Theses (Nursing)

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    The Social Organization of People’s Experiences Enhancing Health for their Young Children after Declining Vaccines
    (2024) Huel, Christine; MacKinnon, Karen
    In this publication-based dissertation, I describe a Ph.D. research project with three manuscripts that seek to form a better understanding about people’s activities to enhance their family’s health after declining routine childhood vaccinations. My experiences as a registered nurse working with people who choose not to vaccinate their children ignited my interest in this topic. After not fully vaccinating, people have described contributing substantial amounts of time, effort, and financial resources towards activities that aimed to thwart vaccine preventable diseases in their families and enhance their children’s health. Declining vaccines was not just a choice, or a perspective confined inside of people’s minds. Their efforts to do “health work” for their family can be observed in different families and communities, at different times. Recognizing that what people do is as intensive as it is invisible has led me to engage in a dissertation that seeks to form awareness about this facet of vaccine refusal. Using Institutional Ethnography, my dissertation research began illuminating how institutions within ruling relations influence the social organization of people’s experiences of health work that aims to enhance the health in their children while protecting their rights to choose which health treatments their children will receive. In this work, a JBI qualitative systematic review, a key informant interview, and a meta-ethnographic exploratory synthesis provided rich descriptions of informant’s health work for their children. My goal was to produce an understanding that assists people and healthcare providers, like nurses, to recognize potential influencing factors of vaccine hesitancy that may have gone unnoticed. From this understanding, I hope that healthcare providers and researchers recognize that respect for people’s “health work” can exist in tandem with a difference in opinion on the topic of vaccines.
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    Shaping Experiences: Exploring the Impact of Legislation, Policy, and Programs on Family Members of MAID Recipients
    (2024-01-05) Powell, Tracy L.; Stajduhar, Kelli I.
    Published literature on family members’ experiences with assisted dying is minimal, with only a limited number of studies exploring the perspectives of bereaved family members. Studies have shown family members can play a significant role in assisted dying. My study aimed to understand the experiences of bereaved family members who have had a loved one receive medical assistance in dying (MAID) and describe how MAID implementation, policy, and processes in two different settings in Canada influenced these experiences. The study used interpretive description, a qualitative research methodology framed by the theoretical lens of relational ethics. A total of 31 family members and 15 key informant participants took part in the study. The analysis of the data identified three descriptive themes: (a) they want MAID, now what, (b) prepared but maybe not ready, and (c) evolving understanding of this type of death, with associated subthemes that revealed the complex and layered experience of family members whose loved one received MAID. Study findings also revealed the experience of family members was influenced not only by individual-level factors but also by meso-level factors, including programs, processes, policy, and macro-level elements, including MAID legislation. These elements did not operate in isolation; instead, they interconnected to influence family members. Based on study findings, recommendations focus on policy, practice, and education, as well as future research and propose options to address the elements that affect the experiences of bereaved family members of MAID recipients.
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    A Gendered Analysis of Implemention and Impacts of Prescribed Safer Supply in BC: A Qualitative Exploration during Dural Public Health Emergencies
    (2023-08-31) Sullivan, Ginger; Pauly, Bernie
    Women and gender diverse persons often remain underserved by harm reduction programs and initiatives (e.g., needle distribution, supervised consumption services, prescribed safer supply programs). A lack of attention to gender and other intersecting factors in the design of harm reduction programs means that the needs of women and gender diverse persons may be overlooked or unmet. This research provides a gendered analysis of the design, implementation, and impacts of prescribed safer supply during the dual public health emergencies (overdose emergency and the COVID-19 pandemic) in British Columbia (BC), Canada. A qualitative methodology informed by critical, feminist, and implementation theory guided this dissertation. The research questions were: (1) Do the existing clinical guidance and policy direction on prescribed safer supply address the unique needs of women and gender diverse persons in BC? (2) Using prescribed safer supply as a case study, how could health equity be integrated into the Consolidated Framework for Implementation Research (CFIR)? (3) What were women’s and gender diverse person’s experiences accessing or attempting to access prescribed safer supply in BC during the dual public health emergencies (overdose emergency and COVID-19 pandemic)? The dissertation is organized into three papers, one for each research question. In paper one, I examine how BC’s prescribed safer supply initiatives (as represented in the Risk Mitigation Guidance [RMG] and prescribed safer supply policy direction) respond to the unique intersecting needs of women and gender diverse persons who use drugs. This study drew on intersectionality-based policy analysis (IBPA) developed by Hankivsky et al. (2012). Findings revealed that the documents were primarily gender silent. When gender was mentioned, it was in the context of reproduction. None of the documents mentioned specific considerations for women or gender diverse persons seeking or receiving prescribed safer supply. In paper two, based on my experience using the CFIR to organize a study evaluating prescribed safer supply in BC, I conducted a critical analysis of the framework with specific attention to equity and gender. Findings from the critical analysis were used to generate recommendations on how to further integrate health equity and gender considerations into the CFIR and implementation science (IS), more generally. Based on my experience, I see community-based participatory research as a potential approach that can help to operationalize equity considerations in the CFIR In paper three interpretive description (ID) was used to analyze 21 in-depth interviews with women and gender diverse persons who accessed prescription opioids or stimulants under the RMG during the dual crisis of drug overdose during the COVID-19 pandemic. Interviews were conducted as part of a larger evaluation of the RMG in BC in 2020-21. Findings highlight that women and gender diverse persons experienced a lack of gender-responsive supports when accessing or attempting to access prescribed safer supply. Together, this research offers novel evidence that can be used to improve women’s and gender diverse persons’ access to harm reduction services, specifically prescribed safer supply programs. The findings from this research extend our understanding of current overdose responses and inform ongoing public health and harm reduction efforts in BC, Canada, and beyond. Findings from this research highlight that current policy documents and emerging models of prescribed safer supply are predominately gender silent and do not address the unique and specific barriers faced by women and gender diverse persons who use drugs. Further research is needed to specifically examine how gender intersects with race, class, and sexuality to influence people’s access to safe supply. Implications for nursing policy, practice, research, and education include specialized training and education around harm reduction for nurses and student nurses, expanding registered nurse prescribing to include medications for safer supply, and future research examining nurse’s role (including nurse practitioners) in safer supply responses.
