School of Nursing

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This collection contains pre-prints and post-prints of journal articles written by selected York University Nursing faculty.

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Open Access
Development of a multi-component intervention to promote sleep in older persons with dementia transitioning from hospital to home
(International Journal of Older People Nursing, 2022-04-01) sidani, souraya; Fox, Mary; Butler, Jeffrey; Maimets, Ilo-Katryn
Background and objectives: Hospitalized older persons with dementia are commonly discharged with intensified sleep disturbances. These disturbances can impede the recovery process. Nurses are well-positioned to assist persons with dementia and their family caregivers in managing sleep disturbances during the transition from hospital to home. In this paper, we describe the development of a multi-component intervention to promote sleep. Research design and methods: We applied three stages of the intervention mapping method to develop a non-pharmacological, multi-component sleep intervention. The first stage involved a review of the literature to generate an understanding of the determinants of sleep disturbances experienced by persons with dementia in hospital and home settings. The second stage consisted of a literature review to identify therapies for managing commonly reported determinants of sleep disturbances. The third stage entailed delineation of the intervention components. Results: The most common determinants of sleep disturbances experienced by persons with dementia in hospital and home settings were: physiological changes associated with aging, sleep environments non-conducive to sleep, limited exposure to light and engagement in physical activity, stress, and sleep-related beliefs and behaviors. Therapies found effective included: light therapy, physical activity therapy, sleep hygiene, and stimulus control therapy. These therapies were integrated into a multi-component sleep intervention to be provided using the teach-back technique, during and following hospitalization. Discussion and implications: Consistent with the principles of patient engagement, the multi-component sleep intervention will be evaluated for its acceptability and feasibility.
Open Access
Healthcare Consumers’ and Professionals’ Perceived Acceptability of Evidence-Based Interventions for Rural Transitional Care
(Worldviews on Evidence-Based Nursing, 2022-07-25) Fox, Mary; sidani, souraya; Butler, Jeffrey
Background: There is a pressing need for high quality hospital-to- home transitional care in rural communities. Four evidence- based interventions (discharge plan-ning, treatments, warning signs, and physical activity) have the potential to improve rural transitional care. However, there is limited understanding of how the percep-tions of healthcare consumers and professionals compare on the acceptability of the interventions. Convergent views on intervention acceptability support imple-mentation, whereas divergent views highlight areas requiring reconciliation prior to implementation. Aims: This study compared the acceptability of four evidence- based interventions proposed for rural transitional care, as perceived by healthcare consumers and professionals. Methods: A cross-sectional, comparative design was used. The convenience sample included 36 healthcare consumers (20 patients and 16 family caregivers) who had experienced a hospital-to- home transition in the past month and 30 healthcare pro-fessionals (29 registered nurses and one nurse practitioner) who provided transitional care in rural Ontario, Canada. Participants were presented with descriptions of the four interventions and completed an established intervention acceptability meas-ure. Presentation of the four intervention descriptions and respective acceptability measures was randomized to control for possible order effects. The perceived overall acceptability of the interventions and their attributes (i.e., effectiveness, appropriate-ness, risk, and convenience) were compared using independent samples t-tests. Results: Consumer ratings were consistently higher across all four interventions in terms of overall acceptability as well as effectiveness, appropriateness, and conveni-ence (all p's < .01; effect sizes 0.70–1.13). No significant between- group differences in perceived risk were found. Linking evidence to action: Contextual and methodological differences may account for variability in ratings, but further research is needed to explore these propositions. The results support future qualitative inquiry targeting professionals to better under-stand their perspectives on the effectiveness, appropriateness, and convenience of the four interventions.
