“I Can’T Be The Nurse I Want To Be”: Stories Of Moral Distress In Pediatric Oncology Nurses’ Caregiving Narratives, Monica L. Molinaro

Electronic Thesis and Dissertation Repository

This thesis presents the caregiving narratives of nine pediatric oncology nurses that illustrate the embeddedness of their caregiving and moral distress within institutional contexts that limit their capacity to be the nurses they want to be. Informed by the concepts of moral distress, bearing witness, and narrative repair, a critical narrative methodology was employed to examine the nurses’ caregiving experiences in relation to broader discourses and neoliberal, corporatized health care settings. The nurses’ stories were marked by ambivalence and moral distress and are presented in four narrative themes, which illustrate: the nurses’ struggles to complete their tasks and address multiple …

Reforming Nursing Education To Support Nursing Leadership, Carlyn Tancioco

The Dissertation in Practice at Western University

Abstract

This Organizational Improvement Plan (OIP) examines the lack of effective education to support the development of nursing leadership amongst nurses in a Canadian province. The nursing profession represents a substantial portion of the health-care workforce in this specific Canadian province, and nurses play a central role in patient care as primary providers and by advocating for patients. Nursing care is a critical component of the overall patient experience and has the potential to be one of the most important contributors to positive patient outcomes. Accordingly, it is critical to ensure that nurses develop the leadership mindset required to contribute …

Being A Child Bride In Nigeria: A Feminist Narrative Inquiry, Olubukola Foluke Sonibare

Electronic Thesis and Dissertation Repository

This thesis draws on narratives of northern Hausa-Fulani Nigerian women married as child brides. The aim was to gain an in-depth understanding of Child Early Forced Marriage (CEFM) as experienced by these former child brides and identify the conditions that influence their decision-making autonomy on health care services utilization. A narrative inquiry approach within an intersectional feminist lens was used to analyze the structural, social, cultural, and religious realities that shape the experiences of former child brides in Nigeria. Fifteen former child brides from rural northern Nigeria who now reside in a southern urban setting of the country completed semi-structural …

The Effect Of Authentic Leadership And New Graduate Support On New Graduate Nurses' Job Satisfaction, Stephanie H. Prtenjaca

Electronic Thesis and Dissertation Repository

The purpose of this study was to test a theoretical model linking authentic leadership to new graduate nurses’ job satisfaction through its effect on new graduate support. This study was a secondary analysis of Time 1 baseline data collected in a two-wave national study of Canadian new graduate nurses, which used a non-experimental, predictive survey design. A convenience sample of 215 new graduate nurses with less than two years of experience, working in direct care, was obtained through The College of Nurses of Ontario. Hayes’ PROCESS macro for SPSS, version 3 was used to test the hypothesized simple mediation model. …

"Healthcare Heroes" - The Change In Perceptions Of Nurses' Roles During The Covid-19 Pandemic: A Critical Discourse Analysis, Stephanie Jones

Electronic Thesis and Dissertation Repository

The outbreak of the COVID-19 pandemic has impacted the experience of nursing practice while also making health providers more publicly visible. Public discourses around the role of health providers through the pandemic, in particular nurses, have the potential to shape the nature of their professional role. This study makes use of critical discourse analysis (CDA) influenced by Foucault and social theory to explore discourse, power, and the role of the nurse. In particular, consideration is given to discourses present around the role of the nurse and how these have changed or been accentuated as a result of this global crisis. …

Syrian Refugee Women's Experiences With The Ontario Health Care System: A Critical Ethnography Study, Areej Al-Hamad

Electronic Thesis and Dissertation Repository

There has been growing interest in migration and refugee research; the vulnerability of Syrian refugee women and how they adapt to their host communities. However, there is limited evidence regarding the pre- and post-migration trauma and its impacts on the health of Syrian refugee women in the Canadian context. The purposes of this critical ethnography using intersectional perspectives were: (1) to explore and describe Syrian refugee women’s experiences and meanings of pre- and post-migration trauma and its impact on their health in the context of repeated displacement and migration from their homes and families; (2) to critically examine how the …

Health Care Initiative To Evaluate The Impact Of A Nurse Practitioner Led Community Wound Care Service On Emergency Department Utilization, Sherry Morrell

Electronic Thesis and Dissertation Repository

Nurse Practitioners (NP) diagnose and treat wounds and wound-related conditions based on their advanced scope of practice. An NP with graduate-level wound care education (NP(W)) gains additional knowledge and clinical experience to provide comprehensive wound care.

