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Title: Associations between Relational Aspects of Care and Self-Reported Health Status of Residents Living in Long Term Residential Care Homes
Contributor: Mary K DeLong (author), Richard Sawatzky (thesis supervisor), Lena Cuthbertson (second reader), Sheryl Reimer-Kirkham (third reader), Trinity Western University SGS (Degree granting institution)
Discipline/Stream: Nursing
Abstract: Person-centred care acknowledges the person behind the patient and can enhance the quality of life of long term care residents. Relational aspects of health care are foundational to person-centred care; this study examines associations between relational aspects of care and residents’ self-reported mental and physical health. A secondary analysis of British Columbia Residential Care Survey data (N = 2,108) used hierarchical multivariate linear regression to evaluate the extent to which relational aspects of care explain variation in self-reported physical and mental health, relative to other care experiences. Relative improvement in relational aspects of care was associated with greater self-reported physical and mental health. For self-reported physical health, relational aspects accounted for 34.5% of the explained variance (R2 = 0.279), and for self-reported mental health, accounted for 48.3% of the explained variance (R2 = 0.274). Relational aspects of care do positively influence residents’ physical and mental health outcomes.
Publication Year: 2018

Title: Avoiding Futility: How Nurses and Physicians Experience Emotions, Psychosocial Factors, and Their Professional Roles as Influencing the End-of-Life Decision Making Process
Contributor: Melissa J. De Boer (author), Richard Sawatzky (thesis supervisor), Sheryl Reimer-Kirkham (second reader), Patricia Porterfield (third reader), Trinity Western University SGS (Degree granting institution)
Discipline/Stream: Nursing
Abstract: In this qualitative study, five nurses and four physicians from intensive care settings were interviewed about their experiences of the end-of-life (EOL) decision making process. For both professional groups, a shared mission to avoid futility was identified as foundational and climactic aim to the process. This desire heavily shaped initiation and engagement of what was presented as an ambiguous decision making process. Three themes emerged of elements that most influenced their variable experiences of the EOL decision making process: moral weightiness, family receptiveness, and the individual philosophy of approach. These findings emphasize the wide amount of subjective variability experienced and shed light on the competing emotional, psychological, and social interests for ICU nurses and physicians in the EOL decision making process. There must be greater understanding of the EOL decision making process in an intensive care context to provide better support to nurses and physicians.
Publication Year: 2018

Title: Bullying from Staff Nurses : The Experience of Senior Undergraduate Nursing Students during Clinical Placements
Contributor: Rachel M Froese (author), Landa Terblanche (thesis supervisor), Sheryl Reimer-Kirkham (second reader), Maggie Theron (third reader), Trinity Western University SGS (Degree granting institution)
Discipline/Stream: Nursing
Abstract: The phenomenon of bullying within nursing is not new, and unfortunately nursing students are often victims. The purpose of this qualitative study was to explore the perspectives of nursing students who have been bullied by staff nurses during a clinical experience. Participants from two western Canadian universities were recruited through convenience and snowball sampling using a series of emails and by a social media poster. Data collection involved one on one semi structured interviews with six senior undergraduate nursing students. Three main themes were identified: the student experience of bullying; the intervening influence of nursing educators; and the outcome of (in)security. Recommendations included education provided to students, clinical sites and clinical instructors; clinical setting guidelines for clinical instructors; policy implementation for reporting bullying and creating clinical groups; greater communication by institutional nursing leaders with staff and clinical instructors; and further research.
Publication Year: 2020

