Theses (Nursing)
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Item Community-centred care: Exploring the integration of community context in healthcare(2025) Prosperi-Porta, Gabriella; Slemon, AllieRural healthcare is nuanced, contextual, and embodies principles that intertwine patient-centred care, collaboration, health equity and health promotion, yet is primarily regarded in relation to its perpetual complexities. The purpose of this study is to explore how healthcare workers (HCWs) understand the context of Community-centred care in British Columbia (BC) rural communities. Through semi-structured interviews I explore what HCWs know about the communities they live and work, while also delving into their perceptions of how this knowledge impacts healthcare delivery. For this study, I used Thorne’s Interpretive Description methodology to delve into the complexities of Community-centred care to understand the human experience of providing healthcare in rural communities. This methodology allowed for the translation of research findings into practical outcomes that are relevant to the current state of Canadian healthcare. The findings revealed three main themes: Prioritizing relationships and connections; Demonstrating innovation in overcoming challenges; and Integrating knowledge, which were central to Community-centred care and instrumental in rural healthcare delivery. These findings were discussed in relation to the literature and identified areas for future research opportunities. Additionally, we revealed how this research expands this area of scholarship by exploring Building Capacity, Agency Nurses, and Deficit Discourse in rural settings. This study emphasizes the potential of Collaborative Approaches and calls to action to empower rural HCWs to utilize their understanding of their communities to reduce barriers to healthcare.Item The language of neglect: A critical discourse analysis of single room occupancy housing inspection reports(2025) Beaumont, Madelaine; Slemon, AllieIn Vancouver, Single Room Occupancy (SRO) hotels serve as last-resort housing for people facing structural inequities. SRO building inspection reports frame these spaces through a discourse that individualizes responsibility for poor living conditions while obscuring systemic neglect. Using Norman Fairclough’s Critical Discourse Analysis (CDA), my thesis examines how Vancouver’s annual SRO inspection reports construct tenants, property conditions, and regulatory compliance. Findings reveal that reports discursively position tenants as risky, unpredictable, and the primary source of building deterioration, reinforcing narratives of the hard-to-house tenant, while failing to properly address the broader structural deficits and overall disrepair of the buildings. Safety discourse prioritizes fire code compliance over tenant security, justifying measures like the removal of secondary locks, overlooking the realities of assault, theft, and unauthorized tenant room entry. Similarly, pest infestations and structural decay are framed as tenant-induced problems (hoarding, clutter) rather than the consequences of chronic underfunding and deteriorating infrastructure. The analysis also highlights how inspection reports create manufactured compliance, where issues are deemed “resolved” based on procedural checkboxes rather than actual improvements for tenants. These opaque discursive ideologies normalize inadequate housing conditions, reinforcing the broader regulation of poverty. The findings are situated within the right to housing framework, challenging the dominant bureaucratic narratives that treat tenants as problems to be managed rather than individuals deserving of safe and dignified housing. A critical re-examination of how bureaucratic discourse shapes housing policy is necessary, as it often reinforces systemic inequities rather than addressing them. Drawing on Fairclough’s approach to CDA, the findings illustrate that discourse is not neutral but an instrument of power. Examining discourse through as critical lens exposes its role in maintaining inequality and opens possibilities for challenging dominant narratives and advocating for housing as a fundamental human right.Item Health care provider experiences with an electronic patient portal in cancer care: A qualitative study(2025) Quinn, Sarah Jane; Petrovskaya, Olga; Caine, VeraOnline patient portals offer individuals a secure website and/or mobile app to view their health information and appointment schedules, enter data into their record, and communicate instantly with their health care team. In November 2022, Alberta Health Services launched a new province-wide electronic health record, Connect Care (Epic), with a tethered patient portal, MyAHS Connect, across all Cancer Care Alberta sites. For this descriptive-qualitative study, I aimed to answer the following question: What are the effects of an online patient portal on the health care team’s work in the oncology setting in Alberta? The group of interest for this study was nurses, however clerical staff and medical oncologists were also recruited. From July to October 2024, I conducted semi-structured interviews with 12 registered nurses, 2 medical oncologists, and 1 clerk, recording and transcribing each interview. Data was analyzed using thematic analysis. The theoretical underpinning of this study was a technology-in-practice sociomaterial perspective, originating from actor-network theory. Three main themes were identified: the invisibility of nurses’ responsibility of supporting patient portal use, access to the portal shapes a new type of patient, and MyAHS Connect is as good as the networks of care provision