PRISM :: Browsing by Author "Venturato, Lorraine"

Browsing by Author "Venturato, Lorraine"

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Open Access
A pilot evaluation of the Strengthening a Palliative Approach in Long-Term Care (SPA-LTC) program
(2020-07-13) Kaasalainen, Sharon; Sussman, Tamara; Thompson, Genevieve; McCleary, Lynn; Hunter, Paulette V; Venturato, Lorraine; Wickson-Griffiths, Abigail; Ploeg, Jenny; Parker, Deborah; Sinclair, Shane; Dal Bello-Haas, Vanina; Earl, Marie; You, John J.
Abstract Background Despite increased annual mortality in long-term care (LTC) homes, research has shown that care of dying residents and their families is currently suboptimal in these settings. The purpose of this study was to evaluate resident and family outcomes associated with the Strengthening a Palliative Approach in LTC (SPA-LTC) program, developed to help encourage meaningful end of life discussions and planning. Methods The study employs a mixed method design in four LTC homes across Southern Ontario. Data were collected from residents and families of the LTC homes through chart reviews, interviews, and focus groups. Interviews with family who attended a Palliative Care Conference included both closed-ended and open-ended questions. Results In total, 39 residents/families agreed to participate in the study. Positive intervention outcomes included a reduction in the proportion of emergency department use at end of life and hospital deaths for those participating in SPA-LTC, improved support for families, and increased family involvement in the care of residents. For families who attended a Palliative Care Conference, both quantitative and qualitative findings revealed that families benefited from attending them. Residents stated that they appreciated learning about a palliative approach to care and being informed about their current status. Conclusions The benefits of SPA-LTC for residents and families justify its continued use within LTC. Study results also suggest that certain enhancements of the program could further promote future integration of best practices within a palliative approach to care within the LTC context. However, the generalizability of these results across LTC homes in different regions and countries is limited given the small sample size.
Open Access
An Interpretive Ethnography: Nursing Culture for People with Dementia and Behavioral and Psychological Symptoms of Dementia in the Acute Care Environment
(2018-09-12) Hannaford, Sara Anne Dellarie; Venturato, Lorraine; Fox, Loralee; Holroyd-Leduc, Jayna M.; Raffin Bouchal, Shelley
Objectives: Acute care nurses care for people with dementia (PWD) who suffer from behavioral and psychological symptoms of dementia (BPSD) in care environments that may worsen BPSD. The purpose of this study is to understand the nursing culture of care that exists for PWD with BPSD, and align this culture of care with the theory of person-centered dementia care (PCC). Methods: An interpretive ethnography approach was used, and data was collected on a general medicine unit at one acute hospital through 75 hours of participant observation and five semi-structured interviews with registered nurses and licensed practical nurses. Data was thematically analyzed. Results: A number of facilitators (teamwork, creativity, knowing the person, care plans, flexibility) and barriers (time constraints, safety, restraint use) for prevision of PCC to PWD and BPSD were identified. The culture of care for PWD with BPSD is shaped by formal protocols, informal protocols or unwritten rules, and beliefs about PWD and the nurses’ role in acute care. Nurses’ ability to provide PCC is limited by the incompatibility between the needs of the PWD and the acute care environment, and risk-averse safety culture that promotes physical safety over the needs and wants of the PWD. Conclusion: PWD with BPSD should be supported outside of the acute care environment when possible. The acute care environment needs to become more dementia friendly, and nurses need support and permission on a systems and individual level to re-conceptualize the meaning of risk for PWD with BPSD.
Open Access
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.
Open Access
Continuing the Dance: A Constructivist Grounded Theory of Understanding Transitions of Rural Couples with Parkinson's Disease
(2020-09-14) Robinson, Tanis Arlene La Rose; Venturato, Lorraine; Bouchal, Shelley Raffin; Green, Theresa L.
