Relevant Degree Programs
Graduate Student Supervision
Doctoral Student Supervision (2008-2018)
Individuals with Intellectual Disabilities receive breast, cervical, and colorectal cancer screening at rates lower than the general population. The reasons for this disparity are poorly understood. Additionally, in the general population, a primary care provider’s recommendation for cancer screening is one of the key determinants of whether an individual obtains cancer screening. This mixed methods study explored the role of primary care providers in recommending cancer screening to patients with Intellectual Disabilities. First, 106 primary care providers (family physicians, family medicine residents, and nurse practitioner students from across British Columbia) were surveyed regarding their attitudes towards people with Intellectual Disabilities in general, and their anticipated likelihood of recommending breast, cervical, and colorectal cancer screening to fictional patients with Intellectual Disabilities presented in vignettes. In the second phase, 10 family medicine residents and two family physicians were interviewed regarding their experiences recommending cancer screening to patients with Intellectual Disabilities. The quantitative and qualitative analysis revealed that: (1) participants with negative attitudes towards the community inclusion of individuals with Intellectual Disabilities were less likely to recommend breast and colorectal cancer screening to fictional patients with Intellectual Disabilities; and (2) participants balance applying evidence-based guidelines with exercising clinical judgement to determine the best course of care for each patient, and this balance is situated within the larger medical environment that physicians practice within. In conclusion, this study determined that aspects of attitudes are related to cancer screening recommendations, but given that attitudes are one of many factors related to screening recommendations, future studies should not solely focus on this factor. Second, it appears that clinicians individualize care for all patients, and a patient’s Intellectual Disability is one of many factors considered prior to a screening recommendation. Finally, participants were aware of the evolving nature of cancer screening guidelines, and changed their practice accordingly as guidelines change. More research is needed to determine if these findings are applicable to more experienced primary care providers, given that the majority of participants in the interview phase were residents.
Master's Student Supervision (2010-2017)
Background: It is estimated that 60% of older adults living in Residential Long Term Care (RLTC) experience urinary incontinence that impacts them physically, psychosocially, emotionally and financially. Urinary incontinence can be an embarrassing and devastating experience that impacts older adults’ dignity and quality of life. Nurse Continence Advisors (NCA), experts in incontinence, are independent practitioners that can add value to quality of life who are unknown and under-utilized to health care teams as there is little information about them and so few practice in RLTC. Purpose: To understand the older adults’ experiences working with the NCA and their role and the potential of this role within the RLTC sector. Sample/Methods: Interpretive Description was the method of inquiry and multiple case studies were used to explore the older adults’ experiences of working with an NCA about their incontinence. A purposive sample of three older adults who worked with an NCA were interviewed using a semi-structured process. Data were collected through 1:1 interviews with the older adults and 1 staff member, chart and supporting document reviews. Results: All three participants revealed intense impact of UI on their quality of life, overall day to day function and embarrassment. The involvement of the NCA was positive leading to significant improvements in UI for all three participants affecting their quality of life. The study revealed added value to having NCA involved in UI issues such as UI knowledge, consistent documentation and assessment and strategies to improve UI. Implications: This study revealed the need for the NCA role within the RLTC sector and provides a closer and personal understanding of the impact of UI on older adults. It provides novel insights from the older adults’ experiences towards the broader knowledge of the NCA role that will assist health care providers in gaining knowledge about ways that UI affects older adults’ living in RTLC.
Family relationships are a significant part of a person’s life. Unfortunately, moving a relative from a family home into a long-term care (LTC) home requires the readjustment of family relationships from a familiar to a foreign environment and puts these relationships and associated family identity at risk. With the shift in focus to person-centred care and its need for the maintenance of family connection, the fostering of family relationships in LTC homes becomes an important part of properly enacting this approach to care.This critical ethnography explored the ways in which family relationships are fostered in LTC and identified the efforts made and barriers that exist in the broader organizational and social context of LTC that influence how these relationships are fostered. Data from a larger critical ethnography was collected through semi-structured interviews with and participant observation of 12 family members, seven staff members, and three residents from a LTC home in an urban city in British Columbia, Canada. Family members came into the LTC home to spend time with their relative and maintain a connection with them, but a lack of opportunity to take part in activities that recognized the importance of these connections prevented family relationships from being fostered. Task-focused care overlooked the importance of relational care and further prevented family relationships from being maintained. Physical and cognitive decline also made it difficult for family members to engage and connect with their relative, resulting in a significant impact on the fostering of family relationships. Driving distances and a lack of opportunity to maintain connections with relatives outside of the LTC home added to the challenge of fostering family relationships. Family members want to maintain family identities and associated relationships but require support in doing so. The findings from this study have implications for nursing practice, administration, education, and research.
