Abstract
Female Saudi Nursing Students Sense of Belonging in Clinical Settings
Monirah Albloushi, University of Saskatchewan
Linda Ferguson, University of Saskatchewan
A sense of belonging is one of the important factors in a student’s clinical experience and leads to enthusiasm and a willingness to learn when the student is on a clinical placement. Students who experience a sense of belonging are more likely to have confidence to learn and the ability to ask questions. The literature identified the negative consequences that become apparent with the lack of a sense of belonging on a student’s psychological, social, behavioral, and physical well-being as well as the student’s competence levels. An exploratory mixed methods approach will be used to explore and describe the students’ sense of belonging on clinical placement and outcomes from the perspective of Saudi nursing students, to identify the factors affecting a student’s sense of belonging and the consequences, and to measure and compare the sense of belonging among nursing students at three different universities in Riyadh, Saudi Arabia. For Phase 1, a total of 15 students were interviewed. For Phase 2, the total participants will be 252 students. This study will help to identify factors that affect student’s sense of belonging. Clinical educators and clinical settings will be able to use the findings to design effective clinical experiences and to facilitate the learning process in clinical teaching.
Female Saudi Nursing Students Sense of Belonging in Clinical Settings: An Interpretive Description
Monirah Albloushi, University of Saskatchewan
Linda Ferguson, University of Saskatchewan
A sense of belonging is one of the important factors in a student’s clinical experience and leads to enthusiasm and a willingness to learn when the student is on a clinical placement. Students who experience a sense of belonging are more likely to have confidence to learn and the ability to ask questions. The literature identified the negative consequences that become apparent with the lack of a sense of belonging on a student’s psychological, social, behavioral, and physical well-being as well as the student’s competence levels. It has been found that the degree of a sense of belonging is determined by many factors such as preceptorship, duration of clinical placement, and student–staff relationships. Interpretive description was used to explore and describe the students’ sense of belonging on clinical placement and outcomes from the perspective of Saudi nursing students and to identify the factors affecting a student’s sense of belonging and the consequences. The study was conducted in three government universities in Saudi Arabia. Each of these universities provides a 4-year nursing baccalaureate program and a 1-year internship, and they each differ in the curriculum provided; structure of clinical placements; length of clinical experiences; and models of clinical supervision, cohort size, and students’ demographic backgrounds. A total of 15 students were interviewed. This study will help to identify factors that affect student’s sense of belonging. Clinical educators and clinical settings will be able to use the findings to design effective clinical experiences and to facilitate the learning process in clinical teaching.
Geriatric Perception of a Student-Directed Community Outreach Exercise Program—Women’s Health Issues
Kathleen Alexander, Idaho State University
Julie Dunn, Idaho State University
Beth Ann Soelberg, Idaho State University
Food Insecurity, Poverty, and Homelessness as Key Social Determinants of Health in Northern Ontario
Areej Al-Hamad, Laurentian University
Carol Kauppi, Laurentian University
Rural health concerns related to food insecurity, poverty, and homelessness are emerging as major issues in northern Ontario. Among the most important social determinants of health, these factors have significant implications for rural health. Understanding of gender inequalities related to food insecurity, poverty, and homelessness is vital within the current restraints in public funding. This study has two objectives: (i) to identify patterns and trends in food insecurity, poverty, and homelessness amongst poor and homeless women in rural and urban communities within northeastern Ontario and (ii) to explore the experiences of poor and homeless women in rural and urban communities of northeastern Ontario with regard to hunger, poverty, homelessness, and the perceived impacts on physical and mental health and well-being. The study will utilize a community-based action research design. The research will use a sequential exploratory mixed methods design. The setting is northeastern Ontario including rural and urban communities. The proposed study will be conducted in two phases. The first phase will involve a secondary data analysis of a database developed by the Poverty, Homelessness and Migration project. The second phase will involve a qualitative exploration of the experiences of poor and homeless women in northern Ontario. Interviews utilizing photo-elicitation will be tape-recorded. A thematic, qualitative analysis will be conducted. The results of analyses will be presented in a community forum in Sudbury. Participants will be invited to provide input into the study results and develop action strategies to address food insecurity, poverty, and homelessness in northern Ontario.
Intensive Care Unit Competencies of New Nursing Graduates in Saudi Arabia, Nurse Educator and Preceptor Perspectives
Sarah Almazwaghi, Alriyada College for Health Sciences
@@@The purpose of this study was to describe the competencies needed by nursing intern students as identified by their preceptors and nurse educators, who choose to work as registered nurses in intensive care units (ICUs) in Saudi Arabia. The research questions this study investigated were as follows: (1) What do nurse preceptors and nurse educators believe are the competencies for new graduates to allow them to work safely in an ICU in Saudi Arabia?; (2) What are the competencies they should possess at the end of their internships?; and (3) Is there a difference between nurse educators and preceptors in the perception of required or expected competencies of the nursing role in the ICU? Through the Interpretive Description methodology, data were collected through interviews, the guide for which was developed based on the Canadian Association of Critical Care Nurses standards for critical care nursing practice. The data were analyzed to identify common themes. Themes for ICU competencies included (1) needed skill competencies, (2) development of knowledge application competencies, and (3) strategies for quality improvement. A notable aspect of this study was the finding that in Saudi Arabia, there was agreement among participants that nursing intern students were not prepared to work in ICU immediately after their internship year. Building on participants’ responses, nursing intern students may acquire satisfactory preparation during their internship through continuous evaluation, consistent guidance, extended time period, and orientation. Consequently, it represents a significant contribution to enriching the nursing intern students’ internship outcomes as well as the literature in the context of Saudi Arabia and in advancing the nursing workforce in ICUs in Saudi Arabia.
Breastfeeding and Work: Mothers’ Experiences, Employees, and Managers/Entrepreneurs
Suzana Almeida, University of Sao Paulo
Juliana Stefanello, University of Sao Paulo
Maternal work has been appointed as one of the factors that influence the onset, duration, and intensity of breastfeeding. The lack of adherence by companies/managers in deploying existing actions in an appropriate manner for the employees who return from maternity leave or those who return early to work for not having a formal labor link has been one of the main factors for early weaning. Our aim in this study is to understand the experience of female workers and managers/entrepreneurs in relation to breastfeeding and returning to work in an agricultural enterprise in the region of the city Ribeirão Preto—SP, Brazil—that applies pro-breastfeeding actions. This is a qualitative study in the setting of an agribusiness company in the region of Ribeirão Preto which adopts policies to promote, protect, and encourage breastfeeding, such as maternity leave, breastfeeding room, flexitime, day care centers, among others. The participants of this survey are employees and managers of the chosen company. For the data collection, we will use the method of semistructured interviews which will be recorded after the acceptance to participate in the study and the signature of the FICS. The data will be analyzed by means of the method “interpretation of the senses.” We will present preliminary data from research considering that this study is in development.
Social Representations Regarding the Breastfeeding From the Perspective of Adolescents With Symptoms of Postpartum Depression
Juliana Cafer, University of Sao Paulo
Flávia Azevedo-Gomes Sponholz, University of Sao Paulo
Suzana Stefanini Campos de Almeida, University of Sao Paulo
Juliana Stefanello, University of Sao Paulo, University of Sao Paulo
The postpartum depression is a mental disorder of high prevalence that directly influences the relationship between mother and baby and also the breastfeeding. This study aimed to understand the social representations regarding the breastfeeding between adolescent mothers with depressive symptoms. A qualitative research was developed with adolescent mothers who had positive screening for depressive symptoms and who had children under 1 year of age, who were breastfed or not, and who are users of a public health service in the city of Ribeiro Preto, Brazil. The symptoms of depression were accessed through Edinburgh Postnatal Depression Scale. The data about the social representation were collected using semistructured interviews. The data are being analyzed by the Method of Interpretation of meanings and Social Representation in an anthropological perspective. Four thematic categories emerged from the data: (1) interruption of exclusive breastfeeding and introduction of artificial milk, (2) the positive perception of breastfeeding only for the baby’s health, (3) support in the practice of breastfeeding, and (4) early problems in breastfeeding. Most of adolescent mothers were homemakers, single, had high school incomplete, and who started breastfeeding and weaned in the first year of baby’s life. Early detection of signs and symptoms of postpartum depression prevents maternal suffering and consequences for baby such as difficulty in the management of breastfeeding, early weaning, construction of ineffective bond, which may to reflect directly on growth and health development of the baby.
Examining the Potential for Vitamin D Deficiency in Young Saudi Women Living in Canada: A Qualitative Approach
Reem Alomari, University of Saskatchewan
Susan Whiting, University of Saskatchewan
More than a billion people worldwide may suffer from vitamin D deficiency or insufficiency. The purpose of this study was to examine the risk for vitamin D deficiency in a sample of young Saudi women living in Canada by exploring their knowledge, attitudes, and practices. Health professionals with experience in both Canada and Saudi Arabia acted as key informants. This study examined topics related to the knowledge of vitamin D sources, feelings regarding the importance of vitamin D, and practices indicating if knowledge and attitudes were being implemented. The study was conducted in Canada. Eight Saudi women living in Canada for no more than 5 years, between the ages of 18 and 45, were recruited. Ten health professionals presenting physicians, nutritionists, and nurses agreed to participate. Preliminary data show that Saudi women showed a limitation in their knowledge about the sources of vitamin D, supplementations, and food fortifications. They had limited sun exposure due to long winter in Saskatoon and culture reasons for wearing hijab. Health professionals recommended increase awareness about vitamin D. In-depth analysis is ongoing. This work when completed should add to research regarding vitamin D status in Saudi women who are living in a country such as Canada.
Locked Lives! A Netnographic Study on Virtual Community of Patients With Spinal Cord Paralysis in Turkey
Metin Argan, Anadolu University
Mehpare Tokay Argan, Bilecik Seyh Edebali University
Alper Ozer, Ankara University
‘When the Lights Go Out:’ Qualitative Perspectives of Urban Ghanaian Men and Women in Vasectomy
Ofeibea Asare, Kwame Nkrumah University of Science and Technology
Easmon Otupiri, Kwame Nkrumah University of Science and Technology
Vasectomy is known to be the safest, easiest, and less expensive form of contraceptives. The uptake of vasectomy among Ghanaian is very low. In Ghana, 0.01% of men use vasectomy; over the period 2010–2013, Accra recorded only 50 vasectomies. The study sought to know what opinions do Ghanaian men and women have on vasectomy and what have been the experiences of vasectomized men and their partners. The study explored the perspectives of vasectomy among men and women in urban Accra by assessing the knowledge levels of Ghanaian men and women on vasectomy, the opinions of Ghanaian men and women on vasectomy, the attitudes of Ghanaian men and women on the uptake of vasectomy, the perspectives of women about their male partners undergoing the procedure, and the experiences of vasectomized men and their partners on the procedure. The study was conducted in the five submetropolitan areas of urban Accra. It was a qualitative phenomenological study that employed both focus group discussions (FGDs) and key informant interviews (KIIs). Women aged 18–49 years and men aged 18–59 years who consented were recruited between September and November 2013. Eight FGDs with averagely 8–12 participants in a session were organized separately for women and nonvasectomized men, while five KIIs were held with vasectomized men and their partners. Data were analyzed with thematic Version 0.9. There are numerous personalized factors that influence Ghanaian men and women attitudes toward the uptake of vasectomy: availability of alternative methods, the issues of irreversibility of vasectomy, it is synonymous with castration/impotency, it almost legitimizes married men to cheat on their partners if they wanted to, and religious/cultural beliefs. Due to the perceptions of the participants, education and promotion of vasectomy as a family planning method should be packaged differently from the other methods to encourage its usage.
