PRISM :: Browsing by Author "King-Shier, Kathryn"

Browsing by Author "King-Shier, Kathryn"

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Open Access
Assessing the Impact of Financial Barriers on Care and Outcomes for Patients with Cardiovascular-Related Chronic Diseases
(2017) Campbell, David John Thomas; Manns, Braden; King-Shier, Kathryn; Hemmelgarn, Brenda; Sanmartin, Claudia
Patients with cardiovascular-related chronic diseases, such as coronary artery disease and diabetes may face numerous barriers to accessing the complex care that they require. Even in Canada, which has a universal healthcare system, some patients may face financial barriers to accessing important goods and services. Our objective was to enhance the understanding of financial barriers and their impact on clinical outcomes. This thesis is comprised of four reports of three independent studies that form an overarching sequential mixed methods program of research. The first study was a population-weighted survey of Western Canadians with cardiovascular-related chronic conditions in which we found that 1 in 10 respondents perceived having financial barriers to accessing goods and services required for their chronic disease. Those who reported having a financial barrier self-reported being 70% more likely to require hospital or emergency department care than those who did not perceive having financial barriers. In the second study, we built on this by linking data for patients self-reporting financial barriers within a series of national health surveys to outcomes available within administrative data sources. Those who perceived having a financial barrier to any aspect of their care had a hospitalization rate and mortality rate that was 36% and 24% higher, respectively, than those who denied having financial barriers. In the third study, we explored patients’ experiences with financial barriers using grounded theory methodology. We developed a conceptual framework for understanding how financial barriers impact patients’ lives. We outlined protective, predisposing, and modifying factors that ultimately determine how resilient an individual can be in the face of financial barriers. Finally, we undertook a qualitative descriptive analysis to describe the aspects of care to which patients most commonly experience financial barriers. These include: non-insured goods and services, items required to support self-management and incidental expenses associated with insured services. Many Canadians with chronic diseases face financial barriers to care, which are associated with adverse health outcomes. Interventions to address the prevalence and impact of financial barriers are possible but have never been tested in rigorous trials. Such studies would inform important policy reform at all levels of government.
Open Access
Associations Between Women’s Body Mass Index Category and Positive Psychological Well-being, Health, Internalized Weight Bias, and Exercise Capacity
(2023-04-21) Conradson, Heather Ellen; King-Shier, Kathryn; Raffin Bouchal, Shelley; Russel-Mayhew, Shelly
Background Improved cardiovascular disease outcomes and reduced mortality are associated with optimal fitness and optimal psychological wellbeing (PWB). Women with obesity are at risk for having lower fitness levels and lower PWB attributed, in part, to weight stigmatization. A deeper understanding of how obesity impacts both fitness and PWB in women is required. Methods Methods for three manuscripts include: a retrospective analysis of cardiorespiratory fitness (CFR) in women with differing BMI categories, following cardiac rehabilitation (CR), a scoping review synthesizing what is known about PWB in women with obesity, and a web-based survey examining relationships between general health, internalized weight bias (IWB), BMI and multiple constructs of PWB in a sample of community dwelling women. Results Women with obesity (BMI>30 kg/m2) had smaller gains in CRF (standard mean difference =0.79, p=.028; n=398), relative to women in the normal (BMI between 18.5 to 24.99 kg/m2) and overweight (BMI between 25.00-29.99 kg/m2) categories (SMD=1.03, n=454 and 0.92, n=461 respectively, p values<.001). Findings from thirty-two studies with over 57,000 women with obesity revealed women with obesity rated their PWB lower than women without obesity. However, this relationship was attenuated when self-health, body satisfaction, and social factors were included in the statistical model. In a survey of 1001 community dwelling women, those with obesity rated their positive emotions (p<.001), engagement (p=.007), relationships (p<.001) sense of meaning (p<.001) and accomplishments (p<.001) (acronym: PERMA), happiness (p<.001), and health (p<.001) lower and their IWB higher (p<.001) than women without obesity. Health accounted for up to 22% of the variance in PERMA and happiness scores whereas BMI and IWB contributed to 1-6% of the variance. Conclusion Women with obesity had lower fitness levels, smaller improvements in exercise capacity (METS) in CR, and generally lower PWB compared to women without obesity. This research offered initial insights into a complex relationship between fitness, health, IWB, BMI, and PERMA and happiness in women with obesity. This research highlights an opportunity to explore the causes of these differences, target interventions to improve exercise capacity, and determine how positive psychological interventions could be used as a psychological resource to support women with obesity.