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    Honouring lived experience wisdom: Healing and healing environments according to ‘family members’ in Indigenous-led alcohol harm reduction and culturally supportive housing
    (2023-08-31) Brown, Meaghan; Pauly, Bernie
    Honouring lived experience wisdom: Defining healing and healing environments according to ‘family members’ in Indigenous-led alcohol harm reduction and culturally supportive housing’ illustrates a strengths-based story of ‘culture as healing’ (CAH) and decolonized harm reduction for seven Indigenous people with experiences of homelessness and significant alcohol-related harm. Based in a broader dual-site study on the design, implementation, and evaluation of Indigenous-led Managed Alcohol Programs (MAPs), this research responds to gaps in knowledge on the implementation and impacts of Indigenous-led MAPs and CAH models among primarily western MAPs in Canada. Based in five years of relationship with the Aboriginal Coalition to End Homelessness Society (ACEH), I explore healing perspectives and experiences of ‘family members’ (residents) of the ACEH Indigenous Alcohol Harm Reduction Residence Program (IAHRRP) and Culturally Supportive House (CSH), located on Lekwungen and W̱SÁNEĆ territory (Victoria, BC). Objectives of this study aim to identify practices, policies, and principles that are reflective of ‘healing’ and ‘healing environments’ according to family members. This qualitative collaborative study is guided by Indigenous methodological principles and community protocols developed in partnership with the ACEH and Canadian Managed Alcohol Program Study (CMAPS) as part of an Indigenous-western/Settler research partnership. In outlining the methodological approach to this project, I critically explore my position and role as a Settler student, researcher, and nurse in this partnership and in relation to community. I draw upon three interrelated conceptual frameworks to inform analysis in relation to healing and culture, alcohol, and housing: the First Nations Mental Wellness Continuum Framework (FNMWCF) (Assembly of First Nations (AFN), Thunderbird Partnership Foundation, & Health Canada, 2015), Definition of Indigenous Homelessness in Canada (Thistle, 2017), and the ACEH Dual Model of Housing Care (Hunt-Jinnouchi et al., 2021). Across three manuscripts, I present 10 themes related to definitions of healing, impacts of the CSH and IAHRRP, and factors that promote ‘healing environments’ from the perspectives of family members. Paper one illustrates themes of family members’ definitions and experiences with CAH: Being in an Indigenous home with Indigenous people; Finding purpose and contributing to the home; Learning/re-learning and living Indigenous ways of being and doing; and Land-based healing. In paper two, themes reflecting healing impacts and healing environments of culturally supportive housing are presented: Respite from the street and system in an Indigenous space; Genuine connection; and being heard and mutually respected. Paper three focuses on themes of healing and healing environments in relation to the IAHRRP: A choice I’m making right now; Multiple pathways for connection to culture, with or without alcohol; and Giving me the reigns to take care of myself with a home. Lastly, I conclude with a set of recommendations for the design and implementation of Indigenous-led MAPs and CAH models guided by the perspectives of family members. Four recommendations draw upon learnings identified across the 10 themes, including to create spaces that reflect an “Indigenous home” of belonging and pride; offer land-based healing and teaching accessible to Indigenous people with experiences of homelessness and alcohol use; centralize lived experience wisdom in the development of practices and policies that address the unique safety and wellness definitions of Indigenous people with experiences of homelessness, systemic, and street-based violence; and facilitate multiple pathways to connect to culture as healing. While recommendations are most responsive to the highly localized context of the IAHRRP and CSH, they may offer transferable insights for the design and development of future Indigenous-led MAPs.
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    Improving Care for People with Severe Persistent Mental Illness in the Palliative Phase
    (2023-08-30) Donald, Erin E.; Stajduhar, Kelli I.
    Persons with severe persistent mental illness (SPMI) experience a greater burden and severity of chronic disease, late diagnosis, and premature death compared to the general population. These patients also receive fewer medical treatments, poorer quality of care, and are less likely to receive palliative care compared to the general population. Inequitable health outcomes are related to complex factors including social marginalization, stigma, lack of education and support from healthcare organizations, and siloed health services. The purpose of this study is to bring a critical theoretical perspective to understanding and improving care for the medically ill and dying with SPMI. This manuscript-based dissertation draws upon multiple lenses including a scoping review of the healthcare literature on palliative care for people with SPMI; a co-produced interpretive phenomenological analysis, in partnership with community members with lived experience of homelessness and chronic illness, investigating the appropriateness of patient-reported outcome and patient-reported experience measures for this population; and a critical analysis of historical influences on modern approaches to palliative care for people with SPMI, with an emphasis on inherited assumptions and attention to their role in present-day care. A critical synthesis of findings from these analyses informs key learnings and future recommendations for research, policy, practice, and education.