How Do Emergency Medicine and Internal Medicine Physicians Enable and Enact Care Coordination? The Role of Cross-Referencing of Perspectives in Qualitative Research Credibility
Rakhee Banik, McGill University
Peter Nugus, McGill University
Worldwide, maintaining patient flow is a major challenge in emergency department (ED) care. Yet, the flow of patients through the ED depends on patients being discharged from inpatient units and the ability of emergency clinicians to engage inpatient clinicians in consultations of ED patients. Most research on in-hospital coordination focuses quantitatively on performance outcomes. This ongoing study examines interpretations of coordination and perceptions of respective roles among emergency medicine (EM) and internal medicine (IM) clinicians. Data are drawn from a purposive sample of 20 EM and IM clinicians from two urban teaching hospitals in Canada, 10 from each specialty, and 10 from each hospital. Thematic analysis is used to determine patterns in and generate themes from the data and explain variations. EM and IM clinicians interact mostly where EM clinicians request IM consultations either for admission or to confirm discharge. This is mostly for complex patients with multiple morbidities. A central ideology underlying their joint coordination work is the distinction between “specialization” and “generalism” of patient conditions. This guides whether EM clinicians liaise either with speciality team doctors such as cardiologists or gastroenterologists or with IM as a more generalized field. The treatment of older patients and those with chronic conditions is particularly subject to miscommunication because their conditions are time-consuming and difficult to diagnose. The relationship between EM and IM clinicians, and between specialized and generalized health care, will be increasingly important and consequential as our population ages.
Can We Talk About Race? Disseminating Research Findings With Children Using an Arts-Based Method
Rachel Berman, School of Early Childhood Studies, Ryerson University
Maggie MacNevin, School of Early Childhood Studies, Ryerson University
Rubina Quadri, School of Early Childhood Studies, Ryerson University
Natalie Royer, School of Early Childhood Studies, Ryerson University
The use of theatre and performance in social and health science research is becoming increasingly common. This poster will focus on the use of performance as a means to communicate research results in the field of early childhood education and care (ECEC), in the context of a study exploring how to best support children’s positive identification with race and difference. It will discuss the purpose of using arts-based dissemination methods in ECEC, including its ability to communicate research results beyond the academic community and potential to effect personal and social change. It will explore the possibility of using puppetry as a type of performance with particular relevance and familiarity to young research participants who are often excluded from conventional dissemination methods. Finally, the unique ethical issues of research-based theatre will be discussed.
Youth Advisory Councils in Participatory Action Research: Lessons Learned From a National Multi-Year Grant on Health and Wellbeing
Eugenia Canas, Western University
Michelle Brake, Mount Allison University
Voices against Violence: Youth Action Create Change is a 5-year, Canadian Institutes of Health Research (CIHR)-funded grant examining the impacts of structural violence upon the health and well-being of youth populations across Canada. Since its inception, this project has included the work and perspectives of a National Youth Advisory Board, a team of 10 youth who meet regularly to provide project direction and feedback, shaping significant aspects of the research—its evaluation, methods, and knowledge creation and translation. The development and workings of this youth board draw upon emergent participatory literature as well as expand the methodology by providing a unique case of enduring youth engagement that impacts project governance, development, and dissemination. This presentation shares the methods, as well as challenges and opportunities, in sustaining and measuring the impact of this type of youth participation. The role of the National Youth Advisory Board upon this research project’s impact on health policy will also be discussed. Presentation facilitators will include youth members of the advisory board.
Developing an Information Programme for Parents Whose Child Is Cochlear Implant Candidate
Nurdan Cankuvvet, Anadolu University
Murat Dogan, Anadolu University
Cochlear implant (CI) on children has begun in 1990s and recently the number of these applications continues to increase. As the National Newborn Hearing Screening Program became active throughout the country, CI became accessible to wider populations and age has shown a decrease. Since children have to be operated on at a very young age, this decision is made by their parents on their behalf. For parents, the CI process beginning by decision consists of a series of stages: candidate evaluation, speech processor turn-on, mapping, technical maintenance of the device, and auditory–verbal training. This whole process can be very complex and hard to cope for the parents. Researchers repeatedly emphasize that in order to ensure the parents can overcome the challenges they will meet throughout the process, they should be informed about the process in detail. However, any standard, integrated information program based on analysis of needs and which can be simultaneously presented to a group of parents as necessary could not be found in the available the accessible national and international literature. In this scope, the main purpose of this study is to develop an information program for parents whose children are CI candidates. In order to achieve this purpose, a two-staged research process is planned, which include (1) analysis stage aimed at determining information needs of parents in CI process and (2) program development, implementation, and evaluation stage. Mixed methods design was conducted as the research design with 149 participants. In the first stage consisting of analysis of needs, focus group interview, a qualitative data gathering technique, was exercised with CI team members (n = 6) and parents whose children are CI users (n = 7), while semistructured interviews were conducted with various CI company representatives (n = 4). The data obtained from these interviews were subjected to descriptive analysis by inductive reasoning. In result of the analysis, three main themes have emerged in regard of information needs: (1) program necessity, (2) program structure, and (3) program content. Twelve subthemes of the third theme indicating which subjects should be included in the program include the following: effects of hearing loss, CI process, operation stage, auditory–verbal training stage, hearing and language development, general development of the child, CI device, protection needs, legal rights, parent psychology, experiences of other parents, and future treatment/technology possibilities. At this stage, the Cochlear Implant Information Needs Survey was also practiced with 100 parents whose children are CI users. Results of this survey were subjected to quantitative descriptive analysis and integrated with the qualitative findings. The second stage of the study consists of development, implementation, and evaluation of program. Taba-Tyler Model was taken as reference for program development. In scope of this model, program development and program goals, content, educational strategy, methods, and techniques were determined in collaboration with experts in the field. The program consisting of four main modules (CI process, development with CI, CI device, and parent experiences) was applied to 32 parents whose children are CI candidates. The effectiveness of the implemented program was evaluated with the pretest “posttest” follow-up test experimental design without control group. In this scope, results of related samples analysis of variance and results of paired samples t-test were found to be significant for multiple comparisons of pretest “posttest” follow-up test scores. Therefore, the developed program was evaluated as effective to the extent of limits of the utilised experimental pattern and sample. Finally, an Information Program Satisfaction Survey was practiced with the parents in order to determine the social validity level of the program, and the answers given to the survey have shown the program has a very high level of social validity. Findings of the study have shown that the parents whose children are CI candidates need a wide variety of information in all stages of CI process, that the information program developed on the basis of analysis to meet these needs was effective for this purpose, and the parents were satisfied with the program. Our hope is this program will serve as a first step towards new studies in this direction, and it is our belief this program has the potential to overcome an important deficiency in practice.
Qualitative Exploration of Intervention in Oral Health Guaranteed Program in Pregnant Chilean
Paola Carvajal, University of Chile
Claudia Carvajal, Oral Health Department Ministry of Health of Chile
Valentina Fajreldin, University of Chile
Patricia Hernández-Rios, University of Chile
Johanna Contreras, University of Chile
The Public Oral Health Policy in Chile establishes priority of health care for pregnant women through the GES Pregnant Women Program (GESPP). It gives guaranteed access to promotion, prevention, or treatment procedures in order to either maintain or recover the oral health and to educate about the role of oral health in their family. This study aimed to explore the GESPP in relation to its objectives, implementation, and impact through the discourse of a group of beneficiary mothers of Family Health Centers (CESFAM) selected in two communities in Santiago Chile, and the discourse of institutional actors linked to it. Individual interviews to 20 mothers who were beneficiaries of GESPP and to four institutional leaders at a central level were conducted. Besides, four discussion groups with the key stakeholders involved in the implementation of the program at a local level (CESFAM and Municipalities) and at a central level (Regional Ministerial Health Secretary and Ministry of Health) were performed. Interviews and discussion groups were recorded and transcribed. Data were analyzed using qualitative thematic analysis in line with the framework to explore. Preliminary analyses indicate that mothers have incorporated the educational and preventive part but do not admit to have been part of a special guaranteed program. The main barriers reported by the health team are the low adherence of pregnant women to education and the lack of educational support material. The results of this study will generate recommendations to strengthen the GESPP to help its ultimate goal, which is to reduce the prevalence of oral diseases and for the mothers to take over the health of their family.
The Value of Qualitative Research—Understanding the Link Between Ethnicity, Cardiovascular Disease, and Secondary Prevention Programs
Kanika Chadha, University of Alberta
Ynayara Rosendo, University of Alberta
Alexander M. Clark, University of Alberta
Cardiovascular disease (CVD) is the leading cause of mortality worldwide. Intervention through secondary prevention (SP) programs can significantly reduce mortality, improve the quality of life, and mitigate many CVD complications.
Misoprostol and Fertility Control
Harneet Chahal, University of Alberta
Zubia Mumtaz, University of Alberta
Six decades of family planning programs in Pakistan have failed to significantly increase contraceptive uptake, reaching 35% in 2012–2013. Nonetheless, fertility rates have been declining. This may be due to increasing rates of induced abortion. Traditionally, religious and legal restrictions surrounding this procedure forced women to resort to clandestine services where risks of maternal morbidity and mortality are magnified. But with the abortifacient misoprostol now available, women may have a safer and more practical abortion option. To explore this further, this study examined how the availability of misoprostol has impacted women’s abortion seeking behavior. A focused ethnography was conducted in Chakwal, Pakistan, from September to December 2013. Participants were recruited from a nongovernmental organization that provides abortion services. Twenty-three in-depth interviews were conducted with women seeking or who had abortion, 14 with facility health service providers. One focus group discussion was conducted with health care providers. Our data revealed contraceptives were not adequate in allowing women to meet their fertility needs. Consequently, women turned to abortions specifically through the abortifacient misoprostol to limit their fertility. The numerous advantages of misoprostol meant it not only became the preferred means of pregnancy termination but also the preferred family planning method. Women reconciled this decision by avoiding any discussion around abortions, instead deflecting it as a mistake, miscarriage, or menstrual cycle issue. To support women’s access to safe abortions, we recommend training providers to safely administer misoprostol within women’s homes.
Access to Medicine in Primary Health Care: What Do the Health Care Managers Think?