Open Access
Barriers, Facilitators, and Experiences with Exercise Among Individuals of South Asian Heritage Living with and Beyond Cancer
(2022-07-08) Bansal, Mannat; Culos-Reed, S. Nicole; Bridel, William; King-Shier, Kathryn; Chowdhury, Tanvir Turin
Purpose: The purpose of this study was to understand the physical activity (PA) experiences, as well as needs, barriers, and facilitators to exercise, among individuals of South Asian heritage diagnosed with cancer. Methods: A qualitative descriptive design was used for this study. Individuals of South Asian heritage were recruited via a mix of convenience sampling and purposive sampling, with outreach via radio, posters in community settings, and via participants in current exercise oncology studies. Inclusion criteria included being over the age of 18; diagnosed with any cancer type and stage; pre, during, or post-treatment; able to speak English, Hindi, or Punjabi; and self-identified as South Asian. Data for this study was collected via semi-structured interviews conducted in either Hindi, Punjabi, or English. Interviews were transcribed verbatim in the original language and then analysed using conventional content analysis. The codes created through analysis were then translated and back-translated to ensure accuracy. Codes were then organized into themes and categories. Results: Eight participants were recruited, with 5 interviews in Punjabi and 3 interviews in English. The three themes that were created from the participant interviews include: 1) Culture, 2) Informational Needs, and 3) The Nature of Exercise Oncology Programming. Within these themes, categories included PA needs, barriers, and facilitators. Conclusion: Participants’ perspectives provided insights into the PA experiences, barriers, facilitators, and needs of people of South Asian heritage living with and beyond cancer. The results can be used to inform the tailoring of exercise oncology resources to better support physical activity for this population.
Open Access
Burn Mass Casualty Incident Planning in Alberta: A Case Study
(2023-04-04) Fuchko, Danielle Holly; King-Shier, Kathryn; Gabriel, Vince; White, Deb; Matherly, Annette
There is a lack of burn mass casualty incident (BMCI) preparedness across Canada. Alberta has three important elements which make it ready to be the first province with a BMCI response plan: a singular health authority to plan for, two burn centres, and updated health technology. A focused exploration of the current policies, protocols, and practices that address the provincial response to a BMCI was conducted. In this case study, data were gathered from documents outlining the health system response to a mass casualty incident and health care professionals directly involved in the response. Interviews were conducted online, recorded, and transcribed. Qualitative description was used to code common themes across documents and transcripts. Fifteen documents and nine participant interviews were included in this study. Only three documents included burn-specific considerations. Overall, the current policies, protocols, and practices in place were limited to all-hazards mass casualty incident planning and did not address the specialized needs of burn patients. Some major deficiencies identified included lack of a formalized burn-specific plan at each of the two burn centres, a lack of provincial-level recognition of the unique challenges associated with a BMCI, and the lack of an established Canadian burn disaster network. Suggestions to address the space, staffing, and supplies necessary to care for BMCI patients were proposed. For best patient outcomes the provincial health authority needs to support BMCI response planning efforts to better address this unique hazard prior to an incident occurring.