Parkinson’s disease (PD) is a complex chronic debilitating neurological disease characterized by muscle stiffness, rigidity, tremors, and postural imbalances – making it the second most common neurological disorder in Canada after Alzheimer’s disease. PD affects more men than women, diagnosis occurs around age 60, no known cause or cure exists, and rural living has been linked as a known risk factor. Little extant research helps us understand the rural couple’s experience and the processes used to adapt and transition to living with PD. As a result, adaptations and transitions of couples living in rural areas and implications to accessing health care services were explored. Constructivist grounded theory methodology guided this study. Purposeful sampling was used to recruit five couples and one additional participant living in rural areas, in which one spouse was diagnosed with PD, for a total of 11 participants. Five open-ended intensive joint interviews and one single intensive interview were conducted and transcribed verbatim. Charmaz’s constructivist grounded theory analysis steps were used to guide analysis of the data. Participants described their experience of living with PD in rural areas as an innate process of adapting, planning, and managing PD that allowed them to transition together, as a couple. Their main concern was learning how to negotiate the adaptations and transitions together – continuing a dance they began together many years ago. Through “negotiating the dance” together, couples “choreographed the dance,” “danced together,” and experienced “Adagio–Changing the Tempo.” As a result, they “continue the dance” every day. Recommendations for further research on rural couples with PD and the broader Parkinson’s community are also made.
Open Access
Disclosure of Sexual Orientation in Primary Health Care: Gay Men's Stories of Coming Out
(2018-09-20) Cashen, Daniel Steven; Estefan, Andrew; Venturato, Lorraine; Dela Cruz, Añiela Marie; Ginn, Carla S.; Then, Karen L.
Access to primary health care is important for maintenance of health and well-being and the timely treatment of illness. Primary health carers address many dimensions of people’s health and social welfare. The literature suggests that experiences of primary health care might be problematic for gay men. For many reasons, it can be difficult for gay men to discuss their sexual orientation with primary providers. The health literature offers little guidance about how gay men experience primary health care. The health care literature about gay men is dominated by studies about the transfer and prevention of sexually transmitted diseases, and there is little exploration of patient-practitioner relationships in the context of primary health care. This study is a narrative inquiry into three gay men’s experiences of “coming out,” or disclosure of their sexual orientation in primary health care. Three narrative accounts form the basis for the development and discussion of three narrative threads: Disclosure and Connections, Opportunities Taken and Lost, and Making Maps for Connections. Recommendations for nursing practice, research, and policy development are made.
Open Access
The Educational Needs of Professional Hospice Staff: An Ethnographic Inquiry
(2021-08-26) Mason, Andrea; Raffin-Bouchal, Shelley; Sinclair, Shane; Ginn, Carla; Venturato, Lorraine
Hospice care delivered by an interdisciplinary team of professional staff includes care of those individuals with a life-limiting illness and a prognosis of days to a few months. It serves a variety of individuals with a combination of multiple diseases and co-morbidities and provides support for their families. A skilled health workforce is needed to deliver quality hospice and palliative care services. Inconsistencies in hospice staff knowledge and provided education have been identified locally in Alberta and across Canada. In previous studies, hospice nurses have identified knowledge deficits in pain and symptom management, psychological and spiritual care, and communication with dying patients. This research, engaging a focused ethnographic methodology, occurred at a local 26-bed hospice. I immersed myself in the hospice culture and in the research process to understand ways that the culture of hospice care can shape the educational needs of professional hospice staff. Data consisted of semi-structured interviews of hospice staff key participants, observations of interdisciplinary hospice professionals during their daily work, examination of hospice cultural documents and artifacts, and the writing of field notes over three months. The study findings suggest that at the core of the hospice staff educational needs lies three primary themes: communication as an essential foundation of quality care; interdisciplinary collaboration is vital for team cohesiveness and lastly, the central care philosophy utilized by the hospice interdisciplinary team is person/resident and family-centered care. These findings offer suggestions for hospice education and further research. Relational care is foundational for this philosophy, with trusting relationships at the forefront of care.
Open Access
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.
