School of Nursing Graduate Theses

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    'A Rich Man's Sickness': A Critical Hermeneutic Study on What It Is Like To Live with Diabetes in Liberia
    Bleah, Paulina; Nursing; Camargo-Plazas, Pilar
    Diabetes is a growing public health concern in Liberia, where an estimated 2.1% of its population of 5.2 million people are living with the disease. The challenges with diabetes in Liberia are enormous. Diabetes places immense socioeconomic pressure on individuals and their families and burdens an already overstretched health care system, still recovering from the destructive effects of the 14-year Liberian civil war (1989 – 1996 and 1999 – 2003) and the West African Ebola virus epidemic (2014 – 2016). While efforts towards rebuilding the Liberian health care system are ongoing, people with diabetes experience significant challenges with access to social and health resources to manage their illness. As such, the aim of this critical hermeneutic study was to explore what it is like to live with diabetes in Liberia. I recruited 10 participants from a publicly funded hospital in Monrovia, Liberia, to partake in this study. Photovoice, a well-established participatory data collection approach, was used to gather images and stories that represented participants’ daily experiences of living with diabetes. The themes uncovered highlight the assets, needs, and opportunities related to diabetes management and care in Liberia; assets – participants shared support from family, their church community, and their religious beliefs helped them cope with and manage diabetes; needs – participants voiced challenges with accessing healthy foods, diabetes medications and supplies, and diabetes-related health services; and opportunities – participants advocated for local governments and policy makers to prioritize diabetes on national health agendas and support programs and initiatives (i.e., diabetes centres) to improve care and outcomes for people living with diabetes in Liberia. The findings from this study provide a clearer picture of the impact of diabetes on individuals, families, and communities in Liberia. The experiences of people living with diabetes in Liberia are under-researched. Therefore, this timely research provides an opportunity for local governments and international partners to enact key recommendations for the purposes of improving health outcomes and quality of life for people living with diabetes in Liberia.
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    Transforming Healthcare for Tomorrow: Systems Thinking for Everyday Work
    Fell, Samantha E.; Nursing; Medves, Jennifer
    Introduction Evidence suggests that the traditional, linear approach to developing quality and safety interventions has failed to produce sustainable results. Despite this, most healthcare systems are slow to embrace less traditional quality and patient safety approaches. Systems Thinking is one such approach; however, the concept is often misunderstood. A set of principles has been developed to assist healthcare staff in applying Systems Thinking in their daily work, guiding discussions on the characterization of the system under investigation. This thesis investigated the adaptation and application of a Systems Thinking tool, the Systems Thinking for Everyday Work (STEW) cue cards, to determine their utility in US healthcare. Methods The study occurred in two phases using a pragmatic, participatory research approach. Multiple in-person and virtual sessions were held. Phase one used a consensus-building methodology to adapt a previously published set of STEW cards for use by front-line US healthcare workers. Phase two then applied the new cards to five different settings across the healthcare continuum. Results Findings from this study show that Systems Thinking and its application to healthcare as a complex adaptive system is quite novel and therefore requires the production of two sets of cards - one for the facilitator and one for the user. The participatory co-design approach ensured that the adaptation and testing of the cards were "grounded" and relevant to developing quality and safety interventions in healthcare. The STEW cards were shown to provide conversational cues to characterize the system and as such were compatible with other quality and safety improvement frameworks to develop interventions. The use of STEW cards produced sustainable interventions. Conclusions Overall, the STEW cards have proven useful in various healthcare settings and show early signs of applicability and acceptance for Systems Thinking in healthcare. This work is the first attempt to adapt and use the STEW cards in US healthcare. The cards provide an easy-to-use guide to help them understand the system being studied, learn from encountered problems, and the everyday work involved in their efforts to provide excellent care. Ultimately, the cards offer a practical "systems approach" for use within complex healthcare systems.