Tatiana Chama Borges Luz, Oswaldo Cruz Foundation
Maria Emília Souza Costa, Federal University of Minas Gerais
Lucas Barbi Costa e Santos, Oswaldo Cruz Foundation
Valéria Lima Falcão, Oswaldo Cruz Foundation
Rachel Magarinos Torres, Fluminense Federal University
Maria Auxiliadora Parreiras Martins, Federal University of Minas Gerais
Medicines improve health when they are available, of good quality, and are properly used. Pharmaceutical Services based on Primary Health Care (PHCPS), part of Brazil’s universal national health system, seeks to provide, free of charge, medicine access to the population. However, evidence suggests great difficulty in achieving this goal, especially when considering small municipalities in the country. This qualitative study is based on semistructured in-depth interviews with the 12 primary health care managers (working at the Health Department and at Healthcare units) in Divinópolis, a municipality of approximately 200,000 inhabitants in Minas Gerais, southeast, Brazil. The transcribed interviews were analyzed using thematic content analysis. Problems regarding the infrastructure and organization of the PHCPS emerged (e.g., inadequate storage space and dispensing area; uncomfortable reception area and long queues) and also lack of instructions to the patients on how to use their medicines. The current access of medicines was viewed as reasonable; however, it was acknowledged that there were some medicines that patients were missing out. The main perceived barriers to medicine access were the current service infrastructure and the unavailability of qualified staff to dispense medicines. The results support previous studies in emphasizing that demands for structuring PHCPS have remained repressed. These results also suggest a perception of the pharmaceutical services as a provider of medicines, without considering, that access to medicine only exists when individual and health system factors are optimally aligned.
Men in Nursing: A Thematic Analysis of Male Nursing Students Experiences of Nursing Education in Regional New Zealand
Martin Christensen, Queensland University of Technology
Where Do Women Go When There’s Nowhere to Go?
Denise Dillon Bolland, Griffith University
The latest trend in homelessness is older women who have become unexpectedly homeless or are currently at housing risk for the first time, later in life. Named in the current literature as the silent and/or hidden women little is known about them, as they do not seek help until their situation becomes critical. Using a qualitative, multidisciplinary feminist arts-informed approach, this research seeks to gain insights into the journey from hopelessness to hope taken by 20 older women who became unexpectedly homeless or at housing risk. This research inquiry is a testimony to hope and the use of art for personal transformation and well-being. It describes and analyses the methodological approach and the methods used in three art groups during 2012 and 2013. While facilitating these groups, the researcher spoke to over 150 women of all ages, about their housing situation and their life style, while sitting around tables making art pieces together. First, this research inquiry presents a deeper understanding of how these older women navigated their journey from hopelessness to a feeling of hope about their future. Second, it takes up the participant’s reflections on their lived experiences, and how these experiences impacted their health and well-being. Finally, this inquiry concludes with recommendations for government policy makers about the benefits of supporting creative arts programs for older women to increase their health and well-being, and as an antidote to social isolation.
Classifying Participants for Implementation and Evaluation of a Health Research Network: Unpacking a Seemingly Simple Exercise
Sara Donahue, Abt Associates
Alyssa Kogan, Abt Associates
Ayodola Anise, Patient-Centered Outcomes Research Institute
The Patient Centered Outcomes Research Institute (PCORI) created the Asthma “Evidence to Action Network” (E2AN) of 14 awardee teams working on asthma-related studies. Network participants include investigators, patients and caregivers, and stakeholders involved in the projects. Developing, implementing, and rigorously evaluating the Asthma E2AN required characterizing the roles of network participants in the awardee teams. For example, the process evaluation involves analysis of the ways different team members reported collaborating with members of other teams. Timely, accurate, and precise descriptors were necessary for qualitative evaluation analyses, yet flexible coding was also necessary to respond to real-world implementation. For example, network activities were targeted to network subgroups, populated by participants whose roles sometimes shifted over time. We used an iterative process to develop a coding mechanism for this evolving research network. Awardee team member names and roles were obtained from numerous sources including an initial list provided by PCORI, introductory interviews with awardee teams, a web survey, a network meeting attendance list, and project applications. Project and PCORI staff reviewed compiled lists. Challenges to classification included confirming awardee team members’ roles and determining requisite features of a coding scheme to support implementation and evaluation. Resolving contradictory information about participant roles involved integrating existing definitions, such as those established by PCORI and awardee team leadership, with network participants’ self-reported information. Ultimately, the process yielded a flexible but useful system that adapted to influences on how individuals are classified and defined and facilitated documentation and modification during network implementation and evaluation.
The Social Organization of Nurse Managers’ Work of Staffing in Hospitals in Alberta
Olive Fast, University of Calgary
This research uses institutional ethnography to study the work of frontline nurse managers. The data revealed that nurse managers devote significant time and energy into ensuring there is enough available staff to carry out nursing care. This “staffing work” is a source to tension and worry for nurse managers. The research develops an account of how nurse staffing in Alberta is organized to happen as it does. Beginning in the standpoint of nurse managers, their activities are empirically described and explicated. The account builds an evidentiary trail of how the documents and technologies (such as the workload management system) used to plan and administer nurses’ work schedules conceal serious problems and risks. The findings reveal a disjuncture between knowledge generated from the technological programs that nurse managers’ are accountable to and knowledge generated doing the day-to-day work of staffing. The argument developed is that Nurse Managers’s work of staffing is organized to mediate rationed resources into frontline nursing work. This happens within “knowledge practices” driven by formulations of productivity and efficiency as determined by the big data of health informatics. The compelling rationality of the health informatics logics is buttressed by a leadership discourse focused on personal and organizational transformation. These ruling relations position nurse managers as developers and promoters of “innovations,” such as new models of care (collaborative practice). They also circulate as a powerful organizer and undermine what nurse managers’ know. This research contributes an alternate analysis, a critical empirical description of what it is like to be a nurse manager in contemporary Canadian hospitals. The study has implications for nurse managers. It offers them insight into the social organization of their work and illuminates how they are being organized to think and act in ways that undermine nurses and patient care. The study is a cautionary warning against the increasing reliance on workload management systems and the relations of ruling that they pull nurse managers into.
“Culture Is So Interspersed”: Childcare and Healthcare Providers’ Perceptions of Childhood Obesity in South Africa
Roger Figueroa Bautista, University of Illinois
Jaclyn Saltzma, University of Illinois n
Jessica Jarick, University of Illinois
Angela Wiley, University of Illinois
Obesity has increased in the past 40 years, and developing countries (e.g., South Africa) are particularly affected. Women and children are considered the groups most impacted by obesity. Childcare and health care providers are considered to have critical roles in preventing childhood obesity. The purpose of this study is to explore the current perceptions of obesity in Cape Town, South Africa, among a convenient sample of health care professionals and childcare caregivers. More specifically, this study explores the perceived causes, consequences, and potential solutions, such as intervention strategies towards obesity among providers of health and childcare in Cape Town, South Africa, and pilots an adapted obesity perceptions interview protocol that incorporates a transdisciplinary conceptual framework (Six C’s) in order to assess the potential roles that every level in a child’s ecology plays in childhood obesity prevention. A total of 22 interviews were conducted. Inductive content analysis was used to identify emerging themes, which were identified at all levels of the Six C’s socioecological model. Findings suggest that in South Africa, as it is also true in other countries, childhood obesity is a multilevel public health concern. Participants were aware of the existing contributing factors, consequences of childhood obesity, and identified areas of interest to tackle the epidemic in South Africa.
The Meaning of the Use of Psychotropic Medications in the Everyday Life
Agnes Fonseca Ribeiro Filardi, Universidade Federal de Minas Gerais
Djenane Ramalho de Oliveira, Universidade Federal de Minas Gerais
We have observed in our society a significant increase in the use of psychotropic medications to cope with all forms of malaise and human suffering. Phenomenological research seeks to understand the core meaning of the phenomena studied. This study used hermeneutic phenomenology, as proposed by Max Van Manen, to understand the meaning of the use of psychotropic medication to solve problems in everyday life. We interviewed 19 people, 14 women and 5 men. Participants perceived medications as needed to return to the equilibrium point, which had been affected at any given time when everyday problems were considered so burdensome that went beyond the personal capacity to resolve them. The main issues faced by participants, reported as precipitators to the use of the medications, were related to work, family, and marital problems. When starting the medicine, it promotes a calming effect, which gives the perception of not being affected by the problem anymore. Over time, the use of the medication is maintained by the same initial motives or become associated to other difficulties, such as insomnia, dependence, and withdrawal symptoms. Patients’ suffering is legitimate and inevitable, with strong relationship with psychosocial factors. There is an ideal of normality and the need to restore the equilibrium, regardless of the surrounding reality or the problems faced. Nonpharmacological approaches to dealing with the difficulties presented are used, but for a short period of time and lower frequency.
The Meaning of the Use of Psychotropic Medications in the Everyday Life—Systematic Review
Agnes Fonseca Ribeiro Filardi, Universidade Federal de Minas Gerais
Djenane Ramalho de Oliveira, Universidade Federal de Minas Gerais
Yone de Almeida Nascimento, Universidade Federal de Minas Gerais
Vânia Eloisa de Araújo, Universidade Federal de Minas Gerais
The use of psychotropic drugs to treat problems of everyday life is a growing phenomenon that has occurred in many countries. To understand the meaning of the use of psychotropic drugs in everyday life, this systematic review was conducted in the databases Central (Cochrane), Psycoinfo, and Lilacs until September 2014. We identified 514 publications, of which 27 met the inclusion criteria. These included only qualitative research that investigated the meaning of the use of psychotropic medications from the perspective of doctors, patients, and other health professionals. The physicians and patients refer to the benefits of psychotropic drugs as a way to relieve symptoms of anxiety and stress from everyday life events. The doctors feel touched by the problems of patients and show empathy by prescribing. From their perspective, prescribing appears to be a simpler solution compared to the presented difficulties. Patients feel unable to solve their problems and seek medication as a solution. The use of psychotropic drugs can be connected to medical and patient characteristics, or their interaction, associated with social problems.
