Dissertationen zum Thema „Holistic Case Management“

Thesis advisor: Eva M. Garroutte
Biomedicine has become a gatekeeper to numerous social opportunities and has gained power through the ritual inscription of individual bodies. Bodies serve as intermediaries between personal identities and biomedicine; individuals can reclaim bodies as sites of "identity projects" (Giddens 1991) to resist biomedical power. This project examines the intersection of the societal preoccupations with biomedicine, bodies, and identity through the lens of the religious and healing tradition of Christian Science. Christian Science theologically rejects biomedicine in favor of spiritual healing treatment. Christian Science is an especially appropriate venue for exploring relationships between biomedicine, bodies, and identities because its teachings require not only belief in the ineffectiveness of biomedicine but also embodied resistance to it. Drawing on the work of Foucault (1977), Giddens (1991), and Frank (1995) and using information gleaned from semi-structured interviews--averaging 1.5 hours in length--with 12 Christian Scientists, I argue that Christian Scientists use religious identities to (1) evade biomedical risk society, (2) resist external authority and reclaim bodies as sites of knowledge and power, and (3) build spiritual community
Thesis (MA) — Boston College, 2011
Submitted to: Boston College. Graduate School of Arts and Sciences
Discipline: Sociology

Purpose: The purpose of this research is to investigate how companies address sustainability holistically and compare the practical results to theoretical findings. The holistic approach of sustainability includes four dimensions and five corporate system elements.   Methods: For creating the theoretical framework a literature review was executed. Empirical data was gathered from a multiple case study. In total five case companies have been selected and five interviews have been conducted. Furthermore the interview guideline included a small survey. Empirical data was complemented by information from sustainability reports and companies website.   Main findings: Sustainability is partly executed in differently in practical terms compared to theory research. The differences are mainly explained by the unique use of sustainability initiatives, which are adapted to companies circumstances.   Academic contributions: Previously, only a few researchers investigated the combination of initiatives to provide a holistic sustainability approach. Furthermore a lack of practical research in the field of sustainability has been identified. This thesis contributes to close this gap by investigating five case companies regarding the use of multiple initiatives.   Practical implications: Based on the findings a model was created by the authors. By applying this model and using recommended initiatives companies are able to establish a holistic sustainability approach, involving all sustainability dimensions and corporate system elements.   Limitations: The interviews have been translated from German or Dutch into English, which increases the risk of wrong interpretations. Further the interview involved only one representative per company. Additionally the number of small case study companies and case companies from the service sector might limit the generalization of the results.

