Browsing by Author "Ewashen, Carol J."

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    Clinical Leadership Development Workshops for Licensed Practical Nurses in Supported Living in Alberta: An Exploratory Qualitative study
    (2020-03-27) Enghiad, Parivash; Venturato, Lorraine; Ewashen, Carol J.; King-Shier, Kathryn M.; Raffin-Bouchal, Shelley
    Aim: This study had three aims: 1) to develop and deliver a clinical leadership development (CLD) workshop for licensed practical nurses (LPNs) who work in supported living (SL) contexts; 2) to explore LPN participants’ experiences, as well as the influence of the workshop on their attitudes, knowledge, and skills; and 3) to explore the feasibility of implementing a work-based CLD workshop for LPNs working in SL in Alberta. Background: Effective clinical leaders create an efficient and caring work environment, resulting in quality care for patients that attend to both their physical (e.g., safety) and psychological (e.g., autonomy) needs. In SL in Alberta, nursing care is primarily undertaken by LPNs, who work with both registered nurses (RN) and health care aides (HCA) in delivering quality care to older adults. As a result, LPNs are required to undertake clinical leadership (CL) roles that they are often under-prepared for. CL requires the development of a new set of skills for LPNs. To date, few resources have been devoted to developing educational programs to teach these skills, particularly in relation to work-based learning. This program addressed the issue of improving LPNs’ CL skills by developing and delivering a work-based CLD workshop. Design: An exploratory qualitative design was used, incorporating multiple data collection methods, including individual and focus group interviews, a demographic questionnaire, and a knowledge questionnaire. Interview data were analyzed using thematic description and the knowledge questionnaire data were statistically analyzed using a Wilcoxon signed-rank test. Result: The themes were captured in the findings: exploring and raising awareness of the LPNs role as a clinical leader; a sense of empowerment for LPNs in their role as clinical leader; the influence of the CLD workshop on teamwork and communication; and feasibility’s facilitators and challenges. The data affirmed the need for developing a program to help LPNs improve their CL skills, and understand and undertake their CL roles and responsibilities. The effectiveness of the CLD workshop was demonstrated through the LPN participants’ increased confidence, autonomy, and perceived control over decision-making. Following the workshop, the participants expressed a sense of empowerment, which resulted in changed attitudes about their capacity and their role. Conclusion: This study has shown the importance of LPNs understanding their role as a clinical leader, developing effective communication skills, and establishing a working relationship with and among their staff; it has also shown the significance of empowering LPNs. Limitations of the study included challenges arranging and scheduling the necessary time for LPNs to attend CLD workshop, availability and sustainability of the CL training for new staff, and refresher training for the existing staff.
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    Female Genital Cutting and African Women's Migration to Canada: Toward a Postcolonial Feminist Decolonizing Methodology
    (2020-11-23) Werunga, Jane Nasipwondi; Ewashen, Carol J.; Reimer-Kirkham, Sheryl; Estefan, Andrew
    The discourse on the cultural practice of FGC has captured a lot of attention over the last several decades, and with international migration propelling what was once a private cultural practice onto the global stage, FGC has become a fixture in the international human rights and global health arenas. FGC is a sensitive topic and the debates around it remain politically and culturally contentious. A lot of resources have been poured into eradication endeavors with multiple multinational organizations including the WHO spearheading the effort, the non-negotiable endpoint being the wellbeing, safety, and security of young girls and women. The purpose of this qualitative interpretive description study informed by decolonizing perspectives was to critically examine how immigrant and refugee women who have experienced FGC make sense of and explain the practice for themselves and for younger generations; and to explore the sociopolitical contexts sustaining and perpetuating FGC in the lives of affected younger and older women including their perceptions of as well as interactions with health services in diasporic locations. Participants’ understandings and agency-in-practice were analyzed through the themes of Experiencing, Explaining, Migrating, and Mitigating FGC. A decolonizing interpretation of research findings surfaced the intersections of social, political, economic, and cultural barriers manifesting through racialized and gendered axes of exclusion and marginalization to affect the health and wellbeing of FGC-affected immigrant and refugee women in a globalized milieu. This study highlights the importance of historical and cultural contexts in understanding and researching FGC-affected women as well as the relevance of decolonizing universal norms including in research, in order to effectively do this. This study offers an alternative way of conceptualizing FGC in a transnational setting and has implications for nursing research, health services, nursing education, as well as leadership and policy. Immigrant and refugee women affected by FGC deserve equitable, socially just, culturally responsive, and trauma-informed health services. This is in keeping with the nursing mandate of fostering health equity and social justice for all individuals. This study opens avenues for considering alternative ways of conceptualizing FGC and in doing so lives up to the interpretive description design logic.