Open Access
Care and Outcomes for Older Adults with Advanced Chronic Kidney Disease
(2017) Helen, Tam-Tham; Hemmelgarn, Brenda; Fruetel, Karen; King-Shier, Kathryn; Quinn, Robert; Thomas, Chandra
The prevalence of older adults with advanced chronic kidney disease (CKD) is increasing globally, although optimal treatment remains uncertain. We examined in this thesis survival outcomes for older adults with kidney failure treated and not treated with dialysis. We also sought to identify barriers and facilitators to optimal conservative (non-dialysis) care for older adults with kidney failure managed by primary care physicians. We conducted three studies: a population-based retrospective cohort study using administrative and laboratory data to compare survival outcomes between dialysis and non-dialysis treatment; a qualitative descriptive study to explore primary care physician experiences when providing conservative care to older adults with kidney failure; and a cross-sectional population-based survey study within Alberta, Canada, to quantify results from the previous qualitative study. These last two studies formed a sequential exploratory mixed methods program of work to identify barriers and facilitators to community-based conservative care. We found that compared to non-dialysis care, dialysis was associated with a reduced risk of all-cause mortality but only within the first three years following onset of kidney failure. Conservative care for older adults is commonly provided by primary care physicians; however, they face substantial barriers to optimal care. Primary care physicians also expressed a need for resources including telephone access to nephrology or conservative care expertise, better access to conservative care clinics, and improved ability to appropriately co-manage patients with nephrologists. Research in conservative care has previously focused on patients with advanced CKD referred to nephrology. However, conservative care and outcomes among older adults not referred to nephrology is largely unknown. This thesis examined clinical care and outcomes through a wider perspective. To foster clinical impact we worked closely from conceptualization to dissemination stages with key stakeholders in Alberta including the Southern Alberta Conservative Management Program, the Conservative Kidney Management Pathway Steering Committee, the Kidney Health Strategic Clinical Network, and the Alberta College of Family Physicians. Our findings contributed to development of a conservative kidney management clinical care pathway and province-wide telephone access for primary care physicians to directly contact nephrologists and conservative care specialists.
Open Access
Clinical Appraisal of Needle Thoracostomy in a Canadian Aeromedical System
(2022-03) Newton, Graham; Laing, Catherine; Reay, Gudrun; King-Shier, Kathryn; Mageau, Alexis; Lang, Eddy
Background: Needle thoracostomy (NT) remains the standard for prehospital treatment of tension pneumothorax, but its effectiveness has been questioned in previous literature. The incidence of NT and clinical characteristics of patients receiving NT for tension pneumothorax in a Canadian helicopter emergency medical service (HEMS) setting have yet to be described. This lack of data leads to difficulty understanding who is at greatest risk for requiring NT, identifying factors that may be important to successful clinical outcomes, and implementing changes to practice. Methods: A retrospective chart review was conducted of adult patients who received NT from a Canadian HEMS service and a case study was conducted to document the novel use of an endotracheal tube to perform an improvised tube thoracostomy in response to NT failure. Results: Only a small proportion (1.3%) of patients attended by the HEMS service received NT during their care. The study sample was predominantly male (77.0%), with an average age of 46.4 years, and a presenting complaint of blunt trauma. Logistic regression analysis revealed initial NT treatment was associated with a low likelihood of clinical improvement in patients presenting with blunt trauma (OR = 0.18; p = .021), receiving CPR prior to NT (OR = 0.14; p = .02), or in those who received bilateral NT treatment (OR = 0.13; p < .01). A pre-treatment BP < 90 mmHg was the sole variable which was predictive of a positive clinical response to initial NT (OR = 3.33; p = .04). The case study provided a descriptive account of the successful use of a simple thoracostomy in combination with endotracheal tube insertion into the thorax to relieve tension pneumothorax following the failure of standard NT treatment in the HEMS setting. Conclusions: Of the patients studied, those most likely to receive NT were males who had suffered blunt trauma. NT may have questionable benefit for patients presenting with blunt trauma, cardiac arrest, or requiring bilateral NT. NT may be insufficient to adequately treat tension pneumothorax, and simple thoracostomy with thoracic endotracheal tube insertion has been successfully used to treat tension pneumothorax refractory to standard prehospital treatment.
Open Access
The Experience of Living with a CardioMEMSTM
(2022-01-13) Diakow, Rachel; Reay, Gudrun; Raffin Bouchal, Donna Shelley; King-Shier, Kathryn
Background: Heart failure is a serious health concern and places significant demands on the Canadian health care system. One method of follow-up monitoring is the CardioMEMSTM implant, which measures a patient’s pulmonary artery pressures. Healthcare professionals can use information from the device to make recommendations for the management of heart failure. Research published on CardioMEMSTM focuses predominantly on decreasing admission rates, emergency visits, and length of stay in hospital. Living with the CardioMEMSTM implant requires patients to be directly involved in data transmission, communicating with healthcare professionals, and titrating medications from their home. There is a paucity of information on the patient experience of living with a CardioMEMSTM device. Research Question: What is it like to live with a CardioMEMSTM device? Method: This was an interpretive description study. Six semi-structured individual interviews were conducted with people living with the CardioMEMSTM implant in the Calgary area. Data were analyzed using interpretive description methodology to find both patterns and variances within the data. Findings: The central found was support which was substantiated by the themes of autonomy, improved health, and convenience. Variations to the central theme were a sense of decreased control, anticipatory loss, anxiety and guilt, and inconvenience associated with using the device. Discussion: Findings can be used by healthcare professionals and candidates for the device to further understand the patient experience of living with a CardioMEMSTM device.
