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I feel incredibly lucky to have Dr. Phinney as my doctoral supervisor. She is exactly the supervisor I need to be successful. Alison is an internationally recognized scholar and has been able to guide my scholarship in meaningful and important ways. She has been a fabulous mentor in each step of the research process, helping me to fine tune my ideas, questions, and methods--all aligned with what is current, rigorous, and important in the broader field. She has been a wonderful guide, pointing out opportunities for me to network and learn from some of the top scholars in my field by attending national and international conferences and colloquia with visiting scholars. She has been extremely supportive in building my confidence and competence as an academic scholar, providing feedback in ways that challenge and help me to grow. She is generous with her time, her expertise, and her ideas in ways that make me feel like I am a priority despite all her other commitments. I feel very lucky to work with Dr. Phinney--she has been exceptional in every way possible!
My supervisor, Dr. Alison Phinney is #GreatSupervisor because she is so supportive, and encourages me to think creatively and critically.
Graduate Student Supervision
Doctoral Student Supervision (Jan 2008 - Nov 2019)
Patients with dementia in acute care often experience poor outcomes, as nurses andother staff in hospitals are not equipped to provide good dementia care. Person-centred carehas been recognized as the best practice for dementia care, but its application in hospitalenvironments remains unclear. This action research involved patients with dementia, a teamof staff members, and public advisors to co-create changes in a medical unit.The objectives of the project were to: (a) develop person-centred care in a medicalunit, (b) explore ways to support the involvement of patients with dementia in research, (c)examine the processes of staff engagement for bringing together staff from differentdisciplines to co-inquire, and (d) evaluate the impact of research on the process of changeand identify the lessons learnt to inform practice, education, policy, and research. Variousmethods were used such as: interviewing patients with dementia, focus group sessions with ateam of inter-disciplinary staff, and participant observations.In this thesis, I argue for a new positive and collaborative approach that views changeas a continuous process. In the past, the problem-focused model that sees change as fixingpeople has largely failed with regards to advancing practice developments in dementia care.An important outcome of this research is the heuristic guide ‘Team Engagement ActionMaking’ (TEAM), which can be used to support teams to engage staff in co-creating positivechange. The results of this study indicate that appreciative inquiry is a useful strategy forengaging people on a team to learn together and to co-create a better future of care. Thefindings also suggest that more attention should be paid to the dynamic inter-connection ofresearch and practice, rather than just one or the other. The results demonstrate that actionresearch can affect the process of change by generating positive energy, attitude change, and momentum for action activities in the unit and beyond. Future research should furtherexplore strategies that would maximize the potential of bringing patients, families,researchers, and practitioners to work together for positive change. Supplementary material : http://circle.library.ubc.ca/handle/2429/63499
The purpose of this ethnographic case study research was to examine the experiences of people with advanced dementia nearing the end of life, how carers and family constructed and responded to the psychosocial, spiritual, and physical needs of the residents, and how discursive and contextual factors shaped residents’ experiences. The project comprised case studies of two women with advanced dementia who were identified as nearing the end of life, their carers, and family members. Over an 18-month period, I conducted over 600 hours of participant observation, 30 hours of video observation, and in-depth interviews with 23 carers and 2 family members in a nursing home in British Columbia, Canada. Informed by a dialogical perspective, I employed a case-oriented analysis to construct a rich textual and visual portrait of each woman’s life. The first case study illustrated how carers and family understood the resident’s experiences according to four storylines: 1) the deteriorating body; 2) the institutionalized body; 3) the loved body; and 4) the ambiguous body. These storylines culminated in several tensions that underscore the challenges in caring for someone with advanced dementia nearing the end of life, with the notion of liminality providing a framework for discussing this case. The second case study focused on the co-construction of dialogical relationships between the resident, her carers and family. The findings demonstrated that interactions were marked by an ethical obligation towards the resident that went beyond the boundaries of fulfilling instrumental tasks to encountering and acknowledging the resident as a unique person. Findings are discussed in terms of an aesthetic approach to dementia end-of-life care. The theoretical considerations of silence, the cultivation of knowledge, and the moral obligation for carers to nurture dialogical I-Thou relationships provided a framework for integrating the findings. Together, these case studies inform our understanding of the lived experiences of residents with advanced dementia who are nearing the end of life, and how carers and family come to understand and respond to these experiences.