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    The Impact of Severity, Timing, and Sex on Outcomes of Inpatient Stroke Rehabilitation
    (2020-01-08) Tanlaka, Eric Fover; King-Shier, Kathryn M.; Dukelow, Sean P.; Venturato, Lorraine; King-Shier, Kathryn M.; Dukelow, Sean P.; Green, Theresa L.; Seneviratne, Cydnee C.; Ewashen, Carol J.; Teasell, Robert
    Stroke severity and time to rehabilitation admission are important factors in influencing stroke rehabilitation outcomes. We aimed to determine the impact of: (1) stroke severity and timing to inpatient rehabilitation admission on length of stay, functional gains, and discharge destination; and (2) age and sex differences in time to rehabilitation, length of stay in rehabilitation, and discharge destination for stroke patients in Alberta. The first manuscript offers a discussion of post-positivist critical multiplism and its value for nursing research and describes the steps for conducting critical multiplist nursing research using stroke rehabilitation as an example. We identify that post-positivist critical multiplism offers a useful, rigorous approach that relies on a step-by-step method and a collaboration with a team of scholars who offer different perspectives, open questioning and critique, and rigorous attention to minimize biases throughout the research process. We examined a large retrospective cohort to address the research aims. In the second paper, we identified that length of time to rehabilitation admission was not significantly different between stroke severities. Individuals with moderate and severe stroke made significantly larger FIM gains than mild stroke during inpatient rehabilitation. LOS was longer with increasing stroke severity. Time to inpatient rehabilitation admission had small, but significant impacts on functional gains and LOS. Patients with shorter times to rehabilitation admission and those with mild stroke were more likely to be discharged home without needing health services. In the third paper, we identified that mean length of time from acute care admission to inpatient rehabilitation admission was not significantly different between males and females. There was no significant difference in mean FIM change between males and females during inpatient rehabilitation. Mean LOS in rehabilitation was slightly longer among females compared to males. Male patients and those of younger age were more likely than females and those of older age to be discharged home without needing homecare. In conclusion, stroke severity had a significant impact on the conduct of inpatient rehabilitation. The impact of timing on functional gains and LOS was small. Differences in LOS and discharge destination based on sex and age were significant.
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    A Mixed Studies Systematic Review Evaluating the Effectiveness of Adolescent Inpatient Eating Disorder Treatment
    (2019-09-25) Patel, Shruti; Ewashen, Carol J.; Benzies, Karen Marie; Hayden, K. Alix
    Research literature discussing effective treatment components for adolescents with eating disorders remains unclear. To ensure timely and informed decision-making in clinical practice for adolescent inpatient eating disorders treatment, a systematic review and synthesis of relevant literature is warranted. The objective of the mixed studies systematic review was to identify, assess, and synthesize the best available evidence on inpatient eating disorder programs for adolescents. A literature search was conducted using five electronic databases on the EBSCO and OVID interfaces. Studies were selected by two reviewers. Selection was based on mutually agreed upon inclusion and exclusion criteria targeting adolescents nine to 21 years of age diagnosed with eating disorders on an inpatient setting. Of 2389 titles and abstracts identified, 160 full text articles were screened, and 43 met the inclusion criteria. Of the 43 included studies, 22 focused on specific interventions, while 11 focused on either caregiver or patient perceptions of inpatient treatment. The Joanna Briggs Institute critical appraisal tool for randomized controlled trials, cohort studies, and case control studies was used to assess quantitative studies as appropriate, while Joanna Briggs Institute critical appraisal tool for qualitative research was used to assess qualitative studies. Although evidence around interventions and practices for inpatient eating disorders treatment is available, it is not consistent across studies. Further research should consider identifying effective, evidence-based interventions and practices for adolescent inpatient eating disorder treatment towards positive patient outcomes.