This research aimed to explore community patients’ access to wound care in Southwestern Ontario (Canada). A quality improvement project was initiated utilizing stakeholder feedback to develop and implement a 12-week pilot NP(W)-Led community-based wound care service; the NP(W) wound care practices, clinical outcomes, and adverse events were described. One hundred twelve participants attended the service over 117 visits. The NP(W) services included prescribing and …

Nurses' And Nurse Educators' Experiences Of A Pediatric Nursing Continuing Professional Development Program In Rwanda, Amy K. Olson

Electronic Thesis and Dissertation Repository

Excellence in pediatric nursing education and practice can significantly impact child health globally. Educated pediatric nurses form a strong foundation for healthcare systems globally. In 2016, a Pediatric Nursing Continuing Professional Development (PNCPD) program was created and implemented in Kigali, Rwanda, through the Training, Support, and Access Model (TSAM) for Maternal, Newborn, and Child Health (MNCH) project. This partnership project between Canada and Rwanda provided pediatric nursing education to forty-one Rwandan nurses and nurse educators in 2018 and 2019. An interpretive descriptive study was conducted to explore the experiences of fourteen nurses and nurse educators applying pediatric knowledge and skills …

Trends And Factors Associated With Suicide Deaths In Older Adults, Eada Novilla-Surette

Electronic Thesis and Dissertation Repository

Suicide in older adults is a significant overlooked problem worldwide; particularly in Canada where a national suicide prevention strategy has not yet been established. This population-level study utilized and analyzed linked administrative health care databases (from 2011-2015) that were available at ICES (provincial health care administrative data steward), to build a better understanding of suicide (rate; trends; risks/preventive factors) in older adults living in Ontario, Canada. The findings suggest that suicide remains a persistent cause of death in older adults (with an average annual suicide rate of 0.1 per 1000 people over 5 years; the risks include being male, living …

Exploring The Effects Of The Cycling Without Age Program On Older Adults Living In Long-Term Care, Victoria Cotnam

Electronic Thesis and Dissertation Repository

The Cycling Without Age program, offered in long-term care homes around the world, allows residents to experience the feeling of a bike ride in the trishaw as a volunteer pedals the electrical bike. The purpose of this pragmatic observational study was to measure the effects of an existing program in a Canadian long-term care home on residents’ happiness, quality of life, pain and functional status (using Resident-Assessment Instrument Minimum Data Set 2.0). A convenience sample of 39 residents participated in two groups, a biking group (n=23) and a strolls group (n=16) over the period of 12 weeks. Findings show that …

Caring Revisited: A Foucauldian Discourse Analysis On The Association Of Caring With The Profession Of Nursing, Margot Boulton

Electronic Thesis and Dissertation Repository

There have been numerous theories put forward by nursing theorists on the importance of caring in nursing. Very few studies have looked at the impact that this association has on the practice of nursing. This study will add to the existing literature by using a Foucauldian discourse analysis to examine the material effects that the caring discourse has on nurses’ ability to advocate for safe working conditions during a public health emergency. Using the outbreak of COVID-19 in Ontario, Canada in the Spring of 2020 as a context, this study seeks to establish caring as a discourse and examine how …

Unit Managers’ Authentic Leadership, Staff Nurses’ Work Attitudes And Behaviours, And Outcomes Of Care: A Structural Equation Model, Lisa M. Giallonardo

Electronic Thesis and Dissertation Repository

Nursing leadership is fundamental in the development of positive work attitudes and behaviours among staff nurses, and the provision of high quality patient care. Although direct empirical links were well established, there was a lack of research testing the indirect effects of leadership on nurses and patients. As such, it was proposed that the concept of authentic leadership could help explain the complex psychological processes that mediated relationships between nurse managers’ leadership, staff nurses’ work attitudes and behaviours, and outcomes of care.