Open Access
Exploring Intensive Care Unit Nurses’ Decision Making in Alarm Management
(2023-07) Krakova, Nikola; King-Shier, Kathryn; Banner-Lukaris, Davina; Raffin Bouchal, Shelley
Alarm fatigue, which occurs when the exposure to an increased amount of false or nonactionable alarms leads to alarm desensitization and reduced clinical response by the healthcare provider, can pose a significant risk to patient safety. With the increasing advances in technology and frequency of alarms in our healthcare system, alarm fatigue is an important and growing safety concern that needs to be addressed. Exploring alarm-related decision making is key to reducing alarm fatigue, as it is important to the development of alarm management related initiatives, education, and policies. To examine this, I used Interpretive Description methodology to explore factors that influence Intensive Care Unit nurses’ decision making regarding alarm management, specifically how they triage and respond to various alarms. This study included 12 participants, comprised of nurses with varying levels of experience, working at three different Intensive Care Units. The results of the interviews suggest that the nurses’ decision making consists of three steps that capture their alarm management response: awareness, triage, and response. Based on these results, a positive alarm management culture, standardized alarm-related education, and mentorship should be evaluated to implement an effective alarm management response and reduce alarm fatigue.
Open Access
Exploring Public Expectations of Care and Communication in Intensive Care Units: A Cross-sectional Web-based Survey
(2024-11-18) Trotter, Bethany Therese; King-Shier, Kathryn; Cuthbert, Colleen; Banner- Lukaris, Davina
Background Explaining critical illnesses to family members or support persons of patients admitted to an Intensive Care Unit (ICU) is a sensitive and challenging duty for healthcare providers (HCPs). Current literature indicates that families often report insufficient and inadequate communication from critical care staff, leading to stress, anxiety, and sometimes even post-traumatic stress disorder (PTSD). Inaccurate media portrayals of ICU care and healthcare further contribute to unrealistic expectations, resulting in a mismatch between family expectations and the reality of care in ICUs. Objective This study aimed to identify and understand the public’s expectations of ICU care and communication if they were a family member or support person of an ICU patient. Methods A 36-question online survey of the Canadian public (n=489) was conducted to explore their expectations should they have a family member admitted to an ICU. The currently used and validated Family Satisfaction in the ICU (FSICUR-24) tool was used as a basis for the survey in this study, with the questions amended to be public facing. Participants were recruited through social media. The inclusion criteria required participants to be Canadian citizens or residents, over 18 years old, and could not have had any previous exposure or experience in ICUs. Results Participants expressed high expectations for substantial emotional support, frequent and clear communication from all specialties of HCPs, compassionate care, and a supportive physical environment. Recommendations for practice based on these findings include improving family conversations by managing expectations, expanding ICU HCP education, and procuring organizational support. Conclusions The public holds high expectations of ICU care, particularly regarding communication and support. Understanding these expectations can help improve families’ experiences, foster better communication, and improve patient and family-centred care in ICUs.
Open Access
Exploring the impact of financial barriers on secondary prevention of heart disease
(2017-02-14) Dhaliwal, Kirnvir K; King-Shier, Kathryn; Manns, Braden J; Hemmelgarn, Brenda R; Stone, James A; Campbell, David J T
Abstract Background Patients with coronary artery disease experience various barriers which impact their ability to optimally manage their condition. Financial barriers may result in cost related non-adherence to medical therapies and recommendations, impacting patient health outcomes. Patient experiences regarding financial barriers remain poorly understood. Therefore, we used qualitative methods to explore the experience of financial barriers to care among patients with heart disease. Methods We conducted a qualitative descriptive study of participants in Alberta, Canada with heart disease (n = 13) who perceived financial barriers to care. We collected data using semi-structured face-to-face or telephone interviews inquiring about patients experience of financial barriers and the strategies used to cope with such barriers. Multiple analysts performed inductive thematic analysis and findings were bolstered by member checking. Results The aspects of care to which participants perceived financial barriers included access to: medications, cardiac rehabilitation and exercise, psychological support, transportation and parking. Some participants demonstrated the ability to successfully self-advocate in order to effectively navigate within the healthcare and social service systems. Conclusion Financial barriers impacted patients’ ability to self-manage their cardiovascular disease. Financial barriers contributed to non-adherence to essential medical therapies and health recommendations, which may lead to adverse patient outcomes. Given that it is such a key skill, enhancing patients’ self-advocacy and navigation skills may assist in improving patient health outcomes.