Thesis (MPA)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: Since its inception the Community Development Worker Programme (CDWP) seeks to promote cooperative governance within the context of the Intergovernmental Relations Framework. In pursuit of a holistic approach to development Community Development Workers (CDWs) strive for effectiveness in their role as change agents. This case study was conducted to determine the effectiveness of CDWs as change agents in pursuit of a holistic approach to development in the Western Cape. This was a qualitative study using participatory action research as a CDW in the West Coast; semi-structured interviews with Dedicated Officials from municipalities in the Cape Winelands Region, City of Cape Town and West Coast Region; focus groups with community members and stakeholders from Kayamandi in the Cape Winelands Region, Eerste River in the City of Cape Town and various towns in the West Coast Region; focus group and semi-structured interviews with Supervisors from the City of Cape Town, West Coast Region and Cape Winelands Region. Questionnaires were completed by Regional Coordinators from the West Coast Region, City of Cape Town, Overberg Region and Central Karoo Region; and questionnaires were completed by CDWs from the City of Cape Town, Cape Winelands Region, West Coast Region, Central Karoo Region and Overberg Region in the Western Cape. The findings of the research reveal that the CDWP has made tremendous progress since its inception. Regional Coordinators, supervisors and CDWs have a very good grasp of what is expected of them as change agents. The responses from the community also revealed much appreciation and support for the work done by CDWs in their role as change agents. The effectiveness of CDWs in their role of change agents in pursuit of a holistic approach to development is rated to be between 6-8 on a scale of 1-10; with ten being the highest. There is room for improvement however as the findings indicate that there are several cases where CDWs experience isolation and frustration and are challenged in their pursuit of holistic development as they are hampered by a lack of adequate resources; a lack of access to budgets; a lack of support, cooperation and political interference from ward councillors and politicians; a lack of understanding, appreciation, cooperation and support from local government and a sense of belonging at local municipal level in many instances amongst others. Although the research reveals that the province is effective in its pursuit of a holistic approach to sustainable community development on the part of CDWs as change agents, the researcher wishes to argue that improved collaboration needs to take place amongst the various levels of governments, government departments, development agencies and the beneficiaries of development themselves to further maximise the efforts and effectiveness of CDWs in their role as change agents. The building blocks of development and the Batho Pele Principles must also be more consistently applied and attentively addressed and diligently implemented by all the stakeholders in the development process in order to improve service delivery and enhance more effective community development to the benefit of the community at grassroots whilst meeting local, national and provincial development targets. The challenge to each of us as change agents is therefore to do our all towards reconstruction, community development and equal opportunities for all. We all have to be accountable and answer the question as to what we are doing concerning community development, namely education; poverty relief; service delivery; etc. in our own communities. We need to acknowledge where we have come from, where we are now and where we are going. Much progress has already been made despite a lack of funding, facilities and resources. More sacrifices must still be made however to ensure a better life for all. The issue is around respect, irrespective of who you are dealing with.
AFRIKAANSE OPSOMMING: Van sy ontstaan af probeer die Gemeenskapsontwikkelingswerkerprogram (GOWP) koöperatiewe bestuur in die konteks van die Tussenregeringsverhoudingsraamwerk bevorder. Gemeenskapsontwikkelingswerkers (GOW’s) streef na effektiwiteit in hul rol as veranderingsagente om ’n holistiese benadering tot ontwikkeling te volg. Hierdie gevallestudie is uitgevoer om die effektiwiteit van GOW’s as veranderingsagente wat ’n holistiese benadering tot ontwikkeling in die Wes-Kaap nastreef te bepaal. Dit was ’n kwalitatiewe studie met gebruik van deelnemende aksienavorsing as ’n GOW in die Weskus; halfgestruktureerde onderhoude met toegewyde amptenare van munisipaliteite in die Kaapse Wynlandstreek, Stad Kaapstad en Weskusstreek; fokusgroepe met gemeenskapslede en belanghebbendes uit Kayamandi in die Kaapse Wynlandstreek, Eersterivier in die Stad Kaapstad en verskeie dorpe in die Weskusstreek; fokusgroep- en halfgestruktureerde onderhoude met toesighouers uit die Stad Kaapstad, Weskusstreek en Kaapse Wynlandstreek. Vraelyste is deur streekskoördineerders van die Weskusstreek, Stad Kaapstad, die Overbergstreek en Sentraal Karoostreek ingevul; en vraelyste is deur die GOW’s van die Stad Kaapstad, Kaapse Wynlandstreek, Weskusstreek, Sentraal Karoostreek en Overbergstreek in die Wes-Kaap ingevul. Die bevindings van die navorsing toon dat die GOWP sedert sy ontstaan geweldige vordering gemaak het. Streekskoördineerders, toesighouers en GOW’s het ’n baie goeie begrip van wat as veranderingsagente van hulle verwag word. Die reaksies van die gemeenskap het ook groot waardering en ondersteuning getoon vir die werk wat deur die GOW’s in hulle rol as veranderingsagente gedoen word. Die effektiwiteit van GOW’s in hul rol as veranderingsagente wat ’n holistiese benadering tot ontwikkeling nastreef word beskou as 6-8 op ’n skaal van 1 tot 10, met tien as die hoogste punt. Daar is egter ruimte vir verbetering aangesien die bevindings aandui dat daar verskeie gevalle is waar GOW’s isolasie en frustrasie ondervind en uitgedaag word in hulle nastrewing van holistiese ontwikkeling weens onder andere ’n gebrek aan toereikende hulpbronne; ’n gebrek aan toegang tot begrotings; ’n gebrek aan ondersteuning en samewerking en die politieke inmenging van wyksraadslede en politici; ’n gebrek aan begrip, waardering, samewerking en ondersteuning van die plaaslike regering en ’n gevoel van tuis hoort op plaaslike munisipale vlak in baie gevalle. Hoewel die navorsing toon dat die provinsie effektief is in sy nastrewing van ’n holistiese benadering tot volhoubare gemeenskapsontwikkeling aan die kant van GOW’s as veranderingsagente, wil die navorser aanvoer dat beter samewerking op die verskillende vlakke van regering, regeringsdepartemente, ontwikkelingsliggame en die begunstigdes van ontwikkeling moet plaasvind om die pogings en effektiwiteit van GOW’s in hul rol as veranderingsagente verder te versterk. Die boustene van ontwikkeling en die Batho Pelebeginsels moet deur al die belanghebbendes in die ontwikkelingsproses meer konsekwent toegepas, noulettend gehanteer en toegewyd geïmplementeer word om dienslewering te verbeter en meer effektiewe gemeenskapsontwikkeling in belang van die gemeenskap op grondvlak te bewerkstellig terwyl dit aan plaaslike, nasionale en provinsiale ontwikkelingsteikens voldoen. Die uitdaging aan elkeen van ons as veranderingsagente is dus om alles moontlik te doen in belang van rekonstruksie, gemeenskapsontwikkeling en gelyke geleenthede vir almal. Ons moet almal aanspreeklik wees en die vraag beantwoord oor wat ons doen omtrent gemeenskapsontwikkeling, naamlik onderwys, armoedeverligting, dienslewering, ens. in ons eie gemeenskappe. Ons moet erken waar ons vandaan kom, waar ons nou is en waar ons heengaan. Baie vordering is reeds gemaak ten spyte van ’n gebrek aan befondsing, fasiliteite en hulpbronne. Meer opofferings moet egter nog gemaak word om n beter lewe vir almal te verseker. Dit gaan oor respek, ongeag met wie jy handel.