Open Access
The Relationships Between the Geriatric Practice Environment, Nursing Practice, and the Quality of Hospitalized Older Adults’ Care
(Journal of Nursing Scholarship, 2018-07-26) Fox, Mary; McCague, Hugh; sidani, souraya; Butler, Jeffrey
Purpose. To test the relationships between the geriatric practice environment, geriatric nursing practice, and the overall quality of care for older adults and their families as reported by nurses working in hospitals, while controlling for nurse and hospital characteristics. Design. A cross-sectional tailored survey design was employed. A questionnaire was mailed to a randomly selected sample of nurses whose primary practice area was medicine, surgery, geriatrics, emergency, or critical care in acute care hospitals in Ontario, Canada. Methods. Participants (n = 2005) working in 148 hospitals responded to validated measures of the geriatric practice environment, geriatric nursing practice, overall quality of care for older adults and their families, and nurse and hospital characteristics. The relationships were tested using structural equation modeling. Findings. Controlling for nurse and hospital characteristics, the geriatric practice environment had a statistically significant positive relationship of large magnitude with both geriatric nursing practice (β= 0.52) and overall quality of care (β= 0.92); however, the indirect relationship between the geriatric practice environment and overall quality of care, mediated by geriatric nursing practice, was not significant (β = -0.02). Final model fit was acceptable with the Root Mean Square Error of Approximation = 0.07, Comparative Fit Index = 0.93, and Tucker-Lewis Index = 0.87. Conclusions. A strong geriatric practice environment positively and directly influences geriatric nursing practice and overall quality of care for older adults and their families but does not appear to influence overall quality of care indirectly through geriatric nursing practice. Clinical relevance: The results can be used as the basis for promoting practice environments that support overall quality of care and geriatric nursing practice in acute care hospitals.
Open Access
Nurses’ Perspectives on How Operational Leaders Influence Function-Focused Care for Hospitalized Older People
(Journal of Nursing Management, 2016-09-16) Fox, Mary; Butler, Jeffrey
Aims. To explore nurses’ perspectives on how leaders influence function-focused care (FFC), defined as care that preserves and restores older people’s functional abilities. Background. Hospitalized older people are at risk of functional decline. Although leaders have the potential to influence FFC, few studies explored nurses’ perspectives on how leaders influence FFC. Methods. Thirteen focus groups were held with 57 acute care nurses. Semi-structured questions prompted discussion on nurses’ perspectives, needs and strategies to meet their needs. Data were thematically analyzed. Results. Three themes were identified: 1) the emphasis in hospitals is on moving older people quickly through the system, not supporting their functioning; 2) leaders are generally seen as too disconnected from practice to design system efficiency initiatives that support older people’s functioning and nurses’ provisioning of FFC; and 3) leadership strategies to better support nurses in providing FFC to older people in the context of system efficiency. Conclusions. Leaders should connect with practice to devise age-sensitive efficiency initiatives that support FFC. Nurses need support from leaders in four areas to provide FFC to older people in the current hospital context. Implications. Findings provide direction on how leaders can facilitate FFC in the current healthcare environment emphasizing system efficiency.
Open Access
Nursing Student and Faculty Narratives During COVID-19 Pandemic: Challenges and Recommendations From a Canadian Perspective
(SAGE Open Nursing, 2023) Orazietti, Brenda; Peniston, Brenda; Mohammed, Zubaida; Demelie, Hermila; Duldulao, Jemina Frances; Rao, Misbah
Introduction: Worldwide, COVID-19 affected nursing students’ and faculty's mental and physical health. The final clinical placement for fourth-year nursing students during the third wave of COVID-19 in Toronto, Canada, included direct patient care without vaccination eligibility. Students’ experiences during the pandemic and faculty exposure to teaching and supporting them provide unique reflective opportunities. Objective: To examine the lived experiences of nursing students and faculty during the third wave of the COVID-19 pandemic. Methods: The study used a qualitative phenomenological design with thematic analysis. A voluntary response sample of 80 participants shared their narratives of working and teaching during January to May 2021. An optional interview guide offered open-ended questions requiring reflection. The study was conducted in a nursing school in Toronto, Canada during fourth-year baccalaureate students final clinical placement settings. Results: A total of 77 fourth-year baccalaureate nursing students and three faculty members participated. Thematic analysis of nursing student narratives identified four main themes: (i) fear and anxiety of COVID-19 during clinical practice; (ii) impact on students’ learning environments; (iii) intrinsic and extrinsic factors that enabled students to persevere; and (iv) how to deal with future pandemics. Thematic analysis of faculty narratives identified three main themes: (i) the importance of preparatory work; (ii) psychological and physical manifestations of supporting students; and (iii) the resilience of students and faculty. Conclusion: Future disease outbreaks and other large-scale health events will require nurse educators to understand and plan strategies for both themselves and students practicing in high-risk clinical settings. Nursing schools should rethink all fourth-year students’ experiences, perceptions, and feelings to minimize their susceptibility to physical and psychological distress.