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    Reflective Function, Maternal-Child Interaction and Child Development: Impacts of Intervention for High Risk Families, Innovative Methods, Measurement and Fidelity Assessment
    (2020-08) Anis, Lubna; Letourneau, Nicole; Benzies, Karen Marie; Ewashen, Carol J.
    Parents suffering from toxic stressors (depression, addictions, family violence) are often unable to respond sensitively to their infants. Such early, persistent stress is understood to interfere with infant brain development, placing infants at risk for health and developmental problems over their lifespan. Parental sensitivity is also influenced by parental Reflective Function (RF), the ability to envision mental states in oneself and one’s child. While many modern parenting programs aim to improve parental sensitivity to their infants to promote healthy child development, parental RF is a commonly missing component. Parental RF is modifiable by intervention and predicts improvements in maternal sensitivity and responsiveness and infant attachment security, thus clearly beneficial. However, the link between an intervention aimed at improving parental RF and child development is unexplored. Given the importance of the early years for children’s development, improved interventions for vulnerable children and families have become public health imperatives. My doctoral research sought to examine the effectiveness of an innovative parenting program called Attachment and Child Health (ATTACHTM) on parent-child interaction and child development. In this manuscript-based dissertation, the first manuscript presents the results from the ATTACHTM pilot studies, demonstrating that ATTACHTM improved outcomes. The ATTACHTM pilots employed new accelerated methods to combat time- and cost-related challenges associated with traditional randomized controlled trials. Therefore, in my second manuscript, I undertook a realist review comparing innovative methods for intervention evaluation with traditional randomized controlled trial (RCT) methods in their ability to test, mobilize knowledge and provide recommendations for best approaches to promote child health. In my third manuscript, I compared the validity of different tools to measure RF, given the increasing need for effective, efficient rapid assessment in wide-ranging settings. Finally, I prepared a manuscript on the need to deliver evidence-based programs to promote early childhood development with fidelity. I developed and assessed an intervention fidelity tool for community nursing research by using the ATTACHTM intervention as an exemplar. My dissertation concludes with a summary of the research findings, and recommendation for nursing research, policy and practice.
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    Responsiveness of the Eating Disorders Quality of Life Scale (EDQLS) in a longitudinal multi-site sample
    (BioMed Central, 2010-08-11) Adair, Carol E.; Marcoux, Gisele C.; Bischoff, Theanna F.; Cram, Brian S.; Ewashen, Carol J.; Pinzon, Jorge; Gusella, Joanne L.; Geller, Josie; Scattolon, Yvette; Fergusson, Patricia; Styles, Lisa; Brown, Krista E.
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    Situating power and knowledge in adolescent (mental) health promotion
    (2005) Ewashen, Carol J.; Phelan, Anne
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    Transitioning Fractured Identities: A Grounded Theory Study of Operational Stress Injuries from Veterans’ Perspectives
    (2019-07-31) Smith-MacDonald, Lorraine Alison; Sinclair, Shane; Bouchal, Shelley Raffin; Reay, Gudrun; Ewashen, Carol J.; Konnert, Candace A.