This thesis examines the management of multidisciplinary teams in a highly innovative environment through a study of multidisciplinary patient care teams in palliative care. It investigates management that enables spontaneous innovation where necessary, yet maintains discipline and compliance with legislation, regulation and policy. To assist the explanation a model of palliative care multidisciplinary team management and operation is developed, building on work described in the continuous innovation and organisational configuration literatures. This thesis describes innovative practices as focusing on changing the organisation’s social potential, when necessary, in order to match changes in an individual patient’s situation. A definition of innovation suitable to this environment is developed here, adapted from the innovation literature. A definition of social potential suitable to this environment is also developed, based primarily in the literature of the socialisation of organisations. In palliative care organisations, care is delivered to the patient and any group of people supporting the patient during the end of life process. Care provided to these supporters, referred to in this thesis as patient-based carers, can extend beyond the death of the patient. Palliative care is more than symptom management during the dying process and can involve an interaction lasting weeks or months between the organisation and patients and patient-based carers. A patient’s situation is described at many levels and involves a number of aspects of the patient’s condition and life; for example medical, social, psychosocial, spiritual and physical. In palliative care, patients and patient-based carers are the major sources of information about their situation and changes to it. This makes them active participants in the care team, although some patients and patient-based carers choose not to take this role. Every patient and every group of patient-based carers creates individualised situations when progressing through their end of life processes, requiring individualised care from teams that can change the membership mix to suit the situation. Palliative care professionals can be members of multiple individual patient care teams simultaneously and teams can include heads of discipline (managers). Multidisciplinary palliative care teams can be managed from inside or outside the team, as the situation requires. Uncertainty pervades this environment and the response is flexibility based in learning and understanding. From the model developed of the management of innovation in the palliative care environment implications for the management of multidisciplinary teams in a highly innovative environment are drawn.
Doctor of Philosophy (PhD)

