ERA

Chronicity

The mission of the Chronicity Areas of Excellence (AoE) is to advance and disseminate knowledge and to influence public policy related to living well with chronic health concerns.
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  1. A Pan Canadian Practice Guideline for Screening, Assessment, and Management of Cancer-Related Fatigue in Adults (Version 2) [Download]

    Title: A Pan Canadian Practice Guideline for Screening, Assessment, and Management of Cancer-Related Fatigue in Adults (Version 2)
    Creator: Howell, Doris
    Description: Background Cancer-related fatigue (CRF) is a prevalent problem in cancer and has a side effect of treatment that often worsens during cancer treatment and can persist as a long-term problem for many patients including those in palliative care and cancer survivor populations. Reported prevalence rates for fatigue range from 59% to 100%. CRF is reported as the most distressing side effect of cancer and treatment and causes greater interference with daily life than any other symptom. CRF also impacts on personal, social, work roles and it can have a profound negative impact on overall quality of life (QoL). Because its etiology is not well understood, it is frequently unrecognized and is difficult to manage in clinical practice. Scope and Purpose of this Review The scope of this 2015-Version 2 of CRF guideline is focused on the provision of clinical practice recommendations for members of oncology interdisciplinary team (e.g. primary care physicians, oncologists, nurses, physiotherapist, occupational therapists, rehabilitation specialists), who screen, assess, and manage CRF in their daily clinical practice. Additionally, the recommendations may also help patients and families learn about the most effective strategies for managing CRF. The recommendations apply to those with CRF across the cancer trajectory, from cancer treatment to post-treatment survivorship and palliative or end-of-life care. The guidelines focused on the adult cancer population with fatigue due to cancer and/or cancer treatment. Intended Users The intended users of this guideline are the primary oncology interdisciplinary team, and community practitioners such as family physicians and palliative care teams. The recommendations are intended to also be relevant to specialists in fatigue including psychology and psychiatry, and other members of the allied health care team (occupational therapists, rehabilitation specialists, physiotherapists) who provide counselling to patients in the management of cancer-related fatigue. Patients and their families may also find this guideline useful for understanding the current recommendations and evidence for management for cancer and/or treatment related fatigue. Questions 1. What are the current guideline recommendations for routine screening and assessment of CRF in adults? 2. What is the efficacy of interventions (pharmacological, non‐pharmacological, and/or combinations) for reducing CRF in adults?
    Subjects: cancer, adapted guideline, Fatigue, assessment, screening, supportive care
    Date Created: 2015
  2. Quality of life associated with adult day centers. [Download]

    Title: Quality of life associated with adult day centers.
    Creator: Molzahn, A. E.
    Description: The purpose of this study was to describe the quality of life (QOL) of current adult day center (ADC) clients and their family caregivers in one region of Canada. Semi-structured interviews were conducted with 10 ADC clients and 10 caregivers. Data analysis used a modified constant comparative method. The major categories relating to QOL that emerged in the analysis included Physical Health and Well-Being, Social Networks/Relationships, Aging in Place, Safety, Respite, Activation, Respect and Inclusion, and Adequate Health Care Services. These themes are consistent with those of other studies of QOL of older adults. It was evident that ADCs played an important role in maintaining and improving the QOL of both the older adults and caregivers participating in this study.
    Subjects: quality of life, caregivers, day care
    Date Created: 2009
  3. Canadians with dementia: Gender differences in use and availability of home- and community-based health services. [Download]

    Title: Canadians with dementia: Gender differences in use and availability of home- and community-based health services.
    Creator: Forbes, D.
    Description: The purpose was to examine the use and availability of home and communitybased services by men and women with dementia using data from the 2003 Canadian Community Health Survey.Variables of interest were based on the Andersen and Newman model and included predisposing, enabling, need, and use of health service variables, perceived unmet health and home care needs, and availability of home and community-based health services.Women reported better health and received more supportive care yet had more unmet home care needs than men.Thus, the caregivers of men with dementia (often their wives) were particularly vulnerable to negative outcomes, as their care recipients had poorer health yet received fewer services.These gender differences should be considered when policies and programs are developed, the needs of care recipients and caregivers are assessed, and services are provided.
    Subjects: dementia, gender, Canada, supportive home care, community-based services
    Date Created: 2008
  4. Do learning approaches influence practice-readiness? [Download]

    Title: Do learning approaches influence practice-readiness?
    Creator: Spiers, J.
    Description: There continues to be considerable debate about how to prepare nursing students so that they are ready to practise. A recent study with RNs, managers and educators in Alberta showed that: · there is a strong perception that practice-readiness is an idealistic, largely impossible goal that has reached \"mythical proportions\" because there is a limit to how much students can learn in generalist-oriented programs · the level of practice-readiness is often considered to be an educational problem, but it is more of a larger systems-level problem · there is a persistent perception that nursing programs do not include sufficient opportunity to develop strong psychomotor skills · the multiple stressors experienced by new graduates result in a pervasive fear of making mistakes and \"not doing a good job\" for six months to a year following graduation (availability of consistent mentoring, orientation and clinical support on the unit help to alleviate this stress)
    Subjects: problem-based learning, nursing education, nursing practice
    Date Created: 2010
  5. Graduate nurses' learning trajectories and experiences of Problem Based Learning: A focused ethnography study. [Download]