Title: Clinical reasoning on an assignment : perceptions of third year Baccalaureate nursing students
Contributor: Karen Oostra (author), Barbara Astle (thesis supervisor), Heather Meyerhoff (second reader), Em Pijl Zieber (third reader), Trinity Western University SGS (Degree granting institution)
Discipline/Stream: Nursing
Abstract: Baccalaureate nursing students must develop clinical reasoning skills in order to make sound clinical judgments. How students understand clinical reasoning is of interest to nurse educators. In a qualitative study, eight third-year nursing students were interviewed about their perceptions of clinical reasoning on a Clinical Judgment Exercise (CJE). An overarching theme of Over Time emerged from the data along with two themes: Understanding of Clinical Reasoning and Making Sense of the Assignment. The sub-themes that emerged were the same for each theme and were not knowing, knowing, applying knowing and valuing knowing. Conclusions were that student participants perceived: 1) understanding of clinical reasoning developed over time, 2) understanding of the patient’s problem deepened over the time of writing the assignment, 3) they were challenged by the complexity of the patient, 4) they were able to apply learning from the CJE to nursing practice and 5) writing the CJE was stressful.
Publication Year: 2015

Title: Compassion fatigue and its association with workplace empowerment in acute care settings
Contributor: Danielle Lisa Katherine Chatterton (author), Richard Sawatzky (thesis supervisor), Angela Wolff (thesis supervisor), Landa Terblanche (third reader), Trinity Western University SGS (Degree granting institution)
Discipline/Stream: Nursing
Abstract: Compassion fatigue (CF) has been found to influence nursing care providers (NCP) in a variety of specialized areas; however, general medicine unit settings are often overlooked. A potential way to mitigate CF could be through the use of organizational empowerment structures. 117 nursing care providers (NCP) and health care attendants (HCAs) who provided direct patient care in the hospital medical unit context were surveyed using a cross-sectional survey design. Five units from four hospitals of a large, urban health authority in British Columbia participated. Findings revealed that 55% of the sample reported moderate to severe levels of CF. Accessibility to resources was the only organizational empowerment structure that explained variability in the sample's experience of CF (p < 0.01). In addition, the variance of CF was partially explained by the participants' highest level of education and marital status (p < 0.05). Further investigation is needed to further assess CF mitigation.
Publication Year: 2014

Title: Discerning success of indigenous health students in community-based programs
Contributor: Marti Harder (author), Barbara Astle (thesis supervisor), Sonya Grypma (second reader), Evelyn Voyageur (third reader), Trinity Western University SGS (Degree granting institution)
Discipline/Stream: Nursing
Abstract: Post-secondary educational institutions have partnered with Indigenous groups to provide community-based healthcare programs. In a qualitative study, eight participants from a northern British Columbia community were interviewed about their descriptions of success, and its influencing factors in a community-based healthcare program. The core theme of courage and categorical themes of nurturing the learning, owning the learning, and discerning success for learning emerged from the data, which revealed changes in students' lives as they moved through their schooling. Conclusions were: 1) Courage was needed to overcome fears and barriers during students' education; 2) Receiving nurturing through a whole-person approach promoted success; 3) Students' journeys were fostered through the support of others; 4) Students learning to believe in themselves was a key element of success; and 5) Collective community success was experienced when students were successful in a program. The importance of community voices may contribute towards planning future healthcare programs.
Publication Year: 2014

Title: Experiences of women in early labour sent home following hospital assessment
Contributor: Marilyn Morson (author), Landa Terblanche (thesis supervisor), Maggie Theron (second reader), Sheryl Reimer-Kirkham (second reader), Trinity Western University SGS (Degree granting institution)
Discipline/Stream: Nursing
Abstract: Labour and birth is a life event common to many women yet the physical process, in addition to psychological, social, and spiritual experiences, is unique to each woman. A woman under the care of a physician will come to a hospital when she believes she is in labour. If she is in active labour, the woman is admitted to hospital. If in early labour, the woman is often sent to walk within the hospital prior to reassessment as walking can contribute to progress in labour, or she is sent home. There is limited information about the phenomenon when a woman in early labour is sent home until she is admitted in active labour. Combining the elements of early labour and known possible psychosocial outcomes of birth, this qualitative study explored the experiences of women sent home in early labour within the context of one hospital site in Canada, having 4000 births annually. In-depth interviews with 10 postpartum women within 48 hours of birth yielded the data that were analyzed through a qualitative approach using interpretive description defined by Thorne, Reimer-Kirkham and MacDonald-Emes (1997), and using methods of analysis as outlined by Giorgi (2012). Themes resulting from this analysis were: Conflict between knowledge of labour symptoms and women’s initial responses; background influences and current pregnancy concerns; impact of the unspoken; experiences of pain and coping; and influence of others. Through literature integration it was concluded that all women experience an overwhelming anxiety that may empower/disempower their self-efficacy, confidence, communication with self/others and their coping. Suggestions for practice include a culture of open access to the assessment area and a focus on communication with women in early labour to better understand their individual needs and provide support to decrease anxiety and fear, increase confidence and foster empowerment.
Publication Year: 2013