Background: Transcatheter aortic valve implantation (TAVI) is a minimally invasive treatment option for higher surgical risk patients with severe symptomatic aortic stenosis (AS) and significant co-existing conditions which may preclude them from surgical valve replacement. Patient characteristics and wait time have been shown to impact length of stay (LOS) in individuals with heart disease; however, these variables have not been extensively evaluated in the TAVI population. Objective: The purpose of this study was to explore factors associated with post-TAVI recovery, as measured by hospital LOS. Method: A retrospective chart review of consecutive patients who underwent TAVI in Vancouver, British Columbia between January 01, 2013 to December 31, 2014 was conducted. Study variables included patient characteristics and wait time. The outcome variable, LOS, was defined as time, in days, from procedure to hospital discharge. Univariate and bivariate analyses were used to select moderately correlated variables for multivariate regression analysis. Results: The study sample consisted of 257 patients, with a mean age of 81.4 years. The median wait time from acceptance to procedure was 36 days, while the median LOS was 3.0 days. Bivariate analysis showed age, living situation, symptom severity, prior surgical aortic valve replacement (SAVR), and prior balloon aortic valvuloplasty (BAV) to be statistically significantly associated with post-TAVI stay in-hospital. The multivariate model revealed that relative to having a LOS of 1 to 2 days, patients who had previously undergone a BAV were 10.7 times more likely to stay 5 days or more (CI [1.16, 98.1]) compared with patients who had not undergone a BAV. No other baseline factors were found to be statistically predictive of prolonged LOS, although odds ratios suggest patients with lower symptom severity and patients who underwent valve-in-valve TAVI were less likely to experience a longer LOS. The model also showed that patients 75 to 79 years of age, with NYHA class III or IV symptoms, and no prior history of an AVR were more likely to follow a standard course of recovery, staying 3 to 4 days, while patients who had a valve-in-valve procedure were more likely to stay 1 to 2 days.
Alcohol use among community dwelling older adults is fast becoming a major health concern in Canada. It is fast becoming a major precursor for social dysfunction as many have experienced destructive relationships, financial despair, and social isolation. This population often falls victim to ageist views held by health care providers, delaying recognition and assistance in relation to alcohol misuse. Perhaps the most important gap is the lack of qualitative research that will study the experience of alcohol misuse in older adults from their perspective and try to understand their readiness for change. This critical ethnography explored the attitudes, beliefs, behaviours, and experiences of alcohol use among community dwelling older adults within their social, cultural, or political context with an aim to elicit a change during the process. Data were collected through semi-structured interviews with a total of eighteen individuals; 1) study participants (N=11) that were older adults and dwelled in an urban center in the Interior of British Columbia, and who used alcohol, and 2) key informants (N=7) who had extensive experience with substance use issues working in a variety of fields within the community. Audio-taped interviews were transcribed and analyzed. Using Carspecken’s framework of analysis, three main themes and thirteen subthemes were identified. This study examined the role of environmental factors early in older adults’ life and their influence in forming beliefs, attitudes, and behaviours, related to alcohol use later in life. It examined the older adults’ drinking patterns, consequences of alcohol use, additional substance use, and barriers to seeking assistance. Findings in this study indicated that early adverse life experiences increase the chances of alcohol misuse later in life. Adjunct use of other substances indicated the changing characteristics of this population and the potential increase in health care costs as baby boomers become a predominant faction of the older adult population. Results of the study indicated improved access to nursing services at the primary health care level, a change of physicians’ attitudes, increased resources, and community support would encourage this population to seek out help. These themes have implications for nursing practice, education, nursing administration, and further research.
