Browsing by Author "White, Deborah"
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- ItemOpen AccessBirthing Unit Culture and Its Impact on How Nurses View and Enact Birth Plans(2013-09-23) Sebastian, Sandra Jean; White, DeborahPregnancy and childbirth are important milestones in the development of a family. Birth plans allow childbearing women to plan and express their wishes for their birth experience. Labour and delivery nurses play a key role in providing care on birthing units in Canada and are uniquely placed to enact a woman’s birth plan. A focused ethnographic study was undertaken to examine birthing unit culture and its impact on how labour and delivery nurses care for women with birth plans. Findings revealed three overarching themes (ensuring safe care, teamwork, and connecting with patients) that shaped birthing unit culture and impacted how labour and delivery nurses viewed and enacted birth plans. Organizational influences and individual healthcare provider preferences influenced how birth plans were enacted on the unit. Patient safety was a dominant driver of care. Challenges exist on how to partner with childbearing women and their families while assisting them in the goals for their birth experience. Collaboration is key as providers strive to embrace a woman’s birth plan expectations and work toward a shared understanding and partnership in childbirth.
- ItemOpen AccessConnecting in Crisis: Family Presence in Resuscitation(2014-01-30) Schmidt, Rosemary; White, Deborah; Raffin Bouchal, Shelley; MacLeod, BruceFamily presence during resuscitation, while discussed and championed by numerous health care organizations remains an inconsistent practice in many emergency departments, including the one examined in this study. Nurses who participated in this grounded theory study reported support and advocacy for family presence. Family members were regarded a valuable resources for the patient and health care team. The nurses discussed the importance of families being together and working together with the health care team in the resuscitation effort. The social process that emerged from the study was connecting in crisis. Facilitating family presence via policy development was not palatable to the participants. Rather, an overarching belief in the importance of family presence and a situational assessment of resuscitation, patient, family, and team was deemed as necessary prior to family inclusion.
- ItemOpen AccessExploring the Barriers and Facilitators of Nurse Engagement in Comfort Rounds(2015-01-28) Virk, Navjot; White, DeborahBackground. Nurses have an opportunity to improve services and enhance patient care. The purpose of this research is to highlight the missing voice of the frontline nurses and their experience in implementing a quality improvement (QI) initiative called comfort rounds. Comfort rounds are an Elder-Friendly QI initiative that involves purposive rounding conducted at regular intervals on patient care units. Objectives. 1) To understand the experiences of nurses that participated in comfort rounds. 2) To describe the facilitators and barriers to the participation of nurses in the introduction of comfort rounds. Methods. A single case study design, using multiple data sources, was used to explore and collect detailed descriptions of comfort round implementation on an acute medical unit. Findings. Frontline staff can help identify barriers and facilitators for comfort rounds. Engaging frontline nurses throughout the entire QI initiative process (i.e. from planning stages to sustainability) is essential for implementing practice change.
- ItemOpen AccessGroup Conformity in Interprofessional Teams(2016) Kaba, Alyshah; Beran, Tanya; White, Deborah; McLaughlin, KevinWithin the multidisciplinary team environment, professionals bring varying levels of experience, authority, and responsibility: examining how team members interact is critical to ensure the highest standard of patient care. One type of influence in this environment is peer pressure, whereby an individual changes his or her own behavior to match the responses of others in a group. Known as conformity, this body of research, which spans 60 years since Asch’s (1951) seminal work, has only recently been examined in medical education (Beran et al., 2012). When the individual conforms to an incorrect diagnosis or plan for treatment, the safety of the patient may be compromised, contributing to the burden of adverse events. Given the ubiquity of collaborative practice in healthcare, the research presented in this dissertation is about succumbing to peer pressure - and the greater pressures experienced by nursing as compared to medical students to conform to a procedural task. This thesis is divided into four papers. The first paper is a narrative review, the second paper is a methods paper, the third paper compares the difference between medical and nursing students’ rate of conformity on a vital sign skill task, and the fourth paper examines whether conforming on the vital signs task is related to their clinical interpretations. The study is an adaption of the original Asch design to recreate conformity within an interprofessional simulated environment. The findings from the four papers presented in this dissertation, suggest that social pressure may prevent nursing and medical students from questioning incorrect information within interprofessional environments. If health professional students are making clinical decisions based on the consensus of the group, this is a critical issue for patient safety, as we cannot negate the fact that these students will one day be future doctors and nurses and will be working with real patients. To improve teamwork and collaboration amongst medicine and nursing in practice, Interprofessional Education (IPE) curriculum needs to teach students how to overcome barriers within the medical hierarchy, by encouraging students to question and politely challenge what seems to be incorrect information.
