Browsing by Author "Carr, Eloise"
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- ItemOpen AccessA Systematic Review of the Effectiveness of Knowledge Translation Interventions for Chronic Noncancer Pain Management(2013-01-01) Ospina, Maria B; Taenzer, Paul; Rashiq, Saifee; MacDermid, Joy C; Carr, Eloise; Chojecki, Dagmara; Harstall, Christa; Henry, James LBACKGROUND: Reliable evidence detailing effective treatments and management practices for chronic noncancer pain exists. However, little is known about which knowledge translation (KT) interventions lead to the uptake of this evidence in practice.OBJECTIVES: To conduct a systematic review of the effectiveness of KT interventions for chronic noncancer pain management.METHODS: Comprehensive searches of electronic databases, the gray literature and manual searches of journals were undertaken. Randomized controlled trials, controlled clinical trials and controlled before-and-after studies of KT interventions were included. Data regarding interventions and primary outcomes were categorized using a standard taxonomy; a risk-of-bias approach was adopted for study quality. A narrative synthesis of study results was conducted.RESULTS: More than 8500 titles and abstracts were screened, with 230 full-text articles reviewed for eligibility. Nineteen studies were included, of which only a small proportion were judged to be at low risk of bias. Interactive KT education for health care providers has a positive effect on patients’ function, but its benefits for other health provider- and patient-related outcomes are inconsistent. Interactive education for patients leads to improvements in knowledge and function. Little research evidence supports the effectiveness of structural changes in health systems and quality improvement processes or coordination of care.CONCLUSIONS: KT interventions incorporating interactive education in chronic noncancer pain led to positive effects on patients’ function and knowledge about pain. Future studies should provide implementation details and use consistent theoretical frameworks to better estimate the effectiveness of such interventions.
- ItemOpen AccessAdvanced Cancer Patients' Perspectives on a Video Decision Support Aid used to Enhance Goals of Care Discussions(2016) Grendarova, Petra; Hebert, Marilynne; Carr, Eloise; Trotter, Theresa; Kerba, MarcThe purpose of this study was to explore perspectives of advanced cancer patients on the use of a video decision support aid developed to enhance Goals of Care (GOC) discussions and to examine how the video influenced participants' perceptions and knowledge about GOC. A qualitative approach was applied to collect data from participants before and after watching the video. Semi-structured interviews were conducted with 14 participants from an Outpatient Radiation Oncology Bone Metastases Clinic. Extended Elaboration Likelihood Model was the conceptual framework used to guide data analyses. Participants found the video scenarios made the GOC framework more personally relevant. They were able to relate their experiences to the video. Participants found the timing and professional clinic environment appropriate for watching the video. Several participants expressed their intention to initiate discussions with their health care providers and to formalize their GOC plans.
- ItemOpen AccessBreastfeeding self-efficacy and breastmilk feeding for moderate and late preterm infants in the Family Integrated Care trial: a mixed methods protocol(2018-07-06) Brockway, Meredith; Benzies, Karen M; Carr, Eloise; Aziz, KhalidAbstract Background Breastmilk is the ideal nutrition for preterm infants. Yet, breastmilk feeding rates among preterm infants are substantially lower than those of full-term infants. Barriers incurred through hospital care practices as well as the physical environment of the neonatal intensive care unit (NICU) can result in physical and emotional separation of infants from their parents, posing a substantial risk to establishing and maintaining breastfeeding. Additionally, current practitioner-focused care provision in the NICU can result in decreased breastfeeding self-efficacy (BSE), which is predictive of breastfeeding rates in mothers of preterm infants at 6 weeks postpartum. Methods Family Integrated Care (FICare) integrates and supports parents to actively participate in the care of their infant while in the NICU. Nested within the broader FICare trial, we will conduct an explanatory sequential mixed methods study to investigate if FICare improves maternal BSE and rates of breastmilk feeding in moderate and late preterm infants at discharge from the NICU. In phase 1, we will calculate the mean difference between admission and discharge BSE scores for the intervention group. Mothers who score in the top and bottom 20th percentile of change scores will be invited to participate in a semi-structured telephone interview exploring maternal experiences with infant feeding in the NICU. We will conduct inductive thematic analysis to identify and describe the facilitators and barriers of FICare on maternal feeding experiences. Once data saturation is achieved and themes have been established, phase 2 will revisit the quantitative data to determine whether FICare was impactful on BSE and breastmilk feeding rates. Findings from the qualitative and quantitative phases will be integrated to determine how infant feeding experiences on FICare units work to improve or detract from maternal BSE and rates of breastmilk feeding. Discussion FICare may help to improve maternal BSE and rates of breastmilk feeding in moderate and late preterm infants. Improved breastmilk feeding outcomes can have a substantial impact on overall infant health, developmental outcomes, and maternal-infant bonding and will help to improve long-term health outcomes for moderate and late preterm infants. Trial registration ( NCT02879799 ). Registered May 27, 2016 protocol version June 9, 2016 Version 2.