The health care environment is transforming with new demands and expectations to improve patient outcomes including patient satisfaction. Health care organizations expect front line nurse managers to improve patient quality and satisfaction without a clear direction or meaningful understanding of the holistic role, functions, and competencies required to achieve organizational goals. The purpose of the qualitative transcendental phenomenological study was to explore the lived experiences and perceptions of the holistic and changing nature of the projected contemporary nurse manager’s roles, skills, practices, and dimensions aligned with the expectations for improving patient satisfaction. The exploration of the lived experiences and perceptions among 21 study participants, and data analysis using the modified van Kaam approach, led to the formulation of eight major themes that explained the nature of the experience with the phenomenon. The eight essential themes that encompass the context of the new contemporary and holistic role of the nurse manager to improve patient satisfaction include the following; (a) new expectations, (b) building a patient caring culture, (c) leader rounding, (d) healthy working environment, (e) staff engagement and empowerment, (f) change agent for continuous quality improvement, (g) impact of organization focus and culture, (h) challenges: sustainability of initiatives; lack of interdepartmental and interdisciplinary teamwork. The new proposed nurse manager role in transformation conceptual model aligns nurse manager contemporary and holistic role with transforming cultures for improved patient outcomes. The study findings are significant to health care organization, leaders, policy makers, and educators, in creating new patient caring and healthy working cultures for improved patient satisfaction.

The prevalence of obesity (BMI≥30kg/m²) in the Scottish population is rising at an alarming pace. The health implications for those affected and the lack of sustained success in treatment, demands that new strategies be explored to improve patient outcomes (Harvey et al. 2005). Primary care nurses appear well placed to address obesity management. Therefore, the aim of this research was to develop and evaluate an evidence based, holistic, person centred approach to management, which was relevant to both professionals and those who are obese. A conceptual framework was developed to encompass the physical, social and emotional components of weight management in conjunction with the nursing models of Roper, Logan and Tierney and Peplau. The approach used mixed methods of data collection, which was carried out in two phases. Outcomes from the initial exploratory, longitudinal survey phase, involving 64 outpatients attending a specialist obesity clinic, showed that physical, social and emotional factors, in conjunction with beliefs about weight management are interrelated. Evidence from the exploratory phase contributed to the development of materials for the intervention phase which was implemented in primary care by nine practice nurses (PNs) who recruited 28 obese individuals for a three month period. Methods of data collection included questionnaires, booklets, field notes and interviews. ii The key findings of this study confirmed that obesity is complex and a holistic, person centred approach to weight management through partnership working between nurses and obese individuals can be effective. While PNs have a key role to play in obesity management they recognised their need for appropriate tools and education to help individuals towards self-management. The results also suggested that nurses and individuals who took ownership of this approach had successful outcomes in terms of weight loss.

The goal of this project was to create a grant proposal and identify a potential funding source to develop a holistic mentoring program for foster youth in one non-profit organization in Long Beach, California. A thorough literature review identified risk factors for foster youth and identified evidence-based mentoring programs that the grant writer used to design a holistic mentoring program for foster youth. The Foundation Directory's on-line database at the Long Beach Non-Profit Partnership identified the Dwight Stuart Youth Foundation as the best funding source for this project. A grant was then written to support a holistic mentoring program at Power 4 Youth in Long Beach, California. The actual submission of this grant was not a requirement for the successful completion of the project.