Open Access
Examining End-of-Life Experiences of Family Caregivers for People Living with Dementia During Covid-19: An Interpretive Description Study
(2021-08) Mithani, Sameer Ashraf; McGhan, Gwen; McCaughey, Deirdre; Venturato, Lorraine
Family caregivers of people living with dementia (PLWD) are key participants in determining and carrying out end-of-life care for PLWD. In an effort to contain the spread of Covid-19, public health restrictions, such as no visitation in care settings, were enacted which had the potential to severely impede the family caregiver’s role in providing end-of-life care. This study aims to determine the experiences of family caregivers who provided end-of-life care to PLWD during Covid-19. To examine these experiences, the qualitative method of interpretive description was utilized. Family caregivers in Alberta, Canada were invited to participate in an online survey to examine their caregiving experiences during the Covid-19 pandemic, with the option of participating in a follow-up focus group. Sixteen FCGs whose family members with dementia died during the pandemic participated in the survey. A follow-up focus group (n=3) was conducted virtually to further examine how Covid-19 policies impacted their role as a caregiver for the PLWD in long-term care and affected the family caregiver’s ability to grieve. The results of the survey and virtual focus group suggest that a lack of role clarity and inadequate communication channels between the family caregivers and long-term care centers due to Covid-19 increased the strain family caregivers faced during end-of-life care. Participants also expressed frustration regarding their inability to communicate with the PLWD due to public health restrictions. Additionally, participants felt that protocols related to visitation were unclear. At the end of life, public policies, such as reduced or no visitation, led to feelings of chronic grief. Several participants also expressed appreciation for having previously completing advance care planning documentation prior to Covid-19. Family caregivers also felt that the limitation on gatherings negatively impacted their ability to grieve and organize adequate funeral services for the PLWD. Based on these results, policymakers can help ease the increased challenges faced by family caregivers during end-of-life care in future public health emergencies by involving family caregivers of PLWD in the decision-making process. The completion of advance care planning documentation can also ease the burden family caregivers may experience prior to and during end-of-life care.
Open Access
From apprehension to advocacy: a qualitative study of undergraduate nursing student experience in clinical placement in residential aged care
(2018-03-01) Moquin, Heather; Seneviratne, Cydnee; Venturato, Lorraine
Abstract Background Undergraduate nursing placement in aged care is forecast to grow in importance with the increasing aging population, and to help to reverse trends in student lack of interest in gerontology careers. However, there is a need to better understand undergraduate nursing students’ experiences on placement with older adults, as well as key features of quality learning within residential aged care. The aim of this study was to explore how nursing students understand learning within residential aged care. Methods This qualitative study used a participatory action research approach, and this paper reports on the thematic analysis of data from one cycle of undergraduate nursing placement in a Canadian residential aged care setting, with two groups of 7–8 students and two university instructors. Staff and residents at the research site were also included. Researchers interviewed both groups of students prior to and after placement. Instructors, staff and residents were interviewed post placement. Results Students commenced placement full of apprehension, and progressed in their learning by taking initiative and through self-directed learning pathways. Engagement with residents was key to student learning on person-centred care and increased understanding of older adults. Students faced challenges to their learning through limited exposure to professional nursing roles and healthcare aide/student relationship issues. By placement end, students had gained unique insights on resident care and began to step into advocacy roles. Conclusions In learning on placement within residential aged care, students moved from feelings of apprehension to taking on advocacy roles for residents. Better formalizing routes for students to feedback their unique understandings on resident care could ensure their contributions are better integrated and not lost when placements end.
Open Access
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.
Open Access
Life After ICU: The patient experience with ICU and after hospital discharge
(2023-04-13) McIntyre, Catherine Anne; Venturato, Lorraine; Laing, Catherine; Roze, Amanda; Grant, Chris
ICU can be a life-altering experience for patients and their families. ICU survivors may face a multitude of complications after their hospital stay that have been collectively termed Post Intensive Care Syndrome (PICS). In the current global environment of the COVID-19 pandemic, ICUs across the world have seen a drastic increase in ICU patients. It has been recognized within the ICU community that a better understanding of the post-ICU population is needed as there is a lack of understanding about what the ICU survivor experiences after hospital discharge and what resources may support them to manage best or avoid PICS. To examine the experience of former ICU patients, the qualitative method of Interpretive Description was utilized. Patients who participated in the ICU recovery clinic in Alberta, Canada, were invited to participate in a 45-minute interview about their experience with ICU and their life after hospital discharge. Three former ICU patients were interviewed virtually to share their experiences. The results of this study found themes in data analysis that include communication challenges, living with uncertainty, and post-ICU fallout. These themes do not occur in isolation but are interconnected and can impact the other themes, which ultimately can impact ICU survivors’ recovery. Participants expressed frustration with various communication challenges they experienced both during and after ICU, and the impact of visitation restrictions on their experience. Participants also expressed emotion about the uncertainty they face after an ICU admission, including uncertainty about what happened in ICU and uncertainty with their present and future. Finally, participants discussed their experience of living with the fallout of an ICU admission and the benefit of attending the ICU recovery clinic. The results of this study highlight the need for broader awareness and education for health professionals on the potential complications faced by ICU survivors after discharge. This study also shows support for specialized follow-up services, like the ICU recovery clinic. Specialized follow-up allowed each of the participants to be viewed holistically, beyond their medical diagnosis or physical impairment, and for the first time each had their experience normalized.
