Nursing

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Open Access
"What Were You Doing To Get Shot?" Exploring The Perceptions And Experiences Of Critical Care Trauma Nurses On Gun Violence And Caring For Persons With Gun Violence Injuries
(2024-11-07) Hodder, Jennifer Michelle; van Daalen-Smith, Cheryl
Rising gun violence (GV) means critical care trauma nurses (CCTNs) are caring for those most impacted, navigating complex feelings, family needs and very sick patients. I asked, “What can I do from the bedside?” Grounded in the socio-ecological model and complexity theory, a qualitative exploration of CCTNs’ perceptions and lived experiences began. Community-based professionals’ (CBPs) were consulted and CCTNs interviewed. Thematic analysis allowed four themes to emerge: one from the CBP, highlighting the need for persons with GV injuries to feel safe; the remaining themes tell nurses’ understudied stories, attempts to makes sense of the senseless and the toll of bearing witness. Overarchingly, trauma emerged for those in the bed and those caring for them from the bedside, reminding us that We are all humans – in trauma. Shared experiences of trauma provide the opportunity to engage in activities that improve the lives of CCTNs and those living with GV.
Open Access
Patient-Centered Hemodialysis Nursing Care: An Interpretive Description
(2024-11-07) Hilborn, Billie Adele; Singh, Mina
Background Patient-centred care originated in the 1950s, gained popularity in the 1990’s, and is a professional regulatory, clinical practice guideline, governmental health policy, and perhaps organizational expectation of every nurse in Canada. The term is used liberally on the Health Canada website, and in 2011 the Canadian Institutes of Health Research launched the Strategy for Patient-Oriented Research. Also in 2011, the Canadian Nurses Association (CNA) and Canadian Medical Association (CMA) jointly identified patient-centred care as the first principle to guide healthcare transformation. In 2018, patient-centred care was adopted by Accreditation Canada through the addition of patient surveyors. Patient-centred nursing care could benefit people with end-stage kidney disease (ESKD) however the philosophical ideals of the approach may not consistently align with the everyday reality of hemodialysis nursing. Purpose of Study The study purpose was to describe the experiences and perspectives of hemodialysis nurses in their provision of patient-centred care. Methods A qualitative interpretive description design was used, with purposive sampling of hemodialysis nurses from hospital and satellite hemodialysis units in urban and rural areas registered with the College of Nurses of Ontario and currently employed full or part-time for more than three months. Semi-structured interviews were held, and transcripts were analyzed. Results Ten RNs participated and five themes were constructed through interpretation of their comments during interviews: Knowing, Applying, and Sustaining, plus Promoters and Detours of Patient-Centred Hemodialysis Nursing Care. Conclusions Patient-centred hemodialysis nursing care is a complex process with multiple promoters such as therapeutic relationships, reflective nursing practice, collaboration, and the satellite unit context. Nurses needed to navigate detours that interfered with the provision of patient-centred care related to patients, nurses, and unit, organizational, and system processes. Various interconnections occur within patient-centred hemodialysis nursing care, and certain ethical aspects require consideration. Implications for Nephrology Care Implications and recommendations for nephrology nursing education, practice, policy, and future research are identified.