Title: Exploring How Family Members Experience Medical Assistance in Dying (MAiD)
Contributor: Kelly C H Schutt (author), Sheryl Reimer-Kirkham (thesis supervisor), Derrick Klaassen (second reader), Jennifer Gibson (third reader), Trinity Western University SGS (Degree granting institution)
Discipline/Stream: Nursing
Abstract: This study explored how family members experience Medical Assistance in Dying (MAiD), since the 2016 Canadian legislation. The Listening Guide, a qualitative research methodology, was used to hear the experiences of seven family members from across Canada, whose loved one received MAiD. Analyses revealed that family members experienced tension in negotiating relationship to themselves, to their loved one, and to others involved. These tensions were heard in four voices throughout the study: witnessing, caregiving, honouring choice and supporting dignity, and surrendering and letting go. Current procedures and policies tend to focus on the individual receiving MAiD. Shifting practices to align with relational ethics could challenge healthcare providers to consider how they might support family members. By acknowledging the social context of the patient receiving MAiD, this study extends the discourse surrounding MAiD beyond the realm of individual autonomy, suggesting a shift in care from being patient-focused to being truly person-centred.
Publication Year: 2020

Title: Exploring the Experience of Mothers Who Have Children with Albinism in Tanzania: A Critical Ethnography
Contributor: Emma B. Strobell (author), Sheryl Reimer-Kirkham (thesis supervisor), Barbara J. Astle (second reader), Sonya Sharma (third reader), Trinity Western University SGS (Degree granting institution)
Discipline/Stream: Nursing
Abstract: Little is understood about the everyday lives of mothers of children with albinism in sub-Saharan Africa, specifically Tanzania. This region has a harrowing history of discrimination and violent attacks against persons with albinism, largely rooted in cultural/spiritual beliefs and practices, and perpetuated by layers of myth about albinism. A focused critical ethnographic study, through the lens of Hudson-Weems’ (2019) Africana Womanism, explored the experiences of mothers of children with albinism in Tanzania, addressed the gendered nature of this condition, and considered the human rights and resilience of the mothers. One participant’s story illuminated human rights and resilience from a mother’s standpoint, which was the backdrop for the presentation of findings that included stories of other mothers with albinism and the perspectives of key stakeholders. These findings highlight the social ecological nature of resilience for these mothers. Recommendations focus on policy, advocacy, and research related to health and social services and education.
Publication Year: 2020

Title: Extending the spirit : a qualitative secondary analysis on nurses’ perspectives on spirituality
Contributor: Kyla Janzen (author), Barbara Astle (thesis supervisor), Sheryl Reimer-Kirkham (second reader), Linda Shea (third reader), Trinity Western University SGS (Degree granting institution)
Discipline/Stream: Nursing
Abstract: Once laden with promise, modernization and secularization have not remedied the societal ills of our time. Individuals have begun to seek answers outside of the confines of traditional religion, often developing a personalized spirituality. As Canadian society returns its attention to spirituality, nursing acts of spiritual care arguably gain importance. The purpose of this study was to explore the influences on spirituality and spiritual caregiving in nursing practice. This qualitative secondary analysis compared and contrasted the narratives of fourteen nurses: eight from acute settings and six from community settings. The participants self-identified their spiritual/religious affiliations: Christians, Catholic, Muslim, spiritual but not religious, and not spiritual or religious. From an interpretative descriptive framework, five nested themes were identified as influencing spiritual caregiving in healthcare contexts: the nurse as custodian of spiritual caregiving, nursing acts of spiritual caregiving, professional and organizational silence, distinctive environments, and the Canadian milieu.
Publication Year: 2012