Open Access
Total Adverse Childhood Experiences and Preterm Birth: A Systematic Review
(Maternal and Child Health Journal, 2021-05-26) Sulaiman, Salima; Premji, Shahirose; Tavangar, Farideh; Yim, Ilona; Lebold, Margaret
Introduction Total adverse childhood experiences (ACEs) are gaining prominence as a risk factor for preterm birth (PTB). The emerging literature examining this relationship reports inconsistent findings. The purpose of this systematic review was to summarize the available evidence exploring whether total ACEs predict PTB. Methods A total of 386 studies were returned from searches on PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Nine studies were selected for final analysis and synthesis based on reporting of total ACEs and preterm birth gestational weeks or standard definition of birth before 37 weeks’ gestational age. A systematic review rather than meta-analysis was selected to present the findings given the clinical and methodological (e.g., sample studied, measurement tools) heterogeneity of the retrieved studies and pregnancy outcomes measured. Results The nine studies report on birth outcomes for 6,087 women from a range of sociodemographic and ethnic backgrounds. Despite a wide range of study designs, measurement tools, and timings of ACEs exposure across studies, seven of the nine included studies showed significant relationships between ACEs and PTB. Conclusion Systematic review of the literature suggests that total ACEs are associated with PTB and provides an overview on the known associations. However, to date only nine studies have assessed this link, and more studies are needed, to explore the associations between ACEs and PTB using appropriate and valid instruments and doing so among more diverse populations. Future research should also explore possible biological mechanisms (allostatic load), and moderating and mediating variables.
Open Access
Photo Elicitation Interview (PEI): Using Photos to Elicit Children’s Perspectives
(Sage Journals, 2006-09) epstein, iris; Baruchel, Sylvain; Stevens, Bonnie; McKeever, Patricia
When conducting photo elicitation interviews (PEI), researchers introduce photographs into the interview context. Although PEI has been employed across a wide variety of disciplines and participants, little has been written about the use of photographs in interviews with children. In this article, the authors review the use of PEI in a research study that explored the perspectives on camp of children with cancer. In particular, they review some of the methodological and ethical challenges, including (a) who should take the photographs and (b) how the photographs should be integrated into the interview. Although some limitations exist, PEI in its various forms can challenge participants, trigger memory, lead to new perspectives, and assist with building trust and rapport.
Open Access
Nursing students’ experiences on blogging in the classroom: Linking between ethics and pedagogy
(Sciedu Press, 2014-01) epstein, iris; Ray, Ashleigh
This paper reports students’ perspectives on using blogging in an undergraduate nursing classroom. Blogging refers to a series of entries with limited word count. Several anecdotal reports focus on the potential advantages (e.g., increasing students' writing, reflecting, collaborating, participation and critical thinking skills) of blogging in education. Yet limited reports discuss its challenges. We argue that in order to better understand the use of blogging in the classroom we need to look more closely at students’ values, beliefs and expectations. Thus, to better understand teaching and learning and evaluate blogging we used Gesler’s theory of therapeutic landscape. Students’ retrospective accounts revealed two overarching themes: students’ experiences and students’ responses to blogging. Despite the fact that students experienced and valued blogging in their everyday lives, their responses to in-class blogging were not always positive.
Open Access
The practice and teaching of palpation of the head and neck: A scoping review
(Sciedu Press, 2017-07) epstein, iris; Herne, P.; Masita, S.; Peisachovich, E.; Eliadis, M.; Robinson, B.; Lee, C. P.; Grosman-Rimon, L.; Silva, C.
