Browsing by Author "Ringham, Catherine"

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    Development and validation of the Cannabis Exposure in Pregnancy Tool (CEPT): a mixed methods study
    (2024-04-16) Chaput, Kathleen H.; McMorris, Carly A.; Metcalfe, Amy; Ringham, Catherine; McNeil, Deborah; Konschuh, Shaelen; Sycuro, Laura J.; McDonald, Sheila W.
    Abstract Background Evidence of associations between prenatal cannabis use (PCU) and maternal and infant health outcomes remains conflicting amid broad legalization of cannabis across Canada and 40 American states. A critical limitation of existing evidence lies in the non-standardized and crude measurement of prenatal cannabis use (PCU), resulting in high risk of misclassification bias. We developed a standardized tool to comprehensively measure prenatal cannabis use in pregnant populations for research purposes. Methods We conducted a mixed-methods, patient-oriented tool development and validation study, using a bias-minimizing process. Following an environmental scan and critical appraisal of existing prenatal substance use tools, we recruited pregnant participants via targeted social media advertising and obstetric clinics in Alberta, Canada. We conducted individual in-depth interviews and cognitive interviewing in separate sub-samples, to develop and refine our tool. We assessed convergent and discriminant validity internal consistency and 3-month test–retest reliability, and validated the tool externally against urine-THC bioassays. Results Two hundred fifty four pregnant women participated. The 9-item Cannabis Exposure in Pregnancy Tool (CEPT) had excellent discriminant (Cohen’s kappa = -0.27–0.15) and convergent (Cohen’s kappa = 0.72–1.0) validity; as well as high internal consistency (Chronbach’s alpha = 0.92), and very good test–retest reliability (weighted Kappa = 0.92, 95% C.I. [0.86–0.97]). The CEPT is valid against urine THC bioassay (sensitivity = 100%, specificity = 82%). Conclusion The CEPT is a novel, valid and reliable measure of frequency, timing, dose, and mode of PCU, in a contemporary sample of pregnant women. Using CEPT (compared to non-standardized tools) can improve measurement accuracy, and thus the quality of research examining PCU and maternal and child health outcomes.
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    Tracking the Social Organization of Nurses’ Practices in Level 2 Neonatal Intensive Care Units: An Institutional Ethnography of Feeding Work
    (2017) Ringham, Catherine; Rankin, Janet; Ewashen, Carol; Premji, Shahirose; Marcellus, Lenora; Venturato, Lorraine; Carryer, Jenny
    The character of neonatal nurses’ work is episodic and discontinuous. While nurses play an integral role in mediating the ebb and flow of constantly changing priorities, in the Level 2 Neonatal Intensive Care Units (NICU) their work is also complicated by new technologies, safety work, and institutionally driven quality improvement (QI) projects. As the numbers and types of QI, safety, and standardizing strategies proliferate, they can overwhelm nurses’ responses to infant’s needs, particularly late preterm infants (LPIs) who require less technological interventions during their care in the NICU. An institutional ethnographic approach was used to examine the social organization of nurses’ work with LPIs in Level 2 NICU. Feeding work, a central organizer of nurses’ work, emerged as the main thread of analysis. The data showed that feeding work does not unfold as an orderly, stepwise procedure. Observations revealed how feeding episodes for all infants were broken up by the need for a nurse to attend to technologies developed for ‘safety’ and to meet standardized protocols. The work relies on nurses’ capacity to notice, to respond, to flex, and to adapt. However, nursing tasks are being broken into disparate pieces as nurses become subject to ideological practices that rely on a form of logical/rational thinking about how work can be planned and organized to unfold safely. Often in the milieu of nursing activity, LPIs were viewed ‘out of the corner of nurses’ eyes,’ socially organized to be rendered peripheral to nurses’ full attention. The research findings explicate serious tensions in nurses’ work, particularly with feeding LPIs. The findings call into question the foundations on which standardized protocols and practices are built and offers an opportunity for policy makers, health care leaders, and nurses themselves to understand how neonatal nurses’ work is organized and to begin creative discussions to resolve tensions and to direct further research in Level 2 NICUs.