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. 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
  2. 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
  3. "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
  4. 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
  5. 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
  6. 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
  7. 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
  8. Mobility of Vulnerable Elders (MOVE): Study protocol to evaluate the implementation and outcomes of a mobility intervention in long-term care facilities [Download]

    Title: Mobility of Vulnerable Elders (MOVE): Study protocol to evaluate the implementation and outcomes of a mobility intervention in long-term care facilities
    Creator: Slaughter, S.
    Description: Background: Almost 90% of residents living in long-term care facilities have limited mobility which is associated with a loss of ability in activities of daily living, falls, increased risk of serious medical problems such as pressure ulcers, incontinence and a significant decline in health-related quality of life. For health workers caring for residents it may also increase the risk of injury. The effectiveness of rehabilitation to facilitate mobility has been studied with dedicated research assistants or extensively trained staff caregivers; however, few investigators have examined the effectiveness of techniques to encourage mobility by usual caregivers in long-term care facilities. Methods/Design: This longitudinal, quasi-experimental study is designed to demonstrate the effect of the sit-tostand activity carried out by residents in the context of daily care with health care aides. In three intervention facilities health care aides will prompt residents to repeat the sit-to-stand action on two separate occasions during each day and each evening shift as part of daily care routines. In three control facilities residents will receive usual care. Intervention and control facilities are matched on the ownership model (public, private for-profit, voluntary not-for-profit) and facility size. The dose of the mobility intervention is assessed through the use of daily documentation flowsheets in the health record. Resident outcome measures include: 1) the 30-second sit-to-stand test; 2) the Functional Independence Measure; 3) the Health Utilities Index Mark 2 and 3; and, 4) the Quality of Life - Alzheimer’s Disease. Discussion: There are several compelling reasons for this study: the widespread prevalence of limited mobility in this population; the rapid decline in mobility after admission to a long-term care facility; the importance of mobility to quality of life; the increased time (and therefore cost) required to care for residents with limited mobility; and, the increased risk of injury for health workers caring for residents who are unable to stand. The importance of these issues is magnified when considering the increasing number of people living in long-term care facilities and an aging population.
    Subjects: Mobility Limitation, Quality of Life psychology, Homes for the Aged standards, Activities of Daily Living psychology, Nursing Homes standards
    Date Created: 2011
  9. The many faces of depression in primary care [Download]

    Title: The many faces of depression in primary care
    Creator: Hegadoren, K.M.
    Description: Depression is a serious global health problem. It creates a huge economic burden on society and on families and has serious and pervasive health impacts on the individual and their families. Specialized psychiatric services are often scarce and thus the bulk of care delivery for depression has fallen to primary care providers, including advanced practice nurses and experienced nurses who work in under-serviced regions. These health professionals require advanced knowledge about the many faces that depression can display. This article reviews some of the faces of depression seen by primary care providers in their practices. Considering depression as a heterogeneous spectrum disorder requires attention to both the details of the clinical presentation, as well as contextual factors. Recommendations around engagement and potential interventions will also be discussed, in terms of the client population as well as for the practitioner who may be isolated by geography or discipline.
    Subjects: Combined modality therapy, Primary health care, Depression, Mental health
    Date Created: 2009
  10. Functional outcomes after neonatal open cardiac surgery: comparison of survivors of the Norwood staged procedure and the arterial switch operation [Download]

    Title: Functional outcomes after neonatal open cardiac surgery: comparison of survivors of the Norwood staged procedure and the arterial switch operation
    Creator: Alton, G.
    Description: Background: Improvements in long-term survival of children undergoing the Norwood staged procedure and the arterial switch operation have resulted in the need to prepare these at-risk children for each stage of their developmental trajectory, including school readiness. This study describes and compares functional outcomes following the Norwood staged procedure and arterial switch operations. Methods: This prospective inception cohort study comprised a sample of 73 children (71% boys) who had the Norwood staged procedure (n = 28) or the arterial switch operation (n = 45) at the age of 6 weeks or younger at the Stollery Children's Hospital, Edmonton, Alberta, between 2002 and 2005. We excluded children who had chromosomal abnormalities or cerebral palsy. When children were 18-24 months of age, parents completed the Adaptive Behavioral Assessment System II. Standard scores for the domains are mean 100, standard deviation (15); skill area scaled scores, 10 (3). Student's t-test with Bonferonni correction was used to compare groups. Results: This population has greater than four times the number of children delayed on the General Adaptive Composite than the normative group. Functional outcomes were similar in the two groups other than those of home living (Norwood: 8.8 (2.8) compared with arterial switch: 11.2 (3.1), t = 3.389, p = 0.001) and self-care (Norwood: 5.9 (3.5) versus arterial switch: 8.1 (2.6), t = 3.140, p = 0.002). Conclusion: These survivors are at increased risk for delayed functional abilities. Self-care, necessary for independence and confidence as children reach school age, was particularly low in the Norwood group. Reasons for low self-care abilities require further study.
    Subjects: Early childhood developmnt, Hypoplastic left heart syndrome, Congenital cardiac disease, Transposition of the great arteries, Adaptive behaviour, Functional outcomes
    Date Created: 2010