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Articles 11851 - 11880 of 16679
Full-Text Articles in Entire DC Network
The Post-Secondary School-To-Work Transitional Program: An Occupational Therapist's Guide To Service Delivery, Annemarie Assel, Erin Haugen
The Post-Secondary School-To-Work Transitional Program: An Occupational Therapist's Guide To Service Delivery, Annemarie Assel, Erin Haugen
Occupational Therapy Capstones
Background: Autism Spectrum Disorders (ASDs) are one of the most prevalent childhood diagnoses, occurring in every 1 in 68 children (Centers for Disease Control and Prevention, 2015). Although ASDs are considered childhood disorders, they persist throughout one’s life and are often more pronounced during common life transitions. For adults with ASDs, this is a time marked by fragmented services, as well as disengagement from services (Baldwin, Costley, & Warren, 2014; Friedman, Warfield, & Parish, 2013; Shattuck, Wagner, Narendorg, Sterzing, & Hensley, 2011; Strickland, Coles, & Southern, 2013). Those with ASDs have skills deemed valuable by employers that include being: reliable, …
Use Of Assessments In Occupational Therapy Physical Disability Settings, Caitlin Brown, Jana Carroll
Use Of Assessments In Occupational Therapy Physical Disability Settings, Caitlin Brown, Jana Carroll
Occupational Therapy Capstones
Background: The aim of this study is to evaluate occupational therapists’ (OTs) perceptions and use of informal observation and formal assessments in order to understand if differences exist between acute care and non-acute care occupational therapy (OT) adult physical disability settings. Non-acute settings may include but are not limited to home health, inpatient rehabilitation, transitional care, outpatient rehabilitation, and long term care.
Methods: Study design involved a nonexperimental survey. Qualtrics software was utilized to disseminate the survey across a five-state region to the population under study. Response rate included 88 OTs who answered consistently to the questions analyzed. Data analyses …
An Occupational Therapist's Guide For Mindful Practice Under High Productivity Standards, Breanna E. Coleman, Whitney J. Wilhelmi
An Occupational Therapist's Guide For Mindful Practice Under High Productivity Standards, Breanna E. Coleman, Whitney J. Wilhelmi
Occupational Therapy Capstones
In recent years, healthcare service delivery has been influenced by one factor that has shown to considerably limit occupational therapy (OT) practitioners’ ability to be mindful in the work setting (Black, 2010). This influential factor involves increased productivity standards resulting in high burnout, empathic fatigue, job dissatisfaction, lack of mindful practice, and distress to the point of clinical effectiveness (Irving, Dobkin, & Park, 2009; Poulsen et al., 2014; Vadnais, 2014). In the midst of high productivity standards, a need surfaced for the production of a tool that assisted OT practitioners to overcome these standards as well as to incorporate a …
Intentional Integration Of Service And Therapy Dogs In An Occupational Therapy Program Curriculum, Stephanie Rehovsky, Brittni Danner
Intentional Integration Of Service And Therapy Dogs In An Occupational Therapy Program Curriculum, Stephanie Rehovsky, Brittni Danner
Occupational Therapy Capstones
This scholarly project involves the intentional integration of Buddy, the service/therapy dog of the University of North Dakota’s Occupational Therapy graduate program. This project contains researched evidence regarding the variety of benefits involved with the implementation of animal assisted therapy (AAT) into the curriculum. The final product contains instructor materials for six existing courses in the graduate and undergraduate program. We have also included future implications for this product including adaptation to other similar graduate occupational therapy programs and future use at the University of North Dakota.