Keywords
psychotropic, qualitative research, systematic review
In My Lifetime It’s Been Pretty Bad … I Try to Think Positive: Understanding Dimensions of Post-Disaster Resilience in Rural Appalachia
A Qualitative Study of Health and Emergency Preparedness in an Appalachian Community
Meghan Hayes, University of Tennessee College of Nursing
Lisa Davenport, University of Tennessee College of Nursing
Cameron King, University of Tennessee College of Nursing
Moriah McArthur, University of Tennessee College of Nursing
HIV and Infant Feeding: Serostatus Disclosure and Associated Risk Factors Among HIV-Positive Mothers Accessing PMTCT Services in Lusaka, Zambia
Alice Ngoma Hazemba, University of KwaZulu Natal
Busisiwe P Ncama, University of KwaZulu Natal
As a public health approach in Zambia, all mothers regardless of their HIV status are encouraged to exclusively breastfeed for the first 6 months of infant feeding. This study is linked to the Ministry of Health’s effort to encourage breastfeeding among HIV-positive mothers. Health care workers must offer women counselling, guidance, and support to practice exclusive breastfeeding. However, there are challenges faced in counselling HIV-positive mothers to practice exclusive breastfeeding. The aim of this study was to explore serostatus disclosure and associated risk factors in the context of exclusive breastfeeding among HIV-positive mothers accessing Prevention of mother to child transmission services. This study was part of a research that was conducted to analyse choices and decision outcomes on infant feeding to inform the development of a model for follow-up of HIV-positive mothers in the first 6 months of infant feeding. This was a health facility and community-based study that was designed to follow HIV-positive mothers for 6 months after delivery. The design was an exploratory descriptive qualitative study utilizing participant observation and in-depth interviews with 30 HIV-positive mothers and 6 key informants. This article addresses one theme that emerged from framework data analysis: serostatus disclosure and associated risk factors in the context of exclusive breastfeeding. A semistructured instrument was used to conduct interviews which were digitally recorded, simultaneously transcribed and all files imported into QRS Nvivo 10 version for coding and analysis. Our findings revealed that HIV-positive mothers were aware of the risks of mother-to-child transmission of HIV through breast milk, however, the pattern of serostatus disclosure varied based on individual circumstances. Some mothers disclosed their serostatus to someone, but reasons for disclosure leaned towards the social aspect to their lives as opposed to protection of exclusive breastfeeding practices. Hence, community and family pressure to practice mixed feeding were predominant with some mothers failing to practice exclusive breastfeeding. Nondisclosure was associated with fear of victimization, fear of family and community gossip, and nondisclosure. We conclude that quality counselling that translates into disclosure on the basis of achieving exclusive breastfeeding practices for HIV-exposed infants need to be emphasized during counselling for mothers accessing services for prevention of mother-to-child transmission of HIV.
Immigrant Women’s Experience of Postpartum Depression in Canada: A Narrative Synthesis Systematic Review
Gina Higginbottom, University of Nottingham
Myfanwy Morgan, King’s College
Joyce O’Mahony J, Thompson Rivers University
Knowledge, Awareness, and Practices of Village Health Volunteers Regarding Health Promotion in Northeast Thailand
Machiko Higuchi, National College of Nursing Japan
Thailand has implemented the strategy of primary health care (PHC), which was introduced by the Alma Ata declaration in 1978. Village health volunteers (VHVs) were recruited nationwide from the general population, not only to address the shortage of trained health care providers in the community but also to increase the general public’s health awareness through a community participatory approach, which is one of main strategies of PHC. The Thai government provides a program for VHVs to update their knowledge and skills in order to meet the general public’s health needs. However, very few studies have evaluated the competency of VHVs. Sixteen VHVs were interviewed about their knowledge, awareness, and practices related to health promotion. The VHVs reported that they are motivated to provide services to villagers while continuing activities for more than 5 years. Four main themes differences in understanding among villagers about authorized services, general lack of public participation, factors that hinder villagers’ ability to maintain a healthy lifestyle, and difficulties balancing their private life and working as a volunteer with 13 categories were developed. VHVs reported that they felt encouraged when they recognized villagers’ needs and experienced a sense of self-determination through their daily activities. They have some knowledge of health promotion perspectives. VHVs recognized that they need to update their knowledge and learn how to impart such knowledge to the villagers according each villager’s health issues.
Towards the Implementation of the Malaria Elimination Policy in South Africa: Perspectives From Key Stakeholders
Khumbulani W. Hlongwana, University of KwaZulu-Natal
Joyce M. Tsoka-Gwegweni, University of KwaZulu-Natal
Global decline in malaria episodes over the past decade gave rise to a debate to target malaria elimination in countries where malaria had been substantially reduced, including South Africa. However, there is no evidence to suggest that barriers and facilitating factors to effective implementation of the elimination policy in South Africa have been documented, at least, from the stakeholders’ perspectives. The study used the phenomenology paradigm to investigate the research participants’ subjective experiences and interpretations of malaria elimination policy, including their perceived barriers and facilitating factors to effective implementation of the policy. In-depth interviews were conducted amongst the 12 purposively selected participants, 5 malaria programme employees, 3 policy makers from the South African National Department of Health, and 4 researchers. Researchers were identified from those who had published malaria-related research articles based in South Africa between January 01, 2008, and December 31, 2013, as first, last, or corresponding authors. The study obtained ethical clearance from the University of KwaZulu-Natal Biomedical Research Ethics Committee, and all research participants signed informed consent. Data analysis was performed using the thematic analysis. Four key themes emerged from the preliminary findings, namely, (1) resource availability and utilisation, (2) availability and effectiveness of intervention tools, (3) capacity considerations to implementing the policy, and (4) building a shared vision amongst the stakeholders. The overall observation has been the interest created by this policy in ensuring that health systems’ capacity to enable the successful implementation of the malaria elimination policy in South Africa is scrutinised.
Building Upon a Sense of Place to Develop a Community-Based Wellness Intervention
Sharon Hodges, University of South Florida
Teresa Nesman, University of South Florida
Ruby Joseph, University of South Florida
Melissa Tirotti, University of South Florida
Pine Hills, a community of 60,000, is one of Florida’s most ethnically diverse communities. Despite a rich cultural heritage, Pine Hills current reputation is one of poverty, high crime, and decline. Current efforts by resident activists, private organizations, and public agencies strive to build on the strengths of Pine Hills. One such effort, the Pine Hills Wellness Program (PWHP), focuses on health and wellness to improve quality of life. The PHWP was a pilot project implementing a lay health worker intervention that integrated education and action to address health disparities including lack of physician access and high Emergency Room utilization. The intervention focused on caregivers of Pine Hills children between the ages of two and seven who had missed a primary care well child visit and/or had used hospital emergency department services for nonemergent care. This poster presents results of the evaluation of the PWHP pilot. The evaluation design employed a mixed method approach that included a formative component using community-based participatory research strategies and a summative component using quantitative analyses of cost and service utilization data. The qualitative component, which began with community meetings prior to the development of the intervention, yielded rich results that informed PHWP design and supported implementation of the intervention at the program and community levels throughout the pilot. Strategies included regular participation community advisory meetings, observation/participation in PHWP staff meetings, observation of home visits, interviews with program staff and advisory board members, interviews with program participants, and in-depth qualitative case record review. Qualitative data have supported better understanding of the needs of the Pine Hills community, deeper understanding by program staff of the intervention components and how to maintain fidelity to or initiate adaptation of the intervention, and program sustainability including the establishment of a community advisory board that remains actively engaged with the PHWP as the evaluation draws to a close. In addition, qualitative data supported conduct of the quantitative analyses and provided understanding of program outcomes and impact, which were more difficult to ascertain through quantitative analyses because of small sample size.
Gaming Simulation for the Medical Safety of Instruction-Receiving Skills: Focusing on the Awareness of the Participants
Yoshimi Hyod, Okayama University
Tomoko Tanaka, Graduate School of Humanities and Social Sciences
We examined the educational impact of a simulation game on medical safety, involving experiencing error occurrence while receiving instruction. Of the 85 nursing students who played the game, the responses of 78 participants who agreed were included in the analysis, after excluding incomplete answers. In the game, they were in charge of filling medication in a bag. A senior nurse rushed in and provided ambiguous instructions, such that an error would occur if the participant did not confirm the instructions. They were then explained about human error, and about half of the participants played again to improve their responses. Subsequently, all participants reviewed their experiences, described their level of awareness while playing the game, and evaluated the expected utility of the game. The learning from the game was classified into seven categories. More than half of the participants were aware of the importance of confirming or questioning instructions. Others recognized their own reactions, like hesitation to ask questions or of the fear of committing an error, or paid attention to coping, like understanding the situation or taking notes. Further, about half of the participants reported that the game could be utilized in a practical situation in the hospital. Others were reminded of daily situations of receiving instructions. Based on participants’ objective view of their actions, the error occurrence experience in the game would be useful to understand the flow of actions that lead to accidents and to identify the behaviors necessary for their prevention.
The Process of Critical Care Nursing Resilience in Workplace Adversity
Jennifer Jackson, Athabasca University
Nursing burnout has been identified across critical care units and stems from a variety of social, structural, and environmental factors. There have been efforts to address systemic burnout, with varying success. Researchers have suggested that nurses can become resilient and overcome workplace adversity to achieve positive outcomes. The purpose of this study was to develop a grounded theory of the process of becoming resilient. The research question was what is the process of critical care nursing resilience in workplace adversity? In-depth interviews with critical care nurses provided the data to inductively generate the grounded theory. The resultant grounded theory provides a framework to inform nurse leaders to support critical care nurses in their workplace by fostering resilience. By enhancing nursing resilience, burnout may be avoided, and nurse satisfaction, quality of care, and economic sustainability may be improved in the Canadian health care system.
Using Participation to Support and Sustain Recovery-Oriented Mental Health Care
Amanda Kenny, La Trobe University
Susan Kidd, La Trobe University Rural Health School
Carol McKinstry, La Trobe University Rural Health School
The aim of this study was to understand how participation could support recovery-oriented mental health care. Using cooperative inquiry, underpinned by a participatory methodology, consumers, clinicians, and a carer came together over a 12-month period to explore how recovery-oriented care could be strengthened in a regional mental health service. Internationally, health policy requires mental health services to demonstrate recovery-oriented care. The aim is to provide support through the experience of mental illness and assist people to work towards their future goals. However, enacting recovery-oriented health policy at a service level is complex, and there are few examples of consumer/carer involvement in the process. For many health services driven by quantitative outcome measures, qualitative research is not well understood and is often viewed as “soft” evidence. However, in developing knowledge of success in meeting recovery-oriented service targets, quantitative measures provide little insight to the complexity of the consumer recovery journey. The qualitative approach in this study enabled key findings to emerge that demonstrated an absence of consumer perspectives in treatment, team development, service planning, and evaluation. Asymmetrical power relationships between the service and consumers were uncovered. The action research approach supported dissemination of outcomes throughout the service and promoted service-wide discussions on the need for leadership and governance to support a major cultural change process. The study promoted paradigmatic shifts in the way consumer participation was perceived within the service. Importantly, the value of qualitative research in service planning and policy enactment was reinforced.