    Soldiers who are deployed to military operations are often exposed to unique occupational stressors, particularly when deployed to combat environments. Research has predominantly focused on soldiers’ exposure and experiences of traumatic stress or events which results in the diagnosis of posttraumatic stress disorder. More recently epidemiological research with post 9-11 veterans (those who served in Afghanistan and Iraq) has illustrated that these veterans are experiencing not only posttraumatic stress disorder, but a variety of physiological injures, psychiatric illnesses, and psychosocial challenges. In response, the umbrella term operational stress injuries was introduced to try and capture all injuries and harm, caused by serving within military occupations, regardless of the domain of health. Central to the change of operational stress injuries is not only the language, but also the recognition that there may be injurious components of military service that are currently unidentified or under-researched- including those which may transcend into the spiritual or existential elements of military service. The purpose of this doctoral research was to determine Canadian combat veterans’ perspectives regarding what elements of operational stress injuries they deemed to be most problematic and why. Initial broad searches of military trauma literature indicated that research was predominately focused on the psychological domain of health; (i.e., the development of psychiatric illness from traumatic or stressful experiences), with less understanding of potentially harmful spiritual and existential aspects of soldiers’ experiences. As a result, a systematic review was conducted to synthesize and critically evaluate the relationship between spirituality and mental well-being in post-deployment veterans. Next, a theoretical manuscript was written to discuss points of convergence and divergence when integrating the classical grounded theory method within a patient-oriented research framework. Finally, a patient-oriented research informed classical Grounded Theory study was designed and conducted to create a systematic mid-range theory of operational stress injuries from veterans’ perspectives. Findings from this doctoral research demonstrate that while traumatic stress outcomes such as post-traumatic stress disorder were problematic, most injurious to veterans were what they termed “fracturing experiences” and “limboizing.” Fracturing experiences were largely synonymous with the current classification of moral injury, while limboizing referred to the military-to-civilian transition. Participants identified that from their perspective unresolved morally injurious experiences were the cause of their mental health symptoms, which frequently resulted in formal psychiatric diagnosis and being medically released from the military. More, upon being released, participants struggled to successfully transition to the civilian world which further compounded their psychological, social, and spiritual challenges. Ongoing work to further examine how moral injury may influence veterans’ mental health and their ability to successfully navigate the military-to-civilian transition is crucial, as successfully addressing these injurious components may allow veterans to thrive and not simply survive in their new life.
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    Working Memory and Processing Speed Training in Schizophrenia: A Randomized Controlled Trial
    (2018-06-11) Cassetta, Briana Diane; Tomfohr-Madsen, Lianne M.; Addington, Jean; Goldberg, Joel; Sears, Christopher R.; Ewashen, Carol J.
    Individuals with schizophrenia are generally found to experience cognitive deficits in most domains of cognition. Moreover, greater cognitive deficits have been associated with poorer daily functioning in schizophrenia. Given these findings, cognitive training has been a burgeoning area of research in recent years, with some evidence suggesting that cognitive training programs may improve cognition for individuals with schizophrenia. However, the state of the literature remains unclear as to which domains of cognition should be targeted to produce the most widespread benefits for individuals with schizophrenia. One suggestion is that targeting lower-level cognitive processes that are important for higher-level and more complex aspects of cognition may produce the most widespread and durable benefits in cognition and everyday functioning. In particular, working memory (WM) and processing speed (PS) have been named as two key areas of deficit in schizophrenia, and two domains of cognition that may be linked to higher-order cognition and daily functioning. This study aimed to investigate the near-transfer (transfer of gains to related contexts), far-transfer (transfer of gains to unrelated contexts), and real-world gains associated with WM and PS training in schizophrenia. To this end, 83 participants with schizophrenia or schizoaffective disorder were recruited and randomly assigned to computerized WM training, PS training, or a no-training control group. Results showed that PS training led to significant gains in untrained PS tasks as well as gains in far-transfer tasks that required speed of processing, relative to the other groups. WM training did not lead to gains in untrained WM tasks, and showed inconsistent effects on some far-transfer tasks. These results suggest that there can be benefits of domain-specific cognitive training, specifically PS training, in schizophrenia. Far-transfer of gains to other cognitive domains and to real-world functioning may not occur after targeted WM or PS training, though non-specific effects (e.g., through behavioural activation, increased motivation) may lead to improvements on some cognitive tasks. Future studies should continue to investigate the mechanisms by which cognitive training may lead to enhancements in cognition and functioning in schizophrenia.