Prosthetics Guide For Occupational Therapy Students And New Graduates, Chelsea De Bruto, Kayla Oates
Prosthetics Guide For Occupational Therapy Students And New Graduates, Chelsea De Bruto, Kayla Oates
Occupational Therapy Capstones
"The prosthetic technology is effectively an interface between that person and the life they wish to lead" (Gallagher, 2004, p. 828). Occupational therapy can help individuals with prosthetics deal with psychosocial and physical aspects of his or her condition (Gulick, 2011). Current literature covers all aspects of prosthetics, but it is scattered in many different places. The results of a study conducted by Mitchell, Gorelick, Anderson, and Atkins (2014), approximately 3-5 hours or less are spent on prosthetic training, while 85% of respondents felt that it was considered to be “very important”. This scholarly project focuses to bridge this gap …
A Pilot Study To Document Outcomes Of Occupational Therapy Intervention With Individuals Who Experience Upper Extremity Trauma Using The Role Checklist 2 And Quickdash Assessments, Devan Henderson, Jacob Kucera
A Pilot Study To Document Outcomes Of Occupational Therapy Intervention With Individuals Who Experience Upper Extremity Trauma Using The Role Checklist 2 And Quickdash Assessments, Devan Henderson, Jacob Kucera
Occupational Therapy Capstones
The disabilities of the arm, shoulder and hand (DASH) quick form is a selfadministered patient perception questionnaire used to measure upper extremity disability and symptoms. The Quick DASH (QD) gauges the patient’s difficulty with task performance when impacted by an upper extremity injury. The Role Checklist: Version 2 (RC-V2) is a self-administered, patient perception that focuses mainly on the individual’s daily life roles, role competence, performance, and interest in performing those roles (Scott, 2013). The purpose of this study was to determine which of these assessments best measured progress of occupational therapy interventions for patients who sustained a traumatic upper …
Physical Activities In The Nys/Bya Program On The Turtle Mountain Chippewa Reservation: A Resource Guide For Adaptation, Lauren Herbert, Melissa Hoffman
Physical Activities In The Nys/Bya Program On The Turtle Mountain Chippewa Reservation: A Resource Guide For Adaptation, Lauren Herbert, Melissa Hoffman
Occupational Therapy Capstones
The percentage of children with disabilities in the United States (U.S.) is increasing at an alarming rate. According to the 2000 census, 3.9% of all families reported having a child with disabilities. As of the 2010 census, there were 53.9 million school-aged children (aged 5 to 17) in the U.S with about 2.8 million (5.2%) reporting a disability. Among the American Indian population, these rates are increasing at an even higher rate. American Indians have the highest rates of disability of any group in the United States (Nichols & Keltner, 2005). According to Waldman, Perlman, and Swerdloff (2008), more than …
Factors Influencing Minority Group Pursuit Of Occupational Therapy Education, Heber Hepworth, Courtney Schafer
Factors Influencing Minority Group Pursuit Of Occupational Therapy Education, Heber Hepworth, Courtney Schafer
Occupational Therapy Capstones
There is limited representation of minority groups in the OT workforce and a dearth of research on factors influencing minority groups to pursue and successfully complete OT education. The CINAHL and PUBMED databases were used to explore factors influencing minority population enrollment, experiences in health care programs, and barriers to educational participation. A survey was constructed based on the literature and sent to students in OT programs at the doctorate, master and assistant levels through the AOTA Program Director list-serv. One hundred and thirteen masters (93%) and doctorate (7%) OT students completed the survey. The majority of participants heard about …
Enhancing Single Custodial Father's Parenting Skills: A Group Protocol, Jordyn Johnson, Alicea Steir
Enhancing Single Custodial Father's Parenting Skills: A Group Protocol, Jordyn Johnson, Alicea Steir
Occupational Therapy Capstones
The rate of single-custodial fathers is increasing (Leininger & Ziol-Guest, 2008). As single-custodial fathers have become more prevalent (Leininger & Ziol-Guest, 2008), programs are needed to provide them with support and information regarding the skills needed to raise children at each developmental stage (Panter-Brick et al., 2014). The purpose of this project is to create a set of group protocols that will provide single-custodial fathers that are living in transitional housing with the skills necessary to raise children at different stages of development.
An extensive literature review was conducted, and information pertinent to parenting programs for single-custodial fathers was collected …
Modernizing Leisure Assessment Through Technology Applications, Brooke Johnson, Hanna Stevenson
Modernizing Leisure Assessment Through Technology Applications, Brooke Johnson, Hanna Stevenson
Occupational Therapy Capstones
Purpose: The purpose of the product was to create an electronic based leisure interest companion for occupational therapists to utilize when treating clients. An electronic based leisure assessment would illustrate for the occupational therapy a more comprehensive understanding of the clients’ leisure interests.