in which it is embedded. This is the first study I am aware of evaluating health care provider experiences in Alberta with MyAHS Connect. This study includes recommendations on how health care providers can work at the intersection of the electronic health record (EHR) and patient portal as well as suggestions for future research. Ultimately, patient access to the portal changed the ways that health care providers are working but the degree of this change was highly influenced by patient use of the portal, staff’s use of the EHR, and the greater system context.Item Patient conceptualizations of the patient-provider relationship: A discourse analysis of the r/dialysis subreddit(2025) Ong, Su Han; Slemon, Allie; Caine, VeraPatients on dialysis develop unique relationships with their providers, fellow patients, and the broader healthcare system. These connections are well established as key factors influencing both their healthcare experience and mortality rates. Yet, despite ongoing efforts to improve these relationships, health outcomes remain unfavorable for dialysis patients. Exploring these relationships through a social media platform provides valuable insight into patient lived experiences, shedding light on pervasive power dynamics as seen from the patient perspective. This unique approach helps identify critical areas for improvement to enhance the experience and health outcomes of patients on dialysis. In this paper I use Foucauldian discourse analysis to examine posts and comments from the r/dialysis forum on Reddit submitted between 2012 and 2023, focusing specifically on dialysis initiation. It explores how societal discourse shapes patients’ impressions, communities, and frameworks as it both forms and is formed by peer-to-peer interaction. The study highlights how power and resistance are reflected in the linguistic choices made by patients, as well as their evolving conceptualizations of the patient-provider relationship as they begin their dialysis journey. These insights add to the dearth of current literature that use social media platforms and discourse analysis in investigating the healthcare experience. They lay the groundwork for better supporting a vulnerable clinical population and provide a foundation for future academic research using this methodology.Item Examining symptom burden and the palliative care needs of patients with hematologic malignancies(2024) Booker, Reanne; Stajduhar, Kelli I.; Sawatzky, RichardDespite the proven benefits of integration of palliative care in oncology, it has been well established that patients with hematologic malignancies and those undergoing hematopoietic stem cell transplantation do not routinely receive timely palliative care. Patients with hematologic malignancies are less likely to receive palliative care and more likely to receive aggressive care at end-of- life (such as chemotherapy, admission to hospital, and admission to an intensive care unit) compared to patients with solid tumours. Advances in the understanding and treatment of hematologic malignancies has led to improved survival rates for some patients, but high mortality rates and diminished quality of life for patients who survive persist. This dissertation includes three studies that are presented in paper-based format. The first paper (Chapter 4) describes the qualitative study that was undertaken to examine the perspective of patients (n=8), family caregivers (n=4), and clinicians (n=16) on integrating palliative care for patients with hematologic malignancies undergoing hematopoietic stem cell transplantation. Findings from this study revealed that patients undergoing hematopoietic stem cell transplant experience an array of physical, psychosocial, and practical concerns, during and after hematopoietic stem cell transplantation. In addition, participants spoke of the unique challenges to integrating palliative care in this population, such as prognostic uncertainty, the curative-intent focus, and misperceptions of palliative care held by clinicians, patients, and family caregivers alike. The second paper is the protocol for a randomized clinical trial to examine the impact of early palliative care compared to standard care for patients with hematologic malignancies. The study was developed following the completion of the qualitative study, taking into consideration patient, family caregiver, and clinician input on how to best integrate palliative care in this population. Due to the COVID-19 pandemic, there was a delay in opening the trial and there have been subsequent challenges with recruitment. As such, the findings from this study are not presented in this dissertation as the study is ongoing. The third paper describes a retrospective observational cohort study that examined symptom burden and healthcare utilization in patients with hematologic malignancies (N=7080). This study also involved chart audits of patients who had died within a year of completing symptom questionnaires (n=432) to examine symptom burden and healthcare utilization in this sub-cohort. This study found that patients with hematologic malignancies experience high symptom burden, particularly in the last year of life. In addition, symptom profiles were found to be associated with sociodemographic and clinical variables. In particular, females reported more frequent and severe symptoms compared to males and older adults reported moderate to severe physical symptoms but less frequent and less severe psychological symptoms compared to younger patients. This study also found that symptoms were associated with increased healthcare utilization, particularly emergency department visits. The findings emphasize