    Title: Graduate nurses' learning trajectories and experiences of Problem Based Learning: A focused ethnography study.
    Creator: Spiers, J.
    Description: Background: Problem-based learning seeks to foster active, collaborative and self directed learning. It is increasingly utilized in health professional education; however, it is difficult to ascertain effectiveness. Empirically, student satisfaction does not match academic achievement but the reasons for this are unclear. Objective: To explore the experience trajectories and satisfaction of graduates who had completed an undergraduate problem-based learning nursing program. Design and methods: Qualitative focused ethnography using individual and group semistructured interviews. Categories and themes were identified using inductive constant comparison. A comparative matrix analysis of differing levels of the two core processes illuminated specific experience profiles. Participants and setting: Forty five program graduates who had graduated between one and nine years previously from a Western Canadian program offered at four academic sites. The sample was mostly female (n = 37), aged 26–30 years (n = 23) and graduated 5–8 years previously (n = 20). Results: Levels of satisfaction with the program varied markedly. Two core processes contributed to this: ‘‘understanding’’ and ‘‘valuing’’ problem-based learning. Specific experience profiles included: ‘‘Happy as fish in water’’ which represents those who understood and valued the approach, and flourished; ‘‘I’ll do it but I won’t like it’’ reflects those who understood and could adjust to the academic context but did not particularly value it; ‘‘I just want to be a nurse’’ characterized those who consistently disliked and resisted the process but endured in order to graduate. Each profile was characterized by attitudes, intentions, learning preferences and program satisfaction. Conclusions: We theorize an underlying mechanism explaining these diverse levels of satisfaction are differing orientations to studying. This approach to understanding how students typically approach learning is strongly linked to perceptions of academic quality and program satisfaction in higher education research, although it has been neglected in nursing problem-based learning research. Orientations to studying include reproductive surface learning, deep learning for understanding and meaning, and strategic approaches to maximize desired objectives. These orientations are congruent with the descriptive typologies developed in this research. This provides an effective explanation as to why some students adapt easily and flourish in problem-based learning contexts, while others continually struggle to adapt. Further research is needed to determine the relationship between deep, surface, and strategic orientations to study and student satisfaction in nursing programs.
    Subjects: problem-based learning, orientation to studying, education, student satisfaction
    Date Created: 2014
  6. "But we can't go back": Unexpected consequences of raising expectations through organizational leadership development. [Download]

    Title: "But we can't go back": Unexpected consequences of raising expectations through organizational leadership development.
    Creator: Spiers, J.A.
    Description: In 2004, a provincial cancer agency in Canada developed and implemented a provincewide Leadership Development Initiative (LDI) to enhance organizational leadership and relationships. Research using a quasi-experimental survey design determined whether LDI implementation influenced the emotional health and leadership practices of LDI participants. An ethnographic approach (18 focus groups and 13 individual interviews) explored participants' perceptions of the LDI. This article presents qualitative findings that contribute to understanding the statistically significant findings of increasing levels of cynicism, emotional exhaustion, and burnout for most LDI participants. The LDI was regarded as a critical strategy for helping leaders grow and cope with change and help in changing organizational leadership culture to be more collaborative and inclusive. However, an organizational history of short-lived, flavor-of-the-month development initiatives and growing skepticism and disengagement by leaders represented in the themes of Catch-22 and “there is no going back” contributes to understanding why these quantitative measures increased. Few studies have explored the hypothesis that real organizational development happens through a series of planned stages. In this study, leaders experienced escalating frustration because change was not seen to occur fast enough in “others” and reported that this was necessary before they would alter their own behavior. Leadership development programs in general need to reflect the reality that it takes considerable time, patience, and effort to effect fundamental change in leadership culture.
    Subjects: leadership development, focused ethnography, learning culture, organizational learning in health care, health care managers
    Date Created: 2010
  7. Conservative management for postprostatectomy urinary incontinence [Download]