Methods: A literature review was conducted using the CINAHL, OTSEARCH, Pub Med, and Google Scholar databases. The literature review results supported the value of leisure, and leisure assessment tools were explored. The UK Modified Interest Checklist was chosen as a focal point for the My Leisure Activities (MyLA™) companion tool development. A storyboard was created by the …
Occupational Therapy Interventions For Adhd: A Systematic Review, Kamela L. Kelsch, Kaci L. Miller
Occupational Therapy Interventions For Adhd: A Systematic Review, Kamela L. Kelsch, Kaci L. Miller
Occupational Therapy Capstones
Background: ADHD can have a negative impact on occupational performance of a child, interfering with ADLs, IADLs, education, leisure, and play. However, at this time, a cumulative review of evidence based occupational therapy interventions for children with ADHD do not exist.
Purpose: The purpose of this scholarly project was to complete a systematic review of what occupational therapy interventions are effective for school-aged children with ADHD.
Methods: An extensive systematic review for level T, II, or II research articles was completed using CINAHL and OT Search. Inclusion, exclusion, subject terms, and words or phrases were determined with assistance from the …
The Effects Of Self-Stigma On Occupational Engagement For Adults With Mental Illness, Alyssa A. Kostreba, Taylor E. Lavoi
The Effects Of Self-Stigma On Occupational Engagement For Adults With Mental Illness, Alyssa A. Kostreba, Taylor E. Lavoi
Occupational Therapy Capstones
Purpose: The purpose of this study is to explore the impacts of self-stigma on everyday occupations of persons with serious and persistent mental illness. Greater understanding of the impacts of self-stigma is important to development of occupation-based interventions used by occupational therapists in mental health settings.
Methodology: A qualitative phenomenological approach was utilized to interview six participants between the ages of 31-58 years old with severe and persistent mental illness. High level in vivo coding was used to interpret participant responses.
Results: Four themes emerged from participant interviews: 1) negative impact on self, 2) coping with negative social encounters, 3) …
Studying With Successful Sensory Environments: A Pilot Study, Katrina Kotta
Studying With Successful Sensory Environments: A Pilot Study, Katrina Kotta
Occupational Therapy Capstones
Background/Purpose: Higher education institutions are facing pressure by state and federal authorities to retain and efficiently graduate students. The University of North Dakota (UND) has responded by implementing initiatives in light of declining retention rates within recent years. University of North Dakota’s approach focused on best teaching practices and classroom learning approaches versus individualized student programs for academic success. Studying With Successful Sensory Environments (SWSSE) is an individualized approach created within occupational therapy, which focuses on effective management of the environment through knowledge of sensory processing patterns to enhance focus and productivity in higher education. The purpose of this study …
The Experiences Of Individuals With Visual Changes After A Traumatic Brain Injury (Tbi): An Emphasis On Coping, Katie Kruger, Suzanne Vetter
The Experiences Of Individuals With Visual Changes After A Traumatic Brain Injury (Tbi): An Emphasis On Coping, Katie Kruger, Suzanne Vetter
Occupational Therapy Capstones
Problem: The Center for Disease Control Prevention (CDC, 2010) reports that 2,611,129 individuals visit the Emergency Room each year due to a traumatic brain injury (TBI). In addition, approximately 50% of individuals who have a TBI report visual inefficiencies (Bulson, Jun, and Hayes, 2012; Lew et al., 2009; McKenna, Cooke, Fleming, Jefferson, & Ogden, 2006). Researchers have identified the effects these diagnoses have on ADLs and IADLs. Yet, there is a further need for understanding the experiences of persons post-TBI who have visual inefficiencies, including their coping in everyday life. Aims: This qualitative research study is aimed at determining the …
Virtual Reality: An Evidence-Based Guide For Occupational Therapy, Grant Mitchell, Kyle Nelson
Virtual Reality: An Evidence-Based Guide For Occupational Therapy, Grant Mitchell, Kyle Nelson
Occupational Therapy Capstones
Problem: Virtual reality (VR) is an emerging technology that serves to position the user in control of a virtual environment to maximize interest and function. VR is a context for intervention included in the Occupational Therapy Practice Framework: Domain and Process 3rd edition (OTPF-3; AOTA, 2014). It is crucial that occupational therapy (OT) practitioners enhance their knowledge about VR technology used by their clients to provide effective client-centered practice (AOTA, 2010). There is a lack of organization of the literature and research evidence regarding the use of VR as an intervention modality. While there has been a significant increase in …
The Occupation Of Driving: A Guide For Occupational Therapists Working With Adolescents Who Have Adhd, Molly Schmitz, Morgan Voss
The Occupation Of Driving: A Guide For Occupational Therapists Working With Adolescents Who Have Adhd, Molly Schmitz, Morgan Voss
Occupational Therapy Capstones