the need for more supports for patients, particularly for symptom management. In summary, symptom burden and treatment-related toxicities are known to be high in patients with HMs. Morbidity and mortality associated with HMs and their treatment continue to be high. This research adds to the literature by demonstrating that patients with hematologic malignancies experience high symptom burden, experience high rates of healthcare utilization, and could benefit from integration of palliative care. This research informs implications for clinical practice, education, research, and policy, including better symptom management, education on the potential benefits of palliative care for patients with hematologic malignancies, the need for research on when and how to best integrate palliative care in this population, and consideration of policy changes to remove restrictive criteria in palliative care and hospice that may be barriers for patients with hematologic malignancies. Preliminary findings from this research have already been shared at local, provincial, national, and international levels. Resources on symptom management and palliative care for patients with hematologic malignancies have been developed with patient support societies across Canada. As such, it is hoped that this research will contribute to improving the patient and family caregiver experience and quality of life after the diagnosis of a hematologic malignancy.Item Sister Elizabeth Kenny's methods : freedoms, knowledges and the making of history(2002) Wallace, Patricia JoanneUsing a Foucauldian form of discourse analysis, this historical study explores the methods of poliomyelitis rehabilitation developed between 1911 and 1952 by an Australian nurse, Sister Elizabeth Kenny. The author takes a novel approach to constructing a historical account of Kenny and her work, exploring the ways in which Kenny's practices evolve through an analysis of statements about the body receiving rehabilitation. The author's main argument is that Kenny's practices, and in accordance with them her concept of the body in poliomyelitis, constitute a breach in two narratives of medicine, progress and war, providing an opportunity to envision other possibilities for the body, hence other possibilities for the poliomyelitis survivor and those providing healthcare for the disease. The author explicates the power associated with knowledges of the body and determines Kenny's knowledge to have currency in discourse because of direct impact her practices have on the body. Added to its undeniable benefits for the corporeal body, Kenny's work is textualized and circulated in discourse in unconventional ways, ignoring the rules established in the scientific community regarding the development of healthcare entities. It thus emerges as the first poliomyelitis treatment accessible to those inside and outside of medical science. For this reason, the author examines how the 'truth' about Kenny's practices emerge in relation to the unique positions they sustain in discourse. The author also considers that nurses can take a more critical stance toward their accounts of the body in front-line practice. To address this issue, the author suggests nurse historians, writing within the literary realm, may be freed from the constraints placed on scientific representations of the body in medicine. Thus, nurse historians have the potential to generate narratives that promote critical examination of the medicalized body.Item Perceived impact of work-related role sets : nurses' experiences with their colleagues(1990) Robinson, Patricia HelenA qualitative study was conducted to examine the perceived impact work-related role sets have on distance education learners' ability or willingness to apply concepts or skills acquired in a post-RN baccalaureate program. The Critical Incident Technique was used to elicit 106 incidents from 30 general duty nurses working in acute care hospitals. These incidents were categorized according to the role set, the emotional tone of the interaction, (the incidents were reported as positive, negative or neutral), the concepts or skills initiated and the impact on subsequent behaviour as a result of the interaction. An examination of the incidents showed the greatest number to involve other RN's; with half positive and half negative incidents. In the category of supervisory personnel (head nurses, supervisors and director's of nursing), all the incidents were negative. Physicians provided more negative than positive incidents and incidents involving patients were almost exclusively positive. Acquired concepts or skills identified as being new by the subjects included: nursing process , understanding of physiological processes , interpersonal skills, empowerment, patient advocate, understanding of the elderly and teaching abilities. The most significant finding was that of the effect negative sanctions had on subsequent behaviour. Despite the fact that almost half the incidents were viewed as negative, in only ten incidents did the nurse report she stopped the behaviour. Since the distance education learner experiences some problems not encountered in traditional face- to- face interactions, some strategies are examined: support systems, role models, mentors, and periods of immersion. Future studies might be undertaken to determine how widespread is the phenomenon and how distance education learners cope with the negative interactions they experience.Item Between duty and discretion : paramedics and the implementation of emergency medical services policy with older persons in crisis in the community - a qualitative analysis(1997) James, Pauline MarionThe study