Theses (Nursing)
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Item Sister Elizabeth Kenny's methods : freedoms, knowledges and the making of history(2002) Wallace, Patricia JoanneItem Perceived impact of work-related role sets : nurses' experiences with their colleagues(1990) Robinson, Patricia HelenItem Ordering madness for the social organization of world mental health : an institutional ethnography(2001) Jakubec, Sonya LeeItem Weathering the storm(2003) Hiebert, Walter GerhardItem A phenomenological study of the meaning nursing faculty ascribe in their decision to continue formal education(1989) Hickman, Jocelyne LiseItem 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 MahalahItem The work of long term care case managers : the two faces of case management(1997) Goodwyn, Sherry ElizabethItem The meaning of home for older women residing alone(1999) Furness, Wendy LynnItem Special Care units : the policy practice interface(1993) Frost, Ellenor M.Item Making clients or regenerating citizens : a feminist analysis of community work(1995) Burgess, Judith AnnItem 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.Item The Social Organization of People’s Experiences Enhancing Health for their Young Children after Declining Vaccines(2024) Huel, Christine; MacKinnon, KarenIn 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.Item 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.Item 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, BernieWomen 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.Item 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, BernieHonouring 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.Item 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.