Driving is a rite of passage for all teens with or without a disability. Individuals with ADHD are at a far greater risk of being in an accident or receiving a traffic violation as a compared to their developmental counterparts. In addition, parents and practitioners are often unaware of an individual’s readiness to drive skills prior to receiving formal driver’s education. Thus, this can be a stressful transition or learning process with individuals with ADHD and their families. For parents, practitioners, and teens, it is important that they understand the resources available to them and the steps to access those …
A New Technique To Improve The Operation Of Prosthetic Limbs During Muscle Fatigue, H. Albunashee, G. Rasool, K. Iqbal, G. White
A New Technique To Improve The Operation Of Prosthetic Limbs During Muscle Fatigue, H. Albunashee, G. Rasool, K. Iqbal, G. White
Journal of the Arkansas Academy of Science
Prosthetic limbs hold a promise to renew the quality of life for the amputee. Neural commands are decoded via a classifier to generate control signals for the prosthetic devices. In the literature, many challenges and limitations have been identified that affect the prosthesis operation. One such drawback is muscle fatigue which degrades the surface electromyogram (sEMG) signals, and consequently, the performance of the deployed classification algorithm declines from 90% to 50% of average accuracy. We used a new technique using the Linear Discrimination Analysis (LDA) algorithm and the muscle synergy-based task discrimination (MSD) algorithm to improve the classification accuracy. In …
A Resource Manual For Occupational Therapists To Use With Parents Of Infants Transitioning Home From The Nicu, Alyssa N. Briggs, Nicholle R. Clouse
A Resource Manual For Occupational Therapists To Use With Parents Of Infants Transitioning Home From The Nicu, Alyssa N. Briggs, Nicholle R. Clouse
Occupational Therapy Capstones
One of the many challenges facing health care professionals practicing in the neonatal intensive care unit (NICU) is providing appropriate care and support for parents throughout the transition process from hospital to home. Because the families are often the ultimate advocates and caregivers for infants it is important that they are well equipped with the skills and knowledge needed to take part in their infant’s care. Therefore, by providing clear and easy to use resources that address parental confidence, skills, knowledge, roles, routines, and the environment, professionals can help alleviate parental stress and uncertainty throughout the transition process.
An extensive …
Caregivers Of Stroke Survivors: Exploring The Role Of Spousal Caregivers Through An Occupational Therapy Lens, Lisa J. Knecht-Sabres, Karley Kammer, Matthew K. Kilian, Kim Veverka
Caregivers Of Stroke Survivors: Exploring The Role Of Spousal Caregivers Through An Occupational Therapy Lens, Lisa J. Knecht-Sabres, Karley Kammer, Matthew K. Kilian, Kim Veverka
Internet Journal of Allied Health Sciences and Practice
The purpose of this qualitative study was to explore the occupational needs of caregivers of stroke survivors and to identify potential implications for occupational therapy’s role with this population. Methods: Focus groups and a semi-structured interview were used to gather an in-depth perspective on caregivers’ needs and level of participation in valued activities. Interactions were recorded and transcribed verbatim. Data analysis included open coding, formulation of categorical patterns, and thematic analysis. Rigor was enhanced through peer review, multiple coders, member checking, and triangulation. Results: Four primary themes emerged: (1) the essential need for additional services and support; (2) the amount …
Physical Activity For Adults With Visual Impairments: Impact Of Socio-Demographic Factors, Justin A. Haegele, Xihe Zhu, Jihyun Lee, Lauren J. Lieberman
Physical Activity For Adults With Visual Impairments: Impact Of Socio-Demographic Factors, Justin A. Haegele, Xihe Zhu, Jihyun Lee, Lauren J. Lieberman
Human Movement Studies & Special Education Faculty Publications
Little is known about what factors influence physical activity participation for adult-aged individuals with visual impairments. Therefore, the purpose of this study was to explore the impact of socio-demographic factors on the physical activity participation of adults with visual impairments. The international physical activity questionnaire-short form and a socio-demographic factor questionnaire were distributed to individuals with visual impairments. A total of 176 adults (Mage = 47.04, 52.8% female) completed the questionnaires. Physical activity and socio-demographic variables were analyzed descriptively and relationships were explored using correlation analysis and multiple regression analysis. On average, participants reported 413.79 minutes of moderate-to-vigorous physical …
The Effect Of Thermacare Heat Wraps On Balance And Mobility In Seniors With Impaired Gait - A Cross Over Study, Jerrold S. Petrofsky, Michael S. Laymon, Iman Akef Khowailed, Haneul Lee
The Effect Of Thermacare Heat Wraps On Balance And Mobility In Seniors With Impaired Gait - A Cross Over Study, Jerrold S. Petrofsky, Michael S. Laymon, Iman Akef Khowailed, Haneul Lee
College of Health & Human Services (TUN) Publications and Research
To examine if the use of heat at home can result in better quality and safer mobility in the elderly with gait and balance impairments.