Open Access
Asian Adolescent Experiences of Health-Related Stigma During the Covid-19 Pandemic
(2024-07-18) Hasan, Nasteho Husen; Khanlou, Nazilla
Background: The COVID-19 pandemic, which took place between March 2020 and May 2023, has significantly impacted people’s lives. Individuals with COVID-19, like other infectious diseases, are at risk for stigmatization related to their health status. As a group, Asian Canadians faced increased racism and discrimination during the pandemic in relation to prejudicial attitudes on spread and contagion of the disease. Methods: This study used Interpretive Descriptive methodology to explore the experiences of Asian Canadian adolescents who have had COVID-19 through one-on-one interviews virtually and in person. Prior to the interview, participants filled out informed consent forms and demographic forms to obtain background information. The interviews were conducted between February 2023 and August 2023. Afterwards, the data was analyzed into codes and themes. Results: The sample consisted of eleven Asian Canadian adolescents between the ages of 16 and 19-years old living in Ontario. Seven participants identified as female, three identified as male and one participant identified as non-binary. The participants reported facing stigmatization related to their positive COVID-19 status, their Asian identity, and their age. The findings were organized using the Health Stigma and Discrimination Framework (HSDF), which conceptualizes health-related stigma into drivers and facilitators, intersecting stigmas, manifestations, and outcomes. Drivers and facilitators included attitudes about people with COVID-19, Anti-Asian racism, the media and social media and time of infection. The intersecting stigmas were ageism and racism. Manifestations included negative reactions from others, anti-Asian experiences, and internalized stigma. Lastly, outcomes included the mental health consequences of racism and worsened academic performance. Challenges while isolating included difficulties keeping up with schoolwork and isolation. Positive mediators included peer and familial support and being able to access information about COVID-19 Conclusions: Asian Canadian adolescents faced complex experiences and challenges during the pandemic related to their intersecting identities including stigmatization due to their COVID-19 status, as well as racism due to their Asian background and ageism from older individuals. Understanding these experiences can better inform the services provided to this population and decrease the risks and effects of stigmatization.
Open Access
Secondary Traumatic Stress & Emergency Department Registered Nurses in Ontario: A Cross-Sectional Study
(2024-03-16) Fallis, Kelsey Louise; Mallette, Claire
This thesis explores the prevalence of secondary traumatic stress (STS) among nurses working in Ontario emergency departments. Nurses can develop STS via exposure to traumatic events, such as death, injury, or critical illness (Badger, 2001). Emergency department (ED) nurses are especially susceptible to STS due to frequent exposure to traumatic events (Ratrout & Hamdan-Mansour, 2017). This study aimed to (a) determine the prevalence of STS amongst registered nurses (RNs) working in Ontario emergency departments; and (b) to determine factors influencing STS development. Results showed 91.6% of ED nurses in this study experienced STS. Resilience and COVID-19 fear were both significantly associated with STS development in simple linear regression, though only resilience was a significant factor in multiple linear regression. This study provides insight regarding the prevalence of STS among Ontario ED nurses, which was previously unknown. Additionally, this study identified resilience as a significant protective factor against STS development.
Open Access
The Relevance of Policy, Practices and Other Dynamics in the Lives of People Facing Mental Health and Addictions Challenges and Homelessness
(2024-03-16) Harris, Jacqueline Arlene; Mallette, Claire
Limited research explicitly addresses the diverse experiences of people who face mental health and addictions challenges and homelessness (MHACH) in rural Canada, although it is well documented that they face significant health inequities. This critical ethnography, exploring how policies and dynamics affect the lived experience of adults facing MHACH in rural Southwestern Ontario, aimed to enhance responsive policy and supports. Using purposive convenience sampling, semi-structured interviews were completed with four people with lived experience (PWLE) and three key informants. Using conventional content analysis and critical social theory, themes emerging from the narratives illustrated the complexity of PWLE’s lives, survival strategies and resourcefulness. PWLE were contradictorily visible and invisible, encountering profound barriers to care such as stigma and discrimination that resulted in their feeling “less than human”. Nursing implications include the importance of giving voice to PWLE, so we can understand how policy and practice decisions impact their everyday lives.
Open Access
If not us then who?: A focused ethnography exploring caring patterns among planetary health nurses.