Nurses’ understandings of older patients’ cognitive function are central to how they determine and enact nursing care of older people in hospital, however, it remains unclear how nurses develop these understandings. The nursing literature concerned with how nurses determine actions in practice has begun to shift from instrumental views of reasoning to recognition that judgments are based on complex knowledge and are embedded in the particular context of nurses’ work. This study aimed to make explicit the complex, situated practical judgments of nurses about the cognitive function of older people in hospitals. The conceptual foundation of the study was informed by an integration of Aristotle’s notion of phronesis and Foucault’s understanding of power. A focused ethnographic study was conducted on two units in an urban general hospital over one year. Data were collected from 21 nurse informants through observations and interviews, and an analysis of documents used in their practice. Data analysis was guided by an analytic framework reflective of the conceptual framework. The findings showed that practical judgments about the cognitive function of older patients in hospital were structured through social relations, and nurses worked within that structure toward a complex understanding of patients’ cognitive function that would enable them to improve the situation of patients. Furthermore, ensuring safety and physiological stability emerged as the goals of nursing care related to the cognitive function of older patients and provided direction for practical judgments, including what evidence was sought and how it was used in deliberations about action. This articulation of nurses’ practical judgments about the cognitive function of older patients in hospital is a foundation for further inquiry into the context of nursing practice, educating new nurses on the complexity of nursing judgments and examining policy related to the structures guiding acute care nursing.
Purpose: The movement away from task-oriented care toward the consistent provision of person-centred care (i.e., care based on residents’ needs and preferences) is widely recognized as the goal of the residential care culture change movement. The purpose of this study was to explore why the attainment of this goal has remained elusive for many residential care facilities (RCFs), despite significant effort to alter practice. Methods: I conducted an institutional ethnography to explore the textually mediated work processes that influence the day-to-day work practices of front-line care staff in RCFs. The social organization of RCFs was explored through the observation of resident care attendants’ (RCAs') practices and the interaction of those practices with institutional texts. The data were derived from three RCFs and included 104 hours of naturalistic observation, 76 in-depth interviews, and document analysis. Results: Practical access to institutional texts containing care-related information was dependent on job classification. Regulated healthcare professionals (e.g., RNs) frequently accessed these texts to exchange information. Although RCAs provided 80% of the care to residents, in all sites studied, they lacked practical access to the institutional texts that contained important information relevant to the residents’ individualized care needs and preferences (e.g., assessments, care plans, social histories). The RCAs primarily received and shared information orally; however, the organizational systems in the facilities studied mandated the written exchange of information and did not formally support an oral exchange. Consequently, the oral exchange of care information was largely dependent upon the quality of the RCAs' working relationships with one another and especially with management. Implications: Access to detailed knowledge of residents’ needs and preferences is fundamental to the provision of person-centred care. The transfer of this knowledge to and between front-line care staff is dependent upon the quality of the relationships managers develop with and among RCAs. Initiatives aimed at building supportive and collaborative work teams are essential to the inclusion of RCAs in the care planning process and to the attainment of the goal of person-centred care.
The majority of recipients of nursing care in Canadian hospitals are older adults; however, research about nurses’ knowledge of aging, beliefs about aging, and institutional contexts and their influence on nursing care practice with older adults remains limited. In this study, grounded theory methods, guided by symbolic interactionism, were used to explore nursing practice with hospitalized older adults. The theory orchestrating care was developed after analysis of 375 hours of participant observations and 35 interviews with 24 participants. The theory of orchestrating care explains how nurses are continuously trying to manage their work environment by understanding the status of the patients on their unit, mobilizing the assistance of others, and stretching available resources to resolve their problem of providing their patients with what they perceived as “good care” while sustaining themselves as “good” nurses in their practice that they described as hard, misunderstood, and under-resourced. They did this through the two subprocesses of building synergy and minimizing strain. Building synergy explains how nurses leverage and share information and gain the assistance of others. Minimizing strain explains how nurses use available resources, support and guide one another, and reframe their practices in ways that create a supportive nursing network.Nurses looked for allies as they developed their lines of action to resolve their problem in work environments they characterized as problematic. When they did not regard other care providers and leaders as allies, nurses focused on their top priority of safety and turned inward for support from other nurses in the hope of relieving their feelings of being overwhelmed, pressured, ignored, and misunderstood. Turning inward to resolve their problem both aided the nurses (by providing short-term relief) and inhibited them (by increasing their isolation). It also prevented them from articulating their challenges to their managers, from building synergy with other healthcare professionals, and from viewing their nursing team differently. Care of hospitalized older adults can be improved by listening to nurses who are working with this population, examining the hospital systems that constrain these nurses’ practice and from nurses critically reflecting on how their practices may be contributing to their challenges.
Long-term residential care (LTRC) is a complex sociopolitical milieu where people from diverse backgrounds come to live and work together. In recent years health care restructuring has resulted in the closure of facilities; health care policy has narrowed the population that accesses LTRC so that only those who are the most medically and socially complex are admitted; and there has been a transformation of the work force, a workforce that is mainly comprised of Women of Colour and is among the lowest paid in health care. The purpose of this study was to critically examine the organization of care in LTRC within this context.The theoretical perspective guiding the study was informed by postcolonialism, postcolonial feminism, intersectionalities, and Foucaudian epistemology. The method of inquiry for the study was critical ethnography, which allowed for critical analysis of `taken for granted' assumptions in the organization of care.Over a period of ten months, I was immersed in two LTRC facilities in the Lower Mainland of British Columbia. Field work consisted of approximately 218 hours of participant observation. I conducted 51 interviews with administrators, family members, residents, and staff. I reviewed relevant provincial policies and facility-based policies and procedures. I also collected quantitative data related to resident transitions in the health care system (for example, admissions, discharges, and hospital admissions), and staffing levels.Findings from this study were discussed in three key themes. First, a systematic decommissioning of citizenship occurred for residents and staff in this setting. Second, the impact of health care restructuring over the past decade had important consequences for relationships between residents, family, and staff. Third, relational care took place in `stolen' moments that occurred despite heavy workloads. All of these themes were underscored by intra-gender oppression, relations of power, and influenced by discourses of ageism and corporatism, which ultimately played out in day to day interactions between those who live and work there. Recommendations from this study included: addressing the entrenched hierarchies in nursing, further examination of the public-private funding model in LTRC, and the introduction of an independent ombudsperson to ensure consistent, high quality care across the LTRC sector.