The Right Intervention for the Right Patient at the Right Time: An Ethnography of Polypharmacy and Prescribing in Nova Scotia Long-Term Care Facilities
Olga Kits, Nova Scotia Health Authority
Primary health care for the elderly living in Long-Term Care Facilities (LTCFs) has historically been disjointed. Nova Scotia’s Health Authority “Care by Design” model is a strategy to coordinate primary and emergency care for long-term care residents. One of the several objectives of “Care by Design” is to reduce rates of problematic polypharmacy. Studies have determined that polypharmacy leads to adverse events, higher health care usage, and increased emergency room visits. These studies point to a serious and difficult challenge: How to ensure that persons do not receive more drugs than clinically indicated. I am exploring the complex sociotechnical domain of what the November 2013 British Medical Journal article refers to as a “necessary evil”—as the population ages, becomes more frail, experiences multiple comorbidities, and people are prescribed complex prevention regimes, polypharmacy is understood by some as the “new normal.” This proposed poster is a visual protocol for a novel ethnographic doctoral research project. The goal of the project is to understand the persistence of problematic polypharmacy in Nova Scotia LTCFs. The poster will depict the conceptual frameworks informing the study and the ethnographic data collection methods.
Rural Experience of Electronic Health Record Implementation and Meaningful Use: A Focused Ethnography
Sarah Kooienga, University of Wyoming
In the United States, Electronic Health Record (EHR) implementation has been slow compared to other high resource countries. The Meaningful Use initiative is a national government incentive program to increase EHR usage and achieve high-quality patient and family-centered primary care. Lower rates of EHR implementation that occurred in rural primary care settings due to rural communities have decreased levels of broadband coverage and a lack of information technology (IT) support. The process of EHR implementation in rural primary care is not well understood and a digital divide exists between urban and rural practices. This focused ethnography is informed by the work of Suchman (2009) who examines the tension between technological innovations and works contingent nature and the focus to make work known based on complexity theory, a focused ethnography can open the “black box” of poorly understood primary care practice (Crabtree et al., 2005). The implementation of EHR and Meaningful Use standards was explored in three primary care practices in one remote rural county in the Pacific Northwest. Based on participant observation of clinic practices, 7 key informant interviews and 24 patient–clinic staff interviews, all field notes and interviews were audiotaped, transcribed, and analyzed using the Ethnograph program. Thematic analysis across all three practice settings revealed EHR implementation was based in complex long-standing relationships among providers, individual practice views on technology’s interaction and impact on their relationship with patient and families and the meaning of the federal governments initiative/involvement in an individual practice. Trustworthiness was ensured by team-based analysis and member checking with individual practice members. Internationally, high and low resource countries are challenged to implement EHRs and Health IT to improve patient-centered primary health care. Understanding the complexity and uniqueness of rural primary care practice will improve quality and outcomes through successful implementation of EHRs.
Neonatal Pain Management: Barriers to and Facilitators of Data Entry in the Better Outcomes Registry & Network (BORN) Ontario Information System
Catherine Larocque, Children’s Hospital of Eastern Ontario Research Institute (CHEO RI)/University of Ottawa
Denise Harrison, Children’s Hospital of Eastern Ontario Research Institute (CHEO RI)
Sandra Dunn, BORN Ontario
Jessica Reszel, Children’s Hospital of Eastern Ontario Research Institute (CHEO RI)
All newborns undergo routine newborn screening in their first few days of life. This and other painful blood tests cause distress at the time of the procedure and repeated painful procedures contribute to long-term negative developmental outcomes. In April 2014, a new pain management data element was added to the Better Outcome Registry & Network (BORN) Information system (BIS) to capture information regarding the use of three effective pain reduction strategies: breastfeeding, skin–skin care, and sucrose, during newborn screening. The purpose of this study is to conduct telephone interviews in order to identify the barriers and facilitators to data entry of newborn pain treatment into the BIS. Using stratified sampling, we aim to recruit approximately 25 nurse managers, or their delegates, representative of level of care and geographic location in Ontario. Using a semistructured interview guide, participants will be asked seven open-ended questions about the frequency and type of pain management used at their hospital, barriers and facilitators to entering pain management information into the BIS, and suggestions for improvement. Data collection and data analysis will occur concurrently; the audio-recorded interviews are being transcribed verbatim and analyzed using content analysis. At the time of submission, two interviews have been completed and four more are booked. The results from this study will be disseminated to clinicians and BORN coordinators through BORN provincial rounds (a webinar series). Additionally, a report including potential strategies to address the identified barriers will be produced and distributed to all maternal newborn hospitals in Ontario.
A Critically Reflexive Examination of Sanist Discourses in Health and Social Care: Interrogating Oppressive Practices
Stephanie LeBlanc, Western University
Elizabeth Anne Kinsella, Western University
Sanism is a pernicious system of thought embedded in Western culture, which involves the systematic subjugation and oppression of people who have received psychiatric diagnoses, or who are perceived to be mentally ill (Perlin, 1992, 2013). While sanism is as troubling as other isms, in some ways, it may be even more insidious as it remains largely invisible and is socially sanctioned and practiced regularly (Perlin, 1992; Wolframe, 2013). This presentation engages critical reflexivity to examine discourses of “sanism” that have begun to emerge throughout mental health care literature (Fabris, 2009; Poole et al., 2012; Russo & Beresford, 2015). Using critical accounts drawn from this scholarship, we illustrate how sanism operates both materially and conceptually within health and social care contexts (Fabris, 2011).
Critical reflexivity is defined by Kinsella and Whiteford (2009) in accordance with the work of social philosopher Barry Sandywell (1996) as, “the act of interrogating interpretive systems that influence knowledge production”; this process acknowledges the “sociality of the process of knowledge production” (2009, pp. 250–251). Critical reflexivity involves careful interrogation of the grounds upon which taken-for-granted claims about knowledge are generated and accepted, along with the situated perspectives from which knowledge claims are produced (Harding, 1991; Kinsella, 2012; Kinsella & Whiteford, 2009; Sandywell, 1996). We argue that a critically reflexive interrogation of discourses of sanism offers generative possibilities for advancing less oppressive practices in mental health care contexts and society at large and for advancing social justice for persons experiencing mental illness (Poole et al., 2012).
Translating Patient Involvement Into Clinical Practice: An Example From Psychosocial Cancer Rehabilitation in Denmark
Loni Ledderer, Aarhus University
Nina Nissen, University of Southern Denmark
In this paper, we examine meanings and practices of “patient involvement” expressed in psychosocial cancer rehabilitation in Denmark in three contexts. Drawing on Scandinavian sociological institutionalism and the concepts of translation, we analyse how actors articulate and ascribe meaning to concept of patient involvement. The example of psychosocial cancer rehabilitation in three contexts, with a call for research proposals, to the design of a research study, and to its implementation in clinical practice, forms a single-case study. Our analysis reveals changing understandings and practices of patient involvement, as the concept is translated from one context into another informed by the various actors’ perspectives, experiences, and actors’ interpretation of the concept as well as organizational routines and structures of the health care system. During the translation process, the meaning of patient involvement changed, shifting from patients (and relatives) seeking to engage in health care on their terms, to patients (and relatives) being expected by health care professionals, and the health care system to be “active patients” (and relatives) in particular ways. This highlights the importance of examining the concept of patient involvement and its practice in particular circumstances.
Realistic Evaluation—Promoting Mixed Methodology
Paul Linsley, The University of Lincoln
The author will look at how he has used realistic evaluation (Pawson & Tilley 1997) in his own research and how, as a methodology, it promotes the use of mixed methods. Realistic evaluation is a form of theory-driven evaluation based on the philosophy of critical realism. A key premise of critical realism is that the concepts of truth and falsity do not provide a coherent view of the relationship between knowledge and object. Rather, knowledge is a social and historical product. The choice of method open to the realist evaluator is pluralistic. Pawson and Tilley (1997) argue that it is perfectly possible to carry out realistic evaluation using a variety of data collection methods, but the selection should be made with reference to the proposed theories and explanations put forward by the researcher in answering what worked, for whom, in what circumstances.
Genderacialised Narratives of Women of Colour Engaged in the Labour of Care in Canadian LTC Homes: A Conceptual Framework Using Critical Narrative Inquiry
Kimberly J. Lopez, University of Waterloo
Susan M. Arai, University of Waterloo
Sherry L. Dupuis, University of Waterloo
Racialized women are more likely to be situated in marginalized care positions due to genderacialized histories of caring (Healy & O’Brien, 2007). Many “assume that caring is a female mandate, yet services are organized in ways that do not respond to, or take account of, the daily realities of women’s lives” (Baines, Evans, & Naysmith, 1991, p. 13), reflecting a disconnect between expectations of women and realities of care. Invisibility and stress experienced in caring roles (i.e., compassion fatigue, vicarious trauma, and burnout) are normalized for many women in care settings worldwide (Robinson, 2011), yet there is little critical consideration of how race, gender, and class play out in these care relationships. Examinations of women and care often gloss over intersections of race and class (Cloyes, 2002; Puka, 1990), which may act as further oppressions in ways care roles are taken up. This presentation describes a critical narrative inquiry that uses critical race feminism and anticategorical intersectionality theory to explore genderacialised narratives with racialized women who work as PSWs in Canadian long-term care (LTC) homes. This research interrogates the genderacialisation of metanarratives in frontline LTC home care by engaging polyvocal counternarratives and antenarratives in critical memory work, collective discussion, and critical reflection to consider current challenges (i.e., low wages, employment mobility, health and other benefits, etc.) experienced by PSWs. By acknowledging genderacialised stories of care, this study aims to elucidate the diverse care realties of racialized women to inform practices, services, and systems that support care workers in Canada.
Representations of Aging, Body, and Career by Physical Education Teachers
Silvia Lüdorf, Universidade Federal Do Rio De Janeiro
Francisco Ortega, Universidade Do Estado Do Rio De Janeiro
Aging could be considered a sensitive theme in some contexts of the Brazilian culture where healthy and “beautiful” bodies are highly valued. The physical education teacher is recognized as a professional who detains some knowledge about health and uses his body as a work instrument. This study aims to understand the meaning of body and aging for Physical Education teachers in such a social context. In particular, to understand how the representations of aging influence their professional practice. This is a qualitative study conducted with 43 teachers who have graduated for almost 30 years and were still engaged in the career. Due to a somewhat resistant reaction towards directly talking about the own aging, two different ways of assessment were used: 14 Teachers were interviewed and 29 answered an online open questionnaire. Data were interpreted using content analysis. Results indicated that teachers have ambivalent feelings about aging. They reported that aging gave them maturity, experience, and self-confidence on their work. However, the physical dimension of the body seemed to be separated from the subject. Also, differences in the representations of aging were detected depending on the professional demands. Those who work in the gyms seemed to be adjusted to a context where potentialities of the body and health are valued and reported that a healthy style could slow the process of aging. Wear and fatigue were specially reported by the school’s teachers due to some factors such as sun exposure, stand up position, and relation with kids/teens.