Background: Many older adults experience urinary incontinence (UI) and as a result suffer from a variety of physical, emotional, and social consequences. Despite the presence of an interprofessional team to support urinary continence in hospital-based care, studies show that the team has insufficient knowledge to manage patients’ UI. Purpose: To assess changes in UI knowledge among an interprofessional hospital-based team after following an evidence-based educational intervention. The study also aims to better understand the facilitators and barriers to evidence-based learning in a hospital-based setting. Sample/Methods: 32 participants including registered nurses, licensed practical nurses, physiotherapists and occupational therapists from an older adult unit in an urban community hospital participated in the study. Participants met the pre/post-test study design inclusion criteria by completing the UI pre-test, 2/3 educational interventions and UI post-test. Changes in pre/post-test scores were analyzed to assess the effectiveness of the educational intervention. Semi-structured interviews were also conducted after post-test data collection to gain an in-depth understanding of the facilitators and barriers to learning within the context of the research site. Results: Overall UI knowledge showed statistically higher post-test scores (p = .001). Nevertheless when broken down into foundational and advanced knowledge, the former improved (p = .005) where the latter showed no statistically significant improvement (p = .103). Qualitative results described many facilitators and barriers within the following categories: 1) attempting to learn in the workplace, 2) putting evidence-based education into action and 3) learning and providing care within an interprofessional team. Implications: The Putting Education into Action study supports the need for a critical evaluation of current trends in hospital-based workplace learning. It provides suggestions for effective workplace learning and supports the need for further education-based studies in order to continue learning how to best keep nursing and allied health professional up to date with evidence-based practices that are continuously evolving within healthcare research.
In recent years, the use of DNR orders in acute care has been increasing, especially for older adults. Unfortunately, many nurses misinterpret the definition of DNR and this knowledge gap has implications for how care is provided for older adults. This lack of understanding of meaning as well as care practices associated with DNR designations is a cause for concern, as it has practical, ethical and moral implications for patient care. Nursing practice in relation to DNR orders can have permanent consequences on the health outcomes of patients and it is therefore essential to acknowledge and recognize the personal and contextual forces that shape the care of older adults with DNR orders in acute care so that ethical practice be supported. This interpretive descriptive study explored nursing care of older adults with DNR designations on medical/surgical units in acute care and also identified facilitators and barriers towards their ethical practice in relation to DNR orders. Data were collected through semi-structured interviews with Registered Nurses (N=8) employed on acute medical units at an urban community hospital in British Columbia. Audiotaped interviews were transcribed and analyzed using an interpretive descriptive approach. Five main themes and 19 subthemes were identified. The Registered Nurses indicated the need to clarify the interpretation of DNR in clinical practice and acknowledged the complexities of the DNR decision making process. The nurses emphasized that patients were given safe and ethical care irrespective of code status however nursing interventions were prioritized for full code patients. Nurses reported complex barriers to their ethical practice in relation to DNR order such as unrealistic physician orders, the lack of time in conjunction with the lack of knowledge of the patient’s wishes and highly directive and anxious family members. Facilitating factors towards nursing care of DNR designated patients comprised of education which was viewed as essential in improving care practices and assessment skills for dying DNR designated patients. Team work, higher nurse to patient ratio and support were also associated with propelling better nursing care and practice. The themes have implications for nursing practice, administration, education, and research.
As the body ages, there is a natural decline in physical and cognitive abilities. The presence of chronic disease can accelerate this process. Aortic stenosis (AS) is a structural heart disease primarily associated with aging. Untreated patients die within 2 to 5 years following the onset of symptoms. For individuals with multiple co-morbidities, surgical treatment is not an option because of high risk for surgical complications. An innovative and minimally invasive procedure called transcatheter aortic valve implantation (TAVI) has emerged as a safe and viable treatment option for higher risk patients. Because of the rapid disease progression of severe AS and the varying wait-times prior to procedure, it is important to understand changes in functional status while waiting for TAVI. The purpose of this study was to examine the changes in functional status between time of eligibility assessment and TAVI procedure date. Changes in functional status including 5-Metre Gait Speed, Canadian Study of Health and Aging Clinical Frailty Scale and Mini Mental State Examination were evaluated using an exploratory prospective cohort design.Thirty two patients participated in the study with median age 81 (range 64 to 93). Functional status declined between time of assessment and time of TAVI: Gait speed increased by 0.53 seconds (p = 0.01) and Clinical Frailty Scale increased by 0.31 (from 4.3 to 4.6, p = 0.01). Patients who waited longer than six weeks for TAVI (n = 19) had a larger decline in gait speed than patients who waited less than six weeks (n = 10) (0.8 sec vs 0.0 sec, p = 0.04). Patients who were living alone (n =11) had a larger increase in frailty scores compared to patients living with another adult (n = 21) (0.6 vs 0.1, p = 0.05).This study has shown that change in functional status may be an important assessment to monitor while patients are waiting for TAVI. Results may be used to facilitate individualized care and management strategies and inform health care policy to develop evidence based benchmarks for safe wait-times. Future research with larger samples could validate the exploratory findings of this study.