Open Access
Meaningful connections in dementia end of life care in long term care homes
(2018-09-24) McCleary, Lynn; Thompson, Genevieve N; Venturato, Lorraine; Wickson-Griffiths, Abigail; Hunter, Paulette; Sussman, Tamara; Kaasalainen, Sharon
Abstract Background Most persons with dementia die in long term care (LTC) homes, where palliative approaches are appropriate. However, palliative approaches have not been widely implemented and there is limited understanding of staff and family experiences of dying and bereavement in this context. Method This descriptive qualitative study explored family and staff experiences of end of life and end of life care for persons with dementia in LTC homes. Eighteen focus groups were conducted with 77 staff members and 19 relatives of persons with dementia at four LTC homes in four Canadian provinces. Results Three themes emerged: knowing the resident, the understanding that they are all human beings, and the long slow decline and death of residents with dementia. Discussion Intimate knowledge of the person with dementia, obtained through longstanding relationships, was foundational for person-centred end of life care. Health care aides need to be included in end of life care planning to take advantage of their knowledge of residents with dementia. There were unmet bereavement support needs among staff, particularly health care aides. Persons with dementia were affected by death around them and existing rituals for marking deaths in LTC homes may not fit their needs. Staff were uncomfortable answering relatives’ questions about end of life. Conclusions Longstanding intimate relationships enhanced end of life care but left health care aides with unmet bereavement support needs. Staff in LTC homes should be supported to answer questions about the trajectory of decline of dementia and death. Further research about residents’ experiences of deaths of other residents is needed.
Open Access
Multi-disciplinary supportive end of life care in long-term care: an integrative approach to improving end of life
(2021-05-22) Harasym, Patricia M.; Afzaal, Misha; Brisbin, Sarah; Sinnarajah, Aynharan; Venturato, Lorraine; Quail, Patrick; Kaasalainen, Sharon; Straus, Sharon; Sussman, Tamara; Virk, Navjot; Holroyd-Leduc, Jayna M.
Abstract Background Optimal supportive end of life care for frail, older adults in long term care (LTC) homes involves symptom management, family participation, advance care plans, and organizational support. This 2-phase study aimed to combine multi-disciplinary opinions, build group consensus, and identify the top interventions needed to develop a supportive end of life care strategy for LTC. Methods A consensus-building approach was undertaken in 2 Phases. The first phase deployed modified Delphi questionnaires to address and transform diverse opinions into group consensus. The second phase explored and prioritized the interventions needed to develop a supportive end of life care strategy for LTC. Development of the Delphi questionnaire was based on findings from published results of physician perspectives of barriers and facilitators to optimal supportive end of life care in LTC, a literature search of palliative care models in LTC, and published results of patient, family and nursing perspectives of supportive end of life care in long term care. The second phase involved World Café Style workshop discussions. A multi-disciplinary purposive sample of individuals inclusive of physicians; staff, administrators, residents, family members, and content experts in palliative care, and researchers in geriatrics and gerontology participated in round one of the modified Delphi questionnaire. A second purposive sample derived from round one participants completed the second round of the modified Delphi questionnaire. A third purposive sample (including participants from the Delphi panel) then convened to identify the top priorities needed to develop a supportive end-of-life care strategy for LTC. Results 19 participants rated 75 statements on a 9-point Likert scale during the first round of the modified Delphi questionnaire. 11 participants (participation rate 58 %) completed the second round of the modified Delphi questionnaire and reached consensus on the inclusion of 71candidate statements. 35 multidisciplinary participants discussed the 71 statements remaining and prioritized the top clinical practice, communication, and policy interventions needed to develop a supportive end of life strategy for LTC. Conclusions Multi-disciplinary stakeholders identified and prioritized the top interventions needed to develop a 5-point supportive end of life care strategy for LTC.