A Qualitative Study Exploring the Meaning of Knee Symptoms to Adults Aged 35–65 Years
Crystal MacKay, University of Toronto
While osteoarthritis (OA) has mainly been viewed as a disease affecting older people, the prevalence and burden in younger adults is substantial. To mitigate the increasing burden, there is a need to improve OA prevention and management earlier in life. Research on illness meanings has aided understanding of health behaviours, providing opportunities to enhance health care delivery and public health efforts. However, there is limited research on how younger adults understand knee symptoms. This study explored the meaning of knee symptoms to adults aged 35–65 years. We conducted a qualitative study comprising six focus groups and 10 interviews with 51 participants who self-reported knee OA or reported knee symptoms on most days of the past month. Constructivist grounded theory guided sampling, data collection, and analysis. Data were analyzed using a constant comparative method. Participants perceived that knee symptoms were preventable, meaning there was the potential to prevent the onset of symptoms and to alter the course of symptoms. This understanding was demonstrated in how participants explained symptoms. Participants commented on the cause, prevention, and course of symptoms. Moreover, participants reflected on their experience with symptoms, indicating that symptoms made them feel older than their current age. However, they did not perceive their symptoms as normal or acceptable. Findings highlight that participants interpreted knee symptoms as potentially preventable, suggesting they may be open to primary and secondary prevention strategies. These findings have implications for health policy and practice, particularly for enhancing public awareness, and primary and secondary prevention initiatives for OA.
Body Image of Young Women With Breast Cancer
Paola Alexandria P. Magalhães, University of São Paulo
Marislei Panobianco, University of São Paulo
Edilaine Loyola, University of São Paulo
Beauty and youth for women are considered essential qualities that were culturally constructed. If these ideals of beauty were not achieved, they would result in dissatisfaction, especially when there is rupture of the image for a disease. Breast cancer can increase self-image disorders, reflecting on the functional and productive life of the woman. The objective was to understand the meaning of the experience of breast cancer for young women, with regard to body image. It is a descriptive and qualitative study performed in a Rehabilitation Center of Mastectomized Women and an Ambulatory of Mastology of a Brasilian University Hospital. The theoretical reference is the symbolic interactionism. The methodological strategy was the collective subject discourse. Participated 12 women, 18–40 years, up to 1 year of diagnosis, with data collected from February 2014 to January 2015, through interviews. Two collective subject discourse emerged with two central ideas: Central Idea A—perception of changes in body image (hair loss, changes in the breast, and weight gain) and Central Idea B—psychosocial interference in the new body image (interference of the new self-image femininity and sexuality). The results showed that body modifications of young women, especially due to a disease like breast cancer, generate great concern over the way they are socially viewed. Studies of young women with breast cancer are still scarce, identifying the needs and expectations of these women can contribute to a humanized care to them and to warn of the importance of early detection of the disease in young women.
Women With Breast Cancer: Beliefs About Susceptibility and Seriousness of the Disease
Paola Alexandria P. Magalhães, University of São Paulo
Edilaine Assunção Caetano de Loyola, University of São Paulo
Marislei Sanches Panobianco, University of São Paulo
The objective this study was to analyze the perception of women with breast cancer about the seriousness of the disease and their susceptibility to it. A qualitative study was conducted in the Center for Teaching, Research and Extension Women and Breast Cancer—made in Alfenas—Minas Gerais, Brazil, which used the Health Belief Model and concepts to Field Theory of Kurt Lewin as the theoretical framework. Participated 08 women treated for breast cancer that they were attended regularly in the service, at least 3 months before data collect, which occurred between May and July 2011. Data were collected through focus groups and analyzed by analysis of thematic content, proposed by Bardin. Two themes emerged from the reports: “Women with breast cancer: perceptions of susceptibility of disease” and “The view of the seriousness of breast cancer.” The perceived susceptibility to breast cancer was demonstrated when women reported believing that cancer cannot be avoided, regardless of social class, race, or education. They attributed their occurrence to lack of the preventive health behavior. The perception of the seriousness of breast cancer as a chronic condition proved to consider stigmatizing neoplasm. The individual perceptions of respondents about breast cancer were influenced by their beliefs about susceptibility and seriousness over their experiences with the disease and its treatments, which led them to a health behavior to participate in the rehabilitation group, because they viewed even in a way to take care of your health.
Bricolage Design: Promoting Reflection, Enriching the Results
Brenda Merrill, Metropolitan State University
Qualitative research, such as grounded theory or phenomenology, requires participants to transform a lived experience into language, which can then be interpreted and analyzed by the researcher. Complex phenomena, such as those that unfold over time, are in the distant past, or that are an integral part of the self, requires significant reflection to bring the experience to consciousness. However, the resulting expression, and interpretation, can be limited if a single or series of narrative interviews is the only source of data. Bricolage design, which uses multiple methods for data collection and analysis, gives study participants various ways in which to reflect upon, and to present, the experience. Multiple representations of data can provide important nuances, which are relevant to the interpretation of the data, while supporting the rigor of the research process. This oral presentation will present the principles and philosophical underpinnings of bricolage design and analysis; the strengths, weaknesses, and limitations of bricolage design; and examples and suggestions for bricolage implementation.
Creating Research Relationships With Mental Health Consumers Using Discourse Ethics and Personal Recovery Philosophy
Benjamin Milbourn, Curtin University
Beverley McNamara, Curtin University
Angus Buchanan, Curtin University
The oral presentation will report on a research methodology developed using the theory of discourse ethics and the philosophy of personal recovery. The methodology was incorporated into the data collection process of a 12-month longitudinal community study, involving 11 mental health consumers living in the community in Western Australia. The presentation will discuss some of the ethical challenges experienced by the researcher and offer some practical suggestions for creating and maintaining research relationships with individuals and populations who may be deemed “vulnerable” and “hard-to-reach.”
The Analogy of the Indigenous Proverb Lebitla la Mosadi ke Bogadi
Seepaneng Salaminah Moloko Phiri, University of Pretoria
Fhumulani Mavis Mulaudzi, University of Pretoria
Tanya Heyns, University of Pretoria
This was an African hermeneutic phenomenological study. The African hut was used as an analogy because of its resilience as an African settlement. The hut’s physical configuration has the capability to respond to and accommodate different environmental contexts. It also offers protection to its inhabitants. Inferences were made by relating the hut and sun to the identified themes to understand them better. Comparing the structure and purpose of the African hut to the findings allowed for inferences to be drawn, for example, the roof, poles, thatch, and ropes were compared to patriarchy, aspects of trapped women and stress. The sun gives life to living organism including man and provides vitamin D which is essential for prevention of diseases. The brightness of the sun rather than its side effects was the main purpose of using it as analogy because it resembles a bright future filled with happiness analogically related to increased awareness, empowerment, support, and emancipation of women. The relational similarities were done and it brought new insights into understanding the meaning and interpretations of the proverb and its implications on indigenous African women’s health. Relation to the origin of the ancient proverb was clearly stated by the women and some appreciated its meaning while other women experienced it as discriminating to women because its meaning instructed them to be committed and persevere in the presence of abuse.
Qualitative Research and Educational Change in Registered Nurses
Pnina Mor, Jerusalem College of Technology/Machon Tal
Adi Finkelstein, Jerusalem College of Technology/Machon Tal
We experienced an interesting research process especially the interviews allowed us the unconditional encounter with women for whom breastfeeding is their inner spirit? This paper discusses the impact of qualitative health research practice on registered nurses completing a Bachelor of Science in Nursing (BScN). Our academic program is designed for registered nurses, working in the Israeli health care systems that do not have a BScN. Within the program, the students in groups of no more than 10 are obligated within 1 year to complete a research project. Each student is required to partake in all the stages of the research. Every group is accompanied by a facilitator who is a lecturer and researcher. All teams present their research before faculty members and submit a written paper. This year two of the six groups chose qualitative research as their research method, using semistructured or open interviews. None of the students had previous experience with qualitative research methods. One group researched the experiences of lactation consultants and the second group explored the motives of Israeli midwives who chose midwifery as a profession. Listening to the narratives of fellow colleagues aroused a passion that these nurses did not expect from doing a research project. Both groups concluded that using qualitative research improved their knowledge, qualities, and understanding of their profession in ways that they had not previously been privy to.
More Than Words: Visual Graphics That Improve Health Research Relations
Melody Morton Ninomiya, Li Ka Shing Knowledge Institute
I illustrate and describe how researchers can improve communication of information through the use of visual graphics throughout all research phases. Visual graphics such as graphs, charts, figures, and photographs are common in scientific research materials; however, they are less common as communication tool in research. Using examples from my own community-based health research, I detail how visual graphics made knowledge sharing accessible and engaging with research informants, stakeholders, and researchers alike. While I advocate that researchers use visual graphics to enhance and improve communication and build relationships, I also highlight how researchers must carefully consider how visual graphics are developed, used, and represent concepts.
An Evaluation of the Community and Clinical Use of Kingston Helps: A Community Resource Tool to Reduce the Impacts of Poverty on Health
Cailin Mulvihill, Queens University
Kieran Moore, Queens University
Individuals with low socioeconomic status experience multiple barriers which prevent them from achieving the same level of health attained by those of higher socioeconomic status. In 2013, KingstonHelps.ca was created by KFL&A Public Health in partnership with the Poverty Reduction Health Working Group, the Kingston Community Health Centre, United Way Kingston, and the City of Kingston as per the recommendations of Kingston, Ontario’s Poverty Reduction Committee. KingstonHelps.ca is an online community resource hub, offering links to services in a variety of domains such as health, legal aid, social support, and personal experiences. The aim of the initiative is to build a community in which everyone has equal access to the right help, at the right time, by the right people. In an effort to further increase the utilization of KingstonHelps.ca and reduce the impacts of poverty on health, the tool is being integrated into clinical practice and relevant organizational settings. A series of key informant interviews will be held with family physicians and staff of poverty-targeting organizations to inquire about the possible benefits and barriers to using this tool in practice. For pending data collection from the semistructured interviews, data will be analyzed using thematic content analysis based on the grounded theory method. Results from this analysis will be used to further enhance the content of KingstonHelps.ca and build upon previous evaluation results from individuals living in poverty as well as to inform the design of a similar initiative in a neighbouring community, Greater Napanee.
Rearrangement of Temporal Experience Following Living-Donor Renal Transplantation: Focusing on the Illness Narratives of a Family With ADPKD
Yumi Nishimura, Tokyo Metropolitan University
Hiroki Maeda, Tokai University
The aim of this study was to analyze the experience of living-donor renal transplantation in a family with an autosomal dominant polycystic kidney disease (ADPKD), specifically from a father without ADPKD to a child with ADPKD, focusing on the division of time. Multiple unstructured interviews were conducted with family members and then analyzed using the phenomenological method. This study has research ethics committee approval. Prior to the living-donor renal transplant from the father to the child, the family set down the time division of “until the transplant” and paid a great deal of attention to that but did not look beyond the transplant. Posttransplant, when they discovered that the mother (with ADPKD) faced the start of dialysis treatment in the near future, the family established the new time division of the period up until starting dialysis and began to direct their attention to what they wanted to do before then. Learning about other families’ transplantation experiences made them aware of their own particular decision-making process, enabling them to use that method to also envisage future events such as their child’s getting married and having children. This would imply that through the above transplantation experience, the family has created their own method of dealing with the potential challenges facing patients with inherited disorders. The next step will be to interview multiple families and accumulate the different methods that ADPKD families use for dealing with issues as well as exploring how these methods are being exchanged with other families within patients’ associations.