Title: Faculty Preparation for Accompanying Nursing Students on International Experiences: Moving Beyond Trial-and-Error
Contributor: Amanda Grace Egert (author), Barbara J Astle (thesis supervisor), Sheryl Reimer-Kirkham (second reader), Sonya Jakubec (third reader), Trinity Western University SGS (Degree granting institution)
Discipline/Stream: Nursing
Abstract: Many Canadian nursing programs offer international experiences (IEs) as educational opportunities for students. While evidence of pre-departure preparation exists for students, little is known about the preparation of faculty who accompany them. In this qualitative study, semi-structured interviews were conducted with nine novice-to-expert nursing faculty to explore faculty preparation for accompanying nursing students on IEs. The interpretive description design was informed by critical inquiry methods which examined preparation alignment with critical global perspectives. Four themes were interpreted including: the overarching theme of gaining preparation expertise over time, and three main themes of learning on-the-job, discovering the different responsibilities, and learning for-the-job. In the findings, experience was emphasized over formal preparation. Additionally, preparation was complicated by a lack of global health knowledge and a lack of institutional support. Recommendations include moving beyond learning from trial-and-error and moving towards intentional preparation that better considers the experience, knowledge, skills, and attitudes for preparing nursing faculty for IEs.
Publication Year: 2019

Title: Interpretability of the Canadian Nurse Informatics Competency Assessment Scale Among Fourth-Year Nursing Students
Contributor: Andrea E Dresselhuis (author), Dr. Rick Sawatzky (thesis supervisor), Dr. Maggie Theron (second reader), Dr. Leanne Currie (external examiner), Trinity Western University SGS (Degree granting institution)
Discipline/Stream: Nursing
Abstract: Nursing informatics merges nursing practice, its information and knowledge, with information communication technologies to improve patient care. Uptake of informatics competencies can be measured using self-perceived assessment scales. A scale for measuring Canadian nursing informatics has been recently developed from national competency indicators. In order to examine its wording and interpretability, cognitive interviewing was conducted with eight fourth-year nursing students as they completed the Canadian Nurse Informatics Competency Assessment Scale. Findings revealed issues related to misinterpreted survey items, items seen as “difficult” to answer, and specific words and phrases not recognized or misinterpreted. Furthermore, design flaws such technology-related jargon, wording ambiguity, or double-barrelled questions were revealed. Correspondingly, specific item and response re-wording revisions have been recommended to improve wording, interpretability and scale validity. Improving this scale may contribute to nursing informatics assessment and uptake in Canada which may be timely and strategic given that nursing informatics preparedness in Canada lags.
Publication Year: 2019

Title: Investigation of the Edinburgh Postnatal Depression Scale’s Questions in the Screening of Postpartum Depression in Men
Contributor: Asha R. Parmar (author), Richard Sawatzky (thesis supervisor), Maggie Theron (second reader), Reina van Lagen (third reader), Trinity Western University SGS (Degree granting institution)
Discipline/Stream: Nursing
Abstract: This study was designed to investigate whether the Edinburgh Postnatal Depression Scale (EPDS), which is widely used to screen for PPD in women, is an appropriate tool for men. Six men in their first year postpartum were interviewed between January 2013 and June 2013. The participating men were from a small northern community in the Peace Country region of Alberta. In order to understand how men interpreted the EPDS, cognitive interviews were conducted following guidelines by Willis (2005) to examine the following four cognitive methods of retrieval: comprehension, decision making, memory recall, and response making. The findings provided valuable information regarding the use of the EPDS to screen for paternal PPD. It is recommended that nurses consider men’s interpretations of the EPDS questions as part of the PPD screening. Further research is needed to determine appropriate EPDS cutoff scores for men in the postpartum period and the use of the EPDS in different populations.
Publication Year: 2015