Open Access
Exploring the Relationships Between Ethnicity, Health Literacy, Self-efficacy, and Self-management in Patients Receiving Maintenance Hemodialysis
(2016) Ibelo, Uchenna; King-Shier, Kathryn; Green, Theresa; Reilly, Sandra; Thomas, Bejoy
The purpose of this study was to explore the relationships among health literacy, self-efficacy, self-management and clinical outcomes, and if health literacy and self efficacy differed by ethnicity in the hemodialysis population. A cross-sectional, correlation, between-subjects design was used. The Health Literacy Questionnaire, Strategies Used by People to Promote Health, and Patient Activation Measure-13 measured health literacy, self efficacy, and self management respectively. Clinical measures included three month averages of interdialytic weight gain, serum potassium, and serum phosphate. Forty-four participants from white English speaking backgrounds and 34 participants from visible minorities, with different levels in English speaking proficiency, participated. Analysis indicates an association between health literacy and self efficacy; health literacy and self efficacy are associated with self management; and certain dimensions of health literacy differ between the two groups. The results suggest that health literacy could play a role in improving self-efficacy and self-management behaviors.
Open Access
Factors That Influence 7- and 30-day Readmissions After Heart Failure Hospitalization
(2015-09-09) Eastwood, Catherine Ann; King-Shier, Kathryn; Quan, Hude
Patients with heart failure (HF) frequently return to hospital within days of discharge, yet contributing factors have not been fully explored. Hospitalizations place stress on the patient, family, and healthcare system, and require closer examination to determine potential avoidability and targets for intervention. Thus, current factors that influence readmissions after HF hospitalization in Alberta were examined. A two-phased case-control design was used to compare patients who were readmitted and not readmitted after hospitalization for HF. In Phase One, an 8-year period of hospital discharge abstract data was analyzed. The rate of unplanned all-cause readmission was 6% and 18% within 7 and 30 days respectively after discharge. After risk adjustment for age, sex, and year, all-cause readmission within 7 days after discharge was associated with having kidney disease, and readmission within 30 days was associated with having cancer, pulmonary, liver, and kidney disease. At both time intervals, discharge with homecare services was associated with increased risk of readmission, and discharge from a hospital with HF services was associated with lower risk of readmission. In Phase Two, a health record audit was undertaken for a more detailed examination of factors associated with readmission within 7 days of discharge and potential avoidability. Matched pairs of patients discharged from Calgary hospitals were identified from the Phase One sample. Patients who were frail or had a specialist as attending physician were more likely to be readmitted. Patients who were instructed to see a physician within 1 week of discharge were less likely to be readmitted. Common reasons for readmission included HF then gastrointestinal, other cardiac, and respiratory diagnoses. Almost 60% of readmissions were deemed potentially avoidable based on explicit criteria developed from past research. Several factors were associated with readmission within the 2 time intervals studied. Despite care by specialists and referral to HF clinics, complex frail patients were discharged with unresolved symptoms or inadequate community support. It is important that criteria be developed to screen for frailty, discharge readiness, and to determine avoidability.
Open Access
Factors that Influence South Asian Cardiac Patients’ Medication Adherence
(2013-06-14) Ens, Twyla; King-Shier, Kathryn
South Asians experience high rates of cardiovascular disease. Medications are a major component of chronic disease management. A systematic literature review revealed factors that contributed to medication non-adherence with South Asians. Content analysis strategies were used for the synthesis. Thirteen papers were in the final set with medication side-effects, cost, forgetfulness and language barriers contributing to non-adherence. Inconsistent methodologies and scant information on immigrant factors within the Canadian context led to further exploration. An ethnographic study was conducted between January to September 2012. Observations and interviews were conducted with South Asian cardiac patients, as well as physicians, pharmacists and staff. Fieldnote and interview data were transcribed and analyzed using ethnographic domains and cultural themes. South Asian cardiac patients relied on family members for instrumental support. Medication adherence was enhanced when relationships with healthcare professionals demonstrated clear communication and cultural awareness. Memory mechanisms need to be individualized and were generally ‘low technology’.