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    Practicing on the verge: Nurse practitioner capability development in the care of individuals with opioid use disorder
    Whitfield, Martha M.; Nursing; Wilson, Rosemary
    Nurse practitioner treatment of opioid use disorder in North America has been made possible by changes to prescriptive authority over the past decade and necessitated by the ongoing opioid overdose and poisoning epidemic. As advanced practice nurses, nurse practitioners have traditionally been evaluated using competency-based models. While competency-based education delineates measurable activities and skills, capability has the potential to describe advanced practice nursing within complex clinical settings, especially because the term is inclusive of variation in practice environment. For this thesis I aimed to clarify how capability is described in the global literature about advanced practice nursing and education (Phase 1), and to explore how nurse practitioners experienced capability development in the context of treatment of opioid use disorder (including safe supply) in primary care settings (Phase 2). I conducted a scoping review using the JBI methodology, followed by a phenomenographic study with a purposive sample of 21 nurse practitioners treating opioid use disorder in Canada and the United States. Finally, I synthesized findings from the phenomenographic study in the context of the scoping review results (Phase 3). Nurse practitioners experienced capability development as a process of knowledge acquisition, knowledge integration, evolving practice perspectives, practice adaption, and becoming expert. Although capability is described variously, there was congruence between what is written in the literature and results of the phenomenographic study, including the ability of nurse practitioners to critically evaluate clinical scenarios, identify knowledge gaps, and provide creative leadership to address care needs. Understanding capability in the context of opioid use disorder treatment has the potential to provide greater self-understanding for nurse practitioners and a clearer framework for articulating nurse practitioner contributions to the opioid overdose crisis to regulators, policy makers, and the public.
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    Exploring the Contributions of Nursing to Well-Child Care within Interprofessional Primary Care Teams
    Braithwaite, Suzanne E.; Nursing; Tranmer, Joan
    Background Registered nurses (RN) are well positioned to deliver well-child care, and health system reform calls for the effective use of interprofessional health care providers to meet the evolving needs within the primary care sector. Despite this, little is known about how RNs contribute to the delivery of well-child care or the attributes of the nursing care organization that influence RN scope of practice enactment in the delivery of well-child care. Purpose The overarching aim of this study was to explore attributes within the nursing care organization framework related to RN contributions to well-child care within the context of interprofessional primary care teams. Methodology To address the research aim, a multiple methods study was conducted which included a scoping review and a multiple-case study. We conducted the scoping review using the Joanna Briggs Institute (JBI) scoping review methodology. We used Yin’s approach to case study methodology for the multiple-case study. Cases included three interprofessional primary care teams in Ontario. Data collected included surveys, interviews, and administrative electronic health data. Descriptive pattern matching was the analytic approach implemented. Findings Dimensions of well-child care were well aligned to the scope of practice of RNs; however, scope of practice enactment varied between and within organizations. Support for the RN role, interprofessional collaboration, trust, role clarity, strategic leadership, funding structures, and team composition influenced how RNs contributed to the delivery of well-child care. Conclusions The findings from this study identify how attributes of the nursing care organization influence scope of practice enactment and delivery of well-child care. In particular, findings will support the optimization of the nursing role in primary care and enhance access to well-child care among those who currently do not have access.
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    Postnatal Experiences of South Asian Immigrant Women: A Qualitative Systematic Review
    Gupta, Nikita; Nursing; Macdonald, Danielle
    The goal of this systematic review was to explore, appraise and synthesize current qualitative evidence about the postnatal experiences of South Asian immigrant women in the context of four English-speaking countries: Australia, Canada, the United Kingdom, and the United States of America. Using the Joanna Briggs Institute methodology and methods, a comprehensive search strategy was devised using specific key tearms across five electronic databases. A total number of 2137 studies were identified; 78 studies were removed due to duplicacy and 2059 studies underwent title and abstract screening. 2037 studies were excluded due to irrelevancy and 22 were assessed for full-text review; a total of six studies were critically appraised and three studies were included in the review. From the three studies, 15 findings were identified and aggregated into 5 categories resulting in two synthesized findings: 1) The role of friends and family in the postnatal period and 2) Negotiating ‘culture’ and postpartum in a new country. Considering the limited studies included in the review, there is a need for more research to ensure improved delivery of perinatal nursing care among South Asian immigrant populations across Western nations.