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    The Experience of Adolescent and Young Adult Transplant Recipients Transitioning to Adult-Focused Care: A Constructivist Grounded Theory
    (2023-07-20) Lim, Angie; Marcellus, Lenora
    The healthcare transition for adolescent and young adult (AYA) organ transplant recipients is a critical yet understudied period, marked by a shift from pediatric to adult-focused care. This transition process presents unique challenges, including adherence to immunosuppressive regimens and addressing psychosocial factors that impact long-term graft survival and patient well-being. In this constructivist grounded theory (CGT) study I explored how AYA kidney and liver transplant recipients manage the transition process and identify how nurses and healthcare practitioners support psychosocial adaptation. Through in-depth interviews with transplant recipients, their families, and pediatric nurses, the study generated a substantive theory representative of AYA transplant recipients' experiences and adaptations during the transition process. The primary objective was to understand how AYAs prepare for and engage in the transition process. The secondary aim was to identify strategies for healthcare providers to support their psychosocial well-being. A CGT approach, grounded in symbolic interactionism and constructivism, was employed to systematically gather, synthesize, analyze, and conceptualize qualitative data, ultimately constructing a theory, Riding the Wave of Change: Transforming Through Transition, that captured the complexity of AYA transplant recipients' experiences. This study holds significant implications for nursing practice, as it fills a gap in the literature by addressing the underrepresentation of nursing voices in transition research. By generating a midrange substantive theory, the study enhances nursing knowledge on the transition experience and informs policymaking, practice, and research in the field of healthcare transitions for AYA organ transplant recipients. The findings provide valuable insights for pediatric and adult healthcare providers to better support AYA patients and their families during this critical period.
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    The Social Relations of Home Care Nursing Work
    (2023-04-21) Sanders, Tanya; Duncan, Susan
    There is an increasing need for home care in Canada; however, there is little evidence about the everyday nursing work in home care and the institutional influences that impact this work. As nurses are the largest professional care providers in home care and given the increasing demands for home care services, there is a need to understand the work of nurses, specifically to identify the social organization of this work. As a part of a larger Canadian study on home care systems, this institutional ethnography focused on home care nurses in one health authority in Western Canada. The standpoint of nurses was explored through interviews, observations, and collected texts used to explicate the social relations coordinating home care nursing work. The results of this inquiry show that nurses’ work is coordinated through texts and electronic health documentation systems. Safety, measurement, and efficiency are shown to influence nurses’ work. Alongside the discursive arrangements, increasingly nurses’ time coordinating their work and client care is expanding, with less time for direct client care. To meet the increasing demand for home care, insight is needed to improve access and care. Understanding the invisible but dominant ruling relations organizing influencing, and at times disorganizing, the everyday work of nurses is a vital first step in creating change for home care nursing.
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    Advance Care Planning between Registered Nurses and their Acute Care Patients
    (2022-10-03) Rietze, Lori; Stajduhar, Kelli
    Canadians are living longer with multiple complex illnesses. In turn, older adults are often in need of complex medical attention in crisis situations in acute care hospital settings. Although acute care settings are equipped with a growing variety of life saving technologies, hospitals are still the setting in which most people die. Yet, almost half of the Canadians who have been admitted to acute care centres with chronic life-limiting illnesses have not had advance care planning (ACP) conversations with their substitute decision-maker (SDM) about the personal values that bring quality to their lives. In fact, only 8% of the general Canadian population are ACP ready. Consequently, many SDMs are unprepared to make end of life (EOL) treatment decisions for their loved ones. One way to promote patient-centred care and ease the burden of in-the-moment EOL treatment decisions made by SDMs, is for nurses to engage their patients in ACP. However, very few registered nurses regularly engage their patients in ACP. The purpose of this research is to better understand the organizational factors influencing nurses’ decisions related to ACP in their hospital-based work. This ethnographic study was conducted on three acute care wards in two hospital sites located in Northern Ontario. Data collection methods included observational fieldwork, semi-structured interviews with administrators and registered nurses (n=23), and the collection of documents pertinent to the study purpose (i.e., accreditation reports, practice guidelines, etc.). Findings reveal that the work of nurses in hospital settings is embedded within a context that prioritizes patient flow, and efficiency. Consequently, hospitals often function at overcapacity, and nurses have extremely heavy workloads caring for complex patients with diagnoses that do not match the medical specialty of the units. Although participants state that they value ACP, they maintain that nurses have very little capacity to engage patients in these conversations in their practice. Findings support that expectations for hospital nurses to fully engage in ACP with their patients may be unrealistic given the context within which they work. Alternative models for considering ACP in acute care could be explored to ensure that patients with life-limiting conditions receive care that is best matched to their needs, values, and wishes.