Objective: To explore how palpation of the head and neck is practiced and taught. Methods: The scoping review methodology was guided by Arksey and O’Malley’s five-stage approach. Three experienced and independent reviewers searched nine databases according to a predetermine inclusion and exclusion criteria. Results: A total of 15 articles from medicine, chiropractic and dentistry published between 1987 and 2016 were included. Two overarching themes emerged, a Cartesian and a Pragmatic perspective in practicing and teaching palpating of the head and neck. Although both perspectives are valuable, we advocate to practice and teach palpation of head and neck from a Pragmatic perspective particularly with the increase use of ultrasound technology to detect masses. A pragmatic perspective takes into account the patient’s context, the ethics of care and highlights the importance of health care providers fostering interpersonal relationships with others during physical assessment. Conclusions: Although nursing studies were absent from this review we believe nurses play a vital role when they are aware of the Cartesian and Pragmatics perspectives when practicing and teaching head and neck palpation as part of a physical assessment. Learning how other disciplines are practicing and teaching head and neck palpation skills will improve interdisciplinary collaboration.
Open Access
Refugee smartphone access to health care in Canada: Concept analysis
(Sciedu Press, 2019-01) epstein, iris; Nguyen, Jade; Balaquiao, Lorivie; Chang, Kai Ya
Objective: With the ever-changing smartphone healthcare technology also comes nurses’ responsibilities to recognize its ethical implications particularly among vulnerable population. The aim of this paper is to explore what we know about the use of smartphone to access health care among refugees and new immigrants. Methods: We were guided by Walker and Avant (2011) concept analysis methodology. Concept analysis is a rigorous method to better understand ethical implications, meaning, attributes, antecedents and consequences of smartphone access to health care. Diverse databases were included such as CINAHL, Journals@Ovid, ProQuest Nursing & Allied Health Source, ProQuest Psychology Journals, PsychINFO, ERIC, and Education Full Text. Results: The concept analysis retrieved 23 studies. Overarching themes included the physical (e.g. income, geographical location) and social (generation; access to regular internet; digital literacy; relationship with practitioners) that were attributed to refugee and new immigrant access to health care. Conclusions: Some of the ethical implication when using smartphone to access health care technology with refugees and new immigrants are discussed and the skills needed for nursing practice are identified and recommendations for nurse education and research are made.
Open Access
“A video of myself helps me learn”: A scoping review of the evidence of video-making for situated learning
(Georgia Southern University, 2020) epstein, iris; Baljko, Melanie; Thumlert, Kurt; Kelly, Evadne; Smith, James Andrew; Su, Yelin; ZakiAzat, Justeena; May, Natasha M.
Nursing, dance and studio-based arts, engineering, and athletic therapy are viewed as practice-oriented professions in which the teaching and situated learning of practical skills are central. In order to succeed, students must perform a series of performance-based assessments, which seemingly require an “able” body to enact complex tasks in situated and/or simulation-based contexts (for example, “safe nursing practice”). Our interdisciplinary research seeks to intervene within the culture of professional learning by investigating what we know about the use of smartphone video recording for situated, practice-based learning, and for supporting interactive video-based assessment as a means of accommodation and extending access for students, including students with performance anxiety, mature students, ESL learners, students with disabilities, and students in remote communities. In this paper we employ a scoping review methodology to present our findings related to students’ and instructors’ perspectives on the use of smartphone video to demonstrate and document practical knowledge and practice-oriented competencies across fields in the arts and sciences. We also examine broader research, as well as the ethical and design implications for the development of our technology-based toolbox project – an online resource created to advance pedagogies deploying smartphones as tools for practical skills acquisition - and for accommodation - within multidisciplinary practical learning environments.
Open Access
Meaningful support for lesbian and bisexual women navigating reproductive cancer care in Canada: An exploratory study
(Sage, 2016-05) Legere, Laura; MacDonnell, Judith A.