- ItemOpen AccessDynIA: Dynamically Informed Allegories(2015-03-05) Topps, David; Taenzer, Paul; Armson, Heather; Carr, EloiseAn important strategy for improving population health is to use what we learn from medical research in our patient care. One approach to this is using the highest quality medical research to make recommendations and guide healthcare providers in deciding how to diagnose and treat their patients. These recommendations form the basis of healthcare tools that are called clinical practice guidelines. Theme four focused on strategies for increasing the uptake of clinical practice guidelines on low back pain and headache into community-based care. Theme four researchers collaborated with guideline developers in Alberta at the Institute of Health Economics and an organization called Towards Optimize Practice (TOP) that is sponsored by the Alberta Medical Association and the Alberta Ministry of Health (Alberta Health and Wellness). The research team first looked at what is already been known about uptake of guideline recommendations for chronic pain. This process involved going back to original research from around the world. Research librarians and scientists found 19 scientific papers that are relevant. Taken together, these studies indicated that the best approach to improving uptake of chronic pain guidelines into community care is to present them to care providers in special interactive educational settings where they are able to discuss the recommendations approaches with the educators. Theme four then went on to test this approach in the study of using an interactive educational workshop focused on the low back pain guideline. The study was conducted in collaboration with researchers from the University of Calgary and the University of Alberta. The workshop presenters were an expert team of physicians, physiotherapists, nurses and psychologists that traveled to the offices of the community healthcare providers. This study showed that the providers’ knowledge of low back pain increased after the workshop. When the medical records were examined, the researchers were unable to detect changes in how care was provided. This was a small study involving 24 providers. The researchers concluded that a larger study may confirm the increase in provider knowledge and detect changes in care. An important advance in healthcare is the use of computerized medical records. Computerization also provides an opportunity for healthcare providers to access relevant health information during their time with the patient. Theme four researchers collaborated with the Department of Family Medicine that McMaster University to develop a tool to help community caregivers use the recommendations from clinical practice guidelines while they are in the office with patients. This tool called the McMaster Pain Assistant has undergone successful usability testing and is now being tested in the community to see if using the tool leads to increases in knowledge and decisions that reflect the guideline. Rural physicians face important challenges in accessing medical education. In the past they would have to leave their practices and travel to a distant site to learn. Theme four researchers collaborated with the Department of Continuing Medical Education at the University of Calgary to explore a distance learning approach using Internet-based webinars and “virtual patients” that are designed to teach about the guidelines and how it might affect their care. This preliminary study demonstrated that rural physicians appreciated being able to access high quality medical education where they can interact with experts without having to travel. They found the sessions and the virtual patients highly engaging and realistic. Only small changes were shown in management of the virtual patients through the case series. Detailed analysis of practice patterns showed participants to be very conformant with clinical practice guideline recommendations.
- ItemOpen AccessEvaluating Affective Competency in Undergraduate Nursing: An Interpretive Description(2017) Mill, Megan; Carr, Eloise; Seneviratne, Cydnee; O'Rae, Amanda; Sinclair, ShaneBackground: The Registered Nurse role requires competency of the affective domain; demonstrated by the ability to listen, respond to interactions, demonstrate appropriate attitudes, and display commitment. There is a paucity of research exploring the evaluation of student nurses’ competency in this domain. Aim: To explore how clinical nursing instructors evaluate students’ affective competency. Methods: 12 instructors from a large urban university were interviewed and data was analyzed using qualitative interpretive description methodology. Findings: Affective competency is highly valued in nursing, lacks consensus in definition, exists in a hidden curriculum, and is assessed through observation, dialogue and reflective writing. Explicit connections between assessment and evaluation are lacking. Discussion: Clinical nurse instructors are gatekeepers to the nursing profession. Affective competency is observed rather than evaluated, and an ontological turn in nurse education might change the motivation for affective evaluation; away from competency and toward being a nurse. Word Limit:
- ItemOpen AccessExploring the Perspectives of Hemodialysis Nurses in Supporting Patient Coping and Resilience: An Interpretive Description Study(2021-11) Ortiz, Mia Maris; Carr, Eloise; Raffin Bouchal, Donna Shelley; Forest, Richelle DeniseChronic kidney disease (CKD) is on the rise, as is the prevalence of people with end-stage CKD reliant on hemodialysis (HD) treatment. This is concerning as the burden of disease of CKD, especially in conjunction with HD, is substantial. From a literature review, there is a knowledge gap in HD nurses’ perspectives in supporting patient coping and resilience. HD nurses spend the most clinical time with HD patients, in an ideal position to support patient coping and resilience. The initial research question was: “What are HD nurses’ perspectives on supporting patient coping and resilience when caring for CKD patients receiving chronic HD treatment?” The qualitive methodology of Interpretive Description (ID) was used. Recruitment occurred at a provincial level within Alberta Kidney Care. Semi-structured interviews were conducted with HD nurses (Registered Nurses and Licensed Practical Nurses, n = 12) working in HD with >2 years of HD experience. In tandem with ID, Braun and Clarke (2004)’s method of descriptive thematic analysis was used in data analysis and code generation. During data collection, the research question evolved to: “What negotiations in care do HD nurses experience in striving to support patient coping and resilience for CKD patients on chronic HD treatment?” HD nurses experience four types: nursing perspectives <-> patient perspectives; medical care <-> psychological care; professional boundaries <-> therapeutic relationship; and organizational considerations <-> patient-centered care. Overall, moral distress was prevalent among HD nurses’ negotiations in care. Tailored initiatives to alleviate these specific negotiations may help to assuage this moral distress.