Open Access
Improving Infectious Tuberculosis Education and Counselling in Calgary for Patients who are Foreign-born and their Families
(2022-07-26) Bedingfield, Nancy Joyce; King-Shier, Kathryn; Fisher, Dina; Lashewicz, Bonnie
Patients and family members require comprehensive information and support to manage tuberculosis (TB). However, current TB education and counselling practices often fail to address family needs. This is particularly true in low TB incidence settings such as Canada, where linguistic and cultural dissonance between patients and providers is common. The objective of this research was to explore how TB health care workers (TB HCWs) and health systems leaders can focus education and counselling on the needs and preferences of patients and family members who are foreign-born experiencing advanced infectious TB in Calgary, Canada. The case study was conducted in three phases framed on the Social Ecological Model. In phase one, interviews were conducted with patients and family members to learn about their TB-related needs and experiences. In phase two, staff and physicians at the Calgary TB Clinic were interviewed to learn about their perceptions of barriers and supports to education and counselling for this group. In phase three, data from the first two phases were re-analyzed, relevant documents were reviewed, and health services and community leaders were interviewed to learn how health policy and social context influence education and counselling. Patients and family members described significant isolation associated with TB. Although patients and family members were satisfied with education and counselling, there was evidence that communication problems had occurred. TB HCWs reported numerous, multi-level barriers to providing education and counselling but found that continuity of care and clear information provided early reduced communication problems. Data from community leaders’ interviews and document review revealed that operational and public health priorities often took precedence over strengthening education and counselling. Leaders noted promising developments had recently increased attention to the needs of people who are foreign-born. Key recommendations for change include development of patient education and counselling guidelines, improved patient teaching materials, and offering a cultural patient navigator to families affected by advanced infectious TB. Adopting these changes could reduce fear and isolation in patients and family members; however, policy changes is required to realize the equity-enhancing potential of informing and supporting patients and family members affected by TB.
Open Access
An Intervention to Enhance Mental and Physical Health of Nursing Students
(2022-09) Ciezar Andersen, Sylwia; King-Shier, Kathryn; White, Deborah; Campbell, Tavis
Nursing students exhibit some of the highest symptoms of depression, anxiety, and stress relative to students in other health-related disciplines and to their counterparts outside of university. Up to 50% of nursing students are sedentary, compromising their physical health and exacerbating risk for musculoskeletal injury. Yoga has been associated with improved mental and physical health in a variety of populations. With the ORBIT Model as a guide to implementation, the first manuscript in this thesis consists of a systematic review exploring existing evidence of the effectiveness of yoga interventions for healthcare professionals and students (design phase, Phase I). This evidence was then used to plan and optimize protocol details for Phases IIa and IIb. The process of undertaking a web-based yoga intervention was explored in a proof-of-concept study (Phase II a). After protocol refinement, a pilot study was conducted (Phase II b), and is described in the second manuscript. All 68 participants who completed the pilot study exhibited a significant decrease in symptoms of depression, anxiety, stress, and improved self-compassion and core endurance scores. While significant mental and physical health benefits following yoga intervention were demonstrated in this sample, 44% attrition rates were encountered during the course of the pilot study. Thus, retention challenges were explored and recommendations for further refinement and protocol optimization were the focus of the third manuscript.
Open Access
Palliative Care Advanced Practice Nurses' Experiences with Medical Assistance in Dying
(2021-07-22) Shand, Michelle; Raffin Bouchal, Shelley; King-Shier, Kathryn; Venturato, Lorraine
Medical assistance in dying (MAID) is new to Canada and there have been over 1500 cases in Alberta since June 2016. The philosophy, intent, and approach to care of palliative care and MAID are different; MAID is not part of palliative care. Palliative care philosophy involves neither hastening nor postponing death. The differences between palliative care and MAID lead to inherent tensions for health care providers. Thus, palliative care advanced practice nurses (APNs) experience challenges while following patients and their families through the MAID process. Very little is known about palliative care APNs’ experiences with MAID and how they navigate MAID while working within the philosophy of palliative and hospice care. The purpose of this research was to understand experiences of palliative care APNs when caring for patients requesting or receiving MAID. Using hermeneutics as a methodology, I conducted interviews with guiding prompts to allow for the palliative care APNs’ story to unfold. I recruited palliative care APNs working for Alberta Health Services within the Calgary zone in urban and rural settings. By conducting research on this topic, challenges, and issues that palliative care APNs might be facing were explored. Through the data analysis, moral distress was apparent; the palliative care APNs experienced moral distress. Nurses who face moral distress can be negatively impacted spiritually, emotionally, and physically. Nurses also faced organizational challenges in navigating APN practice and the MAID team processes. There are opportunities for future research to be conducted so that educational and supportive tools can be developed in the future for nurses caring for patients receiving MAID; these include revising regulatory documents pertaining to MAID to incorporate the role of the palliative care APN and addressing the stigma associated with MAID.