Health inequities for sexual minorities are well documented, but there is a gap in nursing research addressing the specific experiences faced by lesbian and bisexual women with reproductive cancers. This critical feminist study explored interactions between sexual minority women with reproductive cancers and their health care providers and how these interactions enable and create barriers to meaningful support. Purposeful convenience sampling was used to recruit lesbian and bisexual reproductive cancer survivors from Ontario, Canada and providers who have cared for this population. Five lesbian and one bisexual woman who were reproductive cancer survivors participated, as well as one registered nurse who was not a survivor but who has cared for sexual minority women with reproductive cancers. Face-to-face interviews were conducted and conventional content analysis was used to analyze the data. The authors report on findings related to meaningful support, interactions with providers and organisational environments. Narratives showed that an understanding of gender norms influenced women’s perceptions of supportive and inclusive care, such as the acknowledgment of social supports and barriers to supportive care that included disclosure of sexual orientation. There are implications for nursing education and policy change to enhance inclusive interactions and environments for diverse sexual minority women with reproductive cancers.
Open Access
Acute care for elders components of acute geriatric unit care: systematic descriptive review
(Wiley, 2013-06) Fox, Mary T.; sidani, souraya; Persaud, Malini; Tregunno, Deborah; Maimets, Ilo; Brooks, Dina; O'Brien, Kelly K
OBJECTIVES: To describe the Acute Care for Elders (ACE) model components implemented as part of acute geriatric unit care and explore the association between each ACE component and outcomes of iatrogenic complications, functional decline, length of hospital stay, nursing home discharges, costs, and discharges home. DESIGN: Systematic descriptive review of 32 articles, including 14 trials reporting on the implementation of ACE components or the effectiveness of their implementation in improving outcomes. Mean effect sizes (ESs) were calculated using trial outcome data. Information describing implementation of the ACE components in the trials was analyzed using content analysis. SETTING: Acute care geriatric units. PARTICIPANTS: Acutely ill or injured adults (N = 6,839) with an average age of 81. INTERVENTIONS: Acute geriatric unit care was characterized by the implementation of one or more ACE components: medical review, early rehabilitation, early discharge planning, prepared environment, patient-centered care. MEASUREMENTS: Falls, pressure ulcers, delirium, functional decline, length of hospital stay, discharge destination (home or nursing home), and costs. RESULTS: Medical review, early rehabilitation, and patient-centered care, characterized by the implementation of standardized and individualized function-focused interventions, had larger standardized mean ESs (all ES = 0.20) averaged across all outcomes, than did early discharge planning (ES = 0.17) or prepared environment (ES = 0.11). CONCLUSION: Specific ACE component interventions of medical review, early rehabilitation, and patient-centered care appear to be optimal for overall positive outcomes. These findings can help service providers design and evaluate the most-effective ACE model within the contexts of their respective institutions to improve outcomes for acutely ill or injured older adults.
Open Access
Perspectives of homeless people on their housing needs and approaches to ensure success
(Common Ground Publishing, 2008) Daiski, Isolde
Recently there has been much public discourse on homelessness and its impact on health and quality of life. Housing is a major determinant of health and strategies are sought to get people off the streets. For maximum success it is important to first determine accurately the needs of those to be housed. As they live their own situations, their perspectives should be considered to ensure success. This paper discusses the findings from a research study on perspectives of homeless people regarding their experiences of homelessness. The research question was: What supports are needed for homeless people to get off the street? The study discussed is qualitative, descriptive, exploratory. Semi-structured interviews were conducted with homeless individuals in a large Canadian city in 2005, regarding their needs and possible solutions to end homelessness. A thematic analysis was carried out on the data. Findings show that individuals’ experiences of homelessness deeply impact all aspects of their lives. Many barriers prevent the homeless from escaping the streets. The welfare system in place was often perceived as disabling and dehumanizing rather than helpful. Service provisions were frequently inappropriate and therefore unsuccessful. Those homeless for a long time fell into patterned cycles of shelter / street life, temporary employment / unemployment and sometimes temporary housing. Participants described the fragmented services provided as ineffective. They had many suggestions for strategies to avoid or escape homelessness. For service providers a power with rather than power over model of collaborative advocacy is proposed to serve this population more effectively, preserve / restore their dignity and invest resources wisely.