(2023-12-08) Cairns, Steven James; Van Daalen-Smith, Cheryl
The environment in which nursing occurs is interdependent and dynamic in relation to people and their health circumstances. Planetary health challenges, such as climate change, pollution, deforestation, overfishing, and habitat destruction, are disproportionately experienced in certain geographies and act as threat multipliers to the health, welfare, and security of human and more-than-human species. Nurses, by virtue of their position, are increasingly confronting the health implications of social and economic inequity when people and populations rendered vulnerable struggle to adapt to and mitigate environmental changes. Working near those who suffer, nurses must understand that human health is interrelated with planetary health. This awareness should inform their role as care providers who can develop solutions to face the unprecedented challenges now and in the future. The urgency to protect the environment is reflected among planetary health-conscious nurses who demonstrate a broad nursing perspective that includes caring for those in need, human and more-than-human alike. The aim of this study was to interpret questions regarding the journeys, approaches, activities, and priorities of 14 registered nurses actively engaged in planetary health initiatives. A focused ethnographic methodology was employed, which included data from semi-structured interviews, participant observations, and arts-informed self-reflections. This data was analyzed using a reflexive thematic analysis to identify themes related to nurses’ experiences and approaches to planetary health. The results of this research have the potential to inform practice, policy, education, and research within the nursing profession. Additionally, this research serves to highlight the importance of empowering nurses to engage in planetary health initiatives as advocates for social and environmental justice.
Open Access
Nursing Students' Comfort with Providing Palliative and End-of-Life Care
(2023-08-04) Beattie, Beverley Marie; Singh, Mina
Open Access
Impact of Social Support and Mentoring on Career Advancement of Internationally Educated Nurses
(2023-08-04) Venkatesa Perumal, Ramesh; Singh, Mina
Background: The upward growth in work level, position, and title, as well as the rise in compensation and income, is known as career advancement (CA). CA is the outcome of career preparation and supportive organizations. Both individual and organizational supports often influence CA among nurses in Canada. Mentorship and social support facilitate CA among nurses, and these supports are available differently to both Canadian Educated Nurses (CENs) and Internationally Educated Nurses (IENs) Purpose: This study identified the perceived impact of mentorship and social support on CA among CENs and IENs. Methods: Data were collected utilizing Organizational Career Growth Scale (OCG), Multidimensional Perceived Social Support (MPSS), and Mentoring Functioning Questionnaire (MFQ 9), from 127 nurses across three provinces, namely Ontario, Manitoba, and British Columbia who met the inclusion and exclusion criteria through an online survey. Results: There were 44 CENs and 83 IENs. The mean score of CENs on OCG was 65.24%, and for IENs, it was 67.68%. The mean score of MPSS for CENs was 76.61%, and for IENs, 73.65%. The mean score on MFQ 9 was 77.84% and 69.11% for CENs and IENs, respectively. There was a positive correlation between MPSS and MFQ 9 with OCG scores. The positive correlation was statistically significant for IENs. With the subscales of OCG, IENs had a statistically significant higher score in remuneration growth (RG) than CENs. In the career growth progress (CGP) subscale, CENs scored higher than IENs. Having a mentor with the title of RN and meeting the mentor regularly positively impacts OCG scores. Conclusion: CENs and IENs have a moderate level of perceived OCG, and IENs have higher scores than CENs. There are differences in the level of mentorship and social support available to CENs and IENs. Recommendations: Organizations/Employers must establish formal mechanisms to facilitate CA among nurses (both IENs and CENs). Coordinated efforts are necessary to help IENs overcome barriers to accessing support. Establishing formal mentorship programs at the workplace will facilitate better career growth among nurses that will help improve job satisfaction, retention, and, ultimately, quality patient care.
Open Access
Describing how Expert Labour and Delivery Registered Nurses Work to Optimize Outcomes for Intrapartum Patients at Risk of Unplanned Caesarean Section
(2023-03-28) Katz, Jessica; Kurtz Landy, Christine
Unplanned caesarean section (c-section) births are common and can have significant negative psychological and emotional outcomes for patients. Expert labour and delivery registered nurses (L&D RNs) are well-positioned to anticipate the need for an unplanned c-section and to support at-risk patients. This qualitative interpretive descriptive study explored how expert L&D RNs anticipate unplanned c-sections and support those patients they deem to be at imminent risk of requiring the procedure. A purposive sample of 16 L&D RNs with minimum five years of L&D nursing experience in Ontario participated in semi-structured telephone interviews. Conventional content analysis was used to analyze interview data. Findings describe tacit knowledge used to anticipate unplanned c-sections, and therapeutic nurse-patient relationships developed to individualize support. The findings bring attention to tacit knowledge that expert L&D RNs use in practice and inform future research into the effectiveness of how expert nurses’ interventions support patients at risk of unplanned c-section.