    Title: Conservative management for postprostatectomy urinary incontinence
    Creator: Anderson, Coral A.
    Description: Background information The prostate is a male sex gland that surrounds the outlet of the bladder. Two main diseases of the prostate (cancer of the prostate, and benign (non-cancerous) prostatic enlargement) can be treated by surgery but some men suffer leakage of urine (urinary incontinence) afterwards. Conservative treatments of the leakage such as pelvic floor muscle training with or without biofeedback or anal electrical stimulation are thought to help men control this leakage. The main findings of the review The review of trials found that there was conflicting evidence about the benefit of therapists teaching men to contract their pelvic floor muscles for either prevention or treatment of urine leakage after radical prostate surgery for cancer. However, information from one large trial suggested that men do not benefit from seeing a therapist to receive pelvic floor muscle training after transurethral resection (TURP) for benign prostatic enlargement. Overall, there was insufficient evidence to demonstrate a beneficial effect from pelvic floor muscle training. Of three external compression devices tested, one penile clamp seemed to be better than the others. Adverse effects This one penile clamp needed to be used cautiously because of safety risks. Any limitations of the review In future updates it may be worth considering two separate reviews, looking separately at 'treatment' and 'prevention' trials. More research that is of better quality is also needed to assess conservative management.
    Subjects: Biofeedback, Magnetic Field Therapy, Exercise Therapy, Prostatectomy, Urinary Incontinence, Electric Stimulation Therapy
  8. The lived experience of family caregivers who provided end-of-life care to persons with advanced dementia. [Download]

    Title: The lived experience of family caregivers who provided end-of-life care to persons with advanced dementia.
    Creator: Peacock, S.
    Description: Objective: Dementia is a terminal illness, and family caregivers play a vital role in providing end-of-life care to their relative. The present study begins to address the paucity of research regarding end-of-life caregiving experience with dementia. Method: This study utilized Munhall's methodology for interpretive phenomenology. Seven women and four men were interviewed two to three times within a year of their relative's death; interviews were transcribed verbatim and hermeneutically analyzed. Results: Findings reveal two essential aspects of end-of-life dementia caregiving: being-with and being-there. Further findings are organized according to the existential life worlds. Examination of the life worlds demonstrates that 1) spatiality provided a sense or lack of feeling welcome to provide end-of-life care; 2) temporality was an eternity or time melting away quickly, or the right or wrong time to die; 3) corporeality revealed feelings of exhaustion; and 4) relationality was felt as a closeness to others or in tension-filled relationships. Significance of results: An understanding from bereaved caregivers’ perspectives will help healthcare practitioners better support and empathize with family caregivers. Further research is warranted that focuses on other places of death and differences in experience based on gender or relationship to the care receiver.
    Subjects: phenomenology, family caregivers, dementia, end-of-life care
    Date Created: 2013
  9. Social-interaction knowledge translation for in-home management of urinary incontinence and chronic care. [Download]

    Title: Social-interaction knowledge translation for in-home management of urinary incontinence and chronic care.
    Creator: Jansen, L.
    Description: Although urinary incontinence (UI) can be managed conservatively, it is a principal reason for the breakdown of in-home family care. This study explored the social interaction processes of knowledge translation (KT) related to how UI management knowledge might be translated within in-home care. In-depth interview data were collected from a theoretical sample of 23 family caregivers, older home care recipients, and home care providers. Constant comparison and Glaser’s analysis criteria were used to create translating knowledge through relating, a substantive theory with 10 subthemes: living with the problem; building experiential knowledge; developing comfort; easing into a working relationship; nurturing mutuality; facilitating knowledge exchange; building confidence; fine-tuning knowledge; putting it all together; and managing in-home care. Findings inform both theory and practice of in-home UI KT, illuminating how intersubjectivity and bi-directional relational interactions are essential to translating in-home chronic care knowledge, which is largely tacit and experiential in nature.
    Subjects: urinary incontinence, knowledge translation, home care, family caregivers, aging, older adults
    Date Created: 2013
  10. The provision of end-of-life care by medical-surgical nurses working in acute care: A literature review. [Download]

    Title: The provision of end-of-life care by medical-surgical nurses working in acute care: A literature review.
    Creator: Gagnon, J.
    Description: Objective: Caring for terminally ill patients is complex, stressful, and at times distressing for nurses. Acute care hospitals continue to be the predominant place of death for terminally ill patients in most Western countries. The objective of the present literature review was to explore and gain an in-depth understanding of the experience of providing end-of-life (EOL) care by medical-surgical RNs working in acute care hospitals, to identify knowledge gaps, and to recommend future research. Method: A comprehensive literature review was conducted using the following electronic databases: CINAHL, MEDLINE, and PsyInfo (from 1992 to October 2012). Results: The findings from the 16 reviewed studies suggest that nurses felt a strong commitment to help terminally ill patients experience a good death. Nurses reported feeling deeply rewarded and privileged to share the EOL experience with patients/families. Organizational and individual factors influenced nurses' experience. Important challenges were associated with managing the divergent needs of a mixed patient load (i.e., curative and palliative care patients) in a biomedical culture of care that is heavily oriented toward cure and recovery. In this culture, nurses' emotional work and ideals of good EOL care are often not recognized and supported. Significance of results: Managerial and organizational support that recognize the centrality of emotional work nurses provide to dying patients is needed. More research exploring ways to improve communication among nurses and medical colleagues is essential. Finally, a critical examination of the ideological assumptions guiding nurses' practice of EOL care within the context of acute care is recommended to help reveal their powerful influence in shaping nurses' overall understanding and experience of EOL care.
    Subjects: surgical nurses, medical nurses, end-of-life care, hospitals, acute care
    Date Created: 2013