http://hdl.handle.net/1974/804 Thu, 20 Jun 2013 07:22:26 GMT 2013-06-20T07:22:26Z http://hdl.handle.net/1974/8017 Title: Symptom Experience and Quality of Life in Children Who Have Survived a Brain Tumour Authors: Macartney, Gail Abstract: Purpose The purpose of this enquiry is to explore the symptom experience and the health-related quality of life (HRQL) of children who have survived a brain tumour. Design An emergent, mixed-method study design was used with three phases of inquiry. 1) A systematic review was undertaken of previous research on the HRQL outcomes and symptom experience of children who have survived a brain tumour. 2) A quantitative study of the relationship between symptom experience and HRQL in 50 children who have survived a pediatric brain tumour was completed. This study was followed by a qualitative study of 12 children that used an interpretive descriptive methodology to understand the perceived relationship between symptom experience, coping and quality of life. 3) The results of phases 1 and 2 were translated into an evidence-informed clinical practice framework. Results 1) Pediatric brain tumour survivors had poorer HRQL outcomes than other cancer survivors or healthy peers. Only two previous studies had explored the relationship between symptoms and HRQL. 2) Pediatric brain tumour survivors experience many symptoms following the completion of treatment. The most distressing symptoms were pain, headaches, fatigue and sleep problems. Survivors of pediatric brain tumours described multiple symptoms that affect their life; yet overall they described their quality of life as good. Survivors used a variety of coping strategies to help mitigate the negative effects of these symptoms. 3) The results of the above studies informed the development of a clinical practice framework (the Queen’s-Macartney Multidisciplinary Action Plan for Oncology Survivors - Q-MapS), that requires further testing. It is intended to optimize clinical practice, to encourage education and to stimulate further research. Conclusions Child survivors of brain tumours experience various symptoms that can affect their HRQL. Nurses play a pivotal role in the systematic assessment and management of the multidimensional symptom experience of children following treatment for a brain tumour. Q-MapS can empower patients and their families by increasing their awareness of potential or actual problems related to their symptom experience and HRQL. More research is needed to better understand the relationship between symptoms and HRQL in children surviving brain tumours. Description: Thesis (Ph.D, Nursing) -- Queen's University, 2013-05-01 21:12:57.809 Thu, 02 May 2013 04:00:00 GMT http://hdl.handle.net/1974/8017 2013-05-02T04:00:00Z http://hdl.handle.net/1974/7957 Title: Continuity of Care in Mental Health Authors: Digel Vandyk, Amanda Abstract: Background: Individuals who make multiple visits to EDs for mental health complaints are a highly visible and challenging group. Recent healthcare priorities aimed at reducing inappropriate or unnecessary service use call for improved continuity of care. Implementing effective continuity interventions is contingent on sound foundational knowledge including population profiling and conceptual understanding. A deficit in these key elements is apparent in existing literature. These gaps in knowledge must be addressed to ensure quality continuity research targeting frequent presenters. Furthermore, there is a paucity of research available that implements evidence-informed methods and theory-driven measurement strategies. Objective: To strengthen the knowledge base on frequent mental health-related ED use and continuity in mental healthcare by addressing existing gaps in foundational knowledge and examining the phenomena at a regional tertiary healthcare centre. Method: This was a three-phase emergent study design using mixed methods. Phase 1 was an integrative study to synthesize research on frequent presenters to the ED for mental health complaints. Phase 2 was a theory analysis to explore the conceptual understanding of continuity in mental healthcare. Phase 3 was an observational case-control study of an exemplar population at a regional tertiary healthcare centre using the evidence-informed methods emerging from the first two phases. Results: From this enquiry, I proposed an evidence-informed profile for frequent presenters to the ED for mental health complaints, summarized parameters used to identify the frequent presenter population, highlighted existing areas of theoretical consensus not yet recognized in continuity research, and provided a global understanding of continuity in mental healthcare and an approach for selecting measurement strategies for continuity research. The observational study strengthened the emerging frequent presenter profile and explored CoC using a comprehensive tool. Conclusion: This doctoral thesis addresses important gaps in foundational knowledge by providing an evidence-informed frequent presenter population profile and global theoretical summary of continuity in mental healthcare. The observational study appears to be the first to use a theory-driven measurement tool and results differ from previous studies in which simple measurement approaches are used. Given this, new hypotheses/questions about the focus and role of CoC with frequent ED use need to be explored. Description: Thesis (Ph.D, Nursing) -- Queen's University, 