Browsing by Author "Reay, Gudrun"

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    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.
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    Creative adapting in a fluid environment: an explanatory model of paramedic decision making in the pre-hospital setting
    (2018-11-15) Reay, Gudrun; Rankin, James A; Smith-MacDonald, Lorraine; Lazarenko, Gerald C.
    Abstract Background Paramedics work in a highly complex and unpredictable environment which is characterized by ongoing decision-making. Decisions made by paramedics in the prehospital setting have implications for patient safety, transport, treatment, and health resource utilization. The objective of this study was; a) to understand how paramedics conduct decision-making in the field, and b) to develop a grounded theory of paramedic decision-making in the prehospital setting. Method This study was conducted using classical grounded theory. Paramedics (n = 13) with five or more years’ experience, who worked in a large urban center in Western Canada were interviewed. Field observations were conducted, each lasting 12 h, with five different ambulance crews. The data were analyzed and coded using the constant comparative method. Results The resultant theory, Creative Adapting in a Fluid Environment, indicates paramedic decision-making is a fluid iterative process. Unpredictable and dynamic features of the prehospital environment require paramedics to use a flexible and creative approach to decision-making. The model consists of the three categories constructing a malleable model, revising the model, and situation-specific action. Two additional components, safety and extrication, are considered at each stage of the call. These two components in conjunction with the three categories influence how decisions are made and enacted. Conclusion Paramedic decision-making is highly contextual and requires accurate interpretation and flexible cognitive constructs that are rapidly adaptable. Evaluation of paramedic decision-making needs to account for the complex and dynamic interaction between the environment, patient characteristics, available resources, and provider experience and knowledge.
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    Enacting Strategic Memory: A Grounded Theory of Critical Care Nurse Decision Making in Crises
    (2019-01-14) MacDougall, Gordon; Estefan, Andrew; Reay, Gudrun; Raffin-Bouchal, Shelley; Venturato, Lorraine
    Decision-making is a key component of registered nurse practice. The decisions registered nurses make in practice have important consequences for healthcare provision and patient outcomes. In critical care, nurses make decisions in complex circumstances, including crisis events in which nurses and others must respond quickly and effectively. The ways that nurses in critical care environments make decisions during crises has not been well studied. Within the nursing and other literature there are numerous theories, conceptualizations, and expert opinions about what constitutes decision-making but few of these describe what is happening when nurses make decisions in their practice contexts. This study was a classical grounded theory study to explain how critical care nurses make decision in crises. Data were collected from ten participants and analyzed using constant comparative analysis. The theory Enacting Strategic Memory accounts for the data provided by participants and explains how nurses make decisions. Findings showed that nurses engage in decision-making through the strategic use of cognitive and physical resources by recognizing triggers, negotiating past and present, and telling stories. The theory is discussed in light of extant literature and recommendations for practice, research, and policy are made.
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    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.
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    Exploring Awareness of a Palliative Approach: A Constructivist Grounded Theory Study
    (2018-09-17) Tellier, Leah; Raffin Bouchal, Shelley; Reay, Gudrun; Shantz, Heather Davison
    Chronic diseases are the leading cause of death in Canada. Advanced cancer, chronic obstructive pulmonary disease (COPD), congestive heart failure, and advanced dementia are life-limiting conditions that would benefit from a palliative approach to care. There is minimal Canadian literature that explores healthcare providers’ knowledge and awareness of introducing a palliative approach for patients living with chronic disease. This thesis outlines a qualitative study using grounded theory methodology, to explore the knowledge, perspectives, and beliefs of healthcare professionals who care for individuals with chronic life-limiting illness. In this study, interviews were conducted to explore healthcare professionals’ understanding of a palliative approach to care, available resources, and their beliefs about introducing a palliative approach earlier in the illness trajectory for patients living with chronic disease. Data was collected and analyzed using constructivist grounded theory methodology. Findings from this study have determined the need for increased awareness of a palliative approach for patients living with chronic disease as well as the resources available for physicians and nurses to make appropriate referrals for patients who would benefit from early palliative care initiatives. In addition, the long-term objective is to decrease the amount of Emergency Department visits and acute care admissions as well as improve quality of life for patients living with chronic disease by increasing access to community palliative care resources through early referral.