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Empresa de Ônibus e Turismo Pedro Antônio LTDA
Mestrado Profissional em Enfermagem Assistencial
O processo de trabalho do (a) enfermeiro(a) é construído por saberes originários de diferentes matrizes científicas e configuram uma atividade centrada no cuidado com articulação no campo da administração. No exercício da função, o (a) enfermeiro (a) utiliza uma série de saberes que podemos chamar de tecnologias. Tecnologias que são empregadas no trabalho do enfermeiro nos diferentes momentos da produção. Este estudo tem como objetivo, analisar o processo de trabalho do (a) enfermeiro (a), buscando identificar o uso das tecnologias no gerenciamento e no cuidado em saúde. Trata-se de um estudo descritivo com abordagem qualitativa. Como campo de estudo foi escolhido o Hospital Universitário Sul Fluminense, no Município de Vassouras. Os dados foram coletados através de entrevista temática com enfermeiros do hospital e observação participante. A análise dos dados se deu por meio da triangulação associada ao método hermenêutico dialético. Os resultados mostraram a utilização de diferentes ferramentas tecnológicas no gerenciamento do cuidado em que a fusão da função gerencial com a assistencial é uma constante. Nesse processo, destacamos o saber da teoria clássica da administração, como elemento presente em grande parte da produção naquele hospital. Apontamos, como conclusão, a importância de novos dispositivos para a descentralização do trabalho e a recuperação da centralidade no usuário
The working process of the nurse is constituted by facts derived from different scientific matrixes and configures an activity centered in the care, with an articulation in the administration field. In the realization of his function, the nurse uses a series of knowledge that we can call technologies. Technologies that are used in the work of the nurse on the different moments of the production. This study has as objective analyze the working process of the nurse, trying to identify the use of the technologies in the management and in the care in health. It‟s a descriptive study with qualitative approach. The Hospital Universitário Sul Fluminense, in Vassouras, was selected as the study field. The data were collected through a theme interview with the nurses of the hospital and participated observation. The analysis of the data was done by triangulation combined with the Hermeneutic-Dialectical Method. The results showed the utilization of different technological tools in the management of the care, in which the fusion of the management and care functions is a constant. In this process, we give emphasis to the knowledge of the administration classic theory, as an element present in a great part of the production in that hospital. We point out as a conclusion, the importance of new ways to the decentralization of work and the re-acquire of the users‟ centrality

The current change theory base is fragmented and siloed. Years of research and studies have yielded nuanced conclusions that demonstrate little practical results. Recent research demonstrates the organizational change failure rate for secular businesses is as high as 80 percent. Since 1994, the church has had a steady failure and plateau rate of 80%. With over two million resources available for organizational change, and an emphasis on church revitalization by organization as such as NAMB, is it possible the disconnected variations of organizational change have created so much confusion that it prevents a simple, comprehensive, and comprehensible understanding? In order to explore this question, and to advance a preferred method, case studies of organizational change within the bible were conducted, and secular organizational change studies were evaluated. A holistic process of organizational change is advanced that is biblical, and universal. Six functions of change are identified: cultural awareness; change catalyst; evaluation of the change and culture, decision, implementation, and monitoring of outcomes. Each function was identified from various organizational change events in the bible, and groupings of secular research. Chapter 1 introduces the problems associated with secular and ecclesiastical change theory, as well as the six core functions of the holistic organizational change process. Chapter 2 reviews the methodology used to compile data in the change theory field. Chapter 3 will use content analysis to provide a literature review of the current change theory field. Six key functions of organizational change are identified, which displayed both divergent and inclusive characteristics with one another: cultural awareness; change catalyst; evaluation of catalyst and culture; decision; implementation; and monitoring the outcomes. Chapter 4 analyzes theological considerations and focuses on seasons of change in the Bible. Three new classifications of change will be introduced based on Scripture and exegesis: change leading to regression, change leading to revival, and covenantal development. Chapter 5 will offer the conclusions of the paper, and will make five key recommendations for future research of organizational change for secular and church related change efforts.

This study of a Portuguese chemical company acquired by a multinational, and, thus going through an integration process, aims to understand the process of a Management Accounting (MA) change. Over three decades, the mentioned company was subject to several changes in ownership and external context, regarding economic and regulatory conditions. Following its last acquisition, the company had to comply with new requirements and targets from the parent company, namely in terms of value creation. Hence, control mechanisms, including stricter KPIs, were set. Ahybrid framework was, the refore, developed to analyse the case thoroughly.