- ItemOpen AccessInside triage: the social organization of emergency nursing work(2012-04) Melon, Karen Anne; Rankin, Janet; Scott, Cathie; White, DeborahEmergency care in large urban hospitals across the country is in the midst of major redesign intended to improve access, decrease wait times and maximize efficiency. Using Institutional Ethnography, I was able to document critical, empiric evidence that shows what nurses actually do to manage the safe passage of patients through their emergency care process starting with the work of triage nurses. The Canadian Triage and Acuity Scale figures prominently in the analysis as a high level organizer of triage work and knowledge production that underpins the way those who administer the system define, measure and evaluate emergency care processes, and then use this information for restructuring. The core argument throughout is that industrial production line values and principles that have infiltrated health care management and reframe patient care, are having serious consequences. This critical analysis uncovers a number of deleterious effects as rapid patient processing disrupts expert nursing work, and will contribute to a broader understanding of health system quality.
- ItemOpen AccessAn Intervention to Enhance Mental and Physical Health of Nursing Students(2022-09) Ciezar Andersen, Sylwia; King-Shier, Kathryn; White, Deborah; Campbell, TavisNursing 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.
- ItemOpen AccessMentorship in Nursing Academia: A Mixed Methods Study(2017) Nowell, Lorelli; White, Deborah; Benzies, Karen; Rosenau, PatriciaNursing educators globally have called for mentorship to help address the nursing faculty shortage. Mentorship is perceived as vital to maintaining high-quality education programs. While there is emerging evidence to support the value of mentorship in other disciplines, the extant state of the evidence for mentorship in nursing academia is not well-established. Little is known about the current state of mentorship or the barriers and facilitators for implementing mentorship programs in Canadian nursing schools. The overarching aim of this dissertation was to explore the current state of mentorship in nursing academia. Three methodologies were employed to examine this phenomenon: 1. A systematic review of the evidence. 2. A cross sectional survey of nursing faculty. 3. Semi-structured interviews with nursing faculty members from across Canada. Descriptive statistics and thematic analysis were used to analyze the data. The results of all three phases were integrated to develop a more robust and meaningful picture of mentorship. Within the literature there is no clear differentiation and operationalization of program and individual outcomes of mentorship nor is there discussion of the role of formal (matched) and informal (self-selected) mentorship within schools that identify mentorship programs. While generally, in the literature at an individual level, mentorship is reported to positively impact behavioural, career, attitudinal, relational, and motivational outcomes; it is important to note that the methodological quality of the mentorship studies is weak. Additionally, while outcomes can be categorized as noted above, it is also apparent that whether academics seek out their own mentors through informal and established networks or are matched with mentors in a formalized program it is difficult to untangle whether the outcomes are a result of the formal program or individual efforts. The survey and interview data revealed that the majority of Canadian nursing schools lack formal mentorship programs and those that exist are largely informal, vary in scope and components, and lack common definitions or goals. Individual perceptions of factors influencing mentorship program implementation include (a) training and guidelines; (b) quality of relationships; (c) choice and availability of mentors; (d) organizational support; (e) time and competing priorities; (f) culture of the institution; and, (g) evaluation of mentorship outcomes. Dyad, peer, group, constellation, and distance mentorship models are present and components include guidelines, training, professional development workshops, purposeful linking of mentors and mentees, and mentorship coordinators. Evaluation of mentorship, where it exists, remains mostly descriptive, anecdotal, and lacks common evaluative metrics. The results from this study confirm lack of formalized mentorship programs in Canadian schools of nursing. To ensure success in developing mentorship programs, academic leaders need to consider multiple barriers, facilitators, models and components to meet their specific needs. Further rigorous evaluation of mentorship programs and components is needed to identify if mentorship programs are achieving specified goals.