inquired, "how do paramedics implement Emergency Medical Services (EMS) policy with discretion, with older persons in crisis in the community?". The purpose of the study was to develop recommendations to reform EMS policy and practice during initiatives to regionalise health care in British Columbia. The method used was ethnography, and I rode the ambulance for ten months, in 1993. An ethical, investigative, participatory procedure was used to collect and analyse data. Sources included (a) field visits and notes, (b) interviews and focus groups, ( c) EMS legislation, regulations, policy and procedure manuals, reports, memoranda, and ( d) my personal journal. Findings confirmed that, in response to street-level dilemmas with older persons in crisis, paramedics implemented EMS policy with discretion. Seven discretionary decision-making processes were identified, and recommendations for EMS policy, planning, paramedic training and practice, including the implementation of guidelines and partnerships with community agencies, and future research, are discussed.Item Ordering madness for the social organization of world mental health : an institutional ethnography(2001) Jakubec, Sonya LeeThis thesis explores how research about mental health services is part of the social organization of international development. Institutional ethnography is used to explicate the social relations of the work of 'World Mental Health'. Data analysed include the author's personal experience in West Africa as a development worker in community mental health services. The inquiry is a textual analysis of a survey called a "Pathways Study" that the author implemented to support her funding requests from international aid agencies. The argument made is that the "Pathways Study", beyond being a source of information for aid agencies, is part of a ruling relation. Its implementation and use inserts a 'World Mental Health' framework into a local setting where it disorganizes local mental health efforts. The survey reconstructs what is known about the setting into concepts that match dominant Western (banking, scientific, professional and corporate) ideas and interests. The author suggests that through the systematic official process of privileging certain discourses, texts and approaches, local perspectives are subordinated.Item A grounded theory of the oral histories of retired nurses : becoming a Royal Jubilee Hospital School of Nursing graduate between 1926 and 1962(2003) Hobson, Cheryl AnnThis grounded theory of the oral histories of seven retired Royal Jubilee Hospital School of Nursing graduates explores the meaning they made of their intense experiences of becoming nurses. They reminisced, during unstructured interviews, about their three year period of living in nurses' residence between 1926 and 1962. Belonging to the sisterhood was the central theme that emerged from the data, and this connection of students to each other was vital to the development of a strong nursing self. It lasted a lifetime. Sisterhood processes played a vital nurturing role in cushioning the student from the harsh realities and hierarchical pressures of demands layered on them. It also supported their venting strategies, releasing pressures for the students' mental health and survival. The consequence was the development of a strong nursing self, a novice graduate who was able to graduate confidently and seamlessly. The sisterhood supported and allowed the fledgling nurse to cope with the stressors of becoming an RJH graduate nurse.Item Weathering the storm(2003) Hiebert, Walter GerhardThe purpose of this ethnographic study was to explore women's experiences of living with HIV / AIDS. Five women diagnosed with HIV / AIDS were interviewed using an unstructured interview format. The interviews were analysed using an ethnographic approach (de Laine, 1997; Spradley, 1980). Three common themes emerged: feeling limited hope, experiencing inconsistent health care, and transforming from victim to advocate. The research findings encapsulated the narratives of five women confronting the most difficult health challenge of their lives. Living with HIV/ AIDS is a complex and powerful experience for these women, one that provided the impetus for them to embark on a journey of creative self-discovery.Item A phenomenological study of the meaning nursing faculty ascribe in their decision to continue formal education(1989) Hickman, Jocelyne LiseThe purpose of this study was to uncover the meaning nursing faculty ascribe to the decision to continue formal education. This phenomenological question was approached by exploring the nature of the experiences as three women made the decision to engage in further education. A phenomenological orientation enabled me to focus on the actual phenomenon as the coresearchers lived, rather than intellectualized, their experiences (van Manen, 1984). The three nursing faculty members, through a series of non-structured interviews, engaged in a dialogue which encouraged them to describe their lived experiences. The stories they provided were rich and reflective. They are presented in prose form so they may more accurately reflect the narrative quality of their descriptions. Themes emerged from each story that spoke of the turmoil experienced by these women and their need to return to fundamentals when contemplating the decision to undertake further education. They needed to reconstruct from early foundations, make broad assessments, seek new goals and gain a deeper understanding of how they stood in the world. This reweaving of personal patterns into a more suitable fabric brought them to the decision to continue their education. Consistent