Open Access
Nurses Experiences, Long-Term Care, and Covid-19
(2024-10-17) Gruszecki, Holly; McGhan, Gwen; Venturato, Lorraine; McAffrey, Graham; Toohey, Ann; McGhan, Gwen; Venturato, Lorraine
This master’s thesis explores the experiences of registered and licensed practical nurses working in long-term care both during, and in the immediate aftermath of the Covid-19 pandemic in Alberta, Canada. Using Van Manen’s Phenomenology as a guiding research methodology, semi structured interviews were conducted with registered and licensed practical nurses working in long-term care to explore the experiences of the participants. There were four common themes identified from the data: (1) fear and uncertainty, (2) workload, (3) burnout, and (4) resilience and adaptability. These themes have been explored in comparison to the literature with the intention to provide recommendations for future pandemics and the retention of a robust, healthy, and experienced workforce. As the healthcare landscape in Alberta approaches another period of change and flux with the introduction of a system wide restructure, these findings may relate to on-going change within the sector and the turbulence that nurses experience following change. In the wake of the pandemic, the experiences of nurses who battled through it can inform policy makers to implement policies that leverage the strengths of the long-term care nursing workforce.
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
Perspectives and experiences of compassion in long-term care facilities within Canada: a qualitative study of patients, family members and health care providers
(2019-05-06) Smith-MacDonald, Lorraine; Venturato, Lorraine; Hunter, Paulette; Kaasalainen, Sharon; Sussman, Tamara; McCleary, Lynn; Thompson, Genevieve; Wickson-Griffiths, Abigail; Sinclair, Shane
Abstract Introduction This paper details a subset of the findings from a participatory action research project exploring a palliative intervention in long-term care sites across Canada. The findings presented in this paper relate to understanding compassion within the context of a palliative approach to long-term care. Methods Findings presented are drawn from qualitative interviews and focus groups with residents, family members, healthcare providers, and managers from 4 long-term care sites across 4 provinces in Canada. In total, there were 117 individuals (20 residents, 16 family members, 72 healthcare providers, and 9 managers) who participated in one of 19 focus groups. Data was analyzed by multiple members of the research team in accordance with thematic analysis. Individual concepts were organized into themes across the different focus groups and the results were used to build a conceptual understanding of compassion within Long Term Care . Findings Two themes, each comprised of 5 sub-themes, emerged from the data. The first theme 'Conceptualizing Compassion in Long-Term Care generated a multidimensional understanding of compassion that was congruent with previous theoretical models. 'Organizational Compassion: resources and staffing', the second major theme, focused on the operationalization of compassion within the practice setting and organizational culture. Organizational Compassion subthemes focused on how compassion could support staff to enact care for the residents, the families, one another, and at times, recognizing their pain and supporting it through grief and mourning. Conclusions Results suggest that compassion is an essential part of care and relationships within long-term care, though it is shaped by personal and professional relational aspects of care and bound by organizational and systemic issues. Findings suggest that compassion may be an under-recognised, but essential element in meeting the promise of person-centred care within long-term care environments.