- ItemOpen AccessRole of Middle Managers in Quality Improvement Implementation(2015-04-23) Zjadewicz, Karolina; White, DeborahLimited consensus exists around the manager’s role in QI project implementation as viewed by both managers and other stakeholders alike. The aim of this research is to investigate how middle managers in a Canadian critical care setting perceive their role and associated responsibilities in facilitating the implementation of a mandated QI project. Interviews with eight critical care middle managers were conducted to understand how they viewed their role during the implementation of a mandated delirium screening and management QI project. Using Charmaz’s (2014) approach to grounded theory, an explanatory framework is created demonstrating that managers perceive their role as ensuring or building multi-faceted understanding of the project amongst frontline staff members. Understanding assists in engaging staff during project implementation and helps to “make sense of the project”. Barriers managers experience include prioritizing QI projects amongst competing priorities, leading the multidisciplinary team, and supporting the local context with limited QI knowledge.
- ItemOpen AccessThe Seamless Transfer-of-Care Protocol: a randomized controlled trial assessing the efficacy of an electronic transfer-of-care communication tool(BioMed Central, 2012-11-21) Okoniewska, Barbara M.; Santana, Maria J.; Holroyd-Leduc, Jayna M.; Flemons, W. Ward; O'Beirne, Maeve; White, Deborah; Clement, Fiona M.; Forster, Alan; Ghali, William A.
- ItemOpen AccessSuffragettes for Caesareans: "Every woman should have a choice"(2016) Imanoff, Julia; Mannion, Cynthia; McCaffrey, Graham; White, Deborah; McNeil, DeborahPatient choice for caesarean delivery (CD) is complex. This choice poses a challenge to maternity Health Care Providers (HCPs) in terms of resource allocation, economics, and surgical risks. Yet, women’s understanding of choice is poorly understood. This study answers the question: how HCPs might understand women’s choice for CD? Four primiparous women who chose a CD were recruited. Semi-structured interviews were used to generate data. The interpretation followed a hermeneutic approach. The interpretations emphasized the complexities of choice, HCPs’ role in birth experiences, and how the woman in this study understood vaginal deliveries as risky and unpredictable and caesarean deliveries as safe and controlled. These findings question how HCP’s understandings of choice can shape patient care. HCPs have the opportunity to recognize the meaning of the choice for each woman and how it is situated in a broader historical context, and how they can promote positive birth experiences in their practice.
- ItemOpen AccessThe Experience of Transitioning into Motherhood: Giving a Voice to Mothers with Very Low Birth Weight Babies(2014-03-06) BRIGHT, KATHERINE; Mannion, Cynthia; Raffin Bouchal, Shelley; White, DeborahThe transition to motherhood is filled with emotional, physical, and social challenges for many women. These challenges are strongly influenced by the physical health of their newborn babies. For women with babies who are medically compromised as a result of being born preterm and of very low birth weight (VLBW), concerns regarding short and long-term health outcomes are often considered to be a critical component contributing to maternal anxiety and depression. Anxiety and depression in mothers has been strongly associated with postpartum depression (PPD) and a reduction in maternal sensitivity and responsiveness to their babies. Little research has addressed the needs of mothers with VLBW babies as they transition from hospital into the community. This study was conducted using Grounded Theory methodology to explore the experiences of these mothers in caring for their VLBW babies during the transition from the Neonatal Intensive Care Unit (NICU) to the family home. Nurses providing comprehensive care to families with VLBW babies require an understanding of these mothers‟ perceptions of their transition into motherhood. Gaining an understanding of the mothers‟ needs will facilitate nursing care improvements to address physical and psychological stresses for mothers, as well as minimize potential negative social development for the babies.
