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Nursing

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  • ItemOpen 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.
  • ItemOpen Access
    Nursing Students' Comfort with Providing Palliative and End-of-Life Care
    (2023-08-04) Beattie, Beverley Marie; Singh, Mina
  • ItemOpen 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.
  • ItemOpen 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.
  • ItemOpen 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.
  • ItemUnknown
    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.
  • ItemUnknown
    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.
  • ItemOpen Access
    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.
  • ItemOpen Access
    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.
  • ItemOpen Access
    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
  • ItemOpen Access
    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.
  • ItemOpen Access
    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.
  • ItemOpen Access
    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.
  • ItemOpen Access
    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.
  • ItemOpen Access
    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.
  • ItemOpen Access
    RNs Experiences of Enactment of Psychotherapy Act, 2007: A Mixed Methods Study
    (2018-03-01) Dresher, Ingrid; Singh, Mina
    The College of Nurses of Ontario will comply with the Psychotherapy Act, 2007 by requiring nurses to initiate psychotherapy by an order from a physician or NP. This study examines the possible constraints to RN psychotherapy service delivery. Quantitative and qualitative date were gathered from 23 RNs using Barretts PKPKCT to measure power of participants experience for the anticipated regulatory change. Findings revealed concerns that RNs ability to practice psychotherapy would likely be negatively affected due to loss of autonomy, uncertainty and ambiguity. Research evidence has shown loss of autonomy and ambiguity in working environments is consistent with the findings in this study. Bureaucratic barriers to public access to RN psychotherapy, and the consequences of demoralization, devalued status and uncertainty regarding the changes to RNs practice are emotional factors that predict reduced ability for RNs to serve the already insufficient mental health care services in Ontario.
  • ItemOpen Access
    The Lived Experience of Bereaved Caregivers: Caring for Loved Ones at End of Life in Rural Ontario Home Settings
    (2017-07-27) Amell, Travis; Johnston, Nancy E.
    The purpose of this study was to explore the lived experience of bereaved caregivers who cared for their loved ones at end of life in rural Ontario home settings. van Manens hermeneutic phenomenology research method was utilized to guide this study and to gain a rich understanding of the lived experience through participants interviews. This studys sample consisted of eight participants from rural locations in the Eastern and Waterloo-Wellington counties of Ontario, Canada. Five themes were uncovered: (1) Facing a Terminal Prognosis and Deciding to be a Caregiver; (2) Being in it for the Long Haul; (3) Drawing on Sustaining Reservoirs; (4) Haunting Concerns and Comforting Memories; (5) Reflecting on an Invaluable Journey.
  • ItemOpen Access
    Exploratory Study of Documented Psychosocial Nursing Interventions within the Palliative Care Setting
    (2017-07-27) Fowler, Sarah Kathleen; Lum, Lillie L. Q.
    Further research is needed to better understand issues related to the provision of psychosocial care at end-of-life (EOL). Nursing documentation provides an effective strategy for assessing quality of care. The objective was to assess the quality of documentation processes for EOL care and to identify the degree to which a process-based approach was utilized. A case study qualitative design was applied through a retrospective chart review of the Powerchart documentation database. The process-based framework set out in the Nursing Role Effectiveness Model (NREM) and a modified version of the Quality of Documentation of Nursing Diagnoses, Interventions and Outcomes (Q-DIO) instrument were utilized to guide data collection and analysis. The majority of nursing documentation was of poor quality and statistically significant differences were noted between Q-DIO subsections. This study showed that nurses working in a palliative care setting vary in their ability to complete accurate high quality documentation of psychosocial care.
  • ItemOpen Access
    An Exploration of Work Related Mental Health Issues Experienced by Rural Emergency Nurses
    (2017-07-27) Dekeseredy, Patricia Lynn; Landy, Christine Kurtz
    Nurses working in rural emergency departments (ED) are exposed to trauma, pain, and suffering on a daily basis. They care for members of their community, including friends and neighbours in an unpredictable environment with limited resources. These contextual factors not only have a negative impact on provision of quality patient care, but also create very stressful work environment putting these ED nurses at high risk for experiencing emotional trauma. This exploratory, qualitative descriptive study used semi-structured interviews to investigate the experiences of rural emergency nurses. A qualitative content analysis was used to analyze the interviews. Findings describe the impact their work experiences had on the nurses mental health and illuminate factors that could contribute to the development of compassion fatigue, burnout and PTSD. Findings will be used to inform future research into early recognition and resiliency programs to mitigate the effects of occupational mental health issues for rural emergency nurses.
  • ItemOpen Access
    "That Look That Makes You Not Really Want to Be There": Health Care Experiences of People Who Use Illicit Opioids in Small Urban and Rural Communities - A Critical Social Theory Analysis
    (2017-07-27) Hardill, Kathryn Ann; van Daalen-Smith, Cheryl L.
    The phenomenon of interest is the health care experiences of people who use illicit opioids in small Ontario urban and rural communities. Using the qualitative constructivist paradigm the perspectives of participants who used opioids and of nurse participants were interpreted using Frieres critical social theory framework to explore sociopolitical, economic and ideological influences. Findings describe a divide between people who use illicit opioids and the nurses who care for them: Its Like A Switch Gets Flipped (describing an abrupt change in attitude by nurses once illicit substance use is identified), Reciprocal Mistrust, Caring for Women is Different and In a Small Town the Stigma Lasts Forever. Discussion places these findings in the context of health care systems as agents of social control, the influence of neoliberalism, and the impact of the global War on Drugs. Findings lead to recommendations for contextualized nursing practice, education and research and for policy change.