Setting: Randomized longitudinal cross over study design in a clinical setting.
Methods: 20 people with impaired mobility (assessed as a score of more than 4 on the Stepping On questionnaire) were tested with a multi-camera gait analysis system, a treadmill with pressure sensors, a balance platform and the timed up and go and walking speed tests before and after using ThermaCare continuous heat wraps on their legs and knees for 6 days at 4 hours …
Disturbed Body Perception, Reduced Sleep, And Kinesiophobia In Subjects With Pregnancy-Related Persistent Lumbopelvic Pain And Moderate Levels Of Disability: An Exploratory Study, Darren Beales, Alison Lutz, Judith Thompson, Benedict M. Wand, Peter O'Sullivan
Disturbed Body Perception, Reduced Sleep, And Kinesiophobia In Subjects With Pregnancy-Related Persistent Lumbopelvic Pain And Moderate Levels Of Disability: An Exploratory Study, Darren Beales, Alison Lutz, Judith Thompson, Benedict M. Wand, Peter O'Sullivan
Physiotherapy Papers and Journal Articles
Background: For a small but significant group, pregnancy-related lumbopelvic pain may become persistent. While multiple factors may contribute to disability in this group, previous studies have not investigated sleep impairments, body perception or mindfulness as potential factors associated with disability post-partum.
Objectives: To compare women experiencing no pain post-pregnancy with those experiencing pregnancy-related persistent lumbopelvic pain (either low- or high-level disability) across multiple biopsychosocial domains.
Design: Cross-sectional
Methods: Participants completed questionnaires for thorough profiling of factors thought to be important in pregnancy-related lumbopelvic pain. Specific measures were the Urinary Distress Inventory, Medical Outcomes Study Sleep Scale, Back Beliefs Questionnaire, Tampa …
The Development Of Narrative Reasoning: Student Physical Therapists’ Perceptions Of Patient Stories, Kathryn C. Nesbit, Kenneth E. Randall, Toby B. Hamilton
The Development Of Narrative Reasoning: Student Physical Therapists’ Perceptions Of Patient Stories, Kathryn C. Nesbit, Kenneth E. Randall, Toby B. Hamilton
Internet Journal of Allied Health Sciences and Practice
Narrative reasoning is an inductive cognitive strategy used to understand patients’ experiences with illness within the biosocial context of their lives. The purpose of this study is to examine the meaning of the patient’s illness experience to physical therapist students and propose a theory of narrative reasoning development in these novice clinicians.The data collected from twenty-one first year physical therapy students consisted of narratives written during their clinical internships describing a patient’s experience with illness and post-internship interviews telling the patient’s story. Data were analyzed in a process of constant comparison, evolving codes, and researcher memoing using both grounded theory …
The Effect Of Therapeutic Horseback Riding On Balance And Self-Efficacy In Children With Developmental Disabilities, Lauren M. Hurley, Alexandra Smola
The Effect Of Therapeutic Horseback Riding On Balance And Self-Efficacy In Children With Developmental Disabilities, Lauren M. Hurley, Alexandra Smola
Williams Honors College, Honors Research Projects
The prevalence of developmental disabilities in children in the United States is a serious problem. Since children with developmental disabilities often show decreased self-efficacy and balance, researchers have studied the effects of interventions in this population. The purpose of this study is to determine the effect of a 10-week THR session on balance and task-specific self-efficacy in children with physical disabilities ages 6 to 18 years old. Bandura’s social cognitive theory and The Physical Stress Theory will guide the quasi-experimental study. A pre-test post-test design will be implemented over a 12 week span at 3 different riding centers in the …
Health-Related Fitness For Children And Adults With Cerebral Palsy, Yvette Blanchard, Mary E. Gannotti, Wendy Romney
Health-Related Fitness For Children And Adults With Cerebral Palsy, Yvette Blanchard, Mary E. Gannotti, Wendy Romney
All PTHMS Faculty Publications
Position Statement of ACSM Sports Medicine Basics 2016: Health-related physical fitness for persons with Cerebral Palsy should be developed in the same model as fitness for all of us: start early, be easily available and continue throughout the life span.