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    Teaching Nursing as a Complex Emergent Discipline
    (2022-08-19) Clancy, Tracey L; Hills, Marcia
    My goal with this inquiry was to seek the meaning of teaching nursing from within the discipline, aligning pedagogy with what it means to become a nurse in addition to revealing what nursing is as an embodied practice and how it should be taught. I utilized Max van Manen’s hermeneutic phenomenological human science research approach as the methodology for the analysis of this research. Five registered nurse educators with more than ten years’ experience teaching undergraduate and/or graduate students, dedicated to the notion that there is a disciplinary perspective that supports nursing research, education, and practice, and who have engaged in philosophical reflection of nursing’s disciplinary perspective participated in the study. Relationality, becoming, and trusting were foundational concepts underpinning teaching practice as revealed within the lived experience of these nurse educators. Relationality was manifest as an embodied exchange within the dynamic and emergent nature of experience with oneself, with another, and with knowledge itself. Becoming was revealed through the lens of a process orientation. Articulating learning nursing through a process of becoming means fostering learning through embracing paradoxical and dialectical thinking and supporting students to engage in learning nursing as a process of navigating complexity, uncertainty, indeterminacy, difference, and paradox that characterize nursing practice. Participants shared that the invisible nature of a process orientation requires trusting learning as an ever-renewing relational process. The meaning of teaching nursing was revealed as a complex emergent discipline.
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    Mastectomy tattoos: transforming perceptions of self
    (2022-05-02) Reid-de Jong, Victoria; Bruce, Anne
    Thousands of women in Canada continue to be diagnosed every year with breast cancer, many undergoing surgical mastectomy as part of their treatment to eradicate or control the spread of disease. At present, the recommendation for breast conserving surgery (BCS) and breast reconstruction dominates discourse in oncological settings, limiting conversations about alternative options for women to consider following the removal of their breast(s). Interesting however is the decision, made by some women in contemporary society, to undertake unconventional practices such as being inscribed with tattoos where breasts once occupied space. Unfortunately, little is known about the experiences of women who have foregone reconstructive surgery and chose to be tattooed post mastectomy. A Gadamerian philosophical hermeneutic approach was used to explore the phenomenon of being tattooed post mastectomy. Six women with mastectomy tattoos were interviewed to learn about the experiences of being tattooed where breast(s) once occupied space. Participants in this study were between 48 and 65 years of age and tattooed from one month to five years after surgery. Meanings about being tattooed post mastectomy surfaced through conversation and photographs. Gadamer’s hermeneutic teachings were engaged to analyze women’s thoughts, feelings, and photographed images of participant tattoos, surfacing meaning about being tattooed where breasts once existed. To establish a passage for understanding, three publishable manuscripts constitute the body of the dissertation. The first manuscript presents my personal narrative [in part] of being diagnosed with breast cancer and undergoing a mastectomy without reconstruction. In the second manuscript, the socio-cultural context of why the mastectomized female body is considered abject in contemporary society is examined. Further, I explore how a mastectomy tattoo may be an emerging alternative for some women following the loss of their breasts(s). In the third manuscript the key interpretive discoveries through hermeneutic analysis of interviews and photographs are presented and include: (1) Feeling sad and damaged post mastectomy (2) Reclaiming self: Taking back power and control; and (3) Transformation: Embodying the tattoo as a novel representation of self. These interpretive findings suggest aesthetic options such as tattooing embolden participants to reclaim power and control lost to cancer and transformed their self perceptions of beauty, femininity, and sexual identity post mastectomy. This dissertation contributes to women’s health, specifically within the field of oncology by offering what I understand to be the first phenomenological study interpreting lived experiences of being tattooed post mastectomy. Understanding how women may feel sad and damaged following surgery opens avenues for empathetic questioning and therapeutic supports from nurses. Sharing experiences of women who found the process of designing and being tattooed transformational and empowering may introduce new options post mastectomy that include aesthetics and beauty. Gaining insight into this unique phenomenon can help make meaning about how aesthetic options such as tattooing can empower some women who may be searching for alternatives to breast reconstruction post mastectomy. Furthermore, challenging dominant discourses specific to how women’s bodies should look can create spaces for discursive conversations and optimistically expand options beyond those currently offered post mastectomy.
