School of Nursing Graduate Theses
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Item Examining Postoperative Pain in South Asian Females with Breast Cancer or Pre-Cancerous Lesions Following Mastectomy or Lumpectomy: A Feasibility Study(2025-03-31) Farwaha, Jasleen; Nursing; Sawhney, MonakshiIntroduction: South Asian females are diagnosed with breast cancer at a later stage as compared to other Canadian females. This may be due to language barriers and fear of stigma in their community. Unfortunately, this can lead to the need for more extensive surgery. Following surgery, South Asian females experience acute pain that may lead to chronic postoperative pain. Research regarding pain in South Asian females who undergo surgery for breast cancer in Canada is lacking. This study aimed to examine the feasibility of recruiting South Asian females and to examine pain following breast surgery. Methods: This descriptive, observational study examined the feasibility of recruiting and retaining South Asian females with diagnosed breast cancer or pre-cancerous lesions in a study that examines acute pain after mastectomy and lumpectomy. South Asian females were recruited in person or over the telephone from a breast cancer clinic in the Greater Toronto Area. Pain was examined using the numeric rating scale, the BPI-SF, on postoperative day (POD) 1 and 7. Analgesic use and side effects were also examined. Results: Twenty-three of 29 eligible South Asian females consented to participate. The mean age of participants was 58.8 years old (SD 13.3), and most were from India (60.9%). On POD 1 participants reported a mean “worst” pain score of 6.3 out of 10 (SD = 2.4), and by POD 7, the mean pain score decreased to 4.5 (SD = 2.5). Pain interfered with normal work, general activity, and sleep. Conclusions: South Asian females who undergo breast surgery are willing to participate in studies that may help others. Participants reported mild to moderate pain up to 7 days after surgery. Education regarding how to treat pain and analgesic protocols may help this population better manage their pain.Item Medication Safety Following Electronic Health Record Implementation in Pediatric Intensive Care(2025-01-31) Pereira, Nichole; Nursing; Egan, RylanBackground: Globally, medication-related safety incidents contribute significantly to patient harm. Patients are at risk of preventable harm from medication use in healthcare, with pediatric care being particularly vulnerable. Electronic Health Records (EHRs) have been implemented to influence medication safety, offering both benefits and challenges for direct care providers and patients. This dissertation investigates the influence of EHR implementation on medication safety in a Pediatric Intensive Care Unit (PICU) at an urban children's hospital in Alberta, Canada, using Safety-II and resilience engineering frameworks. Methods: This manuscript-style dissertation consists of three studies. The first manuscript is a scoping review identifying approaches to studying medication safety following EHR implementation, highlighting gaps in the literature and conceptual design elements for future studies. The second manuscript is a mixed-methods study analyzing voluntary incident reports submitted pre- and post-EHR implementation in the PICU. Quantitative analysis cataloged and compared primary incidents and contributory factors, while thematic analysis identified correlations between socio-technical influences. The third manuscript is a case study realist evaluation, incorporating qualitative socio-technical, Safety-II, and resilience engineering frameworks to explore the experiences and perceptions of PICU nurses, physicians, and pharmacists related to medication use and the EHR. Results: The scoping review revealed conceptual design elements for studying medication safety in EHR contexts. The mixed-methods study found that prescribing incidents were reported significantly more often post-implementation, while administration incidents were reported significantly less. Four qualitative themes emerged from the incident reports: (1) order and instruction (in)accuracy at the user interface; (2) misinformation and decision-making; (3) continuity of care between clinical units; and (4) equipment and supply-related challenges. The case study identified three themes demonstrating how direct care providers adjusted their work to ensure safer outcomes: (1) the evolving roles and responsibilities of physicians, nurses, and pharmacists; (2) staying “on top” of orders; and (3) balancing risk, efficiency, and relationships in patient care. Conclusion: This research highlights the persistent challenges of medication safety post-EHR implementation and the resilient strategies direct care providers employ to mitigate risks. It challenges current structures of power and hierarchy in medication safety and questions the role of standardization as it contributes to safer systems. The findings provide insights to guide future research, system transformation, and quality improvement efforts. Leaders and administrators can use these findings to anticipate potential issues and inform EHR implementation strategies or design their own investigations into medication safety.Item Moving Health Care Upstream to Advance Health, Health Quality, and Health Equity: Defining Social Prescribing and Exploring the Impact on Children and Youth(2025-01-24) Muhl, Caitlin; Nursing; Godfrey, ChristinaSocial prescribing is gaining traction globally, with over 30 countries involved in the social prescribing movement. The aim of this thesis was to contribute to the advancement of this field by addressing two notable evidence gaps, namely the lack of agreement on the definition of social prescribing and the absence of a comprehensive review of the evidence on social prescribing for children and youth. To address the first evidence gap, a Delphi study was conducted to establish internationally accepted conceptual and operational definitions of social prescribing (Chapter 2). This study brought together 48 social prescribing experts from 26 countries to establish global agreement on what social prescribing is. This research culminated in the successful development of internationally accepted conceptual