D.Phil.
South African water resource management policies as well as the country's water law have been under review over the past three to four years. The Water Law Principles, which were established as part of this review process, indicate a commitment to sustainable development of water resources and the protection of an ecological "Reserve". Such policy goals highlight the limitations of conventional water quality management strategies which rely on stressor monitoring and associated regulation of pollution. The concept of an assimilative capacity is central to the conventional water quality management approach. Weaknesses inherent in basing water management on the concept of assimilative capacity are discussed. Response monitoring is proposed as a way of addressing some of the weaknesses. In fact, the inadequate use of biological indicators and techniques in monitoring and evaluating the quality of resources has been identified as a major factor responsible for the continuing decline in the health of natural resource systems. With advances in environmental monitoring over the last decade, it has become clear that biological techniques and protocols need to become part of monitoring in order to allow effective assessment and protection of aquatic resources. One way of incorporating response measures into resource assessment is through the use of toxicological assays. As an example, a toxicological assessment of the environmental risk associated with an organic pesticide (fenthion) is presented. Acute and chronic assays were conducted with a spectrum of test organisms. These toxicological response results provided an ability to predict the ecosystem response that can be expected from certain concentrations of fenthion in the environment. Theoretically, it would be possible to design a risk assessment experiment for every new anthropogenic substance. However, in terms of cost and time, it would not be practically feasible to execute such experiments. To overcome this problem, a method has been developed to derive water quality criteria for toxic substances using existing toxicological data. This provides water resource managers with a readily available set of values to guide them in decision-making. It is demonstrated how available acute and chronic toxicity data can be synthesised into acute and chronic water quality criteria for the protection of aquatic life. As these criteria are intended to extend protection to ecosystems country-wide, they are very conservative by design. Although a set of numeric water quality criteria provides an important tool to water quality managers, the limitations associated with the use of these criteria must be recognised. x Limitations relate either to the design of toxicity experiments or to the use of a chemical-specific approach alone in water resource management. In order to overcome these limitations, three broad supporting technologies are proposed, namely whole effluent toxicity (WET) testing, sitespecific adjustment of water quality criteria, and in-stream biological assessments. Whole effluent testing aims at evaluating the toxic effects of an effluent on organisms. In doing so, acute and chronic toxicity testing (and thus biological responses) becomes part of effluent regulation. An effluent control programme that incorporates toxicity-based standards and compliance criteria is proposed. One of several approaches that can be used for deriving site-specific water quality criteria is the calculation of a water-effect ratio. It is demonstrated that the water-effect ratio method could result in significant adjustments to the national water quality criteria. Although more development and local testing would be required, such site-specific criteria could be in the interest of both ecosystem protection and economic development. In-stream biological assessments introduces a type of response monitoring which provides insight into the overall integrity of aquatic ecosystems. A comprehensive biomonitoring programme is designed. To adhere to the objectives of this programme, specifications have been developed for the selection of sampling sites, the selection of biological and habitat indicators, and the management of the resulting data. This programme is referred to as the River Health Programme (RHP). The ultimate aim of any monitoring programme is to provide useful data. Such data must contribute to effective decision-making. To ensure that the RHP becomes truly operational as a management information system, a step-wise procedure is proposed for linking the collected data with management actions. It is demonstrated how following of this systematic and iterative procedure would facilitate ongoing learning and improvement of the individual steps (e.g. data collection and assessment, goal setting, selection and implementation of management actions) as well as the overall procedure. As a final step, the dynamics that influence the transition of any new technology from scientific development to operational application are explored. The RHP is used as a case study and theoretical models from the field of the management of technology are used to provide valuable insights. Four key components of the RHP design are analysed, namely the (a) guiding team, (b) concepts, tools and methods, (c) infra-structural innovations and (d) communication. These key components evolved over three broad life stages of the programme, which are called the design, growth and anchoring stages.