- ItemOpen AccessUnderstanding patient engagement in health system decision-making: a co-designed scoping review(2019-04-18) McCarron, Tamara L; Moffat, Karen; Wilkinson, Gloria; Zelinsky, Sandra; Boyd, Jamie M; White, Deborah; Hassay, Derek; Lorenzetti, Diane L; Marlett, Nancy J; Noseworthy, ThomasAbstract Background With healthcare striving to shift to a more person-centered delivery model, patient and family involvement must have a bigger role in shaping this. While many initiatives involving patients and family members focus on self-care, a broader understanding of patient participation is necessary. Ensuring a viable and sustainable critical number of qualified patients and family members to support this shift will be of utmost importance. The purpose of this study was to understand how health systems are intentionally investing in the training and skill development of patients and family members. Methods Patient co-investigators and researchers conducted a scoping review of the existing literature on methods adopted by healthcare systems to build the skills and capacity of patients to participate in healthcare decision-making using a recognized methodological framework. Six electronic databases were searched to identify studies. Two independent reviewers screened titles and abstracts and full-text papers for inclusion. The research team independently extracted data. Any disagreements were resolved by achieving consensus through discussion. Quantitative and qualitative content synthesis, as well as a quality assessment, was conducted. Results After eliminating duplicates, the search resulted in 9428 abstracts. Four hundred fifty-eight articles were reviewed and 15 articles were included. Four themes emerged: forums (33%), patient instructors (20%), workshops (33%), and co-design (13%). Four of the identified studies measured the impact and overall effectiveness of the respective programs. Examples of how patient and family members were supported (invested in) included advocacy training to support future involvement in engagement activities, a training program to conduct patient-led research, involvement in an immersive experience-based co-design initiative, and involvement in training pharmacy students. Overall, these studies found positive outcomes when patients and family members were recipients of these opportunities. Conclusions The results of this scoping review demonstrate that an evidence base around programs to advance patient engagement is largely absent. An opportunity exists for further research to identify strategies and measures to support patient engagement in healthcare decision-making.
- ItemOpen AccessUnderstanding the Culture of the Single Room Maternity Care Unit: Ethnographic Study(2015-12-09) Ali, Elena; White, Deborah; Raffin, Shelly; Tough, SuzanneSingle room maternity model of care, where a woman stays in one room throughout her whole childbirth experience, involves continuity of care provider, with the same nurse providing antenatal, intrapartum and postpartum care. This focused ethnographic study was undertaken to explore the values, beliefs and everyday practices of nurses and other members of the healthcare team at a single room maternity care unit, as they care for childbearing women and their families. Findings revealed two interconnected themes-work family, and creating and maintaining culture- that influenced how members of the care team carried out their daily work related activities. Effective communication and collaborative practice created a supportive and positive working environment, and was key to achieving the goals of patient and family centered care. The unit culture greatly influenced healthcare providers’ perceptions of their roles and daily practices.
- ItemOpen AccessUsefulness of a Tailored ‘Situation Background Assessment Recommendation’ Form for Clinical Handover between Postpartum Settings(2014-05-21) MacKay, Jennifer; White, DeborahClinical handover is imperative to safety and quality of care. ‘Situation-Background-Assessment-Recommendation’ (SBAR) communication has been shown to improve the quality of handover. However, usefulness of tailoring the content of an SBAR form for communication between the postpartum acute care and community setting has not been studied. This descriptive mixed methods study evaluates the content validity of a tailored SBAR form and clinicians’ perception of the usefulness of the form to transfer psychosocial information between the postpartum acute care and community setting. In Phase One, an expert panel was employed to determine content validity. In Phase Two, focus group questionnaires and interview data were gathered from social workers and nurses. Findings from both Phases informed revisions. The SBAR form had excellent content validity. Focus group findings revealed multiple themes related to attitude about the usefulness of the form. Participants described the form as useful for improving the quality of clinical handover.