thematic threads emerged across and at the core of the stories. Exploring beyond these themes allowed the essence of the phenomenon to emerge as a meaningful whole. The essence of the lived experiences speak to the meaning of being in harmony with one's own sense of reality; the obstacles which impeded the decision-making process; the bearing of their personal and professional relationships on that decision; and their unique and very personal understanding of education. It is hoped that the phenomenological descriptions in this study act as a window which will enable the reader to see beyond the stories to the foundational ground of the phenomenon and to the deeper significance of the lived experiences described (Aoki , 1985).Item Social organization of eating disorders : two women's stories of resisting oppression(1994) Hammond, Carolyn JoyceItem Home alone : the lived experience of social isloation among women over eighty(1999) Guthrie Longenecker, Deirdre MahalahThis study investigated, from a phenomenological point of view, the experience of social isolation among women over the age of eighty. The purpose of this study was to explore the experience of social isolation in older women through the stories they told. These stories were then used to create a description of the lived world of elderly women. Three isolated women over the age of eighty were interviewed for this study. These interviews were then transcribed verbatim and analyzed. Reoccurring themes were found within the individual accounts as well as in the three women's stories combined. Major reoccurring themes included relationships, loss of personhood, becoming and becoming confident, coping with adversity, fearing, developing mastery, remembering and reminiscing, and centering. The concluding chapter of this thesis discussed relationships between present findings and the literature, application of the present findings for nurses, implications for policy, and recommendations for further research.Item The work of long term care case managers : the two faces of case management(1997) Goodwyn, Sherry ElizabethThis study examines work of Long Term Care Case Managers in British Columbia, Canada. Long Term Care is a publicly funded program. That program's mission is to care for chronically ill adults. This care includes allocation of resources such as homemaker services, adult daycare and care facilities. The everyday lived experiences of Case Managers were the entry point to exploring their work. Ethnographic methods were used to collect data including observations of work with clients and caregivers, interviews of Case Managers, and documentary analysis. The research revealed two facets of Case Managers' work. One facet is the completion of paperwork to meet the organization' s need to be accountable. Standardization of people, both clients and Case Managers can be seen as the effect of completing LTC documentation. 'Pixel reality' named for the smallest square of light on a computer screen, is the ultimate outcome when information on LTC documents is computerized. The documentary process strips information from having any resemblance to a real person. However, this stripped-down information is used to make budgetary decisions that dramatically affect the life of real people. Diametrically opposed is the second facet of Case Managers' work involving support for caregivers/clients. The unpaid caregivers who are shown to be the primary focus of Case Managers' work, do 80-85% of the work of caring for the L TC client. These unpaid caregivers also do some of case management such as monitoring and assessing clients' needs. This uptake of work by families enables LTC Case Managers to ' manage' caseloads of 200 -300 clients. Case Managers are the human link necessary to adapt the formal Long Term Care program to meet the needs of the unpaid informal caregivers. Analysis of ethnographic field notes revealed work by Case Managers to maintain the delicate balance between allocating scarce LTC resources and "propping up" caregivers to continue their participation in client care thereby fulfilling the mandate of Long Term Care. All of Case Managers' work, the visible documentation and the invisible support of caregivers is essential to meet goals stated in the mission statement of Long Term Care.Item The meaning of home for older women residing alone(1999) Furness, Wendy LynnThis phenomenological study explored the meanings of home for four older women who lived alone in an urban dwelling but required assistance from Home Care nursing and / or Long Term Care services to remain there. All the women were Caucasian between the ages of 80 and 91. To gain understanding of the lived-experience of home for each informant, data collection included taped conversational interviews and conscious observation both conducted in the individual's home. Everyone creates the nest they want, home is an expression of self, and home is a place of nurturance and reciprocal support were the three essential themes that were identified from the data. In this paper, each of these themes are presented in detail as they emerged in this research.Item Special Care units : the policy practice interface(1993) Frost, Ellenor M.Item Journey to the right place : constructing the honorable health care relationship through story; experiences of parents during diagnosis and treatment of their child's chronic illness(2000) Capron, Mary AlyseJourney to the Right Place: Constructing the Honorable Health Care Relationship Through Story. Experiences of Parents During Diagnosis and Treatment of Their Child's Chronic Illness. Author: A Capron. A hermeneutic phenomenological study of parent's stories