I denna vetenskapliga essä undersöker jag begreppet helhetssyn som ord, dess historiska utveckling inom hälso- och sjukvård, hur det uppfattas inom aktuell forskning samt ur ett filosofiskt perspektiv. Fenomenologi, hermeneutik och existentialism utgör det filosofiska ramverket och jag låter dessa teorier gå i dialog med gestaltade berättelser från mitt yrkesutövande som fysioterapeut men också med mina reflektioner och tidigare erfarenheter. Hälsa är ett annat begrepp som undersöks eftersom det är nära besläktat med helhet och också något som människan strävar mot genom hela livet. Eftersom mitt arbete huvudsakligen utförs i möte med åldrade patienter ger jag extra mycket utrymme åt just åldrandet och kroniska sjukdom som fenomen. Den praktiska klokheten, kunskapsformen fronesis, växer fram som en grundläggande förutsättning för att kunna sträva mot helhetssyn med en etiskt grundad kvalitet. Även om jag kommer fram till att helhetssyn förmodligen är en utopi så är det fortfarande ytterst viktigt att sträva mot den. Den essentiella delaspekt av helhetssyn som vuxit fram vid sidan av fronesis väljer jag att benämna situasyn. Utmaningen kallas NPM.
In this scientific essay, I examine the concept of the holistic view — as a notion, its historical development in health and medical care, how it is perceived within current research, and from a philosophical perspective. Phenomenology, hermeneutics and existentialism constitute the philosophical framework and I let these theories go into dialogue with depicted stories from my professional practice as a physiotherapist, and also with my own reflections and past experiences. Health is another concept that I investigate because of its close relationship with wholeness, and also because it is something that man strives towards throughout his life. Since my work is mainly done in meetings with elderly patients, I give extra space to aging and chronic illness as phenomena. The practical wisdom, phronesis, as a form of knowledge, emerges as a basic prerequisite for being able to strive towards a holistic view of an ethically founded quality. Although I will argue that a holistic view is a utopic vision, I conclude that it is still important to strive towards it. The essential part of the holistic approach that emerged, alongside phronesis, I've chosen to call situasyn. The challenge is called NPM.

This phenomenological study examined the experiences of women in midlife. The primary purpose of the study was to develop and describe a model of health promotion that will facilitate self-care of women in midlife to support them in the attainment of wholeness. A theory-generative, qualitative, explorative, descriptive and contextual design was utilized to achieve the objectives of the study, namely to explore and describe women's experience of midlife transition; classify concepts of the model; describe the structure and process of a model for support of women during midlife transition, and develop guidelines for operationalization of the model. The study was undertaken in one of the northwest states of the United States of America. Purposive sampling of eight women included women between the ages of 40 and 55 years of age. Women who had undergone surgical menopause were excluded as the influence of prolonged hormone replacement therapy was seen as a bias. Data was collected by using an unstructured interview technique. Data was analyzed according to Tesch's protocol (in Cresswell, 1994:155). Guba's model (in Krefting 1991:215) was utilized to ensure the trustworthiness of the study. Ethical issues were considered throughout and these are reflected in chapter one of the thesis. The study identified two themes: (1) how the women experienced midlife and (2) how they managed it. The experiences of midlife were expressed in physical, psychosocial and spiritual changes while the management of the process was accomplished in two ways, namely self-care and the services of healthcare professionals. The researcher identified that health promotion was essential to facilitate the self-care practices of women in midlife. Essential and related attributes of health promotion were identified, analyzed and synthesized to define health promotion. The process of health promotion was then defined with a description of the structure and process of the model. Concepts identified were classified, defined and placed into relationship statements after which the model was described and evaluated. Guidelines to operationalize the model were then formulated to assist health professionals to support women in self-care for the attainment of wholeness.
Health Studies
D.Litt et Phil (Health Studies)