Nurses Perceptions of Adolescent Pregnancy in Granada Prefecture, Nicaragua
Hiroko Ono, Japan International Cooperation Agency in Nicaragua
Machiko Higuchi, National College of Nursing
Nicaragua has one of the highest adolescent fertility rates in the world. Nurses play significant roles in preventing adolescent pregnancy in this country but little is known about their perceptions of adolescent pregnancy, which affect their activities for supporting adolescents. The purpose of this study is to explore the nurses’ perceptions of adolescent pregnancy in Granada prefecture. Semistructured interviews regarding perceptions of adolescent pregnancy were conducted with 10 nurses of public health institutes. Data were analyzed using qualitative descriptive methods. Nine categories emerged from the data. Nurses recognized that inheritance of sexual culture, changing sexual values, and irresponsible sexual behavior were associated with adolescent pregnancy. Nurses were highly aware of adolescents falling into a vicious spiral of adolescent pregnancy and poverty owing to their families’ social vulnerability. They emphasized the importance of updating nurses’ skill and knowledge related to preventing adolescent pregnancy so that they can provide gender-based sexual education in collaboration with public health institutes, school health, and families and build mutually trusting relationships with adolescents. Nurses recognized that they can increase their motivation to make every effort to support adolescents to avoid pregnancy if they obtain appropriate support and advice on fulfilling adolescents’ needs. These results suggest that constant training programs should be provided to nurses so that not only their motivation to prevent adolescent pregnancy can be sustained but also the quality of the support system for adolescent reproductive health care can be improved.
Innovations in Community Programming for People With Dementia: Building an Evidence Base Using Qualitative Methods
Alison Phinney, University of British Columbia
Elizabeth Kelson, University of British Columbia
Community organizations are developing innovative programs to sustain social connections and meaningful participation of people with dementia who live at home. However, these programs have received little attention from the research community, so there is virtually no evidence base to support their ongoing development. To lay this foundation, we are conducting a focused ethnography guided by the theoretical perspective of intersectionality to explore how community programming can promote social citizenship for people with dementia, and the benefits and challenges involved in this work. We have conducted 9 months of fieldwork at a social club for people with young onset dementia and are analysing data from participant observation, focus groups, interviews, and document analysis. Findings show that by emphasizing activities considered to be “normal and ordinary,” for example, eating together, reading newspapers, or going for a walk, the group provides varied opportunities for growth, purpose, participation, and community. Being situated outside the health care system brings with it certain benefits in the group’s effort to maintain a “nonmedicalized” atmosphere, and yet uncertainties around funding are a source of ongoing strain for the group leaders, as are their concerns for members’ safety. Maintaining an air of normal and ordinary frequently comes up against the perceived need for “constant vigilance,” a tension that demands considerable care and creativity in knowing how to manage the daily activities and interactions while allowing a kind of natural freedom. Findings are further discussed in light of how qualitative approaches to evaluation can contribute to a useful evidence base.
Diffusing Healthy Dementia Culture: Supporting the Narrowing Narrative
Robyn Plunkett, Humber College
Peter Chen, Humber College
Individuals experiencing memory loss can also experience a narrowing of their life’s narrative. Finding ways to reinforce individuals’ narratives might be particularly grounding within the context of dementia. Continued community engagement might be one way to support narratives, which can have a particularly strong mental health benefit for the population affected by dementia. Yet, creating communities that foster such engagement is a planned and deliberate action and requires a culture of awareness and understanding. Research from the church, one of the most attended community centres for individuals living with dementia, highlights key avenues for community institutions to foster healthy culture. Fifty-one church leaders answered open-ended questions mailed by post to expose needs their churches required to promote access to their centre. Following content analysis, the following avenues were identified to move towards inclusive community culture: facilitating stronger links between relevant health services, partnering with private sector and community institutions, building upon existing community capital to promote physical accessibility of infrastructure, and increasing the visibility of community resources that support individuals living with dementia. Church leaders largely indicated that policies to promote the physical accessibility of their facilities significantly shaped the investment of their resources. Ensuring the physical safety of infrastructure is a significant accessibility facilitator, yet cultures that foster emotional and social safety are arguable equally as important, despite their relative exclusion from accessibility policy. Without exception, valuing human dignity, integrity, and agency is essential for the inclusion of all peoples into meaningful community life. Thus, exploring ways to diffuse such cultural traits could support continued community engagement and strengthen narratives.
Complex Diabetes and Patient Illness Experience: A Syndemic Approach
Elisabeth A. Ramdawar, University of Ontario Institute of Technology
Christina Vaillancourt, University of Ontario Institute of Technology
Hilde Zitzelsberger, University of Ontario Institute of Technology
Robert Weaver, University of Ontario Institute of Technology
Over the last decade, the prevalence of diabetes in Canada has nearly doubled. Diabetes is often accompanied by various complications that reduce the quality and span of life, for example, cardiovascular disease, kidney disease, neuropathy, and limb amputations. These complications exacerbate disease burden and sustain health disparities. This study utilizes a syndemic approach to understand the experience of complex diabetes. In contrast to conventional biomedical model, the syndemic approach offers a holistic view, where biological, psychological, social, and economic conditions all interplay in the onset of diabetes.
Innovative Primary Care Workforce Models: Workforce Configurations, Staff Roles, and Defining Characteristics of High-Quality, Comprehensive Teams
Jaclyn Rappaport, Abt Associates
Lisa LeRoy, Abt Associates
Judith Schaefer, MacColl Center for Health Care Innovation at Group Health Research Institute
Revitalizing primary care is a critical part of achieving high-quality, accessible, efficient health care. We need to better understand the kinds of primary care workforce models and role changes that lead to improved care delivery and outcomes. This study characterizes 80 primary care practices in the United States, nominated from experts in the field as being comprehensive and providers of high-quality care. Qualitative data, collected from a combination of publically available practice descriptions and semistructured interviews, consisted of (1) a content analysis of descriptive data on how a particular team structure contributes to providing comprehensive, high-quality health care and (2) coding of which staff type(s) performed an array of common roles and functions; these common roles and functions were developed via a literature review and input by expert team members. We also conducted quantitative analyses, including frequencies and ratios of the Full Time Employees in the primary care teams, to determine the most common staff combinations. Preliminary results indicate that innovative models involve new or expanded roles for nonphysician health care professionals, allowing physicians to focus more time on clinical care. Communication among team members is robust, and staff often work across function and role collaboratively. Teams commonly included medical assistant(s) or other nonclinical staff persons as well as some time from a behavioral health professional, social worker, and/or pharmacist. Next steps in our research involve in-depth case studies to expand on the data described above and analysis of practice operating costs to develop ideal models of a comprehensive and cost-effective primary care workforce.
The Lived Experience of Rural Upstate New York Residents Living With an Implantable Cardioverter Defibrillator
Elizabeth A. Russo, Keuka College
The implantable cardioverter defibrillator (ICD) has been established as effective in the prevention of death from cardiac arrhythmias. However, limited research has been published that explores the lived experience of persons living with an ICD, and none from rural New York (NY) State. This interpretive phenomenological study is seminal in that the researcher’s aim was to explore the lived experience of rural upstate NY residents living with an ICD. Ten participants who resided in designated rural NY counties were interviewed about their experiences living with an ICD. Three themes: vulnerability, vigilance, and vitality; their interrelationships and several contributing notions emerged from the data analysis. The lived experience of rural upstate NY residents living with an ICD is reflected in the themes of vulnerability, vigilance, and vitality. Possibilities of vulnerability exist in regard to the person’s experience of lived time, lived space, lived body, and lived relation to the other. Vigilance results in a heightened and immediate awareness of the possibilities of vulnerability. Vitality is the “power of enduring” wherein the person recognizes possibilities and takes action to preserve and/or enhance his or her experience of lived time, lived space, lived body, and lived relation to the other. The person’s experience of vulnerability, vigilance, and vitality is dynamic and constantly in flux. The person experiencing a state of vigilance is at once aware of his or her vulnerability while also aware of his or her vitality. At times, vulnerability is at the forefront of consciousness while at other times vitality is the focus of his or her consciousness. Implications from the study findings for nursing practice, education, policy, research, and theory are discussed. Most significantly, this study provides nurses and other health care professionals with insight into the lived experience of rural upstate NY residents living with an ICD, enhancing their understanding and ability to provide sensitive care to this population.
Socio-Cultural and Service-Related Factors Influencing Tuberculosis Treatment Adherence at Sekyere South District, Ghana
Yakubu Salifu, Garden City University College
Cecilia Eliason, University of Ghana
George Mensah, Metropolitan Health Directorate
Shannon D Scott, University of Alberta
One difficult problem of tuberculosis (TB) control is nonadherence to anti-TB medications. Nonadherence to TB treatment leads to adverse treatment outcomes, increases morbidity and death, and contributes greatly to the problem of antibiotics resistance. Several factors accounts for TB treatment nonadherence. Understanding these factors from the perspective of the patients has not received enough attention in the Ghanaian context. This highlights the need for better understanding of these factors from that viewpoint. This study explored and described the patient-related, sociocultural, and service-related factors influencing TB treatment adherence at Sekyere South District. A qualitative interpretive descriptive design was used to illuminate findings. Ten semistructured individual interviews were conducted until data reached saturation. Concurrent data analysis with data collection allowed emerging issues to guide selection of subsequent participants. The study found that patients who “make up their mind” to complete treatment have good family support and who have knowledge on consequences of defaulting are more likely to adhere to treatment. Nonadherence was associated with fasting (religious or because of lack of food); conditions not improving after treatment and discomforts associated with taking of the drugs such as dizziness and chocking sensation were the causes of nonadherence. The cultural meaning of TB as “Nsaman wa,” belief of being well, and some unmet needs of patients also affected adherence adversely. Adherence is still a problem, and reducing stigma and educating the community are necessary. The study recommends the development of comprehensive, holistic, and patient-centered treatment approach that incorporates good support systems and adherence counseling to improve adherence.
Phenomenological Nursing Research, Data Presentation, and Scientific Community
Michael Schultz, University of North Carolina at Chapel Hill
In response to critics who challenge whether phenomenological nursing research is science, some phenomenological researchers characterize their work as a different form of science, a form which operates according to standards other than those of accepted science (e.g., the natural sciences). In doing so, these researchers reject fundamental ontological and epistemological commitments of accepted science. I argue that phenomenological nursing research can accommodate the ontological and epistemological commitments of accepted science. To accommodate these epistemological commitments, phenomenological nursing research needs to develop scientific community. Scientific community generates knowledge through transparent and collaborative practice. Current phenomenological methods lack transparency, which impedes collaboration (e.g., peer review). I propose graphical techniques to efficiently present large amounts of data in manuscripts, enhancing both methodological transparency and research participant representation. These techniques do not replace phenomenological narrative; they supplement the narrative to better fulfill the goals of science and phenomenological research.