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    Improving the Adoption of Transitions in Care Technology Between Emergency Medical Services and Emergency Departments: A Scoping Review Protocol
    (2022-05-12) Sterzer, Frances; Caird, Jeff; Reay, Gudrun
    Background: Previous research has shown that miscommunication during transitions in care between emergency medical services (EMS) and emergency departments can result in serious medical errors leading to adverse patient health outcomes and even death. Studies show that interactive mobile technology can assist the patient transfer process. Research indicates that various technologies are available, yet uptake by health systems throughout Canada and the world is limited. A conceptual framework for improving the technology adoption of EMS to emergency department (ED) transitions in care (TiC) software will be used to guide the project. Objectives: The aim of this scoping review is to create an expansive collection of useful mobile software application features, motivations for use, and barriers that interfere with EMS communication technology adoption to assist research and design and improve the technology’s adoption over time. Eligibility Criteria: Only information on smartphone software applications will be eligible for inclusion in this project, although all study designs and types of literature will be included. Included apps, articles, or documents must be published after 2008 and in the English language or feasibly translated (e.g., using Google Translate). Sources of Evidence: Seven academic and seven preprint databases will be searched for published and unpublished artifacts providing access to the latest information. Due to the emerging nature of this topic, exploring Google Play Apps, Apple's App Store, and Google will help ensure that the most current information is represented. Utilizing backward and forward author, reference, and app searching will be crucial for identifying evolutions of the technology and developmental trajectories to their present state. Charting Methods: Data charting will include characteristics of the source, along with any relevant results and findings that pertain to the research questions, which will be coded into emerging categories (i.e., themes), creating an accessible and simplified resource supported by a narrative synthesis.
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    Improving Triage to ECG Time in the Emergency Department
    (2018-03-15) Nosworthy, Sara Eileen; Hirst, Sandra P.; Reay, Gudrun; Mannion, Cynthia A.
    Background: The ST-segment elevation myocardial infarction (STEMI) team of a large Canadian urban tertiary care hospital identified that best practice recommendations were not being met for walk-in patients diagnosed with STEMI to the Emergency Department (ED). The American Heart Association (AHA) (2013) recommends triage to first-device time should be 90-minutes. However, this target was only achieved 6% of the time for walk-in patients diagnosed with STEMI. It is recommended that the initial electrocardiogram (ECG) be completed within 10-minutes for patients presenting with suspected ischemic chest pain (SICP) to the ED (AHA, 2013). Data analysis, performed by the STEMI quality improvement team, identified a significant delay with the initial ECG, for walk-in patients diagnosed with STEMI. This delay places patients at risk for serious adverse outcomes, such as cardiac arrest. Therefore, it was essential to implement a streamlined process to improve triage to ECG times. Objective: The objectives of this study were to investigate if the implementation of a streamlined process at triage for walk-in patients with SICP decreased triage to ECG times, and secondarily if triage to first-device time for walk-in patients diagnosed with STEMI was decreased. Methods: A retrospective study was conducted at a large Canadian urban tertiary care hospital. A new streamlined process at triage for walk-in patients presenting with SICP was evaluated by comparing daily data from May 2016 to May 2017. The primary outcome measured was triage to ECG time for walk-in patients presenting with SICP, and secondarily triage to first-device time for walk-in patients diagnosed with STEMI. Results: There was a statistically significant difference between May 2016 and May 2017 (U = 28425, Z=-5.01, p <.001). Following the streamlined process there was a significant decrease of 16-minutes in the median triage to ECG time for walk-in patients presenting with SICP compared to those prior to the streamlined process. None of the 288 patients evaluated in May 2016 were diagnosed with STEMI. Four of the 265 patients evaluated in May 2017 were diagnosed with STEMIs. Two of the four patients met the recommended target time of triage to first-device time within 90-minutes (AHA, 2013: Heart and Stroke, 2015). Discussion: The best practice recommendation of triage to ECG time within 10-minutes was not achieved for all walk-in patients presenting with SICP. However, the streamlined process has significantly decreased time in triage to ECG for this patient population. Future interventions directed at decreasing triage to ECG time should focus on early identification of patients with chest pain, examining the streamlined process for further improvements, and ongoing evaluation of triage to ECG data. There was limited data for triage to first-device time as there were no walk-in patients diagnosed with STEMI in May 2016. Therefore, it was not possible to evaluate if the streamlined process improved triage to first-device time. Continual evaluation of the triage to first-device times is needed to see if the streamlined process is making a difference.
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    Momentary Fitting in a Fluid Environment: A Grounded Theory of Triage Nurse Decision Making
    (2014-09-12) Reay, Gudrun; Rankin, James A.
    Emergency departments (EDs) are fluid environments where conditions are constantly changing. Triage nurses control access to the ED and make decisions about patient acuity, placement, and priority to be examined by a physician. Understanding the processes and strategies that triage Registered Nurses (RNs) use in decision making is therefore vital for patient safety and operation of the ED. The aim of this classical grounded theory study was to understand the processes and strategies that experienced emergency RNs use when making triage decisions and to generate a substantive grounded theory of triage RN decision making. Data collection consisted of twelve interviews with triage RNs and seven observations of the triage environment at three hospital sites in a major urban centre. Initial sampling was purposive; as categories began to emerge theoretical sampling was used in accordance with grounded theory. The data were analyzed using the constant comparative method. Findings reveal that the main concern of triage RNs was to achieve best possible fit between patients and the ED as a whole, given the circumstances for each moment in time. The main concern was conceptualized as the core category Momentary Fitting in a Fluid Environment. Best possible fit was not synonymous with optimal fit. Decision making occurred in a context where each decision changed the conditions for subsequent decisions. Momentary fitting consists of the interrelated categories determining acuity, anticipating needs, managing space, and creating space. At certain critical junctures, RNs decided to create space by pushing boundaries and, at times, temporarily crossing boundaries. Momentary Fitting theory makes explicit the importance for triage RNs to maintain up to date awareness of what is transpiring in the ED. This includes knowledge of incoming critical patients, the condition of patients waiting to be examined, and real time information about available treatment spaces, patients, and staff resources. Moreover, the findings point to the need for structuring triage environments to facilitate mechanisms that allow quick communication between co-workers. The results have implications for design of triage areas, computer programs, graphical user interfaces and education. Future research needs to account for the contextual and ethical nature of triage decisions.