2013-04-26 10:47:19.626 Fri, 26 Apr 2013 04:00:00 GMT http://hdl.handle.net/1974/7957 2013-04-26T04:00:00Z http://hdl.handle.net/1974/7708 Title: THE EXPERIENCES OF FAMILY MEMBERS WHO PROVIDE SUPPORT TO THEIR RELATIVE WITH RHEUMATOID ARTHRITIS Authors: Fallatah, Fatmah Abstract: Introduction: Rheumatoid arthritis (RA) is characterized by slow progression, functional limitations and poor quality of life. As a chronic disabling disease RA influence not only individuals but also their families. The impact of RA on family members includes providing the required care to the ill relative, postponing family plans, or altering family priorities and decisions due to the illness process. Purpose of the Study: The psychosocial changes that family members experience may possible compromise their health, family function and relationships with each other. The purpose of the current study was to describe the experience of family members who provide social support to their relative with RA. This study was set to explore the forms of support that are needed by family members to provide adequate support to their relative with RA. Method: The exploratory purpose of the study leads the researcher to conduct a descriptive qualitative study within the naturalistic inquiry. Naturalistic inquiry is consistent with the aims of this study in which the social support needs of family members of individuals with RA were explored and described. Findings: Five themes emerged from the data analysis, including: 1) effect of the disease; 2) reshaping the relationship; 3) providing support; 4) social support needs; and, 5) finding balance and coping. Conclusion: The impacts of RA on the lives of family members resulted from the chronicity of RA. Participants in this study described the effects of RA on themselves, the changes in the relationship with their relative with RA and their effort to maintain the relationship by providing support to their relative with RA. Additionally, they described the social support that they received from family members, friends and healthcare providers. They continuously identified the support they lacked. Nearly all participants were able to achieve balance between providing support and care to their relative with RA and engaging in their own life activities. They also utilized several coping strategies to achieve balance while providing support to their relative, carrying on their duty toward the family, work and their own personal needs. Description: Thesis (Master, Nursing) -- Queen's University, 2012-12-20 15:20:50.334 Thu, 03 Jan 2013 05:00:00 GMT http://hdl.handle.net/1974/7708 2013-01-03T05:00:00Z http://hdl.handle.net/1974/7327 Title: Theoretical and experiential perspectives on facilitating evidence-based practice in nursing: toward a conceptual framework Authors: Dogherty, Elizabeth J. Abstract: The Issue: The integration of evidence into practice is a complex process. Facilitation is a strategy that may assist practitioners with enhancing evidence uptake in nursing practice. However, the concept is not well understood from a front-line nursing perspective. Thesis Objectives: To describe facilitation in moving evidence into nursing practice and determine the nature of the facilitator role and the process of facilitation in theory and from actual experience to develop a conceptual framework to guide practitioners. Methods: A descriptive design utilizing mixed methods was employed: 1) Focused review of the literature that synthesized the current state of knowledge on facilitation as role and process in the implementation of evidence-based practice (EBP) in nursing. 2) Case audit and focus group interview with facilitators of cases involved in adapting guidelines and planning for implementation. A provisional framework was developed based on the literature review which guided the case audit and focus group interview. The data from the literature was integrated with data from those actively involved in facilitation to refine the framework. Results: Focused literature review: A final set of 39 papers were identified. Facilitation is described as supporting and enabling practitioners to improve practice through evidence implementation. Certain aspects of the role and the strategies being employed to promote change are evident. Current literature reveals that facilitation is viewed as an individual role as well as a process involving individuals and groups. Case audit and focus group interview: Forty-six discrete, practical facilitation activities discovered in the literature were in large part found as occurring within the cases. An additional 5 new, distinct activities related to facilitation were found in the case documentation. Findings suggest that facilitation is a multifaceted process and a team effort. Communication and relationship-building are key elements. Conclusion: The transparency and detail displayed in the revised framework may contribute to systematically developing, implementing, and testing facilitation interventions in nursing contexts. Facilitation is clearly an important strategy to advance EBP and the improved understanding of facilitation offered in this thesis provides a guiding framework for future investigations of evidence implementation where facilitation is a key element.   Description: Thesis (Master, Nursing) -- Queen's University, 2009-07-30 15:13:59.116 Wed, 18 Jul 2012 04:00:00 GMT http://hdl.handle.net/1974/7327 2012-07-18T04:00:00Z