and operational definitions of social prescribing, as well as the Common Understanding of Social Prescribing (CUSP) conceptual framework. Subsequently, as a knowledge mobilization initiative for this work, a collective commentary was written with over 50 leaders in the field to reflect on the use and utility of the outputs of this work, and where we go from here (Chapter 3). To address the second evidence gap, a scoping review was conducted to map the evidence on the use of social prescribing for children and youth (Chapter 4). This study revealed that this area of research is still in its infancy, with limited, albeit promising, evidence on this topic and notable knowledge gaps in the evidence base. This thesis makes significant contributions to the field, with each phase playing its own unique role in the achievement of the aim of this thesis. By successfully addressing the aforementioned evidence gaps, this thesis has helped to move the field forward.Item The Impact of Early Palliative Care on Survival for Individuals with Advanced Non-Small Cell Lung Cancer(2025-01-09) Rodericks, Meaghan; Nursing; Goldie, Catherine (Katie)Background: Patients with advanced non-small cell lung cancer (NSCLC) face a high symptom burden and poor prognosis. While previous studies suggest early palliative care (EPC) improves quality of life, reduces symptom burden and hospital use, and extends survival for advanced NSCLC patients, there is limited evidence on the real-world impact of EPC on survival for these patients. Objective: This study investigated the association between EPC at the time of advanced NSCLC diagnosis and overall survival, accounting for patient-reported symptom burden. Methods: We conducted a retrospective, population-based cohort study using ICES data. Patients receiving palliative intent anticancer treatment and who had a symptom burden score within 8 weeks of diagnosis were included. EPC was defined by receipt of specialist palliative care consultation within 8 weeks of first palliative intent anticancer treatment. Baseline characteristics were summarized, and patients were stratified by symptom burden (low, moderate, high). Propensity score matching was used to compare those who received EPC with those who received late palliative care or no palliative care. Kaplan-Meier curves and multivariate Cox regression were applied to evaluate the impact of EPC on survival. Results: A total of 1,720 patients were matched on baseline characteristics. Contrary to our hypothesis, those who received EPC had lower survival within the first 4 years. Survival rates were 21.74% vs. 40.58% at 1 year, 8.88% vs. 21.71% at 3 years, and 4.13% vs. 10.41% at 4 years (P < .001). Multivariable Cox regression showed EPC was associated with decreased survival (HR: 1.59, 95% CI 1.48-1.71), consistent across symptom burden groups. Poisson regression analyses revealed that patients with worse patient-reported functional status and symptom burden were more likely to receive EPC. Receipt of EPC also varied based on year of diagnosis, region, rurality, type of first palliative intent anticancer treatment, and number of emergency department visits. Conclusion: Patients receiving EPC had worse survival, likely because EPC was prioritized for those nearing end of life, suggesting it was responsive rather than proactive EPC. This highlights the need for ii timely integration of EPC to maximize its potential benefit on both quality of life and survival in advanced NSCLC patients.Item A Systematic Investigation of Interventions Preventing Vaping Among Adolescents: A Multiple Method Study(2025-01-03) DiCasmirro, Jamie Lyn; Nursing; Goldie, Catherine (Katie)Background: E-cigarettes, also known as vaping devices, are the most commonly used nicotine product among Ontario adolescents, with past year prevalence doubling from 11% to 23% between 2017 and 2019. Since vaping has the potential to lead to future nicotine dependence this escalating prevalence is deeply concerning. The overall aim of this thesis was to examine public health interventions targeting the prevention of adolescent vaping and to identify characteristics associated with vaping among Ontario adolescents. Objectives: 1) To identify existing public health interventions targeting the prevention of adolescent vaping; 2) to determine and compare regional (Greater Toronto Area (GTA), north, west, east) variations in adolescent vaping rates and associated characteristics among a population-based sample of Ontario students; 3) to examine Ontario public health professionals’ perceptions of adolescent vaping. Methods: A multiple method study was used for this thesis. To address Objective 1, a scoping review was conducted using Joanna Briggs Institute methodology. Objective 2, a case-control analysis using cross-sectional Ontario Student Drug Use and Health Survey data was performed. A qualitative collective case study was conducted to address Objective 3. Results: Vaping prevention interventions found in the literature and real-world practice included: school-based, community-based, media/web-based, and policies/regulations. Factors enabling prevention efforts included partnerships and collaborations, and funding. Characteristics associated with vaping included: identifying as male (OR=1.36, 95% CI=1.11, 1.67), being a high school student (OR=2.61, 95% CI=1.95, 3.49); engaging in three hours or more of daily social media (OR=5.57, 95% CI=3.54, 8.76), alcohol use (OR=3.54, 95% CI=2.85, 4.37), smoking (OR=4.76, 95% CI=3.10, 7.30), cannabis use (OR=10.66, 95% CI=8.11, 14.0), having Canadian born parents (OR=1.37, 95% CI=1.06, 1.77); and feeling a part of the school community (OR=1.35, 95% CI=1.08,1.70). Of regional significance, students in northern, western, or eastern Ontario had increased odds of past year vaping compared to those in the GTA. Conclusions: Urgent action is needed to prevent adolescent vaping and protect this generation from associated risks. Public health interventions tailored to local characteristics and contexts are essential for maximizing impact. Study findings offer valuable insights for shaping and implementing effective vaping prevention strategies, contributing to improved population health outcomes for adolescents.