Open Access
“The only reason why it happened is simply because we’re Black women!”: The Black perinatal healthcare experience in Canada.
(2022-12-14) Afranie-Frimpong, Berlinda; Rodney, Ruth
Abstract Background: Black Canadian mothers are more likely to experience an adverse health outcome compared to any other race. Yet, the Black maternal healthcare experience is not adequately documented within a Canadian context. This research study interpreted and analyzed the maternal healthcare experiences of Black women living in the Greater Toronto Area. Methods: Focus groups and interviews were conducted utilizing Zoom, with eight Black Canadian mothers. Findings: The mothers agreed that healthcare organizations provided insufficient perinatal provisions, discussed feeling neglected by healthcare providers, the relationship between culture and care, preconceived healthcare biases, expressed their appreciation for supportive healthcare providers, and the stereotype of the ‘strong’ Black woman. Implications: To provide culturally competent care to Black women, healthcare providers must acknowledge their unconscious biases, health services must be made more public to Black mothers, and the Canadian health policies must be modified to improve the Black Canadian morbidity and mortality rates.
Open Access
Mental Health and Well-Being Among Tamil Youth of Sri Lankan Origin Living in Toronto: A Mixed Methods Approach
(2020-11-13) Shanmuganandapala, Babitha; Khanlou, Nazilla
Literature on the mental health of Tamil youth of Sri Lankan origin living in Canada is scant. In this study, I applied an interpretive descriptive approach to explore, discover, and understand the meanings, beliefs, practices, and experiences of health, well-being, and mental health of thirteen first and second-generation Sri Lankan Tamil youth. I used a convergent parallel mixed methods research design and applied an emancipatory approach to informing culturally competent mental health nursing practice, influenced by critical race, postcolonial feminist and intersectionality theories. Parents, the Tamil community and Tamil culture emerged as major themes reflecting the important roles they play in Tamil youths mental well-being. Experiences related to the Sri Lankan civil war/genocide and immigration appear to impact both collective and intergenerational trauma and resilience. Recommendations include applying a holistic, trauma-informed and integrated/multilevel approach, including traditional and collective methods of healing, capacity building and recognition/acknowledgement of the Tamil Genocide.
Open Access
Inpatient Mental Health: What Helps/Hinders the Transition into Communities?
(2020-08-11) Anderson, Jennifer Marie; Jensen, Elsabeth
The transition period is the most vulnerable period for patients transitioning from inpatient units to community settings (Coleman, Pincus, Epstein & Ofedahl, 2015). Patients with mental illness have unique needs and vulnerabilities, therefore increasing the need for improved coordinated transitional discharge plans (Coleman et al., 2015). The purpose of this study was to explore the transition experience of patients 18 years of age who transitioned into the community from an inpatient mental health unit. This study sought to understand the patients experience of present discharge models from a qualitative perspective. This study addressed a knowledge gap by exploring the consumer survivors voice. Expectations, the environment, level of planning and emotional and physical well-being were all important factors explored that helped and hindered the successful re-integration of patients living with mental illness into the community.
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Public Health Nurses' Perceptions of Assessing, Identifying, and Addressing Elder Abuse: A Descriptive Qualitative Study
(2020-05-11) Agbi, Funmilayo Ibiso; Khanlou, Nazilla
This descriptive qualitative study explores public health nurses perceptions of assessing, identifying, and addressing elder abuse. Ten public health nurses from four public health units were interviewed for the study. Questions were categorized under perceptions of elder abuse, assessment and identification, and addressing elder abuse. A descriptive framework was developed, and findings revealed that the influence of ageism on public health nurses knowledge of elder abuse determined how elder abuse is perceived. Despite general awareness, there is limited knowledge of elder abuse; nurses utilized alternative strategies to assess and identify elder abuse due to absence of screening tools, limited knowledge of interventions, professional obligations and organizational policies and guidelines. This research brings attention to the knowledge gap on elder abuse in nursing scholarship and public health nursing. It highlights the importance of education to advance understanding and promote screening of elder abuse in community nursing. Practice implications and suggestions for future research are provided to aid intervention and advocacy.