Open Access
Parental Technology Use and its Implications for Parent-Child Interactions and Children’s Health and Development
(2023-06) Komanchuk, Jelena; Letourneau, Nicole; Cameron, Judy L.; Duffett-Leger, Linda; King-Shier, Kathryn
Adverse experiences (e.g., poverty, family violence, neglect in childhood) can lead to negative health and developmental consequences, yet impacts may be buffered by positive parent-child interactions. While families experiencing adversity (e.g., poverty) report barriers to attending in-person parenting programs, online parenting programs have potential to improve children’s health and development by increasing accessibility. In contrast, parental technoference (i.e., parental technology use that interrupts interactions with one’s child) can negatively affect parent-child relationships and children’s outcomes (e.g., behavior, mental health). Research is needed on digitally delivered parenting programs for families experiencing adversity and on the implications of parental technoference on parent-child relationships and children’s outcomes. The first manuscript in this dissertation is a realist review of research and theory on serve and return interactions (a metaphor utilized to convey the importance of sensitive and responsive caregiving) and a synthesis of research examining its impacts on children’s health (e.g., mental, physical) and development. The second manuscript presents findings from a randomized controlled trial evaluation of the First Pathways program with families experiencing adversity in Alberta. The First Pathways program is an online tool designed to improve parent-child interactions and children’s development by sharing brain development knowledge and activities for parents and children. Compared to the quartile of parent-child dyads who seldom accessed the website (n = 12), the quartile of parent-child dyads who accessed the website the most (n = 13) demonstrated significantly greater improvements in parent-child interaction quality. Further, daily reminders significantly increased website access. High retention (99%) was observed in the First Pathways study; thus, the third manuscript describes the effective recruitment and retention strategies employed. In the fourth manuscript, a realist review of literature on the psychometrics of digitally delivered child development tools is presented. The last manuscript is a scoping review on parental technoference and its effects on parent-child relationships, children’s health, and development. This dissertation concludes with a discussion of the positive and negative implications of parental technology use on children’s health and development and recommendations for nursing research, education, and practice.
Open Access
Patient experience and healthcare priorities in childhood steroid sensitive nephrotic syndrome
(2021-09) Okpere, Augustina Nwaka; Samuel, Susan; Elliott, Meghan; King-Shier, Kathryn; Hamiwka, Lorraine
Childhood idiopathic steroid sensitive nephrotic syndrome (SSNS) is characterized by sudden and unexpected onset of body swelling, massive proteinuria and hypoalbuminemia. The chronic recurrent relapses and side effects of its treatment can impact patients’ and caregivers’ experiences of the disease. The aims of this qualitative study were to explore the experiences and healthcare priorities of children with SSNS and their caregivers. We interviewed 28 participants that comprised 10 children aged 9 to18 years (6 boys and 4 girls) and 18 caregivers over the internet on Microsoft Teams between January and April 2021. Using qualitative description and thematic analysis, we identified three themes related to the diagnostic journey of childhood nephrotic syndrome (unexpected distressing symptoms, elusiveness of diagnosis and confronting the diagnosis) and three themes related to the experiences of children living with SSNS and their caregivers (disruption of normalcy, regaining control and dependable social support system). Four actionable needs and care priorities of participants were identified: desire to be heard, understanding the cause of nephrotic syndrome, alleviating the burden of steroid regimen and enhanced social support availability. Our study provides insights into several strategies that healthcare professional could adopt to improve the diagnostic experience of children and their caregivers in search of a diagnosis of nephrotic syndrome and care of patients and their families. Also, our findings have the potential to inform the design and conduct of future research in priority setting and treatment of childhood SSNS.