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    Resilience within the Context of Refugee Youth Adaptation to New Life in Canada
    (2020-09-08) Jafari, Helia; Kassan, Anusha; Reay, Gudrun; Climie, Emma Alison
    In response to recent refugee crises around the world, scholars have called for research on resilience among war-affected children and youth as an important area of focus that offers culturally and contextually relevant implications for effective support services. While empirical research on the resilience of refugee youth has been gradually increasing, the current scholarship still lacks social, cultural, and contextual sensitivity. As such, this dissertation research, which consists of three conceptually linked manuscripts, represents a purposeful attempt to address this gap by exploring the resilience of refugee youth in a postmigration Canadian context, with contributions to research, policy, and practice. Specifically, Manuscript 1 centres on the definition of refugee youth resilience as it relates to postmigration resettlement and explores the theoretical connections between resilience and positive adaptation. This manuscript proposes a culturally and contextually relevant conceptualization of resilience from the bioecological lens, integrating the three intertwined developmental, acculturative, and psychological perspectives. Manuscript 2 focuses on a critical and extensive review of the extant literature on refugee children and youth. It synthesizes empirical evidence from scholarship on young refugees’ resilience and presents a host of biological, psychological, social and cultural determinants of resilience, which interact with one another across multiple levels of social and ecological contexts to determine adaptive responds to stressful experiences. Finally, Manuscript 3 reflects qualitative research on pathways leading to positive adaptation to a Canadian postmigration context to provide knowledge about the pathways leading to resilience among refugee youth. It outlines a classic grounded theory study that generated a substantive theory conceptually explaining the underlying process of positive adaptation from the perspectives of 15 Canadian refugee youth. Together, findings from this dissertation research spur integration of knowledge and strategies to inform practice and policies to mitigate risk and promote resilience in multiple systems that shape refugee youth adaptation over the resettlement course.
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    Transition in care from paramedics to emergency department nurses: a systematic review protocol
    (2017-12-19) Reay, Gudrun; Norris, Jill M; Alix Hayden, K.; Abraham, Joanna; Yokom, Katherine; Nowell, Lorelli; Lazarenko, Gerald C; Lang, Eddy S
    Abstract Background Effective and efficient transitions in care between emergency medical services (EMS) practitioners and emergency department (ED) nurses is vital as poor clinical transitions in care may place patients at increased risk for adverse events such as delay in treatment for time sensitive conditions (e.g., myocardial infarction) or worsening of status (e.g., sepsis). Such transitions in care are complex and prone to communication errors primarily caused by misunderstanding related to divergent professional perspectives leading to misunderstandings that are further susceptible to contextual factors and divergent professional lenses. In this systematic review, we aim to examine (1) factors that mitigate or improve transitions in care specifically from EMS practitioners to ED nurses, and (2) effectiveness of interventional strategies that lead to improvements in communication and fewer adverse events. Methods We will search electronic databases (DARE, MEDLINE, EMBASE, Cochrane, CINAHL, Joanna Briggs Institute EBP; Communication Abstracts); gray literature (gray literature databases, organization websites, querying experts in emergency medicine); and reference lists and conduct forward citation searches of included studies. All English-language primary studies will be eligible for inclusion if the study includes (1) EMS practitioners or ED nurses involved in transitions for arriving EMS patients; and (2) an intervention to improve transitions in care or description of factors that influence transitions in care (barriers/facilitators, perceptions, experiences, quality of information exchange). Two reviewers will independently screen titles/abstracts and full texts for inclusion and methodological quality. We will use narrative and thematic synthesis to integrate and explore relationships within the data. Should the data permit, a meta-analysis will be conducted. Discussion This systematic review will help identify factors that influence communication between EMS and ED nurses during transitions in care, and identify interventional strategies that lead to improved communication and decrease in adverse events. The findings can be used to develop an evidence-informed transitions in care tool that ensures efficient transfer of accurate patient information, continuity of care, enhances patient safety, and avoids duplication of services. This review will also identify gaps in the existing literature to inform future research efforts. Trial registration PROSPERO CRD42017068844
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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.