Title: Involking silvern voices in healthcare : transforming practice by engaging older adults in collaborative partnerships
Contributor: Stacy L. Oke (author), Faith Richardson (thesis supervisor), Deborah Gibson (second reader), Kristi Panchuk (external examiner), Trinity Western University SGS (Degree granting institution)
Discipline/Stream: Nursing
Abstract: Canada's population is aging. This growing trend will ultimately have an impact on nursing practice as older individuals continue to seek healthcare services. Nurses must be able to work in collaboration with the older population to provide quality care. This action research study explored participative healthcare from an older adult's perspective. This study revealed that older adults prefer to be active participants in their care. The major theme that emerged was true partnership. Three sub-themes that emerged were communication, respect, and trust. These three sub-themes work in unity to contribute to a healthcare experience that exemplifies true partnerships. This study proposes a definition of true partnership as being open to and inviting mutual communication in an atmosphere that encourages equity sharing of information contributing to respect and the development of trust that results in confident collaboration in care.
Publication Year: 2014

Title: Is nursing transferable and portable : the experiences of travel nurses
Contributor: Rae Ramsden (author), Sonya Grypma (thesis supervisor), Lynn Van Hofwegen (second reader), Barb Astle (external examiner), Trinity Western University SGS (Degree granting institution)
Discipline/Stream: Nursing
Abstract: This study was designed to help us better understand the question of portability and transferability of the Nursing profession by examining the experiences of six travel nurses. The travel nurses described ways in which they believed their skills and practice standards transferred between countries supporting portability and transferability. This study was conducted in the United States Southwest during the period between October 2013 and March 2014. The interviews were recorded with English speaking travel nurses who had international work experience within the countries of Australia, Canada, England and the United States of America. The interviews were transcribed and analyzed following the interpretive descriptive qualitative design methodology by Thorne (2008). The findings revealed the following five themes: (1) ability to transfer skills; (2) navigating policy differences; (3) overcoming English language differences; (4) acculturation, transitioning into new locations; and, (5) becoming aware of healthcare costs.
Publication Year: 2014

Title: Job stress and turnover among registered nurses in acute care : a regression analysis
Contributor: Carolyn Klassen (author), Rick Sawatzky (thesis supervisor), Angela Wolff (thesis supervisor), Karen Jonson (external examiner), Trinity Western University SGS (Degree granting institution)
Discipline/Stream: Nursing
Abstract: Nurse turnover needs further exploration in the Canadian experience. This study’s purpose was to examine whether job stress, as indicated by burnout and psychological distress, explains turnover among acute care registered nurses. The research questions were: To what extent does job stress explain nurses’ intent or likelihood of leaving their position or the nursing profession? What other factors, over and above job stress, explain nurses’ intent or likelihood of leaving their position and the nursing profession? This secondary analysis of cross-sectional survey data from 522 acute care registered nurses in British Columbia was analyzed using ordinal logistic regression. Burnout, specifically emotional exhaustion, was consistently predictive of both intent and likelihood to leave the profession and the position. Emotionally exhausted nurses are two times more likely to have intent to leave the profession and 1.5 times more likely to do so. The other factors played a minimal role in explaining turnover.
Publication Year: 2013

