthermore, what does such a process of preserving and reclaiming mean for future governance? Are these communities prepared to accept the outcomes?
This compilation seeks to address these issues by examining a) the creation and delivery of Western medicine for American Indians in New Mexico and b) a discussion of Pueblo culture and belief systems. The exploration will include not only discussing health and health care concerns, but it will also engage the future considerations that tribal governments in New Mexico, specifically Pueblo Indian communities, must reflect on to ensure the preservation of the culture and values of Pueblo people. Finally, specific recommendations for action and discussion will be delivered in the form of a policy paper that is designed for tribal leadership and tribal administrative audiences and suggested for implementation.
This compilation seeks to address these issues by examining a) the creation and delivery of Western medicine for American Indians in New Mexico and b) a discussion of Pueblo culture and belief systems. The exploration will include not only discussing health and health care concerns, but it will also engage the future considerations that tribal governments in New Mexico, specifically Pueblo Indian communities, must reflect on to ensure the preservation of the culture and values of Pueblo people. Finally, specific recommendations for action and discussion will be delivered in the form of a policy paper that is designed for tribal leadership and tribal administrative audiences and suggested for implementation.
ContributorsLucero, Kenneth Brian (Author) / Sumida Huaman, Elizabeth (Thesis advisor) / Brayboy, Bryan (Thesis advisor) / Martin, Nathan (Committee member) / Arizona State University (Publisher)
Created2015
Description
The primary objective of this study was to develop the Perceived Control of the Attribution Process Scale (PCAPS), a measure of metacognitive beliefs of causality, or a perceived control of the attribution process. The PCAPS included two subscales: perceived control of attributions (PCA), and awareness of the motivational consequences of attributions (AMC). Study 1 (a pilot study) generated scale items, explored suitable measurement formats, and provided initial evidence for the validity of an event-specific version of the scale. Study 2 achieved several outcomes; Study 2a provided strong evidence for the validity and reliability of the PCA and AMC subscales, and showed that they represent separate constructs. Study 2b demonstrated the predictive validity of the scale and provided support for the perceived control of the attribution process model. This study revealed that those who adopt these beliefs are significantly more likely to experience autonomy and well-being. Study 2c revealed that these constructs are influenced by context, yet they lead to adaptive outcomes regardless of this contextual-specificity. These findings suggest that there are individual differences in metacognitive beliefs of causality and that these differences have measurable motivational implications.
ContributorsFishman, Evan Jacob (Author) / Nakagawa, Kathryn (Committee member) / Husman, Jenefer (Committee member) / Graham, Steve (Committee member) / Moore, Elsie (Committee member) / Arizona State University (Publisher)
Created2014
Description
The United States elderly population is becoming increasingly larger, there is a need for a more adequate housing type to accommodate this population. It is estimated that by 2020, there will be a need for approximately 1.6 to 2.9 million units of affordable Assisted Living (Blake, 2005). With limited income and higher health bills, adequate housing becomes a low priority. It is estimated that 7.1 million elderly households have serious housing problems. (Blake, 2005) The scope of this research will look at literature, case studies, and interviews to begin to create and understand the necessary design aspects of Assisted Living and Affordable Housing to better create a housing typology that includes both low income residents and Assisted Living needs. This research hopes to have an outcome of Design Recommendations that can be utilized by designers when designing for an Affordable Assisted Living typology.
ContributorsRothner, Colleen (Author) / Bender, Diane (Thesis advisor) / Shraiky, James (Committee member) / Stapp, Mark (Committee member) / Arizona State University (Publisher)
Created2014
Description
The conflict conditions that afflict the livelihoods of Palestinian residents living in the West Bank are embedded within the population's ability to travel more so than any other routine activity. For Palestinian residents, domestic and international travel is a process of following paths riddled with multiple barriers that are both physical and political. Past studies have done well to paint a clear picture of the harsh transportation landscape in the region. However, less attention has focused on how barriers interact to indirectly and directly affect levels of accessibility and well-being. Additionally, suggested development solutions are rarely capable of being successfully implemented given current political conditions. This dissertation uses a systems approach to understand drivers of accessibility challenges in the West Bank and uses the understanding to propose a method to identify transition strategies that may be presently initiated whilst maintaining the ability to provide adequate benefit. The research question informing the study asks, How do drivers influencing the issue of poor accessibility and well-being in the West Bank persist and interact, and how might solutions be approached? The dissertation approaches the question in four sequential actions that each produces a functional planning deliverable. First, a system map that depicts the drivers and influences to the problem of poor accessibility and well-being is constructed (Chapter 4). Second, a future vision for the transportation system in the West Bank is identified (Chapter 5). Third, the system map and vision are used to assess how conflict conditions affect transition research (Chapter 6). Finally, the previous three deliverables are used to suggest a guide for transition management for transportation development in the West Bank (Chapter 7). Combinations of four different data sets, including an extensive review of published literature, field observations, individual field expert interviews, and group commuter interviews inform the research. Additionally, the Transformational Sustainability Research framework provides a normative base for the steps taken throughout the research. Ultimately, the dissertation presents an interpretation of information that has theoretical and practical application potential in transformational sustainability research and development efforts in the region respectively.
ContributorsAhmad, Omaya Heidi (Author) / Golub, Aaron (Thesis advisor) / Aggarwal, Rimjhim (Committee member) / Saleh Sadaqa, Ahmad (Committee member) / Arizona State University (Publisher)
Created2015