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Canadian Women's Contemporary Experiences Accessing Abortion
(2019-11-22) Lebold, Margaret; MacDonnell, Judith Ann
This thesis explores Canadian womens contemporary experiences accessing abortion. Abortion is a womens health issue, yet little nursing research addresses womens experiences or well-documented barriers to care. After Health Canadas approval of the abortion pill, Mifegymiso (RU-486) in 2015, women had an alternative to surgical abortion. This qualitative study uses narrative and critical feminist approaches, and purposive convenience sampling to explore Canadian womens experiences of abortion and access to care. Seven women over the age of 18, diverse in age, education, sexual orientation, geography and experience with medical or surgical abortion completed semi-structured interviews. Critical analysis illustrated the complex, varied meanings that abortion has for women, including the motherhood journey (regardless of whether or not they considered themselves mothers), the pivotal nature of support, and barriers to access. Implications for nursing include challenging the silence in research and augmenting reproductive justice approaches.
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Companioning End-Of-life: Nurses' Experiences of Caring for the Child Who is Dying Through a Relational Ethics Lens
(2019-07-02) Deangelis, Karlie-Carmen; Jonas-Simpson, Christine M.
Caring for children who are dying requires exploration to understand and validate the meaning of this lived experience for nurses. This study uses a qualitative descriptive method to answer the research question: What is the meaning of caring for a dying child for nurses within their collective ethical commitments and responsibilities in neonatal and paediatric intensive care units? Relational ethics was the theoretical framework guiding this study, where semi-structured interviews were conducted with eleven intensive care nurses. Participants were also asked to provide an image that reflected the meaning of providing this care. Findings are presented in five thematic patterns: a) Careful cultivation of a team approach shapes end-of-life decisions; b) Resilience and affirming of self as nurse arise with alleviating suffering; c) Navigating sustained turmoil; d) Willingly sojourning in loving presence; and, e) Facilitating and valuing a familys role in their experience of end-of-life
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Relational Care and Long-Term Care Home Transitions: Enabling and Constraining Practices
(2019-03-05) Cope, Martha Mary; Choiniere, Jacqueline A.
Care planning in long-term residential care is currently determined mostly by institutional practices whereby decisions about staffing, care delivery, and accountability are made using traditional biomedically focused models. These structures also reflect the influences of neoliberal health care reforms, which began to dominate health care delivery and practices starting in the mid-1990s, creating tensions for nurses between quality of care and the corporatization of health care. A consequence is that long-term care (LTC) care planning and delivery does not emphasize relationships between residents, their family members, and staff as much as it does the biomedical (physical, clinical) aspects of care. Highlighting care as a relationship promotes the uniqueness of individuals. The concern, then, is that relational care (also referred to as relationship-centered care or relationship-focused care) is not being enabled for staff, families, and residents, particularly during transitions. Person-centered (resident-centered) initiatives in LTC have been underway for many years with the intent to improve quality of life and care of residents. In spite of this person-centered notion, long-term residential care homes (LTCHs) are challenged to deliver care that is relational. Transitioning into LTC has been shown to be a stressful and uncertain time for residents and families and a demanding time for staff. Current research lacks experiential data from residents themselves and also about how staff experience this process. Therefore, looking more closely at the specific ways that residents, families, and staff experience transitions will aid in identifying what is currently happening in this area and what could make it better. A qualitative case study design, using purposeful sampling with semi-structured interviews, was used to gather data from various stakeholders in one LTCH. In this thesis I use a critical paradigm and feminist political economy approach to explore what residents, families, and staff identify as the current challenges during transitions into LTC and what would improve this process to further reinforce care as a relationship. This research will contribute to nursing by acknowledging the importance of the nexus of relationships involved in LTCHs and how relational care can offer constructive strategies to address the tensions involved in care quality, accountability, and work conditions so often experienced during transitions.
