Doctor of Philosophy in Nursing (PhD)
Exploring well-being with young people living with home mechanical ventilation: A critical narrative inquiry
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High maternal mortality rates throughout sub-Saharan Africa attest to the critical importance of comprehending barriers to health care during pregnancy and birth. This study examines how maternity care and birth are socially organized in Amuru sub-county, northern Uganda, a rural setting recovering from two decades of conflict. To conduct this study, I spent seven months undertaking fieldwork in Amuru, northern Uganda. In addition to observations, I interviewed and held focus groups with childbearing women, and in a second study stage spoke with health care providers and health care administrators. My research methods draw from institutional ethnography. The challenging context for maternity care and childbirth in Amuru was exacerbated by poor infrastructure and ongoing social distress in the aftermath of the protracted conflict between the Lord’s Resistance Army (LRA) and government forces that ended in 2006. Findings drawn from the data illustrated that approaches to care and birth among participants were shaped by everyday challenges associated with poverty and lack of infrastructure, the most prominent of which were accessing transportation, avoiding arduous physical work while pregnant, and ensuring adequate nutrition. Couples’ HIV testing, which was positioned as compulsory and wherein women were responsible for husbands’ participation, also challenged participants access to antenatal and delivery care. Childbearing women’s approaches to maternity care were also shaped by the mama kit project (distribution of a non-profit ‘gift’ of baby-care basics to mothers), and its associated discourses of deservingness, scarcity, and uncertainty. Imbued with power, all these factors affected access to care. This dissertation contributes to scholarship on the social constitution of maternity care and childbirth in northern Uganda.
No abstract available.
For women with a history of sexual violence, establishing and continuing with breastfeeding can be challenging, with possible disruptions to the maternal-infant attachment process. This Rapid Evidence Assessment (REA) examined how perinatal nurses can optimize breastfeeding experiences and outcomes of increased breastfeeding initiation and duration rates for women who have experienced a history of sexual violence. The objective of this REA was to analyze existing evidence within the literature to construct nursing strategies and recommendations to support and enhance breastfeeding for women who have suffered a history of sexual violence. There were fourteen research studies chosen to be further examined and analyzed to inform the research question. A comprehensive critical appraisal of each study was conducted. Further thematic analysis and coding process utilizing the ecological theoretical perspective identified ten themes within the four ecological systems: 1) microsystem (mother-infant dyad): higher initiation rates, dissociation, and influence of sexual violence on emotional well-being; 2) mesosystem (family and support system): quality of relationships; 3) exosystem (health care system): powerlessness, issues of control and safety, disclosure, and gaps in education and training; & 4) macrosystem (societal and cultural influences): physical exposure of the breast and taboo of sexual violence. The findings of the REA revealed the complexities women face during the perinatal period when they have a history of sexual violence. The recommendations from this REA included nursing strategies within the categories of enhancing the mother and infant relationship, creating a safe and supportive environment, and facilitating women’s empowerment and control. It was identified that nurses need to have the knowledge and skill set to support women and be aware of the challenges they may face during the perinatal period. Further research was identified as needed in this area due to the limited research on the impacts of a history of sexual on the breastfeeding mother.
This Rapid Evidence Assessment (REA) investigated strategies for fostering positive sexual health promotion among Aboriginal girls living in rural Canadian communities. Twenty four research papers oriented to informing and examining sexual and reproductive health of Aboriginal girls' were analysed using established criteria. After comprehensive categorizing, coding and appraisal, seven themes were identified, which outline domains for sexual health promotion with Aboriginal youth. Collectively these themes reflect the complex, intersecting forces shaping reproductive health among Aboriginal youth. Doane and Varcoe’s (2005) approach to relational inquiry, and the concept of cultural safety, provided the theoretical lenses through which to explore and synthesize the literature. The REA analysis resulted in the identification of the following themes: 1) Positive youth development (PYD) which includes peer and mentoring interventions; 2) Health-promotion that reflects diverse approaches to Aboriginal culturally-specific curriculum; 3) Relationship patterns and contextual understanding of risk behaviours; 4) Historic, contextual and structural factors; 5) Protective factors and connectedness; 6) Health practitioner responsibility; and 7) Effective youth skill building. The literature reviewed for this REA demonstrates how Aboriginal youth require effective reproductive health services and interventions grounded in an integrated understanding of specialized sexual health practices, local cultural knowledge, and a meaningful exchange of cultural knowledge. Public health nurses are responsible for providing culturally competent care that moves beyond sensitivity that and is informed by local cultural safety knowledge when planning and implementing care. From this analysis, and drawing on my experiences in practice, I argue that sexual health decisions are strengthened most significantly by the knowledge, self-esteem and confidence gained from authentic positive relationships between girls and the nurses who support them. A relational practice approach of genuinely connecting and responding to Aboriginal girls needs is significant for nurses to support in ways that ultimately affect better decision-making. Given the findings of this analysis, further research that is grounded in local Aboriginal contextual knowledge will provide insights that can support sexual health promotion.
A woman’s experience of miscarriage has been vastly explored in literature. It is well established that a woman’s physical and emotional responses to miscarriage are influenced by a number of factors and that these same factors have long term effects on the recovery process. In particular, health care professionals and their interaction with these women have been identified to be vital and significant in women defining and assigning meaning to such events. The aim of this study is to explore nurses’ understanding of their practice when caring for women experiencing miscarriage in the emergency department (ED) examined through a descriptive qualitative methodology. The study concludes that the unique context of emergency along with externally and internally perceived influences create no time, space or place for miscarriage.This study involved interviewing ten emergency nurses from a tertiary care Canadian hospital. Nurses who have cared for women experiencing miscarriage in the ED were purposefully selected to ensure their ability to speak to the phenomenon being examined. Semi-structured in-depth interviews were used to collect data centred on exploring factors that inform and guide their practice. The tensions emergency nurses encountered while caring for women experiencing miscarriage were then identified using content analysis. As a result, two spheres of influence were noted to affect nursing practice. External influences with subthemes that examine: 1) a medical triage system that de-prioritizes non-urgent pregnancy related needs; and emotional care as secondary to biomedical care; 2) an emergency nursing ‘image’; and 3) gendered explanations about who can best care for miscarrying women, and internal influences which include: nurses 1) perceived lack of perinatal nursing knowledge; and 2) personal life context.The findings of this study hold several implications towards understanding emergency nursing practice. An ED nurse’s confidence in providing care to women experiencing miscarriage can be improved by enhancing nursing education to encompass greater appreciation and understanding of miscarriage and nurses’ role in caring for women. As well, pursuing further research on miscarriage in the ED and cultivating an awareness of the contextual influences on emergency nursing practice may improve the experiences of nurses providing care.
In this inquiry, I investigate the discursive processes of professional identity construction and acquisition in the context of nurses’ participation in abortion work. Guided by social linguistic theory, I have conducted an historical discourse analysis of the abortion-related articles, advertisements, editorials, and letters to the editor published in the national professional journal, The Canadian Nurse, from 1950 to 2000. I have determined that multiple abortion care identities—or the specific ideologies and practices that are normalized as legitimate nursing values and work—have been constructed for nurses through a variety of discursive moves, including didactic messaging and implicit comparison with and in contrast to other social actors and the procedure itself. Ultimately, the availability of professional identities that support abortion as legitimate nursing work enable nurses to provide and promote the physically and psychologically safe abortion services that are essential to the health and well-being of women and communities worldwide. Recommendations and strategies for evaluating and operating professional abortion discourses in practice, research, education, and policy arenas to improve women’s access to safe care are included. Additionally, the findings of this investigation are discussed within the context of professional identity nursing scholarship in general.