The purpose of the present study was to test a model of authentic leadership in a sample of …

Development Of An Academic-Service Alliance To Address New Graduate Registered Nurses’ Practice Readiness, M. Dianne Norman

The Dissertation in Practice at Western University

New Graduate Registered Nurses’ (NGRN) lack of practice readiness is a Problem of Practice (PoP) impacting hospitals. Stemming from the evolving complexity of today’s healthcare environment and the generalist nature of the baccalaureate nursing program, the lack of NGRN practice readiness increases hospital-based orientation costs, patient safety risks, and NGRN attrition. There is currently no formal structure in which key stakeholders can address the NGRN lack of knowledge, skills and judgment and the associated implications for the safety and quality of patient care. This Organizational Improvement Plan (OIP) examines NGRN practice readiness within the organizational context of the Health Centre …

Prematurity, Socioeconomic Status, And Childhood Asthma: A Canadian Cohort Study, Crystal P. Mcleod

Electronic Thesis and Dissertation Repository

Introduction: Preterm birth (PTB) and socioeconomic status (SES) have both been associated previously with the onset of childhood asthma in high income countries. Yet, these factors have been studied minimally outside of an exposure or confounded relationship, and amongst the Canadian population.

Materials and Methods: Merging household interview data from Cycles 2 to 5 of the Canadian Health Measures Survey, this study analyzed data from weighted respondents in early (3-5 years, n = 1,096,609) and middle (6-11 years, n = 2,112,059) childhood. Bivariate, stepwise logistic regression, and logit decomposition were performed using STATA software. Intersectionality guided the study’s methodology.

Results: …

Values, Assumptions, Behaviours, And Practices Influencing The Professional Development Of Nursing Students Within Acute Care Practice Environments In Rwanda: A Focused Ethnographic Study, Benoite Umubyeyi

Electronic Thesis and Dissertation Repository

The future of the nursing profession in Rwanda in large part depends on the nursing students who join the workforce and the training they have received. Preparing them to enter the profession with the necessary clinical competencies, values, and attitudes requires practice-based learning environments to become more supportive of facilitating their professional development. The current learning environments experienced by nursing students in Rwanda, and the values, assumptions, practices, and behaviours of different stakeholders involved in preparing them to enter professional practice, have not yet been explored.

The aim of this study was to address that knowledge gap by exploring the …

A Study Of Job Satisfaction And Turnover Intention Among Acute Care Nurses Working In Rural And Urban Settings, Yasin Yasin

Electronic Thesis and Dissertation Repository

In Canada, a close look at the nursing workforce shows a decline due to limited supply and increasing demand resulting in a looming shortage in the near future. Retaining nurses’ is a key strategy to overcome the shortage by limiting nurses’ turnover. Nurses’ job dissatisfaction is the most significant predictor of turnover intention and is associated with undesired outcomes such as nurses’ absenteeism, burnout, low service quality, and patient dissatisfaction. The differences in factors affecting job satisfaction between rural and urban nurses have not been fully studied. This study aimed to identify the differences and similarities in the extrinsic and …

Exploring Mental Health, Physical Health, And Affective Commitment In Acute Care Oncology Nurses In Ontario, Lesley M. Smith

Electronic Thesis and Dissertation Repository

With reports of a steady increase in cancer risk as the present population ages (Canadian Cancer Society’s Advisory Committee on Cancer Statistics, 2017; Statistics Canada, 2017), and little knowledge of a definitive cure, ensuring cancer sufferers and their families are adequately supported is increasingly essential. Oncology nurses must therefore be the focus of current and future research, as their front-line presence in the lives of those afflicted, is quite substantial. Further, oncology nurses report the most physical symptoms and second highest levels of emotional distress among cancer care health professionals (Jones, Wells, Gao, Cassidy, & Davie, 2013; Kash et al., …

The Association Between Intimate Partner Violence And Functional Gastrointestinal Disorders And Symptoms Among Adult Women: Systematic Review, Ohud Shawqi Banjar

Electronic Thesis and Dissertation Repository

Functional gastrointestinal disorders (FGIDs) and symptoms have been identified as possible health consequences of intimate partner violence (IPV). However, whether specific types of abuse (i.e., psychological, physical and sexual) affect the health of women in different ways, and the mechanisms that explain how these forms of abuse affect their health and quality of life are not well understood. The aims of this systematic review were to examine the association between the different types of IPV and the risk of FGIDs and symptoms among adult women, identify the factors that mediate and/or moderate these health effects, and assess the impact of …