Open Access
Registered Nurses and The Culture of Nursing Burnout in a Canadian Surgical Burn Unit
(2019-09-17) Tilley, Amy Nicole; Goopy, Suzanne E.; Estefan, Andrew; Venturato, Lorraine
The Canadian health care system is facing critical nursing shortages resulting in extensive wait lists and diminishing quality of care due to, among other things, burnout and turnover of nurses. Burnout among nurses has traditionally been researched from an individualistic lens; in other words, the nurse experiencing burnout is studied. However, by researching burnout from a cultural perspective, I was able to learn about aspects of burnout that extend beyond individual nurses. In order to address nursing burnout, it is important to first obtain a thorough understanding of the role that the culture of organizations can play in allowing for burnout. Because individual problems or experiences happen within cultural contexts, they cannot be divorced from each other. In this thesis, I seek to inform this complex subject using an adapted ethnographic approach. This study took place on a surgical burn unit. Five registered nurse participants were observed and eight participants interviewed about their experiences of the unit, its culture, the demands they face, and their coping strategies. Data from ten observational shifts and eight semi-structured interviews, including interviews with key stakeholders, were analyzed. Participants all reported signs and symptoms associated with burnout which were also observed in daily practice. Interestingly, all participants expressed similar experiences of burnout indicative of a culture of nursing burnout within the unit. Varying reasons for this, both stated and observed, are explored in this thesis.
Open Access
Revisiting the Fork in the Road: Exploring the Meaning of Critical Incident Stress Among Intensive Care Unit Nurses
(2018-12-18) Harvey, Giuliana; Tapp, Dianne M.; Venturato, Lorraine; Wulff, Dan
The nature of registered nurses’ (RNs’) work in the intensive care unit (ICU) places them at risk for encountering work-related critical incident stress. Critical incident stress is a term used to describe the broad and diverse range of responses that occur following a sudden and unexpected event known as a critical incident. Critical incident stress in the context of ICU nurses has been understudied. The purpose of this inquiry was to expand understanding of the meanings of work-related critical incident stress for RNs working with adults in the ICU. This research study was conducted using an interpretive approach based on Gadamer’s philosophical hermeneutics. Nine ICU RNs were interviewed to gain insight and further understanding of this topic. The interpretations from this work suggested that nurses attempted to cope with critical incident stress by functioning in “autopilot,” altering their ability to critically think and conceal emotions. Critical incident stress was influenced by the perception of judgment from co-workers and by the organizational culture. Participants emphasized the importance of timely crisis interventions tailored and individualized to support those in need of assistance. The concept of co-worker support underpinned by an authentic way of being with another through relating and connecting with team members was one element of crisis intervention considered beneficial. This study highlighted that critical incident stress was transformative in how ICU nurses’ practiced and in their view of nursing. For some participants, transformation took place in the form of an altered professional self-identity. Understanding the experience of critical incident stress in the context of ICU RNs has implications for nurses, the discipline, and the health care system.
Open Access
The Role of Social Support in Peritoneal Dialysis Management and Outcomes
(2019-07-09) Fox, Danielle Eleri; King-Shier, Kathryn M.; Quinn, Robert Ross; James, Matthew Thomas; Venturato, Lorraine
Peritoneal dialysis (PD) is an effective and cost-efficient renal replacement therapy that enables patients to maintain their independence at home. Unfortunately, technique failure is common and social support is necessary for PD success. The objective of this mixed methods study was to understand the significance and meaning of support in the PD context. Having a support person had a protective effect against technique failure between 3 and 12 months from the onset of PD. Social support was an important part of the PD experience, however, social support needs varied and were dependent on existing support networks and individual perspectives of support. To sustain patients on PD, the breadth of social support needs must be understood by healthcare providers and individualized to the patient/family.
Open Access
Selection of Peritoneal Dialysis Among Older Eligible Patients with End-Stage Renal Disease
(2016) Wong, Ben; Holroyd-Leduc, Jayna M.; Quinn, Rob; Ravani, Pietro; Venturato, Lorraine
This study seeks to explore potential patient and care provider barriers that may explain why older patients with end-stage renal disease (ESRD) are less likely to choose peritoneal dialysis (PD). A mixed methods approach was used: survival analysis was performed on administrative data of patients deemed eligible for both PD and hemodialysis (HD); semi-structured interviews were also conducted with older patients. We found PD and HD are associated with similar survival in incident dialysis patients regardless of patient’s age, and the effect of modality on survival did not vary with follow-up time. Selection of a particular dialysis modality is highly personal and is driven by patient preference for the convenience and maintenance of a normal life provided by PD versus the heightened sense of security afforded by in-centre HD. Addressing these issues when counselling about dialysis choice may help increase PD uptake among older ESRD patients.