Browsing by Author "Reimer-Kirkham, Sheryl"
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- ItemOpen AccessDesign and introduction of a quality of life assessment and practice support system: perspectives from palliative care settings(2018-08-22) Sawatzky, Richard; Laforest, Esther; Schick-Makaroff, Kara; Stajduhar, Kelli; Reimer-Kirkham, Sheryl; Krawczyk, Marian; Öhlén, Joakim; McLeod, Barbara; Hilliard, Neil; Tayler, Carolyn; Robin Cohen, S.Abstract Background Quality of life (QOL) assessment instruments, including patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs), are increasingly promoted as a means of enabling clinicians to enhance person-centered care. However, integration of these instruments into palliative care clinical practice has been inconsistent. This study focused on the design of an electronic Quality of Life and Practice Support System (QPSS) prototype and its initial use in palliative inpatient and home care settings. Our objectives were to ascertain desired features of a QPSS prototype and the experiences of clinicians, patients, and family caregivers in regard to the initial introduction of a QPSS in palliative care, interpreting them in context. Methods We applied an integrated knowledge translation approach in two stages by engaging a total of 71 clinicians, 18 patients, and 17 family caregivers in palliative inpatient and home care settings. Data for Stage I were collected via 12 focus groups with clinicians to ascertain desirable features of a QPSS. Stage II involved 5 focus groups and 24 interviews with clinicians and 35 interviews with patients or family caregivers during initial implementation of a QPSS. The focus groups and interviews were recorded, transcribed, and analyzed using the qualitative methodology of interpretive description. Results Desirable features focused on hardware (lightweight, durable, and easy to disinfect), software (simple, user-friendly interface, multi-linguistic, integration with e-health systems), and choice of assessment instruments that would facilitate a holistic assessment. Although patient and family caregiver participants were predominantly enthusiastic, clinicians expressed a mixture of enthusiasm, receptivity, and concern regarding the use of a QPSS. The analyses revealed important contextual considerations, including: (a) logistical, technical, and aesthetic considerations regarding the QPSS as a technology, (b) diversity in knowledge, skills, and attitudes of clinicians, patients, and family caregivers regarding the integration of electronic QOL assessments in care, and (c) the need to understand organizational context and priorities in using QOL assessment data. Conclusion The process of designing and integrating a QPSS in palliative care for patients with life-limiting conditions and their family caregivers is complex and requires extensive consultation with clinicians, administrators, patients, and family caregivers to inform successful implementation.
- ItemOpen AccessFemale 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, AndrewThe 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.