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    “Nurses can do better”: experiences of LGBTQI+ migrants with nurses and other healthcare professionals in Canada
    (2022-04-27) Haghiri-Vijeh, Roya; McDonald, Carol
    This dissertation starts with a foreword chapter that discusses my situatedness in research which aims to understand the experiences of LGBTQI+ migrants with nurses and healthcare professionals in Canada. This is followed by an overview of literature on the experiences of LGBTQI+ people in their migration trajectories and interactions with social and healthcare professionals. I close the foreword chapter with a discussion of my methodology and research approach. I then present four manuscripts that I prepared for publication and an afterward chapter. In the literature review, I discuss how, over the past two decades, some nurses, along with social and mental healthcare providers, child and youth workers, public service providers, and legal service professionals, in collaboration with migrants, LGBTQI+ people, or those at the intersection of identities, have strived to advance safe and affirming spaces for LGBTQI+ migrants. Despite the work of these scholars, practitioners, and activists, some nurses continue to have a limited understanding of the experiences of LGBTQI+ migrants in the Canadian context, and LGBTQI+ migrants continue to have troubling experiences with nurses. For this reason, the following question undergirds this dissertation: What have been the experiences of LGBTQI+ migrants in their interactions with nurses and other healthcare professionals (NHCPs) in Canada? Within my dissertation, I analyze LGBTQI+ migrants’ encounters with NHCPs by applying a Gadamerian hermeneutic approach with intersectionality as an analytical lens. Utilizing this approach, I conducted 18 semi-structured, in-depth, individual interviews. Two groups of individuals participated in this study: (a) 16 LGBTQI+ migrants who received care from nurses and other healthcare professionals in Canada; and, (b) five nurses or nursing students who experienced, observed, heard, or witnessed the provision of nursing care to LGBTQI+ migrants. Of the latter, three also identified as LGBTQI+ migrants. Three nurses identified as registered nurses, one nurse identified as a registered practical nurse (also known as licensed practical nurse in some provinces) as well as a student in a nursing degree program, and one nurse identified as an educator. Approaching analysis from an intersectional lens, I observed how LGBTQI+ migrants’ experiences were shaped by considerations of physical, mental, and spiritual well-being, which intertwined with race, ethnicity, migration status, sexual orientation, gender identity, and gender expression. Furthermore, I found that migration status added another layer of complexity to the marginalization of LGBTQI+ people, which required intentional allyship from nurses. Chapter two consists of the first manuscript, “Gadamerian Hermeneutics with Intersectionality as an Analytical Lens,” in which I provide an account of the methodological research approach to understand experiences of underserved people, namely LGBTQI+ migrants. Chapter three includes the second manuscript, “Experiences of LGBTQI+ Migrants with Nurses and Other Healthcare Professionals in Canada,” in which it becomes evident that LGBTQI+ migrants’ experiences encompassed both challenges and supportive care in their encounters with nurses and other healthcare professionals. With attention to micro, meso, and macro health policies, the informants identified that feeling inferior to and unacknowledged by NHCPs often created challenges for them in navigating the healthcare system. This leads to the fourth chapter, titled “‘If You Can Just Break the Stigma Around It’: LGBTQI+ Migrants’ Experiences of Stigma and Mental Health.” In this manuscript, I illustrate the multiple forms of stigma that negatively affected LGBTQI+ migrants’ mental health. Here, three themes are discussed: (a) the intersectional experience of stigma, (b) stigma related to fear and safety, and (c) participants’ calls for affirming practices that promote inclusive health services and supports. Given the contextual utility of these findings, I build on existing literature which corroborate that changes in nursing education, practice, and policy need to occur to provide diverse LGBTQI+ migrants with care that addresses trauma-informed and violence-informed practices. In chapter five, the title of “‘Ally Theatre is a Problem’: LGBTQI+ Migrants’ Experiences with Nurses in Canada” arose directly from some informants’ concerns about performative allyship. In the final chapter, or afterward, I provide a synthesis of the dissertation, including implications of its findings for nursing practice, education, policy, and ¬¬research. Intentionally, the final chapter is called an afterward, and not afterword, because I cannot claim that the chapter will outline my final words, since it acts, instead, as a bridge for future scholarship. Here, I elucidate how LGBTQI+ migrants addressed trauma and accessed resources with resiliency, even while they encountered barriers to accessing much-needed healthcare services. This dissertation centres on the voices of an understudied population, LGBTQI+ migrants, receiving nursing and health care in Canada.
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    Hearing their stories: understanding the experiences of Canadian Muslim nurses who wear a hijab
    (2022-01-07) Saleh, Nasrin; Clark, Nancy; Bruce, Winifred Anne
    My experiences as a Canadian Muslim nurse wearing a hijab have sparked the question concerning the experiences of nurses who, in their daily practice, choose to wear a head cover, an immediate visual signifier of their Muslim identity. I wish to generate understanding of how this religious identity and its racialization intersect with gender to shape nurses’ experiences with anti-Muslim racism. Through listening to the stories of ten Canadian Muslim nurses who were recruited across Canada and who wear different types of the hijab, come from varied and diverse cultural and educational backgrounds, and practice in different healthcare settings and contexts, their experiences are highlighted, and their voices are illuminated, revealing valuable insights into the challenges they encounter in their daily nursing practice. I situate these experiences within a conceptualization of Islamophobia and, more specifically, gendered Islamophobia as a form of anti-Muslim racism that is often experienced by women and girls who are identifiable as Muslims. In this dissertation, I attend to the overarching question: What are the experiences of Canadian Muslim nurses wearing hijab and practicing within the Canadian healthcare system? This question encompasses three sub questions: 1) How do Muslim nurses’ social locations that are produced at the intersections of gender-race-religion converge in understanding their experiences? 2) What are the power relations enacted within the discipline of Canadian nursing that produce and sustain social locations experienced by nurses who wear a hijab? 3) What are the ways these nurses resist their racialization and push against master-narratives that are constructed about them? These questions are approached using narrative inquiry as a research methodology that is informed by critical race feminism and care ethics. These questions are also explored through intersectionality as an analytical lens to unpack the complexities of these nurses’ experiences. In this study I present the nurses’ counter-narrative that challenges the stereotypical assumptions about them and unveils the multilevel contextual power structures that preserve racism within the discipline of nursing and reproduce the processes of racialization experienced by nurses who wear a hijab. In doing so, my aim is to provide a vessel in which the nurses share their stories and to reclaim control over the reductionist Orientalist colonial narratives about them. It is my hope that knowledge gleaned from this study will inform the understanding of the structures and processes that produce and maintain racism within nursing with the goal of advancing transformational change in nursing to achieve social justice. I capture the counter-narrative of nurses who wear a hijab in three composite narratives that I constructed from their stories based on key storylines that I needed to unpack. By ‘composite narrative’ I refer to a technique where several interviews are combined and presented in one or more individual stories that are linked by a shared purpose or identity among research participants. The technique of using composite narratives to present and analyse complex and extensive data is congruent with analyzing stories as a whole instead of fragmenting them. The counter-narrative offers a point of resistance as an alternative discourse that uplifts the voices of the nurses through understanding and generating knowledge about their experiences from their standpoint. The stories of Muslim nurses who wear a hijab bridge a gap in the literature about Muslim nurses’ experiences within the current charged political environment, post 9/11 era, the COVID-19 pandemic, the Quebec ban on wearing religious symbols and the ensuing debates it generated in Canada. Their stories provide a needed and timely understanding of the implications for nursing research, policy, practice, and education to create an inclusive and supportive environment for nurses who wear a hijab. Given the interconnected nature between racism and colonialism, fostering such an environment is inherently anti-racist and decolonial. Importantly, doing the work to create safer, anti-racist spaces for nurses who wear a hijab and to decolonize nursing which would benefit all racialized nurses.