A Qualitative Pilot Study Of Aging Women’S Physical Activity Experiences In One University Fitness And Wellness Center, Alexis Hobbs
A Qualitative Pilot Study Of Aging Women’S Physical Activity Experiences In One University Fitness And Wellness Center, Alexis Hobbs
Online Theses and Dissertations
Physical inactivity is one of the driving risk factors for developing health problems such as obesity, diabetes, and cardiovascular diseases (World Health Organization, 2003). The prevalence of these diseases increases with the aging process, which renders participation in physical activity crucial among the aging population. There is strong evidence that physical activity reduces the risk of these health disparities and disabilities (Young & Dinan, 2005), however despite these well-documented benefits, aging women still remain sedentary. This study examined the phenomenon of women 55 years of age or older and their lived experiences of participating in physical activity within a university …
The Deaf Experience In A Hearing Medical World, Sarah Kaylynn Lykins
The Deaf Experience In A Hearing Medical World, Sarah Kaylynn Lykins
Online Theses and Dissertations
Background: The purpose of this narrative study was to understand personal experiences of a Deaf individual when communicating with healthcare professionals, to describe personal feelings regarding challenges and successes experienced during healthcare interactions, and express the need for culturally competent healthcare providers with increasingly diverse populations.
Method: The participant interviewed is a member of the Deaf community, uses American Sign Language (ASL), and had multiple decades of major medical treatments. The study was conducted using a semi-structured method with a certified interpreter (CI) present to interpret and was audio and video recorded to account for all aspects of the signed …
Experiences Of Non-Traditional Female College Students With Bipolar Disorder, Taylor Lynn Massie
Experiences Of Non-Traditional Female College Students With Bipolar Disorder, Taylor Lynn Massie
Online Theses and Dissertations
Background: Although research has been done on many aspects of bipolar disorder, research has not examined the individual living experiences of college students with bipolar disorder. Research looks at the
Methods: In-depth interviews were used to learn the details of the experience of attending college with bipolar disorder. Three volunteers came forward to be interviewed. They had a bipolar disorder diagnosis, and are current students at a southern university. Questions focused on the lived experience of being a student with bipolar disorder, and probing questions were used to learn more about each participant’s particular experience. The first two interviews had …
Lived Experience Of Collegiate Athletes With Season Ending Injuries, Leah Thomas Thomas
Lived Experience Of Collegiate Athletes With Season Ending Injuries, Leah Thomas Thomas
Online Theses and Dissertations
The purpose of this study is to examine the lived experience of collegiate athletes and their experience with a season ending injury. The individuals will have had an injury that has kept them from participating in their sport for the remainder of the season. Evidence shown gives the factors that impact recovery, supports for recovery, the model for response to sport injury, and coping mechanisms of the athletes impacted. However, there is a lack of research on the actual lived experience of the injury for collegiate athletes. Knowing this information could help change the way that we look at their …
The Lived Experience Of Informal Caregivers Of Chronic Stroke Patients, Ann Snider Wigginton
The Lived Experience Of Informal Caregivers Of Chronic Stroke Patients, Ann Snider Wigginton
Online Theses and Dissertations
The purpose of this phenomenological study is to contribute to the literature surrounding stroke-survivor caregivers and to understand the caregivers’ perspective on leisure participation and quality of life. Four caregivers of clients with chronic stroke were recruited for the study via convenience sampling. Participants were audio-recorded during a semi-structured interview lasting 60-80 minutes. The interview guide was consistent across participants and included open-ended questions about the caregiver’s leisure participation and quality of life. Recorded data was transcribed and in-vivo coding was completed. Eight categories were developed from the identified codes and narrowed into primary meaning units: role shift, loss of …