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Nursing Students' Beliefs About Substance Use Disorders
(2019-03-05) Elchuk, Stephanie Ann; Jensen, Elsabeth
Persons with substance use disorder (SUD) are subject to stigma and judgement. Stigma worsens clinical outcomes, undermines life opportunities, and decreases well-being of persons who use substances (Corrigan, Schomerus, Shuman, Kraus, Perlick et al., 2017). This meta-narrative reports on the beliefs of nine fourth year nursing students, using direct quotations to express salient beliefs about SUD, recovery, and nursing. Participants' beliefs evolved throughout the lifespan, with a significant shift in understanding occurring in response to education. SUD is seen as a biopsychosocial condition which is not a choice, but rather an attempt to cope with, or escape from, challenging life circumstances. Participants were reluctant to address stigma in their personal and professional lives. It is recommended nursing students are prepared to address workplace and societal stigma. Due to the effect of social environments outlined in symbolic interactionism, it is recommended to interview the same participants at graduation and in five years time.
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Exploring the Attitudes, Beliefs and Practices Concerning Mental Health Amongst African Immigrant Youth Living in Canada: An Interpretive Description Study
(2018-11-21) Olawo, Omolola Olumayowa; Pilkington, Beryl F.
There has been limited research in Canada on the mental health of African immigrant youth. An Interpretive Description methodology was utilized to interview eight African immigrant youth on their attitudes and beliefs towards mental health, their mental health practices, and factors affecting their mental health. Themes that were identified surrounded transitioning into adulthood, between geographical locations, and between identities; protective factors, including resilience, religion, and hyper-masculinity, and the differing immigration experiences of African immigrant youth. This research brings attention to intersectional factors that play a role in the mental health of African immigrant youth, as well as gender differences in their mental health experiences. It also highlights the need for cultural humility in care as well as the importance of critical inquiry when interacting with immigrant populations. Implications for practice and future research are suggested to help advocate for and effectively treat African immigrant youth experiencing mental health challenges.
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The Effect of Method of Delivery and Psychosocial Factors on Postpartum Sexual Satisfaction
(2018-11-21) Cateni, Debora; Landy, Christine Kurtz
OBJECTIVE: The aim of this study was: 1) to determine factors associated with postpartum sexual satisfaction at 6 and 12 months postpartum; 2) to examine the effect of method of delivery on postpartum sexual satisfaction at 6 and 12 months postpartum. METHODS: This study undertook a secondary data analysis of The Ontario Mother and Infant Study (TOMIS) III which recruited 2560 postpartum women. Participants completed self-report in-hospital questionnaires and structured telephone interviews at 6 months and 12 months. RESULTS: Statistically significant factors associated with sexual satisfaction at 6 months postpartum were country of birth, breastfeeding status, physical health scores, perceived social support, mental health scores and the risk of postpartum depression. At 12 months postpartum, breastfeeding status, physical health scores, perceived social support and mental health scores were associated with postpartum sexual satisfaction. Method of delivery was not found to be statistically significant at both time points.
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Relationship Between Role Conflict, Role Ambiguity, and Interprofessional Team Collaboration Among Nurses Caring For Older Adults in the Intensive Care Unit (ICU)
(2018-11-21) Ejesi, Ike; Fox, Mary
The purpose of this cross-sectional study was to examine the relationship between role conflict (RC), role ambiguity (RA) and interprofessional team collaboration (ITC) among nurses caring for older adults in intensive care units (ICU). Using random sample (n = 403) selected from the primary study by Fox (2014), Pearsons correlations showed statistically significant relationship between RA, RC, as well as between ITC and highest level of nursing education resource availability, and institutional values. There was no statistical significant relationship between gender and ITC. Using regression analysis and controlling for the extraneous variables, a significant regression equation was found (F(7, 403) = 21.19, p < 0.0); whereas RA had a statistical significantly relationship with ITC, RC and the extraneous variables were not significantly associated with ITC. Results suggest a need to reduce role to improve interprofessional collaboration. Further research is needed to identify other variables related to interprofessional team collaboration.