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    Heart failure self-care: an evolutionary concept analysis
    (2022-01-04) Garland, Rachel; Gagnon, Marilou; Lewis, Krystina
    Self-care is a central concept in heart failure management and nursing practice. Yet, the uptake of heart failure self-care has been uncritical and detached from broader contexts. Therefore, heart failure self-care was explored using Rodger’s evolutionary concept analysis approach to identify antecedents, attributes, and consequences with attention to context, time, application, and meaning. The analysis suggests that heart failure self-care tends to focus on individual behaviours to the detriment of social and structural determinants of health. It also shifts responsibility away from the healthcare system and onto the individual. Moving forward, a more robust conceptualization of heart failure self-care is needed or possibly, the development of a new concept that focuses beyond the self.
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    Exploring the role of digital technologies for social connectedness, outcomes and experiences with the chronic obstructive pulmonary disease (COPD) community: A transformative mixed methods research study
    (2021-10-04) Antonio, Marcy; Lau, Francis; Sheilds, Laurene Elizabeth
    Prior to the coronavirus disease-2019 (COVID-19) pandemic people with chronic obstructive pulmonary disease (COPD) were already experiencing social isolation due to the complex intersection of symptoms, and perceptions towards the illness. COPD is a chronic lung illness characterized by progressive shortness of breath, and decreasing lung function, with influenza and other respiratory illnesses more likely to have fatal consequences for this population. Societal beliefs and assumptions around behavioural risk factors, and in particular smoking, contribute to perceptions that COPD diagnosis, outcomes and experiences are self-inflicted and an individual responsibility. This is a perspective that fails to take into the account the complex contextual factors of the social determinants of health, where structural inequities result in higher smoking rates among populations with lower socioeconomic status. Further, these underlying societal values may compound the isolation experienced with COPD in which ongoing stigma towards the illness discourages people from identifying with a COPD diagnosis. The lack of identity may discourage developing a community where people can share experiences and strategies in living with COPD, and form a collective group that can advocate for change. Digital technologies (DTs), such as Facebook and Zoom offer new avenues to support social connectedness. However, little focus has been given on how people with COPD may (or may not) be using DTs to support their illness. This study explored the role DTs could serve in addressing social connectedness and experiences and outcomes for the COPD community. The study was informed by Mertens (2003, 2007) transformative approach where the knowledge of people living with COPD was prioritized in finding out what DTs they may be using to maintain social connectedness and to support their illness. The three stage mixed methods research design consisted of interviews, patient-reported outcome measures, patient-reported experience measures and a DT survey. Bazeley's (2018) approach was used to guide the integrative mixed analysis on data collected across the three stages. The overall findings were: 1) Participants’ experiences in living with COPD had uniquely prepared them for the COVID-19 pandemic, and it was the community that lacked capacity; 2) Dominant discourse around technology may be creating further harms to the COPD population that extend beyond the digital world; 3) Current digital health monitoring strategies for other chronic illnesses do not fully translate to the interests and needs for people living with COPD; 4) People living with COPD are using DTs, but prefer to keep their virtual world separate from their illness world; and 5) Considerations for DTs for COPD should move beyond managing outcomes, and include supporting experiences of living. Conducted between December 2018 and July 2020, and concurrent with the COVID-19 pandemic, the study demonstrated even greater importance with the onset of the pandemic in understanding how DTs may support social connectedness for people living with life-limiting chronic lung conditions.
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    Social media reviews as a supplement to traditional quality survey in the Canadian context
    (2021-09-13) Talusan, Christopher; Marcellus, Lenora; Courtney, Karen L.