Exploring Resiliency During The Nursing Student Clinical Experience, Natalie N. Mcmullin

The Dissertation in Practice at Western University

In nursing programs, it is common for students to not complete their degree (Van Hoek et al., 2019). This problem is perpetuated as students who experience high stress and lack resiliency are more likely to be unsuccessful or take longer to complete their nursing degree (Van Hoek et al., 2019). Resiliency is not only important for students during their degree, it is essential to continuously strengthen it throughout their nursing career (Turner & Kaylor, 2015). The aims of this organizational improvement plan will be to empower nursing students to be more resilient in the clinical setting so that they are …

Nurses' And Midwives' Experiences As Mentors In A Clinical Mentorship Program In Rwanda, Marie Chantal Murekatete

Electronic Thesis and Dissertation Repository

In Rwanda, the provision of maternal and child health care is often hindered by gaps in health care providers’ (HCP) knowledge and skills, and the management of pregnancy-related complications in health facilities. These factors contribute to maternal and child mortality rates (MMR). To help respond to the gaps, the Training Support and Access Model (TSAM) project implemented a practice-based clinical mentorship program (CMP) in the Northern and Southern provinces of Rwanda that involved mentors supporting mentees’ professional development to strengthen nurses’ and midwives’ capacity to provide knowledgeable maternal and child health care.

This qualitative descriptive study aimed to explore nurses’ …

Exploring The Relationships Among New Graduate Nurses’ Structural Empowerment, Psychological Empowerment, Work Engagement, And Clinical Nurse Educator Leadership In Acute Care Settings, Carly Blair

Electronic Thesis and Dissertation Repository

Background: This study aimed to examine relationships and to gain further knowledge into the significance of the leadership role of acute care clinical nurse educators and the relationship with structural empowerment, psychological empowerment, and work engagement amongst new graduate nurses working in acute care settings.

Methods: 83 participants, registered with the College of Nurses of Ontario (CNO), responded to a mail-out survey package containing four instruments corresponding to each study variable, along with a demographic questionnaire. The analysis includes study descriptives, correlations of total and subscales, and moderation analysis of structural empowerment, psychological empowerment and clinical nurse educator leadership

Results: …

Optimization Of Simulated Electronic Medication Administration For Safe Management During Nursing Education, Laura Brennan

Electronic Thesis and Dissertation Repository

Background: Academic institutions have begun to implement electronic medication administration record (eMAR) technologies into simulated education for undergraduate nursing students. As these technologies are adopted, there is an increasing need to develop insights toward optimal medication administration practices, including the decision-making processes undertaken by nursing students.

Research Question: How do nursing students generate optimized medication administration processes using eMAR technology in simulated clinical practice?

Method: This study is underpinned by the theoretical lens of interdependent, cooperative Game Theory. Primary data collection was conducted using direct participant observation of nursing students administering medications using a simulated eMAR system and a semi-structured …

Patient Roles Within Interprofessional Collaborative Patient-Centred Care Teams: The Patient And Health Care Provider Perspectives, Kateryna Metersky

Electronic Thesis and Dissertation Repository

With current rapid expansions to medical knowledge and technology and rising chronicity of diseases, health care providers are increasingly called upon to work together within interprofessional teams to provide the most comprehensive care to their patients. Interprofessional teams have been depicted as enhancing patient health outcomes and increasing patient satisfaction with care, while decreasing health care spending and wait times for receiving care. However, there is little evidence on how to collaboratively include patients in these teams. The study’s purpose was to construct a framework on the conditions and processes required for patients to assume active participant roles in their …

The Effect Of Authentic Leadership On New Graduate Nurses’ Organizational Identification, Trust In The Manager, Patient Safety Climate, And Willingness To Report Errors, Fatmah Fallatah

Electronic Thesis and Dissertation Repository

Background: Error reporting has been identified as an important approach to improve delivery of both safe and quality care. However, existing evidence suggests that nurses are reluctant to report errors they make or fail to speak up about mistakes committed by others. Authentic leadership has been linked to improved work environments for nurses and enhanced quality of care. However, the question of how authentic leaders influence new graduate nurses’ willingness to report errors has received minimal attention.