Narrative Inquiry Into Patient Stories of Interprofessional Care
Kateryna Metersky, University of Western Ontario
Jasna K. Schwind, Ryerson University
Current health care system is filled with rapid technological–medical knowledge advancements, not to mention the rising number of comorbid and chronic diseases. More than before, health care providers (HCPs) are required to work within interprofessional person-centered collaborative teams (IP-PCCT) to provide most comprehensive care to patients. In the literature, IP-PCCT has been depicted as positively influencing patient health outcomes, care satisfaction, costs, and wait times. However, this portrayal has been mostly derived from HCP and student perspectives. Although IP-PCCTs consider patients as active team members, patient’s voice has been missing. Problem created is that most patients do not know whether they can be involved or what role they can play within their IP-PCCT. With limited understanding of patients’ perspectives, it is less likely that IP-PCCTs will deliver effective care in partnership with patients. This study made possible for three patients to share their stories of receiving IP-PCCT care. Utilizing Connelly and Clandinin’s narrative inquiry, as well as Schwind’s narrative reflective process, a two-step data collection was conducted: narrative conversational interview and metaphor selection drawing. Collected data were analyzed using three levels of justification of narrative inquiry: personal, practical, and social. National Interprofessional Competency Framework provided the lens through which results were interpreted in relation to implications for health care delivery. Three narrative threads were identified: IP-PCCT communication, patient role within the IP-PCCT, and professional membership of IP-PCCT. The findings will inform educators, policy makers, researchers, and HCP as they strive to enhance person-centered interprofessional care practice. For patients, their voices have finally been heard.
Active and Inactive Women’s Perceived Health Benefits of Sustaining a Membership in a Commercial Fitness Facility
Shawn Slade, Western University
Don Morrow, Western University
Post-Death Feasibility Study With Parentally Bereaved Adolescents and Surviving Parent
Pam Stephenson, Kent State University
Denice Sheehan, Kent State University
Dana Hansen, Kent State University
In 2012, approximately 174,742 people in the United States between the ages of 34 and 64 died while enrolled in hospice; many had adolescent children. Research on parentally bereaved children suggests that children’s anxiety about losing a parent occurs acutely when the diagnosis is given and later when the parent’s condition deteriorates. Anxiety, depression, and substance abuse are common among adolescents after a parent’s death. This research builds on prior research (Strategies to Help Adolescents with a Parent in Hospice) that used grounded theory methods to explore the strategies used by adolescents with a parent in hospice. This follow-up study tested the feasibility of future longitudinal research with 15 surviving family members (9 adolescents and 6 surviving parents) from 6 families originally interviewed for the parent study. Researchers also sought to produce pilot data about how adolescents were managing their lives after the parent’s death. Qualitative descriptive methods were used for this research. Semistructured interviews were conducted with adolescents and their surviving parent about the adolescents’ experiences during the parent’s final weeks in hospice and after parental death. The pilot data from these interviews showed that how children managed their lives after the death of a parent is partially influenced by predeath family norms and whether their anchor was deceased. The anchor refers to the parent adolescents relied on most prior to death. Two exemplars will illustrate two qualitatively different family responses to parental death and provide a preliminary understanding of the adolescents’ perspectives of life after a parent’s death.
Spiritual Uncertainty at the End of Life
Pam Stephenson, Kent State University
End-of-life transitions are challenging and marked by a multitude of doubts, questions, and uncertainties involving every human dimension (e.g., physical, psychological, and spiritual). Spirituality remains the least understood of these dimensions. Currently, the quality of spirituality at the end of life is portrayed as either good (well-being and integrity) or bad (distress, suffering, and despair). This oversimplifies spirituality by suggesting that it is a dichotomous variable with a limited number of experiences. This is incongruent with the complex nature of spirituality and demonstrates a significant gap in how spirituality at the end of life is understood. This researcher conducted semistructured interviews with seven hospice patients (aged 46–101) about spirituality. In addition to sharing stories about spirituality, each participant talked about uncertainties about spirituality also referred to as spiritual uncertainties. The prevalence and spontaneity with which participants described spiritual uncertainty indicated that it was a salient theme for those involved and warranted further investigation. Additional analysis showed that each hospice patient experienced some degree of uncertainty within at least one aspect of spirituality. Exemplars from two participants presented qualitatively different accounts of spiritual uncertainty on several factors. Their diverse accounts will be reported. Developing a better understanding of spiritual uncertainty has tremendous potential for enhancing patient care at the end of life.
The Experience of Illness Control and Hospital Readmission in Adults With Chronic Heart Failure
Stephanie Turrise, University of North Carolina Wilmington
Denise Phillips Kuhn, New Hanover Regional Medical Center
Heart failure (HF) is a progressive, chronic condition that has become a significant public health problem affecting 5.1 million Americans (Go et al., 2014). Despite advances in the treatment of chronic HF, there has been little improvement in hospital readmission among these patients (Ross et al., 2010). Managing HF requires that patients adhere to a complex treatment plan of dietary changes, medications, and symptom monitoring. Counterintuitive findings have been reported about an individual’s belief about their illness control (Ross et al., 2004; Turrise, 2014). However, exactly how individuals define illness control and in what ways hospital readmission affects their perceptions of illness control are not known. Corbin and Strauss’ Chronic Illness Trajectory Model (1991, 1998) is a grounded theory that describes the process of managing different phases in the trajectory of chronic illness guides this study. The trajectory is uncertain and determined by ill individuals and their caregivers. The trajectory and the work to manage it are shaped by events, such as hospitalizations. The purpose of this study is to explore the experiences of chronic HF patients with illness control and understand the impact of hospital readmission on their perceptions of illness control. Applied thematic analysis is being used to analyze interview data. Participants are being recruited using a nonprobability purposeful sampling strategy and have been readmitted to the hospital for HF exacerbation within 30 days of an index HF hospitalization. An expert qualitative researcher is consulting on data collection and analysis techniques. Results are pending.
Criteria of Diagnostic and Referral to Endodontic Specialists by General Dentists From Public Health System in Chile
Rolando Vernal, Universidad de Chile
Pia Villalobos, Universidad de Chile
Eduardo Mera, Universidad de Chile
Treatment of endodontic infections is one of the primary priorities of the Dental Programs of the Public Health System in Chile. This health guarantee involves, first, control of the infection and pain through dental urgency procedures in primary health care and, second, referral to the endodontic specialist for endodontic treatment in secondary/tertiary health care. The endodontic referral, however, is not usually performed correctly. This study aimed to identify the perception of general dentists regarding key concepts of endodontic diagnosis in the oral health services and its importance for adequate referral for endodontic treatment. Individual interviews were conducted to explore three main concepts: “endodontic diagnostic,” “endodontic referral,” and “prognosis of the endodontic-treated teeth.” In total, there were 12 interviews comprising general dentists working at Primary Health Services, all of whom had at least 2 years of experience in primary care. Discussions of approximately 60-min were conducted, audio-recorded, and transcribed. Data were analyzed by qualitative thematic analysis in line with the framework approach. General dentists reported that they are aware that the onset of the endodontic patient care must happen through correct diagnosis. Nevertheless, they established that this action is often performed incorrectly mainly due to non-up-to-date knowledge in aetio-pathogenesis and diagnosis of both pulpar and periapical diseases. Although they knew the importance of diagnostic for performing an adequate referral to the specialist, they realized that they usually make “arbitrary” diagnostics. There is evidence that primary care dentists are aware of the need of know the state of the art in endodontic pathology.
Its Spirit Is Strong: Shawi Spirits, Healers, and Diarrhea in the Amazon
Rebecca Wolff, University of Guelph
Sherilee Harper, University of Guelph
Waterborne illness remains a public health challenge faced by many indigenous communities. The Shawi, a dominant indigenous group in the Peruvian Amazon, have retained many cultural practices and belief systems. Indigenous illness perceptions may not always reflect known biomedical causes of disease, making some health interventions ineffective. The goal of this research was to explore how Shawi perceptions on the causes of diarrhea, as a symptom of waterborne illness, related to Shawi beliefs and cosmology about water. Semistructured interviews were conducted in two Shawi communities in August 2014 to document beliefs regarding water spirits and the role of traditional healers in causing diarrhea. A phenomenological qualitative analysis involving memo writing and researcher reflexivity was performed. Results of this analysis showed Shawi perceptions on the causes of diarrhea were predominately based in cosmology and beliefs on water spirits as well as the power of traditional healers to cause fatal diarrhea. Many community members did not always perceive drinking water as able to cause illness; however, there was one spiritually perceived cause of diarrhea that reflected known biomedical risk factors for diarrheal disease, presenting a potential area for collaboration between indigenous and biomedical health knowledge. This research sought to demonstrate the importance of incorporating local beliefs and traditional health systems into health intervention and to highlight how understanding indigenous perceptions of illness could be essential to informing the design of health interventions to reduce waterborne disease in Amazonian Indigenous Communities.
Access to Primary Health Care Services for Urban-Dwelling, Canadian Aboriginal Women of Childbearing Age: An Integrative Review
Amy Wright, McMaster University
Olive Wahoush, McMaster University
Marilyn Ballantyne, McMaster University
Chelsea Gabel, McMaster University
Susan Jack, McMaster University
Aboriginal people in Canada experience poor access to health services. Even with increasing Aboriginal migration to urban areas, poor access to health care persists. In a study by Gao et al. (2008), Aboriginal Canadians were almost twice as likely than non-Aboriginal Canadians to be admitted to hospital for a condition that can be prevented by attending outpatient services. Access to primary health care is especially important, as it has been linked to improved health outcomes and a reduction in health inequities. In particular, access to primary health care for childbearing women is important to ensure their own health, and the health of their newborns. Historically, research on Aboriginal populations focused on those living in rural areas, or on-reserve. Although there are studies addressing the health care access of Aboriginal women living off-reserve in urban areas, no critiques or syntheses were located. The purpose of this integrative review is to describe, critique, and synthesize the literature concerning access to primary health care for Canadian Aboriginal women of childbearing age living off-reserve in urban areas, using the Whittemore and Knafl (2005) approach. Penchansky and Thomas’ Access Model of FIT (1981) has been used to organizing the resulting 15 themes. This work is important, as primary health care services are largely delivered by nurses, whose presence has been associated with improved access to health care and outcomes. The results suggest nurses have a unique opportunity to impact access at the service delivery level, through the provision of culturally appropriate services, and increasing awareness of Aboriginal history to reduce racism and discrimination. Nurses should join lobbying groups to advocate for changes to health policy, including increasing the number of Aboriginal health care professionals and supporting self-determination and self-government of Aboriginal peoples across Canada. Finally, nursing researchers should collaborate with the Aboriginal community to address knowledge gaps and identify effective interventions. These changes may have important impacts on access to health care, and ultimately, health outcomes.