of relationship with health care providers at the time of their child's illness. Using honoring as a methodology, the parental experiences are recanted in a final story focusing on the construction of connection through: (a) hearing the story - the role of dialogue/listening in making the connection, (b) inviting the translator in - recognizing parental knowledge, and (c) providing comfort through validation. The thesis concludes with a discussion of this knowledge in relation to the author's practice of nursing, suggesting that honoring and bearing witness may serve as a new means of relating in caring and serve to champion a new form of health promotion through providing a mechanism to translate patient centered theories of care into practice.Item Making clients or regenerating citizens : a feminist analysis of community work(1995) Burgess, Judith AnnThis thesis explores the every day lives of four women, who have been perceived and labelled as 'at-risk' clients. These four women with young children, initially came to the James Bay Family Resource Centre with experiences of powerlessness and devaluation Over time, through the mediating presence of the Family Resource Centre and the support of community workers, the women gained increased independence and self worth, and enhanced capacity to care for their children From taped interviews, I explicated the, often times, invisible work of women as they 'care for' and 'care about' their children. The experiences of these women, corroborated by their workers, are constructed into stories of 'being a client' Committed to the methodology of institutional ethnography, I began the inquiry with the women's everyday encounters and related these experiences to the social relations of ruling, as implicit in their narratives I explored the disjunctures with the larger social relations, and made explicit that which controls their local experience The stories the women told of their interactions with family, with community, and with professionals were not uncommon to many of the women, who come to the Family Centre disenfranchised by an uncaring society From a feminist analysis the women's stories and relevant literature were reviewed I determined that the every day lives of these women have been socially constructed, so that the women themselves have been organized into a role of clientage. I contend that clientage is the process of being contained by organizational structures and professionalism, that adhere to the underpinnings of patriarchy and capitalism, and the concomitant ideology of individualism The research further reveals the work of the women and their community workers at the Family Resource Centre, as the women gained personal power and endeavoured to regenerate as valued neighbourhood citizens Analysis and literature uncovered the features of caring community work, which I assert, contribute to the deconstruction of making clients and the regeneration of citizens I conclude that caring community work, with the feature of 'caring about' individuals, is guided by principles that focus on local action and promote the competence of citizens and neighbourhoods.Item Indigenous Peoples’ experiences with culturally safe health care(2024) Harding, Jillian; Sangster-Gormley, Esther; Doane, GwenethIt is widely recognized that Indigenous peoples have a lower life expectancy and higher rates of chronic health conditions and infectious diseases than non-Indigenous people do. Factors contributing to such health inequities include the impact of colonization on Indigenous peoples’ health and racism that Indigenous peoples often endure in mainstream health care settings. To promote Indigenous peoples’ health and reduce stigma and discrimination in health care, cultural safety is a promising approach. Although there is a substantial body of literature and research on cultural safety, there is a lack of resources to guide health care providers in practicing cultural safety effectively. The overarching purpose of this dissertation was to gain insight into Indigenous peoples’ experiences with culturally safe health care. Two research questions guided the research process: 1. What are Indigenous peoples’ experiences with culturally safe health care encounters? 2. How is cultural safety enacted in health care as described by Indigenous peoples? Two methodologies were used to explore these questions. For the first question, I used the Joanna Briggs Institute meta-aggregative approach to conduct a qualitative systematic literature review. For the second question, I used a descriptive qualitative methodology informed by relational inquiry, which is a nursing approach that is grounded in critical theoretical perspectives, hermeneutic phenomenology, and pragmatism. While the systematic review provided a synthesis of existing evidence, the qualitative study explored the ‘how’ of cultural safety, specifically, how health care providers created positive and safe health care experiences as described by Indigenous peoples, in contrast to much of the existing research that mainly focuses on the ‘what’ of cultural safety. This publication-based dissertation is organized into three papers. The first paper is a published protocol for the qualitative systematic review. The second paper is the completed qualitative systematic review. The third paper is a practice-oriented paper aimed at assisting nurse practitioners in implementing culturally safe practice at the point of care through the creation of a mnemonic. The mnemonic was intended to provide a way for nurse practitioners to think about culturally safe care and enhance their ability to provide that care in specific health care situations.