Master's Student Supervision (2010 - 2018)
One of the most significant factors influencing the health of older men is their engagement in physical activity. Although the benefits of physical activity are well-established, inactivity tends to increase with aging, with men being at a significant risk of sedentary behaviour. Aging men may face significant pressures to embody dominant masculine ideals, affecting their motivations and experiences with physical activity. The purpose of this qualitative study was to enhance understanding of older men’s contextualized experiences with physical activity in their day-to-day lives, with an emphasis on the influence of masculinities on these experiences. These experiences were situated within socioecological and masculinities frameworks to assist healthcare providers develop health promotion interventions that are specific to older men, facilitating healthy aging and enhancing quality of life in this subpopulation. Four older men, over the age of 65, participated in in-depth data collection methods including an initial sit-down interview, three walk-along sessions, and photovoice, resulting in 2.17 hours of video, 10.17 hours of audio, and 54 pictures across the four men. An interpretive descriptive approach to data analysis was used to identify key areas of the men’s personal experiences with physical activity. Data analysis resulted in three key themes: Aging Male Bodies, Out in the Community, and Social Connectedness and Physical Activity. Findings from this study add to the growing knowledge around connections between older men, physical activity, and masculinities. Understanding the intersections between these factors will enhance understanding of older men’s experiences with physical activity in the context of their day-to-day lives, and assist healthcare providers develop health promotion programs targeted to the unique needs of older men.
Preserving dignity is an essential part of nursing. However, there are mounting concerns that nurses are not fulfilling this important responsibility. A gap exists between nursing discourse and practice. The aim of this paper was to examine strategies that have been proposed, or implemented, to translate a conceptual understanding of patient dignity into a central role in daily acute care nursing practice. A greater understanding of strategies offers insight to how nurses can reconnect with upholding patient dignity and provides a starting point for further research. An integrative review was carried out using Whittemore and Knafl’s (2005) updated methodology, which includes 5 stages: problem identification, literature search, data evaluation, data analysis, and presentation. The literature search included the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, PsycINFO, and Academic Search Complete databases. The keywords for the search were: dignity, nursing, nursing interventions, patients, nurse-patient relations, and staff development. Twelve highly relevant publications were identified. These articles consisted of program development initiatives, expert opinion pieces, practice-based journal articles, and a high-profile campaign. Five strategies emerged from the analysis: Training; Reflection and discussion; Imagining the patient perspective; Leadership; and Planning for action. The strategies focused on the individual nurse and nursing relationships. Structural influences had only a limited focus. Although the nurse participants described a greater understanding, a deeper awareness, better skills, and a desire to create change, the impact of the strategies was not evaluated in practice. Further research needs to assess the impact of the strategies in daily nursing practice, their influence on nursing culture, and the patient experience. A long-term view toward the sustainability of any changes once nurses return to their workplaces must also be taken. In addition, strategies must focus on the system and how nurses can be supported to uphold dignity within the challenges of acute care.
No abstract available.
Extensive research has shown that physical activity can protect against health problems including cardiovascular disease and osteoporosis, and may reduce the risk or delay the onset of Alzheimer’s disease and dementia in older adults. Self-report questionnaires have been valuable in assessing physical activity levels and in determining the effectiveness of activity interventions for older adults in community settings and long-term care facilities. However, little research has examined the accuracy of these questionnaires for people in assisted living facilities. This study examined the validity of the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire and the Physical Activity Scale for the Elderly (PASE) in an assisted living population. Four instruments were used to validate these questionnaires: the SF-12® Health Survey, Six-Minute Walk Test, Short Physical Performance Battery, and pedometers. This study was conducted over a period of three months. Despite significant effort, during that time only four participants completed the study. Due to this small sample size, it was only possible to examine patterns in the data; the validity of the CHAMPS and the PASE in assisted living could not be evaluated. The more important findings from this study relate to the question of feasibility of conducting research in assisted living environments. While it was possible to gather data about physical activity of assisted living residents using questionnaire and performance measures, recruitment proved to be a significant challenge. Key barriers to participant recruitment are identified as wearing a pedometer, using a walker and how walkers are perceived by assisted living residents. These barriers are discussed with respect to future research about physical activity assessment in the assisted living population.