Open Access
Positive psychological well-being in women with obesity: A scoping review of qualitative and quantitative primary research
(World Obesity and The Obesity Society and John Wiley & Sons Ltd., 2022-04-14) Conradson, Heather E.; Hayden, K. Alix; Russell-Mayhew, Shelly; Raffin Bouchal, Shelley; King-Shier, Kathryn
Background: Positive psychological well‐being (PPWB) is generally associated with improved physical health, mental well‐being, and healthy behaviors. However, it is not clear how PPWB differs in women with obesity or if improving PPWB will improve their health. The objective of this study was to summarize the evidence onPPWB in women with obesity. Method: A scoping review was conducted in APA PsycINFO, EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL, SocINDEX, Family & Society Studies Worldwide, ProQuest Dissertations and Theses Global databases. Primary research studies, with an analysis of adult women with a BMI ≥30 kg/m2 with measures of PPWB are included. Results: Thirty‐two studies encompassing >57,000 women with obesity, measured constructs of PPWB included: self‐esteem, life satisfaction, positive affect, social support, vitality, happiness, self‐acceptance, and optimism. Most studies showed that PPWB was lower in women with obesity although this association dissipated in studies when health and negative social factors were considered. Improvements in PPWB were associated with weight loss and with successful lifestyle changes with and without weight loss. Positive psychological interventions (PPIs) were used to bolster psychological well‐being. PPIs were associated with improved measures of self‐esteem and well‐being. Conclusions: Prospective longitudinal and intervention studies are required to understand how evaluating and fostering PPWB might support gender‐informed obesity care.
Open Access
Predictors and Outcomes Associated with Improvements in Anxiety and Depressed Mood Among Patients Who Complete Cardiac Rehabilitation
(2024-08-06) Hernandez, Laura; Campbell, Tavis; Rouleau, Codie; King-Shier, Kathryn; Carlson, Linda
Background: Cardiac rehabilitation (CR) is an established treatment for coronary artery disease (CAD) that may also improve psychological functioning. However, the extent to which reductions in depressive and anxious symptoms are clinically meaningful remains unclear. This study examined the proportion of patients achieving a minimal clinically important difference (MCID) on the Hospital Anxiety and Depression Scale (HADS) following CR completion and whether these differences are associated with patient characteristics and subsequent mortality. Methods: Retrospective analyses were performed on data from an observational cohort study of CAD patients following coronary catheterization who completed a 12-week CR program during 2009-2019 (TotalCardiologyTM Rehabilitation, Calgary). Patient characteristics and depressive and anxious symptom severity were measured at baseline and post-CR. Mortality data were extracted from Alberta Vital Statistics. A MCID in depressive and anxious symptoms was indicated by an established cut-off (>1.7 decrease in HADS-Anxiety or HADS-Depression scores). Results: Among 6,208 patients (60.5 ± 10.8 years, 20.8% female), 13.0% and 15.9% achieved clinically significant reductions in HADS-Depression and HADS-Anxiety scores, respectively. In patients with baseline HADS-Depression >8 (n = 657), 31.2% reported improved severity of depressive symptoms. In patients with baseline HADS-Anxiety >8 (n = 1,509), 32.0% reported improved severity of anxious symptoms. Higher baseline anxious symptoms, depressive symptoms, and younger age were associated with a greater likelihood of improvements in depressive symptoms (OR = 0.98, 95% CI [0.97–0.99]) and anxiety (OR = 0.99 [0.98, 0.99]). Higher baseline cardiorespiratory fitness (OR = 1.03 [1.00, 1.06]) and higher baseline hemoglobin A1C (OR = 1.00 [1.00, 1.00]) were associated with improvements in anxiety. A reduction in anxiety during CR was associated with lower all-cause mortality at 3-year follow-up (HR = 0.12, [0.02, 0.88]) in patients with elevated baseline anxiety symptoms. Conclusion: CR completion is associated with improved depressive and anxious symptoms in one-third of patients, which could translate to improved health outcomes. A considerable subset of program completers remained symptomatic and may require targeted psychological intervention. Age, cardiorespiratory fitness, blood sugar control, and baseline mood/anxiety symptoms might contribute to differential treatment response.