Purpose: The aim of this study was to test a theoretical model that examined the influence of authentic leadership on new graduate nurses’ …

Leader Empowering Behaviour As A Predictor Of Nurse And Patient Outcomes, Karen Cziraki

Electronic Thesis and Dissertation Repository

Nursing leadership remains a critical factor during healthcare transformation. Nurse leaders who promote healthy working conditions have been associated with positive nurse and unit outcomes. However, mechanisms to explain how they influence outcomes are not understood (Cummings et al., 2018). Conger and Kanungo’s (1988) Process Model of Empowerment provided a framework to examine how leader empowering behaviour (LEB) influenced experienced nurses’ self-efficacy (SE), interprofessional collaboration (IPC), job turnover intentions (JTI) and nurse-assessed adverse patient outcomes (NAAE).

A non-experimental predictive design and structural equation modelling techniques in Mplus were used to conduct a secondary analysis of experienced registered nurses’ data ( …

An Exploration Of How Persons Requiring Hemodialysis Treatment Explain The Ways In Which Access To Transportation For Such Treatment Influences Their Overall Health., Navpreet Kamboj

Electronic Thesis and Dissertation Repository

The number of Canadians being treated for kidney failure has more than tripled in the last 20 years, making hemodialysis (HD) a more common and expensive treatment option. Individuals having in-center HD require access to transportation to and from an HD center on average three days a week for a total of six trips. Therefore, access to transportation is a vital component for sustaining the health and well-being of this population. The purpose of this interpretive descriptive qualitative study was to explore how persons requiring in-center HD treatment explain the ways in which access to transportation for such treatment influences …

Recovery Following Proximal Humerus Fracture, Azar Varahrami Vigeh

Electronic Thesis and Dissertation Repository

There is currently a glaring gap in the existing knowledge to address individuals’ experiences while recovering from a proximal humeral fracture (PHF). The main objective of this dissertation was to understand better how recovery is perceived by individuals after PHF. This overarching objective aligned well with the broad conceptualization of the issue at hand as those provided by the International Classification of Functioning, Disability and Health (ICF). Three inter-linked studies were conducted to provide a broader picture of recovery after PHF. The first study was a systematic review of prognostic factors predicting recovery after PHF in adults. This review demonstrated …

Exploration Of Knowledge And Skills Development Among Community Health Workers In Rwanda, Schadrack Ngabonziza

Electronic Thesis and Dissertation Repository

Community Health Workers (CHWs) are individuals who are selected and trained to provide healthcare services in the community. To be effective, they need ongoing training opportunities to gain knowledge and skills to perform their tasks. This study used descriptive qualitative methods to explore how Animatrice de Santé Maternelle (ASM)-CHWs working in select regions of Rwanda gained and enhanced their knowledge and skills to support maternal and newborn health care. Thematic analysis was used to analyze data from 110 ASM-CHWs and ten supervisors of CHWs. The analysis yielded two main themes. 1) Formalized training among CHWs, which included the subthemes of …

Women’S Experiences Receiving Humanitarian Aid, Aden M. Hamza

Electronic Thesis and Dissertation Repository

The increase in humanitarian emergencies has left aid organizations searching for ways to better serve populations affected by disaster, and women have often been among those excluded. This study utilized a critical narrative methodology to explore the humanitarian aid response to the 2010 earthquake from the perspective of Haitian women, seeking to understand their experiences and stimulate change through raising awareness of their voices in scholarly literature. The findings highlight the barriers and facilitators to humanitarian aid, which include the gaps in addressing the psychological effects of trauma, lack of accountability, the manipulation of aid, the resiliency of women, as …

Understanding The Lived Experiences Of Saudi Students Enrolled In Canadian Graduate Nursing Programs, Aisha Namshan Aldawsari

Electronic Thesis and Dissertation Repository

Despite the increased number of students in the field of nursing, there is a great shortage of Saudi nurses in Saudi Arabia (SA). Cultural issues in SA have influenced the development of the nursing profession. For instance, it is not culturally acceptable for female nurses or nursing students to work for long hours and night shifts in a mixed-gender practice environment in SA. Thus, a large proportion of nursing students tend to look for positions other than working in hospital settings upon completion of their undergraduate degree. Pursuing graduate nursing education overseas is also viewed as a viable option. To …