    Measurement for quality improvement in health care can be difficult. Measuring patientcentred care ensures both patient, health care professionals and health system perspectives are accounted for. Unfortunately, obtaining meaningful data is challenging as traditional surveys, while necessary for longitudinal comparison, often fail to capture the changing perspectives of patients. The use of natural language processing to mine free-text reviews can supplement data obtained from traditional quality surveys and identify new areas of concern that patients find important. This work used natural language processing of Google user reviews of hospitals in British Columbia to identify topics relevant to the Canadian Patient Experience Survey – Inpatient Care (CPES-IC) and topics that the CPES-IC did not contain. The results also compared the output from computer-coded topics to ones that were manually identified. Of the 23 topics in the CPES-IC, six in the computer-coded and manual analyses were not found. Seventeen topics not in the CPES-IC were found in the computer-coded analysis, whereas 23 topics were identified in the manual coding. Of the newly identified topics, 12 were shared between the manual and computer-coded analyses. The implications of utilizing computers to make data readily accessible can improve decision-makers' ability to access data.
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    How do public health nurses work and support mothering refugee women in the community?
    (2021-09-13) Kassam, Shahin; Marcellus, Lenora
    My doctoral studies contribute toward situating the health of mothering women who have been forcibly displaced within the nursing discipline. Specifically, public health nursing processes used while working with and supporting mothering women who have been forcibly displaced were explored. I use the terms mothering women who have been forcibly displaced to convey and articulate the locations shaping this specific population of women. In doing so, I put emphasis on the women who have been impacted by forcible displacement and pushed into a marginalized state. This approach to terminology also conveys the multiple complexities experienced by these women which public health nurses have the opportunity to engage with. The following question guided this dissertation: How do public health nurses work with women who are mothering and managing the effects of their refugee status? This question was approached using two distinct methodologies. The first was a Joanna Briggs Institute (JBI) qualitative systematic review in which I identified, critically appraised and synthesized current knowledge on nurses’ experiences of providing care to mothering women who have been forcibly displaced. Of note, the JBI review question was broadened to include nurses caring for women experiencing any form of precarious migrant status. This was due to the limited number of articles addressing the concept of nurses caring specifically for maternal refugee women. The second approach was a constructivist grounded theory (CGT) using intersectionality as an analytical tool. In this study I described the processes public health nurses used to establish trusting relationships with mothering refugee women. Findings within the JBI review and CGT study included nurses identifying inequities women faced as stemming from their precarious migrant status and thereby needing to flex care provision to meet women’s needs. The findings also demonstrated the need to examine uptake of trauma-informed principles within care with focus on how organizations are structurally supporting nursing in their practice. I conclude this dissertation with the Afterword Chapter which is a summary and synthesis of significant findings and nursing implications.
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    Exploring the challenges and issues facing undergraduate nursing education in one Canadian province from an institutional theory perspective: a case study
    (2021-04-30) Sheane, Vanessa; Duncan, Susan; Mallidou, Anastasia
    Aim The study aim was to explore the issues and challenges facing undergraduate nursing education in one Canadian province from an institutional theory perspective. The research questions were: What is the institutional field of nursing education? What are the issues and challenges facing nursing education? How is the institutional field of nursing education contributing to the issues and challenges? How are the issues and challenges contributing to the institutional complexity? Background Nursing education is essential for the health care of society, yet face various issues and challenges at the system level. Institutional theory has been used in higher education to better understand how higher education institutions are structured and operate. Institutional theory has not been used in nursing education. The issues facing nursing education have been examined from a critical or descriptive perspective, but a system-level perspective is missing. Institutional theory could fill this gap and examine the institution of nursing and how its structure, behaviours, and rules influence those issues and challenges. Methods An exploratory single-case study with embedded units design was used. Theoretical propositions from institutional theory informed the sample, recruitment, data collection, and data analysis. In 2019, representatives from organizations comprising the institutional field of nursing education and senior-level administrators were interviewed and relevant documents were collected and reviewed. The data were analyzed using deductive and inductive thematic analysis, building a case description, and visual analysis techniques. Findings The findings from sixty documents and seven interviews suggested the institutional field of nursing education is composed of postsecondary institutions, health service organizations, the regulatory body, the ministry for health, and the ministry for postsecondary education. The issues and challenges facing nursing education included demands on curricula, teaching and learning values versus practice, the relationship between education and practice, limiting financial supports, clarity of the RN role, and need for faculty. The institutional field of nursing education is complex and includes dominant organizations, such as the regulatory body and health service organization, and the non-dominant organization, postsecondary institutions. Discussion / Conclusion The use of institutional theory was beneficial to explore the issues and challenges facing undergraduate nursing education from a system-level perspective and captured the complexity within the system. The institutional field including the influences of structure, dominance, and complexity impact the issues and challenges facing nursing education. The institutional perspective of the issues and challenges diverges from previous examinations. In addition, the use of institutional theory in higher education offers strategies for advocacy in nursing education. Recommendations for nursing education practice, policy, and research include: (a) awareness of the organizations comprising the institutional field of nursing education, (b) including the nursing education accreditation body and the professional association within the interorganizational structures, (c) acknowledgement of the sources of dominance within the field, and (d) developing strategies for academic nurse leaders to navigate the complexity of nursing education. The most urgent consideration arising from this research is the dominant forces from regulation and health service organizations and the subsequent non-existence of the professional voice of nursing for nursing education within the institutional field.
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    Living<=>Dying with metastatic breast cancer: women's accounts of living longer in smaller communities
    (2020-06-05) Shermak, S. Lee; Moss, Pamela; Stajduhar, Kelli I.