- ItemOpen AccessFactors Influencing Orthopedic Nurses' Pain Management Decision Making: A Focused Ethnography(2016) Denness, Kayla; Carr, Eloise; Seneviratne, Cydnee; Rae, Janice; Sawhney, MonakshiThe experience of acute pain is highly subjective, and poor pain management contributes to a multitude of harmful conditions. Examining the context in which pain management occurs is important in formulating plans for improvement. The aim of this focused ethnography was to explore the factors orthopedic surgery nurses consider when deciding whether to initiate opioid analgesia for patients who have received a nerve block following total knee arthroplasty. Ten nurses participated in semi-structured interviews using a case study vignette. The overarching factors affecting pain management decision-making in this study relate to the culture of the unit, the self-concept of nurses, and nurses’ perception of patient assessments. Nurses are challenged to provide quality patient-centered care in a fast-paced clinical environment where efficiency and a brief length of stay are prioritized. Supporting informal nursing leaders and facilitating patient-centred care while maintaining efficiency may improve the unit culture and, in turn, pain management practices.
- ItemOpen AccessNurse Managers and Interprofessional Collaboration: A Grounded Theory Study(2017) Kirkpatrick, Megan; Carr, Eloise; Laing, Catherine; Suter, Esther; Deutschlander, SiegridEffective nurse-physician collaboration is an essential component of providing safe patient care. Nurse managers are in a unique position to witness, experience, and lead collaborative practice. The purpose of this study is to gain a better understanding of the social process of nurse-physician collaboration through the lens of nurse managers, as well as how the system supports or impedes collaboration. Seven nurse managers from surgical inpatient units from three major hospitals in western Canada were interviewed following the constructivist grounded theory methodology. Findings revealed five categories in the process of nurse-physician collaboration: (1) communicating expectations and accountability, (2) creating intentional interactions, (3) building trust and earning respect, (4) building relationships, and (5) enculturating collaboration. Nurse-physician collaboration is a multi-faceted, on-going process with the relationship at the centre. Gaining an understanding of the process of nurse-physician collaboration will facilitate improvements to collaborative practice and the delivery of safe health care.
- ItemOpen AccessOlder women’s experiences of companion animal death: impacts on well-being and aging-in-place(2021-08-23) Wilson, Donna M.; Underwood, Leah; Carr, Eloise; Gross, Douglas P.; Kane, Morgan; Miciak, Maxi; Wallace, Jean E.; Brown, Cary A.Abstract Background Companion animal death is a common source of grief, although the extent and context of that grief is poorly understood, especially in older adulthood. The aim of this multiple-methods study was to develop a greater understanding of the impact of companion animal death on older women living alone in the community, as older women are a distinct at-risk group, and the supports that should be available to help these individuals with their grief. Methods Participants were recruited from across Alberta, a Canadian province, through seniors’ organizations, pet rescue groups, and social media groups of interest to older women. After completing a pre-interview online questionnaire to gain demographic information and standardized pet attachment and grief measures data, participants were interviewed through the Zoom ® computer program or over the telephone. An interpretive description methodology framed the interviews, with Braun and Clarke’s 6-phase analytic method used for thematic analysis of interview data. Results In 2020, twelve participants completed the pre-interview questionnaires and nine went on to provide interview data for analysis. All were older adult (age 55+) women, living alone in the community, who had experienced the death of a companion animal in 2019. On the standardized measures, participants scored highly on attachment and loss, but low on guilt and anger. The interview data revealed three themes: catastrophic grief and multiple major losses over the death of their companion animal, immediate steps taken for recovery, and longer-term grief and loss recovery. Conclusions The findings highlight the importance of acknowledging and addressing companion animal grief to ensure the ongoing well-being and thus the sustained successful aging-in-place of older adult women in the community.
- ItemOpen AccessPatient Experience Living with Split Thickness Skin Grafts(2013-08-20) Burnett, Lindsay Nicole; Carr, Eloise; Gabriel, VinceThere is a lack of research exploring the experiences of those living with split thickness skin grafts (STSG). The qualitative methodology of interpretive description (Thorne, 2008) was employed. The process included a single patient interview, coding, describing, and interpreting the data. Participants were selected through purposive sampling and data was collected through in-depth, semi-structured interviews. Data was coded into themes for analysis. Eight male patients and four female patients 20-62 years old ranging 2-29 months post STSG were interviewed. The most significant concerns voiced by patients were identified and organized into five themes: a new normal, split thickness skin graft symptoms, appearance of new skin, coping, and preference to participate in future clinical trials. Patients discussed problems associated with their STSG; these concerns were significant enough to motivate them to participate in future clinical trials using human stem cells.