Title: The Kilburn connection : public health nursing education and the child guidance clinics in British Columbia 1932-1950
Contributor: Melissa Suzuki (author), Sonya Grypma (thesis supervisor), Geertje Boschma (second reader), Barbara Astle (second reader), Trinity Western University SGS (Degree granting institution)
Discipline/Stream: Nursing
Abstract: Mental Hygiene emphasized mental illness prevention and mental health promotion. In British Columbia, Child Guidance Clinics (CGC) were established to promote mental hygiene among children. This study draws from institutional records on the CGC from Riverview Hospital archives (1932-1950). Using nurse and social worker Josephine Kilburn as a central figure, it explores linkages between the CGCs and public health nursing education at UBC, as well as the role of nursing in the mental hygiene movement. The study highlights how nursing has been taken for granted in the mental hygiene movement, as well as how nursing and social work identities were interconnected. Josephine Kilburn found ways to use both her nursing and social work identities to advantage, working across institutional boundaries at the CGC and UBC School of Nursing. Working within established social hierarchies Kilburn’s work reveals changing priorities and approaches to mental health over the course of twenty years.
Publication Year: 2013

Title: Lessons from the red nose : what nurses can learn from therapeutic clowns
Contributor: Sandra Graham (author), Sonya Grypma (thesis supervisor), Landa Terblanche (second reader), Joan Boyce (third reader), Trinity Western University SGS (Degree granting institution)
Discipline/Stream: Nursing
Abstract: In this qualitative study, seven participants from two volunteer therapeutic clown troupes were interviewed about their experiences in order to discover how clowns and clowning techniques can inform nursing practice, specifically in the art of relationship. Clowning emerged as a complex art, combining the visual elements of the costume, make-up and props with ubiquitous humour, laced with sensitivity and compassion. Participants described having a vocation for clowning, with intrinsic motivation and passion. They articulated how their clown costumes and personas provided emotional shielding, giving them protection from – while also allowing entrance into – emotionally difficult situations. They also used judicious humour, intuiting when, where and how best to use humour in myriad patient situations in a way that brought relief to patients and families. Insights from clowning can help nurses to expand their relational art: In patient settings, when used judiciously, there may be no place where humour is off limits.
Publication Year: 2015

Title: Life Satisfaction and Associated Predictors in An Older Adult Population
Contributor: Gwendolyn M. Williams (author), Richard Sawatzky (thesis supervisor), Angela C. Wolff (second reader), Marvin Mc Donald (third reader), Trinity Western University SGS (Degree granting institution)
Discipline/Stream: Nursing
Abstract: Older adults are increasing in numbers worldwide. Life satisfaction, a component of subjective wellbeing, is believed to be indicative of successful aging and longevity in older adults. The aim of this investigation was to explore socio-demographic, social support, and health-related factors explaining life satisfaction among community dwelling older adults. An ordinal logistic regression was conducted on data collected by the Canadian Community Health Survey 2015-2016 (N = 2678). Older men had higher life satisfaction, as did those attaining secondary school education. The factors explaining life satisfaction were perceived general and mental health, perceived life stress, having a strong sense of belonging to a local community, and physical activity. This result indicates that emphasizing healthy lifestyle practices earlier in life and keeping older adults active and socially engaged could increase and ensure satisfaction with life as people age. In designing, implementing, and evaluating care, clinicians should consider and utilize this construct.
Publication Year: 2020

Title: The lived experience of learning psychomotor nursing skills
Contributor: Anne Marie Redmond (author), Sonya Grypma (thesis supervisor), Mark Pijl-Zieber (second reader), Darlaine Jantzen (third reader), Trinity Western University SGS (Degree granting institution)
Discipline/Stream: Nursing
Abstract: Psychomotor skills are an integral component of the knowledge, attitude, and skills of nursing education. Using van Manen's approach to phenomenology (1997; 2006), this project explored third year nursing students' "lived experiences" of learning psychomotor skills. The aim of the study was to reveal how "learning to care" might be embedded in the process of learning psychomotor skills, based on the assumption that "caring" is a present but elusive concept in the experience. Data provided some fresh understandings of nursing pedagogy. The students' memorable learning experiences revealed a learning anxiety arising from the knowledge that a person will be the recipient of their care. This anxiety is present in different ways in the skills lab and clinical setting. In addition, students' experiences revealed caring through empathy, relationships, advocacy, integrating, affecting patient outcomes, and professional behaviors. These themes resonate with Roach's theory (2002) of caring as a human mode of being.
Publication Year: 2013