    As a life-limiting illness mediated by rapid advancements in biomedical technologies, metastatic breast cancer (MBC) now presents in increasingly unexpected ways where women are living longer. These women’s lives may not fit well with established healthcare and societal understandings of an advanced breast cancer, including disease progression and prognosis. This qualitative inquiry aims to think differently about women’s daily lives with an ongoing MBC. While also considering the underexplored context of these women living in smaller communities. I explored communities on Central Vancouver Island, which is on the west coast of British Columbia, Canada. The research question directing my inquiry was: how are women, who are living with MBC as a life-limiting illness over an extended period, produced as both living and dying subjects? Informing this research was a feminist relational materialist approach with a healthcare practitioner orientation, primarily informed by Braidotti. I used multiple data collection methods centred around sequential interviews with 14 women who had been living relatively well with MBC for at least two years. Working with relational materialist and post qualitative principles, analysis disclosed the importance of temporal pulses and bodily transpositions in women’s lives. Temporal pulses speak to how time was laden with tensions such that a distinctive part of living with ongoing MBC was an embodied sense of fluctuating time. There was also the idea as to how, at any given moment, women could bodily know their illness and mortality through varying frequencies of the presence and/or absence of markers of living and dying, often at the same time. Bodily transpositions speak to how life-limiting illness was not so much about women moving from one set of circumstances to another as part of a clean-edged transition. Rather, the women navigated daily life with few set waymarkers. Within this context, ‘hope’ took on new forms and living with their advanced breast cancer became a kind of endurance demarcated by what I refer to as generative living. These findings call into question the ways in which MBC gets talked about in categorical terms as palliative or end of life, and/or as chronic. Findings are an opportunity for healthcare practitioners, policymakers, and interdisciplinary leaders to further understand MBC specific to our contemporary context. Project findings renew discussions of how best to support women’s needs, including the ways MBC is talked about. There is also the opportunity to direct further research into MBC as an example of today’s shifting boundaries of living and dying (which I am framing as living<=>dying).
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    When it is no longer your call: managing the eroding public health nurse role
    (2020-06-02) Kirk, Megan Elise; MacDonald, Marjorie A.
    The purpose of this study was to explain how public health renewal has shaped public health nursing practice, how public health nurses have managed these changes, and the perceived impact of such changes on health outcomes. I used the grounded theory method to develop a theoretical explanation of how public health nurses navigated the changing organizational milieu in British Columbia. I interviewed 29 public health nurses and three public health nursing managers in three health authorities to explicate the impact of healthcare reform initiatives on public health nurses and public health nursing practice. Over the last few decades, there have been several organizational and policy changes in British Columbia, intended to strengthen the health system and health service delivery. These changes have eroded the nature of the public health nurse role and negatively influenced public health nursing practice, undermining the ability of public health nurses to improve population health and health equity. Many participants were concerned about changes in their practice and reported that leaders restricted their role, particularly in their broad health promotion and community development efforts. Nurses in this study highlighted specific organizational and policy changes that have undermined their effectiveness. For example, nurses talked about cuts to the public health budget, the disbanding of health unit structures, the appointment of leaders who lacked public health or public health nursing knowledge and experience, and the increase in mandated targeted public health nursing programs with a corresponding decrease in universal programs. As a result, participants engaged in the process of managing the eroding of the public health nurse role, which comprises five strategies. In standing tall, a number of nurses in this study advocated for their practice and pushed back against decisions that jeopardized the quality of public health nursing programs and services with varying degrees of force. Public health nurse participants also worked within organizational expectations and constraints in the process of getting by. In going underground, several public health nurses engaged in various activities in secret by harnessing their community connections and attended to community issues they believed went unaddressed. A number of nurses, dissatisfied by the state of their role, were contemplating getting out and considered other employment possibilities. Throughout the process of navigating external changes affecting practice, many nurses restored their dedication to the public health nurse role in reaffirming commitment. Given the limited research exploring the impact of healthcare reform and public health renewal on public health nursing practice, this research helps to provide an initial glimpse into the effects of such change on public health nurses in British Columbia.
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    Enacting medication administration as nursing practice in a neonatal intensive care unit: a praxiographic study
    (2020-05-20) Neander, Wendy; Purkis, Mary Ellen
    The purpose of this research was to offer a description of the complexity of nurses’ medication administration practices in relationships with technology. The clinical situations and circumstances in which nurses administer medications today are comprised of rapidly changing technological initiatives that are intended to support safe, efficient care. Nurses’ medication administration practices are not immune to a rapidly changing technological health care environment. Research and literature has documented medication administration occurs in complex situations and nurses apply particular knowledge that supports decision-making and clinical practices for patient safety. Praxiographic methodology was used to describe deeply embedded knowledge and values that shape and guide contemporary nursing practice. Lack of attention to knowledge and values that shape and guide nursing practice and care, may contribute to the risk that those practices may be lost as nurses retire amongst a rapidly changing healthcare environment. A highly technical Neonatal Intensive Care Unit (NICU) was the location for the study. Participants included twelve NICU nurses and a pharmacist. The research findings included the significance of understanding NICU nurses’ use of local and universal maps to navigate the complexity of medication administration. Furthermore, the research documented NICU nurses’ medication administration practices as inseparable from technology. Further practice-based research is recommended to support the development of technologies that incorporate nurses’ medication administration practices.