Open Access
Giving Voice to Expressions of Quality of Life for Persons Living With Dementia Through Story, Music, and Art
(Lippincott Williams & Wilkins, Inc., 2005-01) Jonas-Simpson, Christine; Mitchell, Gail J.
The purpose of this qualitative descriptive study was to give voice to expressions of quality of life for persons who live with dementia and who reside in long-term care, primarily on locked cognitive support units.With the assistance of music and art therapists, mediums of music and art were offered as a way for participants to further describe their quality of life. Eight key messages emerged from the descriptions about what life was like for the 17 participants: feeling content, importance of relationships, choosing an attitude for living on, feeling worthy, wishes for freedom amid restrictions, living with loss, struggles with thinking and communicating, and persisting with life patterns. The open-ended questions used in this study may be considered for future research as well as in practice with persons who live with dementia even in the latter part of their journey. Ultimately, it is hoped that the findings described here will enhance understanding of what life is like for persons living with dementia, in order to diminish any unnecessary suffering that can emerge with lack of understanding.
Open Access
Awakening to space consciousness and timeless transcendent presence (when caring for persons who are living dying or deeply grieving)
(Sage Publications, Inc., 2010) Jonas-Simpson, Christine
Space consciousness is emerging as significant and necessary for the evolution of humanity according to spiritual teacher, Eckhart Tolle. Through space consciousness people become aware that we are timeless transcendent presence. This awareness is pronounced when with those who are living dying and their close others who are deeply grieving. Space consciousness and transcendent timeless presence in the context of living dying and deeply grieving are explored using nurse theorists’ works in dialogue with Tolle’s teachings.
Open Access
The language of loss when a baby dies prior to birth: Cocreating human experience
(Sage Publications, Inc., 2005) McMahon, E.; Jonas-Simpson, Christine
When a baby dies prior to birth, a woman and her family begin a life long journey of living and transforming with loss. The language used with families during times of devastating loss is important to reflect upon since, language has the potential to either intensify suffering or enhance the family’s experience of grieving. Words that affirm the meaning the baby holds for the family can provide comfort as families engage with the reality of lost hopes and dreams. Recognizing that healthcare professionals do not intend to harm families whose babies die prior to birth, the current authors offer this column as a vehicle for reflecting on the meanings of words used during this particular time of loss and grief. The authors further explore the role that the arts have to play in expressing loss and in helping others to understand.
Open Access
The possibility of changing meaning in light of space and place
(Sage Publications, Inc., 2006) Jonas-Simpson, Christine
The author considers the possibility of changing meaning in light of space and place. Many questions are raised, including a fundamental question: If we simply choose the meaning of space and place based on personal knowing, regardless of the space and place we are in, does space and place really matter with regard to the possibility of changing meaning? Many possibilities of changing meaning in light of space and place are explored, including the influence of personal knowing, new life experiences and understandings, changes to space and place, unique languaging in space and place, imaging space and place, and engaging in the wonder and mystery of space and place beyond this realm. The possibility of changing meaning is significant in that new meanings open doors to different choices—and living choices is living health.
Open Access
Metamorphosis: A Story of Loss, Transformation and Abiding Love
(The Centering Corporation, 2011) Jonas-Simpson, Christine
Open Access
Living with changing expectations for women living with high-risk pregnancies: A Parse method study
(Sage Publications, Inc., 2009) Jonas-Simpson, Christine; MacDonald, C.
The purpose of this research was to uncover the structure of the lived experience of living with changing expectations from the perspectives of women with high-risk pregnancies. The researchers’ nursing theoretical perspective is the humanbecoming theory and the Parse research method was used. For the participants, living with changing expectations is foreboding disquietude arising with arduous restrictions, while envisioning the yearned-for with mitigating nurturing engagements. Findings enhance the theory of humanbecoming as well as enhance understanding of the experience of living with changing expectations. Recommendations for future research and practice are discussed.